Experience Of Adverse Life Events Research Articles

Exposure to violence, adverse life events and the mental health of adolescent girls in Nairobi slums

IntroductionMental health problems rank among the leading causes of disability among young people globally. Young people growing up in urban slums are exposed to adverse childhood experiences, violence, and other adversities. There is limited research on how exposure to violence and adverse life events influence adolescents’ mental health in urban poor settings. This study examines the associations between exposure to violence, adverse life events and self-reported depression in the slums of Nairobi.MethodsThis study draws on data collected from 2106 adolescent girls aged 12–19 years who were interviewed in the third wave of the Adolescent Girls Initiative Kenya (AGI-K). Mental health was measured using the Patient Health Questionnaire (PHQ 9). Frequency distributions, bivariate chi-squared analysis and multi-variate regression models were computed to identify factors that are independently associated with depression.ResultsAbout 13.3% of girls had symptoms of depression based on PHQ 9, 22% reported physical or sexual violence in the past year and about 47% of girls reported exposure to adverse life events in the family in the past year. After adjusting for the effects of socio-demographic factors, exposure to physical violence (AOR = 2.926, 95% CI 2.175–3.936), sexual violence (AOR = 2.519, 95% CI 1.637–3.875), perception of neighborhood safety (AOR = 1.533, 95% CI 1.159–2.028) and experience of adverse life events (AOR = 1.326, 95% CI 1.002–1.753) were significantly associated with self-reported depression. The presence of social support moderated the relationship between violence and mental health by reducing the strength of the association between violence and mental health in this setting.ConclusionGiven the magnitude of violence victimisation, adverse life events and depressive symptoms, there is a need to design interventions that reduce exposure to violence and provide psychosocial support to adolescents exposed to adverse events in urban slums in Nairobi.

The Bittersweet Effects of COVID-19 on Mental Health: Results of an Online Survey among a Sample of the Dutch Population Five Weeks after Relaxation of Lockdown Restrictions.

Previous research shows that crises can have both negative and positive mental health effects on the population. The current study explored these effects in the context of the COVID-19 pandemic after relaxation of governmental measures. An online survey was administered among a representative sample of the Dutch population (n = 1519) in June 2020, ten weeks after the peak of COVID-19 had passed, and five weeks after restrictions were relaxed. Participants were asked about mental health, adverse events during COVID-19, and about any positive effects of the pandemic. Most participants (80%, n = 1207) reported no change in mental health since the COVID-19 pandemic. This was also the case among respondents who had experienced an adverse event. Protective factors of mental health were being male and high levels of positive mental well-being. Risk factors were emotional loneliness and the experience of adverse life events. Social loneliness was positively associated with stable mental health, stressing the importance of meaningful relationships. Note that 58% of participants reported positive effects of the pandemic, the most common of which were rest, working from home, and feeling more socially connected. In summary, 10 weeks after the start of the crisis, and 5 weeks after relaxation of the restrictions, most people remained stable during the crisis, and were even able to report positive effects.

DRD4 interacts with adverse life events in predicting maternal sensitivity via emotion regulation.

We examined whether and how the dopamine receptor D4 (DRD4) interacts with adverse life events to predict maternal sensitivity directly and indirectly via emotion regulation. The sample included 209 (106 European American, 103 African American) mothers and their children (52% female). Sensitive maternal behavior was rated and aggregated across five stress-free and stress-inducing tasks when children were about 2 years old, when mothers also retrospectively reported on their adverse life experiences and transitions throughout childhood from birth to age 20. When children were about 1 year old, mothers reported on their difficulties with emotion regulation. Results from path analysis indicated that mothers who carried the long allele of DRD4 and experienced more adverse life events were less sensitive in interactions with their children. These mothers were also more likely to have difficulties with emotion regulation, which in turn predicted lower maternal sensitivity. These effects were significant above and beyond the effects of maternal education, coherence of mind, race, or infants' DRD4 genotype, and did not vary for African American and European American mothers. Results suggest that genetic predispositions modify the effects of maternal experience of adverse life events on maternal sensitivity and that emotion regulation serves as one mechanism by which genetic factors and gene-environment interactions affect maternal behavior. (PsycINFO Database Record

Childhood abuse and psychotic experiences - evidence for mediation by adulthood adverse life events.

We have previously reported an association between childhood abuse and psychotic experiences (PEs) in survey data from South East London. Childhood abuse is related to subsequent adulthood adversity, which could form one pathway to PEs. We aimed to investigate evidence of mediation of the association between childhood abuse and PEs by adverse life events. Data were analysed from the South East London Community Health Study (SELCoH, n = 1698). Estimates of the total effects on PEs of any physical or sexual abuse while growing up were partitioned into direct (i.e. unmediated) and indirect (total and specific) effects, mediated via violent and non-violent life events. There was strong statistical evidence for direct (OR 1.58, 95% CI: 1.19-2.1) and indirect (OR 1.51, 95% CI: 1.32-1.72) effects of childhood abuse on PEs after adjustment for potential confounders, indicating partial mediation of this effect via violent and non-violent life events. An estimated 47% of the total effect of abuse on PEs was mediated via adulthood adverse life events, of which violent life events made up 33% and non-violent life events the remaining 14%. The association between childhood abuse and PEs is partly mediated through the experience of adverse life events in adulthood. There is some evidence that a larger proportion of this effect was mediated through violent life events than non-violent life events.

Patient Characteristics, Length of Stay, and Functional Improvement for Schizophrenia Spectrum Disorders: A Population Study of Inpatient Care in Ontario 2005 to 2015.

Schizophrenia and associated illnesses account for a large proportion of mental illness burden and health care expenditures, with the majority of expense involving inpatient care. To date, the literature exploring factors associated with length of stay (LOS) and functional improvement during inpatient care is underdeveloped. In response, this study examined the association between patient characteristics, LOS, and functional improvement using Ontario Mental Health Reporting System (OMHRS) data from 2005 to 2015. The associations of patient characteristics (including key demographics, psychosocial variables, reasons for admission, and service use history) and 2 outcome measures (LOS and Global Assessment of Functioning [GAF]) were analysed with generalised linear mixed modelling (GLMM). From 2005 to 2015, a total of 48,498 episodes for distinct patients from 18 psychiatric hospitals and 57 general hospitals in Ontario were included. For psychiatric and general hospitals, mean LOS was 96.6 and 20.5 days, and mean GAF improvement was 14.8 and 16.1, respectively. The majority of associations probed demonstrated a high degree of significance with similar patterns across general and tertiary facility contexts. Older age and more recent readmission following a psychiatric discharge were associated with longer LOS and less GAF improvement. Recent experience of adverse life events and substance misuse were associated with shorter LOS. While the findings of this exploratory cross-sectional analysis will require further inquiry with respect to validity and reliability, they suggest that a different service pathway is likely required for individuals with greater psychosocial challenge and extensive service use histories.

Wisdom and Hard Times: The Ameliorating Effect of Wisdom on the Negative Association Between Adverse Life Events and Well-Being.

Old age is characterized by many physical and social losses that adversely affect subjective well-being (SWB). Yet, past studies have shown that wisdom tends to be positively related to SWB in old age, particularly under adverse circumstances. We tested whether three-dimensional wisdom, measured as a combination of cognitive, reflective, and compassionate (affective) personality qualities, moderated the inverse association between adverse life events and well-being. A sample of 994 adults aged 51-99 years (M = 77) from the Successful AGing Evaluation (SAGE) study and structural equation models with well-being as a latent variable were used to test the hypothesis. Greater wisdom, in particular the reflective wisdom dimension, was positively associated with SWB and buffered the inverse relation between the experience of adverse life events during the previous year and current well-being. Wisdom appears to strengthen older adults' ability to cope with aging-related losses and, therefore, is a valuable psychological resource in old age.

The Lancaster and Northgate Trauma Scales (LANTS): The development and psychometric properties of a measure of trauma for people with mild to moderate intellectual disabilities

People with intellectual disabilities are exposed to a high number of adverse life events, and evidence supports a link between the experience of adverse life events and trauma. Interventions for trauma have been found to be efficacious if case recognition can be facilitated. However to date there are no psychometrically validated measures of trauma for people with intellectual disabilities. This study describes the development of the Lancaster and Northgate Trauma Scales (LANTS), which comprise a self-report and an informant measure of the effects of traumatic life events on people with intellectual disabilities. The pool of items for the measures was created via a systematic review, and consultation with key stakeholders. 99 service users and 88 staff completed the LANTS measures during a pilot. The 29-item self-report LANTS and the 43-item informant LANTS were found to have good psychometric properties, including internal and test retest reliability, plus convergent and construct validity. The findings suggest the LANTS are promising trauma screening tools for use in clinical and research settings.

Determinants of burden in those who care for someone with dementia

Caregiver burden is a key measure in caregiver research and is frequently used as a baseline measure in intervention studies. Previous research has found numerous factors associated with caregiver burden such as the relationship quality between carer and patient, the patient's cognitive ability, behavioural and psychological symptoms displayed by the patient, caregiver gender, adverse life events to name a few. Many studies have investigated these factors singularly however current thought suggests a multi-factorial role and inter-dependence of these factors. Based on this it was decided to investigate factors associated with caregiver burden using a multiple regression analysis in order to ascertain the predictive quality of these factors of caregiver burden. Cross-sectional study using validated measures of a patient's cognitive ability, ability to carry out day-to-day tasks and behavioural and psychological symptoms. Caregiver outcomes used are caregiver burden, relationship quality, caregiver confidence, experience of adverse life events, neuroticism, age and gender. Interviews and questionnaires were carried out on 74 patients diagnosed with dementia and their main caregivers from the Midlands of England. Multiple regression analysis showed that caregiver overload, carer-patient relationship quality, the experience of adverse life events, caregiver gender, caregivers' level of neuroticism, caregiver role captivity and the level of caregiver confidence accounted for over 80% of the variance in caregiver burden. These results confirm previous correlational research on caregiver burden. Furthermore, due to the use of multiple regression analysis the findings also show factors that are clear predictors of caregiver burden and we offer possible suggestions from these findings on future clinical practice interventions on caregiver burden.

No ecological effect modification of the association between negative life experiences and later psychopathology in adolescence: A longitudinal community study in adolescents

Background The aim of the study was to examine the potential contribution of exposure to bullying and adverse life events to the development of psychopathology in adolescents, and possible effect modification by neighbourhood social capital. Methods Two waves of routine, longitudinal, standard health examinations at local community paediatric health services, pertaining to 749 adolescents living in Maastricht (The Netherlands) who were attending second grade of secondary school (age 13/14 years) and approximately 2 years later going to the fourth grade (age 15/16 years), were analysed. A self-report questionnaire was used, including measures of psychopathology and two measures of negative life experiences, exposure to bullying and adverse life events, that were available for both age groups and subjected to (multilevel) regression analysis. Results Exposure to bullying in the past school-year as well as the experience of adverse life events over a 12 month period, at the age of 13/14 years, predicted an increase in psychopathology at follow-up. Exposure to bullying was associated with the development of hyperactivity and emotional problems, while the experience of adverse life events predicted the development of conduct problems. Family-related adverse events had greatest effect sizes. Effects of bullying and adverse life events were not moderated by neighbourhood social capital. Conclusion Negative life experiences impact on liability to psychopathology in adolescents independent of the wider social environment.

Dissociation: Cognitive Capacity or Dysfunction?

SUMMARY Dissociative experiences are mostly studied as a risk factor for dissociative pathology. Nonpathological dissociation is quite common in the general population, however, and may reflect a constitutionally determined cognitive style rather than a pathological trait acquired through the experience of adverse life events. In a theoretical model, we propose that nonpathological dissociation is characterized by high levels of elaboration learning and reconstructive retrieval, for which enhanced levels of attentional and working memory abilities are a prerequisite. These characteristics, in general, seem to be representative for a higher ability to (re-)construct conscious experiences. We review some of our behavioral as well as neural (i.e., fMRI, ERPs) studies, suggesting that high dissociative individuals are characterized by heightened levels of attention, working memory and episodic memory. In nonpathological conditions a person may benefit from these dissociative abilities, although after adverse (e.g., traumatic) events the disposition may develop into dissociative pathology.

Sylvia Plath and the depression continuum.

Sylvia Plath, a gifted young poet, died by her own hand in London forty years ago. Subsequently a friend and fellow-poet, Al Alvarez, included a personal account of her final illness, as well as of his own unconnected suicidal attempt, in The Savage God: a Study of Suicide. 1 A review in the British Journal of Psychiatry by Eliot Slater, at that time its editor, concluded that Alvarez had failed to grasp the essential difference between his own depression and hers: ‘His own experience’, he wrote, ‘so similar as he must think, does not help him to understand the act of Sylvia Plath; he is cut off by the gulf that separates the reactive from the endogenous depression, alike in appearance but different in kind. Sylvia Plath was a manic-depressive. ’2 How well do these comments stand up today? Leave aside the fact that the two suicidal acts were not so different in terms purely of dangerousness, and that in each instance chance played some part in deciding on survival or death. The question remains of interest because it throws light on changing trends in the nosology and classification of psychiatric disorders, as well as on the psychology of a writer who since her untimely death has acquired iconic status both for the feminist movement and for a new literary generation. Dr Slater's appraisal was based on a binary model of affective illness, in which the terms endogenous and reactive—or alternatively psychotic and neurotic—were used to denote two contrasting syndromes: the one consisting of recurrent severe disorders of mood (depressive and/or manic), apparently spontaneous in onset, the depressive phase being accompanied by psychomotor retardation, feelings of guilt and unworthiness, early-morning waking and somatic changes; the other presenting as milder, often intermittent depression mingled with anxiety, triggered by adverse life events, marked by irritability and self-concern rather than guilt and by subjective complaints rather than objective bodily disorder. 3 If one accepts this model, there is undoubtedly a strong case for allocating Sylvia to the former group. It was given support by John Horder, the respected London general practitioner (GP) who treated her in her last illness and who later wrote: ‘I believe, indeed it was repeatedly obvious to me, that she was deeply depressed, “ill”, “out of her mind”, and that any explanations of a psychological sort are inadequate... ’. 4 In the intervening decades, however, the underlying assumptions of this model have been seriously challenged. To begin with, belief in a natural boundary or discontinuity between the main types of depression has been weakened by repeated failure to confirm a bimodal distribution, or to demonstrate any point of rarity between the subgroups, when the clinical features of unselected case series are submitted to discriminant function analysis. 5,6 Secondly, there has been a corresponding failure to demonstrate clear-cut differences in the frequency of provoking stresses. Brown and his co-workers, 7 on the basis of detailed standardized assessments, found that depressed patients diagnosed as psychotic and neurotic, respectively, did not differ in experience of adverse life events over the months before illness onset. Indeed, age and experience of ‘past loss’ were the only personal characteristics that distinguished between them. When patients with and without a history of preceding severe life events were compared, only a slight tendency was found for the latter group to have more psychotic features. Thirdly, US workers, bringing together evidence from various research fields, concluded that depressive illness represents the final common pathway of several different pathogenetic processes focused on the diencephalon, and is essentially the same whether the processes in question are biochemically, experientially or behaviourally triggered. 8 These various findings, whose influence on psychiatric thinking became apparent when the standard classifications were last revised (see later), do not imply that individual cases cannot be characterized as typically endogenous or typically reactive. They do, however, suggest that the distribution as a whole corresponds to a dimensional rather than a categorical model, in which such pure-culture cases represent the extremes on a continuum and are likely to be greatly outnumbered by others presenting intermediate or mixed clinical pictures. Sylvia Plath's illness can be placed roughly on this continuum because information now in the public domain, including her posthumously published journals9 and letters home, 10 a semi-autobiographical novel, 11 the memoirs of family and friends, a well-researched, sensitive biography12 (one of several) and a life of her husband, 13 together provide material for a reconstruction of the case history.

Ward-Level Deprivation and Individual Social and Economic Outcomes in the British Household Panel Study

This paper is an investigation of the association between the level of social deprivation in electoral wards and various aspects of individuals' lives using data from the British Household Panel Study 1991 to 1998 and the 1991 Census. The main finding is to establish that ecological associations of various indicators of individual adversity with a census-based indicator of area deprivation are largely, if not entirely, accounted for by individual and household characteristics. For some outcomes there is evidence that social and economic inequalities between more and less disadvantaged individuals are especially marked in more affluent areas, rather than in more deprived areas. This emerges in the form of significant interactions between residence in social housing and ward deprivation in models allowing such interdependence. At the same time, there is evidence of variation in the experience of adverse life events between wards not accounted for by individual and household factors and area deprivation. It is concluded that, although individual characteristics are very important for the differences in social and economic outcomes observed between people, their geographical setting also has some significance. The results have implications for policies aiming to reduce social and economic inequalities

Suicide following psychiatric hospitalization.

The hypothesis was tested that following psychiatric hospitalization, those subjects who subsequently completed suicide would be distinguished from those who did not by the interaction of two circumstances: a state of defenselessness at the time of hospitalization, and experience of adverse life events following release from hospital. Subjects were 40 male VA psychiatric inpatients: 20 who completed suicide following release, and 20 controls matched on age, race, and time at risk in the community. Defenselessness (the incapacity to defend against distressful negative self-feelings) was defined in terms of scores derived from the extended Brief Psychiatric Rating Scale administered shortly after the patient's hospitalization. Adverse life events were eight events characterized simultaneously as undesirable, unlikely to have been initiated by the subject, and having a score of 30 or above on the Social Readjustment Rating Scale. In confirmation of the hypothesis, it was found that completed suicide subjects were significantly and appreciably more likely both to have had high defenselessness scores at the time of hospitalization and to have experienced adverse life events during the posthospitalization period, whereas neither circumstance in the absence of the other was predictive. The findings support the position that suicide is a response to experiences with self-threatening implications, in the face of personal incapacity to defend against, adapt to, or cope with such experiences.