List Of Threatening Experiences Research Articles

An Interaction Effect of Life-Threatening Experience, Self-Efficacy, and Financial Resources on Quality of Life Among Chinese Middle-Aged and Older Women

The current study explores the interaction effect of adversities and self-efficacy at baseline on quality of life (QoL) at follow-up among middle-aged and older Chinese women. 531 women were interviewed in 2008 and 226 of them were re-interviewed a year later using Quality of Life Ladder (QoLL), General Self-Efficacy Scale (GSE), List of Threatening Experiences (LTE), Somatic Complaint Scale, and self-rated health. Respondents’ mean age at baseline was 55.7 (SD = 4.7, range: 50–78). Over a year’s time, respondents had a decline in quality of life and self-rated health (p < .001), experienced more life-threatening events (p < .05) and somatic complaints. The hierarchical multiple regression model, employed in the study, identifies three predictors of future quality of life after adding the interaction term ‘Previous LTE × Previous GSE × Previous household income’ — previous quality of life (β = .492, p < .001), previous LTE (β = -.292, p < .001), and the interaction term (β = .221, p < .05). This model explains 34.1% of the variance of future quality of life (Adjusted R2 = .341, p < .001). The findings suggests that respondents’ good self-appraisal of coping resources could moderate the impact of adversities on their future quality of life. Interventions for promoting positive psychological growth among middle-aged and older adults should cover four domains, i.e. event-related factors, environmental factors, personal factors, and cognitive and coping responses. Traditional Chinese wisdom emphasizes the importance of understanding the bad (‘Yin’—the shady side) and the good (‘Yang’—the sunny side) aspect of life events. Future research may explore the Yin Yang perspective on life-threatening experiences and its applications in cross-cultural quality of life studies in the era of globalization.

Stress impairs response to antidepressants by activating HPA axis and immune system

While early adverse events as well as severe stressful events occurring later in life have been associated with depression, the interaction is still not understood. The objective of this study is to disentangle the interaction by evaluating the main stress-response systems of the body, the hypothalamic-pituitary-adrenal (HPA-) axis and the immune system in depressed patients. HPA-axis function was evaluated by analyzing FKBP5, SGK1 and NR3C1 mRNA-expression in whole blood after an in vivo glucocorticoid receptor challenge with 1.5 mg dexamethasone in 150 depressed in-patients. Early adverse events were evaluated using the Childhood Trauma Questionnaire (CTQ), severe life events occurring one year prior to hospital admission were assessed with the List of Threatening Experiences (LTE). History of 3 and more severe life events was associated with a significantly impaired treatment response to antidepressants. Additionally, there was a significant association with an impaired GR-induction of SGK1 and FKBP5 mRNA expression, as well as with increased measures of the immune system such as lymphocyte count and CRP. These alterations were not observable in relation to early adverse effects. Severe life events that happen prior to the development of depression significantly impair the HPA-axis and the response to antidepressants. Therefore patients who report stressful life events should receive additional treatment options such as psychotherapy already at the beginning of therapy.

The mediating role of impulsivity in the relationship between suicidal behaviour and early traumatic experiences in depressed subjects

IntroductionDepressed patients with early traumatic experiences may represent a clinically distinct subtype with worse clinical outcome. Since early traumatic experiences alter the development of systems that regulate the stress response, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behaviour.ObjectivesTo determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behaviour in patients with major depressive disorder (MDD).MethodsThe sample included 190 patients [mean age (SD)=53.71 (10.37); females: 66.3%], with current MDD. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity. We developed mediation models by bootstrap sampling methods.Results81 (42.6%) patients had previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b=0.007, 95% CI=0.001, 0.015), after controlling for sex, HDRS-Total, and LTE-Total.ConclusionsImpulsivity could mediate the influence of childhood trauma on suicidal behaviour. This will help understand the role of risk factors in suicidal behaviour and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.

Stress impairs response to antidepressants via HPA axis and immune system activation

Childhood trauma as well as severe events occurring later in life have been associated with the development of major depressive disorder (MDD). However, the interaction of early and later occurring adverse events in patients with MDD is understudied. This study aims to disentangle this interaction by investigating the effects on two of the main stress-response systems of the body, the hypothalamic–pituitaryadrenal (HPA-) axis and the immune system in depressed patients.The function of the HPA-axis was assessed by measuring FKBP5, SGK1 and NR3C1 mRNA-expression in peripheral blood after an in vivo glucocorticoid receptor (GR) challenge with 1.5 mg dexamethasone in 150 depressed in-patients (47.4% females). Childhood trauma was evaluated using the Childhood Trauma Questionnaire (CTQ), severe life events occurring one year prior to hospital admission were assessed with the List of Threatening Experiences (LTE).Multiple childhood traumata, i.e. ≥ 3, were present in 68 (45.5%) patients, 59 (39.3%) experienced ≥ 3 severe recent life events. The history of ≥ 3 severe recent life events was associated with an impaired GR-induction of SGK1 (F = 10.455; df = 1; p = 0.002) and FKBP5 mRNA expression (F = 8.720; df = 1; p = 0.004), and with elevated measures of the immune system such as CRP and lymphocyte count. In addition, severe recent life events were associated with a substantially impaired treatment response to antidepressants (F = 7.456; df = 1; p = 0.008). These effects could not be observed in relation to childhood trauma.Severe life events occurring prior to MDD development substantially impaired the stress-response systems and the response to treatment with antidepressants. This finding may indicate the need to employ additional treatment options such as psychotherapy right at the beginning of treatment or immune-modulating approaches.

The Mediating Role of Impulsivity in the Relationship Between Suicidal Behavior and Early Traumatic Experiences in Depressed Subjects.

Background: Depressed patients with early traumatic experiences may represent a clinically and biologically distinct subtype, with worse clinical outcomes and greater risk of suicide. Since early traumatic experiences alter development of systems that regulate the stress response, increasing sensitivity to stress and mood disorders later in life, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behavior.Objective: To determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behavior in patients with major depressive disorder (MDD).Methods: The total sample consists of 190 patients [mean age (SD) = 53.71 (10.37); females: 66.3%], with current MDD (DSM-5 criteria). The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity, respectively. We developed mediation models by bootstrap sampling methods.Results: Eighty-one (42.6%) patients had a history of previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were significantly higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b = 0.007, 95% CI = 0.001, 0.015), after statistically controlling for sex, the HDRS-Total, and the LTE-Total.Discussion: Data suggest that impulsivity could mediate the influence of childhood trauma on suicidal behavior. This will help understand the role of risk factors in suicidal behavior and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.

Sex-dependent grades of haematopoietic modulation in patients with major depressive episodes are associated with suicide attempts

Suicide is the leading cause of non-natural death worldwide, and major depressive disorder (MDD) is the mood disorder with the highest prevalence among individuals with suicidal behaviour (SB). The role of inflammation and immunomodulation in mood disorders has raised interest in recent years, as inflammation biomarkers have been reported to be increased in mood disorder patients, suggesting a role of inflammation in their pathogenesis. The influence of inflammation on the haematopoietic production is well known; however, a comprehensive study of the haematopoietic production in patients with major depressive episodes (MDE) is lacking. We examined global haematopoietic parameters from complete blood counts (CBC) of patients with MDE, in search of prognostic patterns. MDE patients presented differences in several CBC parameters, differences that were clearly pronounced and/or significant in concurrence with suicide attempts (SA). Red and white blood cell lineage parameters were affected, suggesting general haematopoietic modulation or imbalance. We observed distinct haematological parameter changes in women versus men, with men presenting milder alterations than women. Interestingly, we found that the List of Threatening Experiences (LTE) score, but not the Childhood Trauma Questionnaire (CTQ), was associated with the haematopoietic alterations observed exclusively in women and, more importantly, served as a parameter to stratify female MDE patients based on concurrence or non-concurrence with SA. In conclusion, grades of haematopoietic modulation in MDE patients are associated with absence or presence of SA. Haematopoietic manifestations differ between men and women and, in the latter, are markedly influenced by late, and not early, traumatic events.

Refuge in Digital Worlds - the Association of Critical Life Events with Pathological Internet Use in Adolescence

Refuge in Digital Worlds - the Association of Critical Life Events with Pathological Internet Use in Adolescence The present study sought to clarify the potential relationship between critical life events and pathological internet use in adolescents. A cross-sectional survey was conducted within the framework of a European school-based study (SEYLE) which included a representative sample of 1,444 students from the Rhein-Neckar catchment area. The Young Diagnostic Questionnaire (YDQ) was used to assess pathological internet use, whereas a combination of the List of Threatening Experiences (LTE) and Life Events Checklist (LCE) was administered to assess critical life events over the period of the last six months. Statistical models were adjusted for the presence of psychopathological distress using the Strengths and Difficulties Questionnaire (SDQ). 4.8 % of the participating students reported pathological internet use, 14.5 % met criteria for risky Internet use. Overall, adolescents with risky or pathological internet use recalled more critical life events, particularly within the context of interpersonal relationships and academic performance. After adjusting for sociodemographic variables and psychopathological distress, results showed that an unexpected decrease in academic performance as well as the termination of a romantic relationship, both were significantly associated with pathological internet use. Adolescents with pathological internet use reported significantly more frequent interpersonal problems and an unexpected decrease of academic performance. Based on the cross-sectional nature of the investigation, causality of the association cannot be established. However, results point towards potential risk factors (academic performance, termination of relationships) which may guide the identification of adolescents with risky or pathological internet use in child- and adolescent psychiatry.

Psychometric properties of the List of Threatening Experiences—LTE and its association with psychosocial factors and mental disorders according to different scoring methods

BackgroundThe List of Threatening Experiences (LTE) questionnaire is frequently used to assess stressful events; however, studies of its psychometric properties are scarce. We examined the LTE's reliability, factorial structure, construct validity and explored the association between LTE scores and psychosocial variables and mental disorders. MethodThis study involved interviewing 5442 primary care attendees from Spain. Associations between four different methods of quantifying LTE scores, psychosocial factors, major depression (CIDI), anxiety disorders (PRIME-MD), alcohol misuse and dependence (AUDIT) were measured. ResultsThe LTE showed high test–retest reliability (Kappa range=0.61–0.87) and low internal consistency (α=0.44). Tetrachoric factorial analysis yielded four factors (spousal and relational problems; employment and financial problems; personal problems; illness and bereavement in close persons). Logistic multilevel regression found a strong association between greater social support and a lower occurrence of stressful events (OR range=0.36–0.79). The association between religious–spiritual beliefs and the LTE, was weaker. The association between mental disorders and LTE scores was greater for depression (OR range=1.64–2.57) than anxiety (OR range=1.35–1.97), though the highest ORs were obtained with alcohol dependence (OR range=2.86–4.80). The ordinal score (ordinal regression) was more sensitive to detect the strength of association with mental disorders. LimitationsWe are unable to distinguish the direction of the association between stressful events, psychosocial factors and mental disorders, due to our cross-sectional design of the study. ConclusionsThe LTE is a valid and reliable measure of stress in mental health, and the strength of association with mental disorders depends on the method of quantifying LTE scores.

Negative and positive life events are associated with small but lasting change in neuroticism

High neuroticism is prospectively associated with psychopathology and physical health. However, within-subject changes in neuroticism due to life experiences (LEs) or state effects of current psychopathology are largely unexplored. In this 2-year follow-up study, four hypotheses were tested: (1) positive LEs (PLEs) decrease and negative LEs (NLEs) increase neuroticism; (2) LE-driven change in neuroticism is partly long-lasting; and (3) partly independent of LE-driven changes in anxiety/depression; and (4) childhood adversity (before age 16 years) moderates the influence of NLEs/PLEs on neuroticism scores in adult life. Data came from the Netherlands Study of Depression and Anxiety [NESDA, n = 2981, mean age 41.99 years (s.d. = 13.08), 66.6% women]. At follow-up (T₂) we assessed PLEs/NLEs with the List of Threatening Experiences (LTE) over the prior 24 months and categorized them over recent and distant PLE/NLE measures (1-3 and 4-24 months prior to T₂ respectively) to distinguish distant NLE/PLE-driven change in trait neuroticism (using the Dutch version of the Neuroticism-Extroversion-Openness Five Factor Inventory, NEO-FFI) from state deviations due to changes in symptoms of depression (self-rated version of the 30-item Inventory of Depressive Symptomatology, IDS-SR30) and anxiety (Beck Anxiety Inventory, BAI). Distant NLEs were associated with higher and distant PLEs with lower neuroticism scores. The effects of distant LEs were weak but long-lasting, especially for distant PLEs. Distant NLE-driven change in neuroticism was associated with change in symptoms of anxiety/depression whereas the effect of distant PLEs on neuroticism was independent of any such changes. Childhood adversity weakened the impact of distant NLEs but enhanced the impact of distant PLEs on neuroticism. Distant PLEs are associated with small but long-lasting decreases in neuroticism regardless of changes in symptom levels of anxiety/depression. Long-lasting increases in neuroticism associated with distant NLEs are mediated by anxiety/depression.

Validation of the Long-term Difficulties Inventory (LDI) and the List of Threatening Experiences (LTE) as measures of stress in epidemiological population-based cohort studies

Stress questionnaires are included in many epidemiological cohort studies but the psychometric characteristics of these questionnaires are largely unknown. The aim of this study was to describe these characteristics for two short questionnaires measuring the lifetime and past year occurrence of stress: the List of Threatening Events (LTE) as a measure of acute stress and the Long-term Difficulties Inventory (LDI) as a measure of chronic stress. This study was performed in a general population cohort consisting of 588 females (53.7%) and 506 males (46.3%), with a mean age of 53.5 years (s.d.=11.3 years). Respondents completed the LTE and the LDI for the past year, and for the age categories of 0-12, 13-18, 19-39, 40-60, and >60 years. They also completed questionnaires on perceived stress, psychological distress (the General Health Questionnaire, GHQ-12), anxiety and depression (the Symptom Checklist, SCL-8) and neuroticism (the Eysenck Personality Questionnaire - Revised Short Scale, EPQ-RSS-N). Approximately 2 years later, 976 respondents (89%) completed these questionnaires for a second time. The stability of the retrospective reporting of long-term difficulties and life events was satisfactory: 0.7 for the lifetime LDI and 0.6 for the lifetime LTE scores. The construct validity of these lists is indicated by their positive associations with psychological distress, mental health problems and neuroticism. This study in a large population-based sample shows that the LDI and LTE have sufficient validity and stability to include them in major epidemiological cohort studies.

FC01-01 - Does stress-related major depression differ from non-stress related major depression in primary care? Results from the PredictD-Spain study

IntroductionResearch has consistently documented the significance of severe life events for the onset and course of major depression. However, no research has been done on whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to those who have not.ObjectivesWe investigated whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to depressed primary care attendees who have not.MethodsWe undertook a prospective cohort study involving 5,442 consecutive primary care attendees with evaluations at baseline and at 6 months. Patients aged 18-75 years were recruited in six Spanish provinces between October 2005 and February 2006. The incidence of major depression was assessed at 6 months with the Depression Section of the Composite International Diagnostic Interview (CIDI). Stressful life events were measured with the List of Threatening Experiences (LTE).Results3,804 (70%) were interviewed at 6 months of follow-up. Among 200 attendees with a first episode of major depression, 24.5% had experienced no stressful life events, 30.5% had suffered one, 20.5% had experienced two and 24% had suffered three or more in the 6 months prior to the onset of depression. Depressed primary care attendees who had experienced three or more stressful life events differed from depressed patients with no stressful life events in the following variables: economic difficulties, dissatisfaction with unpaid work, relational variables, psychiatric co-morbidity and family history.ConclusionsStress-related major depression differs from non-stress-related depression in primary care.

Factors influencing antenatal depression, anxiety and stress

The purpose of this study was to investigate the prevalence and factors influencing antenatal depression, anxiety and stress symptomatology. The study used a cross-sectional survey design in a sample of 302 antenatal women across the trimesters of pregnancy. The questionnaire collected demographic and pregnancy data, included two measures of emotional distress; the Edinburgh Depression Scale (EDS) and Depression Anxiety Stress Scale (DASS-21), a measure of social support; the Significant Others Scale (SOS), and an adapted measure of distress from life events; the List of Threatening Experiences (LTE). Seventeen per cent were identified as suffering from depression symptomatology, 25% as having symptoms of anxiety and 25% as having symptoms of stress. Analysis revealed that a lack of support from a partner, mother, and an ‘other’ (typically a sibling or friend) were significant predictors of symptomatology. There were different predictive factors for antenatal women with children and primiparous women. Information was also obtained about antenatal women's preferences for health-care support with emotional distress. The need to widen the focus from postnatal depression to perinatal mental health was demonstrated. Interventions with an interpersonal focus may prove particularly effective as lack of social support appears to be a significant predictor of antenatal emotional distress.

Does the occurrence of adverse life events in patients with breast cancer lead to a change in illness behaviour?

It was examined whether life-changing events may lead to changes of illness behaviour in women prior to breast cancer diagnosis. We considered the delay in three different aspects: date of breast self-examination, routine visits at the doctor, and finally changes in the length of time intervals between the detection of suspicious breast symptoms and the subsequent verification of diagnoses. The data of 240 patients (age <70 years) with a first manifestation of breast cancer were used for analysis. Life events were assessed by means of a semi-structured interview as proposed by Brown and Harris and classified according to a system proposed by Brugha et al., the List of Threatening Experiences (LTE). All analyses were performed by means of Cox's proportional hazard regression. Women with stressful events went to the doctor earlier than those without events. The date of breast self-examination remained unchanged after the occurrence of events. Women who had discovered suspicious breast symptoms delayed the subsequent visit at the doctor if they had experienced two serious events within this period. The occurrence of life events may have effects on illness behaviour, but into different directions. In the majority of cases, event-related delays were shorter than those reported to aggravate the prognosis of breast cancer.

The List of Threatening Experiences: the reliability and validity of a brief life events questionnaire

During the 23 years since the original work of Holmes & Rahe, research into stressful life events on human subjects has tended towards the development of longer and more complex inventories. The List of Threatening Experiences (LTE) of Brugha et al., by virtue of its brevity, overcomes difficulties of clinical application. In a study of 50 psychiatric patients and informants, the questionnaire version of the list (LTE-Q) was shown to have high test-retest reliability, and good agreement with informant information. Concurrent validity, based on the criterion of independently rated adversity derived from a semistructured life events interview, making use of the Life Events and Difficulties Scales (LEDS) method developed by Brown & Harris, showed both high specificity and sensitivity. The LTE-Q is particularly recommended for use in psychiatric, psychological and social studies in which other intervening variables such as social support, coping, and cognitive variables are of interest, and resources do not allow for the use of extensive interview measures of stress.