title: Stressful life events severity in patients with first and recurrent depressive episodes.
abstract: BACKGROUND
  Stressful life events are associated with depression and their role in first onset and recurrences is a promising but controversial perspective of research. The objective is to analyze the role of number of previous episodes and life events exposure in a large sample of primary care depressive patients taking into account life events severity.
  
  
  METHODS
  10,257 patients with DSM-IV criteria for a current single or recurrent major depressive episode were recruited by 2,056 general practitioners in a cross-sectional epidemiological study. Patients answered the Montgomery-Asberg Depression Rating Scale, the Patient Health Questionnaire and the Social Readjustment Rating Scale (SRRS). Stressful life events were categorized into three levels of severity (severe, moderate and mild). All relevant confounding variables were analyzed: age, gender, depression severity, somatic symptoms severity and length of episode.
  
  
  RESULTS
  We found a significant positive correlation with number of episodes and depression severity. There was no significant correlation of SRRS scores with age, gender and length of episode. ANOVA exploring life events severity with regard to number of episodes showed statistically differences in SRRS total score, moderate life events and mild life events (F = 15.14, p < 0.001) but not for severe life events.
  
  
  CONCLUSIONS
  Prevention and treatment strategies for recurrent depression need to manage life stressful events during mild and long-term periods and not just in the initial recurrences of the disease.
authors.affiliation: Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Carretera de Valldemossa km 7.5, 07071, Palma de Mallorca, Spain, mroca@uib.es.
authors.forename: M
authors.initials: M
authors.lastname: Roca
authors.forename: M
authors.initials: M
authors.lastname: Gili
authors.forename: J
authors.initials: J
authors.lastname: Garcia-Campayo
authors.forename: S
authors.initials: S
authors.lastname: Armengol
authors.forename: N
authors.initials: N
authors.lastname: Bauza
authors.forename: M
authors.initials: M
authors.lastname: García-Toro
mesh_terms: D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012307:Risk Factors; D012424:Rural Population; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D014505:Urban Population