Disease, distress and depression. A comment

Bebbington et al. (1981) in their paper in the present number of this Journal suggest that psychiatric disorders in the community are likely to be cases of distress and base this assertion on the fact that very few out-patients have a significant life event preceding onset. A review of 7 recent studies of depressive patients, using a broadly comparable life-event instrument, gives a quite different picture: an average of 56% had an important life event before onset, compared with 18% in the general population. It is concluded that the authors arrive at their conclusion because they have failed in a number of critical respects to replicate previous analyses. The distinction between disease and distress is discussed in the light of these results.