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Arch Gen Psychiatry -- Life Event Dimensions of Loss, Humiliation, Entrapment, and Danger in the Prediction of Onsets of Major Depression and Generalized Anxiety, A…

1/27/07 10:12 AM

ALTHOUGH THE correlation between stressful life events (SLEs)

1-3

and the onset of

major depression (MD) has been replicated frequently

4-8

and is probably causal,

9

the attributes that render the events depressogenic are still uncertain.

The concept of loss as the central depressogenic experience can be traced

to Freud

10

and was first operationalized in SLE research as "exit events."

11

An

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alternative

view,

influenced by evolutionary theory and animal behavior research, is that reduction of

status—forcing the individual into a subordinate position—is the essential depressogenic attribute of

events.

12

Another perspective, influenced

by

animal

studies,

12-14

is that helpless entrapment is the key

feature

of

depressogenic

experiences.

Another central question in life event research is the diagnostic specificity of events, as SLEs also precede

episodes of anxiety disorders,

15-17

alcoholism,

18

bulimia,

19

and schizophrenia.

20

Most studies,

15, 21-22

however, have examined whether SLEs are divisible into categories of depressogenic vs anxiogenic.

Building on previous methodological developments, Brown and colleagues

13

(G. W. Brown, PhD,

unpublished manual, Guidelines, Examples and LEDS-2 Notes on Rating for a New Classification Scheme

for Humiliation, Loss, and Danger, 1996) proposed a more refined system for rating 4 dimensions of

SLEs: loss, humiliation, entrapment, and danger (Table 1). To date, only 2 studies samples of women—have used this system.

13, 23

  • both with small

View this table: [in this window] [in a new window]

Table 1. Brief Definitions of Stressful Life Event Categories*

Several previous studies have examined sex differences in sensitivity to the depressogenic effects of

standard SLEs.

24

Most studies

25-28

have reported an increase in sensitivity among women that is either

global or restricted to certain events usually involving either interpersonal relations or family. However,

analysis of the Epidemiologic Catchment Area study data found greater male sensitivity to the

depressogenic effects of marital disruption, a stronger depressogenic effect of divorce or 29

and, examining standard separation in men.

event

categories,

our

group

30

found

In this study, we examine, in 7322 male and female twins from a population-based register, SLEs blindly rated using the 4-dimension system and the onsets in the past year of (1) pure MD episodes, (2) pure episodes of a brief generalized anxiety disorder (GAD) syndrome we call generalized anxiety syndrome (GAS), and (3) mixed MD-GAS episodes. We examine these 2 disorders in part because results of twin s t u d i e s s u g g e s t t h a t t h e g e n e t i c f a c t o r s t h a t i n f l u e n c e l i a b i l i t y t o M D a n d G A D a r e s o c l o s e l y r e l a t e d that it is environmental risk factors that determine whether a vulnerable individual develops one or the - 3 1 3 4

other or both of these syndromes.

Using these more refined event ratings, we seek to (1) define the features of SLEs that predispose to pure MD, pure GAS, and mixed MD-GAS episodes and (2) determine whether men and women differ in the depressogenic and anxiogenic effects of these event dimensions and categories.

METHODS

SAMPLE

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