Interpersonal loss has long been regarded as central to depression. Interpersonal loss, social rejection, and depression We argue that while such changes can be adaptive, several factors may prolong these reactions, leading to sustained inflammatory processes that precipitate depression for vulnerable individuals.ġ. Our overarching goal is twofold: first, identify the attributes that make social rejection particularly depressogenic and second, propose a model to explain how rejection events elicit a distinct and integrated set of cognitive, emotional, and biological changes that may evoke depression. We focus on social rejection because rejection-related life events increase risk for depression to a greater degree than any other type of stress ( Kendler et al., 2003). The present review explores an instance of this stressor specificity by examining the psychobiology of social rejection and depression. This has occurred despite evidence that biological and behavioral responses may not in fact be uniform across stressors, but may be differentiated and specific ( Denson et al., 2009 Kemeny, 2003 Weiner, 1992). For example, very few studies have looked beyond stressor severity to investigate how the characteristics of different life events might predict clinical aspects of depression ( Hammen, 2005). This view is not uncommon but rather pervades the literature on stress and depression. A fundamental question along these lines is whether some life events increase risk for depression more than others and, if so, why? This question has been underappreciated in part because early theories postulated that organismic responses to stress are uniform and similar regardless of the eliciting condition (see Selye, 1956). At the same time, little is known about what makes particular stressors depressogenic. Given the consistency with which depression follows major life stress, there can be little doubt that such events play a role in bringing about at least some forms of depression. Major life events, therefore, are one of the best predictors of an impending onset of depression. Depressed individuals are 2.5- to 10-times more likely than nondepressed persons to have experienced a recent major life event ( Kendler et al., 1995 Shrout et al., 1989), and up to 82% of depressive episodes appear to be precipitated by such stress ( Mazure, 1998). Stressors of this type typically involve serious threats to an important relationship or job, or significant changes in health, housing, or financial status. Although many questions remain regarding its etiology, risk for the disorder substantially increases following an acute major life event ( Monroe et al., 2009). This response also may be moderated by several factors, including prior life stress, prior depression, and genes implicated in stress reactivity.ĭepression is a serious psychiatric condition that approximately 20% of people experience in their lifetime ( Kessler et al., 2010). Although these changes can be short-lived, sustained inflammation may occur via glucocorticoid resistance, catecholamines, sympathetic innervation of immune organs, and immune cell aging. Pro-inflammatory cytokines play an important role in this process because they induce a constellation of depressotypic behaviors called sickness behaviors. Downstream biological consequences include upregulation of the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, and inflammatory response. They also elicit negative self-referential cognitions (e.g., “I’m undesirable,” “Other people don’t like me”) and related self-conscious emotions (e.g., shame, humiliation). In this model, social rejection events activate brain regions involved in processing negative affect and rejection-related distress (e.g., anterior insula, dorsal anterior cingulate cortex). To account for this relation, we propose a psychobiological model in which rejection-related stressors elicit a distinct and integrated set of cognitive, emotional, and biological changes that may evoke depression. Major life events involving social rejection are strongly associated with onset of depression.
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