Life events, social problems and physical health status as predictors of emotional distress in men and women in a community setting

The main aim of this study was to construct logistic models of emotional distress (defined as a GHQ-30 score of 6 or greater) in a community sample of 226 men and 225 women. The independent variables included were: sociodemographic characteristics, physical health status, social problems and undesirable life events. Univariate comparisons showed that in both sexes undesirable life events and social problems were associated with emotional distress; in men the presence of physical symptoms and widowed, separated or divorced status also showed such an association. Separate logistic regression models for men and women confirmed the importance of undesirable life events and social problems as predictors for emotional distress. In women there was also a significant interaction effect between the two variables on emotional distress. Sociodemographic characteristics and physical health status did not exert a statistically significant effect in these models.     

The relationship between life events and mental health in homosexual men

In a study to determine the extent to which stigmatization influences mental health in homosexual men, 80 homosexual men were administered the General Health Questionnaire and the Gay Affect and Life Events Scale. Data indicated that there were significant associations between life events and mental health; events related to AIDS had the highest correlations. However, general life event scales that included Finances and Work also were associated significantly with mental health, as previously reported in the general population. These data suggest that the impact of life events may be amplified by stigmatization and that degree of life change is associated closely with psychological dysfunction. It is concluded that life events that are related to both stigmatization and life change and related emotional distress are significant predictors of psychology dysfunction.     

Total workload as related to psychological well-being and symptoms in full-time employed female and male white-collar workers

Most research on the combined effects of paid and unpaid workload has related these factors to stress, depression, and physical symptoms. Thus, comparative knowledge concerning positive aspects of human functioning, such as health and well-being and how they relate to total workload of employed women and men, is limited. Our aim in this study was to investigate how total workload including paid and unpaid work is related to psychological well-being and symptoms in full-time employed women and men. We obtained data on workload, general symptoms, and the Ryff scales covering self-acceptance, environmental mastery, positive relations, personal growth, purpose in life, and autonomy from questionnaires mailed to a stratified sample of highly educated white-collar workers aged between 32 and 58 years. Data from women (n = 430) and men (n = 400) living in partner relationships with at least one child showed that increasing hours of unpaid work was associated with decreasing levels of self-acceptance and environmental mastery in women, whereas paid work was associated with increasing levels of personal growth and decreasing levels of purpose in life. For men, paid work was associated with increasing levels of personal growth and more symptoms. We discuss factors underlying the gender-specific relationships between paid and unpaid work, psychological well-being, and symptoms.     

Gender differences in health-related quality of life in patients with bipolar disorder

Health-related quality of life (HRQOL) is a widely accepted measure of illness state that is related to morbidity and mortality. Findings from various populations show that women report lower HRQOL than men. We analyzed baseline HRQOL data for gender differences from a multisite, randomized controlled study for adults with bipolar disorder. HRQOL was assessed using the 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) health scales. Multivariate linear and bivariate regression models examined differences in self-reported data on demographics, depressive symptoms (nine-item Patient Health Questionnaire), bipolar disorder symptoms (Internal State Scale), and medical comorbidities. Out of 384 enrolled (mean age?=?42 years), 256 were women (66.7 %). After controlling for sociodemographic characteristics and clinical factors, women had lower SF-12 PCS scores than men [β?=??1.78, standard error (SE)?=?0.87, p?<?0.05], indicating worse physical health, but there were no gender differences in MCS scores. After controlling for patient factors including medical and behavioral comorbidities, the association between gender and PCS score was no longer significant. Of the medical comorbidities, pain was associated with lower PCS scores (β?=??4.90, SE?=?0.86, p?<?0.0001). Worse physical HRQOL experienced by women with bipolar disorder may be explained by medical comorbidity, particularly pain, suggesting the importance of gender-tailored interventions addressing physical health conditions.     

Gender,work-home conflict,and morbidity amongst white-collar bank employees in the United Kingdom

Most research on work-home conflict focuses solely on women. This study compares men and women’s perceptions of the extent to which paid work interferes with family life, and examines associations between work-home conflict and health. Data were collected from 2,176 full-time white-collar employees of a British bank. We did not find any significant gender differences in perceptions of work-home conflict. However, predictors of work-home conflict did vary by gender; having children and being in a senior position were more strongly related to work-home conflict for women than for men, while working unsociable hours was more important for men than for women. Work-home conflict was strongly associated with reporting fair or poor self-assessed health, a high number of reported physical symptoms and minor psychological morbidity (GHQ-12). These associations were equally strong for men and women. Our results suggest that work-home conflict is a problem for men as well as women.     

Adverse life experiences and common mental health problems in pregnancy: a causal pathway analysis

Risk factors for antenatal common mental problems include a history of depression, lack of social support and a history of both childhood and adulthood sexual and physical abuse. However, it is less clear whether pregnancy is a time of particular susceptibility to mental disorders due to prior childhood experiences. The aim of the paper was to investigate the potential pathways to antenatal mental health problems. A total of 521 women attending prenatal care attended a clinical interview and answered psychological questionnaires. Univariate analysis, sequential binary logistic regression and structural equation modelling (SEM) were used to analyse the relationships between variables. Having experienced parental maladjustment, maltreatment and serious physical illness in childhood and domestic violence, financial difficulties and serious spousal substance abuse in adulthood significantly predicted antenatal common mental health symptoms. SEM showed that history of depression and adverse experiences in adulthood had mediating effects on the relationship between adverse childhood events and symptoms of antenatal common mental disorders. Adverse childhood experiences are distal risk factors for antenatal common mental health problems, being significant indicators of history of depression and adverse experiences in adulthood. We therefore conclude that pregnancy is not a time of particular susceptibility to common mental health problems as a result of childhood abuse, but rather, these childhood experiences have increased the risk of adulthood trauma and prior mental disorders. Women at risk for antenatal common mental disorders include those with a history of depression, domestic violence, financial difficulties, spousal substance abuse and lack of social support.

     

The health status and life satisfaction of first-year medical students

The self-reported health status and life satisfaction of 286 first-year Duke University medical students in four consecutive classes were measured at the beginning and end of the school year and compared statistically with relevant sociodemographic and behavioral factors. Health status, quantitated in terms of Duke Health Profile scores, was generally lower for women than for men. Although there was a definite trend of worsening along all parameters of health and satisfaction during the year for both women and men, the most marked change was the increase in depressive symptoms. The students who were very satisfied with life had fewer symptoms of depression and anxiety; higher self-esteem, better physical, mental, and social health; stronger social ties; more physical activity; more sleep; and fewer stressful life events. Strong social ties was the factor most positively related to better health and life satisfaction.     

Prospective effects of post‐bereavement negative events on cortisol activity in parentally bereaved youth

Dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis has been implicated in the association between adverse childhood experiences, such as parental death, and mental and physical health problems. Recent research indicates that children who experience the death of a parent exhibit HPA axis dysfunction; however, the mechanisms underlying this association have not been explored. It is theorized that physiological dysregulation may result from exposure to stressful life events subsequent to parental death. The current study examined the prospective relations between negative events following parental death and cortisol activity in parentally bereaved youth. A greater number of post‐bereavement negative events predicted significantly lower levels of cortisol activity 6 years later; this association remained significant after controlling for current externalizing symptoms and recent negative events. Results suggest that higher exposure to stressful events following childhood parental loss may result in long‐term attenuated cortisol activity. © 2010 Wiley Periodicals, Inc. Dev Psychobiol 52: 394–400, 2010.     

Opening the proverbial ‘can of worms’ on trauma-specific treatment in prison: The association of adverse childhood experiences to treatment outcomes

A large body of research has shown that incarcerated populations have a high prevalence of adverse childhood experiences (ACEs), increasing their risk for associated mental health problems and violent and aggressive behaviours. Emerging research on treatment for trauma survivors shows evidence that incarcerated women and men, with the most complex histories of trauma and abuse, can be responsive to trauma-specific treatment. Current research assessing two gender-responsive and trauma-specific brief interventions (e.g., Healing Trauma for Women and Exploring Trauma for Men) have demonstrated feasibility, consistency and efficacy among incarcerated populations. The current study uses secondary data analysis to explore the relationship between cumulative ACEs and the impact of the Healing Trauma and Exploring Trauma on participant's (682 women and 624 men) mental health, aggression and anger outcomes. The mixed-method regression results show that the impact of ACEs on treatment outcomes is strong and cumulative (i.e., greater exposure to childhood traumatic events increased the likelihood of participant programme gain on all the mental health and aggression outcomes, ranging from .13 to 1.2 for women and .15 to .77 for the men). The lowest significant coefficient for both women and men was for verbal anger and the largest was for current trauma symptoms. The association of ACEs on anger outcomes varied between women and men (revealing more association among the men). The findings show a strong positive impact for the trauma-specific brief interventions, particularly for those with the highest levels of trauma, whom otherwise might not have been ineligible for any programme participation.     

Premenstrual symptoms are associated with psychological and physical symptoms in early pregnancy

The reproductive life of women is characterised by a number of distinct reproductive events and phases (e.g. premenstrual phase, peripartum, perimenopause). The hormonal transitions during these phases are often associated with both psychological and physical symptoms. Associations between these reproductive phases have been shown by numerous studies. However, the relationship between symptoms during the premenstrual phase and during early pregnancy has received little attention thus far, although early pregnancy is a time of dramatic hormonal as well as physical adaptation. Findings are based on a prospective longitudinal study with N?=?306 pregnant women (MARI study). Three hundred five women that had menstrual bleeding in the year before pregnancy rated the severity of psychological and physical symptoms during premenstrual phases in the year preceding pregnancy. Besides this, they rated the severity of the same symptoms during early pregnancy (weeks 10 to 12 of gestation). The overall severity of premenstrual symptoms was significantly associated with the overall severity of early pregnancy symptoms (b?=?0.4, 95 % CI?=?0.3–0.5; p?<?0.001). The overall severity of early pregnancy symptoms was best predicted by the severity of premenstrual irritability. The best predictor for a particular symptom in early pregnancy mostly was the corresponding premenstrual symptom. The associations between premenstrual and early pregnancy symptoms support the reproductive hormone sensitivity hypothesis that some women are prone to repeatedly experience specific psychological and physical symptoms during different reproductive phases. The findings further imply that the nature of symptoms might be rather consistent between different reproductive phases.     

Symptom experience in Australian men and women in midlife

OBJECTIVE: To compare the experience of vasomotor, psychological and somatic symptoms in Australian men and women in midlife, to investigate whether symptoms often attributed to endocrine changes in midlife are associated with health and psychological well-being, and to evaluate their relationship to menopausal status in women. METHODS: A cross-sectional, correlational, population-based study based on self-report questionnaires. Participants comprised 451 men and 766 women, aged between 39 and 65, from urban and rural South Australia, who responded to invitations to participate, or who volunteered to participate following media releases. Outcome measures used comprised a 47-item symptom checklist of current presence and severity of vasomotor, somatic and psychological symptoms experienced by men and women during midlife, and measures of health and psychological well-being. RESULTS: The majority of men and women reported that they were not 'bothered' by vasomotor, psychological and somatic symptoms. For those symptoms in which men and women differed significantly, women generally reported being more 'bothered' than men, although the pattern of association between symptoms and measures of health and psychological well-being was the same for both men and women. Items from all three symptom clusters were independently related to menopausal status. CONCLUSIONS: Health and psychological well-being play a role in the genesis of symptoms experienced by men and women in midlife. Both men and women experience similar symptoms, although women are more distressed by them signifying support for a menopausal syndrome in women. The finding of an independent relationship between menopausal status and psychological and somatic symptoms, in addition to the vasomotor symptoms, contradicts the narrow-estrogen hypothesis of climacteric symptoms.     

Childhood adversity, recent life events and depression in late life

BACKGROUND: The study investigates whether persons who have experienced childhood adversity are more likely to develop depressive symptoms when faced with recent events. METHOD: Data were used from a population-based sample, aged 55 to 85 years (n=1887), which were not depressed at baseline. Childhood adversities and recent stressful life events were retrospectively assessed. Depressive symptoms were measured with the CES-D. RESULTS: 14.4% of our sample experienced adverse events during childhood (<18 yrs) and 35.4% experienced recent events. Associations of depressive symptoms were found with both, childhood adversity (OR 1.80, 95% CI 1.21-2.69) and recent life events (OR 1.42, 95% CI 1.01-2.00). The effect of recent events on depressive symptoms was not modified by childhood adversity. LIMITATIONS: Underreporting may be present due to unwillingness to report embarrassing events or to disclose painful memories. CONCLUSIONS: No evidence was found for the assumption that older persons were more vulnerable for depression in reaction to recent life events when they were exposed to childhood adversity.     

Childhood trauma and adulthood physical health in Mexico

Background  The present study examined the effect of childhood trauma on adulthood physical health among a randomly selected sample of adults (N = 2,177) in urban Mexico. Methods  Adults were interviewed about their experiences of trauma, post-traumatic stress disorder, depression, and physical health symptoms using Module K of the Composite International Diagnostic Interview, the Center for Epidemiologic Studies Depression Scale, and the Physical Symptoms Checklist. Results  Trauma was prevalent, with 35% reporting a traumatic event in childhood. In general, men reported more childhood trauma than women, with the exception of childhood sexual violence where women reported more exposure. For men, childhood sexual violence was related to total and all physical health symptom subscales. For women, childhood sexual violence was related to total, muscular-skeletal, and gastrointestinal-urinary symptoms; hazards/accidents in childhood were related to total, muscular-skeletal, cardio-pulmonary, and nose-throat symptom subscales. Depression mediated the relationship between childhood sexual violence and physical health symptoms for men and women. Among women only, PTSD mediated the relationship between childhood sexual violence and total, muscular-skeletal, and gastrointestinal-urinary symptoms. PTSD also mediated the relationship between hazards/accidents in childhood and total, muscular-skeletal, cardio-pulmonary, and nose-throat symptoms. Conclusion  These findings can be used to increase awareness among general practitioners, as well as community stakeholders, about the prevalence of childhood trauma in Mexican communities and its impact on subsequent physical health outcomes. With this awareness, screening practices could be developed to identify those with trauma histories in order to increase positive health outcomes among trauma survivors.

Social Adversity Experience and Blood Pressure Control Following Antihypertensive Medication Use in a Community Sample of Older Adults

Background

Psychosocial stress is a risk factor for hypertension and has been shown to affect response to treatment for psychiatric illnesses.

Purpose

We investigate the relationship between a history of social adversity experience and blood pressure control following antihypertensive medication use.

Methods

A total of 1,186 participants selected from the European Prospective Investigation into Cancer-Norfolk study (531 men and 655 women, aged 42 to 80 years) had attended two health checks at which blood pressure measurements were taken; were taking antihypertensive medication at the second, but not the first health check; and had completed a questionnaire assessment of their social and psychological circumstances which included details of traumatic experiences in childhood and of adverse life events, long-term difficulties, and perceived stress in adulthood.

Results

Experience of recent loss events in adulthood was associated with a smaller reduction in systolic blood pressure after starting hypertension treatment (β?=?1.78, 95 % confidence interval 0.15–3.40, per life event), independently of age, sex, preexisting health conditions, cigarette smoking history, alcohol consumption, physical activity, and obesity.

Conclusion

Results from this study suggest that stress caused by recent losses may be associated with reduced effectiveness of treatment for hypertension. Subject to replication, these findings may help determine the specific physiological mechanisms by which medication treatment effectiveness is affected by stress.     

Early risk factors and adult person--environment relationships in affective disorder

BACKGROUND: Lower cognitive ability, higher neuroticism and symptoms of anxiety and depression in childhood predict non-psychotic disorder in adulthood. This study examined whether these early risk factors act by modifying relationships with life events close to disease onset in adulthood. METHODS: Childhood measures of neuroticism (N) (including maternal N), cognitive ability (CA) and symptoms of anxiety and depression were measured in a national British birth cohort of 5362 individuals born in the week 3-9 March, 1946. At ages 36 and 43 years, mental state examinations were carried out by trained interviewers, and subjects were asked about the occurrence of stressful life events in the previous year (SLE). RESULTS: The effect of aggregated SLEs on mental health was greater in women, in individuals with higher childhood N and poorer childhood mental health. Higher maternal N was also associated with greater sensitivity to SLEs, independent of subject's N, suggesting possible familial transmission of vulnerability. In addition, higher childhood N predicted, independent of later mental health, greater likelihood of reported exposure to SLEs. In general, individuals with higher childhood CA also reported more SLEs. CONCLUSIONS: The results suggest that early risk factors for affective disorder exert effects by modifying person-environment relationships close to onset of adult symptoms. Sensitivity to life events may be transmitted from parents to offspring; psychopathological continuity over the life-span may be explained in part by continuity of altered stress sensitivity.     

Chronic and episodic stress predict physical symptom bother following breast cancer diagnosis

Breast cancer patients often experience adverse physical side effects of medical treatments. According to the biobehavioral model of cancer stress and disease, life stress during diagnosis and treatment may negatively influence the trajectory of women’s physical health-related adjustment to breast cancer. This longitudinal study examined chronic and episodic stress as predictors of bothersome physical symptoms during the year after breast cancer diagnosis. Women diagnosed with breast cancer in the previous 4 months (N = 460) completed a life stress interview for contextual assessment of chronic and episodic stress severity at study entry and 9 months later. Physical symptom bother (e.g., pain, fatigue) was measured at study entry, every 6 weeks through 6 months, and at nine and 12 months. In multilevel structural equation modeling (MSEM) analyses, both chronic stress and episodic stress occurring shortly after diagnosis predicted greater physical symptom bother over the study period. Episodic stress reported to have occurred prior to diagnosis did not predict symptom bother in MSEM analyses, and the interaction between chronic and episodic stress on symptom bother was not significant. Results suggest that ongoing chronic stress and episodic stress occurring shortly after breast cancer diagnosis are important predictors of bothersome symptoms during and after cancer treatment. Screening for chronic stress and recent stressful life events in the months following diagnosis may help to identify breast cancer patients at risk for persistent and bothersome physical symptoms. Interventions to prevent or ameliorate treatment-related physical symptoms may confer added benefit by addressing ongoing non-cancer-related stress in women’s lives.     

Gender and alcohol use: the roles of social support, chronic illness, and psychological well-being

Men and women differ in their use of alcohol, in their rates of chronic illnesses and psychological symptoms, and in the social support they receive. In this paper, we assess how the latter three factors are associated with alcohol use, and how these associations differ by gender. Respondents were 3,074 male and 3,947 female randomly selected Health Maintenance Organization members who responded to a mail survey in 1990. Hierarchical multiple regression analyses indicate that social support is associated with alcohol consumption in similar ways for both genders, yet the associations between some demographic, physical health/functioning, and psychological well-being measures are different for men and women. Men with fewer role limits due to physical health drank more, while women with better psychological well-being drank less. Poor psychological well-being may be a modifiable risk factor for increased alcohol use among women; practitioners should be alert for greater consumption among men with few functional limitations and good health.     

Relative impact of adverse events and screened symptoms of posttraumatic stress disorder and depression among active duty soldiers seeking mental health care

Symptoms of depression and posttraumatic stress are among the most studied psychological difficulties among soldiers. Such symptoms have been linked to a history of adverse events among both civilians and combat veterans. There is a paucity of research on this topic that can be applied to an active duty clinical population. Intake screening data were reviewed for 1,626 soldiers presenting to an outpatient mental health clinic to identify variables, including history of potentially traumatic experiences, associated with screened symptoms of posttraumatic stress disorder (PTSD) and depression. Demographics such as age, gender, and military rank, as well as number of adverse childhood experiences were significant predictors of screened PTSD and depression. A history of deployment to a combat zone predicted screened PTSD, but not depression. The role of childhood abuse as a risk factor is discussed and highlighted in the etiology of symptoms for soldiers seeking mental health care.     

Relations of caregiving stress and health depend on the health indicators used and gender

Extensive research has evaluated relations between stress and health. These studies have varied in the type of stress examined (acute vs. chronic) and in the way in which health has been operationalized. Here we examine relations between chronic stress and 25 indicators of various health dimensions (e.g., physiological indexes, medical records, and self-reports of global health; symptoms, functional status, health service utilization, and psychosocial distress/quality of life). We also assessed whether such relations are moderated by gender, an individual difference variable that is important to health and longevity. Samples included 157 community-residing older adults (M age = 69.4 years, 31.8% men), approximately half of whom were caregivers for a spouse with Alzheimer’s disease, and half were demographically similar noncaregiver spouses. Principal component analyses on the 25 health measures resulted in 5 factors that met standard criteria for acceptance. In women, caregivers reported worse physical health and psychological health than noncaregivers, but their physiological risk was similar. In men, caregivers had greater physiological risk, but they reported better physical health than did men noncaregivers. Researchers who study chronic stress and health should consider the possibility that the relation between chronic stress and health may vary for men and women depending on the type of health being assessed.     

Death or illness of a family member,violence, interpersonal conflict,and financial difficulties as predictors of sickness absence: longitudinal cohort study on psychological and behavioral links

OBJECTIVE: Although an association between stressful life events and health problems has been demonstrated, the underlying mechanisms have remained unclear. We examined whether psychological problems and health-risk behaviors underpin the health effects of different event categories. METHOD: The initially healthy participants were 2991 (796 men, 2195 women) municipal employees who had taken no sick leave in 1995. In 1997, they completed a questionnaire requesting information on recent life events and psychological and behavioral factors. The outcome was recorded sickness absences in 1998. RESULTS: In men, the death or serious illness of a family member, violence, and financial difficulties increased the risk of later sickness absence. According to structural equation modeling, violence and financial difficulties also induced psychological problems such as anxiety, mental distress, and lowered sense of coherence. Psychological problems were associated with heightened cigarette and alcohol consumption, which in turn increased sickness absence. A corresponding structural model did not fit the data in relation to death or serious illness of a family member. In women, life events were associated with psychological problems and smoking but not sickness absence. CONCLUSIONS: Longitudinal evidence suggests that increased psychological problems and behaviors involving risk to health partially mediate the effect of stressful life events on health, as indicated by sickness absence. This model received support among men and for the event categories of violence and financial difficulties. Women were less affected by stressful life events than men.