Psychological Medicine

Original Article

A prospective study of the transition rates of subthreshold (hypo)mania and depression in the general population

E. J. REGEER a1c1, L. KRABBENDAM a2, R. DE GRAAF a3, M. TEN HAVE a3, W. A. NOLEN a4 and J. VAN OS a2a5
a1 Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
a2 Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
a3 Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
a4 Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
a5 Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, UK

Article author query
regeer ej   [PubMed][Google Scholar] 
krabbendam l   [PubMed][Google Scholar] 
de graaf r   [PubMed][Google Scholar] 
ten have m   [PubMed][Google Scholar] 
nolen wa   [PubMed][Google Scholar] 
van os j   [PubMed][Google Scholar] 


Background. Previous work suggests that subthreshold depression and subthreshold (hypo)mania are common, although little is known about the prognosis in terms of transition to clinical disorder. This paper presents data on the temporal relationship between subthreshold and clinical expression of mood phenotypes.

Method. In a random general population sample of 7076 individuals, symptoms of depression and (hypo)mania were measured with the Composite International Diagnostic Interview (CIDI) at baseline, after 1 year, and 2 years later.

Results. At baseline, the lifetime prevalences of depressive and (hypo)manic symptoms were 17·2% and 1·2% respectively. Predictive values of mood symptoms for a DSM-III-R mood disorder ranged from 14·3% to 50%. (Hypo)manic mood symptoms had much higher predictive values than unipolar manifestations, not only for bipolar disorder but also for major depression.

Conclusions. The subthreshold expressions of depression and (hypo)mania are prevalent and continuous with more severe clinical states. The cross-prediction of mood symptoms may support a continuum from depressive to (hypo)manic symptoms. The high predictive value of (hypo)manic symptoms for mood disorders suggests that the experience of (hypo)manic symptoms is a stronger indicator of vulnerability for mood dysregulation than the experience of depressive symptoms.

(Published Online January 26 2006)

c1 Altrecht GGZ, Tolsteegsingel 2A, 3582 AC Utrecht, The Netherlands. (Email: