(PDF) The Relationship Between Stress and Depression in First Onsets Versus Recurrences - A Meta-Analytic Review

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112 Citations 54 References
Stress and Depression in First Onsets Versus Recurrences: A Meta-Analytic Review
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n Journal of Abnormal Psychology 117(1):206-13 · March 2008 with 2,033 Reads
17.1.206 · Source: PubMed
B Stroud
Joanne Davila Anne Moyer
Williams College
Purple bacteria can turn h

L. Harkness reviewed the empirical evidence supporting R. M. Post's kindling model, which suggests the 1st episode hydrogen energy Read More
likely to be preceded by major stressors than are subsequent episodes. Their review highlighted the diverse
t's premise in the current literature and the changes in research methods that have contributed to this interpretive
ducted a meta-analysis (N=13 studies) to test Post's premise that integrated early and recent research and
oderators. A proportion difference effect size was used. Results indicated that 1st onsets of depression were more
s to be preceded by severe life events, supporting Post's premise. The moderator analyses suggested that support
in patient samples and may vary according to age and gender, with less support for Post's premise evidenced in
in women. Although these results are preliminary, as the analysis included a small number of studies, they suggest
hould further examine factors that influence the stress-depression relationship with successive recurrences.
research
bers
cations
rojects
atherine B Stroud Author content Download full-text PDF

t to copyright.
mal Psychology Copyright 2008 by the American Psychologica

No. 1, 206 –213 0021-843X/08/$12.00 DOI: 10.1037/0021-843
https://www.researchgate.net/publication/5584653_The_Relationship_Between_Stress_and_Depression_in_First_Onsets_Versus_Recurrences_A_… 1/16
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Relationship
112 Citations 54 Between
References Stress and Depression in First Onsets Vers
Recurrences: A Meta-Analytic Review
Catherine B. Stroud, Joanne Davila, and Anne Moyer
Stony Brook University, State University of New York
S. M. Monroe and K. L. Harkness (2005) reviewed the empirical evidence supporting R. M. Post’s (1992)
kindling model, which suggests the 1st episode of depression is more likely to be preceded by major
stressors than are subsequent episodes. Their review highlighted the diverse interpretations of Post’s
premise in the current literature and the changes in research methods that have contributed to this
interpretive shift. The authors conducted a meta-analysis (N ⫽ 13 studies) to test Post’s premise that
integrated early and recent research and examined potential moderators. A proportion difference effect
size was used. Results indicated that 1st onsets of depression were more likely than recurrences to be
preceded by severe life events, supporting Post’s premise. The moderator analyses suggested that support
may be most evident in patient samples and may vary according to age and gender, with less support for
Post’s premise evidenced in younger samples and in women. Although these results are preliminary, as
the analysis included a small number of studies, they suggest that future research should further examine
factors that influence the stress– depression relationship with successive recurrences.
Keywords: kindling hypothesis, life stress, depression, meta-analysis, recurrence
onship between life stress and major depression is well stress autonomy) is the observation that after an initial s
(Kessler, 1997; Mazure, 1998). Most reports, however, tion to stressors, recurrences of depression occur autonom
vestigated the role of stress in the etiologies of first the absence of stressors (Post & Weiss, 1998).
recurrences separately (Monroe, Rhode, Seeley, &
1999), in spite of widespread acceptance of Post’s Unification of the Literature on Post’s Premi
rtion that the nature of the relationship between stress-
In a critical examination of the empirical evidence fo
ts (SLEs) and depression changes “as a function of the
premise, Monroe and Harkness (2005) called attentio
course of illness” (p. 1005).
contrasting interpretations of Post’s (1992) theory that h
sic premise is that the first episode of a mood disorder
used interchangeably to explain the changes that occu
ly to be preceded by major psychological stressors than
stress– depression relationship with successive recurren
ent episodes (Post, 1992). At the basis of this premise
authors suggest that one source of this problem is that the
tinct models that offer potential mechanisms of this
largely (although with some exceptions) failed to disting
bservation: behavioral (stress) sensitization and elec-
tween the two models (stress sensitization and stress au
gical kindling (Post & Weiss, 1998). In the animal
underlying Post’s formulation. This “interpretative elasti
ress sensitization, levels of electrical stimulation that
led to a “subtle shift in emphasis with regard to the natu
y below the threshold needed to elicit seizures in brain
association between life stress and first onsets versus recu
seizures after repeated applications as a result of
(Monroe & Harkness, 2005, p. 424). Specifically, earlie
increases in behavioral and physiological reactivity
investigated “differences in the proportion [italics added]
McIntyre, & Leech, 1969). The analogue process in
roe & Harkness, 2005, p. 424) of individuals experie
he observation that less and less SLEs elicit depression
precipitating SLE in first onsets versus recurrences and
ourse of the disorder. In the animal model of electro-
that a greater proportion of first onsets of depression are
al kindling, the repetition of electrical stimulation
by major SLEs than are recurrences (Mazure, 1998; M
esults in autonomous seizures (i.e., seizures occurring
Harkness, 2005; Post, 1992). However, more recent studi
nce of stimulation). The analogue in humans (termed
tigated the “differential prediction [italics added] by life
a first onset versus a recurrence” (Monroe & Harkness,
424) using the odds ratio (OR; and other statistical in
B. Stroud, Joanne Davila, and Anne Moyer, Department of strength) and demonstrated a decline in the strength of th
Stony Brook University, State University of New York.
depression relationship across the course of the disord
wledge Daniel N. Klein for his advice, particularly to include
lines of research have been interpreted as supportin
atus moderator; Lisa Starr for her assistance in coding; and the
hors who provided their data via e-mail correspondence. premise. However, earlier and more recent studies inv
dence concerning this article should be addressed to Catherine two different questions (Monroe & Harkness, 2005). T
Department of Psychology, Stony Brook University, State the present analysis sought to unify the existing rese
of New York, Stony Brook, NY 11794-2500. E-mail: examining the results of studies using one statistical index
es.cc.sunysb.edu all existing research to examine the same question.
206
STRESS AND DEPRESSION: A META-ANALYSIS
Monroe and Harkness (2005) identified potential con- SLEs across episodes (providing greater support for Post’s
he use of the OR and other indices of strength used in tion) as sample age increases.
es, we have integrated the literature examining Post’s
g the statistical index of proportion differences. Al-
problematic in itself, the OR may pose problems due to Gender
in which it was used and interpreted in recent studies.
Gender was selected as a moderator, as research indic
dies, two ORs (a first-onset OR and a recurrence OR)
in comparison with men, women experience higher rates
ated and compared to illustrate the nature of the rela-
(Bebbington et al., 1988; Spangler, Simons, Monroe, &
er time, such that a decline in strength would be
1996; Wagner & Compas, 1990) and may be at greater
f the OR for first onsets was larger than the OR for
The concern in using the OR arises in making this depression following SLEs (Cronkite & Moos, 1984;
Thornton, & Prescott, 2001; Kessler & McLeod, 1984; M
because the first-onset OR includes never-depressed
ereas the recurrence OR includes once-depressed per- ski, Prigerson, & Mazure, 2001; Nazroo, Edwards, &
there is a substantial shift in the number of individuals 1997; Uhlenhuth & Paykel, 1973; Van Os & Jones, 1999
each OR, as the majority of individuals in the first- basis of this research, we predicted that Post’s premise w
never-depressed individuals) is not included in the supported to a lesser extent in women than in men. To th
OR. Monroe and Harkness (2005) argued that as a that women experience higher rates of severe SLEs acro
s sample shift, the first-onset OR will be larger than the rences (Spangler et al., 1996) and are at greater risk for de
OR, regardless of “actual changes in the impact and depression in response to those events (not just at greater
etween major stress and episode onset, or changes in depression on average), the difference in the proportion
strength of the association between major stress and onsets and recurrences preceded by severe SLEs will be
et” (Monroe & Harkness, 2005, p. 438). than the difference in the same proportions among men. H
it is certainly mathematically possible that this sample some research suggests no gender differences in rates o
not pose a concern in comparing the ORs (and other SLEs (Maciejewski et al., 2001; Sherrill et al., 1997)
easures of strength), it remains to be evaluated (Mon- (Kendler, Hettema, Butera, Gardner, & Prescott, 2003; W
ness, 2005). Because the effect of such a sample shift Compas, 1990). Therefore, it is possible that the stress– de
mparisons has not yet been evaluated, in the present relationship will operate similarly in men and women.
void potential concerns associated with the OR by
the results of recent studies, which used the OR and
Patient Status
ical indices of strength, to differences in proportions
e in earlier studies) and thereby examine the literature Patient status was selected as a moderator because of
remise using one statistical index. that patient samples are not representative of the general
tion (e.g., Goodman et al., 1997; Uhlenhuth & Paykel, 1
Moderators are biased by treatment seeking (e.g., Kendler, Thornton,
ner, 2000; Paykel, 2003). In addition, Post and colleagu
on to unifying the literature on Post’s premise, we
asserted that treatment may affect (or reverse) the proc
his meta-analysis seeking to examine factors that may
stress sensitization and stress autonomy (Post & Weiss
e stress– depression association and thus affect support
Because of this, we predicted that there would be less evid
mise.
Post’s premise in patient samples. However, other rese
suggested that depression in community samples is merely
(Bebbington, Tennant, & Hurry, 1981; Coyne, Thompson
per, 2004) and that community samples may provide onl
selected as a potential moderator on the basis of research
servative test of the relationship between SLEs and sympt
differences in the nature of depression (e.g., Jorm, 2000;
to the rarity and stability of SLEs (Billings & Moos, 1982
et al., 1994; Lewinsohn, Allen, Seeley, & Gotlib, 1999)
this research leads to the alternative prediction that there w
uency and severity of SLEs as a function of age (Oei &
less evidence for Post’s premise in community samples.
6; Ormel, Oldehinkel, & Brilman, 2001; Perris, 1984;
& Paykel, 1973). We predicted that as the mean age of the
eased, Post’s premise would be supported to a greater Method
is based on the observation that those included in the
group of the adult samples likely have experienced a Literature Searches
ber of episodes than have those in the adolescent samples
et al., 1994). As such, research investigating younger Three methods were used to locate potentially eligible
ely compares first onsets and first recurrences, whereas First, all studies included in reviews (Mazure, 1998; M
estigating older samples likely compares first onsets and Harkness, 2005; Post, 1992) were retrieved. Second, the P
urrences. If severe SLEs become less common triggers (using records dated between the years 1887 and 2006) and
ive recurrences, and if older samples contain individuals (using records dated up to 2006) databases were searched
See
ingly all ›recurrences,
more Seeit all ›
follows that there would be a following terms: major depression, depression, onset, relaps
ence112
in Citations
the proportion54ofReferences
episodes triggered by severe Download
rence, stress, life experiences citation
, life events, lifeShare
change events, Download full-text PDF
STROUD, DAVILA, AND MOYER
subtype(s), and risk factor(s). Third, the reference lists of prior to an episode of depression or depressive sympt
cles were scanned.1 proportion difference ES was used. Two proportions we
lated for each study: (a) the proportion of individuals w
Exclusion Criteria rienced a severe SLE prior to a first onset and (b) the prop
individuals who experienced a severe SLE prior to a rec
d studies, dissertations, and unpublished studies were
The proportion for the recurrence group (Group 2; p
Studies were included if a self-report or interviewer-
subtracted from the proportion for the first-onset group (G
od was used to assess major life stress as a predictor
pG1) to calculate the ES for each study: ES ⫽ pG1 ⫺ pG
ted assessment of depression was used as an outcome.
Thus, an ES of zero indicates no difference in the prop
and retrospective designs were accepted. There were
individuals in the first-onset group versus the proportion of
vel-of-depression restrictions. Studies were excluded if
uals in the recurrence group who experienced a precipitating
not compare participants with and without a history of
positive ES indicates that a greater proportion of individua
(b) were not published in English, (c) included distal
first-onset group experienced a precipitating severe SLE re
proximal) stressors, (d) did not investigate severe
the recurrence group, whereas a negative ES indicates that
e stress (e.g., daily hassles, chronic stress studies,
proportion of individuals in the recurrence group experienc
pisodic stress), (e) investigated bipolar depression, or
cipitating severe SLE relative to the first-onset group. Whe
patients with comorbid physical illness. Most studies
gating across ESs, each ES was weighted according to the i
ded because information about the proportion of par-
its variance (w) using the formula shown below (Lipsey &
o experienced an SLE was not reported or because this
2001, p. 51), where nG1 is the number of participants in the f
ported separately for participants with and without a
group, nG2 is the number of participants in the recurrence gr
epression. If author communication provided informa-
p ⫽ (nG1 pG1 ⫹ nG2pG2)/(nG1 ⫹ nG2):
proportions, the study was included.4
w ⫽ (nG1 )(nG2 )/p共1 ⫺ p 兲共nG1 ⫹ nG2 兲.
s
The ES and weight computations were repeated by an
he mean age of participants at study entry was calcu-
dent investigator to ensure accuracy.
dies in which some participant groups were excluded
Multiple ESs. Some studies reported results that allow
ls), mean age was based only on included participants.
tiple ESs to be computed, for example, if (a) different pro
The percentage of female participants was calculated.
were given for different lengths of time for which stres
in which some participant groups were excluded, the
ment occurred (e.g., 3 and 6 months) or (b) different pro
of female participants was based only on included
were given for different levels of severity of SLEs. So
assumption of independence was not violated by includi
tatus. Patient status was coded as (a) patients for
than one ES per study in the same analysis, decision ru
included only psychiatric inpatients, outpatients, or
used. If separate ESs could be calculated for multiple peri
mmunity for studies that used community participants;
which stress assessment occurred, the period that was the
er for studies in which the patient status could not be
was selected, as major events commonly occur within 6 m
or for studies that included patients and community
an episode (Brown & Harris, 1978). If separate ESs c
in the same sample. The studies that were coded as
ed participants recruited from the following groups: (a)
receiving antidepressant medication from two general 1
We thank Toni Bifulco, Shannon Daley, Anne Farmer, Kate
armer et al., 2000) and (b) patients from primary care Yoav Kohn, Peter Lewinsohn, Scott Monroe, Tineke Oldehinkel, an
tric practices (Coyne et al., 2004). These studies were Pepper, who generously provided their data through e-mail corresp
om the patient status moderator analysis. 2
To obtain unpublished data, we contacted researchers in th
depression field by e-mail. However, contacting the authors did not
ns Among Moderators unpublished data matching the inclusion criteria. Thus, although un
data were not excluded, no unpublished data were included in the
iate correlations for the moderators were ⫺.03 for gender 3
We attempted to integrate a second meta-analysis into this
6 for gender and patient status, and ⫺.07 for age and aggregating studies investigating first onsets or recurrences separ
s. Thus, the moderator variables were independent. thank an anonymous reviewer for this suggestion. However, the
search resulted in only one first-onset study and three recurrenc
See allof› Moderator
liability See all ›
Variables thus, a second meta-analysis could not be performed. There
eligible studies, because Download citation
most studies Share depressio Download full-text PDF
did not measure
112 Citations
es included 54 References
in the analysis were coded by Catherine B. illustrating a limitation in the literature that has been highlighted b
an independent coder. Cohen’s kappa was .87 for others (e.g., Monroe et al., 1999).
us. Intraclass correlation coefficients were 1.0 for age 4
Attempts to obtain relevant data to calculate effect sizes (ESs
gender. possible in the following case: Maciejewski et al. (2001). In addit
not feasible to integrate the results from the Virginia Twin Regist
on of Effect Sizes (ES) used in Kendler et al. (2000) and Kendler, Thornton, and Gardn
because the person–month unit of analysis (with multiple perso
on difference. Because the interest was in investigat- for each individual) used in those studies did not correspond
portion of individuals who experienced a severe SLE proportion difference ES used in this meta-analysis.
, Proportions, Effect Size, Weighted Effect Size, and Moderators for the 13 Included Studies
Study N p G1 pG2 ES wES MA PF
(1998) 39 .857 .920 ⫺.063 ⫺.044 41.0 100.0

rmel (2001); Ormel et al. (2001)a 83 .342 .095 .247 .211 71.4 59.9
(1994) 331 .600 .525 .075 .176 — 100.0
(2004) 131 .308 .238 .070 .055 37.0 74.2
2000) 128 .154 .243 ⫺.089 ⫺.112 18.3 100.0
1985) 72 .620 .294 .326 .144 41.6 60.0
al. (1987) 97 .500 .269 .231 .150 56.6 84.5
(2000) 108 .444 .250 .194 .152 39.8 64.8
98) 76 .333 .269 .064 .017 37.3 100.0
t al. (1999); Monroe et al. (1999)a 113 .457 .442 .015 .012 16.6 52.0
2001) 115 .393 .219 .174 .147 54.0 72.0
. (2003) 270 .375 .221 .154 .467 — 63.7
t al. (1998) 26 .647 .555 .092 .016 15.4 80.8
es indicate data were not available for calculation. pG1 ⫽ first-onset proportion; pG2 ⫽ recurrence proportion; ES ⫽ effect size; wES ⫽
MA ⫽ mean age; PF ⫽ percentage female; PS ⫽ patient status; C ⫽ community sample; P ⫽ patient sample.
d the same sample and results were combined.
or different levels of severity of included SLEs, the ES not provide this information. One study was excluded becau
LEs was selected, as Post’s (1992) basic tenet is that were reported on participants experiencing unipolar and bi
cally severe (or major) SLEs that are more common pression combined. Two sets of studies used the same sample
s of first onsets than recurrences. sohn et al., 1999, and Monroe et al., 1999; and Brilman &
2001, and Ormel et al., 2001). The combined results (pro
ysis author communication) were used so that one ES was used
sample. Four studies that met all other requirements were
ses were performed using SPSS macros designed for because nonsevere and severe SLEs were investigated togeth
across ESs and examining moderators (Lipsey & severity of included SLEs could not be ascertained). There
01). Mean weighted aggregate ESs were computed and unique studies in the final sample.
utions examined for homogeneity. A random-effects
adopted for computing the aggregate ES, and moder- Overall ES
fitted with mixed-effects models.
rse-variance-weighted one-way analogue to analysis of The unweighted and weighted ESs for each study are pre
NOVA) was used to investigate the categorical vari- Table 1. The proportion of first onsets preceded by severe SL
ator (patient status). Similar to an F ratio, the analogue was varied and ranged from .15 to .86. This was also tru
tests the variance among the ESs between categories proportion of recurrences preceded by severe SLEs ( pG2
ance among the ESs within categories. In the case of ranged from .10 to .92. The mean aggregate inverse-weighte
ects model, a moderator explaining some of the heter- .11, with a 95% confidence interval (.05, .17), assuming a
ll reduce heterogeneity within groups to nonsignifi- effects model, and was significantly different from 0 ( p ⬍
eas heterogeneity between groups will remain signif- credibility interval was ⫺.01 to .23. Variability of ESs
5
See all to
analogue › ANOVA Seeproduces
all › a separate inverse- significant (Q ⫽ 20.22, p ⬎ .05), with ESs ranging from
ighted Download
.33.6 The weighted standard citation of the
deviation Share
observed ESs Download full-text PDF
112 ES for each category
Citations of the moderator.
54 References
us variable moderators (age and gender) were analyzed and the true standard deviation of the population of ESs wa
modified weighted least squares regression analysis
each ES by the inverse of its variance) assuming a 5
Although the Q was not significant, the moderator variab
ts model. Each dimensional moderator analysis pro- tested, as Q is a crude measure of homogeneity, especially when
dardized regression coefficient that indicates the extent small number of studies (Lipsey & Wilson, 2001), and because h
e moderator explains heterogeneity in the model. concerning these moderators were made a priori.
6
When all studies were included that investigated nonsevere
Results severe SLEs together (or in which SLE severity could not be asc
the mean aggregate inverse-weighted ES was .09, with a 95% c
tudies interval (.00, .18), assuming a random-effects model, and was sig
different from 0 ( p ⬍ .05). The ESs were not homogeneous (Q
ature search yielded 28 potentially eligible studies that
p ⬍ .05), with ESs ranging from ⫺.38 to .41. In addition to the
ults for the stress– depression relationship for individuals presented in Table 1, this included the results of the followin
hout a history of depression. Five studies (three published studies: (a) Cassano et al. (1989), (b) Ghaziuddin, Ghaziuddin,
ublished dissertations) were excluded because the authors (1990), (c) Bruce (1997), and (d) Leskela et al. (2004). In this a
de the proportion of individuals who experienced an SLE 17 studies, patient status and age were significant moderators (
st onset and a recurrence and author communication did but gender was not significant.
Analyses cating that 11% more individuals in the first-onset group

the recurrence group experienced a severe SLE. Of co
modified weighted least squares regression was con- clinical significance of 11% is open to interpretation and
etermine whether age influenced the stress– depression that, although there is evidence for Post’s premise, it
across episodes. Assuming a mixed-effects model, age explain all of the variance in the stress– depression rela
ficant moderator, and the standardized regression co-
over time. Furthermore, support for the premise may
s significant (see Table 2; p ⬍ .05).7 As the mean age evidenced among certain groups of individuals or unde
le increased, the difference between the proportion of conditions.
experiencing a severe SLE prior to a first onset and the
of individuals experiencing a severe SLE prior to a
increased. That is, as mean age increased, there was Age May Affect the Stress–Depression Relationship
port for Post’s premise. Across Recurrences
A modified weighted least squares regression was
Post’s premise was supported to a greater extent as the m
to determine whether gender influenced the stress–
of the sample increased. As elaborated earlier, as the mea
elationship across episodes. Assuming a mixed-effects
the sample increases, the number of recurrent episodes
der was a significant moderator, and the standardized
enced by those in the recurrence group also likely i
oefficient was significant (see Table 2; p ⬍ .05). As
Indeed, in adult samples the recurrence group is most of
age of female participants in the sample increased, the
posed of individuals with multiple recurrences (e.g., fr
n the proportion of individuals experiencing a severe
⬍ 34 recurrences in the Kendler et al., 2000, sample), s
to a first onset versus the proportion of individuals
first onsets are compared to multiple recurrences. Conver
g a severe SLE prior to a recurrence decreased. That is,
recurrence group in adolescent samples is most often com
le included more female participants, it was less likely
individuals experiencing first recurrences (Lewinsohn et a
premise was supported.
such that first onsets are compared to first recurrences.
atus. Results of the patient status analysis are shown
pirical evidence for Post’s premise indicates that seve
An inverse-variance-weighted one-way analogue to
become less and less likely to precipitate successive rec
as performed to determine whether patient status influ-
(e.g., Post, 1992). Thus, as the mean age of the sample in
tress–depression relationship across episodes.
there will be a larger difference in the proportion of
g a mixed-effects model, patient status was a signifi-
preceded by severe SLEs for first onsets and recurrence
ator, QB(1) ⫽ 3.78, p ⫽ .05, and Q W was not significant
called the first-onset/recurrence differential).
As can be seen from Table 2, studies using patient
The results of this analysis highlight the need for futu
und that a greater proportion of individuals in the
with adults to investigate these questions in early recurr
roup experienced a precipitating severe SLE, whereas
depression (Monroe & Harkness, 2005) to ascertain whe
i l f d h f il l
g community
See all › samples found
See all › that fairly equal propor- moderates the stress–depression association across epi
ividuals in the first-onset and recurrence groups expe- whether this findingDownload citation
is an artifact of theShare
limitations inh Download full-text PDF
112 Citations
recipitating 54 References
severe SLE. In the community samples
combining individuals with multiple recurrences in a sing
eterogeneity was detected ( p ⬎ .05); ESs ranged from
5, and the credibility interval was ⫺.05 to .10. The
andard deviation of the observed ESs was .12, and the Gender May Affect the Stress–Depression Relation
d deviation of the population of ESs was .07. In the Across Recurrences
ples group, no heterogeneity was detected ( p ⬎ .05);
from .08 to .33, and the credibility interval was .04 to As the percentage of women increased in the sample (fr
ighted standard deviation of the observed ESs was .11, to 100%), it was less likely that Post’s premise would
standard deviation of the population of ESs was .06. ported. As noted earlier, research suggests that women a
likely than men to experience a severe SLE (Bebbingto
1988; cf. Maciejewski et al., 2001; Perris, 1984) or certain
Discussion
SLEs (Kendler, Thornton, & Prescott, 2001; Spangler et a
results provide support for Post’s (1992) premise. The Wagner & Compas, 1990) prior to episodes and prior
gate inverse-weighted ES of .11 was significant, indi- rences specifically (Sherrill et al., 1997; Spangler et al
Thus, because women experience greater rates of sever
these events may continue to have the opportunity to pr
episodes, decreasing the first-onset/recurrence differen
Moderator Analyses though it is beyond the scope of this analysis to di
between the proposed models underlying Post’s prem
Q(1) n QR ␤ explanation is consistent with the stress-sensitization mode
model, as individuals become sensitized to stress, lower
10.47*** 11 8.53 0.74***
6.33** 13 11.00 ⫺0.60** stress gain the capacity to trigger episodes (and increas
⫽ model heterogeneity; n ⫽ number of studies in analysis;

7
al heterogeneity; ␤ ⫽ standardized regression coefficient. The results of Mitchell, Parker, Gladstone, Wilhelm, and Aus
***
p ⬍ .01. were not included in the analysis, as they included age as a cov
Table 3
Categorical Moderator Analysis
Moderator QB df Group Group n ES 95% CI
Patient status 3.78 * 1 Patient 6 .16*** .07, .24

Community 5 .03 ⫺.08, .13
Note. QB ⫽ model heterogeneity; group n ⫽ number of studies in the group; ES ⫽ effect size; CI ⫽ confidence
interval.
*
p ⫽ .05. *** p ⬍ .01.
with which they do so), but severe SLEs continue to be impact of history of depression on this association rema
riggering episodes (Monroe & Harkness, 2005). In the evaluated. Further, the extent to which individuals are r
omy model, however, severe SLEs lose their impact in treatment in community samples is also unknown. Thus,
episodes, as episodes begin to occur autonomously esting avenue of future research is to elucidate whether
Harkness, 2005). Future work is needed to examine the treatment seeking affects the empirical work on Post’s p
ender differences on Post’s premise and the interaction
ferences with the mechanisms of stress sensitization Limitations and Strengths
utonomy.
This work has several limitations. First, only 13 stud
r Post’s Premise May Be Limited to Patient included in the meta-analysis due to (a) a small number o
investigating Post’s premise, (b) sample overlap, and (c)
ties in obtaining relevant data. The small number of studi
l i di id l lik l t i th l i th t b d B f thi th
samples,
See to
individualsSee
wereallmore
all a› first onset ›
likely to experience a the conclusions that can be drawn. Because of this, the
prior (supporting Post’s premise), particularly from theDownload
moderatorcitation
analyses, Share
should be view
112 Citations
community samples, 54 References equally likely to
individuals were tively. Second, not all factors known to influence the Download full-text PDF
a severe SLE prior to a recurrence and prior to a first depression relationship were included as moderators, as t
e are a number of possible explanations for this finding. number of included studies limited the number of modera
tent with concerns that depression in community sam- could be tested. Further, research on moderators of Post’s
ely distress (Bebbington et al., 1981; Coyne et al., is limited. As such, future research should further invest
ght be argued that Post’s premise was not supported in influence of social (e.g., Brown & Harris, 1978), biologi
samples because participants were not experiencing Kendler, Thornton, & Gardner, 2001), and cognitive (e.g.
ression. However, the majority of studies included in sohn et al., 1999) factors on Post’s premise in order to m
s used samples with interviewer-assessed diagnosable capture the etiological complexity of depression (Monroe
decreasing the plausibility of this explanation. ness, 2005). Third, this analysis could not differentiate bet
another potential difference between community and two underlying models of Post’s premise (i.e., the stress-a
ples is that the recurrence group of patient samples may and stress-sensitization models). Future research is neede
viduals with more episodes than the recurrence group regard (Monroe & Harkness, 2005). Finally, we were no
ity samples. This assertion is supported by the notion correct for study artifacts, such as measurement error. Be
sion in patient samples is characterized by a more this, diagnostic unreliability for current episodes (classify
se (Coyne et al., 2004). If true, there would be a larger depressed individuals as depressed) and past episodes (cl
ecurrence differential in patient samples (due to com- recurrences as first onsets) likely operated to decrease th
onsets to a larger average number of recurrences) than ES, and thus the present results may underestimate the su
tial in community samples (due to comparing first Post’s premise.
smaller average number of recurrences). This idea is Despite limitations, this meta-analysis succeeded in in
y research demonstrating that the proportion of epi- research on Post’s premise and avoiding potential method
ded by SLEs decreases as the episode number increases problems associated with the OR. The use of the pr
Gutierrez, & Lopez, 1987). This may make support for difference ES allowed the unification of research and its
ise more apparent in patient samples. This possibility ation, with all studies focusing on differences in proporti
the need for further research defining recurrence ac- than differential prediction. Although narrative reviews h
pisode number rather than combining individuals with ered this topic (Mazure, 1998; Monroe & Harkness, 2005
umber of past episodes into a single group (Monroe & knowledge this is the first meta-analysis to do so. In addi
005). meta-analysis extended previous reviews by testing potent
prominent concern with the use of patient samples is erators of the stress–depression association.
mples are potentially biased by treatment seeking (e.g., In conclusion, the results of this meta-analysis suppo
3). However, the extent to which this influences sup- premise: First episodes of depression were more like
t’s premise is unclear. Although limited research has precipitated by severe SLEs than were recurrences of de
he relationship between stress and treatment seeking Although the results of the moderator analyses should be
& Brown, 1982; Monroe, Simons, & Thase, 1991), the tentatively, these analyses suggest that support for the prem
ident in patient samples and may vary according to change in brain functioning resulting from daily electrical sti
ifference characteristics such as age and gender. Future Experimental Neurology, 25, 295–330.
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n model relating unemployment stress, spiritual intelligence, and mental health components: Mediators of
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etween distinct circadian manifestations of possible bruxism, perceived stress, chronotype and social jetlag
ndergraduate students
BIOL INT
skas · Ausra Baltrusaityte · Gaivilė Pileičikienė · Gediminas Zekonis
ve disorder (MDD) is the most common psychiatric disorder with a lifetime prevalence of approximately 14%
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for depression [8][9][10] [11] [12] . Genetic control of sensitivity to stress may vary between individuals, resulting
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· Erin Macdonald-Dunlop · M J Adams
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ences in the depressogenic effects of SLE, i.e., genotype-byenvironment interaction (GxE) 4,[13][14][15][16] . ...
vironment interaction studies of depressive symptoms and psychosocial stress in UK Biobank and
d
vailable
· Erin Macdonald-Dunlop · Mark J. Adams · Pippa Thomson
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nt associations between SLE and major depressive disorder (MDD) [1][2][3][4] [5] [6][7] . Some studies suggest
sity is present before the onset of illness in over 50% of individuals with depression 8 and may characterize a
9 . ...
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depressive or anxious symptoms or none. 30 A recent review found relatively large effects of maternal
oms on infant birth weight. ...
factors: A major predictor of anxiety and depression among pregnant women

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· Shafiq
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ealth Med
essie S. M. Chan · Xiaowen Ji · Celia Chan
ce of the impact of dog ownership and dog walking on mental health
alth
Davern · H Christian
rough a network analysis of residual depression and anxiety symptoms after cognitive behavioural therapy:
study
THER RES
Jaime Delgadillo · Stephen Kellett · Gary Brown
ression, emotion regulation, episodic memory, and hippocampal development
M PSYCHOL
Michael P Harms · Rebecca Tillman · Joan Luby
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Stress and Depression in First Onsets Versus Recurrences: A Meta-Analytic Review

Purple bacteria can turn h

atherine B Stroud Author content Download full-text PDF

mal Psychology Copyright 2008 by the American Psychologica

Keywords: kindling hypothesis, life stress, depression, meta-analysis, recurrence

STRESS AND DEPRESSION: A META-ANALYSIS

STROUD, DAVILA, AND MOYER

STRESS AND DEPRESSION: A META-ANALYSIS

Study N p G1 pG2 ES wES MA PF

(1998) 39 .857 .920 ⫺.063 ⫺.044 41.0 100.0

STROUD, DAVILA, AND MOYER

Analyses cating that 11% more individuals in the first-onset group

⫽ model heterogeneity; n ⫽ number of studies in analysis;

STRESS AND DEPRESSION: A META-ANALYSIS

Moderator QB df Group Group n ES 95% CI

Patient status 3.78 * 1 Patient 6 .16*** .07, .24

STROUD, DAVILA, AND MOYER

STRESS AND DEPRESSION: A META-ANALYSIS

· Erin Macdonald-Dunlop · M J Adams

· Erin Macdonald-Dunlop · Mark J. Adams · Pippa Thomson

iathesis-stress model for depression in Generation Scotland

· Mark J. Adams · Toni-Kim Clarke · Pippa Thomson

factors: A major predictor of anxiety and depression among pregnant women

ce of the impact of dog ownership and dog walking on mental health

ression, emotion regulation, episodic memory, and hippocampal development

Changes needed in the classification of depressive disorders: options for ICD-11

[In Process Citation].

Antidepressant drugs and the hypothalamic-pituitary-thyroid axis

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