The role of life events in depression in primary medical care versus psychiatric settings

Abstract

Background The relationship between negative life events and depression is inconsistent. The purpose of the current study is to investigate the hypothesis that depression in the community may be related more to major life events than is depression in psychiatric settings. Methods This hypothesis was tested using depressed primary medical care (PC; n=70) and psychiatric patients ( n=62). Nondistressed ( n=109) and distressed/nondepressed PC patients ( n=43) served as comparison-control groups. Life events were rated using the contextual method of Brown and Harris (Brown, G.W., Harris, T.O., 1978. Social origins of depression. Tavistock, London). Results Depressed PC patients, but not depressed psychiatric patients, were significantly more likely to have recent severe events than the comparison-control groups. Self-reported distress in the absence of depression was not associated with severe life events. Limitations History of depression was assessed using a simple count of number of previous episodes, and the assessment of depression history may require more sophisticated assessment. The measure of endogenous depression used in this study was created post-hoc and needs replication. Conclusions Diathesis-stress models need to accommodate a lack of universality for severe stress prior to the onset of depression. Clinical strategies may need to reflect patient treatment preferences associated with differences across settings with respect to the perceived role of stress in their depression.