The impact of clinical significance criteria on subthreshold depression prevalence rates

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. 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. 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. 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.