The Vicious Cycle of Psychopathology and Stressful Life Events: A Meta-Analytic Review Testing the Stress Generation Model

Stress generation theory initially posited that depression elevates risk for some stressful events (i.e., dependent events) but not others (i.e., independent events). This preregistered meta-analytic review examined whether stress generation occurs transdiagnostically by examining 95 longitudinal studies with 38,228 participants (537 total effect sizes) from over 30 years of research. Our multilevel meta-analyses found evidence of stress generation across a broad range of psychopathology, as evidenced by significantly larger prospective effects for dependent (overall psychopathology: r = .23) than independent (overall psychopathology: r = .10) stress. We also identified unique patterns of effects across specific types of psychopathology. For example, effects were larger for depression than anxiety. Furthermore, effects were sometimes larger in studies with younger participants, shorter time lags between assessments, checklist measures of stress, and for interpersonal stressors. Finally, a multilevel meta-analytic structural equation model suggested that dependent stress exacerbates psychopathology symptoms over time (beta = .04), possibly contributing to chronicity. Interventions targeting the prevention of stress generation may mitigate chronic psychopathology. Conclusions of this study are limited by the predominance of depression effect sizes in the literature and our review of only English language articles. On the other hand, the findings are strengthened by rigorous inclusion criteria, lack of publication bias, and absence of moderating effects by publication year. The latter underscores the replicability of the stress generation effect over the last 30 years. Taken together, the review provides robust evidence that stress generation is a cross-diagnostic phenomenon that contributes to a vicious cycle of increasing stress and psychopathology. Public Significance Statement Stress generation theory originally showed that people with depression can create their own stress. This meta-analysis indicates that stress generation is a cross-diagnostic phenomenon that contributes to the chronicity of symptoms of psychopathology. Findings imply that interventions aimed at preventing stress generation may mitigate chronic psychopathology. Stress generation also varied in nuanced ways across various types of psychopathology, thereby indicating for whom and under what conditions stress generation is most prominent. Importantly, a lack of publication bias and absence of moderating effects by publication year and by most demographic variables underscores the replicability of the stress generation effect over time and its universality across groups.

Automated summary

Stress generation theory posits that depression can increase the risk of dependent stress events. This meta-analysis examined whether stress generation occurs across various types of psychopathology and found evidence of its presence. The review also identified unique patterns of effects for different types of psychopathology. Additionally, the study suggests that interventions targeting stress generation may help mitigate chronic psychopathology. The replicability of the stress generation effect over time and its universality across groups is underscored by the lack of publication bias and moderating effects.