Depression's vicious scree: Self-propagating and erosive processes in depression chronicity

Depression is remarkably persistent and recurrent. Why? Although several pr edictors of depression chronicity have been identified, a conceptual framew ork regarding mechanisms whereby depression chronicity occurs is lacking. T he goal of this article is to explain depression chronicity, at least in pa rt, with reference to processes, mostly interpersonal in nature, that serve to extend and reestablish depression. Several such processes are described , and available empirical evidence regarding each is reviewed. Clinical and research implications of the present conceptualization are elucidated. To the degree that these processes receive continued empirical support as mech anisms whereby depression persists, they represent leverage points to comba t the vexing problem of depression chronicity.