Biopsychosocial pathways from early adversity to depression: Potential mechanisms and implications for intervention

Early life adversity (ELA) has consistently been associated with the development of depressive symptoms and linked to comorbid psychiatric outcomes, greater disorder severity, slower rates of remission/recovery, and increased risk of suicidality. Existing research suggests that ELA has a dose-dependent association with depressive outcomes; however, a comprehensive review of the pathways that may underlie this association is needed to synthesize current knowledge, inform future research, identify at-risk populations, and understand opportunities for prevention and treatment. In the current review we provide an overview of existing empirical research using a biopsychosocial model to develop an integrated conceptual framework for some of the pathways that may explain the association between ELA and depression, as well as other related outcomes. With a focus on modifiable psychosocial factors, evidence-based recommendations for identifying individuals most at risk and potential pathways for individualized assessment and intervention are made. Such interventions may be beneficial not only for decreasing depressive symptoms, but also for addressing a host of other negative outcomes that are also known to be associated with ELA.