The Camberwell Collaborative Depression Study. I. Depressed probands: adversity and the form of depression (original) (raw)
Related papers
Reconfirming the role of life events for the timing of depressive episodes
Journal of Affective Disorders, 2000
Background: Since the 1960s the association of stressful life events and depression seemed to be firmly established. However, a few recent studies did not confirm those earlier findings. One of the reasons discussed for the inconsistencies was the sampling of milder depressed neurotic out-patients in the earlier studies vs. more severely ill endogenous type in-patients in recent studies. Methods: This investigation was carried out with 50 consecutively admitted in-patients with endogenous depression according to ICD 9 and unipolar major depression according to DSM-III-R as ascertained by SCID. The control sample consisted of 26 healthy volunteers. Life events and chronic distressing life conditions were recorded with the Munich Interview for the Assessment of Life Events and Conditions (MEL) every 3 months over a period of 2 years along with psychopathological symptoms and recurrencies. Hence the design was prospective in the sense that life events were recorded for one 3-month cross-section, the depressive reaction for the subsequent one. BDI scores taken at the respective cross section were used to control for depressive bias of the subjective part of the patient's life event evaluation. Results: Three months prior to the index hospitalization patients were more often affected by life events and conditions than controls. The number of stressful conditions prior to the index hospitalization indicated the time to relapse after discharge. Controls showed more desirable positive conditions than patients. Relapse patients suffered more often stressful life events and conditions than non-relapsers 3 months prior to their relapse. Multivariate analysis indicates that the cumulative number of life events within the 2-year course is the best predictor of the BDI score at the end of the follow-up period. Limitations: Since the subjective component of life event assessment by MEL displayed a higher impact on the course of depression than the objective part of the assessment, confounding of subjective ratings, attributional styles, and depressive symptoms may be a problem although controlled for in this study. Conclusion: The results support the importance of stressful life events and chronic distressing conditions for the 2-year course and outcome of major depression in an in-patient sample. Since the overall consistency of significant results was more pronounced in the subjective than in the objective part of the MEL the results fit best a circular pathogenetic model of interactions between life events, their individual evaluation by the patient, and depressive symptoms.
Journal of Affective Disorders, 2000
BACKGROUND: Since the 1960s the association of stressful life events and depression seemed to be firmly established. However, a few recent studies did not confirm those earlier findings. One of the reasons discussed for the inconsistencies was the sampling of milder depressed neurotic out-patients in the earlier studies vs. more severely ill endogenous type in-patients in recent studies.METHODS: This investigation was carried out with 50 consecutively admitted in-patients with endogenous depression according to ICD 9 and unipolar major depression according to DSM-III-R as ascertained by SCID. The control sample consisted of 26 healthy volunteers. Life events and chronic distressing life conditions were recorded with the Munich Interview for the Assessment of Life Events and Conditions (MEL) every 3 months over a period of 2 years along with psychopathological symptoms and recurrencies. Hence the design was prospective in the sense that life events were recorded for one 3-month cross-section, the depressive reaction for the subsequent one. BDI scores taken at the respective cross section were used to control for depressive bias of the subjective part of the patient's life event evaluation.RESULTS: Three months prior to the index hospitalization patients were more often affected by life events and conditions than controls. The number of stressful conditions prior to the index hospitalization indicated the time to relapse after discharge. Controls showed more desirable positive conditions than patients. Relapse patients suffered more often stressful life events and conditions than non-relapsers 3 months prior to their relapse. Multivariate analysis indicates that the cumulative number of life events within the 2-year course is the best predictor of the BDI score at the end of the follow-up period.LIMITATIONS: Since the subjective component of life event assessment by MEL displayed a higher impact on the course of depression than the objective part of the assessment, confounding of subjective ratings, attributional styles, and depressive symptoms may be a problem although controlled for in this study.CONCLUSION: The results support the importance of stressful life events and chronic distressing conditions for the 2-year course and outcome of major depression in an in-patient sample. Since the overall consistency of significant results was more pronounced in the subjective than in the objective part of the MEL the results fit best a circular pathogenetic model of interactions between life events, their individual evaluation by the patient, and depressive symptoms.
Life events, difficulties and onset of depressive episodes in later life
Psychological Medicine, 2001
Background. The importance of stressful life events and long-term difficulties in the onset of episodes of unipolar depression is well established for young and middle-aged persons, but less so for older people.Method. A prospective case–control study was nested in a large community survey of older people. We recruited 83 onset cases during a 2-year period starting 2½ years after the survey, via screening (N = 59) and GP monitoring (N = 24), and 83 controls, a random sample from the same survey population. We assessed depression with the PSE-10 and life stress exposure with the LEDS.Results. Risk of onset was increased 22-fold by severe events and three-fold by ongoing difficulties of at least moderate severity. Severe events accounted for 21% of all episodes but ongoing difficulties for 45%. The association of onset with life stress, often health-related such as death, major disability and hospitalization of subject or someone close, was most pronounced in the cases identified by s...
Life events, vulnerability and onset of depression: some refinements
The British Journal of Psychiatry, 1987
Access the most recent version at doi: 1987 150: 30-42 The British Journal of Psychiatry GW Brown, A Bifulco and TO Harris refinements Life events, vulnerability and onset of depression: some References http://bjp.rcpsych.org/cgi/content/abstract/150/1/30#otherarticles Article cited in: permissions Reprints/ permissions@rcpsych.ac.uk to To obtain reprints or permission to reproduce material from this paper, please write to this article at You can respond http://bjp.rcpsych.org/cgi/eletter-submit/150/1/30
Journal of Affective Disorders, 2003
Recent studies have reignited debate concerning the relationship between stressful life events and depressive subtypes, particularly in relation to first versus subsequent episodes. To investigate the relationship between stressful life events and variably defined melancholic/non-melancholic depressive subtypes, and the import of such life events to first compared with subsequent episodes across those subtypes. Acute and chronic stressful life events were rated in 270 patients with DSM-IV Major Depressive episodes who were allocated to melancholic and non-melancholic groups separately as defined by DSM-III-R, DSM-IV, the Newcastle criteria and the CORE system. Severe stressful life events (both acute and chronic)-as defined by DSM-III-R axis IV-were more likely to occur prior to first rather than subsequent episodes, particularly for those with non-melancholic depression. Dependence or independence of life events was not assessed. Genetic vulnerability to depression was not determined. Life events in first and subsequent depressive episodes were compared cross-sectionally between groups, not prospectively in the same cohort of patients. There were no differences in the number of severe life events-as defined by clinician consensus-between the first and subsequent episodes. These findings are consistent with other studies in suggesting an enhanced sensitisation of depressed patients to subsequent episodes of depression, but suggest that any such phenomenon is specific to non-melancholic depression, in comparison to one key previous study.
Journal of Abnormal Psychology, 2010
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 , a state-of-the-art contextual interview and life stress rating system. Women reported significantly more severe and nonsevere, independent and dependent, and other-focused and subject-focused life events prior to onset of depression than did men. Further, these relations were significantly moderated by age, such that gender differences in rates of most types of events were found primarily in young adulthood. These results are discussed in term of their implications for understanding the etiological role of stressful life events in depression.
Clinical and Psychosocial Origins of Chronic Depressive Episodes
British Journal of Psychiatry, 1994
BackgroundWe consider how well the psychosocial and clinical factors found to predict a chronic course for depressive episodes in the community, held for female psychiatric patients.MethodA consecutive series of depressed patients, aged 18 to 60, treated as in-patients, out-patients or day-patients at psychiatric departments of two London hospitals, were interviewed initially and at follow-up two years later.ResultsIndices of childhood adversity and current interpersonal difficulties predicted episodes taking a chronic course (of more than 12 months' duration). Half of the episodes associated with one or the other factor were chronic, compared with 22% of those with neither. The patients were at higher risk than the community series (75% v. 34%) and this explains their much greater rate of chronicity. There was also some evidence that social support reduced risk. Clinical features and the presence of a personality disorder were unrelated to chronicity.ConclusionsSimilar psychoso...
Causal Relationship Between Stressful Life Events and the Onset of Major Depression
American Journal of Psychiatry, 1999
Objective: Stressful life events are associated with the onset of episodes of major depression. However, exposure to stressful life events is influenced by genetic factors, and these factors are correlated with those that predispose to major depression. The aim of this study was to clarify the degree to which stressful life events cause major depression. Method: The authors assessed the occurrence of 15 classes of stressful life events and the onset of DSM-III-R major depression over a 1-year period in female twins ascertained from a population-based registry. The sample contained 24,648 person-months and 316 onsets of major depression. Stressful life events were individually rated on contextual threat and dependence (the degree to which the stressful life event could have resulted from the respondent's behavior). The nature of the relationship between stressful life events and major depression was tested by 1) discrete-time survival analysis examining the relationship between dependence and the depressogenic effect of stressful life events and 2) a co-twin control analysis. Results: While independent stressful life events were significantly associated with onsets of depression, when level of threat was controlled, the association was significantly stronger for dependent events. The odds ratio for onset of major depression in the month of a stressful life event was 5.64 in all subjects, 4.52 within dizygotic pairs, and 3.58 within monozygotic pairs. Conclusions: Stressful life events have a substantial causal relationship with the onset of episodes of major depression. However, about one-third of the association between stressful life events and onsets of depression is noncausal, since individuals predisposed to major depression select themselves into highrisk environments.
Psychosocial Stressors in Patients Presenting with Depression Episodes
Pakistan Journal of Health Sciences
Depression is a mood disorder characterized by aversion to activities that affects a person's thoughts, behaviour, feelings, and sense of well-being. Objective: To explore the psychosocial stressors / life events and demographic variables in patients with major depression in 1st and subsequent episodes with related sociodemographic factors in each. Methods: The sample of this study was 50 consecutive in-patients with Major Depression. Detailed open-ended interview was conducted and also administered The Presumptive Stressful Life Events Scale (PSLES) to elicit psychosocial stressors and major life events in 1st episode and in the subsequent episodes. Results: showed that of the 50 subjects, majority of subjects 32(64%) were female, 13 (26%) were 26-30 years’ age group, 33(66%) belonged to urban area, 23(46%) were suffering from 3rd and more depressive episodes, 21(42%) reported positive family history, 28(56%) were suffering for 3 months. In psychosocial stressors / life events,...
Types of stressful life event and the onset of anxiety and depressive disorders
Psychological Medicine, 1981
SynopsisThe notions of loss and danger are briefly described. Two groups of raters in London and Canberra were shown to be reliable in rating the degree of loss and the degree of danger associated with a sample of life events previously rated as ‘severe’ on a contextual measure of long-term threat. The life events were reported by 164 young women attending a general practitioner in London. The women were interviewed by a psychiatrist using the Present State Examination. Their psychiatric symptoms were rated by a team of raters who were ignorant of the life events reported by the young women. Three types of cases of psychiatric disorder of recent onset were diagnosed: depression, anxiety, and mixed depression/anxiety. The frequency of life events reported by these three types of cases as occurring in the year before the onset of their disorder was compared with the frequency of events in the same time period reported by a group of women without severe psychiatric disorder. The result...