Clinical and psychosocial origins of chronic depressive episodes. I: A community survey

Abstract

Background: We consider how far it is possible to predict a chronic course of a depressive disorder from psychosocial and clinical material available at the point of onset.

Method: A population survey found 404 working-class mothers living in an inner-city area of London. The majority were interviewed three times over a 3-year period.

Results: Chronicity (more than 12 months' duration) was strongly related to both childhood adversity (parental indifference, family violence or any sexual abuse) and current adult interpersonal difficulties. The lack of positive events during the course of the episode was also independently related to chronicity, but to a lesser degree. Clinical characteristics were relatively unimportant compared with psychosocial factors.

Conclusions: The childhood risk factors were particularly important (judged by a path analysis), and a challenge for future research will be to establish the intervening processes involved with this distal link.