Major depression and depressive symptomatology among the physically disabled. Assessing the role of chronic stress.

Although it is generally agreed that life stress represents a risk factor for depressive symptomatology, there is less agreement on the significance of such stress for the occurrence of major depression. Indeed, it has been suggested that stress factors of importance for depressive symptoms may be irrelevant for major depression. We report results based on a large sample of physically disabled and nondisabled adults that contradict this suggestion. The physically disabled show seriously elevated rates of both depressive symptomatology and major depressive disorder. Subgroup analyses confirmed the finding on depressive symptomatology within all age-gender groupings and the finding on major depression for young and middle-aged men and women but not for the aged. It is argued that these findings can be attributed to differences in chronic stress associated with disability status. We conclude that chronic stress represents a significant risk factor with respect to both depressive symptomatology and major depressive disorder.