In modern psychiatry, it is considered that the development of depression, like most other mental disorders, requires the combined effect of three factors: biological, psychological and social (O. Ergmann et al., 1984; Bragina NN, Dobrokhotova TA. 1988 ; Dinan T., 1994; Bardenstein L., 2000, etc.). This is a complex, so-called. “Biopsychosocial” model of the formation of depression (Akimskal X., McKinney W., 1973, 1985).
According to this model, people biologically predisposed to depression in an unfavorable social situation, especially under chronic stress, show inconsistency in psychological adaptation mechanisms, lack of skills in coping with stress, or the absence of “coping strategies.” Inadequate psychological defense mechanisms, in turn, have a destructive impact not only on psychological, but also on biological processes.
Biological factor
Heredity
The role of the biological factor in the development of depressive spectrum disorders is indicated by a high correlation between hereditary burden, the number of symptoms of depression during the illness and the average number of relapses as it progresses (Kessler R. et al., 1996). It was noted that various psychosomatic disorders are often found in relatives of patients with depression.
Heredity and familial burden of depression play an important role in susceptibility to this disease. For the first time, the assumption of the presence of a special “gene of depression” was made in the late 80s of the 20th century, when a gene located on chromosome 11 was identified. This gene is associated with bipolar affective disorder. However, later it was discovered that the genetic component in depression and other mental disorders most often turns out to be identical. The impression was that, most likely, a predisposition to depression can be controlled by several genes. Genetics have also shown that in people prone to depression, there are changes in the gene on the X chromosome associated with the human sex, as well as on the 4th chromosome.
The effect of heredity on the risk of developing depression is especially noticeable in the case of bipolar mental disorder. The risk of disease among direct relatives of people who suffer from bipolar depression was fifteen times higher than that of relatives of healthy people. Those who have relatives suffering from bipolar psychosis, the likelihood of a severe depressive episode is six times higher than in the absence of hereditary burden of bipolar disorder.
The effect of heredity on the risk of developing depression is especially noticeable in the case of bipolar mental disorder. The risk of disease among direct relatives of people who suffer from bipolar depression was fifteen times higher than that of relatives of healthy people. Those who have relatives suffering from bipolar psychosis, the likelihood of a severe depressive episode is six times higher than in the absence of hereditary burden of bipolar disorder.
Unipolar depression is often found in families whose members suffer from either unipolar or bipolar depression. If a close relative has suffered a severe depressive episode, then the likelihood of bipolar disorder or a depressive episode in other close relatives is about doubled.
If the father or mother suffers from bipolar depression, in 25% of cases Children of these parents will have one of the disorders of the depressive spectrum. In the presence of bipolar depression in both parents, the likelihood of depression in children already reaches 75%. Also in 75% of cases, depression develops in identical twins, if it was recorded in one of them. The latter fact does not necessarily indicate the significance of heredity in the genesis of depression, since the twins can be brought up in the same conditions. Of interest is the fact that in individuals with a genetic predisposition to depression, the phenomenon of the deficiency of the function of glucocorticoid receptors of neurons occurs (Model S. and so aut., 1997). In other words, there is a deficiency of those nerve cells of the brain that are particularly sensitive to stress.
Gender
According to most scientists, gender does not affect the onset of depression and is not a biological risk factor for it. The key factors determining the predominance of women among patients with depression, in most cases, are social conditions.
Psychological factor
In people whose organism is biologically predisposed to depression, due to the upbringing and other social environmental factors, personality characteristics are formed, characterized by inadequate mechanisms of psychological defense.
From the point of view of 3. Freud, depression arises from the treatment of anger at himself. Hence its symptoms, such as self-accusation and self-blame, which, in the opinion of psychoanalysts, represent anger displaced in the subconscious by other people. According to psychoanalysis, at the level of subconsciousness, persons prone to depression are formed with confidence in the absence of love on the part of parents.
Freud (1926) suggested that the predisposition to depression is laid in early infancy. In clinical studies, it was established that the loss of a mother under the age of 11 years is one of the predictors of the likely occurrence of frequent depressive episodes in the future (Angold A., 1988). Depressive patients have a significantly greater number of mental injuries (mainly, the loss of loved ones) within 6 months preceding the depressive episode (M. Davidson, 1963). However, the role of the latter in the etiology of affective disorders remains not entirely clear (Borisova, OA, 1989).
The role of premorbid personality traits in the genesis of affective disorders also remains unclear. Some personality types — emotionally unstable, anxious (sensitive), hysteroid — are more susceptible to depression than ananastical, schizoid, and paranoid (Anufriev AK, 1978; Bruder D., Stuart D., Tuwei D., 1992). The symptomatology of depression, apparently, is directly dependent on the premorbid personality structure, the level of mental disorders and the nosological affiliation of depression (Sinitsyn VN, 1976).
It has been observed that people prone to depression are characterized by self-doubt and isolation. They are prone to self-criticism, focused on support and help from the inner circle, are emotionally expressive, look at life with pessimism and do not cope with any stress situation.
There are three types of personality, especially those prone to the development of depression. This is a “static-personality”, distinguished by diligence, accuracy and exaggerated conscientiousness; personality of “melancholic type”, characterized by a desire for order, consistency, pedantry, increased demanding of themselves, good faith in the performance of their assigned work, and a “hypothetical person” who has a tendency to lower mood, anxiety, empathy, a feeling of insecurity in themselves and a sense of inadequacy . Comparatively often, the psychological factor, especially contributing to the formation of depression, is the desire for excellence with high levels of aspirations, with a simultaneous tendency toward low self-esteem of their successes and achievements.
For people who are psychologically predisposed to depression, equity is crucial, and therefore undeserved punishment can be a starting factor for the onset of depression.
Constant search for the meaning of life and inability to find it, painful attitude to money as, perhaps, to the only means of receiving pleasure, the need for the support of other people, the desire to realize their expectations, explanation of their problems by external causes and blows of fate that are not dependent on the person inability to relax, stubbornness, self-love and pride, which impede recourse to help, a tendency to mysticism and religiosity are also those personality traits that favor the development of depression.
Probably, a person who is prone to depression is characterized by alexithymia – the inability to express in words his feelings, as well as the difficulties that arise in the process of communicating with other people. This is noticeable especially when you need to get advice or share your problems with loved ones. The depressive spectrum disorder arises more easily in a person who does not receive adequate support from those people to whom he devoted a lot of time and attention and from whom, in turn, expected response feelings. It should be noted that up to 50% of patients with borderline personality disorder (DSM-IV) have a concomitant diagnosis of severe depression or bipolar affective disorder.