Joiner (this issue) outlines an organizational framework of dysfunctional p
sychological processes observed in unipolar major depressive disorder (MDD)
patients, which he hypothesizes makes substantial contributions to the chr
onicity of this common and disabling disorder. Rather than concentrating on
the clinical characteristics, past history, biological markers, or genetic
variables as risk factors for chronicity, Joiner references the scarring e
ffects of repeated episodes and a set of destructive interpersonal processe
s present in depressed patients that he feels promotes depressive chronicit
y. This extends observations reported in prior studies on psychosocial disa
bility in depression, which have concentrated primarily on such issues as e
mployment status, estimates of well-being, and so on, whereas Joiner emphas
izes psychological disability and disrupted interpersonal relationships.
This commentary introduces a new dimension of chronicity of unipolar MDD th
at involves the long-term, chronic manifestation of depressive symptomatolo
gy, in addition to the frequent major depressive episode relapse. Further,
the long-term symptomatic structure of unipolar MDD is described as a dimen
sional continuum of symptom severity and illness activity and then highligh
ted as to the relevance of both of these newer concepts to Joiner's proposa
ls. A number of interesting research questions are outlined in by Joiner th
at need empirical validation but, if answered, could make a contribution to
the understanding and reduction of depression chronicity.