# Family history is a good predictor of risk for psychiatric illness



## David Baxter PhD (Jul 7, 2009)

Family history good predictor of psychiatric illness risk
by Kendall Morgan 
Tuesday, 7 July 2009

We've all been asked at routine visits to the doctor to record our family's history with medical problems like cancer, diabetes or heart disease. But when it comes to mental disorders, usually mum's the word. 

New findings by researchers at the Duke Institute for Genome Sciences & Policy (IGSP) make a strong case for changing that status quo. They have found that 30 minutes or less of question-and-answer about the family history of depression, anxiety, or substance abuse is enough to predict a patient's approximate risks for developing each disorder and how severe their future illness is likely to be. 

"There are lots of kids with behavior problems who may outgrow them on their own without medication, versus the minority with mental illnesses that need treatment," said Terrie Moffitt, a professor of psychology and neuroscience in the IGSP. "Family history is the quickest and cheapest way to sort that out." 

Researchers who are on the hunt for genes responsible for mental disorders might also take advantage of the discovery, added Avshalom Caspi, an IGSP investigator and professor of psychology and neuroscience. "It suggests they may be better off selecting people with more serious illness or, better still, collecting family history information directly," he said. 

That mental illnesses tend to run in families is certainly no surprise. In fact, psychiatric conditions are some of the most heritable of all disorders. But the link between family history and the seriousness of psychiatric disease has been less certain. 

Moffitt, Caspi and their colleagues looked to 981 New Zealanders born at a single hospital in 1972 or 1973, who are participants in what is known as the Dunedin Study. Researchers have been tracking the physical and mental health and lifestyles of those enrolled in the longitudinal study since they were 3 years old. 

In this case, Caspi and Moffitt's team tested each individual's personal experience with depression, anxiety, alcohol dependence and drug dependence in relation to their family history "scores" - the proportion of their grandparents, parents and siblings over age 10 who were affected. The analysis shows that family history can predict a more recurrent course of each of the four disorders. It is also indicative of those more likely to suffer a worse impairment and to make greater use of mental health services. Contrary to earlier reports, those with a stronger family history did not necessarily develop their disorders at an earlier age. 

Family history could be used to identify those in need of early intervention or more aggressive treatment, the researchers said. But if a few, simple questions could have that much value, why has family history been ignored for so long? *1*

Moffitt said that health professionals have shied away from questioning people about their family history of mental illnesses because of the stigma attached to them. *1* "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 new findings suggest those concerns may be overblown. One key, they say, is in how you go about asking the questions. 

For example, instead of asking each person if any of their relatives had a history of anxiety disorder outright, 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 interviewee came up with a name, they were then asked, "Did this person have several attacks of extreme fear or panic, even though there was nothing to be afraid of?" 

There is another very practical reason that those in the mental health profession don't ask about family history. *1* The "bible of psychiatry," officially known as The Diagnostic and Statistical Manual of Mental Disorders (DSM), makes no mention of it. The DSM is the primary tool for making mental health diagnoses and delivering mental healthcare in the U.S. and, to some extent, in other countries around the world. 

"There's nothing about family history in the DSM even though it may be the most important," Moffitt said. There will soon be an opening to fix that. Experts including Moffitt are now in the process of revising the DSM, which is currently in its fourth edition. The next edition, DSM-V, is due for publication in 2012. 

*Source:* Milne BJ, Caspi A, Harrington H, et al. Predictive Value of Family History on Severity of Illness: The Case for Depression, Anxiety, Alcohol Dependence, and Drug Dependence. _Arch Gen Psychiatry_. 2009;66(7):738-747 [Abstract]


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## David Baxter PhD (Jul 7, 2009)

*1* These references at various points in the article above are a bit mystifying to me. I routinely ask about family history when I see clients, and other practitioners who I respect and whose work I know do the same. Where does Professor Moffitt get the idea that mental health professionals do NOT ask about family history?

If you are a "mental health consumer", i.e., someone who has seen a counsellor or therapist, what was your experience? Did your therapist inquire about family history as well as personal history?


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## Daniel (Jul 7, 2009)

David Baxter said:
			
		

> If you are a "mental health consumer", i.e., someone who has seen a counsellor or therapist, what was your experience? Did your therapist inquire about family history as well as personal history?


They always did with me.


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## Fiver (Jul 7, 2009)

Absolutely, and apparently wisely so. My therapist sat up and took interest when she asked and learned that my grandmother, who was my primary care-giver since she lived with us when I was a kid, committed suicide in our basement when I was in elementary school. I didn't realize that this alone could be a big risk factor for me, but thankfully my therapist did and thus we're even more vigilant to the early signals of suicidal ideations.


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## Always Changing (Jul 7, 2009)

No one asked me, but I do hope in time that they ask my children about their parents history should they see a mental health professional or even their G.P.


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## Mari (Jul 7, 2009)

> We've all been asked at routine visits to the doctor to record our family's history with medical problems



The problem for me starts with the family doctor who never asked questions about mental disorders. Seeing a counselor/therapist was completely on my own initiative and whenever I asked for help for my children I felt that my concerns were dismissed. I might have received better assistance if I had thought to mention other family members and their history. I do not recall ever answering any questions about family members other than in relation to heart disease.  Mari


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## David Baxter PhD (Jul 7, 2009)

Did your family doctor ask you about your family medical history, Mari?

I do think more emphasis should be given by some family physicians on screening for mental health issues but I also recognize that they are increasingly overworked and overwhelmed. One consequence of this is that family physicians are becoming more and more like ER physicians - deal with the crisis and move them along. However, given the workloads I see most of them carrying in this country, I cannot fault them for that.

On the other hand, in my experience, once the issue of a mental health issue is raised with the family physician, they are quite willing and ready to address it, within the limits of their training. I suppose this puts the onus on the patient to bring up the issue, but that's what collaborative medicine (which is increasingly becoming a necessity) is all about.


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## Disturbedforlife (Jul 7, 2009)

I used to see a counselor back in February and March (of 2009) and she never asked me. Had she asked me, I wouldn't've even known. I only found out near the end of June that there has been a history of schizophrenia, OCD, and depression in my family..


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## Andy (Jul 7, 2009)

David Baxter said:


> *1* These references at various points in the article above are a bit mystifying to me. I routinely ask about family history when I see clients, and other practitioners who I respect and whose work I know do the same. Where does Professor Moffitt get the idea that mental health professionals do NOT ask about family history?
> 
> If you are a "mental health consumer", i.e., someone who has seen a counsellor or therapist, what was your experience? Did your therapist inquire about family history as well as personal history?



I have for the most part found that all mental health professionals ask about mental health in the family and ask about personal history.  I always assumed it was part of the intake process. That is weird that Moffitt suggests otherwise.  

The people I find that do not ask are MD's or doctors of other specialties, where it is just as important to know the information but I'm guessing because it isn't there specialty it's not high on their list of things they need to know.


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## Meg (Jul 7, 2009)

The doctor I've seen most recently did.

The doctors I've seen in the past have only asked about my family's medical history.


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## Jazzey (Jul 7, 2009)

My more recent psychologist wanted to know all of mine and my family's history.  My doctor has always informed himself of my mental health history too.  But prior mental health professionals have never asked and, at the time, I didn't necessarily understand the relevance.


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## David Baxter PhD (Jul 7, 2009)

I have to say I'm finding this quite surprising and rather worrisome.


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## Jazzey (Jul 7, 2009)

No to sound too cynical Dr. Baxter, but until I found this last psychologist, I wasn't really sure about why I was going down this path.  Some of the people I saw really didn't put me at ease about discussing much with them.  When I tried to talk about my cousin's suicide attempt in December with my psychologist and my concerns about her possible schizophrenia - I was told we weren't here to talk about my cousin...Conversation ended there.  And so did that relationship.

Again, I know there are some really good psychologists out there.  But for someone in crisis, it's going to be hard to distinguish that diamond in the rough. And, in my opinion, the damage can be quite (looking for the right word) scarring (this is not the right word either, but it's as close as I can find right now).


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## David Baxter PhD (Jul 7, 2009)

It is alarming.


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## NicNak (Jul 7, 2009)

My GP when I first went to see her asked "Have you ever been treated for a mental illness" I broke down and cried and said "No but I think I should be"  :blush:

Both the psychiatrists I have been evaluated by asked about family history of mental illness.  The hard part, at least with my family, is that I am speculating on what _might_ be mental illness symtoms (I always state this to them) and one realitive who has actually admitted to having treatment for anxiety still to this day, for over 40 years.  

I think the stigma keeps them "quiet" to this day, the rest of my family.  It might be difficult to find that out from some generations out of their fear.  Cause of how much worse the stigma use to be and how treatments were given.


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