Skip to main content Accessibility help

Validation of the Long-term Difficulties Inventory (LDI) and the List of Threatening Experiences (LTE) as measures of stress in epidemiological population-based cohort studies

  • J. G. M. Rosmalen (a1), E. H. Bos (a1) and P. de Jonge (a1)



Stress questionnaires are included in many epidemiological cohort studies but the psychometric characteristics of these questionnaires are largely unknown. The aim of this study was to describe these characteristics for two short questionnaires measuring the lifetime and past year occurrence of stress: the List of Threatening Events (LTE) as a measure of acute stress and the Long-term Difficulties Inventory (LDI) as a measure of chronic stress.


This study was performed in a general population cohort consisting of 588 females (53.7%) and 506 males (46.3%), with a mean age of 53.5 years (s.d.=11.3 years). Respondents completed the LTE and the LDI for the past year, and for the age categories of 0–12, 13–18, 19–39, 40–60, and >60 years. They also completed questionnaires on perceived stress, psychological distress (the General Health Questionnaire, GHQ-12), anxiety and depression (the Symptom Checklist, SCL-8) and neuroticism (the Eysenck Personality Questionnaire – Revised Short Scale, EPQ-RSS-N). Approximately 2 years later, 976 respondents (89%) completed these questionnaires for a second time.


The stability of the retrospective reporting of long-term difficulties and life events was satisfactory: 0.7 for the lifetime LDI and 0.6 for the lifetime LTE scores. The construct validity of these lists is indicated by their positive associations with psychological distress, mental health problems and neuroticism.


This study in a large population-based sample shows that the LDI and LTE have sufficient validity and stability to include them in major epidemiological cohort studies.


Corresponding author

*Address for correspondence: Professor J. G. M. Rosmalen, ICPE, CC72, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. (Email:


Hide All
Bebbington, PE, Tennant, C, Hurry, J (1981). Adversity and the nature of psychiatric disorder in the community. Journal of Affective Disorders 3, 345366.
Brown, GW, Harris, T (1982). Disease, distress and depression. A comment. Journal of Affective Disorders 4, 18.
Brugha, T, Bebbington, P, Tennant, C, Hurry, J (1985). The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine 15, 189194.
Brugha, TS, Cragg, D (1990). The List of Threatening Experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatrica Scandinavica 82, 7781.
Chida, Y, Hamer, M (2008). Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: a quantitative review of 30 years of investigations. Psychological Bulletin 134, 829885.
Cohen, J (1988). Statistical Power Analysis for Behavioral Sciences. Academic Press: New York.
Deary, V, Chalder, T, Sharpe, M (2007). The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clinical Psychology Review 27, 781797.
Goldberg, DP, Gater, R, Sartorius, N, Ustun, TB, Piccinelli, M, Gureje, O, Rutter, C (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine 27, 191197.
Hendriks, AAJ, Ormel, J, van de Willige, G (1990). Long-term difficulties measured by a self-report questionnaire and semi-structured interview: a comparison of methods [in Dutch]. Gedrag en Gezondheid 18, 273283.
Huisman, M (2000). Imputation of missing item responses: some simple techniques. Quality and Quantity 34, 331351.
Jorgensen, CK, Fink, P, Olesen, F (2000). Psychological distress among patients with musculoskeletal illness in general practice. Psychosomatics 41, 321329.
Kendler, KS, Kuhn, J, Prescott, CA (2004). The interrelationship of neuroticism, sex, and stressful life events in the prediction of episodes of major depression. American Journal of Psychiatry 161, 631636.
Koeter, MWJ (1992). Validity of the GHQ and SCL anxiety and depression scales: a comparative study. Journal of Affective Disorders 24, 271279.
Leichsenring, F, Leibing, E, Kruse, J, New, AS, Leweke, F (2011). Borderline personality disorder. Lancet 377, 7484.
Lucini, D, Norbiato, G, Clerici, M, Pagani, M (2002). Hemodynamic and autonomic adjustments to real life stress conditions in humans. Hypertension 39, 184188.
Ormel, J, Rosmalen, J, Farmer, A (2004). Neuroticism: a non-informative marker of vulnerability to psychopathology. Social Psychiatry and Psychiatric Epidemiology 39, 906912.
Paykel, ES (2003). Life events and affective disorders. Acta Psychiatrica Scandinavica. Supplementum 418, 6166.
Pinto-Sietsma, SJ, Janssen, WM, Hillege, HL, Navis, G, de Zeeuw, D, de Jong, PE (2000). Urinary albumin excretion is associated with renal functional abnormalities in a nondiabetic population. Journal of the American Society of Nephrology 11, 18821888.
Sanderman, R, Eysenck, SBG, Arrindell, WA (1991). Cross-cultural comparisons of personality: the Netherlands and England. Psychological Reports 69, 10911096.
Surtees, P, Wainwright, N (1998). Adversity over the life course: assessment and quantification issues. Stress Medicine 14, 205211.
van Eck, M, Berkhof, H, Nicolson, N, Sulon, J (1996). The effects of perceived stress, traits, mood states, and stressful daily events on salivary cortisol. Psychosomatic Medicine 58, 447458.
Yusuf, S, Hawken, S, Ounpuu, S, Dans, T, Avezum, A, Lanas, F, McQueen, M, Budaj, A, Pais, P, Varigos, J, Lisheng, L (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364, 937952.


Validation of the Long-term Difficulties Inventory (LDI) and the List of Threatening Experiences (LTE) as measures of stress in epidemiological population-based cohort studies

  • J. G. M. Rosmalen (a1), E. H. Bos (a1) and P. de Jonge (a1)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed