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Current Psychological Reviews (1982), 2, 123-13 8

Stressful Life Events: Their Past and Present


Status

B. E. C H A L M E R S
University of the Witwatersrand

The p r e s e n t p a p e r r e v i e w s some o f t h e m a j o r f i e l d s o f i n t e r e s t in c u r r e n t l i f e e v e n t
r e s e a r c h . Some t h e o r e t i c a l issues a r e e x a m i n e d : f o r e x a m p l e , g e n e r a l i t y v e r s u s
s p e c i f i c i t y o f l i f e e v e n t e f f e c t s , t h e t i m e span e n c o m p a s s e d by l i f e e v e n t r e s e a r c h ,
d e v e l o p m e n t of l i f e c h a n g e s c a l e s , and p e r c e p t u a l concensus c o n c e r n i n g t h e s e v e r i t y
of l i f e c h a n g e s . M e t h o d o l o g i c a l p r o b l e m s c o n c e r n e d w i t h c a u s a l or c o r r e l a t i o n a l
c o n c l u s i o n s and i l l n e s s b e h a v i o u r a r e a l s o d i s c u s s e d . M o d e l s of t h e l i f e e v e n t
stress process a r e m e n t i o n e d w i t h r e f e r e n c e t o ' r e s i s t a n c e r e s o u r c e s ' . F i n a l l y t h e
f i e l d o f l i f e e v e n t r e s e a r c h has been i n t e g r a t e d i n t o M c G r a t h ' s c o n c e p t u a l i z a t i o n o f
stress r e s e a r c h .

In r e c e n t y e a r s some r e s e a r c h e r s in t h e f i e l d o f 'stress' h a v e c o n c e n t r a t e d on an
a s p e c t o f t h e f i e l d k n o w n as ' l i f e e v e n t s ' ( D o h r e n w e n d & D o h r e n w e n d , 1974a). These
r e s e a r c h e r s share t w o sets of c o n c e r n s t h a t g i v e t h e i r w o r k u n i t y . F i r s t , t h e y f o c u s
on a class o f s t r e s s f u l s t i m u l i or s i t u a t i o n s t o w h i c h n e a r l y e v e r y o n e is e x p o s e d ,
t o a g r e a t e r or l e s s e r e x t e n t , in t h e c o u r s e o f l i f e . These s i t u a t i o n s , c a l l e d ' l i f e
e v e n t s ' , i n c l u d e such s e r i o u s e x p e r i e n c e s as m a r r i a g e , b i r t h o f a c h i l d , d i v o r c e or
d e a t h of a l o v e d o n e , and such less s e v e r e e v e n t s as c h a n g e in l i v i n g c o n d i t i o n s or
s o c i a l h a b i t s . The second focus s h a r e d by r e s e a r c h e r s in t h i s f i e l d is t h e g e n e r a l
h y p o t h e s i s t h a t life e v e n t s play a role in t h e a e t i o l o g y of v a r i o u s s o m a t i c ( H o l m e s
& Masuda, 1974; R a h e , 1975) 1977) and p s y c h o l o g i c a l d i s o r d e r s (Holmes & H o l m e s ,
19705 Myers et al) 19725 Dohrenwend, 19735 Myers) L i n d e n t h a l and P e p p e r ) 19745
3ohnson and Sarason) 1978). Among the s o m a t i c c h a n g e s which h a v e been a s s o c i a t e d
with life e v e n t s a r e t u b e r c u l o s i s (Holmes et al) 1957)) a c u t e g l a u c o m a (Cohen &
H a j i o f f , 1972), inguinal h e r n i a (Rahe et a l , 1964), r h e u m a t o i d a r t h r i t i s ( H e i s e i ,
1972), l e u k a e m i a (Wold, 1968, c i t e d by Ruch, 1977), m y o c a r d i a l i n f a r c t i o n (Rahe &
P a a s i k i v i , 1971; Theorell & R a h e , 1971) and sudden c a r d i a c d e a t h (Rahe & Lind,
1971). Other i n v e s t i g a t o r s have found an a s s o c i a t i o n b e t w e e n life e v e n t s and v a r i o u s
m e n t a l i l l n e s s e s such as s c h i z o p h r e n i a (Brown, 1974), d e p r e s s i o n (Brown, 1974;

0144-3895/82/0202-123 $02.00 1982 Praeger Publishers


124 B. E. Chalmers

Markush & Favero, 1974; Paykel., 197#;" Brown & Harris, 1978; 3ohnson & Sarason,
1978), a t t e m p t e d suicide (Paykel, 1974) and psychophysiological symptoms (Markush &
Favero, 1974). AdditionTal research indicates that the severity of physical and
mental health problems increases with the i n t e n s i t y of l i f e change the i n d i v i d u a l
experiences (WyJer~ Masuda:& Holmes, 1971; Holmes & Masuda~ 1974; Rahe, 1974;
Lazarus, 1981)~ although some doubt has been cast on this proposition (Tennant 9
Bebbington & Hurry, 1981).

THEORETICAL ISSUES IN THE FIELD

A question of some importance in the f i e l d of l i f e events is whether studies should


concentrate on examining the e f f e c t s of general l i f e events on the onset of general
illnesses ( e . g . , Holmes & Masuda, 1974; Rahe, 1974), or whether the e f f e c t of
general l i f e events on a p a r t i c u l a r type of illness, for example m y o c a r d i a l
i n f a r c t i o n (Rahe & Paasikivi, 197l; Theorell & Rahe, 1971), should be studied. In
a d d i t i o n , the effects of a specific l i f e event on specific or general illnesses can
also be examined. Underlying these various approaches are assumptions regarding the
g e n e r a l i t y or s p e c i f i c i t y of somatic illness response (Lazarus, 1977). Selye (1956)~
o r i g i n a l l y argued for a generalist position in that he claimed that any noxious
agent could mobilize the GAS, even psychological demands or threats. Levi's (1965)
research on increased catecholamine excretions f o l l o w i n g stress suggests much the
same thing. In addition~ the work of Holmes and Rahe (1967), Dohrenwend (1973) and
Levi (1974), as well as studies growing out of this research, also tends to adopt a
position of g e n e r a l i t y . On the other hand, some researchers have argued for a
position of s p e c i f i c i t y with regard to stress r e a c t i v i t y (Mason, 1971; Lazarus~
1977). One argument f r e q u e n t l y put forward in favour of response s p e c i f i c i t y is t h a t
bodily response appears to vary depending on the type of stress. As y e t , however~ no
convincing arguments have been put f o r w a r d to indicate that e i t h e r one of these
approaches to research in the f i e l d of l i f e events is superior to the o t h e r .
There is general agreement among researchers in the f i e l d that illness onset is
l i k e l y to occur w i t h i n , at most, a period of two years f o l l o w i n g a cluster of l i f e
events. Consequently, in retrospective studies (Hinkle, 1974; Holmes & Masuda, 1974;
Theorell, 1974) in the f i e l d , namely those studies where indications of l i f e event
occurrences in the past are obtained from subjects once illness has been r e p o r t e d ,
most researchers consider only those events which occur in the period up to two
years preceding the onset of illness. In prospective studies, ( e . g . 9 Holmes &
Masuda, 1974)~ on the other hand, namely those studies where reports of l i f e events
are obtained from subjects who are then f o l l o w e d up xvith regard to illness onset, a
period of u s u a l l y one year but up to two years f o l l o w i n g the l i f e event reports is
generally considered. However, with few exceptions (Chaimers, 1979, unpublished
i n f o r m a t i o n ) prospective studies have f r e q u e n t l y f a i l e d to take account of l i f e
events occurring in the period between the measurement of l i f e events and illness
onset. In a d d i t i o n , with the exceptions of Antonovsky (1974), Theorell (1974), Eyer
and Sterling (1977), Simonton (1977), Brown and Harris (1978), Chaimers (1979,
unpublished i n f o r m a t i o n ) and Porter and Suedfield (1981), few researchers have
examined l i f e event changes occurring over a longer t i m e period9 for instance the
whole l i f e span, or a short t i m e period, for example months (Lazarus~ 1981).
The development of a method of recording l i f e events and t h e i r impact on
individuals has allowed researchers to explore the f i e l d of crises more o b j e c t i v e l y
than has been the case in the past. Early research i n t o the relationship of stress
Stressful Life Events 12~

to physiological e m o t i o n a l arousal was stimulated by Cannon's (1929) observations


showing that e m o t i o n a l l y arousing s t i m u l i may cause h a r m f u l changes in basic
physiological processes. As early as 1930, Myer~ cited by Winters (1951)~ added to
Cannon's (1929) c o n t r i b u t i o n by suggesting that even the most normal and necessary
l i f e e v e n t s are p o t e n t i a l c o n t r i b u t o r s to t h e d e v e l o p m e n t of p a t h o l o g i c a l
conditions. This early work in the f i e l d was hampered by r e l a t i v e l y inadequate
methods of recording l i f e events. In current research, scales or lists of l i f e
events~ based on the experiences of the e x p e r i m e n t e r s , the opinions of medical
practitioners~ other professional people and the general population~ have been
devised. The development of some of these scales is subject to c r i t i c i s m on the
grounds that only the experiences of the e x p e r i m e n t e r s or 'experts' have been taken
into account when listing events~ and not the experiences of the sample group who
quite probably face d i f f e r e n t situations in t h e i r lives (Dohrenwend et a19 1978).
Lists have been described as i n s u f f i c i e n t l y comprehensive~ with items lacking
s p e c i f i c i t y (Tennant, Bebbington & Hurry, 1981). F u r t h e r m o r e , Gersten et al (1974)
have suggested that lists should include not only events which have occurred but
also 'non-events'. Non-events are events which are desired or a n t i c i p a t e d but which
do not occur~ for example~ 'denial of a p r o m o t i o n f e l t to be deserved'. Hultsch and
Plemons (1979) suggest that the d i f f i c u l t i e s encountered when compiling a p p r o p r i a t e
lists of l i f e events may r e f l e c t inadequate p r e o p e r a t i o n a l c o n c e p t u a l i z a t i o n of the
l i f e change concept on the part of researchers.
In addition~ lists of events have been c r i t i c i z e d on the grounds that these
lists have been regarded as unidimensional rather than m u l t i d i m e n s i o n a l . For
instance~ l i f e change as conceptualized by Holmes~ Rahe and colleagues (Holmes &
Masuda~ 1974; Rahe, 1974, 1977) is a unidimensional concept r e f e r r i n g only to the
quantity of l i f e change required by an e v e n t . Other investigators have questioned
the unidimensional concept by focusing on the q u a l i t a t i v e nature of the changes. For
example~ l i f e events have been subclassified in terms of social d e s i r a b i l i t y
(Dohrenwend, 1973; Gersten et a l , 1974; Kellam~ 1974; Paykel, 1974; Rahe, 197t~;
Mechanic, 1975~ Myers et al, 1974; Vinokur & Seizer, 1975~ 3ohnson & Sarason, 1978;
Chalmers, 1979)~ the l i f e area encompassed (Myers et al~ 1972~ Gersten et al, 197t+~
Miller et al~ 1974; Paykel, 1974), gain or loss (Dohrenwend~ 19731 Brown, 1974) and
entrances or exits from the social f i e l d (Myers et al~ 19721 Paykel, 1974).
A d d i t i o n a l dimensions explicated are focus of the event (Brown~ 1974)~ c o n t r o l which
the individual has over the change (KelJam~ 197t+~ PaykeI, 1974~ Dohrenwend~ 197gi
Chalmers~ 1979~ unpublished d a t a ) , the s e v e r i t y of the long-range t h r e a t (Brown~
1974), the subjective or o b j e c t i v e perception of the l i f e change (Thurlow~ 19715
Hinkle~ 1974~ Caplan, 1975~ 3ohnson & Sarason~ 1975~ Masuda & Holmes, 197g~
Chalmers~ 1979, unpublished i n f o r m a t i o n ) ~ events as hassles or u p l i f t s / b u f f e r s
(Brown & Harris, 1978; Lazarus~ 1951), i n d i v i d u a l or c u l t u r a l events (Hultsch &
Plemons, 1979)~ p r e d i c t a b i l i t y of events (Dohrenwend & Dohrenwend, 1975~ Chalmers~
1979~ unpublished i n f o r m a t i o n ) ~ the length of t i m e the individual is a f f e c t e d by the
events (Chalmers~ 197% unpublished i n f o r m a t i o n ) ~ and distal or p r o x i m a l events
(Masuda & Holmes~ 1978~ Hultsch & Plemons~ 1979). In a d d i t i o n , l i f e event lists may
be contaminated by the inclusion of events which e i t h e r p r e c i p i t a t e the illness or
which are caused by the illness (Hudgens~ 1974~ Brown & Harris, 1978~ Tennant~
Bebbington and Hurry, 1981). Furthermore it has been suggested that the stage of
life~ that is, childhood~ adolescence~ adulthood~ that subjects are in, should
determine the items to be included on an event list (Kellam~ 1974).
Some l i f e event lists have been subclassified either a r b i t r a r i l y (Antonovsky &
Katz~ 19675 Antonovsky~ 1974; Hultsch and Plemons~ 1979) or by the use of
126 B. E. Chalmers

m u l t i d i m e n s i o n a l scaling t e c h n i q u e s ( D o h r e n w e n d , 197; Miller et a l , 197; C h a l m e r s ,


1979, unpublished i n f o r m a t i o n ) . I n i t i a l l y , Antonovsky and Katz (1967) divided life
e v e n t s into four categories" physical t r a u m a , c h a n g e s in the e n v i r o n m e n t , c h a n g e s in
i n t e r p e r s o n a l r e l a t i o n s and changes in s t a t u s . L a t e r , Antonovsky (1974) e x t e n d e d
t h e s e c a t e g o r i e s to include e v e n t s r e l a t i n g to e c o n o m i c crises~ s e p a r a t i o n from or
death of someone close, i n t e r p e r s o n a l r e l a t i o n s , major role a c t i v i t i e s , m i g r a t i o n or
life in danger i t e m s . The life e v e n t c a t e g o r i e s developed by Miller et al (1974) and
Dohrenwend (197t~) overlap largely with those e s t a b l i s h e d by Antonovsky and co-
workers. Likewise, the e v e n t s d i f f e r e n t i a t e d by C h a l m e r s (1979, unpublished
i n f o r m a t i o n ) r e f l e c t s i m i l a r i t y with e x i s t i n g c a t e g o r i e s , with the e x c e p t i o n of
e v e n t s i n d i c a t i v e of 'feeling i n a d e q u a t e ' , ' f e e l i n g b e t r a y e d ' , ' u n d e s i r a b l e social
s i t u a t i o n s ' and ' e x p e r i e n c e s of f a i l u r e ' . In a d d i t i o n , Hultsch and Plemons (1979)
have arbitrarily categorized the interpersonal environment category, first
d e m a r c a t e d by Antonovsky and Katz (1967), into four areas; the f a m i l y , the social
and c o m m u n i t y c o n t e x t , the o c c u p a t i o n and c a r e e r c o n t e x t , and p r i m a r y f r i e n d s h i p
n e t w o r k s . Such c a t e g o r i z a t i o n s are supported by the life e v e n t s c a l e a n a l y s i s of
Chalmers (1979, unpublished i n f o r m a t i o n ) .
R e p o r t s w h i c h i n d i c a t e t h a t the onset of illness is r e l a t e d t o the q u a l i t y o f
l i f e change as w e l l as to the d e g r e e of l i f e change e x p e r i e n c e d by t h e i n d i v i d u a l
( C a p l a n , 1975; R a b k i n & S t r e u n i n g , 1976; Ruch, 1977; D o h r e n w e n d & D o h r e n w e n d , 1978)
suggest t h a t the d i s t i n c t i o n b e t w e e n l i f e e v e n t l i s t s as u n i - or m u l t i d i m e n s i o n a l is
p r o b a b l y an i m p o r t a n t one. H o w e v e r , a m u l t i d i m e n s i o n a l a p p r o a c h to l i f e e v e n t s has
p r o v e d useful to d a t e l a r g e l y w i t h studies of m e n t a l r a t h e r t h a n p h y s i c a l i l l n e s s .
F u r t h e r m o r e , r e s e a r c h f i n d i n g s w i t h m u l t i d i m e n s i o n a l l i f e e v e n t l i s t s suggest t h a t
the e f f e c t s of q u a l i t a t i v e d i m e n s i o n s may v a r y a m o n g d i f f e r e n t m e n t a l d i s o r d e r s t o o
(Myers et a l , 1972, 1974; P a y k e l , 197t~).
In o r d e r to o b t a i n an i n d i c a t i o n of how s t r e s s f u l l i f e e v e n t s a r e , r e s e a r c h e r s
have d e v e l o p e d ' r e a d j u s t m e n t r a t i n g s c a l e s ' , f o r i n s t a n c e t h a t of Holmes and Rahe
(1967). Subjects are g e n e r a l l y asked to r a t e l i f e e v e n t s in t e r m s of how d i f f i c u l t
they c o n s i d e r a d j u s t m e n t to t h e m to b e . An a r b i t r a r y i t e m such as ' m a r r i a g e ' may be
given an a r b i t r a r y score o f , say, 500 and s u b j e c t s are asked to r a t e a l l o t h e r
events in r e l a t i o n to this i t e m ( H o l m e s & Masuda, 1974). A v e r a g e r a t i n g s are t h e n
used as a measure of ' s t r e s s f u l n e s s ' o f the events d e s p i t e t h e f a c t t h a t i t e m s
i n c l u d e d on f i n a l e v e n t l i s t s are not a l w a y s t h e same as those used in t h e
p r e l i m i n a r y ' c a l i b r a t i o n ' study and t h a t some of these i t e m s are a m b i g u o u s l y w o r d e d
( B r o w n , 1974; T e n n a n t , B e b b i n g t o n & H u r r y , 1981). F u r t h e r m o r e , w h i l e g e n e r a l
a g r e e m e n t in e v e n t r a t i n g s is found across s a m p l e s , d i f f e r e n c e s t o o are o f t e n
o b t a i n e d ( R a b k i n & S t r e u n i n g , 1976). For e x a m p l e , r u r a l and urban p o p u l a t i o n s d i f f e r
in t h e i r p e r c e p t i o n of seriousness of l i f e events ( M i l l e r et a l , 1974), as do
d i f f e r e n t c u l t u r a l groups (Rahe et a l , 1971; H o l m e s & Masuda, 1971+; K e l l a m , 1974;
Caplan, 1975) and d i f f e r e n t s o c i a l classes ( R a b k i n & S t r e u n i n g , 1976). Such
d i f f e r e n c e s in t h e r a t i n g s of s t r e s s f u l l i f e e v e n t s have not in the past p r e c l u d e d
the e x t e n s i v e use of scales such as the H o l m e s & Rahe (1967) s c a l e . H o w e v e r ,
Askenasy, D o h r e n w e n d and D o h r e n w e n d (1977) have r e c e n t l y s u g g e s t e d t h a t such
d i f f e r e n c e s are g r e a t e r than p r e v i o u s r e p o r t s have s u g g e s t e d . Askenasy, D o h r e n w e n d
and Dohrenwend's (1977) c r i t i c i s m of t h e e a r l y r a t i n g scales is based on t h e f a c t
t h a t samples used in such studies as t h a t of Holmes and Rahe (1967) w e r e 'samples o f
c o n v e n i e n c e ' which tend to be u n r e p r e s e n t a t i v e of t h e g e n e r a l p o p u l a t i o n . It is
possible t h a t t h e c o n s i s t e n c i e s in e v e n t r a t i n g s t h a t have been r e p o r t e d by Holmes~
Rahe and o t h e r s are due p a r t l y to c o n s i s t e n c i e s p r e s e n t in t h e s o c i a l r e l a t i o n s h i p s
of these 'samples of c o n v e n i e n c e ' ( L a z a r u s , 1977). Such an i n t e r p r e t a t i o n w o u l d
Stressful Life Events 12'7

suggest that it is hal necessarily the events that are i n h e r e n t l y similar in terms
of t h e i r stressfulness, b u t . t h e perceptions of the people viewing these events
(Lazarus) 1977). Lazarus ) (1977) i n t e r p r e t a t i o n is supported by the finding that
such factors as whether the subject has or has not experienced the event being rated
(Askenasy, Dohrenwend & Dol~renwend, 1977; Chalmers, 1979, unpublished i n f o r m a t i o n )
or whether the event is seen as desirable for that subject or not (Theorell) 197~;
Chalmers, 1 9 7 9 ) unpublished i n f o r m a t i o n ) have been shown to influence the
seriousness score assigned to an e v e n t .
In general) most researchers would agree that the stressfulness of f i l e events
depends on how these events are perceived by the i n d i v i d u a l (WolfI) 1956; Dohrenwend
& Dohrenwend, 197#a). Researchers appear to d i f f e r , however, in the amount of
perceptual consensus about f i l e changes that they assume exists. It is possible t h a t
the perception of stressfulness cr[ events is t o t a l l y i d i o s y n c r a t i c and d i f f e r s ~rom
individual to i n d i v i d u a l (Thurlow, 1971; Theorell) 197~; Yamamoto & Kinney) 1976;
Lazarus) 1977). Current t h e o r e t i c a l approaches to stress which support the idea of
'mediating variables' in the assessment of the stress impact on the i n d i v i d u a l
(Chalmers) 1979) unpublished i n f o r m a t i o n ; Hultsch & PIemons, 1979; Cox & Mackay,
1981) would support this b e l i e f . On the other hand) stress perception may be the
same w i t h i n c u l t u r a l l y or otherwise homogeneous groups but may d i f f e r from group to
group (Rahe et al) 1971; Holmes & Masuda, 1974; M i l l e r et al) 197~).

METHODOLOGICAL PROBLEMS

Early research in the f i e l d of l i f e events has been severely c r i t i c i z e d on


methodological grounds. The most commonly used design in the early studies was
retrospective (Hinkle) 1974; Holmes & Masuda) 1974; T h e o r e l l , 197t~). In addition to
problems of recall accuracy, such studies are easily biased by the subject's
i n t e r p r e t a t i o n of the 'cause' of his illness as being a p a r t i c u l a r event in his
past, or what Brown (1974) has called direct c o n t a m i n a t i o n . If such designs are
used) Caplan (1975) s t r o n g l y suggests t h a t at l e a s t the a c c u r a c y of t h e
retrospection should be v a l i d a t e d . Instead, researchers have recommended using a
prospective design for research in this f i e l d (Hudgens, 1974; Caplan) 1975; Tennant)
Bebbington & Hurry) 1981). Such a design overcomes the problem of subject 'bias' but
causes other problems which are not easy to e r a d i c a t e . For example) rather than
denoting an event as being c o n t r i b u t o r y to an illness) both the event and the
illness could be seen as being caused by some other f a c t o r (Brown, 1974). Such
i n d i r e c t c o n t a m i n a t i o n may be f u r t h e r confounded by the subject's experience of his
events a f f e c t i n g his r e p o r t i n g of them (Tennant) Bebbington & Hurry, 1981); this was
called 'spuriousness' by Brown (1974). In designs where i n d i r e c t c o n t a m i n a t i o n or
spuriousness may occur (Brown) 1974) it is s t r i c t l y accurate to reach conclusions
only of a c o r r e l a t i o n a l nature rather than of a causative nature (Caplan, [975;
Chalmers, 1979) unpublished i n f o r m a t i o n ; Dohrenwend & Dohrenwend, 197g). As Caplan
(1975) suggests, the problem of causal or c o r r e l a t i o n a l conclusions is not overcome
by the use of r e l a t i v e l y sophisticated s t a t i s t i c a l techniques such as m u l t i p l e
regression in contrast to simple c o r r e l a t i o n . Such advanced c o r r e l a t i o n a l techniques
are equally susceptible to the problem of coincidental relationships between
dependent and independent variables.
An independent s t a t i s t i c a l c r i t i c i s m is c u r r e n t l y being applied to l i f e event
stress research. Researchers are advising against the simple use of ' s t a t i s t i c a l l y
significant' findings to i n t e r p r e t the true meaning of relationships between l i f e
128 B. E. Chalmers

events and illness occurrence (Rabkin & Streuning, 19761 3ohnson & Sarason, 19781
Chalmers, 1979, unpublished i n f o r m a t i o n l Tennant, Bebbington & Hurry, 1981).
S t a t i s t i c a l significance (usually P ~ 0.05) means that findings similar to the ones
obtained in the research conducted w i l l be obtained if the study is repeated, with
an acceptable degree of c e r t a i n t y . The concept of s t a t i s t i c a l significance does not,
however, imply that the results obtained are i m p o r t a n t , or make a major c o n t r i b u t i o n
to the understanding of the relationship between l i f e stress a n d illness. It is
quite feasible for s t a t i s t i c a l l y s i g n i f i c a n t results to be obtained ( i . e . , the
results have not occurred by chance), which results do not make a remarkable
c o n t r i b u t i o n to the understanding of the subject investigated ( i . e . , a low
percentage of variance in the data is e x p l a i n e d ) . Such, in ( a c t , appears to be the
s i t u a t i o n with respect to much of the research i n v e s t i g a t i n g the r e l a t i o n s h i p
between l i f e event experience and subsequent illness. For instance, the results of
Wyler, Masuda and Holmes's (1971) studies p r e d i c t i n g illness on the basis of l i f e
event experiences, while highly s i g n i f i c a n t ( P ~ 0.005), explain less than [2 per
cent of the t o t a l variance occurring in the d a t a . Similarly~ predictions of illness
f o l l o w i n g l i f e e v e n t e x p e r i e n c e s by Rahe (1974), w h i l e h i g h l y s i g n i f i c a n t
s t a t i s t i c a l l y (P < 0 . 0 5 ranging to P < 0 . 0 0 l ) , explain as l i t t l e as 4 per cent of
variance, and at most 25 per cent, with amounts of 9, i l , 12 and 14 per cent of
explained variance being obtained. Likewise, Rahe (1974), using a r e t r o s p e c t i v e
design, has reported significant (P ~ 0 . 0 1 ) illness predictions on the basis of l i f e
event experiences, which predictions explained from only I to 13 per cent of data
variance. Gersten et al (1974) too, when p r e d i c t i n g behaviour change and
psychological impairment (rom l i f e event experiences, have reported s t a t i s t i c a l l y
significant correlations which account for from only 2 to I I per cent of the data
variance. Tennant, Bebbington and Hurry (1981) report that more recent l i f e event
researchy u t i l i z i n g regression techniques~ reveals s i m i l a r amounts of e x p l a i n e d
variance (I to 7 per c e n t ) , depending on the order of the variables entered into the
regression equations (Gersten et al, 1977~ Andrews et al," 1978). It is t h e r e f o r e
necessary for research into the role of l i f e events in the development of illnesses
to a t t e m p t not simply to report s i g n i f i c a n t findings but to understand the high bulk
of unexplained variance involved in the dynamics of illness onset.
In a d d i t i o n , r e l i a b i l i t y and v a l i d i t y estimates o f l i f e event scales have
generally not been adequate (Rabkin & Streuning, 19761 Shapiro, 19791 Tennant,
Bebbington & Hurry, 198I). R e l i a b i l i t y of reporting has been measured in two ways"
t e s t - r e t e s t r e l i a b i l i t y , and r e l i a b i l i t y between a subject's and an informer's
reports. Test-retest r e l i a b i l i t y estimates range from 0.26 to 0.9 (Mendels &
Weinstein, 1972; Rabkin & Streuning, 19761 Chalmers, 1979, unpublished i n f o r m a t i o n l
Tennant, Bebbington & Hurry, 1981). Tennant, Bebbington and Hurry (1981) suggest
that such differences may be due to lack of i t e m s p e c i f i c i t y in some scales used and
the d i f f e r e n t types of subjects studied. Tennant, Bebbington and Hurry (1981) also
report that the agreement between a subject's responses and the responses of a close
i n f o r m a n t about the occurrence of the subject's l i f e experiences is also r e l a t i v e l y
low, ranging from 0.05 to 0.75 for various t i m e periods. V a l i d i t y . e s t i m a t e s of l i f e
event scales are also inadequate. C r i t e r i a used as v a l i d a t i o n standards are based on
concepts of stress which range from ' l i f e change' (Holmes & Rahe~ 1967) and 'threat'
(Brown & Harris, 1978) to other r e l a t e d concepts such as 'distress' or 'upset'
(Paykel, Prusoff & Uhlenhuth, 1971; Tennant & Andrews, 1977). As yet no adequate
v a l i d a t i o n technique has been f o r m u l a t e d .
A f u r t h e r issue presenting some m e t h o d o l o g i c a l problems in the f i e l d of l i f e
events has been called 'illness behaviour' (Mechanic, 1974; Rahe, 1974). It appears
Stressful Life Events 129

that some people rarely consult doctors while others f r e q u e n t l y do. Consequently,
results of studies in the f i e l d of l i f e events may be biased due to the lack of
reporting of many illnesses. However, this f a c t o r is not f r e q u e n t l y taken into
account in l i f e event studies as, despite the possible lack of illness r e p o r t i n g )
s i g n i f i c a n t r e l a t i o n s h i p s between l i f e events and illness are f r e q u e n t l y found. The
p r o b a b i l i t y is that were such illnesses always r e p o r t e d , results of studies would
a c t u a l l y be more significant than they are usually found to be.

RESISTANCE TO LIFE EVENT STRESS

Studies of the effects of l i f e events have shown t h a t some people who have high l i f e
event scores sometimes show l i t t l e or no illness reaction (Antonovsky, 1974; Hinkle,
1974). Antonovsky (1974):has proposed that some individuals are able to escape the
i l l - e f f e c t s of numerous serious l i f e changes by having what he calls 'resistance
resources'. Accordin'g to Antonovsky (1974), such people display 'good tension
management'; that is, they are able when confronted with a problem to resolve i t
rapidly and c o m p l e t e l y . Factors which enhance one's a b i l i t y to manage tension are
homeostatic f l e x i b i l i t y ) ties to others and community ties. Homeostatic f l e x i b i l i t y
is characterized by having more than one social role in l i f e , by the capacity to
t o l e r a t e differences in values and by the capacity to adapt quickly to m i s f o r t u n e .
Ties to others and to the community imply having the support f r o m ) and f e e l i n g
l o y a l t y f o r , other people or a community close to one (Antonovsky, 1974).
Hinkle (1974) like Antonovsky (1974), has reported that some people manage to
remain free from illness in the face of major l i f e changes. Hinkle, unlike
Antonovsky, proposes that such people have physiological and psychological
characteristics which help to 'insulate' them from the e f f e c t of some of t h e i r l i f e
e x p e r i e n c e s . F i r s t , these i n d i v i d u a l s do not have p r e - e x i s t i n g p a t t e r n s of
s u s c e p t i b i l i t y to illness and, second, such people o f t e n show l i t t l e psychological
reaction to events which cause profound reactions in others. Hinkle's (1974)
suggestion that such people have a 'sociopathic' aura to them an i m p l i c i t l y
undesirable c h a r a c t e r i s t i c - is unlike Antonovsky's (197#) concept that such people
have resistance resources - an i m p l i c i t l y desirable t r a i t .
The concept of individual a b i l i t y to resist illness has given rise to theory and
research examining those features which may mediate between l i f e changes and
illness. T h e o r e t i c a l approaches to this issue stress the importance of the appraisal
p r o c e s s in the stress e x p e r i e n c e ( C o x , 1978; C h a l m e r s , 1979, u n p u b l i s h e d
i n f o r m a t i o n ; Cox & Mackay, 1981), with the individual's perception of stress being a
crucial issue. A d d i t i o n a l factors have been i m p l i c a t e d in explaining resistance
resources: for i n s t a n c e ) the characteristics of the stress situation (Rabkin &
Streuning, 1976), social S.upport systems (Nuckolls, Cassel & Caplan, 1972; Rabkin &
Streuning, 1976; Dohrenwend & Dohrenwend, 1978; 3ohnson & Sarason, 1978; Smith)
3ohnson & Sarason, 1978; Hultsch & Plemons, 1979; Henderson et al, 1980), b u f f e r
events (Lazarus) 1981) and individual a t t r i b u t e s (Rabkin & Streuning, 1976; Brown &
Harris) 1978; 3ohnson & Sarason, 1978; Hultsch & Plemons, 1979; Tennant, Bebbington
& Hurry, 1981). According to Rabkin & Streuning (1976), individual a t t r i b u t e s may be
i n t e r n a l or personal - for example, b i o l o g i c a l f a c t o r s , psychological and threshold
s e n s i t i v i t i e s , i n t e l l i g e n c e , verbal skills, morale, personality type, psychological
defences, past experiences) a sense of mastery of one's f a t e - or they may be
e x t e r n a l ) such as a t t r i b u t e s accruing from social p o s i t i o n . It remains for future
130 B. E. Chalmers

r e s e a r c h t o e x p l a i n w h i c h of t h e s e a p p r o a c h e s to the concept of resistance resources


carries more weight.

MODELS OF THE LIFE EVENT STRESS PROCESS

The concept of resistance resources is an a t t e m p t to conceptoal!ze the pathway


between the onset of stress and the resulting illness on a psychological l e v e l . The
stages i n t e r v e n i n g between stress and illness have been hypothesized by only a few
workers in the f i e l d (Cobb, [974; Rahe, [974; Hultsch & Plemons, 1979). Rahe (1974),
however, has proposed a conceptual model of the stages occurring between li;[e change
and illness. According to Rahe (1974), l i f e experienc.es are filt'ered out by the
i n d i v i d u a l on the basis of past e x p e r i e n c e s and p s y c h o l o g i c a l d e f e n c e s .
Physiological arousal may then result which may not be handled by the individual's
coping processes, with consequent resulting illness.. Such illness~ t o o , is subject
to the individual's illness behaviour.
Cobb's ([974) model of the processes t a k i n g place between l i f e e v e n t occurrence
and illness m a n i f e s t a t i o n is s i m i l a r in many ways to that of Rahe (1974). Like Rahe,
Cobb suggests that a l i f e event has to pass through succeeding stages before it
results in illness. For instance, a Hfe event ( o b j e c t i v e or subjective stress) may
result in work overload or 'role ambiguity'~ leading to p h y s i o l o g i c a l , a f f e c t i v e or
behavioura[ manifestations of s t r a i n . Such s t r a i n , if of s u f f i c i e n t magnitude~ may
result in illness which, in t u r n , may be a f f e c t e d by the ind.ividual's illness
behaviour. In a d d i t i o n , Cobb (1974) proposes Shat th~ movements fr'om l i f e event to
illness are a f f e c t e d by personal c h a r a c t e r i s t i c s of the individual - defence
mechanisms, past experiences, a b i l i t i e s and a t t i t d d e s - as well as by the social
situation for instance, a v a i l a b i l i t y of social support - in which he finds
himself.
In g e n e r a l , b o t h R a h e (1974) a n d C o b b (197t~) p r o p o s e t h a t s i m i l a r p r o c e s s e s
intervene between event occurrence and illness manifestation although the ordering
of e a c h s t e p in t h e t w o m o d e l s is d i f f e r e n t . Cobb.'s (1974) m o d e l , by i n c o r p o r a t i n g
t h e s o c i a l s i t u a t i o n of t h e i n d i v i d u a l , e x p a n d s t h e s c o p e of R a h e ' s (197#) m o d e l
f r o m an i n t r a - i n d i v i d u a l or m i c r o e n v i r o n m e n t a l l e v e l t o t h a t of a n i n t e r - i n d i v i d u a l
or m a c r o e n v i r o n m e n t a l l e v e l . C o b b ' s (1974) c o n c e p t u a l l y broader model may offer a
m o r e u s e f u l f r a m e w o r k f o r f u t u r e r e s e a r c h in t h e f i e l d of l i f e e v e n t s t h a n R a h e ' s
(197) a p p r o a c h .
The Hultsch and Piemons (1979) life span developmental model, while
i n c o r p o r a t i n g m a n y s i m i l a r c o n c e p t s , e x t e n d s t h e m o d e l s of R a h e (197t~) a n d C o b b
(197#) e v e n f u r t h e r . The H u l t s c h a n d P l e m o n s (1979) a p p r o a c h is c o n s i s t e n t w i t h t h e
m e c h a n i s t i c m o d e l (by w h i c h i l l n e s s is r e g a r d e d as t h e r e s p o n s e t o t h e s t i m u l i o f
life changes with variables mediating between stimulus and response) which typically
underlies life event stress research. A central feature of the Hultsch and Plemons
(1979) m o d e l is t h e e x a m i n a t i o n of b o t h i n d i v i d u a l a n t e c e d e n t events - those
o c c u r r i n g as p a r t of t h e u s u a l l i f e c o u r s e - a n d c u l t u r a l a n t e c e d e n t e v e n t s - t h o s e
n o t u s u a l l y e x p e r i e n c e d in l i f e ( e . g . , w a r s ) a n d t h e i r i n t e r a c t i o n . Even antecedents
m a y a l s o b e concurrent or h i s t o r i c a l t o t h e p r e s e n t . In a d d i t i o n ~ H u l t s c h a n d
P l e m o n s (1979) d r a w a t t e n t i o n t o t h e p a t t e r n of l i f e e v e n t s : f o r e x a m p l e , their
t i m i n g , s e q u e n c e a n d d u r a t i o n . T h e i m p a c t of l i f e e v e n t s a n d t h e i r a n t e c e d e n t s is
mediated by b i o l o g i c a l ~ c o n t e x t u a l and psychological variables which define a
b a l a n c e of r e s o u r c e s or d e f e c t s in r e s o u r c e s f o r c o p i n g w i t h e v e n t s . Biological
variables usually~ but not always, reflect the individual's adaptive capacity while
Stressful Life Events 131

d e f i c i t s therein predict an i m p a i r m e n t of the individual's adaptive a b i l i t y .


C o n t e x t u a l variables are reminiscent of the concept of social support systems
(Nuckolls, Cassel & Kaplan, 1972; Rabkin & Streuning, 1976; Brown & Harris, 1978)
and usually decrease with advancing age. Psychological variables r e f l e c t , for
example, c o g n i t i v e a b i l i t i e s , knowledge, a n t i c i p a t o r y s o c i a l i z a t i o n or p r e p a r a t i o n
for events, the individual's t i m e perspectives, a t t i t u d e s to s e l f , and personality
f a c t o r s . F l e x i b i l i t y in considering what constitutes resources or d e f i c i t s for any
i n d i v i d u a l is advocated. What might be l a b e l l e d as a d e f i c i t for one type of event
or at one point in time may be i r r e l e v a n t or serve as a resource at another time or
for another type of event. The impact of l i f e events, as mediated by b i o l o g i c a l ,
c o n t e x t u a l and psychological variables is f o l l o w e d by a complex adaptation process
i n v o l v i n g the appraisal of threat and the s e l e c t i o n , i m p l e m e n t a t i o n , m o d i f i c a t i o n
and evaluation of coping strategies. Consequences of such coping mechanisms include
adaptive reorganization and maladaptive outcomes, for e x a m p l e , illness. Hultsch and
Plemons' (1979) mode] provides a general f r a m e w o r k w i t h i n which a broad range of
l i f e events, mediating variables and developmental outcomes can be viewed. Like the
Cobb (197#) model, but in a more detailed manner, Hultsch and Plemons (1979)
emphasize a macrolevel sociological perspective as well as a more molecular
psychological perspective.

E V E N T R E S E A R C H A N D STRESS

The place of l i f e event research within the broader f r a m e w o r k of 'stress' may be


examined. Life event research can be seen as c u t t i n g across three possible levels of
stress analysis, as discussed by McGrath (1970). First, l i f e events can be
categorized as physiological ( e . g . serious illness), psychological ( e . g . m a r i t a l
r e c o n c i l i a t i o n ) , or social ( e . g . change in social a c t i v i t i e s ) . Second, the response
to stress events can occur at physiological ( e . g . illness), psychological ( e . g .
neuroses) or behavioural ( e . g . illness behaviour) levels. In a d d i t i o n , the m e d i a t i o n
process has also been approached on physiological and psychological l e v e l s . For
instance, Hinkle's (197t~) approach outlines the idea that social or psychological
changes may be associated with changes in physiological processes ( e . g . d i e t ) which
may be associated with disease. A physiological explanation of the l i f e e v e n t -
illness link is f u r t h e r supported by TheoreH's ([974) findings t h a t increased
catecholamine e x c r e t i o n occurs in response to stress. In addition to Selye's (1956)
GAS t h e o r y , research into the functioning of the neurological ( K i e l y , 1977),
endocrine (\Vhybrow & Silberfarb, 1977) and immune (Amkraut & Solomon, 1977) systems
also provides evidence supporting a b i o l o g i c a l e x p l a n a t i o n of psychological impact
on pathophysiological reactions. On the other hand, Antonovsky's (197#) concept of
resistance recourses provides a social-psychological e x p l a n a t i o n of the processes
that mediate the impact on the individual of stressful l i f e events. Rahe's (1974),
Cobb's (1974) and Huitsch and Plemon's (1979) explanations of the m e d i a t i o n process
take a m u l t i l e v e l approach to the f i e l d of l i f e events in that p h y s i o l o g i c a l ,
psychological, sociological and behavioura! elements can all be discerned in t h e i r
models.
While stress research can be defined as stimulus-based, response-based or
i n t e r a c t i o n i s t in nature, the field of life event stress falls primarily into an
interactionist framework. The majority of current research in the area of life
events is concerned with the transaction which takes place between the environment
and the organism (Dohrenwend & Dohrenwend, I97#b, 197t~c; Rabkin & Streuning, 1976).
132 B. E. Chalmers

H o w e v e r , some r e s e a r c h in this f i e l d c e n t r e s on a s t i m u l u s - b a s e d c o n c e p t u a l i z a t i o n
of stress in t h a t the focus of such r e s e a r c h is on d e f i n i n g l i f e events or t h e
m e a s u r e m e n t of such events ( R u c h , 1977).
G e n e r a l stress research and l i f e e v e n t r e s e a r c h may also be c o m p a r e d w i t h
r e s p e c t to McGrath's (1970) p r o p o s e d sequence of t h e stress p r o c e s s . For i n s t a n c e ,
l i f e e v e n t r e s e a r c h may be e x a m i n e d in t e r m s of McGrath's (1970) c o n c e p t u a l i z a t i o n
of stress as a ' d e m a n d - p e r c e p t i o n - r e s p o n s e - c o n s e q u e n c e ' s e q u e n c e . In l i f e e v e n t
r e s e a r c h , the d e m a n d s i t u a t i o n is d e f i n e d by t h e l i f e e v e n t or events e x a m i n e d .
Included in this 'demand' a s p e c t of stress are t h e r e s e a r c h q u e s t i o n s r e l a t i n g t o
the a d e q u a c y of the l i f e e v e n t scales used. McGrath's (1970) c a t e g o r y of
' p e r c e p t i o n ' of stress is perhaps "in most need of i n v e s t i g a t i o n w i t h r e g a r d to l i f e
e v e n t r e s e a r c h ( D o h r e n w e n d & D o h r e n w e n d , 197#c; C a p l a n , 1975; 3ohnson & Sarason,
197g). I n v e s t i g a t i o n s r e g a r d i n g f a c t o r s w h i c h a f f e c t t h e r a t i n g s of s t r e s s f u l n e s s
attributed to life events are relevant to this 'perception stage' of McGrath's
stress model. McGrath's (1970) third stage in the stress process, that of
' r e s p o n s e ' , is i n d i c a t i v e of p a r t i c u l a r i s s u e s in t h e f i e l d of l i f e e v e n t s , v i z . t h e
specificity v. generality controversy; somatic illness v. psychological illness,
illness measurement and coping strategies.
Of t h e f o u r s t a g e s of s t r e s s p r o p o s e d by M c G r a t h ( 1 9 7 0 ) , t h e f i n a l s t a g e -
' c o n s e q u e n c e ' - a p p e a r s t o b e t h e m o s t p o o r l y r e p r e s e n t e d in l i f e e v e n t r e s e a r c h .
I l l n e s s b e h a v i o u r ( M e c h a n i c , 197#), f o r m s o n e p a r t of t h e c o n s e q u e n c e s t a g e b u t , in
general, t h i s a s p e c t of t h e l i f e e v e n t s t r e s s s e q u e n c e has been given scant
attention.
The e m p h a s i s p l a c e d on t h e l i n k a g e s b e t w e e n t h e f o u r s t a g e s of s t r e s s by M c G r a t h
(1970) h a s a l s o r e c e i v e d s o m e a t t e n t i o n f r o m l i f e e v e n t r e s e a r c h e r s . Antonovsky's
(197#) c o n c e p t of r e s i s t a n c e r e s o u r c e s is a n a t t e m p t to explain the mediation
p r o c e s s b e t w e e n e n v i r o n m e n t a n d i l l n e s s , as a r e t h e p r o p o s i t i o n s p u t f o r w a r d by R a h e
( 1 9 7 # ) , C o b b ( 1 9 7 # ) , H i n k l e ( 1 9 7 # ) , H u l t s c h a n d P l e m o n s (1979) a n d T h e o r e l l ( 1 9 7 # ) .
C e n t r a l t o t h e m e d i a t i o n i s s u e is t h e p r o b l e m of c a u s a l i t y .

CONCLUSIONS

The p r e s e n t paper has h i g h l i g h t e d some of the m a j o r areas of c o n c e r n in c u r r e n t l i f e


e v e n t r e s e a r c h . In need of f u r t h e r study are q u e s t i o n s r e l a t i n g to t h e g e n e r a l i t y o r
s p e c i f i c i t y of l i f e e v e n t e f f e c t s ; a d e q u a t e d e v e l o p m e n t of l i f e e v e n t scales w i t h
the a s s o c i a t e d p r o b l e m of u n i - or m u l t i d i m e n s i o n a l i t y of such scales; t h e a m o u n t of
p e r c e p t u a l consensus e x i s t i n g a b o u t l i f e changes; an u n d e r s t a n d i n g of ' r e s i s t a n c e
resources'; and a c l o s e r e x a m i n a t i o n of l i f e e v e n t s in t e r m s of McGrath's ( I 9 7 0 )
f i n a l stage of the stress process - 'consequences'. While some m a j o r s t r i d e s have
been t a k e n t o w a r d s an u n d e r s t a n d i n g of some of these issues much s t i l l r e m a i n s t o
be c l a r i f i e d .

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DR B . E . CHALMERS School of Psychology, University of the Witwatersrand, I Jan


Smuts Avenue, Johannesburg 2001, South Africa.

Date of acceptance for publication: June 1982