As far as recent life events are concerned, the situation is less intriguing. Table 2 shows the results of the controlled studies in this area. It may be seen that, with the exception of the earlier studies, almost all papers are consistent in finding an excess of stressful life events in the period preceding the onset of a depressive episode. However, since most of the latest studies were carried out in community sam­ples and the diagnoses were made by nopsychiatrists, there is some doubt as to whether such cases correspond to those usually described among psychiatric samples. Moreover, in some cases the results obtained in the community could
pp, patients; ss, subjects.
not be repeated when psychiatric patients were studied, e.g., Brown and Harris (6). One explanation for this latter fact could be that the presence of a stressful event negatively conditions the probability of being seen by a psychiatrist. On the other hand, the suspicion cannot be ruled out that the same term, depression, is used with different meanings, i.e., that different concepts of depression would lead to different diagnostic criteria. We have attempted to bypass this difficulty by selecting a sample of depressives that would be comparable to those encoun­tered in biological research and, in the meantime, be representative of the entire population of depressives. First, we carried out a community survey in Florence that showed epidemi­ological figures comparable with those found in most other Western countries using the DSM-III criteria (17). The second stage was to investigate the use of care facilities in these cases: Here we found that 87% of the cases meeting our intake criteria were referred to a psychiatrist, in most cases a private consultant. We have therefore drawn our patients from four different facilities (university hospital in- and outpatients, private hospital inpatients, and private practice inpatients) with a relative percentage that reproduces the relative use of these services in the community. The intake criteria we adopted were: (a) diagnosis of Major Depressive Episode (DSM-III) (1), (b) Major Depressive Disorder, Pri-m агу Subtype (Research Diagnostic Criteria) (45), and (c) initial Hamilton score, 21-item version (22), of at least 18. Eighty- nine patients were selected; the mean age was 52.2 (S.D. ±12.9), 38 were males and 51 females. These patients also showed characteristics that ren­dered this sample closely comparable to those generally used for biological or psychopharmacological research. The initial mean Hamilton score was 26.3 ± 5.1; 80% were endogenous, 24% were bipolar, and 56% were nonsuppressor at the DST. The sample closely corresponded to the community cases with the same diagnostic criteria for age, sex, age at onset, and social and educational level. The control group was made up of 116 healthy subjects, drawn from a pool of hospital employees and their relatives and matched with the depressives for age, sex, educational level, and social class. Patients and controls were given a semistructured interview in which the events of the preceding 12 months and all the surrounding circumstances were exten­sively registered. The records, with depressives and controls randomly mixed, were evaluated by assessors blind to whether the records referred to a patient or to a control subject. Two methods of assessment were used, as described in detail elsewhere (15), one normative, based on the list of Paykel et al. (38), and the other contextual, following a modified form of Brown’s procedure (6). Table 3 shows that the life events occurring in the year prior to the onset of depression were significantly superior to those undergone by controls, when both the normative and the contextual methods were used. Although these data seem to confirm the existence of an association between life events and the onset of depression, in order to establish a causal relationship of life events to depression it is necessary to exclude the opposite possibility, i.e., that some events are sec­ondary to subclinical symptoms of the depressive onset. This could be the case for certain events, such as financial failure and marital conflict. We have prelisted a series of 20 events not likely to be under the subject’s control (e.g., death of a
relative). Even with this procedure, the number of depressives who underwent at least one independent event was greater than that of controls, attaining a high statistical significance (Table 4). As far as the meaning of events is concerned, we attempted to ascertain whether events with a particular meaning would be specifically implicated in depression. To do so, we evaluated separately three components, i.e., the magnitude of loss, of threat, and of adjustment attached to each event. Such an assessment was made on the basis of predefined rating scales. No single component was found to be specific for the precipitation of depression (Table 5). Finally, a last possibility remains to be considered. Since peculiar predepressive personality traits have been described in these subjects, it could be that a stress-prone pattern of living on the part of these patients would bear a higher risk of experiencing stressful events. We have investigated this possibility by evaluating the life events of a small group of depressives during a phase of well-being. The comparison with the symptomatic depressives revealed a higher incidence of events in this latter group, although the difference was significant only when using the contextual assessment. The role of recent life events in precipitating the illness, therefore, seems well established, although the events seem to act as undifferentiated cues rather than as specific stimuli. REFERENCES
1.American Psychiatric Association. (1980): Diagnostic and Statistical Manual of Mental Disorders, 3rd ed American Psychiatric Association, Washington, D.C. 2.Beck J С and Worthen, K. (1972): Arch. Gen. Psychiatry, 26:123-129. 3. Birtchnell, J. (1970): Br. J. Psychiatry, 116:299-306. 4. Bohman, M., and von Knorring, A. L. (1979): Acta Psychiatr. Scand., 60:106-112. 5 Brown, F. (1961): J. Ment. Sci., 107:754-777. 6. Brown! G. W., and Harris, T. (1978): Social Origin of Depression: A Study of Psychiatric Disorder in Women. Tavistock, London. 7 Brown, G. W., Harris, Т ., and Copeland, J. R. (1977): Br. J. Psychiatry, 130:1-18. 8. Brown G. W., Harris, Т . О ., and Peto, J. (1973): Psychol. Med, 3:159-176. 9 Brown! G. W., Sklair, R, Harris, T. O., and Birley, J. L. T. (1973): Psychol. Med., 3:74-87. 10 Cadore’t, R. J., Winokur, J., Dorzab, J., and Baker, M. (1972): Arch. Gen. Psychiatry, 26:133- 136. 11 Campbell, E. A., Cope, S. J., and Teasdale, J. D. (1983): Br. J. Psychiatry, 143:548-553. 12 Caplan, M. G., and Douglas, V. I. (1969): J. Child Psychol. Psychiatry, 10:225-232. 13. Dennehy, С M. (1966): Br. J. Psychiatry, 112:1049-1069. 14 Endicott, N. A.: Childhood death of a parent and adult depression, (unpublished). 15 Faravelli, C, and Ambonetti, A. (1983): Soc. Psychiatry, 18:51-56. 16 Faravelli, C, Ambonetti, A., Pallanti, S., Sacchetti, E., Conte, G., and Vita, A. (1986): Br. J. Psychiatry, 148:288-295. 17. Faravelli, C, and Incerpi, G. (1985): Ada Psychiatr. Scand., 72:331-333. 18. Faravelli, C, Webb, Т
., Ambonetti, A., Fonnesu, F., and Sessarego, A. (1985): Am. J. Psychiatry, 142:1493-1494. 19. Fava, G. A., Munari, F., Pavan, L., and Kellner, R. (1981): / Affective Disord., 3:159-165. 20. Finlay-Jones, R., and Brown, G. W. (1981): Psychol. Med., 11:803-815. 21. Forrest, C, Frazer, R., and Priest, R. (1965): Br. J. Psychiatry, 111:243-253. 22. Hamilton, M. (1960): J. Neurol. Neurosurg. Psychiatry, 23:56-62. 23. Hill, O. W., and Price, J. S. (1967): Br. J. Psychiatry, 113:743-751. 24. Hopkinson, G., and Reed, G. F. (1966): Br. J. Psychiatry, 112:459-463. 25. Hudgens, R. W., Morrison, J. R., and Barchha, R. G. (1967): Arch. Gen. Psychiatry, 16:134-145. 26. Jacobs, S. C, Prusoff, B. A„ and Paykel, E. S. (1974): Psychol. Med, 4:444-453. 27. Jacobson, S., Fasman, J., and DiMascio, A. (1975): J. Nerv. Ment. Dis., 160:5-13. 28. Johnson, J. H., and Sarason, G. I. (1978): J. Psychosom. Res., 22:205-208. 29. Levi, L. D., Fales, C, Stein, M., and Sharp, V. (1966): Arch. Gen. Psychiatry, 15:158-164. 30. Malmquist, С . Р . (1970): Am. J. Psychiatry, 126:1782-1786. 31. Munro, A. (1966): Br. J. Psychiatry, 112:443-457. 32. Munro, A., and Griffiths, A. B. (1969): Br. J. Psychiatry, 115:305-311. 33. Murphy, E. (1982): Br. J. Psychiatry, 141:135-142. 34. Myers, J. K., Lindenthal, J. J., and Pepper, M. P. (1971): J. Nerv. Ment. Dis., 152:149-157. 35. Oltman, J. E., McGarry, J. J., and Fiedman, S. (1952): Am. J. Psychiatry, 108:685-694. 36. Parker, G. (1979): Br. J. Psychiatry, 134:138-143. 37. Paykel, E. S., Mayers, J. K., Dienelt, M., Klerman, G., Lindenthal, and Pepper, M. (1969): Arch. Gen. Psychiatry, 21:753-760. 38. Paykel, E. S., Prusoff, B. A., and Uhlenhuth, E. H. (1971): Arch. Gen. Psychiatry, 25:340-347. 39. Perris, C, Jacobsson, L., Lindstrom, H., von Knorring, L., and Penis, H. (1980): Acta Psychiatr. Scand, 61:265-274. 40. Pfohl, В ., Stangl, D., and Tsuang, M. T. (1983): Arch. Gen. Psychiatry, 40:965-967. 4′- Pitts, F. N., Meyer, J., and Brooks, M. (1965): Am. J. Psychiatry, 121(suppl. 12):1-10. 42. Roy, д . (1978): Br. J. Psychiatry, 133:106-110. 43- Roy, A., and Phil, M. (1981): Am. J. Psychiatry, 138:959-961. 44- Sethi, В . В . (1964): Arch. Gen. Psychiatry, 10:486-496. 45.Spitzer, R. L„ Endicott, J., and Robin, E. (1978): Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders. Biometrics Research, New York State Psychiatric Institute, New York. 46. Tennant, C, Hurry, J., and Bebbington, P. (1982): Br. J. Psychiatry, 141:475-482 47. Uhlenhuth, E. H., and Paykel, E. S. (1973): Arch. Gen. Psychiatry, 28:744-748 48. Vadher, A., and Ndetei, D. M. (1981): Br. J. Psychiatry, 139:134-137. 49. von Knorring, A. L., Bohman, M., and Sigvardsson, S. (1982): Acta Psychialr. Scand., 65:283 50. Warheit, G. J. (1979): Лт . J. Psychiatry, 136:502-507.
















Anxious Depression: Assessment and Treatment, edited by G. Racagni and E. Smeraldi. Raven Press, New York © 1987.
Schizoaffective Disorder, Depressed Type: Clinical, Biological, and

This entry was posted on Thursday, April 2nd, 2009 at 2:59 pm and is filed under Anxious Depression: Assessment and Treatment,. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.