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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

effects of SLEs on depressive and anxiety conditions are not fully captured by a single severity dimension.

Second, in addition to loss, humiliation events were strongly linked to risk of depressive episodes. Indeed, the most potent depressogenic events combined elements of both dimensions. Environmental experiences that involve loss of status and

elicit "psychobiological programmes of defeat and submission" involving solely loss.


are more depressogenic than those

Third, we found moderate specificity for the prediction of pure MD vs pure GAS episodes. Using event dimensions, humiliation predicted onsets of pure MD but not pure GAS episodes, and danger predicted pure GAS but not pure MD episodes. Loss was not specific. However, using event categories, death and respondent-initiated separation were specific for pure depressive episodes. These results are consistent

with findings


from twin modeling that suggest that the correlation in environmental risk factors for

MD and GAD is positive but only moderate in magnitude.

Fourth, the event dimensions that preceded mixed depressive/anxiety episodes were approximately the sum of those that preceded pure MD (loss and humiliation) and pure GAS (danger). The exception to this pattern was the significant association of high levels of entrapment to onsets of mixed episodes.

Fifth, although the effects of loss and humiliation on risk of episode onset were restricted to the month

of event occurrence, the impact of danger (and perhaps entrapment) on risk of illness was more prolonged.


Five limitations are noteworthy. First, because our sample consisted entirely of white twins from Virginia, these findings may not extrapolate to other ethnic groups or geographic regions. Second, our analyses assumed that when SLEs occurred in the same month as depressive onsets, the relationship between these 2 was causal. In another section of our interview, we inquired of twins with depressive onsets in the

past year whether anything happened to precipitate their episodes. Using data from the first 2 waves of

our study,


we examined interviews from 96 twins who reported a severe SLE and a depressive onset in

the same month. In 84% of them, the twin responded with the same previously reported SLE. In another

11%, they reported a different SLE that had also co-occurred in the same month in an understandable

sequence of events including the severe SLE. We replicated these results for a later wave, review of 102 similar cases revealed none in which the depressive onset plausibly caused


in which a

the SLE. Although our data are retrospective (over the recall interval of up to 1 year), our analyses support the assumption of a largely causal relationship between the SLE and the onset of MD when they

t occur in the same month. Furthermore, analyses based on a co-twin control design h e S L E - M D r e l a t i o n s h i p i s a c a u s a l o n e . T h i r d , u n l i k e t h e m e t h o d s o f B r o w n e t a l 9 13 suggest that most for rating event


dimensions and categories by with high interrater reliability.

committee, they were, in our study, performed by a small team of editors Given our sample size, rating each SLE by committee would have been

unfeasible. Fourth, our diagnostic category of GAS was was that required for GAD when it was first proposed. unconventional—although the minimum duration We kept differences between GAS and MD to the 48

level of symptoms, thereby not confounding analysis using a 1-month minimum duration modest changes.

our analyses with differences in f o r G A S a s r e q u i r e d i n D S M - I I I 4 9 duration. We repeated —and found only



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Corresponding author and reprints: Kenneth S. Kendler, MD, Department of Psychiatry, PO Box 980126, Richmond, VA 23298-0126.

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