Are depressed outpatients with and without a family history of substance use disorder different? A baseline analysis of the STAR*D cohort.
OBJECTIVE
This report compares the baseline demographic and clinical characteristics of outpatients with nonpsychotic major depressive disorder (MDD) and a family history of substance use disorder (SUD) versus those with MDD and no family history of SUD.


METHODS
Using data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, we grouped participants with MDD (DSM-IV criteria) according to presence or absence of family history of SUD based on participant report. Between-group comparisons were made of demographic and clinical characteristics, depressive symptoms, and psychiatric co-morbidities. Patients were enrolled from July 2001 until August 2004.


RESULTS
Of 4010 participants, 46% had a positive family history of SUD. Those with a positive family history were less likely to be Hispanic (p = .0029) and more likely to be female (p = .0013). They were less educated (p = .0120), less likely to be married (p < .01), and more likely to be divorced (p < .01). They also reported an earlier age at onset of MDD, greater length of illness, and more major depressive episodes (all p < .001). They had an increased likelihood of recurrent MDD, more prior suicide attempts, and more concurrent psychiatric comorbidities, including posttraumatic stress disorder, SUD, and generalized anxiety disorder (all p < .0001).


CONCLUSIONS
Depressed patients with a family history of SUD had a more severe previous course of depression, were more likely to have attempted suicide, and had a greater burden of psychiatric comorbid conditions than patients without such a family history. These findings represent important clinical features to be considered in the evaluation and treatment planning of patients with MDD.
Davis
Lori L
LL
Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Ala. 35404, USA. lori.davis@va.gov
Frazier
Elizabeth C
EC
Gaynes
Bradley N
BN
Trivedi
Madhukar H
MH
Wisniewski
Stephen R
SR
Fava
Maurizio
M
Barkin
Jennifer
J
Kashner
T Michael
TM
Shelton
Richard C
RC
Alpert
Jonathan E
JE
Rush
A John
AJ
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003710:Demography; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010045:Outpatients; D010375:Pedigree; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000235:genetics; D013406:Suicide, Attempted