21642850%2E2014%2E897624

This article was downloaded by: [viviana puebla] On: 15 November 2014, At: 04:58 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Health Psychology and Behavioral Medicine: An Open Access Journal Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rhpb20 Life stress as a determinant of emotional well-being: development and validation of a Spanish-Language Checklist of Stressful Life Events ac b c Roxanna Morote Rios , Odin Hjemdal , Patricia Martinez Uribe & a Jozef Corveleyn a Department of Psychology, University of Leuven, Tiensestraat 102, box 3722, Leuven 3000, Belgium b Department of Psychology, Norwegian University of Science and Technology, Dragvoll Edvard Bulls veg 1, Trondheim 7491, Norway c Department of Psychology, Catholic University of Peru, Av. Universitaria 1801, San Miguel, Lima 32, Peru Published online: 04 Apr 2014. To cite this article: Roxanna Morote Rios, Odin Hjemdal, Patricia Martinez Uribe & Jozef Corveleyn (2014) Life stress as a determinant of emotional well-being: development and validation of a Spanish-Language Checklist of Stressful Life Events, Health Psychology and Behavioral Medicine: An Open Access Journal, 2:1, 390-411, DOI: 10.1080/21642850.2014.897624 To link to this article: http://dx.doi.org/10.1080/21642850.2014.897624 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. 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This article may be used for research, teaching, and private study purposes. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions Downloaded by [viviana puebla] at 04:58 15 November 2014 It is essential that you check the license status of any given Open and Open Select article to confirm conditions of access and use. San Miguel. then. The need for contextually relevant and updated instruments has been also addressed.059. HSCL-25 Literature review Introduction Despite the relevance of stressful events in health and well-being. cDepartment of Psychology. Peru Downloaded by [viviana puebla] at 04:58 15 November 2014 b (Received 19 November 2013.edu.moroterios@ppw. rmorote@pucp. the two studies presented here account for culture and diversity in a non-Western context. Trondheim 7491. This research aims at developing a screening instrument to evaluate the occurrence of severe stressful life events and provide initial evidence of its clinical utility.org/ licenses/by/3. Department of Psychology. distribution. psychopathology.001).c*. N = 844). provided the original work is properly cited. box 3722. Av. Adults born in inland regions (Mdn = 4) or with secondary or technical education (Mdn = 5) reported significantly more stressors than participants born in Lima or with higher education. Events increase significantly until 60 years of age (Mdn = 6). root-mean-square error of approximation = 0.77). accepted 20 February 2014) Objectives: To develop a screening instrument for investigating the prevalence and impact of stressful life events in Spanish-speaking Peruvian adults. Norway. Dragvoll Edvard Bulls veg 1.93.897624 Life stress as a determinant of emotional well-being: development and validation of a Spanish-Language Checklist of Stressful Life Events Roxanna Morote Riosa. Leuven 3000. Odin Hjemdalb. Methods: A sequential exploratory design combined qualitative and quantitative information from two studies: first.be.kuleuven. Background: Researchers have demonstrated the causal connection between life stress and psychosocial and physical complaints. Norwegian University of Science and Technology. *Corresponding author.01.0/. 390–411. Previously. a criterion-related validity process with affective symptoms as criteria (Hopkins Symptom Checklist (HSCL-25). Universitaria 1801. Catholic University of Peru. Tiensestraat 102.01. the two-factor structure of the HSCL-25 was verified (Satorra–Bentler chi-square. p < . which permits unrestricted use. Four-step hierarchical models showed that life stress is the best unique predictor (β) of HSCL anxiety. Published by Taylor & Francis This is an open-access article distributed under the terms of the Creative Commons Attribution License http://creativecommons. SD = 7. University of Leuven.001). Conclusion: The Spanish-Language Checklist of Stressful Life Events is a valid instrument to identify adults with significant levels of life stress and possible risk for mental and physical health (clinical utility).pe © 2014 The Author(s). Results: 93% of the participants reported one to eight life events (X = 3. 1.Health Psychology & Behavioural Medicine. the content validity of 20 severe stressors (N = 46).1080/21642850. standardized root-mean-square residual = 0. depression and general distress (p < . there is not a valid instrument to investigate their prevalence and impact on Spanish-speaking populations of Latin America. With a sequential exploratory strategy. The moral rights of the named author(s) have been asserted. Keywords: stressful life events. p < . Patricia Martinez Uribec and Jozef Corveleyna a Department of Psychology. and reproduction in any medium. validation. No.055). . Age and gender are significant for the three criteria (p < .doi. 2014 Vol. Mdn = 3.2014.05). Lima 32. There are no differences by gender. Emails: roxanna. Belgium.org/10. 2. http://dx. checklist. lower education and unemployment are significant unique predictors of general distress and depression (p < . 1987). 1991). In the last decades. an organism. Stressful life events The concept of stress involves the environment. While the last point has been systematically controlled (Paykel. Folkman. On the one hand. 2001). content and psychometric validities). Secondly. 1980). Complex cognitive appraisals focus on how to overcome. 2003. thus research emphasizes on different aspects according to its objectives (Monroe. Rickels. & Klump. Additionally. The authors asked a group of adults (acting like judges) to rate life events according to the amount of readjustment needed to go back to previous homeostasis. On the other hand. appeals to recollections and examines the relations between life events and the psychobiological mechanisms activated. confounding is a sensitive issue in the measurement of stress and psychopathology (Lazarus. Special attention is paid to the social readjustment model of Holmes and Rahe (1967) because its rationale and items are used to develop a checklist of life stressors for the Peruvian context. Today the scale is used widely and its predictive validity is demonstrated with regard to specific psychopathologies (Woods. 1974). and Alvarez (1979) inspired the development of sophisticated methods to assess the perceived stress of any event. Luthar & Zigler. unexpected or expected). 2009). Firstly. After more than three decades of use and revisions.. but the comparison and rating process was based on the evaluation of resources needed to face it (readjustment). Lipman. 1986. research on stressful life events has shown its relevance and challenges. Monroe. 2008.Health Psychology & Behavioral Medicine 391 Downloaded by [viviana puebla] at 04:58 15 November 2014 They integrate qualitative and quantitative information coming obtained from two independent samples (Creswell. Racine. An event might be subjectively experienced as positive or negative (controllable or uncontrollable. Paykel.2 Although the use of differential weights for stressors has to be cautious (Skinner & Lei. Derogatis. 1985. 2008). the model Social Readjustment Rating Scale (SRRS) shows that it is possible to establish certain standards of life stress comparison. & Gruen. prevent or accept the stressful situation (Folkman & Lazarus. Therefore.1 The first section presents a brief overview of current research on stressful events as determinant of health.e. or the possible negative outcomes. time and outcomes. Uhlenhuth. they include methods and results subsections. the work of Horowitz. Wilner. The second and third sections correspond to Studies 1 and 2 (i. Interestingly the two most used approaches depart from a shared principle: the cognitive evaluation of a factual stressor will determine to a great extent its consequences. Each component adds on the possible variability of the stress experience. Study 1 describes the rational identification of items. the SRRS is a commonly used method in life stress research (Hobson & Delunas. different research methodologies have dealt with challenges of individual variability and cognitive appraisals. the social readjustment model of Holmes and Rahe (1967) provided a method of life stress quantification and established fixed parameters to rate and compare 43 severe life stressors. particularly in multi-cultural and developing countries. & Covi. 2010) and physical diseases (Mujakovic et al. 2006). 2001). This paper is divided into four sections and one appendix with the protocol of the SpanishLanguage Checklist of Stressful Life Events (SL-SLE). 2001. DeLongis. individual variability may question a shared criterion to evaluate and compare life stressors. The fourth section discusses the findings and further research with the SL-SLE. challenges rise from the fissure between a hypothesized objective environmental stress and the subjective appraisals that precede the response. Yin. Research on stressful events focuses on natural contexts. . Lazarus & Folkman. while Study 2 presents the confirmatory factor analysis (CFA) of the criteria used to validate the SL-SLE (Hopkins Symptom Checklist (HSCL-25). The occurrence of specific events (e. Shonkoff & Garner. force migration (Terheggen. Paykel. 2003). stressful events have to be differentiated from vulnerabilities. and usually. In both cases. bulimia and psychosis in children. Occasionally. However. the study of life stress has to account for social exclusions. researchers are aware that certain environmental risks are stable social or cultural conditions. 2001) or environmental disasters (Masten & Narayan. (2003) found similar results for young adults (until 26 years old) and reported 1–3 stressful life events in 86% of a national sample. & Varese. adolescents or adults. Downloaded by [viviana puebla] at 04:58 15 November 2014 Life events research: psychopathology. affective. 2005. 2012). Shonkoff & Garner. The number and characteristic of the life stressors change considerably in multi-trauma or complex trauma research. either as recent life events or as cumulative events along life (Foster. in war context people suffer mostly up to 11 severe events along their life. 1983). Children and adolescents exposed to poverty face deficiencies in health (malnutrition and health services) and education (quality of schooling). Lopes. Risch et al. Moreover. In developing countries or impoverished communities. 2012) where the number of life stressors is notably higher. In addition. Today. Hammen. 1995) or dysfunctional patterns of attachment (Geenen & Corveleyn. although a small group reported up to 27 events (Neuner et al. lack of stimulation. hormones and neurological elements) or as early traumatic experience – related to attachment and first relations in developmental research (Masten & Narayan. There are not standard rules for the time elapsed or for the number of severe life stressors to predict physic or psychological outcomes. Nackerud. The accumulation of stressors is a bigger threat to cognitive. PTSD) and treatment (Courtois. 2012. and a range of 1–19 events along life (Sabin. risk and vulnerabilities There is well-documented evidence connecting stressful life events with poor psychosocial adjustment and physical distress. Kaiser. Additional challenges are posed by research on trans-generational and cumulative risk factors – for instance. physical or social well-being (Moen & Erickson. their impact is investigated in short periods of time (weeks or months after the event). asylum. 1984. 2001. and strong criticisms to the unrevised use of life stress instruments and diagnosis criteria in other non-Western societies (Eyton & Neuwirth.g. 2004). & Kleber. Scully. sexual violence) or the accumulation of stressful events is used as a predictor of psychopathology. aggression. and it poses additional issues to conventional psychological diagnosis (e. studies of abuse and maltreatment in children (Knutson. Gonzales de Rivera y Revuelta & Morera. For instance. Poverty and diversity in the study of stressful life events There is a lack of research about life stress and symptoms in Latin America. research has demonstrated that the increase of severe life stressors leads to the presence of symptoms.. 2004).392 R. post-traumatic stress disorder (PTSD). However. 2011. suicide. depression. vulnerabilities are moderators of the impact of life events on well-being. Caspi et al. (2009) carried out a meta-analysis of 14 studies where the increment of life events (1–3 or more) predicts depression in adults.g. 2013). socio-political. and Banning (2000) rejected empirically the hypothesis that mainly undesirable and uncontrolled events are at the base of this association. cultural and economic contexts. addictions. 2012). Among others. stressful life events have been associated with anxiety. In Mexico. stressful life events are used as a measure of environmental risk. 1995). Stroebe. Here. Tosi. . Guatemalan refugees reported 8 life stressors in average. Epps and Jackson (1993) summarize risk factors as stable conditions in four domains: family. vulnerabilities are mainly studied as biological conditions (genes. Morote Rios et al. methods and designs account for circumstances such as war. Kotch et al. Community violence is a complex stressor in contexts of urban poverty. 1994. Study 1: development and content validity of the SL-SLE The aim of Study 1 is to develop a short list of contextually relevant and severe stressful life events for Peruvian adults. 2004). Richard. Broad reviews conclude that there are specific risks. racism is not considered a traumatic experience or a stressful life event and its consequences in mental health are underestimated. the challenge for life events research is to differentiate them from demographic characteristics – because of progressive adaptation and possible diffuse symptoms (Rosenthal & Wilson. Ethnicity influences both appraisals and frequency of life events: minorities (African. 1993. religious. Reyes & Acuña. thus women’s social roles may act as specific affective and social stressors or protection. The higher prevalence of depression in women is the most studied sex difference. . Research has to turn its focus from dysfunctional outcomes to the modifying factors that break the causative chain between life stress and emotional and physical distress (Paykel.. ethnicity. the meaning of life events are under-explored. 2001. 2007) and a trans-generational shared experience (Tummala-Narra. education. values. 1995). 2008). Hobson & Delunas. family and community ties (Pine. undergraduate students. 1998. In Mexican samples.. life events and vulnerabilities that lead to negative outcomes for women and men. Diversity has broadened the study of life stress and well-being in psychology (Frable. research found consistent evidence connecting stressful events to affective disorders (mainly depression. but the study of gender as a critical category to understand sex-related differences is scarce (Stewart & McDermott. 2007). 2002). sex-related biological factors cannot account for it. the main goal of the following studies is to develop and to validate a screening instrument to evaluate the occurrence and impact of stressful life events in Peru. Here. In summary. Therefore. lack of infrastructure and services (O’Donnell. 2005).Downloaded by [viviana puebla] at 04:58 15 November 2014 Health Psychology & Behavioral Medicine 393 poor maternal health. Bebbington et al. and yet. and social and civil status in life stress research (Bruner et al. Sex difference is a profuse field of study in psychology. marital status could be risk or protective factor for women depending on cultural values. In the first case. satisfaction and retributions. SchwabStone.. 2005). however. social insecurity. Sex-differentiated roles take in hierarchical status. However. Brown. while Hobson. unemployment. Grigorenko et al. 2011. 1985). ethnicity connects to race-related traumatic experiences that act not as differentiated life-threatening events. There is an increasing tendency to include gender. 2004). it is studied as crime (witnessed and experienced victimization). Hispanic or Native Americans) have more in common than Caucasian middle-class groups of the USA due to migration. 2003). ritual or military services and parents underemployment (Garmezy. Racial discrimination within the family is a strong element of internal vulnerability (Sorsoli. Padilla. & Wingate. 2007. commonly. & Maldonado. Frequently. & Kubany. 1998). Hernandez. 1995). studies have focused on suicide and poor health (Foster. (1994) found that women.. For instance. Stewart & McDermott. Acuña (2012) and Bruner et al. Kamen. fragile connections to home and school. child labor. living conditions. single participants and those with basic education assigned higher scores to the life events. life events affecting emotional ties have stronger impact on women (Bebbington. & Muyeed. while in the second case. and Szostek (1998) found differences in the evaluation of the stressors by gender and income in the USA. attributions. 2001). several decades of research has left a main task: to develop valid instruments able to collect retrospective information (memory and cognitive bias) and to account for the stressors’ relevance in their contexts. Hammen. Moreover. The study uses a multi-method approach with expert sampling (Haynes. single parenting. Joiner. 2002. 1997. Participants of low SES are volunteers of a subsidized non-formal education program for adults living in inland regions. They were sorted in 2 groups of women (15 of middle and 11 of low SES) and 2 groups of men (13 of middle and 7 of low SES). Firstly. 2001. (1998) provide essential information to adapt the items.. They have mainly bachelor or postgraduate education (n = 25. survey and group interview First. ‘changing work responsibilities’).80%). Other changes are the following: original items 3 and 9 (‘separation’ and ‘reconciliation’) were merged and rated in the 12th position. ‘changing positions –transfer. 77.. subgroups are compared by gender and socio-economic status (SES) using the original items (translated and validated). ‘infidelity’.2% of the group (n = 10) has secondary or technical education. original item 4 (‘jail term’) was broadened to include ‘other institutions’. About the contents. they are born in Lima (n = 25) or in regions of Peru (n = 21). ‘experiencing domestic violence/sexual abuse’ and ‘surviving a disaster’ (rated as 8. Thirdly.394 R.. 1994) showed important changes in the rating positions. Downloaded by [viviana puebla] at 04:58 15 November 2014 Methods Rational selection of items. ‘sex difficulties’ and 19. Morote Rios et al. Because of their misrepresentation of women and ethnic minorities. 9. 28 (of 43) items of the SRRS were selected based on 6 studies: the original SRRS research (Holmes & Rahe. 1998) and an empirical study to address content criticisms (Scully et al. (1998). Participants of middle SES are residents of Lima and have pursued professional private education. Here.2). while the new version of item 20 does not specify the amount of money (now rated 47th. parenting and sexuality. There are clear differences in the 20 first positions of the original list of Holmes and Rahe (1967) and the updated version of Hobson et al. Only original items 1 (‘Death of a spouse’) and 4 (‘Jail term’) kept the same position. two original items related to work (15. (1994). Secondly. 43. they included 5 new items in the first 20 positions: ‘being a victim of crime’. ‘home mortage’). Participants are 25–60 years old (M = 41. Once selected the 28 items. (2) to assess its accuracy and readability (dichotomous: yes/no) and (3) to suggest new items or modifications. 1967) and 3 revisions. 45.. two studies with Spanish-speaking groups (Mexico) were included: Acuña (2012) and Bruner et al. ‘business readjustment’ and 18. Besides. 10. Hobson et al. the survey and group interview were conducted. the update of items and national norms (Hobson & Delunas. 2000). The instrument also collected socio-demographic information. ‘change to different line of work’) were replaced by precise items and were rated in less relevant positions (33. SD = 9. 2000) and Mexico (Bruner et al. two original items (13. items originally rated as 7. 12 15. Participants Forty-six Peruvian adults answered a survey and a group interview. 11 and 16 in the new national sample). Participants were asked to act as a ‘group of experts’ in order to evaluate the list of life events as significant (or not) . ‘changing employers/careers’. rated now 14th). ‘change in number of arguments with spouse’) were replaced by items about family. promotion’. studies conducted with the original items after 33 and 27 years in the USA (Scully et al. the updating studies of Hobson and Delunas (2001) and Hobson et al. ‘being the victim of police brutality’. 10. 18 and 20 changed 23–39 positions. but 22. Materials The survey was designed (1) to rate the relevance of 28 life stressors (three points scale). original item 16 makes explicit the kind of financial ‘change’ (‘problems/difficulties’.2. the item ‘Getting married’ was phrased as ‘Getting married/living together’. participants had to locate the events – written in A4 paper – in a ‘line of severity’ drawn in a blackboard. time or resources to adapt to it or to overcome it’. The four group interviews were tape-recorded and transcribed. Ten less relevant events were not included in the final list. Based on their individual answers to the survey. children . Downloaded by [viviana puebla] at 04:58 15 November 2014 Data analysis Together. 1995). Haynes et al.Health Psychology & Behavioral Medicine 395 according to their experiences or the experiences of others. children or siblings’. Finally. The group interview was designed as a collective and visual evaluation of the stressors.3 Qualitative information (survey’s open-ended questions and group interviews) increased the contextual validity of the items (changes in writing style and contents). The quantitative rating process of the 28 life stressors reached an inter-rater reliability of 0. Three items rated above a subgroup’s cut-off point were included in the final list: ‘Death of close friend’ (included by women). qualitative and quantitative information outline the content validity process of the SLSLE (Creswell. 2011). Participants said that.5 minutes to answer the survey and 95 minutes in the group interview. because it is not comparable with a violent assault or rape. Results In average. The analysis will inform the most severe life stressors and in-depth understanding of their impact on adult’s lives. money or heir conflicts. Table 1 shows the 18 items rated as highly relevant in the total group (N = 46) and four subgroups. discuss and explain their appraisals. The evaluator followed an interview guide. Men agreed on 12 life events. maltreatment of children and wife. while women and groups divided by SES agreed on 13 life events. Instructions included the definition of a ‘relevant stressful event of adult life’ as an ‘event (positive or negative) of great importance in adult life. The groups agreed to include two additional stressors: ‘Conflicts or violence in the family’ and ‘Not to get justice from the state’. Quantitative data (survey): Inter-rater reliability (Cronbach’s α) and cut-off values were calculated for the total group and each subgroup was analyzed (by gender and SES). Cut-off values (means plus one standard error) were used to identify the most relevant stressors (up to 28 selected life events) in the total group and each subgroup. The total group pointed out 15 life events as highly stressful (cut-off value for the total group = 2.49).86. They had to find certain consensus. Group interviews also provided information regarding the appraisals of the stressors.72 to . 2003. sentences or groups of sentences (Esin. the groups used 16. ‘Death of close family member’ must clarify that it is about ‘parents. The unit of analyses was themes marked in words. Coding and analysis was supported by NVivo (QSR version 10). Qualitative information (survey’s open-ended question and group interviews): It was used to evaluate the linguistic accuracy of the items and to suggest modifications or additional stressors. ‘interference of relatives’ in the family affairs.. ‘ … auto accident’ must precise the severity of the incident. in which people must use significant amounts of energy. infidelity. ‘Reconciliation with spouse or partner’ (included by men) and ‘Obtaining a major loan or home mortgage’ (included by the low SES participants). The first one built in contents such as forced migration or separation from children or elderly relatives because of migration.80 (standardized Cronbach’s α) for the complete group (N = 46) and within-groups from α = . Analyses were done with SPSS (IBM version 22). Participants considered mandatory to eliminate ‘robbery’ of item 9. to equate with other items and to avoid gender bias. ‘life project’ and personal expectations.50 15a 2. because everything is related to our families.46 2.65 2.58 14a 2. etc.58 2.86 2. death).46/0. means of severity and cut-off values per groups (N = 46).82 4 2.56 2.e.72 2.58 2.33 2.71 2.72 6 9 14a 2.44 2.58 2.50 15a 10 11 2.76 2. low SES n = 18 and middle SES n = 28.39 19a 2.00 1 2.e. etc. robbery.g.61 2.06 2.53 7 13b 16a 18a 2.45 2.23 15a 2.46/0. disaster. 3. disease.65 2. a participant said ‘everything is about feelings.78 2. accident. a Item rated below group’s cut-off value.85 2. the anticipated impact of a personal stressor on own family seems to be experienced as an additional stressor or the worst emotional cost of a life event.91 2 2.44 15a 10 12b 21a 2. our close environment’ (Man. Table 2 exemplifies the subjective evaluations of the 10 life events rated as highly severe in the group interviews.50 2.64 2. 5 and 8 in Table 2). participants emphasize the impossibility of changing the situation. earthquake.70 2.51 2.04 2.54 2.55 6 17a 13a 2.57 14 15b 16a 17a 2.e. When asked about the most stressful events.52 2.61 2. The stressor ‘Not to get justice from the state’ included contents such as inefficient.54 9 2.64 7 8 9 2.54 2.54 2.46 2.35 22a 2.54 2.53 2.44/0.78 4 5 6 2. Events referred to the loss of freedom or independence (i. . drugs.46 3 9 5 2.48 2.50 10 11 12 2.52 2. illness.06 2. start living independently and ‘psychological problems’ within the family.56 23a 2. crime) or because it is a stable condition that has to be accepted (i.07 2. low SES). finances) elicit appraisals about individual choice.95 2 2.51 Note: Women n = 26. although the impact on relatives’ life is also mentioned (e.58 2.94 1 3.21 2.47 2.61 2.61 2.54 16a 13a 12 2. adoption.57 13 2.50 10b 2.44 2.70 19a 14a 16a 12 2.75 2. rape. Study 1: rank-ordered life events. either just after the event (i. jail.50 12 2.45/0. denied access to higher education. In fact.44/0.54 6 11 13 2.60 2.24 11 17a 19a 8b 2.98 1 2.65 7 6 10 2.96 1 3. Total Downloaded by [viviana puebla] at 04:58 15 November 2014 Stressful life events Death of spouse/mate or partner Detention in jail or other institution Surviving a disaster (fire. bad (or ‘atrocious’) laws of the country.65 3 9 7 2.) Death of close family member Major injury/illness to self Important changes in financial state Separation of spouse or partner Being fired Being a victim of crime (assault. bad judges.50 2.50 2.) Being involved in auto accident Getting married Gaining a new family member (birth.79 4 2.07 2. b First item rated equal or above group’s cut-off value.) Divorce Pregnancy Death of close friend Reconciliation with spouse or partner Obtaining a major loan or home mortgage Mean/SE mean Cut-off value Order Women X Order X Men Order Low SES X Order X Middle SES Order X 1 2.396 R.61 2.88 2 2.59 14 8 16a 2. events 2. grandparents) Trying to modify addictive behavior of self (smoking.75 11 8 5 2.80 2. men n = 20.49 2.75 2. Morote Rios et al.67 5 3 8 2.35 2.46 2. social conflicts and social insecurity.65 3 5 7 2.89 2 2.65 2.00 2 2.93 3 2.80 4 2.77 2. flood. alcohol. In several cases.83 2.80 4 2. Table 1. etc. Health Psychology & Behavioral Medicine 397 Downloaded by [viviana puebla] at 04:58 15 November 2014 Table 2. Clearly. middle SES) (6) Important changes in financial state I have felt that. Study 1: evaluations of relevant and highly stressful life events. not understanding why (Man. my tendon. etc. everything around you (Woman. low SES) You wonder why. rape. it is much harder for men because you never foresee to be in that situation. unique (Woman. it has been 5 or 6 years and they miss their husband or wife (Man. As a result. they lock you. family. suddenly you have nothing. it was very difficult … I have overcome it little by little (Woman. It included 20 stressful life events listed in random order. I will never think that something like that may happened to me (Woman. time buffers the impact but there is always something missing. knee and arm had to be plastered. low SES) (4) Death of close family member Nothing can substitute a loved one. it happened to me. what did you wrong … I’ve seen people faint. it is the love (Woman. low SES) Everything is worse for your family. events 7 and 8). when you remember you feel broken. when you lose your husband or wife. Low SES) (5) Major injury/illness to self You have your dreams. you are more vulnerable (Man. I lost my job. I lost half of my salary and I didn’t know what to do. when I see a car approaching I have that feeling (Woman. because they can say we must be prepared … but we do not know … You cannot be prepared for a sudden change. middle SES) (3) Surviving a disaster (fire. if you loss that. the people around you … maybe you can accept it. who will support financially the household? when you have a wife. it’s a very desperate situation. The list contains events about family. that’s what they say … I have close friends. Not just for you. you are under somebody’s command. until you get another job. it is very difficult to get use to that. work and social life. 4.g. events 1. it stays with you. you don’t have anything to feed your children. unforeseen and they are experienced as changes of lost or harm. the most stressful events are uncontrolled. as a single occurrence. imagine they will ask you money. it’s frustrating (Woman. the stress is for your children. middle SES) The 10 most relevant stressors are negative life events – although the total list included four positive events (e. your husband. you cannot find anything. low SES) (9) Being a victim of crime (assault.g. Getting married) and three events that could be considered neutral (e. that’s what would hurts me (Woman. they might be considered either positive or undesirable. being a victim of a violent act. you run. as well as controllable or . Events are described independently. Obtaining a major loan or home mortgage). robbery. children who are studying.g. middle SES) Your life depends on your decisions.) It hits pretty much. low SES) (8) Being fired If you have family. low SES) (2) Detention in jail or other institution Horrible. cry. earthquake. Table 2 shows that participants evaluate the impact of the stressors in terms of the time needed to recover after the events (e. 9 and 10 in Table 2) or the use of inner resources unexpectedly (e. we are going through other problems (Woman. an institution that decides for you … What is life if you do not decide for yourself? (Woman. even if it is not a sever crash. Physic or psychological symptoms and personal changes that could be related to previous stressors were not included. your family.g. flood. who commit suicide. what happened.) The issue of violence. is stressful (Man. middle SES) Two years ago I was assaulted. low SES) (7) Separation of spouse or partner I have seen many women who have suffered. I had many debts … it hurts even today. low SES) (10) Being involved in auto accident The auto accident is serious psychologically for anyone. the protocol of the SL-SLEs was elaborated. it’s like half of you will die. (1) Death of spouse/mate or partner I have seen many people. and sex bias was eliminated. no water. your life projects. trauma. etc. your children. 69.7%). Their individual consent was obtained. 1987. 61. 50. Tinghög & Carstensen.40%).6%).7%).90%). Asian countries (Kaaya et al.54) and they were mainly born in Lima (n = 541. 33 and 41 years old (n = 111. Study 2. Middle East. The increase of the score indicates an intensification of symptoms. Participants have undergraduate (n = 507. Morote Rios et al. & Lavelle. The concurrent validity of the SL-SLE is established with psychological symptoms (HSCL-25) as related criterion (Cramer & Howitt. 18.. Their age is distributed between 18 and 25 years old (n = 412. 1998. Hopkins Symptom Checklist The 25-item version of the instrument of Derogatis et al. 2007). education and employment).75 is used for screening and/or classification (sensitivity and specificity) in Western countries (Sandanger et al. Ventevogel et al. Pedersen. These studies also show the good internal consistency (standardized Cronbach’s α) of the . 84 are subemployed (temporary or independent jobs. The pencil-and-paper self-report asks about the presence of symptoms over the last week. clinical utility: criteria-related validation process The aim of Study 2 is to get a valid instrument to evaluate the prevalence and impact of stressful life events in Peruvian adults. 138 participants have stable jobs (17. Tremblay. African. Participants were asked to put a check mark next to the events experienced along life. and Latin American countries (Sabin et al. age. 2002. Timpka. Item responses range from ‘not at all’ (1) to ‘extremely’ (4). & Thyberg.50%) and 18 participants are unemployed or housewives (no income. a cut-off point of 1. It is expected that they reflect the experience of diverse segments of Peruvian multi-cultural society. 2. 26.. The final version of the instrument is in the appendix.6%). 2004). 17. uncontrollable. and 42 and 76 years old (n = 139. 65.6%).398 R. 2003... Instructions asked to mark the events experienced along life. Mollica. 2007). (1974) is a measure of general distress. 26 and 32 years old (n = 152. Sixty percent of the participants were women. It is expected that higher number of events reflects an increase in life stress (continuous variable. 1995. Mouanoutoua & Brown.60%).4 Materials Spanish-Language Checklist of Stressful Life Events The instrument includes 20 positive and negative life stressors (Study 1) and also collects sociodemographic information (gender. 2010). & Errazuriz. Wyshak. 0 = had not). Silove et al. Downloaded by [viviana puebla] at 04:58 15 November 2014 Methods Participants A community sample of 844 adult residents of Lima (older than 18 years) participated in this validation stage. 10.and postgraduate students). They were contacted through a private university (pre.76 (SD = 11. 1999. 2009). 2003. postgraduate education (n = 222. Participants study or study and work simultaneously (n = 549. 11. and secondary or technical education (n = 97.70%).1%). 13.. a municipality (social promoters and public servants) and an NGO (volunteers and grassroots leaders).20%). place of birth. Even though there are exceptions (Hermansson. 0–20). participant’s mean age was 29. depression and anxiety symptoms. SL-SLE total score is calculated as the unweighted sum of answers to the items (1 = had ever been experienced. 000): skew of 0. depression and total score. The total score of the SL-SLE ranges from 0 to 16 life events (N = 844. composed of 10. employment (step 3) and life stress (step 4.80 for anxiety and depression. α > . Robust maximum-likelihood estimation (MLM) and the Satorra–Bentler chi-square (SB χ 2) were used in order to account for the non-normality of the data. 2010).168). Descriptive statistics of each life stressor and meaningful differences between subgroups were explored (non-parametric analyses). age.839. Modeling with hierarchical regression analyses explored the association between life stress and psychology symptoms. Then reliability of the scales was confirmed (Cronbach’s α). The continuous variables were log transformed. respectively). Mode = 2. 2004. homoscedasticity was explored (Levene’s test with rank transformations. p = .and 15-factor indicators. As expected. 813) = 2. The four most frequent events in the total sample are the most frequent events across the subgroups (they change only one position).551. 833) = 0. 2004. M = 3. it has a non-parametric positively skewed distribution (K–S = 0. p = . They appear ranked in position numbers 6 and 13.000. The variable age has non-homogeneous variances between subgroups (F(4. Adjusted R 2 was compared between participants with an SL-SLE total score up to 8 life events (N = 751. In order to compare SL-SLE total score between subgroups (Mann–Whitney U and Kruskal– Wallis K). 93% (n = 751) of the participants experienced 8 or less events along life.153. age. place of birth (F(1.. Variances are homogeneous in the subgroups defined by gender (F(1.77). Subgroups by gender. while only 7% of them (n = 60) declared 9–16 events. p = . 825) = 1. Mdn = 3. Based on the literature review (Courtois. . 2003) and the identification rule of Hoaglin and Iglewicz (1987) (g′ = 2.771. place of birth (step 1).. Nordstokke & Zumbo. SL-SLE) in predicting three-symptom scores (effect indicators): HSCL anxiety.93.084) and kurtosis of 0. Descriptive and inferential analyses were performed with SPSS (IBM version 22).254).6 There is no evidence of the measurement model of the HSCL-25 in Peru or Latin America. a cut-off point was fixed in eight events. Sabin et al. three models) and all the participants (N = 811. Results SL-SLE descriptive information Table 3 shows the frequencies and percentages of each life stressor in the total group (N = 844) and groups by gender and place of birth. Table 3 shows also the relevance of the items qualitatively added to the list of stressors (Study 1). S–W = 0. Four-step hierarchical regression analyses tested the criterion-related validity of the SLSLE (concurrent). p = . As expected.849 (SE = 0. three models). Three four-step regression models differentiate systematically the effect of gender. anxiety and depression. thus its two-factor structure was tested (CFA. Neuner et al. education (step 2).5 Downloaded by [viviana puebla] at 04:58 15 November 2014 Data analysis Mplus6 was used to estimate model parameters and run the CFA of the HSCL-25.972 (SE = 0.90 for the total score and α > .361.2). SD = 7. More variability is observed in the frequency of events reported for those who are not born in Lima: not any of the seven most frequent events in the total group keep the same position in the first generation of migrants in Lima.001).Health Psychology & Behavioral Medicine 399 HSCL-25 in these settings: generally.360).380) and education (F(3. p = . age was mean centered and HSCL-25 outliers were controlled.924. place of birth and education show similar non-parametric distribution (p < . 823) = 0. 44 0. Morote Rios et al.07 0. siblings.50 0.09 0. e Items added by qualitative study of content validity.48 0.42 0.59 2 3 4 218 212 188 0.66 R.62 1 258 0. adoption.47 1 149 0. b c Limac Regiond Order f % Order f % Order f % Order f % Order f % 1 404 0. earthquake) Conflicts or violence in the familye Getting married Death of close friend Being fired/laid-off/unemployed Separation of spouse/mate Attempting to modify addictive behavior of self (smoking.33 0.56 0. Downloaded by [viviana puebla] at 04:58 15 November 2014 Life event Womenb .03 0.53 0.41 0.400 Table 3.38 5 6 7 8 9 10 11 244 234 198 186 160 137 129 0.37 312 0. children) Surviving a disaster (fire.37 1 250 0.49 0.30 0.67 0.62 0.42 0.01 17 11 12 14 13 14 16 15 18 12 42 34 29 32 29 13 17 1 0.44 0.57 0.38 0.50 0.87 12 14 15 13 15 16 17 18 19 56 54 46 55 46 41 23 15 3 0.55 0.46 0. n = 501.61 1 4 3 141 0.16 0.15 5 8 7 6 6 10 9 97 70 75 82 82 43 60 0.54 0.58 183 0.65 0.62 0.66 0.51 0.71 7 6 5 8 9 10 13 84 85 91 77 71 57 36 0.45 0.39 95 0.27 0. flood.43 315 0. d n = 283. n = 541. alcohol.61 182 0.65 0.22 0.89 0.64 0.62 0.59 0.19 0.37 2 3 4 141 0.12 8 13 12 14 15 16 17 18 19 102 61 65 54 45 36 27 10 7 0.32 0.37 0.35 0.68 0.55 0.51 0.58 0.46 6 5 7 8 10 9 11 144 161 119 102 76 92 69 0.37 0. grandparents) Changing economic status Being a victim of crime (assault.04 0.60 0.61 0.12 0.28 12 13 14 15 16 17 18 19 20 117 106 101 83 77 65 40 29 9 0.23 0.34 2 3 4 370 0.57 0. drugs) Pregnancy Not to get justice from the statee Obtaining a major loan or home mortgage Major injury/illness to self Reconciliation with spouse/mate Experiencing a severe auto accident Divorce Detention in jail or other institution Death of spouse/mate a n = 333.13 0.51 0.53 5 6 8 7 10 11 9 154 144 96 105 86 75 90 0.69 0.48 0.10 0.59 0.49 0.67 0. frequency and percentage of stressful life events in the total sample (N = 844) and subgroups by gender and place of birth.65 2 136 0.40 2 4 3 224 0.12 0.28 0.33 10 11 12 15 14 16 17 18 19 57 51 47 26 28 21 17 13 6 0. Study 2: order.48 0.34 0.31 0. rape) Death of close family member (parents.38 129 0.40 0.30 118 0.69 0.43 0.09 0.41 125 0.40 0.37 0.32 0.34 0. Mena Total Gaining a new family member (birth. p < . p < . The covariance paths between the factors (anxiety and depression) are significantly different from 0 (p < .08 (SE = 0.09) and kurtosis = 0. 263) = 9. Ohaeri. participants (30) with more than one missing response in any HSCL item were excluded – Little’s missing completly at random test: χ 2 (504.824.431. M = 1.500.001.39). However. two-tailed).01. 10 items and depression. p < . M = 1. HSCL total (n = 807).822.814). RMSEA corrects for parsimony and provides a test against the perfect model.1% for depression. anxiety (six cases) and depression (four cases) (Hoaglin & Iglewicz.49 (SD = 0. and between 33–41 and 42–60 years old (Mdn = 6) (χ 2 (1.0728).059. r = 0.038). There is no significant difference between adults from 42 to 60 and 61 to 76 years old (Mdn = 6) (χ 2 (1.09) and kurtosis of 0. HSCL-25 scores were computed as the weighted sum of answers divided by the number of items of each scale.428. and HSCL depression (n = 807). and similarly to results reported by Al-Turkait.452). 15 items) show excellent or good internal consistency (Cronbach’s α) in the Peruvian sample (George & Mallery.06 (RMSEA = 0. The regression weights (factor loadings) are all significantly different from 0 (p < .230. Following the general criteria of Hu and Bentler (1999). The two-factor model of the HSCL-25 fits the data well in the Peruvian sample. M = 1.418. thus it is essential in judging a model with 25 indicators. the criteria for the comparative fit index (CFI) and the Tucker–Lewis Index (TLI) (above 0.001): secondary and technical education (Mdn = 5). p < .36). inter-item correlations were verified in order to proceed with the CFA.Downloaded by [viviana puebla] at 04:58 15 November 2014 Health Psychology & Behavioral Medicine 401 p = .91 (SE = 0.9% for anxiety and 79. thus SL-SLE total score was compared by age groups.49 (SD = 0. two-tailed). .01. p < . El-Abbasi. the root-mean-square error of approximation (RMSEA) is below 0. There are no significant differences in SL-SLE total score by gender (Mdn = 3. two-tailed).36). On the contrary.169.001.001).9% of the sample) with a single expectation maximization process (Scheffer. p = .71 (SE = 0.7 There are significant differences in SL-SLE total score in the three levels of education (H (2) = 59. In the Peruvian sample.055). p < .830. Pairwise comparisons revealed significant differences between 18–25 (Mdn = 2) and 26– 32 years old (Mdn = 4) (χ 2 (1. between 26–32 and 33–41 years old (Mdn = 5) (χ 2 (1. Outliers were controlled for HSCL total score (four cases).90) were not met (CFI = 0.055–0. HSCL-25 factor validity First. Nunnally & Bernstein. skew = 1. anxiety: α = .13. two-tailed). stressful life events are positively associated with age (Pearson r (776) = . HSCL anxiety (n = 805). p < . N = 841) = 572. 79. and Naguy (2011) in an Arab sample. twotailed).904. p < .01.786.019. undergraduate education (Mdn = 3) and postgraduate education (Mdn = 4). The overall fit indices for the CFA are S–B χ 2 (274) = 1047.17).001.17). One missing completely at random value was imputed in 40 cases (4.60 (SE = 0. 564) = 18. TLI = 0.01.82 (SE = 0.41.806 and depression: α = .04 (SE = 0.09) and kurtosis = 0.75 for the total score. 239) = 12.063) and the standardized root-mean-square residual (SRMR) is below 0.001. Then.138. and scaling correction factor for MLM: 1. 2002). U = 80874. skew = 0. p = . 95% IC RMSEA = 0. S–B χ 2/df = 3. 1994). Pairwise comparisons show differences between categories (p < .49 (SD = 0.864. two-tailed).7% of the participants are below the international cut-off point of 1.500. two-tailed). The median of SL-SLE is significantly different across age groups (Mood’s median test χ 2 (4. HSCL-25 total: α = . p < .17). 2003. HSCL-25 total scale and subscales (anxiety.08 (SRMR = 0. skew = 1. there are significant differences in participants who were born in inland regions of Peru (Mdn = 4) and in Lima (Mdn = 3) (U = 64342.305. two-tailed). r = −0. As expected. 139) = 1. 78.030.001. 814) = 122. 1987) prior to explore the basic statistics of the scales. the accumulation of stressors and mainly. followed by step 1. whether or not a person will go through psychosocial or physical impairments will depend on diverse conditions. was introduced at the fourth step to explore its predictive capacity above the others. The SL-SLE does not assess objective stress. Stressful life events (step 4) increases significantly and consistently the prediction of general symptoms.9 Thus. The hierarchical multiple regression analysis revealed that each of the four steps contributes to the regression models (ANOVA. Downloaded by [viviana puebla] at 04:58 15 November 2014 Modeling SL-SLE Six four-step hierarchical multiple regression analyses were carried out with HSCL anxiety.000). tolerance and variance inflation factor (VIF)) are all within accepted limits – the lowest levels of tolerance is 0. the subjective evaluation of the event and its consequences. Lower levels of education (secondary and technical) and unemployment (unemployed participants and housewives) are also unique predictors of general distress and depression.e. Ten independent variables were organized in four steps to distinguish their capacity to account for by the outcomes’ variance.05). with the exception of stressful life events and age.000). stressful life events remain as the most important predictor of psychological symptoms. the SL-SLE shows satisfactory psychometric characteristics and capacity to identify adults at risk of developing symptoms of anxiety and depression. All the regression models for the dependent variables show significant predictive capacity (adjusted R 2. p < . while the highest level of VIF is 1. Although further research should extend this conclusion. β in Table 4). it aims at providing a shared criterion to identify potentially harmful life events for the emotional well-being of adults in Peru. the first set of analyses has better predictive capacity10 (Table 4). These events correspond to diverse domains of adult life (relationships. Independent variables are not highly correlated. anxiety and depression (p = . positive (4) and neutral (3) events. the content and psychometric validity processes of the SLSLE resulted in negative (13). The increase of this contribution (adjusted R 2 and F change) is not significant only at step 3 for any criteria (‘occupation’ as a block of variables). However.000) and depression (p < .402 R. such as previous life experiences.871. Analysis including participants with one to eight stressful life events along life (n = 751) showed stronger adjusted R 2 than models tested with all the participants (n = 811). The collinearity statistics (i. 14% of the variation in anxiety and 17% of the variation in depression. In accordance with the literature. psycho-biological characteristics.001). family and community life) and they may activate internal and external resources in the individual. Gender and age have a unique predictive capacity of the three dependent variables. Discussion Results show that the SL-SLE is an empirically supported and evidence-based instrument to investigate the prevalence and impact of stressful life events in Peruvian adult population (Holmbeck & Devine. Morote Rios et al. It explains uniquely 18% of the variation in general distress.535.05). depression and total score as dependent variables. SL-SLE total score. . with F parameters at p = . When all the independent variables are compared in step 4 of the regression models (standardized beta weights. The main variable of interest. The direction of the associations shows that women and younger participants have stronger probabilities to show higher scores in the three-symptom scales. The quantitative study provided initial evidence of risk associated with the number of events (specially for age groups and birth place). demographic characteristics in the prediction of general distress and anxiety (p < . work. as well as uncontrollable (9) and controllable (11) events. Step 2 (education) significantly increases the prediction of general distress and depression (p < . 2009). 007 0.072 0. anxiety and depression.037 0.101** 0.01.686 0.174*** Notes: Education and employment are dummy variables with 0: ‘graduated’ and 0: ‘employed’ as the reference group.055 20. c n = 696.018 13. ΔR 2 0. a n = 696.010 2.053 ΔF 0.008 −0.042 −0.041 0.144*** ΔF 0.051 −0. respectively.135** 0.570*** 19.180*** 0.017 0.019 0.063 0.118** −0.080* 0. 0. ***p < . ΔR 2 0.822*** 0.049 −0.695 0.079* 0.791 0.959*** 0.041 0. Health Psychology & Behavioral Medicine Downloaded by [viviana puebla] at 04:58 15 November 2014 Table 4.685* 0.088 0.165** R2Adj.011 1.056 1.087* β 13.023 0. **p < .003 0.021 −0.112** 0.001.028 3. *p < .984*** ΔR 2 0.091 0.179*** β HSCL depressionc 0. Age is centered at its mean.415 0.029 HSCL anxietyb ΔF 7.029 −0.05.013 3.Summary of hierarchical regression analyses for variables predicting HSCL total score.029 0.105** 0.405*** 0. HSCL totala Predictor Step 1: Demographics Gender Born in Lima Age Step 2: Education Secondary Technical Undergraduate Step 3: Occupation Student and working students Subemployed Unemployed and housewives Step 4: Life stress Stresful life-events β R2Adj.054 0.026 0.095* 0.016 3.121** −0.047 0. b n = 695.020 0.723* 0.007 0.073 0. 403 .091* 0.068 R2Adj. Standardized beta weights (β) belong to the fourth step. studies focus on proximate events and connect them to reactive episodes of anxiety (mainly PTSD) or depression (for instance. the inclusion of this highly stressed group weakened the predictive power of life stress on psychopathology (hierarchical models with N = 811 and Pearson’s r). social violence and disasters. 2002) and Peruvian (Elsass. Recently. These preliminary findings are consistent with current research on multi-traumatized groups.9%) who declare an unusual number of stressors along their lives: from 9 to 16. This study aimed at developing an accurate instrument for researching in natural contexts. This amount of stressors is not only labeled as outliers by psychometric procedures (Hoaglin & Iglewicz. 2009). Further research is needed to clarify the specific characteristics of these participants. 2001) populations. looking for a broad and diverse group of participants. The relevance of life events related to family and community ties has been studied as a cultural characteristic of Latin American (Hernandez. as suggested by Luthar and Zigler (1991). The study provides normative information about Peruvian adults’ life stress. Although migration may entail a transition out of poverty. . 2004). services of health or education) to the insertion in contexts of urban poverty.. It comprises the departure from contexts of severe exclusion (i. These findings can lead us to some conclusions and further paths of research. However. The new items developed for the SL-SLE reveal that family and social contexts are simultaneously a domain of meaningful personal experience and source of stress and vulnerability. 2004). cumulative stressors and the uncontrolled time between events and outcomes could obscure their impact on well-being. and there is a significant increase of life events by age (from 3 to 6 events between 18 and 60 years of age). In this study. especially for young adults (Crivello. Firstly. The first ones are mainly connected to cumulative experiences of child abuse. the SL-SLE did not explore a recent or fixed period of time. prioritizing the cultural and social diversity of the target population. the number of stressors does not differ for men and women. The exploration of SL-SLE total scores revealed unforeseen results: there is a small group of participants (4. it kept a community-based approach.and long-term impact of migration for adults’ wellbeing in Peru or other Latin American contexts.and post-migration stress and has been empirically connected to mental health symptoms in Peruvian migrants (Lahoz & Forns. 1987). while the outcomes are a challenge for diagnostics and treatment (Courtois. the validation process showed that being a migrant in Lima determines an experience of numerous and stressful life events. Two conditions of the study make these findings specially challenging. They not only experience unusual amounts of life stressors but also show patterns of complex physical and psychological outcomes. the differential and severe effect of these stressors has been studied as pre. neglect. their vulnerabilities.e. Secondly. patterns of life events may be explored to better understand the influence of gender and age in life stress. Commonly. Silove et al. internal and external migration in Peru is a phenomenon associated with lack of social opportunities. 1997. In accordance with the literature. In both cases. The most important result to emerge from the data is the significant and consistent predictive capacity of stressful events assessed with the SL-SLE – on psychopathology symptoms. 2013). Contrary to what could be expected. Modeling with hierarchical multiple regressions demonstrate its capacity to identify systematic variations of symptoms’ scores as a function of distal and complex background characteristics (Bryk & Raudenbush. On the contrary. Morote Rios et al. possible negative outcomes as well as resources developed to face the repetitive occurrence of severe stressors. after a significant lost) (Kessler.Downloaded by [viviana puebla] at 04:58 15 November 2014 404 R. 2007). this research does not control the presence and intensity of the dependent variables (psychopathology) by focusing on clinical samples. Interestingly. the life event ‘change of residence (migration)’ was excluded from the group of highly relevant stressors (content validity study). Further research is needed to understand in depth the short. 1987) but it is comparable to the number of stressors reported in contexts of war and forced migration (refugees) (Neuner et al.. Age is the most consistent and powerful socio-demographic predictor of mental health (anxiety. unusual expressions of psychosomatic symptoms have been identified in Middle East (Tinghög & Carstensen. depression and general distress). Brown. and the demographic characteristics of the sample were inspected during the data collection. 1995) – with current stressors are major predictors of women’s depression. Traditional psychometric instruments of depression. In Peru. Prospective-longitudinal studies would also broaden the clinical utility of the SL-SLE. Ventevogel et al.. The increase of stressful events in fixed periods of time is not only related to affective symptoms but their interaction with genetic conditions can be . stomach or chest pains. 2009). responding to specific objectives or target groups. further research should expand our understanding of somatic symptoms in the expression of emotional distress. 2007) or subjective distress (Morote. dizziness or weakness. 1988) and early absence of own mother (Kotch et al. along with stressful life events. indicators of social disadvantage (lower education. consistently predict dysfunctional responses and greater risk. headaches. Social roles and expectations ascribed to women might be affecting their well-being. Distal risk factors – i.. accessibility and diversity were the main criteria to reach the participants. For instance. It is important to contextualize women’s regulation of emotions because it is not purely individual processes.Downloaded by [viviana puebla] at 04:58 15 November 2014 Health Psychology & Behavioral Medicine 405 In accordance with research in Western and non-Western contexts. Clearly.. thus it is important to investigate youngsters’ life conditions and inner resources as a risk factor in the Peruvian context. convulsions and general weakness.. although the results provide evidence of the accuracy of the HSCL-25 scales of anxiety and depression. Asian (Pernice & Brook. 2011). as explained. Lee. the final format of the SL-SLE does not exclude the possibility to restrict the time assessed. 1998. a university. anxiety or PTSD may find little support in non-Western contexts. & Campbell. Cross-cultural clinical research has shown that some expressions of mental distress are culturally dependent. & Gross. and the combination of distal risks – such as maternal loss (Tennant. In this study. This is consistent with previous findings reported in the introduction. but culturally constructed patterns of adaptation with different consequences in women’s health (Butler. education and employment. research has already shown the necessity of specific methods to assess subjective and somatic distress in traumatized Quechua groups – such as worrying memories.e.. 2002). trembling. employment insecurity or unemployment) play a key role in psychosocial well-being of individuals or in the accumulation of stressors (migration). PTSD or physical conditions could be tested in series of time points. However. Age and gender are specially challenging for further research. Roles such as family or community caregivers – especially for migrant and poor women – single parenting or social leadership could be associated with symptom manifestation (Bebbington et al. faintness. Moran. 2010). 5 or even 10 years.. 1998). symptoms such as headaches. local and metropolitan municipalities and an NGO) were contacted. thus several recruiting strategies were used to improve the sample composition. The sampling method may be considered as a limitation of Study 2. Terheggen et al. Finally. and difficulty falling asleep. 2007). child neglect/abuse – are associated with women’s depression (Bifulco.e. 1996. group comparisons are possible with the validation sample though generalization has to be cautious. This might be a convenient choice in further research. 2001) and African countries (Kaaya et al. As a result. More precisely. Women show greater risk of depression and general distress. However. The capacity of the SL-SLE to predict affective symptoms. while research including culturally relevant outcomes and adapted instruments showed consistent explanatory power (Tremblay et al. showed unexpected patterns of correlations with their scales. and it also provides some paths of analysis for gender. Ball. The impact of severe stressors on the development of symptoms is more obvious when time is limited to 1. different institutions (i. . In Study 1. F(10. 9. ‘change in number of arguments with spouse’. p = .023 and depression 0. The translation into Spanish used was made by the Harvard Program in Refugee Trauma and published by Oficina en México del Alto Comisionado de las Naciones Unidas para los Derechos Humanos (2007). further research could also include clinical samples or valid diagnostic instruments in order to screen for psychopathology.714. demonstrated (Caspi et al. strong direct associations (r) were found between the SL-SLE total score and HSCL-25 scales (means) but just until SL-SLE total score reaches eight events (N = 751. disadvantaged groups and for people with unusual accumulation of stressors along life. Tremblay et al. Morote Rios et al.Downloaded by [viviana puebla] at 04:58 15 November 2014 406 R. = 0. The items are ‘illness of close family member’. with anxiety 0.64. 8. Finally. Berry.000). F(10. migrants. 6. This study also provides a springboard for the study of life stress in natural contexts and to search for connections with possible negative or positive outcomes. The effect size r was calculated by dividing Z(−3. Subsample number of participants for each category does not always add up to 844 due to missing information. 5. ‘assuming responsibility for sick or elderly loved one’. p = . anxiety (n = 753. Interestingly. The usefulness of the SL-SLE has to be proved in the prevention and management of physical and mental consequences of life stress. the association is not significant: R 2 of SLE (0–16) with HSCL total score is 0. p = . the authors used the scores in an additive manner to determine life stress of each individual in a fixed period of time (generally in the last year).00). R2Adj. 2003).051. Spanish version: ‘Listado de Eventos de Vida Estresantes en Español – LEVE’. In conclusion. Reliability and dimensionality reduction are inappropriate analyses to validate a checklist of life events (Shalowitz. quantitative rating process of events and the qualitative appraisals of their severity followed the rationale of the model of Holmes and Rahe (1967). 743) = 6. 2. The promising results of the HSCL-25 CFA allow trustworthy use of the HSCL-25 in Peru. ‘trouble with boss’ and ‘change in living conditions (migration)’. F(10. promising applications of the SL-SLE are the exploration of distinctive patterns of stressors for men. R 2 of stressful life event (SLE) (0–8) with HSCL total score is 0. When included the small group of participants with 9–16 life events (n = 59). Once established the norms per event (‘Life Change Units’). 743) = 5. Rasinski. 2009).71. The effect size r was calculated by dividing the chi-square value H (2) = 59. Results with N = 811: HSCL total score (n = 754. 793) by the square root of N (824).138 by N−1 (825). 7.022 . women. 93% of the sample). Satisfactory results were obtained to support its capacity to identify adults at psychosocial risk.51. ‘change to different line of work’. 10. R2Adj. & Dannhausen-Brun. with anxiety 0. these findings represent an initial validation of a useful instrument to evaluate the occurrence and impact of relevant life stressors for adults in a Latin American sample. ‘retirement’.. ‘change in work hours or conditions’. ‘no health insurance’. Notes 1. 742) = 6. = 0. 1998.00) and depression (n = 754. Acknowledgments The authors are grateful to the Peruvian institutions and individuals who participated in these studies and to Marcela Quiñones Herrera (University of Leuven) for her contribution to the analysis of data.714 .484. ‘sex difficulties’.376 and depression 0. R2Adj. The use of the SL-SLE as a screening instrument (to gather information at an early stage of a relevant risk condition) could be used to prevent or to monitor treatments in diverse physic and psychological conditions.411. 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