Life Events And Difficulties Schedule Research Articles

Predictors of Prenatal Depression: A Cross-Sectional Study in Rural Pakistan

Objective: To determine the prevalence and association of prenatal depression with socioeconomic, demographic and personal factors among pregnant women living in Kallar Syedan, Rawalpindi, Pakistan.Methods: Five hundred women in the second and third trimester of pregnancy, living in Kallar Syedan, a rural area of district Rawalpindi Pakistan, were included in the study. Depression was assessed using “Patient health questionnaire” (PHQ9) in Urdu, with a cut-off score of 10. Multi-dimensional scale of perceived social support (MSPSS) was used to assess perceived social support. Life Events and Difficulties Schedule (LEDS) were used to measure stressful life events in past 1 year. Tool to assess intimate partner violence (IPV) was based on WHO Multi Country Study on “Women's Health and Domestic Violence against Women.”Results: Prevalence of prenatal depression was found to be 27%. Number of pregnancies was significantly associated with prenatal depression (p < 0.01). Women living in a joint family and those who perceived themselves as moderately satisfied or not satisfied with their life in the next 4 years were found to be depressed (p < 0.01, OR 6.9, CI 1.77–26.73). Depressive symptomatology in women who experienced more than five stressful life events in last 1 year was three times higher (p < 0.001, OR 3.2, CI 1.68–5.98) than in women with 1–2 stressful events. Women who were supported by their significant others or their family members had 0.9 times (p < 0.01, OR 0.9, CI 0.85–0.96) less chance of getting depressed. Pregnant women who were psychologically abused by their partners were 1.5 times more depressed (p < 0.05 CI 1.12–2.51). Odds of having depression was also high in women who had less mean score of MSSI (p < 0.05, OR 1.1, CI 1.01–1.09). Women who had suitable accommodation had 0.5 times less chance of having depression than others (p < 0.05, OR 0.5, CI 0.27–0.92).Conclusion: Over a quarter of the women in the study population reported prenatal depression, which were predicted predominantly by psychosocial variables.

Adult men suicide: a developmental approach

Background and objective: This study aims to verify the role of humiliating events and their context in provoking suicide and the contribution of childhood parental maltreatment. Materials and methods: A family member of consecutive adult male suicides, aged between 18 and 53, was recruited at the Montreal coroner’s mortuary for a psychosocial autopsy interview (N = 63) and 7 others through the coroner-in-chief’s office. Live events were assessed with the Life Events and Difficulties Schedule (LEDS) and parental maltreatment with the Child Experience of Care and Abuse (CECA) Interview. Results: Two thirds of the suicides presented most of the following factors: a separation from a partner, half of them involving the man’s intractable behavior, financial and marital difficulties, a diagnosis of substance use and/or personality disorder, a history of parental maltreatment and impulsivity. However, other subgroups of men suicide differed significantly from this portrait. Conclusions: Humiliation events and parental maltreatment are key factors of men’s suicide.

Journal Digest: Events Before First-Episode Psychosis; Poor Neuron Insulation and Autism; Memory Suppression and Adaptation After Trauma

Journal Digest: Events Before First-Episode Psychosis; Poor Neuron Insulation and Autism; Memory Suppression and Adaptation After Trauma

Threatening Life Events and Difficulties and Psychotic Disorder.

ObjectiveStressful life events have been implicated in the onset of psychotic disorders, but there are few robust studies. We sought to examine the nature and magnitude of associations between adult life events and difficulties and first-episode psychoses, particularly focusing on contextual characteristics, including threat, intrusiveness, and independence. MethodThis study forms part of the Childhood Adversity and Psychosis Study (CAPsy), an epidemiological case-control study in London, United Kingdom. Data on life events and difficulties (problems lasting 4 wk or more) during 1 year prior to onset (cases) or interview (controls) were assessed using the semi-structured Life Events and Difficulties Schedule (LEDS). Data were available on 253 individuals with a first episode of psychosis and 301 population-based controls. ResultsWe found strong evidence that odds of exposure to threatening and intrusive events in the 1 year prior to onset were substantially higher among cases compared with controls, independent of age, gender, ethnicity, and social class (ORs > 3). This was consistent across diagnostic categories. We found further evidence that the effect of threatening events and difficulties was cumulative (1 event odds ratio [OR] 2.69 [95% confidence interval (CI) 1.51–4.79]; 2 events OR 4.87 [95% CI 2.34–10.16]; ≥3 events OR 5.27 [95% CI 1.83–15.19]; 1 difficulty OR 3.02 [95% CI 1.79–5.09]; 2 difficulties OR 9.71 [95% CI 4.20–22.40]; ≥3 difficulties OR 12.84 [95% CI 3.18–51.85]). ConclusionsThreatening and intrusive life events and difficulties are common in the year pre-onset among individuals with a first episode of psychosis. Such experiences may contribute to the development of psychotic disorders.

Web-Based Measure of Life Events Using Computerized Life Events and Assessment Record (CLEAR): Preliminary Cross-Sectional Study of Reliability, Validity, and Association With Depression.

BackgroundGiven the criticisms of life event checklists and the costs associated with interviews, life event research requires a sophisticated but easy-to-use measure for research and clinical practice. Therefore, the Computerized Life Events and Assessment Record (CLEAR), based on the Life Events and Difficulties Schedule (LEDS), was developed.ObjectiveThe objective of our study was to test CLEAR’s reliability, validity, and association with depression.MethodsCLEAR, the General Health Questionnaire, and the List of Threatening Experiences Questionnaire (LTE-Q) were completed by 328 participants (126 students; 202 matched midlife sample: 127 unaffected controls, 75 recurrent depression cases). Test-retest reliability over 3-4 weeks was examined and validity determined by comparing CLEAR with LEDS and LTE-Q. Both CLEAR and LTE-Q were examined in relation to depression.ResultsCLEAR demonstrated good test-retest reliability for the overall number of life events (0.89) and severe life events (.60). Long-term problems showed similar findings. In terms of validity, CLEAR severe life events had moderate sensitivity (59.1%) and specificity (65.4%) when compared with LEDS. CLEAR demonstrated moderate sensitivity (43.1%) and specificity (78.6%) when compared with LTE-Q. CLEAR severe life events and long-term problems were significantly associated with depression (odds ratio, OR 3.50, 95% CI 2.10 to 5.85, P<.001; OR 3.38, 95% CI 2.02 to 5.67, P<.001, respectively), whereas LTE-Q events were not (OR 1.06, 95% CI 0.43 to 2.60, P=.90).ConclusionsCLEAR has acceptable reliability and validity and predicts depression. It, therefore, has great potential for effective use in research and clinical practice identifying stress-related factors for the onset and maintenance of depression and related disorders.

Adaptation and Validation of the Life Events and Difficulties Schedule for Use With High School Dropouts.

The Life Events and Difficulties Schedule (LEDS) is considered the standard for measuring psychosocial stressor exposure, but it has not been used with academically at-risk adolescents, including high school dropouts. The goal of this study was to (1) adapt the LEDS for use with this population, and (2) examine the reliability (interrater) and validity (concurrent and predictive) of this adaptation among a sample of vulnerable adolescents (N=545). Good reliability coefficients (.79-.90) were obtained, and stressor exposure was associated with concurrent criteria indexing mental health outcomes (depression) and major risk factors for dropout (administratively recorded and self-reported). Also, LEDS scores predicted dropout beyond these risk factors. The adapted LEDS appears useful for describing academically struggling adolescents' stressor exposure.

The association between hippocampal volume and life events in healthy twins.

Hippocampal volume deficits have been linked to life stress. However, the degree to which genes and environment influence the association between hippocampal volume and life events is largely unknown. In total, 123 healthy twins from monozygotic and dizygotic twin pairs underwent magnetic resonance imaging (MRI), and 57 healthy twins were interviewed with the Life Events and Difficulties Schedule (LEDS), with an overlap of 54 twins undergoing both MRI and the life events interview. Hippocampal volumes were segmented with Freesurfer software. Data were analyzed with OpenMx software. Smaller hippocampal volume was associated with higher severe life event load (rph = -0.39), where shared environmental factors influencing both measures fully explained the association. Hippocampal volume was not associated with total or mild life event load. Hippocampal volume showed high heritability (range, h(2) : 57%-81%) whereas life event measures were influenced by shared (c(2) ) and unique (e(2) ) environmental factors only (range, c(2) :40%-64%, e(2) : 36%-60%). The results suggested that shared environmental factors influenced the relationship between smaller hippocampal volume and severe (but not mild) stress. This indicated that particularly severe life events that were shared between twins were associated with smaller hippocampal volume. Furthermore, it is suggested to distinguish between mild and severe life events in life event research. © 2016 Wiley Periodicals, Inc.

Perceived life stress exposure modulates reward-related medial prefrontal cortex responses to acute stress in depression

IntroductionMajor depressive disorder (MDD) is often precipitated by life stress and growing evidence suggests that stress-induced alterations in reward processing may contribute to such risk. However, no human imaging studies have examined how recent life stress exposure modulates the neural systems that underlie reward processing in depressed and healthy individuals. MethodsIn this proof-of-concept study, 12 MDD and 10 psychiatrically healthy individuals were interviewed using the Life Events and Difficulties Schedule (LEDS) to assess their perceived levels of recent acute and chronic life stress exposure. Additionally, each participant performed a monetary incentive delay task under baseline (no-stress) and stress (social-evaluative) conditions during functional MRI. ResultsAcross groups, medial prefrontal cortex (mPFC) activation to reward feedback was greater during acute stress versus no-stress conditions in individuals with greater perceived stressor severity. Under acute stress, depressed individuals showed a positive correlation between perceived stressor severity levels and reward-related mPFC activation (r=0.79, p=0.004), whereas no effect was found in healthy controls. Moreover, for depressed (but not healthy) individuals, the correlations between the stress (r=0.79) and no-stress (r=−0.48) conditions were significantly different. Finally, relative to controls, depressed participants showed significantly reduced mPFC gray matter, but functional findings remained robust while accounting for structural differences. LimitationSmall sample size, which warrants replication. ConclusionDepressed individuals experiencing greater recent life stress recruited the mPFC more under stress when processing rewards. Our results represent an initial step toward elucidating mechanisms underlying stress sensitization and recurrence in depression.

Psychosocial risk factors which may differentiate between women with Functional Voice Disorder, Organic Voice Disorder and a Control group

This study aimed to explore psychosocial factors contributing to the development of functional voice disorders (FVD) and those differentiating between organic voice disorders (OVD) and a non-voice-disordered control group. A case-control study was undertaken of 194 women aged 18–80 years diagnosed with FVD (n = 73), OVD (n = 55), and controls (n = 66). FVD women were allocated into psychogenic voice disorder (PVD) (n = 37) and muscle tension voice disorder (MTVD) (n = 36) for sub-group analysis. Dependent variables included biographical and voice assessment data, the number and severity of life events and difficulties and conflict over speaking out (COSO) situations derived from the Life Events and Difficulties Schedule (LEDS), and psychological traits including emotional expressiveness scales. Four psychosocial components differentiated between the FVD and control group accounting for 84.9% of the variance: severe events, moderate events, severe COSO, and mild COSO difficulties. Severe events, severe and mild COSO difficulties differentiated between FVD and OVD groups, accounting for 80.5% of the variance. Moderate events differentiated between PVD and MTVD sub-groups, accounting for 58.9% of the variance. Psychological traits did not differentiate between groups. Stressful life events and COSO situations best differentiated FVD from OVD and control groups. More refined aetiological studies are needed to differentiate between PVD and MTVD.

Life events and difficulties and their association with antenatal distress in White and South Asian women in the UK

Symptoms of distress during pregnancy are common and often go unnoticed. There is a well-established relation between life events and depression. The current study aims to explore the association between life events and difficulties, and symptoms of emotional and somatic distress during pregnancy in White and South Asian women in the UK. 100 pregnant women attending routine antenatal appointments were interviewed using the Life Events and Difficulties Schedule (LEDS). We investigated the frequency and type of events experienced in the year prior to conception and during pregnancy, as predictors for somatic and emotional distress, measured using the GHQ-28. Non-severe stressors accounted for over 90 % of those reported, half of which (43-53 %) were health and reproduction-related. Somatic symptoms were associated with the number of non-severe events, and number of children and emotional symptoms were associated with non-marked difficulties. There was little evidence of an association between severe events and distress. Ethnicity had little effect on any associations although South Asian women were at slightly higher odds of experiencing emotional symptoms, which appear to be buffered by social support. In routine antenatal care it is important to assess both emotional and somatic symptoms. Health professionals need to be sensitive to the health, social, cultural and environmental circumstances of women during pregnancy and ensure appropriate support is in place, particularly for multi-parous women. Regression models explained a small but significant amount of the variance in distress symptoms. Further work is necessary to explore other contributory factors and also the mechanisms through which stressors have their effect.

Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: a cohort study.

BackgroundDepressive disorders are common and disabling among perinatal women. The rates are high in ethnic minority groups. The causes are not known in British Pakistani women. The aim of this study was to estimate the rates, correlates and maintaining factors of perinatal depression in a Pakistani sample in UK. The design used was a cross-sectional two phase population based survey with a prospective cohort study.MethodsAll women in 3rd trimester attending antenatal clinic were screened with the Edinburgh postnatal depression scale (EPDS). Women scoring 12 or more on EPDS and a random sample of low scorers were interviewed using the Schedules for Assessment in Neuropsychiatry (SCAN) and the Life Events and Difficulties schedule (LEDS). Social support was assessed with the Multidimensional Scale for Perceived Social Support (MSPSS). They were reassessed 6 months after the delivery using the same measures.ResultsThe weighted prevalence of depression was 16.8%. Depressed mothers had more marked non health difficulties (housing, financial and marital). They had less social support and were socially isolated. Marked social isolation and marked non-health related difficulties were independent predictors of depression. Analyses of all the possible risk factors, comparing 26 persistent depressed with 27 depression resolved group showed significant differences in the MSPSS subscales between the two groups.LimitationsThe study lacked inter-rater reliability testing between the individuals carrying out diagnostic interviews. The study sample did not accurately represent the general population and information about the origins of depression in this group of mothers was limited.ConclusionDepression in British Pakistani mothers is associated with social isolation, poor social support and severe and persistent social difficulties. The findings will have implications in planning suitable services for this group.

019 Life events in the year preceding the onset of conversion disorder: the role of the type and timing of events

AimsClassical models of Conversion Disorder (CD) hypothesise that specific stressful experiences are “converted” into symptoms to relieve psychological pressure, and would suggest those experiences should be of a nature that...

Antidepressants, social adversity and outcome of depression in general practice

Background The role of current social risk factors in moderating the impact of antidepressant medication has not previously been explored. Method In a RCT of SSRIs of general practice patients with mild to moderate depression (HDRS 12–19) two social indices of aversive experience were developed on the basis of prior research. First, the Life Events and Difficulties Schedule (LEDS) was used twice to document: i) recent stressful experience prior to baseline, and ii) after baseline and before follow up at 12 weeks both stressful and positive experiences, taking account of ‘fresh start’ and ‘difficulty-reduction’ events . Second, an index of unemployment-entrapment at baseline was developed for the current project. The HDRS was used to measure outcome as a continuous score and as a cut-point representing improvement below score 8. Results Each social index (LEDS and Unemployment-entrapment) was associated with a lower chance of remission at 12 weeks and each was required to model remission along with treatment arm. However there was no interaction: the degree of increased remission for those randomised to SSRIs plus supportive care compared to that for those with supportive care alone was the same regardless of social context. Limitations Dating of remission was not as thorough as in previous work with the LEDS. Detailed examination of positive experiences suggested the large majority were not the result of remitting symptoms, but it is impossible to rule this out altogether. Conclusions Remission rates among patients in aversive social contexts are consistently much lower irrespective of treatment. There is thus a need to evaluate the efficacy of alternative more socially focussed interventions for depressive conditions likely to take a chronic course in general practice.

P01-261 Perinatal depression and use of health services in British women of Pakistani origin

Background:Perinatal depression (PND) has adverse effects on the well being of the mother-infant dyad. Women with PND often show different patterns of help seeking behaviour.Objective:We aimed to examine the association between PND and the reporting of health events and healthcare use in a cohort of British women of Pakistani origin.Method:Participants were recruited from antenatal clinics in the North West of England and followed up 6 months postnatal. Sixty-seven women diagnosed with depression using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were compared with 156 non depressed controls in terms of reporting of health events elicited using the Life Events and Difficulties Schedule (LEDS). Health events included any condition that involved attending primary or secondary care.Results:Depressed mothers were 1.5 times more likely to report a health event within the perinatal period (p=0.005) and 1.8 times more likely to report a health event (0.031) outside the perinatal period. Depressed mothers were more likely to attend secondary care services for their children (p=0.001) but there was no significant difference in terms of attendance at primary care.Conclusion:Depressed mothers were more likely to report personal health events and more likely to access secondary care rather than primary care services for health events affecting their children. This highlights the hidden costs of this condition and the need for adequate diagnosis and management of this treatable but under recognised illness.

Humiliation and Entrapment Among Depressed Women of Pakistani Origin Living in the UK

In a population-based sample of women of Pakistani origin in UK we tested the hypothesis that chronic difficulties involving humiliation and entrapment will be associated with depressive disorder.487 randomly selected women were screened for depressive disorder with the Self- Rating Questionnaire (SRQ). All high scorers and 1:4 low scorers were interviewed, using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Of these 193 women were also administered the Life Events and Difficulties Schedule (LEDS) to measure social stress.92 women had a depressive disorder, 62 had SRQ score&gt;7 but no depressive disorder and 39 were not depressed. 89 of the 92 depressed women were followed up to six months later, 55 women remained depressed and 34 were no longer depressed.In univariate analysis at baseline they had significantly more marked difficulties in the domains of health, money/possession, marital/partner and other relationships. In logistic regression analysis difficulties associated with depressive disorder were marked marital/partner and other relationship difficulties. 87% of women who experienced humiliation and 84% of those experiencing entrapment had marked marital partner and other relationship difficulties.At 6 months follow-up chronic difficulties in the domains of marital/partner and other relationship were associated with persistent depression. 90% of women experiencing humiliation and entrapment had marked marital/partner and other relationship difficulties.Humiliating difficulties directly devaluing a woman's core role where she finds herself to be trapped with no way out is associated with depressive disorder in women of Pakistani origin in the UK.

Imaging Repressed Memories in Motor Conversion Disorder

Conversion disorders comprise neurologically unexplained symptoms with a presumed psychiatric cause, though a neuroscientific basis for this is lacking. The standard psychiatric model of conversion holds that events and processes that might explain the symptoms are, by hypothesis, either repressed or subconscious. This makes assessments based on subjective reports unreliable. We circumvent this by using a standardized method to quantify stressful life events and by assessing objectively the neural correlates of emotion processing. Single case study of a 37-year-old woman with clinically repressed recall and unexplained right-sided paralysis. We describe the application of the Life Events and Difficulties Schedule (LEDS) to her history, and a novel functional magnetic resonance imaging (fMRI) procedure exploring emotion processing of traumatic and control memories. While in the scanner, cued recall of the clinically repressed event was associated with regional brain activations characteristic of emotional arousal, including the amygdala and right inferior frontal lobe, when compared with an equally severe event from the patient's past, as rated by the LEDS. Such recall was also associated with decreased motor activity in the area corresponding to the subjectively paralyzed limb. This case study provides neuroimaging evidence for a connection between traumatic events and ongoing neurological symptoms.

Development and evaluation of an instrument to assess social difficulties in routine oncology practice

To develop and preliminarily evaluate a Social Difficulties Inventory (SDI) for use in oncology practice. Item generation from patients (n = 96), staff (n = 49) and the literature. Questions constructed and pre-tested (n = 42) resulting in a 22-item questionnaire. Psychometric evaluation (n = 271) assessed frequency of endorsement, factor structure, summated scales and construct validity followed by randomisation to criterion validity or test-retest arms. Items met preset frequency of endorsement criteria. Factor analysis revealed a four-factor structure, three clearly definable, (1) Physical ability, (2) Providing for the family and (3) Contact with others, explaining 45.8% variance. Summated scales developed from these demonstrated good reliability (Cronbach's alpha > 0.7) and were used to test and confirmed construct validity. Several comparators from the Life Events and Difficulties Schedule (LEDS) and Cancer Rehabilitation Evaluation System Short Form (CARES-SF) tested criterion validity and majority agreements were moderate to good. Test-retest reliability was good with most kappa values > 0.6. One item was eliminated resulting in a 21-item questionnaire. The SDI is relevant and easy to understand. Initial psychometric evaluation was encouraging. Ongoing work to evaluate the clinical meaning and utility of the instrument and to examine the relationships between SDI scores and clinical outcomes will provide guidance about its usefulness as an assessment tool in routine oncology practice.

Facteurs psychosociaux associés à des épisodes dépressifs avec hospitalisation chez des femmes : étude cas-témoins

The part played by psychosocial factors has frequently been studied in mental disorders whether as protective factors or as vulnerability factors, using variously adequate methods. A large body of research has shown that poor social support or poor self-esteem or presence of stressful life events could play a large part in triggering disorders. The importance of socioeconomic factors in mental illness is so great that such factors (unemployment, insecurity in employment, homelessness, lower social classes, low income) skew the studies in which they are not considered. In this study, in order to take into account these methodological problems, the study of psychosocial factors was undertaken in a standardized clinical manner and on a relatively socially privileged population. Two homogeneous samples for several variables, using a case-control approach have been formed. A group of hospitalized women for "neurotic" depressive disorders, aged 30-50 (n=59) was systematically recruited in a psychiatric hospital located in the Paris area depending on MGEN (Mutuelle Générale de l'Education Nationale). The control group (n=76) was recruited among the 75 000 individuals in the Paris area registered as members of MGEN. A large group of women received a physical and mental health questionnaire for initial screening, the CIDIS (Composite Diagnostic Interview Simplified), by post. Among the 395 women that did not show mental disorders, a group of 90 was examined a second time using a more discriminating tool: the SCAN (Schedule for Clinical Assessment in Neuropsychiatry). In fine, the control group was based on 76 women that did not show and had never shown any mental disorders. To assess neurotic mental disorders in a clinical standardized manner, the SCAN (Schedule for Clinical Assessment in Neuropsychiatry) was used for inpatients. Scores were processed by CATEGO software which enables subjects to be classified according to the ICD-10 system. Events and difficulties experienced by subjects were recorded using the LEDS (Life Events and Difficulties Schedule). The clinicians that interviewed subjects and collected date were trained beforehand by Harris. The Brown and Haris methodology was used to rate subjects' responses and to classify events and difficulties. To assess and measure self-esteem and social support two check-lists elaborated and implemented by Pearlin were used. Means were compared using Student t test and frequencies using the c2 method (Yates'correction or Fisher exact test when necessary) to analyse independent associated factors. A multivariate logistic analysis was performed to identify significant variables. The association between factors and mental pathology studied was expressed with an odds ratio (OR) with the 95% confidence interval. Compared to the control group, the hospitalized patients reported higher levels of exposure to six factors: practising an intermediate profession (p=0.051), living alone (OR=4, 38); low self-esteem (OR=40, 96); low social support (OR=6, 46); having experienced at least one severe event (OR=2,45), at least one difficulty lasting 6 Months or more (OR=25, 57) and at least one provoking agent (a severe event or a major difficulty) (OR=3,49). These six variables were considered as potential associated factors to "neurotic depressive disorders" and thus entered into a logistic regression analysis. From these six variables, four may be considered as psychosocial associated factors in "neurotic depressive disorders": poor self-esteem is the highest risk factor (OR=71,43), and having experienced at least one difficulty (OR=15,75). Having poor social support and having experienced one or more "provoking agents" (one severe event or one major difficulty lasting 24 Months or more) correspond to approximatively OR=3. Following this study, four psychosocial associated factors in depressive episodes can be considered as being risk factors for "neurotic depressive disorders". In the literature psychosocial factors are frequently considered to be factors that possess a certain independence. This idea is discussed in the full article.

The Stressful Life Events Schedule for children and adolescents: development and validation

The development and psychometric properties of the Stressful Life Events Schedule (SLES), an interview instrument to assess stressors in children and adolescents, are described. Children (≤12 years) and adolescents (>12 years) with psychopathology ( n=30) and non-psychiatric controls ( n=30) were interviewed with the SLES about the occurrence of stressful life events during the prior year. To examine concurrent validity of the SLES, all subjects also completed the self-report Life Events Checklist (LEC) and half the sample completed the Life Events and Difficulties Schedule (LEDS). To examine informant validity, the parent/guardian also reported on stressful life events occurring to their child during the year prior to interview. Test–retest reliability of the SLES was examined by re-assessing all children approximately one week after the initial interview. Subjects rated subjectively how stressful an event was on a 4-point scale. Additionally, panel ratings of objective stress and behavior-dependence/independence were made on 4-point scales. The SLES was found to have substantial inter-rater consensus reliability for objective threat ( κ=0.67) and almost perfect reliability for event behavior-dependence/independence ( κ=0.84). Similarly, the test–retest reliability of the SLES was also found to be substantial at the level of specific event comparisons ( κ=0.68). The SLES discriminated between children with and without psychopathology on all measures of stressful life events. Total stressful life events assessed with the SLES concurred well with those assessed by the LEC (ICC=0.83) and the LEDS ( κ=0.77) although, as expected, examination of specific events showed much smaller overlap between the SLES and the LEC ( κ=0.26). Child–parent agreement for the occurrence of severe events was substantial ( κ=0.73) but tended to be only moderate when all events were examined ( κ=0.48). The results of this study indicate that the SLES has good psychometric properties. The SLES is a useful, cost-effective tool for assessing stressful life events in children and adolescents.

Epidemiological evidence for a relationship between life events, coping style, and personality factors in the development of breast cancer

Objective: Review empirical evidence for a relationship between psychosocial factors and breast cancer development. Methods: Standardised quality assessment criteria were utilised to assess the evidence of psychosocial predictors of breast cancer development in the following domains: (a) stressful life events, (b) coping style, (c) social support, and (d) emotional and personality factors. Results: Few well-designed studies report any association between life events and breast cancer, the exception being two small studies using the Life Events and Difficulties Schedule (LEDS) reporting an association between severely threatening events and breast cancer risk. Seven studies show anger repression or alexithymia are predictors, the strongest evidence suggesting younger women are at increased risk. There is no evidence that social support, chronic anxiety, or depression affects breast cancer development. With the exception of rationality/anti-emotionality, personality factors do not predict breast cancer risk. Conclusion: The evidence for a relationship between psychosocial factors and breast cancer is weak. The strongest predictors are emotional repression and severe life events. Future research would benefit from theoretical grounding and greater methodological rigour. Recommendations are given.