Some findings

The first use of the Life Events and Difficulties Schedule to study depressive conditions took place in the early 1970s and involved a patient series seen at the Maudsley Hospital together with a random series of women from the local Camberwell population. All were aged between 18 and 65. A threshold of 'caseness' developed at that time reflected what an outpatient psychiatrist would accept as a 'case'.(18) This enquiry, and a number of subsequent ones, have established that the majority of episodes of clinical relevance are preceded by a severely threatening event. (29 Only events having long-term threat some 10 to 14 days later are considered for a severe rating. The presence of a severe ongoing difficulty has turned out to be of less significance. Nothing has so far emerged to suggest that events with only short-term threat play a role.

T.a.b.l.§..,1 gives a typical result from a prospective enquiry of 400 women living in Islington in North London with at least one child at home. The table shows the women who at the time of first contact did not qualify as cases of depression; 29 of the 32 onsets in the first follow-up year were preceded by at least one severe event in the prior 6 months with most occurring within a matter of weeks.(36> For example, a woman experiencing a second miscarriage after persistent attempts to have her first child would probably have the event rated severe, but a first miscarriage shortly after marriage would most likely be rated upsetting but not severely so.

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Table 1 Onset of depression within 6 months of a severe event or a severe difficulty among 303 women in Islington

This set of results emerged despite the use of contextual ratings of events that, as already made clear, are based on a limited amount of information and deliberately designed to be approximate and probabilistic. Moreover, it was possible to obtain more direct evidence about the relevance of plans and purposes. Their importance was confirmed by the use of a measure of commitment to a number of core roles made at the time of the first interview based on how they and the activities associated with them were talked about. Where a severe event (e.g. a child's delinquency) in the subsequent follow-up year 'matched' an area of high emotional commitment (e.g. to motherhood), risk of an onset was considerably increased when compared with a non-matching severe event. (36>

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