[Increased incidence of depression and its socio-cultural background in Japan]

It is often pointed out that the incidence of monopolar depression, new type depressions and protracted depression has increased. Why have such types of depression been appearing more frequently than before? We should not overlook the possibility that changing modern society could actually result in increased depression.

After World War II, a period of rapid industrialization occurred in Japan. The younger generation largely moved to urban areas, leaving older people behind and collapsing traditional rural communities. This population shift resulted in two major changes among Japanese people. One is external, in occupational life. The other is internal, in the mentality of the younger generation. Industrialized society brings a variety of occasions for new adaptation. Each time a transfer to another workplace, promotion, demotion, retirement, residential changes or other such occasion takes place, an adaptation to a new environment must be made. Middle-aged individuals with typus melancholicus, who a generation ago would have been able to adapt themselves without problem, are likely to break down easily due to the difficulties posed by modern society. Most show mild monopolar depression without intense psychomotor inhibition and without severe anxiety. It is rare for them to fall into severe depression because they display a rather asthenic premorbid personality, as emphasized by von Zerssen. In modern society children are indulged without any confrontation with their father. As a result, children are brought up less adept at introjecting paternal authority and identifying with social norms than those brought up a few generations ago under traditional communities, while tending to be narcissistic and dependent following the strong maternal relationship. Some of them can become depressed following trivial events. As a result, new types of depression have been observed, such as bipolar II disorder, which consists of escaping-type depression (Hirose, T.), and immature-type depression (Abe, T. et al). Both types are observed at a younger age than that seen with typus melancholicus. Their appearance reflects the above-mentioned changes in the mentality of the younger generation. Whether with escaping--or immature-type depression, patients are not norm-oriented and are rather more narcissistic than typus melancholicus individuals. The escaping-type is, however, more intelligent and asthenic and displays less plain dependency than the immature-type, which can switch to bipolar I over the long-term. Regarding clinical pictures, the former is characterized by mild psychomotor inhibition and a tendency towards withdrawal from their reality The latter is characterized by marked anxiety/agitation, suicidal tendencies, and aggression towards key relationship and authority figures. Here, I refer to depression protracted by psychosocial factors. Both monopolar depression in the typus melancholicus personality and new type depressions can present as prolonged or repeated depressive phases in the presence of disadvantageous environment to which the patient returns. In the case of typus melancholicus individuals, if an environment to which they could not adapt themselves remains unchanged, or if a new form of order is not implemented, partial recovery with antidepressants is seen, but not full recovery. In the case of escaping- or immature-type depression, patients can recover if they re-enter protective environments, but if they don't, repeated depressive phases occur.

1) The increased incidence of depression is attributable to the appearance of new types of depression among young people, and the augmentation of monopolar depression among middle-aged typus melancholicus individuals. 2) Changes to modern society have influenced the premorbid personality of young depressives on the one hand, and increased the frequency of potential catalysts for depression among the middle-aged on the other. 3) Modern society may well facilitate recurrence and relapses for both types of depressive.