Encyclopedia of Sociology Vol

Auty (1993) and Khalil and Mansour (1993) suggest that competition between export sectors such as minerals, oil, and agriculture often impedes prosperity of the other two or one another. In countries where that occurs, governments tend to adopt lax economic policies that, for example, increase agricultural dependencies in favor of oil exports. Internal conflicts then become self-per- petuating and play out in the physical and economic well-being of the populace. Some investigators also point out that the internal dynamics of different types of export commodities will have differential impacts on the economy as a whole and on state bureaucracies as differing degrees of infrastructure are implicated (Talbot 1998).

A number of critics have asserted that dependency theory is flawed, fuzzy, and unable to withstand empirical scrutiny (Peckenham 1992; Ake 1988; Becker 1983). Even Marxist theorists find fault with dependency theory for overemphasizing external, exploitative factors at the expense of attention to the role of local elite (Shannon 1996). Other critics have focused on the evidence mustered and suggested that only about one-third of the variance in inequality among nations is accounted for by penetration of multinational corporations or other forms of foreign investment

(Kohli et al. 1984; Bornschier, Chase-Dunn, and Rubinson 1978). Interestingly, still others have concluded that economic development of the type being discussed here is a significant facilitator for political democracy (Bollen 1983).

Defenders react by challenging measures of operationalization, the way variables are defined, and whether the complex of concepts embraced by the multidimensionality of the notion of dependency can be assessed in customary ways or in the absence of a comparative framework juxtaposing developing nations with their industrial counterparts (Ragin 1983; Robinson and Holtzman 1982; Boyce 1993). Efforts to isolate commodity concentration and multinational corporate investments have not proven to be reliable indicators and, as noted, even per capita GDP has its detractors. While important questions on heterogeneity, dispersion, or heteroskedasticity can be addressed by slope differences and recognized estimation techniques (Delacroix and Ragin 1978), proponents of the model are adamant that contextualized historical analysis is not only appropriate but mandated by the logic of dependency itself (Bach

1977; Bertocchi and Canova 1996). In their investigation of former colonies in Africa, Bertocchi and

Canova (1996) concluded that colonial status is central to explaining relatively poor economic performance in ensuing years.

Proponents have also turned to sophisticated statistical procedures to elucidate their claims. For example, Bertocchi and Canova (1996) ran regression models on forty-six former colonies and dependencies in Africa to test their contention that colonialization makes a difference in subsequent societal and economic well-being. In a separate examination of state size and debt size among

African nations, Bradshaw and Tshandu (1990) concluded that international capital penetration in the face of a mounting debt crisis may precipitate antagonism and austerity measures as the IMF and foreign capital debt claims are pitted against local claimants such as governmental subsidies and wages. In discussing capital penetration and the debt crises facing many developing nations, Bradshaw and Huang (1991) attributed incidences of political turmoil to austerity measures imposed on domestic welfare programs by IMF conditions and transnational financial institutions. They went on to assert that dependency theorists must take into consideration international recessions and global monetary crises if they are to understand structural accommodations and shifts in the quality of life in developing nations. In light of interlocking monetary policies, a single country teetering on the brink of economic adversity portends consequences for not only its trading partners but many other countries as well.

Several dependency analysts have utilized advanced analytic techniques to examine whether income inequality within countries is related to status in the world economy (Rubinson 1976; London and Robinson 1989; Boyce 1993). Both Rubinson (1976) and London and Robinson (1989) looked at interlocking world economies and their affect on governmental bureaucracies and internal structural differentiation. London and Robinson (1989) noted that the extent of multinational corporate penetration, and indirectly, its affect on income inequality, is associated with political malaise. Walton and Ragin (1990) concurred, maintaining that the involvement of international economic interests in domestic political-economic policy combine with ‘‘overurbanization’’ and associated dependency to help pave the way to political protest.

Boswell and Dixon (1990) carried the analysis a step further. Using regression and path analysis, they examined both economic and military dependency, concluding that both forms contribute to political instability through their effects on domestic class and state structures. They asserted that corporate penetration impedes real growth while exacerbating inequalities and the type of class polarization that leads to political violence. In his analysis of the economic shambles created in the Philippines under Ferdinand Marcos, Boyce

(1993) concluded that the development strategies adopted during the Marcos era were economically disastrous for the bulk of the populace as ‘‘imperfections’’ in world markets precluded even modest capital accumulation for all but a privileged few.

Though not speaking strictly in terms of dependency theory, Milner and Keohane (1996) point out that domestic policies are inevitably affected by global economic currents insofar as new policy preferences and coalitions are created as a result, by triggering domestic political and economic crises or by the undermining of governmental autonomy and thereby control over local economic policy. Dependency theorists customarily incorporate attention to all three in addressing the role international markets play in local economic policy.

Alternative interpretations of underdevelopment began to gain strength in the early 1970s. The next step was a world systems perspective, which saw global unity accompanied by an international division of labor with corresponding political alignments. Wallerstein (1974), Chirot and Hall (1982), and others shifted the focus from spatial definitions of nation-states as the unit of analysis to corporate actors as the most significant players able to shape activities—including the export of capital—according to their own interests. Wallerstein suggested that the most powerful countries of the world constitute a de facto collective core that disperses productive activities so that dependent industrialization is an extension of what had previously been geographically localized divisions of labor. World systems analysts see multinational corporations rather than nation-states as the means by which articulation of global economic arrangements is maintained. So powerful have multinationals become that even the costs of corporate organization are borne by those countries in which the corporations do business, with costs calculated according to terms dictated by the multinational

corporations themselves. Yet state participation is undoubtedly necessary as a kind of subsidization of multinational corporate interests and as a means for providing local management that, in addition to facilitating political compliance and other functions, promotes capital concentration for more efficient marketing and the maintenance of demand for existing goods and services. Thus production, consumption, and political ideologies are transplanted globally, legitimated, and yield a thoroughgoing stratification that, while it cuts across national boundaries, always creates precedence at the local level.

Dependency theory and collateral notions have become dispositional concepts utilized by numerous investigations of the effect of dependent development on diverse dimensions of inequality. Using a liberal interpretation of the model, many investigators have sought to understand how political economy affects values, types of rationality, definitions of efficiency and so on, as well as evaluations of those who do not share those values, views, or competencies. The social organization of the marketplace is thus thought to exert suzerainty over many types of social relationships and will continue to drive analysis of internal disparities in underdeveloped regions (Zeitlin 1972; Hechter 1975; Ward 1990; Shen and Williamson 1997). It remains to be seen how the absence of Soviet influence, often underemphasized during the formative period of dependency theory, will play out in analyses of international economic development in the twenty-first century (Pai 1991).

Substituting a figurative, symbolic relationship for spatial criteria, a generalized dependency model alloyed ideas of internal colonialism and has been widely employed as an explanatory framework wherein social and psychological distance from the center of power is seen as a factor in shaping well-being and other aspects of quality of life such as school enrollment, labor force participation, social insurance programs, longevity and so on. Likely as not, the political economics of development will continue to inform analysis of ancillary spheres for some time to come.

Gamson’s (1968) concept of ‘‘stable unrepresentation’’ helped emphasize how the politics of inequality are perpetuated by real or emblematic core complexes. Internal colonialism and

political economic variants have been widely adopted in examinations of many types of social problems. Blauner’s (1970) analysis of American racial problems is illustrative of one such application. So too is Marshall’s (1985) investigation of patterns of industrialization, investment debt, and export dependency on the status of women in sixty lessdeveloped countries. While she was unable to draw firm conclusions relative to dependency per se, Marshall did assert that with thoughtful specification, gender patterns in employment and education may be found to be associated with dependen- cy-based economic change. In a manner similar to

Blauner, Townsend (1981) spoke of ‘‘the structured dependency of the elderly’’ as a consequence of economic utility in advanced industrial societies. Many analysts have advocated the use of dependency-driven approaches to examine various consequences of dependency and development such as fertility, mortality, differential life expectancy, health patterns, and education (Hendricks 1982, 1995; Neysmith and Edwardth 1984;

London 1988; Ward 1990; Lena and London 1993;

Shen and Williamson 1997). Such a perspective casts the situation of the elderly as a consequence of shifts in economic relationships and state policies designed to provide for their needs. For example, Neysmith (1991) maintained that as debts are refinanced to retain foreign capital, domestic policies are rewritten in such a way as to disenfranchise vulnerable populations within those countries in favor of debt service. To support her point,

Neysmith cites a United Nations finding that human development programs tend to benefit males, households in urban areas, and middleor higherincome people, while relatively fewer are targeted at women, rural residents, or low-income persons

(United Nations Department of International Economic and Social Affairs 1988). Interestingly, according to a United Nations report issued two decades ago, women account for approximately half the world’s adult population, one-third of the formal labor force, and two-thirds of all the recorded work hours, yet receive one-tenth of the earned income (cited in Tiano 1988; Ward 1990). In an examination of capital penetration in eighty-six countries, Shen and Williamson (1997) suggest that as penetration increases and sectorial inequalities are exacerbated between tertiary and informal labor markets vis-à-vis other sectors, there is a degradation of women’s status in all economic activities. At the same time, fertility rates remain

high partly because child labor provides an integral component of household income.

Variation in the life experiences of subpopulations is one of the enduring themes of sociology. Despite wide disparities, a central focus has been the interconnections of societal arrangements and political, economic, and individual circumstances. It is through them that norms of reciprocity and distributive justice are fostered and shared. As contexts change, so too will norms of what is appropriate. The linkage between political and moral economies is nowhere more apparent than in dependency theory as it facilitates our understanding of the dynamic relationship between individuals and structural arrangements.

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JON HENDRICKS

DEPRESSION

INTRODUCTION

Semyonov, Moshe, and Noah Lewin-Epstein 1986 ‘‘Economic Development, Investment Dependence, and the Rise of Services in Less Developed Nations.’’

Social Forces 64:582–598.

The term ‘‘depression’’ covers a wide range of thoughts, behaviors, and feelings. It is also one of the most commonly used terms to describe a wide range of negative moods. In fact there are many

types of depression, each of which vary in the number of symptoms, their severity, and persistence. The prevalence of depression is surprisingly high. Between 5 and 12 percent of men and 10 to

20 percent of women in the United States will suffer from a major depressive episode at some time in their lives. Approximately half of these individuals will become depressed more than once, and up to 10 percent will experience manic phases where they are elated and excited, in addition to depressive ones; an illness known as ‘‘manic-de- pressive’’ or bipolar disorder. Depression can involve the body, mood, thoughts, and many aspects of life. It affects the way people eat and sleep, the way they feel about themselves, and the way they think about things. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

TYPES OF DEPRESSION

Depression can be experienced for either a short period of time or can extend for years. It can range from causing only minor discomfort, to completely mentally and physically crippling the individual. The former case of short-term, mild depression is what is most commonly referred to as ‘‘the blues’’ or when people report ‘‘feeling low.’’ It is technically referred to as dysphoric mood. Feelings of depression tend to occur in almost all individuals at some point in their lives, and dsyphoric mood has been associated with many key life events varying from minor to major life transitions (e.g., graduation, pregnancy, the death of a loved one). The feelings of separation and loss associated with leaving a town one has grown up in, moving to a new city for a job or school, or even leaving a work environment that one has grown accustomed to, can cause bouts of depression signaled by a loss of motivation and energy, and sadness. Other common features of dysphoric mood, include sighing, an empty feeling in the stomach, and muscular weakness, are also associated with changes such as the breakup of a dating relationship, divorce, or separation. In the case of bereavement, most survivors experience a dysphoric mood that is usually called grief (although some studies have shown that these feelings may be distinct from depression).

Many of these feelings are seen as representing the body’s short-term response to stress. Other

kinds of stressful events like losing a job; being rejected by a lover; being unable to pay the rent or having high debts; or losing everything in a fire, earthquake, or flood; may also bring on feelings of depression. Most of these feelings based on temporary situations are perfectly normal and tend to fade away.

A more severe type of depression than dysphoric mood, dysthymia (from the Greek word for defective or diseased mood), involves long-term, chronic symptoms that do not disable, but keep those individuals from functioning at their best or from feeling good. People with dysthymia tend to be depressed most of the day, more days than not, based on their own description or the description of others. Dysthymics have a least two of the following symptoms: eating problems, sleeping problems, tiredness and concentration problems, low opinions of themselves, and feelings of hopelessness. Unlike major depression, dysthymics can be of any age. Often people with dysthymia also experience major depressive episodes.

If ‘‘the blues’’ persist, it is more indicative of major depression, also referred to as clinical depression or a depressive disorder. Major depression is manifested by a combination of symptoms that interfere with the ability to work, sleep, eat, and enjoy once-pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime. Clinical practitioners (both clinical psychologists and psychiatrists) make use of a multiple-component classification system designed to summarize the diverse information relevant to an individual case rather than to just provide a single label. Using a specified set of criteria in the Diagnostic and Statistical Manual of Mental Disorders (referred to as DSM-IV, American Psychiatric Association 1994), a diagnosis of depressive disorder includes symptoms such as dissatisfaction and anxiety; changes in appetite, sleep, and psychological and motor functions; loss of interest and energy; feelings of guilt; thoughts of death; and diminished concentration. It is important to keep in mind that many of these symptoms are also reported by individuals who are not diagnosed with clinical depression. Only having many of these symptoms at any one time qualifies as depression. An individual is said to be experiencing a ‘‘major depressive episode’’ if he or she experiences a depressed mood or a loss of interest

or pleasure in almost all activities and exhibits at least four other symptoms from the following list: marked weight loss or gain when not dieting, constant sleeping problems, agitated or greatly slowed-down behavior, fatigue, inability to think clearly, feelings of worthlessness, and frequent thoughts about death or suicide. Anyone experiencing these symptoms for a prolonged period of time should see a doctor or psychiatrist immediately.

Another type of depression is bipolar disorder, formerly called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder involves interspersed periods of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, individuals have any or all of the symptoms of a depressive disorder. When in the manic cycle, individuals tend to show inappropriate elation, social behavior, and irritability; have disconnected and racing thoughts; experience severe insomnia and increased sexual appetite; talk uncontrollably; have grandiose notions; and demonstrate a marked increase in energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when an individual is in a manic phase. Bipolar disorder is often a chronic condition. For more details on types of depression, including symptoms, see either a good textbook on abnormal psychology (e.g., Sarason and Sarason 1999), DSM-IV (American Psychiatric Association 1994) or use the search term ‘‘depression’’ on the web site for the National Institute of Health (http://search.info.nih.gov/).

THEORIES OF DEPRESSION

Most theorists agree that depression can be best studied using what health psychologists refer to as a biopsychosocial approach. This holds that depression has a biological component (including genetic links and biochemical imbalances), a psychological component (including how people think, feel, and behave), and a social component (including family and societal pressures and cultural factors). Individual theories have tended to emphasize one or the other of these components. The main theories of depression are biological and

cognitive in nature, although there are also psychodynamic and behavioral explanations which are discussed below.

Psychodynamic Theories of Depression. The psychological study of depression was essentially begun by Sigmund Freud and Karl Abraham, a German physician. Both described depression as a complex reaction to the loss of a loved person or thing. This loss could be real or imagined, through death, separation, or rejection. For Abraham (1911/ 1968), individuals who are vulnerable to depression experience a marked ambivalence toward people, with positive and negative feelings alternating and blocking the expression of the other. These feelings were seen to be the result of early and repeated disappointments. Depression, or melancholy, as Freud called it, was grief out of control

(Freud 1917/1957). Unlike those in mourning, however, depressed persons appeared to be more self-denigrating and lacking self-esteem. Freud theorized that the anger and disappointment that had previously been directed toward the lost person or thing was internalized, leading to a loss of selfesteem and a tendency to engage in self-criticism. Theorists who used a similar approach and modified Freud’s theories for depression were Sandot Rado and Melanie Klein, and most recently John Bowlby (1988).

Behavioral Theories of Depression. In contrast to a focus on early-childhood experiences and internal psychological processes, behavioral theories attempt to explain depression in terms of responses to stimuli and the overgeneralization of these responses. For example, loss of interest to a wide range of activities (food, sex, etc.) in response to a specific situation (e.g., loss of a job). The basic idea is that if a behavior is followed or accompanied by something good (a reward), the behavior will increase and persist. If the reward is taken away, lessened, or worse still, if the behavior is punished, the behavior will lessen or disappear. B. F. Skinner, a key figure in the behaviorist movement, postulated that depression was the result of a weakening of behavior due to the interruption of an established sequence of behavior that had been positively reinforced by the social environment. For example, the loss of a job would stop a lot of the activities that having a salary provides (e.g., dining out often, entertainment). Most behavioral theories extended this idea, focusing on specific

others as the sources of reinforcement (e.g., spouses, friends).

Cognitive Theories of Depression. Although it is probably indisputable that the final common pathways to clinical depression and even dysphoric mood involve biological changes in the brain, the most influential theories of depression today focus on the thoughts of the depressed individual. This cognitive perspective also recognizes that behavior and biochemistry are important components of depression, but it is more concerned with the quality, nature, and patterns of thought processes. Cognitive therapists believe that when depressive cognitions are changed, behavior and underlying biological responses change as well. Cognitive theories of depression differ from behavioral theories in two major ways (see Gotlieb and Hammen 1992 for a more detailed description). First, whereas behavioral theories focus on observable behaviors, cognitive theories emphasize the importance of intangible factors such as attitudes, self-statements, images, memories, and beliefs. Second, cognitive approaches to depression consider maladaptive, irrational, and in some cases, distorted thoughts to be the cause of the disorder and of its exacerbation and maintenance. Depressive behaviors, negative moods, lack of motivation, and physical symptoms that are seen to accompany depression are all seen as stemming from faulty thought patterns. There are three main cognitive theories of depression:

Beck’s cognitive-distortion model, Seligman’s learned helplessness model, and the hopelessness theory of depression.

Beck’s cognitive-distortion model. The most influential of these theories is Aaron Beck’s cognitivedistortion model of depression (1967). Beck believes that depression is composed of three factors: negative thoughts about oneself, the situation, and the future. A depressed person misinterprets facts in a negative way, focuses on negative aspects of a situation, and has no hope for the future. Thus any problem or misfortune experienced, like the loss of a job, is completely assumed to be one’s own fault. The depressed individual blames these events on his or her own personal defects. Awareness of these presumed defects becomes so intense that it overwhelms any positive aspects of the self and even ambiguous information is interpreted as evidence of the defect in lieu of positive explanations. A depressed person might focus on

a minor negative exchange within an entire conversation and interpret this as a sign of complete rejection. These types of thought patterns, also referred to as ‘‘automatic thoughts’’ when responses based on insufficient information are made, are persistent and act as negative filters for all of life’s experiences. Excellent descriptions of the way these thoughts operate can be found in books by the psychologist Norman Endler (Holiday of Darkness, 1990) and the writer William Styron (Darkness Visible: A Memoir of Madness, 1982).

Together with the idea that depressed individuals mentally distort reality and engage in faulty processing of information, the most important part of Beck’s cognitive model of depression is the notion of a ‘‘negative self-schema.’’ A schema is a stored body of knowledge that affects how information is collected, processed, and used, and serves the function of efficiency and speed. In the context of depression, schemas are mental processes that represent a stable characteristic of the person, influencing him or her to evaluate and select information from the environment in a negative and pessimistic direction. Similar to psychoanalytical theories, negative self-schemas are theorized to develop from negative experiences in childhood. These schemas remain with the individual throughout life, functioning as a vulnerability factor for depression. Cognitive treatments of depression necessarily work to change these negative schemas and associated negative-auto- matic thought patterns.

Seligman’s learned helplessness model. Based on work on animals (later replicated in humans), Martin Seligman’s (1975) theory of learned helplessness and his model of depression holds that when individuals are exposed to uncontrollable stress they fail to respond to stimulation and show marked decrements in the ability to learn new behaviors. Because this theory did not sufficiently account for the self-esteem problems faced by depressed individuals, it was reformulated by Abramson who hypothesized that together with uncontrollable stress, people must also expect that future outcomes are uncontrollable. When they believe that these negative uncontrollable outcomes are their own doing (internal versus external), will be stable across time and will apply to everything they do (global), they feel helpless and depressed.

Hopelessness theory of depression. The most recent reformulation of the learned helplessness theory, referred to as the ‘‘hopelessness theory’’ of depression (Abramson, Seligman, and Alloy 1989) holds that depression is a result of expectations that highly undesired outcomes will occur and that one is powerless to change these outcomes. The hopelessness theory of depression is receiving a large amount of attention as it has been found to be particularly useful in predicting the likelihood of suicide among depressed people.

Biological Theories of Depression. The most compelling of the recent theories of depression rely heavily on the biological bases of behavior. Biological theories assume the cause of depression lies in some physiological problem, either in the genes themselves or in the way neurotransmitters

(the chemicals that carry signals between nerve cells in our brains and around our bodies) are produced, released, transported, or recognized (see Honig and van Praag 1997 for a detailed review of biological theories of depression). Most of the work focuses on neurotransmitters, especially a category of chemicals in our bodies called the monoamines, the main examples of which are norepinephrine (also called noradrenalin), dopamine, and serotonin. These chemicals first attracted attention in the 1950s when physicians discovered that severe depression arose in a subset of people who were treated for hypertension with a drug (reserpine) that depleted monoamines. Simultaneously, researchers found that a drug that increased the monoamines, this time given to medicate tuberculosis, elevated mood in users who were depressed. Together these results suggested that low levels of monoamines in the brain cause depression. The most important monoamine seems to be norepinephrine although it is now acknowledged that changes in levels of this neurochemical do not influence moods in everyone. Nevertheless, this biochemical theory has received much experimental support.

Apart from the neurochemicals, there are also other physiological differences between depressed and nondepressed individuals. Hormones are chemical substances that circulate in the blood and enable communication between different systems of the body. Some hormones control the release of other hormones which then stimulate growth and help prepare the body to deal with,

and respond to, stress (e.g., adrenocorticotropic hormone or ACTH). Depressed patients have repeatedly been demonstrated to show abnormal functioning of these hormones (see Nemerof 1998 for a detailed review). Another difference is seen in one of the major systems of the body that affects how we respond to stress; the hypothalamic-pitui- tary-adrenal (HPA) axis. From the late 1960s and early 1970s, researchers have found increased activity in the HPA axis in unmedicated depressed patients as evidenced by increased levels of stress markers in bodily fluids. Now a large volume of studies confirm that substantial numbers of depressed patients display overactivity of the HPA axis. According to Charles Nemeroff (1998) and his colleagues, and based on studies on animals, all these biological factors including genetic inheritance of depression, neurotransmitter and hormonal levels, and HPA axis and related activity, could relate to early childhood abuse or neglect, although this theory has yet to be fully substantiated.

The antecedents and consequences notwithstanding, it is well accepted that one of the major causes of depression is based in our biology.

RISK FACTORS

Depression can have many different causes as indicated by the different theories that have been formulated to explain it. Accordingly, there are different factors that indicate a risk for depression. Some of the main risk factors for long-term depression include heredity, age, gender, and lack of social support.

Studies of twins and of families clearly suggest a strong genetic component to clinical depression, which increases with genetic closeness. There is a much greater risk of developing a major depression if one’s identical twin has had it than if one’s parent, brother, or sister developed it. Chances are even less if no close relatives have ever had it.

Furthermore, the younger people are when they experience depression, the higher the chances that one of their relatives will also get severely depressed. Relatives of people who were over forty when they first had a major depression have little more than the normal risk for depression.

One of the most clear risk factors is gender. Women are at least twice as likely to experience

all types of depressed states than are men and this seems to occur from an early age. There are no gender differences in depression rates in prepubescent children, but after the age of fifteen, girls and women are about twice as likely to be depressed as boys and men. Many models have been advanced for how gender differences in depression might develop in early adolescence. For example, one model suggests that the causes of depression can be assumed to be the same for girls and boys, but these causes become more prevalent in girls than in boys in early adolescence. According to another model, there are different causes of depression in girls and boys, and the causes of girls’ depression become more prevalent than the causes of boys’ depression in early adolescence. The model that has received the most support suggests that girls are more likely than boys to carry risk factors for depression even before early adolescence, but these risk factors lead to depression only in the face of challenges that increase in early adolescence (Nolen-Hoeksema and Girgus 1994). For a review of the epidemiology of gender differences in depression including prominent theories for why women are more vulnerable to depression, cross-cultural studies of gender differences in depression, biological explanations for the gender difference in depression (including postpartum depression, premenstrual depression, pubescent depression), personality theories (relationship with others, assertiveness), and social factors for the gender difference (increases in sexual abuse in adolescent females) see Susan NolenHoeksema (1995).

Age by itself is a major risk factor for depression, although as described this varies for each gender. For women, the risk for a first episode of depression is highest between the ages of twenty and twenty-nine. For men, the risk for a first episode is highest for those aged forty to fortynine. A related risk concerns when a person was born. People born in recent decades have been found to have an increased risk for depression as compared to those born in earlier cohorts.

Another significant risk factor for depression is the availability and perception of social support. People who lack close supportive relationships are at added risk for depression. Additionally, the presence of supportive others may prevent depression in the face of severe life stressors. Support is

especially important in the context of short-term depression that can result from events like conflictual work or personal interactions, unemployment, the loss of a job, a relationship break-up, or the loss of a loved one.

MEASUREMENT OF DEPRESSION

Most of the commonly used techniques to assess for depression come from clinical psychology and are heavily influenced by the cognitive theories of depression. For example, the work of Beck and other cognitive theorists has led to the development of many ways to measure the thoughts that depressed individuals may have. Most of these measures are completed by the individuals themselves, while some are administered in an interview format where the therapist asks a series of questions. Some interviews are delivered by trained clinical administrators (e.g., the Structured Clinical Interview for DSM-IV), while others are highly structured, can be computer scored to achieve diagnoses based on the DSM-IV, and can be administered by lay interviewers with minimal training (e.g., the Diagnostic Interview Schedule). Separate measures have also been designed for adults and children to compensate for differences in level of comprehension and sophistication, although measures of symptoms and diagnoses in children and adolescents are less-extensively studied. The methods used work well for children provided that information from both parent and child sources are included in the final decisions.

There are different types of self-report measures for depression. It can be assessed by having the patient fill out a questionnaire. Because our thought processes may operate at varying levels of consciousness, we may not always be able to access what they are to report on them. For this reason different cognitive measures of depression were designed to operate at various levels of consciousness. For example, the most direct measures ask about the frequency with which negative automatic thoughts have ‘‘popped’’ into a person’s head in the past week (e.g., ‘‘no one understands me’’).

Another type of measure attempts to get at the cognitive and social cognitive mechanisms by which people formulate their beliefs and expectations.

Because many negative thoughts take the form of comparing the self with others, these types of