Environmental Factors in Depressive Illness

¹ Royal Edinburgh Hospital, Morningside, and Department of Psychiatry, University of Edinburgh

1. One hundred and fifty-eight patients and 58 control subjects under treatment in medical wards have been studied in regard to their experience of certain social and medical factors in the three years prior to admission or referral The childhood experience of parental bereavement in both groups was also studied.

2. The depressive patients had experienced more childhood bereavement (significant), more social factors (significant), and more medical or physical illness factors (not significant) in the three years prior to admission or referral.

3. Data on symptomatology had been recorded on a symptom-sign inventory for 105 patients. On the basis of scoring on four out of five symptoms (retardation, diurnal variation, early morning wakening, impaired concentration, and ideas of guilt) patients were classified as "endogenous", while the rest were classified as "neurotic". These groups were then compared for severity of illness, incidence of age over sixty years, incidence of pre-admission social and medical stress factors, and incidence of manic-depressive illness. The "endogenous" group had all the manic-depressive patients and the majority of severely ill patients. Other factors did not discriminate between the groups.

4. These findings have been discussed in relation to the concept of depressive illness as having some biological purpose as in some way protecting or removing the subject from a noxious or stressful life situation.

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