Social stress

Depressed patients report more 'life events', especially loss events, than general population controls during the few months before their illness onset. About 80 per cent of depressive episodes appear to be precipitated by life-event stress.

Chronic social difficulties, lack of confiding relationships, and absence of a supportive social network are important mediating factors.

The role of life events is strongest in respect of first episodes of depression. In subsequent episodes, the role of life events is less, and episodes of depressive illness can come on without life events (this is sometimes referred to as 'kindling'). In patients where there is a strong genetic component, the reduction in the importance of life events in triggering depressive episodes is seen early in the course of the illness ('pre-kindling'). In cases where there was a lesser genetic component, the reduction in the impact of life events occurred more gradually (Kendler et al., 2001). In other words, patients can reach a state in which they are vulnerable to the occurrence of further episodes of depression in the absence of life events, either because of genetic vulnerability or because of the cumulative effects of previous depressive episodes.

There is also evidence that some social factors, such as the presence of a confiding relationship, can be protective.

Life events can also precipitate manic episodes.

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