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Life event scaling: The Chinese experience
Sot. Sci. Med. Vol. 18. No. 5, pp. 44-446. Printed in Great Britain
0277-9536/84 53.00 + 0.00 Pergamon Press Lld
1984
LIFE EVENT SCALING: THE CHINESE EXPERIENCE* Department
DAVID W. CHAN, M. W. CHAN-HO and TIM S. C. CHAN of Psychiatry and Psychiatric Epidemiology Research Unit, Chinese University of Kong, Shatin, NT, Hong Kong
Hong
Abstract-Two hundred and sixty-one staff and student members in a university community responded to a questionnaire to rate 69 life events on a scale of ‘upsettingness’. There were relatively great consensus in their ratings as a group and relatively great consistency in their ratings across diverse status groups differing in age, sex, marital status and staff-student membership. An examination of specific events however revealed subtle differences among groups. In general, the perception of life events could be meaningfully conceptualized in dimensions interpretable as personal loss and failure, gain and achievement, environmental and role change, personal catastrophe, minor interpersonal problems, and legal and court-related problems. It was suggested that adjustment, control and desirability are event attributes which capture different aspects of the perception of life events.
Naturally occurring experiences perceived by individuals as stressful have long been implicated in the development and the course of physical diseases and psychiatric disabilities [ 1,2]. Therefore, one major concern of health-care professionals has been the understanding of the nature and effects of stressful life events. A pioneering effort to systematize the temporal relationship between the occurrence of life events and symptoms dated back to the ‘life chart’ of Adolf Meyer [3]. A further advance in the direction of quantifying life stress came from the work of Holmes and Rahe [4]. They selected 43 life events and quantified the extent of readjustment required by using a magnitude estimation scaling technique based on social concensus. In this approach, social readjustment refers to the degree and duration of an individual’s accommodation to changes induced by a life event, regardless of the perceived desirability of the event. Holmes and Rahe [4] reported substantial agreement in the rating of life events across status groups differing in age, and in sociocultural and ethnic backgrounds. Their subsequent research studies, however, have revealed differences among Americans, Europeans and Japanese [S-8] and among whites, Negroes and Mexicans [9]. Other investigators have also reported group differences in mean readjustment ratings, both with and without rank-order differences [lO-121. These cultural, ethnic or group differences in the perception of life events have thus pointed to the importance of assessing the impact of life events on different status groups and on groups differing in cultural and ethnic backgrounds. In addition, in adapting a life event scale for local use, *Reprint requests should be sent to: Dr David W. Chan, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin. NT, Hong Kong. This study is supported in part by research grants from the United College Research Fund and the Keswick Foundation. Parts of the results have been presented at the Annual General Meeting of the Hong Kong Psychiatric Association. Hong Kong, June 1982.
the inclusion of local events of cultural and ethnic significance are recognized as important in achieving an adequate coverage. Consequently, investigators have devised new event scales, expanded the original list of life events, reworded items to aim at individuals of lower socioeconomic classes, excluded events which might be ‘antecedents’ of other events for the study of the causal relations between events and the onset of illness, and included local events which appeared vital to the specific community [13-IS]. Although it is generally acknowledged that life change or readjustment is a central component of stressful experiences, the unidimensional conception of life events which implicitly equates life change with stress is an oversimplification. Vinokur and Selzer [16], for example, maintained that the critical feature of life events in generating stress lies in their threatening and undesirable quality. In this regard, Paykel et al. [13] suggested that by asking subjects to rate events on a scale of ‘upsettingness’, both change and desirability could be. invoked. Other investigators have also suggested that event undesirability is stressproducing only if combined with uncontrollability [17, 181. Ruth [19], in a multidimensional scaling study of the rating of life events, identified three event dimensions interpreted as degree of life change, desirability of life change, and area of life change. In another investigation designed to examine individual viewpoints of stressful life events, Redfield and Stone [20] reported a three-mode factor analysis that produced three idealized individuals with three event factors (personal catastrophe, achievement and domesticity) and three scale factors (desirability, meaningfulness and change). Thus, the perception of life events may well be meaningfully conceptualized in a number of distinct yet interrelated dimensions. Along the lines of past studies in life event scaling, in the present study, we aimed at investigating the perception of a set of life events in a Chinese sample. Specifically, our study had the following objectives: (1) to scale unidimensionally the perception of life events; (2) to explore status group differences (e.g. age, sex, marital status) in the perception of life 441
DAVID W. CHAN et
442
events; (3) to examine status group differences in the perception of specific life events; and (4) to uncover the number and nature of dimensions necessary to characterize adequately the perception of life events. METHOD
Subjects and procedure
Our subjects consisted of academic and nonacademic staff members and undergraduate students of the Chinese University of Hong Kong. They were either solicited by mail or asked through their instructors to participate in the study. A total of 261 subjects (182 males, 69 females and 9 unknown) responded to a questionnaire designed for the rating of 69 life events. Their ages ranged from 18 to 60 (mean 31, median 27). All subjects were asked to rate on a 7-point scale whether a specific event was upsetting (l-least upsetting and 7-most upsetting). Subjects were reminded that they should rate how upsetting a particular event was for the average person rather than for himself/herself. Another separate sample of ten psychologists and one psychiatrist were also enlisted to rate the 69 events on three scales: Adjustment (l-requires the least adjustment, ‘J-requires the most adjustment), Uncontrollability (l-easy to control by self, 7difficult to control by self) and Desirability (l-least desirable, 7-most desirable). They were also reminded to rate the events for the average person. Set of life events Sixty events were taken directly for the list of 61 events of Paykel et al. [13]. The omitted event ‘son drafted’ did not apply to the local people since military conscription was nonexistent. Instead, we added nine local events which might be perceived as stressful by the local people. ‘House broken into’ and ‘got mugged’ were included because of the recent increasing number of such offences. ‘Trouble with in-laws’, ‘trouble with co-workers’ and ‘trouble with neighbours’ were included since interpersonal problems appeared to constitute a constant source of conflicts for the local people living in overcrowded conditions. ‘Return to Hong Kong after long stay abroad’ was deemed applicable to many staff members in the university community. ‘Child first starts school’ reflected the concern of many parents in placing children in highly competitive schools, and ‘vacation’ reflected the trend in recent years set by local people in spending their holidays abroad. ‘End of Hong Kong lease’ was included because it appeared disturbing to some people that the year 1997 might mark the end of British rule and the beginning of communist takeover. ‘Trouble with in-laws’ and ‘vacation’ are also on the list of the 43 events compiled by Holmes and Rahe [4]. The order of the 69 events were arranged haphazardly in the questionnaire. RESULTS
Perceived ratings of‘ Ijfe events
Individual ratings of ‘upsettingness’ on the 69 events were aggregated across subjects. The com-
al.
puted mean ratings ranged from 1.73 to 6.43, covering almost the entire scale. Variability of ratings of events across subjects as indicated by the corresponding standard deviations was reasonably small ranging from 0.92 to 1.80. The mean ratings and corresponding standard deviations were ranked in descending order of magnitude. Table 1 presents the ten most upsetting and the ten least upsetting events as perceived by our subjects. It appeared that events which were perceived as least or most upsetting were not perceived very differently across subjects, whereas variability of responses was greatest for events lying between the two extremes. On the top of the list were events which indicated great personal loss and failure. The least upsetting events were those involving achievement or those demanding some changes, yet these changes appeared to be desirable and controllable. To examine what the ratings of ‘upsettingness’ meant to subjects, we correlated the group mean ratings with the ratings on the three scales of adjustment, uncontrollability and desirability by the separate group of judges. The correlations were, respectively, 0.83, 0.78 and -0.88 (all P < O.OOl), indicating that the notion of ‘upsettingness’ included aspects reflecting adjustment, control and desirability. We further compared our group mean ratings with those of the New Haven-Chicago sample of Paykel et al. [13] on the 60 common items. Pearson productmoment correlation reached 0.93 and Spearman rank-order correlation achieved 0.94, both indicating good correspondence. A closer examination on specific rank-ordering of life events, however, revealed some notable rank discrepancies in such events as ‘marital separation not due to argument’, ‘cease steady dating’, ‘separation from significant person’ and ‘cease full-time education’. These events were ranked as more upsetting by our subjects, reflecting the importance they attached to interpersonal relationships and their concern with Table I. Perceived upsettingness of life events (N = 261) Mean rating Ten Most
1. Death of spouse 2. Death of child 3. Jail sentence 4. Death of close family member 5. Divorce 6. Major financial difficulties 7. Spouse unfaithful 8. Court appearance for serious legal violation 9. Business failure IO. Fired Ten Least I. Vacation 2. Move in same city 3. Child married with respondent’s approval 4. Wanted pregnancy 5. Begin education 6. Promotion 7. Child becomes engaged 8. Child first starts school 9. Wife becomes pregnant IO. Change in schools
(SD)
UpsettingEvents 6.43 6.43 6.23 6.09 5.85 5.84 5.68
(0.92) (0.94) (1.02) (1.17) (1.21) (1.14) (1.19)
5.56
(1.23)
5.50 5.45
(1.19) (1.21)
1.73 2.09
(1.19) (1.18)
2.12 2.16 2.29 2.32 2.41 2.42 2.46 2.55
(I ,421
UpsettingEvents
(1.51) (1.25) (I .66) (1.37) (1.36) (1.55) (1.35)
443
Life event scaling Table 2. Corrcsnondence
of mean ratings across status arouns
Product Variable
status group
sex
Male vs female
0.988. 0.9999
Male vs total Female vs total Marital status
Age
3
0.994’
Single vs married Single vs total Married vs total
0.977. 0.995. 0.993.
7
27 or below vs above 27
a
above 27 vs total
0.942. 0.9939 0.953.
Staff vs student Staff “S total Student vs total
0.974’ 0.9949 0.998.
11
27 or belowvs total
Staff/student
No. of individual events differing at P
moment correlation
lP < 0.001.
education and career. Somewhat more puzzling were events such as ‘unemployed for one month’ and ‘miscarriage or stillbirth’ which were ranked much lower by our subjects. Status-group
dxerences
on mean ratings
To further explore the consistency of the mean ratings, we examined the correspondence and
difference of mean ratings across different status groups. Specifically we divided the total group into separate subgroups by age (median split), sex, marital status (single vs married) and staff-student membership. Product-moment correlations across corresponding groups are presented in Table 2. The remarkably high correlations of ratings between pairs of status groups and between each
Table 3. Status group differences on spcciftc life events Sex difference Event
NO. 1. 2. 3.
Got mugged Retirement Return to Hong Kong after long stay abroad
Marital status group difference Nil
1. 2. 3. 4. 5. 6. 7.
Event Death of spouse Death of close friend Separation from significant person Got mugged Loss of personally valuable object Cease steady dating Trouble with in-laws
Age differences No. 1. 2. 3. 4. 5. 6. 7. 8.
Event Death of spouse Death of close friend Break engagement Separation from significant person Take a large loan Cease steady dating Trouble with in-laws Minor personal physical illness
Staff-Student No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
group ditTerences Event
Death of close friend Academic failure Separation from significant person House broken into Loss of personally valuable object Cease steady dating Trouble with in-laws Unemployed for 1 month Argument with nonresident family member Trouble with neighbours Birth of a child (father) or adoption
lP < 0.01; tP < 0.005; SP c 0.001
Male (N = 183) Mean (SD)
Mean
(SD)
Z
(1.59)
4.59 4.00
(1.45) (1.66)
2.69. 2.87t
(1.50)
3.27
(1.61)
2.66.
4.02 3.34
(1.49)
2.69
Single (N = 150) Mean (SD) 6.30 5.50 4.74 3.98 4.37 4.26 4.14
$48; (1.37) (1.45) (1.54) (1.40) (1.36)
27 or below (N = 125) Mean (SD) 6.25 5.52 5.25 4.83 4.42 4.28 4.25 2.85
(1.08) (1.30) It::;; (1.32) (1.43) (1.40) (1.35)
Staff (N = 169) Mean (SD) 5.10 4.87 4.30 4.18 4.03 3.74 3.62 3.38 3.15 2.78 2.72
Female (N = 69)
Married (N = 104) Mean (SD) 6.64 4.97 4.19 4.43 3.77 3.53 3.59
Z
(0.63) (1.35) (1.45) (1.53) (1.50) (1.47) (1.51)
3.02t 3.127 3.02t 2.337 3.08t 3.971 2.9at
Above 27 (N = 125) Mean (SD) 6.63 (0.66) 5.06 (1.36) 4.82 (1.35) 4.21 (1.40) 3.39 (1.53) 3.67 (1.46) 3.64 (1.43) 2.4 1 (1.17)
3.25t 2.71* 2.61. 3.43: 2.649 3.2at 3.353 2.76.
Z
Student (N = 68) Mean
Z
;;$ (1.30) (1.46) (1.50) (1.53)
5.63 5.38 4.91 4.67 4.61 4.41 4.44 3.39
(SD) (1.21) (1.10) (1.35) (1.34) (1.51) (1.39) (1.17) (1.50)
3.007 3.231 3.29t 2.64t 3.802 3.54$ 4.40: 2.79’
(1.28) (1.45) (1.71)
3.60 2.97 2.50
(1.19) (1.71) (1.47)
2.69. 2.74. 3.01t
I:.::;
DAVID W. CHAN et al.
344
specific status group and the total group suggested that the total group mean ratings were representative of the ratings of the subgroups which did not differ among themselves. However, notable differences between groups on specific events did occur despite the general substantial agreement. Table 3 presents the specific events which were rated as significantly different (P c 0.01) between pairs of status groups. Regarding sex differences, female subjects rated all the three events in Table 3 as more upsetting than their male counterparts. Particularly noteworthy were ‘retirement’ and ‘return to Hong Kong after long stay abroad’. Both events could not be easily explained away as attributable to the greater vulnerability and emotional attachment to family life of the female subjects. Table 3 also shows the specific events perceived as different in ‘upsettingness’ by single and married subjects. Only two out of the total seven were perceived as more upsetting by the married subjects. ‘Death of spouse’ could be much better appreciated by married people, and ‘got mugged’ should be more Table 4. summary of varimaxrotated
six factor
solution
and correlations
with judgment
scales (N = 261)
Factor
No.
Event
I
Increased arguments
with resident family member 2. Increased arguments with spouse 3. Major personal physical illness 4. Academic failure 5. Unwanted pregnancy 6. Separation from significant person 7. Troubles with co-workers 8. Business failure 9. Fired IO. Increased arguments with fiance or steady date II. House broken into 12. Arguments with boss or co-worker 13. Break engagement 14. Birth of a child (father) or adoption 15. Wanted pregnancy 16. Marriage Promotion 17. Become engaged 18. 19. Birth of live child (for mother) 20. Child married with respondent’s approval 21. Child becomes engaged Wife becomes pregnant 22. Begin education 23. Marital reconciliation (after 24. one partner left home) Vacation 25. Move in same city 26. 21. Change in work conditions Moderate financial difficulties 28. Menopause 29. Death of spouse 30. Death of child 31. 32. Divorce Death of close family member 33. Minor legal violation 34. Trouble with in-laws 35. Major financial difficulties 36. (very heavy debts, bankruptcy) pail sentence 37. Variance I.
upsetting to a married person with a family to support. The other five events rated as more upsetting by single subjects, for example, ‘death of close friend’, ‘cease steady dating’ and ‘separation from significant person’, all reflected the importance of peer influence and social support. It is interesting to note that ‘trouble with in-laws’ was regarded as more upsetting by single subjects. Regarding age differences, one event was perceived as more upsetting by the older age group. This same event ‘death of spouse’ was also perceived as more upsetting by the married people. Similar to the events rated as more upsetting by the single subjects, the seven events rated as more upsetting by the younger age group also reflected the peer influence and the dependence and insecurity of the younger subjects. Again, ‘trouble with in-laws’ emerged as one event rated as much more upsetting by the young subjects. Table 3 also presents the eleven specific events perceived as different by staff and student groups. Only ‘birth of child (father) or adoption’ was rated as more upsetting by staff members. The remaining ten
Correlation with scale Adjustment Uncontrollability Desirabilitv
71 69 65 62 62 60 58 58 56 54 53 50 50 -
-
II
III
-
-
80 78 77 74 73 73 70 68 57 56
-
-
-
-
-
-
-
-
-
-
0.54
-
-
0.23
0.08
0.23 0.35. -0.66t
-0.31. -0.52t 0.91t
-0.36t -0.17 -0.04 loadings
VI
-
-
60 59 51 50 -
V
-
-
54 52 -
events with nonsalient
IV
-
-
Note: Only salient loadings above IO.50 1are shown. Thirty-two factor loadings and on correlations are also omitted. ‘P < 0.005; tP < 0.001.
-
70 69 54 52 -
0.06
0.64t 0.64t -0.53t are omitted.
-
-
57 55 0.05
-0.30 -0.06 -0.23
All decimal
-0.46t points on salient
445
Life event scaling events were all rated by students as more upsetting. The interpretation which was applied to marital status group differences equally applied to the staff-student group differences. For example, the young, single students all viewed ‘death of close friend’, ‘separation from significant person’, ‘cease steady dating’ and ‘trouble with in-laws’ as more upsetting. Evidently, there was confounding in age, marital status and staff-student differences, since a student tended to be younger and single and a staff member tended to be older and married. Nonetheless, the separate comparisons also allowed a closer examination of specific events particulary meaningful to specific groups. For example, ‘academic failure’ emerged as very significantly different in the degree of ‘upsettingness’ when perceived by students as opposed to staff members. Perceived dimensions of Iife events The ratings of the life events were found to be highly consistent across groups and internal consistency of the ratings on ‘upsettingness’ achieved an alpha coefficient of 0.95. However, the mean ratings on ‘upsettingness’ correlated sizeably with ratings of adjustment, uncontrollability and desirability by a separate group of judges, though adjustment, uncontrollability and desirability were highly intercorrelated to a magnitude of about 0.60. The substantial associations suggested that the perception of life event might not be unidimensional, and separate yet distinct dimensions could emerge. Consequently, we performed an iterated principal-axis factor analysis on the ratings of the 69 events. Sixteen factors with eigenvalues exceeding unity accounted for 67.2% of the total variance. On the basis of the scree test and factor interpretability, we rotated six factors accounting for 48.0% of the total variance for interpretation. Table 4 presents a summary of the varimax rotated factor structure of the perceived ratings on 69 events arranged according to their highest loadings on one of the six factors. To simplify, only events with salient loadings IO.50 1 or above are shown. Table 4 also shows the correlations of the factors with the ratings on adjustment, uncontrollability and desirability. Factor I was characterized by a complex array of events involving personal losses, failures, misfortunes, domestic problems. work-related and interpersonal problems. This factor appeared to encompass a heterogeneous set of events accounting for over half of the variance of the six factors. Table 4 shows that this factor correlated positively and moderately with adjustment and uncontrollability but negatively and substantially with desirability. Events perceived along this dimension interpretable as personal loss and failure required some adjustment, were somewhat uncontrollable, and were very undesirable. Factor II was defined by events involving entrances to the social field and personal achievement. This factor correlated highly with desirability and substantially but negatively with uncontrollability and adjustment. This was a dimension of personal gain and achievement. Events perceived along this dimension were very desirable, mostly controllable and requiring little adjustment.
Factor III was loaded by events denoting work or role changes and changes in environment. This factor correlated substantially and negatively with adjustment indicating that very little adjustment would be required. This dimension could be labelled environmental and role change. Factor IV was characterized by events of great loss such as death and separation. This factor of personal catastrophe was distinguished from Factor 1 in the intensity and severity of the consequences incurred by the loss. Its strong association with all three scales indicated that events perceived along this dimension required a great amount of adjustment, were mostly uncontrollable and very undesirable. Factor V and Factor VI were two relatively minor factors in terms of the variance accounted for. Factor V was loaded by a small number of events involving minor interpersonal problems which, though undesirable, required little adjustment. The interpretation was substantiated by the moderate correlations with adjustment and desirability. Factor VI was defined by a few events all involving legal and court-related problems. This dimension correlated substantially and positively with adjustment but negatively with desirability, showing that legal problems were both undesirable and required a relatively large amount of adjustment. DISCUSSION
Our findings served to expand and replicate past findings in life event scaling. There appeared to be relatively great consensus regarding the perception of life events on a scale of ‘upsettingness’ in our Chinese sample. In addition, the unidimensional mean ratings of life events were relatively consistent across status groups differing in age, sex, marital status and staff-student membership. However, correlations of mean ratings between diverse groups were relatively insensitive to differences in group ratings on critical subsets of events. Indeed, our findings suggested that subtle differences did exist between age groups, male and female groups, single and married groups, and staff and student groups, although there was some confounding in age, marital status and staff-student differences. Events which were perceived as significantly more upsetting were events which were less remote. They reflected the immediate concern, the dependence and the need for social support of the younger age group or the greater likelihood of experiencing such events by the older age group. Although life events could be rated very consistently along a dimension of ‘upsettingness’, perceived life events could be conceptualized meaningfully along separate yet distinct dimensions such as loss and failure, gain and achievement, environmental and role change and personal catastrophe. Events perceived along each dimension could also be assessed on the amount of adjustment it required, the degree of control one could exercise on the particular event, and the degree of desirability of the event. Further, adjustment, control and desirability were perceived as interrelated and associated with upsettingness. The exact interactive nature of change, desirability, and controllability and their joint contributions to the event-illness or event-symptom
446
DAVID W. CHAN et al.
relationship, however, have to be determined in future investigations. The general correspondence between the results of the ratings of our sample and those of the New Haven-Chicago sample [ 131 suggested that distressing events were perceived as distressing to more or less the same degree across culture. The difference between Americans and Swedes regarding workrelated items and the difference between Americans and Japanese regarding retirement, for example, did not appear in the present study. However, there was a small subset of events which were perceived as much less upsetting by our sample. Such discrepancies may arise from at least two possible reasons. One is the differential exposure of different samples to this subset of events. A check with our respondents revealed that some of the discrepant events such as unemployment and marital separation were experienced by very few of our respondents and miscarriage and stillbirth did not occur to any of our subjects. However, the lack of exposure can only partially account for the difference in ratings as other discrepant events such as change in work hours and separation from significant person were experienced by 20% or more of our respondents. A related issue is the characteristics of our sample. At best, we sampled a relatively educated and English-speaking sector of the Chinese community. Extrapolation of our findings to the less educated Chinese will likely require further work along the lines of interview rather than selfadministered checklists. The second plausible reason is the difference in contextual implications of events for different samples. Being ‘unemployed for one month’ may mean a total lack of income for a month, living on welfare, or depending on the goodwill and support of other members of the extended family. Thus, contextual descriptions of such events designed for international comparison may shed more light on the similarity and differences in life event scaling across cultures. One final point worthy of note in the present study is the set of nine local events. They were included to reflect the immediate concern of the local people although they can hardly be claimed to be peculiar to Hong Kong. Among them, the crime-related items were rated as most upsetting. Next were the events regarding interpersonal conflicts. Less expected was the event ‘end of Hong Kong lease’ which was not rated as particularly upsetting, contrary to the view of many business people in Hong Kong who regard it somewhat disturbing in deciding whether to continue to invest as the lease is to expire in 15 years. One possible reason is that young subjects who have never experienced living under a different regime view this event as somewhat remote, and older subjects perceive themselves as too advanced in age in 15 years, or have planned to emigrate to other countries or to return to their home countries. However, this reason appears to be inadequate in many ways in accounting for the relatively low upsettingness of this event. Notice also that the present study was conducted just before the British Prime Minister’s visit to Beijing and the establishing of a formal and open dialogue between Beijing and London on the future of Hong Kong. Since then, there appears to be greater public awareness and more open commentaries on the issue
by local people. Soft data by various colleagues have also testified that some local patients were very disturbed by this event. Therefore the relatively low upsettingness of this event may be akin to an earlier process of group denial by the local people. We suspect that a similar study done now after the British Prime rating
Minister’s visit may yield a rather for this specific local event.
different
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0277-9536/84 53.00 + 0.00 Pergamon Press Lld
1984
LIFE EVENT SCALING: THE CHINESE EXPERIENCE* Department
DAVID W. CHAN, M. W. CHAN-HO and TIM S. C. CHAN of Psychiatry and Psychiatric Epidemiology Research Unit, Chinese University of Kong, Shatin, NT, Hong Kong
Hong
Abstract-Two hundred and sixty-one staff and student members in a university community responded to a questionnaire to rate 69 life events on a scale of ‘upsettingness’. There were relatively great consensus in their ratings as a group and relatively great consistency in their ratings across diverse status groups differing in age, sex, marital status and staff-student membership. An examination of specific events however revealed subtle differences among groups. In general, the perception of life events could be meaningfully conceptualized in dimensions interpretable as personal loss and failure, gain and achievement, environmental and role change, personal catastrophe, minor interpersonal problems, and legal and court-related problems. It was suggested that adjustment, control and desirability are event attributes which capture different aspects of the perception of life events.
Naturally occurring experiences perceived by individuals as stressful have long been implicated in the development and the course of physical diseases and psychiatric disabilities [ 1,2]. Therefore, one major concern of health-care professionals has been the understanding of the nature and effects of stressful life events. A pioneering effort to systematize the temporal relationship between the occurrence of life events and symptoms dated back to the ‘life chart’ of Adolf Meyer [3]. A further advance in the direction of quantifying life stress came from the work of Holmes and Rahe [4]. They selected 43 life events and quantified the extent of readjustment required by using a magnitude estimation scaling technique based on social concensus. In this approach, social readjustment refers to the degree and duration of an individual’s accommodation to changes induced by a life event, regardless of the perceived desirability of the event. Holmes and Rahe [4] reported substantial agreement in the rating of life events across status groups differing in age, and in sociocultural and ethnic backgrounds. Their subsequent research studies, however, have revealed differences among Americans, Europeans and Japanese [S-8] and among whites, Negroes and Mexicans [9]. Other investigators have also reported group differences in mean readjustment ratings, both with and without rank-order differences [lO-121. These cultural, ethnic or group differences in the perception of life events have thus pointed to the importance of assessing the impact of life events on different status groups and on groups differing in cultural and ethnic backgrounds. In addition, in adapting a life event scale for local use, *Reprint requests should be sent to: Dr David W. Chan, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin. NT, Hong Kong. This study is supported in part by research grants from the United College Research Fund and the Keswick Foundation. Parts of the results have been presented at the Annual General Meeting of the Hong Kong Psychiatric Association. Hong Kong, June 1982.
the inclusion of local events of cultural and ethnic significance are recognized as important in achieving an adequate coverage. Consequently, investigators have devised new event scales, expanded the original list of life events, reworded items to aim at individuals of lower socioeconomic classes, excluded events which might be ‘antecedents’ of other events for the study of the causal relations between events and the onset of illness, and included local events which appeared vital to the specific community [13-IS]. Although it is generally acknowledged that life change or readjustment is a central component of stressful experiences, the unidimensional conception of life events which implicitly equates life change with stress is an oversimplification. Vinokur and Selzer [16], for example, maintained that the critical feature of life events in generating stress lies in their threatening and undesirable quality. In this regard, Paykel et al. [13] suggested that by asking subjects to rate events on a scale of ‘upsettingness’, both change and desirability could be. invoked. Other investigators have also suggested that event undesirability is stressproducing only if combined with uncontrollability [17, 181. Ruth [19], in a multidimensional scaling study of the rating of life events, identified three event dimensions interpreted as degree of life change, desirability of life change, and area of life change. In another investigation designed to examine individual viewpoints of stressful life events, Redfield and Stone [20] reported a three-mode factor analysis that produced three idealized individuals with three event factors (personal catastrophe, achievement and domesticity) and three scale factors (desirability, meaningfulness and change). Thus, the perception of life events may well be meaningfully conceptualized in a number of distinct yet interrelated dimensions. Along the lines of past studies in life event scaling, in the present study, we aimed at investigating the perception of a set of life events in a Chinese sample. Specifically, our study had the following objectives: (1) to scale unidimensionally the perception of life events; (2) to explore status group differences (e.g. age, sex, marital status) in the perception of life 441
DAVID W. CHAN et
442
events; (3) to examine status group differences in the perception of specific life events; and (4) to uncover the number and nature of dimensions necessary to characterize adequately the perception of life events. METHOD
Subjects and procedure
Our subjects consisted of academic and nonacademic staff members and undergraduate students of the Chinese University of Hong Kong. They were either solicited by mail or asked through their instructors to participate in the study. A total of 261 subjects (182 males, 69 females and 9 unknown) responded to a questionnaire designed for the rating of 69 life events. Their ages ranged from 18 to 60 (mean 31, median 27). All subjects were asked to rate on a 7-point scale whether a specific event was upsetting (l-least upsetting and 7-most upsetting). Subjects were reminded that they should rate how upsetting a particular event was for the average person rather than for himself/herself. Another separate sample of ten psychologists and one psychiatrist were also enlisted to rate the 69 events on three scales: Adjustment (l-requires the least adjustment, ‘J-requires the most adjustment), Uncontrollability (l-easy to control by self, 7difficult to control by self) and Desirability (l-least desirable, 7-most desirable). They were also reminded to rate the events for the average person. Set of life events Sixty events were taken directly for the list of 61 events of Paykel et al. [13]. The omitted event ‘son drafted’ did not apply to the local people since military conscription was nonexistent. Instead, we added nine local events which might be perceived as stressful by the local people. ‘House broken into’ and ‘got mugged’ were included because of the recent increasing number of such offences. ‘Trouble with in-laws’, ‘trouble with co-workers’ and ‘trouble with neighbours’ were included since interpersonal problems appeared to constitute a constant source of conflicts for the local people living in overcrowded conditions. ‘Return to Hong Kong after long stay abroad’ was deemed applicable to many staff members in the university community. ‘Child first starts school’ reflected the concern of many parents in placing children in highly competitive schools, and ‘vacation’ reflected the trend in recent years set by local people in spending their holidays abroad. ‘End of Hong Kong lease’ was included because it appeared disturbing to some people that the year 1997 might mark the end of British rule and the beginning of communist takeover. ‘Trouble with in-laws’ and ‘vacation’ are also on the list of the 43 events compiled by Holmes and Rahe [4]. The order of the 69 events were arranged haphazardly in the questionnaire. RESULTS
Perceived ratings of‘ Ijfe events
Individual ratings of ‘upsettingness’ on the 69 events were aggregated across subjects. The com-
al.
puted mean ratings ranged from 1.73 to 6.43, covering almost the entire scale. Variability of ratings of events across subjects as indicated by the corresponding standard deviations was reasonably small ranging from 0.92 to 1.80. The mean ratings and corresponding standard deviations were ranked in descending order of magnitude. Table 1 presents the ten most upsetting and the ten least upsetting events as perceived by our subjects. It appeared that events which were perceived as least or most upsetting were not perceived very differently across subjects, whereas variability of responses was greatest for events lying between the two extremes. On the top of the list were events which indicated great personal loss and failure. The least upsetting events were those involving achievement or those demanding some changes, yet these changes appeared to be desirable and controllable. To examine what the ratings of ‘upsettingness’ meant to subjects, we correlated the group mean ratings with the ratings on the three scales of adjustment, uncontrollability and desirability by the separate group of judges. The correlations were, respectively, 0.83, 0.78 and -0.88 (all P < O.OOl), indicating that the notion of ‘upsettingness’ included aspects reflecting adjustment, control and desirability. We further compared our group mean ratings with those of the New Haven-Chicago sample of Paykel et al. [13] on the 60 common items. Pearson productmoment correlation reached 0.93 and Spearman rank-order correlation achieved 0.94, both indicating good correspondence. A closer examination on specific rank-ordering of life events, however, revealed some notable rank discrepancies in such events as ‘marital separation not due to argument’, ‘cease steady dating’, ‘separation from significant person’ and ‘cease full-time education’. These events were ranked as more upsetting by our subjects, reflecting the importance they attached to interpersonal relationships and their concern with Table I. Perceived upsettingness of life events (N = 261) Mean rating Ten Most
1. Death of spouse 2. Death of child 3. Jail sentence 4. Death of close family member 5. Divorce 6. Major financial difficulties 7. Spouse unfaithful 8. Court appearance for serious legal violation 9. Business failure IO. Fired Ten Least I. Vacation 2. Move in same city 3. Child married with respondent’s approval 4. Wanted pregnancy 5. Begin education 6. Promotion 7. Child becomes engaged 8. Child first starts school 9. Wife becomes pregnant IO. Change in schools
(SD)
UpsettingEvents 6.43 6.43 6.23 6.09 5.85 5.84 5.68
(0.92) (0.94) (1.02) (1.17) (1.21) (1.14) (1.19)
5.56
(1.23)
5.50 5.45
(1.19) (1.21)
1.73 2.09
(1.19) (1.18)
2.12 2.16 2.29 2.32 2.41 2.42 2.46 2.55
(I ,421
UpsettingEvents
(1.51) (1.25) (I .66) (1.37) (1.36) (1.55) (1.35)
443
Life event scaling Table 2. Corrcsnondence
of mean ratings across status arouns
Product Variable
status group
sex
Male vs female
0.988. 0.9999
Male vs total Female vs total Marital status
Age
3
0.994’
Single vs married Single vs total Married vs total
0.977. 0.995. 0.993.
7
27 or below vs above 27
a
above 27 vs total
0.942. 0.9939 0.953.
Staff vs student Staff “S total Student vs total
0.974’ 0.9949 0.998.
11
27 or belowvs total
Staff/student
No. of individual events differing at P
moment correlation
lP < 0.001.
education and career. Somewhat more puzzling were events such as ‘unemployed for one month’ and ‘miscarriage or stillbirth’ which were ranked much lower by our subjects. Status-group
dxerences
on mean ratings
To further explore the consistency of the mean ratings, we examined the correspondence and
difference of mean ratings across different status groups. Specifically we divided the total group into separate subgroups by age (median split), sex, marital status (single vs married) and staff-student membership. Product-moment correlations across corresponding groups are presented in Table 2. The remarkably high correlations of ratings between pairs of status groups and between each
Table 3. Status group differences on spcciftc life events Sex difference Event
NO. 1. 2. 3.
Got mugged Retirement Return to Hong Kong after long stay abroad
Marital status group difference Nil
1. 2. 3. 4. 5. 6. 7.
Event Death of spouse Death of close friend Separation from significant person Got mugged Loss of personally valuable object Cease steady dating Trouble with in-laws
Age differences No. 1. 2. 3. 4. 5. 6. 7. 8.
Event Death of spouse Death of close friend Break engagement Separation from significant person Take a large loan Cease steady dating Trouble with in-laws Minor personal physical illness
Staff-Student No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
group ditTerences Event
Death of close friend Academic failure Separation from significant person House broken into Loss of personally valuable object Cease steady dating Trouble with in-laws Unemployed for 1 month Argument with nonresident family member Trouble with neighbours Birth of a child (father) or adoption
lP < 0.01; tP < 0.005; SP c 0.001
Male (N = 183) Mean (SD)
Mean
(SD)
Z
(1.59)
4.59 4.00
(1.45) (1.66)
2.69. 2.87t
(1.50)
3.27
(1.61)
2.66.
4.02 3.34
(1.49)
2.69
Single (N = 150) Mean (SD) 6.30 5.50 4.74 3.98 4.37 4.26 4.14
$48; (1.37) (1.45) (1.54) (1.40) (1.36)
27 or below (N = 125) Mean (SD) 6.25 5.52 5.25 4.83 4.42 4.28 4.25 2.85
(1.08) (1.30) It::;; (1.32) (1.43) (1.40) (1.35)
Staff (N = 169) Mean (SD) 5.10 4.87 4.30 4.18 4.03 3.74 3.62 3.38 3.15 2.78 2.72
Female (N = 69)
Married (N = 104) Mean (SD) 6.64 4.97 4.19 4.43 3.77 3.53 3.59
Z
(0.63) (1.35) (1.45) (1.53) (1.50) (1.47) (1.51)
3.02t 3.127 3.02t 2.337 3.08t 3.971 2.9at
Above 27 (N = 125) Mean (SD) 6.63 (0.66) 5.06 (1.36) 4.82 (1.35) 4.21 (1.40) 3.39 (1.53) 3.67 (1.46) 3.64 (1.43) 2.4 1 (1.17)
3.25t 2.71* 2.61. 3.43: 2.649 3.2at 3.353 2.76.
Z
Student (N = 68) Mean
Z
;;$ (1.30) (1.46) (1.50) (1.53)
5.63 5.38 4.91 4.67 4.61 4.41 4.44 3.39
(SD) (1.21) (1.10) (1.35) (1.34) (1.51) (1.39) (1.17) (1.50)
3.007 3.231 3.29t 2.64t 3.802 3.54$ 4.40: 2.79’
(1.28) (1.45) (1.71)
3.60 2.97 2.50
(1.19) (1.71) (1.47)
2.69. 2.74. 3.01t
I:.::;
DAVID W. CHAN et al.
344
specific status group and the total group suggested that the total group mean ratings were representative of the ratings of the subgroups which did not differ among themselves. However, notable differences between groups on specific events did occur despite the general substantial agreement. Table 3 presents the specific events which were rated as significantly different (P c 0.01) between pairs of status groups. Regarding sex differences, female subjects rated all the three events in Table 3 as more upsetting than their male counterparts. Particularly noteworthy were ‘retirement’ and ‘return to Hong Kong after long stay abroad’. Both events could not be easily explained away as attributable to the greater vulnerability and emotional attachment to family life of the female subjects. Table 3 also shows the specific events perceived as different in ‘upsettingness’ by single and married subjects. Only two out of the total seven were perceived as more upsetting by the married subjects. ‘Death of spouse’ could be much better appreciated by married people, and ‘got mugged’ should be more Table 4. summary of varimaxrotated
six factor
solution
and correlations
with judgment
scales (N = 261)
Factor
No.
Event
I
Increased arguments
with resident family member 2. Increased arguments with spouse 3. Major personal physical illness 4. Academic failure 5. Unwanted pregnancy 6. Separation from significant person 7. Troubles with co-workers 8. Business failure 9. Fired IO. Increased arguments with fiance or steady date II. House broken into 12. Arguments with boss or co-worker 13. Break engagement 14. Birth of a child (father) or adoption 15. Wanted pregnancy 16. Marriage Promotion 17. Become engaged 18. 19. Birth of live child (for mother) 20. Child married with respondent’s approval 21. Child becomes engaged Wife becomes pregnant 22. Begin education 23. Marital reconciliation (after 24. one partner left home) Vacation 25. Move in same city 26. 21. Change in work conditions Moderate financial difficulties 28. Menopause 29. Death of spouse 30. Death of child 31. 32. Divorce Death of close family member 33. Minor legal violation 34. Trouble with in-laws 35. Major financial difficulties 36. (very heavy debts, bankruptcy) pail sentence 37. Variance I.
upsetting to a married person with a family to support. The other five events rated as more upsetting by single subjects, for example, ‘death of close friend’, ‘cease steady dating’ and ‘separation from significant person’, all reflected the importance of peer influence and social support. It is interesting to note that ‘trouble with in-laws’ was regarded as more upsetting by single subjects. Regarding age differences, one event was perceived as more upsetting by the older age group. This same event ‘death of spouse’ was also perceived as more upsetting by the married people. Similar to the events rated as more upsetting by the single subjects, the seven events rated as more upsetting by the younger age group also reflected the peer influence and the dependence and insecurity of the younger subjects. Again, ‘trouble with in-laws’ emerged as one event rated as much more upsetting by the young subjects. Table 3 also presents the eleven specific events perceived as different by staff and student groups. Only ‘birth of child (father) or adoption’ was rated as more upsetting by staff members. The remaining ten
Correlation with scale Adjustment Uncontrollability Desirabilitv
71 69 65 62 62 60 58 58 56 54 53 50 50 -
-
II
III
-
-
80 78 77 74 73 73 70 68 57 56
-
-
-
-
-
-
-
-
-
-
0.54
-
-
0.23
0.08
0.23 0.35. -0.66t
-0.31. -0.52t 0.91t
-0.36t -0.17 -0.04 loadings
VI
-
-
60 59 51 50 -
V
-
-
54 52 -
events with nonsalient
IV
-
-
Note: Only salient loadings above IO.50 1are shown. Thirty-two factor loadings and on correlations are also omitted. ‘P < 0.005; tP < 0.001.
-
70 69 54 52 -
0.06
0.64t 0.64t -0.53t are omitted.
-
-
57 55 0.05
-0.30 -0.06 -0.23
All decimal
-0.46t points on salient
445
Life event scaling events were all rated by students as more upsetting. The interpretation which was applied to marital status group differences equally applied to the staff-student group differences. For example, the young, single students all viewed ‘death of close friend’, ‘separation from significant person’, ‘cease steady dating’ and ‘trouble with in-laws’ as more upsetting. Evidently, there was confounding in age, marital status and staff-student differences, since a student tended to be younger and single and a staff member tended to be older and married. Nonetheless, the separate comparisons also allowed a closer examination of specific events particulary meaningful to specific groups. For example, ‘academic failure’ emerged as very significantly different in the degree of ‘upsettingness’ when perceived by students as opposed to staff members. Perceived dimensions of Iife events The ratings of the life events were found to be highly consistent across groups and internal consistency of the ratings on ‘upsettingness’ achieved an alpha coefficient of 0.95. However, the mean ratings on ‘upsettingness’ correlated sizeably with ratings of adjustment, uncontrollability and desirability by a separate group of judges, though adjustment, uncontrollability and desirability were highly intercorrelated to a magnitude of about 0.60. The substantial associations suggested that the perception of life event might not be unidimensional, and separate yet distinct dimensions could emerge. Consequently, we performed an iterated principal-axis factor analysis on the ratings of the 69 events. Sixteen factors with eigenvalues exceeding unity accounted for 67.2% of the total variance. On the basis of the scree test and factor interpretability, we rotated six factors accounting for 48.0% of the total variance for interpretation. Table 4 presents a summary of the varimax rotated factor structure of the perceived ratings on 69 events arranged according to their highest loadings on one of the six factors. To simplify, only events with salient loadings IO.50 1 or above are shown. Table 4 also shows the correlations of the factors with the ratings on adjustment, uncontrollability and desirability. Factor I was characterized by a complex array of events involving personal losses, failures, misfortunes, domestic problems. work-related and interpersonal problems. This factor appeared to encompass a heterogeneous set of events accounting for over half of the variance of the six factors. Table 4 shows that this factor correlated positively and moderately with adjustment and uncontrollability but negatively and substantially with desirability. Events perceived along this dimension interpretable as personal loss and failure required some adjustment, were somewhat uncontrollable, and were very undesirable. Factor II was defined by events involving entrances to the social field and personal achievement. This factor correlated highly with desirability and substantially but negatively with uncontrollability and adjustment. This was a dimension of personal gain and achievement. Events perceived along this dimension were very desirable, mostly controllable and requiring little adjustment.
Factor III was loaded by events denoting work or role changes and changes in environment. This factor correlated substantially and negatively with adjustment indicating that very little adjustment would be required. This dimension could be labelled environmental and role change. Factor IV was characterized by events of great loss such as death and separation. This factor of personal catastrophe was distinguished from Factor 1 in the intensity and severity of the consequences incurred by the loss. Its strong association with all three scales indicated that events perceived along this dimension required a great amount of adjustment, were mostly uncontrollable and very undesirable. Factor V and Factor VI were two relatively minor factors in terms of the variance accounted for. Factor V was loaded by a small number of events involving minor interpersonal problems which, though undesirable, required little adjustment. The interpretation was substantiated by the moderate correlations with adjustment and desirability. Factor VI was defined by a few events all involving legal and court-related problems. This dimension correlated substantially and positively with adjustment but negatively with desirability, showing that legal problems were both undesirable and required a relatively large amount of adjustment. DISCUSSION
Our findings served to expand and replicate past findings in life event scaling. There appeared to be relatively great consensus regarding the perception of life events on a scale of ‘upsettingness’ in our Chinese sample. In addition, the unidimensional mean ratings of life events were relatively consistent across status groups differing in age, sex, marital status and staff-student membership. However, correlations of mean ratings between diverse groups were relatively insensitive to differences in group ratings on critical subsets of events. Indeed, our findings suggested that subtle differences did exist between age groups, male and female groups, single and married groups, and staff and student groups, although there was some confounding in age, marital status and staff-student differences. Events which were perceived as significantly more upsetting were events which were less remote. They reflected the immediate concern, the dependence and the need for social support of the younger age group or the greater likelihood of experiencing such events by the older age group. Although life events could be rated very consistently along a dimension of ‘upsettingness’, perceived life events could be conceptualized meaningfully along separate yet distinct dimensions such as loss and failure, gain and achievement, environmental and role change and personal catastrophe. Events perceived along each dimension could also be assessed on the amount of adjustment it required, the degree of control one could exercise on the particular event, and the degree of desirability of the event. Further, adjustment, control and desirability were perceived as interrelated and associated with upsettingness. The exact interactive nature of change, desirability, and controllability and their joint contributions to the event-illness or event-symptom
446
DAVID W. CHAN et al.
relationship, however, have to be determined in future investigations. The general correspondence between the results of the ratings of our sample and those of the New Haven-Chicago sample [ 131 suggested that distressing events were perceived as distressing to more or less the same degree across culture. The difference between Americans and Swedes regarding workrelated items and the difference between Americans and Japanese regarding retirement, for example, did not appear in the present study. However, there was a small subset of events which were perceived as much less upsetting by our sample. Such discrepancies may arise from at least two possible reasons. One is the differential exposure of different samples to this subset of events. A check with our respondents revealed that some of the discrepant events such as unemployment and marital separation were experienced by very few of our respondents and miscarriage and stillbirth did not occur to any of our subjects. However, the lack of exposure can only partially account for the difference in ratings as other discrepant events such as change in work hours and separation from significant person were experienced by 20% or more of our respondents. A related issue is the characteristics of our sample. At best, we sampled a relatively educated and English-speaking sector of the Chinese community. Extrapolation of our findings to the less educated Chinese will likely require further work along the lines of interview rather than selfadministered checklists. The second plausible reason is the difference in contextual implications of events for different samples. Being ‘unemployed for one month’ may mean a total lack of income for a month, living on welfare, or depending on the goodwill and support of other members of the extended family. Thus, contextual descriptions of such events designed for international comparison may shed more light on the similarity and differences in life event scaling across cultures. One final point worthy of note in the present study is the set of nine local events. They were included to reflect the immediate concern of the local people although they can hardly be claimed to be peculiar to Hong Kong. Among them, the crime-related items were rated as most upsetting. Next were the events regarding interpersonal conflicts. Less expected was the event ‘end of Hong Kong lease’ which was not rated as particularly upsetting, contrary to the view of many business people in Hong Kong who regard it somewhat disturbing in deciding whether to continue to invest as the lease is to expire in 15 years. One possible reason is that young subjects who have never experienced living under a different regime view this event as somewhat remote, and older subjects perceive themselves as too advanced in age in 15 years, or have planned to emigrate to other countries or to return to their home countries. However, this reason appears to be inadequate in many ways in accounting for the relatively low upsettingness of this event. Notice also that the present study was conducted just before the British Prime Minister’s visit to Beijing and the establishing of a formal and open dialogue between Beijing and London on the future of Hong Kong. Since then, there appears to be greater public awareness and more open commentaries on the issue
by local people. Soft data by various colleagues have also testified that some local patients were very disturbed by this event. Therefore the relatively low upsettingness of this event may be akin to an earlier process of group denial by the local people. We suspect that a similar study done now after the British Prime rating
Minister’s visit may yield a rather for this specific local event.
different
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