The Etiology of Depression

It comes as no surprise that the prevalence of depression is on the rise, as was recently reported in The Journal of American Medicine. Increased awareness, diagnosis, and lack of effective therapies contribute to the increase, along with complex and diverse risk factors affecting individuals, from familial, social, environmental, and other domains.

The risk factors range from poor diets, smoking and lack of physical activity to early adverse childhood experiences (ACEs). Whereas success in physical illnesses has been through prevention, prevention of depression has largely been a failure.

Most research on prevention of depression has focused on the individual and identifying those at risk (such as in schools). Although multiple programs based upon adaptive individual abilities and knowledge aim to foster individual-level competencies and well-being beyond schools and into the workplace, they may not carry over to the wider social environment and cultural practices.

The workplace is considered an important setting for interventions targeting adults. Depression and anxiety have been identified as major causes of work absence due to sickness and long-term disability. Problem solving, stress reduction and cognitive behavioral therapeutic techniques delivered in the workplace are often offset by such qualities of the workplace as employment demands, level of employee control, perceived relational and procedural justice.

But what if we go up a level, beyond the individual and workplace and look at the societal treatments and means of prevention of depression? Here we see public policies that contribute to depression, along with poor public physical and mental health. It is no secret that living in poverty, without sufficient housing, nourishing food or good schools contributes to depression. It is no secret that feeling and being powerless contributes to depression. It is no secret that trauma from gun violence in one’s streets contributes to anxiety and depression. And it is no secret that the public and politicians care little.

The place to create the greatest impact upon mental and physical health, I believe, is with our wider social environment and cultural practices. It’s been reported that 40 million of us are hungry, 600,000 are homeless, 2,300,000 are in prisons and jails (70 percent of whom experience mental health or substance abuse), 40 million are living in poverty, and 40 percent of elderly live in loneliness, while public transport in cities is decaying. Decades of research on the true causes of ill health, a long series of pedigreed reports, and voices of public health advocacy have not changed this dynamic.

Social determinants of health include a strong sense of solidarity, a sense that we can depend on each other. If this were a moral imperative, government—the primary expression of shared responsibility—would defend and improve public health just as energetically as it defends territorial integrity.

But the status quo is simply too strong. And the political cards are too stacked against any profound change.

Yet there is always hope, particularly among young people, who are not necessarily burdened with social prejudices carried-over from the past. As they see themselves falling behind economically, unable to reach the quality of life of their parents, perhaps online social networking and shared values will initiate a shared responsibility to overcome the current status quo.

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This blog is co-published with PsychResilience.com.