BASIC ASSUMPTIONS

• 1. EXTERNAL ENVIRONMENT LEADS TO MENTAL CONDITION

• LIFE EVENTS, CHRONIC STRAINS, SOCIAL ROLES

Yearly rates of severe events and depression in six population (Brown 1998).

-45-35-25-15

-55

152535455565758595

Rate

per 100

women

87

3121

118

0

30.0

15.1 10.3 10.6 11.02.4

Zimbabwe London BilbaoOuter Hebrides

Spanishrural

Basquerural

Severe events

Case depression

.

Stressful Life Events and Rates of Depression

ASSUMPTIONS (CONT.)

• 2. CURRENT ENVIRONMENT MOST IMPORTANT

• 3. GROUPS HAVE DIFFERENT EXPOSURE TO STRESSORS AND RATES OF DISORDER

• 4. FOCUS ON COMMUNITY POPULATIONS NOT CLINICAL CASES

• 5. DISTRESS IS OFTEN COLLECTIVE AND NOT INDIVIDUAL

I. DURKHEIM

• SUICIDE (1897)

• SUICIDE RATES VARY SYSTEMATICALLY WITH SOCIAL CONDITIONS

CAUSES OF SUICIDE

• 1. LACK OF CONNECTION TO SOCIAL GROUPS AND MEANING SYSTEMS - EGOISTIC (ALTRUISTIC)

• 2. LACK OF CONSTRAINT OVER BEHAVIOR – ANOMIC (FATALISTIC)

• FOCUS ON SOCIAL NOT INDIVIDUAL

II. MILITARY PSYCHIATRY

• LESSONS OF WWI

• HUGE PROPORTION OF PSYCHIATRIC CASUALITIES

• LED TO PRESCREENING OF ALL DRAFTEES IN WWII

MILITARY PSYCHIATRY

• HUGE PROPORTION OF PSYCHIATRIC CASUALTIES IN WWII

• OVERALL 25%; OVER 70% FOR LONG STRETCHES

• AVERAGE SOLDIER WOULD BREAKDOWN AFTER 80 DAYS OF CONTINUOUS COMBAT

EFFECT OF COMBAT

• HIGHLY PRESCREENED• NO INDIVIDUAL PREDISPOSITIONS

PREDICTED BREAKDOWNS• WHAT DID?• LENGTH OF COMBAT BEST

PREDICTOR• CAUSE WAS ENVIRONMENTAL NOT

INDIVIDUAL

EFFECT OF COMBAT

• TREATMENT NEAR UNITS

• 2/3 RETURNED TO UNITS WITHIN 2 DAYS

• MINORITY MORE LASTING PROBLEMS (PTSD)

MAJOR REORIENTATION

• ENVIRONMENT CAUSE OF MUCH DISORDER - “EVERYONE HAS THEIR BREAKING POINT”

• FOCUS ON ENTIRE POPULATION NOT JUST TREATED CASES

• TREATMENT SHOULD BE IN COMMUNITY NOT HOSPITALS

III. STRESS THEORY

• AMBIGUITY OF “STRESS”

• HERE: STRESSORS = CAUSES

• DISTRESS = EFFECTS

HANS SELYE

HANS SELYE

• PHYSIOLOGIST

• STUDIED STRESS IN ANIMALS

• STRESS RESULTED FROM DISTURBANCES OF EQUILIBRIUM - CHANGE

SELYE (CONT.)

• ENVIRONMENTAL CAUSES – TEMPERATURE, FOOD, CROWDING

• STRESSORS CAUSE PROBLEMS BY WEAKENING IMMUNE SYSTEM

• GAS - GLOBAL ADAPTATION SYNDROME

• ANY DISTURBANCE OF EQUILIBRIUM CAN LEAD TO GAS

HOLMES AND RAHE

• MILITARY PSYCHIATRISTS

• TRANSLATE STRESS THEORY AND WWII TO CIVILIANS

• STARTED WITH SAILORS

• MANY OTHER GROUPS

• SRRS IN 1968

HOLMES AND RAHE SRRS

• STANDARDIZED SCORE

• NEGATIVE - DEATH, DIVORCE, JAIL

• AND POSITIVE - MARRIAGE, HAVE CHILD, XMAS

• BOTH CAN DISTURB EQUILIBRIUM

• FOCUS ON CHANGES

• SUM NUMBER AND GET SCORE

H+R LIFE EVENTS

• RELATED TO BOTH MENTAL AND PHYSICAL HEALTH (NON-SPECIFIC)

• LESS THAN 150 - FEW HEALTH PROBLEMS

• OVER 300 - 80% HAVE PROBLEMS

• OVERALL MODERATE CORRELATION WITH HEALTH PROBLEMS

CRITICISMS OF SRRS

• IGNORES CONTEXT AND MEANING

• ONLY NEGATIVE ARE STRESSFUL

• WHAT IS CAUSE AND EFFECT?

• NOT UPDATED

• IGNORES DIVERSITY OF RESPONSES

GRADE DISTRIBUTION

• 90 – 100 A N = 65

• 88 B+ N = 17

• 80 - 86 B N = 75

• 76 - 78 C+ N = 21

• 60 - 74 C N = 64

• 50 - 58 D N = 11

• 32 - 48 F N = 4

GRADE DISTRIBUTION

• 90 – 100 A N = 45

• 88 B+ N = 15

• 80 - 86 B N = 69

• 76 - 78 C+ N = 36

• 60 - 74 C N = 65

• 50 - 58 D N = 20

• 32 - 48 F N = 11