Research report Stressful life events as a link between problems in nonverbal communication and recurrence of depression Elisabeth H. Bos a, ⁎ , Antoinette L. Bouhuys a , Erwin Geerts a,b , Titus W.D.P. van Os b , Johan Ormel a a Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands b Mental Health Care Friesland, Leeuwarden, The Netherlands Received 28 March 2006; received in revised form 13 June 2006; accepted 14 June 2006 Available online 11 July 2006 Abstract Background: Interpersonal difficulties and stressful life events are important etiological factors in (recurrence of) depression. This study examines whether stressful life events mediate the influence of problems in nonverbal communication on recurrence of depression. Methods: We registered nonverbal expressions of involvement from videotaped behavior of 101 remitted outpatients and their interviewers. During a 2-year follow-up, we assessed stressful life events and recurrence of depression. Results: The less congruent the levels of nonverbal involvement behavior of participants and interviewers, the higher the incidence of stressful life events, and –via these – the risk of recurrence. Limitations: Nonverbal behavior was measured in an experimental setting. Conclusions: The results suggest that lack of nonverbal congruence during social interaction contributes to the occurrence of stressful life events, which in turn may trigger depression. © 2006 Elsevier B.V. All rights reserved. Keywords: Depression; Recurrence; Life events; Nonverbal behavior; Interpersonal 1. Introduction Major depressive disorder is a highly recurrent disease. About 50% of patients recovered from an episode of major depression will suffer another episode once in their life (Belsher and Costello, 1988). Moreover, risk of recurrence increases progressively with each successive episode (e.g., Bauer et al., 2002). One possible explanation for this progressive risk has been provided by the work of Hammen (1991, 1999). Hammen suggested that individuals with a history of recurrent depression are exposed to higher levels of stress by virtue of their conditions and behaviors. She proposed that they may, to some degree, generate the stressful life events that befall them. Stressful events, in turn, precipitate further depression (e.g., Brown and Harris, 1989). Hammen's stress generation hypothesis has been adopted by several investigators. There is mounting evidence now supporting the basic idea that formerly Journal of Affective Disorders 97 (2007) 161 – 169 www.elsevier.com/locate/jad ⁎ Corresponding author. Department of Psychiatry, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Tel.: +31 50 361 1242; fax: +31 50 361 9722. E-mail address: e.h.bos@med.umcg.nl (E.H. Bos). 0165-0327/$ - see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2006.06.011