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Stress, Coping, and Adaption
March 24, 2008
Stressful Life Events and Depression
Eric Weiser
Curry College
Stressful Life Events
(SLEs)

Catastrophic events


Life changes
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Hurricanes, earthquakes, fires, terrorist attacks
Death in the family, job loss, divorce, moving, break-ups and
other “exits” from the social realm
Daily hassles

Rush hour traffic, job stress, financial problems, home
foreclosure
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Depression

Depression is a heterogeneous syndrome, meaning that it
is comprised of many different variations of symptoms

Affective symptoms

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Cognitive symptoms


Profound sadness, dejection, inability to experience pleasure
Self-recriminations, difficulty concentrating, viewing world in
negative light, hopelessness
Physical and behavioral symptoms

Fatigue, low energy, difficulty falling asleep, loss of appetite, lethargy,
agitation, social withdrawal, somatic complaints
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Major Depressive Disorder (MDD)

Depressed mood OR loss of interest or pleasure (anhedonia)
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
Minimum period of 2 weeks
Not due to normal bereavement
PLUS four of the following symptoms:
1.
2.
3.
4.
5.
6.
7.
Change in sleep patterns (sleeping more or less)
Change in appetite or weight (eating more or less)
Agitation or psychomotor retardation (lethargy)
Loss of energy, fatigue
Feelings of self-blame, worthlessness, guilt
Difficulty concentrating, indecisiveness
Thoughts of death or suicide
MDD is sometimes referred to as “unipolar depression,” or
just “depression.”
Depressive Symptoms Mnemonic:
“Space Drags”
S leep disturbance
D epressed mood
P leasure/interest (lack of)
R etardation movement
A gitation
A ppetite disturbance
C oncentration
G uilt, worthless, self-blame
E nergy (loss of)/fatigue
S uicidal thoughts
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Stress and Depression

Overactivity of HPA axis

Triggers release of cortisol


Stress hormone
High cortisol levels linked to depression

Cushing’s syndrome
Causes oversecretion of cortisol
 Symptoms include depressive symptoms


Injecting cortisol in animals produce depressive
symptoms
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Stress and Depression

Even among people who are depressed but do
not have Cushing’s, cortisol is poorly regulated

Dexamethasone suppression test


Dexamthethason suppresses cortisol in most people, but
does not seem to do suppress cortisol in people with
history of depression
Thus, there is good reason, physiologically
speaking, why stress and depression are linked.
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Stressful Life Events and Depression
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Stressful Life Events and Depression

Mazure (1998)

Reviews research examining the relationship
between exposure to stressful life events (SLE) and
depression

Studies using two primary forms of methodology
are included in the review
Case-control studies
 Community studies

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Mazure
(1998)
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Mazure
(1998)
Stressful Life Events and
Depression

There are four models that have been proposed to
characterize the SLE-depression relationship
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Victimization model
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Diathesis-stress model
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SLE lead to depression in people with an underlying biological
diathesis (personality, genes, etc.)
Additive burden model


SLE  depression
SLE, personality dispositions, social situations, etc. all contribute
additively to the development of depression
Proneness model

Depression  SLE  recurrence of depression
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Stressful Life Events and
Depression

Paykel et al. (1969)
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Classic study
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Examined the types and frequencies of life events that
preceded the onset (six months) of depression in 185 patients,
and compared them to the types and frequencies of life
events (one year prior to interview) among a matched
community sample of 185 non-depressed people.

The life events of interest were derived from the Holmes and
Rahe SRRS, and consisted of a list of 33 items (Table 1).
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Paykel’s Study
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Paykel’s Study
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Paykel’s Study
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Paykel’s Study

Results

Depressed individuals appear to experience a large
number of life events prior to the onset of
depression, compared to non-depressed individuals.

Most of these life events involve:
Undesirable life events
 Losses or exits from the social field (i.e., “social exits”)
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The Work of George W. Brown

George W. Brown, a distinguished professor
from University of London, was an international
pioneer in the investigation of “life events” and
depression
His research dates back to the 1960s
 He is regarded as one of the world’s foremost
experts in the psychosocial aspects of mental illness
 His most famous study is known as the Camberwall
Study
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Brown & Harris
(1978)
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The Camberwall Study
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Sample consisted of the following:
114 female psychiatric inpatients and outpatients from
Camberwall
 485 females from same community (while screening for
mental disorders)
 Both groups were interviewed using the LEDS


Purpose was to compare both groups of women to
determine whether stressful life events occurred
more commonly before the onset of depression
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Brown & Harris
(1978)
Stressful life events (or, events that entailed long-term threat)
were coded in one of 10 categories

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Deaths
Illness and accidents to subject
Interaction changes (e.g., close friend moves away)
Disappointments
Miscellaneous crises (e.g., lost pets, burglaries, etc)
Illness and accidents to others
Role change to subject (subject divorces husband)
Job changes
Residence changes
Role changes to others (e.g., son breaks off engagement)
These events were rated as either severe or non-severe, as well
as involving marked vs. moderate long-term threat
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Brown & Harris
(1978)
78 of the original 458 “normal” women
were excluded from the analysis
because they were found to have a
psychiatric disorder
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Brown & Harris
(1978)

Brown and Harris noted that “loss” and “disappointment” were
common themes in the severe events

So, they examined the relationship between these kinds of events
and depression; long-term threatening events were thus classified
into one of six categories

Separation or threat of it

Unpleasant revelation about someone close that forces a reassessment of the
person and relationship
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Life-threatening illness to someone close
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Major material loss or disappointment

Enforced change of residence (or threat of it)
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Miscellaneous crises involving some element of loss (e.g., layoff, legal
separation)
Brown & Harris
(1978)
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Freud and Depression
The notion that loss leads to depression can be traced to
the writings of Freud
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Freud and Depression

Freud (1917)

In his classic paper, Mourning and Melancholia, Freud described his famous
“hatred-turned-inward” theory of depression (melancholia)

Freud directed his attention to the loss of self-esteem in melancholia

In Freud’s view, loss of a loved or cherished person causes one to introject
(i.e., incorporate) the lost person

Because we unconsciously harbor negative feelings toward those we love
(ambivalence), the mourner turns those feelings of hatred inward toward
the self (because the lost person has been introjected)

So, mourners castigate, vilify, and reproach themselves for the faults and
shortcomings perceived in the lost one who has been introjected (loss of
self-esteem)
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The Work of Edward Bibring
Bibring (1953)

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Like Freud, he focused on loss of self-esteem in depression

Unlike Freud, Bibring thought self-esteem may be lowered (thus
producing depression) in ways other than by the frustration of
the need for affection and love

Three types of aspirations which the (pre)depressive may seek:
1.
2.
3.
The wish to be worthy and loved, and to avoid inferiority and
unworthiness
The wish to be strong, superior, secure, and to avoid being weak
and insecure
The wish to be loving and good, and not aggressive, hateful, or
destructive
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Brown, Harris, & Hepworth
(1995)

The purpose of this study was to get a clearer picture of
the specific kinds of stressful life events that are most
likely to lead to depression

A total of 404 women living in Islington (an inner city
section of London) were interviewed using the LEDS

In addition, the interviewers probed for the presence of
psychiatric disorder (depression)
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Brown, Harris, & Hepworth
(1995)
Classification of Events
A.
Humiliation/trapped
1.
Humiliation: separation

2.
3.
Humiliation: other’s delinquency
Humiliation: put down

4.
Some element of failure or rejection in a relationship
e.g., infidelity, verbal or physical attack, daughter wanting to leave
mother
Trapped

An on-going marked difficulty (e.g., learning that a paralyzed and
bedridden husband will not improve)
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Brown, Harris, & Hepworth
(1995)
Classification of Events
B.
Loss alone
1.
2.
Death
Separation-subject initiated

3.
Other key loss
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4.
Subject plays a major part in bringing on a separation (but,
excluding those following the discovery of infidelity or extreme
abuse)
Moderate losses, such as abortion or giving up a valued job
Lesser loss

Death of cat, distant relative, husband being laid off, etc.
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Brown, Harris, & Hepworth
(1995)
Classification of Events
C.
Danger alone


Covers events not meeting criteria for other
categories,
e.g., serious car accident, violent ex-husband
calling to say he knows where you live, serious
asthma attack
Rate of depression onset by humiliation/trapped, loss alone, and
danger, following 377 event sequences among Islington women
Humiliation/Trapped
% onset and provoking agent
Total: 41/131 (31%)
Loss Alone
% onset and provoking agent
Total: 14/157 (9%)
Humiliation: separation
12/34 (35%)
Death
Humiliation: other’s delinquency
7/36 (19%)
Separation: subject-initiated
2/18 (11%)
Humiliation: put down
12/32 (38%)
Other key loss
4/58 (7%)
Trapped
Lesser loss
7/24 (29%)
10/29 (34%)
1/57 (34%)
Danger
% onset and provoking agent
3/89 (3%)
Total
% onset and provoking agent
58/377 (15%)
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Kendler et al.
(2003)

A total of 7,322 adult twins were interviewed

During interview, the interviewers probed for the
presence of either major depression (MD), generalized
anxiety “syndrome” (GAS), or mixed MD-GAS

In another interview, researchers assessed the monthly
occurrence of certain “personal events” (i.e., SLE) using
a classification scheme that was mostly inspired by
G.W. Brown
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Kendler’s Study
Loss
1.
•
Reduced sense of connectedness due to loss of person,
material possessions, job, health, or respect by others
Humiliation
2.
•
Feeling devalued, usually due to rejection or role failure
Entrapment
3.
•
Ongoing unpleasant circumstances that are expected to
persist or get worse, and nothing can be done about it
Danger
4.
•
Exposure to circumstances in which there is a good chance
traumatic or dire consequences could have occurred
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Kendler’s Study
Note: Higher numbers (e.g., 1.70 vs. 0.95 in upper left section) indicate
greater likelihood of developing the psychiatric disorder
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Kendler’s Study
Again, higher numbers (e.g., 3.09 vs. 2.99) indicate greater
likelihood of developing the psychiatric disorder
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Stressful Life Events and
Depression

So, there does appear to be a strong and
consistent relationship between life events and
depression

Events involving a combination of loss and
humiliation (i.e., loss of self-esteem) play very
significant roles in provoking the onset of
depression, above and beyond events involving
pure loss
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