In the Shadow of Adversity: the Evolution and Resolution of Anxiety and Depressive Disorder

BACKGROUND: It was proposed to explore the longitudinal relationship between adverse experience and mental health; in particular, whether particular adverse experiences influence the form of subsequent expression of morbidity. METHOD: Three groups of women were selected: 64 whose marital partner had recently died, 143 whose husbands had recently experienced a myocardial infarction and a third group of 32 women who had sought protection in a Women's Aid refuge. An initial interview assessed psychiatric status according to the RDC for the six months before the event and up to the time of interview, and a second interview was completed four months after the event had occurred. The course was assessed using the Longitudinal Interval Follow-up Evaluation. RESULTS: For the coronary group, the prevalence of psychiatric disorder doubled following the experience of the event, and was most pronounced for anxiety disorder. For the bereaved, rates increased over eight times for major depressive disorder and more than twice for anxiety disorder, following the loss; for the refuge group, prevalence rates were lower after entering the refuge than those before. Analyses that took account of the timing of the onset of disorders showed that in almost half of those experienced by the coronary group, and about 40% of the bereaved group, onset pre-dated the timing of the event. CONCLUSIONS: The results further advance knowledge of the evolution and form of psychiatric conditions following the experience of severe adversity.