Stress generation: future directions and clinical implications.

Although the past two decades have seen increasing empirical interest in stress generation, the process whereby depressed or depression-prone individuals experience higher rates of life stress that are at least in part influenced by their own cognitive and behavioral characteristics, several important aspects of this phenomenon remain relatively unexamined, leaving open several promising opportunities for future advancement of the field. The current paper begins with a brief review of the extant literature on the influence of cognitive, behavioral and interpersonal, childhood maltreatment, and genetic factors on stress generation. An integrative theoretical model is then presented tying together these different lines of research in accounting for the stress generation effect and its potential depressogenic sequelae (i.e., depression recurrence and depression contagion). Drawing on this model, particular focus is given to the need to identify the behavioral processes through which cognitive factors confer risk for stress generation, as well as to the need for research assessing the full etiological chain posited by the stress generation hypothesis linking self-generated stress with subsequent depression. In addition, methodological issues of particular relevance to this area of research are discussed. The current review ends with a consideration of the clinical implications of the stress generation phenomenon.