In support of hassles as a measure of stress in predicting health outcomes

We investigated the impact of frequently occurring minor stressors (hassles) upon health status in a sample of low-income, elderly persons with osteoarthritis. These individuals are characterized by conditions which are precursors to experiencing stress. Using a modified Hassles scale, we replicated some important findings in a sample demographically distinct from earlier studies on hassles. Specifically, hassles were better predictors of health status than major life change events, and the influence of life change events was indirect, i.e., it increased hassles, which in turn, negatively affected health status. Furthermore, hassles correlated strongly with validated indicators of health status. By replicating earlier studies in a demographically dissimilar sample, and by finding significant correlations between hassles and valid physical health measures, we have strengthened the conceptual development of hassles.     

Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events

The standard life events methodology for the prediction of psychological symptoms was compared with one focusing on relatively minor events, namely, the hassles and uplifts of everyday life. Hassles and Uplifts Scales were constructed and administered once a month for 10 consecutive months to a community sample of middle-aged adults. It was found that the Hassles Scale was a better predictor of concurrent and subsequent psychological symptoms than were the life events scores, and that the scale shared most of the variance in symptoms accounted for by life events. When the effects of life events scores were removed, hassles and symptoms remained significantly correlated. Uplifts were positively related to symptoms for women but not for men. Hassles and uplifts were also shown to be related, although only modestly so, to positive and negative affect, thus providing discriminate validation for hassles and uplifts in comparison to measures of emotion. It was concluded that the assessment of daily hassles and uplifts may be a better approach to the prediction of adaptational outcomes than the usual life events approach.Writing of this paper was supported in part by a research grant from the National Institute on Aging (AG 00799).     

Psychosocial factors and psychological symptoms: HIV in a public health setting

The association between psychosocial factors (e.g., social support, coping, stress, relationship status, sexual orientation) and psychological symptoms within an HIV-positive sample population that has been underrepresented in prior research was examined in this study. The study's sample reflects many African Americans, injecting drug users, heterosexuals, and women. Structural equation modeling was used to examine the relations among psychosocial factors and psychological symptomatology. There are several notable findings from this study. First, this study's sample appeared to exhibit greater psychological symptomatology than community samples and other HIV-infected demographic groups. Second, both internal factors (i.e., coping response) and external factors (i.e., life stress) influenced psychological symptomatology. Finally, sexual preference and relationship status influenced the association between social support and psychological well-being. © 1998 John Wiley & Sons, Inc.     

Longitudinal Predictors of Bipolar Spectrum Disorders: A Behavioral Approach System Perspective

We review longitudinal predictors, primarily psychosocial, of the onset, course, and expression of bipolar spectrum disorders. We organize our review along a proximal–distal continuum, discussing the most proximal (i.e., prodromes) predictors of bipolar episodes first, then recent environmental (i.e., life events) predictors of bipolar symptoms and episodes next, followed by more distal psychological (i.e., cognitive styles) predictors, and ending with the most distal temperament (i.e., Behavioral Approach System [BAS] sensitivity) predictors. We then present a theoretical model, the BAS dysregulation model, for understanding and integrating the role of these predictors of bipolar spectrum disorders. Finally, we consider the implications of the reviewed longitudinal predictors for future research and psychosocial treatments of bipolar disorders.     

Stress,Social Support,and Behavior Symptoms in Middle Childhood

This research concerns the distinction between stress associated with major life events and that associated with "daily hassles" as well as the possible moderating influences of social support. We analyzed data from 159 school-age children, 6 and 9 years old, and their mothers to examine the relationship between stress and behavior symptoms. We considered a subsample of 35 of these families to be a high stress group because of marital separation or divorce within the 4-year period prior to the study. The findings documented the expected relationships between behavior symptoms and stress, whether operationalized as life events or hassles. Undesirable life events showed the strongest relationship to behavior symptoms. Multiple-regression models with R2 = .32 (p < .0001) included significant main effects for stress, social support, and some interactions between them. Evidence was provided for a moderating or buffering influence of social support on the relationship between stress and illness. However, the model including interaction effects did not account for appreciably more variance, suggesting that the simpler, more parsimonious main effects conceptualization was at least as useful, if not more so.     

Dysregulation of the behavioral approach system (BAS) in bipolar spectrum disorders: review of theory and evidence

In recent years, a call for increased research on bipolar disorder has been answered with methodologically diverse studies exploring goal striving, life events, cognitive style, decision-making, and neurobiological abnormalities in bipolar disorder. In order to further this spurt of research and to systematize our understanding of bipolar disorder, an integrative perspective is warranted. The behavioral approach system (BAS) dysregulation theory, proposed by Richard Depue and colleagues, provides such an integrated model for understanding psychosocial and biological aspects of bipolar disorder. In this paper, we review studies on life events, cognitive style and other psychosocial and neurobiological factors to examine whether the BAS dysregulation theory is supported by existing data. Then, we draw on recent advances in the study of emotion and motivation, and propose an expansion of the BAS dysregulation model of bipolar spectrum disorders to foster further biopsychosocial investigations of bipolar disorder. This expanded model provides greater specificity in predictions, especially about the nature of BAS dysregulation, environmental factors and psychological processes (e.g., appraisal processes) featured in a causal chain culminating in bipolar symptoms. Finally, we discuss the implications of the expanded BAS model for the course of bipolar spectrum disorders.     

Social and Familial Factors in the Course of Bipolar Disorder: Basic Processes and Relevant Interventions

This article reviews the role of social factors, notably life events and family relationships, in the course of bipolar illness in adults and youth. We also discuss psychological variables that help explain the vulnerability of bipolar patients to social environments, including personality factors (e.g., neuroticism), reward sensitivity, and difficulty with the accurate perception of facial emotions. Bipolar patients are highly sensitive to reward, and excessive goal pursuit after goal-attainment events may be one pathway to mania. Negative life events predict depressive symptoms, as do levels of familial expressed emotion. Psychosocial interventions can speed recoveries from episodes and delay recurrences over one- to two-year intervals. Future research should examine the nature of vulnerability/stress interactions at different phases of development, and the role of psychosocial interventions in altering these processes.     

Relationship of hassles, uplifts, and life events to psychological well-being of freshman medical students

Hassles, uplifts, and life events were related to psychological well-being with a representative sample of 55 (of 179) freshman medical students. Students were sent measures of hassles, uplifts, and affect-moods measures for 9 consecutive months and a measure of life stress at the beginning and middle of the school year. The hassles measure was found to be a better predictor of concurrent and subsequent negative mood than was the life stress measure, whereas life stress was found to be a better predictor of subsequent positive mood than hassles. On the whole, uplifts were unrelated to mood. The relationship between life stress and hassles was also investigated. The implications of the findings for future stress and health outcome research are discussed.     

Effects of political and military traumas on children: The palestinian case

Social scientists have long recognized that individuals subjected to traumatic events associated with military and political conflict experience dire psychological consequences. The systematic study of this phenomenon, however, could be considered a nascent event. Research on the psychological sequel of traumatic events (traumatology) is well-rooted in the recognition and development of posttraumatic stress disorder as a separate psychological disorder category. The early studies in this field focused mainly on adult populations. With the recent advent of involvement of children in military conflicts such as in Africa (e.g., Mozambique), the Middle East (e.g., Palestine, Lebanon), and Southeast Asia (e.g., Cambodia), psychologists have taken a keen interest in examining the psychological effects such conflicts reap on children. Hence, a growing but modest body of literature has been amassed within the past 20 years on the subject. This article is an attempt to synthesize this literature in order to examine the universal and culture-specific correlates of political and military trauma. Specifically, the article will focus on the psychological symptoms children display following their exposure to such traumatic events. Special emphasis will be placed on anxiety, phobic, psychosomatic, and depressive symptoms. More importantly, however, an examination will be made to ascertain which factors (e.g., psychosocial, cultural, and political) serve to shield (protect) or predispose (vulnerability) children to psychological dysfunction. Furthermore, the analyses presented will be gender specific. The article will attempt to delineate a paradigm that explains the relationship between trauma, culture, and personality. Although the article will examine studies from various regions, specific emphasis will be placed on the Palestinian experience.     

Rumination,goal linking,daily hassles and life events in major depression

Background: Rumination in response to stressful events and depressed mood leads to harmful outcomes. In addition to intra‐psychic processes, depression is also associated with daily hassles and major life events. Self‐regulatory beliefs such as goal linking could mediate the link between life events, daily hassles, rumination and major depression. Method: The relationships between depressed mood, rumination, goal linking, life events and daily hassles were investigated in a between‐groups design. Standardized questionnaire measures of these constructs were used to compare depressed participants with a group of people experiencing psychological distress, but not major depression, and a never‐depressed group. Results: Participants with major depression experienced similar numbers of life events as the other groups, though the impact of these was greater for the depressed group than either the psychological distress group or the healthy controls. Depressed participants also experienced greater daily hassles than either of the other two groups. Depressed participants were also higher in goal linking and rumination. Regression analysis demonstrated that neither life events nor goal linking predict rumination or depressed mood. Rumination appears to moderate the relationship between daily hassles and depressed mood. Discussion: Theoretical and clinical implications are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Life events and juvenile bipolar disorder: conceptual issues and early findings

There is increasing interest in the psychosocial variables that might predict the course of child and adolescent bipolar disorder. In the literature on adult bipolar disorder, life events have been shown to be a major predictor of symptoms. In this review, we focus on studies of how life events influence the course of child and adolescent bipolar disorder. To begin, we review methodological considerations in life events research, and briefly summarize the findings regarding life events in adult bipolar disorder. Then, we discuss available studies on life events as a predictor of the course of juvenile bipolar disorder. We conclude with suggested directions for future research.     

Risk and resistance factors in the adaptation in mothers of children with juvenile rheumatoid arthritis

OBJECTIVE: To examine the importance of illness severity, child functional status, psychosocial stress, intrapersonal factors, stress processing, and social-ecological factors in predicting psychological symptoms among mothers of children with juvenile rheumatoid arthritis (JRA). METHODS: Mothers of 92 children with JRA completed surveys while waiting with their children for physician appointments or during JRA meeting breaks. RESULTS: Mothers reported higher mean levels of psychological symptoms than a normative group. Higher levels of psychosocial stress predicted increased psychological symptoms after accounting for disease severity and functional status. Maternal appraisal of the illness tended to moderate the relationship between illness stress and psychological symptoms, and maternal education moderated the relationship between daily hassles stress and psychological symptoms. CONCLUSIONS: These data indicate that mothers of children with JRA are at risk for psychological distress. Inteventions that take into account the buffering effects of maternal education and appraisal may serve to decrease the effects of maternal stress.     

The psychosocial impact of psoriasis: physical severity, quality of life, and stigmatization

Men (N=58) and women (N=43) living with psoriasis completed questionnaires assessing quality of life and feelings of stigmatization. Physician ratings of disease severity were used in conjunction with these variables to account for psychosocial impact. Results showed that ratings of severity were poor predictors of quality of life and stigmatization. Demographic variables (e.g., sex and education) were also generally poor predictors of psychosocial outcome. It is concluded that attempts to understand the psychological impact of psoriasis in terms of current measures of disease severity and demographic characteristics will be limited.     

Major life events and daily hassles in predicting health status: methodological inquiry

The present study (N = 97) hypothesized that both major life events and daily hassles would be associated with anxiety and depressive symptomatology. While the results partially supported the hypothesis, the inconsistent findings suggest methodological flaws in each life stress measure. These limitations are reviewed, and the use of the semi-structured interview is presented as one possible refinement.     

Life stress and the course of early-onset bipolar disorder

BACKGROUND: Studies of adult bipolar patients and adolescents with major depression indicate that life stress and mood symptoms are temporally and causally related to one another. This study examined whether levels of life stress predict levels of mood symptoms among bipolar adolescents participating in a treatment development study of family-focused psychoeducation and pharmacotherapy. METHODS: Bipolar adolescents (n=38) who reported a period of acute mood symptoms within the prior 3 months were recruited for a 1-year study of life stress. Clinician-administered evaluations were completed with adolescents and parents at 3-month intervals for up to 12 months, using the UCLA Life Stress Interview and the K-SADS Mania and Depression Rating Scales. RESULTS: Chronic stress in family, romantic and peer relationships was associated with less improvement in mood symptoms over the study year. The frequency of severe, independent life events also predicted less improvement in mood symptoms. Higher levels of chronic stress in family and romantic relationships, and higher severity of independent events, were more strongly associated with mood symptoms among older adolescents. Results were independent of adolescents' psychosocial treatment regimens. LIMITATIONS: The majority of adolescents received family-focused psychoeducational treatment and all were being treated with psychotropic medication. The influence of life stress on mood symptoms may have been attenuated by intensive intervention. CONCLUSIONS: Stress is linked to changes in mood symptoms among bipolar adolescents, although correlations between life events and symptoms vary with age. Chronic stress in family, romantic, and peer relationships are important targets for psychosocial intervention.     

Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study

BACKGROUND: Depression is a common and disabling psychiatric disorder in later life. Particular frail nursing home patients seem to be at increased risk. Nursing home-based studies on risk indicators of depression are scarce. METHODS: Prevalence and risk indicators of depression were assessed in 333 nursing home patients living on somatic wards of 14 nursing homes in the North West of the Netherlands. Depressive symptoms were measured by means of the Geriatric Depression Scale (GDS). Major and minor depression were diagnosed according to the DSM-IV criteria, sub-clinical depression was defined as a GDS score >10 while not meeting the DSM-V criteria for depression. RESULTS: The prevalence of major depression was assessed to be 8.1% and the prevalence of minor depression was 14.1%, while a further 24% of the patients suffered from sub-clinical depression. For major depression significant risk indicators were found for pain, functional limitations, visual impairment, stroke, loneliness, lack of social support, negative life events and perceived inadequacy of care. For sub-clinical depression the same risk indicators were found, with the exception of lack of social support. LIMITATIONS: Data were collected cross-sectional. CONCLUSIONS: The prevalence of depression in the nursing home population is very high. Whichever way defined, the prevalence rates found were three to four times higher than in the community-dwelling elderly. Age, pain, visual impairment, stroke, functional limitations, negative life events, loneliness, lack of social support and perceived inadequacy of care were found to be risk indicators for depression. Consequently, optimal physical treatment and special attention and focus on psychosocial factors must be major goals in developing care programs for this frail population.     

Health and hassles in older and younger men

This study compared hassles and uplifts in older and younger chronically ill men in regard to whether they perceived their health as good or poor (N = 50). Hassles are irritating and frustrating demands (minor stress) that characterize everyday transaction with the environment, such as losing things or being in traffic jams. Uplifts are positive events that could help counteract the effects of stress. Men in the study rated 40 potential hassles and 40 uplifts on 1 to 4 scales for the preceding month. These were compared by multivariate analysis of variance between older (age 65 and over) and younger (ages 45 through 64) men and between good vs. poor perceptions of health. Uplifts did not discriminate significantly between ages or health perceptions. In addition, hassles were similar between old and young; however, they differed significantly by good and poor assessments of health. Those who viewed their health as poor reported more hassles, mostly from events that were related to their physical health care. Because of the confounding effects with health in individuals who are already ill, hassles may not be good predictors of future health status, but they can help health professionals understand the kinds of demands that produce stress in management of diseases.     

Risk for recurrence in depression

Depression is a highly recurrent disorder with significant personal and public health consequences. Prevention of recurrence would be extremely desirable, and thus researchers have begun to identify risk factors that are specific to recurrence, which may be different from risk factors for first onset of depression. Methodological issues in this area of research are briefly reviewed (e.g., the various definitions of "recurrence" and "depression"), followed by a review of studies on specific risk factors, including demographic variables (gender, socio-economic status, and marital status), clinical variables (age at first onset, number of prior episodes, severity of first/index episode, and comorbid psychopathology), family history of psychopathology, and psychosocial and psychological variables (level of psychosocial functioning, cognitions, personality, social support, and stressful life events). In addition, scar theories are evaluated for their potential to explain how these variables and recurrent depression are linked. Our review suggests that recurrent depression reflects an underlying vulnerability that is largely genetic in nature and that may predispose those high in the vulnerability not only to recurrent depressive episodes, but also to the significant psychosocial risk factors that often accompany recurrent depression.     

Daily hassles and social support as predictors of adjustment in children with pediatric rheumatic disease

OBJECTIVE: To test hypotheses that social support moderates the effects of microstressors on the psychosocial adjustment of children with pediatric rheumatic diseases (PRDs) and that among multiple sources of support, classmate and parent support are significant predictors of adjustment, after controlling for demographic and disease severity variables. METHODS: Children with PRDs (N = 160 children; 8-17 years) were recruited from three pediatric rheumatology centers and completed measures of daily hassles, social support, depressive symptoms, and state and trait anxiety; their parents completed measures of internalizing and externalizing behaviors. RESULTS: Fewer daily hassles and higher social support predicted fewer adjustment problems. Among the sources of support, classmate and parent support were significant predictors. Tests for moderation were significant only for a Hassles x Classmate Support interaction in the prediction of depression. A plot of the interaction between hassles and classmate support showed that children with high classmate support had lower levels of depression than children with low classmate support under high or low levels of daily hassles. Furthermore, children with high classmate support had lower levels of depression under conditions of low versus high daily hassles. DISCUSSION: Results are consistent with a main effect rather than buffering model for social support. CONCLUSIONS: Interventions should focus on management of daily hassles and increasing social support for children with PRDs.     

Chronic Minor Stressors and Major Life Events Experienced by Low-Income Patients Attending Primary Care Clinics: A Longitudinal Examination

Chronic minor stressors and major life events were assessed from 129 randomly selected low-income patients attending primary care medical clinics. Participants reported experiencing an average of 15 chronic minor stressors in a 12-month period. The most common chronic minor stressors were reported in the areas of finances and domestic activities. Participants also reported these stressors as the most intense. The t tests revealed that female participants reported significantly (p = .05) more chronic events than males. The most common major life events were reported in the areas of vegetative symptoms (i.e., major change in sleeping and eating habits), financial status, illness, and interpersonal relationships. The most stressful life events were changes in vegetative symptoms, family illness, and interpersonal relationships. The t tests revealed that employed participants reported significantly (p < .05) more positive life events than did unemployed participants. Implications of the findings are discussed.