Are Depressed Outpatients With and Without a Family History of Substance Use Disorder Different? A Baseline Analysis of the STAR*D Cohort

Lori L. Davis, M.D.; Elizabeth C. Frazier, M.A.; Bradley N. Gaynes, M.D., M.P.H.; Madhukar H. Trivedi, M.D.; Stephen R. Wisniewski, Ph.D.; Maurizio Fava, M.D.; Jennifer Barkin, M.P.H.; T. Michael Kashner, Ph.D.; Richard C. Shelton, M.D., Ph.D.; Jonathan E. Alpert, M.D., Ph.D.; and A. John Rush, M.D.

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.

Method: 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 comorbidities. 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).

Conclusion: 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.

(J Clin Psychiatry 2007;68:1931-1938)

Received May 29, 2006; accepted April 29, 2007. From the Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Ala., and Department of Psychiatry, University of Alabama School of Medicine, Tuscaloosa and Birmingham (Dr. Davis); Department of Psychology, University of Alabama at Birmingham (Ms. Frazier); Department of Psychiatry, University of North Carolina at Chapel Hill (Dr. Gaynes); Department of Psychiatry, University of Texas (UT) Southwestern Medical Center at Dallas (Drs. Trivedi, Kashner, and Rush); University of Pittsburgh Epidemiology Data Center, Pittsburgh, Pa. (Dr. Wisniewski and Ms. Barkin); Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston (Drs. Fava and Alpert); and Department of Psychiatry, Vanderbilt University, Nashville, Tenn. (Dr. Shelton).

This project has been funded with Federal funds from the National Institute of Mental Health (NIMH), National Institutes of Health, under Contract N01MH90003 (ClinicalTrials.gov identifier NCT00021528) to UT Southwestern Medical Center at Dallas (Dr. Rush).

The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Acknowledgments are listed at the end of the article.

Financial disclosure appears at the end of the article.

Corresponding author and reprints: Lori L. Davis, M.D., VA Medical Center (151), 3701 Loop Rd. East, Tuscaloosa, AL 35404 (e-mail: lori.davis@va.gov).