British Medical Bulletin 2001;57: 17–32 The British Council 2001 Recent developments in understanding the psychosocial aspects of depression

Recent advances in the psychosocial understanding of depression have elaborated an already complex aetiological model. Yet each new strand seems to echo, and forge links with, themes uncovered earlier, making it easier to see what is common about the ‘final common pathway ’ to onset. For example, although recent stressors have for some time been recognised predictors of onset, new insights about the origins of these stressors have overlapped with other new work on depression and childhood adversity to identify a group who ‘produce ’ their own severe life events in response to early negative experience. And recent studies have traced the well-known gender difference in depressive prevalence to differences both in gender role involvement with the provoking life events and in styles of support-seeking/ support-giving. What emerges is the powerlessness, loss and humiliation character-ising the final pathway. Both naturalistic studies and controlled trials suggest that psychosocial situations reflecting the opposite emotional meaning, that is new hope, characterise a similar pathway to remission. Conclusions speculate whether awareness of this pathway might enhance purely pharmacological treatment