- Email: [email protected]
illness relationship: how useful is the concept of stress?
Person. individ. Diff: Vol. 17. No. 4, pp. 577-580, 1994
Pergamon 0191-8869(94)00079-4
Copyright 0 1994 Elsevier Science Ltd Printed in Great Britain. All rights reserved 0191-8869/94 $7.00+0.00
A re-examination of the stress/illness relationship: how useful is the concept of stress? ALISA PEARLSTONE,
Psychology
Department,
ROBINJ. H. RUSSELL* and PAMELAA. WELLS
Goldsmiths’ College, University London SE14 6NW, England (Received 30 November
of London,
Lewisham
Way,
1993)
Summary-Relationships among major life events, hassles, neuroticism and reported somatic symptoms were examined using a sample of 131 people. Principal components analysis of the Hassles questionnaire revealed four factors. One of these, concerns about money, did not correlate significantly with any of the other variables. A LISREL model incorporating the remaining variables suggested that neuroticism and life events contribute differentially to the three hassles factors, which in turn are related to somatic symptoms. It was argued that the hassles factor most strongly predictive of somatic symptoms, concerns about health, was more likely to be a consequence than a cause of ill-health. It was concluded that minor stressors fall into a number of different classes, which have different causes and different effects. This casts doubt on the concept of stress as a unitary phenomenon.
INTRODUCTION Various perspectives have been adopted in the definition of stress, including the notion of stress as stimulus, stress as response, and the view that there arc both stressor events and individual differences in the appraisal of those events (Hobfoll, 1989). There is so little agreement that some researchers have been led to conclude that stress is merely a heading for a range of diverse phenomena that may or may not be causally related (Reynolds & Briner, 1993). Thus, although the received wisdom may be that “stress causes illness”, Cohen and Williamson (1991) state that “it would be premature to suggest that any of this evidence is more than suggestive”. Despite the difficulties with the concept of stress, most research has used one or both of two approaches. Either major life events occurring in the last year or so of a s’s life are counted, or the impact of recent minor stressors is tallied, typically using a Hassles questionnaire. The use of these approaches to the assessment of stress has led to mixed findings as to the relative importance of each type of stressor, as judged by their impact on questionnaire measures of health. For example, Zarski (1984) found that life events significantly predicted somatic symptoms; adding hassles as a predictor made little, if any, difference. On the other hand, De Benedittis and Lorenzetti (1992) found that hassles but not life events correlated with headaches. Perhaps the most typical finding is that life events do correlate with health measures, but cease to play a role as predictors when hassles are also entered into a multiple regression equation. One example is the study by Kanner, Coyne. Schaefer and Lazarus (I 98 I), who recorded information from Ss over IO months and found that the hassles scale was a better predictor of current and future psychological symptoms than were life event scores, and that the hassles scale shared most of the variance in symptoms accounted for by life events. The implication here is that the role of major occasional stressors is to reduce a person’s ability to deal with minor daily pressures. Such research ignores the conceptual problems associated with stress mentioned at the outset. Each investigation cited has simply used each type of stress questionnaire as something to be summed to provide a total score, whether of major or minor stressors. Chamberlain and Zika (1990) looked at hassles patterns in differing groups (student, community, mothers with children, the elderly). As expected, they found that hassles predicted mental health and wellbeing measures better than life events, the latter dropping out when regression was used. At the same time, different hassles patterns were found across groups, suggesting that different people encounter different types of stressor, with possibly different effects. There is some support for the idea that a stress scale should not be considered as unitary. Lazarus, DeLongis, Folkman and Gruen (1985) used a hassles scale of over 100 items over a 9-month interval. They dropped rarely endorsed items and those not loading highly on any factor, factored the remainder obliquely, found eight factors (household, health, time pressure, inner concern, environmental, financial responsibility, work, future security), and correlated these with a symptom check list. All bar one (time pressures for males) correlated with illness. There is also some support for the notion that individual differences should be taken into account. For example, McCrae (I 990) has argued that neuroticism is a variable that has been unwisely neglected by stress researchers. He considered that relations among variables such as stress, failure to cope, dissatisfaction with social support, and so on, may all be due to the common influence of neuroticism rather than to the processes of stress and coping. If nothing else, neuroticism could positively bias reporting of symptoms, as suggested by Jorm, Christensen, Henderson, Korten, MacKinnon and Scott (1993). They found that correlations between neuroticism and self-reported health depended on the nature of each health item: the more objective the item, the lower the correlation. The aim of the present study is to re-examine the relationships among major life events, daily hassles, and questionnaire-assessed health, while including a measure of neuroticism. At the same time, the dimensionality of the hassles items will be examined, to ascertain whether different types of hassles seem to have different causes or different effects. *To whom all correspondence PAID17:4-I
should be addressed. 577
578
NOTESANDSHORTERCOMMUNICATlONS
Table I. Correlations among neuroticism, stresses, and somatic symptoms N
Life Events ‘Health’ ‘Money’ ‘Intimacy’
0.02 I 0.311** 0.019 0.090
‘Work’ GHQ
0.276** 0.354**
Life Events 0.078 - 0.038 0.272**
0.307** 0.219*
‘Health’
- 0.002 0.004 0.015
0.399**
‘Money’
‘Intimacy’
‘Work’
0.002
0.005 0.075
- 0.055 0.246’
0.285**
Number of subjects: 131. One-tailed significance: * - 0.01 ** - 0.001.
METHOD
One-hundred and fifty-six Ss were recruited by approaching them informally in various settings such as a university, a Rotary club and their own homes. Ss were sampled from both urban and rural settings. Ages ranged from 15 to 83 yr, with a peak in the 20-30 age band. Sixty per cent of the sample was female. Some of the Ss did not feature in all the analyses reported below, because occasional missing values on the relevant variables led to their exclusion. There were 131 complete cases on all variables. Each of these S’s completed a questionnaire pack which contained a number of scales with minor modifications. The pack included: (1) a Life Events scale from Horowitz, Schaeffer and Cooney (1974) covering the occurrence of 3 1 major life events over the previous year, each event being coded as None, Once, or More than once; (2) the Hassles questionnaire, from DeLongis, Folkman and Lazarus (1988); (3) Scale A, somatic symptoms, from Genera1 Health Questionnaire 28 (Goldberg & Williams, 1988); and (4) a Neuroticism scale, using half of the items from the Eysenck Personality Questionnaire (Eysenck, Eysenck & Barrett, 1985). The modifications mainly involved dropping a few items judged inappropriate for the British sample, except in the case of the N scale, which was halved to keep the length of the pack down. With the length reduced in this way, the reliability was still satisfactory, with a Cronbach’s c( value of 0.74 in this sample.
RESULTS
A principal components analysis was carried out on the 5 1 items of the hassles scale. Inspection of a graph of the eigenvalues suggested that a four-factor solution was appropriate, using the criterion of the scree test (Cattell, 1966). The first four principal components all had eigenvalues over 2.5 and accounted for 36% of the total variance. After varimax rotation, the four items loading most highly on factor 1 were: exercise, physical abilities, cooking, and health. The top four on factor 2 were: money for necessities, money for emergencies, money for extras, and children. The top four on factor 3 were: intimacy, friends, sex, and relatives. The top four on factor 4 were: nature of work, workload, deadlines, and boss. The interpretation of each factor is fairly obvious. The first primarily concerns health and fitness, the second, money, the third, close relationships, and the fourth, work. Scores on all four principal components were saved for subsequent analysis. Correlations among all the relevant variables are shown in Table 1. Responses to the GHQ are coded so that a high score indicates poor health. The four Hassles factors are labelled ‘Health’, ‘Money’, ‘Intimacy’ and ‘Work’, respectively. An obvious feature of the correlation matrix is that the second hassles factor, ‘Money’, is unrelated to neuroticism, major life events, or health as measured by the relevant GHQ scale. It is therefore excluded from subsequent analyses. All the remaining variables correlate significantly with the somatic symptoms scale of the GHQ in the expected direction. To presume that they can all be viewed as directly causing physical complaints would be unwise. The total Life Events scores correlate more highly with two of the Hassles factors than with the GHQ measure. To the extent that stressful life events promote feelings of being unwell, they should be considered to do so by making people cope less successfully with the pressures of daily life. Although neuroticism correlates with two of the hassles factors, its relationship to the GHQ measure is stronger: it may have a direct causal impact on responses to the GHQ scale. To assess the magnitude of these potential causal relationships, the variables were entered into a LISREL model (Joreskog and Sorbom, 1989). Estimates of error variance were not available for the majority of the variables, so latent variables were not introduced into the model. Basing the model on the correlation matrix, Life Events were allowed to affect Hassles factors 3 (Intimacy) and 4 (Work). Neuroticism was allowed to affect Hassles factors I (Health) and 4 (Work), and also exert a direct influence on the GHQ measure. Each of the three Hassles factors mentioned was allowed to influence the GHQ measure. When this model was fitted, the strength of the direct path from Neuroticism to the GHQ measure was 0.15. When this path was excluded in a second analysis, the deterioration in goodness of fit did not quite reach the 0.05 level of significance (x2 = 3.73, d.f. = I). The remaining paths were all clearly significant and are shown in Fig. 1. These are analogous to /I coefficients in multiple regression. The detached arrows pointing into the dependent variables represent the proportion of variance unexplained by the independent variables. The model shown in Fig. 1 fits the data reasonably well. The value of xZ is 12.59, which, with 7 d.f. is non-significant. The goodness of tit index is 0.971, and the adjusted goodness of fit index is 0.912. The root mean square residual is 0.393.
DISCUSSION
In common with most studies, the results here suggest that the occurrence of occasional major stressors does not have an immediate effect on feelings of wellbeing. Rather, the stress induced by such events seems to reduce a person’s resources for dealing with day to day pressures. Neuroticism, too, has an effect on the ease with which a person deals with daily tasks: as McCrae (1990) suggests, it should be routinely assessed in studies of stress and its effects. The results here hint at the possibility raised by Jorm et al. (1993)
NOTESANDSHORTERCOMMUNICATIONS
579
.83’
Fig. 1. Model of relationships among neuroticism, stresses, and somatic symptoms.
that neuroticism may also affect health scores directly by making a neurotic person more likely to report a problem than someone with a low neuroticism score whose state of health, objectively assessed, is the same. However, the main conclusion to be drawn from the results is that immediate minor stressors fall into different classes, which have different causes and different effects. Apart from financial worries, which correlate with none of the other variables employed in this study, each of the three other hassles factors appears to be differentially affected by life events and neuroticism. They do not have an equal impact on the GHQ measure of health complaints. It would be unwise to be dogmatic about exactly how many hassles factors there are, or what they consist of. While we found four, using a sample of around 150, Lazarus er al. (1985) found eight. However, they used oblique rotation, a sample of 100, and excluded 53 items from the final results. Most important, their analysis involved the sum of a number of questionnaire administrations extending over several months. Perhaps, therefore, it tapped into clusters of items reflecting persistent themes, rather than immediate and changing pressures. While the model shows that the factor which has the most powerful causal impact on the GHQ measure is factor I, ‘Health’, it would be unwise to accept that the causal direction operates entirely in that direction. Indeed, it seems more plausible to argue that people who suffer from poor health become hassled by this experience, rather than to argue that health worries led health to deteriorate. The idea that poor health causes health hassles, rather than vice versa as is typically assumed, has been put most forcefully by Dohrenwend, Dohrenwend, Dodson and Shrout (1984). More generally, they view the hassles scale as a measure of symptoms of distress rather than a cause. Their view has been criticised by Lazarus et al. (1985), but the criticisms have been rebutted (Dohrenwend & Shrout 1985). Whichever side one takes in this debate, it seems most unwise to study the effect of stress on health using a measure of stress which includes several items relating to possible consequences of ill health. Aside from the ‘Health’ factor, however, it does appear to be the case that people experiencing stress in close relationships or under pressure at work are more likely to complain of physical symptoms. On a closing note, it should be pointed out that it is quite possible that different life events also have different effects in important ways. We have been unable to examine this possibility in this study. Most of the events that are typically regarded as potential major stressors happen to people extremely rarely, if ever. To detect differential effects between, say, stressors involving loss of a person close to one and stressors involving loss of work, money or status, would require a very large sample. Nevertheless, research needs to be conducted on this issue. Until it has been established that different types of stressors have the same pattern of impact on those experiencing them, one should be cautious about accepting the validity of the stress construct.
REFERENCES Cattell, R. B. (1966). The scree test for the number of factors. Sociological Methods and Research, I, 24.5-276. Chamberlain, K. & Zika, S. (I 990). The minor events approach to stress: support for the use of daily hassles. British Journal of Psychology, 81, 469-48 I. Cohen, S. & Williamson, G. M. (1991). Stress and infectious diseases in humans. Psychological Bulletin, 109, 5-24. De Benedittis, G. & Lorenzetti, A. (1992). The role of stressful life events in the persistence of primary headache: major events vs. daily hassles. Pain, 51, 3542. Dohrenwend, B. S., Dohrenwend, B. P., Dodson, M. & Shrout, P. E. (1984). Symptoms, hassles, social supports, and life events: problem of confounded measures. Joumul of Abnormal Psychology, 93, 222-230. Dohrenwend, B. P. & Shrout, P. E. (1985). “Hassles” in the conceptualization and measurement of life stress variables. American Psychologist, 40, 780-785.
DeLongis, A., Folkman, S. & Lazarus, R. S. (I 988) The impact of daily stress on health and mood: Psychological and social resources as mediators. Journal of Personality and Social Psychology, 54, 486-495. Eysenck, S. B. G., Eysenck, H. J. & Barrett, P. (I 985). A revised version of the Psychoticism scale. Personalityand Individual Dtrerences,
6, 2 1-29.
Goldberg, D. & Williams, P. (1988) A user’s guide to rhe General Health Questionnaire. Windsor, Berks: NFER-Nelson.
580
NOTES AND SHORTER COMMUNICATIONS
Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologisf, 44, 513-524. Horowitz, M. J., Schaeffer, C. & Cooney, P. (1974). Life event scaling for recency of experience. In Gunderson, E. K. E. & Rahe, R. H. (Eds) Life stress and illness. 2nd edn. Springfield, IL: Charles Thomas. Joreskog, K. G. and S&born D. (1989). LLSREL 7 user’s reference guide. Chicago, IL: Scientific Software. Jorm, A. F., Christensen, H., Henderson, S., Korten, A. E., MacKinnon, A. J. &Scott, R. (1993). Neuroticism and self-reported health in an elderly community sample. Personality and Individual Differences, 15, 5 15-521. Kanner, A. D., Coyne, J. C., Schaefer, C. & Lazarus, R. S. (1981). Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. Journal of Behavioral Medicine, 4, l-39. Lazarus, R. S., DeLongis, A., Folkman, S. & Gruen, R. (1985). Stress and adaptational outcomes: The problem of confounded measures. American Psychologist, 40, 770-779. McCrae, R. R. (1990). Controlling neuroticism in the measurement of stress. Stress Medicine, 6, 237-24 1. Reynolds, S. & Briner, R. B. (1993). Bad theory and bad practice in occupational stress. Paper presented at the Occupational Psychology Conference, Brighton, U.K. Zarski, J. J. (1984). Hassles and health: A replication. Health Psychology, 3, 243-25 1.
Pergamon 0191-8869(94)00079-4
Copyright 0 1994 Elsevier Science Ltd Printed in Great Britain. All rights reserved 0191-8869/94 $7.00+0.00
A re-examination of the stress/illness relationship: how useful is the concept of stress? ALISA PEARLSTONE,
Psychology
Department,
ROBINJ. H. RUSSELL* and PAMELAA. WELLS
Goldsmiths’ College, University London SE14 6NW, England (Received 30 November
of London,
Lewisham
Way,
1993)
Summary-Relationships among major life events, hassles, neuroticism and reported somatic symptoms were examined using a sample of 131 people. Principal components analysis of the Hassles questionnaire revealed four factors. One of these, concerns about money, did not correlate significantly with any of the other variables. A LISREL model incorporating the remaining variables suggested that neuroticism and life events contribute differentially to the three hassles factors, which in turn are related to somatic symptoms. It was argued that the hassles factor most strongly predictive of somatic symptoms, concerns about health, was more likely to be a consequence than a cause of ill-health. It was concluded that minor stressors fall into a number of different classes, which have different causes and different effects. This casts doubt on the concept of stress as a unitary phenomenon.
INTRODUCTION Various perspectives have been adopted in the definition of stress, including the notion of stress as stimulus, stress as response, and the view that there arc both stressor events and individual differences in the appraisal of those events (Hobfoll, 1989). There is so little agreement that some researchers have been led to conclude that stress is merely a heading for a range of diverse phenomena that may or may not be causally related (Reynolds & Briner, 1993). Thus, although the received wisdom may be that “stress causes illness”, Cohen and Williamson (1991) state that “it would be premature to suggest that any of this evidence is more than suggestive”. Despite the difficulties with the concept of stress, most research has used one or both of two approaches. Either major life events occurring in the last year or so of a s’s life are counted, or the impact of recent minor stressors is tallied, typically using a Hassles questionnaire. The use of these approaches to the assessment of stress has led to mixed findings as to the relative importance of each type of stressor, as judged by their impact on questionnaire measures of health. For example, Zarski (1984) found that life events significantly predicted somatic symptoms; adding hassles as a predictor made little, if any, difference. On the other hand, De Benedittis and Lorenzetti (1992) found that hassles but not life events correlated with headaches. Perhaps the most typical finding is that life events do correlate with health measures, but cease to play a role as predictors when hassles are also entered into a multiple regression equation. One example is the study by Kanner, Coyne. Schaefer and Lazarus (I 98 I), who recorded information from Ss over IO months and found that the hassles scale was a better predictor of current and future psychological symptoms than were life event scores, and that the hassles scale shared most of the variance in symptoms accounted for by life events. The implication here is that the role of major occasional stressors is to reduce a person’s ability to deal with minor daily pressures. Such research ignores the conceptual problems associated with stress mentioned at the outset. Each investigation cited has simply used each type of stress questionnaire as something to be summed to provide a total score, whether of major or minor stressors. Chamberlain and Zika (1990) looked at hassles patterns in differing groups (student, community, mothers with children, the elderly). As expected, they found that hassles predicted mental health and wellbeing measures better than life events, the latter dropping out when regression was used. At the same time, different hassles patterns were found across groups, suggesting that different people encounter different types of stressor, with possibly different effects. There is some support for the idea that a stress scale should not be considered as unitary. Lazarus, DeLongis, Folkman and Gruen (1985) used a hassles scale of over 100 items over a 9-month interval. They dropped rarely endorsed items and those not loading highly on any factor, factored the remainder obliquely, found eight factors (household, health, time pressure, inner concern, environmental, financial responsibility, work, future security), and correlated these with a symptom check list. All bar one (time pressures for males) correlated with illness. There is also some support for the notion that individual differences should be taken into account. For example, McCrae (I 990) has argued that neuroticism is a variable that has been unwisely neglected by stress researchers. He considered that relations among variables such as stress, failure to cope, dissatisfaction with social support, and so on, may all be due to the common influence of neuroticism rather than to the processes of stress and coping. If nothing else, neuroticism could positively bias reporting of symptoms, as suggested by Jorm, Christensen, Henderson, Korten, MacKinnon and Scott (1993). They found that correlations between neuroticism and self-reported health depended on the nature of each health item: the more objective the item, the lower the correlation. The aim of the present study is to re-examine the relationships among major life events, daily hassles, and questionnaire-assessed health, while including a measure of neuroticism. At the same time, the dimensionality of the hassles items will be examined, to ascertain whether different types of hassles seem to have different causes or different effects. *To whom all correspondence PAID17:4-I
should be addressed. 577
578
NOTESANDSHORTERCOMMUNICATlONS
Table I. Correlations among neuroticism, stresses, and somatic symptoms N
Life Events ‘Health’ ‘Money’ ‘Intimacy’
0.02 I 0.311** 0.019 0.090
‘Work’ GHQ
0.276** 0.354**
Life Events 0.078 - 0.038 0.272**
0.307** 0.219*
‘Health’
- 0.002 0.004 0.015
0.399**
‘Money’
‘Intimacy’
‘Work’
0.002
0.005 0.075
- 0.055 0.246’
0.285**
Number of subjects: 131. One-tailed significance: * - 0.01 ** - 0.001.
METHOD
One-hundred and fifty-six Ss were recruited by approaching them informally in various settings such as a university, a Rotary club and their own homes. Ss were sampled from both urban and rural settings. Ages ranged from 15 to 83 yr, with a peak in the 20-30 age band. Sixty per cent of the sample was female. Some of the Ss did not feature in all the analyses reported below, because occasional missing values on the relevant variables led to their exclusion. There were 131 complete cases on all variables. Each of these S’s completed a questionnaire pack which contained a number of scales with minor modifications. The pack included: (1) a Life Events scale from Horowitz, Schaeffer and Cooney (1974) covering the occurrence of 3 1 major life events over the previous year, each event being coded as None, Once, or More than once; (2) the Hassles questionnaire, from DeLongis, Folkman and Lazarus (1988); (3) Scale A, somatic symptoms, from Genera1 Health Questionnaire 28 (Goldberg & Williams, 1988); and (4) a Neuroticism scale, using half of the items from the Eysenck Personality Questionnaire (Eysenck, Eysenck & Barrett, 1985). The modifications mainly involved dropping a few items judged inappropriate for the British sample, except in the case of the N scale, which was halved to keep the length of the pack down. With the length reduced in this way, the reliability was still satisfactory, with a Cronbach’s c( value of 0.74 in this sample.
RESULTS
A principal components analysis was carried out on the 5 1 items of the hassles scale. Inspection of a graph of the eigenvalues suggested that a four-factor solution was appropriate, using the criterion of the scree test (Cattell, 1966). The first four principal components all had eigenvalues over 2.5 and accounted for 36% of the total variance. After varimax rotation, the four items loading most highly on factor 1 were: exercise, physical abilities, cooking, and health. The top four on factor 2 were: money for necessities, money for emergencies, money for extras, and children. The top four on factor 3 were: intimacy, friends, sex, and relatives. The top four on factor 4 were: nature of work, workload, deadlines, and boss. The interpretation of each factor is fairly obvious. The first primarily concerns health and fitness, the second, money, the third, close relationships, and the fourth, work. Scores on all four principal components were saved for subsequent analysis. Correlations among all the relevant variables are shown in Table 1. Responses to the GHQ are coded so that a high score indicates poor health. The four Hassles factors are labelled ‘Health’, ‘Money’, ‘Intimacy’ and ‘Work’, respectively. An obvious feature of the correlation matrix is that the second hassles factor, ‘Money’, is unrelated to neuroticism, major life events, or health as measured by the relevant GHQ scale. It is therefore excluded from subsequent analyses. All the remaining variables correlate significantly with the somatic symptoms scale of the GHQ in the expected direction. To presume that they can all be viewed as directly causing physical complaints would be unwise. The total Life Events scores correlate more highly with two of the Hassles factors than with the GHQ measure. To the extent that stressful life events promote feelings of being unwell, they should be considered to do so by making people cope less successfully with the pressures of daily life. Although neuroticism correlates with two of the hassles factors, its relationship to the GHQ measure is stronger: it may have a direct causal impact on responses to the GHQ scale. To assess the magnitude of these potential causal relationships, the variables were entered into a LISREL model (Joreskog and Sorbom, 1989). Estimates of error variance were not available for the majority of the variables, so latent variables were not introduced into the model. Basing the model on the correlation matrix, Life Events were allowed to affect Hassles factors 3 (Intimacy) and 4 (Work). Neuroticism was allowed to affect Hassles factors I (Health) and 4 (Work), and also exert a direct influence on the GHQ measure. Each of the three Hassles factors mentioned was allowed to influence the GHQ measure. When this model was fitted, the strength of the direct path from Neuroticism to the GHQ measure was 0.15. When this path was excluded in a second analysis, the deterioration in goodness of fit did not quite reach the 0.05 level of significance (x2 = 3.73, d.f. = I). The remaining paths were all clearly significant and are shown in Fig. 1. These are analogous to /I coefficients in multiple regression. The detached arrows pointing into the dependent variables represent the proportion of variance unexplained by the independent variables. The model shown in Fig. 1 fits the data reasonably well. The value of xZ is 12.59, which, with 7 d.f. is non-significant. The goodness of tit index is 0.971, and the adjusted goodness of fit index is 0.912. The root mean square residual is 0.393.
DISCUSSION
In common with most studies, the results here suggest that the occurrence of occasional major stressors does not have an immediate effect on feelings of wellbeing. Rather, the stress induced by such events seems to reduce a person’s resources for dealing with day to day pressures. Neuroticism, too, has an effect on the ease with which a person deals with daily tasks: as McCrae (1990) suggests, it should be routinely assessed in studies of stress and its effects. The results here hint at the possibility raised by Jorm et al. (1993)
NOTESANDSHORTERCOMMUNICATIONS
579
.83’
Fig. 1. Model of relationships among neuroticism, stresses, and somatic symptoms.
that neuroticism may also affect health scores directly by making a neurotic person more likely to report a problem than someone with a low neuroticism score whose state of health, objectively assessed, is the same. However, the main conclusion to be drawn from the results is that immediate minor stressors fall into different classes, which have different causes and different effects. Apart from financial worries, which correlate with none of the other variables employed in this study, each of the three other hassles factors appears to be differentially affected by life events and neuroticism. They do not have an equal impact on the GHQ measure of health complaints. It would be unwise to be dogmatic about exactly how many hassles factors there are, or what they consist of. While we found four, using a sample of around 150, Lazarus er al. (1985) found eight. However, they used oblique rotation, a sample of 100, and excluded 53 items from the final results. Most important, their analysis involved the sum of a number of questionnaire administrations extending over several months. Perhaps, therefore, it tapped into clusters of items reflecting persistent themes, rather than immediate and changing pressures. While the model shows that the factor which has the most powerful causal impact on the GHQ measure is factor I, ‘Health’, it would be unwise to accept that the causal direction operates entirely in that direction. Indeed, it seems more plausible to argue that people who suffer from poor health become hassled by this experience, rather than to argue that health worries led health to deteriorate. The idea that poor health causes health hassles, rather than vice versa as is typically assumed, has been put most forcefully by Dohrenwend, Dohrenwend, Dodson and Shrout (1984). More generally, they view the hassles scale as a measure of symptoms of distress rather than a cause. Their view has been criticised by Lazarus et al. (1985), but the criticisms have been rebutted (Dohrenwend & Shrout 1985). Whichever side one takes in this debate, it seems most unwise to study the effect of stress on health using a measure of stress which includes several items relating to possible consequences of ill health. Aside from the ‘Health’ factor, however, it does appear to be the case that people experiencing stress in close relationships or under pressure at work are more likely to complain of physical symptoms. On a closing note, it should be pointed out that it is quite possible that different life events also have different effects in important ways. We have been unable to examine this possibility in this study. Most of the events that are typically regarded as potential major stressors happen to people extremely rarely, if ever. To detect differential effects between, say, stressors involving loss of a person close to one and stressors involving loss of work, money or status, would require a very large sample. Nevertheless, research needs to be conducted on this issue. Until it has been established that different types of stressors have the same pattern of impact on those experiencing them, one should be cautious about accepting the validity of the stress construct.
REFERENCES Cattell, R. B. (1966). The scree test for the number of factors. Sociological Methods and Research, I, 24.5-276. Chamberlain, K. & Zika, S. (I 990). The minor events approach to stress: support for the use of daily hassles. British Journal of Psychology, 81, 469-48 I. Cohen, S. & Williamson, G. M. (1991). Stress and infectious diseases in humans. Psychological Bulletin, 109, 5-24. De Benedittis, G. & Lorenzetti, A. (1992). The role of stressful life events in the persistence of primary headache: major events vs. daily hassles. Pain, 51, 3542. Dohrenwend, B. S., Dohrenwend, B. P., Dodson, M. & Shrout, P. E. (1984). Symptoms, hassles, social supports, and life events: problem of confounded measures. Joumul of Abnormal Psychology, 93, 222-230. Dohrenwend, B. P. & Shrout, P. E. (1985). “Hassles” in the conceptualization and measurement of life stress variables. American Psychologist, 40, 780-785.
DeLongis, A., Folkman, S. & Lazarus, R. S. (I 988) The impact of daily stress on health and mood: Psychological and social resources as mediators. Journal of Personality and Social Psychology, 54, 486-495. Eysenck, S. B. G., Eysenck, H. J. & Barrett, P. (I 985). A revised version of the Psychoticism scale. Personalityand Individual Dtrerences,
6, 2 1-29.
Goldberg, D. & Williams, P. (1988) A user’s guide to rhe General Health Questionnaire. Windsor, Berks: NFER-Nelson.
580
NOTES AND SHORTER COMMUNICATIONS
Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologisf, 44, 513-524. Horowitz, M. J., Schaeffer, C. & Cooney, P. (1974). Life event scaling for recency of experience. In Gunderson, E. K. E. & Rahe, R. H. (Eds) Life stress and illness. 2nd edn. Springfield, IL: Charles Thomas. Joreskog, K. G. and S&born D. (1989). LLSREL 7 user’s reference guide. Chicago, IL: Scientific Software. Jorm, A. F., Christensen, H., Henderson, S., Korten, A. E., MacKinnon, A. J. &Scott, R. (1993). Neuroticism and self-reported health in an elderly community sample. Personality and Individual Differences, 15, 5 15-521. Kanner, A. D., Coyne, J. C., Schaefer, C. & Lazarus, R. S. (1981). Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. Journal of Behavioral Medicine, 4, l-39. Lazarus, R. S., DeLongis, A., Folkman, S. & Gruen, R. (1985). Stress and adaptational outcomes: The problem of confounded measures. American Psychologist, 40, 770-779. McCrae, R. R. (1990). Controlling neuroticism in the measurement of stress. Stress Medicine, 6, 237-24 1. Reynolds, S. & Briner, R. B. (1993). Bad theory and bad practice in occupational stress. Paper presented at the Occupational Psychology Conference, Brighton, U.K. Zarski, J. J. (1984). Hassles and health: A replication. Health Psychology, 3, 243-25 1.