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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

1.51) and humiliation (HR, 1.43) but not for entrapment (HR, 1.12) or danger (HR, 1.04) (Table 2). We then ran a model containing the 2 strong predictors, and both remained significant (loss: HR, 1.37; 95% CI, 1.16-1.63; and humiliation: HR, 1.31; 95% CI, 1.13-1.52; P<.001 for both), indicating that each dimension made an independent contribution to the prediction of mixed depression/anxiety onsets. Next, we examined the impact of event dimensions on risk of a mixed episode onset 1, 2, and 3 months after the event occurrence (Table 2). One month after event occurrence, ratings of entrapment (HR, 1.33) and danger (HR, 1.48) significantly predicted onset.


The baseline risk per month for a pure GAS episode was 0.7%. In the month of occurrence, high-threat events were significantly associated with the onset of a pure anxiety episode (HR, 4.5; 95% CI, 3.6-5.6; P<.001). In months containing high-threat events, the risk for an onset of a pure GAS episode was significantly increased by high ratings for loss (HR, 1.35) and danger (HR, 1.18) but not for humiliation (HR, 1.01) or entrapment (HR, 0.98). We then ran a model containing the 2 significant predictors. Loss remained significant (HR, 1.34; 95% CI, 1.12-1.61; P = .001), and danger fell below traditional levels of statistical significance (HR, 1.16; 95% CI, 0.99-1.36; P = .07). Next, we examined the impact of event dimensions on risk of a pure GAS episode onset 1, 2, and 3 months after the event

occurrence (Table 2). The only significant finding was an impact of danger ratings 3 months after event occurrence (HR, 1.50).


We examined the categories of loss, humiliation, and entrapment for all analyses in which that SLE dimension significantly predicted onsets (Table 3). Compared with SLEs with the category of lesser loss, the specific categories of loss, in the month of event occurrence, carried substantially increased risk for onset of pure MD: death (HR, 2.99), respondent-initiated separation (HR, 3.18), and other key loss (HR, 2.58). Compared with high-threat events with no evidence of humiliation, the risk of a pure depressive onset in the month of event occurrence was substantially increased for those with other- initiated separation (HR, 3.09), with a weaker but still significant effect seen for put down (HR, 1.73).

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Table 3. Prediction of Onset of 3 Disorders as a Function of Event Category Within the Month of Occurrence of High-Threat Events

For mixed depression/anxiety episodes, the pattern of results was similar to that seen for pure MD for the categories of loss and humiliation in the month of event occurrence (Table 3). The only substantial difference was that with mixed episodes, respondent-initiated separation no longer significantly predicted onset. Compared with SLEs with no entrapment rating, mixed depression/

anxiety episodes were significantly predicted by long-term sustained entrapment 1 month after event occurrence.

Pure GAS episodes were significantly predicted, in the month of event occurrence, only by other key loss and not by the 2 other categories of loss (death and respondent-initiated separation).

Given the strong and similar predictive roles for loss and humiliation in the month of event occurrence for pure MD and mixed depression/anxiety episodes, we explored the risk for both syndromes collapsed together as a function of the categorizations of both loss and humiliation (Table 4). This examination is limited by the strong interdependencies of these 2 ratings. As expected, all



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