Stressors and aetiology of depression: a comment on Hällström, March 11, 1987

Effects of Family Structure on Mental Health of Children: A Preliminary Study

BACKGROUND

To find any association between family structure and rates of hospitalization as an indicator for behavior problems in children.

METHODS

Retrospective chart review of 154 patients who were admitted to the preadolescent unit at Lincoln Prairie Behavioral Health Center between July and December 2012.

RESULTS

We found that only 11% of children came from intact families living with biological parents while 89% had some kind of disruption in their family structure. Two-third of the children in the study population had been exposed to trauma with physical abuse seen in 36% of cases. Seventy-one percent had reported either a parent or a sibling with a psychiatric disorder. Children coming from biologically family were less likely to have been exposed to trauma. Children coming from single/divorced families were less likely to have been exposed to sexual abuse but more likely to have a diagnosis of attention deficit hyperactivity disorder (ADHD) compared to other types of families. Strong association was found between exposure to trauma and certain diagnoses in respect to hospitalization. ADHD predicted a 4 times likelihood of having more than one previous hospitalization, with mood disorder, oppositional defiant disorder, and physical abuse increasing the risk by more than twice.

CONCLUSIONS

Significant differences in family structure were demonstrated in our study of children being admitted to inpatient psychiatric hospitalization. The presence of trauma and family psychiatric history predicted higher rates of readmission. Our study highlighted the role of psychosocial factors, namely, family structure and its adverse effects on the mental well-being of children.

Physical activity, but not environmental complexity, facilitates HPA axis response habituation to repeated audiogenic stress despite neurotrophin mRNA regulation in both conditions

Stress exacerbates several physical and psychological disorders. Voluntary exercise can reduce susceptibility to many of these stress-associated disorders. In rodents, voluntary exercise can reduce hypothalamic-pituitary-adrenocortical (HPA) axis activity in response to various stressors as well as upregulate several brain neurotrophins. An important issue regarding voluntary exercise is whether its effect on the reduction of HPA axis activation in response to stress is due to the physical activity itself or simply the enhanced environmental complexity provided by the running wheels. The present study compared the effects of physical activity and environmental complexity (that did not increase physical activity) on HPA axis habituation to repeated stress and modulation of brain neurotrophin mRNA expression. For six weeks, male rats were given free access to running wheels (exercise group), given 4 objects that were repeatedly exchanged (increased environmental complexity group), or housed in standard cages. On week 7, animals were exposed to 11 consecutive daily 30-min sessions of 98-dBA noise. Plasma corticosterone and adrenocorticotropic hormone were measured from blood collected directly after noise exposures. Tissue, including brains, thymi, and adrenal glands was collected on Day 11. Although rats in both the exercise and enhanced environmental complexity groups expressed higher levels of BDNF and NGF mRNA in several brain regions, only exercise animals showed quicker glucocorticoid habituation to repeated audiogenic stress. These results suggest that voluntary exercise, independent from other environmental manipulations, accounts for the reduction in susceptibility to stress.

A comparison of life events in patients with unipolar disorder or bipolar disorder and controls

OBJECTIVE

The present study aimed to explore the association between stressful life events (LEs) and the development of affective psychopathology.

METHOD

Thirty patients with unipolar disorder and 30 patients with bipolar disorder were compared to 60 matched healthy controls in regard to the rate of stressful LEs. Assessment measures included the Beck Depression Inventory, the Adult Life Events Questionnaire, and the Childhood Life Events List.

RESULTS

The entire sample of affective patients had more LEs in general, more negative LEs, and more loss-related LEs in the year preceding their first depressive episode as compared with normal controls. Subjects with unipolar disorder had more positive LEs and more achievement LEs, whereas subjects with bipolar disorder had more uncontrollable LEs in the year preceding the first depressive episode. The relationship between LEs and manic episodes was prominent in the year preceding the first manic episode, with subjects with bipolar disorder reporting more LEs in general and more ambiguous events in that year. Almost no significant differences on LE frequency were observed in the year before the last depressive and manic episodes in the patient groups with unipolar and bipolar disorder. A significant relationship was found between childhood LEs and the development of affective disorders in adulthood, with patients with unipolar disorder exhibiting less positive and achievement LEs.

CONCLUSIONS

In both the unipolar and the bipolar groups, the major impact of LEs on the onset of affective disorders was found in the year before the first depressive or manic episodes. This suggests that the accumulation of stressful LEs at this crucial period contributes to the precipitation of a pathological response mechanism. Once established, this mechanism would be reactivated in the future by even less numerous and less severe stressors, compatible with the kindling hypothesis.

A comparison of life events in suicidal and nonsuicidal adolescents and young adults with major depression and borderline personality disorder

This retrospective study assessed the correlations between various types of stressful life events (SLE) and suicidal adolescents and young adults with major depressive disorder (MDD;22), borderline personality disorder (BPD;18), and nonsuicidal adolescents and young adults with MDD (20) and BPD (20). A community control group of 40 participants was also evaluated. The measurements used were Life Events Checklist, Childhood Sexual Abuse Questionnaire, Suicide Risk Scale, and Beck Depression Inventory. Suicidal participants experienced a greater number of total lifetime negative events compared with nonsuicidal participants, irrespective of diagnosis, including a greater amount of negative life events in the year before the suicide attempt compared with the year before referral in the nonsuicidal group. Participants with MDD reported more lifetime negative events than participants with BPD. Suicidal adolescents did not have more lifetime death-related SLE than nonsuicidal adolescents, but MDD adolescents experienced more lifetime death-related SLE than BPD adolescents. Suicidal BPD participants reported more lifetime sex abuse-related SLE compared with nonsuicidal BPD participants. The complexity of the relationships between SLE and the interplay of both suicidality and underlying psychopathology is discussed with the relevant treatment implications.

Stressful life events and major depressive disorders

This study examined the relationship between stressful life events (SLE) and recurrent major depressive disorders. Three groups of 50 subjects were assessed: Patients with recurrent major depressive disorder with melancholic features; patients with borderline personality disorder; and healthy controls. Interviews for AXIS I and II DSM-IV Disorders were used for diagnosis. The Israel Psychiatric Epidemiology Research Interview Life Event Scale and the Coddington Life Events Schedule were used to measure life events and were confirmed with an interview. Beck Depression Inventory was also administered. The proportions of loss-related events in childhood and in the year preceding the first episode were higher in the depressed group than in the control groups during the same time period. Proportions of SLE, uncontrolled and independent events were also more common in the depressed patients in the year preceding the first episode. No category of SLE differentiated the groups following the first depressive episode. The study's conclusion is that SLE play an important role in the onset of depressive disorders. There are specific kinds of SLE that occur in childhood and in the year preceding the first episode. SLE has a less significant role in the maintenance of this illness.

Is onset of Tourette syndrome influenced by life events?

The aim of this study is to investigate the possible relationship between stressful life events, personality, and onset of Tourette syndrome in children. The study group included 93 subjects aged 7-18 years: 41 with Tourette syndrome (TS), 28 with obsessive-compulsive disorder (OCD), and 24 healthy controls. Diagnoses were based on the Child Schedule for Schizophrenia and Affective Disorders (K-SADS). All children were tested with the Screen for Child Anxiety Related Emotional Disorders, Children's Yale Brown Obsessive Compulsive Scale, Beck Depression Inventory or Children's Depression Inventory, the Life Experience Survey, and the Junior Temperament and Character Inventory. The findings were compared among the groups. Subjects with Tourette syndrome and healthy controls had significantly less stressful life events than subjects with (OCD). There were no significant differences between the TS subjects and the healthy controls. This finding applied to total lifetime events, total lifetime negative events, and events in the year before and after illness onset. Subjects with TS and the healthy controls also showed a significantly lesser impact of life events than subjects with OCD. The Tourette syndrome group showed a significantly lesser impact of stressful life events than controls. Harm avoidance tended to be higher in the patients with Tourette syndrome and comorbid attention deficit hyperactivity disorder and obsessive-compulsive disorder than in patients with Tourette syndrome only. There seemed to be no association between life events, diagnosis, and personality. Although there is some research suggesting that tics can be influenced by the environment, the onset of Tourette syndrome does not seem to be related to stressful life events, nor to an interaction between stressful life events and personality.

Hosts to adversity. II. Psychiatric sequelae

This article examines the relationship between event rates, demographic and psychosocial factors and the onset of psychiatric disorder according to Research Diagnostic Criteria in the context of a longitudinal general population survey of women. Life events were classified according to ratings of their severity and dependence. Analyses revealed the extent to which case inception was associated with risk factor status, as determined from respondents when psychiatrically well, and the complex interrelationship between the factors according to powerful statistical modelling techniques.