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How should we construct psychiatric family history scores? A comparison of alternative approaches from the Dunedin Family Health History Study

  • B. J. Milne (a1), T. E. Moffitt (a1) (a2), R. Crump (a3), R. Poulton (a3), M. Rutter (a1), M. R. Sears (a4), A. Taylor (a1) and A. Caspi (a1) (a2)...



There is increased interest in assessing the family history of psychiatric disorders for both genetic research and public health screening. It is unclear how best to combine family history reports into an overall score. We compare the predictive validity of different family history scores.


Probands from the Dunedin Study (n=981, 51% male) had their family history assessed for nine different conditions. We computed four family history scores for each disorder: (1) a simple dichotomous categorization of whether or not probands had any disordered first-degree relatives; (2) the observed number of disordered first-degree relatives; (3) the proportion of first-degree relatives who are disordered; and (4) Reed's score, which expressed the observed number of disordered first-degree relatives in terms of the number expected given the age and sex of each relative. We compared the strength of association between each family history score and probands' disorder outcome.


Each score produced significant family history associations for all disorders. The scores that took account of the number of disordered relatives within families (i.e. the observed, proportion, and Reed's scores) produced significantly stronger associations than the dichotomous score for conduct disorder, alcohol dependence and smoking. Taking account of family size (i.e. using the proportion or Reed's score) produced stronger family history associations depending on the prevalence of the disorder among family members.


Dichotomous family history scores can be improved upon by considering the number of disordered relatives in a family and the population prevalence of the disorder.


Corresponding author

*Address for correspondence: Mr B. Milne, SGDP Centre, Institute of Psychiatry, PO80, De Crespigny Park, London SE5 8AF, UK. (Email:


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Andreasen, NC, Rice, J, Endicott, J, Reich, T, Coryell, W (1986). The family history approach to diagnosis. Archives of General Psychiatry 43, 421428.
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn.American Psychiatric Association: Washington, DC.
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychiatric Association: Washington, DC.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.American Psychiatric Association: Washington, DC.
Bandelow, B, Späth, C, Tichauer, GA, Broocks, A, Hajak, G, Rüther, E (2002). Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with panic disorder. Comprehensive Psychiatry 43, 269278.
Bandelow, B, Torrente, AC, Wedekind, D, Broocks, A, Hajak, G, Rüther, E (2004). Early traumatic life events, parental rearing styles, family history of mental disorders, and birth risk factors in patients with social anxiety disorder. European Archives of Psychiatry and Clinical Neuroscience 254, 397405.
Byrne, M, Agerbo, E, Mortensen, PB (2002). Family history of psychiatric disorders and age of first contact in schizophrenia: an epidemiology study. British Journal of Psychiatry 181 (Suppl. 43), s19s25.
Chapman, TF, Mannuzza, S, Klein, DF, Fyer, AJ (1994). Effects of informant mental disorder on psychiatric family history data. American Journal of Psychiatry 151, 574579.
Chen, X, Wang, X, Hossain, S, O'Neill, FA, Walsh, D, van den Oord, E, Fanous, A, Kendler, KS (2007). Interleukin 3 and schizophrenia: the impact of sex and family history. Molecular Psychiatry 12, 273282.
Coelho, HF, Cooper, PJ, Murray, L (2006). Impact of psychiatric disturbance on identifying psychiatric disorder in relatives: study of mothers and daughters. British Journal of Psychiatry 188, 288289.
Coelho, HF, Cooper, PJ, Murray, L (2007). A family study of co-morbidity between generalized social phobia and generalized anxiety disorder in a non-clinic sample. Journal of Affective Disorders 100, 103113.
Costello, A, Edelbrock, C, Kalas, R, Kessler, M, Klaric, S (1982). Diagnostic Interview Schedule for Children (DISC). National Institute of Mental Health: Rockville, MD.
Davies, NJ, Sham, PC, Gilvarry, C, Jones, PB, Murray, RM (1997). Comparison of the family history with the family study method: report from the Camberwell Collaborative Psychosis Study. American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics 74, 1217.
Hardt, J, Franke, P (2007). Validity, reliability and objectivity of the family history method in psychiatry: a meta analysis. European Psychiatry 22, 4958.
Heun, R, Maier, W, Müller, H (1997). Subject and informant variables affecting family history diagnoses of depression and dementia. Psychiatry Research 71, 175180.
Higgins, M, Province, M, Heiss, G, Eckfeldt, J, Ellison, RC, Folsom, AR, Rao, DC, Sprafka, JM, Williams, R (1996). NHLBI Family Heart Study: objectives and design. American Journal of Epidemiology 143, 12191228.
Kendler, KS, Davis, KL, Kessler, RC (1997). The familial aggregation of common psychiatric and substance use disorders in the National Co-morbidity Survey: a family history study. British Journal of Psychiatry 170, S41S48.
Kendler, KS, Silberg, JL, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1991). The family history method: whose psychiatric history is measured? American Journal of Psychiatry 148, 15011504.
Kim-Cohen, J, Caspi, A, Moffitt, TE, Harrington, H, Milne, BJ, Poulton, R (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry 60, 709717.
Klein, DN, Lewinsohn, PM, Rohde, P, Seeley, JR, Shankman, SA (2003). Family study of co-morbidity between major depressive disorder and anxiety disorders. Psychological Medicine 33, 703714.
Kosten, TA, Anton, SF, Rounsaville, BJ (1992). Ascertaining psychiatric diagnoses with the family history method in a substance abuse population. Journal of Psychiatric Research 26, 135147.
Miles, DR, Stallings, MC, Young, SE, Hewitt, JK, Crowley, TJ, Fulker, DW (1998). A family history and direct interview study of the familial aggregation of substance abuse: the adolescent substance abuse study. Drug and Alcohol Dependence 49, 105114.
Moffitt, TE, Caspi, A, Rutter, M, Silva, PA (2001). Sex Differences in Antisocial Behaviour: Conduct Disorder, Delinquency, and Violence in the Dunedin Longitudinal Study. Cambridge University Press: Cambridge, UK.
Moffitt, TE, Harrington, H, Caspi, A, Kim-Cohen, J, Goldberg, D, Gregory, AM, Poulton, R (2007). Depression and generalized anxiety disorder: cumulative and sequential co-morbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry 64, 651660.
Murad, H, Kalter-Leibovici, O, Chetrit, A, Freedman, LS (2007). A statistical comparison of different family history scores. Statistics in Medicine 26, 27852798.
Newman, SC, Bland, RC (2006). A population based family study of DSM-III generalized anxiety disorder. Psychological Medicine 36, 12751281.
Orvaschel, H, Thompson, WD, Belanger, A, Prusoff, BA, Kidd, KK (1982). Comparison of the family history method to direct interview: factors affecting the diagnosis of depression. Journal of Affective Disorders 4, 4959.
Prescott, CA, Sullivan, PF, Myers, JM, Patterson, DG, Devitt, M, Halberstadt, LJ, Walsh, D, Kendler, KS (2005). The Irish affected sib pair study of alcohol dependence: study methodology and validation of diagnosis by interview and family history. Alcoholism: Clinical and Experimental Research 29, 417429.
Qin, P, Xu, H, Laursen, TM, Vestergaard, M, Mortensen, PB (2005). Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study. British Medical Journal 331, 23.
Reed, T, Wagener, DK, Donahue, RP, Kuller, LH (1986). Young adult cholesterol as a predictor of familial ischemic heart disease. Preventive Medicine 15, 292303.
Rice, JP, Reich, T, Bucholz, K, Neuman, RJ, Fishman, R, Rochberg, N, Hesselbrock, VM, Nurnberger, JJ, Schuckit, MA, Begleiter, H (1995). Comparison of direct interview and family history diagnoses of alcohol dependence. Alcoholism: Clinical and Experimental Research 19, 10181023.
Robins, LN, Helzer, HE, Croughan, J, Ratcliff, KS (1981). National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Archives of General Psychiatry 38, 381389.
Robins, LN, Cottler, L, Bucholz, K, Compton, W (1995). Diagnostic Interview Schedule for DSM-IV. Washington University Press: St Louis, MO.
Roy, M-A, Walsh, D, Kendler, KS (1996). Accuracies and inaccuracies of the family history method: a multivariate approach. Acta Psychiatrica Scandinavica 93, 224234.
Sears, MR, Greene, JM, Willan, AR, Taylor, DR, Flannery, EM, Cowan, JO, Herbison, GP, Poulton, R (2002). Long-term relationship between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet 360, 901907.
Selzer, ML, Vinokur, A, Van Rooijen, L (1975). A self-administered Short Michigan Alcoholism Screening Test (SMAST). Journal of Studies on Alcohol 36, 117126.
Silberberg, JS, Fryer, J, Wlodarczyk, J, Robertson, R, Dear, K (1999). Comparison of family history measures used to identify high risk of coronary heart disease. Genetic Epidemiology 16, 344355.
Simon, GE, VonKorff, M (1995). Recall of psychiatric history in cross-sectional surveys: implications for epidemiologic research. Epidemiologic Reviews 17, 221227.
Skinner, HA (1982). The drug abuse screening test. Addictive Behaviors 7, 363371.
Statacorp (2005). Stata Statistical Software: Release 9.1. Stata Corporation: College Station, TX.
Stoltenberg, SF, Mudd, SA, Blow, FC, Hill, EM (1998). Evaluating measures of family history of alcoholism: density vs dichotomy. Addiction 93, 15111520.
Sullivan, PF, Neale, MC, Kendler, KS (2000). Genetic epidemiology of major depression: review and meta-analysis. American Journal of Psychiatry 157, 15521562.
Sullivan, PF, Wells, JE, Joyce, PR, Bushnell, JA, Mulder, RT, Oakley-Browne, MA (1996). Family history of depression in clinic and community samples. Journal of Affective Disorders 40, 159168.
Thompson, D, Witte, JS, Slattery, M, Goldgar, D (2004). Increased power for case–control studies of single nucleotide polymorphisms through incorporation of family history and genetic constraints. Genetic Epidemiology 27, 215224.
Thompson, WD, Kidd, JR, Weissman, MM (1980). A procedure for the efficient collection and processing of pedigree data suitable for genetic analysis. Journal of Psychiatric Research 15, 291303.
Turner, WM, Cutter, HSG, Worobec, TG, O'Farrell, TJ, Bayog, RD, Tsuang, MT (1993). Family history models of alcoholism: age of onset, consequences and dependence. Journal of Studies on Alcohol 54, 164171.
Vandeleur, CL, Rothen, S, Jeanpretre, N, Lustenberger, Y, Gamma, F, Ayer, E, Ferrero, F, Fleischmann, A, Besson, J, Sisbane, F, Preisig, M (2008). Inter-informant agreement and prevalence estimates for substance use disorders: direct interview versus family history method. Drug and Alcohol Dependence 92, 919.
Weissman, MM, Wickramaratne, P, Adams, P, Wolk, S, Verdeli, H, Olfson, M (2000). Brief screening for family psychiatric history: the family history screen. Archives of General Psychiatry 57, 675682.
Williams, RL (2000). A note on robust variance estimation for cluster-correlated data. Biometrics 56, 645646.
Yoon, PW, Scheuner, MT, Peterson-Oehlke, KL, Gwinn, M, Faucett, A, Khoury, MJ (2002). Can family history be used as a tool for public health and preventive medicine? Genetics in Medicine 4, 304310.
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