15 to 17 pages
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ImpactofstressfuleventsonthementalwellbeingofpeoplewithIDD.docxImpact of stressful events on the mental wellbeing of people with IDD
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Life events Early life stress Stress |
Lunsky, Y., & Benson, B. A. (2001). Association between perceived social support and strain, and positive and negative outcome for adults with mild intellectual disability. Journal of Intellectual Disability Research, 45(2), 106-114.
Social strain has been identified as a trigger for both depression and physical health problems, but has not been well researched in people with intellectual disability (ID). The present study contrasted the effects of social support with social strain on depressive symptoms, somatic complaints and quality of life over time in adults with mild ID. The level of social support explained a significant proportion of variance in quality of life 6 months later, but not depressive symptoms or somatic complaints. In contrast, the level of social strain accounted for a significant proportion of variance in depressive symptoms and somatic complaints 6 months later, but not quality of life. The results suggest that interpersonal relationships can be both positively and negatively associated with physical and mental health for people with ID.
Hanson, J. L., Nacewicz, B. M., Sutterer, M. J., Cayo, A. A., Schaefer, S. M., Rudolph, K. D., ... & Davidson, R. J. (2015). Behavioral problems after early life stress: contributions of the hippocampus and amygdala. Biological Psychiatry, 77(4), 314-323.
BACKGROUND: Early life stress (ELS) can compromise development, with higher amounts of adversity linked to behavioral problems. To understand this linkage, a growing body of research has examined two brain regions involved with socioemotional functioning—amygdala and hippocampus. Yet empirical studies have reported increases, decreases, and no differences within human and nonhuman animal samples exposed to different forms of ELS. This divergence in findings may stem from methodological factors, nonlinear effects of ELS, or both. METHODS: We completed rigorous hand-tracing of the amygdala and hippocampus in three samples of children who experienced different forms of ELS (i.e., physical abuse, early neglect, or low socioeconomic status). Interviews were also conducted with children and their parents or guardians to collect data about cumulative life stress. The same data were also collected in a fourth sample of comparison children who had not experienced any of these forms of ELS.
Lunsky, Y., & Havercamp, S. M. (1999). Distinguishing Low Levels of Social Implications for Dual Diagnosis. American Journal on Mental Retardation, 104(2), 200-204.
Abstract: Low social support is known to be a risk factor for mental illness in the general population. Social strain, or stressful social interaction, has also been shown to correlate highly with psychopathology but has been largely ignored for individuals with mental retardation. Results based on staff ratings of 104 adults with mental retardation are presented, highlighting the relationship among support, social strain, and psychopathology. Data suggest that social strain is more strongly associated with psychopathology than are overall low levels of social support for individuals with mental retardation.
Wigham, S., Hatton, C., & Taylor, J. L. (2011). The effects of traumatizing life events on people with intellectual disabilities: A systematic review. Journal of Mental Health Research in Intellectual Disabilities, 4(1), 19-39.
This article systematically reviews the literature on the effects of adverse life events or trauma on people with intellectual disabilities. It is important to systematically examine empirical evidence of the effects of trauma in people with intellectual disabilities as to date the number of studies in this area is not substantial, and the effects of trauma seen in the predominately general population literature are not necessarily transferable to the intellectual disability population. Identification of the effects of trauma on people with intellectual disabilities facilitates case recognition and appropriate treatment. Fifteen articles were selected for the review, and the results suggest that studies to date have been hampered by the lack of a consistent definition of trauma and the lack of a reliable and valid means of measuring the effects of trauma in people with intellectual disabilities. The review also indicates a lack of studies establishing causal links between life events and trauma.
Eskow, K., Pineles, L., & Summers, J. A. (2011). Exploring the effect of autism waiver services on family outcomes. Journal of Policy and Practice in Intellectual Disabilities, 8(1), 28-35.
This study examined the effect of services provided through Maryland's Home and Community-Based Services Medicaid waiver for children with autism on several outcomes related to families, specifically family quality of life (FQoL) and employment. The purpose of this study was to assess the impact of the services provided through the Maryland autism waiver on families' perceived quality of life by comparing responses of families receiving waiver services in Maryland with families in the same state who were on the registry (i.e., a waiting list) for waiver services. An invitation letter and Internet-based survey were sent out to 723 waiver recipients and 2,298 families on the wait-list registry by the state's agency administering the waiver program. Some 861 surveys (229 waiver, 632 registry) were returned, yielding an overall response rate of 28.8% (31.6% waiver, 27.5% registry). Both study groups reported lower satisfaction with FQoL and the majority of respondents in both groups reported that having a child with autism affected their employment. However, the findings suggest that families of children with autism who currently receive services through the waiver report higher FQoL than those not receiving services through the waiver. The authors note that there needs to be additional research to fully understand the most effective features of the waiver, including whether and how waiver programs make a difference in families' quality of life, health, and participation in school, work and leisure activities, and the effect of self-determination on these outcomes.
Hulbert‐Williams, L., Hastings, R., Owen, D. M., Burns, L., Day, J., Mulligan, J., & Noone, S. J. (2014). Exposure to life events as a risk factor for psychological problems in adults with intellectual disabilities: a longitudinal design. Journal of Intellectual Disability Research, 58(1), 48-60.
Background: Several cross-sectional studies have shown an association between exposure to life events and psychological problems in adults with intellectual disability (ID). To establish life events as a risk factor, prospective designs are needed. Methods: Support staff informants provided data on the psychological problems of 68 adults with ID and their recent exposure to life events. Using data collected on the same sample 3.5 to 4 years earlier, prospective analysis of the relationships between life events exposure and psychological problems over
time was explored.
Hamilton, D., Sutherland, G., & Iaiono, T. (2005). Further examination of relationships between events and psychiatric symptoms in adults with intellectual disability. Journal of intellectual disability research, 49(11), 839-844.
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Background: It has been proposed that people with intellectual disability (ID) might be similar to the general population in the way they respond to significant life events. Some preliminary findings have demonstrated that adults with ID who have experienced recent life events have an increased probability of having psychiatric problems. The aims of the present study were to determine whether previous findings can be replicated, and to examine the influence of additional diagnoses associated with ID on the strength of relationships between life event frequency and psychiatric problems.
Owen, D. M., Hastings, R. P., Noone, S. J., Chinn, J., Harman, K., Roberts, J., & Taylor, K. (2004). Life events as correlates of problem behavior and mental health in a residential population of adults with developmental disabilities. Research in Developmental Disabilities, 25(4), 309-320.
Very few existing empirical studies have explored the putative association between exposure to negative life events and psychological well-being in adults with developmental disabilities. In the present study, data on exposure to life events in the previous 12 months, adaptive behavior, problem behavior, and psychiatric problems were provided by care staff for 93 adults with developmental disabilities living in a residential hospital setting. Residents had typically been exposed to between three and four negative life events mainly relating to staffing and residence changes, conflict, family bereavements and relationships, and illness or injury. Those exposed to more recent life events were also rated as displaying more frequent aggressive/destructive behavior, and were at increased risk for affective/neurotic disorder. The need for replication of these data, especially using designs allowing causality to be inferred, is emphasized.
Ghaziuddin, M., Alessi, N., & Greden, J. F. (1995). Life events and depression in children with pervasive developmental disorders. Journal of autism and developmental disorders, 25(5), 495-502.
To determine the role of life events in the occurrence of depression in children with pervasive developmental disorders (PDD), we compared 11 patients (DSM-III-R; 9 male; 2 female; Mage: 11.0 years; Mfull-scale IQ: 75.3) with PDD and depression, with an age- and sex- matched control group of patients with PDD without depression (DSM-III-R; 9 male; 2 female; Mage: 9.8 years; Mfull-scale IQ: 60.6). Information was collected about the occurrence of unpleasant life events in the 12 months prior to the onset of depression. Depressed children experienced significantly more life events in the 12 months prior to the onset of depression. Exit events such as bereavement were more common in the depressed group. Findings suggest that, as in the general population, significant life events, particularly those with a negative impact, may contribute to the occurrence of depression in children with PDD. Future studies should explore the role of both biologic factors and environmental Stressors in the onset of depression in this population.
Biswas, A. B., & Furniss, F. G. (2009). Life events and mental illness in people with learning disabilities. Psychiatry, 8(11), 445-447.
Specific traumas, such as abuse and bereavement, and overall extent of potentially stressful life experiences are associated with increased levels of a range of behavioural and affective difficulties in people with learning disabilities. Although causality is probably complex and variable across diagnostic groups, evidence for a causal role for life events in the incidence of mental ill-health is growing. Even salient events, however, may not be perceived by carers as relevant to emotional and behavioural disturbance. Preventative strategies including use of social stories may reduce distress when life events can be anticipated. Supportive groupwork and a number of behavioural and cognitive–behavioural interventions offer promising interventions to reduce affective and other symptoms subsequent to traumatic life events.
Patti, P. J., Amble, K. B., & Flory, M. J. (2005). Life events in older adults with intellectual disabilities: Differences between adults with and without Down syndrome. Journal of Policy and Practice in Intellectual Disabilities, 2(2), 149-155.
Abstract Life events can have a negative impact on older adults with intellectual disabilities (ID) and are associated with depression and functional decline. Research on life events in people with ID revealed few reports that investigated life events exposure in people with Down syndrome (DS). The number and types of life events experienced in a cohort of 211 adults with ID (108 with DS, and 103 without DS) older than 50 years of age were studied. Data on life events exposure were collected from clinical records and informant interviews. The findings revealed that persons with DS in the sixth decade of life experienced a significantly greater number of life events and changes than adults without DS of similar or older ages. The number of relocations and medical events were found to be significantly greater in those with DS, whereas adults without DS experienced a significantly lower number of occurrences in all the life events categories studied. Adults with DS 50–59 years of age experienced a greater number of life events than did a group of adults without DS 50 years of age and older. Of the categories of life events investigated, changes in environment, experienced losses/separations, and medical events appear to be a common occurrence in the lives of older adults with DS. Functional decline, which commonly occurs during the dementia process, was seen as directly related to the prevalence and types of life events that adults with DS experience.
Hastings, R. P., Hatton, C., Taylor, J. L., & Maddison, C. (2004). Life events and psychiatric symptoms in adults with intellectual disabilities. Journal of Intellectual Disability Research, 48(1), 42-46.
Background: Previous research has indicated that children and adults with intellectual disabilities (ID) may respond to traumatic and other life events in a similar way to the general population. However, few studies have charted the extent of exposure to recent life events in samples of adults with ID and the association of such exposure with general psychiatric problems. Methods: Adults with ID (n = 1155) in community and residential services in a county district in North-east England were assessed using the Psychiatric Assessment for Adults with Developmental Disabilities Checklist (PAS-ADD Checklist), which includes a checklist of recent life events. Data were provided by informants who knew the index client well.
Hulbert‐Williams, L., & Hastings, R. P. (2008). Life events as a risk factor for psychological problems in individuals with intellectual disabilities: a critical review. Journal of Intellectual Disability Research, 52(11), 883-895.
Background Stressful life events such as bereavement, moving house and changing jobs have repeatedly been implicated as risk factors for mental and
physical ill health. Since the 1940s, researchers have demonstrated the negative effects of stressful life events, refined methods of recording such events and investigated the relative impact of different types of event. These investigations have generally not extended to include people with intellectual disabilities.
Methods We conducted a narrative review of research on life events as they occur to people with intellectual disabilities and critically assessed the evidence that life events function as a risk factor for psychological problems. Evidence was reviewed for an association between life events and a range of outcome variables, including affective disorders, challenging behaviour, psychosis and psychological problems more generally. We also critiqued the methodology behind the current evidence base and discussed a number of methodological advances that would help to strengthen it.
Tsakanikos, E., Bouras, N., Costello, H., & Holt, G. (2007). Multiple exposure to life events and clinical psychopathology in adults with intellectual disability. Social Psychiatry and Psychiatric Epidemiology, 42(1), 24-28.
Relatively few studies have examined the impact of life events on mental health in the field of intellectual disability (ID), despite the possibility that adults with ID and mental health problems might be particularly vulnerable to multiple events.
Bramston, P., Fogarty, G., & Cummins, R. A. (1999). The nature of stressors reported by people with an intellectual disability. Journal of Applied Research in Intellectual Disabilities, 12(1), 1-10.
design of appropriate programs of interventions.
Hill, J., & Furniss, F. (2006). Patterns of emotional and behavioural disturbance associated with autistic traits in young people with severe intellectual disabilities and challenging behaviours. Research in Developmental Disabilities, 27(5), 517-528.
Emotional and behavioural disturbance was assessed in 82 individuals with severe intellectual disabilities and challenging behaviour using the Diagnostic Assessment for the Severely Handicapped-II (DASH-II). Levels of disturbance were compared firstly in individuals with and without features of autism as assessed by the DASH-II, and secondly in individuals with varying severities of autism. In both cases levels of ability and overall severity of behaviour disorder were comparable across groups. Individuals with autistic features were found to have significantly higher scores than nonautistic individuals on the DASH-II organic disorder, anxiety, mania, PDD/autism and stereotypies subscales. When participants with autistic features were separated into groups of severe and moderate autism and compared with nonautistic participants, significant effects of group were found for scores on the anxiety, mood, mania, PDD/autism, schizophrenia and stereotypies subscales. Scheffé tests were conducted to further evaluate between-group differences. Item analysis showed seven DASH-II items to have a 30% or more difference between levels of endorsement in autistic and nonautistic individuals, with six further items showing a 20% or greater difference in levels of endorsement. Findings are compared to those from previous research and implications for the conceptualisation of emotional and behavioural disorders in individuals with autism are discussed.
Lunsky, Y., & Bramston, P. (2006). A preliminary study of perceived stress in adults with intellectual disabilities according to self‐report and informant ratings. Journal of Intellectual and Developmental Disability, 31(1), 20-27.
Background: Stress is a major risk factor for mental health problems in individuals with intellectual disabilities, however few studies on stress have been conducted that take into account the perspective of both the person with the disability and the caregiver. The present study evaluated an informant version of the Lifestress Inventory, and compared it to the self‐report version. Method: Seventy individuals with intellectual disability paired with their caregivers completed the Lifestress Inventory, the Inventory of Negative Social Interactions and the Birleson Depression Scale.
Esbensen, A. J., & Benson, B. A. (2006). A prospective analysis of life events, problem behaviours and depression in adults with intellectual disability. Journal of Intellectual Disability Research, 50(4), 248-258.
Life events have consistently been found to be associated with behaviour problems and depression among individuals with intellectual disability (ID). However, prior findings have typically been based on correlational or retrospective analyses of case files. The current study attempted to replicate prior findings from life events with concurrent data and extend them to the prospective prediction of behaviour problems and depression. The influence of impact ratings of life events was also explored. Seventy-four informants rated 104 adults with ID on measures of life events, behaviour problems and depressive symptoms. Life events were rated as having either a positive, negative or no impact on the life of the individual with ID. Measures were completed twice, at a 4-month interval. Behaviour problems were both correlated with and predicted by frequency counts of life events and life events perceived as negative. However, the predictive ability depended on which measure of problem behaviour was selected. Positive life events were not associated with concurrent behaviour problems. Depressive symptoms were correlated with all life changes, but only predicted by frequency counts of life events and life events perceived as negative. Again, the predictive ability depended on which measure of depression was selected. Findings were corroborated with a group of individuals with clinical diagnoses of major depression. Frequency counts of all life events and life events perceived as negative play a role in the development of behaviour problems and depressive symptoms among adults with ID. The results have implications for interventions for behaviour problems following a life event, and for reducing depressive symptoms for adults with mild ID.
Allen, D. (2008). The relationship between challenging behaviour and mental ill-health in people with intellectual disabilities A review of current theories and evidence. Journal of Intellectual Disabilities, 12(4), 267-294.
Abstract Challenging behaviours and problems of mental ill-health are common amongst people with intellectual disabilities. The article examines conceptual similarities and differences between these conditions, examines the data on comorbidity, and explores possible hypothetical relationships between behavioural and psychiatric disorder in this population. While there is little evidence at present to suggest that many of the challenging behaviours seen in people with intellectual disabilities are underpinned by problems of mental ill-health, only qualified conclusions are possible because of limitations in the quality and scope of existing research. A conceptual model for looking at the risk variables that may contribute to both conditions is suggested, and requirements for future research and current multi-disciplinary practice are outlined.
Hatton, C., & Emerson, E. (2004). The relationship between life events and psychopathology amongst children with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 17(2), 109-117.
Background: Research has established a clear relationship between life events and psychopathology amongst children generally, but this relationship has not been investigated in children with intellectual disabilities. Methods: A secondary analysis of data collected by the 1999 ONS survey of the Mental Health of Children and Adolescents in Great Britain, investigating associations between adverse life events and psychopathology amongst 264 children with intellectual disabilities and 10 040 children without intellectual disabilities.
Hulbert‐Williams, L., Hastings, R. P., Crowe, R., & Pemberton, J. (2011). Self‐Reported Life Events, Social Support and Psychological Problems in Adults with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities, 24(5), 427-436.
Background: Several studies have reported relationships between life events and psychological problems in people with intellectual disabilities. In contrast to the general literature, data have consistently been collected via proxy informants and putative moderator variables such as social support have not been examined. Materials and Methods Thirty-eight adults with intellectual disabilities completed three psychological measures in a semi-structured interview setting: the Bangor Life Events Schedule for Intellectual Disabilities Self-Report, the Brief Symptom Inventory, and the Social Network Map. Results Exposure to life events was positively associated with measures of psychological problems. Social support was generally not found to be associated with psychological problems, although more psychological problems were reported by participants who also reported more criticism of them by others. Conclusion Findings are broadly consistent with the proxy-report literature, though self-report measures may prove more sensitive. A number of methodological issues, clinical implications, and future research directions are discussed.
Martorell, A., & Tsakanikos, E. (2008). Traumatic experiences and life events in people with intellectual disability. Current Opinion in Psychiatry, 21(5), 445-448.
The role of recent life events and traumatic experiences across the life-span of people with intellectual disability deserves more research. An outstanding question is whether these events are risk factors or triggering factors, as well as how to differentiate between traumatic and life events. Identifying possible protective factors for mental health seems to be a very promising line for future research with important clinical implications.
Janssen, C. G. C., Schuengel, C., & Stolk, J. (2002). Understanding challenging behaviour in people with severe and profound intellectual disability: a stress‐attachment model. Journal of Intellectual Disability Research, 46(6), 445-453.
Background: Advances in our knowledge of attachment, stress and coping may foster new explanations for the development of challenging behavior in people with intellectual disability (ID). Method: Research on stress and coping among
people with ID was reviewed initially, and then studies on the security of the attachment relationships of people with ID with their caregivers were analysed.
