Self-esteem, life stress and psychiatric disorder.

Using a special subsample from a survey of women in Edinburgh investigations were carried out into (a) which types of life event are associated with lowered self-esteem; (b) the role of life events and self-esteem in onset of psychiatric disorder; and (c) the additional significance of prior psychiatric consultation in determining onset. Stressors involving impaired relationships with others were the only ones clearly associated with lowered self-esteem. Minor psychiatric illness was predicted by stress of uncertain outcome, and, to a lesser extent, by impaired relationship stress. Onset of major depression was best predicted by an interaction between total stress experienced and low self-esteem. There was evidence that such onset involves a pre-existing low level of self-esteem on which life stress impinges, rather than life stress generating low self-esteem and then onset. A small group of subjects characterised by low self-esteem, prior psychiatric consultation and maladaptive coping seemed to be fluctuating in and out of psychiatric illness irrespective of stress.

Life events and other factors implicated in onset and in remission of psychiatric illness in women.

Life stressors for 574 Edinburgh women were assessed for uncertain outcome, impaired relationships and other characteristics. Thirteen weeks were covered either with no illness present or before a transient episode of Research Diagnostic Criteria (RDC)-defined anxiety/depression (duration less than 13 weeks) or before a longer episode or before illness remission or during continuing illness. Exploratory analysis suggested that stressors of uncertain outcome preceded longer illness onset. Impaired relationships went with continuing illness. Stressors with neither of these, and with fewer than two other characteristics, preceded transient illness. Remaining stressors predicted remission, as did ending of long-term difficulties. Self-esteem, support, coping, previous illness and marital status also discriminated between the groups.

Life events and the onset of affective disorder. A longitudinal general population study.

This paper examines the relationship between life events (ascertained by the Bedford College method) and the onset of affective disorder (defined according to the RDC scheme) in a longitudinal general population survey of women. Fall-off in the reporting of minor events is examined and discussed. Event rates, proportions of women challenged by events, and measures of the risk of RDC disorder associated with the experience of particular events are reported. The results based upon data from an initial interview were largely consistent with those based upon follow-up data, and underpinned earlier work. For both data sets, major difficulties were associated with illness onset. Severe dependent events showed stronger effects than severe independent events but both categories were rare. New substantive findings arising from short-term general population event research are unlikely.

Suicide among hospital-treated alcoholics in Scotland, 1974-83.

Two cohorts of suicide (and undetermined deaths) in Scotland for the quinquennia 1974-78, 1979-83 were investigated. A national record linkage exercise was carried out relating the deaths to admissions for alcoholism in the preceding 5 years (minimum) to 10 years (maximum). No differences were found between the cohorts in socio-demographic or clinical characteristics at the time of initial admission. The survival time as measured from either first admission or from last discharge to death was appreciably longer in the second quinquennium. This improvement might reflect changes in the patterns of services provided for alcoholics, especially the increased emphasis on the extra-mural care.

The epidemiology of life events and long-term difficulties, with some reflections on the concept of independence.

A total of 576 women aged 18-65, drawn from an area in Edinburgh, were interviewed. Data on life events and long-term difficulties over a six-month period prior to interview were gathered and classified according to area of life, the Bedford system, the Edinburgh system, and the independence of the event or difficulty from the subject's own actions. The highest rates of Bedford system 'provoking' situations were found in the working class, among those not employed, among women with three or more children under 14, and in the separated, divorced, widowed or cohabitating group. Similar findings emerged for hopeless situations involving choice or loss. Dependent situations were four times more common in the youngest group than the oldest, and showed a high rate among those divorced, separated, widowed, or cohabiting. It is suggested that both dependent and independent life situations should be studied.

Self-esteem, vulnerability and psychiatric disorder in the community.

One hypothesis concerning the nature of the link between negative self-appraisal and certain psychological disorders is that low self-esteem may be a consequence of both early and current experiences, and may predispose to breakdown. An alternative view is that the negative self-concept is only to be found in the presence of illness, which is the primary cause. Results are reported from a community survey, confirming the influence of certain biographical factors on self-esteem in the absence of illness, whereas other factors appear to operate only after the onset of illness. Anxiety as well as depression, has effects on self-esteem.

Hospital-treated and general-population morbidity from affective disorders. Comparison of prevalence and inception rates.

In this study, we compare the rates of psychiatric disorders found among women in a random sample of the general population with those of patients referred to specialist services. Both these groups were drawn from the same geographical area. The ratio of prevalence rates is less than the ratio between inception rates in the two groups. When only those with affective disorders were considered, the results revealed that the point prevalence in the treated-disorders group was only 1% of the community-group prevalence, while the inception into care in the former group was nearly 6% of that in the latter. Single women and older women were over-represented in the hospital sample.

Self-appraisal, anxiety and depression in women. A prospective enquiry.

Depressive illness is known to be associated with low self-evaluation, but it has been suggested that there may be a reciprocal connection as well, such that low self-appraisal (in the absence of illness) makes the subsequent onset of depression more likely. A prospective study, using a community sample of 376 women, provided data about clinical state over a period of 18 months, and self-appraisal questionnaire scores were determined on two occasions separated by 6 months. There was no evidence that low self-evaluation predicted future episodes of depressive illness, except in women who reported previous psychological episodes for which they had sought medical help, and, even for those with previous episodes, much of the predictive power of low self-esteem was accounted for by individuals who were subsequently recognised to have been in the early stages of illness. Conversely, there was little evidence that prior episodes predicted future illness in people with high self-esteem. One explanation of the findings is that recurrent episodes of illness cause progressive impairment of self-appraisal, but other possibilities are also considered. Women who had recovered from illnesses detected at the first interview still had significantly less self-confidence 6 months later than those who were well throughout.

Psychiatric disorder in women from an Edinburgh community: associations with demographic factors.

The prevalence of psychiatric disorder was determined according to alternative diagnostic criteria in a random sample of 576 women from an Edinburgh community. Whichever diagnostic system was applied, significantly higher rates of disorder were found among the working class, the unemployed and women who were divorced, widowed, separated or cohabiting; in the subgroup of women who met all these conditions, up to half were found to satisfy the diagnostic criteria. The observed prevalence estimates can be explained as the effects of each demographic factor acting independently, no interaction effects being needed. Our results are discussed in relation to the findings of others, and in terms of the statistical issues involved.

Affective disorders among women in the general population and among those referred to psychiatrists. Clinical features and demographic correlates.

In a study comparing depressive disorders detected in a field survey (n = 90) with patients referred to a specialist treatment setting (n = 63), the clinical features and demographic correlates of 'cases' of affective disorders proved to be similar. However, those in treatment settings appeared to have more people achieving definite case status. Hospital-referred cases were also more likely than community cases to be older and single, and this difference persisted even after controlling for chronicity of symptoms.

Maladaptive coping reactions to stress. A study of illness inception.

Eleven ways in which people might react to life stress were studied in a sample of 576 Edinburgh women. For each item the subjects were asked whether they had reacted that way in general in the past 6 months and whether they had reacted in that way in response to any specific life stresses they had experienced. Being angry with oneself, being angry with others, rumination, use of alcohol, and use of tobacco all discriminated between those who were well and those who were psychiatrically ill at first interview and these items were formed into a 6-point scale of maladaptive reaction, based largely on specific response. The researchers conducted a follow-up analysis of 306 women who were well at first interview, 35 of whom suffered a psychiatric illness episode (23 depression, 12 anxiety) within the subsequent year. Maladaptive reaction at interview one predicted later illness inception, even after taking life stress into account. Several extraneous variables were considered, none of which could explain this effect. Maladaptive reaction seemed sometimes to lead to illness even when there was only minimal later life stress. Attempts to find coping reactions which afford protection against illness inception were unsuccessful.