Stress and depression can be a vicious cycle

A meta-analysis finds the established stress generation model applies not only to depression, but also other mental health disorders.

A recent quantitative meta-analysis, published in the Psychological Bulletin, concludes that those who suffer from mental disorders are more likely to find themselves in stressful situations of their own making.

The team, co-led by Angela Santee, a psychology graduate student at the University of Rochester, and Katerina Rnic, a postdoctoral fellow at the University of British Columbia, looked at 95 longitudinal studies, spanning over 38,000 study participants, and more than 30 years of research.

They found that psychopathology—such as mental illness or disorders, including depression—predicted dependent stressful life events (events that the person, at least in part, contributed to) more strongly than it predicted independent or fateful events.

The stress generation model

The meta-analysis bore out the stress generation model, developed in 1991 by University of California, Los Angeles, psychology professor Constance Hammen. According to the model, some people contribute more than others to the occurrence of dependent stressors—that is stressful life events that occur, at least in part, due to a person’s behavior or personal characteristics—such as relationship breakups, failing a class, or job loss because of conflict with a coworker. Conversely, according to the model, people do not influence independent stressors like fateful events that occur regardless of a person’s influence—such as the death of a loved one, or job loss due to an economic downturn.

While Hammen’s model had spawned plenty of research over the past three decades, the resulting literature had never been quantitatively summarized before.

“People with depression might be more likely to have arguments with others, or put off completing important tasks at work or home,” says Rnic. “This can lead to more stressors in their relationships, work, education, finances, health—all domains of life.”

Importantly, though, the team found that the theory of stress generation not only holds for people with depression but also across many other mental health disorders, such as anxiety, personality disorders, substance use, and childhood disruptive disorders.

The finding is crucial, the team argues, because it means that people have some agency over the stress they experience. To Santee, this degree of stress malleability could be a silver lining:

“It’s a powerful realization that some of the stressors we experience are within our control and so, theoretically, we can act to control how much stress we experience and the impact of that stress on us,” Santee says. “We all have the ability to shape our worlds.”

The meta-review’s findings include:

• There’s clear evidence of stress generation across a broad range of psychopathologies, with a significantly larger effect for dependent stress (caused by the person), rather than independent stress (fateful outside events).
• Stress generation effects were larger for people with depression than people with anxiety.
• While stress generation occurs across all mental disorders and demographic groups, the effects were strongest among children, adolescents, and young adults.
• The team found no differences in stress generation by gender, race, or geographic location, which indicates a universal phenomenon.
• Over time, dependent stress (caused by the person) worsened a person’s mental illness symptoms, possibly contributing to chronic psychopathology, such as chronic depression.
• Interventions seeking to prevent stress generation may lessen chronic psychopathology.
• Importantly, the new meta-analysis offers strong evidence that stress generation seems to act as a factor that maintains and feeds a person’s depression.

“This finding is crucial because the major reason that depression is such a burden on society is that it’s a recurrent and often chronic problem,” says Lisa Starr, a senior coauthor of the meta-analysis, an associate professor in the University of Rochester’s psychology department, and Santee’s advisor.

How can someone break this cycle?

Being able to target the self-perpetuating stress generation with specific interventions can lessen a person’s mental illness or psychological disorder. That’s why the researchers embarked on a second undertaking: trying to isolate the specific processes that contribute to, or protect against, the occurrence of life stress. Treatments that target stress generation could reduce “the personal and economic cost of mental disorders,” the team writes.

The result is a second meta-analysis, published in Clinical Psychology Review, which looked at both modifiable risk and protective factors in stress generation, incorporating the findings of 70 studies with a total of nearly 40,000 participants, and spanning more than 30 years of research.

Risk factors that predict stress generation over time are:

• Personal characteristics, traits, and behaviors commonly associated with mental disorders
• Ineffective interpersonal emotion regulation, such as excessively seeking reassurance from others or excessive co-rumination—that is, conversations with others that focus repetitively on one’s own stresses
• Repetitive negative thoughts, including excessive ruminating and worrying
• Excessive standards for oneself
• The tendency to withdraw or avoid challenging situations or social interactions

Addressing these risk factors in treatment approaches, the authors argue, may be crucial to breaking the vicious cycle of stress generation. Because a plethora of factors contribute to the generation of stress, a multi-pronged approach may be most effective. The team also found that preventive factors remained generally understudied.

Additional coauthors of the two meta-analyses are from the University of Rochester; the University of British Columbia; and the University of Western Ontario.

Source: University of Rochester

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