Adolescent Depression: Stressful Interpersonal Contexts and Risk for Recurrence

Abstract

High rates of diagnosable depression in adolescence, especially among young women, present challenging clinical and research issues. Depression not only portends current maladjustment but may also signal risk for recurrent or chronic depression and its associated impairment. Because depression is most often a response to stressful events and circumstances, it is important to understand the stress context itself. Individuals with depression histories are known to contribute to the occurrence of interpersonal and other stressors at a high rate, and for young women particularly, the occurrence of interpersonal stressors and conditions in turn predicts recurrences of depression, in a vicious cycle. Interpersonal dysfunction in early adolescence predicts the likelihood of continuing maladaptive functioning in peer, family, romantic, and parenting roles. The transmission of depression from one generation to the next involves not only heritable factors but also the likelihood that depressed youth become caught in life contexts of marital and parenting discord that portend dysfunction for their offspring and continuing depression for themselves.

Fig. 1

The intergenerational transmission of depression and stress. The red arrows represent continuity from early childhood to adulthood, and the blue arrows represent proposed causal pathways. As shown in the lower portion of the model, maternal depression is a well-known predictor of youth depression; depression during adolescence in turn predicts recurrence of depression in many youth and is hypothesized to predict becoming a depressed parent, especially in females. The upper portion of the model shows the intergenerational transmission of stress in families of depressed parents, from early childhood through the transition to adulthood. Stress and depression in the youth are reciprocally related. Interpersonal dysfunction in childhood is hypothesized to be a mediator of the link between both early stress exposure and maternal depression and the two outcomes of adolescent stress and depression.