Wesner, 2006; Rajaratnam et al., 2008). In a randomized trial in which residents residing in neighborhoods characterized by concentrated poverty were given the opportunity to move to higher income neighborhoods, those who moved experienced declines in mental health problems, including depression, supporting the importance of residential context in shaping mental well-being (Del Conte and Kling, 2001; Goering et al., 1999). Efforts to prevent depression should focus not only on individuals and families but also on those larger structural interventions that can make profound differences (e.g., alleviating poverty, moving to a better neighborhood).

Finally, brief mention should be made of stressful parenting circumstances and their contribution to depression. Many parents are challenged by infants’ and children’s medical illnesses, developmental disabilities, and psychological disturbances, and the stress associated with such circumstances may result in depression. For example, a meta-analysis of 18 studies of mothers of children with and without developmental disabilities found that the former had higher rates of elevated symptoms of depression, falling above suggested clinical cutoffs compared with mothers of children without disabilities (29 versus 19 percent) (Singer, 2006). A further review of a broad array of samples, including mothers with children with mental retardation, autism, and other forms of developmental delay, found similar rates of elevated depressive symptoms and also noted a limited number of studies that reported on depressive diagnoses (Bailey et al., 2007). While limited in number, the findings suggest that depressive diagnoses were more frequent among mothers with disabled children. The study also noted that higher rates of depression were associated with multiple stressors in the family: higher levels of mother-reported stress, less effective coping styles, poorer health, low family support or cohesion, and presence of more than one child with a disability. Similarly, custodial care of children by grandparents (including both three-generation and “skipped-generation” households) is well-known to be associated with elevated depression symptoms and increased medical problems (e.g., Blustein, Chan, and Guanais, 2004; Hughes et al., 2007). Such chronically stressful circumstances are often compounded by low income, disadvantaged social status, and grandchildren with special needs (Blustein, Chan, and Guanais, 2004). Adolescent mothers are another group known to be at substantial risk for significant depression, often compounded by multiple chronic stressors such as low income, relationship difficulties, and reduced social support (Panzarine, Slater, and Sharps, 1995; Reid and Meadows-Oliver, 2007).

Exposure to Early Adversity

In addition to recent negative events and chronically stressful conditions, increasing evidence focuses on the link between childhood exposure



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