Depressive disorder associated with physical illness. The impact of stroke

The consultation-liaison psychiatrist is confronted time after time with depression in the context of physical illness, and the link between the two is of practical and theoretical interest. In addressing this topic, current classification systems are ambiguous. The advent of research diagnostic criteria and the primary/secondary depression dichotomy have not clarified the problem as was hoped. The conventional view that physical illness only precipitates depression in the genetically predisposed has been challenged by recent studies in patients with stroke. These studies point to a specific role for factors such as lesion location, severity of disability, and social support. In addition, the process of adjustment to serious physical illness can be understood in terms of personal vulnerability including low self-esteem, conflict within close relationships (particularly marital), and negative experiences in the developmental history. Acting on this vulnerability is the stressful life event (e.g., illness) that can have particular force if "matched" to the subjects existing psychologic conflicts. A modifying factor on the outcome of the adjustment is the influence of social support in protecting the individual from the life event. A list of potential factors influencing the occurrence of depression with physical illness is proposed. Variables likely to have an important place include 1) family history of psychiatric disorder, 2) a past personal history of depression, 3) the premorbid personality, 4) the impact of life events including the illness, 5) the degree of disability from the illness, 6) the presence of brain pathology and neuroendocrine abnormalities, and 7) the quality of social support during the time of illness.(ABSTRACT TRUNCATED AT 250 WORDS)