The impact of clinical significance criteria on subthreshold depression prevalence rates

Abstract

Objective: To examine and compare prevalence rates of subthreshold depression (SD) based on symptom count only as well as additional categorically and dimensionally operationalized clinical significance (CS) criteria.

Method: Data were drawn from the German National Health Survey (n = 4181). DSM-IV-SD and categorically defined CS criteria were operationalized by means of the Munich-Composite International Diagnostic Interview, dimensionally defined CS criteria by means of the SF-36-mental component summary score (MCS) Scale.

Results: Four-week and 12-month prevalence rates of SD ranged from 0.7% (MCS-CS criteria) to 1.8% (symptom count) and 1.8% to 6.8% respectively. Prevalence rates of SD were lower than those of Major Depression (5.7% and 10.9%). Within linear regression models, the association between SD and health care utilization variables remained insignificant.

Conclusion: Although prevalences rates of SD are bound to the CS criterion used, they are lower than for Major Depression. The use of a CS criterion is recommended to avoid pathologizing human behavior.