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Effects of positive and negative life events on time to depression onset: an analysis of additivity and timing

  • E. Frank (a1), X. M. Tu (a1), B. Anderson (a1), C. F. Reynolds (a1), J. F. Karp (a1), A. Mayo (a1), A. Ritenour (a1) and D. J. Kupfer (a1)
  • DOI:
  • Published online: 01 July 2009

While the relationship of life events to depression onset has occupied researchers for almost a quarter of a century, few studies have attempted to account for either the temporal patterning of events relative to episode onset, or, the effect of multiple events in a study period. In this report, we attempt to address the issues of timing of events, multiple events (both positive and negative) and multiple aspects (both positivity and negativity) of single events on latency time to depression onset, while simultaneously accounting for possible decay in the effects of events over time. We use the proportional hazards approach to model the effects of life events and consider modelling the change in impact of events with the passage of time.

After interviewing 142 recurrent unipolar patients using the Life Events and Difficulties Schedule, we rated severity and positivity of life events reported during the 6-month period prior to onset. As we hypothesized, additional life events occurring after an initial provoking agent level event significantly alter the risk of illness onset. Additional severely threatening events decrease the time to onset, but positive events do not appear to delay onset. Interestingly, seemingly neutral events had a highly significant effect in shortening the time to onset. We note the many limitations imposed on the interpretation of these findings related to the selected group of subjects studied and encourage those who have more generalizable data to apply these methods of analysis.

Corresponding author
1Address for correspondence: Dr Ellen Frank, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213., USA.
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G. W. Brown (1993). Life events and affective disorder: replications and limitations. Psychosomatic Medicine 55, 248259.

G. W. Brown , F. Sklair , T. O. Harris & J. L. T. Birley (1973). Life events and psychiatric disorders, part I. Some methodological issues. Psychological Medicine 3, 7487.

G. W. Brown , A. Bifulco , T. O. Harris & L. Bridge (1986 a). Life stress, chronic psychiatric symptoms and vulnerability to clinical depression. Journal of Affective Disorders 11, 119.

G. W. Brown , A. Bifulco & T. O. Harris (1986 b). Life events. vulnerability and onset of depression: some refinements. British Journal of Psychiatry 150, 3042.

G. W. Brown , L. Lemyre & A. Bifulco (1992). Social factors and recovery from anxiety and depressive disorders: a test of specificity. British Journal of Psychiatry 161, 4454.

G. W. Brown , T. O. Harris & C. Hepworth (1994). Life events and ‘endogenous’ depression: a puzzle re-examined. Archives of General Psychiatry 51, 525534.

E. Frank , B. Anderson , C. F. Reynolds , A. Ritenour & D. J. Kupfer (1994). Life events and the RDC endogenous subtype: a confirmation of the distinction using the Bedford College Methods. Archives of General Psychiatry 51, 519524.

M. Hamilton (1960). A rating scale for depression. Journal of Neurology and Neurosurgery Psychiatry 23, 5662.

J. F. Karp , E. Frank , B. Anderson , C. George , C. F. Reynolds , S. Mazumdar & D. J. Kupfer (1993). Time to recovery in late-life depression: analysis of effects of demographic, treatment, and life-events measures. Depression 1, 250256.

N. M. Laird & J. H. Ware (1982). Random-effects models for longitudinal data. Biometrics 38, 963974.

P. G. Surtees & J. G. Ingham (1980). Life stress and depressive outcome: application of a dissipation model to life events. Social Psychiatry 15, 2131.

P. G. Surtees , J. Kiff & D. Rennie (1981). Adversity and mental health: an empirical investigation of their relationship. Acta Psychiatrica Scandinavia 64, 177192.

P. G. Surtees , P. McM. Miller , J. G. Ingham , N. B. Kreitman , D. Rennie & S. P. Sashidharan (1986). Life events and the onset of affective disorder: a longitudinal general population study. Journal of Affective Disorders 10, 3750.

C. Tennant , P. Bebbington & J. Hurry (1981). The short-term outcome of neurotic disorders in the community: the relation of remission to clinical factors and to ‘neutralizing’ life events. British Journal of Psychiatry 139, 213220.

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