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Am J Psychiatry 1993; 150:1139-1148
Copyright © 1993 by American Psychiatric Association
The prediction of major depression in women: toward an integrated etiologic model
KS Kendler, RC Kessler, MC Neale, AC Heath and LJ Eaves
Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond.
OBJECTIVE: The authors develop an exploratory, integrated etiologic model
for the prediction of episodes of major depression in an epidemiologic
sample of women. METHOD: Both members of 680 female- female twin pairs of
known zygosity from a population-based register were assessed three times
at greater than 1-year intervals. The last two assessments included a
structured interview evaluation for presence of episodes of major
depression, defined by DSM-III-R, in the preceding year. The final
structural equation model contained nine predictor variables: genetic
factors, parental warmth, childhood parental loss, lifetime traumas,
neuroticism, social support, past depressive episodes, recent difficulties,
and recent stressful life events. RESULTS: The best-fitting model predicted
50.1% of the variance in the liability to major depression. The strongest
predictors of this liability were, in descending order, 1) stressful life
events, 2) genetic factors, 3) previous history of major depression, and 4)
neuroticism. While 60% of the effect of genetic factors on the liability to
major depression was direct, the remaining 40% was indirect and mediated
largely by a history of prior depressive episodes, stressful life events,
lifetime traumas, and neuroticism. The model suggested that at least four
major and interacting risk factor domains are needed to understand the
etiology of major depression: traumatic experiences, genetic factors,
temperament, and interpersonal relations. CONCLUSIONS: Major depression is
a multifactorial disorder, and understanding its etiology will require the
rigorous integration of genetic, temperamental, and environmental risk
factors.
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