Life events, social support, and illness

Positive and negative life events and social support were correlated with illness among Navy Submarine School students. Negative, but not positive, life events in the recent past were related to reports of illness. Although social support by itself was not related to illness reports, the relationship between negative life events and illness was stronger among subjects with low rather than high levels of social support. The results suggest the importance of assessing both stressful life events and moderators of response to stress, such as social support, in investigating the role played by personality in illness.     

Life events and depression in a community sample of siblings

BACKGROUND: The overall aim of the GENESiS project is to identify quantitative trait loci (QTLs) for anxiety/depression, and to examine the interaction between these loci and psychosocial adversity. Here we present life-events data with the aim of clarifying: (i) the aetiology of life events as inferred from sibling correlations; (ii) the relationship between life events and measures of anxiety and depression, as well as neuroticism; and (iii) the interaction between life events and neuroticism on anxiety/depression indices. METHODS: We assessed the occurrence of one network and three personal life-event categories and multiple indices of anxiety/depression including General Health Questionnaire, Anhedonic Depression, Anxious Arousal and Neuroticism in a large community-based sample of2150 sib pairs, 410 trios and 81 quads. Liability threshold models and raw ordinal maximum likelihood were used to estimate within-individual and between-sibling correlations of life events. The relationship between life events and indices of emotional states and personality were assessed by multiple linear regression and canonical correlations. RESULTS: Life events showed sibling correlations of 0-37 for network events and between 0-10 and 0.19 for personal events. Adverse life events were related to anxiety and depression and, to a less extent, neuroticism. Trait-vulnerability (as indexed by co-sib's neuroticism, anxiety and depression) accounted for 11% and life events for 3% of the variance in emotional states. There were no interaction effects. CONCLUSIONS: Life events show moderate familiality and are significantly related to symptoms of anxiety and depression in the community. Appropriate modelling of life events in linkage and association analyses should help to identify QTLs for depression and anxiety.     

Psychiatry: life events and social support in late life depression

OBJECTIVES:

To examine the association of life events and social support in the broadly defined category of depression in late life.

INTRODUCTION:

Negative life events and lack of social support are associated with depression in the elderly. Currently, there are limited studies examining the association between life events, social support and late-life depression in Brazil.

METHODS:

We estimated the frequency of late-life depression within a household community sample of 367 subjects aged 60 years or greater with associated factors. “Old age symptomatic depression” was defined using the Composite International Diagnostic Interview 1.1 tool. This diagnostic category included only late-life symptoms and consisted of the diagnoses of depression and dysthymia as well as a subsyndromal definition of depression, termed “late subthreshold depression”. Social support and life events were assessed using the Comprehensive Assessment and Referral Evaluation (SHORT-CARE) inventory.

RESULTS:

“Old age symptomatic depression” occurred in 18.8% of the patients in the tested sample. In univariate analyses, this condition was associated with female gender, lifetime anxiety disorder and living alone. In multivariate models, “old age symptomatic depression” was associated with a perceived lack of social support in men and life events in women.

DISCUSSION:

Social support and life events were determined to be associated with late-life depression, but it is important to keep in mind the differences between genders. Also, further exploration of the role of lifetime anxiety disorder in late-life depression may be of future importance.

CONCLUSIONS:

We believe that this study helps to provide insight into the role of psychosocial factors in late-life depression.     

Assessing prenatal depression in the rural developing world: a comparison of two screening measures

Significant levels of prenatal depression are reported from the Indian subcontinent (25–45%). A wide variety of measures have been used to screen for prenatal depression in western research. However, little evidence exists on the use of such measures in the context of the developing world. The objective of this study was to assess the validity of the Edinburgh Postnatal Depression Scale (EPDS) and the Kessler 10 Scale of Psychological Distress (K10) as screening measures for prenatal depression in rural South India. One hundred ninety-four women in their third trimester of pregnancy were assessed at a rural prenatal clinic in Karnataka, South India, using the EPDS, the K10 (scored 0–40) and a structured diagnostic psychiatric interview to establish a DSM-IV diagnosis of depression. Depressed women scored significantly higher on the EPDS and K-10 than controls. A receiver-operating characteristic analyses showed both scales to be good screening instruments for prenatal depression in rural South India at a cut-off of ≥13 on the EPDS (sensitivity = 100%, specificity = 84.90%, and area under the curve = 0.95) and ≥6 on the K10 (sensitivity = 100%, specificity = 81.30%, and area under the curve = 0.95). The EPDS and K10 have thus been shown to have equally good sensitivity and specificity in rural settings in the developing world at a cut-off score of ≥13 and ≥6, respectively. This study demonstrates the validity of the EPDS and K10 in screening pregnant women for depression during their prenatal check-ups.     

Life events and social support in prediction of stroke outcome

A prospective study of 252 patients (average age 73, range 26-95) admitted to a regional general hospital over a 12-month period was carried out. 241 patients had stroke verified by the initial neurological examination and CT scan, and of these baseline data were not available on 27%. 34% died before or were not willing or able to provide data at follow-up. 39% survived and completed the study. Prestroke life events and social support could not predict the outcome of stroke rehabilitation measured as survival, length of stay, functional recovery (Barthel's Index) or placement at the follow-up 12 months after the onset of stroke. Age and arteriosclerotic heart disease predicted poor survival at follow-up. Premorbid hypertension, stroke, diabetes, obesity, tobacco smoking, and alcohol consumption did not significantly influence the outcome. Problems in stroke rehabilitation research are discussed.     

The relation of economic conditions,social support,and life events to depression

Evidence for a connection between recession and psychopathology has come from aggregate and individual-level studies. The aggregate studies cannot identify particular mechanisms (e.g., personally experienced life changes caused by the economy versus anticipation of stress on the basis of perceived community conditions versus the interaction of the two). Individual-level studies rarely control for earlier symptoms or, if they do, never include a measure of aggregate conditions (making a cross-level analysis). This study is novel in that it crosses levels of analysis, controls for earlier symptoms, replicates the tests in metropolitan and nonmetropolitan sites, and controls for social support and social support buffering effects. Economic conditions did not affect covariate-adjusted depression directly or in interaction with events, and life events (including economic ones) accounted for little variance in adjusted depression. Controlling for prior symptoms also eliminated the main and buffering effects of social support. The negative results from this cross-level, panel approach raises doubts about the “recession-causes-psychopathology” view and, by inference, lends credence to rival views, such as, “recession-uncovers-pathology.”     

Life events and depression: A replication

A study which was first carried out in the United States was repeated in Northern Italy. Life events reported to have occurred 6 months before the onset of illness were compared in 40 outpatients who had a first episode of primary depression, and a matched normal control group. Depressives reported significantly more events than the control groups, and had significantly more of the following: undesirable events, exits from the social field, events which had an ‘objective negative impact’ (rated as being traumatic) and ‘independent events’ (events which were unlikely to be a consequence of the depression); the last 2 were judged by a rater who was unaware whether the event had occurred in a depressed patient or in a control subject. There were no significant differences in desirable events, entrances into the social field and events which were within the subjects' control. These findings replicate previous results and are consistent with the view that certain recent life events play a substantial role as precipitants in some depressed patients.     

Life events, anxious depression and personality: a prospective and genetic study

BACKGROUND: The association between life events and anxious depression might be due to causality or to gene-environment correlation. We examined unidirectional and reciprocal causality and a gene-environment correlation model, in which genes that influence the vulnerability for anxious depression also increase the risk of exposure to life events. The effect of genes that influence environmental exposure might be mediated through personality and we therefore also examined the association between life events and personality (neuroticism and extraversion). METHOD: Information on life events, anxious depression, neuroticism and extraversion was collected in 5782 monozygotic (MZ) and dizygotic (DZ) twins who participated in a longitudinal survey study of the Netherlands Twin Register. To examine causality, data were analysed longitudinally. To examine gene-environment correlation, the co-twin control method was used. RESULTS: Anxious depression and, to a lesser extent, neuroticism scores increased after exposure to life events. Anxious depression and neuroticism also predicted the experience of life events. Prospectively, extraversion was not associated with life events. Anxious depression, neuroticism and extraversion scores did not differ between the non-exposed subjects of MZ and DZ twin pairs and unrelated subjects discordant for life events. CONCLUSIONS: Our findings suggest that reciprocal causation explains the relationship between life events and anxious depression and between life events and neuroticism. Extraversion is not related to life events. No evidence was found for gene-environment correlation, i.e. the genes that influence anxious depression, neuroticism or extraversion do not overlap with the genes that increase the risk of exposure to life events.     

Life events and depression in women: a structural equation model

A non-recursive structural equation model designed to examine the reciprocal relationship between life event reports and depressive symptoms in women is presented. The model was fitted to data from a 2-year longitudinal study of life events and depression in a sample of women with 5-year-old children. The findings suggest that life event reports may be influenced by mental state; however, even when this tendency is taken into account, there is still a substantial relationship between life events and depressive symptoms in women. This indicates that it is unlikely that the life events/depression correlation can be explained simply by a tendency for depressed women to over-report life events.     

The effects of social support,life events,and demographic factors on depression among Maori and Europeans in New Zealand rural,town, and urban environments

Little empirical research has been done in New Zealand into factors associated with depression. In all reviewed studies of depression conducted in the United States, towns have not been examined separately from rural districts and cities. A sample of 342 New Zealand adolescents and adults completed a questionnaire constructed by Bell, LeRoy, and Stephenson (1982) to measure depression, social support, stressful life events, and demographic factors. A three-way analysis of variance (ANOVA) demonstrated significant interaction effects of ethnicity and recent life events on depression, but social support did not significantly affect depression nor interact with life events to ameliorate the effects of life events on depression. Maori experiencing few life events had higher depression than Europeans with few events. A five-way ANOVA with the effects of area, sex, ethnicity, age, and socioeconomic staus (SES) on depression showed significant main effects for sex, age, and SES. Area interacted significantly with ethnicity and age. Compared to similar groups in the rural district and the city, Maori and young people in town had significantly higher mean depression scores. Maori reported significantly more depressive symptoms and stressful life events than Europeans in the town but not in the rural or urban environments. Young adults had the highest mean depression score, and the oldest group the lowest, both in the rural area. Results are discussed with reference to the rural, town, and urban environments in New Zealand, and to possible reasons for the weakness of the effect of social support on depression. © 1997 John Wiley & Sons, Inc.     

Life events, social interaction and psychiatric symptoms in general practice: a pilot study

Thirty-two adult females who consulted a general practitioner with psychiatric training were assessed by questionnaires on first attendance and at follow-up 6 months later. Major life events and the degree of social support were of importance. Failure to improve was associated with major negative life events; in the absence of such events, improvement seemed likely to occur given a high degree of social support; major positive events appeared to be associated with improvement, regardless of the degree of social interaction. These factors, and the initial and final GHQ scores, are inter-related in a complex manner and it is suggested that these findings merit further investigation on a larger sample of patients.     

Health-related behaviors, social support, and community morale

The relation among health behaviors, social support, and community morale--attitudes toward one's community, such as attachment and social participation--was examined in 597 adults living in a Japanese community. Logistic models revealed that strong spousal support was related to reduced alcohol drinking and enhanced family support was related to a reduction in smoking. The support of friends was positively associated with the frequency of alcohol drinking by men. Among women, family support was positively related to the frequency of consuming Japanese-style food. Community morale was positively associated with consuming Japanese-style side dishes and negatively associated with alcohol consumption. The results indicate that there are varied associations between social relationships and health-related behavior and that these associations are gender-related. Knowing the specific associations between an individual's social relationships and his or her health-related behavior will he helpful for community-based intervention.     

Alexithymia, depression and social support among Japanese workers

BACKGROUND: A number of studies have shown that social support has a direct beneficial effect on well-being and also serves as a buffer to protect people from health problems due to excessive stress. Although preliminary studies report a positive relationship of alexithymia both with depression and reduced social support, there is no study examining whether the beneficial effect of social support on depression differs with the presence of alexithymia. METHODS: A total of 120 workers aged 19-39 completed the 20-item Toronto Alexithymia Scale (TAS-20) to measure alexithymia, the Beck Depression Inventory-II (BDI-II) to evaluate depressive symptomatology, and the Job Content Questionnaire (JCQ) to assess job strain based on Karasek's demand-control-support model. The interrelationship among TAS-20, BDI-II and 3 subscales of JCQ (job demand, control, and support) were examined. RESULTS: A significant association of depression with low support and high alexithymia was observed. Alexithymia was also associated with reduced support. Further, a statistically significant interaction between alexithymia and support in terms of their effect on depression was observed. Nonalexithymic individuals with low support showed a significantly higher depression score than those who received high support, while alexithymics did not differ in their depression score depending on the degree of support. Consistent results were obtained from the logistic regression analysis examining the odds ratio for depression by support by alexithymia; a significantly increased odds ratio for depression associated with low social support was observed only among nonalexithymics. CONCLUSIONS: Alexithymic individuals might be unable to benefit from social support because of their cognitive deficits of emotion.     

Antenatal depression, substance dependency and social support.

BACKGROUND: The purpose of this study was to explore the prevalence of depression and factors associated with depressive mood among pregnant women. METHOD: 391 women who were 14-37 weeks pregnant were evaluated with the Edinburgh Postnatal Depression Screen (EPDS), which has also been validated for prenatal use. Four questionnaires were used in order to explore associated factors: a questionnaire on background and pregnancy data, the Substance Abuse Subtle Screening Inventory (SASSI) and two Social Support Questionnaires (SSQ1 and 2). RESULTS: 7.7% of the total sample screened positive on the EPDS with a cut-off point of 12/13 recommended. Substance dependency and experienced difficulties in social environment had an independently significant association with maternal depression. LIMITATION: The caseness was defined with a self-report instrument. CONCLUSION: Substance dependency and experienced difficulties, especially in relation to friends, partner and own mother, are associated with antenatal depression. It is important to be aware of this when developing interventions in maternity care primary units.     

Life events, social problems and physical health status as predictors of emotional distress in men and women in a community setting

The main aim of this study was to construct logistic models of emotional distress (defined as a GHQ-30 score of 6 or greater) in a community sample of 226 men and 225 women. The independent variables included were: sociodemographic characteristics, physical health status, social problems and undesirable life events. Univariate comparisons showed that in both sexes undesirable life events and social problems were associated with emotional distress; in men the presence of physical symptoms and widowed, separated or divorced status also showed such an association. Separate logistic regression models for men and women confirmed the importance of undesirable life events and social problems as predictors for emotional distress. In women there was also a significant interaction effect between the two variables on emotional distress. Sociodemographic characteristics and physical health status did not exert a statistically significant effect in these models.     

农村老年人生活质量及与负性生活事件、社会支持的相关性

目的:了解农村老年人生活质量的相关因素,以及负性生活事件和社会支持对生活质量的交互作用.方法:在湖南浏阳农村社区采用多阶段抽样方法,共调查了839名≥60岁的常住居民(应答率为89.2％).用老年人生活事件量表(LESE)评估老年人的生活事件及其刺激量,用社会支持评定量表(SSRS)评估社会支持,用6条目生活质量量表(QOL)评估生活质量.结果:样本QOL得分为(20±4),SSRS得分为(40±8),负性生活事件总刺激量得分在0 ～ 240分之间,中位数M=12(P25=2,P75=32).多元线性回归分析显示,与配偶一起生活(b=-0.55)、收入较高(b=0.52)、负性生活事件刺激量较低(b=1.63)、社会支持较高(b=-0.69)的老人有较高的生活质量.交互作用分析显示负性生活事件刺激量评分与社会支持评分存在交互作用(超额相对危险度为2.72,95％CI =0.48 ～4.97;交互作用指数为2.42,95％ CI=1.25～4.62).结论:本研究提示对农村老年人,尤其是遭遇了负性生活事件的农村老年人,提供社会支持,有助于改善其生活质量.     

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.     

Anxiety and depression in a community sample: the influence of comorbidity on social functioning

The main aim of the present study was to examine whether the well-established association between depression and social dysfunction still remains when effects of a coexistent anxiety disorder are eliminated from the data. As these effects strongly depend on the proportion of depressed subjects suffering simultaneously from an anxiety disorder, we first examined the frequency of mixed and pure depressive disorders and that of pure anxiety disorders (control subjects) in a community sample (n = 483). Using DIS/DSM-III criteria (reference period 6 months), pure anxiety disorders were most frequent (6%), followed by pure depressive disorders (3%) and the coexistence of anxiety and depression (2%). Cases suffering from both disorders were most severely afflicted in terms of psychopathology (persistence of symptoms, comorbidity regarding other mental disorders). At the diagnostic level, the association between depression and social dysfunction was only slightly influenced by effects resulting from comorbidity; at the level of actual symptoms, however, we found that cases suffering simultaneously from severe depression and severe anxiety were significantly more handicapped in their social lives than depressive subjects with only mild anxiety symptoms.