Tirril Harris

Life-events and psychiatric disorders Part 1: some methodological issues

The paper focuses on recent criticisms of the study of the role of life-events in the onset of psychiatric conditions and suggests that measurement error and bias can be reasonably well controlled by various methodological procedures. Failure to comply with these may be expected, however, to increase rather than decrease the chances of establishing a ‘positive’ resuit. Three further factors to do with the design of studies and the analysis of data are discussed which are likely to mask real differences between patient and comparison group, and which therefore might explain the ‘negative’ results reported in the literature. They concern: (1) the choice of an appropriate comparison group; (2) specification of the length of the period between event and onset; and (3) specification of the event in terms of some measure of severity. Results from two London studies of schizophrenic and depressive patients are presented to illustrate the argument. The studies suggest that life-events do play an important causal role in bringing about both disorders.

Social origins of depression: a reply.

Many of the criticisms of our work made by Tennant & Bebbington in the current edition of this journal touch on issues which have already been discussed in our recent book Social Origins of Depression. We do not think that any of their points pose significant threats to our aetiological model of depression. We welcome this opportunity to clarify their questions about our data, and to use their re-analysis of our material as a basis for a wider discussion of certain general aspects of the statistical analysis and interpretation of data and the pitfalls which await the unwary.

Life events and psychiatric disorders Part 2: nature of causal link

Methods are first described for testing for and measuring the proportion involved in the causal link between life-events and psychiatric disorders; the paper then deals with the nature of the causal effect itself. A method is described (and developed mathematically in an appendix) which enables a choice to be made between a triggering effect in which events are seen as precipitating an illness that would probably have occurred before long for other reasons, and a formative effect in which life-events either substantially advance onset in time, or bring it about altogether. The method is used to demonstrate the presence of a formative effect in depressive and a triggering effect in schizophrenic disorders.

Fall-off in the reporting of life events

SummaryA recent paper by Schmid et al. (1981) suggests that there is a very marked fall-off in the reporting of events in the 21 weeks before interview when using the Bedford College life-event instrument. A general review of other research suggests that fall-off is in fact remarkably slight in this period and also that the instrument is effective under certain circumstances for even longer periods of time. The probable reasons for the results obtained by Schmid and his colleagues are discussed in the light of the investigator rather than respondent-based nature of the instrument.

Loss of parent in childhood and adult psychiatric disorder: A tentative overall model

Two previous reports on a female population sample in Outer London, UK, had identified certain environmental experiences–such as lack of adequate replacement care after parental loss in childhood, premarital pregnancy, and low social class and poor emotional support in adulthood–as key factors intervening between childhood loss of parent and depression in adulthood. A third paper introduced a measure of the cognitive set of situational helplessness-mastery which was associated, on the one hand, with current depression and, on the other, with loss of mother in childhood. This article examines the relationship between these other factors and situational helplessness both in childhood and in adulthood. Most are highly associated with the cognitive set, but the relationship between childhood helplessness and loss of mother appears to be differentially mediated according to whether the loss was by death or separation. A series of multivariate statistical analyses aims to integrate all the findings so far reported on in this sample into a biographical model of the developmental pathways from childhood loss of mother to current depression.

Depression and situational helplessness/mastery in a sample selected to study childhood parental loss.

This paper continues the investigation of differential states of depression in a sample of 225 women selected for different experiences of parental loss in childhood by introducing a measure of the cognitive-behavioural set of situational helplessness/mastery which uses actual rather than hypothetical situations as the basis for scoring. The measure is also specifically designed to take account of differences according to the time of its completion (before, during or after a psychiatric episode). The relationship is explored between this attribute and, on the one hand, depressive disorder, and on the other, parental loss in childhood. Rates of current depression increased progressively with the degree of helplessness rated not only for the current period but also, in instances where there was a current depressive episode, for the time immediately prior to its onset. For those with depression the degree of helplessness was often found to be higher during the episode than just before it. A measure of helplessness in childhood was associated not only with current depression but with previous episodes. Continuity between childhood and adult helplessness was apparently considerable, and both were associated with loss of mother in childhood. A rating of helplessness shown in the past just before onset of a prior depressive episode suggested a similar raised rate compared to those never depressed. The failure to find an association between prior episodes of depression and current helplessness among those currently not depressed is discussed in terms of the likely durability of long-term cognitive-behavioural sets and the possibility that with improved social circumstances and relationships, helplessness may decrease.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychiatric disorder in a rural and an urban population: 2. Sensitivity to loss.

In an earlier paper we found that a model of depression developed on a sample of women in a London population was confirmed in a female population in the Outer Hebrides. Differences in the rates of onset and chronic cases between the two populations, however, suggested that the Scottish women might be more likely to become depressed after the death or intimation of death of close relatives; furthermore, it seemed that such depressions were more likely to remain chronic in the Scottish islands than in London, and to contain a strong anxiety component. This difference is discussed in the light of socio-cultural differences between the two populations, particularly in terms which relate family structure, marital position and contact with relatives to affective disorder in terms of theories of attachment.