Major Depression and Its Recurrences: Life Course Matters.

Major depression is one of the most prevalent and debilitating personal and public health conditions worldwide. Less appreciated is that depression's tremendous burdens are not shared equally among all who become depressed. Some will suffer recurrences over the rest of their lives, whereas half or more will never have a recurrence.

More treatment but no less depression: The treatment-prevalence paradox.

Treatments for depression have improved, and their availability has markedly increased since the 1980s. Mysteriously the general population prevalence of depression has not decreased. This "treatment-prevalence paradox" (TPP) raises fundamental questions about the diagnosis and treatment of depression.

Life stress and major depression: The mysteries of recurrences.

Approximately half of the people who suffer a major depressive episode for the first time experience recurrences, while the other half do not. Among the initially depressed, however, who will have recurrences remains a mystery, and cannot be forecasted with any statistical or clinical confidence. It is well documented, though, that highly stressful life events commonly precede first episodes of major depression, and that these experiences become progressively less common prior to recurrences.

The assessment and measurement of adult life stress: Basic premises, operational principles, and design requirements.

Life stress is a central factor in the onset and course of a wide range of medical and psychiatric conditions. Determining the precise etiological and pathological consequences of stress, though, has been hindered by weaknesses in prevailing definitional and measurement practices. The purpose of the current paper is to evaluate the primary strategies for defining and measuring major and minor acute life events, chronic stressors, and daily hassles as informed by 3 basic scientific premises.

Questioning kindling: An analysis of cycle acceleration in unipolar depression.

The kindling hypothesis for depression predicts that with more recurrences, the interval between successive recurrences decreases. Studies with unipolar and bipolar samples generally have been consistent with this premise. However, previous research is subject to a statistical artifact.

Life stress and family history for depression: the moderating role of past depressive episodes.

Three of the most consistently reported and powerful predictors of depression are a recent major life event, a positive family history for depression, and a personal history of past depressive episodes. Little research, however, has evaluated the inter-relations among these predictors in depressed samples. Such information is descriptively valuable and potentially etiologically informative.

Recurrence in major depression: a conceptual analysis.

Theory and research on major depression have increasingly assumed a recurrent and chronic disease model. Yet not all people who become depressed suffer recurrences, suggesting that depression is also an acute, time-limited condition. However, few if any risk indicators are available to forecast which of the initially depressed will or will not recur.

Early parental loss and depression history: associations with recent life stress in major depressive disorder.

Although exposure to early adversity and prior experiences with depression have both been associated with lower levels of precipitating life stress in depression, it is unclear whether these stress sensitization effects are similar for all types of stress or whether they are specific to stressors that may be particularly depressogenic, such as those involving interpersonal loss. To investigate this issue, we administered structured, interview-based measures of early adversity, depression history, and recent life stress to one hundred adults who were diagnosed with major depressive disorder. As predicted, individuals who experienced early parental loss or prolonged separation (i.

Gender differences in life events prior to onset of major depressive disorder: the moderating effect of age.

Theoretical models attempting to explain why approximately twice as many women as men suffer from depression often involve the role of stressful life events. However, detailed empirical evidence regarding gender differences in rates of life events that precede onset of depression is lacking, due in part to the common use of checklist assessments of stress that have been shown to possess poor validity. The present study reports on a combined sample of 375 individuals drawn from 4 studies in which all participants were diagnosed with major depressive disorder and assessed with the Life Events and Difficulties Schedule (Bifulco et al.

Stressful life events, chronic difficulties, and the symptoms of clinical depression.

Major life events and chronic difficulties have been found to be associated with the onset of depression. Little is known, however, about how exposure to such stressors is related to the clinical presentation of this disorder. We addressed this issue by administering an interview-based measure of life stress, the Beck Depression Inventory, and the Global Assessment of Functioning scale to 100 adults diagnosed with major depressive disorder.

TARGETED REJECTION PREDICTS HASTENED ONSET OF MAJOR DEPRESSION.

Although severe life stress frequently precipitates the onset of major depression, little is known about the basic nature of stressors in this general category of adversity and how exposure to different life events might be related to clinical aspects of the disorder. We addressed this issue by introducing, and examining the effects of, targeted rejection (TR), which involves the exclusive, active, and intentional social rejection of an individual by others. Twenty-seven adults with major depressive disorder were administered an interview-based measure of life stress.

Gene-environment interactions in depression research: genetic polymorphisms and life-stress polyprocedures.

Recent studies on life stress, depression, and polymorphisms in the promoter region of the serotonin transporter gene (5-HTTLPR) are characterized by powerful genetic techniques, but are also characterized by unconventional and inconsistent approaches to assessing life stress. The present review addresses this problem by critically evaluating this rapidly growing literature with regard to the concepts and procedures employed to assess life stress and the research designs used to test causal associations. The existing body of evidence is seriously compromised by the predominance of ad hoc approaches for measuring life stress and by a lack of attention to key issues concerning research design.

Placing the mnemonic model in context: diagnostic, theoretical, and clinical considerations.

The mnemonic model of posttraumatic stress disorder (PTSD) proposed by D. C. Rubin, D.

Modern approaches to conceptualizing and measuring human life stress.

The idea that adverse life circumstances and negative life events contribute to disorder and disease has long been held. Advances in conceptualizing and defining these conditions under the common label of life stress have led to progress in measuring both the environmental and individual response characteristics that may promote disorder and disease. In general, a substantial and growing research literature supports the basic premise that life stress plays an important role in the development of many psychological and physical problems.

Severe life events predict specific patterns of change in cognitive biases in major depression.

Background: A long-standing debate concerns whether dysfunctional cognitive processes and content play a causal role in the etiology of depression or more simply represent correlates of the disorder. There has been insufficient appreciation in this debate of specific predictions afforded by cognitive theory in relation to major life stress and changes in cognition over time. In this paper we present a novel perspective for investigating the etiological relevance of cognitive factors in depression.

Major life events and major chronic difficulties are differentially associated with history of major depressive episodes.

Major life events have been found to precede onsets of a 1st lifetime episode of depression more commonly than subsequent recurrences. Despite general empirical support for this finding, few data directly address how the role of major life events may change over successive recurrences. Further, little research has examined major chronic difficulties in relation to a 1st lifetime episode versus a recurrence of depression.

Major depressive disorder in adolescence: the role of subthreshold symptoms.

Objective: To examine the longitudinal association between individual subthreshold symptoms and onset of major depressive disorder (MDD) in adolescence.

Method: Data for analysis come from the Oregon Adolescent Depression Project, a prospective epidemiological study of psychological disorders among adolescents, ages 14 to 18 years, from the general community. A total of 1,709 adolescents completed the initial diagnostic assessments between 1987 and 1989 (T1) and approximately 1 year later (T2), 1,507 adolescents returned for readministration of assessments (88% response).

Life stress and the long-term treatment course of recurrent depression: III. Nonsevere life events predict recurrence for medicated patients over 3 years.

Research has consistently documented the significance of severe life events for onset of major depression. Theory, however, suggests other forms of stress are relevant for depression's recurrence. Nonsevere life events were tested in relation to depression for 126 patients with recurrent depression in a 3-year randomized maintenance protocol.

Severe melancholic depression is more vulnerable than non-melancholic depression to minor precipitating life events.

Background: The present study examines the moderating role of global depression severity on the relation of melancholic versus non-melancholic depression to severe and non-severe levels of stress.

Method: A community sample of 50 women with unipolar major depressive disorder, of which 54% met Research Diagnostic Criteria for melancholic depression, were interviewed regarding stressful life events experienced prior to onset. Events were coded as severe or non-severe based on the rigorous Bedford College contextual rating system.

Life stress, the "kindling" hypothesis, and the recurrence of depression: considerations from a life stress perspective.

Major depression is frequently characterized by recurrent episodes over the life course. First lifetime episodes of depression, however, are typically more strongly associated with major life stress than are successive recurrences. A key theoretical issue involves how the role of major life stress changes from an initial episode over subsequent recurrences.

Childhood adversity and the endogenous versus nonendogenous distinction in women with major depression.

Objective: Previous research has reported an association between childhood adversity and the nonendogenous subtype of depression. The present study sought to address this association by 1) investigating the relationship between depression subtype and different levels of childhood adversity and 2) examining the relative contribution of different types of childhood adversity to depression subtypes.

Method: The authors conducted an investigator-based assessment of childhood adversity in a community group of 76 depressed women, 31 of whom met Research Diagnostic Criteria for endogenous depression.