Cumulative Adversity and Mental Health: Accounting for Adversity Type and Time of Occurrence
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1 Cumulative Adversity and Mental Health: Accounting for Adversity Type and Time of Occurrence Amit Shrira 1,2, Howard Litwin 1, and Dov Shmotkin 2,3 1 The Israel Gerontological Data Center, Paul Baerwald School of Social Work and Social Welfare, the Hebrew University of Jerusalem; 2 Department of Psychology, Tel Aviv University; 3 Herczeg Institute on Aging, Tel Aviv University Trauma Through the Life Cycle from a Strengths-Based Perspective The Hebrew University, Mount Scopus, January 9 th 2012
2 Pablo Picasso (1937) Guernica Cumulative Lifetime Adversity Definition: Exposure to a wide spectrum of potentially traumatic events Depletionvs. Inoculation: Exposure to adverse life events may generate vulnerability, but may also foster resilience (Bonanno, 2004; Breslau et al., 1999; Kessler, 1997; Seery et al., 2010) Delineating the differential effects of cumulative adversity through adversity type and its time of occurrence
3 Adversity type Self vs. Other: A largely overlooked distinction in the DSM-IV (1994) definition of traumatic event The person experienced or witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
4 Self-oriented adversity Other-oriented adversity Frida Kahlo (1946) The little deer Michelangelo ( ) Pietà The potentially traumatic infliction primarily targets the self The potentially traumatic infliction affects the self by primarily targeting others (e.g., being at risk of death due to illness or accident, being a victim of violence) (e.g., witnessing people killed, learning about the death of a loved one)
5 Adversity type CONFLICTING HYPOTHESES 1) Other-oriented adversity disrupts social networks, and consequently may increase distress. (Brewin et al., 2000) 2) Other-oriented adversity strengthens commitment to care for those who were primarily harmed. Consequently, debilitating effects must frequently be limited or deferred. (Shmotkin & Litwin, 2009)
6 Adversity timing CONFLICTING HYPOTHESES 1) Adversity in the formative years of early life may disrupt subsequent psychological development in profound ways. (Mitchell & Black, 1995) 2) Individuals show resilience and flexible recovery from early-life adversity, possibly due to: (a) the plasticity of personality and, (b) the not fully developed autobiographical memory in young age. (Bonanno, 2004; Krause, 2004)
7 Study aim: To examine the association between cumulative adversity and mental health, focusing primarily on type of adversity and time of occurrence. Hypothesis: Late-life self-oriented adversity would have the strongest negative association with mental health while early-life other-oriented adversity would have the weakest negative association.
8 Participants The Survey of Health, Ageing and Retirement in Europe (SHARE) collects data about Europeans aged 50 and older (W1, included 11 European countries and Israel). The Israeli component of SHARE: A random sample of the Israeli population (N=2603). 1,130 respondents from SHARE-Israel Drop-Off sample Aged 50+ (Mean=64.2; SD=9.8; range=50-94) 55.0% women; 76.0% Israeli veteran Jews, 10.0% from former USSR, 14.0% Arab Israelis; average education level of upper secondary education; 78.1% married.
9 Measures Potentially Traumatic Events Inventory (Shmotkin & Litwin, 2009) Events N Mean age Experienced the death of a spouse (O) Experienced the death of a child or grandchild (O) Had a loved one at risk of death due to illness or accident (O) Experienced extremely severe economic deprivation (S) Was at risk of death due to illness or serious accident (S) Needed long term care due to difficulty in caring for herself/himself (S) Provided long term care to a disabled or impaired relative (O) Lost a loved one in a war or in military service (O) Witnessed the serious injury /death of someone in war or military action (O) Experienced the injury or the death of a loved one in a terrorist act (O) Was wounded in war or military action (S) Witnessed a terrorist act in which she/he was not harmed personally (O) Was wounded in a terrorist act (an attack by terrorists against civilians) (S) Was the victim of crime (such as robbery ) (S) Witnessed an accident in which someone was seriously injured/killed (O) Was the victim of violence or abuse (S) Experienced sexual assault (rape or harassment) (S) Note. S=self-oriented event, O=other-oriented event. Self- and other-oriented adversity were positively correlated, r=.46, p <.0001.
10 Adverse life events experienced by type Type Total Self Other Adverse events experienced Mean (SD) 2.20 (2.35) 0.69 (1.09) 1.15 (1.59) Experienced 1+ adverse events N (%) 756 (66.9) 466 (41.2) 705 (62.4) Adverse life events experienced by age group Age at time of event Adverse events experienced Mean (SD) 0.29 (0.69) 0.75 (1.13) 0.64 (0.96) Experienced 1+ adverse event N (%) 221 (19.6) 488 (43.2) 456 (40.4)
11 Measures Dependents: Markers of Mental Health 1) Depressive symptoms : European Depression scale (Euro-D; Prince et al., 1999) 12 items. (Cronbach s α=.75) 2) Depressive symptoms: the adapted version of the Center for Epidemiological Studies-Depression scale (ACES-D; Radloff, 1977) 14 items. (Cronbach s α=.87) 3) Quality of life: CASP-12 (Hyde et al., 2003) 12 items. (Cronbach s α=.80) 4) Life satisfaction: a single item (cf. Oswald & Wu, 2010).
12 The relationship of mental health with self- and other-oriented adversity in different age periods Note. N=1130. Y axis values refer to standardized regression coefficients (βs) after controlling for age, gender, origin, and education. R 2 ranged.09 to.23. *p<.05, **p<.001, ***p<.0001
13 The relationship of mental health with self- and other-oriented adversity in different age periods Note. N=1130. Y axis values refer to standardized regression coefficients (βs) after controlling for age, gender, origin, and education. R 2 ranged.09 to.23. *p<.05, **p<.001, ***p<.0001
14 The relationship of mental health with self- and other-oriented adversity in different age periods Note. N=1130. Y axis values refer to standardized regression coefficients (βs) after controlling for age, gender, origin, and education. R 2 ranged.09 to.23. *p<.05, **p<.001, ***p<.0001
15 The relationship of mental health with self- and other-oriented adversity in different age periods Note. N=1130. Y axis values refer to standardized regression coefficients (βs) after controlling for age, gender, origin, and education. R 2 ranged.09 to.23. *p<.05, **p<.001, ***p<.0001
16 Summary and conclusions Late-life self-oriented adversity, which assaults core elements of one's physical and mental integrity, may decrease mental health. Early life other-oriented adversity that challenges one's social commitments and valued relationships may still have room and time to be beneficially worked out. Lifetime cumulative adversity may both impair and strengthen mental health, and its differential effects may co-reside in some cases
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