Family Best and Easiest Predictor of Mental Disease Severity Family Best and Easiest Predictor of Mental Disease Severity

July 10, 2009

Physicians who spend 30 minutes asking a patient about family history of depression, anxiety, and substance abuse can gather enough information to approximate a patient’s risk for developing a disorder.

Physicians who spend 30 minutes asking a patient about family history of depression, anxiety, and substance abuse can gather enough information to approximate a patient’s risk for developing each disorder and to gauge how serious the future illness or illnesses might become.

These findings, from the Duke Institute for Genome Sciences & Policy (IGSP), showed that when patients were asked about their personal history with depression, anxiety, alcohol dependence, and drug dependence in relation to their “family history scores,” or “the proportion of their grandparents, parents and siblings over age 10 who were affected,” family history was able to accurately show “a more recurrent course of each of the four disorders.” In addition, family history also accurately showed those who were more likely to suffer more seriously and utilize mental health services more often.

Terrie Moffitt and Avshalom Caspi, both professors of psychology and neuroscience in the IGSP, and their colleagues examined 981 New Zealanders born at one hospital in 1972 or 1973, tracking the physical and mental health and lifestyles of the participants from age 3 years on. They report that the findings may “make a strong case” for changing the usual way questions about a patient’s familial mental history are handled. As questions about mental health are usually left out of a family history discussion, unlike when attempting to uncover heart disease, cancer, and diabetes, the researchers state that their findings may change the way the usual questions are asked.

According to Moffitt, the reason many healthcare professional have shied away from asking patient about family history—despite widespread knowledge mental health issues are some of the most heritable of all disorders—is because of the stigma attached to them. “There’s a sense that families are not as open about mental disorders—that people may not know or may make incorrect assumptions,” she said. The researchers feel their findings show that such concerns may be “overblown” and that the key is in how you ask the questions about family history of mental health disorders.

As opposed to asking outright about the history of anxiety disorder in any of a given patient’s relatives, the researchers asked, Has anyone on the list of family members ever had a sudden spell or attack in which they felt panicked?” If the patient said yes in regards to any relative(s), they then asked, “Did this person have several attacks of extreme fear or panic, even though there was nothing to be afraid of?”

Moffitt also noted that the DSM makes no mention of family history—another reason mental health professionals don’t often ask about family history. But that will soon change; Moffitt is among the experts who are currently working on revisions to the DSM, and you can bet that family history will be included. This next edition DSM-V, is set for publication in 2012.