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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

interviewer rated on the level of long-term contextual threat,

previously shown to have an interrater

and test-retest reliability (by weighted


) of 0.41 and 0.69, respectively.


We define high-threat events

as those with a long-term contextual threat score of 3 (high moderate) or 4 (severe).

Coding of Event Dimensions and Categories

All high-threat SLEs were selected for additional nonmutually exclusive ratings of loss, humiliation,

entrapment, and danger by using an adaptation of the measures developed by Brown et al.



audiotapes were reviewed by a team of 1 senior and 2 experienced editors trained according to rating

guidelines (G. W. Brown, PhD, unpublished manual, Guidelines,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). No team member was assigned to rate items in interviews from both individuals in a twin pair. Weekly review were held to maintain rating proficiency, and blind cross-ratings of event items by different interviewers were conducted.


Levels of loss, humiliation, entrapment, and danger were rated contextually using a 5-point scale (0 indicates none present; 1, minor; 2, low moderate; 3, high moderate; and 4, severe) taking into account descriptive information provided in the interview itself, the narrative summary, and the tape-recorded interview. Reports of emotional reactions were ignored. Raters remained blind to the association of rated events with onsets of MD or GAS. Brief definitions of the event dimensions are as f o l l o w s : 1 3

Loss. Diminution of a sense of connectedness or well-being potentially covering every aspect of life, including a real or realistically imagined loss of a person, material possessions, health, respect in the community, employment, or a cherished idea about self or a close tie. Humiliation. Feeling devalued in relation to others or to a core sense of self, usually with an element of rejection or a sense of role failure. Entrapment. Ongoing circumstances of marked difficulty of at least 6 months' duration that the individual can reasonably expect to persist or get worse, with little or no possibility that a resolution can be achieved as a result of anything that might reasonably be done. Danger. The level of potential future loss, including the chance that a given traumatic event will recur or reflecting a possible sequence of circumstances in which the full threat or dire outcome has yet to be realized.

We rated all 4 dimensions on each high-threat event (differing thereby from Brown et



who rated humiliation and entrapment conditional on high ratings of loss and danger). In addition to

scoring these dimensions, we scored 1 of 3 hierarchically specific entrapment and 1 of 4 categories for loss (Table 1).



humiliation and

Interrater reliability of the dimensions was assessed blindly by pairs of raters examining 348 individual

events with the following weighted

estimates (and 95% confidence intervals [CIs]): loss, 0.77 (0.72-

0.83); humiliation, 0.87 (0.84-0.91); entrapment, 0.92 (0.87-0.96); and danger, 0.79 (0.75-0.83). When

both raters agreed on a nonzero dimension score, the weighted

estimates (and 95% CIs) for the

categories were as follows: loss, 0.91 (0.87-0.95) (n = 348); humiliation, 0.99 (0.97-1.00) (n = 107); and entrapment, 0.92 (0.81-1.00) (n = 47).


To model an underlying continuous-time process with data grouped into person-months, discrete-time




carried out in SAS PROC GENMOD


using a complementary log-log link function.


Advantages of this approach compared with the logit link are that the model is invariant to intervals of



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