The relationship between stress and depression in first onsets versus recurrences: a meta-analytic review.

S. M. Monroe and K. L. Harkness reviewed the empirical evidence supporting R. M. Post's kindling model, which suggests the 1st episode of depression is more likely to be preceded by major stressors than are subsequent episodes. Their review highlighted the diverse interpretations of Post's premise in the current literature and the changes in research methods that have contributed to this interpretive shift. The authors conducted a meta-analysis (N=13 studies) to test Post's premise that integrated early and recent research and examined potential moderators. A proportion difference effect size was used. Results indicated that 1st onsets of depression were more likely than recurrences to be preceded by severe life events, supporting Post's premise. The moderator analyses suggested that support may be most evident in patient samples and may vary according to age and gender, with less support for Post's premise evidenced in younger samples and in women. Although these results are preliminary, as the analysis included a small number of studies, they suggest that future research should further examine factors that influence the stress-depression relationship with successive recurrences.