A number of other factors playa role in the development of major depression and other mood disorders. Age is one of them. Although there is virtually no age at which depression can not appear, major depression in women is at its highest prevalence between the ages of 18 and 44, with the average time of onset of about 25 years of age. In older people, the prevalence of the diagnosis of major depression declines, although clinically significant symptoms of depression that fall short of the total syndrome of major depression (i.e.
, minor depression or depression NOS) are still common. Race does not appear to be a factor in the prevalence of depression. Several studies have demonstrated that lower socioeconomic status is positively correlated with the development of depressive symptoms.
Marital Status Marital status is a risk factor for both major and minor depressionY Although married women have higher rates of depression than single women, some studies show that happily married women have lower rates of depression than single women. Stressful life events that are associated with marital status (e.g.
, death, divorce, domestic violence, sexual abuse, abortion, and miscarriage) also increase the risk of depression. Many women find themselves in caretaker roles, and assuming this role is a risk factor for the development of depression. Women caring for demented spouses or parents are at higher risk for depression. Mothers of children with attention deficit-hyperactivity disorder also have more symptoms of depression.
Family History and Experiences Family history and childhood experience are also risk factors for depression. There is an increased risk of depression among first-degree relatives of individuals with depression however, environmental factors likely contribute to this risk as well. Genetic transmission is more clearly established in bipolar disorder.
There is an increased risk of both bipolar disorder and major depression in first-degree relatives of persons with bipolar disorder. Among childhood influences, parental loss before the onset of adolescence clearly contributes to risk, as do major life events such as divorce and separation. Subtle influences, such as parental neglect, are more difficult to quantify in terms of their ability to affect the development of depression. Previous episodes of depression are a risk factor for future episodes, and increased vigilance is necessary in monitoring patients with a history of depression.
Fifty percent of people with a first episode of depression experience a second episode of depression within 5 years. Two previous episodes confer an 80 to 90 percent risk of subsequent depressive episodes. Physical Illness Finally, serious physical illness especially in the elderly, increases the risk of depression.
Depression can affect up to 50 percent of hospitalized patients, especially those with serious or life-threatening illnesses, such as stroke, trauma, myocardial infarction, and cancer. Some illnesses that disproportionately affect women are also known to increase the risk of depression. These illnesses include thyroid disease, multiple sclerosis, and systemic lupus erythematosus. Medications may also cause depression. Among the most common medications specifically known to cause depression are 3-blockers, corticosteroids, and most importantly in the case of women, progestin-containing contraceptives.
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