Depression is highly prevalent and, for many, a chronic or recurring problem that interferes with work and family. It erodes the motivation, energy, and enjoyment needed to nurture and sustain marital, parenting, and social relationships. It is a disorder with many faces—starting at different ages, possibly chronic or waxing and waning, and typically mixed with a variety of other complicating problems, such as anxiety disorders, substance abuse, and behavioral disorders. It frequently occurs as a causal factor or contributor to medical illnesses. There is considerable information on depression prevalence and manifestations in the general population, but less information specifically about depression in adults who are parents and caregivers. However, it is clear that depression’s negative and enduring effects on personal functioning also have adverse effects on those living with a depressed person. Children of depressed parents are at great risk for depression and maladjustment in academic, social, and intimate roles, and depressed parents have difficulty functioning effectively in their parenting and marital roles.

Risk factors and causal mechanisms involved in depression have implicated a wide range of biological (genetic, neurological, hormonal, and endocrinological) factors that may play a role in underlying vulnerability or in the processes by which stressors trigger depression in some people. Fundamentally, etiological models are diathesis-stress models, in which stressful experiences—whether early childhood trauma, acute recent life events, or ongoing chronic strains—trigger depression. Finding depression “genes”—or another simple chemical marker—is an illusory goal, and it is not likely to be of practical help in identifying those at risk. Depression will most commonly be found among those facing chronically stressful conditions, such as social disadvantage and distressed relationships or lack of supportive and intimate relationships. There are numerous individual characteristics that moderate or mediate the effects of stress on depression, including personality traits that reflect emotional reactivity and negativity, as well as styles of thinking about self and the world that emphasize beliefs about worthlessness, helplessness, and futility. Skills for coping with adversity that are passive, avoidant, and ineffective may perpetuate depression. Unraveling the complex and interlocking contributors to depression requires more integrative and long-term study than has yet been conducted or supported. Substantial gaps occur in the application of knowledge about etiology to the detection and early treatment of depression.

Because of depression’s varying clinical manifestations and co-occurring mental health and medical conditions, its different symptom and course profiles, and its likelihood of recurrence, depression is very difficult to treat effectively in a universal way and over long periods of time. What may help a depressed teenage mother could be very different from what is needed

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