The chances of major depressive disorders recurring In mental healthcare settings are 60% after 5 years, 67% after 10 years, and 85% after 15 years. In contrast, in the general population, the chances of a recurrence of the disorder drop to 35% after 15 years. Factors that increase the risk of recurrence include the prevalence of residue symptoms in the aftermath of a depressive phase and the number of previous depressive episodes (Hardeveld et al, 2010). However, there is another potentially very important reason why some depressions may recur and this is known as STRESS GENERATION.
The relationship between stress and depression is bidirectional. Stress can exacerbate depression but depressive ways of thinking and behaving can also create stress.
The stress generation hypothesis was developed by Hammen, 1991 and is based upon the idea that individuals suffering from depression are prone to experience significantly negative life events as a result of their own behaviors and personality traits and that this may partly explain why, in many people, depression recurs.
Childhood Abuse, Stress Generation and Recurrent Depression
A study (Liu et al., 2013) involving 66 adults examined which types of child abuse increased the likelihood of negative life events in individuals with a history of depression.
The occurrence of negative life events was measured by utilizing a 4-month prospective follow-up.
It was found that emotional abuse but not physical or sexual abuse predicted greater stress generation/negative life events over the 4-month follow-up period and that a negative inferentially style mitigated this relationship.
These findings suggest that targeting negative cognitive styles (e.g. with cognitive therapy) in depressed people in clinical settings, especially in patients with a history of childhood emotional abuse, may reduce the number of negative life events befalling the person thus also reducing the chances of the depressive disorder recurring. thereby possibly decreasing the risk for depression recurrence
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Possible Life-Long Effects Of Toxic Stress On The Child.
We have been programmed by evolution to have physical responses to perceived dangers and threats. These evolved to prepare our ancestors for ‘fight or flight, when, for example, they were being stalked by a predator. The bodily responses we experience when we feel endangered and threatened to include:
– an increased heart rate
– an increase in blood pressure
– an increase in the number of stress hormones (such as cortisol) in our bloodstream
If a child experiences severe and chronic (ie. long-lasting) stress and has no emotional support (or poor and inadequate emotional support) to help him/her cope with the stress and buffer its effects then it can result in the actual architecture of the brain being damaged (the young brain is particularly sensitive and susceptible to the adverse effects of stress – psychologists call this sensitivity and susceptibility to architectural/physical change as the result of experience plasticity).
For example, a child may be emotionally abused by the mother over a number of years with no adequate support from the father (perhaps due to divorce from the mother, which was my own situation), older siblings (indeed, they may even join in the abuse), school, wider family or wider society.
The Three Types Of Stress Response:
1) Positive stress response:
This is a functional, normal, non-damaging type of stress, causing only mild physiological response. An example might be a child’s first day at school. It is actually helpful to the child to experience such mild forms of stress and learn that s/he can cope with it as it helps to prepare him/her for adult life.
2) Tolerable stress response :
Here the stress experienced is more severe and/or long-lasting. The corresponding physiological response is, therefore, greater but still does no long-term damage as long as the child receives sufficient emotional support.
3) Toxic stress response:
Here the stress experienced is severe, long-lasting, and frequent. Examples include:
– physical/emotional abuse
– maternal depression
– lack of adequate stimulation due to poverty
– living in a household where there is domestic violence
– living in a household where there is alcoholism/drug abuse
– parental mental illness
The effects of toxic stress on the young mind can be lifelong. Physical effects on the brain may include:
– disruption of brain circuitry
– anatomical changes
– physiological dysregulation
– damage to the brain structure called the amygdala
– damage to the brain structure called the hippocampus
– damage to the brain structure called the prefrontal cortex
Adverse effects resulting from the above may include:
– poor mood control
– high, chronic anxiety
– severely reduced capacity to cope with stress
– severe reduction in socio-emotional skills
– excessive drinking in an attempt to reduce anxiety
– excessive smoking in an attempt to reduce anxiety
– poor academic achievement
– gang membership
– highly unstable and volatile interpersonal relationships
– unhealthy lifestyle leading to physical illnesses
– greater proneness to some medical conditions even in the absence of an unhealthy lifestyle
Toxic stress is a prevalent and very serious threat to young people’s welfare. Its adverse effects can be devastating, and, without appropriate therapy, last a lifetime.
It is therefore vital to identify individuals at risk as early as possible and to develop more effective therapeutic interventions. The earlier effective intervention occurs, the less likely the damage done to the young person will be irrevocable.
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Hardeveld F, Spijker J, De Graaf R, Nolen WA, Beekman AT. Prevalence and predictors of recurrence of major depressive disorder in the adult population. Acta Psychiatr Scand. 2010 Sep;122(3):184-91. doi: 10.1111/j.1600-0447.2009.01519.x. Epub 2009 Dec 11. PMID: 20003092.
Liu RT, Choi JY, Boland EM, Mastin BM, Alloy LB. Childhood abuse and stress generation: the mediational effect of depressogenic cognitive styles. Psychiatry Res. 2013 Apr 30;206(2-3):217-22. doi: 10.1016/j.psychres.2012.12.001. Epub 2012 Dec 27. PMID: 23273609; PMCID: PMC4081492.