Socioeconomic factors

In clinical practice, the predominant impression is of depression being linked to adverse life circumstances and to things that happen. The NICE guidelines go so far as to refer (http://www.nice.org.uk/page.aspx?o=236667) to the 'social origins of depression', and cite a study showing that up to 50 per cent of the difference between the rates of depression in neighbouring general practices could be explained by differing rates of unemployment, poverty, and related factors.

As well as long-term social difficulties, there is a well-established body of evidence indicating that patients with depression have experienced more adverse 'life events' than people without depression. These events, particularly so-called 'loss events', appear to be the precipitant of the majority of episodes of diagnosed depression. Such 'events, dear boy, events', seem to combine with the above-mentioned long-term difficulties, which include not only material poverty, but also absence of confiding relationships and family/social support, to produce the depressive episode.

Hence the medico-legal debate about the causation of an episode of depression following an accident, and the possible contribution of previously existing factors, such as social adversity, can be seen to have sound underpinnings in research on depression causation.

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