Measurement of Life Stress by Means of The Multi-modal Questionnaire for Life Events Survey and an Evaluation of its Validity (II)

Measurement of Life Stress by Means of The Multi‑modal Questionnaire for Life Events

Survey and an Evaluation of its Validity (II)

著者 Ishikawa Akira

journal or

publication title

関西大学社会学部紀要

volume 24

number 2

page range 109‑154

year 1993‑03‑05

URL http://hdl.handle.net/10112/00022569

ISSN 0287-6817

Measurement of Life Stress

by Means of The Multi-modal Questionnaire for Life Events Survey

and an Evaluation of its Validity-(II)

Akira ISHIKAWA

Abstract

A previous article (Ishikawa, 1992) int rciduced the Multi-modal Question- naire for Life Events Survey (MQLES), which was developed by the author.

In Study I, the results of which were reported in the previous article, a total of 474 adults (221 control subjects, 107 neuropsychiatric patients and 146 peptic ulcer patients) completed the MQLES. The computation meth- ods used in Study I for both the neurotic stress and psychosomatic stress scores were developed based on the results of discriminant analysis of the data obtained from the control subjects and neuropsychiatric patients and the control subjects and the peptic ulcer patients, respectively.

In this second study, validity was evaluated by administering MQLES to a new sample of subjects consisting of a total of 365 adults, which in- cluded 130 control subjects, 30 neuropsychiatric out-patients, 52 psy- chogenic otorhinological out-patients, and 153 asthma in and out-patients.

The neurotic stress scores, used diagnose stress victims in each group, demonstrated the following results; 66.7%,45.4%,13.7%,6.5% and 2.3% among the neuropsychiatric out-patients, the otorhinological out-patients, the peptic ulcer in and out-patients (data obtained in the first study), the asthma in and out-patients, and the control subjects, respectively.

On the other hand, diagnosis based on the psychosomatic stress scores showed the following results; 60.3%, 53.3%, 45-4%, 40.5% and 23.1% among the paptic ulcer patients, the neuropsychiatric patients; the otorhinological patients, the asthma patients, and the control subjects, respectively.

The symptoms or complaints, the Life events experienced, the personal dispositions, and the social conditions for each of these five sample groups were compared and other correlations, reliability, and factor ana- lytic data are included. The suitability of six hypotheses concerning the Life stress process was also discussed.

The results of this study suggest that the neurotic and psychosomatic stress scores are powerful diagnostic tools and that MQLES could be use- ful in the clinical field.

Key Words: life stress process, measurement of life stress, type A-B behavior pattern,

locus of control, social support, neurotic stress score, psychosomatic stress

score, neuropsychiatric outpatients, peptic ulcer patients, psychogenic otorhi-

nological patients, asthma patients.

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Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa)

STUDY II

Study II was conducted in 1991 in order

1) to examine the discriminant validity of the neurotic stress score and the psychosomatic stress score which are obtained from the responses to the MQLES,

2) to examine the factorial validity of the MQLES, especially the ones of Part A (current symptoms or complaints) and Part B (stressful life events experienced),

3) to examine the reliability of the MQLES,

4) to examine the fitness of each of the hypotheses as to the life stress process consisting of stressful life events, personal dispositions and social conditions.

Method

1 Subjects

The number of subjects of Study II totalled 365 adults. Of these 365 subjects, 130 were control subjects (71 males and 59 females), 30 were neuropsychiatric out-patients (16 males and 14 females), 52 were psychogenic otorhinological patients (27 males and 25 females), and 153 were asthma out-patients (82 males and 71 females), respectively.

The subjects were recruited at the following places and hospitals.

The control subjects were the participants to an extension lecture by the Kansai Univer- sity and the medical doctors and nurses at the Tokyo Teishin Hospital.

The neuropsychiatric patients were those out-patients at the Osaka Medical College Hospital who were diagnosed to be psychogenic on the first interview by the medical doctors. Most of them are "neurosis" but several depression patients are included in this sample.

Of these 30 neuropsychiatric patients, 22 showed various neuroses, 3 were hypochon- driasis, and 2 were in depressive states. The remaining three patients were diagnosed later to be suffering from a conflict reaction, a psychogenic reaction and a doubtful case of cerebral vascular disorder.

The otorhinological patients were those out-patients at the Medical School Hospital of

Osaka University and at the Ohtemae Hospital, Osaka, whose diseases were diagnosed to

be psychogenic. Of these 52 otorhinological patients, 12 were cases of sudden deafness,

7 were KKN (Kehlkopfes Neurose), 5 were tinnitus, 17 were Meniere disease and 11 were vertigo dizziness, respectively.

The asthma patients were the in and out-patients at the Habikino Hospital, Osaka, and at the Tokyo Teishin Hospital.

The demographic characteristics or" these samples are shown in Table 11-1.

As to these demographic characteristics, there were no significant differences among the four suoject groups in Study II. Furthermore, there was no significant differences between the 221 control subjects in Study I and the 130 control subjects in Study II, or between the 107 neuropsychiatric patients in Study I and the 30 neuropsychiatric patients in Study II.

Therefore, the comparisons among or between these subject groups are possible and the differences among or between these subject groups could be concluded due to their patho- logical differences, not due to their demographic differences.

Procedure

The MQLES was completed by .the 365 subjects.

I) In order to examine a discriminant validity of the neurotic stress score and the psy- chosomatic stress score which were developed in Study I, these scores were calculated for each of the 365 subjects.

(The neurotic stress score is a weighted composite score based on the responses to Parts A -symptoms or complaints- and Part B -stressful life events- of the MQLES.

The weights for each items of Part A and B were obtained by a discriminant analysis between 221 control subjects and 107 neuropsychiatric patients in Study I. The psy- chosomatic stress score is a similar weighted composite score but the weights for the items were obtained by a discriminant analysis between 221 control subjects and 146 peptic ulcer patients in Study I)

A diagnosis wh~ther each subject is a stress victim or not was made by the following criteria.

As to the neurotic stress score, the subjects whose scores were greater than 0. 750 were diagnosed to be "stress victim", the subjects whose scores were between 0. 700 and 0.750 were diagnosed to be "borderline case", and the subjects whose score were less than 0. 700 were diagnosed as "normal".

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Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa) Table 11-1 Demographic Characteristics of the Subjects (Study II)

Controls Neuropsychiatric Otorhinological Asthma

Patients Patients Patients

Male Female Male Female Male Female Male Female

n=71 n=59 n=l6 n=l4 n=27 n=25 n=82 n=71

Mean Age (S.D.)

49.3 47.3 45.1 46.3 47.4 52.8 54.2 50.6

(15.7) (16.6) (12.6) (12.8) (15.4) (12.7) (12.2) (12.8) Marital Status

% % % % % % % %

Single 18.3 20.3 31.3 21.4 22.2 8.0 7.3 12.7

Married 78.9 71.2 62.5 78.6 77.8 84.0 89.0 81.7

Divorced 1.4 1.7 6.3 0.0 0.0 8.0 1.2 1.4

Widowed 1.4 6.8 0.0 0.0 0.0 0.0 2.4 4.2

Education

Junior High 4.3 6.8 0.0 28.6 11.1 13.0 26.3 15.5

High school 35.7 47.5 25.0 28.6 55.6 43.5 32.5 50.7

Junior college 7.1 27.1 12.5 21.4 0.0 21.7 2.5 19.7

University 42.9 13.6 43.8 14.3 22.2 4.4 31.3 9.9

Graduate col. 1.4 0.0 6.3 0.0 3.7 4.4 1.3 0.0

Others 8.6 5.1 12.5 7.1 7.4 4.4 6.3 4.2

Occupation

Manager 9.9 3.4 37.5 0.0 25.9 8.3 19.5 2.8

Employee 45.1 30.5 31.3 14.3 25.9 8.3 17.1 19.7

Teacher 0.0 0.0 6.3 0.0 3.7 4.2 23.2 2.8

Self Employed 4.2 0.0 18.8 7.1 14.8 7.0 13.4 7.0

Housewife 50.9 42.9 62.5 52.1

Retired 32.4 0.0 6.3 0.0 18.5 0.0 22.0

Others 8.5 15.3 0.0 35.1 11.1 2.4 2.4 5.6

Annual Income Less than

2 million yen 2.9 40.4 12.5 71.4 3.7 61.9 4.0 56.7

4 ⁿ 31.4 29.8 18.8 28.6 33.3 19.1 15.0 23.9

6 35.7 15.8 18.8 0.0 22.2 4.8 35.0 7.5

8 ⁿ 18.6 5.3 18.8 0.0 11.1 4.8 20.0 6.0

IO n 5.7 1.8 12.5 0.0 11.1 0.0 0.0 3.0

More than 10 m. 5.7 3.5 18.8 0.0 18.5 9.5 16.3 3.0

Unknown 1.4 3.5 0.0 0.0 20.0 2.4 5.6

As to the psychosomatic stress score, the subjects whose scores were greater than 0.460 were diagnosed to be "stress victim", the subjects whose scores were between 0.410 and 0.460 were diagnosed to be "borderline case", and the subjects whose score were less than 0.410 were diagnosed as "normal".

These cutting points were determined by both the distributions of these scores and the results of the discriminant analyses in Study I. However, the positive or nega- tive weights of the items for the psychosomatic stress scores were reversed in Study II so that positive scores point to psychosomatic stress.

2) In order to examine the characteristics of each of five subject groups regarding the symptoms or complaints (Part A), stressful life events experienced (Part B), personal dispositions (Part C) and social conditions (Part D), comparisons were made by sex between these five subject groups on all items of the MQLES by using chi-square tests or t-tests.

In this comparison, 221 control subjects in Study I and 130 control subjects in Study II were combined to one group of a total of 351 subjects (181 males and 170 females), since there were no significant differences between these two groups in terms of their demographic characteristics. Similarly, 107 neuropsychiatric patients in Study I and 30 neuropsychiatric patients in Study II were combined to one group of a total of 137 neuropsychiatric patients (64 males and 73 females) through the same statistical tests.

Therefore, a total of 839 subjects was compared by group and by sex in these com- parative analyses.

3) In order to examine the factorial validity of Part A and B of the MQLES, the principal factor analysis was applied to the data of 839 subjects and six factors were extracted according to the scree test. The factor matrix obtained was then rotated by the Promax method. Based on the rotated reference structure, the meaning of each factor was interpreted.

4) The Spearman-Brown split-half reliability, inter-item consistency (Cronbach's alpha) values, and test-retest correlations were calculated for only Part Cl (Type A-B behavior pattern), and Part C2 (Locus of control).

For Part A (Symptoms or Complaints) and Part B (Stressful life events), the test- retest reliability of the neurotic stress score and the psychosomatic stress score were examined. Because the notion of internal consistency is inappropriate to examine the phenomena of independently occurring life events or symptoms.

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Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa)

The reliability of Part D (Social conditions) was examined in terms of the test-retest correlation for the same reason.

The subjects of this reliability analysis were 63 control subjects and they completed a second MQLES four weeks after the first administration.

Results

1 Discriminant Validity

The means and the standard deviations of the neurotic stress scores and the percentages of "stress victims" diagnosed by the scores are shown in Table II-2A. Similar statistics of the psychosomatic stress score are shown in Table II-2B.

It could be concluded from Table II-2A that the diagnostic power of the neurotic stress score is very high because the percentages of the subjects diagnosed as stress victim by this score were only 2.30Jo for the control subjects, while the percentages were 63.30Jo for the neuropsychiatric patients (78.60Jo among the female neuropsychiatric patients), 30.80Jo for the psychogenic otorhinological patients, 13.70Jo for the peptic ulcer patients, and 5.90Jo for the asthma patients respectively.

The reason for a relatively low percentage of 50.00Jo of stress victims among the male neuropsychiatric patients seems to be due to the fact that five non-neurotic patients (31 OJo) were included in this sample. If only the neurotic patients were adopted, the percentage would become 63.60Jo.

The diagnostic power of the psychosomatic stress score could be said to be moderate.

The percentages of the stress victims diagnosed by this score were 53.30Jo for the neuropsy- chiatric patients, 40.40Jo for the psychogenic otorhinological patients, 38.60Jo for the asthma patients and 23.1 OJo for the controls.

A relatively high percentage of the stress victims among the control subjects by the psy-

chosomatic score seems to be due to the fact that there were not so many significant

differences in the numbers of psychophysical symptoms or complaints and stressful life

events between the control subjects and the peptic ulcer patients as seen between the con-

trols and the neuropsychiatric patients.

oo~*•ra•••e~Jmuwm2~

Table II-2A The Means and the Standard Deviations of the Neurotic Stress Score and The Percentages of "Stress Victims" by the Score

Diagnosed As

Mean S.D. Normal Borderline Stress Victim N

Controls M -0.517 0.595 97.2% 1.4% 1.4% 71

F -0.586 0.657 94.9% 1.7% 3.3% 59

M+F -0.548 0.625 96.2% l .50Jo 2.3% 130

Asthma M -0.530 0.708 95.1 OJo 0.0OJo 4.9% 82

Patients F -0.604 0.773 91.5% 1.4% 7 .OOJo 71

M+F -0.564 0.740 93.5% 0.7% 5.9% 153

Peptic M -0.250 0.694 85.8% 0.9% 13.3% 113

Ulcer F -0.051 0.760 84.8% 0.0OJo 15.lOJo 33

Patients* M+F -0.205 0.714 85.6% 0.7% 13.7% 146

Otorhin. M 0.027 1.104 66.7% 0.0OJo 33.3% 27

Patients F 0.061 0.981 72.00Jo 0.0OJo 28.00Jo 25

M+F 0.043 1.020 69.2% 0.0OJo 30.8% 52

Neuropsy. M 1.157 0.950 43.7% 6.3% 50.00Jo 16

Patients F 1.405 0.659 21.4% 0.0OJo 78.6% 14

M+F 1.273 0.837 33.3% 3.3% 63.3% 30

*These peptic ulcer patients were the subjects in Study I. Since the data of this group was not used in the development for the neurotic stress score, the results of this group are presented here as validation data for the neurotic stress score.

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Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- {II) (Ishikawa)

Table 11-28 The Means and the Standard Deviations of the Psychosomatic Stress Score and the Percentages of "Stress Victims" by the Score

Diagnosed As

Mean S.D. Normal Borderline Stress Victim N

Controls M -0.111 0.770 77.5% 0.9% 21.1 OJo 71

F -0.103 0.969 74.6% 0.0OJo 25.4% 59

M+F -0.107 0.866 76.2% 0.1 OJo 23.1 OJo 130

Asthma M 0.201 1.094 68.3% 1.2% 30.5% 82

Patients F 0.564 1.090 49.3% 2.8% 47 .90Jo 71

M+F 0.370 1.101 59.5% 2.00Jo 38.6% 153

Peptic M 0.783 1.042 41.6% 1.8% 56.6% 113

Ulcer F 0.941 0.999 33.3% 0.0OJo 66.7% 33

Patients M+F 0.818 1.034 39.7% 1.4% 58.9% 146

Otorhin. M 0.191 0.828 63.00Jo 0.0OJo 37 .0OJo 27

Patients F 0.302 1.071 56.00Jo 0.0OJo 44.00Jo 25

M+F 0.244 0.954 59.6% 0.0OJo 40.4% 52

Neuropsy. M 0.297 1.290 43.8% 0.0OJo 56.3% 16

Patients F 0.194 0.974 50.00Jo 0.0OJo 50.00Jo 14

(Study II) M+F 0.249 1.154 46.7% 0.0OJo 53.3% 30

Neuropsy. M 0.051 1.031 62.5% 2.1 OJo 35.4% 48

Patients F 0.418 1.579 50.8% 1.7% 47.4% 59

(Study I) M+F 0.253 1.372 56.1 OJo 1.9% 42.1 OJo 107

2 Comparative Analyses between Five Subject Groups

As mentioned earlier, since there were no significant differences between the samples of control subjects in Study I and II as to demographic characteristics, both subjects were combined into one sample of control subjects. This was also done for the neuropsychiatric patients in Study I and II. Then, the comparisons were made by sex between five groups of subjects.

The number of subjects of each group in the comparative analyses were as follows:

Group Sex Number of Subjects

Control Subjects (Gr.C) Male 181

Female 170

Neuropsychiatric (Gr .P) Male 64

Patients Female 73

Peptic Ulcer (Gr.U) Male 113

Patients Female 33

Otorhinological (Gr.O) Male 27

Patients Female 25

Asthma Patients (Gr .A) Male 82

Female 7.1

Total 839

1) Number of Symptoms or Complaints

The number of Symptoms or complaints during the previous month reported by all 839 subjects formed a Poisson distribution as shown in Table 11-3. That is, the mode of the distribution rested on one or two symptoms or complaints and about 64% of the subjects reported less than five symptoms or complains.

By subject group, the estimated ramdas (A) of the Poisson distribution curves were 1.0 for the controls, 2.0 for the peptic ulcer patients, 3.0 for the asthma patients, and 4.0 for the otorhinological patients. The curve for the neuro-psychiatric.patients was a rectangu- lar distribution rather than a Poisson distribution.

The male subjects who reported more than six symptoms or complaints were 81.2% of the neuropsychiatric patients, 51. 9% of the otorhinological patients, 35 .4o/o of the asthma

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Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa)

patients, 23.00Jo of the peptic ulcer patients, and 13.3% of the controls.

Among female subjects, these percentages were 83.6% for the neuropsychiatric patients, 46.8% for the asthma patients, 44.00Jo for the otohinological patients, 39.4% for the peptic ulcer patients and 21.2% for the control subjects.

The neuropsychiatric patients complained of many more symptoms than any other patient groups as anticipated, and the female subjects reported more symptoms or complaints compared to the male subjects throughout all groups.

2) Contents of Symptoms or Complaints by Group and by Sex

The percentages by group for each of 33 items of the symptoms or complaints reported by male subjects are shown in Table 11-4, and the significant differences of the percen- tages between the groups are shown in Table 11-5. Table 11-6 and Table 11-7 are similar statistics for female subjects.

Among the male subjects, the percentages of symptoms or complaints reported by the neuropsychiatric patients were very high compared to those percentages reported by any other groups. Additionally they tended to cite more psychological symptoms such as

"irritation and anxiety" than physical symptoms. More than 600Jo of the neuropsychiatric patients reported "irritation and anxiety", "excessive fatigue", "insomnia", "powerless sensation", "repeated peculiar thought" and "depression".

Compared to the control subjects, the neuropsychiatric patients showed significantly high percentages on twenty six items of psychophysical symptoms at more than a 50Jo level, while the peptic ulcer patients showed significant differences on 12 items, the otorhinological patients showed on 11 items, and the asthma patients on 13 items as shown in Table 11-5.

Among the female subjects, many neuropsychiatric patients, as in the case of male patients, complained more of psychological symptoms as mentioned above than physical symptoms, but "anorexia" was reported more frequently by female patients (63.00Jo) compared to the male patients (48.4%).

Compared to the control subjects, the female neuropsychiatric patients showed signifi-

cantly high percentages on twenty six items at more than the 50Jo level, while the female

peptic ulcer patients showed on 8 items, the female otorhinological patients on 6 items,

and the female asthma patients on 11 items as shown in Table II-7.

.... .., 0 I

Table 11-3 .Number of Symptoms or Complaints Reported by Subject Groups Number of Symptoms/Complaints 0 ... I ••1•1 • • • • • ••11II1•111••• ••• •• 1• • •• • •••• • • •• • ••• • • •••• •• 2 ••••••••••••••••••••••••••••••••••••••••••••••••••••••• 3 ... 4 ... 11111111111111•11•11 5 11111•1111•••111111•11111111••·11•11• 6 11•111111•••11•1111•11••11 7 11•111111•••11•11•11• 8 •1111•11•1111 9 •1111•1111111111• 10 ... 111111• ll •11111111• 12 111•11• 13 11111111 14 11•111111 15 •1111•11 16 1111 17 ... 18 1111• 19 11• 2011 21 •11 22 • 26 • 27 • 10 20 30 40 50 60 70 80 90 100 110 FREQUENCY

FREQ 79 110 109 91 74 76 51 42 26 33 26 19 13 16 18 16 7 6 9 5 4 5 1 2 1

TOTAL CUM. CUM. FREQ OJo OJo 79 9.42 9.42 189 13.11 22.53 298 12.99 35.52 389 10.85 46.36 463 8.82 55.18 539 9.06 64.26 590 6.08 70.32 632 5.01 75.33 658 3.10 78.43 691 3.93 82.36 717 3.10 85.46 736 2.26 87.72 749 1.55 89.27 765 1.91 91.18 783 2.15 93.33 799 1.91 95.23 806 0.83 96.07 812 0.72 96.78 821 1.07 97.85 826 0.60 98.45 830 0.48 98.93 835 0.60 99.52 836 0.12 99.64 838 0.24 99.88 839 0.12 100.00

MALE FEMALE Gr.C Gr.P Gr.U Gr.O Gr.A Gr.C Gr.P Gr.U Gr.O Gr.A OJo OJo OJo OJo OJo OJo OJo OJo OJo OJo 20.99 0.00 4.42 3.70 2.44 14.71 0.00 0.00 12.00 5.63 25.97 3.13 15.04 11.11 9.76 14.71 1.37 3.03 4.00 9.86 17.13 4.69 10.62 14.81 13.41 18.82 4.11 12.12 8.00 9.86 9.94 1.56 14.16 7.41 17.07 15.88 2.74 6.06 12.00 9.86 7.73 3.13 14.16 7.41 10.98 7.06 2.74 21.21 16.00 7.04 4.97 6.25 18.58 3.70 10.98 7.65 5.48 18.18 4.00 11.27 3.31 7.81 4.42 18.52 7.32 5.88 2.74 6.06 16.00 8.45 4.42 9.38 2.65 11.11 9.76 2.94 5.48 6.06 0.00 4.23 1.10 1.56 3.54 7.41 3.66 2.94 4.11 3.03 4.00 5.63 1.10 9.38 5.31 0.00 4.88 3.53 4.11 3.03 4.00 5.63 0.55 6.25 2.65 0.00 1.22 1.76 9.59 9.09 8.00 2.82 1.66 7.81 1.77 0.00 2.44 0.59 5.48 0.00 4.00 1.41 0.00 1.56 0.88 7.41 0.00 2.35 4.11 0.00 0.00 4.23 0.00 6.25 0.00 0.00 1.22 0.00 6.85 9.09 0.00 1.41 0.00 4.69 1.77 3.70 2.44 0.00 6.85 0.00 0.00 7.04 0.00 7.81 0.00 0.00 0.00 0.00 10.96 0.00 4.00 2.82 0.00 3.13 0.00 0.00 0.00 0.00 5.48 0.00 0.00 1.41 0.00 3.13 0.00 0.00 0.00 0.00 4.11 0.00 4.00 0.00 0.00 3.13 0.00 3.70 1.22 0.59 4.11 3.03 0.00 0.00 0.55 1.56 0.00 0.00 1.22 0.00 2.74 0.00 0.00 0.00 0.00 3.13 0.00 0.00 0.00 0.00 2.74 0.00 0.00 0.00 0.55 1.56 0.00 0.00 0.00 0.59 2.74 0.00 0.00 0.00 0.00 1.56 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.37 0.00 0.00 1.41 0.00 1.56 0.00 0.00 0.00 . 0.00 0.00 0.00 0.00 0.00 181 64 113 27 82 170 73 33 25 71 NUMBER OF SUBJECTS

Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa) Table 11-4 Prevalence of Certain Symptoms or Complaints (Male)

Gr.C Gr.P Gr.U Gr.O Gr.A

Controls Neuro- Peptic Otorhin. Asthma Psychiat. Ulcer Patients Patients

Patients Patients·

N= 181 N=64 N=113 N=27 N=82

Ofo ^0,10 Ofo Ofo Ofo

Symptom/complaint

Al Migraine 5.52 25.00 0.88 18.52 10.98

A2 Headache 12.71 42.19 13.27 37.04 23.17

A3 Dizziness 4.42 37.50 8.85 40.74 7.32

A4 Fainting spells 0.00 4.69 0.88 0.00 1.22

A5 Blurred vision 17.13 37.50 15.93 14.81 29.27

A6 Skin rashes 6.63 7.81 1.77 14.81 13.41

A7 Indigestion 15.47 23.44 16.81 22.22 6.10

AS Stomachache 16.57 29.69 64.60 22.22 14.63

A9 Vomiting 2.76 17.19 13.27 18.52 4.88

AlO Excessive appetite 6.08 7.81 7.08 3.70 3.66

All Weight gain 9.39 9.38 6.19 14.81 24.39

A12 Weight loss 9.94 35.94 24.78 14.81 12.20

Al3 Excessive menstruation

A14 Palpitation 5.52 37.50 3.54 7.41 18.29

A15 Asthma 1.10 4.69 0.88 3.70 78.05

A16 Excessive sweating 2.76 29.69 1.77 18.52 15.85

A17 Difficulty in swallowing 3.31 14.06 3.54 11.11 6.10

A18 Anorexia 8.33 48.44 30.97 3.70 9.76

A19 Chest pain 7.18 31.25 23.01 14.81 15.85

A20 Choking sensation 2.21 18.75 7.96 7.41 42.68

A21 Drug intake-increase 11.60 34.38 37.17 22.22 26.83

A22 Alcohol intake-increase 11.05 14.06 4.42 18.52 7.32

A23 Smoking-increase 11.05 21.88 10.62 7.41 4.88

A24 Reduced work efficiency 3.87 60.94 19.47 33.33 10.98

A25 Excessive fatigue 24.31 68.75 34.51 44.44 30.49

A26 Powerlessness sensation 8.84 62.50 13.27 14.81 12.20

A27 Insomnia 17.13 68.75 19.47 33.33 31.71

A28 Nightmares 5.52 18.75 0.88 14.81 7.32

A29 Persistent fears 2.76 34.38 1.77 3.70 0.00

A30 Shaking head and hands 4.42 31.25 2.65 7.41 9.76

A31 Irritation and anxiety 6.08 70.31 12.39 29.63 13.41

A32 Repeated peculiar thoughts 16.02 57.81 14.16 33.33 17.07

A33 Depression 3.31 57.81 14.16 14.81 8.54

li!W:k~ H±~~Jm~~J ffi24~ffi 2 % Table 11-5 Significant Differences Among Five (Male) Groups

C:P C:U C:O C:A P:U P:O P:A U:O U:A O:A Symptom/ complaint

Al Migraine *** * * *** * *** **

A2 Headache *** *** * *** * ** ^!:,.

A3 Dizziness *** *** *** *** *** ***

A4 Fainting spells **

AS Blurred vision *** * *** * *

A6 Skin rashes ^{!:,. !:,.} * ** ***

A7 Indigestion * ** * *

AS Stomachache * *** *** * *** ***

A9 Vomiting *** *** *** * ^!:,. *

AlO Excessive appetite

All Weight gain *** * ***

Al2 Weight loss *** *** * *** *

Al3 Excessive menstruation

Al4 Palpitation *** *** *** ** ** ***

Al5 Asthma ^!:,. *** *** *** ***

Al6 Excessive sweating *** *** *** *** * *** ***

Al 7 Difficulty in swallowing ** ^{!:,. !:,.}

Al8 Anorexia *** *** * *** *** ** ***

Al9 Chest pain *** *** * *

A20 Choking sensation *** * *** * ** *** ***

A21 Drug intake-increase *** *** **

A22 Alcohol intake-increase * * ** ^!:,.

A23 Smoking-increase * * ^!:,. **

A24 Reduced work efficiency *** *** *** * *** * *** **

A25 Excessive fatigue *** ^!:,. * *** * ***

A26 Powerlessness sensation *** *** *** ***

A27 Insomnia *** * ** *** ** *** ^!:,.

A28 Nightmares *** * ^!:,. *** * *** *

A29 Persistent fears *** *** ** *** ^!:,.

A30 Shaking head and hands *** ^!:,. *** * *** *

A3 l Irritation and anxiety *** ^!:,. *** * *** *** *** * ^!:,.

A32 Repeated peculiar thoughts *** * *** * *** * ^!:,.

A33 Depression *** *** ** ^!:,. *** *** ***

*** p< .001 ** ^p<.01 * ^{p<.05 !:,. p<.10}

-122-

Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa) Table 11-6 Prevalence of Certain Symptoms or Complaints (Female)

Gr.C Gr.P Gr.U Gr.O Gr.A

Controls Neuro- Peptic Otorhin. Asthma Psychiat. Ulcer Patients Patients

Patients Patients

N=170 N=73 N=33 N=25 N=71

OJo % % % %

Symptom/ complaint

Al Migraine 11.18 23.29 21.21 12.00 16.90

A2 Headache 25.29 36.99 30.30 40.00 42.25

A3 Dizziness 14.12 36.99 21.21 36.00 19.72

A4 Fainting spells 0.00 4.11 0.00 0.00 1.41

A5 Blurred vision 27.06 42.47 12.12 20.00 30.99

A6 Skin rashes 7.65 12.33 6.06 4.00 5.63

A7 Indigestion 9.41 20.55 18.18 16.00 14.08

AS Stomachache 22.35 41.10 69.70 16.00 26.76

A9 Vomiting 2.35 20.55 21.21 12.00 16.90

AlO Excessive appetite 10.00 6.85 15.15 - 4.00 19.72

All Weight gain 20.00 6.85 12.12 8.00 19.72

A12 Weight loss 9.41 49.32 18.18 20.00 14.08

A13 Excessive menstruation 2.94 6.85 18.18 8.00 2.82

A14 Palpitation 8.24 56.16 18.18 16.00 23.94

A15 Asthma 0.00 1.37 9.09 0.00 76.06

A16 Excessive sweating 10.59 30.14 9.09 4.00 14.08

A17 Difficulty in swallowing 0.59 26.03 12.12 16.00 7.04

A18 Anorexia 9.41 63.01 21.21 12.00 15.49

A19 Chest pain 8.82 30.14 21.21 16.00 23.94

A20 Choking sensation 5.29 34.25 12.12 8.00 38.03

A21 Drug intake-increase 11.18 52.05 21.21 40.00 32.39

A22 Alcohol intake-increase 2.35 8.22 9.09 0.00 1.41

A23 Smoking-increase 2.94 4.11 6.06 4.00 0.00

A24 Reduced work efficiency 9.41 42.47 9.09 12.00 12.68

A25 Excessive fatigue 34.71 61.64 45.45 44.00 36.62

A26 Powerlessness sensation 17.06 63.01 24.24 20.00 18.31

A27 Insomnia 15.29 75.34 27.27 48.00 35.21

A28 Nightmares 8.24 - 36.99 3.03 12.00 5.63

A29 Persistent fears 2.35 35.62 0.00 4.00 1.41

A30 Shaking head and hands 1.76 23.29 6.06 8.00 14.08

A31 Irritation and anxiety 10.59 78.08 27.27 32.00 16.90 A32 Repeated peculiar thoughts 22.35 64.38 39.39 40.00 21.13

A33 Depression 12.94 75.00 30.30 20.00 14.08

oo ■*•rtt•••E•J•~••z%

Table 11-7 Significant Differences Among Five (Female) Groups

C:P C:U C:O C:A P:U P:O P:A U:O U:A O:A Symptom/ complaint

Al Migraine *

A2 Headache A **

A3 Dizziness *** ** *

A4 Fainting spells **

A5 Blurred vision * ^A ** * *

A6 Skin rashes

A7 Indigestion *

AS Stomachache ** *** ** * ^A *** ***

A9 Vomiting *** *** * ***

AIO Excessive appetite * * ^A

Al 1 Weight gain A *

Al2 Weight loss *** ** ** ***

Al3 Excessive menstruation *** ^A **

Al4 Palpitation *** ^A *** *** *** ***

Al5 Asthma *** *** ^.A *** *** ***

Al6 Excessive sweating *** * ** *

Al 7 Difficulty in swallowing *** *** *** ** **

Al8 Anorexia *** * *** *** ***

Al9 Chest pain *** * **

A20 Choking sensation *** *** * * ** **

A21 Drug intake-increase *** *** *** ** *

A22 Alcohol intake-increase * ^{A A A}

A23 Smoking-increase A * ^A

A24 Reduced work efficiency *** *** ** ***

A25 Excessive fatigue *** **

A26 Powerlessness sensation *** *** *** ***

A27 Insomnia *** ^A *** *** *** * ***

A28 Nightmares *** *** * ***

A29 Persistent fears *** *** ** ***

A30 Shaking head and hands *** ^A *** * ^A

A3 l Irritation and anxiety *** ** ** *** *** ***

A32 Repeated peculiar thoughts *** ^{A A} * * *** ^{A A}

A33 Depression *** ^A *** *** *** ^A

*** p<.001 ** p<.01 * ^{p<.05 A p<.10}

-124-

Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa)

3) Number of Stressful Life Events Experienced

The distribution of the number of stressful life events in the previous one year experienced by all 839 subjects was also a Poisson curve, with the mode at zero occurrence as shown in Table 11-8. However, the shapes of the curves were different by the subject groups. That is, the distribution for the control subjects had an estimated ramda value of approximately 0. 7, suggesting that most of control subjects experienced a stressful life event none or only one time during the period. On the contrary, the majority of the neu- ropsychiatric patients reported three to six stressful life events. The ramda value for the neuropsychiatric patients estimated to be 4.0. The estimated ramda values for other patient groups were 2.0 for the otorhinological patients and 1.0 for both the peptic ulcer patients and the asthma patients.

The number of subjects who reported more than three stressful life events by sex were as follows:

Male N Female N

Control Subjects 45.9% 181 41.2% 170

Neuropsychiatric Patients 65.6% 64 67.1 OJo 73

Peptic Ulcer Patients 37 .20Jo 113 17.3% 33

Otorhinological Patients 59.2% 27 44.00Jo 25

Asthma Patients 42.7% 82 39.4% 71

These results suggest that, except for the neuropsychiatric patients, the frequencies of

stressful life events experienced are not so much different by group but the control sub-

jects may have a better coping ability compared to the patient groups.

.... ""

I

Table 11-8 Number of Stressful Life Events Experienced by Subject Groups TOTAL FREQ CUM. CUM. Number of Life Events FREQ OJo OJo 0 11111111111111111 I IIII I I II I I I I I 111 172 172 20.50 20.50 1 111111111111111111 IIII IIII I II 1 151 323 18.00 38.50 .2 1111111111111111111 Ill I II 126 449 15.02 53.52 3 11111111111111111111 101 550 12.04 65.55 4 11111111111111 II 11 91 641 10.85 76.40 5 11111111111 56 697 6.67 83.08 6 11111111111 54 751 6.44 89.51 7 111111 29 780 3.46 92.97 8 1111 19 799 2.26 95.23 9 1111 18 817 2.15 97.38 10 I 7 824 0.83 98.21 11 I 3 827 0.36 98.57 12 I 7 834 0.83 99.40 lJ I 3 837 0.36 99.76 14 1 838 0.12 99.88 16 1 839 0.12 100.00 20 40 60 80 100 120 140 160 FREQUENCY

Gr.C OJo 23.76 20.99 9.39 13.26 8.84 7.18 6.63 3.31 0.55 3.31 1.10 0.55 1.10 0.00 0.00 0.00 181

MALE FEMALE Gr.P Gr.U Gr.O Gr.A Gr.C Gr.P Gr.U Gr.O Gr.A OJo OJo OJo OJo OJo OJo OJo OJo OJo 7.81 23.89 7.41 20.73 24.12 9.59 18.18 24.00 26.76 7.81 20.35 11.11 17.07 20.00 9.59 27.27 24.00 19.72 18.75 18.58 22.22 19.51 14.71 13.70 27.27 8.00 14.08 9.38 15.04 25.93 14.63 9.41 6.85 6.06 16.00 11.27 12.50 4.42 14.81 15.85 11.76 15.07 9.09 16.00 5.63 15.63 4.42 7.41 4.88 4.12 12.33 6.06 0.00 2.82 6.25 3.54 0.00 3.66 7.65 5.48 6.06 8.00 14.08 3.13 2.65 3.70 2.44 3.53 10.96 0.00 0.00 1.41 7.81 5.31 3.70 0.00 1.18 2.74 0.00 4.00 1.41 3.13 1.77 0.00 0.00 1.18 5.48 0.00 0.00 2.82 3.13 0.00 0.00 0.00 0.59 2.74 0.00 0.00 0.00 1.56 0.00 0.00 0.00 0.00 1.37 0.00 0.00 0.00 1.56 0.00 0.00 1.22 0.59 2.74 0.00 0.00 0.00 1.56 0.00 3.70 0.00 0.59 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.37 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.59 0.00 0.00 0.00 0.00 64 113 27 82 170 73 33 25 71 NUMBER OF SUBJECTS

Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa)

4) Contents of Stressful Life Events by Group and by Sex

The percentages by group for each of 55 items of stressful life events.or daily hassles reported by the male subjects are shown in Table 11-9, and the significant differences of the percentages between groups are shown in Table 11-10.

Table 11-11 and Table 11-12 are the similar statistics for the female subjects.

As shown in Table 11-10, the significant differences between the male control subjects and the male neuropsychiatric patients were mainly seen in those items relating to a) habitual changes such as in sleeping hours, in meal habits, in life habits, in life environ- ment, and b) work conditions such as unemployment, new jobs, organizational changes at work site, changes in both work conditions and in work line etc. Furthermore, it was noteworthy that ''troubles in sexual life'' were reported significantly more frequently by the neuropsychiatric patients compared to the controls.

As shown in Table 11-11, the male peptic ulcer patients, compared to the control subjects, showed significant differences on the only four items: "decrease of family circle", "decreased opportunity to go out", "new job", and "law suit".

The items reported significantly more frequently by the male otorhinological patients in comparison with the control subjects were "hospitalization of family member", "loan more than 5 million yen", "new job" and "law suit". The items significantly cited by the asthma patients were "changes in sleeping hours", "changes in life habits", "child leaves home" and "death of close friends".

These findings are very interesting to note but it would be premature to make conclu-

sions based on only the significant differences between the control subjects and each of

the patient groups that the life events or daily hassles as pointed out above are the stres-

sors to each illness.

OOi!i:k~ rtt:4l.~$kc~J ffi24~ffi 2 ~

Table 11-9 Prevalence of Certain Stressful Life Events (Male)

Gr.C Gr.P Gr.U Gr.O Gr.A

Controls Neuro- Peptic Otorhin. Asthma Psychiat. Ulcer Patients Patients

Patients Patients

N=181 N=64 N=113 N=27 N=82

OJo OJo OJo OJo OJo

Symptom/ complaint

Bl Change in sleeping hours 28.73 42.19 21.24 37.04 17.07

B2 Change in meal habits 11.60 21.88 13.27 22.22 6.10

B3 Change in life habits 12.15 23.44 7.08 11.11 3.66

B4 Change in life environment 11.60 26.56 8.85 11.11 10.98

BS Wife's pregnancy 2.21 1.56 2.65 3.70 1.22

B6 Wife's delivery 2.21 1.56 5.31 3.70 1.22

B7 Wife's miscarriage

BS New person in household 4.97 6.25 8.85 0.00 2.44

B9 Hospitalization of family member 11.05 12.50 8.85 29.63 18.29

BIO Death of family member 3.31 1.56 4.42 3.70 1.22

Bll Death of spouse 1.10 0.00 0.00 0.00 1.22

B12 Child leaves home 3.87 1.56 2.65 11.11 10.98

B13 Increase of family circle 6.08 4.69 8.85 3.70 12.20

B14 Decrease of family circle 14.92 25.00 7.08 11.11 8.54

BIS Family discord 10.00 12.50 7.96 3.70 3.66

B16 Child's entrance exam. 6.63 3.13 5.31 11.11 8.54

B17 Child's academic failure 2.76 1.56 1.77 0.00 3.66

BIS Child's school refusal 0.00 3.13 0.00 0.00 0.00

B19 Child's violence

B20 Child's misdeed 1.10 0.00 0.00 0.00 0.00

B21 Child's major illness/injury 1.66 0.00 1.77 0.00 0.00

B22 Arguments with child 6.63 3.13 5.31 0.00 2.44

B23 Marriage 3.31 0.00 1.77 0.00 0.00

B24 Wife got a job 1.10 3.13 0.88 0.00 0.00

B25 Divorce 0.55 0.00 0.88 0.00 0.00

B26 Marital separation due to argument 0.00 1.56 0.88 0.00 1.22 B27 Marital separation not due to argument 1.66 1.56 2.65 3.70 1.22

B28 Troubles in sexual life 2.21 7.81 3.54 3.70 2.44

B29 Spouse unfaithful 0.00 1.56 0.00 0.00 0.00

B30 Increased arguments with spouse 9.94 7.81 6.19 7.41 8.54 (continued)

-128-

Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa) Table 11-9 (continued)

Gr.C Gr.P Gr.U Gr.O Gr.A

Controls Neuro- Peptic Otorhin. Asthma Psychiat. Ulcer Patients Patients

Patients Patients

N= 181 N=64 N=113 N=27 N=82

OJo OJo OJo OJo OJo

Symptom/ complaint

B31 Decreased income 12.15 14.06 9.73 7.41 9.76

B32 Decreased assets 3.31 0.00 1.77 7.41 3.66

B33 Loan more than 5 million yen 2.21 1.56 0.88 11.11 4.88 B34 Loan less than 5 million yen 2.76 3.13 1.77 0.00 1.22 B35 Major financial difficulties 1.10 0.00 0.88 0.00 2.44

B36 Arguments with neighbots 3.31 1.56 3.54 0.00 0.00

B37 Arguments with friends 2.21 3.13 1.77 0.00 0.00

B38 Arguments with relatives 2.76 6.25 3.54 3.70 4.88

B39 Decreased opportunities to go out 14.92 34.38 5.31 29.63 21.95

B40 Death of close friend 5.52 6.25 1.77 7.41 13.41

B41 Decrease of close friends 7.73 18.75 6.19 7.41 7.32

B42 Trouble with lover 4.42 7.81 2.65 3.70 2.44

B43 Retirement 12.71 7.81 6.19 7.41 6.10

B44 Unemployment 0.55 4.69 3.54 0.00 3.66

B45 New job 2.21 18.75 10.62 11.11 0.00

B46 Organizational change at work site 3.31 20.31 2.65 0.00 6.10 B47 Change in work conditions 7.18 18.75 14.16 11.11 8.54

B48 Change in line of work 7.73 21.88 6.19 18.52 10.98

B49 Promotion 6.08 9.38 4.42 11.11 2.44

B50 Argument with boss or coworker 7.73 10.94 8.85 3.70 6.10

B51 Minor legal violation 2.21 4.69 0.88 3.70 0.00

B52 Jail sentence

B53 Law suit 0.00 1.56 2.65 3.70 0.00

B54 Trouble in religion or in faith 1.10 4.69 0.00 3.70 0.00

B55 Unfavorable conditions in neighborhood 3.87 1.56 0.88 3.70 4.88

oow*•rtt••~~~Jmu~m2•

Table 11-10 Significant Differences Among Five (Male) Groups

C:P C:U C:O C:A P:U P:O P:A U:O U:A 0:A Symptom/ complaint

Bl Change in sleeping hours * * ** *** * *

B2 Change in meal habits * ** *

B3 Change in life habits * * ** ***

B4 Change in life environment ** ** *

BS Wife's pregnancy B6 Wife's delivery B7 Wife's miscarriage

BS New person in household ^I::,.

B9 Hospitalization of family ** * ** ^I::,.

member

BIO Death of family member Bl 1 Death of spouse

Bl2 Child leaves home * * * ^I::,. *

Bl3 Increase of family circle ^I::,.

Bl4 Decrease of family circle ^I::,. * *** **

BIS Family discord ^I::,. *

Bl6 Child's entrance exam.

Bl7 Child's academic failure

BIS Child's school refusal ** ^I::,.

Bl9 Child's violence B20 Child's misdeed B21 Child's major illness/

injury

B22 Arguments with child

B23 Marriage ^I::,.

B24 Wife got a job B25 Divorce

B26 Marital separation due to ^I::,.

argument

B27 Marital separation not due to argument

B28 Troubles in sexual life **

B29 Spouse unfaithful ^I::,.

B30 Increased arguments with spouse

(continued)

-130-

Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa) Table 11-10 (continued)

C:P C:U C:O C:A P:U P:O P:A U:O U:A 0:A Symptom/complaint

B31 Decreased income

B32 Decreased assets *

B33 Loan more than 5 million * * ** ^l::,.

yen

B34 Loan less than 5 million yen

B35 Major financial difficulties

B36 Arguments with neighbors ^{l::,. l::,.}

B37 Arguments with friends B38 Arguments with relatives

B39 Decreased opportunities *** * ^l::,. *** ^l::,. *** ***

to go out

B40 Death of close friend * ***

B41 Decrease of close friends * ^l::,. *

B42 Trouble with lover

B43 Retirement l::,.

B44 Unemployment * ^{l::,. l::,.}

B45 New job *** ** * *** ** **

B46 Organizational change *** *** * ^l::,.

at work site

B47 Change in work conditions ** ^{l::,. l::,.}

B48 Change in line of work ** ^l::,. ** ^l::,. **

B49 Promotion ^{l::,. l::,.}

B50 Argument with boss or coworker

B51 Minor legal violation * ^l::,.

B52 Jail sentence

B53 Law suit * * ** ^l::,.

B54 Trouble in religion or in ^l::,. * * * ^l::,.

faith

B55 Unfavorable conditions in ^l::,.

neighborhood

*** p< .001 ** ^p<.01 * p<.05 ^l::,. p<.10

oo"ffi*~ n±~~®R:cJ!J m24~m 2 ~-

Turning to the female data, as with the male subjects, more significant differences with respect to stressful life events or hassles were seen between the controls and the neuropsy- chiatric patients than among any other groups.

As shown in Table 11-12, the female neuropsychiatric patients reported significantly more frequent experience of a) habitual changes in meal habits, in life habits, and in life environment, and of b) events relating a human relationships such as family discord, divorce, and arguments with relatives or neighbors compared to the control subjects. Here again "troubles in sexual life", as seen in the male patients, were pointed out more signifi- cantly by the female neuropsychiatric patients compared to the controls.

The female peptic ulcer patients, compared to the control subjects, showed a significant difference on four items. They were "delivery", "miscarriage", "retirement" and

"trouble in religion or in faith".

In cases of the female otorhinological patients, the significant differences against the controls were seen in only two items: "troubles in sexual life" and "marital separation due to argument".

The female asthma patients reported significantly more experiences compared to the controls on four items: hospitalization of family member, arguments with relatives, decreased assets, and retirement.

The above findings are noteworthy but, here again, it would be premature to conclude that such life events or daily hassles as mentioned above are the stressors to each illness.

-132-

Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa) Table 11-11 Prevalence of Certain Stressful Life Events (Female)

Gr.C Gr.P Gr.U Gr.O Gr.A

Controls Neuro- Peptic Otorhin. Asthma Psychiat. Ulcer Patients Patients

Patients Patients

N=170 N=73 N=33 N=25 N=71

OJo OJo OJo OJo OJo

Symptom/ complaint

Bl Change in sleeping hours 25.88 38.36 30.30" 24.00 22.54

B2 Change in meal habits 9.41 24.66 12.12 0.00 8.45

B3 Change in life habits 14.12 32.88 9.09 12.00 9.86

B4 Change in life environment 17.65 39.73 9.09 12.00 8.45 B5 Wife's pregnancy

B6 Wife's delivery 0.00 0.00 3.03 0.00 0.00

B7 Wife's miscarriage 0.00 0.00 6.06 0.00 0.00

B8 New person in household 2.35 4.11 6.06 0.00 2.82

B9 Hospitalization of family member 8.82 23.29 9.09 20.00 28.17

BIO Death of family member 4.71 10.96 9.09 0.00 5.63

Bll Death of spouse 1.18 0.00 0.00 0.00 1.41

B12 Child leaves home 6.47 13.70 3.03 8.00 8.45

Bl3 Increase of family circle 5.88 4.11 0.00 8.00 11.27

Bl4 Decrease of family circle 15.29 17.81 9.09 8.00 11.27

B15 Family discord 11.18 23.61 6.06 12.00 4.23

B16 Child's entrance exam. 9.41 12.33 12.12 4.00 9.86

Bl7 Child's academic failure 6.47 1.37 6.06 0.00 2.82

Bl8 Child's school refusal 0.59 4.11 0.00 0.00 0.00

Bl9 Child's violence 0.00 1.37 0.00 0.00 0.00

B20 Child's misdeed 0.59 0.00 0.00 0.00 0.00

B21 Child's major illness/injury 2.35 2.74 0.00 4.00 2.82

B22 Arguments with child 10.00 12.33 9.09 4.00 9.86

B23 Marriage 1.76 2.74 0.00 4.00 1.41

B24 Wife got a job 2.35 1.37 3.03 0.00 0.00

B25 Divorce 0.59 4.11 0.00 0.00 0.00

B26 Marital separation due to argument 0.00 1.37 0.00 4.00 0.00 B27 Marital separation not due to argument 5.29 2.74 0.00 0.00 2.82

B28 Troubles in sexual life 0.00 2.74 0.00 8.00 1.41

B29 Spouse unfaithful 0.59 0.00 0.00 0.00 0.00

B30 Increased arguments with spouse 6.47 9.59 3.03 12.00 5.63

(continued)

OOi!i:k~ rt1:~~$Ri!!l!J ffi24~ffi 2 % Table 11-11 (continued)

Gr.C Gr.P Gr.U Gr.O Gr.A

Controls Neuro- Peptic Otorhin. Asthma Psychiat. Ulcer Patients Patients

Patients Patients

N=l70 N=73 N=33 N=25 N=71

% % % % %

Symptom/ complaint

B31 Decreased income 5.88 13.70 3.03 12.00 7.04

B32 Decreased assets 1.18 2.74 6.06 4.00 7.04

B33 Loan more than 5 million yen 2.35 2.74 0.00 0.00 2.82 B34 Loan less than 5 million yen 2.35 2.74 0.00 0.00 2.82 B35 Major financial difficulties 3.53 5.48 0.00 0.00 2.82

B36 Arguments with neighbors 2.94 8.22 0.00 0.00 1.41

B37 Arguments with friends 5.29 2.74 0.00 4.00 1.41

B38 Arguments with relatives 0.59 8.22 3.03 4.00 7.04

B39 Decreased opportunities to go out 12.94 34.25 12.12 20.00 21.13

B40 Death of close friend 3.53 1.37 3;03 0.00 4.23

B41 Decrease of close friends 7.65 12.33 6.06 16.00 7.04

B42 Trouble with lover 4.71 2.74 0.00 4.00 2.82

B43 Retirement 11.18 9.59 0.00 4.00 2.82

B44 Unemployment 0.59 4.11 0.00 0.00 0.00

B45 New job 7.06 12.33 6.06 0.00 8.45

B46 Organizational change at work site 4.12 5.48 3.03 8.00 2.82

B47 Change in work conditions 4.12 8.22 3.03 0.00 4.23

B48 Change in line of work 3.53 5.48 3.03 0.00 5.63

B49 Promotion 1.18 2.74 0.00 0.00 1.41

B50 Argument with boss or coworker 5.88 5.48 0.00 8.00 5.63

B51 Minor legal violation 2.35 0.00 3.03 0.00 0.00

B52 Jail sentence B53 Law suit

B54 Trouble in religion or in faith 0.00 1.37 3.03 0.00 1.41 B55 Unfavorable conditions in neighborhood 4.12 9.59 3.03 4.00 4.23

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Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa) Table 11-12 Significant Differences Among Five (Female) Groups

C:P C:U C:O C:A P:U P:O P:A U:O U:A O:A Symptom/complaint

Bl Change in sleeping hours t::. *

B2 Change in meal habits ** ** ** ^t::.

B3 Change in life habits *** ** * ***

B4 Change in life environment *** ^t::. *** * ***

B5 Wife's pregnancy

B6 Wife's delivery *

B7 Wife's miscarriage *** * *

BS New person in household

B9 Hospitalization of family ** ^t::. *** ^t::. *

member

BIO Death of family member t::. t::.

Bll Death of spouse

B12 Child leaves home t::. t::.

B13 Increase of family circle t::. *

B14 Decrease of family circle

B15 Family discord * ^t::. * ***

B16 Child's entrance exam.

B17 Child's academic failure t::.

BIS Child's school refusal * ^t::.

B19 Child's violence B20 Child's misdeed B21 Child's major illness/

injury

B22 Arguments with child B23 Marriage

B24 Wife got a job

B25 Divorce * ^t::.

B26 Marital separation due to ** ^t::.

argument

B27 Marital separation not due to argument

B28 Troubles in sexual life * *** ^t::.

B29 Spouse unfaithful B30 Increased arguments with

spouse

(continued)

~~*•rtte•$E~JffiU~ffi2%

Table 11-12 (continued)

C:P C:U C:O C:A P:U P:O P:A U:O U:A O:A Symptom/ complaint

B3 l Decreased income * ^!:,.

B32 Decreased assets ^!:,. *

B33 Loan more than 5 million yen

B34 Loan less than 5 million yen

B35 Major financial difficulties

B36 Arguments with neighbors ^{!:,. !:,. !:,.}

B37 Arguments with friends

B38 Arguments with relatives *** **

B39 Decreased opportunities to go out *** * ^!:,.

B40 Death of close friend B41 Decrease of close friends B42 Trouble with lover

B43 Retirement * * ^{!:,. !:,.}

B44 Unemployment * ^!:,.

B45 New job !:,.

B46 Organizational change at work site

B47 Change in work conditions B48 Change in line of work B49 Promotion

B50 Argument with boss or ^!:,.

coworker

B5 l Minor legal violation B52 Jail sentence B53 Law suit

B54 Trouble in religion or in _faith *

B55 Unfavorable conditions in ^!:,.

neighborhood

*** ^p<.001 ** ^p<.01 * p<.05 ^!:,. p<.10

-136-

Measurement of Life Stress By Means of The Multi-Modal Questionnaire For Life Events Survey And an Evaluation of Its Validity- (II) (Ishikawa)

5) Type A-B Behavior Pattern and Locus of Control

Table 11-13 shows the means and the standard deviations of the score for Type A behavior pattern by subject group and by sex, which were measured by means of Part C of MQLES. In this table, the significant differences between the mean scores were also shown.

Table 11-14 shows similar statistics for the score of internal locus of control which was also measured by Part C of MQLES.

With respect to the mean scores of Type A behavior pattern, the mean scores of the neuropsychiatric patients and of the otorhinological patients were significantly higher than those scores of the male controls, the male peptic ulcer patients and the male asthma patients.

This result may suggest that the neuropsychiatric and psychogenic otorhinological patients are those people who exerted themselves strongly to achieve control first but failed to achieve control over their environment. However, there were no significant differences among five female groups in regard to Type A scores.

In contrast, there were no significant differences among male subjects as to the mean score for internal control, while the significant differences did exist between female con- trol subjects and three female patient groups. That is, the female neuropsychiatric, otorhinological and asthma patients showed lower internal control scores compared to the control subjects, suggesting that female patients group tend to have an external locus of control expectancy.

The findings seen in the female patients are in line with the hypothesis advocated by Lefcout (1976) that persons with an external locus of control expectancy have greater proneness to pathology, particularly psychopathology, than those with an internal locus of control expectancy.

Further study would be necessary in order to find the reason why there are differences

among these two scores by group and by gender.

oo ■ *•rttQ••e•J•u••z*

Table 11-13 The Means and the Standard Deviations of the Score for the Type A Behavior Pattern by Subject Group and by Sex

Group Sex N Mean S.D Sig. Level

Control Subjects Male 181 3.64 2.12]

Neuropsychiatric Patients Male 64 4.28 2.21] *

Peptic Ulcer Patients Male 113 3.45 2.20] ** *

** **

Otorhinological Patients Male 27 4.59 1.73]

Asthma Patients Male 82 3.24 2.20 **

Control Subjects Female 170 3.06 1.84

Neuropsychiatric Patients Female 73 3.47 2.41 Peptic Ulcer Patients Female 33 3.27 1.74 Otorhinological Patients Female 25 3.24 2.80

Asthma Patients Female 71 3.59 2.04

* p<.05 ** p<.01

Table 11-14 The Means and the Standard Deviations of the Score for Internal Control by Subject Group and by Sex

Group Sex N Mean S.D Sig. Level

Control Subjects Male 181 3.34 1.74

Neuropsychiatric Patients Male 64 3.53 1.64 Peptic Ulcer Patients Male 113 3.35 1.70 Otorhinological Patients Male 27 3.81 1.66

Asthma Patients Male 82 3.47 1.71

Control Subjects Female 170 3.58

l . 6 7 ~ Neuropsychiatric Patients Female 73 3.05 1.74

Peptic Ulcer Patients Female 33 3.51 1.91 *

Otorhinological Patients Female 25 2.88 1.17

Asthma Patients Female 71 3.01 1.57 *

* p<.05 ** p<.01

-138-