Life events Flashcards
What are the 3 stages of response to a stressor according to Selye General Adaptation Syndrome (1936)?
Alarm – appraisal of threat and physiological fight/flight response
Resistance –bodily defences weakened by maintenance of threat and physiological responses
Exhaustion – bodily defences (various) breakdown leading to illness susceptibility
What are the 2 types of stressors
Chronic difficulties
Acute life events
- Actual change
- Decision by S to do something
- News
- Forecast
- Revelation (other to S)
- Disclosure (S to other)
How do we measure stressors?
Measure Es and Ds
Cover wide range of different experiences
Define what and who counts (e.g who is a ‘close’ relative?)
What can stressors be defined as?
Change (Selye)?
Threat?
Specific types of ‘threat’
Loss
Danger
Goal Frustration
(defined by person or researcher)
How do we measure stressors?
Simple respondent questionnaire
Above plus ‘weights’
Investigator rated interview
Categories e.g ‘entrance’ and ‘exit’ events
Contextual ratings
What are the challenges?
- Reverse causality (e.g. depression->marital difficulty (stressor) -> depression (outcome) *goes back to depression in beginning
- Recall bias & effort after meaning (e.g. stressor->outcome -> recall)
- confounding (e.g. life event and other factor -> disorder)
What are some examples of checklist self report measures?
Schedule of Recent Experiences (SRE, Hawkins et al 1957)
- Simple list yes/no
Social Readjustment Rating Scale (SRRS; Holmes &Rahe 1967)
- Scaled version of SRE
- Based on extent of life change for each event
- Summed score
What are the pros of checklist measures?
Easy to administer
*Cheap
*Limited or no training required
*Low respondent and researcher burden
What are the cons?
Is it change or something else that constitutes stress?
Limited number of possible events
Other life circumstances mean that a similar named event can affect people in different ways so a disadvantage not to have access to context
Cannot take account of independence
May not take dates into account so cannot take temporal relationships between events and health outcomes
What are the 3 major weaknesses of checklists?
Independence
Some events may be the result rather than the cause of illness
Can you think of an example?
Context
The impact of an event may be influenced by wider circumstances in which it occurs.
Eg. A birth
Biased Appraisal
Effort after Meaning
What are some interview based measures of life events?
-Life Events and Difficulties Schedule (LEDS; Brown & Harris, 1978)Gold Standard comprehensive. But it’s a lengthy interview and extensive training is required.
-Interview for Recent Life Events (IRLE; Paykel, 1983, 1997) Shorter and easier to administer than LEDS. Also includes measures of independence and objective threat ratings. But doesn’t have the capacity to probe as much.
-Psychiatric Epidemiology Research Interview Life Events Scale (PERI-LE; Dohrenwendet al., 1978) Structured and briefer than measures above. Latest version now includes ratings for independence & threat.
-List of Threatening Experiences (LTE; Brugha& Cragg, 1990) Can be used as both an interview and self-report checklist. Too brief to provide comprehensive coverage (only 12 events) but ideal for larger studies
- McQuaid et al. (1992) – Only 38.5% of life events reported on self-report checklist correspond with events elicited by interview
- Duggal et al. (2000) – Self-report measure captured only 32% of severe events and 36% of major difficulties identified by LEDS
Lewinsohn et al. (2003) – Overall % of checklist events also rated by LEDS was <50%
What is LEDS interview?
Questions cover actual occurrences but also transfers of information ( revelations, disclosures etc)
As happen to S or pre defined close others
Collect detailed context for each E or D
Everything dated including onset of DV and questions go back and forth between dates and onsets to improve accuracy of dating
Contextual Rating of Threat
Short term
Long term
Rated by researcher with reference to extensive dictionary and consensus meeting
Ordinal Scales eg for Es:
Marked, moderate, Some, Little/none
Separate self-report rating
What are the pros and cons of LEDS
Pros
Precision in definition of what Es and Ds to include
Covers very wide range of experiences
Strategies to reduce bias of self report
Contextual measurement of meaning
Cons
Costs of implementation
Need for training
Respondent burden
What was found about depression?
If properly enquired about, the majority of new onsets of depression are preceded by severely threatening life events
But
Only about 1:25 of all those experiencing one of these events in any year will go on to develop depression
Therefore
There must be something else that makes people specially vulnerable to the impact of severe events.
What did the Islington study find? (Brown et al 1986)
400 working class mothers (1/4 single mothers) did an interview, had vulnerability of either childhood, self esteem or quality of relationships - 12 months = 126 women free of depression as baseline and who had severe event in the follow up year
events and difficulties included- psych disorder, crisis support, coping
