Psychosocial processes underlying the maintenance and persistence of depression: Implications for understanding chronic depression

The three major theoretical perspectives on the maintenance and persistence of depression in the psychological literature are reviewed. Cognitive theo rists, such as Teasdale and Nolen-Hoeksema, focus on how a reciprocal relat ionship between depressed mood and the individual's processing of; and resp onse to, their symptoms maintains and prolongs the duration of depressive e pisodes. interpersonal theorists, such as Lewinsohn and Coyne, hypothpsize that the depressed person's interpersonal behavior elicits negative reactio ns from the social environment, leading to a downward spiral of persistent depression. Finally, recent studies have indicated that individuals who exp erienced childhood adversity are more susceptible to a chronic course of de pression. Although these three perspectives vary somewhat in the degree of support they have accumulated each exhibits some promise for helping to elu cidate the maintenance and persistence of depression. However, much of the available empirical literature suffers from a number of critical limitation s, including the lack of clinical samples, longitudinal studies, and adequa te attention to confounding variables, such as the severity and duration of depression at baseline and comorbid psychopathology. We conclude by sugges ting a number of ways in which cognitive and interpersonal factors and earl y adversity may interact to maintain and prolong depressive episodes. (C) 1 999 Elsevier Science Ltd.