Life stress and major depression: The mysteries of recurrences.
Abstract
Approximately half of the people who suffer a major depressive episode for the first time experience recurrences, while the other half do not. Among the initially depressed, however, who will have recurrences remains a mystery, and cannot be forecasted with any statistical or clinical confidence. It is well documented, though, that highly stressful life events commonly precede first episodes of major depression, and that these experiences become progressively less common prior to recurrences. Determining the basis for this consistent empirical observation holds promise for discovering among the initially depressed who will become recurrent, helping to solve the current-day conundrum of recurrences. The present article has 2 overarching objectives. First, we evaluate stress sensitization, the prevailing theory for explaining the decreasing association of major life events with successive recurrences. Conceptual gaps, discrepancies, and misunderstandings are found for understanding the decreasing association, as well as for understanding recurrences. Research practices and logical errors also are exposed that compromise the integrity of the existing empirical record. Second, alternative theoretical accounts are proposed to explain the decreasing association of major life stress with recurrences. Two "dual pathway models" provide viable alternative explanations, fill in existing theoretical gaps, and supply additional advantages for understanding life stress, depression, and recurrences. Recommendations are made for evaluating the 3 respective models. In closing, limitations and remaining questions are discussed for discovering who, early in the lifetime course of major depression, is likely to have a lifetime of repeated recurrences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Environmental factors are strongly associated with the risk of developing MDD and other stress-related disorders.
“Epidemiological studies indicate that environmental factors are strongly associated with the risk of developing MDD and other stress-related disorders.18–22”
From Epigenetic regulation in major depression and other stress-related disorders: molecular mechanisms, clinical relevance and therapeutic potential (2023) · cites this paper as [18]
Severe stressful life events frequently precede the onset of a first episode of MDD.
“severe stressful life events frequently precede the onset of a first episode of MDD150.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [150]
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“Together, these statistics suggest that the perception of stress may vary between students, despite being exposed to similar environmental challenges (Monroe et al., 2019).”
BackgroundSoberano, J. I. D., Siongco, K. L. L., Kabristante, E. I. A., Leyva, E. W. A., & Evangelista, L. S. (2021) · PubMed · Cited by 1 · see citing works
Rumination and psychological pain in depressed patients as Risk Factors for Suicide
Emara, A., Abdelraof, A. I., & Razek, R. A. A. (2023) · Assiut Scientific Nursing Journal · doi:10.21608/asnj.2023.243260.1698 · Cited by 1 · see citing works
Mathisen, J., Nguyen, T., Madsen, I. E. H., Xu, T., Jensen, J. H., Sørensen, J. K., Rugulies, R., & Rod, N. H. (2024) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796024000167 · Cited by 2 · see citing works
“These findings are in accordance with the stress sensitisation theory, the dominant theory of stress in recurrent depression, which posits that non-major stressors can trigger subsequent episodes (Monroe et al. , 2019).”
BackgroundResultWang, Y., Wei, S., Li, Y., & Jiang, X. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119980 · Cited by 1 · see citing works
Wong, S. M. Y., Chen, E. Y. H., Suen, Y. N., van Os, J., Jones, P. B., McGorry, P. D., Lam, T., Morgan, C., McDaid, D., Sham, P. C., et al. (2025) · Psychological Medicine · doi:10.1017/s0033291725102468 · Cited by 1 · see citing works
“Cognitive models of enduring depression have suggested that, whereas exter-nal factors might trigger the onset of depression, intrinsic vulnerabilities play a stronger role in its maintenance (Lewinsohn et al., 1999; Monroe et al., 2019; Teasdale, 1988).”
The Functional Domain of Self-Other Regulation
Lorenzini, N., Fonagy, P., & Luyten, P. (2021) · Depression and Personality Dysfunction · doi:10.1007/978-3-030-70699-9_4
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Widiger, T. A., & Cannon, T. D. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-cp-9-031513-100001
Amestoy, M. E., & Fiocco, A. J. (2024) · doi:10.32920/25569636.v1
Amestoy, M. E., & Fiocco, A. J. (2024) · doi:10.32920/25569636
Grogans, S. E., DeYoung, K. A., Hur, J., Anderson, A. S., Islam, S., Kim, H. C., Wedlock, J., Craig, L. E., Tillman, R. M., Das, S., et al. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.06.11.659182
“Our findings, which leveraged neuroimaging data from individuals who were free from internalizing disorders at baseline, weigh against this possibility.”
Depressive symptoms predict divergent trajectories of well-being in US adults
Lyman, C., Ong, A. D., & Rottenberg, J. A. (2026) · Nature Mental Health · doi:10.1038/s44220-026-00705-6
“By contrast, people whose symptoms began in response to addressable life stressors may be more likely to experience well-being turning points 51 .”
Adebahr, R., Savard, J., Åkerstedt, U., Byström, M., Sparre, C., Hadding, C., Öberg, K. G., & Jokinen, J. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1618162
“…are the basic hallmark of trauma-and stress-related disorders (e.g., acute stress disorder, adjustment disorder, and post-traumatic stress disorder) and have been associated with the onset of major depressive disorder and a risk of developing or relapsing in substance use disorders (20, 21).”
Ackerman, S. L., & Moore, M. T. (2026) · International Journal of Cognitive Behavioral Therapy · doi:10.1007/s41811-026-00277-4
“…group of individuals who will experience one episode of depression, only, in their lifetimes (i.e., the depression capable ) and a second group that will experience recurrent episodes (i.e., the recurrence prone ; see Monroe & Harkness, 2022, and Monroe et al., 2019 for more detailed reviews).”
Loneliness and social support mediate stress–depression in truck drivers
Zhang, J., Wang, S., Chen, S., Feng, C., & Liu, J. (2026) · Occupational Medicine · doi:10.1093/occmed/kqag013
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“Stress sensitization frameworks, therefore, caution against inferring sensitization from static between-person differences in vulnerability (Monroe et al., 2019; Stroud, 2020).”
InfluentialGiglberger, M., Henze, G., Bärtl, C., Peter, H. L., Konzok, J., Zänkert, S., Kirsch, P., Frank, J., Kudielka, B. M., Walter, H., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-9858017/v1
Jonassen, R., Øverli, Ø., Hilland, E., Nilsen, H. L., Esbensen, Q. Y., Lirussi, L., Heiberg, H., Rønning, K. H., Gorissen, M. E. E., Kraft, B., et al. (2026) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2026.100363
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- Authors
- Monroe, S. M., Anderson, S. F., & Harkness, K. L.
- Venue
- Psychological Review
- Published
- 2019-11
- Volume
- 126
- Issue
- 6
- Pages
- 791-816
- ISSN
- 0033-295X (ISSN-L)
- 1939-1471
- OpenAlex
- W2967472886
- Cited by
- 102
- References
- 0
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 15 · 2023: 14 · 2022: 8 · 2021: 22 · 2020: 10 · 2013: 1
- FWCI
- 11.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Review (publishedVersion)
- PubMed (publishedVersion)
- Funders
- John Simon Guggenheim Foundation
- William K. Warren Foundation
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- major depressive disorder, depression recurrence, life events, stress sensitization, dual-pathway model, first-episode depression
- MeSH terms
- Depressive Disorder, Major, Major Depressive Disorder, Humans, Models, Psychological, Psychological Theory, Stress, Psychological, Disease Progression
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