British Journal of Psychiatry (1988), 152, 754—765 The Camberwell Collaborative Depression Study I. Depressed Probands: Adversity and the Form of Depression P. E. BEBBINGTON, T. BRUGHA, B. MacCARTHY, J. POTTER, E. STURT, T. WYKES, A. KATZ and P. McGUFFIN The Camberwell CollaborativeDepressionStudy is an investigationof a series of 130 patients (76 female; 54 male) attending the Maudsley Hospital Services with unipolar depressionof recent onset (the probands),and of their first-degreerelatives. This paper describesthe first elementof the study, the investigationof the indexcasesor probands, which was carried out by members of the MRC Social Psychiatry Unit over the period 1982-1985. A descriptionof the methods of the study is followed by an analysis of lifeeventsin relationto the symptomaticpatternof the depressivestate. An ‘¿endogenous' group was defined as cases of depressionfalling within Catego classes D and R, and compared with a ‘¿neurotic' group conformingto classes N and A. The hypothesisthat the ‘¿endogenous' group of disorderswould be relatively independentof prior life stress was not confirmed. Depressedwomen were more likelyto have experiencedlife events or difficulties than their male counterparts, and there was some evidence that sex, but not age or social class, influencedthe relationshipbetween adversity and the type of depression.Examinationof the timing of life events was stronglysuggestiveof a causal effect, with a pronouncedrise in the month before onset. This was not limited to the most severe events. Differencesbetween the ‘¿endogenous' and ‘¿neurotic' groupsin the temporal patterning of events before onset are discussed.The findings are interpreted in terms of the literature on the topic. approach. A number of studies have now examined variables of these types together (e.g. Pollitt, 1972; Calloway et al, 1984a,b; Dolan et al, 1985; Zimmerman et al, 1986a), and this is the primary objective of the Camberwell Collaborative Depressive Study described in this paper. Its specific aim is the investigation of the relationship between the social attributes of depressed patients (such as their experience of life events and the state of their social networks), the tendency of depression to run in families, and the different symptom pictures covered by the diagnosis. The relationship between the onset of depressive episodes and antecedent misfortune, usually in the form of life events, is well established (Paykel et al, 1969; Cadoret et al, 1972; Thompson & Hendrie, 1972; Markush & Favero, 1974; Brown & Harris, 1978; Bebbington et al, 1981a; Cooke, 1981; Fava et a!, 1981; Henderson et al, 1981; Costello, 1982; Surtees et al, 1986). However, practising clinicians from the nineteenth century onwards (Griesinger, 1861) have felt that the more severe forms of depression were relatively independent of adversity: â€oe¿What think you, friend― said he â€oe¿whose condition is most to be pitied, the Emperor Achmet's, the Emperor Ivan's, King Charles Edward's or mine?― â€oe¿Faith, I cannot resolve your question― said Martin, â€oe¿unless I had been in the breasts of all of you.― Voltaire. Candide.Translatedby TobiasSmollett. Recent studies of depressive conditions encompass both their social and their biological characteristics (Thase et al, 1985; Wing & Bebbington, 1985; McGuffin & Katz, 1986). However, most studies have been restricted to an account of only one of these. Moreover, few provide a proper account of the vary ing clinical pictures under investigation, making it difficult to integrate knowledge obtained from different studies, particularly as biological studies tend to be of relatively severe clinical conditions, and social investigations of milder disorders. In our view, this state of affairs is a strong argument for a multidisciplinary approach incorpor ating variables from more than one category. Indeed, the coaction and interaction of social and biological factors cannot be established without such an Pip Sturt died in a road traffic accident in May 1985. She was centrally involved in the design and implementation of the study, and we honour her memory with this paper. 754