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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

event occurrence and, more strongly, 3 months later.

SLE Categories

In addition to rating dimensions of high-threat events, event categories were available for loss, humiliation, and entrapment. A unique pattern of associations was seen among the 3 categories of loss and the 3 types of episodes. Pure MD was significantly associated with death, respondent-initiated separation, and other key loss. Mixed depression/anxiety episodes were significantly associated with death and other key loss. Pure GAS was only significantly predicted by other key loss.

In contrast, the patterns of findings for the event categories of humiliation were identical for the pure depressive and mixed depression/anxiety episodes: significant associations with other-initiated separation and put down. The entrapment categories were examined only for the mixed episodes, in which a significant association was seen only with long-term sustained entrapment.

The most refined analysis we performed was an examination of the risk for depressive onsets (pure and mixed) as a function of ratings of high-threat events on categories of loss and humiliation. By far, the highest risk was seen for events scored as the loss category of other key loss and the humiliation category of other-initiated separation. The probability of a depressive onset associated with this kind of event was more than twice as great as that seen with pure loss associated with death or respondent-

initiated separation.

Previous Literature

Both previous studies

13, 23

that used these event ratings examined only depressive onsets and only in

women. Like us, Brown et al


found that the highest risk of depression was associated with

combined humiliation and loss events, whereas danger ratings were at most weakly associated with

onsets. Unlike us, however, they found that entrapment events were strongly predictive of risk for MD

and that death was more strongly associated with depressive onsets than was respondent-initiated

separation. Broadhead and Abas


found that with high-threat events, the rates of depressive onset were

highest after the combined categories of humiliation or entrapment, next highest with loss due to death,

next with other forms of loss, and lowest after danger events. Given the differences between these

studies and ours in sample composition, assessment methods, and diagnostic outcomes, the similarity of results is reassuring.

Previous studies, using a variety of samples and methods, have attempted to distinguish anxiogenic and

depressogenic features of SLEs. Results have ranged from no evidence of specificity


to moderate


16, 22, 46

to high levels of event specificity.


One study


examined SLEs before mixed

depression/anxiety episodes and found that they were significantly more frequently preceded by severe loss and danger events than were pure depressive or pure anxiety syndromes.


Using relatively refined SLE dimensions, we did not uncover any significant differences in sensitivity to the depressogenic or anxiogenic effects of SLEs in men and women. We were, therefore, unable to contribute to an understanding of the well-documented sex differences in the prevalence of depressive and anxiety disorders. 47


We highlight 5 results. First, beginning with high contextual threat events, themselves strongly related to risk of MD and/or GAS, we detected event characteristics that further predicted onsets. The pathogenic



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