Psychological Medicine

Original Articles

How should we construct psychiatric family history scores? A comparison of alternative approaches from the Dunedin Family Health History Study

B. J. Milnea1 c1, T. E. Moffitta1a2, R. Crumpa3, R. Poultona3, M. Ruttera1, M. R. Searsa4, A. Taylora1 and A. Caspia1a2

a1 Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK

a2 Departments of Psychology and Neuroscience, and Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA

a3 Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

a4 Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Ontario, Canada


Background There is increased interest in assessing the family history of psychiatric disorders for both genetic research and public health screening. It is unclear how best to combine family history reports into an overall score. We compare the predictive validity of different family history scores.

Method Probands from the Dunedin Study (n=981, 51% male) had their family history assessed for nine different conditions. We computed four family history scores for each disorder: (1) a simple dichotomous categorization of whether or not probands had any disordered first-degree relatives; (2) the observed number of disordered first-degree relatives; (3) the proportion of first-degree relatives who are disordered; and (4) Reed's score, which expressed the observed number of disordered first-degree relatives in terms of the number expected given the age and sex of each relative. We compared the strength of association between each family history score and probands' disorder outcome.

Results Each score produced significant family history associations for all disorders. The scores that took account of the number of disordered relatives within families (i.e. the observed, proportion, and Reed's scores) produced significantly stronger associations than the dichotomous score for conduct disorder, alcohol dependence and smoking. Taking account of family size (i.e. using the proportion or Reed's score) produced stronger family history associations depending on the prevalence of the disorder among family members.

Conclusions Dichotomous family history scores can be improved upon by considering the number of disordered relatives in a family and the population prevalence of the disorder.

(Received October 18 2007)

(Revised January 08 2008)

(Accepted January 30 2008)

(Online publication March 26 2008)


c1 Address for correspondence: Mr B. Milne, SGDP Centre, Institute of Psychiatry, PO80, De Crespigny Park, London SE5 8AF, UK. (Email: