Predisposing, precipitating and perpetuating factors in depression
Risk factors for depression are sorted by when they act: predisposing factors come before the illness, precipitating factors trigger it and perpetuating factors keep it going.
Remember
Sort each factor by when it happens: something present before the illness that cannot be changed is predisposing, a trigger (usually a loss event) is precipitating, and a continuing state that keeps the illness going is perpetuating.
Memory aid
Predisposing is the soil, precipitating is the spark, and perpetuating is the fuel.
Use the picture to recall the order: what is in place beforehand, what sets the illness off, and what keeps it going.
Doctors often explain why a person has developed depression at this time. One way is to sort each risk factor (it raises the chance of illness) by when it acts and what it does. Risk factors present at the same time can increase the risk of mental illness, and they fall into three kinds.
Predisposing factors are present before the illness and cannot be changed. They include genetic risk, such as a family history of depression, and childhood experiences such as abuse, loss of a parent and bullying. They raise vulnerability (they make depression more likely) but do not themselves trigger an episode.
Precipitating factors are the trigger: an event that pushes a vulnerable person into illness. They are usually life events related to loss, such as the death of a loved one, the end of a relationship or declining physical health.
Perpetuating factors, also called maintaining factors, are current parts of a patient's life that keep the illness going once it has begun. Examples are a stressful job or unemployment, financial strain, substance misuse, relationship difficulties and housing uncertainty. They are continuing states, not trigger events.
A stress that was already present and had not changed does not explain why the low mood began when it did; the recent event that triggers the episode marks its start.
Key facts
- Predisposing
- present before the illness and cannot be changed, such as genetics and childhood experiences.
- Precipitating
- the trigger, an event that pushes a vulnerable person into illness, usually related to loss.
- Perpetuating
- things in a person's life now that keep the illness going, such as financial strain and unemployment.
- Loss events
- precipitating factors are typically life events related to loss, such as the death of a loved one, the end of a relationship and declining physical health.
- Several together
- risk factors usually add up, and those present at the same time can increase the risk of mental illness.
- When it acts
- a factor present before the illness that cannot be changed is predisposing, the trigger is precipitating, and a continuing state that keeps the illness going is perpetuating.
Exam traps
- A family history of depression is predisposing, not precipitating: the genetic risk is there from birth and raises vulnerability without triggering an episode.
- An early life experience such as emotional neglect is a predisposing factor, not a precipitating one: it was in place long before the illness and makes depression more likely without setting off an episode.
- Long-term unemployment with ongoing stress is perpetuating, not precipitating, because it is a continuing state that keeps symptoms going rather than an event that starts the illness.
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