To what extent are experiences such as ‘depression’ and ‘anxiety’ dependent on life events and circumstances?
Research in psychology and psychiatry has long tried to establish causal relationships between life events and psychological disorders. In 1926, Freud suggested that “anxiety is the reaction to the danger of losing an object, and the pain of mourning the reaction to the actual loss of the object” (as cited in Finaly-Jones & Brown, 1981). Paykel dedicated a large portion of his career to researching the relationship between life events and psychiatric disorders such as depression, suicidal tendencies and schizophrenia. He then went on to develop the Paykel Interview, which is to this day, widely used in life events assessment (Oei & Zwart, 1986). Brown and Harris on the other hand, were concerned with biographical detail (Dohrenwend et al, 1990), the social origins of depression (Brown & Harris, 1978) and the concept of contextual threat (Brown & Harris, 1989). Over the past two decades, certain authors have managed to find strong relationships between certain events and the subsequent development of mental health problems while others haven’t had the same success.
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According to Heim and Nemeroff (2001), women with experiences of sexual and physical abuse in childhood tend to show more symptoms of depression and anxiety. It seems they also attempt suicide more often than women without a history of childhood abuse (McCauley et al, 1997). Early life parental loss appears, regardless of family and genetic factors, related to the development of anxiety disorders as well as unipolar and bipolar depression (Agid et al, 1999; Kendler et al, 1992; Kendler et al, 1993). A number of studies have looked into the relationship between socioeconomic status, job insecurity and mental health. Some found that high job insecurity was positively related to common mental health issues (Stansfeld & Candy, 2006; Meltzer et al, 2010), others found that these variables are rather implicated in the maintenance of depression than its onset (Lorant et al, 2003). Many studies have focused on major life events that signify loss in an effort to demonstrate the predictive power of this experience on the onset of depression. In contrast, events that signify danger are thought to precede episodes of anxiety (Finlay-Joness & Brown, 1981; Paykel, 1982). Although substantial evidence now exists to suggest that adverse life events are a predisposing factor to the later development of mental health problems, the specificity of these events remains uncertain. In fact, in spite of the evidence, consensus remains lacking in terms of life events measures.
In understanding the underlying mechanisms of experiences of depression and anxiety, it is essential that we understand the importance of comorbidity among these disorders (Kessler et al, 1994). In fact, research has shown that they share a variety of risk factors, occurring both in childhood and adulthood (Spinhoven et al, 2010). This paper will discuss in further detail the literature’s most explored relationships between events and the development of depression and anxiety. It will also cover life events measures, mainly to discuss validity and reliability concerns. We will therefor discuss (i) the implications of loss, threat and danger in depressive and anxiety disorders, (ii) the implications of childhood trauma in depressive and anxiety disorders and finally (iii) measures, validity and reliability.
Implications of loss, threat and danger in depressive and anxiety disorders
Loss, threat and danger have extensively been studied as potential predictors of psychological disorders. However, event definitions vary across the literature. As a general rule, it would appear that loss is conceptualized more or less as follows: (i) death or separation of a valued person, (ii) loss of the respondent’s physical health, (iii) lost jobs, career opportunities and material possessions and finally, (iv) loss of a cherished idea (Finlay-Jones & Brown, 1981). Danger, on the other hand is conceptualized in terms of the gravity of unpleasantness associated with certain future crises. Basically, to assess danger, the following questions must be answered: “Does the present event raise the possibility of specific unpleasant crises occurring in the future to the respondent? Is there some probability of at least one of them happening? How unpleasant is the effect of these possible specific future crises?” (Finlay-Jones & Brown, 1981).
Irrespective of the lack of specificity within event categories, it appears that severe and major loss events such as loss of an important person or role from one’s life, heavily factor into depressive psychological responses (Monroe & Simons, 1991; Brown & Harris, 1986; Finlay-Jones, 1981; Paykel, 1982). Events implying danger, not loss, are found to stimulate the onset of episodes of anxiety disorders (Finlay-Jones & Brown, 1981; Paykel, 1982). Investigations on this matter have not found significant implications for other types of major or minor stressors (or at least, not for clinical forms of depression). Although some believe chronic hardships and daily hassles, because they occur more frequently, might be better indicators of vulnerability than major stress events (Kanner et al, 1981; Lazarus, 1990), others have found these low-level issues etiologically irrelevant, especially for depression (Bebbington et al, 1988; Brown & Harris, 1986). These findings suggest the existence of a level of severity that must be reached in order for socioenvironmental circumstances to precede depression.
Most studies on the matter have found strong relationships between loss and depression and loss and mixed episodes of anxiety and depression (Kendler et al, 2003). These same studies have in contrast, demonstrated that anxiety alone is not vulnerable to loss (Monroe & Simons, 1991). Studies have also shown that high-threat events such as death, other key losses (anything other than death that is considered major to the individual) and separation are highly predictive of the onset of depression and mixed episodes of depressive and anxiety disorders (Kendler et al, 2003). Although the relationship between high-threat events and anxiety is significant, it remains weaker than the ones previously mentioned (Kendler et al, 2003). These findings underline the prevalence of comorbidity in these disorders (Kessler et al, 1994). However, literature seems lacking in the pure anxiety department.
Implications of childhood trauma in depressive and anxiety disorders
Childhood trauma is one the most studied phenomena in the emergence of psychopathology, especially in depressive and anxiety disorders in adulthood. It is thought that childhood adverse experiences have the power to alter the child’s belief system, consequently contributing to the development of cognitive vulnerability, in particular helplessness and an external locus of control (Hovens, 2015). It has also been hypothesized that adverse childhood experiences affect the onset of depressive and anxiety disorders through their impact on neurobiology and neurochemistry (Heim & Nemeroff, 2001). In this context, childhood trauma is (i) psychological and emotional abuse, (ii) physical abuse, (iii) sexual abuse and (iv) neglect.
Compelling evidence from a range of studies underlines early life stresses as major risk factors for subsequent development and persistence of mental health problems (Heim & Nemeroff, 2001). Indeed, childhood trauma has proven to be a strong predictor of mixed anxiety and depression episodes. It is important to note that such adversities are related to adulthood psychopathology in the following order of intensity (the last being the strongest): anxiety, depression, comorbid anxiety and depression (Hovens, 2015). These findings not only underline the presence of comorbidity among these difficulties, but they suggest that childhood trauma may produce longstanding effects on individuals and may affect the severity of an illness as well as its recurrence (Hovens, 2015). Surprisingly however, the effects of childhood trauma are as weak on anxiety as was ‘loss’ in the previous section. It seems anxiety is less vulnerable to these types of events (Kendler, 2003). Spinhoven and his colleagues (2010) have noticed that in evaluating the effects of childhood trauma on anxiety, emotional neglect and emotional abuse appear to be stronger predictors of anxiety disorders in adulthood than physical and sexual abuse. They believe that both physical and sexual abuse are accompanied by neglect, which might explain the emergence of anxiety disorders (Spinhoven et al, 2010).
It is important to mention that the literature seems lacking in terms of anxiety disorders. Indeed, the proportion of studies on this subject is significantly smaller than the one exploring depression. Moreover, of the few existing studies, most have only investigated generalized anxiety disorders. There are not enough studies to take position on the strength of the relationship between life events and the development of anxiety disorders or depressive disorders, for that matter. Most existing studies need to be replicated as they are methodologically weak. It is clear that a relationship between life events and mental health exists. However, the events related to these problems remain non-specific.
Measures, validity and reliability
What and who exactly define what qualifies as a stressful life event? Some say it is the individual (i.e. respondent) who is most qualified to define stress, as he is the expert on his own life and experiences. This system of assessment is designated by the term respondent based assessment (Brown, 1981). The opposite viewpoint is that although the respondent is the expert of his personal experience, there are certain considerations that render his perception of stress scientifically problematic. Indeed, a person’s perception of stress is often the result of psychopathology. This implies that depending on the psychological state of the individual, they will report more or less intense levels of stress, providing establishment of a relationship between event and mental state much more easily (Brown, 1974; Monroe & Peterman, 1988). Beyond this point, these types of procedures often result in serious issues of variability among experiences that are only homogenous in appearance (B.P. Dohrenwend, Link, Kern, Shrout & Markowitz, 1990). ‘Illness of a close relative’ can mean many things. When perception is the basis of our measurement, we risk working with identical stress scores despite the reality being strikingly different. A person’s interpretation of an item can be so different to what the investigator is looking for that they can entirely miss the objective of a question (if an event occurred in the past and is no longer of significance to the individual at the time of investigation). This can cause discrepancies between the respondent’s label and what the investigator would define as an event (Brown, 1981). Briefly, this demonstrates that this type of stress measurement is riddled with idiosyncratic interpretations that affect stress labelling. This issue goes hand in hand with problems associated with self-report methods of mental health problems. In this respect, checklists are considered to provide a limited amount of information on the experiences involved and circumstances (Depue & Monroe, 1978). Subjects don’t possess the overall perspective of the investigator necessary to understanding the meaning and evaluation of items for endorsement. Assessment of life events should strive to be as standardized as possible in terms of definitions in an effort to perfect measurement reliability. Measurement concerns are exponentially important in situations like these, where different types of stress are at hand. “What is deemed major or minor, acute or chronic, clearly cannot be left to the respondent (for the errors noted above may only be compounded) and must be confronted in a direct, elaborate manner.” (diathese-stress study). How do we define which events are ongoing, separate or part of a certain difficulty? What are the threshold determinants that separate major events, minor events, intermittent events, and chronic difficulties? Extensive rules and explicit guidelines about the time frame involved, frequency of the event, and severity of the circumstances are required to provide an adequate system of measurement.
Literature on measures report interviews as far more adequate than self-report methods (Paykel, 1983; Oei & Zwart, 1986). This is increasingly true the more a person is unwell. Self-report may lead to objective registration of scoring behavior but interviews, such as the Paykel Interview allow for clinical observation (Oei & Zwart, 1986).
Different forms of stress could prove important in the development of particular problems, which seems rather true for depression. – maybe put in general conclusion of paper
In research, we don’t seem to differentiate the types of stressors in our conceptualization, which is problematic as it seems NECESSARY. See conclusion of article to guide me through my write up.
La recherche montre que oui il y a un lien, mais reste que c’est pas un lien direct. Il faut aussi faire tres attention à la causalité en psychologie, parce que ce sera jamais aussi simple. Ya une foule de paramètres qui entrent en ligne de compte et pleins de modalités qui peuvent modifier les résultats de nos recherches ET le cours de certaines difficultés. La vérité c’est qu’on pourra surement jamais avoir de réponse exacte et que dans cette optique, oui ces problèmes dérivent de certaines experiences (jusqu’à un certain point), mais les outils d’aujourd’hui et les résultats de la recherche prouvent rien de manière certaines. Les biais individuels et les problèmes de méthodologie demeurrent plus importants que les résultats des recherches. L’important c’est de continuer d’une part de travailler sur l’amélioration de nos outils d’évaluation, tout en prenant en compte le contexte comme le disait Brown, parce que même si un des biais est la « perception » de la personne, il reste que cette perception est l’équivalent de son expérience personnelle. C’est comme ça qu’elle en a fait sens. La réalité objective… on s’en tappe. C’est le danger, la douleur, la peine, PERCUE qui compte. Et donc, on peut se déchirer à tenter de créer des liens forts entre évènement et troubles, la vérité c’est que les gens souffrent de toute manière et qu’on doit se concentrer sur l’expérience subjective, plutôt que sur l’expérience objective.
It seems that childhood events are stronger determinants than adverse events across the lifespan in terms of influence on the onset of affective disorders.
Childhood trauma are found to be characteristic of BOTH depressive and anxiety issues across the lifespan, but seem much stronger for depressive disorders than anxiety disorders.
Difference between childhood adversities and negative life events:
- The first is evaluated through interviews, which is considered more reliable.
- The second is done through questionnaires, which provide less detail.
the difference in methodology might account for the differences and a stronger association to childhood adversities.
“Although adversity is an important predictor of a great many other disorders that PTSD, the association of childhood adversity with any anxiety disorder may have been underestimated in the present study because sexual and physical abuse may result in PTSD as an anxiety disorder, while the experience of neglect and emotional abuse is not sufficient for fulfilling criterion A of the DSM-IV diagnosis of PTSD and is also more strongly related to dysthymia and depression”
this quote illustrates that we speak of “experiences” such as “depression” and “anxiety”, then these events are ALL significant. However, the difference to be made here is in the weight that is required in order for something to be considered a “clinical” issue. But do we really need diagnosis to consider someone’ poor mental health state?
Both methods have their advantages and it would be wise to keep using both, to avoid sticking to just one and to keep working on differenciating events and declustering them to avoid scientific mistakes.
Personal predispositions such as previous experiences of disorders, vulnerabilities (genetic and personality variables) as well as early experiences are central elements of measurement. It is “[…] in relations between these components of the life-stress processes that the strongest clues are to be found as to whether, to what extent and how environmental stress induces psychopathology” (ref 16-17)
Mentionner que l’importance des outils et leur qualité est dans le fait que ça nous permettrait d’isoler des évènements particulièrement problématiques et ca nous aiderait en termes de prévention, encore une fois ET dans la profession, ca nous permettrait d’essayer de voir si les gens qui ont ce vécu souffrent des troubles les plus souvent reliés
Par contre, qu’est-ce que ça change de pas savoir ce qui précède le problème? Le problème demeurre. Et l’objectif reste d’aider la personne. Un autre problème majeur est que les recherches sont en grande partie faite sur la base de critères cliniques, notamment basés sur le DSM. Qu’est-ce qui arrive aux gens qui ne sont pas « cliniquement » significatifs? Ils ont quand même besoin d’aide.
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