Social rank theory of depression: A systematic review of self-perceptions of social rank and their relationship with depressive symptoms and suicide risk.

Abstract

BACKGROUND\nDepression can be debilitating, as well as a risk factor for self-harm and suicide. Social rank theory (SRT) suggests depression stems from feelings of defeat and entrapment that ensue from experiencing oneself to be of lower rank than others. This study aims to review the literature investigating the relationship between self-perceptions of social rank and depressive symptoms or suicidal ideation/behaviour.\n\n\nMETHODS\nA keyword search of three psychological and medical databases was completed (Psychinfo, Medline, Web of Knowledge). Studies were quality assessed using established criteria.\n\n\nRESULTS\nAn initial 1290 records were identified. After application of inclusion and exclusion criteria, 70 remained measuring depressive symptoms (n\u202f=\u202f68), self-harm (n\u202f=\u202f3) and suicidal ideation (n\u202f=\u202f3). The main measures assessing social rank were the social comparison scale (SCS; n\u202f=\u202f32) and subjective social status (SSS, n\u202f=\u202f32), with six additional papers including another measure of social rank. In univariate analyses, as perceptions of social rank decreased, depressive symptoms (and suicidal ideation/self-harm) increased. Multivariate analyses indicated that social rank may act as a psychosocial mechanism to explain the relationship between social factors (in particular socio-economic status) and depressive symptoms. Additionally, psychological variables, such as rumination or self-esteem, may mediate or moderate the relationship between social rank and depressive or suicidal symptoms.\n\n\nLIMITATIONS\nStudy quality was variable and 89% of studies were cross-sectional.\n\n\nCONCLUSIONS\nAlthough more prospective research is required, this review highlights the importance of understanding an individual s perception of their social position compared to others as it may lead to an enhanced understanding of the aetiology of depressive disorders.