Role of stress areas, stress severity, and stressful life events on the onset of depressive disorder: a case-control study.

BACKGROUND Although the stress and stressful life events are known as the precipitation of depressive disorder, the areas of stress and types of stressful life events found in depression are varied by different socio-cultural context. OBJECTIVE Identify the stress areas, stress severity, and types of stressful life events associated with the onset of depressive disorder in Thai depressed patients. MATERIAL AND METHOD Ninety depressed and ninety non-depressed subjects, aged above 18 years old, from the Department of Psychiatry, King Chulalongkorn Memorial Hospital, were recruited into the present study between July 2007 and January 2008. All subjects completed a demographic data form, and a 1-Year Life Stress Event Questionnaire. The association between the number of stressful life events, stress areas, stress severity, types of stressful life events, and the onset of depressive disorder were analyzed by independent t-test and chi-square test. Logistic regression was performed to identify the predictors of depressive disorder. RESULTS Most of the subjects were young and middle-aged women, living in Bangkok and the central region. The depressed subjects experienced more stressful life events than the non-depressed subjects (5.81 +/- 3.19 vs. 3.24 +/- 2.80 events in one year) (p < 0.01). All stress areas (health-related, family-related, financial, occupational, and social stress), and overall stress were associated with the onset of depressive disorder (p < 0.05). Subjects with the moderate-to-severe stress in all areas were at the higher risk of depressive disorder than those with the mild stress (p < 0.05). Health-related stress was the stress area highest associated with the depressive disorder (OR = 5.93, 95% CI = 2.33-16.92, p < 0.01). The types of stressful life events associated with the onset of depressive disorder were the medical hospitalization, medical illness leading to missing work or disturbed daily routine, change in sleeping habits, absence of recreation, arguments with spouse, sexual difficulties with spouse, family financial problems, job loss, and trouble with boss (p < 0.05). The logistic regression showed that the moderate-to-severe stress was the significant predictor of depressive disorder (adjusted OR = 5.26, 95% CI = 1.85-14.92, p < 0.01). CONCLUSION Stress areas, stress severity, and stressful life events had the impact on the onset of depressive disorder in Thai depressed patients. The important stressful life events in Thai depressed patients included severe medical illness, job loss, financial distress, and relationship problems.