Recent life events pose greatest risk for onset of major depressive disorder during mid-life

Bauke T Stegenga,Heidi-Ingrid Maaroos,Mirjam I Geerlings,Michael King,Igor Švab,Miguel Xavier,Christian Bottomley,Sandra Saldivia,Irwin Nazareth,Diederick E Grobbee,Francisco Torres-González

doi:10.1016/j.jad.2011.10.041

Abstract

BackgroundThe authors examined an additive model for the association of life events and age with onset of major depressive disorder (MDD) and whether the combination of life events and age posed greater risk than the sum of their independent effects.MethodsData were used from a prospective cohort study of 10,045 general practice attendees (PredictD). We included those without MDD at baseline (N = 8293). We examined age divided into tertiles and into 10 year groups. Life events were assessed at baseline using the List of Threatening Life Experiences Questionnaire and categorized according to type. Main outcome measure was onset of DSM-IV MDD at 6 or 12 months of follow-up. The authors calculated Relative Excess Risks due to Interaction (RERI).Results6910 persons (83.3%) had a complete follow-up, of whom 589 (8.5%) had an onset of MDD (166 younger, 254 middle aged and 169 older). The combined effect of personal problems (RERI = 1.30; 95% CI 0.29 to 2.32), events in family or friends (RERI = 1.23; 95% CI 0.28 to 2.19), or problems with law (RERI = 1.57; 95% CI 0.33 to 2.82) and middle age was larger than the sum of individual effects.LimitationsLower response to recruitment in the UK and the Netherlands.ConclusionsRecent life events carry the largest risk of onset of MDD in mid-life. Understanding the different vulnerability to life events according to age may help to indicate groups at a particular risk and assist in preventive strategies.

Highlights

Major depressive disorder (MDD) is a serious health problem and will be the second leading cause of burden of disease worldwide by 2030 (Mathers and Loncar, 2006)
These findings suggest that some people may be more vulnerable to onset of major depressive disorder (MDD) than others, which is in accordance with the vulnerability-stress model (Holmes and Rahe, 1967; Krantz et al, 1985; Masuda and Holmes, 1967; Ormel, 1999)
Attrition rates were similar for women (16.4%) and men (17.2%) and for those who were middle aged (16.0%) or older (15.7%) but those who were younger were slightly more likely to be lost to follow-up (18.2%)

Summary

Introduction

Major depressive disorder (MDD) is a serious health problem and will be the second leading cause of burden of disease worldwide by 2030 (Mathers and Loncar, 2006). Another study reported that women were approximately three times more likely to become depressed than men when a life event occurred (Maciejewski et al, 2001) These findings suggest that some people may be more vulnerable to onset of MDD than others, which is in accordance with the vulnerability-stress model (Holmes and Rahe, 1967; Krantz et al, 1985; Masuda and Holmes, 1967; Ormel, 1999). The authors examined an additive model for the association of life events and age with onset of major depressive disorder (MDD) and whether the combination of life events and age posed greater risk than the sum of their independent effects. Understanding the different vulnerability to life events according to age may help to indicate groups at a particular risk and assist in preventive strategies

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