Aetiological factors
The aetiology of depressive disorder is multifacto-
rial [8]; risk factors may be divided into those that
predispose to (increase vulnerability to) and pre-
cipitate (lead to its development at a specific point
in time) a depressive episode. These influences
act through biochemical and psychological pro-
cesses. Once established, depressive episodes may
be prolonged by maintaining factors that treat-
ment approaches aim to alleviate. These risks are
described more fully in Table 30.1.
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Depression and suicidal behaviour in children and adolescents
Table 30.1
Aetiological factors for depressive disorders.
Risk factor
Evidence
Predisposing factors
Genetic factors
Greater genetic influence for adolescent than for childhood
depression
Children of depressed parents at greater risk
Twin studies — heritability 15—80% for depressive symptoms
Indirect genetic influences, e.g. increased risk of experiencing more
negative life events
Family environment
Low levels of parental warmth, high levels of hostility and conflict
are associated with increased depressive symptoms
Parental mental health problems impact on parenting, making it
more difficult to meet the child’s emotional needs and provide a
confiding relationship
Temperament/personality
Children who are slow to adapt to new experiences, socially
reticent, easily upset
Elevated levels of anxiety, high self-criticism and negative
attributional style — tendency to blame self rather than others
Early/chronic adversity
Poverty/social disadvantage
Physical,sexual or emotional abuse
Neurobiological factors
Underactivity of cerebral amine systems
Abnormalities in cortisol secretion
Functional and anatomical brain differences in depressed and
non-depressed young people
Precipitating factors
Stressful life events
Examples include losses (e.g. parental separation or bereavement),
disappointments and failures (e.g. peer problems, bullying,
academic difficulties, failing exams)
Maintaining factors
Persistent depressive
symptoms
Recognized as a risk factor for further depressive episodes
Psychosocial scars
Individuals may experience residual effects from a depressive
episode — ‘psychosocial scarring’, which increases the likelihood of
further episodes
Persistent
biological/cognitive
vulnerabilities
As above
Persistent adversity
Examples include family dysfunction, lack of a confiding
relationship with mother, poor peer relationships
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