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Introduction Since the 1960s there has been a large volume of systematic research on the role of life events in psychiatric disorder The life event literature now clearly indicates that the risk of depression is considerably increased following stressful life events Type of life event is only weakly related to type of disorder Those events which are more generally stressful are also more likely to produce disorder Some disorders are more strongly associated with life events than others Depression is one of these with the possible exception o bipolar disorder 1 The diathesis stress model shows that a wide range of psychological disorders result from the impact of an environmental event stressorstress factor on a person who had a predisposing vulnerability 2 Fig 1 Diathesis stress model 2 As the level of vulnerability increases the degree of stress needed to precipitate a disorder decreases Vulnerability is affected by biological and environmental factors Life events and onset of depression There is a large body of evidence showing that stressful life events are closely associated with the onset of major depressive episodes 3 4 5 Table 1 summarises findings of 27 retrospective controlled comparisons of psychiatrically treated depressed patients one employing two comparison groups 16 studies from 9 countries employed general population controls including two studies of elderly patients which were conducted by Murphy and Emmerson et al 67 All found more events reported prior to depressive onset although in one study with small numbers the difference was not significant One study conducted by Bebbington et al 8 found greater life events in depressed people in the community than in outpatients Table 1 Controlled comparisons of Life Events and Onset of Clinical Depression 1 Nature of ControlsAuthorExcess any EventsExcess SeparationsExcess Other Types of Events General PopulationPaykel et al 9 YesYesVarious especially undesirable events Thompson and Hendrie 10 YesNot reportedMore stress overall Cadoret et al 11SuggestiveSuggestiveNot
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