Combinations of risk factors

It seems, then, that the risk of further episodes of depression is predicted by many factors. It is likely that it is the combination of several of these risk factors that poses the greatest risk. Thus, for instance, Beardslee et al. (1996) examined risk factors for affective disorder within a random sample of 139 adolescents. Single risk factors such as parental major depression, parental non-affective diagnosis, or a previous child psychiatric diagnosis increased the risk of subsequent affective disorder from 7% to 18%. However, when all three risk factors were present, the risk jumped to 50%!

It is not clear whether the factors that lead to continuity simply add up, or whether there is some kind of interaction such that some risk factors operate only in the presence of others. There is some evidence of such interactions in adult depression. For instance, studies of major depression in women suggest that genetic influences may alter the sensitivity of individuals to the depression-inducing effect of adverse life events (Kendler et al., 1995). In other cases, it seems as if people act in ways that increase their likelihood of adversity, a pattern which in turn increases their risk of depression. One of the best-known examples of this phenomenon comes from the research of Brown et al. (1986) with inner-city young women. They found that women who had experienced lack of care during childhood (such as abuse) were more likely to become pregnant while young. In turn, early pregnancy increased the risk of other forms of adversity, such as marrying an abusive partner. These later forms of adversity were strongly associated with depression.

Similar kinds of processes may occur in juvenile depression. Daley and colleagues (Daley et al., 1998) conducted a community study of personality functioning in older adolescents, who were then followed up for 2 years. They found that certain personality disorder features seemed to generate chronic interpersonal stress, which increased vulnerability to depression. Goodyer and Altham (1991) reported that the families of depressed girls seemed to become "life event prone" as a result of parental psychopathology. In their study, it seemed that young people became depressed when depressed parents were no longer able to protect them from adversity.

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