Two previous reports on a female population sample in Outer London, UK, had identified certain environmental experiences–such as lack of adequate replacement care after parental loss in childhood, premarital pregnancy, and low social class and poor emotional support in adulthood–as key factors intervening between childhood loss of parent and depression in adulthood. A third paper introduced a measure of the cognitive set of situational helplessness-mastery which was associated, on the one hand, with current depression and, on the other, with loss of mother in childhood. This article examines the relationship between these other factors and situational helplessness both in childhood and in adulthood. Most are highly associated with the cognitive set, but the relationship between childhood helplessness and loss of mother appears to be differentially mediated according to whether the loss was by death or separation. A series of multivariate statistical analyses aims to integrate all the findings so far reported on in this sample into a biographical model of the developmental pathways from childhood loss of mother to current depression.

Two population enquiries in Walthamstow and Islington, London, have shown that loss of the mother before the age of 17 years, either by death or separation for a year or more, doubles the risk of depressive and anxiety disorders among adult women. Furthermore, there was a particularly high rate of adult depression among those whose mothers died before they were 6 years old, and this was associated with a measure of childhood helplessness. There was no such link of either adult disorder or childhood helplessness with age at loss under 6 years for those losing a mother by separation. Two possible explanations were explored for these contrasting results. That concerning the adequacy of mourning of the mother's death received no support. However, evidence indicated that experience with the mother before the loss (usually affected by ongoing illness) explained the link of adult depression or anxiety with her early death. The failure of age at loss to relate in the separation group was probably due to the fact that among them age of separation was not a good indication of the quality of maternal care before age 6. Indirect evidence emerged which suggested that quality of early attachment (before age 6) to the natural mother before any loss relates to childhood helplessness. This in turn relates to a higher risk of disorder in adult life.

“The role of stressful life events in the onset of Graves' disease (toxic diffuse goitre) is controversial. However, the numerous early clinical reports that supported such an association were not adequately controlled and specificity of the diagnosis could be questioned. Later studies have not shown a causal relation, but these studies were small, did not have proper controls, or epidemiological methods were inappropriate. To assess possible associations between life events, heredity, social support, and Graves' disease, we have done a population-based case-control study in a defined area with about 1 million inhabitants. Over 2 years, 208 (95%) of 219 eligible patients with newly-diagnosed Graves' disease and 372 (80%) of all selected matched controls answered an identical mailed questionnaire about marital status, occupation, drinking and smoking habits, physical activity, familial occurrence of thyroid disease, life events, social support, and personality. Compared with controls, patients claimed to have had more negative life events in the 12 months preceding the diagnosis, and negative life-event scores were also significantly higher (odds ratio 6.3, 95% confidence interval 2 · 7–14 · 7, for the category with the highest negative score). Individuals who had relatives with thyroid disease (especially first-degree and second-degree relatives) were more likely to have Graves' disease (3 · 6, 2 · 2–5 · 9). Slightly more patients than controls were divorced (1 · 8, 1 · 0–3 · 3) and reported a less frequent intake of alcohol (0 · 4, 0 · 2–0 · 8). When results were adjusted for possible confounding factors in multivariate analyses, risk estimates were almost unchanged. These findings indicate that negative life events and hereditary factors may be risk factors for Graves' disease.”

“To isolate and quantify possible determinants of any increased prevalence of depressive disorders in women we studied a select group of men and women, initially similar in terms of a number of putative social determinants of depression, and reviewed the sample five years later when social role diversity was anticipated. We used the Diagnostic Interview Schedule (DIS) to generate DSM–III and RDC diagnoses to estimate lifetime depressive disorders, and established (via corroborative reports) the likely accuracy of those data. Despite lifetime depression being a relatively common experience, no significant sex differences in depressive episodes were demonstrated, suggesting the possible irrelevance of biological factors in determining any sex difference. As there was not major social role divergence over the five year study, we interpret the lack of a sex difference as a consequence, and suggest that findings support the view that social factors are of key relevance in determining any female preponderance in depression described in general population studies.”

This paper addresses the critique which maintains that loss of parent in a sample of female adults plays no role in determining current depression over and above that of low social class position with which such loss is associated. It examines a series of variables which combine to determine current social class position and which seem to stem from lack of adequate replacement care following loss of mother. The experience of a premarital pregnancy and the way in which women cope with it emerge as critical in this process. The relationship of low social class to the onset of depression is discussed in the light of better-known vulnerability factors such as low confiding in, and undependability of, marital partner, employment outside the home and number of children. It is concluded that a current low social class position, far from explaining away the association between loss of mother and current depression, may itself be brought about by a chain of circumstances stemming from the loss. Once again, the quality of replacement care is shown to play a critical role.

The inconclusiveness of the literature on the role of loss of parent in influencing psychiatric disorder in adulthood is well known. A number of reasons involving sampling, location and other methodological features, are given to account for these contradictory findings. A study specially designed to cope with these features is then described and basic results are reported. These indicate that, in a sample of women aged 18–65, loss of mother before the age of 17, either by death or by separation of one year or more, was associated with clinical depression in the year of interview. Loss of father by death was in no way associated with current depression, but separation from father showed a trend which, however, did not reach statistical significance. Control for other possible confounding factors did not change this patterning of results; these were further supported when psychiatric episodes earlier in adulthood were examined. Examination of the caregiving arrangements in childhood suggests that it is ‘lack of care’, defined in terms of neglect rather than simply hostile parental behaviour, which accounts for the raised rate of depression. Such ‘lack of care’ is more frequent after loss of mother than after loss of father.

Surveys using clinical-type interviews have documented a high rate of depression among working-class women, and this is discussed in the light of a recent survey in an inner-city area. While women with caseness of depression contacting a psychiatrist did not differ in number of core depressive symptoms from those who did, they did in certain characteristics that would make them worrying for a general practitioner to deal with. It is concluded that there is a considerable overlap in the severity of depressive conditions between those seen by psychiatrists and those defined as cases in population surveys; any differences that do exist may relate more to the way symptoms are expressed than to the severity of the depressive disorder as such.

Although recent research in social psychiatry has produced an encouraging congruence of findings and conclusions, puzzling inconsistencies continue to be reported. One explanation which is often overlooked is that subtle differences in the way seemingly identical variables are grouped can produce sizeable, and sometimes dramatic, differences in the patterning of the same data. Re-examination of existing results can therefore often better clarify confusing inconsistencies than collection of new data. This is illustrated by examples from recent studies of affective disorder where the grouping of variables is discussed in three broad areas: parental loss in childhood, precipitating stress, and social support. Until the aetiology of affective disorder is more fully understood, it will often be clearer if data are analysed more than once, so that several combinations of variables are systematically examined.