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Scott Taney Young, Psy.D., is a 2025 graduate of the PsyD Program in Clinical Psychology at Antioch University, Santa Barbara.

Dissertation Committee:

  • Betsy Bates Freed, PsyD, Committee Chair
  • Brett Kia-Keating, EdD, Committee Member
  • Robert H. Pietrzak, PhD, Committee Member

Keywords

adult, assessment, AUDADIS, characteristic, classification, clinical significance, comorbidity, conditional logic, consensus, continuum, cross sectional, demographic, depressed, depression, depressive, diagnosis, diagnostic, differentiation, dimensional, dimensionality, disability, DSM, economic impact, economic cost, epidemiologic, epidemiological, epidemiology, gateway, history of depression, impact, impairment, longitudinal assessment, longitudinal course, major depression, minor depression, morbidity, mortality, multidimensional, nationally representative, NESARC, NESARC-III, NIAAA, nosology, operational definition, operationalization, pathognomonic, prevalence, public assistance program usage, secondary data analysis, severity, SF-12, skip logic, social cost, subclinical depression, subdiagnostic depression, subjective health ratings, subsyndromal depression, subthreshold depression, suicidal behavior, suicidality, symptomatic course, United States of America, USA

Document Type

Dissertation

Publication Date

2025

Abstract

While subthreshold depression (subD) is relatively young for a diagnostic concept at a mere half century old, it has burdened individuals and societies for far longer. Research has established that it is a highly prevalent, clinically important entity with clear links to personal distress and impairment (including increased suicidal ideation and behavior), societal burden (e.g., increased reliance on public assistance programs), and economic costs (both personal and public). Research has also demonstrated that it represents a significant risk factor for incident major depression (MD) and that it likely represents both a prodromal and residual state in the normal course of that disorder. Yet, as a diagnosis, subD is notably absent in the prevailing nosologies and epidemiologic research instruments, leading to the underrepresentation and misconstrual of this condition in the research, clinical, and community domains. Complicating the matter even further, a marked lack of consensus persists about how subD ought to be defined and operationalized—an issue which is perpetuated and reinforced by a failure to explicitly account for it in the DSM. The following study examined subD in the context of the National Epidemiologic Survey on Alcohol and Related Conditions III (i.e., a nationally representative sample) and found that individuals who have experienced subD at some point in their lifetime can be clearly distinguished from those who have never experienced it in terms of demographic characteristics, comorbidity patterns, subjective health ratings, and suicidal behavior. Most notably, individuals with a history of subD had more than 2.5x greater odds of suicidal behavior when compared to those with no lifetime history of depression. The data also show that individuals with a history of MD can be clearly distinguished from those with a history of subD, reinforcing the idea that subD exists on an escalating continuum of severity with MD. Such findings augment arguments which hold that subD is a clinically significant and clinically relevant construct that needs to be better studied, characterized, and represented. The time has come for consensus to be reached around what subD is and for it to be included in the field’s nosologies and research instruments. Only in so doing will both clinicians and the general public gain a much needed awareness of this important condition and only thus will the measures needed to mitigate its impact be developed and implemented. This dissertation is available in open access at AURA, https://aura.antioch.edu and OhioLINK ETD Center, https://etd.ohiolink.edu.

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ORCID iD.: 0000-0002-2109-9797

BIO:

Scott Taney Young, PsyD is a practicing psychotherapist in Santa Barbara, CA. He enrolled in the PsyD program at Antioch University Santa Barbara after spending 15 years pursuing fulfillment in what ultimately proved to be (for him) an unfulfilling field – the software industry. After being “workforce reduced” for the third time, he realized that he lacked a passion for software (and software companies) and that what he truly craved was meaningful work—work where he would know, at the end of the day, that he had truly had a positive impact on others’ lives. Once this criteria became clear, it also became clear that clinical psychology was a natural choice. And so began a nine-year journey through higher education—one which culminated in the publication of this dissertation. Along the way, he discovered subthreshold depression and it opened his eyes to both the world of subthreshold disorders and the very real, tangible impact they have on the lives of so many. Now, as a practicing psychotherapist, he brings what he has learned over the course of nearly a decade to his work with individuals and couples who are interested in understanding themselves better, understanding their dynamics with others better, and, perhaps, understanding that their experience of the world is not a pathologization of normal sadness.

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