# 05 - 5. Life events # 5. Life events © SPMM Course 5. Life events (This section is best read in conjunction with the section on Stress in Basic Psychology chapter) The impact of social and family life events on mental health can be measured in two ways. a. Ranking various events according to the degree of association with mental difficulties in a sample and use this list to study other populations. This is the method followed by Holmes & Rahe (1967) Social Readjustment Rating Scale where 43 life events in the last 2 years are rated using arbitrary ‘stress’ units. The death of spouse generates 100 units of stress while divorce tops the rest of the list of stressors list with 73 units. b. Brown and Harris popularized a different method whereby life events are graded according to the inherent meaning of the events to the individual concerned – i.e. contextual rating of the social adversity. Accordingly the effect and impact of a life event is understood in light of one’s current social context and self-perspective. LEDS – Life events and Difficulties schedule was devised by Brown and Harris. Types of life events 1. Loss includes events such as death, respondent initiated separation (long-term separation) and other key losses which are rated as ‘high’ by the subject. If the lower loss is felt by the subject, these are placed at lower dimensions. 2. Humiliation includes other-initiated separation from a spouse or partner or a falling out, quarrelling, or rift in a relationship involving a close tie with a reasonable inference that the separation would be permanent or long duration event. Here the separation or estrangement is either initiated by the other person or “forced” by circumstances such as the infidelity of the subject or marked violence. The delinquent behaviour of a child or a criminal act committed by a close tie could be a humiliation. ‘Put down’ events are events such as rejection or verbal or physical attack by a close tie, or any other person if the event is highly public. This may be humiliating or threaten a core role. It includes all rapes; if the subject feels responsible in some way this might increase the humiliation felt. 3. Entrapment includes long-term sustained entrapment includes serious difficulties that can only get worse or persist according to the subject; or a failed positive event where a potential fresh start went disastrously wrong within 1-2 wk, leaving the person stuck in ‘square one’. It is recognised that the unidimensional measure of severity of life events (either loss or threat, etc.) is not sufficient to explain the effects on mental illness. Combined loss and humiliation events are more depressogenic than a threat or other individual types of events. Humiliation events induce defeat and submission responses which may be directly related to depression. In a study by Kendler et al. (2003), humiliation predicted onsets of pure major depression but not pure generalised anxiety episodes, and danger © SPMM Course predicted pure generalised anxiety but not pure major depression episodes. But the results had only moderate strength in prediction. Depressed patients may recall more stressful life events due to cognitive bias. It is shown that the frequency of desirable or entrance life events in the depressed population is comparable to controls – so the absence of positive events cannot be the simple explanation for depression. It is demonstrated that those with a recurrent episode of depression have less preceding life events than those with the first episode of depression. This may be related to kindling phenomenon. Genes and life events: Kendler (1997) examined the relationship between genetic vulnerability to depression and the risk of experiencing stressful life events. A reverse causality effect (i.e. vulnerability to depression itself could explain the occurrence of more frequent stressful life events) was demonstrated. In a sample of over 2000 female twins, genetic liability to depression was associated with a significantly increased risk of experiencing an assault, serious marital problems, divorce/break-up, job loss, serious illness, major financial problems, and trouble getting along with relatives/friends. Similarly, the genetic liability to alcoholism impacted on the risk of being robbed and having trouble with the law. Hence, genes can probably impact on the risk for psychiatric illness by causing individuals to select themselves into high-risk environments. Therefore, life events are ‘heritable’ to some extent. Life events measures Semi-structured interviews  Life events & Difficulties Scale (Brown & Harris)  Interview for Recent Life Events (Paykel) Life events scales  Social Readjustment Rating Scale (Holmes & Rahe)  Adverse Childhood Events Scale  Hassles & Uplifts Scale (Lazarus & Folkman) .