Life events and personal problems: Their physiological and emotional effects

Person. individ. Di# Vol. 18. No. I, pp. 101-I 16. 1995 Cowrkht 0 1995 Elsevier Science Ltd Printed in &at Britain. All rights reserved 0191-8869/95 $9.50 + 0.00

Pergamon

LIFE EVENTS AND PERSONAL PROBLEMS: THEIR PHYSIOLOGICAL AND EMOTIONAL EFFECTS Shulamith Kreitler,‘* Moshe Aronson,’ Shlomo Berliner,3 Hans Kreitler,lm Kinereth Weissler’ and Nadir Arber4 ‘Department

of Psychology, ‘Department of Cell Biology, Sackler School of Medicine, ‘Department of Internal Medicine, Sackler School of Medicine and 4 Institute of Gastroenterology, Ichilov Hospital, Tel Aviv & Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Received

28 February

1994)

Summary-A large body of research deals with the effect of life events (LE) on stress and health. Since the findings were controversial, attempts were made to circumscribe the kind or aspect of LEs affecting stress. Our purpose was to show that it is not the LE per se but the problem to which it is related (problem-ladenness) or personal problems which are stress related. Subjects were 68 healthy men and women, 29 to 53 years old. They were examined on physiological stress measures (erythrocyte sedimentation rate [ESR], white blood cell count and aggregated white blood cells in peripheral blood), and were administered the Life Experiences Survey, the Personal Problems (PP) scale, Eysenck’s neuroticism scale, Tellegen’s stress reaction, emotional scales (The Profile of Mood States and the Positive Emotions Check List) and the Strelau Temperament Inventory. The findings showed that problem-ladenness was a distinct aspect of LEs, related only lowly to the number of LEs, regardless of their appraisal, but correlated highly with number of PPs. The number of LEs and the number of negative LEs were each related to only one stress index. The number of positive LEs was related to counter-stress indices, mainly increased positive emotions. LEs high on problem-ladenness were related to many stress indices (e.g., neuroticism, tension-anxiety, depression). The number of PPs was related to these, to increased ESR, anger, and to decreased excitation and vigor. The conclusions are that problem-ladenness is the stress-effective element in LEs and that the number of PPs provides a preferable, direct, simple and fast measure of a major stress determinant for both genders.

INTRODUCTION

Life events (LEs) is a well-established construct enjoying a respectable status in the matrix of psychological factors widely recognized as contributing to physical disease or health. In contrast, personal problems (PPs) is as yet an unknown construct whose effects have not been studied. Our purpose is to highlight its advantages, especially in contrast to LEs, in an attempt to resolve some of the problems besetting research on LEs. The “life-change-health-change” hypothesis has gained ground especially after the development of a method for assessing the amount and effect of recent LEs (Holmes & Rahe, 1967; for other methods see Garrity & Marx, 1985; Sarason, Sarason & Johnson, 1985). A body of research is now available which relates life stress to a broad range of health problems, such as sudden cardiac death (Rahe & Lind, 1971), myocardial infarction (Rahe, Romo, Bennett & Siltanen, 1974), pregnancy and birth complications (Gorsuch & Key, 1974), chronic illness (Bedell, Giodani, Amour, Tavormina & Boll, 1977; Wyler, Masuda & Holmes, 1971), tuberculosis, diabetes, multiple sclerosis, etc. (Rabkin & Struening, 1976). Studies of this type lent support to the thesis that LEs increase the individual’s susceptibility to illness (Holmes & Masuda, 1974). The effect was usually explained through the mediation of psychophysiological strain. The underlying assumption was that LEs disrupt the daily routine and require mobilizing coping mechanisms for the purpose of adjustment. Hence they cause stress that is detrimental to health. However, it became evident soon that the relations of LEs to physiological phenomena are far from simple. The major problems were (a) that the observed relations between LEs and health are typically very low, often in the range of r = 0.20 to r = 0.30; and (b) in many cases the relation of LEs to impaired health did not show up (Agrawal 8z Naidu, 1988; Antoni & Goodkin, 1989; Grand, Grosclaude, Bocquet, Pous et al., 1988; Norris & Murrel, 1990; Warner, 1990). * To whom all correspondence W Deceased 7 January 1993.

should be addressed. 101

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Shulamith Kreitler et al.

Considerable research has been devoted in the last two decades to accounting for these facts. The major attempts were focused on the following theses: (a) It is not LEs or changes per se but only those evaluated negatively that have adverse effects (Klages, 1991; Ross & Mirowsky, 1979; Weinberger, 1986). (b) It is not the LE per se but the meaning attributed to it which accounts for its adverse effects (Folkman, Schaefer & Lazarus, 1979). (c) The relationship of LEs to health is moderated by personality variables, for example, sensation seeking (Smith, Johnson & Sarason, 1978), self complexity (Linville, 1987), hardiness (Nakano, 1990) and religiosity (Anson, Carmel, Bonneh, Levenson er al., 1990) may decrease the stress induced by LEs whereas external locus of control (Johnson & Sarason, 1978) and low self esteem when the LEs are negative (Brown & McGill, 1989) increase the stress. (d) The relationship of LEs to health is moderated by situational factors, for example, social problems (Zimmermann-Tansella, Donini, Lattanzi & Siciliani, 1991) exacerbate the effect whereas social support (Cutrona, 1990; Mor-Barak, Miller & Syme, 1991), and material support (Hill, 1987) may reduce the stressfulness of LEs. The characteristic common to these and similar claims is the shifting of weight from the LE per se to the personality of the individual to whom the LE occurs. One implication of this shift is that even slight occurrences in daily life, if interpreted as harrassing, may be as stressful as dramatic LEs or even more so. This line of thought has generated the group of studies on the stress of daily hassles (DeLongis, Coyne, Dakof, Folkman &Lazarus, 1982; Weinberger, Hiner & Tiemey, 1987). However, the supporting evidence has also been contradictory (Zarski, 1984; Holahan, Holahan & Belk, 1984). Another possible implication is that the very occurrence of LEs depends on the individual’s personality. This line of thought has generated studies showing that LEs do not happen to everyone: they happen less to those who avoid stresses and challenges (Hinkle, 1974) or high scorers on social conformity (Garrity, Somes & Marx, 1977) and they happen more to extreme Type A’s (Suls, Gastrof & Witenberg, 1979), extraverts (Zautra, Finch, 1991) and high scorers on Liberal Intellectualism (liberal, tolerant, flexible) or Emotional Sensitivity (express emotions and willing to accept emotional expression) (Garrity et al., 1977). Similarly, negative LEs happen more to individuals high in depression (Hammen, 1991) or hostility (Hardy & Smith, 1988). The findings about the role of personality in responding to LEs and even generating LEs lead to the realization that it is not the LE per se which is harmful to health but how the person construes it, the role it plays in his or her life, in short, whether it represents a problem for the person. Being a problem signifies that the person is bothered by the event, feels threatened by potential developments, wonders what to do about it, considers possible solutions, is oppressed by having no solution, and is perhaps conflicted about the advisable course of action. It is evident that whereas the LE is of limited duration, it is the problem it has elicited or to which it is related that lasts and constitutes the stress which may even be exacerbated over time. Focusing on the problem the LE represents or generates is in accord with the dominant assumption that the harmful effect of the LE-if any-is due to its stressful nature. Thus, our first assumption was that the stressful element about a LE depends on whether it poses a problem for the individual or not, namely, its problem-ladenness. Secondly, we assumed that problem-ladenness is an aspect of LEs that is distinct from their appraisal (i.e., positive/desired or negative/undesired) and emotional tone (e.g., sad, joyful). Thirdly, we assumed that problems are not necessarily related to specific LEs but may also be related to continuing situations (e.g., working in a place one does not like) or internal inputs (e.g., frustration due to nonattainment of a highly desired goal). In view of these assumptions our hypothesis was that stress effects would be found to be related to problem-ladenness or to problems bothering the individual but not to LEs per se regardless of whether they are appraised as negative or positive. These expectations imply that if stress effects are found to be related to LEs then only to those high but not to those low in problem-ladenness or to LEs as such. Stress effects were defined on physiological and psychological levels. The physiological indicators for stress were the state of leukocyte adhesiveness/aggregation (LAA) in the peripheral blood, the total white blood cell count (WBCC) and the erythrocyte sedimentation rate (ESR). Though initially LAA

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was shown to he a reliable marker of inflammation (Berliner & Aronson, 1991; Berliner, Fried, Caspi & Weinberger, 1988; Fadilah, Berliner, Kidron et al., 1990; Goldman, Kahn, Aronson, Kariv, Stadler & Wiznitzer, 1988), a group of recent studies showed that LAA was a reliable indictor for stress, when inflammation is excluded (Arber, Berliner, Tamir, Lieberman, Segal, Pinkhas & Aronson, 1991; Arber, Berliner, Pras, Arber, Fishelson, Kahn, Bassat, Pinkhas & Aronson, 1991; Arber, Berliner, Rotenberg, Friedman, Belagodatni, Ostfeld, Aronson & Pinkhas, 1991; Arber, Berliner, Arber, Lifshitz, Sinai, Zajicek, Eilat, Pinkhas & Aronson, 1991). The role of adhesiveness for various leukocytic functions has by now been clarified, for example, leukocyte adhesive glycoproteins are essential for adhesion to the endothelium, aggregation, natural killer cytotoxicity, protection against herpes simplex virus cytotoxicity, grunolocyte migration and phagocytosis (Springer, 1990). In addition we used the measure of WBCC because studies showed the leukocyte count is affected, mostly in a negative sense following exposure to stress, such as electric shock, loud white noise, dietary restraint or mental computations (Haslam, Stevens & Haslam, 1989; Jern, Wadenvik, Mark, Hallgren & Jem, 1989; Weisse, Pato, McAllister & Littman, 1990). Similarly, also ESR was shown to be affected by psychological stress (Jem, Jem & Wadenvik, 1991), as claimed by Selye already in 1956. An interesting study that points in the same direction showed that Israeli pilots who consistently had high ESR levels in seasonal checkups, without any apparent medical reason, tended in later years to suffer from coronary heart disease with an above-chance frequency (Froom, Margaliot, Caine & Benbassat, 1984). The psychological indices for stress were personality dispositions and emotions. The focusing on personality variables was based on the recently voiced plea for incorporating traits into stress research (Ben-Porath & Tellegen, 1990). The personality variables selected for this study were stress susceptibility (Tellegen, 1982), neuroticism (Eysenck & Eysenck, 1975) and excitation, inhibition and mobility (Strelau, 1983). They were chosen because of their role in regard to stress. Stress susceptibility seemed adequate for reflecting the effects of stress because it assesses the tendency to be “stressed by one’s own and others’ actions and attitudes” (Tellegen, 1985, p. 696). High scorers were shown to experience life as stressful and disturbing, to feel victimized, put upon and harassed (ibid), to be nervous, vulnerable, prone to worry and easily upset (Tellegen, 1982, p. 7). Further, a body of research shows that neuroticism is involved in higher stress perception in caregivers of sick spouses (Hooker, Monahan, Shifren & Hutchinson, 1992); in increased physiological reactivity (heart rate, cortisol secretion) especially long-term in response to the stress of lecturing (Houtman & Bakker, 1991); in increased perception of stressful events as stress rather than as challenge (Gallagher, 1990); in increases in daily anxiety under stress prior to exams (Bolger, 1990); in increased prolonged negative affect in response to stress of unemployment (Payne, 1988); and in increased response to occupational stress in teachers and managers (Buhr & Talaska, 1985). Finally, excitation, inhibition and mobility were shown to be involved in reactions to stress insofar as low sensitivity, high endurance and low tendency to be disrupted in performance under stress (high scores on excitation), good capacity for restraint (high scores on inhibition) and ease in responding adequately to rapidly changing circumstances (high scores on mobility) are related to low reactivity to stress (Halmiova & Sebova, 1985; Kreitler, Kreitler & Weissler, 1993; Schulz, 1985). The emotional variables selected for this study were negative emotions, viz. depression, anxiety, anger, fatigue and bewilderment, and positive emotions, viz. vigor, affection, joy, satisfaction, and curiosity. The emotional variables were chosen because of their involvement in stress reactions. Thus, it was shown that the manifestations of stress include increases in depression, for example, in AIDS virus-positive gay men (Folkman, Chesney, Pollack & Coates, 1993) in adolescent girls involved in their mothers’ problems in the family (Gore, Aseltine & Colten, 1993) or in teachers suffering from burnout (Beer & Beer, 1992). Stress also increases levels of anxiety, for example, in women exposed to the stress of a discovered breast lump (MacFarlane & Sony, 1992) or in individuals with a high number of daily hassles (Russell & Davey, 1993). Further, stress may be manifested in increased expressions of anger, for example, in midlife women (Thomas & Ataken, 1993) or in sick individuals (Lane & Hobfoll, 1992); in increased bewilderment and grief, for example, after bereavement or brain damage to a close relative (Averill & Nunley, 1993; Lezak, 1986); in increased fatigue and reduced vigor in chronic pain patients (Feuerstein, Carter & Papciak, 1987); in reduced happiness in individuals exposed to hazardous workplaces (Roberts, 1993): and diminished satisfaction in adolescents (Hawkins, Hawkins & Seeley, 1992).

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The listed observations indicate that stress may be manifested in the selected personality and emotional variables. Accordingly, our expectation was that following stress the personality dispositions including stress susceptibility and neuroticism as well as the negative emotions would be elevated whereas excitation, inhibition, flexibility or mobility as well as the positive emotions would be reduced. The study was done with healthy adults because we wanted to get uncontaminated measures of LEs and problems. In most studies on the effects of LEs, these were assessed retrospectively, after the occurrence of some disease. Studies showed that occurrence of a disease may have a distorting impact on the assessment of LEs (Brown, 1974), for example, magnifying a previous LE in order to ‘blame’ it for a subsequent myocardial infarction; disregarding a previous LE in order to avoid at present (as a patient with myocardial infarction) any intense emotional responses; or overlooking a previous LE because of its slight importance as compared with a serious health impairment that happened later.

METHOD

Subjects. (M = 37.12, (Kibbutzim) in the course exams.

The subjects were 68 healthy adults, 32 women and 36 men, aged 29 to 53 years SD = lOSO), selected randomly from the population of two collective settlements in Israel. Rejection rate was lower than 2%. None was ingesting anti-inflammatory drugs of the study. Their freedom from disease was established both by self-report and medical

Assessment instruments (a) Physiological indices. We used three physiological indices: WBCC, ESR and LAA. WBCC and the differential count were performed in a Technicon Hl Autoanalyzer. The ESR was determined by the method of Westergren (International Committee for Standardization in Hematology, 1977). LAA in the peripheral blood was assessed by means of a simple slide test (Berliner, Fishelson, Bomhis, Kaufman, Pinkhas & Aronson, 1987): blood was drawn in a syringe containing sodium citrate (one volume of 3.8% sodium citrate and 3 volumes of whole blood). Several large drops of blood were placed on a slide that was held for 2 to 3 seconds at a 45degree angle so that the blood could slip down by gravity, leaving only a fine film of blood. The slides were then dried in a completely horizontal position in an incubator at room temperature. The dried slides were placed for 10 minutes in - 18 degrees centigrade in order to cause hemolysis. Fixation was done with absolute methanol and staining with hematoxylin. The percentage of aggregated leukocytes on the slides was determined by counting 300 white blood cells at random (e.g., the percentage of aggregated leukocytes was 10% if, say, there were 10 aggregates composed of 3 cells each or 3 aggregates composed of 10 cells each). The criterion for aggregation was that 3 or more nuclei were placed less than one cell diameter apart. For microscopic examination we put a drop of immersion oil on the stained slide and covered it with a cover glass. The X 40 objective was used for examination. It was necessary often to adjust the focus because due to the relative thickness of the blood film not all the leukocytes were present on the same level. Like the differential WBCC, the aggregates consist mainly of neutrophils in cases of neutrophilia or of lymphocytes in cases of lymphocytosis. Mixed aggregates of polymorphonuclear and mononuclear leukocytes are often seen. Two slides were prepared from each subject. The final result was a mean of both. Variation between duplicates did not generally exceed 20%, which is also the variation noted for two independent observers examining slides of the same subject. The test-retest differences of the same sample did not exceed 15%. The intra-essay coefficient of variation (calculated from 15 slides prepared from the same subjects) was 0.2, and the inter-essay coefficient of variation (calculated when the same normal subject was examined on 15 successive days) was 0.3. (b) Life events. We used the Life Events Survey (LES) (Sarason et al., 1985) which asked the subject to indicate whether the stated events have happened in the preceding year, and if yes to rate the degree to which they were viewed as positive (i.e., slightly, moderately or extremely positive) or negative (i.e., somewhat, moderately or extremely negative) or as neutral (i.e., having no impact) at the time of their occurrence. The three positive ratings and the three negative ratings of LEs were combined into one positive and one negative category, respectively. We did not combine the different rating categories (positive, negative and neutral) into a composite index because previous research suggested

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that they represent distinct categories rather than one continuous variable (Kreitler et al., 1993). The scores included the total number of stated events for the whole year, the number of events evaluated as positive (i.e., were rated as slightly, moderately or extremely positive), the number of events rated as negative (i.e., somewhat, moderately or extremely negative), the number of events rated as neutral (i.e., checked as having had ‘no impact’), and their proportions out of the total number of events. In addition, the subject was asked to check on a 4-point scale (1 = low, 4 = high), in regard to each LE, the degree to which it was problem-laden for him or her. (c) Personal Problems (PPs). They were assessed by means of the Personal Problems Questionnaire (PPQ) that has been pretested and validated in a sample of students with satisfactory results. [The validation consisted in comparing the responses of the students to the questionnaire with (a) their responses in an oral interview, and (b) the information provided (with consent) by their friends]. The subjects were requested to state whether they are bothered by some problem (one or more), and if yes to describe it or state its general domain (e.g., work, family) and duration (days, weeks, months, years); and to assess (on four separate 4-point scales running from low = 1 to high = 2) its difficulty, disturbingness, the degree to which its solution depends on the individual and the degree of experienced subjective pressure to solve it. The scores were the number of PPs mentioned and the means of the five descriptive dimensions of the PPs (i.e., duration, difficulty, disturbingness, dependence of solution on individual and pressure to solve). In order to get more global assessments representing both the number of PPs and their characterization, five indices based on the products of the number of PPs and each of the five descriptive dimensions of PPs were computed. f’d)Emotions. For assessing affective states, we used the Profile of Mood States (POMS) (McNair, Lorr & Droppelman, 197 1) which provides scores of tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia, and confusion-bewilderment, and the Positive Emotions Check List (PECL) (Kreitler & Kreitler, 1991) which provides scores of love-affection, curiosity-interest, happiness-joy and contentment-satisfaction. (e) Personality tendencies. There were two measures of susceptibility to stress: The Multidimensional Personality Questionnaire (MPQ; Scale No. 5, full version including 26 True/False items; Tellegen, 1982) and Eysenck’s Neuroticism scale (Eysenck & Eysenck, 1975); and three further measures of personality traits, assessed by the Strelau Temperament Inventory (STI; Strelau, 1983): strength of excitation, strength of inhibition and mobility of nervous processes. Procedure. After having given their informed consent, the subjects were examined for LAA, WBCC and ESR and were administered the questionnaires in random order. The subjects were told they would participate in a study including both physiological and psychological measures, and were asked to refrain from coffee, smoking and physical activity prior to the testing. The study was done in the framework of the routine annual health care check-ups in the settlements.

RESULTS

Control Analyses. Control analyses showed that the two Kibbutzim differed significantly in only one of the tested variables (1 of 43 = 2.32%). This finding does not exceed the 5% expected by chance. On the other hand, the genders differed significantly in 5 variables (5 of 43 = 11.63%): women scored higher in number of problems in the family, neuroticism, stress reaction and fatigue-inertia and lower in ESR. This finding exceeds the 5% attributable to chance. Therefore in the major analyses we did not relate to the kind of Kibbutz but did consider gender. Further, we checked whether any of the factors serving as independent variables in the analyses (see below ‘Stress Manifestations of LEs and PPs’) was related significantly to gender or age. The findings showed no significant relations. Table 1 presents descriptive statistics about the different variables of the study. Life Events. Table 1 shows that the mean number of LEs in the preceding year was 8.75 per person. Of these 26.90% were evaluated negatively, 45.03% positively, and 28.06% as neutral. The differences are significant (X2 = 6.161, df= 2,~ < 0.05). Hence, there were more positively evaluated events than expected by chance. Table 2 shows that the total number of LEs is related positively and significantly to the number of LEs evaluated negatively, the number of those evaluated positively and the number of those evaluated as neutral. These results are to be expected because the total number of LEs includes the

106

Shulamith Kreitler et al. Table 1. Means and standard deviations (SD) of the Variables in the Studv Variable

Mean

SD

6755.55 18.42 5.29

1799.32 13.35 3.19

8.75 2.35 0.27 3.94 0.45 2.46 0.28 2.09

1.69 0.82 0.13

2.13

0.77

3.53 3.12 3.22 2.19 3.23

0.69 0.74 0.84 0.99 0.90

0.40 0.46 0.26 0.09 0.34 0.09 0.19 0.25 0.03 0.01 0.01

0.35 0.25 0.24 0.15 0.22 0.14 0.21 0.19 0.15 0.10 0.10

24.15 39.25 36.71 30.70 21.45 21.98 31.07 31.06 29.57 31.24

5.17 6.32 6.84 3.65 4.19 4.36 3.60 4.79 4.60 4.32

9.03 8.23 53.23 53.47 52.37

4.93 5.68 10.34 6.85 1.41

Immunity Indices

White blood cell count (WBCC) Erythrocyte sedimentation rate (ESR) Leukocyte adhesiveness/aggregation (LAA) Life Events Survey

Number of LEs Number of negative LEs Proportion of negative LEs out of total Number of positive LEs Proportion of positive LEs out of total Number of neutral LEs Proportion of neutral LEs out of total Problem-ladenness of LEs

1.23 0.21 0.96 0.01 1.12

Personal Problems Questionnaire

Number of problems Characteristics of problems: Duration Difficulty Disturbingness Dependence of solution on individual Pressure to solve Stated Domains of Problems’: Work Family-spouse Family--children Health Interpersonal Studies Living conditions Kibbutz Political/security Death in the family Economic/financial Emotions

POMS: Tension-anxiety POMS: Depression-dejection POMS: Anger-hostility POMS: Vigor-activity POMS: Fatigue-inertia POMS: Confusion-bewilderment PECL: Love-affection PECL: Curiosity-interest PECL: Happiness-Joy PECL: Contentment-satisfaction Personality Tendencies

Stress reaction (MPQ) Neuroticism STI: Excitation STI: Inhibition STI: Mobility/flexibility

’ The frequencies of the problems do not add up to the mean number of problems because one person could have mentioned more than one problem.

subcategories of differentially evaluated LEs. Somewhat more surprising are the positive correlations between positively, negatively and neutrally evaluated LEs. Though the correlation coefficients are low (in the range of r = 0.19 to r = 0.24), they suggest that the individual may play an active, even if small, role in regard to LEs of any kind that happen to him or her.

Table 2. Correlation coefficients of LEs variables and number of PPs

Variables No. of LEs No. of neg. LEs No. of pos. LEs No. of neut. LEs Prob. ladenness No. of PPs *p<0.05;

**p
No. of LEs

No. of neg. LEs

No. of pas. LEs

No. of neut. LEs

Prob. laden.

0.56*** 0.78*** 0.65*** 0.22* 0.23*

0:9* 0.24* 0.29** 0.21*

0.23* 0.20* 0.17

0.19* 0.19*

oY5***

***p<0.001.

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Table 3. Means and standard deviations (SD) of problem-ladenness differently evaluated LEs

Prob. laden.

Neg. LEs

Pos. LEs

Neut. LEs

2.44 1.13

2.01 1.16

I .88

Mean SD

in

1.11

Note. The results of the ANOVA were nonsignificant.

Is the number of LEs related to the assessment of LEs in terms of problem-ladenness? Table 2 shows that the overall number of LEs as well as the number of LEs evaluated negatively, positively and neutrally are related positively to the assessment of the problem-ladenness of the LEs. Thus, an individual who mentions, say, a high number of LEs also has a higher mean evaluation of the LEs problem-ladenness than an individual who mentions a lower number of LEs. The correlation coefficients are low and indicate that the two variables-number of listed LEs and the mean problem-ladenness of LEs-share only a small core of common variance (in the range of 3.6% to 8.4%). Notably, all categories of LEs are related to problem-ladenness and approximately to the same extent (the slightly higher correlation with negatively assessed LEs, r = 0.29, than with the positively assessed LEs, r = 0.20, is not significant, CR = 0.484, df= 65, ns). This finding lends support to our assumption that problem-ladenness is not related to LE appraisal: not only negatively evaluated LEs but also positively evaluated LEs may be related to problems, and even to the same extent. In order to further analyze the relations of LEs to problem-ladenness of LEs we also examined the mean values of problem-ladenness. Table 1 shows that the overall mean problem-ladenness of LEs was 2.091, namely, not too high considering that on the assessment scale 2 represents ‘low’ and 3 ‘medium’. Table 3 presents separate mean problem-ladenness values for the three categories of LEs (positive, negative and neutral). A one-way analysis of variance showed that the differences are not signficant (F = 2.90, df= 2/65, ns). We further subdivided each category of LEs into those that were assigned high scores on problem-ladenness (3 or 4) and those that were assigned low scores on problem-ladenness (1 or 2). The results (Table 4) showed that in each category of LEs there were events with high problem-ladenness, and that they constituted about a third of the LEs in each category (see proportions presented in Table 4). The differences between the proportions in the three categories were not significant (X2 = 1.448, df= 2, ns) despite the apparently higher proportion in the negative LEs (39.1% versus 30.5% and 30.7% in the other categories). Thus, there was no difference between the different categories of LEs in the proportion of LEs high in problem-ladenness (or, low in problem-ladenness) that they included. Personal Problems (PPs). The mean number of PPs mentioned was 2.132 per person. This mean was calculated for all subjects in the sample. However, 14 (20.59%) mentioned no PPs so that the mean for those who did mention PPs (79.41% of the sample) was actually higher (X = 2.685). The mean of PPs was lower (about a quarter, 0.249) than the mean number of LEs. Table 1 shows the frequency of the domains in which PPs were mentioned. The most frequently mentioned domains were

Table 4. Means and proportions of differently evaluated LEs when oroblem-ladenness is hieh (scores 3 or 4) and low (scores I or 2) Problem Ladennesr Low, High Negative LEs Mean of problem-ladenness Mean number of neg. LEs Proportion of neg. LEs Posit&e LEs _ Mean of problem-ladenness Mean number of pas. LEs Proportion of pos. LEs Neutral LEs Mean of problem-ladenness Mean number of neut. LEs Proportion of neut. LEs

I .70 0.92 0.39

3.60 I .43 0.61

1.41 2.73 0.69

3.40 I.21 0.3 I

1.30 1.71 0.69

3.20 0.75 0.3 I

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Shulamith Kreitler et al. Table 5. Results of factor analysis on the domains of the personal problems mentioned by the subjects Variables

Fat.

1

Fat. 2

Fat. 3

Fat. 4

Fat. 5

Studies Econlfinan. Work Interpersonal Living cond. Health Polit./security Family/spouse Family/children In Kibbutz

0.72 0.57 0.3 1

Eigenvalues Accounted for variance

1.073

0.889

0.673

0.452

0.359

10.7%

8.9%

6.7%

4.5%

3.6%

0.41 0.36 0.70 0.50

0.37 0.64 0.39 0.68 0.45 0.42

Note. The factor analysis was done by the varimax method after Kaiser normalization. Only saturations 2 0.30 are presented.

family/spouse (e.g., tension, misunderstanding, divorce), work (e.g., relations with boss, no promotion), family/children (e.g., strained relations), Kibbutz (e.g., further survival, decline of ideals, change processes), and interpersonal (e.g., love affair, betrayal by a friend, loneliness) (the provided examples are based on written remarks mentioned by the subjects in the questionnaire). The factor analysis of the mentioned PPs (Table 5) shows that they fall into five factors, all of which are small and only the first is stable (eigenvalue > 1.00). This indicates that the PPs are largely unrelated to each other. Thus, a person who is bothered, say, by family problems (Factor 5) is not necessarily bothered by problems related to physical survival (Factor 3). The grouping of the problems suggests that the first factor represents problems of personal advancement through studies or promotion (dependent on financial possibilities), the second represents interpersonal problems (at work, and social relations at large), the third represents problems of physical survival (related to health and political states like the gulf war), the fourth represents issues related to family life (spouse, children), and the fifth represents issues related to the Kibbutz (living in a collective settlement and the changes currently occurring in that system, which may also have financial implications). Our data also included information about five characteristics of each PP: its duration, assessed difficulty, assessed disturbingness, dependence of solution on the individual, and experienced subjective pressure to solve the problem. Table 6 shows that these characteristics are positively intercorrelated. The mean correlations for duration with all the rest is r = 0.29, for difficulty r = 0.49, for disturbingness r = 0.5 1, for dependence of solution on self r = 0.23, and for experienced pressure to solve r = 0.34. Hence, disturbingness and to a similar though lesser degree difficulty are the most representative characteristics. The intercorrelations are high especially for the indices representing the products of each characteristic by the number of PPs. Relations of LEs and PPs. Are LEs related to the number of PPs? Table 1 shows that PPs are related to the total number of LEs but only to a low extent (r = 0.23). The number of PPs is related also to the number of negatively evaluated LEs and the number of neutrally evaluated LEs but not to the number of positively evaluated LEs.

Table 6. Intercorrelations among the characteristics of PPs Variables Duration Difficulty Disturbingness Depend. on self Pressure to solve

Dur.

Diff.

Disturb.

Depend.

0.72*** 0.68*** 0.38** 0.51***

0.42*** o.ss*** 0.45*** 0.63***

0.45*** 0.79***

0.15 0.21* 0.21*

0.47*** 0.62***

Pressure 0.12 0.40*** 0.43*** 0.37**

0.63***

Note. The coefficients in the upper quadrant represent intercorrelations among the raw scores, those in the lower quadrant represent intercorrelations among index scores based on summing the products of the raw scores and the numbers of PPs. *p
Life events and personal problems Table Var.

I

1. 2. 3. 4. 5. 6. 7. 8. 9. IO. I I. 12. 13. 14. IS. 16. 17. 18.

WBCC ESR LAA Ext. Inh. Mob. New. Stress Anx. Depr. - 25 Anger Vigor Fatig. - 28 Conf. Love Cur. Happ. cont.

2

3

4

7. Significant 5

correlation

6

coefficients

7

8

9

25

26

29

- 36 -42

- 35 - 28

97

73 76

109

among the dependent IO

II

12

- 25

25 31

;:

25 -27 -36 -35

28

- 35

25

31 -29 -42 -28 - 35

- 32

- 26

24

-26 -29

97 73 65 37 - 25 49 45

76 68 34 - 26 47 43

- 24 -45

- 25 -49

70 42 54 51

27

13

14

- 3.5

45 - 43 37 52

- 43 -43

16

17

18 Mean 26 26

24 - 32

-35 65 68 69

I5

- 28 28

24 37 36

- 25 - 26

45

-43

45 40

- 26 49 53 54 37 45

45 45 51 52 40

-24 -25 -43 64

49

55 65 41

50 31

74

37 37 64

24

27

variables

49 14 45

-33

-37

50 48

28 27 -49 -46 49 -43 45 -33 -37 41 31 48

32 31 27 53 55 54 49 38 49 39 41 45 47 49 40

Note. The sequence of the variables in the heading corresponds to that in the first column. In order to save space the period preceding numbers has been deleted. p < 0.05 for correlations = 0.24 to 0.30; p < 0.01 for correlations = 0.31 to 0.40; p < 0.001 for correlations 2 0.41.

the

However, there is a high positive correlation between PPs and the problem-ladenness of LEs. This finding raises the issue: To what extent the LEs that were assigned high scores on problem-ladenness (3 to 4) are identical to the PPs the individual mentions? On the basis of judgements of similarity by two independent judges (with 97% unanimity in judgements), the findings showed that of the 145 PPs mentioned by the subjects, 41 (28.27%) were mentioned also in connection with LEs, whereas 104 (71.72%) were not (the difference is significant by the binomial test, z = 5.149, p < 0.001). The 41 PPs that were mentioned also in connection with LEs included problems of all kinds in line with the grouping of problems by factor analysis: work (n = 9), family/spouse (n = 14), family/children (n = 7), health (n = 2), interpersonal (n = 3), concerning the Kibbutz (n = 3) political/security (n = 2), and death in the family (n = 1). Of these 41 problems mentioned in connection with LEs, 30 (73.17%) were assigned high scores (3 or 4) on problem-ladenness, and 11 (26.83%) were assigned low scores (1 or 2). The difference between the number of those scoring high on problem-ladenness and those scoring low is significant (by the binomial test, z = 2.812, p < 0.01). Intercorrelations among the dependent variables. As may be recalled, the dependent variables included three groups-physiological, personality and emotional variables. Table 7 shows that the mean number of intercorrelations with other variables was lowest for the physiological variables (M = 2.3) and higher for the personality (M = 8.2) and emotional (M = 7.9; positive, M = 6.6, negative, M = 9.2) ones. Of the physiological variables ESR was related to the largest number of variables but the mean of the correlations was low (r = 0.26). Of the personality variables, those correlated with the largest number of variables were neuroticism and stress susceptibility (each with 12), and the mean correlations ranged from 0.53 to 0.55. The ST1 variables were correlated each with 4 to 7 variables and the mean correlation coefficients ranged from 0.27 to 0.32. Of the emotional variables those correlated with the highest number of variables were satisfaction, depression and fatigue, those with the lowest number were love and curiosity. The highest mean correlations (ranging from 0.38 to 0.54) were observed for anxiety, depression, vigor, happiness and curiosity. The correlations of the physiological and ST1 measures with stress indicators replicate largely those formerly reported (Kreitler et al., 1993, 1994). Stress manifestations of LEs and PPs. In exploring the stress effects of the variables involved in the hypothesis we first examined the effects associated with each of the variables. Table 8 shows that subjects who mentioned a high number of LEs differed from those who mentioned a low number only in scoring lower on curiosity-interest. Subjects who appraised a high number of LEs as neutral did not differ from those who appraised a low number as neutral in any of the variables. Subjects who appraised a high number of LEs as negative differed from those who appraised a low number as negative only in being more susceptible to stress. More significant differences were obtained between subjects who appraised a high number of LEs as positive and those who appraised a low number as

ShulamithKreitleret al. Table 8. Significant correlations and mean comparisons of groups defined by different LE characteristics Variables

Gr

Dep. Var.

Mean

SD

t-Test

A. Number of LEs

Low Hieh Lo\ High LOW Hieh Loyw High LOW High Low High Low High LOW High Low Hieh LOG High Low Hieh Lovw High LOW High Low High

Curiosityinterest Stress reaction Neuroticism

32.96 29.16 1.77 10.28 9.61 6.84

3.24*

- 0.26*

2.10*

0.28*

2.57*

- 0.29*

Mobility (ST]) Vigoractivity Loveaffection Haooinessjoi. Curiosityinterest Neuroticism

50.05

4.01 5.56 5.07 4.78 6.19 3.65 6.58 8.42 3.68 3.35 4.14 2.98 4.97 4.86 5.23 3.33 5.44 5.75 4.86 6.72 5.21 6.89 6.72 5.07 4.95 4.23 4.29 5.39

B. Number of neg. LEs C. Number of pos. LEs Number of pos. LEs Number of pos. LEs Number of pos. LEs Number of pos. LEs Number of pos. LEs D. Problem-ladenness Problem-ladenness Problem-ladenness Problem-ladenness Problem-ladenness Problem-ladenness

Stress reaction Tensionanxietv Deprekiondeiection Fatigueinertia Confusionbewilderment

54.70 29.28 32.11 30.70 32.51 28.08 31.07 29.48 32.64 7.21 9.97 6.26 13.78 19.70 31.82 37.10 42.96 17.99 28.85 18.47 26.58

C0r.

2.54*

0.32**

2.17*

0.26*

2.07*

0.26*

2.70**

0.27*

2.93**

0.3 I **

2.00*

0.27*

4.90***

0.40***

7.62***

0.56***

4.06***

0.43***

9.58***

0.69***

6.44***

0.61***

Note. High and low are defined in terms of above or below the groups mean, respectively. For the first 8 variables, the number of subjects in the low and high groups was 34 in each, for the last 6 variables it was 43 in the low and 25 in the high. The last column presents correlation coefficients between the variables listed in the first and third columns. *p
positive. The former scored lower on neuroticism and higher on mobility/flexibility, vigor-activity, love-affection, happiness-joy and curiosity-interest. It is evident that positively appraised LEs are related to low indices of stress. An important implication of our hypothesis refers to the difference in stress effects of LEs high and low in problem-ladenness. Table 8 shows that the high scorers in problem-ladenness of LEs scored higher than the low scorers on neuroticism, stress reaction, tension-anxiety, depression-dejection, fatigue-inertia and confusion-bewilderment. In view of the multiplicity of comparisons, it is advisable to apply the Bonferroni criteria for assessing the required significance levels (Rosenthal & Rubin, 1984). For 18 comparisons (i.e., the number of variables representing our stress indicators) the significance level required for the p = 0.05 level is 0.003 (i.e., p < 0.01). Thus, only two of the results for the number of positive LEs (i.e., happiness-joy and curiosity-interest) but five of the six results for problem-ladenness of LEs pass the required criteria. In regard to PPs, one-way analyses of variance (Table 9) showed significant differences between subjects with no PPs, a few PPs and many PPs: there were regular linear increases from the first to the third group in ESR, neuroticism, stress reaction, tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, confusion-bewilderment and curiosity-interest (!) but a decrease in vigor-activity and excitation. Notably, only four of these results pass the Bonferroni criteria (i.e., for p C 0.05, p < 0.01): Tension-anxiety, depression-dejection, confusion-bewilderment and excitation. In order to get an estimate of the size of the involved relations correlation coefficients were computed, despite the large differences in ranges of these variables. The correlation coefficients in the last columns of Tables 8 and 9 indicate that the mean correlation for number of LEs was 0.26, for negatively as well as positively evaluated LEs 0.28, for problem-ladenness 0.56 and for PPs 0.41. The significant differences between mean correlations were for number of LEs and problem-ladenness (CR = 2.16, p C 0.05) as well as for negative LEs and problem-ladenness (CR = 2.00, p < 0.05), and for positive LEs and problem-ladenness (CR = 2.00, p < 0.05).

111

Life events and personal problems Table

9. Significant correlations and mean comparisons by one-way analyses of wxiance of groups differing in number of PPs

Gr No PPs Low High No PPs Low High No PPs Low High No PPs Low High No PPs Low High No PPs Low High No PPs Low High No PPs Low High No PPs Low High No PPs Low High No PPs Low High

Depend. Variable ESR

Neurot.

Stress reaction Tensionanxiety Depress.. dejection Angerhostility Vigoractivity Fatigueinertia Conf.bewilder. curios.interest Exit.

Mean

SD

II.37 19.80 21.31 4.32 8.84 10.19 5.17 9.26 1I .87 19.15 24.19 27.02 32.66 39.70 43.98 32.04 37.77 38.27 32.08 31.66 27.19 17.98 22.26 22.55 18.47 22.40 24.06 30.23 29.98 34.36 34.83 42.1 I 46.79

8.43 15.09 13.53 6.29 5.12 6.10 6.42 5.65 6.65 4.36 4.85 5.99 6.22 5.37 6.60 6.99 6.49 7.15 3.29 3.49 3.66 3.00 5.08 4.04 4.19 3.88 4.82 6.33 4.65 3.87 8.24 9.36 Il.14

Analysis of Variance Source DF MS F Bet. With.

2 67

484.16 146.71

3.30*

Bet. With.

2 67

127.74 31.00

4.12*

Bet. With.

115.91 37.01

3.13*

6;

Bet. With.

2 67

206.96 23.79

s.70***

Bet. With.

2 67

362.24 34.18

10.60****

Bet. With.

2 67

170.29 48.88

3.48*

Bet. With.

2 67

51.00 12.66

4.03*

Bet. With.

2 67

94.26 20.95

4.50*

Bet. With.

2 67

I I I .69

6.44**

Bet. With.

2 67

68.88 22.00

3.13*

Bet. With.

2 67

763.28 105.27

7.25**

Cor.

0.28*

0.35**

0.29*

0.46***

0.65***

0.29*

0.32*

0.36**

17.34

0.4x**

031**

0.57***

Note. No PPs = Zero PPs (n = 14), Low = below the group’s mean of PPs (n = 38). High = above the group’s mean of PPs (n = 16). The last column presents correlation coefficients between the variables listed in the first and second columns. * p < 0.05; ** p < 0.01; *** p < 0.001.

In order to further explore the construct of PPs we examined the correlations of each of the five descriptive dimensions of PPs with the stress indicators. Table 10 shows that disturbingness was the dimension that yielded the largest number of significant correlations (n = 12) with the stress variables. The mean of the correlations was 0.34, and it was the only mean that differed significantly from zero (CR = 2.05, p -=c 0.05).In fact, disturbingness yielded the same results as the number of PPs (except for curiosity-interest), and in addition showed lower happiness-joy and contentment-satisfaction for the problems higher in disturbingness. The only other dimension that was related to a fair number of variables (n = 7) was the rated dependence of the solution on the individual. Notably, duration of problem was not related to any of the stress variables. In sum, in terms of mean correlations, problem-ladenness was related most highly to stress variables (0.56), followed by number of PPs (0.41) and disturbingness of problems (0.35). The other variables involved in LEs or PPs were related only lowly to stress (mean correlations ranged from 0.26 to 0.29). In the second stage of analyzing the findings two-way analyses of variance were done with the following combinations of factors (in each case the factor was dichotomized in terms of high versus low): Number of LEs and number of negatively appraised LEs; Number of LEs and number of positively appraised LEs; Number of LEs and number of neutrally appraised LEs; Number of LEs and problem-ladenness of LEs (i.e., number of LEs evaluated as high versus those evaluated as low in problem-ladenness). In all cases the same variables yielded significant results as in the case of the presented f-tests or one-way analyses of variance (Tables 7 and 8). In no case were there any significant interactions.

112

Shulamith Kreitler et al. Table IO. Significant correlations between the descriptive dimensions of PPs and stress indicators Descriptive Dimensions of PPs

Stress indicators

Duration

Difficulty

WBCC ESR LAA Excitation (STI) inhibition (ST11 Mobility (STI) Neuroticism Stress reaction Tension-anxiety Depres-dejection Anger-hostility Vigor-activity Fatigue-inertia Conf.-bewilder. Love-affection Cur.-Interest Happ.-joy Cont.-satis. Mean *p<0.05;

Disturbing

Depend. of solution on individual

Pressure to solve

- 0.32** 0.29* 0.39**

0.26*

0.30* 0.2s* 0.34** 0.38** 0.36** -0.31*

- 0.26* - 0.35**

0.26* 0.31**

0.27*

0.26* 0.30*

0.27* 0.41***

0.28* 0.26*

0.26*

- 0.30* - 0.29* 0.34**

0.29*

0.27*

**p
DISCUSSION

One major conclusion of the findings is that LEs and PPs are distinct constructs. PPs may be accessed indirectly, through the problem-ladenness of LEs, or directly, through the statement of problems. About a third of LEs mentioned by an individual as having occurred in the last preceding year are high in problem-ladenness, regardless of how the LE itself is appraised-as positive or negative or neutral. We found that problem-ladenness of LEs was only lowly related to LE appraisal. Also the number of PPs a person mentions is related only lowly to LEs, in particular to those evaluated as neutral or negative. Thus, both problem-ladenness of LEs and the statement of PPs differ from LEs. The two measures of problems-PPs and problem-ladenness of LEs-are highly interrelated. Nevertheless, the two measures are distinct insofar as only 28% of stated problems are similar to LB, especially those evaluated as high in problem-ladenness. In sum, PPs represent a class of psychological phenomena which may be associated with LEs but not necessarily so. Some PPs-about a third in our sample-were anchored on LEs of the preceding year-positive, negative or neutral LEs-but the majority were not. Further, our findings showed that problems come in distinct units, and tend to be grouped into particular domains (e.g., advancement, interpersonal), which however are not highly intercorrelated. Their characteristics-such as duration, disturbingness, experienced pressure for solution-tend to be interrelated and may be represented by a total index or by the rating of the PPs on disturbingness. Having established the distinctiveness of PPs from LEs enabled testing the major hypothesis of the study. The results showed clearly and sharply that it is PPs that are associated with stress indices and not LEs. This conclusion is based on the demonstration that PPs were related to 11-12 stress manifestations whereas LEs were related to fewer manifestations: the total number of LEs and the number of negatively evaluated LEs were related each to only one stress manifestation, and the number of positively evaluated LEs was related to 6 of the stress variables but in a direction contrary to stress. More specifically, a higher number of PPs is related to higher ESR, neuroticism, stress susceptibility, tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, confusion-bewilderment, and curiosity-interest as well as lower vigor-activity and excitation, and when the problems are particularly disturbing, also to lowerjoy-happiness and contentment-satisfaction. This impressive list that includes indices from the domains of physiology, personality and emotions, all in the expected direction (except curiosity, dealt with later), leaves little doubt about the association of PPs with stress. In contrast, LEs-their total number as well as the number of those evaluated as negative or as neutral-are not related to stress indices. On the other hand, the positively appraised LEs were related to stress in an interesting respect: the more positive LEs the individual mentioned the more

Life events and personalproblems

113

counter-stress manifestations that individual had. This indicates that positively evaluated LEs do not simply decrease stress but rather increase the counter-stress indices, including flexibility, vigor-activity, love-affection and joy-happiness. As expected, the only LEs related to stress indications were those high in problem-ladenness, which were indeed associated with higher neuroticism, stress susceptibility, tension-anxiety, depression-dejection and confusion-bewilderment. In view of our results, which measure should be preferred for assessing stress: the statement of PPs or evaluating the problem-ladenness of LEs? We would recommend the statement of PPs for three reasons: (a) PPs is related to more stress indices than problem-ladenness (12 versus 6 indices, respectively); (b) The stress indices to which PPs are related are more variegated-they include the physiological index, personality dispositions and emotions, both positive and negative-whereas problem-ladenness includes only personality dispositions and negative emotions; and (c) PPs is a more direct measure and requires a much shorter time for administration. In the same vein, we may ask whether it is recommended to obtain from the subjects an evaluation of different aspects of the stated problems (e.g., their duration, pressure for solution). Our data suggest that disturbingness is the only aspect that is both related highly to all the rest and is also related highly to decreases in positive affects. Thus, assessment of the different aspects does not seem to be essential and the only one to consider is disturbingness. It is noteworthy that of the 3 physiological indices only ESR was related to the number of PPs. This might suggest either that number of PPs is not an agent of stress or that the physiological indices WBCC and LAA are not sensitive to stress. Both conclusions contradict findings in this study and others (e.g. Berliner & Aronson, 1991). Thus, we had to assume that there may be further psychophysiological processes mediating between number of PPs and manifestation of effects in terms of WBCC and LAA. Also the findings in regard to curiosity-interest were intriguing. Curiosity-interest decreased with number of LEs but increased with number of positive LEs and of PPs. Possibly, there are two types of curiosity: curiosity for its own sake that decreases when one is preoccupied with LEs but increases following the invigorating effects of positive LEs. In addition, there may be a problem-dependent curiosity, that subserves the cognitive effort to solve a bothersome personal problem, and this type increases with the number of PPs (Kreitler & Kreitler, 1994). Evidently, our findings do not provide information about the direction of the causal effects. One could argue that the stress phenomena found to be related to PPs or problem-ladenness are not the results but the causes of problems, for example, that stress susceptibility, confusion, or depression may cause PPs rather than result from having unresolved problems. The findings seem to us important in regard to stress regardless of the direction of causality that will have to be clarified in future research. Another issue that could seem to be controversial is the special population on which the study was performed. A Kibbutz may seem to provide a sheltered environment, shielded from LEs or PPs. This is evidently mistaken both because a Kibbutz is not separate from the whole population of Israel (see the Gulf war mentioned by our subjects) and because the Kibbutz is undergoing serious changes that threaten its further survival, a fact that may be stressful for its members (see list of problems). There is little doubt that problems will change with the environment and culture. However, this does not detract from our findings in any way because the major variable of interest-the agent of stress, is the number of PPs rather than any specific kind of problem. At present, the findings suggest that the stress-effective ingredient of LEs is their problem-ladenness, which is distinct from the appraisal of LEs. This conclusion may explain why LEs were not always found to be related to stress or health failures (see Introduction). Previous researchers felt the need to include in the assessment of LEs the personal relevance or evaluation. However, the aspect they selected-appraisal of LEs as positive or negative-turned out not to be the crucial one for stress: negative LEs were unrelated to stress whereas positive LEs were related to counter stress effects. In the applied sense, our findings suggest that it would be advisable to assess directly the major stress agent by asking the subject to list the types or domains of one’s PPs. The advantages of this measure are its simplicity, brevity, its proven applicability to individuals of different ages and genders, its discretion (it does not violate the subject’s privacy because merely indicating the general type or domain of the problem suffices), and the evidence that it is related to stress. Further research is however needed to establish the relations of this factor specifically to health.

114

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