Psychosocial processes underlying the maintenance and persistence of depression: implications for understanding chronic depression

Clin Psychol Rev. 1999 Aug;19(5):553-70. doi: 10.1016/s0272-7358(98)00066-x.


The three major theoretical perspectives on the maintenance and persistence of depression in the psychological literature are reviewed. Cognitive theorists, such as Teasdale and Nolen-Hoeksema, focus on how a reciprocal relationship between depressed mood and the individual's processing of, and response to, their symptoms maintains and prolongs the duration of depressive episodes. Interpersonal theorists, such as Lewinsohn and Coyne, hypothesize that the depressed person's interpersonal behavior elicits negative reactions from the social environment, leading to a downward spiral of persistent depression. Finally, recent studies have indicated that individuals who experienced childhood adversity are more susceptible to a chronic course of depression. Although these three perspectives vary somewhat in the degree of support they have accumulated, each exhibits some promise for helping to elucidate the maintenance and persistence of depression. However, much of the available empirical literature suffers from a number of critical limitations, including the lack of clinical samples, longitudinal studies, and adequate attention to confounding variables, such as the severity and duration of depression at baseline and comorbid psychopathology. We conclude by suggesting a number of ways in which cognitive and interpersonal factors and early adversity may interact to maintain and prolong depressive episodes.

Publication types

  • Review

MeSH terms

  • Adaptation, Psychological*
  • Chronic Disease
  • Depression / etiology*
  • Depression / psychology*
  • Humans
  • Interpersonal Relations*
  • Life Change Events*
  • Models, Psychological
  • Reinforcement, Social*