Three-variable systems: An integrative moderation and mediation framework for developmental psychopathology

Abstract In this article, we consider an often overlooked model that combines mediation and moderation to explain how a third variable can relate to a risk factor–psychopathology relationship. We refer to it as moderation and mediation in a three-variable system. We describe how this model is relevant to studying vulnerability factors and how it may advance developmental psychopathology research. To illustrate the value of this approach, we provide several examples where this model may be applicable, such as the relationships among parental externalizing pathology, harsh parenting, and offspring psychopathology as well as between neuroticism, stressful life events, and depression. We discuss possible reasons why this model has not gained traction and attempt to clarify and dispel those concerns. We provide guidance and recommendations for when to consider this model for a given data set and point toward existing resources for testing this model that have been developed by statisticians and other methodologists. Lastly, we describe important caveats, limitations, and considerations for making this approach most useful for developmental research. Overall, our goal in presenting this information to developmental psychopathology researchers is to encourage testing moderation and mediation in a three-variable system with the aim of advancing analytic strategies for studying vulnerability factors.

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Can Experiencing Stressful Life Events Be a Risk Factor of Stroke?

Journal of Medical Sciences(Faisalabad) ◽

10.3923/jms.2009.280.283 ◽

2009 ◽

Vol 9 (6) ◽

pp. 280-283 ◽

Cited By ~ 4

Author(s):

D. Savadi-Osk ◽

H. Sadeghi-ba ◽

L. Mohammadza

Keyword(s):

Risk Factor ◽

Life Events ◽

Stressful Life Events ◽

Stressful Life

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A Genetic Variant in 12q13, a Possible Risk Factor for Bipolar Disorder, Is Associated with Depressive State, Accounting for Stressful Life Events

PLoS ONE ◽

10.1371/journal.pone.0115135 ◽

2014 ◽

Vol 9 (12) ◽

pp. e115135 ◽

Cited By ~ 7

Author(s):

Ayu Shimasaki ◽

Kenji Kondo ◽

Takeo Saito ◽

Kosei Esaki ◽

Yasuyo Otsuka ◽

...

Keyword(s):

Bipolar Disorder ◽

Risk Factor ◽

Life Events ◽

Stressful Life Events ◽

Genetic Variant ◽

Stressful Life ◽

Depressive State

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Major stressful life events and risk of developing lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.1575 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 1575-1575 ◽

Cited By ~ 2

Author(s):

Syed Hasan Raza Jafri ◽

Faisal Ali ◽

Arash Mollaeian ◽

Syed Mojiz Hasan ◽

Rahat Hussain ◽

...

Keyword(s):

Lung Cancer ◽

Risk Factor ◽

Life Events ◽

Stressful Life Events ◽

Stressful Life Event ◽

Smoking Status ◽

Stressful Life ◽

Life Event ◽

The Past ◽

History Of

1575 Background: Lung cancer is the leading cause of cancer-related mortality linked with smoking, though only 6-18% of heavy smokers die of lung cancer. We hypothesized that major stressful life events are a risk factor for developing lung cancer. Methods: In our matched case-control study, cases (CA) were lung cancer patients diagnosed within past 12 months. Controls (CO) were patients without a prior history of malignancy. CA and CO were matched for age, gender and smoking status. Smokers had at least 10 packs/years history of smoking. Data was collected using standardized research questionnaire on 11 major stressful life events using Holmes and Rahe stress scale. The primary endpoint was odds of having a major stressful life event. A sample of 360 patients (120 CA and 240 CO), was needed to achieve 80% power to detect an odds ratio (OR) of 2.00 using Chi-Square test with a P = 0.05 significance. The study was IRB approved at each institution. Results: Between May 2015 and December 2016, 324 patients were enrolled (23 were excluded due to prior cancer history or incomplete information). 301 (CA = 102; CO = 199) were included in the final analysis. The two groups were well matched in median age (CA = 64.4 years; CO = 63.9years), gender (CA-Male = 48%; CO-Male = 49.2%) and smoking status (ever smoker, CA = 86%; CO = 85%). There was no difference in lifetime stressful life event between CA and CO (95% vs 93.9% P = 0.68%). However, CA were significantly more likely to have had a major stressful life event within the past 5 years than controls (CA = 77.4% vs CO = 65.8%, P = 0.03, (OR = 1.78). Serious life-threatening illness of an immediate family member (P = 0.04) and retirement (P = 0.07) within the past 5 years were noticeably more common among CA. Holmes-Rahe stress score in the last 5 years was higher in men (86.3 vs 63.3, P = 0.07) and those > 65 years old (82.4 vs 57.2,P = 0.04) as compared with CO and in those with squamous histology than with adenocarcinoma (115.6 vs 63.4, P = 0.005). Conclusions: Patients with lung cancer (CA) were significantly more likely to have had a major stressful life event within the past 5 years than the matched controls (CO), especially in older men with squamous histology. Major stressful life events should be considered a risk factor for developing lung cancer.

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On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events

The British Journal of Psychiatry ◽

10.1192/bjp.179.5.426 ◽

2001 ◽

Vol 179 (5) ◽

pp. 426-431 ◽

Cited By ~ 65

Author(s):

Edwin De Beurs ◽

Aartjan Beekman ◽

Sandra Geerlings ◽

Dorly Deeg ◽

Richard Van Dyck ◽

...

Keyword(s):

Risk Factors ◽

Life Events ◽

Stressful Life Events ◽

Late Life ◽

Community Dwelling ◽

Self Report ◽

Stressful Life ◽

Depression And Anxiety ◽

Vulnerability Factors ◽

Risk Profiles

BackgroundLittle research has been done on the uniqueness of risk profiles for depression and anxiety in late life.AimsDelineating risk factors for the decline of mental health in older persons, comparing risk profiles for developing symptoms of pure depression, pure anxiety and both anxiety and depression in a prospective design.MethodSelf-Report data on depression and anxiety were collected from community-dwelling older respondents (⩾55 years) on two occasions, 3 years apart. Data from emotionally healthy respondents (n=1810) were used to investigate the effects of long-standing vulnerability factors and stressful life events.ResultsAfter 3 years 9% of the subjects had scored beyond the thresholds for symptoms. Vulnerability for depression and anxiety was quite similar, but life events differed: onset of depression was predicted by death of a partner or other relatives; onset of anxiety was best predicted by having a partner who developed a major illness. No support for moderator effects between vulnerability factors and stress was found; the effects were purely additive.ConclusionsDepression and anxiety have many risk factors in common, but specific risk factors also were found, especially in subjects developing both depression and anxiety.

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Gender Differences in the Interrelations Among Social Support, Stressful Life Events, and Smoking Cessation in People With Severe Mental Illnesses

Journal of the American Psychiatric Nurses Association ◽

10.1177/10783903211008248 ◽

2021 ◽

pp. 107839032110082

Author(s):

Hamzah M. Alghzawi ◽

Carla L. Storr

Keyword(s):

Social Support ◽

Gender Differences ◽

Smoking Cessation ◽

Life Events ◽

Stressful Life Events ◽

Population Sample ◽

Influential Factors ◽

Mental Illnesses ◽

Stressful Life ◽

Data Set

BACKGROUND: Social support and stressful life events (SLEs) have been found to be influential factors for smoking cessation in the general population, but little is known about these factors among smokers with severe mental illnesses (SMIs) and whether their associations with smoking cessation differ by gender. OBJECTIVE: To examine the association between social support and smoking cessation as mediated by SLEs in people with SMI and to examine whether the interrelations among social support, SLEs, and smoking cessation differ by gender. METHOD: A population sample of 4,610 American lifetime adult smokers with schizophrenia, bipolar disorder, or major depressive disorder were identified in a limited public use data set of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Four mediation and moderated mediation models were used to examine gender differences in the interrelations among social support (total and three subscales of the Interpersonal Support Evaluation List–12), SLEs (summative score of positive responses to 16 types experienced in past year and related to health, job, death, or legal situations), and smoking status in prior year. RESULTS: Total, appraisal, and tangible support among females exerted indirect effects on smoking cessation via decreasing SLE scores. Among males, only belonging support exerted an indirect effect on smoking cessation via an increased SLE score. CONCLUSIONS: Findings suggest that interventions focusing on improving social support should be a priority for those working with smokers with SMI.

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Life Events and Coping Strategies Among Young People Who Died by Suicide or Sudden Violent Death

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.670246 ◽

2021 ◽

Vol 12 ◽

Author(s):

Annelie Werbart Törnblom ◽

Kimmo Sorjonen ◽

Bo Runeson ◽

Per-Anders Rydelius

Keyword(s):

Young People ◽

Coping Strategies ◽

Life Events ◽

Stressful Life Events ◽

Stressful Life ◽

Violent Death ◽

Vulnerability Factors ◽

Childhood Experiences ◽

Adverse Childhood ◽

And Coping

Objective: Most empirically anchored psychological models of suicide focus either on the perceived situational stress or on vulnerability factors and coping deficits. The interaction between life stressors and vulnerability factors is less explored.Methods: This case-control study examines interactions between life events and coping strategies in three groups of young people: cases of suicide, cases of other sudden violent death (SVD), and control cases.Results: Four coping strategies, two more adaptive and two more maladaptive, were identified. Distinctive of the suicide and the SVD group was significantly less Planful Problem-Solving, and more Escape-Avoidance and Confrontive Coping than among the controls. Furthermore, Confrontive Coping had significantly higher level in the SVD group than in the suicide group. Between-group differences were partly accounted for differences in negative life events, early and late in life. Both target groups experienced significantly more adverse childhood experiences and recent stressful life events than the controls—the suicide group being more exposed to recent stressful life events even in comparison with the SVD group. This might indicate that adverse childhood experiences are a risk factor for both causes of death, whereas proximal stressful life events are a risk factor for death by suicide to a higher degree than for SVD.Conclusions: Improved understanding of the interplay between life events, both in the far past and present, and coping styles, may facilitate the identification of young people at risk of suicide and violent death.

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Association between stressful life events and psychotic experiences in adolescence: Evidence for gene–environment correlations

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.159079 ◽

2016 ◽

Vol 208 (6) ◽

pp. 532-538 ◽

Cited By ~ 17

Author(s):

Sania Shakoor ◽

Helena M. S. Zavos ◽

Claire M. A. Haworth ◽

Phillip McGuire ◽

Alastair G. Cardno ◽

...

Keyword(s):

Risk Factor ◽

Life Events ◽

Environmental Risk ◽

Structural Equation ◽

Stressful Life Events ◽

Model Fitting ◽

Stressful Life ◽

Environmental Risk Factor ◽

Psychotic Experiences ◽

The Relationship

BackgroundStressful life events (SLEs) are associated with psychotic experiences. SLEs might act as an environmental risk factor, but may also share a genetic propensity with psychotic experiences.AimsTo estimate the extent to which genetic and environmental factors influence the relationship between SLEs and psychotic experiences.MethodSelf- and parent reports from a community-based twin sample (4830 16-year-old pairs) were analysed using structural equation model fitting.ResultsSLEs correlated with positive psychotic experiences (r = 0.12–0.14, all P<0.001). Modest heritability was shown for psychotic experiences (25–57%) and dependent SLEs (32%). Genetic influences explained the majority of the modest covariation between dependent SLEs and paranoia and cognitive disorganisation (bivariate heritabilities 74–86%). The relationship between SLEs and hallucinations and grandiosity was explained by both genetic and common environmental effects.ConclusionsFurther to dependent SLEs being an environmental risk factor, individuals may have an underlying genetic propensity increasing their risk of dependent SLEs and positive psychotic experiences.

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Late-onset obsessive–compulsive disorder: the role of stressful life events

International Psychogeriatrics ◽

10.1017/s1041610205002735 ◽

2006 ◽

Vol 18 (2) ◽

pp. 341-344 ◽

Cited By ~ 10

Author(s):

Latha Velayudhan ◽

Anthony W. Katz

Keyword(s):

Obsessive Compulsive Disorder ◽

Life Events ◽

Stressful Life Events ◽

Late Onset ◽

Stressful Life ◽

Vulnerability Factors ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

First Time

The onset of obsessive–compulsive disorder (OCD) for the first time in old age is uncommon and has been mostly related to cerebral abnormalities. We report a case of late-onset OCD in a 77-year-old woman following stressful life events but with a normal cerebral structure. The contribution of life events and vulnerability factors on the genesis and the presentation of her illness are discussed in relation to the literature on OCD.

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