The Camberwell Collaborative Depression Study. III. Depression and adversity in the relatives of depressed probands

Implications of high-risk family studies for prevention of depression

The high-risk family study is a powerful design that facilitates identification of early forms of expression of depression and premorbid vulnerability, risk, and protective factors that are important for defining prevention targets and program foci. This paper (1) highlights the strengths of high-risk studies for informing early intervention efforts; (2) summarizes findings of familial aggregation from controlled high-risk studies of depression; and (3) briefly reviews evidence for potential mediators (i.e., early forms of expression, vulnerability factors) that explain familial risk and for moderators (i.e., interactive risk and protective factors) that enhance or minimize familial risk. New data from the Yale High-Risk Study of Comorbidity of Substance Use and Affective Disorders are presented to exemplify strategies for identifying specific familial pathways to depression among offspring of parents with substance and anxiety disorders. Likewise, parental depression is associated with a range of emotional and behavioral problems, including anxiety and conduct disorder, in their offspring. These nonspecific effects, together with emerging findings on mechanisms of risk, support early intervention efforts that target a range of youth at risk for depression through multipronged approaches that attend to the individual characteristics of the child and parent, clinical comorbidity, and the broader family and social context.

Personality, neuroticism, and coping towards the end of life

The influence of personality characteristics on how patients cope with various challenges at the end of life has not been extensively studied. In order to examine the association between end-of-life experience and neuroticism (defined within the personality literature as a trait tendency to experience psychological distress), a measure of neuroticism was administered to a cohort of dying cancer patients. Various other measures of physical, psychological, and existential distress were also measured to explore their possible connection to patient personality style. The personality characteristic neuroticism demonstrated a significant relationship with several end-of-life sources of distress, including depression, anxiety, sense of dignity, quality of life (rating and satisfaction), hopelessness, concentration, and outlook on the future. Neuroticism appears to have a significant association with the dying experience. This association is expressed across the psychological, existential and, to a lesser extent, physical and social domains of end-of-life distress. This may help clinicians identify vulnerable individuals who are most likely to have poorer adjustments and may benefit from earlier targeted interventional approaches. Exploring the relationship between various facets of personality and end-of-life distress, and mapping this information against optimal therapeutic responses, remains the challenge for future research broaching this intriguing and largely ignored area of palliative care.

Stress, personality and depressive symptoms in a 6.5 year follow-up of subjects at familial risk for affective disorders and controls

BACKGROUND

The aim of the study was to identify risk factors in subjects at risk for depressive disorders and controls.

METHODS

In a 6.5 year follow-up study we examined the effects of personality (neuroticism, frustration intolerance, rigidity, melancholic type), adverse life events and chronic difficulties on depressive symptoms in 89 high-risk subjects (HRS, siblings and children of patients suffering from an affective disorder), without any mental illness at wave 1 (T1), and 49 controls without any personal and family history of psychiatric disorder at T1. To this end, regression analysis and path analysis using a structural equation model (only for HRS) were performed.

RESULTS

Risk factors for depressive symptoms at wave 2 (T2) in HRS comprised acute adverse life events, frustration intolerance (T1) and depressive symptoms (T1). Risk factors for depressive symptoms in controls included chronic difficulties, neuroticism and rigidity. HRS had less stressful life events and the same risk for chronic difficulties, but perceived adverse events as more stressful.

LIMITATION

The sample size of the control group is too small for identifying slight effects.

CONCLUSION

Our results indicate that the impact on the emergence of depressive symptoms of various risk factors is different in high-risk subjects and controls. High-risk subjects are more sensitive to the depressogenic effects of acute stress and thus avoid potential stressful changes in their life to a higher extent. On the other hand, the influence of persistent factors such as personality traits (neuroticism, rigidity) and chronic difficulties on subsequent depressive symptoms was less pronounced in HRS as compared to controls.

Moderators of the association between relationship discord and major depression in a national population-based sample

Although there is a well-documented association between relationship discord and depression, many individuals experience either discord or depression without experiencing the other. To understand this phenomenon, the authors evaluated moderators of the association between relationship discord and major depression among married or cohabiting individuals in the National Comorbidity Survey (N = 2,538; R. C. Kessler et al., 1994). Potential moderators included demographics, personality characteristics, parental depression, and childhood loss. Only one significant moderator was found: There was a stronger association between discord and depression for married people (vs. cohabiters). Among married individuals only, neuroticism also served as a moderator: Individuals higher in neuroticism showed a stronger association between discord and depression. In general, findings suggest that when a person or family presents with one problem (e.g., relationship discord), it is important to evaluate and potentially treat the other problem (e.g., depression) as well.

Life events and onset of a new phase in bipolar affective disorder

BACKGROUND

There is an increasing focus on the impact of psychosocial factors and stressors on the course of bipolar affective disorder. The life event research has revealed many biases and the results are conflicting. In a prospective study we examined the relationship between life events and affective phases in a group of bipolar patients with a long duration of the disease.

METHODS

A group of patients with at least three admissions to hospital for bipolar disorder was followed every 3 months for up to 3 years. At each examination an evaluation of affective phase was made according to the Hamilton Depression Scale, the Newcastle Depression Rating Scale and the Bech-Rafaelsen Mania Rating Scale. Moreover, the patients were rated according to the Paykel Life Events Scale. Their current medical treatment was noted.

RESULTS

Fifty-six patients (19 men and 37 women) were included in the study. Women experienced a significantly higher number of life events than men. In 21% of the 353 examinations of women, a new phase was preceded by life events whereas this was the case only in 8% of the 152 examinations of men. In 13% of the male examinations the patients were in a manic phase and in 5% in a depressive phase. In 5% of the female examinations the patients were in a manic phase and in 15% in a depressive phase. Half of the women's depressive phases were preceded by life events, but none of the depressive phases of men. The categories of life events preceding the depressive phases presented a significant overweight of somatic ill health and conflicts in the family.

CONCLUSION

We found a gender difference in the course of bipolar affective disorder, as women had a significantly higher number of depressive episodes than men and men had a higher number of manic episodes than women. In bipolar patients with long duration of disease a significant number of depressive episodes in women were preceded by negative life events. Somatic health problems and conflicts in the family were significant factors preceding new depressive phases.

The etiology, biology, and evolving pathology of premenstrual syndromes

Menstrually related symptoms and disorders are multidimensional and affect diverse physiologic systems. Elucidation of the pathophysiologic mechanisms of these disorders should allow for a more precise diagnosis, and provide direction for targeted therapeutic interventions. Several biologic mechanisms that underlie menstrually related symptoms have been proposed. They focus mostly on gonadal hormones, their metabolites and interactions with neurotransmitters and neurohormonal systems, such as serotonin, GABA, cholecystokinin, and the renin-angiotensin-aldosterone system. Altered responses of these systems to gonadal hormone's fluctuations during the menstrual cycle, as well as an increased sensitivity to changes in gonadal hormones may contribute to menstrually related symptoms in vulnerable women. Disrupted homeostasis and deficient adaptation may be core underlying mechanisms. Future directions for clinically-relevant progress include identification of specific subgroups of menstrually-related syndromes, assessment of the genetic vulnerability and changes in vulnerability along the life cycle, the diversified mechanisms by which vulnerability is translated into pathophysiology and symptoms, the normalization process as well as syndromes-based and etiology-based clinical trials.

Neuroticism, extraversion, life events and depression. The Cardiff Depression Study

BACKGROUND

Certain personality traits may mediate the relationship between familiality and adversity in causing depression.

AIMS

To examine whether the neuroticism and extraversion scales of the Eysenck Personality Inventory (EPI) represent enduring traits underlying the vulnerability to respond to adversity by developing depressive episodes.

METHOD

A total of 108 subjects with depression and their siblings were compared with 105 healthy control subjects and their siblings. All were interviewed using the Schedules for the Clinical Assessment of Neuropsychiatry and the Life Events and Difficulties Schedule. Subjects also completed the EPI.

RESULTS

Both neuroticism and extraversion were familial and correlated with mood and life event measures. There were no differences on either measure between the never-depressed siblings of probands with depression and controls. Regression analyses showed that the major influence on neuroticism was current mood.

CONCLUSIONS

Neither extraversion nor neuroticism measures trait vulnerability to depression, and neuroticism scores mainly reflect symptoms of depression.

Life events, stress and depression: a review of recent findings

OBJECTIVE

To review recent empirical prospective studies on the relation between life event stressors and depression.

METHOD

A systematic literature search focusing on predictive studies was carried out from 1980 to early 2001 using Medline, Embase and PsychInfo.

RESULTS

The empirical findings for the most part support clinical impressions of the relation of stressors to depression but at the same time provide some clearer understanding in relation to differences of stressor impact on depression type and on index episode, relapse or recurrence. Twin studies now provide the strongest evidence of the relative magnitude of effect of environmental stressors and genetic factors: the former explains at least as much of the variance in depression as our genes.

CONCLUSIONS

Continuing research into life events and depression have been fruitful especially those studies assessing the effect of stressors in combination with other aetiological variables such as genetic factors.

Sensation-seeking, life events and depression. The Cardiff Depression Study

BACKGROUND

The relationship between adversity and genetic risk factors in depression could be mediated by familial 'hazard prone' traits, as reflected in high levels of sensation-seeking.

AIMS

To examine whether high sensation-seeking scores are associated with more adverse life events resulting in depression.

METHOD

In a sib-pair design, 108 probands with depression and their siblings and 105 healthy control subjects and their siblings were compared for psychopathology, life events and scores on the Sensation-Seeking Questionnaire (SSQ).

RESULTS

The SSQ scores were correlated negatively with depression, were familial and were correlated positively with less severe events, but not the severe events typically associated with depressive onsets.

CONCLUSIONS

The SSQ measures a familial personality trait and depression is associated with lower scores. Although high sensation-seeking is associated with a higher rate of life events, these carry little threat.

Epidemiology in neurobiological research: exemplified by the influenza-schizophrenia theory

BACKGROUND

During recent years the strategy for aetiological research in schizophrenia has been to concentrate on two closely connected directions: the search for the genetic element and the search for environmental factors. Damage to the immature brain during pregnancy and delivery has given us the most interesting results from recent environmental research.

AIMS

To examine the validity of the influenza-schizophrenia hypothesis.

METHOD

A review of register-based epidemiological studies in Denmark conducted over a 10-year period.

RESULTS

The studies reviewed provided strong inferential evidence in favour of the hypothesis, but some methodological problems are unresolved and not all replication studies have been positive.

CONCLUSIONS

The brain-damage hypothesis points to possibilities for identifying high-risk individuals at an early stage of life and perhaps establishing specific preventive programmes. There is, however, a great need for closer international collaboration in future research.

Neuroticism, life events and mental health: evidence for person-environment correlation

BACKGROUND

There is some evidence that genetic effects on the likelihood of experiencing stressful life events (SLEs) are mediated by heritable traits such as cognitive ability (CA) and neuroticism (N).

AIMS

To examine whether the association between CA, N and mental ill-health is driven in part by a predisposition to experience depressogenic SLEs.

METHOD

Childhood measures of N and CA were available in a birth cohort of 5362 individuals. At ages 36 and 43 years, mental state and occurrence of SLEs in the previous year were assessed. Using a path-analytic approach, models with and without a hypothesised influence of N and CA on the occurrence of SLEs were compared.

RESULTS

The fit of the model with childhood N having a direct influence on SLEs was good with chi 2 = 5.72, d.f. = 4, P = 0.22 at age 36 years and chi 2 = 3.50, d.f. = 5, P = 0.62 at age 43. The fit of the model was significantly worse without this path at both ages (36 years: chi 2 = 42.5, d.f. = 1, P < 0.001; 43 years chi 2 = 15.3, d.f. = 1, P < 0.001). No consistent differences were seen in comparisons of models with CA.

CONCLUSIONS

The results are congruent with the suggestion that genetic effects on SLEs are mediated by personal characteristics. Part of the well-established association between N and minor psychiatric disorder may be mediated by an indirect effect of N on the likelihood of experiencing SLEs.

Gender differences in depression. Critical review

BACKGROUND

With few exceptions, the prevalence, incidence and morbidity risk of depressive disorders are higher in females than in males, beginning at mid-puberty and persisting through adult life.

AIMS

To review putative risk factors leading to gender differences in depressive disorders.

METHOD

A critical review of the literature, dealing separately with artefactual and genuine determinants of gender differences in depressive disorders.

RESULTS

Although artefactual determinants may enhance a female preponderance to some extent, gender differences in depressive disorders are genuine. At present, adverse experiences in childhood, depression and anxiety disorders in childhood and adolescence, sociocultural roles with related adverse experiences, and psychological attributes related to vulnerability to life events and coping skills are likely to be involved. Genetic and biological factors and poor social support, however, have few or no effects in the emergence of gender differences.

CONCLUSIONS

Determinants of gender differences in depressive disorders are far from being established and their combination into integrated aetiological models continues to be lacking.

Environmental stress and psychiatric illness

It has long been recognized that environmental stress plays a pivotal role in the pathogenesis of psychiatric disorders. The relationship is complex and the neurobiological mechanisms that mediate the contribution of stressful experiences to the manifestation of illness are not well understood. In considering this relationship, it is important to differentiate between the role of environmental stressors as vulnerability factors that predispose the individual to psychiatric illness and may be temporally distant from its clinical onset, and their role as direct precipitants of the illness. Furthermore, environmental stressors must be considered in the context of constitutional vulnerability factors, such as genetic predisposition, with which such stressors may interact. Genetic predisposition may influence not only vulnerability to illness but also the nature of the individual's response to stress and the likelihood of exposure to stressful events. In this paper, we focus on two areas that illustrate the complexity of the field and the important findings that have emerged--the role of early parental loss (EPL) in adult psychopathology, particularly major depression, and the relationship between recent significant life events and depressive episodes. We conclude with a preliminary conceptual framework for considering the relationship between genetic susceptibility and environmental stress in the pathogenesis of psychiatric illness.

The genetics of major depressive disorder

There is consistent evidence that major depression is familial and population-based twin studies as well as hospital register-based twin studies find substantial heritability. However, there is also a large proportion of variation in liability left to be explained by nongenetic factors. Although there seems little doubt that life events play a role in precipitating depression, studies that have attempted to examine familial liability along with social adversity find that environmental measures tend to be contaminated by genetic effects. Thus, the tendency to experience (or report) life events appears to be influenced by shared family environment, and for certain types of events there is a genetic component. The molecular genetic basis of liability to depression is an under-researched area, but some candidate gene studies show potentially promising results. Systematic mapping studies aiming to cover the entire genome are currently being launched.

A pilot study of sibling resemblance in later life

OBJECTIVE

Behavioural genetic studies of later life are strictly limited. We carried out a community-based pilot study of sibling resemblance with the primary aims of establishing the feasibility of such work in this population and estimating genetic influence on depression and its risk factors.

METHODOLOGY

Data were collected on surviving siblings of individuals interviewed in previous phases of an epidemiological study of the elderly (the Gospel Oak survey); scales relevant to the investigation of late life depression and its risk factors were utilized. Since families tend to be geographically scattered, the interview was conducted by telephone. Comparisons were made between data relating to the siblings and those obtained on the probands. Variability in phenotypic traits and environmental measures was partitioned into between- and within-family variation, in order to distinguish familial and non-familial sources of variation. Intraclass correlations were used to estimate the strength of genetic influences on continuous measures, while pairwise concordances were calculated for dichotomous traits.

RESULTS

Thirty-two siblings from 20 families were ultimately identified and interviewed. Intraclass correlations for the Depression and Dementia Diagnostic Scales and the Handicap Scale were 0, 0.27 and 0.22, respectively. Those for number of life events, number of friends in contact and number of neighbours in contact were 0.08, 0.03 and 0, respectively. Concordance for both depression caseness and dementia caseness was 0.

DISCUSSION

There were difficulties carrying out this study, which are discussed. The study is the first of its kind to examine familial resemblance for the common disorders of old age. Establishing ways of engaging elderly families with research will be a challenge that future research will need to meet.

Cardiff depression study. A sib-pair study of life events and familiality in major depression

BACKGROUND

An excess of both depression and undesirable life events in first-degree relatives of probands with depression as compared with controls has been reported. This association may have reflected a familial factor in common.

AIMS

To examine the familiality of life events and depression and whether there may be a common familial factor influencing vulnerability to depression and the experiencing of life events.

METHOD

In a sib-pair design, 108 probands with depression and their siblings were compared with 105 healthy controls and their siblings for psychopathology and life events.

RESULTS

The lifetime relative risk of depressive disorder in the siblings of depressed subjects as compared with siblings of controls was 9.74, although these groups did not differ in the life events measures. Several categories of events showed significant sibling correlations, but this was due to the same event affecting both members of the pair.

CONCLUSIONS

Although depressive disorder was strongly familial, the familial effects on life events were largely explained by shared experiences. There was no evidence for a common factor influencing both depression and life events.

Psychiatric genetics: back to the future

For the last decade or more geneticists have been predicting that advances in molecular genetics are going to revolutionize our understanding of psychiatric disorders and human behavior. However, with a few exceptions, these expectations have yet to be fulfilled. As the century draws to a close and we contemplate the prospect of the complete sequence of the human genome it seems timely to consider the state of the field and to consider carefully how it might advance, the problems to be faced and the resources required. Molecular Psychiatry (2000) 5, 22-31.

Comparison of the diagnosis of melancholic and atypical features according to DSM-IV and somatic syndrome according to ICD-10 in patients suffering from major depression

While melancholic (according to DSM) or somatic syndrome (according to ICD) has strong historical roots and substantial empirical verification, the concept of atypical features is relatively new and not sufficiently studied. The aim of the current study was to investigate the reliability of these diagnostic subcategories in patients suffering from major depression in Greece. Forty patients (eight males and 32 females) aged 19-60 years (mean 39.3, sd 12.2) suffering from major depression according to DSM-IV criteria were studied. SCAN v.2.0 was used to assess symptomatology. The presence of each criterion according to DSM-IV and ICD-10 was registered. Frequency tables were developed and factor and cluster analysis were performed. The results of the analysis suggest the existence of three syndromes which roughly reflect the melancholic and atypical but also propose a third, which can be considered as an 'undifferentiated' syndrome. The DSM demand that the existence of melancholic features be excluded first and then that diagnosis of atypical features be made was confirmed.

Depression: an inability to adapt to one's perceived life distress?

A comprehensive biopsychosocial distress adaptation model of depression in which neurochemical shortages are awarded a necessary but insufficient status is proposed. In context of this model, depression is seen as a function of inadequate behavioural, psychological, socioenvironmental and biological coping resources (all of which may be partly a function of genetic factors) for managing one's individually appraised level of life distress. It is further hypothesized that the physiological symptoms of depression arise as a result of a lack of available neurotransmitters to contend with stressors as well as maintain the normal functioning of the individual. Unlike many other theories, this distress adaptation model may account for several of the demographics of depression.

The evolving face of psychiatric epidemiology

In 1978, Michael Shepherd gave a Maudsley Bequest Lecture in which it was necessary for him to argue from first principles for the need for epidemiological research within clinical psychiatry (Shepherd, 1978). This paper will take stock of the 20 years since his lecture and point to the new directions for this research approach. Shepherd listed the contributions of psychiatric epidemiology as follows: (a)

Life events and personality in late adolescence: genetic and environmental relations

The relationship between life events and personality was investigated in the Minnesota Twin/Family Study, using 216 monozygotic and 114 dizygotic 17-year-old male twin pairs. Participants completed a life events interview designed for adolescents and the Multidimensional Personality Questionnaire. Life events were categorized into three types: life events to which all members of a family would be subject and those affecting an individual, which can be broadly construed as either nonindependent or independent. Univariate genetic model fitting indicated the presence of significant genetic effects (h2 = 49%) for nonindependent nonfamily life events but not for the other two types of life events. Bivariate genetic model fitting further confirmed that the significant phenotypic correlation between nonindependent life events and personality is in part genetically mediated. Specifically, the findings suggest that genetically influenced individual differences in constraint play a substantial role in life events whose occurrence is not independent of the individual's behavior.

Number of symptoms, quantification, and qualification of depression

Current classification systems (ICD-10 and DSM-IV) require a quantitative criterion for differentiating depressive states, suggesting a correlation between the number of symptoms, i.e., the pervasiveness of the syndrome, and the subtype of the illness. All the symptoms (within those contained in the diagnostic lists) are assumed to have comparable value. To investigate the relevance of the number and the type of symptoms reported by 196 patients suffering from depression, we compared the symptoms using independent indicators of severity such as the Clinical Global Index (CGI) and the social functioning subscale of the Global Assessment of Functioning (GAF). A second comparison using the same indicators was made between qualitatively distinct categories of DSM-IV and ICD-10 (i.e., melancholic v nonmelancholic, somatic v nonsomatic, and psychotic v nonpsychotic). There was evidence that increasing numbers of symptoms actually reflect higher levels of severity, but the categorizations that were mainly based on qualitative criteria (e.g., melancholia, somatic syndrome, etc.) usually attained better discrimination compared with those based on the number of symptoms. Moreover, certain symptoms (usually those indicated as endogenous) were more likely to be associated with greater severity and pervasiveness. Finally, the results clearly showed that different symptoms had different weight in establishing the gradient of severity.

Life events and depression in children with pervasive developmental disorders

To determine the role of life events in the occurrence of depression in children with pervasive developmental disorders (PDD), we compared 11 patients (DSM-III-R; 9 male; 2 female; M age: 11.0 years; M full-scale IQ: 75.3) with PDD and depression, with an age- and sex-matched control group of patients with PDD without depression (DSM-III-R; 9 male; 2 female; M age: 9.8 years; M full-scale IQ: 60.6). Information was collected about the occurrence of unpleasant life events in the 12 months prior to the onset of depression. Depressed children experienced significantly more life events in the 12 months prior to the onset of depression. Exit events such as bereavement were more common in the depressed group. Findings suggest that, as in the general population, significant life events, particularly those with a negative impact, may contribute to the occurrence of depression in children with PDD. Future studies should explore the role of both biologic factors and environmental stressors in the onset of depression in this population.

The genetic epidemiology of self-esteem

BACKGROUND

Previous studies on self-esteem have focused exclusively on its psychosocial determinants. The goal of the present study is to clarify genetic v. environmental determinants of self-esteem.

METHOD

Participants were Caucasian women sampled from the Virginia Twin Register: 363 pairs of MZ and 238 pairs of DZ twins were available from the first wave of the study, and 430 pairs of MZ and 308 pairs of DZ twins from the second. Self-esteem was assessed with the Rosenberg's Self-Esteem Scale.

RESULTS

Using univariate twin analyses of self-esteem and a repeated measurement twin model, we found that self-esteem is a moderately heritable trait (heritability = 52% in the repeated measurement model); environmental influences are also very important, and are probably mostly not shared by members of a twin pair.

CONCLUSIONS

Aetiological models of self-esteem which examine only psychosocial factors are incomplete; genetic factors need to be integrated.

Developmental pathways to bipolarity: are juvenile-onset depressions pre-bipolar?

This article approaches the question of bipolarity in childhood and adolescence from an "adult" perspective. It argues that clinically ascertained juvenile depressions--with onsets typically in late childhood or early adolescence--have affinity to bipolar spectrum disorders based on (1) early age at onset; (2) even gender ratio; (3) prominence of irritability, labile moods, and explosive anger indicative of mixed episodes; (4) high rates of "comorbid" substance abuse; (5) questionable response to antidepressants and/or brief hypomanic switches; (6) high rates of recurrence; (7) familial affective loading; and (8) frequent superposition on affective temperamental dysregulation. Building on the last point, the author submits that dysthymic, cyclothymic, and hyperthymic temperaments represent putative developmental pathways to bipolarity (as contrasted to "inhibited" anxious-phobic types, which appear related to nonbipolar outcomes.

History of early loss among a group of suicide survivors

Suicide-bereaved families have been described as more depression-prone and their bereavement process as more complicated and difficult. Few studies have aimed specifically to investigate the history of transgenerational childhood loss in suicide survivor families as an indicator of greater vulnerability. Childhood separation experiences are associated with difficulties in forming and maintaining attachments. Bonding difficulties are also associated with greater vulnerability to depression and may constitute a suicide risk factor. This exploratory study (n = 32) focused on two groups, each of 16 mothers who had lost a son to suicide and car accidents, respectively. History of loss and early separation experiences were investigated through a clinical interview of the bereaved mothers and through a psychological autopsy of the deceased sons. Results indicate significant transgenerational indices of loss, separation, and inadequate child-rearing. Pre-death life events and adversities in the family may be as important to bereavement outcome as post-death happenings. The cycle of these events, the role of fathers and the role of protective factors must be further studied using detailed life-course reconstructions.

Recurrently situational (reactive) depression: a study of course, phenomenology and familial psychopathology

Probands with non-bipolar major depressive disorder (MDD) were grouped according to the consistency across episodes with which depression appeared to arise from situational factors. Situational depression showed significant diagnostic stability across the second and third recurrences in a 10-year follow-up. The relatives of recurrently situational probands had higher neuroticism scores, higher lifetime rates of MDD and, when depressed, fewer endogenous symptoms than did the relatives of non-situational probands. This study joins two others in finding an association between stress-related depression and high familial loadings for MDD. It also illustrates the value of diagnostic consistency across episodes as a means of refining groups for the study of diagnostic subtypes.

Life events, social support and depression

This paper reviews current findings regarding social stress and support in clinical depression. Comparisons of recent life events at depressive onset and in general population controls show consistently raised event rates. The events span a range of threatening and undesirable experiences, with limited selectivity to exit events and interpersonal losses. Effects are similar in endogenous and non-endogenous symptom pictures, and there are suggestive findings in bipolar disorder, but these require further study. Events are also related to outcome and to relapse. Effects are moderate in degree, but relatively short-term of over six months to a year. For social support there are greater problems in the extent to which social support may be determined by the individual's own behaviour. Absence of social support appears to be associated with onset and relapse of depression, both acting independently and modifying effects of life events. Social stress findings have implications for prevention. The occurrence of major life events signals a period of increased risk when supportive interventions may prevent evolution of distress to disorder.

Multiple Regression With Data Collected From Relatives: Testing Assumptions of the Model

Multiple regression is a causal model of the relationship between sets of independent (X) and dependent (Y) variables. This model is extended to cover data collected from relatives, where the observations are not independent. If correct, the model permits appropriate statistical tests of regression coefficients in data collected from relatives. Across relative covariances, particularly across the independent and dependent variables may reject the basic regression model. Further extensions of the model are developed that permit tests of several assumptions implicit in multiple regression: (a) the assignment of variables as dependent or independent; (b) the relationship between X and Y variables is not due to some latent variable which causes variation in both; and (c) there is no reciprocal interaction between the X and the Y variables. Discrimination between these alternatives is especially strong if data are collected from more than one class of relative, which differ in their X and Y variable covariance structure. Data on Eysenck Extraversion, Neuroticism and CESD depression collected from twins are used as an illustrative example.

On the functions of monoamine oxidase, the emotions, and adaptation to stress

Monoamine oxidase is an iron containing enzyme that exists as 2 isozymes, A and B, that have different affinities for various amines as substrates. The activity of monoamine oxidase helps to maintain neuron firing rates throughout the body within homeostatic limits. It does this by metabolizing in the liver bioactive amines absorbed into the bloodstream from food, by metabolizing in the endothelial cells of cerebral vascular microvessels, as part of the blood brain barrier, bioactive amines in the bloodstream, and by metabolizing in the cytoplasm of neurons, molecules of biogenic amine neurotransmitters that are not enclosed in vesicles. Part of the biochemical activity of monoamine oxidase generates hydroxyl radicals, very toxic members of the oxygen free radical group, that may be involved in neurodegenerative disorders such as Parkinson's disease. Inhibiting monoamine oxidase with selegiline (1-deprenyl) seems to have neuroprotective actions but this may be due to inducing the release of neuronal growth factors rather than by preventing the formation of free radicals. Other drugs that inhibit monoamine oxidase are used to treat patients with atypical depression, panic attacks or post traumatic stress syndrome. It is hypothesized that the emotions act as positive or negative reinforcers of behavior patterns that increase the probability of survival of the organism. The original releasing stimuli for the emotions are related to the basic survival reflexes of the hypothalamus but the emotional response can be easily conditioned to formerly neutral stimuli by association. In the absence of the original releasing stimuli, these learned emotions increase the frequency of survival oriented behavior and decrease the frequency of behavior that jeopardizes survival. The emotional disorders are conditions in which the brain's reinforcement system is inoperative, the person loses contact with reality and the person's behavior bears no relationship to survival. Aversive stimulation evokes a negative emotional response that motivates the organism to escape from the aversive stimulation, and to avoid it, and any conditioned stimuli associated it, in the future. When the aversive stimulation and to avoid it, and any conditioned stimuli When the aversive stimulation is inescapable or unavoidable, the organism experiences stress. When the stressful aversive situation is not lethal, survival does not depend on escape but rather on conservation of energy. With repeated exposure, the negative emotional response to the aversive stimulation extinguishes, the organism adapts to the situation and takes on a passive, energy saving behavior pattern.(ABSTRACT TRUNCATED AT 400 WORDS)

Life events and depression in Japan

The relationship of life events to the onset of depression as well as the relationship between positive family history and reactivity to stress were investigated. Our results indicated that life stress in general plays an important role for women in the onset of depression and that undesirable events and problems of work specifically play a role in the onset of depression. The dichotomy of reactive and endogenous depression was not supported based on our result that no relationship was observed between the presence of familial loading and reactivity to stress.

Psychiatric morbidity in bus crews following violent assault: a follow-up study

In a prospective study 22 bus crews who were victims of physical assault were assessed using standardized psychiatric instruments, followed up for 18 months and compared to a non-assaulted control group drawn from the same bus garage. At initial assessment the assaulted group, compared to the controls showed a significant increase in psychiatric impairment and distress (as measured by the GHQ-30 and IES respectively), with 23% of assault victims developing post-traumatic stress disorder as defined by DSM-III-R. At follow-up, while high levels of both psychiatric impairment and distress persisted there was evidence that they may be separate phenomena.

Personality as a cause of adverse life events

The element of chance and the role of the individual in causing negative life events was explored by examining the relationship between measures of personality, symptoms, and a number of demographic variables in a nonclinical population (n = 892). The results indicated that Eysenck's neuroticism was the best predictor of negative interpersonal life events. Symptoms added a negligible amount to the variance explained in the occurrence of life events. The well-established relationships between neuroticism and symptoms and life events and symptoms are discussed in the light of these findings.

The Zurich Study. XVI. Early antecedents of depression. A longitudinal prospective study on incidence in young adults

The purpose of this study was to investigate antecedents of first incidence of major depressive disorder and recurrent brief depression with the help of a cohort of 20 year-old Swiss, who was interviewed four times up to age 30. Cases diagnosed as depressed at the third or fourth interview (age 28 or 30) were compared with never diagnosed controls for antecedents at the first and second interview (age 21 and 23). Besides retrospectively assessed childhood precursors, later depressives showed slight differences in their relationship to parents and friends and early symptoms of subclinical depression, persistent helplessness and a surplus of life events. These antecedents were mainly found in females. The most persistent antecedent of later depression for both sexes was a higher score than controls' on the SCL-90R ("negative affectivity"). Whether this finding signifies that proneness to the milder depressions in young adults is rooted in personality is subject to discussion.