Chronic and Acute Stress

7/30/2019 Chronic and Acute Stress

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American Journal of Community Psychology, Vol. 18, No. 5, 1990

C h r o n i c S t r e s s , A c u t e S t r e s s , a n dD e p r e ss iv e S y m p t o m s xK a t h er in e A . M c G o n a g l e a n d R o n a l d C . K e ss le r 2University of Michigan

A l t h o u g h l if e e v e n t s c o n t i n u e t o b e th e m a j o r f o c u s o f s t re s s r e se a rc h , r e -c e n t s tu d i e s s u g g e s t t h a t c h r o n i c s tr e s s s h o u M b e a m o r e c e n t r a l f o c u s . A ne v a l u a ti o n o f t h is i ss ue i s p r e s e n t e d u s in g d a t a f r o m a l ar ge c o m m u n i t y s u r-v e y o f marr i e d m e n ( n = 819) an d w om e n ( n = 936). Re su l t s sh ow tha t c hron ics t re s ses a re m ore s t rong ly r e la t e d to de pre s s iv e s y m p t om s than ac u te s tr e s se s ina l l b u t o n e l i fe d o m a i n . T h e in t e r a c t io n p a t t e r n s e x h i b i t e d b y c h r o n i c a n da c u t e s tr e ss e s a re p r e d o m i n a n t l y a s s o c i a t e d w i t h l o w e r l e v el s o f d e p r e s s io nt h a n t h o s e p r e d i c t e d b y a m a i n e f f e c t s m o d e l . T h i s p a t t e r n s u g g e s t s t h a tc h r o n i c st re s se s m a y r e d u c e t h e e m o t i o n a l e f f e ct s o f a c u t e s tr es se s. A l t h o u g ht h e p r o c e s s e s t h r o u g h w h i c h t h i s e f f e c t o c c u r s a r e n o t c le a r, i t is s u g g e s t e dt h a t a n t i c i p a t io n a n d r e a p p r a i s a l r e d u c e t h e s t r e s sf u l n e s s o f a n e v e n t b y m a k -i n g it s m e a n i n g m o r e b e n ig n . I m p l i c a t i o n s f o r f u t u r e r es ea rc h o n c h r o n ica n d a c u t e s t r e s s e f f e c t s a r e d i s c u s s e d .

O v e r t h e p a s t tw o d e c a d e s s in c e H o l m e s a n d R a h e ' s ( 1 9 67 ) g r o u n d b r e a k i n gw o r k o n l i f e e v e n t s a n d i l ln e s s, a c u t e l i fe ev e n t s h a v e b e e n t h e m a j o r f o c u so f p s y c h o l o g i c a l s t r e s s r e s e a r c h . Y e t i t i s b e c o m i n g i n c r e a s i n g l y c l e a r t h a tt h i s a t t e n t i o n i s m i s p l a c e d a n d t h a t c h r o n i c s t r e s s s h o u l d b e a m o r e c e n t r a lf o c u s . W h e n V e r o f f , D o u v a n , a n d K u l k a ( 19 81 ) a s k e d a n a t i o n a l s a m p l e o f

1 T h is r e s e a r c h w a s s p o n s o r e d b y T r a i n i n g G r a n t T 3 2 M H 1 6 8 0 6 , b y R e s e a r c h S c i en t is tD e v e l o p m e n t A w a r d 1 K 0 2 M H 0 0 5 0 7 , a n d b y M e ri t A w a r d 1 M 0 1 M H 1 6 8 0 6 f r o m t h eN a t i o n a l I n s t i tu t e o f M e n t a l H e a l t h . W e t h a n k o u r c o l le a g u es in t h e S o ci al E n v i r o n m e n ta n d H e a l t h P r o g r a m a t t h e I n s t i t u t e f o r S o c i a l R e s e a r c h f o r h e l p f u l c o m m e n t s o n a p r e v i o u sd r a f t o f th i s p ap e r , w h i c h w a s p r es e n t e d at o u r o n g o i n g P r o g r a m s e m i n a r . W e a l s o t h a n kt h e a n o n y m o u s r e v ie w e rs f o r v e r y h e lp f u l c o m m e n t s .Z All c o r r e s p o n d e n c e s h o u l d b e s e n t t o R o n a l d C . K e s s l er , In s t i t u t e f o r S o c i a l R e s e a r c h ,T h e U n i v e rs i ty o f M i c h i g a n , B o x t 2 4 8, A n n A r b o r , M i c h i g a n 4 8 10 6 -1 2 48 .

6 8 10091-0562/90/1000-0681506.00/0 !990 P lenum Publishing Corporation


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6 8 2 M e G o n a g l e a n d K e s s le r

adults to describe their major sources of stress, chronic situations were men-tioned much more often than events. Mattlin, Wethington, and Kessler (1990),in a more recent general population survey, asked respondents to describetheir most stressful experience over the past year and found that chronicdifficulties were again reported more often than life events. Recent empiri-cal analyses of chronic and acute stress effects have also demonstrated thatchronic stress is a stronger predicto r of psychological adjustment than acutestress (Avison & Turner, 1988; Eckenrode, 1984; Mitchell, Cronkite, & Moos,1983). The work of Lazarus and DeLongis (1983) documenting a strongereffect of "daily hassles" than major life events on psychological adjustmentcan be interpreted as consistent with this same pattern, in that many o f thehassles in their inventory were indicators of ongoing role-related stresses.

Fur thermore , several recent studies suggest that chronic stress can helpexplain the relationship between life events and psychological adjustment.In a study of working-class women, Brown and Harris (1978) found thatchronic stresses of a variety of sorts can magnify the effects of life eventson clinical depression. Pearlin, Lieberman, Menaghan, and Mullan (1981)demonstrated that the relationship between life events and depression oc-curs through the exacerbation of chronic role-related strains. Drawing onresults such as these, several investigators have called for more serious studyof the joint effects of chronic and acute stress (Costello, 1982; Mitchell etal., 1983; Wheaton, 1983, 1990).The results of such an analysis are presented in this report. Unlike mostprior investigations, we base our analysis on a data collection scheme thatgenerates parallel information about a wide range of both chronic and acutestresses, thus allowing us to assess their relative effects on psychological func-tioning in an even-handed fashion. Substantive disaggregation is used to makedomain-specific comparisons. We also investigate the possibility, suggestedby Brown and Harris (1978), that chronic difficulties modify the effects oflife events on distress. All of these analyses are carried ou t in a large popula-tion survey of married men and women designed to elicit broad-based infor-mation about the occurrence of major life events and chronic stresses.

M E T H O DThe Sample

Data were obtained from face-to-face interviews with 1,755 respondentsin the Detroit metropolitan area in the spring and summer of 1985. All respon-dents Were married and living in nonins titutionalized housing at the time ofinterview. Interviews too k place in respondents' homes. Selection of house-holds was made in a multistage strat ified cluster design that gave each m a r -


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C h r o n i c a n d A c u t e S t r e s s 683

r i e d p e r s o n i n t h e s a m p l i n g f l a m e a n e q u a l p r o b a b i l i t y o f s e l e c t i o n . T h es c r e en i n g r e s p o n s e r a t e ( w h i c h d e t e r m i n e d e l i g ib i li ty f o r th e s t u d y ) w a s 9 8 % ,a n d 7 8 % o f e l ig i b le r e s p o n d e n t s w e r e s u c c e s s fu l l y i n t e r v i e w e d i n s c re e n e dh o u s e h o l d s , f o r a n o v e r a l l r e s p o n s e r a te o f 7 6 % . R e s p o n d e n t s w e r e el ig ib lei f a t le a s t o n e m e m b e r o f t h e c o u p l e w a s b e t w e e n t h e a g e s o f 18 a n d 6 5 a tt h e t i m e o f t h e i n t e r v i e w . O n l y n o n b l a c k c o u p l e s w e r e i n c l u d e d i n t h e s u r -v e y . N o a t t e m p t w a s m a d e t o i n te r v ie w r e s p o n d e n t s w h o h a d t r o u b l e s p e a k -i n g E n g l i s h , w e r e se n il e , o r w h o h a d a p h y s i c a l i ll n es s t h a t m a d e c o m p l e t i o no f t h e i n t e r v i e w b u r d e n s o m e .

D e m o g r a p h i c c h a r a c t e r i s t ic s o f t h e s a m p l e c l o s e l y r e f l ec t t h o s e o f t h et a r g e t p o p u l a t i o n . M e a n a g e w a s 4 2 y e a r s, m e a n e d u c a t i o n 13 y e a rs , a n dm e a n h o u s e h o l d i n c o m e ( in 1 9 8 4 d o l l a rs ) $ 4 1 ,8 0 0 . T h i s h i g h a v e r a g e i n c o m e ,w h i c h a c c u r a te l y c o r r e s p o n d s t o t h e p o p u l a t i o n d a t a f o r n o n b l a c k c o u p l e si n t h e D e t r o i t m e t r o p o l i t a n a r e a , r e f l ec t s t h e f a c t t h a t t h e v a s t m a j o r i t y o fm e n ( 8 4 % ) w e r e e m p l o y e d f u l l- ti m e a n d a l a rg e p r o p o r t i o n o f w o m e n ( 4 8 % )w e r e e m p l o y e d a t l e a s t 2 0 h o u r s a w e e k .

Depressive SymptomsD e p r e s s i o n w a s a s s e ss e d b y t h e 1 0 - it e m d e p r e s s i o n s u b s c a l e o f t h e r e -

v is e d H o p k i n s S y m p t o m C h e c k l is t (H S C L ; D e r o g a t i s , 1 9 77 ). R e s p o n d e n t sr a t e d t h e f r e q u e n c y w i t h w h i c h e a c h s y m p t o m o c c u r r e d i n th e 3 0 d a y s p r i o rt o t h e i n t e r v i e w u s i n g a 4 - p o i n t s c a l e , r a n g i n g f r o m never t o very often.R e p r e s e n t a ti v e i te m s i n cl u d e " H o w o f t e n h a v e y o u f e lt w o r t h l e s s ? " a n d " H o wo f t e n h a v e y o u f e l t s a d o r b l u e ? " T h e s c a le w a s s c o r e d b y s t a n d a r d i z in g e a c hi t e m t o a m e a n o f z e r o a n d a v a r i a n c e o f 1 , s u m m i n g a c r o s s a l l t h e i t e m s ,a n d t h e n s t a n d a r d i z i n g t h e t o t a l . A l p h a r e l ia b i l i ty is .8 3 f o r m e n a n d .8 4 f o rw o m e n .

Chronic and Acute StressC o n v e n t i o n a l l i f e e v e n t s u r v e y s u s u a l l y a s k r e s p o n d e n t s t o r e a d a l o n g

l is t o f e v e n t s a n d e n d o r s e t h o s e t h a t o c c u r r e d t o t h e m o v e r a sp e c i f ie d t i m ep e r i o d . S u m s o f t h e l if e e v e n t s o n t h e li st a r e t h e n u s e d a s t h e m e a s u r e o fs tr es s e x p o s u r e . W e m o d i f i e d t h is a p p r o a c h i n s ev e r a l w a y s . F i r st , w e c r e a t -e d a s e ri e s o f s h o r t l i f e e v e n t l is ts r a t h e r t h a n o n e l o n g l i st . E a c h l is t f o c u s e do n e v e n t s in a p a r t i c u l a r d o m a i n o f l i f e ( e .g . , p h y s i c a l il ln e s s, f i n a n c i a ld i f f ic u l t y , d e a t h o f a l o v e d o n e ) . T h e l is ts w e r e i n t er s p e r se d t h r o u g h o u t t h ei n te r v ie w s c h ed u l e r a t h e r t h a n p r e s e n t e d to g e t h e r . T h e p u r p o s e o f t h is m o d i f i -c a t i o n w a s t o a v o i d c r e a ti n g t h e " n o " r e s p o n s e s e t t h a t c a n o t h e r w i s e o c c u rw h e n r e s p o n d e n t s a r e a s k e d t o c o n s i d e r a s i ng l e l o n g l is t o f q u e s t i o n s ( S u d -


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684 M cGonagle and Kessler

m a n & B r a d b u r n , 1 97 4). W e a ls o h o p e d t o h e l p t r ig g e r a m e m o r y s c h e m at h a t w o u l d f a c i l i t a t e r e c a l l ( H i g g i n s , R h o l e s , & J o n e s , 1 97 7) b y f o c u s i n g e a c hs h o r t l i s t o n a p a r t i c u l a r d o m a i n o f l i f e . E a c h s h o r t e v e n t l i s t w a s i n c l u d e di n a s e c t i o n o f t h e i n t e r v ie w t h a t a s k e d o t h e r q u e s t i o n s a b o u t t h e l i fe d o -m a i n i n a n e x t r a e f f o r t t o c r e a t e a c o n t e x t t h a t w o u l d s t i m u l a t e r e ca l l.

T h e q u e s t i o n s i n c l u d e d i n th i s s e ri es o f s h o r t l is ts w e r e b a s e d o n i te m sd e v e l o p e d o r i g in a l l y b y B r o w n a n d H a r r i s ( 19 7 8) a n d b y B . S . D o h r e n w e n d ,K r a s n o f f , A s k e n a s y , a n d D o h r e n w e n d ( 1 97 8 ). Q u e s t i o n s w e r e i n c l u d e d a b o u ta t o t a l o f 8 7 s t re s se s i n al l, a i m e d a t c o v e r i n g t h e m a j o r d o m a i n s o f s e r i o u ss t re s s c a p t u r e d i n th e s e p r e v i o u s i n v e n t o r i e s . P r o b e s w e r e u s e d to o b t a i n i n -f o r m a t i o n a b o u t t h e c o n t e x t o f e v e n t s. S t r es s s e v e ri ty r a ti n g s w e r e b a s e d o nt h e r a t in g s c h e m e d e v e l o p e d b y B r o w n a n d H a r r i s (1 9 78 ). O n l y e v e n ts i n t h eh i g h e s t tw o c a t e g o r i e s o f s e v e r i t y i n t h e B r o w n a n d H a r r i s s c h e m e a re c o n s i-d e r e d i n t h e f o l l o w i n g a n a l y s e s .

A s i n p r e v i o u s s u r v e y s o f l i fe st re s s , s o m e o f t h e i t e m s i n o u r l is ts d e a l tw i t h s t r e s s e s t h a t c o u l d b e o n g o i n g r a t h e r t h a n a c u t e , s u c h a s " a l i f e -t h r e a t e n i n g i l l n es s " o r " s e ri o u s m a r i t a l d i f f i c u l t i e s . " W h e n a r e s p o n d e n tr e p o r t e d s u c h a s t re s s , w e a s k e d w h e t h e r t h i s s i t u a t i o n h a d b e g u n i n t h e p a s t12 m o n t h s o r h a d b e e n g o i n g o n l o n g e r . I f t h e l at t er , w e a s k e d w h e t h e r t h e r eh a d b e e n a m a j o r c h a n g e i n t h e s it u a t i o n d u r i n g t h e p a s t 12 m o n t h s a n d ,i f s o , w h e t h e r t h e c h a n g e w a s f o r t h e b e t t e r o f w o r s e . A chronic stress w asd e f i n e d as o n e t h a t b e g a n m o r e t h a n 12 m o n t h s b e f o r e t h e in t e rv i e w . A nacute stress w a s d e f i n e d a s o n e t h a t s t a r te d w i t h in 12 m o n t h s o f t h e i n te r -~ i ew . A l l p o i n t - i n - t i m e e v e n t s ( e .g . , t h e d e a t h o f a l o v e d o n e , j o b l o ss ) w e r ec o d e d a s a c u t e s t re s se s . O n g o i n g s i t u a t i o n s c r e a t e d b y p o i n t - i n - t i m e e v e n t s( e . g ., f i n a n c i a l d i f f ic u l t i e s c r e a t e d b y j o b l o ss ) w e r e c o d e d a s c h r o n i c i f t h ee v e n ts th a t c a u s e d t h e m h a d o c c u r r e d m o r e t h a n 12 m o n t h s b e f o r e th e in t e r-v i e w . T w o s e p a r a t e s t r e s s e s , o n e c h r o n i c a n d t h e o t h e r a c u t e , w e r e c o d e dw h e n a r e s p o n d e n t r e p o r t e d t h e e x i st e n c e o f a n o n g o i n g s t re s s s it u a t i o n ( e . g .,a t r o u b l e d m a r r i a g e ) t h a t h a d s i g n i fi c a n t ly c h a n g e d f o r t h e w o r s e (e . g ., m a r i t a ls e p a r a t io n ) d u r i n g t h e p a s t 12 m o n t h s .G i v e n o u r i n t e r e s t i n c o m p a r i n g c h r o n i c a n d a c u t e s t r e s s e s , q u e s t i o n si n o u r s t re s s l is ts t h a t t o u c h e d o n p o t e n t i a l l y c h r o n i c s i t u a t io n s w e r e c o n -s c io u s l y p h r a s e d t o r e m o v e t h e t i m e r e f e r e n t f o u n d i n t y p i c al li fe e v e n t i n v en -t o r i e s. F o r e x a m p l e , t h e B . S . D o h r e n w e n d e t al . ( 19 7 8 ) l i fe e v e n t i n v e n t o r yi n c l u d e s a n e n t r y f o r " r e l a t i o n s w i t h s p o u s e / m a t e c h a n g e d f o r t h e w o r s e , "b u t n o e n t r y f o r o n g o i n g m a r i ta l d i f fi c u lt ie s . W e a t t e m p t e d t o m e a s u r e b o t ht y p e s o f s t r e s s i n t h i s d o m a i n b y a s k i n g a b o u t " s e r i o u s m a r i t a l d i f f i c u l t i e s "a n d p r o b i n g p o s i ti v e r e s p o n se s f o r c o n t e n t a n d d u r a t i o n .

T h i s a p p r o a c h r e ta i n s th e p r o b l e m o f s u b j e c ti v i ty in h e r e n t i n th e d e -t e r m i n a t i o n o f w h a t c o n s t i t u t e s a " s e r i o u s " d i f f ic u l t y . M a n y o f t h e q u e s t i o n st h a t e li ci t i n f o r m a t i o n a b o u t c h r o n i c s tr es se s h a v e a s u b je c t iv e c o m p o n e n t


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Chronic and Ac ute Stress 685

o f t h i s s o rt . P r e v i o u s r e s e a r c h o n t h e r e li a b il it y o f l if e e v e n t r e p o r t s h a s s h o w nt h a t q u e s t i o n s t h a t c o n t a i n s u c h q u a l i f i e r s a r e a s se s s e d l es s r e l i a b l y t h a n t h o s et h a t c a n b e d e f i n e d m o r e o b j e c t i v e l y ( e .g . , d e a t h , d i v o r c e , jo b l os s; N e u g e -b a u e r , 1 9 81 ). T h i s r a is e s th e p o s s i b i l it y t h a t s e l ec t iv e p e r c e p t i o n s , b a s e d e i t h e ro n c u r r e n t l ev e l o f d e p r e s s io n o r o n i n d i v id u a l d i f f e re n c e s l in k e d t o c h r o n i cd e p r e s s i o n ( e .g . , n e g a t iv e a f fe c t iv i t y ; W a t s o n & P e n n e b a k e r , 1 98 9), m i g h tp l a y a l a r g e r p a r t i n r e p o r t s a b o u t c h r o n i c s t r e s s e s t h a n a c u t e s t r e s s e s . T h i si s su e is d i s c u s se d a t th e e n d o f th e p a p e r i n a c o n s i d e r a t i o n o f l i m i t a t io n s .

S u m m a r y c h r o n i c a n d a c u t e s t r e s s s c a l e s w e r e c r e a t e d i n a t w o - s t e pf a s h i o n . I n t h e f ir s t s t e p , a se r ie s o f f i v e d o m a i n - s p e c i f i c s tr e s s m e a s u r e s w a sg e n e r a t e d f o r e a c h r e s p o n d e n t . T h e d o m a i n s , w h i c h a r e t h e su b j e c t o f m o r ed i s a g g r e g a t e d a n a l y s e s i n a l a t e r s e c t io n o f th e p a p e r , i n c l u d e p h y s i c a l il l-n e s s , f i n a n c i a l d i f f ic u l t y , m a r i t a l c o n f l i c t , o t h e r i n t e r p e r s o n a l c o n f l i c t , a n dd e a t h o f a l o v e d o n e . T h e s e d o m a i n s c a p t u r e t h e v a s t m a j o r i t y o f t h e s er io u ss tr e ss e s r e p o r t e d in t h e s u rv e y . E a c h d o m a i n - s p e c i f i c m e a s u r e w a sd i c h o t o m i z e d t o d i s c r i m i n a t e b e t w e e n r e s p o n d e n t s w h o h a d n o s t r e s s e s i nt h e d o m a i n f r o m t h o s e w h o h a d o n e o r m o r e .

I n t h e s e c o n d s t e p , s u m m a r y c h r o n i c s t r es s a n d a c u t e s tr e ss sc o r e s w e r ec r e a te d b y s u m m i n g t h e n u m b e r o f d o m a i n s i n w h i c h e a c h r e s p o n d e n t r e p o r t -e d o n e o r m o r e s tr e ss e s. T h e s e s u m m a r y s c o re s a r e v e r y h ig h l y c o r r e l a te dw i th m o r e c o n v e n t i o n a l s u m m a r y m e a s u r e s th a t s i m p l y s u m u p a l l c h r o n ico r a c u t e s tr e ss e s a c r o s s d o m a i n s ( P e a r s o n c o r r e l a t i o n s o f .9 5 f o r c h r o n i c a n d. 9 3 f o r a c u t e s t r e s s ) . W e c h o s e t o u s e t h e l e s s c o n v e n t i o n a l m e a s u r e s , t h o u g h ,b e c a u s e p r e l i m i n a r y a n a l y s e s sh o w e d t h a t t h e i n c r e as e in d e p r e s si v e s y m p t o m sa s s o c i a t e d w i t h m u l t i p l e s t r e s s e s c o m p a r e d t o o n l y a s i n g l e s t r e s s w i t h i n as in g le d o m a i n i s c o n s i d e r a b l y s m a l l e r t h a n t h e i n c r e a s e a s s o c i a t e d w i t h a s i ng l es tr es s c o m p a r e d t o n o s t re s s w i t h i n a si ng le d o m a i n . T h e c o n v e n t i o n a l s u m -m a r y m e a s u r e , w h i c h s i m p l y s u m s s t re s se s ac r o s s d o m a i n s , i m p l i ci tl y e q u a t e sm u l t i p l e s t r e s s e s i n a s i n g l e d o m a i n w i t h a s i n g l e s t r e s s i n e a c h o f m u l t i p l ed o m a i n s . O u r m e a s u r e d o e s n o t .

R E S U L T ST h e D i s a g g r e g a t i o n o f C h r o n i c a n d A c u t e S t r e s s

T a b l e I p r e s e n ts th e m e a n s a n d s t a n d a r d d e v i a t io n s o f t h e s u m m a r yc h r o n i c a n d a c u t e s tr e ss s c al es . W o m e n a r e e x p o s e d t o a c u t e s t re s se s i n m o r ed o m a i n s t h a n m e n , t( 17 5 2) = - 1 . 7 , p < .1 0 , a l t h o u g h th i s d i f f e re n c e iso n l y m a r g i n a l l y s i g n i f i c a n t .T a b l e I I p r e s e n t s t h e r e s u l t s o f r e g r e s s i o n a n a l y s e s in w h i c h c h r o n i cs t re s s, a c u t e s tr e s s, a n d c o n t r o l v a r i a b l e s ( a g e , e m p l o y m e n t s t a t u s , e d u c a -


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6 8 6 M eGo n a g le a nd Kessl er

T a b l e I. Exposure to.Chronic and Acute Stresses AmongMen and WomenaMen Women(n = 819) (n = 936)

Type of stress M SD M SDChronic .374 .603 .402 .611Acute .391 .594 .441 .647aMeans are the average number of domains in which atleast one stress was reported.

tional level, and two dichotomous variables for the presence of preschoolor older children in the home) were used to predict depressive symptoms.We find that both chronic an d acute stress significantly predict depressi ona mo n g me n, b = .295, t(813) = 5.5, p < .05 an d b = .145, t(813) = 2.7,p < .05, an d amo ng wo me n, b = .480, t(933) = 8.9, p < .05 an d b = .196,t(933) = 3.9, p < .05. The uns ta nd ar di ze d regress ion coefficie nts can beinterpreted as suggesting that each add itiona l chronic stress dom ai n increasesdepressive symptoms by 0.295 standar d devi ation units amon g m en a nd 0.480standa rd deviat ion units among women, while each addit ional acute stressdoma in increases depressive symptoms 0.145 standar d deviation units amon gmen and 0 .196 stan dard deviat ion units among wome n.

An eval uati on of the statistical significance of the differ ence in theregression coefficients associated with chronic and acute stress was carriedout by estimating revised regression equations with contrast codes (J.Coh en & Cohen, 1983). The results of this analysis indicate that for bot h me nand women, chronic stress is a stronger predictor of depressive symptomsth an acute stress, z~b = .150, t(813) = 1.8, p < .06 a mo ng men and Ab= .284, t(933) = 3.6, p < .05, am on g wom en, al tho ugh the diffe renc e for

Table lI. Estimated UnstandardizedRegressionof DepressiveSymptoms on Chronic and Acute Stress for Men andWomenMen Women(n = 819) (n = 936)

Type of stress b t b tChronic .295 5.5 b .480 8.9bAcute .145 2.7b .196 3.9bDifference .150 1.8 .284 3.6baCoefficients are based on the number of domains inwhich at least one stress occurred. Adjusted R 2 = .087for men and .112 for women.bp < .05, two-tailed.


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C h r o n i c a n d A c u t e S t r e ss 68"/

m e n i s o n l y m a r g i n a l l y s i g n i f i c a n t . T h e r e i s n o s e x d i f f e r e n c e i n t h e i m p a c to f a c u t e st r es s o n d e p r e s s i o n , A b = . 0 5 1 , t ( 1 7 4 6 ) = 0 . 7 , p = n s . T h e a s s o c i -a t i o n o f d e p r e s s i o n w i t h c h r o n i c s t r e s s i s n e a r l y t w o t i m e s s t r o n g e r a m o n gw o m e n t h a n a m o n g m e n , A b = . 1 85 , t (1 7 4 6 ) = 2 . 4 , p < . 05 . 3

I t i s i m p o r t a n t t o r e m e m b e r , i n t h i s c o n t e x t , t h a t t h e d a t a c o l l e c t i o ns t r a te g y u s e d t o e l ic it i n f o r m a t i o n a b o u t c h r o n i c a n d a c u t e s tr es se s f o c u s e do n se r ious s t r e s s e s ( t h o s e r a t e d i n t h e h i g h e s t t w o c a t e g o r i e s o f t h e B r o w na n d H a r r i s r a t i n g s c h e m e ) a cr o s s a r a n g e o f st re s s d o m a i n s . T h i s m e a n s t h a tt h e r e s u l ts i n T a b l e I I c a n b e i n t e r p r e t e d a s s h o w i n g t h a t t h e t yp i ca l s e r i o u sc h r o n i c s t re s s is m o r e s t r o n g l y r e l a t e d t o d e p r e s s i o n t h a n t h e t yp i ca l s e r i o u sa c u t e s t r e s s , n o t t h a t a l l c h r o n i c s t r e s s e s a r e m o r e i m p o r t a n t t h a n a l l a c u t es tr es se s. F o r e x a m p l e , t h e e m o t i o n a l c o n s e q u e n c e s r e su l ti n g f r o m a n a c u t es tr e ss s u c h a s a r a p e a r e n o d o u b t m o r e s e v e re t h a n t h e e f f e c t s o f m a n y s e ri -o u s c h r o n i c s t r e s s e s .

E x p o s u r e t o C h r o n i c v e rs u s A c u t e S t re ss b y S u b s t a n t i v e D o m a i nT h e l ar g e s a m p l e m a k e s i t p o s s i b l e t o e x p l o r e a s s o c i a t io n s a m o n g d i s -

a g g r e g a t e d m e a s u r e s o f c h r o n i c a n d a c u t e s t r e s s . T h i s w a s d o n e b y c r e a t i n gf i v e s u b s c al e s o f t h e m o s t c o m m o n s tr e ss t y p e s . A s n o t e d e a r l ie r , th e s e f iv ec a t e g o r i e s a r e p h y s i c a l i ll n es s , f i n a n c i a l d i f f i c u l t y , m a r i t a l c o n f l i c t , o t h e r i n -t e r p e r s o n a l c o n f l i c t, a n d d e a t h o f a lo v e d o n e . M o s t o f th e e v e n t s t h a t c o n -s t i tu t e t h e s e c a t e g o r ie s a r e d i v e r s e . F i n a n c i a l d i f f i c u l t y , f o r e x a m p l e , i n c l u d e ss u c h t h in g s a s b e in g f i r e d , b u s i n e s s f a i l u r e , f o r e c l o s u r e o f a m o r t g a g e ( a lld e f i n e d a s a c u t e ) , a n d o n g o i n g p r o b l e m s m e e t i n g r e g u l a r f i n a n c i a l o b l i g a -t i o n s ( a c h r o n i c st re s s) . I n t e r p e r s o n a l c o n f l i c t i n c l u d e s s u c h t h in g s a s a b r o k e ne n g a g e m e n t , t e r m i n a t i o n o f o t h e r i m p o r t a n t r e la t io n s h i p s , p r o b l e m s g e t ti n ga l o n g w i t h s u p e r v i s o r s o r c o - w o r k e r s , e t c .

W e r e c o g n i ze t h a t c o n c e n t r a t io n o n t h es e c o m p a r a t i v e l y c o m m o n s tr es sd o m a i n s f ai ls t o c a p t u r e t h e f u l l c o m p l e x i t y f o u n d i n a m o r e c o m p r e h e n s i v ea g g r e g a t e a n a l y s i s o f st re s s e f f e c t s . W e a l s o r e c o g n i z e t h a t t h e c o m b i n a t i o no f d i v er s e e v e n t s i n t o t h e s e fi v e s u b s t a n t i v e c l u st e rs m a s k s i m p o r t a n t v a r i a -b i l it y a m o n g s t r es s e s, b o t h i n t h e i r m e a n i n g s a n d t h e i r e m o t i o n a l e f fe c t s .H o w e v e r , t h is p a r t i a l d i s a g g r e g a t i o n is m o r e t r u e t o r e a l it y t h a n t h e c o n v e n -t i o n a l a p p r o a c h o f c o m b i n i n g a l l s tr es se s in t o o n e s u m m a r y m e a s u r e . I t iss u f f ic i e n t ly d e ta i l ed t o c a p t u r e i m p o r t a n t s u b s t a n ti v e s p e c i f ic a t io n s o f a g -g r e g a t e e f f e c t s . I t i s a l so m o r e f e a s ib l e t h a n a t o t a l l y d i s a g g r e g a t e d a n a l y si s

3 O n e p o s s ib l e in t e r p r e t a t i o n o f t h i s s e x d i f f e re n c e i s t h a t w o m e n h a v e a l a r g e r a v e r a g e n u m b e ro f c h r o n i c s t r e s s e s w i t h i n t h e d o m a i n s w h e r e t h e y e x p e r ie n c e t h i s t y p e o f s t r es s . W e i n v e s t ig a t -e d t h is p o s s ib i l it y a n d f o u n d n o e v i d e n c e t o s u p p o r t i t .


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688 McGo n a gle a nd Kes sler

Table IlL Exposure to Chronic and Acute Stresses bySubstantive Domain and Their Difference for Men andWomen"Men Women(n = 819) (n ---- 936)

Type of stress M SD M SDPhysical illnessChronic .092 .289 .090 .286Acute .076 .265 .077 .267Difference (AM) .016 .013t Difference 1.3 1.1Financial difficultyChronic .057 .233 .060 .237Acute .096 .295 .085 .280Difference (&~/) -.039 -.025

t Difference - 3.3 b - 2.4bMarital conflictChronic .090 .287 .094 .292Acute .046 .210 .067 .251Difference (Ad4) .044 .027t Difference 3.9b 2.3 bInterpersonalconflictChronic .134 .341 .158 .365Acute .072 .259 .102 .302Difference (AM) .062 .056t difference 4.3 b 3.7 bDeath of a lovedoneAcute .100 .300 .110 .313aMeans are based on dichotomized variables (0 = nostress, 1 = at least 1 stress).bp < .05, two-tailed.

of the m an y differe nt events include d in the full interview, almost all of whichoccurred so infr eque ntl y that it would be imposs ible to carry ou t a statisti-cally powerful analysis of their association with depression.Table III reports the percentage of respondents who reported thepresence of one or mo re stresses in each of these five bro ad stress domain s.All disaggregated analyses are based on dichotomous measures of presenceversus absence of at least one stress in each domain rather than continuousvariabl es because of the extre me skew in all disaggregated me asure s of stress.The data in Table III undersc ore the im portan ce of e xamining event chro-nicity across substa ntivel y diverse domai ns by showing that chronici ty de-pends on the substantive dom ai n under considerat ion. For both men andwome n, chronic marit al conflicts (M = .090 amo ng men, and M = .094amo ng wome n) an d interpe rsonal conflicts (. 134 am ong me n, an d M = . 158among women) occur signif icantly more often tha n their acute counterparts[for mar it al confl icts , M = .046, t(813) = 3.9, p < .05, am on g me n, an d


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Chronic and Acute Stress 689

M = . 0 6 7 , t (9 3 3 ) = 2 . 3 , p < . 05 , a m o n g w o m e n ; f o r i n t e r p e r s o n a l c o n -f l i c t s , M = . 0 7 2 , t ( 8 1 3 ) = 4 . 3 , p < . 0 5 , a m o n g m e n , a n d M = . 1 0 2 , t ( 9 3 3 )= 3 .7 , p < . 0 5 , a m o n g w o m e n ] . S e r i o u s f i n a n c i a l d i f f i c u l t i e s , h o w e v e r , a r em o r e l ik e l y t o b e a c u t e ( M = . 09 6 a m o n g m e n , a n d M = . 08 5 a m o n g w o m -e n ) t h a n c h r o n i c [ M = . 0 5 7 , t (8 1 3 ) = - 3 . 3 , p < . 05 , a m o n g m e n , a n d M= . 0 6 0 , t ( 93 3 ) = - 2 . 4 , p < . 0 5, a m o n g w o m e n ] . P h y s i c a l i l ln e s s i s t h e o n l y

t y p e o f s tr e s s c o n s i d e r e d h e r e t h a t o c c u r s e q u a l l y o f t e n i n c h r o n i c a n d a c u t ef o r m s [ M = . 0 92 a n d . 0 7 6 , r e s p e c t i v e l y , t (8 1 3 ) = 1 .3 , p = n s , a m o n g m e n ,a n d M = . 0 90 a n d . 0 7 7 , r e s p e c t i v e l y , t (9 3 3 ) = 1 .1 , p = n s , a m o n g w o m e n ] .W e a l s o s e e i n t h is d i s a g g r e g a t i o n t h a t t h e h i g h e r e x p o s u r e o f w o m e n t h a nm e n t o a g g r e g a t e a c u t e s t r e s s ( T a b l e I ) s t e m s l a r g e l y f r o m s i g n i f i c a n t l y m o r ee x p o s u r e t o i n t e r p e r s o n a l c o n f l ic t s w i t h f a m i l y a n d w o r k c o l l ea g u e s , t (1 7 52 )= - 2.12, p < . 0 5 , a n d m a r g i n a l l y w i t h s p o u s e s , t ( 1 7 5 2 ) = - 1 . 9 , p < . 0 7 .

R e s p o n s e t o C h r o n i c an d A c u t e S t re s s b y S u b s t a n t iv e D o m a i nT a b l e I V p r e s e n t s r e s u lt s f r o m t h e r e g r e s s io n o f d e p r e s s iv e s y m p t o m s o n

d i s a g g r e g a t e d m e a s u r e s o f c h r o n i c a n d a c u t e s t re s s a n d c o n t r o l s , s e p a r a t e l y

Table I V . E s t im a te d U n s t a n d a r d i z e d Re g r e s s io n o fDepress ive Sym ptom s on Ch ron ic and Ac u te S t resses byS u b s t a n ti v e D o m a in f o r M e n a n d W o m e n a

M e n W o m e n(n = 819) (n = 936)Typ e of s tress b t b tPhysical illnessCh ronic .308 2 .6 b .298 2 .6 bA cute .057 0 .5 .033 0 .3D iffe ren ce .251 1.4 .265 1.5F inanc ia l d i f f icu l ty

C hr on ic .245 1.8 .283 2.1 bA c u te . 01 6 0 .2 - . 0 8 5 - 0 .7D ifferen ce .229 1 .2 .368 1 .9Mar i ta l conf l ic tCh ronic .381 3 .4b .739 6.6 bA cu te .496 3.2 b .531 4.1 ~Dif fe ren ce - . 1 15 - 0 .6 .208 1 .2In te rpe rsona lconf l ic tC hro nic .239 2.5 b .496 5.6 bA cu te .117 1.0 .179 1.7D ifferen ce .122 0 .8 .317 2 .2 bD e a th o f a l o v e do n eA cut e .186 1 .8 .308 2 .9 b~Adjus ted R 2 = .098 fo r men and .139 fo r women .bp < .05, two-ta i led .


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690 M eGonagle and Kesslerf o r m e n a n d w o m e n . T h e r e s u l t s s u g g e s t t h a t f o r b o t h m e n a n d w o m e n ,c h r o n i c s t r e s s i s a s t r o n g e r p r e d i c t o r t h a n a c u t e s t r e s s . F e w s t a t i s t i c a l l y s i g -n i f i c a n t s l o p e d i f f e r e n c e s e x i st w i t h i n d o m a i n s , h o w e v e r , r e f l e c t i n g t h e f a c tt h a t t h e t w o - l e v e l d i s a g g r e g a t i o n l e a v e s u s w i t h t o o f e w o c c u r r e n c e s f o rs t a t i s t i c a l l y p o w e r f u l a n a l y s i s . N o n e t h e l e s s , i t i s c l e a r t h a t c h r o n i c s t r e s s i sm o r e p o w e r f u l l y a s s o c i a te d w i t h d e p r e s si v e s y m p t o m s t h a n a c u t e st re ss . A ss h o w n i n T a b l e I V , m e a n i n g f u l p r e d i c t i v e e f f e c t s o f s t r e s s a r e c o n f i n e d t oc h r o n i c s t r e s s i n t w o d o m a i n s ( p h y s i c a l i l l n e s s a n d f i n a n c i a l d i f f i c u l t y ) .A m o n g w o m e n , t h e e f f e c t is m u c h l a r g e r fo r c h r o n i c t h a n a c u t e s tr es s ina t h i r d d o m a i n ( i n t e rp e r s o n a l c o n f l ic t ). I n o n l y o n e d o m a i n ( m a r i t a l c o n -f li c t) is t h e r e e v i d e n c e t h a t a c u t e s t r e s s h a s a n e f f e c t a s la r g e a s t h a t o f c h r o n i cs tr e ss . F u r t h e r m o r e , t h e d i s a g g r e g a t e d a n a l y s is s h o w s t h a t t h e g r e a t e r e f fe c to f a g g r e g a te c h r o n ic s t r es s a m o n g w o m e n c o m p a r e d t o m e n ( se e T a b l e I I )is d u e t o c h r o n i c i n t e r p e r s o n a l c o n f l ic t in m a r r i a g e a n d w i t h f a m i l y a n d w o r kcol l ea gu es , Ab = - . 358 , t (1752) - - - 2 .2 , p < .05 , an d Ab = - . 257 , t (1752)= - 1 . 9 , p < . 06 , r e s p e c t i v e l y .

T h e J o i n t E f f e c t s o f C h r o n i c a n d A c u t e S t r e s s

Aggregate PatternsA s n o t e d a b o v e , t h e r e h a s b e e n c o n s i d e r a b l e d i sc u s s io n o f t h e p o s si b il -

i ty t h a t c h r o n i c s tr e ss c a n m a g n i f y t h e i m p a c t o f l i fe e v en t s o n d e p r e s si o n .T o e v a l u a t e t h i s p o s s i b i l i t y , w e e x t e n d e d t h e a n a l y s i s r e p o r t e d i n T a b l e I Ib y in c l u d i n g a m u l t i p l ic a t i v e i n t e r a c t i o n b e t w e e n c h r o n i c a n d a c u t e s tr e s si n t h e r e g re s s io n e q u a t i o n . T h i s m o d e l w a s e s t i m a t e d s e p a r a t e ly f o r m e n a n dw o m e n . A s s h o w n i n T a b l e V , th e s l o p e s a s s o c i a te d w i th t h e i n t e r a c t io n e f -f e c t a r e n e g a t i v e b o t h a m o n g m e n [b = - . 0 7 7 , t (8 1 3 ) = - 1 .0 , p = n s]a n d a m o n g w o m e n , f o r w h o m th e e f f e c t is s i g n if i ca n t [b = - . 1 5 4 , t( 93 3 )= - 2 . 1 , p < .0 5 ].G i v e n t h e c o u n t e r i n t u i t i v e s ig n o f th i s in t e r a c t i o n a n d i ts p o t e n t i a l i m -

p o r t a n c e f o r f u t u r e r e s e a r c h o n j o i n t s t r e ss e f f e c t s , it is w o r t h n o t i n g t h a tw e c a r r i e d o u t s e n s i t i v i t y a n a l y s e s t o i n v e s t i g a t e t h e p o s s i b i l i t y t h a t t h e i n -t e r a c t i o n w a s c r e a te d b y s o m e a n o m a l y i n t h e d a t a . U n d e r l y i n g n o n l i n e a ri -t ie s in m a i n e f f e c ts c a n s o m e t i m e s g i v e t h e f a l s e a p p e a r a n c e o f i n t e r a c ti o n s( C l e a r y & K e s s le r , 1 9 8 2 ), s o w e a l s o in v e s t i g a t e d t h e e f f e c t s o f n o n l i n e a r m a r -g i n a l e f fe c t s o n t h e i n t e r a c t i o n . T h e s e i n v e s t i g a t i o n s s h o w t h a t t h e n e g a t i v ei n t e r a c t i o n b e t w e e n c h r o n i c a n d a c u t e s t r e s s i s q u i t e s t a b l e a n d n o t d u e t oa s m a l l n u m b e r o f i n f l u e n t i a l d a t a p o i n t s , t o s y s t e m a t i c n o n l i n e a r i t i e s i n t h em a i n e f f e c ts , n o r t o s o m e c o m b i n a t i o n o f th e s e in f l u en c e s .


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Ch ron ic a n d Acu te S tres s

Table V. Estimated Unstandardized Regression of the Marginal andJoint Effects of Chronic and Acute Stresses Predicting Depressive Symptoms

for Men and Women"Men Women

(n = 819) (n = 936)Type of stress b t b tChronic .338 4.8 b .573 8.2 bAcute .181 2.7 b .275 4.4 bChronic Acute - .0 77 -1 .0 - .1 54 -2. 1 b~Coefficients are ba sed on the num ber o f do mains in w hich at leastone stress occurred. Adjusted R 2 = .088 for m en and .117 for wom en.bp < .05, two-tailed.

69 1

I t is p o s s i b l e t o i n t e r p r e t t h is i n t e r a c t i o n e i t h e r a s e v i d e n c e t h a t p r e e x -i s t i n g c h r o n i c s t r e s s r e d u c e s t h e i m p a c t o f a c u t e s t r e s s o n d e p r e s s i o n o r t h a ta c u t e s t re s s a m e l i o r a t e s t h e e f f e c t o f c h r o n i c s t r e s s. T h e t w o i n t e r p r e t a t i o n sa r e e q u i v a l e n t a l g e b r a i c a l l y . W e f o c u s o n t h e f i r s t o f t h e s e t w o i n t e r p r e t a -t i o n s in t h e f o l l o w i n g d i s c u s s i o n , b u t t h e c o n s i d e r a t i o n s a r e t h e s a m ew h i c h e v e r w a y o n e t h i n k s a b o u t t h e i n t e r a c ti o n . T h e i m p o r t a n t p o i n t i s t h a tt h e j o i n t o c c u r r e n c e o f b o t h s t r e s s t y p e s i s a s s o c i a t e d w i t h l e s s d e p r e s s i o nt h a n o n e w o u l d p r e d i c t b a s e d o n a n a d d i t i v e m o d e l .

T h e m a r g i n a l e f f e c t o f e i t h e r c h r o n i c o r a c u t e s t r e s s i n t h i s m o d e l c a nb e in t e r p r e t e d a s t h e e f f e c t o f t h is s t re s s a m o n g r e s p o n d e n t s w h o h a v e n os tr e ss o f t h e o t h e r t y p e . A s s h o w n in T a b l e V , a l l o f t h e s e m a r g i n a l e f f e c t sa r e s ig n i f ic a n t , w h i c h m e a n s t h a t b o t h c h r o n i c a n d a c u t e s tr e ss e s a r e a s s o c ia t -e d w i t h d e p r e s s i v e s y m p t o m s i n t h e a b s e n c e o f s t r e s s e s o f t h e o t h e r t y p e .T h e s l o p e s l i n k i n g c h r o n i c s t r e s s i n t h e a b s e n c e o f a c u t e s t r e s s w i t h d e p r e s -s iv e s y m p t o m s a r e , h o w e v e r , s t r o n g e r t h a n t h o s e l in k i n g a c u t e s t r es s in th ea b s e n c e o f c h r o n i c s t re s s w i t h d e p r e s si v e s y m p t o m s , b o t h a m o n g m e n , A b= . 1 57 , t (8 1 3 ) = 1 . 6, p = n s , a n d a m o n g w o m e n , A b = . 2 98 , t (9 3 3 ) =3 .2 , p < .0 5 . T h i s i s, o f c o u r s e , c o n s i s t e n t w i t h th e m a i n e f f e c t s m o d e l inT a b l e I I .

Disaggregated PatternsW e a l s o e v a l u a t e d t h e s i g n i f i c a n c e o f d i s a g g r e g a t e d i n t e r a c t i o n s b e t w e e n

p a r t i c u l a r k i n d s o f c h r o n i c a n d a c u t e s tr e ss . R a t h e r t h a n e v a l u a t e a ll 5 0 l o g i-c a l ly p o s s i b l e in t e r a c t i o n s ( f iv e t y p e s o f c h r o n i c s t r e s s f i v e t y p e s o f a c u t es tr es s, s e p a r a t e ly f o r m e n a n d w o m e n ) i n a n e x p l o r a t o r y f a s h i o n , w e f o c u s e do n f o u r b r o a d i n t e ra c t i o n s u b t y p e s t h a t a r e o f p a r t i c u l a r c o n c e p t u a l i n t e re s t.


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Wi t h i n - D om ai n P a t t e r nsT h e f ir s t s u b t y p e w e c o n s i d e r e d i n v o l v es i n t e ra c t i o n s o f c h r o n i c a n d

a c u t e s tr es s w i th i n t h e s a m e l if e d o m a i n , a v e rs i o n o f w h a t B r o w n a n d H a r -r is ( 1 9 7 8) ca ll a " m a t c h i n g " e v e n t . T h e r e i s s o m e r e a s o n t o b e l i e v e t h a t i n t e r-a c t i o n s o f th i s s o r t w il l b e p o s i t i v e , in d i c a t i n g t h a t t h e e m o t i o n a l e f f e c t o fa c u t e s t r es s is m o r e p o w e r f u l i n t h e p r e s e n c e o f a p r e v i o u s l y e x is t in g s t re s so f a s i m i l a r s o r t . T h i s c o u l d o c c u r e i t h e r b e c a u s e t h e a c u t e s t r e s s c o m p l i -c a t es t h e c h r o n i c s i t u a t i o n ( a s a h e a r t a t t a c k , f o r e x a m p l e , m i g h t c o m p l i c a t et h e t r e a t m e n t o f a p r e e x i s t i n g c h r o n i c m e d i c a l c o n d i t i o n ) o r b e c a u s e t h ec h r o n i c st re s s re p r e s e n t s a d e f ic i t w h i c h m i g h t m a g n i f y th e i m p a c t o f t h e a c u t es t re s s ( as p r e e x is t i n g f in a n c i a l p r o b l e m s , f o r e x a m p l e , m i g h t h e i g h t e n t h ee m o t i o n a l i m p a c t o f a s u b s e q u e n t j o b l os s) . A n o t h e r p o s s ib i li ty is t h a t t h ec h r o n i c s t re s s c r e a t e s a m e a n i n g c o n t e x t w h i c h l e a d s to a m o r e n e g a t i v e a p -p r a i s a l o f t h e a c u t e s t re s s .

A t t h e s a m e t i m e , a c a se c o u l d b e m a d e f o r t h e p o s s ib i li ty t h a t s o m ew i t h i n - d o m a i n i n t e r a c t i o n s b e t w e e n c h r o n i c a n d a c u t e s t r e s s w i l l b e n e g a -t i v e . W h e a t o n ( 1 99 0 ), i n f a c t , a r g u e d t h a t t h i s w il l b e t h e c a s e w h e n e v e r t h ea c u t e s t r es s is e x p e r i e n c e d a s t h e e n d o f a n o n g o i n g d i f f i c u l t y in t h e s a m el i fe d o m a i n , a s a d i v o r c e m i g h t r e p r e s e n t t h e e n d o f a t r o u b l e d m a r r i a g e ( A s el -t i n e & K e s s le r , 1 9 90 ). A n e g a t i v e i n t e r a c t i o n c o u l d a l s o o c c u r i f c h r o n i c s tr e ssi n a p a r t i c u l a r li fe d o m a i n l e ad s t o e m o t i o n a l h a b i t u a t i o n , p r e e m p t i v e c o p -i n g , o r d e v a l u a t i o n o f a s u b s e q u e n t s t r es s .

T o e v a l u a t e t h e s e p o s si b il it ie s , a r e g r e s s i o n e q u a t i o n w a s e s t i m a t e d t h a tc o n t a i n e d a ll th e p r e d i c t o rs i n t h e d i s a g g re g a t e d m a i n e f f e c t m o d e l ( T a b l eI V ) p l u s f i v e w i t h i n - d o m a i n i n t e r a c t i o n s b e t w e e n c h r o n i c a n d a c u t e s t re s s.T h i s m o d e l w a s e s ti m a t e d s e p a r a t e ly f o r m e n a n d w o m e n . S u m m a r y r es u lt sa r e r e p o r t e d i n T a b l e V I ? I n g e n e r al , m a r g i n a l e f f e c ts a r e s tr o n g e r f o r c h r o n i cth a n a c u te s t r e s s (i n 7 o f 10 r e p l i c a t ions ) , c ons i s t e n t w i th t he a gg r e ga t e r e su lt s .M o r e o v e r , f o r t w o o f t h e d o m a i n s , p h y s i ca l il ln e ss a n d f i n a n c ia l d i ff i c u lt y ,a c u te s t r es s e f f e c t s e x i s t only i n t h e p r e s e n c e o f c h r o n i c s tr e ss , w h e r e a s c h r o n i cs t re s s i n e a c h o f t h e s e d o m a i n s h a s a s i g n i f ic a n t a n d i n d e p e n d e n t e f f e c t o nd e p r e s s i o n . I t i s n o t e w o r t h y t h a t b o t h c h r o n i c a n d a c u t e s t r e s s i n t h e d o -m a i n s o f c o n f l i c t w i t h f r i e n d s a n d w o r k c o l le a g u es a n d i n m a r r i a g e h a v e i n-d e p e n d e n t e f f e c ts (a l t h o u g h t h e a c u t e c o m p o n e n t o f c o n f l i c t w i t h f r i e n d s a n d

4 C h r o n i c i l l n es s o f a l o v e d o n e i s i n c l u d e d i n t h i s a n a l y s is a s t h e a c u t e c o u n t e r p a r t o f d e a t ho f a l o v e d o n e . T h i s c h r o n i c i ll n e ss m e a s u r e w a s n o t i n c l u d e d i n p r e v i o u s a n a l y s e s b e c a u s es i t u a t i o n s o f th i s s o r t , w h i le v e r y f r e q u e n t l y re p o r t e d , a r e g e n e r a ll y n o t f o u n d t o h a v e s t r o n ge f f e ct s o n d e p r e s s i o n . T h e B r o w n a n d H a r r i s L E D S r a t i n g s c h e m e , o n w h i c h o u r l if e e v e n tc o d i n g s c h e m e is b a s e d , w o u l d e x c l u d e t h e v a s t m a j o r i t y o f t h e s e e v e n t s f r o m a n i n v e n t o r yo f m a j o r s t r e s s e s .


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C h r o n i c a n d A c u t e S t re s s 6 93Table Vl. Estimated Unstandardized Regression of theMarginal and Joint Effects of Within-Domain Chronic andAcute Stresses Predicting Depressive Symptoms for Men

and WomenaMen Women

(n = 819) (n = 936)Type of stress b t b tPhysical illnessChronic .377 2.9 c .408 3.3 c

Acute .145 1.0 .161 1.2Chronic x Acute - . 337 -1 .2 - .6 46 -2. 1 b

Financial difficultyChronic .146 0.9 .399 2.5 bAcute - .024 -0 . 2 - .019 -0 .2Chronic x Acute .283 0.9 -. 50 4 - 1 . 6

Marital conflictChronic .398 3.3 ~ .697 5.8 cAcu te .534 2.9" .499 3.4 ~Chronic x Acute -. 13 6 -0 . 4 .338 1.1

InterpersonalconflictCh roni c .256 2.5 b .614 6.4"Acute .146 1.1 .346 2.9 ~Chronic x Acute - .1 25 -0 .4 - .7 83 -3. 0"

Chronic iIlness/Death of a lovedoneChronic (illness) -. 03 1 -0 . 3 .025 0.3Acu te (dea th) .251 1.9 .290 2.3 bChronic x Acute -. 17 1 -0 . 7 .036 0.2

aAdjusted R 2 = .102 for men an d .156 for wom en.bp < .05, two-tailed.Cp < .05 fo r t > 2.6.

w o r k c o l l e a g u e s is n o t s i g n i f i c a n t f o r m e n ) , c o n s i s t e n t w i t h o t h e r r e s e a r c hi m p l i c a t i n g t h e r o l e o f i n t e r p e r s o n a l c o n f l i c t i n p s y c h o l o g i c a l d i s t r es s (B o l g e r ,D e L o n g i s , K e s s l e r , & S c h i l l i n g , 1 9 8 9 ) .T h e i n t e r a c t i o n e f f e c t s i n t h i s m o d e l c a n b e i n t e r p r e t e d a s t h e d e v i a -t io n s o f o b s e r v e d a s s o c ia t io n s f r o m t h o s e e x p e c t ed b y t h e m a i n e f f e c ts m o d e l .S e v e n o f t h e s e 1 0 i n t e r a c t i o n s a r e n e g a t i v e a n d 2 o f t h e n e g a t i v e i n t e r a c t i o n s( b o t h o f t h e m a m o n g w o m e n ) a r e s i g n if i ca n t a t p < .05: th e in t e r a c ti v e e f-f e c t s o f c h r on i c a n d a c u t e i n t e r pe r s o na l c on f l i c t , b = - . 783, t (93 3) = - 3 . 0,

p < . 05 , a n d o f c h r o n i c a n d a c u t e ph ys i c a l i l lne s s , b = ~ . 64 6 , t ( 93 3) =- 2 . 1 , p < . 05 . B y c h a n c e a l o n e , w e w o u l d e x p e c t t h a t i n a s e t o f 1 0 c o m -

p a r i s o n s , l es s t h a n 1 o f t h e m w o u l d b e s i g n i f i c a n t , s o it is u n l i k e l y t h a t t h e2 w e o b s e r v e h e r e a re s i g n if i ca n t b y c h a n c e . W h e n a d j u s t e d f o r s i m u l t a n e -o u s s i g n i f i c a n c e , t h e i n t e r a c t i v e e f f e c t o f i n t e r p e r s o n a l c o n f l i c t r e m a i n s s i g -n i f i c a n t a t p < . 05 ( t > 2 . 6 ) .


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694 McGonagle and Kessler

T h i s p a t t e r n o f i n t e r a c t i o n s c a n b e i n t e r p r e t e d e i th e r a s e v id e n c e t h a tc h r o n i c s tr e ss b u f f e r s t h e e m o t i o n a l i m p a c t o f a c u t e s t re s s o r t h a t a c u t e s tr e ssd a m p e n s t h e e f f e c t o f c h r o n i c s t re s s. 5 I n e i t h e r c a s e i t i s p o s s i b l e t o i n t e r p r e tt h e g e n e r a l l y n e g a t i v e p a t t e r n , a f t e r th e f a c t , a s d u e t o a n t i c i p a t i o n o r t op r i o r d e v a l u a t i o n o r t o c o p i n g p r e p a r e d n e s s , b u t n o n e o f th e s e g en e r a l e x -p l a n a t i o n s s u g g es ts w h y t h e in t e r a c t i o n s o c cu r m o r e s t r o n g l y a m o n g w o m e nt h a n m e n , n o r w h y t h e y ex i st f o r s o m e s t re ss d o m a i n s a n d n o t o t h e r s .

Patterns Invo lving Chronic Interpersonal ConflictT h e r e is a v a s t l i t e r a t u r e s h o w i n g t h a t t h e e f f e c t s o f s t r e s s f u l l if e e v e n t s

a r e s i g n i f i c a n t ly l es s p r o n o u n c e d a m o n g p e o p l e w i t h a c c es s t o s u p p o r t i v e s o -c i al r e l a t i o n s h i p s th a n a m o n g t h o s e w h o s e r e l a t i o n s h i p s a re n o t s u p p o r t i v e( e . g ., S . C o h e n & W i l l s, 1 9 85 ; K e s sl e r & M c L e o d , 1 98 4) . O n e m i g h t , b y e x-t e n s i o n , h y p o t h e s i z e t h a t p e o p l e w i th c h r o n i c i n t e r p e r s o n a l c o n f l ic t w o u l db e p a r t i c u l a r l y v u l n e r a b l e t o t h e e f f e c t s o f s t re s s. T h e r e h a s b e e n s o m e r e-c e n t i n t e r e s t i n t h e s o c i a l s u p p o r t l i t e r a t u r e i n i n v e s t i g a t i n g t h e e f f e c ts o f t h e s em o r e n e g a t i v e so c i al r e l a t i o n s h i p s o n h e a l t h ( A b b e y , A b r a m i s , & C a p l a n ,1 9 8 5 ; F i o r e , B e c k e r , & C o p p e l , 1 9 8 3 ; P a g e l , E r d l y , & B e c k e r , 1 9 8 7 ; R i l e y& E c k e n r o d e , 1 9 86 ; R o o k , 1 9 84 ; S c h u s t e r , K e s s l e r , & A s e l t i n e , 1 99 0) .T h e s e i n v e s t i g a ti o n s h a v e c o n s i s t e n t ly d o c u m e n t e d a s u b s t a n t i a l ly s t ro n g e re f f ec t o f n e g a ti v e so c i a l i n t e r a c t i o n s o n m o o d c o m p a r e d t o s u p p o r t i v e i n t e r-a c t i o n s . T h e r e h a s b e e n m u c h l es s e v i d e n c e , h o w e v e r , t o s u g g e st t h a t n e g a -t i v e s o c i a l r e l a t i o n s h i p s e x a c e r b a t e t h e e f f e c t o f l if e e v e n t s o n m o o d a sp o w e r f u l l y a s s u p p o r t i v e i n t e r a c t i o n s a m e l i o r a t e t h is e f fe c t . O n t h e b a si s o ft h is p r e v i o u s e v i d e n c e , w e h y p o t h e s i z e d t h a t t h e r e w o u l d n o t b e s i g n i f i ca n ti n t e r a c t i o n s b e t w e e n o u r m e a s u r e s o f c h r o n i c i n t e r p e r s o n a l s tr es s a n d a c u t es tr es s f r o m o t h e r l if e d o m a i n s .

5A reviewer suggested an interp retation of a m ore m ethodolo gical nature. As noted above, wecode d both first occurrences of acute stresses (such as a hea rt attac k occurring to a personwith no previous history of heart disease) and significant worsenings (such as a second heartattac k occurring to a person with a p rior history o f hear t disease) as acute stresses. The reviewersuggested that the negative interactions found between chronic and acute str es se s- which, bydefinition , include all the worsenings in ad dition to unrelated chronic an d acute stresses inthe same life dom ain (such as a first heart atta ck occurring to a person with a prior historyof some serious health problem other than hear t disease) - could reflect the fac t that worsen-ings are less stressful than first occurrences of acute stress. We evaluated this hypothesis byreanalyzing the disaggregated mod els in Table VI and foun d that the p attern o f negative inter-actions exists bo th for first occurrences and worsenings. It should be noted that the acute stressesin the dom ain o f phy sical illness were mostly first occurrences, as one w ould expect in a fairlyyou ng sample. M ost acute fina ncial stresses were also first occurrences. Most acute interpe r-sonal conflicts an d deaths, in c omp arison, were worsenings.


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C h r o n i c a n d A c u t e S t r e ss 6 9 5

Ta bl e VI I. Estimated Unstandardized Regression of the Join t Effectsof C hronic Interpersonal Conflicts and A cute Stre sses PredictingDepressive Symptoms for M en and W om en ~M e n W o m e n(n = 819) (n = 936)

Typ e of s tress b t b tM o d e l 1

Chron ic mar i ta l conf l ic tAcute physical i l lnessAcu te f inanc ia l d i f f icu l tyAcu te in te rpe rsona l conf l ic tA c u te d e a th o f a l o v e d o n eChron ic mar i ta l conf l ic t Physical illness

F inanc ia l d i f f icu l tyx In te rpe rsona l conf l ic t D e a th o f a l o v e d o n e

Chron ic in te rpe rsona l conf l ic tAcute physical i l lnessAcu te f inanc ia l d i f f icu l tyA c u te m a r i t a l c o n f l i c tA c u te d e a th o f a l o v e d o n eChron ic in te rpe rsona l conf l ic t

Physical illness F inanc ia l d i f f icu l tyx Mar i ta l conf l ic t D e a th o f a l o v e d o n e

.494 3.6 b .891 6.3 b.198 1.5 .028 0.2.024 0.2 .022 0.2.153 0.1 .275 2.3 b.196 1.7 .346 3.0 b- . 5 3 0 - 1 . 5 .3 35 0. 9

.1 76 0 .4 - . 3 5 5 - 0 . 9.005 0 .0 - . 3 8 9 - 1 .2.319 0.8 .079 0.2M o d e l 2

.365 3.2 b .564 5.2 b.184 1.3 .098 0.7.0 49 0 .4 - . 0 1 0 - 0 .1.686 3.9 b .544 3.6 b.280 2.4 b .415 3.6 b

- . 2 6 0 - 0 . 9 .1 14 0. 4.0 48 0 .2 - . 1 8 3 - 0 . 6- . 2 9 6 - 0 . 8 .4 74 1 .5- . 6 5 3 - 2 . 1 b - . 6 5 5 - 2 . 2 b"Ad justed R 2 for M odels 1 and 2 are .078 and .070 forand .090 fo r women , respec t ive ly .bp < .05, two-ta i led .

men , and .090

T h e r e s u l t s o f a n a l y s e s e v a l u a t i n g t h i s h y p o t h e s i s a r e p r e s e n t e d i n T a -b l e V I I . T h e t w o p r e d i c t i o n e q u a t i o n s o n w h i c h t h e s e r e s u l t s a r e b a s e d a r es i m i l a r in s t r u c t u r e t o th e e q u a t i o n t h a t g e n e r a t e d t h e r e s u l ts i n T a b l e V I .T h e m a i n e f f e c t s o f a l l c h r o n i c a n d a c u t e s t r e ss e s , p l u s c o n t r o l s , w e r e i n -c l u d e d a s p r e d i c t o r s a l o n g w i t h e i g h t i n t e r a c t i o n t e r m s : f o u r i n v o l v i n g t h ej o i n t e f f e c t s o f c h r o n i c m a r i t a l c o n f l i c t s a n d a c u t e s t r e ss e s in e a c h o f t h eo t h e r f o u r d o m a i n s , a n d f o u r i n v o l v i n g t h e j o i n t e f f e c t s o f c h r o n i c i n t e r p e r -s o n a l c o n f l i c t s w i t h o t h e r f a m i l y a n d / o r w o r k c o l l e a g u e s a n d a c u t e s t re s se si n t h e o t h e r f o u r d o m a i n s . A s s h o w n i n T a b l e V I I , t h e m a r g i n a l e f f e c t s o fc h r o n i c m a r i t a l a n d i n t e r p e r s o n a l c o n f l i c t a r e g e n e r a l l y s t r o n g e r t h a n t h e e f -f e c t s o f t h e a c u t e s t r e s s e s , c o n s i s t e n t w i t h t h e a g g r e g a t e r e s u l t s . I n s p e c t i o no f i n t e r a c t i o n t e r m s s h o w s t h a t h a l f a r e p o s i t i v e a n d h a l f a r e n e g a t i v e . O n l y


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2 o f 1 6 (8 i n t e r a c t i o n s s e p a r a t e l y f o r m e n a n d w o m e n ) a r e s i g n i f i c a n t a t p< .0 5 a n d b o t h o f t h e s e a r e n e g a t i v e .

T h e t w o s i g n if i ca n t in t e r a c ti o n s o c c u r in d e p e n d e n t l y f o r t h e s a m e p a i ro f s tr es se s in th e s u b s a m p l e s o f m e n a n d w o m e n . T h e d e a t h o f a l o v e d o n e ,i n b o t h t h e s e s a m p l e s , h a s a s i g n i f i c a n t ly le ss p o w e r f u l e f f e c t o n d e p r e s s i o na m o n g r e s p o n d e n t s w h o r e p o r t p r e v i o u s l y e x is ti n g in t e r p e r s o n a l c o n f l ic t s i nt h e i r s o c ia l n e t w o r k s ; b = - . 6 5 3 , t ( 81 3 ) = - 2 . 1 , p < .0 5 , a m o n g m e n ,b = - . 6 5 5 , t (9 3 3 ) = - 2 . 2 , p < . 0 5 , a m o n g w o m e n . I t s h o u l d b e n o t e d ,t h o u g h , t h a t w h e n a d j u s t e d f o r s i m u l t a n e o u s s i g n if ic a n c e, n e i t h e r e f f e c t r e-m a i n s s i g n i f i c a n t ( t < 2 . 5 ) . A p l a u s i b l e a f t e r - t h e - f a c t i n t e r p r e t a t i o n o f t h i sp a t t e r n , a s s u m i n g i t i s r e a l , i s t h a t n e t w o r k l o s s e s a r e le s s d i s t r e s s in g t o p e o -p l e w h o a r e n o t c l o s e t o t h e i r n e t w o r k s t h a n t o p e o p l e w h o a r e c lo s e ly i n-v o l v e d i n th e i r n e t w o r k s . T h e r e is s o m e p r e v i o u s e v i d en c e a b o u t t h e e f f e ct so f n e t w o r k e v e n t s c o n s i s t e n t w i t h t h i s i n t e r p r e t a t i o n ( K e s s l e r & M c L e o d ,1984) .

Patterns Involving Chronic Physical IllnessA c c o r d i n g t o B . P . D o h r e n w e n d ( 1 97 9 ), p h y s i c a l d i s a b i li t y is a co n s i s-

t e n t f e a t u r e i n t h e k i n d s o f s e v e r e c h r o n i c s t re s s t h a t c r e a t e e m o t i o n a l b r e a k -d o w n i n v i rt u a ll y a ll w h o a r e e x p o s e d t o i t. D o h r e n w e n d c o n t e n d s t h a t c h r o n i cp h y s i c a l d i s a b i li t y is p a r t o f a m u l t i p l e s t re s s s y n d r o m e a s s o c i a t e d w i t h p a r -t i c u la r l y s tr o n g v u l n e r a b i l t y t o a c u t e s tr es s. T h e r e f o r e , w e h y p o t h e s i z e d t h a tc h r o n i c p h y s i c a l i ll n es s w o u l d e x a c e r b a t e th e i m p a c t o f a c u t e s tr e ss o n d e p r e s -s i o n i n o u r s a m p l e .

R e s u lt s o f t h e m o d e l t h a t e v a l u a t e d t h is h y p o t h e s i s a r e r e p o r t e d i n T a -b l e V I II . A n e x a m i n a t i o n o f t h e m a r g i n a l e f f e c t s s h o w s t h a t t h e e f f e c t o fc h r o n i c p h y s i c a l i ll ne s s in t h e a b s e n c e o f a n a c u t e s t re s s is n o t c o n s i s t e n t l ys t r o n g e r t h a n t h e i n d e p e n d e n t a c u t e s tr e ss e f fe c t s . I n d e e d , i n t h e a b s e n c e o fa n a c u t e s t r es s , c h r o n i c p h y s i c a l il ln e s s d o e s n o t h a v e a s i g n i f i c an t e m o t i o n -a l e f f e c t . A c u t e s t r e ss i n t h e f o r m o f m a r i t a l c o n f l i c t a n d d e a t h o f a l o v e do n e f o r w o m e n h a v e i n d e p e n d e n t e f f e c t s o n d e p r e s s i o n , c o n s i s te n t w i t h t h ea d d i t i v e m o d e l p r e s e n t e d i n T a b l e I V .

I n s p e c t i o n o f t h e i n t e r a c t i o n t e r m s s h o w s t h a t 7 o u t o f 1 0 a r e p o s i t i v e ,c o n s i s te n t w i t h o u r h y p o t h e s i s . O n e o f t h e se p o s i ti v e i n t e r a c ti o n s ( a m o n gm e n ) i s s i g n i f i c a n t a t p < . 0 5 : t h e i n t e r a c t i v e e f f e c t o f c h r o n i c p h y s i c a l il l-n e s s a n d t h e d e a t h o f a l o v e d o n e , b = . 7 7 0 , t (8 1 3 ) = 2 . 5 , p < . 05 . O n eo t h e r i n t e r a c t i o n , a l s o a m o n g m e n , i s m a r g i n a l l y s i g n if i ca n t : c h r o n i c p h y s i -c a l i l lne s s a n d a c u te i n t e r pe r so na l c on f l i c t , b = . 777 , t ( 813 ) = 1 .6 , p < . 10.W h e n a d j u s t e d f o r s i m u l t a n e o u s s i g n i fi c a n c e , n e i t h e r e f f e c t is s t a ti s ti c a ll ys i g n i f i c a n t ( t < 2 . 5 ); h o w e v e r , t h e o b s e r v e d p a t t e r n o f s l o p es is c o n s i s t e n t l y


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Ch ron ic an d Acu te S tres s 697

Table VIII. Estimated Unstandardized Regression of the Joint Effectsof Chronic Physical Illness and Acute Stresses Predicting Depressive

Symptoms for Men and Women~Men Women

(n = 819) (n = 936)Type of stress b t b tChronic physical illness .159 1.2 .257 1.9

Acute financial difficulty .050 0.4 -. 03 5 - 0 .3Acute marit al conflic t .557 3.5 b .709 5.2 bAcut e int erpersona l conflic t .075 0.6 .192 1.6Acut e death of a loved one .052 0.4 .310 2.7 b

Chronic physical illnessx Financ ial difficu lty .143 0.4 .086 0.2x Marital conflict .910 1.3 -. 61 2 - 0 . 8x Int erp ersonal conflic t .777 1.6 .414 1.2x Dea th of a loved one .770 2.5 b .127 0.4

~Adjusted R 2 = .084 for men an d .061 for wo membp < .05, two-ta iled.

i n t h e p r e d i c te d d i r e c t i o n a n d s u b s t a n t i a l i n m a g n i t u d e , p a r t i c u la r l y a m o n gm e n . T h u s , w e h a v e s o m e r e a s o n t o b e li e ve t h a t t h e s e e f f ec t s a r e m e a n i n g f u lo n e s .

I t is n o t e w o r t h y t h a t b o t h o f t h e s e e f f e c t s ( i .e . , c h r o n i c p h y s i c a l il ln e ssw i t h d e a t h o f a l o v e d o n e , a n d c h r o n i c p h y s i c a l i ll n es s w i t h i n t e r p e r s o n a lc o n f l i c t ) h a v e a n i n t e r p e r s o n a l c o m p o n e n t . T h i s s u g g es t s t h a t t h e s tr e ss -e x a c e r b a t i n g e f f e c t s o f c h r o n i c i ll n es s m a y b e i m p l i c a t e d i n i n t e r p e r s o n a l l o ssi n s o m e w a y , p e r h a p s b e c a u s e c h r o n i c i ll n es s cr e a t e s p r o b l e m s o f s o ci a l i so -l a t io n t h a t m a g n i f y t h e i m p o r t a n c e o f t h e se ty p e s o f e v e n t s. T h e p e r p l e x in ga s p e c t o f th i s , t h o u g h , is t h a t t h e i n t e r a c t i o n s e x is t f o r m e n r a t h e r t h a n w o m -e n . W e g e n e r a ll y fi n d t h a t i n t e r p e r s o n a l is su e s a r e m o r e i m p o r t a n t f o r w o m -e n 's a d j u s t m e n t t h a n f o r m e n ' s ( e .g . , K e s s le r & M c L e o d , 1 98 4) .U n f o r t u n a t e l y , w e d o n o t h a v e e n o u g h d e ta i l ed i n f o r m a t i o n t o c l a r if y w h yt h is e f f e c t is c o n f i n e d t o m a l e r e s p o n d e n t s .

Patterns Involving Chronic Financial DifficultyT h e r e m a i n i n g i n t e r a c ti o n s c o n s i d e r e d h e r e i n v o lv e o n g o i n g f i n an c i a l

d i f f i c u l t y . O n a s u p e r f i c i a l l e v e l , o n e c o u l d a r g u e t h a t a c h r o n i c s t r e s s o ft h i s s o r t w o u l d m a g n i f y t h e e f f e c t s o f a c u t e s t r e s s o n d e p r e s s i o n . C e r t a i n l yt h i s is c o n s i s t e n t w i t h g e n e r a l t h i n k i n g t h a t m o n e y is a f le x i b l e a n d b r o a d l yu s e f u l c o p i n g r e s o u r c e ( H o r w i t z , 1 98 4) a s w e ll a s w i t h e v i d e n c e t h a t l o w e rs o c i o e c o n o m i c s ta t u s i s a s s o c i a t e d w i t h h i g h v u l n e r a b i l i t y to t h e e f f e c t s o fs t r e s s f u l l i f e e v e n t s ( K e s s l e r & C l e a r y , 1 9 8 0 ) .


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H o w e v e r , a d e e p e r a n a l y s i s s u gg e s ts t h a t f i n a n c i a l d i f f i c u l t y i s n o t i n -v o l v e d i n m o d i f y i n g t h e e f f e c t s o f o t h e r s t r es s f u l l if e e x p e r i e n c e s . F ir s t , d i s -a g g r e g a te d a n a l y s e s o f t h e r e l a t io n s h i p b e t w e e n s o c i o e c o n o m i c st a tu s a n dd e p r es s io n s h o w t h a t e d u c a t i o n is m u c h m o r e i m p o r t a n t t h a n i n c o m e ( K es s-l e r, 1 9 82 ). T h i s is a l s o tr u e i n a n a l y s e s t h a t d i s a g g r e g a t e t h e c o m p o n e n t o fs o c i a l c l as s t h a t i s a s s o c i a t e d w i t h s t re s s r e a c t i v i t y ( M c L e o d & K e s s l e r , 1 9 9 0) .S e c o n d , f o c u s e d a n a l y s es o f p e o p l e e x p o s e d t o c h r o n i c f i n a n c i al d i f f ic u l t yd u e t o j o b l os s s h o w t h a t f i n a n c ia l d i f f ic u l t y d o e s n o t m o d i f y t h e e f f e c ts o fo t h e r s t r e s s e s o n m o o d ( K e s s l e r , T u r n e r , & H o u s e , 1 9 8 9 ) . B a s e d o n t h e s ep r i o r a n a l y se s , w e h y p o t h e s i z e d t h a t t h e r e w o u l d n o t b e a s i g n if ic a n t m a g -n i f y i n g e f f e c t o f c h r o n i c f i n a n c i a l s tr e ss o n t h e r e l a t i o n s h i p b e t w e e n a c u t es t r e s s a n d d e p r e s s i o n .

R e s u lt s o f t h e a n a l y s es a r e r e p o r t e d i n T a b l e I X . C o n s i s t e n t w i t h p a t -t e r n s o b s e r v e d e a r l i e r, t h e m a r g i n a l e f f e c t o f c h r o n i c f i n a n c i a l d i f f i c u l t y iss t r o n g e r t h a n t h e e f f e c t s o f th e a c u t e s t re s se s , w i t h t h e e x c e p t i o n o f a c u t em a r i ta l c o n f l i c t, f o r b o t h m e n a n d w o m e n . M o r e o v e r , a ll a c u t e st re ss es b u to n e , p h y s i c a l i ll n e ss , h a v e s i g n i f i c a n t e f f e c t s in t h e a b s e n c e o f c h r o n i c s tr e ss .

A n e x a m i n a t i o n o f t h e i n t e ra c t i o n e f f e ct s s h o w s t h a t t h e r e a r e n om e a n i n g f u l p o s i ti v e i n te r a c t io n s b e t w e e n c h r o n i c f i n a n c i a l s tr es s a n d o t h e rk i n d s o f s tr e ss . I n d e e d , f i v e o f t h e e i g h t i n t e r a c t i o n s i n t h e t a b l e a r e n e g a -t iv e , as is t h e o n l y s i g n if i ca n t in t e r a c ti o n . A m o n g w o m e n , t h e d e a t h o f al o v e d o n e h a s a s i g n i f i c a n tl y le ss p o w e r f u l e m o t i o n a l e f f e c t i f it o c c u r s i nt h e c o n t e x t o f p r i o r f i n a n c i a l d i f f i c u l t y , b = - . 9 5 5 , t (9 3 3 ) = - 2 .0 , p. 0 5 . T h i s i n t e r a c t i o n i s a l s o n e g a t i v e a n d c o m p a r a b l e i n m a g n i t u d e a m o n gm e n , b = - . 8 4 8 , t (8 1 3 ) = - 1 . 5, p = n s . B u t w h e n w e e v a l u a t e t h e s ig -n i f ic a n c e o f t h e c o e f f i c ie n t u s in g a n a d j u s t m e n t f o r s i m u l t a n e o u s t es ts , t h ee f f e c t a m o n g w o m e n i s n o l o n g e r s t a t is t i ca l ly s i g n i fi c a n t .

A l t h o u g h w e d i d n o t h y p o t h e s i z e t h e e x i s te n c e o f a s i g n if i ca n t n e g a t iv ei n t e r a c t i o n , a n d d o n o t h a v e a p r i o r i i n t e r p r e t a t i o n s o f i t , i t s e e m s p o s s i b l et h a t t h e i n t e r a c t io n is a m e a n i n g f u l o n e b e c a u s e it a p p e a r s a m o n g b o t h m e na n d w o m e n . O n e i n t e r p r e t a t i o n is t h a t a d e a t h t h a t o c c u r s i n t h e c o n t e x t o fa c h r o n i c f i n a n c i a l s t r es s a l le v i at e s d e p r e s s i o n t h r o u g h i ts r e l i e f o f m e d i c a le x p e n s es . W e e x a m i n e d t h e v a l i d i ty o f th i s i n t e r p r e t a t io n b y u s i n g i n f o r m a -t i o n o n s tr es s r e s o l u t i o n t o c o m p a r e t h e n u m b e r o f re s p o n d e n t s w h o h a v er e s o lv e d a c h r o n i c f i n a n c i a l d i ff i c u l t y a s a f u n c t i o n o f w h e t h e r o r n o t t h e ye x p e r i e n c e d a d e a t h . F o r o u r i n t e r p r e t a t i o n t o b e v a l id w e w o u l d e x p e c t f i n a n -c i a l s t r e s s r e s o l u t i o n t o b e a s s o c i a t e d w i t h a d e a t h . T h i s h y p o t h e s i s i s n o ts u p p o r t e d t h o u g h , a s r e s p o n d e n t s w h o r e p o r t a d e a t h d o n o t d i f f e r i n t h e f re -q u e n c y w i t h w h i c h t h e y h a v e r e s o l v e d a c h r o n i c f i n a n c i a l d i f f i c u l t y .

A n o t h e r p o s t h o c i n t e r p r e t a t i o n o f t h e n e g a t iv e i n t e r a c ti o n b e t w e e nc h r o n i c f i n a n c i a l d i f f i c u l t y a n d d e a t h i s p o s s i b l e. A l o v e d o n e ' s d e a t h c a ng i v e r is e t o a r e a s s e s s m e n t o f th e m e a n i n g a n d p u r p o s e o f l i fe (B r o w n & H a r -


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C h r o n i c a n d A c u t e S t r es s

Table IX. Estimated Unstandardized Regression of the Joint Effectsof Chronic FinancialDifficultyand Acute Stresses PredictingDepressiveSymptoms for Men and Women"Men Women

(n = 819) (n = 936)Type of stress b t b tChronic financial difficulty .400 2.6b .479 2.9bAcute physical illness .174 1.4 .177 1.4Acute marital conflict .616 3.9b .687 4.8 bAcute interpersonal conflict .122 0.9 .242 2.1 bAcute death of a loved one .235 2.1 b .381 3.4 bChronic financial difficultyx Physical illness -.320 -0. 3 - 1.01 - 1.6x Marital conflict -.243 -0. 3 .007 0.0x Interpersonal conflict .021 0.0 .277 0.4x Death of a loved one -.848 - 1.5 -.955 -2.0 b"Adjusted R 2 = .072 for men and .067 for women.bp < .05, two-tailed.

6 9 9

ris, 1978; Silver & Wor tm an , 1980). I n this light, a f inanc ial difficulty ma ybe reappraised as less imp ort ant and threatening. Unfor tuna tel y , we do nothave data to examine the validity of this inter pret atio n.

DISCUSSIONOur analysis document s two ma in results that war rant further d iscus-

sion. First, we docum en t that c hronic stress more power fully predicts depres-sive symptoms than acute stress. Disaggregation shows that this is true notonly on average but also for most m aj or stress domains. Second, we findthere is a general pat ter n of negative intera ctions between chronic an d acutestress in predicting depression. This implies that the depression created byacute stress is, in general, less pr ono unc ed a mon g people who have preexist-ing chronic difficulties than among those without such difficulties. Disag-greagated analyses docum ent some dif ferentiat ion of th is modifying effectacross stress domains.

The Effects of Chronic and Acute StressThe first of these two findings suggests that the near-exclusive empha -sis of stress research on life events has been misplaced. Chronic stresses ap-

pear to be more important predictors of depression, as measured in the


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700 M cGon ag le and Kessl er

H o p k i n s S y m p t o m C h e c k l is t , t h a n a c u t e s tr es se s. T h i s is tr u e n o t o n l y int e r m s o f v a r i a n c e e x p l ai n e d b u t a ls o i n te r m s o f u n s t a n d a r d i z e d r e g re s s io nc o e f f i c i e n t s , w h i c h m e a n s t h a t t h e s t r u c t u r a l e f f e c t s o f c h r o n i c s t r e s s e s a r el a r g e r t h a n t h o s e o f a c u t e s tr es s es . T h i s is a n i m p o r t a n t p o i n t b e c a u s e it s p ea k st o t h e o b s e r v a t i o n o f D e p u e a n d M o n r o e ( 19 8 6) t h a t t h e v a r i a n c e in d e p re s -s i o n s c re e n i n g sc a le s m a y b e m o r e s u b s t a n t i a l ly d u e t o c h r o n i c m i n o r d e p r e s -s i o n t h a n t o e p i s o d i c m a j o r d e p r e s s i o n . I f th i s o b s e r v a t i o n is c o r r e c t , it s h o u l dn o t b e s u r p r i s i n g t h a t c h r o n i c s t r e s s e s e x p l a i n m o r e variance i n d e p r e s s i o nt h a n d o a c u t e s tr es se s. T h i s o b s e r v a t i o n c a n n o t p r o v i d e as o b v i o u s a n e x p la -n a t i o n , h o w e v e r , f o r t h e f a c t th a t t h e s t r u c t u r a l e ff e c ts o f c h r o n i c s t r e s s e s - t h ea m o u n t o f c h a n g e i n a n i n d i v id u a l 's d e p r e s s io n s c o r e a s so c i a te d w i th t h e o c -c u r r e n c e o f t h e se s t r e s s e s - a r e s o m u c h l a rg e r t h a n t h e s t r u c t u r a l e f f ec t s o fa c u t e s t r e s s e s .

A t l e as t tw o s u b s t a n t i v e i n t e r p r e t a t i o n s e x i s t f o r t h e g r e a t e r s t r u c t u r a le f f e c t s o f c h r o n i c s t r e s s e s . O n e s t a n d s o n i t s h e a d t h e c o n v e n t i o n a l n o t i o nt h a t change is a n i m p o r t a n t d i m e n s i o n o f s t re s s (e . g ., R a h e , 1 9 69 ) a n d a r -g u e s , i n s t e a d , t h a t p r o b l e m a t i c s i t u a t i o n s a r e m o s t s t r e s s f u l w h e n t h e y a r epersistent. T h i s i n t e r p r e t a t i o n i s c o n s i s t e n t w i t h B r o w n a n d H a r r i s ' s ( 1 9 7 8 )w o r k o n c o n t e x t u a l m o d e l s o f s t r e s s e f f e c t s , w h i c h s h o w e d t h a t l o n g - t e r mt h r e a t is t h e c o r e d i m e n s i o n o f s t re s s a s s o c i a te d w i t h t h e o n s e t o f m a j o rd e p r e s s i o n . I t is a ls o c o n s i s t e n t w i t h s e v e r a l t h e o r e t i c a l p e r s p e c t i v e s o n t h es t re s s p r o c e s s. I f a st re s s h a s b e e n o n g o i n g f o r a l o n g t i m e , c o p i n g e f f o r t sh a v e a l m o s t c e r t a i n l y b e e n u n s u c c e s s f u l a n d t h i s i s l i k e ly t o l e a d t o a n a p -p r a i s a l o f t h e s t re s s a s m o r e t h r e a t e n i n g ( L a z a r u s & F o l k m a n , 1 98 4 ) a s w e l la s t o a n a t t r i b u t i o n o f th e c a u s e as m o r e s ta b l e ( A b r a m s o n , S e l ig m a n , &T e a s d a l e , 1 97 8) a n d u n c o n t r o l l a b l e ( T h o i t s , 1 9 83 ), al l o f w h i c h a r e t h o u g h tt o i n c r e a s e t h e d e p r e s s i o n a s s o c i a t e d w i t h s t re s s. F u t u r e r e s e a r c h o n c h r o n i ca n d a c u t e s t re s s e f f e c t s c o u l d e v a l u a t e t h is i n t e r p r e t a t i o n b y o b t a i n i n g i n f o r -m a t i o n o n c o p i n g , a p p r a i s a l , a n d a t t r ib u t i o n s a s s o c i at e d w i t h st re ss es o f b o t ht y p e s .

A s e c o n d l i n e o f i n t e r p r e t a t i o n i s a l s o p l a u s i b l e . I n o u r d a t a a s w e l la s i n t h o s e o f o t h e r i n v e s t i g a t o r s ( A v i s o n & T u r n e r , 1 9 8 8 ) , s e v e r e s t r e s s e st h a t b e g a n d u r i n g t h e 12 m o n t h s p r i o r t o t h e i n te r v ie w a r e m u c h m o r e l i ke lyt o b e r e s o l v e d a t t h e t i m e o f t h e i n t e r v i e w t h a n s t r e s s e s t h a t b e g a n e a r l i e r .T h e g r e a t e r i m p a c t o f c h r o n i c st re s s t h a n a c u t e s tr es s o n d e p r e s s iv e s y m p t o m s ,t h e n , m i g h t a c t u a l l y r e f le c t a g r e a t e r i m p a c t o f o n g o i n g s t re s s t h a n r e s o l v e ds t r e s s .B o t h l in e s o f i n t e r p r e t a t i o n s u g g es t t h a t p e r s is t en c e o f s t r e s s - f a i l u r et o r e s o l v e s t r e s s - p l a y s s o m e p a r t i n e x p l a in i n g th e s t r o n g e r a s s o c i a t io n w i t hd e p r e s s i o n o f c h r o n i c st re s s t h a n a c u t e s t re s s. B o t h i n t e r p r e t a t i o n s h a v e t h ep o t e n t i a l t o b e c o n f o u n d e d w i t h s e l e c ti o n e f f ec t s , w h e r e b y d e p r e s s io n i n t e r-f e re s w i t h t h e a b i l i t y t o r e s o l v e st re s s. P r i o r r e s e a r c h h a s d o c u m e n t e d t h a t


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t h is s o r t o f s e l e c t io n c a n p o w e r f u l l y a f f e c t c o n c l u s i o n s a b o u t t h e r e l a ti v e i m -p a c t o f o n g o i n g v e r s u s r e s o l v e d s tr es s o n m o o d ( K e s sl e r e t a l ., 1 9 89 ). P a n e ld a t a a r e r e q u i r e d t o a d d r e s s t h i s p r o b l e m . S e l e c t i o n is d i s c u s se d i n m o r e d e -t a il a t t h e e n d o f t h e p a p e r i n a r e v ie w o f l i m i t a t io n s o f t h e a n a l y s i s.

I n t e r a c t i v e S t r e s s E f f e c t sA s n o t e d a b o v e , B r o w n a n d H a r r i s ( 1 9 78 ) a r g u e d t h a t c h r o n i c d if f ic u l -

t ie s c a n e x a c e r b a t e t h e e f f e c t s o f l if e e v e n t s o n c l i n i c a l d e p r e s s i o n . I f a si m i -l a r p r o c e s s i s a l s o o p e r a t i v e f o r t h e k i n d o f d e p r e s s i v e s y m p t o m s w e s t u d yh e r e , w e w o u l d e x p e c t t o f i n d p e r v a s i v e e v i d e n c e o f p o s i t i v e i n t e r a c t i o n s b e -t w e e n c h r o n i c a n d a c u t e s tr es s es . Y e t w e f i n d n o s u c h e v i d e n c e . I n d e e d , a g -g r e g at e a n al y s es d o c u m e n t a s ig n i f ic a n t n e g a t iv e i n t e r a c ti o n a m o n g w o m e na n d a n o n s i g n i f i c a n t , b u t s u b s t a n t i v e l y s i m i l ar , i n t e r a c t i o n a m o n g m e n . D i s-a g g r e g a te d a n a l y s e s d o c u m e n t t h a t 7 o f 1 0 w i t h i n - d o m a i n i n t e r a c t io n s a r en e g a t i v e a n d o f t e n l a r g e r t h a n t h e i r a s s o c i a t e d m a i n e f f e c t s .

I t is n o t e w o r t h y t h a t t h e m a g n i t u d e s o f t h e i n t e r a c t io n s a r e a s la r g ea s t h o s e t y p i c a l l y f o u n d i n s tu d i e s o f s o c ia l s u p p o r t a n d o t h e r w i d e l y s t u d i e ds t r e s s b u f f e r s ( S . C o h e n & W i l l i s , 1 9 8 5 ) . T h i s m e a n s t h a t c h r o n i c s t r e s s e sa r e a s p o t e n t a s t h e m o d i f i e r s t h a t h a v e b e e n t h e f o c u s o f c o n s i d e r a b l e i n -t e r e s t a m o n g s t re s s re s e a r c h e r s o v e r t h e p a s t d e c a d e . Y e t , w i t h a f e w e x c e p -t i o n s ( e .g . , C a s p i , B o l g e r , & E c k e n r o d e , 1 9 87 ; W h e a t o n , 1 9 90 ), t h es t r e s s - b u f f e r in g e f f e c t s o f c h r o n i c s t r es s h a v e n o t b e e n e x p l o r e d .

A t l e a s t t h r e e i n t e r p r e t a t i o n s o f t h e g e n e r a l l y n e g a t i v e m o d i f y i n g e f -f e c ts f o u n d i n o u r a n a l y s e s a re c o n s i s t e n t w i t h t h e d a t a . O n e i s t h a t a d v e r s i -t y f a c i l i t a t e s t h e d e v e l o p m e n t o f c o p i n g r e s o u r c e s w h i c h a r e a s s o c i a t e d w i t hr e si l ie n c e t o s u b s e q u e n t s tr e ss . E l d e r ( 1 9 7 4) d o c u m e n t e d a p r o c e s s o f th i ss o r t w h e n h e s h o w e d t h a t p e o p l e w h o w e r e e x p o s e d t o t h e h a r d s h i p s o f th eG r e a t D e p r e s s i o n a s c h i l d r e n d e v e l o p e d a g e n e r a l i ze d s e n se o f p e r s o n a l c o m -p e t e n c e w h i c h e n h a n c e d t h e i r c o p i n g e f f i c a c y l a t e r in l if e .A s e c o n d p o s s i b i l i ty is t h a t e n m e s h m e n t i n a n o n g o i n g s t r es s f u l si tu a -t i o n a t t h e t im e a s u b s e q u e n t a c u t e s tr es s o c c u r s l ea d s t o m o r e r a p i d m o b i l i -z a t i o n o f c o p i n g r e s o u r c e s t h a n w o u l d o c c u r in t h e a b s en c e o f a p r i o r o n g o i n gs t re s s. S o m e d i s c u s s io n o f t h i s p o s s i b il i ty c a n b e f o u n d i n t h e l it e r a t u r e o na n t i c i p a t i o n a s a d e t e r m i n a n t o f l if e e v e n t e f f e c t s ( T h o i t s , 1 9 83 ). A s i m i l a rt h e m e c a n b e f o u n d i n t h e o r e t i c a l d i sc u s s io n s o f m u l t ip l e r o l e st re s se s, w h i c ha r g u e t h a t e x p o s u r e t o s t r e s s i n o n e d o m a i n c a n p r o m o t e c o p i n g v i g i l a n c ei n a n o t h e r d o m a i n ( M a r k s , 1 97 7; T h o i t s , 1 9 86 ). T h i s m o b i l i z a t i o n c o u l d i n -v o l v e c h a n g e s i n o b j e c t i v e r e s o u r c e s f o r m a n a g i n g s tr e ss , c h a n g e s i n c o g n i -t i o n s ( e .g . , h a b i t u a t i o n , d e v a l u a t i o n ) , o r c h a n g e s in c o p i n g s tr a te g i e s ( P e a r l i n& S c h o o l e r , 1 9 7 8 ) . P e a r l i n e t a l . ( 1 9 8 1 ) p r o v i d e d a n e x a m p l e o f o n e s u c h


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process when they showed that chronic financial difficuky leads to the devalu-ation of monetary success and that this cognition, in turn, attenuates theassociation between acute financial stress and depression. In this fashion,the prior existence of a chronic difficulty.can help facilitate a more benignappraisal of the subsequent acute stress and, in turn, reduce its emotionaleffect.A third possibility has been suggested by Wheaton (1990), who arguedthat some acute life stresses may actually lead to the resolution of morechronic difficulties. An example is the resolution of ongoing marital difficulty(a chronic stress) by divorce (an acute stress). Indeed, both Wheaton (1990)and Aseltine and Kessler (1990) have presented panel data documenting tha tdivorce is actually associated with a reduction in distress among respondentswho previously reported seriously troubled marriages. Wheaton's analysis,furthermore, suggests that this kind of stress-reversal process may be a per-vasive feature of many interpersonal stress situations.An evaluation of these various possibilities requires more fine-grainedmeasures and, in the ideal case, more dynamic data than we have here. Allof the possibilities are plausible and consistent with the data. They differ,however, in their implications for theory and intervention. Given the scantattention paid to chronic stress in prior research and the even smaller em-phasis on the possibility that chronic stress can modify the effects of acutestress, there is virtually no empirical basis for adjudicating among the differentinterpretations.

Limitations of the StudyThis study has several significant limitations. The first is tha t the anal-

ysis is based on cross-sectional rather than longitudinal data. This makes itimpossible to resolve the important issue of how much depression is an an-tecedent and how much a consequence of the stresses under consideration.This is a particularly important limitation for the comparative analysis ofchronic and acute stress effects, because a plausible case could be made thatselection effects are stronger for chronic than acute stresses. Differential selec-tion could explain why the results reported here show the association betweenchronic stress and depressive symptoms to be stronger than the associationbetween acute stress and depressive symptoms. It is more difficult to con-struct a post hoc interpretation of how selection could explain the negativeinteraction between chronic and acute stress.Previous cross-sectional analyses of life events and depression have beenable to provide some evidence on the selection issue by categorizing eventsalong the dimension of independence from or dependence on prior mentalhealth (e.g., see Brown & Harris, 1989). Our comparative analysis of chronic


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a n d a c u t e s t re s s e f f e c t s is li m i t e d b y t h e f a c t t h a t n o s u c h c a t e g o r i z a t i o n isp o s s i b l e f o r t h e c h r o n i c s t r e ss e s w e c o n s i d e r b e c a u s e t h e c h r o n i c i t y o f v i r t u -a l ly a ll o f t h e m c o u l d b e a f f e c t e d b y p r i o r m e n t a l h e a l th , e v e n i f t h e e v e n t st h a t p r e c i p i ta t e d t h e m w e r e e n ti r e ly i n d e p e n d e n t . T h i s p r o b l e m h a s h a m p e r e de f f o r t s t o i n v e s t i g a t e c h r o n i c s t r e s s e f f e c t s w i t h t h e s a m e r i g o r a s t h a t a p -p l i e d t o r e s e a r c h o n l i fe e v e n t s . A c h a l l e n g e f o r f

Chronic and Acute Stress

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