Skip to main content
Log in

Stressful life events preceding the acute onset of schizophrenia: A cross-national study from the World Health Organization

  • Published:
Culture, Medicine and Psychiatry Aims and scope Submit manuscript

Abstract

This study reports on the findings from a WHO sponsored cross-national investigation of life events and schizophrenia. Data are presented from a series of 386 acutely ill schizophrenic patients selected from nine field research centers located in developing and developed countries (Aarhus, Denmark; Agra, India; Cali, Colombia; Chandigarh, India; Honolulu, USA; Ibadan, Nigeria; Nagasaki, Japan; Prague, Czechoslovakia; Rochester, USA). On a methodological level, the study demonstrates that life event methodologies originating in the developed countries can be adapted for international studies and may be used to collect reasonably reliable and comparable cross-cultural data on psychosocial factors affecting the course of schizophrenic disorders. Substantive findings replicate the results of prior studies which conclude that socioenvironmental stressors may precipitate schizophrenic attacks and such events tend to cluster in the two to three week period immediately preceding illness onset.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • American Psychiatric Association (APA) 1980Diagnostic and Statistical Manual, Third Edition. Washington D.C.: APA.

    Google Scholar 

  • Bebbington, P. 1980Causal Models and Logical Inference in Epidemiology and Psychiatry. British Journal of Psychiatry. 136: 317–325.

    Google Scholar 

  • Birley, J. and G. W. Brown 1970Crisis and Life Changes Preceding the Onset or Relapse of Acute Schizophrenia: Clinical Aspects. British Journal of Psychiatry. 16: 327–333.

    Google Scholar 

  • Brown, G. W. 1974Meaning, Measurement and Stress of Life Events. In Dohrenwend, B. S. and Dohrenwend, B. P. (eds.), Stressful Life Events: Their Nature and Effects. New York: John Wiley and Sons.

    Google Scholar 

  • Brown, G. W. and J. Birley 1968Crisis and Life Changes and the Onset of Schizophrenia. Journal of Health and Social Behavior 9: 203–214.

    Google Scholar 

  • Brown, G. W., J. Birley and J. Wing 1972Influence of Family Life on the Course of Schizophrenia: A Replication. British Journal of Psychiatry 121: 241–258.

    Google Scholar 

  • Brown, G. W. and T. Harris 1978The Social Origins of Depression. London: Tavistock.

    Google Scholar 

  • Brown, G. W., T. Harris and J. Peto 1973a Life Events and Psychiatric Disorders II: The Nature of the Causal Link. Psychological Medicine 3: 159–176.

    Google Scholar 

  • Brown, G. W., et al. 1973b Life Events and Psychiatric Disorders I: Some Methodological Issues. Psychological Medicine 3: 74–87.

    Google Scholar 

  • Day, R. 1981a Life Events and Schizophrenia: the ‘Triggering’ Hypothesis. Acta Psychiatrica Scandinavica 135: 420–426.

    Google Scholar 

  • Day, R. 1981b Recent Directions in Life Stress Research from a Public Health Perspective. In B. S. Dohrenwend and B. P. Dohrenwend (eds.), Stressful Life Events and Their Contexts. New York: Prodist.

    Google Scholar 

  • Day, R. 1982Research in the Course and Outcome of Schizophrenia in Traditional Cultures: Some Implications for Psychiatry in the Developed Countries. In M. Goldstein (ed.), Preventive Intervention in Schizophrenia: Are We Ready? Rockville, Md.: NIMH.

    Google Scholar 

  • Day, R. 1986Social Stress and Schizophrenia: From the Concept of Recent Life Events to the Notion of Toxic Environments. In G. Burrows et al. (ed.), Handbook of Schizophrenia Studies. Amsterdam: Elsevier Science Publishers.

    Google Scholar 

  • Doan, J., et al. 1981Parental Communication Deviance and Affective Style. Archives of General Psychiatry 38: 679–685.

    Google Scholar 

  • Doan, J., et al. 1985 Parental Affective Style and the Treatment of Schizophrenia. Archives of General Psychiatry 42: 34–42.

    Google Scholar 

  • Dohrenwend, B. P. 1975Sociocultural and Sociopsychological Factors in the Genesis of Mental Disorders. Journal of Health and Social Behavior 16: 365–392.

    Google Scholar 

  • Dohrenwend, B. P., and G. Egri 1981 Recent Stressful Life Events and Episodes of Schizophrenia. Schizophrenia Bulletin 7: 12–23.

    Google Scholar 

  • Dohrenwend, B. P., et al. 1980Mental Illness in the United States. New York: Praeger.

    Google Scholar 

  • Dohrenwend, B. S. and B. P. Dohrenwend 1981Life Stress and Illness: A Formulation of the Issues. In B. S. Dohrenwend and B. P. Dohrenwend (eds.), Stressful Life Events and Their Contexts. New York: Prodist.

    Google Scholar 

  • Fairbank, D. and R. Hough 1981Cross-Cultural Differences in the Perception of Life Events. In Dohrenwend, B. S. and B. P. Dohrewend (ed.), Stressful Life Events and their Contexts. New York: Prodist.

    Google Scholar 

  • Finley-Jones, R. and G. W. Brown 1981 Types of Stressful Life Events and the Onset of Anxiety and Depressive Disorders. Psychological Medicine 11: 803–815.

    Google Scholar 

  • Gottesman, I. and J. Shields 1976A Critical Review of Recent Adoption, Twin and Family Studies of Schizophrenia: Behavioral Genetics Perspectives. Schizophrenia Bulletin 2: 360–401.

    Google Scholar 

  • Gottesman, I. and J. Shields 1982Schizophrenia: The Epigenetic Puzzle. London: Cambridge University Press.

    Google Scholar 

  • Harder, D., et al. 1980Life Events and Psychopathology Severity Among First Psychiatric Admissions. Journal of Abnormal Psychology 89: 165–180.

    Google Scholar 

  • Hinkel, L. 1974The Effect of Exposure to Cultural Change, Social Change and the Effects of Interpersonal Relations in Health. In B. P. Dohrenwend and B. S. Dohrenwend, Stressful Life Events: Their Nature and Effects. New York: John Wiley and Sons.

    Google Scholar 

  • Hirsch, S., et al. 1973Outpatient Maintenance of Chronic Schizophrenic Patients with Long Acting Fluphenazine. British Medical Journal 5854: 633–637.

    Google Scholar 

  • Hogarty, G. 1975 Informant Ratings of Community Adjustment. In E. Waskow and M. Parloff (eds.), Psychotherapy Change Measures. Rockville, Md.: NIMH.

    Google Scholar 

  • Holmes, T. and R. Rahe 1968 The Social Readjustment Rating Scale. Journal of Psychosomatic Research 11: 213–218.

    Google Scholar 

  • Hudgens, R. 1974Personal Catastrophe and Depression. In B. P. Dohrenwend and B. S. Dohrenwend (eds.), Stressful Life Events: Their Nature and Effects. New York: John Wiley and Sons.

    Google Scholar 

  • Jablensky, A., et al. 1980 WHO Collaborative Study on Impairments and Disabilities Associated with Schizophrenic Disorders: A Preliminary Communication on the Objectives and Methods. In E. Strömgren et al. (eds.), Epidemiological Research as the Basis for the Organization of Extramural Psychiatry. Copenhagen: Munksgaard.

    Google Scholar 

  • Jacobs, S. C. and J. Myers 1976 Recent Life Events and Acute Schizophrenic Psychoses: A Controlled Study. Journal of Nervous and Mental Disease 162: 75–87.

    Google Scholar 

  • Jenkins, C. D., M. Hurst and R. Rose 1979 Life Changes: Do People Really Remember? Archives of General Psychiatry 36: 379–384.

    Google Scholar 

  • Katz, M. M. and S. B. Lyerly 1963 Methods of Measuring Adjustment and Social Behavior in the Community. Psychological Reports 13: 503–535.

    Google Scholar 

  • Katz, M. M., et al. 1966 Behavior Patterns of Schizophrenics in the Community. In M. Lorr (ed.), Explorations in Typing Psychotics. New York: Pergamon.

    Google Scholar 

  • Kuipers, L 1979 Expressed Emotion: A Review. British Journal of Clinical and Social Psychology 18: 237–243.

    Google Scholar 

  • Leff, J. P. and C. Vaughn 1980 The Interaction of Life Events and Relatives' Expressed Emotion in Schizophrenia and Depressive Neuroses. British Journal of Psychiatry 136: 146–153.

    Google Scholar 

  • Leff, J. P. and C. Vaughn 1981 Role of Maintenance Therapy and Relatives Expressed Emotion in Relapse of Schizophrenia: A Two Year Follow-Up. British Journal of Psychiatry 139: 102–104.

    Google Scholar 

  • Leff, J. P., et al. 1973Life Events and Maintenance Therapy in Schizophrenic Relapse. British Journal of Psychiatry 123: 659–660.

    Google Scholar 

  • Leff, J. P. and J. Wing 1971 Trial of Maintenance Therapy in Schizophrenia. British Medical Journal 5775: 599–604.

    Google Scholar 

  • Leff, J. P., et al. 1982 A Controlled Trial of Social Intervention in the Families of Schizophrenic Patients. British Journal of Psychiatry 141: 121–134.

    Google Scholar 

  • Leff, J. P., et al. 1985 Influence of Relatives' Expressed Emotion on the Course of Schizophrenia in Chandigarh. Manuscript.

  • Lloyd, C. 1980Life Events and Depressive Disorder Reviewed. Archives of General Psychiatry 37: 520–548.

    Google Scholar 

  • Malzacher, M., J. Merz and D. Ebonther 1981 Einscheidende Lebensereignisse im Vorfeld akuter schizophrener Episoden. Archiv Für Psychiatrie und Nervenkrankheiten 230: 227–242.

    Google Scholar 

  • Mechanic, D. 1968Medical Sociology. New York: Basic Books.

    Google Scholar 

  • Mechanic, D. 1974Discussion of Research Programs on Relations Between Stressful Life Events and Episodes of Physical Illness. In B. P. Dohrenwend and B. S. Dohrenwend (eds.), Stressful Life Events: Their Nature and Effects. New York: John Wiley and Sons.

    Google Scholar 

  • Menon, D., et al. 1985 Distribution of Expressed Emotion Components Among Relatives of Schizophrenic Patients in Aarhus and Chandigarh. Manuscript.

  • Myers, J., J. Lindenthal and M. Pepper 1971Life Events and Psychiatric Impairment. Journal of Nervous and Mental Disease. 152: 149–157.

    Google Scholar 

  • Myers, J., et al. 1972Life Events and Mental Status: A Longitudinal Study. Journal of Health and Social Behavior 13: 398–406.

    Google Scholar 

  • Neugebauer, R. 1983Reliability of Life Events Interviews with Outpatient Schizophrenics. Archives of General Psychiatry 40: 379–383.

    Google Scholar 

  • Noreik, K. 1970Follow-Up and Classification of Functional Psychoses with Special Reference to Reactive Psychoses. Oslo: Universitetsforlaget.

    Google Scholar 

  • Parker, G., et al. 1982 Parental Representations of Schizophrenics and their Association with the Onset and Course of Schizophrenia. British Journal of Psychiatry 141: 573–581.

    Google Scholar 

  • Rabkin, J. 1980Stressful Life Events and Schizophrenia: A Review of the Research Literature. Psychological Bulletin 87: 408–425.

    Google Scholar 

  • Ryan, T., B. Joiner and B. Ryan 1982Minitab: Reference Manual. Boston, Ma.: Duxbury Press.

    Google Scholar 

  • Sartorius, N., et al. 1972Preliminary Communication on the WHO International Pilot Study of Schizophrenia. Psychological Medicine 2: 422–475.

    Google Scholar 

  • Sartorius, N., et al. 1977 Preliminary Communication on the Two-Year Follow-Up of the Patients Included in the WHO IPSS. Psychological Medicine 7: 529–541.

    Google Scholar 

  • Saxena, S., D. Mohan and S. Duke 1983 Reliability of Life Events Information: A Study of 83 Psychiatric Patients. Social Psychiatry 18: 177–179.

    Google Scholar 

  • Schless, A. and J. Mendels 1978 The Value of Interviewing Family and Friends in Assessing Life Stressors. Archives of General Psychiatry 35: 565–567.

    Google Scholar 

  • Steinberg, H. and J. Durell 1968A Stressful Social Situation as a Precipitant of Schizophrenic Symptoms: An Epidemiological Study. British Journal of Psychiatry 114: 1097–1105.

    Google Scholar 

  • Strauss, J. and W. Carpenter 1981Schizophrenia. New York: Plenum Press.

    Google Scholar 

  • Strömgren, E. 1965Schizophreniform Psychoses. Acta Psychiatrica Scandinavica 42: 483–488.

    Google Scholar 

  • Vaughn, C. and J. Leff 1976a The Influence of Family and Social Factors on the Course of Psychiatric Patients. British Journal of Psychiatry 129: 125–137.

    Google Scholar 

  • Vaughn, C. and J. Leff 1976b The Measurement of Expressed Emotion in the Families of Psychiatric Patients. British Journal of Social and Clinical Psychology 15: 157–165.

    Google Scholar 

  • Wing, J. K. 1978a Reasoning About Madness. New York: Oxford University Press.

    Google Scholar 

  • Wing, J. K. (ed.) 1978b Schizophrenia: Towards a New Synthesis. London: Academic Press.

    Google Scholar 

  • Wing, J. K. 1978c The Social Context of Schizophrenia. American Journal of Psychiatry 135: 1333–1339.

    Google Scholar 

  • Wing, J. K. and G. W. Brown 1970Schizophrenia and Institutionalism. London: Cambridge University Press.

    Google Scholar 

  • Wing, J. K., J. Cooper and N. Sartorius 1974The Present State Examination. New York: Oxford University Press.

    Google Scholar 

  • World Health Organization (WHO) 1973The International Pilot Study of Schizophrenia. Geneva: WHO.

    Google Scholar 

  • World Health Organization (WHO) 1974The International Classification of Diseases: Glossary to the Section on Mental Disorders. Geneva: WHO.

    Google Scholar 

  • World Health Organization (WHO) 1978 Schizophrenia: An International Follow-up Study. London: John Wiley and Sons.

    Google Scholar 

  • World Health Organization (WHO) 1980The Research Component of the WHO Mental Health Program. Psychological Medicine 10: 175–185.

    Google Scholar 

  • Zubin, J. and B. Spring 1977Vulnerability: A New View of Schizophrenia. Journal of Abnormal Psychology 86: 103–126.

    Google Scholar 

  • Zubin, J. and S. Steinhauer 1981How to Break the Logjam in Schizophrenia: A Look Beyond Genetics. Journal of Nervous and Mental Diseases 169: 477–492.

    Google Scholar 

  • Zubin, J., J. Magaziner and S. Steinhauer 1983The Metamorphosis of Schizophrenia. Psychological Medicine 13: 551–557.

    Google Scholar 

Download references

Authors

Additional information

The paper was prepared by these authors on behalf of the collaborating investigators listed on page 196.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Day, R., Nielsen, J.A., Korten, A. et al. Stressful life events preceding the acute onset of schizophrenia: A cross-national study from the World Health Organization. Cult Med Psych 11, 123–205 (1987). https://doi.org/10.1007/BF00122563

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00122563

Keywords

Navigation