{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:04:07Z","timestamp":1789610647502,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01MH126798"],"award-info":[{"award-number":["U01MH126798"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["WT 200176\/A\/15\/Z"],"award-info":[{"award-number":["WT 200176\/A\/15\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stressful life events (SLEs) are a well\u2010established etiologic risk factor for major depressive disorder (MDD). The kindling hypothesis proposes that their role diminishes as episodes recur, with illness becoming progressively autonomous from environmental triggers. It remains unclear whether this reflects true within\u2010person change or a compositional shift\u2014whereby more highly recurrent patients are those whose episodes were stress\u2010independent from the outset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from life history calendars, a structured method for reconstructing lifetime sequences of depressive episodes and antecedent life events, from 5843 Korean women with recurrent MDD (\u2265\u20092 lifetime episodes) contributing 17,338 episode observations (KOMOGEN\u2010D), with replication in 708 Chinese women contributing 1905 episode observations (CONVERGE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Consistent with the kindling hypothesis, the proportion of episodes preceded by any SLE declined substantially and monotonically across episode order, from 94.8% (95% CI, 94.2%\u201395.4%) at the first episode to 77.7% (95% CI, 71.2%\u201384.2%) at the seventh (OR per episode increase, 0.66; 95% CI, 0.62\u20130.71). Inter\u2010episodic intervals shortened with episode order (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22121.50\u2009years; 95% CI, \u22121.61 to \u22121.38), indicating that episodes became more frequent. Within\u2010individual analyses revealed that more participants had decreasing than increasing SLE counts across episodes, with more frequent transitions from SLE\u2010associated to non\u2010SLE\u2010associated episodes than the reverse. Stratification by SLE type showed that independent SLEs decreased across episodes, whereas dependent SLEs increased. The main findings were replicated in CONVERGE, although some within\u2010person transition analyses were limited by smaller sample size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Across two large cohorts collected in different cultural settings, SLE involvement preceding episodes decreased across episode order while the rate of recurrence accelerated, and within\u2010person analyses supported stress\u2010episode decoupling as an individual\u2010level process. These findings provide some of the strongest evidence yet assembled that the course of recurrent MDD is consistent with the kindling hypothesis: episodes become progressively less dependent on external stressors, shifting toward a more autonomous illness. These results have direct implications for stratifying recurrence risk by episode stage and for identifying the point in the illness course at which preventive strategies should shift emphasis from targeting environmental stressors toward sustained pharmacological or psychological relapse prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.70141","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:34:28Z","timestamp":1789608868000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reduction in Rates of Stressful Life Events Preceding Depressive Episodes in the Course of Recurrent Major Depressive Disorder"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9414-5635","authenticated-orcid":false,"given":"Sooyeon","family":"Min","sequence":"first","affiliation":[{"name":"Department of Neuropsychiatry Seoul National University Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0594-7346","authenticated-orcid":false,"given":"Yoojin","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kangwon National University Hospital  Chuncheon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9560-2383","authenticated-orcid":false,"given":"Heon\u2010Jeong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Korea University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4858-6173","authenticated-orcid":false,"given":"Seunghee","family":"Won","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine Kyungpook National University  Daegu Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyu Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Nowon Eulji University Hospital  Seoul Republic of Korea"},{"name":"Department of Neuropsychiatry, School of Medicine Eulji University  Daejeon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3977-3663","authenticated-orcid":false,"given":"Dong Yun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Gyeongsang National University Changwon Hospital Gyeongsang National University School of Medicine  Jinju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6588-9221","authenticated-orcid":false,"given":"Do Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Chuncheon Sacred Heart Hospital and Mind\u2010Neuromodulation Laboratory Hallym University College of Medicine  Chuncheon South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1366-0396","authenticated-orcid":false,"given":"Ji Hyun","family":"Baek","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Samsung Medical Center Sungkyunkwan University School of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0148-9827","authenticated-orcid":false,"given":"Kyoung\u2010Sae","family":"Na","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Gachon University College of Medicine, Gil Medical Center  Incheon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8766-8713","authenticated-orcid":false,"given":"Eun\u2010Jeong","family":"Joo","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, School of Medicine Eulji University  Daejeon Republic of Korea"},{"name":"Department of Psychiatry, Uijeongbu Eulji Medical Center Eulji University  Uijeongbu Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry National Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9045-2494","authenticated-orcid":false,"given":"Ji\u2010Woon","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Pusan National University Yangsan Hospital  Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Hyung Keun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woojae","family":"Myung","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Seoul National University Bundang Hospital  Seongnam Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-126X","authenticated-orcid":false,"given":"So Young","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Seoul Metropolitan Government\u2010Seoul National University Boramae Medical Center  Seoul Republic of Korea"},{"name":"Department of Psychiatry Seoul National University College of Medicine  Seoul Republic of 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Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1286-264X","authenticated-orcid":false,"given":"Jeong Hun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Seoul National University Bundang Hospital  Seongnam Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0828-3557","authenticated-orcid":false,"given":"Jung Jae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Dankook University Hospital  Cheonan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0561-2503","authenticated-orcid":false,"given":"Young Tak","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of 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