Weighted versus unweighted life event scores: is there a difference?

Recent Stressful Life Events (SLE) and Adolescent Mental Health: Initial Validation of the LEIA, a New Checklist for SLE Assessment According to Their Severity, Interpersonal, and Dependent Nature

The main aim of the present study was to develop and validate a checklist for adolescents, the Life Events Inventory for Adolescents (LEIA), for screening stressful life events (SLEs) of different nature (major-minor, dependent-independent, and personal-interpersonal). The LEIA was administered together with another SLE checklist (Escala de Acontecimientos Vitales [Life Events Scale], EAV), and with measures of life satisfaction and externalizing and internalizing symptoms. The results showed that the kappa and the percentage agreement reliability indices were adequate. Regarding validity evidences, the correlations found between the LEIA and the EAV ranged from .65 to .69, and between the LEIA and the psychopathological symptoms ranged from .26 to .38. Specifically, major dependent noninterpersonal SLEs were the best predictors of externalizing psychopathology; while major independent noninterpersonal SLEs were the best predictors of internalizing symptoms and low life satisfaction. To conclude, the LEIA could be considered an adequate checklist to screen for SLEs in adolescents.

Impact of disclosure of HIV infection on health-related quality of life among children and adolescents with HIV infection

BACKGROUND

Little is known concerning the impact of HIV status disclosure on quality of life, leaving clinicians and families to rely on research of children with other terminal illnesses.

OBJECTIVES

The purpose of this work was to examine the impact of HIV disclosure on pediatric quality of life and to describe the distribution of age at disclosure in a perinatally infected pediatric population. METHODS. A longitudinal analysis was conducted of perinatally HIV-infected youth >/=5 years of age enrolled in a prospective cohort study, Pediatric AIDS Clinical Trials Group 219C, with >/=1 study visit before and after HIV disclosure. Age-specific quality-of-life instruments were completed by primary caregivers at routine study visits. The distribution of age at disclosure was summarized. Six quality-of-life domains were assessed, including general health perception, symptom distress, psychological status, health care utilization, physical functioning, and social/role functioning. For each domain, mixed-effects models were fit to estimate the effect of disclosure on quality of life.

RESULTS

A total of 395 children with 2423 study visits were analyzed (1317 predisclosure visits and 1106 postdisclosure visits). The median age at disclosure was estimated to be 11 years. Older age at disclosure was associated with earlier year of birth. Mean domain scores were not significantly different at the last undisclosed visit compared with the first disclosed visit, with the exception of general health perception. When all of the visits were considered, 5 of 6 mean domain scores were lower after disclosure, although the differences were not significant. In mixed-effects models, disclosure did not significantly impact quality of life for any domain.

CONCLUSIONS

Age at disclosure decreased significantly over time. There were no statistically significant differences between predisclosure and postdisclosure quality of life; therefore, disclosure should be encouraged at an appropriate time.

Noncancer life stresses in newly diagnosed cancer

GOALS OF WORK

Noncancer life stresses affect psychosocial stress processes and have an impact on quality of life (QOL) of the patients. However, investigating life stresses in cancer is a recent development. We evaluated the life stresses of newly diagnosed melanoma, breast cancer, and prostate cancer patients in detail and investigated their impact on QOL outcomes after localized cancer diagnosis.

MATERIALS AND METHODS

Life change events from the previous year (negative events, positive events, total impact of events, impacts of the negative events, and impacts of loss events) and chronic ongoing life strains were measured with the Life Experience Survey and the Chronic Strains Survey in newly diagnosed patients 3 months after the diagnosis. Also, perceived symptoms and QOL were measured, and in melanoma and breast cancer, these were repeated up to 2 years later.

RESULTS

Noncancer life stress was common in newly diagnosed cancer patients: Both acute and chronic life stresses were experienced by four-fifths. Loss events (fateful negative events or social loss events) were reported by one-third. Many patients had a preceding chronic illness. Along with the cancer and treatment stresses, the noncancer life stresses predicted poorer QOL, particularly psychological and depressive symptoms. Different life stresses predicted slightly different domains of QOL, and depressive symptoms tended to be predicted by several kinds of life stresses. Baseline life stresses had impact also on later QOL in breast cancer.

CONCLUSIONS

Noncancer life stresses are common among newly diagnosed cancer patients and have impact on QOL, and thus they should be taken into account in cancer care. Screening for noncancer life stresses may offer means to enhance QOL outcomes in cancer.

Negative life events: risk to health-related quality of life in children and youth with HIV infection

Children and youth with perinatally acquired HIV infection are living longer because of improved drug therapies, but they may be at risk for poor health-related quality of life (HRQOL) outcomes because of nondisease factors. Families affected by HIV disease are more likely to experience major negative life events (NLEs). The effects of NLEs, shown to impact HRQOL in children with other chronic illnesses, have not been evaluated in children with HIV infection. The primary objective of this study was to determine if NLEs occurring in the previous 12 months were associated with increased risk for poorer outcomes in three measures of HRQOL (health perception, behavior problems, and symptom distress) in a cohort of children and youth with HIV infection. The authors conducted a cross-sectional analysis of data determined in 1999 from 1,018 children and youth 5 to 21 years of age enrolled in a longitudinal follow-up study. Multivariate logistic regressions estimated the odds for worse HRQOL outcomes. Children and youth with one or more NLEs had significantly lower health perceptions, more behavior problems, and greater symptom distress than children with no reported NLEs. The occurrence of NLEs may present a significant nondisease risk for diminished HRQOL among children and youth challenged by HIV disease. Nursing efforts to support these younger patients and their families sustaining major family disruption caused by NLEs may improve overall health outcomes in this vulnerable population.

The Temperamental Determinants of Stressors as Life Changes

Behavioral genetic studies have demonstrated the heritability of many variables taken to be measures of environment and previously thought to be determined only by environment. It has been also shown that personal variables may determine the appearance of stressors understood as life changes (events). The hypothesis underlying this study predicted that the genetic factor does not contribute to the variance of subject-independent stressors, whereas in case of subject-dependent stressors the contribution of the genetic factor is essential. Further, it was hypothesized that temperamental traits that moderate the intensity of experienced stressors account for a considerable portion of the genetic variance of subject-dependent stressors. The study was conducted on 245 pairs of MZ and 219 pairs of DZ twins aged from 19 to 66. Stressors were assessed with the Polish adaptation of the Rahe 's Recent Life Changes Questionnaire. Based on two preliminary studies, life events were divided into three following categories: subject-independent life events, negative subject-dependent life events, and challenges. Temperament traits were measured by means of the Formal Characteristics of Behavior-Temperament Inventory. The data, based on structural equation models and multivariate genetic analysis, allowed for the following conclusions: (1) The variance of independent stressors can be explained by environment only, whereas the additive genetic model best fits the subject-dependent stressors. (2) Heritability of negative, subject-dependent stressors is lower than in case of challenges. (3) Temperament variables, among them especially activity, explain only one type of stressors challenges. (4) Additional analysis of data confirm the role of activity as a moderator that increases the risk of environmental effects and evokes challenges.

Emotional stress, social support and symptoms of myoarthropathy in adolescents 1The authors thank Dr. Samuel F. Dworkin for critically reviewing the manuscript and J. Hofstetter for editing the English

Myoarthropathies of the masticatory system (MAP) are a common chronic orofacial condition confronting dentists. Emotional stress is seen as one possible etiological factor of MAP in adults. However, a review of the literature reveals that the correlation between stress and MAP in adolescence has been rarely investigated. If stress is related to MAP as early as adolescence it might be an important risk factor for the course of MAP later on. The aim of this study was to assess the relationship between stress (life events, daily hassles), social support and MAP in a non-selected population of adolescents. Participants were 417 pupils 11 to 16-years old. MAP signs and symptoms were assessed by clinical examination during routine dental screening at school, negative life events, school problems and social support by questionnaires. All correlations between stress indicators and the MAP-index were significant, although low (r < .24). Social support correlated negatively with the MAP-index (r = -.14). Multiple regression analyses revealed a significant correlation between the stress indicators and the MAP-index when age and gender were included (multiple R = .27; p < .0001). Stress was a small but significant risk factor for MAP. There was no significant stress-reducing buffering effect of social support. In discriminant analyses and logistic regression about 65% of all cases were correctly classified into two groups with and without MAP. According to these results from a non-selected sample of adolescents, stress and social support are relevant factors already at the beginning of the development of MAP.

The evaluation of life event data

Data from three life event studies are compared. The interviews covered events that occurred within a period of 2 years before interview. The same inventory was used in each of the studies. Samples were drawn from depressives, myocardial infarction patients and an industrial worker population. The patient groups were interviewed twice within 4 weeks. Fewer than 50% of the total number of events reported in the retests were recorded twice. For events reported in both interviews the correlations of subjective appraisals were only moderate. There is considerable fall-off for reports of events occurring more than 6 months before interview. It was expected that the severest events would have the lowest, and the least severe ones the highest frequencies. Instead, inappropriate labels of the rating scales led to clusterings of severity ratings at their extreme points. Numbers of events and severity ratings were positively correlated with measures of depression.

Relationship of hardiness and current life events to perceived health in rural adults

The purpose of this descriptive study was to examine the relationship of hardiness and current life events to perceived health in rural adults. Instruments used included Kobasa's (1982) Hardiness Scale, SRLE (Holmes & Rahe, 1967), and Engel's (1984) Perceived Health Status. Study results were based on 162 participants responding to a mailed questionnaire. The typical respondent was a 55-year-old married male who lived on a farm or ranch. Participants with higher levels of hardiness demonstrated a better perception of their mental and social health but not physical health. The study findings did not support the buffering effects of hardiness in the presence of greater amounts of stress.

Stress, coping, family conflict, and adolescent alcohol use

This study examined alcohol use among seventh graders in relation to life events, daily hassles, the supportive quality of the family environment, coping, and anxiety. Four hundred twenty-five students participated, 228 girls and 197 boys. Stepwise regression and discriminant function analyses indicated that the students reported more alcohol use if they also reported more life events, more daily hassles, and more conflict in the family. A stress-buffering effect of low family conflict on life events could not be substantiated for extent of alcohol use. The results are discussed in the context of the developmental transitions of adolescence.

The life events stress-performance linkage: an exploratory study

For a long time, the relationship between life events, psychological adjustment, and illness has been a subject of much concern in the medical literature. Very recently, several management theorists have proposed a life events stress-performance linkage. In the present study, such a linkage was tested in a classroom setting. One hundred fifty-nine university students were asked to estimate the degree of readjustment required for each of 43 life events and, subsequently, to identify events that they had experienced during the past year. Weighted and unweighted life event stress scores were later correlated with six indices of classroom performance. As hypothesized, measures of stress collected early in the semester were inversely related to future performance. The predictive ability of the stress scores was not enhanced by using readjustment values to weight life events experienced.