Types of stressful life event and the onset of anxiety and depressive disorders

The notions of loss and danger are briefly described. Two groups of raters in London and Canberra were shown to be reliable in rating the degree of loss nd the degree of danger associated with a sample of life events previously rated as 'severe' on a contextual measure of long-term threat. The life events were reported by 164 young women attending a general practitioner in London. The women were interviewed by a psychiatrist using the Present State Examination. Their psychiatric symptoms were rated by a team of raters who were ignorant of the life events reported by the young women. Three types of cases of psychiatric disorder of recent onset were diagnosed: depression, anxiety, and mixed depression/anxiety. The frequency of life events reported by these three types of cases as occurring in the year before the onset of their disorder was compared with the frequency of events in the same time period reported by a group of women without severe psychiatric disorder. The results were used to argue that severe loss was a causal agent in the onset of depressive disorder and severe danger was a causal agent in the onset of anxiety states in this sample. Cases of mixed depression/anxiety were more likely to report both a severe loss and a severe danger before onset. This supported the argument for recognizing a distinct group of mixed disorders in the classification of depressive illnesses.