Joiner's article (this issue) is a welcome contribution toward clarifying the role of interpersonal factors underlying depression chronicity. We believe, however, that three issues need to be considered regarding an interpersonal research agenda. First, Joiner's proposal would benefit from a discussion of the evidentiary requirements that risk factors must meet. Second, our reading of the literature suggests that interpersonal processes interact with cognitive processes that involve the activation of depressive knowledge structures and that these processes do meet criteria as a possible causal risk factor. Finally, Joiner's global concept of depression chronicity fails to recognize important differences in the mechanisms underlying each of the phenomena of episode prolongation, relapse induction, and recurrence as well as the changes that might occur in these processes with repeated episodes. .
Key words: cognitive reactivity, depression relapse/recurrence, cognitive factors.
Although our understanding of the processes implicated in acute episodes of major depressive disorder has expanded in recent years, relatively little work has gone into exploring mechanisms associated with the chronic and recurrent nature of this disorder. With multiple determinants likely implicated in this aspect of depression (Judd, 1997), clarifying the role of psychological factors could advance our understanding of this troubling feature of the illness. Joiner's article (this issue) is a provocative and timely example of such work, linking the problem of depression's chronic nature to the continued reliance on maladaptive interpersonal response styles. .
Joiner proposes that depression chronicity is due, in part, to a set of "self-propagatory processes," interpersonal behaviors that are depression-related and serve to prolong current symptoms or induce recurrence. He outlines how these processes create interpersonal and other problems that predict lengthened or future depression.
