The association between cumulative adversity and mental health: considering dose and primary focus of adversity



The study addressed the dose–response model in the association of cumulative adversity with mental health.


Data of 1,725 participants aged 50+ were drawn from the Israeli component of the Survey of Health, Ageing, and Retirement in Europe. Measures included an inventory of potentially traumatic events, distress (lifetime depression, depressive symptoms), and well-being (quality of life, optimism/hope).


The maximal effect of cumulative trauma emerged in the contrast between 0–2 and 3+ events, where the higher number of events related to higher distress but also to higher well-being. While self-oriented adversity revealed no, or negative, association with well-being, other-oriented adversity revealed a positive association.


The study suggests an experiential dose of cumulative adversity leading to a co-activation of distress and well-being. The source of this co-activation seems to be other-oriented adversity.

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The Israeli component of the Survey of Health, Ageing, and Retirement in Europe was funded by the US National Institute on Aging (R21 AG2516901), by the German-Israeli Foundation for Scientific Research and Development (G.I.F.), and by the National Insurance Institute of Israel. We are grateful to Howard Litwin for facilitating our study with the data. We thank Rany Abend for his assistance.

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Correspondence to Giora Keinan or Amit Shrira.

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Keinan, G., Shrira, A. & Shmotkin, D. The association between cumulative adversity and mental health: considering dose and primary focus of adversity. Qual Life Res 21, 1149–1158 (2012).

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  • Dose–response
  • Cumulative adversity
  • Self-oriented adversity
  • Other-oriented adversity
  • SHARE-Israel