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Page | Last updated: 07 May 2021

Factors associated with depression

Health Promotion Knowledge Gateway

Factors associated with depression as described by health-related organisations

Effect of non-communicable diseases on depression
  • Non-communicable diseases are risk factors for mental disorders and the prevalence of mental disorders is associated with mortality rates of NCDs.
  • People diagnosed with chronic conditions such as cardiovascular disease, cancer and diabetes, suffer from very high rates of depression, often remaining undiagnosed, and associated with higher mortality.
  • Exposure to adversity at a young age is an established preventable risk factor for mental disorders.
  • Depression occurs in 16-23% of patients with coronary artery disease.
  • Depression and anxiety have been found in patients following coronary artery bypass graft and in patients with congestive heart failure, while panic disorder has been linked to coronary artery disease.
  • People with diabetes mellitus have high rates of depression and anxiety.
  • Diabetes complications are also risk factors for depression.
  • 'A chronic physical health problem can both cause and exacerbate depression: pain, functional impairment and disability associated with chronic physical health problems can greatly increase the risk of depression in people with physical illness, and depression can also exacerbate the pain and distress associated with physical illnesses and adversely affect outcomes including shortening of life expectancy'
  • There is a relationship between heart disease and depression. People who are diagnosed with heart disease have an increased risk of developing depression.

Effect of physical activity on depression
  • 'Physical activity is a protective factor for depressive symptoms in all age groups'
  • 'More physical activity can decrease the risk of depression by up to 45%'
  • 'As little as 60 min of physical activity each week is sufficient to prevent 12% of new cases of depression'
  • The maintenance of physical activity in later life (>65 years) has beneficial effects on general health, mobility and independence, and is associated with a reduced risk of depression and related benefits for mental wellbeing, such as reduced anxiety and enhanced mood and self-esteem.
  • Engaging in regular physical activity reduces the risk of developing depression in children and adults and can improve many of the symptoms experienced by people with depression

Socioeconomic, psychosocial, and work-related determinants of depression
  • There is convincing evidence that low socioeconomic position is systematically associated with increased rates of depression.
  • Socially disadvantaged position, isolation and social exclusion are important underlying factors of higher risk for depression.
  • Low income, high debt levels and relative poverty have clear association with the risk of mental disorders.
  • Poor quality employment, such as employment with no or short-term contracts, and jobs with low reward and control at work, have significant harmful impacts on mental health.
  • Social and family isolation -and also bereavement – are significant predictors of depression in older age.
  • Poverty and associated conditions of unemployment, low educational level, deprivation and homelessness are all strong markers for mental illness.
  • Exposure to adversity at a young age is an established preventable risk factor for mental disorders.
  • Children of depressed parents have a high risk of developing depression by age 20. Parental depression is a depression-specific risk factor while inadequate parenting, child abuse and neglect, stressful life events and bullying increase the depression risk. Transgenerational transfer of depression is the result of interactions of all risk factors from early on.
  • In elderly people, risk of depression is raised by bereavement, perceived loss of status and identity, and loss of contact with family and friends.
  • Both major and minor stressful life events often precede the onset of depression, and an accumulation of stressors can have a graded relationship with the severity of the resulting depressive disorder. Adverse life events, such as physical assault, death of a close relative, unemployment, or termination of a romantic relationship, have been found to be associated with more severe depression.
  • Low socioeconomic status has consistently been associated with depression. In this association a variety of mechanisms play a role, including employment opportunities, debt or financial strain, alcohol misuse and living conditions.
  • Low social and economic status increases vulnerability for mental ill health. Job loss and not being in employment can lower self-esteem and lead to depression.
  • Work stress and unemployment represent two stressors that can increase the incidence of depression, anxiety, burnout, alcohol-related problems, cardiovascular illness and suicidal behaviour.
  • Work-related factors may contribute to depression, in particular psychosocial work characteristics.
    • Putting high effort at work and receiving low reward has been associated with depression.
    • Low decision authority, high job demands, low social support at work, and job insecurity have been related with a moderate risk of common mental disorders; i.e. depressive and anxiety disorders.
    • Bullying strongly increases the risk of depression.
  • People with at most lower secondary educational attainment are almost two-times more likely to report chronic depression compared to those with higher educational level.
  • Across EU countries, women and men living in the lowest income group are more than two times more likely to report chronic depression than those in the highest income group.
  • People who are employed generally report lower levels of depression than those who are not, and people with a mental disorder are more likely to be unemployed.

Effect of alcohol intake and substance use on depression
  • The associations between patterns of alcohol use and depression have been addressed in a number of studies, which suggest close links. It is still unclear, how the two disorders affect each other. There is some evidence that alcohol misuse is a risk factor for depression and that depression is a risk factor for harmful use of alcohol.
  • Mental disorders such as depression are associated with a large number of risk behaviour and risk factors such as alcohol.
  • 'There is a linear relationship between alcohol consumption and symptoms of depression and anxiety, with increasing prevalence of symptoms with greater consumption'.
  • 'Alcohol use disorders are a risk factor for depressive disorders in a dose dependent manner, often preceding the depressive disorder, and with improvement of the depressive disorder following abstinence from alcohol'.
  • Alcohol-dependent individuals demonstrate a two- to three-fold increase in risk of depressive disorders.
  • People with major depression show a higher vulnerability to develop substance use disorder, and substance users are at higher risk of developing major depression.