Life events, psychiatric disorder and physical illness

Abstract

Investigator- and respondent-based approaches to measurement are outlined and the limitations of the latter for life-event research are discussed in terms of inaccuracy and bias. An investigator-based approach has much greater potential for accuracy. Furthermore, its greater flexibility allows methods of meeting possible bias in reporting and rating which are largely ruled out by respondent-based measures. The failure of recent prospective studies, using respondent-based instruments, to show an association between life events and onset of various kinds of disorder are discussed in these terms; and also in terms of the assumption built into the Holmes-Rahe instrument that the influence of life events is additive. The second part of the paper discusses some of the aetiological models which have been developed with the use of investigator-based measures. It goes on to deal with the requirements of future research and the role that prospective research can be expected to play. It is argued that the latter are of limited relevance to the study of life events as such; here it is more important to develop instruments capable of accuracy, sensitivity and that have some control over possible bias in reporting and rating. However, prospective designs are likely to play a major role in the study of background protective factors such as amount and type of social support.