The Stress We Make: Dependent Stress and Why It Matters

How we turn early struggles into subsequent ones.

Reviewed by Michelle Quirk

Key points

• The stress generation hypothesis holds that people are agents—participants in shaping the world around them.
• The theory argues that the relations between stress and pathology are reciprocal.
• Interpersonal stress produced by mental health challenges is a key mechanism for subsequent psychopathology.

The link between stress and psychopathology is an old, established finding in psychology. The mechanisms underlying this link, however, are not as clear. Early theories advanced a "stress exposure model," whereby experiences of life stress create risk for psychopathology. The more frequent and severe the stress, the greater the risk. Later, researchers proposed a second mechanism, known as the "diathesis-stress model," which argues that cumulative stress does not create psychopathology but rather exposes preexisting vulnerabilities. Both these models have received considerable empirical support, particularly regarding the emergence of depressive disorders.

Yet these models carry several limitations. For one, they pay scant attention to human agency and ignore the fact that individuals may influence life events that may in turn be relevant to psychopathological outcomes. Moreover, the early views conceptualize the stress-psychopathology link as unidirectional (stress causes mental health outcomes), while neglecting the possibility that mental health problems may also cause stress. Finally, these views focused heavily on "independent" stress—stressful life events outside individual control (e.g., the death of a loved one), while neglecting to consider the potential role of “dependent” stress—stressful life events that are influenced by individual behavior (such as the dissolution of a marriage).

Stress Generation Hypothesis

To correct for these limitations, a more recent competing idea, termed the "stress generation hypothesis,” argues that psychologically vulnerable individuals may not differ from others in their experience of independent stress. They do, however, experience significantly higher levels of dependent stress, particularly within the interpersonal realm, due in part to their cognitive and behavioral habits. These higher levels of dependent stress constitute a risk for future psychopathology.

The stress generation hypothesis views the symptoms of psychopathology as a unique source of stress. Such stress, and the difficulties handling it, may contribute to the development of future disordered states. In other words, vulnerable individuals may inadvertently contribute to the emergence of psychopathology symptoms by engaging in behaviors that place them at higher risk.

Originally posited specifically to explain depression, the theory has since been broadened to address other disorders. Yet researchers have acknowledged that stress generation may operate differently for different disorders. For example, while interpersonal stress generation may be central to depression, non-interpersonal dependent stress may be central to externalizing psychopathology.

Further, researchers have expanded the idea by looking at specific "dependent stress" factors other than psychopathology that may create vulnerability. One central stress-generating factor identified in the literature is cognitive vulnerability, a tendency for negative self-expectations. Other proposed factors that may be potential stress-generation mechanisms include avoidance, as well as aggression and impulsivity, insecure attachment styles, and rejection sensitivity, among others.

New Meta-Analysis Findings

A recent (2024) meta-analysis by Richard Liu of Harvard Medical School and colleagues sought to examine the bulk of the research on stress generation over the past 30 years. The authors analyzed 104 separate studies from this period (N = 31,541). The meticulous effort involved a traditional meta-analysis as well as a Bayesian meta-analysis, an approach to statistical inference and probability that enables previously known (a priori) information about a population characteristic of interest to be incorporated into the analysis. Findings are considered stronger when both methods converge on similar results.

The results found “strong support” for the notion that psychopathology predicts dependent stress. Among the risk factors, “depressogenic cognitive styles” (which involve negative self-expectations and negative inferential style) emerged as “the most robust predictor of dependent stress.”

In addition “general interpersonal vulnerability,” which involves excessive reassurance-seeking, negative attachment, rejection sensitivity, and co-rumination (having an excessive discussion of problems with a close friend or friends, including rehashing the problems and focusing on negative feelings) was the second strongest stress generation mechanism.

The authors do not dismiss the role of independent stress, and their analyses found a modest association with psychopathology. However, “associations with dependent stress were, for the most part, significantly stronger than associations with independent stress.”

They found “General support…for dependent stress as a mediator for psychopathology and associated risk factors concerning subsequent psychopathology.” In other words, certain individual behaviors and cognitive habits are the mechanisms by which prior mental health problems may lead to later trouble.

The authors note that the fact that psychopathology may generate dependent stress would not be of much interest if that stress was not shown to increase the odds of later psychopathology. Their analysis of the role of dependent stress in bringing about later pathological outcomes found support for this “mediational component” of the stress generation hypothesis. Specifically, this effect was produced by interpersonal-dependent stress rather than non-interpersonal-dependent stress or independent stress.

The authors conclude: “We found strong and consistent support for stress generation effects for overall psychopathology, internalizing psychopathology, and depression. They remained reasonably robust to statistical adjustments for potential publication biases.”

In sum, the stress generation hypothesis holds that people are not passive recipients of events but rather agents—participants in shaping the world around them. The theory argues that the relations between stress and pathology are reciprocal. In this view, psychopathology and certain individual coping habits are themselves sources of stress that may lead to subsequent psychopathology. This meta-analysis of the stress generation literature supports this notion, finding that Interpersonal stress produced by mental health challenges is a key mechanism in the emergence of subsequent psychopathology.