Various impairments of the mind are commonly associated with old age. To what extent are these biological in origin? To what extent, social in origin?

Answer:

Timing and Course of Depression

Age of onset of major depression may have both clinical and etiological implications. Clinically, earlier age of onset is associated with a worse course of depression with greater chances of recurrence, chronicity, and impairment. Etiologically, first onset of depression at different ages (e.g., childhood, adolescent, adult, and older adult) may reflect somewhat different causal factors.

Many individuals may experience a single, major depressive episode following an acute stressor and recover with little implication for future vulnerability. However, most (50–80 percent) who have one significant episode will have recurrent episodes and intermittent subclinical symptoms, with the risk of recurrence progressively increasing with each episode of major depression.

Biological Factors

Genetic, neurological, hormonal, immunological, and neuroendocrinological mechanisms appear to play a role in the development of major depression, and many of these factors center around reactions to stressors and the processing of emotional information. Etiological processes may be modified by gender and developmental factors.

Environmental and Personal Vulnerabilities

Etiological models for depression are largely diathesis-stress models in which stressful experiences trigger depression in those who may be vulnerable due to biological and psychosocial characteristics and circumstances.

Environmental stressors associated with depression include acute life events, chronic stress, and childhood exposure to adversity. Personal vulnerabilities associated with depression include cognitive, interpersonal, and personality factors.

Biological, environmental, and personal vulnerabilities interact to contribute to the development of depression and also may be affected by depressive states in a bidirectional process.

Co-Occurring Disorders

Depression rarely occurs independent of other psychological disorders, including anxiety, substance abuse, behavioral, and personality disorders, as well as other medical illnesses. The presence of co-occurring psychological and medical disorders exacerbates the clinical and social consequences of depression, and makes it more challenging treating.

Resilience and Protective Factors

Certain biological, environmental, and personal factors have also been associated with the protection from or the overcoming of risk factors and adverse conditions related to the development of depression.

The purpose of this chapter is to review what is known or suspected about the causes of depression. Fundamentally, such depressive symptoms as sad mood, pessimism, and lethargy, are universal human experiences and are considered normal reactions to the struggles, disappointments, and losses of everyday life. However, for some individuals, the intensity and persistence of depressive symptoms are not typical, and a challenge for researchers has been to understand why some individuals experience marked and enduring depressive reactions and others do not. This chapter discusses some characteristics of individuals that may make them vulnerable, as well as the features of environments that are particularly likely to provoke depression. The chapter also emphasizes the interplay between persons and environments—the ways in which, for example, stressors may provoke depression but depression further influences social environments, often a vicious cycle that promotes chronic or recurrent depression. A further aspect of this bidirectional influence is the frequent co-occurrence of depression and other disorders, which may complicate its course and treatment. It is noted that some individuals are remarkably resilient in the face of adversity, and a further challenge to the field is to understand such processes.

The first topic to address is that not all depressions are alike; therefore, different etiological models and perspectives are likely to apply to different expressions of depressive disorder.

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