The Causative Role Of Stress In Depression: Gender Diffences.

5498 words - 22 pages

IntroductionSince the 1960's there has been a large volume of systematic research on the role of life events in psychiatric disorder. The life event literature now clearly indicates that the risk of depression is considerably increased following stressful life events. Type of life event is only weakly related to type of disorder. Those events, which are more generally stressful, are also more likely to produce disorder. Some disorders are more strongly associated with life events than others. Depression is one of these, with the possible exception o bipolar disorder [1].The diathesis stress model shows that a wide range of psychological disorders result from the impact of an environmental event (stressor/stress factor) on a person who had a predisposing vulnerability [2].Fig. 1. Diathesis stress model [2]As the level of vulnerability increases, the degree of stress needed to precipitate a disorder decreases. Vulnerability is affected by biological and environmental factors.Life events and onset of depressionThere is a large body of evidence showing that stressful life events are closely associated with the onset of major depressive episodes [3, 4, 5]. Table 1 summarises findings of 27 retrospective controlled comparisons of psychiatrically treated depressed patients, one employing two comparison groups. 16 studies from 9 countries employed general population controls including two studies of elderly patients, which were conducted by Murphy and Emmerson et al [6,7]. All found more events reported prior to depressive onset, although in one study, with small numbers, the difference was not significant. One study conducted by Bebbington et al [8] found greater life events in depressed people in the community than in outpatients.Table 1 Controlled comparisons of Life Events and Onset of Clinical Depression [1]Nature of ControlsAuthorExcess any EventsExcess SeparationsExcess Other Types of EventsGeneral PopulationPaykel et al [9] YesYesVarious, especially undesirable eventsThompson and Hendrie [10] YesNot reportedMore stress overallCadoret et al [11]SuggestiveSuggestiveNot reportedBrown et al [12]YesNot reportedMarkedly and moderately threatening eventsFava et al [13]YesYesUndesirable, negative impactVadher and Ndetei [14]YesYesSuggestive onlyChatterjee et al [15]YesYesHealth, interpersonalBebbinton et al [8]Yes, males onlyNot ReportedEvents of severe and moderate threatMurphy [6]YesSuggestiveHealthBillings et al [16]YesYesVarious negative eventsFaravelli and Ambonetti [17]YesNot reportedUndesirable, exit and severeBidzinska [18]YesNoMarital and family conflicts, work overload, failuresRoy et al [19]YesNoUndesirable eventsBrugha and Conroy [20]YesNot reportedUndesirable, threatening. Not independent, uncontrolledEzquiaga et al [21]YesNot reportedThreatening, independentEmmerson et al [7]YesNot reportedSeverely threateningCornelis et al [22]YesNoUndesirable, higher stressMedical PatientsForrest et al [24]Yes, weakNoSocial FactorsHudgens et al [25]Yes,...

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