In modern psychiatry, it is considered that for the development of depression, as for most other mental disorders, the combined effect of three factors is required: biological, psychological and social ( O. Ergmann et al ., 1984; N. Bragina, T. Dobrokhotova 1988; Dinan T., 1994; Bardenstein L., 2000, etc.). This is a complex, so-called. ” Biopsychosocial ” model of the formation of depression ( Akimskal X., McKinney W., 1973, 1985).
According to this model, people biologically predisposed to depression in an unfavorable social situation, especially under chronic stress, show inconsistency in psychological adaptation mechanisms, lack of skills in coping with stress, or lack of coping strategies. Inadequate psychological defense mechanisms, in turn, have a destructive impact not only on psychological, but also on biological processes.
On the role of the biological factor in the development of the spectrum of depressive disorders indicates a high correlation between the family history, the amount of depression symptoms entirely during illness and the average number of relapses as its flow (Kessler F. et al., 1996). It is noted that various psychosomatic disorders are often found in relatives of patients with depression.
Heredity and familial burden of depression play an important role in susceptibility to this disease. For the first time, the assumption of the presence of a special “gene of depression” was expressed in the late 1980s, when a gene located on chromosome 11 was identified. This gene is associated with bipolar affective disorder. However, later it was discovered that the genetic component in depression and other mental disorders most often turns out to be identical. The impression was that, most likely, a predisposition to depression can be controlled by several genes. Geneticists have also shown that in people prone to depression, there are changes in the gene on the X chromosome associated with the human sex, as well as on the 4th chromosome.
The effect of heredity on the risk of developing depression is especially noticeable in the case of bipolar mental disorder. The risk of disease among direct relatives of people who suffer from bipolar depression was fifteen times higher than that of relatives of healthy people. Those who have relatives suffering from bipolar psychosis, the likelihood of a severe depressive episode is six times higher than in the absence of hereditary burden of bipolar disorder.
Unipolar depression is often found in families whose members suffer from either unipolar or bipolar depression.
If a close relative has suffered a severe depressive episode, then the likelihood of bipolar disorder or a depressive episode in other close relatives increases about twice.
If the father or mother suffers from bipolar depression, in 25% of cases the children of such parents will have one of the disorders of the depressive spectrum. In the presence of bipolar depression in both parents, the likelihood of depression in children already reaches 75%. Also in 75% of cases, depression develops in identical twins, if it was recorded in one of them. The latter fact does not necessarily indicate the significance of heredity in the genesis of depression, since the twins can be brought up under the same conditions.
Of interest is the fact that in individuals with a genetic predisposition to depression, the phenomenon of the deficiency of the function of glucocorticoid receptors of neurons occurs ( Model S. et al ., 1997). In other words, there is a deficiency of those nerve cells of the brain that are particularly sensitive to stress.
According to most scientists, gender does not affect the onset of depression and is not a biological risk factor for it. The key factors determining the predominance of women among patients with depression, in most cases, are social conditions.
In people whose body is biologically predisposed to depression, due to upbringing and other social environmental factors, personality features are formed, characterized by inadequate mechanisms of psychological defense.
From the point of view of 3. Freud, depression arises from the treatment of anger at himself. Hence its symptoms, such as self-accusation and self-blame, representing, in the opinion of psychoanalysts, anger displaced into the subconscious by other people. According to psychoanalysis, at the level of subconsciousness, persons prone to depression are formed with confidence in the absence of love on the part of parents.
- Freud (1926) suggested that the predisposition to depression is laid in early infancy. In clinical studies, it was established that the loss of a mother under the age of 11 years is one of the predictors of the likely occurrence of frequent depressive episodes in the future ( Angold A., 1988). Depressive patients have a significantly greater number of mental injuries (mainly, the loss of loved ones) within 6 months preceding the depressive episode ( M. Davidson , 1963). However, the role of the latter in the etiology of affective disorders remains not entirely clear (Borisova, OA, 1989).
The role of premorbid personality traits in the genesis of affective disorders also remains unclear . Some personality types — emotionally unstable, anxious (sensitive), and hysterical — are more susceptible to depression than the anankastic, schizoid, and paranoid (Anufriev AK, 1978; Bruder D., Stuart D., Tuwei D., 1992). The symptomatology of depression, apparently, is directly dependent on the premorbid personality structure, level of mental disorders and nosological affiliation of depression (Sinitsyn VN, 1976).
It has been observed that people prone to depression are characterized by self-doubt and isolation. They are prone to self-criticism, focused on support and help from the inner circle, are emotionally expressive, look at life with pessimism and do not cope with any stress situation.
There are three types of personality, especially prone to the development of depression. This is a “ static- personality”, distinguished by diligence, accuracy and exaggerated conscientiousness; personality of “melancholic type”, characterized by a desire for order, consistency, pedantry, increased demanding of themselves, good faith in the performance of the assigned work, and a “ hypothetical person” who has a tendency to lowered mood, anxiety, empathy, a feeling of insecurity in themselves and a sense of inadequacy.
Comparatively often, the psychological factor, especially contributing to the formation of depression, is the desire for excellence with high levels of aspirations, with a simultaneous tendency to underestimate self-esteem of their successes and achievements.
For people who are psychologically predisposed to depression, fairness is crucial, and therefore undeserved punishment can be a starting factor for the onset of depression.
Constant search for the meaning of life and the inability to find it, painful attitude to money as, perhaps, to the only means of receiving pleasure, the need for the support of other people, the desire to put their expectations into life, the explanation of their problems by external causes and blows of fate not depending on the person , inability to relax, stubbornness, self-love and pride, which impede recourse, a tendency to mysticism and religiosity are also those personality traits that favor the development of depression and.
Probably, for a person prone to depression, alexithymia is characteristic – the inability to express in words his feelings, as well as the difficulties that arise in the process of communicating with other people. This is noticeable especially when you need to get advice or share your problems with loved ones. An upset depressive spectrum disorder arises more easily in a person who does not receive adequate support from those people to whom he devoted a lot of time and attention and from whom, in turn, expected response feelings.
It should be noted that up to 50% of patients with borderline personality disorder (DSM-IV) have a concomitant diagnosis of severe depression or bipolar affective disorder.
The experience of depression should be characterized as a phenomenon of the man-environment system, that is, taking into account the influence of the social factor ( Coyne J., 1976; McCullough J., 1984, 1996).
Urbanization, acute and chronic stress, increase in life expectancy, population migration are distinguished as social factors contributing to the formation of depression ( Veltishchev D.Yu., 2000).
Experimental models of the formation of depression suggest that it most often develops in conditions of chronic stress (conflict in the family, at work, etc.) and attempts to cope with it using inadequate psychological defense mechanisms.
The most destructive for the body is a chronic stressful situation, less often – acute stress in young years. It was at this time that the need for independent living, a change in its stereotypes and the need to achieve goals for a certain period of time, appears. Weak control skills, most often formed as a result of increased parental care, in this case play the role of additional “harm”. Constant reproaches from parents, the tendency to blame a young person for any failures, frequent insults, expressively expressed remarks eventually form a feeling of helplessness and increase the likelihood of the risk of developing depression.
Persistent failures, repeated situations of stress are often caused by a distorted psychological attitude, and the expectation of another misfortune. Having failed to cope with one problem, a person loses a feeling of self-confidence, a feeling of helplessness, vulnerability to adverse external events and uselessness to resist them appears. With an external locus of control, when a person explains the cause of his misfortunes by external circumstances that go beyond his ability to control them, the risk of depression appears.
If a person, being in a chronic stressful situation, additionally suffers an acute mental trauma, the development of depression becomes a more likely event, since a prolonged state of stress probably sets the stage for the manifestation of an episode of depression. The early loss of one of the parents, divorce, experiences associated with a catastrophe or war, the loss of work and other difficult life situations can contribute to the occurrence of depressive spectrum disorders, revealing a predisposition to these conditions. Repeated stressful situations especially increase the predisposition to the occurrence of depressive spectrum disorders. More rarely, depression can manifest itself for the first time without the influence of stressful factors or even against the background of favorable events and a positive situation.
Unfavorable family situation, improper and distorted upbringing can predispose to depression. Frequent quarrels, accompanied by scandals, fights, mutual insults are a breeding ground for the development of depression. Physical violence, brutal upbringing, the presence of a mental disorder in one of the parents (in fact, it is a chronic stressful situation) contribute to the appearance of depression in adolescents. When there are frequent family quarrels, children are emotionally involved in the situation. A child accumulates negative memories, traumatic experiences, which further determines his emotional vulnerability, the tendency to interpret any situation in a special way that persists even when children grow up ( Lagerheim B., 2004). The inability to distance oneself from the emotions of others remains a kind of stigma for such children even at a later age.
Unhappy childhood contributes to the early onset of depression, which can debut at the age of 18-20 years. This circumstance is probably due to the fact that an unhappy childhood complicates the period of puberty and thereby affects the nervous and hormonal systems of the body.
Depressive spectrum disorders more easily occur during menopause, especially if it occurs during a stressful situation. Here we can note another environmental factor associated with increased care, protection of one person by another. If this protection disappears, for example, in case of a divorce, the second person is particularly sensitive to depression.
Despite the important role of stress in the genesis of depression, it remains unclear why her first episode is more sensitive to stress than subsequent ones, that in the case of bipolar depression, external factors have little effect on the onset of depression. With prolonged depression, it is difficult to determine what plays the main role in its occurrence – a stressful situation or a depression that precedes this situation.
According to the hypothesis of spontaneous sensitization, the first prolonged depressive episode, usually occurring after a prolonged psychological situation, leaves behind pronounced and persistent neurobiological changes in certain brain structures, especially in the limbic system, sensitize the human body to a recurrent depressive episode after minor stress or even spontaneously. Repeated depressive episode occurs much more easily in the same setting as the first one. Sometimes it is more pronounced and develops faster than the first. In the case of the development of bipolar depression, a repeated depressive episode may proceed as a double phase.