ABSTRACT
This chapter addresses both the clinical and conceptual issues related to depression in the medically ill. It emphasizes especially the underlying principles regarding the etiology, diagnosis, and management of this perplexing condition. The chapter details theories of the nature of affect, and formulations involving various factors that may produce depressive affect. Several theories have emphasized the cognitive components of affective experience. The appraisal theorists proposed that the specific meaning attached to emotion arises from cognitive appraisal of the situation, and that a physiological response is secondary to this appraisal process. The etiological factors that may contribute to depression in the medically ill are discussed. Nevertheless, it is evident that depressive affect derives its essence from each of the biological, psychological, and social spheres. Medical illness may produce profound changes in a variety of biological and psychosocial systems, and thus may create multiple risk factors for depression.
