Life problems,social supports,and psychological functioning of emotionally disturbed and well low-income women

The relationship between stressful life events, social supports, and psychological functioning was examined in a low-income population of schizophrenic, depressed, and well mothers of young children. It was expected that the disturbed populations and those rated lowest on psychological functioning would have the most problems and the fewest resources. A buffering effect was hypothesized such that for the individuals with many problems, those with many resources would show better functioning than those with few resources. The results indicated that neither number of problems nor number of resources was related significantly to levels of psychological functioning. For disturbed women, having fewer problems may be associated with higher functioning. Both schizophrenic and depressed women reported more problems, but also more resources, than well women. Finally, having many resources did not affect the level of functioning of those with many stressful life events. Results were interpreted as failing to support the buffering hypothesis. Alternative explanations are proposed in terms of factors predisposing to vulnerability (e.g., low self-esteem) and alternative conceptualizations of social support.     

Death or illness of a family member,violence, interpersonal conflict,and financial difficulties as predictors of sickness absence: longitudinal cohort study on psychological and behavioral links

OBJECTIVE: Although an association between stressful life events and health problems has been demonstrated, the underlying mechanisms have remained unclear. We examined whether psychological problems and health-risk behaviors underpin the health effects of different event categories. METHOD: The initially healthy participants were 2991 (796 men, 2195 women) municipal employees who had taken no sick leave in 1995. In 1997, they completed a questionnaire requesting information on recent life events and psychological and behavioral factors. The outcome was recorded sickness absences in 1998. RESULTS: In men, the death or serious illness of a family member, violence, and financial difficulties increased the risk of later sickness absence. According to structural equation modeling, violence and financial difficulties also induced psychological problems such as anxiety, mental distress, and lowered sense of coherence. Psychological problems were associated with heightened cigarette and alcohol consumption, which in turn increased sickness absence. A corresponding structural model did not fit the data in relation to death or serious illness of a family member. In women, life events were associated with psychological problems and smoking but not sickness absence. CONCLUSIONS: Longitudinal evidence suggests that increased psychological problems and behaviors involving risk to health partially mediate the effect of stressful life events on health, as indicated by sickness absence. This model received support among men and for the event categories of violence and financial difficulties. Women were less affected by stressful life events than men.     

The interaction of social network size and stressful life events predict delayed-type hypersensitivity among women with metastatic breast cancer.

This study examined relationships between social support, stressful life events and antigen-specific cell-mediated immunity. Participants were 72 women with documented metastatic breast carcinoma, who completed self-report measures of social support and life stress. Immune response was assessed using the delayed type hypersensitivity (DTH) skin test. Number of positive antigens was significantly related to the interaction of social network size and stressful life events (p<0.05). Number of positive antigens was greater for women who had experienced a high frequency of stressful life events but who reported a larger network of support. However, social network size was inversely related to DTH response among women who had experienced fewer stressful life events. Average induration size was not significantly related to the quality of social support, life stress per se, or their interactions. The relationship between social network size and immune response in women with metastatic breast cancer depends on prior stressful life experience.     

Life Events,Emotions, and Immune Function: Evidence from Whitehall II Cohort Study

Abstract

Stressful life events have been shown to increase vulnerability to infections. However, the effects may be dependent on specific emotional responses associated with these events. In general, negative emotions are thought to exacerbate and positive emotions to protect from the adverse effects of stressors on health. In this study, we adopted an evolutionary and functionalist perspective on emotions and hypothesized that both positive and negative emotions in response to stressful events are protective, whereas absence of emotional reactions exacerbates vulnerability to infections. We assessed immune function using lymphocytes to white blood cells ratio as a proxy for current viral infection in 3,008 British civil workers (30% women). No main effect of stressful life events or emotions on lymphocyte ratio was observed in either sex. However, in men, there was an interaction of life events with both positive and negative emotions as well as a combined measure of general affect. Supporting our hypothesis, stressful life events were associated with impaired immune function in men who reported very low levels of both positive and negative emotions but not in others. We discuss potential benefits of negative and positive emotions in the context of stress and immunity.     

Childhood adversity, recent life events and depression in late life

BACKGROUND: The study investigates whether persons who have experienced childhood adversity are more likely to develop depressive symptoms when faced with recent events. METHOD: Data were used from a population-based sample, aged 55 to 85 years (n=1887), which were not depressed at baseline. Childhood adversities and recent stressful life events were retrospectively assessed. Depressive symptoms were measured with the CES-D. RESULTS: 14.4% of our sample experienced adverse events during childhood (<18 yrs) and 35.4% experienced recent events. Associations of depressive symptoms were found with both, childhood adversity (OR 1.80, 95% CI 1.21-2.69) and recent life events (OR 1.42, 95% CI 1.01-2.00). The effect of recent events on depressive symptoms was not modified by childhood adversity. LIMITATIONS: Underreporting may be present due to unwillingness to report embarrassing events or to disclose painful memories. CONCLUSIONS: No evidence was found for the assumption that older persons were more vulnerable for depression in reaction to recent life events when they were exposed to childhood adversity.     

Interpersonal stress and depression in women

The article presents a review and discussion of several aspects of the interpersonal context in which depression occurs that are unique to women. Women commonly experience depression in response to interpersonal life events, and also they contribute to the occurrence of stressful events and life contexts. Four key topics are reviewed: childrearing and parenting; romantic and marital relationships; generation of stressful life events; enduring social dysfunction even when not depressed. It is argued that depressed women are often locked into maladaptive interpersonal environments that contribute to the recurrence or chronicity of depression. Implications for treatment, conceptualization, and future research are noted.     

Life events and prodromal symptoms in bulimia nervosa

BACKGROUND: Little is known about the interaction of life events with prodromal symptoms in bulimia nervosa. METHODS: A semistructured research interview based on Paykel's Interview for Recent Life Events and on the Clinical Interview for Depression for eliciting prodromal symptoms was administered to 30 patients with bulimia nervosa and 30 healthy control subjects matched for sociodemographic variables. RESULTS: Patients reported significantly more stressful life events than controls. Most of the patients reported prodromal symptoms. Anorexia, low self-esteem, depressed mood, anhedonia, generalized anxiety and irritability were the most common prodromal symptoms. CONCLUSIONS: The prodromal phase of bulimia nervosa was found to be characterized by a combination of prodromal symptoms of affective type and stressful life events. Their joint occurrence may increase vulnerability to bulimia nervosa.     

Severity of stressful life events in first and subsequent episodes of depression: the relevance of depressive subtype

BACKGROUND: Recent studies have reignited debate concerning the relationship between stressful life events and depressive subtypes, particularly in relation to first versus subsequent episodes. AIMS: To investigate the relationship between stressful life events and variably defined melancholic/non-melancholic depressive subtypes, and the import of such life events to first compared with subsequent episodes across those subtypes. METHOD: Acute and chronic stressful life events were rated in 270 patients with DSM-IV Major Depressive episodes who were allocated to melancholic and non-melancholic groups separately as defined by DSM-III-R, DSM-IV, the Newcastle criteria and the CORE system. RESULTS: Severe stressful life events (both acute and chronic)-as defined by DSM-III-R axis IV-were more likely to occur prior to first rather than subsequent episodes, particularly for those with non-melancholic depression. LIMITATIONS: Dependence or independence of life events was not assessed. Genetic vulnerability to depression was not determined. Life events in first and subsequent depressive episodes were compared cross-sectionally between groups, not prospectively in the same cohort of patients. There were no differences in the number of severe life events-as defined by clinician consensus-between the first and subsequent episodes. CONCLUSIONS: These findings are consistent with other studies in suggesting an enhanced sensitisation of depressed patients to subsequent episodes of depression, but suggest that any such phenomenon is specific to non-melancholic depression, in comparison to one key previous study.     

Life stress, social support, and psychological vulnerability: epidemiological considerations.

Previous research indicates that relatively disadvantaged sociodemographic groups (women, the poor, the unmarried) are more vulnerable to the impacts of life events. More recently, researchers have hypothesized that the psychological vulnerability of these groups may be due to the joint occurrence of many stress events and few psychological resources with which to cope with such events. This latter hypothesis is called here the applied buffering hypothesis. Using data from the New Haven Community Survey, the existence of differential psychological vulnerability is first reconfirmed. Women; older adults; unmarried persons; those with less education, income, and occupational prestige; married women; and unmarried women are found significantly more distressed by the experience of life events than their sociodemographic counterparts. The applied buffering hypothesis is then tested with several measures of social support. Little support for the hypothesis is found. That is, the psychological vulnerability of low status groups cannot be explained by the interaction of many events and few available sources of social support. Limitations of the data and alternative explanations of these findings are discussed. The confirmation of psychological vulnerability in disadvantaged groups suggests new directions for future epidemiological research.     

Stability and change of emotional functioning in late life: modelling of vulnerability profiles

BACKGROUND AND AIMS: The present study investigated stability and change in emotional well-being in a prospective study of a large sample of community-dwelling older adults (> or = 55 years). Emotional functioning was conceptualized according to the tripartite model distinguishing three aspects: general negative affect (NA), depression, and anxiety. The study tested models for the decline of mental health in late life based on the diathesis-stress model. In previous studies, support has been found for the diathesis-stress model (for an overview, see [Goldberg, D.P., Huxley, P., 1992. Common mental disorders: a biosocial model. Routledge, London; Zuckerman, M., 1999. Vulnerability to psychopathology. American Psychological Association, Washington, DC.]). The predictive ability of vulnerability factors (the personality characteristics mastery and neuroticism) and stressful life events and their interaction was tested for an increase in general negative affect, decreased positive affect (PA), and increased anxiety. More specifically, we tested the hypothesis that loss leads to decreased positive affect in subjects with low mastery, whereas threat leads to anxiety in subjects with high neuroticism. METHODS: Data from the Longitudinal Aging Study Amsterdam (LASA) were used. LASA is a longitudinal study in a large representative sample of adults aged 55 to 85 (N=1837). Self-report data on depression, anxiety, and negative affect were collected from adults over a 6-year period in three waves. The data were analyzed using multilevel analysis. RESULTS: The findings revealed an association between low mastery, high neuroticism, and an increase in negative affect, lack of positive affect, and anxiety. Furthermore, high mastery protected against the negative impact of loss events, but neuroticism did not augment the negative impact of threat events on emotional health. CONCLUSION: Partial support was found for a diathesis-stress model of change in emotional functioning in late life. Furthermore, support was found for distinguishing between symptoms of negative affect, depression, and anxiety.     

Depression and sensitization to stressors among young women as a function of childhood adversity

The authors tested a stress-sensitization version of a diathesis-stress approach to depression. In a 2-year longitudinal follow-up design, exposure to stressful life events was examined in young women in the transition to adulthood. The authors hypothesized that those who had experienced one or more significant childhood adversities would have a lower threshold for developing a depressive reaction to stressors. Results indicated that women with exposure to one or more childhood adversities--such as family violence, parent psychopathology or alcoholism, and others--were more likely to become depressed following less total stress than women without such adversity. The results could not be accounted for by chronic stress or prior depression. Both biological and psychological sensitization mechanisms may be speculated to play a role, but the actual mechanisms of stress sensitization remain to be explored.     

Persistent cortisol non-suppression after clinical recovery predicts symptomatic relapse in unipolar depression

We assessed the length and the quality of remission of 13 unipolar endogenous depressed patients, DST non-suppressors before treatment, in a 2-year prospective study. During this period, we recorded stressful life events. Persistent dexamethasone non-suppression, after treatment and complete clinical recovery, correlated highly with early clinical relapse. All six non-normalizers but only one normalizer were rehospitalized within the following 2 years for a major depressive relapse. Persistent DST non-suppression was unrelated to any impact of drug discontinuation, the occurrence of stressful life events or the length of illness-free intervals in the patient's prior course of illness. Persistent DST non-suppression appears to have significant prognostic value.     

Vulnerability to life events exposure

A theoretical model designed to assess the contribution of systematic factors contributing to vulnerability to life-events exposure is described. This model is applied to six-year longitudinal data on life events exposure for a sample of New Zealand women with school-aged children. The fitted model suggests that in the region of 30% of the variance in life-event reports over the six-year period was attributable to a common vulnerability factor. Modelling of this vulnerability factor suggested that two major determinants of vulnerability to life events were the level of social disadvantage of the woman and her level of neuroticism: women of socially disadvantaged backgrounds and women with high neuroticism scores showed a consistent tendency to report high life-event exposure during the six-year period. The implications of these findings are discussed.     

Stress reactivity following brief treatment for depression: differential effects of psychotherapy and medication

Psychotherapy and medication treatments are both effective in reducing depressive symptoms. However, only psychotherapy provides an enduring effect by reducing depressive vulnerability following treatment termination. This differential efficacy may reflect mode-specific effects on the longitudinal relationship between depression and stress. The current study examined posttreatment data from 153 outpatients enrolled in the Treatment of Depression Collaborative Research Program. Longitudinal analyses using the latent difference score (LDS) framework (a structural modeling technique that combines features of latent growth curve and cross-lagged regression models) evaluated the temporal relationship between severity of depression and frequency of stressful life events, assessed by interviewers at treatment termination and at 6, 12, and 18 months following treatment. Results supported a stress reactivity model in that stressful events led to elevations in the rate of depression change. Furthermore, multigroup LDS analysis indicated that this longitudinal stress reactivity occurred only for outpatients in the medication conditions. Results demonstrate that the enduring impact of psychotherapy involves the development of enhanced resiliency to stressful life events.     

Stressful life events and survival after breast cancer

OBJECTIVE: This study assessed the relation of stressful life events with survival after breast cancer. METHODS: This study was based on women with histologically confirmed, newly diagnosed, localized or regional stage breast cancer first treated in 1 of 11 Quebec City (Canada) hospitals from 1982 through 1984. Among 765 eligible patients, 673 (88%) were interviewed 3 to 6 months after diagnosis about the number and perceived impact of stressful events in the 5 years before diagnosis. Three scores were calculated: number of events; number weighted by reported impact; and for almost 80% of events, number weighted by community-derived values reflecting adjustment required by the event. Scores were divided into quartiles to assess possible dose-response relationships. Survival was assessed in 1993. Hazard ratios and 95% confidence intervals (CIs) comparing all-cause and breast cancer-specific mortality were calculated with adjustment for age, presence of invaded axillary nodes, adjuvant radiotherapy, and systemic therapy (ie, chemotherapy and hormone therapy). RESULTS: When quartiles 2, 3, and 4 were compared with the appropriate lowest quartile, adjusted hazard ratios for all-cause mortality were 0.99 (CI = 0.70-1.38), 0.97 (CI = 0.73-1.31), and 1.04 (CI = 0.78-1.40) for number, number weighted by impact, and number weighted by community-derived values, respectively. Results were essentially similar for the relation between stressful life events limited to those occurring within the 12 months before diagnosis and overall mortality and between stressful life events in the 5 years before diagnosis and breast cancer-specific mortality. CONCLUSIONS: Stress was conceptualized as life events presumed to be negative, undesirable, or to require adjustment by the person confronting them. We found no evidence indicating that this kind of stress during the 5 years before diagnosis negatively affected survival among women with nonmetastatic breast cancer. Evidence from this study and others on the lack of effect of this type of stress on survival may be reassuring for women living with breast cancer.     

Social stress and women's risk for recurrent depression

Summary The lives of depressed women appear to be stressful. Based on data from a community sample of women with histories of depression, support for an interpersonal stress perspective on women's depression is presented. Women often find themselves embedded in environments with high levels of chronic stress and negative life events. Compared to never-depressed women, those who are currently depressed, and even those with prior but not current depression, are relatively more likely to experience divorce and marital difficulties, spouses with psychiatric disorders, problematic relationships with their children, children with high rates of disorder, and recent elevated rates of personal stressful life events. Such life challenges may increase the likelihood of further depressive experiences. While both psychosocial and genetic factors may contribute to the interpersonal vulnerabilities, once caught up in depression-maintaining environments, treatments for women may require intervention in the family and interpersonal domains. Received October 15, 2002; accepted November 17, 2002 Published online January 17, 2003 RID="*" ID="*"  Presented at the First World Congress on Women's Mental Health, Berlin, March, 2001; Symposium: Understanding the interaction of stress and gender in the prediction of major depression and treatment response. Correspondence: Constance Hammen, Ph.D., Department of Psychology, University of California, Los Angeles, 405 Hilgard Ave., Los Angeles, CA 90095, U.S.A.; e-mail: hammen@psych.ucla.ed     

Vulnerability to Stress among Women with in Utero Diethylstilbestrol (DES) Exposed Daughters

Abstract

In utero exposure to diethylstilbestrol (DES) was initially linked to vaginal-cervical cancer and subsequently to reproductive difficulties. These unanticipated and ongoing health risks to female offspring may constitute a chronic source of stress for DES mothers. We interviewed 60 mothers of exposed daughters and 30 acquaintance controls. Two hypotheses were tested in regard to DES mothers: (1) DES discovery and its aftermath have a direct, long-term, negative effect on psychological health and (2) the DES experience intensifies the negative psychological effects of other adverse life circumstances. To operationalize psychological health, we measured symptoms of ?demoralization” and positive health practices—the latter as a behavioral indicator of mastery and personal control. We also measured adversities that may mediate the threat posed by DES, including stressful events, medical problems, and chronic burdens. We found DES history to be associated with poorer psychological health only when mothers encountered other losses and threats to themselves and their families. We concluded that DES mothers may manifest increased vulnerability to subsequent stresses in their lives.     

Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample

Summary Background: Depression and other psychiatric disorders during pregnancy and postpartum is an important health problem, especially if the symptoms are recurrent or sustained.Methods: All Swedish speaking women attending their first antenatal care visit during three predestined weeks were invited to participate. Depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy, two months and one year postpartum.Results: In all, 2430 women completed three questionnaires. A dose-effect relation was found between the numbers of stressful life events experienced in the year prior to pregnancy and mean EPDS score in pregnancy. The prevalence of recurrent or sustained depressive symptoms (EPDS12 on all three evaluations) was 3% (79/2430). Three factors were associated with depressive symptoms, two or more stressful life events in the year prior to pregnancy, native language other than Swedish and unemployment.Conclusions: Apart from questions about psychiatric history, a psychosocial history in early pregnancy including stressful life events, native language and employment status could help the health professionals to identify women at risk for recurrent or sustained depression during pregnancy and the year after giving birth.     

Daily hassles, cortisol, and the pathogenesis of depression

Daily hassles and/or ongoing stress are associated with increased cortisol secretion in healthy individuals. Hassles are also associated with increased cortisol levels in depressed patients. Considerable evidence suggests that hypercortisolism is involved in the pathogenesis of depressive disorders. Over the past decade, there has been a shift from viewing excessive hypothalamic-pituitary-adrenal (HPA) activity in depression as an epiphenomenon to its having specific effects on symptom formation. The author suggests that increased cortisol secretion caused by daily hassles and/or ongoing stress contributes to the development of depressive disorders. Minor stressful events may lead to depression in vulnerable individuals. Genetic factors interact with environmental factors to influence the vulnerability to stress and mood disorders. The author also proposes that elevated cortisol levels associated with stressful daily events may worsen the condition of depressed patients. The author notes that one of the goals of prevention of stress-related disorders is to help individuals be more competent in managing their behavior and emotions in reaction to negative aspects of their environment, and briefly discusses stress management methods and techniques. The risk of developing depression is determined by a complex interplay between genetic susceptibility, environmental exposures, and aging. These influences also account for long term changes in the regulation of HPA function. Further studies of HPA function may not only advance our understanding of the role of the HPA system in the etiology and pathogenesis of psychiatric disorders, but also be useful in refining conceptions of psychiatric disorders themselves and possible approaches to the treatment of these conditions.     

Predictors of change in anxiety symptoms of older persons: results from the Longitudinal Aging Study Amsterdam

BACKGROUND: Data on the course of anxiety in late life are scarce. The present study sets out to investigate the course of anxiety, as measured by the HADS-A (Zigmond & Snaith, 1983) in community dwelling older persons, and to evaluate predictive factors for change over 3 years in anxiety symptoms following the vulnerability/stress model. METHOD: Based on the first anxiety assessment, two cohorts were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort (N = 1602) we studied risk factors for the development of anxiety symptoms; in the anxious cohort (N = 563) the same factors were evaluated on their predictive value for restitution of symptoms. Risk factors included vulnerability factors (demographics, health status, personality characteristics and social resources) and stressors (life events occurring in between both anxiety assessments). Logistic regression models estimated the effects of vulnerability factors, stress and their interaction on the likelihood of becoming anxious and chronicity of anxiety symptoms. RESULTS: It was indicated that the best predictors for becoming anxious were being female, high neuroticism, hearing/eyesight problems and life-events. Female sex and neuroticism also increased the likelihood of chronicity of anxiety symptoms in older adults, but life events were not related to chronicity. The main stressful event in late life associated with anxiety was death of one's partner. Vulnerability factors and stress added on to each other rather than their interaction being associated with development or chronicity of anxiety. CONCLUSION: The vulnerability/stress model offers a useful framework for organizing risk factors for development and chronicity of anxiety symptoms in older persons, but no support was attained for the hypothesis that vulnerability and stress amplify each others effects. Finally, the results indicate to whom preventive efforts should be directed: persons high in neuroticism, women, and those who experience distressing life events.