Severity of stressful life events in first and subsequent episodes of depression: the relevance of depressive subtype

J Affect Disord. 2003 Feb;73(3):245-52. doi: 10.1016/s0165-0327(01)00479-7.


Background: Recent studies have reignited debate concerning the relationship between stressful life events and depressive subtypes, particularly in relation to first versus subsequent episodes.

Aims: To investigate the relationship between stressful life events and variably defined melancholic/non-melancholic depressive subtypes, and the import of such life events to first compared with subsequent episodes across those subtypes.

Method: Acute and chronic stressful life events were rated in 270 patients with DSM-IV Major Depressive episodes who were allocated to melancholic and non-melancholic groups separately as defined by DSM-III-R, DSM-IV, the Newcastle criteria and the CORE system.

Results: Severe stressful life events (both acute and chronic)-as defined by DSM-III-R axis IV-were more likely to occur prior to first rather than subsequent episodes, particularly for those with non-melancholic depression.

Limitations: Dependence or independence of life events was not assessed. Genetic vulnerability to depression was not determined. Life events in first and subsequent depressive episodes were compared cross-sectionally between groups, not prospectively in the same cohort of patients. There were no differences in the number of severe life events-as defined by clinician consensus-between the first and subsequent episodes.

Conclusions: These findings are consistent with other studies in suggesting an enhanced sensitisation of depressed patients to subsequent episodes of depression, but suggest that any such phenomenon is specific to non-melancholic depression, in comparison to one key previous study.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adjustment Disorders / classification
  • Adjustment Disorders / diagnosis*
  • Adjustment Disorders / psychology
  • Adult
  • Chronic Disease
  • Cohort Studies
  • Cross-Sectional Studies
  • Depressive Disorder / classification
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / psychology
  • Depressive Disorder, Major / classification
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / psychology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Life Change Events*
  • Male
  • Middle Aged
  • Prospective Studies
  • Recurrence
  • Risk Factors