What is Situational Depression?

Depression can take many different forms. The American Psychiatric Association (APA) publishes a diagnostic tool known as the Diagnostic and Statistical Manual of Mental Health Disorders (or the DSM-V) which is the principal authority for psychiatric diagnoses.

Within the DSM-V, depression falls into many categories. Some of these are well known – such as postpartum depression or bipolar depression – whereas others are less well known. You can read about the 10 most common types of depression here.

Situational depression is a type of depression that’s also known as adjustment disorder. The term refers to depression that’s triggered by a specific stressor, such as the loss of a job, the breakdown of a significant relationship, the death of a loved one, etc.

 

What is the difference between sadness and depression?

We all experience difficult and distressing events or scenarios in life. While we might describe these events as ‘depressing’, this is different from receiving a clinical diagnosis of depression (also known as major depressive disorder).

Clinical depression is a diagnosis received by around 19 million people every year. As defined by the DSM-V, clinical depression is diagnosed in individuals who experience at least five of the following symptoms for at least two weeks:

• Depressed or irritable mood
• Diminished interest or loss of pleasure, even in previously pleasurable activities
• Significant weight changes or appetite disturbance
• Sleep disturbance
• Psychomotor agitation or retardation
• Fatigue
• Feelings of worthlessness or guilt
• Inability to concentrate; indecisiveness
• Recurrent thoughts of death or suicide

Read more about the symptoms of clinical depression.

 

What are the symptoms of situational depression?

Those experiencing situational depression will have a range of symptoms, all of which have been triggered by a stressor.

While there are no specific criteria for defining a stressor, research^[1] suggests the sorts of events that can trigger situational depression include ‘traumatic events, such as exposure to actual or threatened death, as well as non-traumatic stressful events such as interpersonal conflict, death of a loved one, unemployment, financial difficulties, or illness of a loved one or oneself’.

According to the World Health Organization (WHO)^[2] situational depression comprises two core symptoms: preoccupation and failure to adapt.

Preoccupation with the stressor is described as ‘a state of recurring distressing thoughts about the event or its consequences, and of constant rumination’.

Failure to adapt symptoms include generalized stress-response symptoms, such as sleep disturbances or concentration problems.

Some people might experience an inappropriate emotional and/or behavioral response to the stressor, and difficulties adjusting at a level disproportionate to the severity or intensity of the stressor.

Look out for stress responses that are out of step with socially or culturally expected reactions to the stressor, and those which cause marked distress and impairment in daily functioning.

Other symptoms may also be experienced, such as avoidance, anxiety, depressive symptoms, or impulsivity.

What is the difference between clinical depression and situational depression?

Situational depression could be thought of as an exaggerated stress response that can lead to mental illness.

Some of the symptoms of clinical depression might be experienced by those in the immediate aftermath of a seismic event in their lives. However, clinical depression is a chronic mental health disorder whereas situational depression is not (chronic refers to an illness that persists for a long time or is constantly recurring).

Similarly, a clinical diagnosis of depression is not an appropriate diagnosis when symptoms are in response to an identifiable trigger or stressor.

In this case, the diagnosis would be situational depression or adjustment disorder, but only in certain circumstances as set out in the DSM-V.

Diagnosing situational depression

According to the DSM-V, the criteria for diagnosis of situational depression are:

• The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
• These symptoms or behaviors are clinically significant, as evidenced by one or both of the following: 1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation. 2. Significant impairment in social, occupational, or other important areas of functioning.
• The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
• The symptoms do not represent normal bereavement.
• Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.

Situational depression falls into a DSM-V category called Trauma- and Stressor-Related Disorders, where it is considered a stress-response syndrome. This category also includes Post Traumatic Stress Disorder (PTSD), which is also worth considering when thinking about what might be the most appropriate or likely diagnosis.

 

How many people experience situational depression?

Situational depression is thought to affect around 2% of the general population. However, rates are much higher in specific high-risk populations such as the recently unemployed (around 27% of whom experience situational depression) and bereaved individuals (around 18%).

 

What are the causes of situational depression?

While it might be possible to identify the stressor that triggered situational depression, it’s harder to say why one person develops the disorder whereas another experiencing the same stressor does not. We are all unique individuals, which makes it harder to identify specific causes.

The biopsychosocial model of health was developed by Dr George Engel to consider the biological, psychological, and social factors that determine illness and health. The model allows us to move beyond looking at single causes of disease or disorder development, and instead allows for a more individualized approach to treatment.

For example, patients with situational depression may have a biological disposition to the condition, or their psychological make-up might mean stressors have a greater impact, or they may lack a strong social support network. A combination of all three factors could instead be at play.

Covid-19 and situational depression

The Covid-19 pandemic is a good example of a major stressor or life event that impacted mental health across the globe.

Data from the Centers for Disease Control and Prevention and Census Bureau dated mid-May 2020 found that around 28% of adults in the U.S. reported symptoms of an anxiety disorder and 24% said they experienced symptoms of depressive disorder in the last seven days. The previous year, those numbers looked like 8% for anxiety disorder and 6.5% for depressive disorder.

These numbers are not unexpected. Covid-19 was an unprecedented situation that resulted in many people feeling scared, anxious, and depressed. People lost their jobs, were separated from loved ones, and there was fear of falling ill, losing friends and family members to the virus, alongside uncertainty around how long the pandemic would last.

However, not everyone responded to the pandemic in the same way. Some people will have experienced situational depression as a result of Covid-19, while others have not.

Risk factors for situational depression

The research does tell us that those at greater risk for developing situational depression^[3] include people who fit one or more of the following factors:

• Women
• Younger people
• Existing mental ill health
• Inability to identify and label emotions
• Neuroticism
• Psychoticism
• Harm avoidance
• Social issues including loneliness, and lower social support

 

When to seek help for situational depression

You should seek help from a medical professional if you suspect you may have situational depression, have recently experienced a stressor in your life, and you feel unable to cope with the impact of this stressor on your life beyond what would usually be expected.

In any case, if you are concerned about your mental health, seek help. The Center • A Place for HOPE works within a Whole Person Care approach, meaning that treatment addresses the physical, emotional, intellectual, relational, and spiritual elements of your life. In this way, you can start healing from all of the different ways that depression has affected you. Contact us today to find out how we can help you.

 

What is the best treatment for situational depression?

Some people suffering with situational depression do get better on their own. For others, treatment can help.

There is little evidence about the effectiveness of psychopharmacological or psychosocial treatments for situational depression. Instead, psychological treatments such as talking therapies are thought to be the most effective. These include CBT for depression and psychotherapy.

The first attempts to develop low-intensity cost-effective self-help interventions for situational depression are currently in development, and there is evidence^[4] to suggest that internet-based interventions could be effective for the treatment of situational depression.

 

Is situational depression related to ADHD?

Yes, it can be. As well as attention-deficit/hyperactivity disorder (ADHD), there are several mental health issues that can co-occur with situational depression.

These include:

• Bipolar disorder
• Communication disorders
• Conduct disorder
• Depressive disorders
• Eating disorders
• Generalized anxiety disorder
• Obsessive-compulsive disorder (OCD)
• Oppositional defiant disorder (ODD)
• Panic disorder
• Social anxiety disorder
• Specific phobias

It’s important to seek the advice of a medical professional if you believe you might have situational depression and/or any of the mental health issues listed above.

 

Why situational depression can be a problematic diagnosis

You could think of situational depression as falling somewhere in between a typical emotional response to a distressing situation, and clinical depression.

Lack of research

Despite situational depression persisting as a frequently diagnosed mental health issue that is highly prevalent, there is a lack of research into the condition. What research there is has struggled to neatly establish the extent to which it differs from other psychiatric disorders, or from ‘normal’ stress responses.

Medicalizing ‘problems of living’

One criticism of the diagnosis is that it is an example of medicalizing ‘problems of living’. It’s impossible to protect ourselves from stressors, difficult life events, or grief.

The way we respond to these normal problems of living will vary from person to person, with some suffering in more overt ways, and for a longer duration.

While the DSM-V necessarily has to define the point at which symptoms stop being a ‘normal’ response and begin to be a more diagnosable one, it can feel shaming for patients to feel that they are unable to cope with life. For others, they may feel that the additional help and support offered to them after a diagnosis is essential to their recovery.

Systemic issues

Finally, some within the mental health profession are starting to speak out about the ethics of locating a mental health disorder within individuals, when symptoms may be a completely appropriate response to a broken system.

Whole Person Care at The Center • A Place for HOPE treats the entire you — your mind, body and spirit. It treats all aspects of your life – physical, emotional, nutritional, intellectual, relational, and spiritual – to enable complete healing. In this way, you work through all components of your life that have contributed to your current condition. The result is a deeper, longer-lasting, and more complete recovery.

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[1] O’Donnell ML, Agathos JA, Metcalf O, Gibson K, Lau W. Adjustment Disorder: Current Developments and Future Directions. Int J Environ Res Public Health. 2019 Jul 16;16(14):2537. doi: 10.3390/ijerph16142537. PMID: 31315203; PMCID: PMC6678970.
[2] World Health Organization (1992). The ICD-10 classification of mental and behavioral disorders (Vol. 10). Geneva: Author.
[3] Lorenz L, Perkonigg A, Maercker A. A socio-interpersonal approach to adjustment disorder: the example of involuntary job loss. Eur J Psychotraumatology. 2018 Jan 31;9(1):1425576. doi: 10.1080/20008198.2018.1425576. PMID: 29410777; PMCID: PMC5795703.
[4] Zelviene P, Kazlauskas E. Adjustment disorder: current perspectives. Neuropsychiatr Dis Treat. 2018 Jan 25;14:375-381. doi: 10.2147/NDT.S121072. PMID: 29416339; PMCID: PMC5790100.