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Effects of positive and negative life events on time to depression onset: an analysis of additivity and timing

Published online by Cambridge University Press:  09 July 2009

E. Frank*
Affiliation:
Department of Psychiatry and Department of Mathematics and Statistics, University of Pittsburgh, PA, USA
X. M. Tu
Affiliation:
Department of Psychiatry and Department of Mathematics and Statistics, University of Pittsburgh, PA, USA
B. Anderson
Affiliation:
Department of Psychiatry and Department of Mathematics and Statistics, University of Pittsburgh, PA, USA
C. F. Reynolds III
Affiliation:
Department of Psychiatry and Department of Mathematics and Statistics, University of Pittsburgh, PA, USA
J. F. Karp
Affiliation:
Department of Psychiatry and Department of Mathematics and Statistics, University of Pittsburgh, PA, USA
A. Mayo
Affiliation:
Department of Psychiatry and Department of Mathematics and Statistics, University of Pittsburgh, PA, USA
A. Ritenour
Affiliation:
Department of Psychiatry and Department of Mathematics and Statistics, University of Pittsburgh, PA, USA
D. J. Kupfer
Affiliation:
Department of Psychiatry and Department of Mathematics and Statistics, University of Pittsburgh, PA, USA
*
1Address for correspondence: Dr Ellen Frank, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213., USA.

Synopsis

While the relationship of life events to depression onset has occupied researchers for almost a quarter of a century, few studies have attempted to account for either the temporal patterning of events relative to episode onset, or, the effect of multiple events in a study period. In this report, we attempt to address the issues of timing of events, multiple events (both positive and negative) and multiple aspects (both positivity and negativity) of single events on latency time to depression onset, while simultaneously accounting for possible decay in the effects of events over time. We use the proportional hazards approach to model the effects of life events and consider modelling the change in impact of events with the passage of time.

After interviewing 142 recurrent unipolar patients using the Life Events and Difficulties Schedule, we rated severity and positivity of life events reported during the 6-month period prior to onset. As we hypothesized, additional life events occurring after an initial provoking agent level event significantly alter the risk of illness onset. Additional severely threatening events decrease the time to onset, but positive events do not appear to delay onset. Interestingly, seemingly neutral events had a highly significant effect in shortening the time to onset. We note the many limitations imposed on the interpretation of these findings related to the selected group of subjects studied and encourage those who have more generalizable data to apply these methods of analysis.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCES

Bebbington, P., Der, G., MacCarthy, B., Wykes, T., Brugha, T., Sturt, P. & Potter, J. (1993). Stress incubation and the onset of affective disorders. British Journal of Psychiatry. 16, 358362.CrossRefGoogle Scholar
Brown, G. W. (1989). Life events and measurement. In Life Events and Illness (ed. Brown, G. W. and Harris, T. O.), pp. 345. Guilford Press: London.Google Scholar
Brown, G. W. (1993). Life events and affective disorder: replications and limitations. Psychosomatic Medicine 55, 248259.CrossRefGoogle ScholarPubMed
Brown, G. W. & Harris, T. O. (1978 a). Social Origins of Depression: A Study of Psychiatric Disorder in Women. Tavistock: London.Google Scholar
Brown, G. W. & Harris, T. O. (1978 b). The Bedford College Life Events and Difficulty Schedule: Directory of Contextual Threat Ratings of Events. Bedford College, University of London: London.Google Scholar
Brown, G. W., Sklair, F., Harris, T. O. & Birley, J. L. T. (1973). Life events and psychiatric disorders, part I. Some methodological issues. Psychological Medicine 3, 7487.CrossRefGoogle Scholar
Brown, G. W., Bifulco, A., Harris, T. O. & Bridge, L. (1986 a). Life stress, chronic psychiatric symptoms and vulnerability to clinical depression. Journal of Affective Disorders 11, 119.CrossRefGoogle ScholarPubMed
Brown, G. W., Bifulco, A. & Harris, T. O. (1986 b). Life events. vulnerability and onset of depression: some refinements. British Journal of Psychiatry 150, 3042.CrossRefGoogle Scholar
Brown, G. W., Lemyre, L. & Bifulco, A. (1992). Social factors and recovery from anxiety and depressive disorders: a test of specificity. British Journal of Psychiatry 161, 4454.CrossRefGoogle ScholarPubMed
Brown, G. W., Harris, T. O. & Hepworth, C. (1994). Life events and ‘endogenous’ depression: a puzzle re-examined. Archives of General Psychiatry 51, 525534.CrossRefGoogle Scholar
Finlay-Jones, R. & Brown, G. W. (1981). Types of stressful life events and the onset of anxiety and depressive disorders. Psychological Medicine 11, 803815.CrossRefGoogle ScholarPubMed
Frank, E., Anderson, B., Reynolds, C. F., Ritenour, A. & Kupfer, D. J. (1994). Life events and the RDC endogenous subtype: a confirmation of the distinction using the Bedford College Methods. Archives of General Psychiatry 51, 519524.CrossRefGoogle Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology and Neurosurgery Psychiatry 23, 5662.Google Scholar
Kalbfleisch, J. D. & Prentice, R. L. (1980). The Statistical Analysis of Failure Time Data. John Wiley: New York.Google Scholar
Karp, J. F., Frank, E., Anderson, B., George, C., Reynolds, C. F., Mazumdar, S. & Kupfer, D. J. (1993). Time to recovery in late-life depression: analysis of effects of demographic, treatment, and life-events measures. Depression 1, 250256.CrossRefGoogle Scholar
Klerman, G. L., Weissman, M. M., Rounsaville, B. J. & Chevron, E. S. (1984). Interpersonal Psychotherapy of Depression. Basic Books, Inc: New York.Google Scholar
Laird, N. M. & Ware, J. H. (1982). Random-effects models for longitudinal data. Biometrics 38, 963974.Google Scholar
SAS Institute Inc. (1991). SAS Technical Report P-217, SAS/STAT Software: The PHREG Procedure, Version 6, p. 63. SAS Institute Inc: Cary, NC.Google Scholar
Silver, R. L. & Wortman, C. B. (1980). Coping with undesirable life events. In Human Helplessness (ed. Garber, J. and Seligman, M. L. P.), pp. 279340. Academic Press: New York.Google Scholar
Surtees, P. G. (1989). Adversity and psychiatric disorder: a decay model. Life Events and Illness (ed. Brown, G. W. and Harris, T. O.), pp. 161195. Guilford Press: London.Google Scholar
Surtees, P. G. & Ingham, J. G. (1980). Life stress and depressive outcome: application of a dissipation model to life events. Social Psychiatry 15, 2131.Google Scholar
Surtees, P. G., Kiff, J. & Rennie, D. (1981). Adversity and mental health: an empirical investigation of their relationship. Acta Psychiatrica Scandinavia 64, 177192.Google Scholar
Surtees, P. G., Miller, P. McM., Ingham, J. G., Kreitman, N. B., Rennie, D. & Sashidharan, S. P. (1986). Life events and the onset of affective disorder: a longitudinal general population study. Journal of Affective Disorders 10, 3750.CrossRefGoogle ScholarPubMed
Tennant, C., Bebbington, P. & Hurry, J. (1981). The short-term outcome of neurotic disorders in the community: the relation of remission to clinical factors and to ‘neutralizing’ life events. British Journal of Psychiatry 139, 213220.CrossRefGoogle ScholarPubMed