Inventorying stressful life events as risk factors for psychopathology: Toward resolution of the problem of intracategory variability.

“…& Gordon, 1997a; Day, 1989; Dohrenwend, 2000; Gorman, 1993; Grant et al., 2003; Kessler, 1997; Lloyd, 1980; Mechanic, 1975; Monroe & Roberts, 1990; Norman & Malla, 1993; Paykel, 2001; Rabkin & Struening, 1976; Rutter, 1986; Tennant, Bebbington, & Hurry, 1981; Thoits, 1995; Turner & Wheaton, 1997).”

“Stressors that occur in central role areas of an individual’s life, affect multiple areas, lead to loss of resources, have objective negative impact on the normal activities of the individual, and cause a lot of change, disruption or readjustment are likely to be very consequential (Dohrenwend 2006; Carter 2007).”

“As we alluded to at the outset of this article, literally thousands of books and articles have considered the issue of how stress promotes depression (e.g., Allen & Badcock, 2003; Beck, 1967, 2008; Brown & Harris, 1978; Coyne & Downey, 1991; Dohrenwend, 2006; Hammen, 2005; Kendler et al., 1999; Kessler, 1997; Mazure,…”

“Self-report assessments of life events are not without criticism (Dohrenwend, 2006), but sensitive topics are more likely to be acknowledged in selfreport assessments than in interviews.”

“For example, Dohrenwend (2006) advocates for an objective definition of stressors.”

“When measured with the externally rated methods recommended by Dohrenwend (2006), minority stress—operationalized as prejudice events—was associated with onset of a physical health problem over a 1-year period among LGB people.”

“Dohrenwend[22] has developed a methodology for assessing the potential toxicity of different events.”

“There has been an explosion of research on stressful life events since the publication in 1967 of the Holmes and Rahe inventory of events called the ‘‘Schedule of Recent Experiences’’ (SRE) ( Dohrenwend 2006 ).”

“Dohrenwend et al. (Dohrenwend 2006; Dohrenwend et al. 1993, 1978) advocate the use of independent assessments of respondent reported stressful events; this approach is more timely and costly than respondent-driven checklists of stressful events, but when feasible provides well-validated assessment…”

“The SRRS has been used in numerous studies (Dohrenwend, 2006), although its relationships with mental and physical symptoms were generally modest, with”

“The NSCH employed a crude adversity checklist with dichotomous items, which masks intra-category variability related to chronicity and severity.(58) Our adjusted analyses used cumulative adversity as the outcome; further research that applies an intersectionality approach is needed at the “item level.”

“Psychosocial theory distinguishes stressor and context in predictions of stress-related outcomes (for reviews, see Brown & Harris, 1989; Dohrenwend, 1998; Dohrenwend, 2006).”

“Finally, life events that are objectively similar are not necessarily experienced similarly by everyone (Dohrenwend, 2006), and neglecting these idiosyncratic experiences may hinder a complete understanding of the effects of life events.”

“Although self-report checklist measures are inexpensive and relatively easy to administer, researchers have raised concerns about their reliability and validity (Brown, 1974; Dohrenwend, 2006; Hammen, 2005; Monroe, 2008; Paykel, 2001).”

“Quantifying an individual’s stressors has been attempted [20].”

“However, an equally likely contributor involves the fact that many stress assessment instruments include items that are not sufficiently precise to enable consistent reporting over time (22).”

“Second, we note that the use of retrospective subjective appraisals of stressfulness are notorious for confounding stress exposure and the outcome of interest (for a review, see Dohrenwend, 2006).”

“Second, adversity was assessed using a self-report measure, which can have limitations relative to interviews (Dohrenwend, 2006), and the measure entailed a simple count of events rather than an assessment of detailed event characteristics, which could omit relevant information (see Seery, Holman,…”

“As introduced above, these procedures inevitably result in extensive intracategory variability (see Dohrenwend, 2006).”

“” This issue, which has been called the intracategory variability problem (Dohrenwend, 2006), can cause substantial measurement error and lead to poor concurrent validity of these instruments with more probing, investigator‐based measures of life stress exposure (Monroe, 2008).”

“Negative emotional states can be a consequence of more or less severe life events, and the association between stressful life events and mental disorders has been extensively studied [”

“These contrary findings vioral Reviews 36 (2012) 786–798 reveal a yet unsettled point in the methodological approaches of studies using retrospective questionnaires, as discussed by Caspi et al. (2010), Dohrenwend (2006) and others.”

“Moreover, we interviewed 296 participants five times over 16 years and assessed life events, LTDs, and life situation change with interviews and panel ratings, the current gold standard (Dohrenwend, 2006; Monroe, 2008).”

“Finally, given that NLEs, in general, have a greater etiological and pathological association with some psychiatric conditions (e.g., depression, substance disorders; Dohrenwend, 2006) than others, we also examined the effect of psychiatric symptoms on the NLE-suicide association.”

“This list of event types does not adequately capture the “dose” of the traumatic experience, the severity of the event, or the context in which the event was experienced.(64) This makes it difficult to determine whether familial and sexual violence experiences are more strongly associated with deleterious outcomes bec…”

“Especially in contrast to semi-structured interview measures commonly used that has been recommended as a gold standard in the stressor measurement literature (e.g., Dohrenwend, 2006; Monroe, 2008).”

“Thus, when measuring respondents’ stress appraisal, it may reflect this stress buffering or modifying the response of these protective resources with lower subjective perceptions of stress (Dohrenwend, 2006).”

“, 2003), early (between age 5 and 15) and recent (last 3 years) stressful life events were scored by trained raters on the Social Readjustment Rating Scale (SRRS)(Holmes and Rahe, 1967), which focuses on occurrences that lead to readjustment-requiring changes in usual activities and that frequently precede illness ons…”

“There appears to be a strong relationship between duration of combat exposure and the severity of mental illness (Dohrenwend, 2006), suggesting that the severity of stress may play a role.”

“…some LEs (e.g. moving house) may elicit mixed emotional responses, NLEs/PLEs may have complementary longitudinal relationships (e.g. divorce and remarriage ; Overbeek et al. 2010), and PLEs may buffer the impact of NLEs (Dohrenwend, 1978 ; Rutter, 1987 ; Baumeister et al. 2001; Dohrenwend, 2006).”

“…the vast majority of studies on life stress and depression have utilized self-report checklist measures of stress for which the limitations (e.g., variability in reporting, as well as confounding between life stress and the symptoms of depression ) are well documented (see Dohrenwend, 2006).”

“Some researchers have suggested that the same nominal type of stressor can have differential effects on health and well-being depending on the characteristics of the stressor and circumstances surrounding it (Dohrenwend, 2006; Almeida et al., 2010).”

“1,41 Notably, our findings suggest that stress associated with discrimination may be more important in the health of women in this sample.”

“Additionally, there is a substantial literature demonstrating the reliability and validity of the core questions and interview methods from which the STRAIN was developed (for reviews, see Dohrenwend, 2006; Hammen, 2005; Monroe, 2008; Monroe, Slavich, & Georgiades, 2014).”

“One was a checklist completed annually, and the other was an open-ended questionnaire requesting retrospective self-appraisals (cf. Dohrenwend, 2006) as the students graduated.”

“This problem is named “intracategory variability” and more usually underlies a recognized lack of reliability and validity in traditional life events checklists (Dohrenwend, 2006).”

“Informant agreement is generally low (De Los Reyes & Kazdin, 2005), and the moderate positive effect size may be larger than expected based on similar work (Dohrenwend, 2006).”

“Future studies should attempt to replicate our findings and, in addition, investigate whether the long-term significance of an exposure varies systematically with the type of exposure (which, in turn, may alter the type of response).(39) Under normal circumstances, PTS reactions might be expected to result more from t…”

“Moreover, reactivity varies by stressor type (Bolger et al., 1989), and stressor severity varies across situations within specific stressor types (also discussed as intraevent or intracategory variability; Almeida, Stawski, & Cichy, 2010; Dohrenwend, 2006).”

“However, such studies generally assess the impact through checklists that treat life-events as equal (Dohrenwend, 2006; Gray, Litz, Hsu, & Lombardo, 2004; Wethington, Brown, & Kessler, 1997); or are restricted to the impact of a small set of life events on a single measure of wellbeing (Luhmann, Hofmann, Eid, & Lucas,…”

“Determining whether or not a specific potentiallytraumatic event is fateful is complex and may require time consuming assessment procedures [38].”

“The LEDS has considerably higher test–retest reliability and intra-pair agreement than checklist measures (Dohrenwend, 2006).”

“…feature that is notably rare in the existing literature are interview-based assessments of life stress, particularly contextual threat life stress interviews, which are considered the gold standard in life stress research (Dohrenwend, 2006; Hammen, 2005; Kessler, 1997; Monroe, 2008; Paykel, 2001).”

“It is a striking biological fact that substances and medical conditions as diverse as therapeutic corticosteroids, illicit cocaine use or pancreatic carcinoma can cause depression. The pathophysiological mechanisms of these depressions may differ from each other, as well as from depressions without underlying substanc…”

“Checklists are also subject to recall errors, as evidenced by their low test–retest reliability (Steele et al. 1980), which may be exacerbated by psychiatric conditions (Dohrenwend, 2006).”

“structured questionnaires (Brown, 1989; Dohrenwend, 2006; Gorman, 1993; Monroe, 2008; Paykel, 2001), because interviews are believed to be less influenced by respondent bias and subjective interpretation of questionnaire items (Dohrenwend, 2006; Grant, Compas, Thurm, McMahon, & Gipson, 2004; Hepp et al.”

“However, in this study, the occurrence of events was used as indicator of stress in the analyses, because the measures obtained from evaluating the degree of stress experienced can easily be contaminated by depressive symptoms and cognitive style (Dohrenwend 2006).”

“Considerable research over multiple generations have used the SSRS, and its many alternate versions, to assess the extent of stress in people’s lives and thus attempt to predict heightened illness rates, especially mental health disturbances, emanating from a sum of such life alterations (77, 79).”

“Further, it is now recognized that respondents often interpret and respond to self-report checklist items idiosyncratically (Dohrenwend, 2006).”

“The flaw in objective measures may be even more profound: By eliminating subjectivity altogether, they do not allow that a given event might have different impacts on different people (Dohrenwend 2006; Hough et al. 1976).”

“This work should incorporate detailed assessments of stressors that cover the entire lifespan, that include information on the psychological impact of stressors, and that overcome the limitations of stressful event checklists (Dohrenwend, 2006).”

“Interviewers seek to accumulate sufficient narrative detail about life events to allow trained raters to pass judgement on the key characteristics of the events ( Dohrenwend, 2006 ).”

“Moreover, early adversity is strongly associated with poorer response to treatment, increased chronicity of symptoms, and suicide risk (Dube et al., 2001, Zlotnick et al., 2001, Brown et al., 2014).”

“The life event tradition focuses on discrete, observable, and objectively reportable life changes that are relatively infrequent (e.g., marriage, divorce, or job loss) and require significant adjustment on the part of the individual (e.g., Dohrenwend, 2006).”

“These second-generation inventories have been found to be more reliable than traditional checklists (see Dohrenwend, 2006, for a more detailed discussion), and thus should be used in preference over the latter when more intensive life stress interviews are not a possibility.”

“Stressful life events are defined as occurrences that require readjustment in people’s usual activities.(6) Stressful life events have psychological as well physiological consequences.”

“In this study, we used the total number of events experienced as the measure, because those scores obtained by evaluating the degree of stress experienced can easily be contaminated by depressive symptoms and cognitive styles (Dohrenwend 2006).”

“A limitation of this study is that the life events were measured retrospectively, without regard to contextual information, and were based on self-reports [36].”

“Besides the genetic background stressful life events and environmental factors significantly contribute to the development of depression as well (Paykel, 1994, 2001a,b; Dohrenwend, 2006; Fountoulakis, 2004).”

“Further, the self-report nature of this study’s measurements might have yielded biased estimates, given the known confounds between mental health status and reports of stress (Dohrenwend, 2006; Meyer, 2003a).”

“However, given that comprehensive interviews that rely on objective definitions of adversity allow for a more precise assessment [24, 26] and may be better suited for delineating more specific models of the effects of adversity exposures (e.”

“In addition, a large literature exists that has shown the reliability and validity of the core questions and interviewing procedures on which the STRAIN is based (for reviews, see Dohrenwend, 2006; Hammen, 2005; Monroe, 2008; Monroe, Slavich, & Georgiades, 2009).”

“Interview-based measures can be time-consuming and costly, though, and self-report questionnaires often lack item specificity and validity (Cohen, Kessler, Underwood, & Gordon, 1997; Dohrenwend, 2006; Shields & Slavich, 2017).”

“Substantial evidence indicates that objectivemeasures of stressful experiences aswell as information on the context of the experience is necessary to fully analyze and interpret stress in mental health research (Dohrenwend, 1998, 2006).”