1. Psychological
1.1. Learnt Helplessness
1.1.1. -People become anxious and depressed when they decide that they have no control over the stress in their lives. -This can be shown in rats too. -This evolved from rats into the important model called the learnt helplessness theory of depression.
2. Attribution Styles
2.1. -2 Styles: Depressive attributional style and Negative attributional style. Depressive attributional style: 1. Internal, individuals attributes negative events to personal failings. 2. Stable, even after a particular negative event passes, the attribution that 'additional bad things will always be my fault' remains. 3. Global, attributes extend across a variety of issues. Negative attributional style: did not predict later symptoms of depression in young children; rather, stressful life events seemed to be the major precipitant of symptoms. Children under stress grew older, they tended to develop more negative cognitive styles, which tended to predict symptoms of depression in reaction to additional negative events. Negative attributional styles are not specific to depression but also characterise people with anxiety.
3. Depressive Cognitive Triad
3.1. -People that are depressed all the time think of things as their fault. -They make cognitive errors in thinking negatively about themselves, their immediate world and their future, these three areas together are called the Depressive Cognitive Triad.
4. Social and Cultural
4.1. Marital Relations
4.1.1. -Marital dissatisfaction and mood disorder, particularly bipolar disorder, are strongly related. -Participants of a study by Bruce and Kim (1992), 695 women and 530 men, were interviewed and re-interviewed a year later. During this time, many separated from or divorced their spouses, though the majority reported stable marriages. -21% of women who reported a marital split during the study experienced severe depression, at a rate 3 times higher than for women that were still married. -17% of men who reported the marital split developed severe depression at a rate 9 times higher than the men that remained married. -Only the men faced a heightened risk of developing a mood disorder for the first time immdiately following a marital split. -Depression and chronic depressive symptoms may erode marital relationships. -Conflict within marriage has different effects on men and women. -Depression seems to cause men to withdraw or otherwise disrupt the relationship. For women, problems in the relationship often cause depression. -Depression and problems in marital relations are associated for men and women, but the causal direction is different.
4.2. Social Support
4.2.1. -Risk of depression for people who live alone is almost 80% higher than for people who live with others. -Social support is important in the onset of depression. -In a study on women with serious life stress, only 10% of the women with someone to confide in became depressed, compared to 37% of women who did not have a close supportive relationship. -Social support can help predict the onset of depressive symptoms at a later time. -Important with speeding recovery from depressive episodes. -Does not seem to help with manic episodes.
4.3. Gender Differences
4.3.1. -Bipolar disorder is even divided between men and women. -Almost 70% of the individuals with major depressive disorder and dysthymia are women. -Gender imbalance is constant around the world, though rates of disorder may vary from country to country. -Often overlooked is similar ratio for most anxiety disorders, particularly PD and GAD. -Women represent an even greater proportion of specific phobias. -Gender differences in development of emotional disorders are strongly influenced by perceptions of uncontrollability. -Men as hunters, women as homemakers, this culturally induced dependence and passivity may put women at heightened risk of emotional disorders by increasing their feelings of uncontrollability and helplessness. -Parenting styles that encourage stereotypic gender roles are implicated in the development of early psychological vulnerability to later depression or anxiety, specifically, a smothering, overprotective style that prevents the child from developing initiative. -Accelerated emergence of depression among girls during puberty. -Women place greater value on intimate relationships, which can be protective if social networks are strong, but can also put them at risk. -Disruptions in relationships, combined with the inability to cope with the disruptions are more damaging to women than men. -Tendency for youn girls to express aggression by rejecting other girls, combined with a greater sensitivity to rejection, may precipitate more depressive episodes in these young girls compared with boys. -Women have larger and more intimate social networks than men and that emotionally supportive groups of friends protect against depression. -Women tend to ruminate more than men about their situation and blame themselves for being depressed. -This response style predicted the later development of depression when under stress. -Men ignore feelings, which may be therapeutic, because 'activating' people is a common element of successful therapy for depression. -Disadvantages for women: harder to get jobs, less power, abuse, poverty, sexual harrassment and discrimitation. -Single mothers have a harder time getting jobs/ -Single, divorced and widowed women experience significantly more depression than men in similar situations.
5. Biological Dimensions
5.1. Genetics
5.1.1. -Look at given disorder in the first-degree relatives of individuals with disorder (the proband) -Rate in relatives of probands is consistently 2-3 times greater than in relatives of controls who do not develop mood disorders. -Studies on twins suggest mood disorders are heritable. -Gender differences in genetic vulnerability. -40% genetic contribution to depression for women. 20% for men. -3 factors underlie major depression syndrome: Cognitive and psychomotor symptoms, associated with mood, neurovegetative symptoms. -More anxiety or depression in one person in family studies leads to greater rate of anxiety or depression, or both in first-degree relatives and children. Social and psychological explanations account for factors that differentiate anxiety from depression rather than genes. -Biological vulnerability for mood disorders may not be specific to that disorder, but may reflect more general predisposition to anxiety or mood disorders, or to basic tempermant underlying all emotional disorders, such as neuroticism.
5.2. Neurotransmitter
5.2.1. -Possible exception of schizophrenia, mood disorders have been the subject of more intense neurobiological study than any other area of psychopathology. -Decreased serotonin activity with mood disorders, but only in relation to other neurotransmitters, including noradrenaline and dopamine. -Serotonin regulates emotional reactions. -'Permissive' hypothesis: Serotonin is low, other neurotransmitters are 'allowed' to range more widely, becoming dysregulated and contribute to mood dysregulation, including depression. -Chronic stress reduces dopamine activity and produces depressive-like behaviour. -Excessive cholinergic activity from the basal forebrain appears to be associated with depressive phenomenology. -Abnormalities in GABAergic and glutamatergic transmission have also been implicated in the pathogenesis of depression.
5.3. Sleep Disturbances
5.3.1. -Sleep disturbances demonstrable by EEG also predate mood disorder symptoms. -Takes less than typical 90 min before REM-sleep sets in. -Individual could not be depressed even with recurrent depression, disturbances in sleep continuity and reduction of sleep. -Sleep disturbances are most severe among depressed elderly. -Insomnia is frequently experienced by older adults, and is a risk factor for both the onset and persistence of depression. -Sleep disturbances can also occur in bipolar patients.
5.4. Endocrine System
5.4.1. -Research focus on the pathogenesis of depression has shifted to the endrocrine system and the 'stress hypothesis'. -Stress hypothesis- Focuses on hyperactivity in the hypothalamic-pituitary-adrenocortical (HPA) axis, which produces stress hormones. -Investigators became intrerested in the endocrine system when they noticed patents with endocrinopathy (Disorders of the hormonal endocrine system) sometimes became depressed. -Cortisol is called a 'stress hormone' because it is elevated during stressful life events. -In addition to supressing neurogenesis, cellular toxicity may arise, resulting in hippocampal cell death. -Evidence of healthy girls at risk of developing depression because their mothers have recurrent depression, have reduced hippocampal volume compared to girls with non-depressed mothers. -Low hippocampal volume may precede and perhaps contribute to the onset of depression. -Electroconvulsive therapy seem to produce neurogenesis in the hippocampus, along with other treatments, thereby reversing the process of depression.