conditions: (1) acute negative life events, (2) chronically stressful life circumstances, and (3) exposure to adversity in childhood.

Acute Life Events

A major risk factor for depression is the experience of undesirable, negative life events. There is ample evidence that most major depressive episodes are triggered by stressful life events (see reviews by Hammen, 2005; Kessler, 1997; Mazure, 1998). According to Mazure (1998) recent stressors were 2.5 times more likely in depressed patients compared with controls, and, in community samples, 80 percent of depressed cases were preceded by major negative life events. Most assessment methods survey the occurrence of stressors within the past 3 to 6 months in relation to depression, but Kendler, Karkowski, and Prescott (1998) found that the great majority of major depression onsets occurred within the first month after a significant negative life event. There is some evidence of a generally linear association between severity and number of negative events and the probability of depression onset (Kendler, Karkowski, and Prescott, 1998). However, the “severity” of the impact of an acute life event depends not only on the actual circumstances of the event but also on its subjective meaning to the individual. Thus, one person might become depressed only under extreme conditions of loss and deprivation, but another might become depressed because his or her personal vulnerabilities lead to exaggeration of the meaning of an acute event that is objectively minor.

It has been generally observed throughout the ages that depression is most likely to occur following the loss of something important to the sense of self, such as the loss of significant others or relationships or of a sense of worth and competence. Interpersonal losses or “exits” have been shown to be more associated with depression than with other forms of disorder (Tennant, 2002; see also Kendler et al., 1995)—perhaps especially for women.

For immigrant and refugee populations, experiences of loss and isolation are pervasive (Heilemann, Coffey-Love, and Frutos, 2004). Many immigrants and refugees experience lengthy or permanent separation from immediate and extended family. Loss of home, property, cultural ties, and customs may be significant for these communities. For many refugees and immigrants, these losses are also experienced in the context of the trauma of migration or the trauma of war. The impact of these experiences on the psychological functioning of individuals in these communities is profound. Rates of depression are reportedly high among these groups (Aguilar-Gaxiola et al., 2008). Owing to both biological and socialization processes, women are likely to be more attuned to and concerned about others’ reactions to them, as well as reactive to the needs of others (e.g., Cyranowski



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