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

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Abstract

Purpose

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

Method

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).

Results

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.

Conclusions

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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References

  1. Turner, R. J., & Lloyd, D. A. (1995). Lifetime traumas and mental health: The significance of cumulative adversity. Journal of Health and Social Behavior, 36, 360–376.

    Article  PubMed  CAS  Google Scholar 

  2. Green, B. L., Goodman, L. A., Krupnick, J. L., et al. (2000). Outcomes of single versus multiple trauma exposure in a screening sample. Journal of Traumatic Stress, 13, 271–286.

    Article  PubMed  CAS  Google Scholar 

  3. Schnurr, P. P., Spiro, A., Vielhauer, M. J., et al. (2002). Trauma in the lives of older men: Findings from the normative aging study. Journal of Clinical Geropsychology, 8, 175–187.

    Article  Google Scholar 

  4. Cloitre, M., Stolbach, B. C., Herman, J. L., et al. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22, 399–408.

    Article  PubMed  Google Scholar 

  5. Courtois, C. A. (2004). Complex trauma, complex reactions: Assessment and treatment. Psychotherapy: Theory, Research, Practice, Training, 41, 412–425.

    Article  Google Scholar 

  6. Dohrenwend, B. P., Turner, J. B., Turse, N. A., et al. (2006). The psychological risks of Vietnam for U. S. veterans: A revisit with new data and methods. Science, 313, 979–982.

    Article  PubMed  CAS  Google Scholar 

  7. Mollica, R. F., Mcinnes, K., Pham, T., et al. (1998). The dose-effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group. Journal of Nervous and Mental Disease, 186, 543–553.

    Article  PubMed  CAS  Google Scholar 

  8. Chipman, K. J., Palmieri, P. A., Canetti, D., et al. (2011). Predictors of posttraumatic stress-related impairment in victims of terrorism and ongoing conflict in Israel. Anxiety, Stress, and Coping, 24, 255–271.

    Article  PubMed  Google Scholar 

  9. Harvey, P. D., & Yehuda, R. (1999). Strategies to study risk for the development of PTSD. In R. Yehuda (Ed.), Risk factors for posttraumatic stress disorder (pp. 1–22). Washington, DC: American Psychiatric Press.

    Google Scholar 

  10. McNally, R. J. (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229–252.

    Article  PubMed  Google Scholar 

  11. Rosen, G. M., & Lilienfeld, S. O. (2008). Posttraumatic stress disorder: An empirical evaluation of core assumptions. Clinical Psychology Review, 28, 837–868.

    Article  PubMed  Google Scholar 

  12. Shevlin, M., Houston, J. E., Dorahy, M. J., et al. (2008). Cumulative traumas and psychosis: An analysis of the national comorbidity survey and the British psychiatric morbidity survey. Schizophrenia Bulletin, 34, 193–199.

    Article  PubMed  Google Scholar 

  13. Chapman, D. P., Whitfield, C. L., Felitti, V. J., et al. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82, 217–225.

    Article  PubMed  Google Scholar 

  14. Breslau, N., Chilcoat, H. D., Kessler, R. C., et al. (1999). Previous exposure to trauma and PTSD effects of subsequent trauma: Results from the detroit area survey of trauma. American Journal of Psychiatry, 156, 902–907.

    PubMed  CAS  Google Scholar 

  15. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  16. Breslau, N., Kessler, R. C., Chilicoat, H. D., et al. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 detroit area survey of trauma. Archives of General Psychiatry, 55, 626–632.

    Article  PubMed  CAS  Google Scholar 

  17. Shmotkin, D., & Litwin, H. (2009). Cumulative adversity and depressive symptoms among older adults in Israel: The differential roles of self-oriented versus other-oriented events of potential trauma. Social Psychiatry and Psychiatric Epidemiology, 44, 989–997.

    Article  PubMed  Google Scholar 

  18. Kira, I., Lewandowski, L., Somers, C. L., et al. (in press). The effects of trauma types, cumulative trauma, and PTSD on IQ in two highly traumatized adolescent groups. Psychological Trauma: Theory, Research, Practice, and Policy.

  19. Keyes, C. L. M. (2007). Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health. American Psychologist, 62, 95–108.

    Article  PubMed  Google Scholar 

  20. Kessler, R. C. (1997). The effects of stressful life events on depression. Annual Review of Psychology, 48, 191–214.

    Article  PubMed  CAS  Google Scholar 

  21. Krause, N. (2004). Lifetime trauma, emotional support, and life satisfaction among older adults. The Gerontologist, 44, 615–623.

    Article  PubMed  Google Scholar 

  22. Krause, N. (2005). Traumatic events and meaning in life: Exploring variations in three age cohorts. Aging and Society, 25, 501–524.

    Article  Google Scholar 

  23. Royse, D., Rompf, E. L., & Dhooper, S. S. (1993). Childhood trauma and adult life satisfaction. Journal of Applied Social Sciences, 17, 179–189.

    Google Scholar 

  24. Litwin, H., & Sapir, E. V. (2008). Israel: Diversity among population groups. In A. Börsch-Supan, A. Brugiavini, H. Jürges, et al. (Eds.), First results from the survey of health, ageing and retirement in Europe (2004–2007): Starting the longitudinal dimension (pp. 93–98). Mannheim: Mannheim Research Institute for the Economics of Aging.

    Google Scholar 

  25. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn. text revision). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  26. Lloyd, D. A., & Turner, R. J. (2003). Cumulative adversity and posttraumatic stress disorder: Evidence from a diverse community sample of young adults. American Journal of Orthopsychiatry, 73, 381–391.

    Article  PubMed  Google Scholar 

  27. Robinson, J. S., & Larson, C. (2010). Are traumatic events necessary to elicit symptoms of posttraumatic stress? Psychological Trauma: Theory, Research, Practice and Policy, 2, 71–76.

    Article  Google Scholar 

  28. Prince, M. J., Reischies, F., Beekman, A. T. F., et al. (1999). Development of the Euro-D scale—A European Union initiative to compare symptoms of depression in 14 European centres. British Journal of Psychiatry, 174, 330–338.

    Article  PubMed  CAS  Google Scholar 

  29. Hyde, M., Wiggins, R. D., & Blane, D. B. (2003). A measure of quality of life in early old age: The theory, development and properties of a needs satisfaction model (CASP-19). Aging and Mental Health, 7, 186–194.

    Article  PubMed  CAS  Google Scholar 

  30. Von Dem Knesebeck, O., Wahrendorf, M., Hyde, M., et al. (2007). Socio-economic position and quality of life among older people in 10 European countries: Results of the SHARE study. Aging and Society, 27, 269–284.

    Article  Google Scholar 

  31. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the life orientation test. Journal of Personality and Social Psychology, 67, 1063–1078.

    Article  PubMed  CAS  Google Scholar 

  32. Snyder, C. R., Harris, C., Anderson, J. R., et al. (1991). The will and the ways: Development and validation of an individual-differences measure of hope. Journal of Personality and Social Psychology, 60, 570–585.

    Article  PubMed  CAS  Google Scholar 

  33. Amit, K., & Litwin, H. (2010). The subjective well-being of immigrants aged 50 and older in Israel. Social Indicators Research, 98, 89–104.

    Article  Google Scholar 

  34. United Nations Educational Cultural Scientific Organisation (UNESCO). (1997). International standard classification of education 1997. Geneva: UNESCO.

    Google Scholar 

  35. Brickman, P., & Coates, D. (1987). Commitment and mental health. In C. B. Wortman & R. Sorrentino (Eds.), Commitment, conflict, and caring (pp. 222–276). Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  36. Staub, E., & Vollhardt, J. (2008). Altruism born of suffering: The roots of caring and helping after victimization and other trauma. American Journal of Orthopsychiatry, 78, 267–280.

    Article  PubMed  Google Scholar 

  37. Brown, S. L., Smith, D. M., Schulz, R., et al. (2009). Caregiving behavior is associated with decreased mortality risk. Psychological Science, 20, 488–494.

    Article  PubMed  Google Scholar 

  38. Roth, D. L., Perkins, M., Wadley, V. G., et al. (2009). Family caregiving and emotional strain: Associations with quality of life in a large national sample of middle-aged and older adults. Quality of Life Research, 18, 679–688.

    Article  PubMed  Google Scholar 

  39. Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, 20–28.

    Article  PubMed  Google Scholar 

  40. Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1–18.

    Article  Google Scholar 

  41. Updegraff, J. A., & Taylor, S. E. (2000). From vulnerability to growth: Positive and negative effects of stressful life events. In J. Harvey & E. Miller (Eds.), Loss and trauma: General and close relationship perspectives (pp. 3–28). Philadelphia, PA: Brunner-Routledge.

    Google Scholar 

  42. Folkman, S., & Moskowitz, J. T. (2000). Positive affect and the other side of coping. American Psychologist, 55, 647–654.

    Article  PubMed  CAS  Google Scholar 

  43. Larsen, J. T., Hemenover, S. H., Norris, C. J., et al. (2003). Turning adversity to advantage: On the virtues of the coactivation of positive and negative emotions. In L. G. Aspinwall & U. M. Staudinger (Eds.), A psychology of human strengths: Fundamental questions and future directions for a positive psychology (pp. 211–225). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  44. Cacioppo, J. T., Gardner, W. L., & Berntson, G. G. (1999). The affect system has parallel and integrative processing components: Form follows function. Journal of Personality and Social Psychology, 76, 839–855.

    Article  Google Scholar 

  45. Ryff, C. D., Singer, B., Love, G. D., et al. (1998). Resilience in adulthood and later life: Defining features and dynamic processes. In J. Lomranz (Ed.), Handbook of aging and mental health: An integrative approach (pp. 69–99). New York: Plenum.

    Google Scholar 

  46. Shmotkin, D. (2005). Happiness in face of adversity: Reformulating the dynamic and modular bases of subjective well-being. Review of General Psychology, 9, 291–325.

    Article  Google Scholar 

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Acknowledgments

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). https://doi.org/10.1007/s11136-011-0035-0

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