Life Change Units Research Articles

2. Phenomenology

We worked on characterizing suicide attempts in patients with schizophrenia in comparison with mood disorders. This study population comprised 260 patients with F2 disorders (ICD-10), i.e., “schizophrenic group” and 705 patients with F3 disorders, i.e., “depressive group” who presented at the psychiatric emergency department of our hospital for 8 years. They were compared in three age groups: young (≤ 24 years), middle-aged (25–44 years), and elderly (≥ 45 years). Multivariate logistic regression analysis identified factors associated with the seriousness of the suicide attempt method. The schizophrenic group (≥ 25 years) had a younger mean age and higher prevalences of “within-1-year suicide attempts” and “past suicide attempts” than the depressive group. The Schizophrenic group tended to use serious methods, such as “jumping from high places,” “throwing oneself in front of an oncoming train,” and “burning oneself,” in their suicide attempts, with “hallucination–delusion” accounting for an overwhelmingly large percentage of suicide attempt motives, irrespective of the age group. In the elderly group, the ratio of “no-housemate” patients was high. In all age groups, jobless individuals were prevalent, and the schizophrenic group had lower LCU (Life Change Unit) scores than did the depressive group. The middle-aged cases of schizophrenic group had higher BPRS (Brief Psychiatric Rating Scale) scores and lower GAS (Global Assessment Scale) scores. Regarding factors influencing the seriousness of the methods, a history of within-1-year suicide attempts increased the method seriousness in the schizophrenic group. Years of education correlated with the method seriousness in the schizophrenic group. Low scores of overall health on the GAS increased the method seriousness in both groups.

LIFE EVENTS AND PSYCHOLOGICAL WELL-BEING IN WOMEN SENTENCED TO PRISON

There have been no systematic analyses of the factors that influence the development of psychological well-being in women sentenced to prison. This study identified relationships among life events, coping resources, and psychological well-being (indicated by the absence of anxiety and depression). A descriptive correlational design was used in a convenience sample of 62 incarcerated female offenders. The respondents were in their early 30s, single, unemployed, and receiving financial support from a variety of sources. They reported an average of 10 life events in the 12 months preceding incarceration and accumulated an average of 354 life change units. A positive correlation between the number of life events and depression was identified (r =. 24, p <. 05). The women in this study had high levels of depression as measured by the Center for Epidemiologic Studies Depression Scale (L. Radloff, 1977; M = 31) and anxiety as measured by the State-Trait Anxiety Inventory (C. D. Spielberger, 1983; M = 46). Nursing interventions to reduce psychological distress at the time of admission to a correctional facility may reduce of loss, inadequacy, and powerlessness that the might otherwise have to endure.

A Life Stress Instrument for Classroom Use

Most introductory psychology textbooks describe Holmes and Rake's Social Readjustment Rating Scale (SRRS; 1967) instrument, which generates stress scores as life change units. Although students seem willing to entertain the possibility that stressors can affect their health, the SRRS does not include many common events that act as stressors for college students and includes many items not meaningful to most college students. This article describes an instrument intended for use in classroom demonstrations, the College Undergraduate Stress Scale (CUSS), and reports a local set of norms for a population of traditional-age college students. The CUSS is useful in teaching concepts within health psychology that are associated with stress and its cumulative effects.

The life change inventory and the MMPI depression subscale in predicting failure in the compulsory conscript service

This study was performed to examine how two different inventories can predict failure in the compulsory conscript service. The study was organized in the Turku Coastal Regiment in Finland during 1991–92. All 693 recruits who came to do their military service during 1 year took part in the study. We used a 35-item short form of the Life Change Inventory (La) and a 22-item subscale of the Minnesota Multiphasic Personality Inventory depression scale (MMPI). Each life change event was assigned a numerical value ranging from 11 to 65 Life Change Units (LCU). A large number of LCUs and positive answers in the MMPI were statistically significantly associated with failure in the military service. Furthermore, both inventories included many questions that were significantly associated with exemptions from military service. When the study population was divided into 5 different risk groups, the probability of failure in military service was 45 times higher in the highest risk group than it was in the lowest risk group. Accordingly, it is possible to form different risk groups by using these two inventories, with the failure risk in military service being at most 67%. The possibility of forming different risk groups provides better opportunities to make recommendations and offer increased support and counseling to an individual conscript. It also gives a clearer argument on which to base the decision to exempt a youth from military service in advance.

Personality and stress: An exploratory comparison of rheumatoid arthritis and osteoarthritis

Objective: To characterize and investigate the relationship between stress and personality in people with rheumatoid arthritis (RA) compared to those with osteoarthritis (OA). Design: Survey of personality characteristics determined by using Cattell's 16 Personality Factor (16PF) questionnaire and stressful life events at disease onset determined by using the Social Readjustment Rating Scale of Holmes and Rahe. Setting: Inpatients of an arthritis hospital and outpatients of a clinic, both of which specialize in rheumatic diseases and musculoskeletal problems. Participants: Diagnosed as “definite” or “classical” RA (N = 128) according to the ARA Diagnostic Criteria for Rheumatoid Arthritis (1958 Revision) or as OA (N = 79) according to radiological and clinical evidence; randomly selected, resulting in a close match for gender, age at disease onset, duration of disease, functional classification, and pattern of disease progress. All individuals approached participated. Interventions: None. Main Outcome Measures: Twenty personality characteristics, as well as amount of stressful life events at disease onset (Life Change Units). Results: The RA subjects had significantly ( p < .001) more stress at disease onset compared to the OA subjects. A subgroup of high-stress-at-onset RA subjects experienced a higher degree of disease severity ( p < .01) than did the RA subjects with no stress at onset. Although the mean personality scores for those with RA were not significantly different from those with OA, the RA personality frequency distributions were different. Some of these differences could be explained by the stress-at-onset subgroup personality characteristics. Conclusions: As a group, subjects with RA exhibited more stress at disease onset than those with OA. Although mean personality scores were not different between RA and OA subjects, they did exhibit different frequency distributions. There appeared to be a high-stress-at-onset subgroup of RA patients who had a worse disease prognosis and who corresponded to a personality frequency subgroup. The interaction between these variables is more complex than implied by the “RA personality” concept.

A longitudinal study of life events and metabolic control among youths with insulin-dependent diabetes mellitus.

In a study of school-age children with new-onset insulin-dependent diabetes mellitus (IDDM), life stress, metabolic control (glycosylated hemoglobin), and psychiatric and psychosocial variables were assessed repeatedly for up to 6 years. Life stress was defined as the number of undesirable life events and extent of life change necessitated by all life events. In univariate longitudinal analyses, total life change units were related to metabolic control, with a trend for number of undesirable events to be associated with metabolic control. In multivariate analyses, metabolic control was related to life change units, whether the glycosylated hemoglobin was in the 1st year of IDDM, IDDM duration, and the diagnosis of pervasive noncompliance with medical regimen. The relationship of life stress to metabolic control among youths with diabetes in significant but clinically modest and may be partially mediated by serious noncompliance with the medical regimen.

A longitudinal study of life events and metabolic control among youths with insulin-dependent diabetes mellitus.

In a study of school-age children with new-onset insulin-dependent diabetes mellitus (IDDM), life stress, metabolic control (glycosylated hemoglobin), and psychiatric and psychosocial variables were assessed repeatedly for up to 6 years. Life stress was defined as the number of undesirable life events and extent of life change necessitated by all life events. In univariate longitudinal analyses, total life change units were related to metabolic control, with a trend for number of undesirable events to be associated with metabolic control. In multivariate analyses, metabolic control was related to life change units, whether the glycosylated hemoglobin was in the 1st year of IDDM, IDDM duration, and the diagnosis of pervasive noncompliance with medical regimen. The relationship of life stress to metabolic control among youths with diabetes in significant but clinically modest and may be partially mediated by serious noncompliance with the medical regimen.

Life Changes and Protective Capacities in Enuretic and Non‐Enuretic Children

Life changes and protective factors of 156 enuretic and 170 non-enuretic 7-yr-old children were analysed using the multi-item Life Change Unit method and psychological examination. Of the single life events, divorce or separation were seen to increase the risk of enuresis. The weighted life change scores were significantly higher for the enuretics than for the controls at age levels of 3, 5 and 6 yrs. Secondary night-wetting was precipitated by increased life stress, but this was not the case with secondary day-wetting. Repression showed a predominance in enuretics. A strong ego was found to serve as a protective factor against enuresis under changing life conditions.

The role of stressful life events in the onset of chronic primary headache

This study investigated the relationship between stressful life events and the onset of chronic primary headache (CPH), using both normative group ratings and self-report ratings of the desirability and the perceived impact of stressful events. We hypothesized that CPH patients ( n = 63) would report significantly more stressful life events with negative impact on their life style in the year prior to headache onset compared with headache-free controls ( n = 44). The prediction was fully confirmed. CPH patients were exposed to a significant increase ( P < 0.001) in their final year life change unit (LCU) totals prior to headache onset as compared to the previous corresponding time interval and to headache-free controls. Furthermore, a highly significant peaking ( P < 0.001) of negative change scores, based on personal ratings of the distress concerning life events in the same time interval, was observed in the CPH group. In terms of event content, exits or losses were prominent in being perceived as stressful. Significant differences between headache subgroups (chronic tension-type headache, migraine, mixed headache and psychogenic headache) were not found, although mixed headache sufferers reported a higher incidence of interpersonal arguments and difficulties than migrainous patients. We conclude that a sudden increase in the frequency and magnitude of stressful life events, associated with a cognitive-emotional appraisal of their negative impact on life patterns, appears to herald the onset of headache, independently of the developing clinical headache syndrome.

Impact of stress on alcoholic liver injury; a histopathological study

Certain behaviors can have an influence on the cause and progression of liver disorders. To clarify the relation between histopathological change of the liver and psychosocial stress, behavioral traits, and psychological state, patients with fatty liver ( n = 14) were compared with patients with chronic hepatitis ( n = 16). Both groups were alcohol-induced without other causes and consumed the same dose of alcohol. By morphometric methods, fat deposit ratio (FDR) and degree of liver damage (DLD) which reflects lobular fibrosis, inflammatory cell infiltration, and necrosis were evaluated. Life Change Unit scores from the Social Readjustment Rating Scale were significantly higher in chronic hepatitis than in fatty liver ( p < 0.001). DLD was significantly correlated with Life Change Unit ( r = 0.59, p < 0.01). It is suggested that psychosocial stress is one of the aggravating factors of fibrosis and inflammatory change of the liver which is previously damaged by alcohol in man just like the rat liver following stress.

Life Change Units in Japanese Children

Life Change Units in Japanese Children

Measuring small life events.

The development of an inventory to assess small events is described. In the construction of the inventory specific criteria were established and existing event inventories were screened for items and new items written to fit these criteria. The event had to denote an observable change in a person's everyday life, have a discrete beginning, be classifiable as either desirable or undesirable, and be scaled as having an average of 250 Life Change Units or less using B. S. Dohrenwend, Krasnoff, Askenasy, Dohrenwend's (1978) magnitude estimation parameters. The inventory was constructed to cover events in major areas of life concern: family, work, leisure, household, financial, health/illness, nonfamily relations, crime/criminal activity, education, religion, and transportation. Two studies are reported that test the utility of the inventory.

The effect of recent life events stress, life assets, and temperament pattern on cardiovascular risk factors for Akron City police officers.

Police officers, as a group, experience many occupational demands with physiological and psychological effects that could be harmful to their health. A primary objective of this study was to analyze specific behavioral and physiological risk factors that could lead to hypertension and accelerated coronary artery disease. Three hundred thirty-one male Akron City police officers participated in the study. A group of volunteer males (n = 48) who worked in city clerical jobs were used as controls. Questionnaires were administered in order to measure such behavioral variables as recent life change, life assets, and temperament pattern. Blood chemistry and physiological variables were also measured. The police officers had higher diastolic blood pressure (DBP), norepinephrine (NE) levels, and recent life change unit (LCU) scores than the control group. Increased hostility and depression scores were associated with higher DBP and recent LCU scores and lower life asset unit (LAU) scores. Individuals with higher "dominant" scores and moderate to high recent LCU scores had higher cardiovascular risk factors than those with moderate to high recent LCU scores who were ranked as "subordinate." Rotating shift workers had abnormally elevated NE levels, which, if not controlled, may lead to higher cardiovascular risk. Behavioral intervention programs have been introduced with the goals of reducing stress, increasing life assets, and teaching relaxation techniques.

Life Events and Child Psychiatric Disorders

Parents of a sample of 272 children and adolescents admitted consecutively to a child psychiatric outpatient department responded to a questionnaire asking for prior life events. A subsample of 54 subjects was matched with a control group randomly collected from private pediatric practice. Scores based on the total number of life events and the number of undesirable life events and respective scores based on life change units were calculated. Compared to controls the child psychiatric group had higher scores with regard to number of total past life events and past undesirable life events. There were no significant differences as far as recent events were concerned. Life change units led to nothing more than a standard weight for each item. When life events scores were compared among various child psychiatric diagnoses no significant differences emerged. In comparison with a rating of psychosocial situation, the discriminative power of life-event scores with regard to the two main groups of conduct and emotional power was rather limited. We conclude that the effect of life events as measured by questionnaire techniques on child psychiatric disorder seems to be rather unspecific.

Problems encountered by the single working mother

Abstract Thomas Holmes and Richard Rahe, in their table of Life Change Units, list death of a spouse, divorce and marital separation as the most stressful life events to be encountered by an individual. They receive ratings of 100, 73 and 65, respectively. Any one of these life changes could trigger other life changes so that, in addition to coping with the problems of bereavement or a broken marriage, there are other life changes which could raise the total score. Holmes and his researchers found that once an individual ‘earns’ 200 or more points in a single year, there is at least a 50:50 chance of a fairly serious breakdown in health in the following year, If the score rises to 300 or more points in a year this risk factor is increased to 75-80%. In addition to the life changes involved in becoming a single parent there are high physical demands which are imposed by the dual responsibilities of running a home and managing a job and even the most resilient woman has to perform a very delicate balancing act to avoid becoming the victim of stress-related illness. This article looks at the Holmes and Rahe Rating Scale in relation to the emotional, behavioural and physiological reactions to stress. It offers advice, both to the individual involved and to the employer, on what positive steps can be taken to combat the effects of this particularly stressful lifestyle.

Stressful sequelae of disabling illness.

Fifty former rehabilitation patients completed the recent life changes questionnaire (RLCQ), an inventory of potentially stressful life events. Subjects indicated those that had occurred to them during the 6 months prior to onset of illness/injury and during the 6 months following hospital discharge. Certain RLCQ items have associated point values ("life change units" or LCU) indicative of the amount of stress induced by that event. The average number of LCU reported for the post-discharge period exceeded by 3 1/2 times the average for the pre-injury epoch. Ranges for both sets of values were substantial. Forty-five of the fifty-seven events were reported more frequently for the later period, while eight occurred slightly more often before the onset of illness or injury. These findings have implications for the genesis, frequency, magnitude and individual variability of depression following the onset of disabling illness.

Stressful life events associated with bulimia in anorexia nervosa. Empirical findings and theoretical speculations

The present study examines the relation of life event stress to the occurrence of bulimia in young anorexia nervosa patients. Life events recorded in the 18 months preceding symptomatic onset were analyzed in 25 anorexics with bulimia and a matched group of 25 anorexics characterized by strict dietary control (restricters). Scores were derived by summing life change unit values for events experienced during successive six-month time blocks and were subjected to repeated measures analysis of variance. Findings indicated that bulimics experienced significantly more life stress than restricters in each six-month period (all ps < .001) and experienced 21/2 times the magnitude of life stress observed in normal adolescents (Codding-ton, 1972) for a comparable time period. Results are discussed with respect to biological, psychological, and cognitive processes of possible relevance to the genesis of binge eating in anorexic patients. It is suggested that concepts drawn from developmental theory, attribution theory, and psycho-biology are relevant to our understanding of the genesis and maintenance of deranged eating patterns in bulimic anorexics.

Life Change Unit Rating Scale for College Students

Life Change Unit Rating Scale for College Students

Stress and Illness

Events on the Holmes and Rahe (1967) Schedule of Recent Life Events were separated into controllable and uncontrollable categories based on subjects' ratings. It was found that the relationship between life events and illness depended upon whether events were viewed as controllable. Specifically, the more life events individuals identified as uncontrollable, the greater the illness reported. Moreover, events perceived as uncontrollable were rated as significantly more stressful than events perceived as controllable. It was also demonstrated that the effect the controllability-uncontrollability dimension had in moderating the relationship between total life events and illness was stronger than the effect of severity (i.e., life change units) of life events.

Serum gastrin and the family environment in duodenal ulcer disease.

The study investigated the relationships between specific demographic, psychosocial, and physiological variables and the severity of duodenal ulcer disease in a population of patients with proved duodenal ulcer. Intercorrelations between psychosocial and physiological variables were also studied. The study design was cross sectional and retrospectively assessed life change units and DUD severity during the previous 6 months in 39 male ulcer clinic outpatients. Anxiety, depression, life change units, the family environment, ABO blood type, secretor status, serum pepsinogen, and serum fasting gastrin were evaluated. A DUD severity score was calculated from self-reported ulcer pain symptoms and ulcer complications. Gastrin levels correlated significantly with three Family Environment Scale (FES) subscales, including: (a) independence, (b) achievement orientation, and (c) expressiveness. Duodenal ulcer disease severity scores correlated with Zung SDS scores, but not with state or trait anxiety, life change units, or the FES.