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The Family History Screen

Myrna M. Weissman, PhD; Priya Wickramaratne, PhD; Philip Adams, PhD; Susan Wolk, MD; Helen Verdeli, PhD; Mark Olfson, MD

Arch Gen Psychiatry. 2000;57:675-682.

Background  Brief screens to collect lifetime family psychiatric history are useful in clinical practice and for identifying potential families for genetic studies.

Methods  The Family History Screen (FHS) collects information on 15 psychiatric disorders and suicidal behavior in informants and their first-degree relatives. Since each question is posed only once about all family members as a group, the administrative time is 5 to 20 minutes, depending on family size and illness. Data on the validity against best-estimate (BE) diagnosis based on independent and blind direct interviews on 289 probands and 305 relatives and test-retest reliability across 15 months in 417 subjects are presented.

Results  Agreement between FHS and BE diagnosis for proband and relative self-report had median sensitivity (SEN) of 67.6 and 71.1 respectively; median specificity (SPC) was 87.6 and 89.4, respectively. Marked decrease in SEN occurred when a single informant (the proband) reported on a relative (median, 37.5); however, median SPC was 95.8. Use of more than 1 informant substantially improved SEN (median, 68.2), with a modest reduction in SPC (median, 86.8). Test-retest reliability across 15 months resulted in a median of 0.56.

Conclusions  The FHS is a promising brief screen for collecting lifetime psychiatric history on an informant and/or first-degree relatives. Its validity is best demonstrated for major depression, anxiety disorders, substance dependence (alcohol and drug dependence), and suicide attempts. It is not a substitute for more lengthy family history if more detail on diagnosis is required.

From the Department of Psychiatry, College of Physicians and Surgeons (Drs Weissman, Wickramaratne, Wolk, and Olfson), and the Departments of Epidemiology (Dr Weissman) and Biostatistics (Dr Wickramaratne), Joseph P. Mailman School of Public Health, Columbia University, and the Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute (Drs Weissman, Wickramaratne, Adams, Verdeli, and Olfson), New York, NY.