Exposure to Armed Conflict in Childhood vs Older Ages and Subsequent Onset of Major Depressive Disorder

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Abstract
Although important advances have been made in our understanding of the underpinnings of major depressive disorder (MDD) at the individual level (eg, genes, temperament, and direct experiences of traumatic events), less is understood about wider contextual risk factors, such as those at the neighborhood level.1 A large body of research has demonstrated that direct exposure to community violence (as either a victim or a witness) is associated with depressive symptoms and MDD,2,3 but fewer studies have evaluated the potential risks of living in a more violent neighborhood, independently of personal exposure to violence.4,5 Living in a neighborhood with greater levels of violence may be associated with the development of depression through Beck’s proposed triad of cognitions,6 specifically perceiving the world as dangerous or without meaning, the self as worthless, and the future as hopeless. Other mechanisms might include greater daily stress, disruption of social networks, loss of social capital,7,8 and in the case of children, the impact of neighborhood violence on caregivers.9,10

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