Stress generation in depression: A systematic review of the empirical literature and recommendations for future study
Introduction
Depression is one of the most prevalent forms of psychopathology, afflicting approximately 20 to 25% of women and 10 to 17% of men within their lifetime (Kessler et al., 1994, Levinson, 2006). It is also recurrent, with each episode increasing risk of subsequent ones (Kessler, 2002). Current estimates of the recurrence of depression suggest that 50 to 60% of individuals who experience one depressive episode go on to experience a second one, with 70 to 80% of these eventually experiencing a third episode, and 90% of individuals with three past episodes going on to experience a fourth (American Psychiatric Association, 2000, Burcusa & Iacono, 2007, Lewinsohn et al., 1989, Monroe & Harkness, 2005, Solomon et al., 2000). Fully elucidating relations between stress and depression is critical to advancing our understanding of the processes involved in the etiology and often chronic course (i.e., duration, relapse, and recurrence) of this common and debilitating disorder.
In the present article, we begin with a brief discussion of the early history of research on stress and depression, with its emphasis on the stress exposure model. From this context, we then focus on emergence of the stress generation hypothesis and present a review of the evidence to date concerning this perspective. As stress generation has been hypothesized to be a product not only of individuals' depressive symptoms, but also of their characteristics and behavioral tendencies (e.g., cognitions, values, and traits; Hammen, 1991, Hammen, 2006), this review will include a discussion of the literature on depression, past stress, negative cognitive styles, and personality or interpersonal styles in relation to the stress generation process. Several notable reviews of research on stress generation have been published in recent years (i.e., Hammen, 1999, Hammen, 2006). We attempted to add to these past reviews in several ways. First, based on our inclusion/exclusion criteria detailed below, the rate at which articles in this area are published seems to be steadily increasing each year, doubtless a reflection of the still-growing interest in stress generation. Consequently, since the most recent of these reviews (Hammen, 2006), 21 new articles have been published, representing 37% of extant reports on stress generation based on the present literature search. Thus, the current article provides an update in the form of a comprehensive review of the research on this topic. In addition, we attempted to offer several recommendations for future research, while also elaborating on issues raised by Hammen (2006) that as yet remain unaddressed in the empirical literature.
That stressful life events are associated with risk for depression is a well-established finding in the research literature (Hammen, 2005, Kessler, 1997, Mazure, 1998, Paykel, 2003). The relation between stress and risk for depression has been documented for episodic, or acute, stresses (Kendler, Karkowski & Prescott, 1998) and chronic stresses (Hammen, Kim, Eberhart & Brennan, 2009; see Hammen, 2005 for a review), and both recent and early negative life events (Gibb et al., 2003, Harkness et al., 2006). It has been documented in child (Cole & Turner, 1993), adolescent (Tram & Cole, 2000), young adult (Hankin, Kassel & Abela, 2005), and geriatric samples (Fiske et al., 2003, Moos et al., 2005). Moreover, life stress has been implicated in the first onset of depression (Kendler et al., 1999, Lewinsohn et al., 1999), depressive relapse (Swindle, Cronkite & Moos, 1989), recurrence of depression (Monroe, Roberts, Kupfer & Frank, 1996; see Burcusa & Iacono 2007, for a recent review; but also see Paykel, 2003, Stroud et al., 2008, for some evidence to indicate that major life stressors are more strongly associated with the first one or two depressive episodes than with later ones), and the exacerbation of depressive symptoms (Lewinsohn, Hoberman & Rosenbaum, 1988).
Guiding much of early research on stress and depression was a tacit assumption that the relation between the two is unidirectional. Specifically, in what has been termed a stress exposure model of depression, it is implied that stressful life events significantly increase individual susceptibility to this disorder. Initial conceptualizations of this model also held that individuals are largely passive recipients of environmental stressors, having little, if any, significant role in the shaping of events within their lives relevant to the development of depression. Thus, early research gave primacy to independent relative to dependent events. Independent, or fateful, life events are those whose occurrence is outside the individual's control (e.g., death of a friend or relative), whereas dependent life events are those whose occurrence is influenced by characteristics of the individual (e.g., getting into an argument). Several mediational and moderational models elaborating on this basic relation between stress and depression have received empirical support, including biological diathesis-stress models (see Levinson, 2006 for a recent review), bio-cognitive mediational models (e.g., Beevers et al., 2009, Hilt et al., 2007), cognitive diathesis-stress models (e.g., Abramson et al., 1989, Beck, 1967, Beck, 1987), cognitive-developmental mediational conceptualizations (e.g., Cole, 1990, Cole, 1991), as well as interpersonal diathesis-stress theories (e.g., Joiner, Metalsky, Katz & Beach, 1999; also see Van Orden, Wingate, Gordon & Joiner, 2005 for a review).
Although several researchers have speculated that depression may be associated with an increased likelihood of subsequent stress (e.g., Compas et al., 1989, Dohrenwend & Dohrenwend, 1981, Depue & Monroe, 1986), early studies largely treated this issue as a methodological confound, with the principal objective being to investigate the predominant stress exposure perspective (Cui & Vaillant, 1997, Hammen, 1991, Hammen, 1992). In accurately documenting the causal relation from stress to depression, it was necessary to control, statistically or otherwise address, any stresses that may be the product of prior symptoms of depression or characteristics of the individual (i.e., dependent life stresses). Together with the early view of individuals as passive recipients of life stresses, this may in part account for the greater initial attention given by researchers to the role of independent or fateful life events, relative to dependent life events, in predicting depression, which is nevertheless of important theoretical and empirical interest in its own right (see Daley et al., 1997). Although crucial to establishing the link between exposure to stressful life events and development of depression, the approach taken by these early studies also left outside of consideration the possibility of additional, but equally important, relations between stress and depression (Hammen, 1991).
Within the last 20 years, however, the focus of depression research has shifted towards a greater awareness of the complex and reciprocal relation between stress and depression. That is, while the traditional stress exposure model of depression very much remains an important focus of research, increasing consideration also has been given to a complimentary and similarly important process, whereby depression, or depressogenic vulnerability factors, plays an active role in generating the very stresses that place individuals at heightened risk for future depression.
Although, as previously mentioned, several researchers have commented on the possibility of a relation between depression and subsequent stressors, Hammen (1991) was the first clearly to formulate and test the stress generation model of depression. According to the stress generation perspective, depression-prone individuals are not simply passive respondents to stressful events in their lives, but active agents in the creation of depressogenic life stressors. That is, individuals vulnerable to depression, when compared to those without such vulnerability, are likely to experience a higher rate of dependent events, particularly within interpersonal domains, but not independent or fateful events. Moreover, these dependent events are, in some measure, influenced by maladaptive characteristics (e.g., cognitive styles, traits, attachment styles, values and expectations) and behaviors of the individual (Hammen, 1991, Hammen, 2006). Considering that interpersonal and dependent events, compared to independent ones, seem to be more predictive of depression (Kendler et al., 1999), the generation of dependent life stresses, in turn, may potentially have a role in the maintenance of current depression or increase in the likelihood of subsequent depression onset and recurrence (Hammen, 1991, Joiner, Wingate & Otamendi, 2005). Thus, stress generation to some degree may account for the often chronic course of depression (Belsher & Costello, 1988, Monroe & Harkness, 2005, Solomon et al., 2000).
Before proceeding with a review of the stress generation literature, it should be noted that recognition of the important role of stress generation in depression pathogenesis has also led to revisions of earlier theoretical models and development of new ones integrating both stress exposure and stress generation perspectives within fully transactional models of depression (e.g., Hankin & Abramson, 2001, Joiner, Wingate & Otamendi, 2005). In these transactional or reciprocal models, individual depressogenic characteristics or depressive symptoms are hypothesized to interact with stress in a bidirectional manner, with depressogenic characteristics or symptoms generating later stress, and prior stress influencing the development of these same characteristics or symptoms.
Section snippets
Method
In reviewing the extant literature on stress generation, it is worth noting that the amount of research that may be interpreted as generally in line with the stress generation perspective is quite broad, and could essentially encompass any study that includes putative risk factors (e.g., perfectionism or physical illness) as predictors, and some form of stress (e.g., general distress, quality of peer or romantic relationships) as an outcome of interest. For this reason, in the present review,
Predictors of stress generation: depression
Preliminary support for the stress generation model came from Hammen (1991) original finding that, relative to treatment-seeking women with chronic physical health conditions, bipolar disorder, and healthy controls, those with a history of recurrent unipolar depression reported higher rates of dependent episodic stressors, especially in the form of conflicts within interpersonal domains. The groups, however, did not differ in rates of independent stressful life events over a one-year
Conclusions and future directions
In summary, there is now a substantial amount of support for the stress generation effect in depression, with many studies replicating the original finding (Hammen, 1991) that depression is associated with subsequent occurrence of dependent stress. The majority of these studies, however, have focused on episodic stress, and very little attention has been devoted to establishing the generation of chronic stress. Stress generation research has expanded beyond the effects of depressive
References (141)
- et al.
Are reported differences in life events for anxious children and controls due to comorbid disorders?
Journal of Anxiety Disorders
(2009) - et al.
Lack of association between conversation partners' nonverbal behavior predicts recurrence of depression, independently of personality
Psychiatry Research
(2006) - et al.
Stressful life events as a link between problems in nonverbal communication and recurrence of depression
Journal of Affective Disorders
(2007) - et al.
A prospective investigation of the impact of attachment style on stress generation among clinically depressed individuals
Behaviour Research and Therapy
(2007) - et al.
Risk for recurrence of depression
Clinical Psychology Review
(2007) - et al.
Interpersonal dysfunction in depressed women: impairments independent of depressive symptoms
Journal of Affective Disorders
(2002) - et al.
The BDNF Val66Met polymorphism predicts rumination and depression differently in young adolescent girls and their mothers
Neuroscience Letters
(2007) Life events in bipolar disorder: Towards more specific models
Clinical Psychology Review
(2005)The genetics of depression: A review
Biological Psychiatry
(2006)- et al.
Hopelessness depression: A theory-based subtype of depression
Psychological Review
(1989)
Stress exposure and stress generation in children of depressed mothers
Journal of Consulting and Clinical Psychology
The Temple–Wisconsin Cognitive Vulnerability to Depression Project: Lifetime history of Axis I psychpathology in individuals at high and low cognitive risk for depression
Journal of Abnormal Psychology
Diagnostic and statistical manual of mental disorders
Antecedents of stressful experiences: Depressive symptoms, self-esteem, gender, and coping
International Journal of Stress Management
Depression: Clinical, experimental, and theoretical aspects
Cognitive therapy of depression: New perspectives
Cognitive models of depression
Journal of Cognitive Psychotherapy: An International Quarterly
The BDNF Val66Met polymorphism is associated with rumination in healthy adults
Emotion
Relapse after recovery from unipolar depression: A critical review
Psychological Bulletin
Parents as direct facilitators of children's peer relationships: Effects of age of child and sex of parent
Journal of Social and Personal Relationships
The sociotropy-autonomy scale: Structure and implications
Cognitive Therapy and Research
Affect and memory
Psychological Bulletin
Social origins of depression
Fall-off in the reporting of life events
Social Psychiatry
The development of companionship and intimacy
Child Development
Reciprocal influences among relational self-views, social disengagement, and peer stress during early adolescence
Child Development
Modeling relations between hassles and internalizing and externalizing symptoms in adolescents: A four-year prospective study
Journal of Abnormal Psychology
Stress generation in depressed patients and community controls
Journal of Social and Clinical Psychology
The dynamics of life stressors and depressive symptoms in early adolescence: A test of six theoretical models
Child Development
Relation of social and academic competence to depressive symptoms in children
Journal of Abnormal Psychology
Preliminary support for a competency-based model of depression in children
Journal of Abnormal Psychology
Models of cognitive mediation and moderation in child depression
Journal of Abnormal Psychology
Parent and child stress and symptoms: An integrative analysis
Developmental Psychology
Depression and the response of others
Journal of Abnormal Psychology
Thinking interactionally about depression: A radical restatement
Does depression generate negative life events?
Journal of Nervous and Mental Disease
Predictors of the generation of episodic stress: A longitudinal study of late adolescent women
Journal of Abnormal Psychology
Axis II symptomatology, depression, and life stress during the transition from adolescence to adulthood
Journal of Consulting and Clinical Psychology
Depression and Axis II symptomatology in an adolescent community sample: Concurrent and longitudinal associations
Journal of Personality Disorders
Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: Addressing issues of specificity
Journal of Abnormal Psychology
The longitudinal relation between personality disorder symptoms and depression in adolescence: The mediating role of interpersonal stress
Journal of Personality Disorders
Poor interpersonal problem solving as a mechanism of stress generation in depression among adolescent women
Journal of Abnormal Psychology
Marital functioning and depressive symptoms: Evidence for a stress generation model
Journal of Personality and Social Psychology
Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: Addressing issues of specificity
Journal of Abnormal Psychology
Conceptualization and measurement of human disorder in life stress research: The problem of chronic disturbance
Psychological Bulletin
Socioenvironmental factors, stress, and psychopathology
American Journal of Community Psychology
Interpersonal predictors of stress generation
Personality and Social Psychology Bulletin
Social zeitgebers and biological rhythms
Archives of General Psychiatry
The impact of high neuroticism in parents of children's psychosocial functioning in a population at high risk for major affective disorder: A family-environmental pathway of intergenerational risk
Development and Psychopathology
Cited by (481)
Characterizing stress processes by linking big five personality states, traits, and day-to-day stressors
2024, Journal of Research in PersonalityCirculating mitochondrial long non-coding 7S RNA in primary health care patients with depression/anxiety
2024, Journal of Affective DisordersExamining insomnia disorder and stress generation among individuals who have experienced involuntary job loss
2024, Journal of Psychosomatic ResearchIs everything really okay?: Using ecological momentary assessment to evaluate daily co-fluctuations in anxiety and reassurance seeking
2023, Behaviour Research and TherapyThe social cost of depression: Investigating the impact of impaired social emotion regulation, social cognition, and interpersonal behavior on social functioning
2023, Journal of Affective Disorders ReportsExamining the relationship between genetic risk for depression and youth episodic stress exposure
2023, Journal of Affective Disorders