Gender moderates the relationship between stressful life events and psychopathology: Findings from a national study

Highlights

• As compared to men, women report significantly more stressful events.

• Increasing severity of stressful life events is associated with psychopathology.

• The associations are stronger in women than in men.

Abstract

Background

While data suggest a strong relationship between trauma exposure and psychopathology, less research has investigated relationships between psychopathology and stressful life events more broadly, and how these relationships may differ by gender.

Aim

To examine strengths of associations between stressful life events and psychiatric disorders (i.e., past-year Axis I and lifetime Axis II, per DSM-IV) and how they may differ by gender.

Methods

Data from Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC; n = 43,093) were analyzed using chi-square tests and multinomial logistic regression analyses. Participants were categorized according to occurrence of stressful life events (low, moderate, and high).

Results

Women as compared to men were more likely to report moderate (p < 0.0001) or high occurrence stressful life events (p < 0.0001). Increasing experiences of stressful life events were associated with increasing odds of most past-year Axis I and lifetime Axis II disorders in both gender groups, with the largest odds typically observed in association with more frequent stressful life events. Associations between stressful life events and multiple psychiatric disorders were stronger in women compared to men.

Conclusions

Stressful life events are associated with multiple Axis I and Axis II psychiatric disorders in both men and women. This relationship is moderated by gender. Screening female patients who endorse significant stressors for mood, anxiety, and substance-use problems might be particularly important. The stronger associations in women between stressful life events and personality disorders in particular warrant further investigation.

Introduction

Data suggest strong relationships between trauma exposure and psychopathologies (e.g., Hasin and Grant, 2015; Kucharska, 2017a, 2017b; Overstreet et al., 2017; Reardon et al., 2014). Past trauma is associated with mood, anxiety, substance-use, and personality disorders (Galea et al., 2002; Koss et al., 2003; Reardon et al., 2014). A cumulative effect of traumatic experiences may exist such that more frequent experiences of trauma and victimization in the course of one's lifetime may be associated with greater mental health concerns (Hodges et al., 2013; Kira et al., 2014; Kucharska, 2017a; Palm et al., 2016). The relationships between stressful life events and psychopathology more broadly among the general adult population – irrespective of trauma or trauma-related conditions – are arguably less well understood. Some researchers have begun to evaluate the lasting and potentially serious impact that stressful life events, or significant experiences in one's life that involve sudden and lasting change, may produce (Buccheri, Musaad, Bost, Fiese, & the STRONG Kids Research Team, 2017). However, further research is needed to better understand how the occurrence of stressful life events may relate to the prevalence of psychiatric disorders in community samples.

Gender-related differences in stress experiences and severity, as well as in the associations between traumas and psychopathologies, have been reported (Tolin and Foa, 2006). For example, differences in what is considered to be stressful by women and men have been identified (Chaplin et al., 2008; Keyes et al., 2012; Matud, 2004), including differences in appraisal of trauma and rates of psychopathology (Kucharska, 2017b). Women as compared to men have been reported to experience more sadness and anxiety in response to stress (Chaplin et al., 2008). Further, the associations between trauma and psychiatric diagnoses may vary according to gender (Kucharska, 2017b), with trauma potentially leading to different psychopathologies in women and men. Whether differences in the associations between stressful life events and adult psychopathologies are moderated by gender or merely reflect gender-related differences in the distribution of psychiatric disorders in the general population is unclear.

While there is some evidence of connection between stress and psychiatric disorders (e.g., substance-use disorders (SUDs); Sinha, 2007, 2008), the extent to which stressful life events relate to psychopathologies and whether these relationships may differ between women and men is incompletely understood. The purpose of the current study is to extend previous work by examining relationships between stressful life events and psychopathologies in women and men and whether gender moderates the relationships between stressful life events and psychiatric disorders in the large, National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) sample. We utilized the NESARC database in order to investigate within-gender relationships and gender-related differences in the relationships between stressful life experiences and psychopathologies, including mood, anxiety, substance-use, and personality disorders (PDs). The specific hypotheses for this study were: (1) women, as compared with men, would report more stressful life events; (2) increases in stressful life events would be associated with more psychopathologies in both women and men; and, (3) gender would moderate the relationships between stressful life events and psychopathologies such that there would be stronger relationships between stressful life events and psychiatric disorders, particularly mood and anxiety disorders, in women as compared to men. Given the possibility that greater psychopathology may lead to more stressful life events and these relationships may differ across gender groups, we also explored relationships with lifetime PD measures.