The relationship between the extent of life changes ...

Saulo Sirigatti, Silvia Casale, Enrichetta Giannetti, Cristina Stefanile

The relationship between the extent of life changes and psychological problems European University of Rome (Italy) University of Florence (Italy)

Life Events are changes which require adaptive behavior and cause significant alterations to an individual's psychological or physiological system (Cooke & Rousseau, 1983) Numerous studies have investigated the relationships among life events and susceptibility to physical illness and psychological problems of various types

These studies have been based on the assumption that life changes (whether positive or negative) require adaptation and are stressful to a greater or lesser degree depending on the experience of specific events Early studies (e.g. Paykel, Myers, Dienelt, Klerman, Linderthal, & Popper, 1967; Dekker & Webb, 1974) have demonstrated a relationship between extent of life change and psychiatric symptomatology Recently, Anders et al. (2012) found that individuals who reported more lifetime events also reported poorer outcomes (e.g., poorer health)

Distinction between: early life events (childhood and adolescence; may act as predisposing factor)

recent life events (6-12 months before the onset of the disorder; may act as precipitating factor)

With regards to recent life changes, a significant association has been found with internalizing disorders: Disorder

Authors

Main results

First onset of depression

Kendler et al., 1999; Kessing & Bukh, 2013

Generalized anxiety syndrome

Blazer et al., 1987; 87.5% reported stressful life events Romosan et al., occurring in the year before the onset 2004

Panic disorder

Venturello et al., 2002; Klauke et al., 2010

About 70% of the sample experience a moderate to severe stressful life event half a year prior to the first onset. Interactive effect with genetic variations in the serotonin receptor system

Evidence for a significant impact of cumulative as well as specific life events

….externalizing disorders, especially maniacal episodes: Authors Kennedy et al., 1983 Hunt et al., 1992

Horesh & Iancu, 2010

Hosang et al., 2012

Main results Two fold increase in life events during the 4 month period before admission to hospital. Of 52 relapses 19% were preceded by a severe event in the previous month The relationship between LEs and manic episodes was prominent in the year preceding the first manic episode Independent events were not associated with bipolar episodes, suggesting that life stress may be a consequence of, rather than a trigger for, bipolar episodes

…thought disfunction disorders, especially psychosis: Authors

Main results

Seminal study by Brown and Birley (1968)

46% of cases were exposed to recent independent events compared with 14% of controls

Dohrenwend et al. (1987)

Did not find any increase in independent events prior to onset

Raune et al. (2009)

Almost all cases (95%) experienced a life event 1 year prior to the development of symptoms

A recent meta-analysis (Beards et al., 2013) claims that the literature is suggestive but too weak to permit firm conclusions

The distinction between independent (beyond the individual’s control) and dependent events is fundamental, but it is often neglected. For example, individuals predisposed to major depression put themselves into highrisk environments (Kendler et al., 1999) The majority of the studies used a retrospective design

Recently, a restructured version of the MMPI-2, the MMPI-2-RF, has been published The revision was designed to provide an exhaustive and efficient assessment of the clinically relevant variables measurable with the instrument’s item pool The MMPI-2-RF provides a broad assessment of emotional, thought, and behavioral dysfunction through three higher-order scale. Moreover, the Restructured Clinical Scales provide clinically significant information since they capture the core component of one or more of the Clinical Scales

To investigate the association between recent life changes and psychopathology assessed with the MMPI-2-RF

Participants 267 males (age: M=31.72. SD=12.51) and 307 females (age: M=32.64; SD=16.57)

Measures Life Experiences Survey. The LES is 41 item self-report modified version of the Recent Life Events Survey by Holmes and Rahe, covering significant changes in life during six-month period preceding its completion (Butcher et al,, 1989). It includes both negative and positive events, regarding five life arenas: personal, family, financial, social, and work. The Italian version (Sirigatti & Faravelli, 2012) of the MMPI-2-RF (Ben-Porath & Tellegen, 2008)

Validity Scales

Content

VRIN-r Variable Response Inconsistency

Random responding

TRIN-r True Response Inconsistency

Fixed responding

F-r

Infrequent Responses

Responses infrequent in the general populations

Fp-r

Infrequent Psychopathology Responses

Responses infrequent in psychiatric populations

Infrequent Somatic Responses

Somatic complaints infrequent in medical patient populations

Fs

FBS-r Symptom Validity

Somatic/Cognitive complaints associated at high levels with over-reporting

RBS

Response Bias Scale

Symptoms validity

L-r

Uncommon Virtues

Rarely claimed moral attributes or activities

K-r

Adjustment Validity

Avowals of good psychological adjustment associated at high levels with over-reporting

Higher-Order (H-O) Scales

Content

EID

Emotional / Internalizing Dysfunction

Problems associated with mood and affect

THD

Thought Dysfunction

Problems associated with disorder thinking

BXD

Behavioral / Externalizing Dysfunction

Problems associated with under-controlled behavior

Restructured Clinical (RC) Scales

Content

RCd

Demoralization

General unhappiness and dissatisfaction

RC1

Somatic Complaints

Diffuse physical health complaints

RC2

Low Positive Emotions

RC3

Cynicism

RC4

Antisocial Behavior

RC6

Ideas of Persecution

RC7

Dysfunctional Negative Emotions

Lack of positive emotional responsiveness Non-self-referential beliefs expressing distrust Rule breaking and irresponsible behavior Self-referential beliefs that others pose a threat Maladaptive anxiety, anger, irritability

RC8

Aberrant Experiences

Unusual perceptions or thoughts

RC9

Hypomanic Activation

Over-activation, aggression, impulsivity, and grandiosity

Somatic/Cognitive Scales

Content Overall sense of physical debilitation, poor health Nausea, recurring upset stomach, and poor appetite

MLS

Malaise

GIC

Gastrointestinal Complaints

HPC

Head Pain Complaints

Head and neck pain

NUC

Neurological Complaints

Dizziness, weakness, paralysis, loss of balance, etc.

COG

Cognitive Complaints

Memory problems, difficulties concentrating

Internalizing Scales SUI

Suicidal/Death Ideation

HLP

Helplessness/Hopelessness

SFD

Self-Doubt

NFC

Inefficacy

Content Direct reports of suicidal ideation and recent suicide attempts Belief that goals cannot be reached or problems solved Lack of confidence, feeling of uselessness

AXY

Anxiety

ANP

Anger Proneness

Belief that one is indecisive and inefficacious Preoccupation with disappointments, difficulty with time pressure Pervasive anxiety, frights, frequent nightmares Become easily angered, impatient with others

BRF

Behavior-Restricting Fears

Fears that significantly inhibit normal activities

MSF

Multiple Specific Fears

Fears of blood, fire, thunder

STW Stress/Worry

Externalizing Scales

Content

JCP

Juvenile Conduct Problems

Difficulties at school and at home, stealing

SUB

Substance Abuse

Current and past misuse of alcohol and drugs

AGG Aggression

Physically aggressive, violent behavior

ACT

Heightened excitation and energy level

Activation

Interpersonal Scales FML IPP SAV

Family Problems Interpersonal Passivity Social Avoidance

SHY

Shyness

DSF

Disaffiliativeness

Interest Scales

Content Conflictual family relationship Being unassertive and submissive Avoiding or not enjoying social events Bashful, prone to feel inhibited and anxious around others Disliking people and being around them

Content

AES

Aesthetic-Literary Interest

Literature, music, the theater

MEC

Mechanical-Physical Interests

Fixing and building things, the outdoors, sports

Psy-5 Scales

Content

AGG-r

Aggressiveness revised

Instrumental, goal-directed aggression

PSYC-r

Psychoticism revised

Disconnection from reality

DISC-r

Disconstraint revised Negative emotionality / NEGE-r Neuroticism revised Introversion / Low Positive INTR-r Emotionality revised

Under-controlled behavior Anxiety, insecurity, worry and fear Social disengagement and anhedonia

Pearson’s correlation between LES and: MMPI-2-RF Validity Scales LES

VRIN

TRIN

.15**

.09*

F-r

Fp-r

Fs

FBS-r

RBS

L-r

K-r

.27** .19** .23** .14** .19** -.17** -.27**

MMPI-2-RF Higher-Order Scales LES

EID

THD

BXD

.23**

.22**

.19**

MMPI-2-RF Restructured Clinical Scales

LES

RCd DEM

RC1 SOM

RC2 LPE

RC3 CYN

RC4 ASB

RC6 PER

RC7 DNE

RC8 ABX

RC9 HPM

.24**

.21**

.08*

.16**

.24**

.21**

.21**

.26**

.21**

*p < .05; **p < .01

Pearson’s correlation between LES and: MMPI-2-RF Somatic Scales

LES

MLS

GIC

HPC

NUC

COG

.18**

.09*

.16**

.17**

.22**

MMPI-2-RF Internalizing Scales SUI LES

HLP

SFD

NFC

STW

ANP

BRF

MSF

.17** .15** .23** .20** .20** .11** .16** .14** .10*

MMPI-2-RF Externalizing Scales

LES

AXY

JCP

SUB

AGG

ACT

.13**

.12**

.25**

.16**

*p