Psychosocial factors in the aetiology of unipolar depression

Author/s
Mina Ibrahimi, Lucia Coulter, Ravi Patel, Mark Agius
Citation
Issue 5 Winter 2018
CEPiP.2018.1.64-69
Abstract

Psychosocial factors are an important contributor to the aetiology of unipolar depression. This paper reviews the evidence for the contribution of different psychosocial factors and provides an overview of the proposed neurobiological mechanisms underlying the link between psychosocial factors and depression. Implicated psychosocial factors fall into three interrelated groups: life events, socioeconomic status and social support. The life events most strongly linked with depression are bereavement, childhood maltreatment, and disability or medical illness. Others include refugee status, workplace stressors, and obesity. Studies linking low socioeconomic status with depression are conflicting. There is strong evidence for an association between lack of social support and depression. Multiple neurobiological mechanisms linking psychosocial factors to depression have been suggested but evidence remains limited. The current evidence points to increased activity in the hypothalamo-pituitary axis, epigenetic modifications of key genes, and inflammatory processes, but other mechanisms being explored include reduced monoamine concentration, and structural changes to the limbic system, prefrontal cortex, cingulate cortex and hippocampus. There is overlap between these mechanisms.

Cite as: Cutting Edge Psychiatry in Practice 2018, 5(1):64-69; https://doi.org/10.65031/vuxq1015

References

  1. Sullivan PF, Neale MC, Kendler KS. Genetic epidemiology of major depression: review and meta-analysis. American Journal of Psychiatry. 2000 Oct 1;157(10):1552-62. https://doi.org/10.1176/appi.ajp.157.10.1552
  2. Bruce ML. Psychosocial risk factors for depressive disorders in late life. Biological Psychiatry. 2002 Aug 1;52(3):175-84. https://doi.org/10.1016/s0006-3223(02)01410-5
  3. Schaakxs R, Comijs HC, van der Mast RC, Schoevers RA, Beekman AT, Penninx BW. Risk factors for depression: differential across age? The American Journal of Geriatric Psychiatry. 2017 Sep 1;25(9):966-77. https://doi.org/10.1016/j.jagp.2017.04.004
  4. Florence C, Emmanuelle L, Florence BL, Mathilde H, Viviane KM. Bereavement-related depression: Did the changes induced by DSM-V make a difference? Results from a large population-based survey of French residents. Journal of Affective Disorders. 2015 Aug 15;182:82-90. https://doi.org/10.1016/j.jad.2016.09.009
  5. Bruce ML, Kim K, Leaf PJ, Jacobs S. Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample. The American Journal of Psychiatry. 1990 May 1;147(5):608. https://doi.org/10.1176/ajp.147.5.608
  6. Geerlings SW, Beekman AT, Deeg DJ, Van Tilburg W. Physical health and the onset and persistence of depression in older adults: an eight-wave prospective community-based study. Psychological Medicine. 2000 Mar;30(2):369- 80. https://doi.org/10.1017/s0033291799001890
  7. Li M, D'arcy C, Meng X. Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions. Psychological Medicine. 2016 Mar;46(4):717-30. https://doi.org/10.1017/s0033291715002743
  8. Cole MG, Dendukuri N. Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry. 2003 Jun 1;160(6):1147-56. https://doi.org/10.1176/appi.ajp.160.6.1147
  9. Aziz R, Steffens DC. What are the causes of late-life depression? Psychiatric Clinics. 2013 Dec 1;36(4):497-516. https://doi.org/10.1016/j.psc.2013.08.001
  10. Lindert J, von Ehrenstein OS, Priebe S, Mielck A, Brähler E. Depression and anxiety in labor migrants and refugees–a systematic review and meta-analysis. Social Science & Medicine. 2009 Jul 1;69(2):246-57. https://doi.org/10.1016/j.socscimed.2009.04.032
  11. Acarturk C, Cetinkaya M, Senay I, Gulen B, Aker T, Hinton D. Prevalence and predictors of posttraumatic stress and depression symptoms among Syrian refugees in a refugee camp. The Journal of Nervous and Mental Disease. 2018 Jan 1;206(1):40-5. https://doi.org/10.1097/nmd.0000000000000693
  12. Bonde JP. Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence. Occupational and Environmental Medicine. 2008 Apr 16. https://doi.org/10.1136/oem.2007.038430
  13. Pikhart H, Bobak M, Pajak A, Malyutina S, Kubinova R, Topor R, Sebakova H, Nikitin Y, Marmot M. Psychosocial factors at work and depression in three countries of Central and Eastern Europe. Social Science & Medicine. 2004 Apr 1;58(8):1475-82. https://doi.org/10.1016/s0277-9536(03)00350-2
  14. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry. 2010 Mar 1;67(3):220-9. https://doi.org/10.1001/archgenpsychiatry.2010.2
  15. Areán PA, Reynolds III CF. The impact of psychosocial factors on late-life depression. Biological Psychiatry. 2005 Aug 15;58(4):277-82. https://doi.org/10.1016/j.biopsych.2005.03.037
  16. Joinson C, Kounali D, Lewis G. Family socioeconomic position in early life and onset of depressive symptoms and depression: a prospective cohort study. Social Psychiatry and Psychiatric Epidemiology. 2017 Jan 1;52(1):95-103. https://doi.org/10.1007/s00127-016-1308-2
  17. Bruce ML, Hoff RA. Social and physical health risk factors for first-onset major depressive disorder in a community sample. Social Psychiatry and Psychiatric Epidemiology. 1994 Jul 1;29(4):165-71. https://doi.org/10.1007/bf00802013
  18. Hölzel L, Härter M, Reese C, Kriston L. Risk factors for chronic depression - a systematic review. Journal of Affective Disorders. 2011 Mar 1;129(1-3):1-3. https://doi.org/10.1016/j.jad.2010.03.025
  19. Vink D, Aartsen MJ, Schoevers RA. Risk factors for anxiety and depression in the elderly: a review. Journal of Affective Disorders. 2008 Feb 1;106(1-2):29-44. https://doi.org/10.1016/j.jad.2007.06.005
  20. Anisman H, Zaharia MD, Meaney MJ, Merali Z. Do early-life events permanently alter behavioral and hormonal responses to stressors? International Journal of Developmental Neuroscience. 1998 Jun 1;16(3-4):149-64. https://doi.org/10.1016/s0736-5748(98)00025-2
  21. Murgatroyd C, Patchev AV, Wu Y, Micale V, Bockmühl Y, Fischer D, Holsboer F, Wotjak CT, Almeida OF, Spengler D. Dynamic DNA methylation programs persistent adverse effects of early-life stress. Nature Neuroscience. 2009 Dec;12(12):1559. https://doi.org/10.1038/nn.2436
  22. Mirescu C, Peters JD, Gould E. Early life experience alters response of adult neurogenesis to stress. Nature Neuroscience. 2004 Aug;7(8):841. https://doi.org/10.1038/nn1290
  23. Wichers M, Schrijvers D, Geschwind N, Jacobs N, Myin-Germeys I, Thiery E, Derom C, Sabbe B, Peeters F, Delespaul P, Van Os J. Mechanisms of gene-environment interactions in depression: evidence that genes potentiate multiple sources of adversity. Psychological Medicine. 2009 Jul;39(7):1077-86. https://doi.org/10.1017/s0033291708004388
  24. Bakusic J, Schaufeli W, Claes S, Godderis L. Stress, burnout and depression: A systematic review on DNA methylation mechanisms. Journal of Psychosomatic Research. 2017 Jan 1;92:34-44. https://doi.org/10.1016/j.jpsychores.2016.11.005
  25. Provenzi L, Giorda R, Beri S, Montirosso R. SLC6A4 methylation as an epigenetic marker of life adversity exposures in humans: a systematic review of literature. Neuroscience & Biobehavioral Reviews. 2016 Dec 1;71:7-20. https://doi.org/10.1016/j.neubiorev.2016.08.021
  26. Swartz JR, Hariri AR, Williamson DE. An epigenetic mechanism links socioeconomic status to changes in depression-related brain function in high-risk adolescents. Molecular Psychiatry. 2017 Feb;22(2):209. https://doi.org/10.1038/mp.2016.82
  27. Beach SR, Dogan MV, Brody GH, Philibert RA. Differential impact of cumulative SES risk on methylation of protein–protein interaction pathways as a function of SLC6A4 genetic variation in African American young adults. Biological Psychology. 2014 Feb 1;96:28-34. https://doi.org/10.1016/j.biopsycho.2013.10.006
  28. Fuchikami M, Morinobu S, Segawa M, Okamoto Y, Yamawaki S, Ozaki N, Inoue T, Kusumi I, Koyama T, Tsuchiyama K, Terao T. DNA methylation profiles of the brain-derived neurotrophic factor (BDNF) gene as a potent diagnostic biomarker in major depression. PLOS One. 2011 Aug 30;6(8):e23881. https://doi.org/10.1371/journal.pone.0023881
  29. Witzmann SR, Turner JD, Mériaux SB, Meijer OC, Muller CP. Epigenetic regulation of the glucocorticoid receptor promoter 17 in adult rats. Epigenetics. 2012 Nov 13;7(11):1290-301. https://doi.org/10.4161/epi.22363
  30. Elliott E, Ezra-Nevo G, Regev L, Neufeld-Cohen A, Chen A. Resilience to social stress coincides with functional DNA methylation of the Crf gene in adult mice. Nature Neuroscience. 2010 Nov;13(11):1351. https://doi.org/10.1038/nn.2642
  31. MacKenzie EM, Odontiadis J, Le Mellédo JM, Prior TI, Baker GB. The relevance of neuroactive steroids in schizophrenia, depression, and anxiety disorders. Cellular and Molecular Neurobiology. 2007 Jul 1;27(5):541-74. https://doi.org/10.1007/s10571-006-9086-0
  32. Miller AH, Raison CL. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nature Reviews Immunology. 2016 Jan;16(1):22. https://doi.org/10.1038/nri.2015.5
  33. Cattaneo A, Macchi F, Plazzotta G, Veronica B, Bocchio-Chiavetto L, Riva MA, Pariante CM. Inflammation and neuronal plasticity: a link between childhood trauma and depression pathogenesis. Frontiers in Cellular Neuroscience. 2015 Mar 31;9:40. https://doi.org/10.3389/fncel.2015.00040
  34. Danese A, Moffitt TE, Pariante CM, Ambler A, Poulton R, Caspi A. Elevated inflammation levels in depressed adults with a history of childhood maltreatment. Archives of General Psychiatry. 2008 Apr 1;65(4):409-15. https://doi.org/10.1001/archpsyc.65.4.409
  35. Miller GE, Cole SW. Clustering of depression and inflammation in adolescents previously exposed to childhood adversity. Biological Psychiatry. 2012 Jul 1;72(1):34-40. https://doi.org/10.1016/j.biopsych.2012.02.034
  36. Magariños AM, Li CJ, Toth JG, Bath KG, Jing D, Lee FS, McEwen BS. Effect of brain‐derived neurotrophic factor haploinsufficiency on stress‐induced remodeling of hippocampal neurons. Hippocampus. 2011 Mar 1;21(3):253- 64. https://doi.org/10.1002/hipo.20744
  37. Teicher MH, Samson JA. Childhood maltreatment and psychopathology: A case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. American Journal of Psychiatry. 2013 Oct;170(10):1114-33. https://doi.org/10.1176/appi.ajp.2013.12070957
  38. Becker C, Zeau B, Rivat C, Blugeot A, Hamon M, Benoliel JJ. Repeated social defeat-induced depression-like behavioral and biological alterations in rats: involvement of cholecystokinin. Molecular Psychiatry. 2008 Dec;13(12):1079. https://doi.org/10.1038/sj.mp.4002097
  39. Husum H, Wörtwein G, Andersson W, Bolwig TG, Mathé AA. Gene–environment interaction affects substance P and neurokinin A in the entorhinal cortex and periaqueductal grey in a genetic animal model of depression: implications for the pathophysiology of depression. International Journal of Neuropsychopharmacology. 2008 Feb 1;11(1):93-101. https://doi.org/10.1017/s146114570700778x
  40. Leussis MP, Andersen SL. Is adolescence a sensitive period for depression? Behavioral and neuroanatomical findings from a social stress model. Synapse. 2008 Jan;62(1):22-30. https://doi.org/10.1002/syn.20462
  41. Babenko O, Golubov A, Ilnytskyy Y, Kovalchuk I, Metz GA. Genomic and epigenomic responses to chronic stress involve miRNA-mediated programming. PLOS One. 2012 Jan 24;7(1):e29441. https://doi.org/10.1371/journal.pone.0029441
  42. Suderman M, Borghol N, Pappas JJ, Pereira SM, Pembrey M, Hertzman C, Power C, Szyf M. Childhood abuse is associated with methylation of multiple loci in adult DNA. BMC Medical Genomics. 2014 Dec;7(1):13. https://doi.org/10.1186/1755-8794-7-13