On the etiologic role of stressful life-change events.
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Research on the relationship between life stress and illness has focused largely on stress caused by change. The present study examines a relatively neglected source of stress: everyday problems, defined as ongoing, often chronic situations, which are stressful for a substantial period of time. An inventory of everyday problems was developed, designed to minimize as much as possible potential confounds present in earlier work. It was administered to 281 undergraduate women along with a life events inventory, the Hopkins Symptom Checklist, and a social support scale, which measured family and nonfamily sources of support. Stepwise regression analyses indicated that everyday problems were more effective than life events in predicting psychological symptoms. Everyday problems were significant predictors of symptoms even after statistically controlling for life events, whereas life events had no predictive ability beyond that attributed to everyday problems. In addition, a significant interaction between everyday problems and life events was found. Multiple regression analyses also showed an interaction between everyday problems and nonfamily social support, as predicted by the buffering hypothesis. Within the methodological limitations of this study, these findings are interpreted as supporting the importance of everyday problems as a significant source of stress.
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Studies on the role of life events in the development of malignant diseases (particularly breast cancer) often rely on so-called limited prospective designs: Women with a suspicious breast lump are interviewed prior to surgery. After having learnt the final diagnosis, the sample is divided into a group having cancer and a control group. Research using this approach was criticised for producing artifacts: knowledge of diagnosis should cause reevaluations of past events and lead to overreporting of stressful experiences. Two limited prospective studies using different assessment methodologies are compared for possible artifacts due to knowledge of diagnosis. When considering less severe events, the application of a checklist technique leads to marked memory bias as assumed above. When leaving the respondents time to reconstruct their events at length, no artifacts are present. Reporting of the severest event categories remains unaffected under both methods.
The role of biologic, psychological and social factors and their interactions in etiology of psychotic disorders, is the objective of studies in psychiatry during the last 20 years. These changes in the outside world and social environment as well as life events may affect the development of psychopathologic phenomena in "sensitive" persons. This paper presents life events as predisposing factors (connection between life events in childhood and psychopathology in adulthood) and precipitating factors (life events which occur during the period which precedes the onset of the diseases) of psychotic disorders.
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One of the most popular approaches concerned with the etiological significance of psychosocial factors is life event research. Life event research concentrates on the relationship between psychosocial events normally occurring in people's lives and the onset of somatic or psychic illnesses. Starting with the approach of Holmes and Rahe a systematic survey about fundamental approaches in life event research is given, guided by the question of the definition of critical events and the question of how to quantify their impact. Based on this survey, representative findings with regard to the relation between life events and illness-related measures are presented, followed by a critical discussion of the relevance of life event research. This discussion concentrates on the problem that life events do not account for a substantial proportion of the variance in the criterion variables. In this context several omissions of previous and recent life event research are noted. It is emphasized that further progress in life event research will only be possible through a substantial conceptual reorientation.
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This paper considers the hypothesis that the relationship between social class and impairment may be accounted for by the greater prevalence of life events among lower-class individuals. This hypothesis was evaluated on data from 713 rural Tennessee adults. The data indicated that, although social class indices were inversely related to psychiatric impairment as expected there was no significant tendency for lower-class individuals to report a greater number of life events. For total number of events, as well as total number report a greater number of life events. For total number of events, as well as total number of undesirable, unexpected, or unpreventable events, middle- and upper-class individuals tended to report more events. Controls for the event indices did not affect the relationship between social class and symptomatology as the stress hypothesis would predict. However, locus of control was positively related to social class and was found to influence the event-impairment relationship. These data raise questions regarding the etiological role of life events in the relationship between social class and psychiatric impairments. The data suggest that observed social class differences in impairment may arise from the coping styles of certain social classes (as measured by locus of control) rather than from the differential prevalence of life events.
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In recent developmental and psychosomatic studies the focus shifts from pathogenic to health protective factors. Literature on coping with daily stresses, life events and biographic determinants is reviewed. Despite conceptual (negative health definitions, divergent theoretical backgrounds and values) and methodological problems (reliance on self-report and trait measurement) moderate, however consistent health protective affects of personal resources are shown. These are mainly generalized attitudes of persons toward self and their environment (e.g. optimism, internal locus of control, self-efficacy, commitment). Contrasting influential concepts (sense of coherence, hardiness) the bias toward self-reliant, internal control as health protective resource is criticized and a plea is made for conjoint consideration of health-protective influences of social relationships.
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Recent critiques in the stress literature have identified several methodological shortcomings, including ignoring control over event occurrence, the confounding of life event and outcome measures, the lack of consistent and reliable measures, and few cross-validational studies. Each of these problems is addressed empirically by examining two independent samples of adolescents. A 39-item life event measure, developed previously in one sample of 1018 adolescents, was administered to a second sample of 376 teenagers. Second-order factors of six stress scales were clustered into controllable and uncontrollable events, both of which were related to psychological distress. Poor health was significantly related to an uncontaminated factor of uncontrollable events. Means and covariances of the seven stress factors were compared between the derivation sample and an age-matched subset of the cross-validation sample. Correlates of the scales with drug use and personality revealed interpretable associations within the cross-validation sample and were quite similar to those in the original sample. Finally, few sex differences were evident, whereas scores on controllable events scales increased with age.