Depression in Parents, Parenting, and Children Opportunities to Improve Identification, Treatment, and Prevention (2009) / Chapter Skim
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3 The Etiology of Depression
3 The Etiology of Depression
Pages 73-118
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From page 73... ...
• Many individuals may experience a single, major depressive epi sode following an acute stressor and recover with little implication for future vulnerability. However, most (50–80 percent)
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From page 74... ...
Resilience and Protective Factors • Certain biological, environmental, and personal factors have also been associated with the protection from or the overcoming of risk factors and adverse conditions related to the development of depression. ____________________ The purpose of this chapter is to review what is known or suspected about the causes of depression.
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TIMING AND COURSE OF DEPRESSIVE DISORDERS Age of onset of major depressive disorder and lifetime course are two factors that have etiological as well as treatment and outcome implications. Age of First Onset First onset can occur at any time.
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For all women pregnant in the past year, their depression was associated with not being married, exposure to trauma and stressful life events in the past year, and overall poor health. The dramatic hormonal changes a woman experiences during and after pregnancy have focused much attention on the biological and hormonal etiological factors of postpartum depression.
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Some individuals may experience a single, major depressive episode in response to an acute stressor, never seek treatment, and, except for impairment associated with the acute episode, recover with little implication for future vulnerability. However, many others, especially those with sufficient distress and impairment who seek (or should seek)
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and a relatively elevated exposure to early adverse conditions, including physical and sexual abuse, as well as ongoing stressful life conditions (Riso, Miyaktake, and Thase, 2002)
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. Similarly, the risk of developing major depression increases about 2.5–3 times for those who have a first-degree relative with depression, whereas having a highly threatening life event increases risk from 5 to 16 times in a few months after the event (Kendler, Karkowski, and Prescott, 1998; Sullivan, Neale, and Kendler, 2000)
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(2005) found that individuals with one or two copies of the short allele of 5-HTTLPR experienced more depressive symptoms and higher rates of major depressive disorder in response to stressful life events than individuals who are homozygous for the long allele.
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. That said, continuing analysis of genetic correlates of depression will doubtlessly contribute valuable information to fuller understanding of the neurobiological mechanisms underlying depression, and it may play a role in the development of pharmacotherapeutic agents.
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with generalized effects on the circuits underlying emotion regulation. It is hypothesized that both genetic and environmental factors account for individual differences in how individuals respond to (and recover from)
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. Recent models have proposed that chronic stress activates the immune system in a way that leads to inflammation, and that chronic inflammation in turn leads to symptoms of depression as well as pathological processes underlying heart disease (Miller and Blackwell, 2006)
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Etiological models are largely diathesis-stress perspectives. A diathesis is a risk factor or vulnerability process, such as people's biological, personality, or cognitive characteristics, that accounts for individual differences in how they respond to similar stressful challenges.
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Acute Life Events A major risk factor for depression is the experience of undesirable, negative life events. There is ample evidence that most major depressive episodes are triggered by stressful life events (see reviews by Hammen, 2005; Kessler, 1997; Mazure, 1998)
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Gender differences in depression may be accounted for in part by women's greater exposure to interpersonal life events, as well as their greater likelihood, compared with men, of reacting to such events with depression. Results of studies of adults have been mixed with regard to whether or not women experience more overall recent stressors (e.g., Kendler, Thornton, and Prescott, 2001; McGonagle and Kessler, 1990; Spangler et al., 1996)
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For example, Barrett and Turner (2005) reported that among those with higher socioeconomic position, the adverse impact of racial discrimination and recent life events were more marked than that seen for those with lower socioeconomic position.
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The environment can act as a source of chronic stressors as well. Extensive research has been devoted to the area of residential neighborhoods and mental well-being (Muntaner et al., 2004; O'Campo, Salmon, and Burke, 2009; O'Campo and Yonas, 2005)
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From page 89... ...
. Adolescent mothers are another group known to be at substantial risk for significant depression, often compounded by multiple chronic stressors such as low income, relationship difficulties, and reduced social support (Panzarine, Slater, and Sharps, 1995; Reid and Meadows-Oliver, 2007)
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In a later similar study, Kessler, Davis, and Kendler (1997) , examining 26 adversities occurring by age 16, found that although many of the events were associated with adult major depressive disorder, the adversities were also related to a broad array of psychological disorders besides depression.
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From page 91... ...
. Exposure to adverse conditions in childhood may sensitize the youth to stress, so that it may take minimal exposure to later stressful life events to precipitate depression in them compared with those without childhood adversity (e.g., Hammen, Henry, and Daley, 2000; Harkness, Bruce, and Lumley, 2006)
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. Interpersonal Vulnerabilities to Depression Depressive disorders are known to be associated with considerable impairment in interpersonal functioning -- marital discord, intimate partner violence, parenting difficulties, insecure attachment, and low social support, to mention several specific areas.
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. The romantic relationships of young women assessed over a 5-year period indicated that lower quality of the relationships at the end of the followup, as well as the boyfriend's dissatisfaction, were significantly correlated with the amount of time the woman had spent in major depressive episodes (Rao, Hammen, and Daley, 1999)
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From page 94... ...
An additional pathway to discord is that depressed people tend to marry other people with psychological problems, thus increasing the chances of marital disharmony. A review and meta-analysis of several studies of patients with mood disorders confirmed the significant likelihood that individuals with depressive disorders marry others with depression (Mathews and Reus, 2001)
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. Although the level of neuroticism may decline with reductions in depressive symptoms, recent longitudinal studies have supported the idea that relatively higher levels of neuroticism persist independent of depressive states (e.g., Clark et al., 2003; Kendler, Karkowski, and Prescott, 1999; Kendler and Karkowski-Shuman, 1997; Santor, Babgy, and Joffe, 1997)
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, for example, found that neuroticism was a strong predictor of stressful life events, particularly those related to interpersonal relationships. In other analyses, Kendler, Kuhn, and Prescott (2004)
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CO-OCCURRING DISORDERS As this chapter has indicated, depression co-occurs with a host of stressful life events, early adversities, and ongoing strains, and it is also commonly associated with a variety of interpersonal difficulties and problematic traits and behavioral tendencies. A further complexity is introduced by the reality that depression typically does not occur in a "pure" form, independent of the effects of additional psychological disorders.
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From page 98... ...
According to the Diagnostic and Statistical Manual of Mental Disorders, not only are Axis I disorders (i.e., clinical disorders, including major mental disorders, as well as developmental and learning disorders) highly likely to co-occur with depression, but also personality disorders are more the rule than the exception with depressed patients.
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, and it predicts longer and more frequent episodes of major depression. RESILIENCE AND PROTECTIVE FACTORS The rich literature on biological, environmental, and personal risk factors for depression also indicates a striking finding: not all individuals who have been exposed to risk factors for depression develop the disorder.
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Research on biological processes related to resilience has been complemented by evidence for psychological and behavioral features of resilience -- that is, research concerned with what resilient individuals think and do in response to exposure to risk factors that reduce the likelihood that they will develop depression. Research has examined the psychological processes that
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. Although limited, the research on resilience in the face of risk factors for depression points in the direction of early interventions to improve parenting and children's emotion regulation, and stress management as ways to reduce the negative impact of parental depression and other adverse conditions.
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factors that may play a role in underlying vulnerability or in the processes by which stressors trigger depression in some people. Fundamentally, etiological models are diathesis-stress models, in which stressful experiences -- whether early childhood trauma, acute recent life events, or ongoing chronic strains -- trigger depression.
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From page 103... ...
. The epidemiology of major depressive epi sodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE)
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From page 104... ...
. Risk factors associated with the development of postpartum mood disorders.
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. Aetiology of anxiety and depressive disorders in an inner-city population: 1.
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. Negative life events, social support and gender difference in depression.
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. Population based study of first onset and chronicity in major depressive disorder.
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. Trajectories of stressful life events and depressive symptoms during adolescence.
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. The role of childhood abuse and neglect in the sensitization to stressful life events in adolescent depression.
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. A prospec tive 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders.
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. Gender differences in the rates of exposure to stressful life events and sensitivity to their depressogenic effects.
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. Major depressive disorder in older ado lescents: Prevalence, risk factors, and clinical implications.
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. Life stressors as risk factors in depression.
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. The role of rumination in depressive disorders and mixed anxi ety/depressive symptoms.
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. Personality disorders in bipolar and depressive disorders.
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. Multiple recurrences of major depressive disorder.
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. Absence of interactions between social support and stressful life events in the prediction of major depression and depressive symptomatology in women.
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. Stressful life events, 5-HTT genotype and risk of depres sion.
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