J.G. Ingham

Friends, confidants and symptoms

SummaryBrown, Bhrolchain & Harris (1975) have found that intimate social relationship may afford some protection against the onset of depressive illness in women. Our investigation involved 337 subjects sampled from the list of one general practice. Half had consulted their doctor within the previous 7 days and half had not. It examined the association between social support and the severity of some psychological and physical symptoms. The psychological symptoms were tiredness, anxiety, depression and irritability; and the physical symptoms were backache, headache, palpitations, dizziness and breathlessness. Social support and symptoms were assessed in a home interview. The results supported those of Brown et al. in showing that women reporting the lack of an intimate confidant had psychological symptoms of significantly greater severity than those reported by their more adequately supported counterparts. However, in contrast to Brown et al., we observed that the absence of many casual, less intimate friends was also associated with higher symptom levels (both physical and psychological). The discrepancy might arise because few of our subjects were suffering from severe psychiatric illness. The results were less clear for men but showed the same trends.

Life events and the onset of affective disorder: A longitudinal general population study

This paper examines the relationship between life events (ascertained by the Bedford College method) and the onset of affective disorder (defined according to the RDC scheme) in a longitudinal general population survey of women. Fall-off in the reporting of minor events is examined and discussed. Event rates, proportions of women challenged by events, and measures of the risk of RDC disorder associated with the experience of particular events are reported. The results based upon data from an initial interview were largely consistent with those based upon follow-up data, and underpinned earlier work. For both data sets, major difficulties were associated with illness onset. Severe dependent events showed stronger effects than severe independent events but both categories were rare. New substantive findings arising from short-term general population event research are unlikely.

Life events, symptoms and social support.

Abstract Thirty-four people sampled from the list of one general practice and who had consulted their doctor in the previous 7 days were matched with 34 people of the same age and sex who had not recently consulted. In a home interview with each subject the severity of 5 common physical symptoms (backache, headache, palpitations, dizziness, breathlessness) and 4 common psychological ones (anxiety, depression, tiredness, irritability) was measured, together with the degree of social support and the numbers of threatening and non-threatening life occurrences during the previous three months. The consulters experienced more of the threatening life events than the non-consulters, and this was the only significant discriminator between the two groups. In the combined samples the number of threatening life events was strongly related to severity of the psychological symptoms, and only weakly, if at all, to the severity of the physical symptoms. People with few casual friends tended to have higher symptom levels and, among the consulters only, a greater number of threatening events. Non-threatening events showed virtually no significant relationships to any of the other variables.

Life stress and depressive outcome: Application of a dissipation model to life events

SummaryA group of 71 patients were interviewed seven months after they had been screened for a new episode of unipolar depressive illness and the relationship between symptom severity at this time and the life stresses experienced over this period investigated. On the basis of the follow-up assessment, patients were divided into a ‘well’ and ‘ill’ group. The mean number of life events experienced during the study period did distinguish patients ‘ill’ from patients ‘well’ at follow-up but with less success than has been claimed for onset. Further analysis took into account both the severity of life stress suffered and the time of its occurrence. This improved the discrimination. Both time of event occurrence and event severity were then included in a model of adversity in which it was postulated that event stress dissipates with time. Application of the model to the study data resulted in the statistical relationship between life stress and outcome being somewhat strengthened. The possible implications of this result for further research in life stress are discussed.

Self-esteem, life stress and psychiatric disorder.

Using a special subsample from a survey of women in Edinburgh investigations were carried out into (a) which types of life event are associated with lowered self-esteem; (b) the role of life events and self-esteem in onset of psychiatric disorder; and (c) the additional significance of prior psychiatric consultation in determining onset. Stressors involving impaired relationships with others were the only ones clearly associated with lowered self-esteem. Minor psychiatric illness was predicted by stress of uncertain outcome, and, to a lesser extent, by impaired relationship stress. Onset of major depression was best predicted by an interaction between total stress experienced and low self-esteem. There was evidence that such onset involves a pre-existing low level of self-esteem on which life stress impinges, rather than life stress generating low self-esteem and then onset. A small group of subjects characterised by low self-esteem, prior psychiatric consultation and maladaptive coping seemed to be fluctuating in and out of psychiatric illness irrespective of stress.

Life events and other factors implicated in onset and in remission of psychiatric illness in women.

Life stressors for 574 Edinburgh women were assessed for uncertain outcome, impaired relationships and other characteristics. Thirteen weeks were covered either with no illness present or before a transient episode of Research Diagnostic Criteria (RDC)-defined anxiety/depression (duration less than 13 weeks) or before a longer episode or before illness remission or during continuing illness. Exploratory analysis suggested that stressors of uncertain outcome preceded longer illness onset. Impaired relationships went with continuing illness. Stressors with neither of these, and with fewer than two other characteristics, preceded transient illness. Remaining stressors predicted remission, as did ending of long-term difficulties. Self-esteem, support, coping, previous illness and marital status also discriminated between the groups.

Are life events which cause each other additive in their effects

SummaryIn a study in which life event data collected on 1060 people from Livingston New Town, life situations (i. e. events and/or long-term difficulties) which might have been causally linked were identified. Some of these causal chains were unequivocal. Given the occurrence of the first event, the occurrence of the second could be predicted with near certainty. Others were less definite; the situations were clearly linked but the second could not be definitely predicted from the first. Symptom scores (anxiety + depression) of people whose life situations were causally linked were compared to those of people with no linked situations. The comparison involved 167 matched pairs in which the number, degree of threat, and timing of life situations were equalised. Those with no linked situations tended to have higher symptom scores than matched subjects with linked situations, provided the earlier situations were at least moderately threatening. The effect was much stronger when the causal connections between situations were unequivocal. In the total sample the life situation threat scores of all such people were then modified, discounting where feasible all situations bar the latest one in the chain. Where two or more linked long-term difficulties were both still operative at the time of interview they were amalgamated and scored as one. The result was a highly significant gain in the symptom variance which could be explained by life events. The effect appeared to be to some extent applicable irrespective of the threat values of the situations making up the causal chain. However, there were slight indications that it might be stronger when a neutral or pleasant event terminates a threatening situation. It could not be explained by prior members of a causal chain tending to occur earlier in time or by a general tendency for non-additivity of effect to occur among people with many life situations in a short space of time.