Predictive Value of Family History on Severity of Illness

Abstract

Context If family history is associated with clinical features that are thought to index seriousness of disorder, this could inform clinicians predicting patients’ prognosis and researchers selecting cases for genetic studies. Although tests of associations between family history and clinical features are numerous for depression, such tests are relatively lacking for other disorders. Objective To test the hypothesis that family history is associated with 4 clinical indexes of disorder (recurrence, impairment, service use, and age at onset) in relation to 4 psychiatric disorders (major depressive episode, anxiety disorder, alcohol dependence, and drug dependence). Design Prospective longitudinal cohort study. Setting New Zealand. Participants A total of 981 members of the 1972 to 1973 Dunedin Study birth cohort (96% retention). Main Outcome Measures For each disorder, family history scores were calculated as the proportion of affected family members from data on 3 generations of the participants’ families. Data collected prospectively at the study’s repeated assessments (ages 11–32 years) were used to assess recurrence, impairment, and age at onset; data collected by means of a life history calendar at age 32 years were used to assess service use. Results Family history was associated with the presence of all 4 disorder types. In addition, family history was associated with a more recurrent course for all 4 disorders (but not significantly for women with depression), worse impairment, and greater service use. Family history was not associated with younger age at onset for any disorder. Conclusions Associations between family history of a disorder and clinical features of that disorder in probands showed consistent direction of effects across depression, anxiety disorder, alcohol dependence, and drug dependence. For these disorder types, family history is useful for determining patients’ clinical prognosis and for selecting cases for genetic studies.

Predicting relapse in major depressive disorder using patient-reported outcomes of depressive symptom severity, functioning, and quality of life in the individual burden of illness index for depression (IBI-D)

“…The latter is of particular importance given that relapse continues to be a significant challenge to clinicians (Keller et al, 1982; Dobson and Ottenbreit, 2004). A number of biopsychosocial factors have been implicated in increasing relapse risk including genetic loading with mood disorders, co-morbid medical and psychiatric conditions and substance use, psychosocial stressors, and personality coping styles (Klein et al, 2004; Milne et al, 2009; Zisook et al, 2004; Riise and Lund, 2001; Kivelä et al, 2000). Furthermore, baseline symptom severity, duration of illness, number of depressive episodes, duration of depressive episode, and number of medication trials until remission play an important role as well (Pintor et al, 2004; Mulder et al, 2006; Holma et al, 2008; Greer et al, 2010; Rush et al, 2012).…”

Anxiety Disorder Comorbidity in Bipolar Disorder, Schizophrenia and Schizoaffective Disorder

“…A substance use disorder was defined as current or lifetime drug and/or alcohol abuse and/or dependence. At the final block, we entered the risk variables, which included family history of an anxiety disorder in a first-, second- or third-degree relative (dichotomous) [29,30,31] and current treatment with clozapine (dichotomous). Clozapine was entered as a risk variable due to its association with the development of anxiety disorders [32,33,34].…”

Genetic Influences on the Development of Alcoholism

“…Analysis of data from a prospective New Zealand birth cohort of nearly 1000 individuals has shown that family history is a strong predictor of AUD and is associated with a more recurrent course and worse impairment [15]. It is well known that an important risk factor is having an alcoholic parent.…”