Fig. 1.

The pathways through which exposure to stressful life events leads to the onset or intensification of depression. In the context of stressor exposure, some individuals show cognitive and biological stress responses that contribute to symptoms of depression. Cognitive stress reactivity and biological stress reactivity contribute independently to symptoms of depression. In addition, cognitive and biological stress reactivity are reciprocally associated with one another, which over time, creates a downward spiral of increasingly maladaptive stress reactivity and greater depression. Further, as per the stress-generation hypothesis, depression leads to higher rates of stressful life events, thereby perpetuating the stress–depression cycle.