Families, life events and family service delivery

A literature review
Research Report No. 20 – August 2012

2. Life events and related literature

2.1 Life events as a field of study

Life events or transitions are understood to be circumstances that have an unsettling element for individuals and, from a systemic perspective, for family members also. Life events or transitions, even when they are pursued and ultimately beneficial, usually require adjustment on one or more fronts and relinquishment of at least some areas of familiarity.

It is generally accepted that the same externally defined transition (such as leaving home) will be experienced as a unique event by those involved. That is, although the transition might be both common and predictable, the experiences associated with that transition will be unique. In addition, how an event or transition is experienced and understood will have considerable impact on our sense of wellbeing.

The various models of understanding that have grown out of the life events research literature all have a degree of focus on "stress". Connected to life events research is also a large and quite disparate body of literature on needs and desires, some of which tends to be translated into more practical constructs, such as goals, commitments and priorities. Constructions of health and illness are also linked to the idea of success in managing life transitions - especially the idea that health is more than a mere absence of illness. An overview of the literature on "stress science", on human needs and desires, and on constructions of illness and health can be found in sections 2.2 and 2.3 below.

It is important to appreciate that the development of the life events approach was strongly influenced by models of physiological stress, especially reflected in the work of endocrinologist Selye (e.g., 1956, 1974, 1976). Selye maintained that stress is part of the everyday human experience, with the continuous presence of stressors leading to the incessant expenditure of "adaptation energy".16 Although Selye accepted that stress could have beneficial effects on health under certain conditions, he argued that repeated or chronic demands for adaptation accumulate and that this causes "wear and tear" on the organism. Such processes were considered to contribute to illness and ageing.17

The early authors of life events research assumed that the amount of stress a person experienced could be gauged by identification of the stressful events alone, since the latter would create demands upon the body's adaptive functions in the way that Selye proposed. In an attempt to quantify the adjustment demanded by life events within a given time period, Hawkins, Davies, and Holmes (1957) developed the Schedule of Recent Experience (SRE) scale to cover events occurring in the social, occupational, family and personal domains of life. The list included both positive and negative life changes, on the grounds that both require adjustment and had been earlier found to precede illness.18 That is, instead of identifying demands for adjustment independently of any observed relationship with illness, these authors selected for their scale those events found to hold a positive relationship with illness, ignoring other events that, a priori, may have been considered as demands for adjustment.

Holmes and Rahe (1967) modified this scale, with the new version called the Social Readjustment Rating Scale (SRRS). Each life change in the list - whether apparently positive or negative - was assigned an a priori weight for the amount of readjustment it required.19 The list of SRRS items has been used widely, with a modified version having been used in the HILDA survey since Wave 2, conducted in 2002. The HILDA measure comprises 21 events (see Wilkins, Warren, Hahn, & Houng, 2011). In this survey, respondents, all of whom are at least 15 years old, are asked to indicate whether they had experienced the event in the previous 12 months and, if so, the number of months ago that this event took place (4 categories).

Rahe (1974) argued that the greater the number of life changes, both positive and negative, the greater the likelihood of multiple illnesses. This contention is consistent with Selye's earlier notion (1956) of the "wear and tear" on the organism by positive and negative stimuli. But it does not take account of many of the qualifications outlined by Selye, which allowed for individual differences in responses to environmental circumstances. These qualifications included an emphasis on constitutional differences between people that were considered to promote vulnerability or resistance to the negative impact of stress, and the notion of an optimal level of stress that varies across individuals. For some people, the accumulation of few life events may exceed their optimal level of stress, while others may be able to avoid distress or achieve "eustress" despite experiencing a larger number of events (Selye, 1976).

In the SRRS, the weighting of events was designed to measure the "objective" demands for readjustment required of the individual, and no account was made of the impact of individual differences in perceived salience or severity of each event. In fact, Holmes and Rahe (1967) specifically stated that the weights for life events in the SRRS referred to changes in the life pattern of the individual rather than to the psychological meaning of events or to emotions. This approach represented quite a contrast to models of "psychological stress" that were current at the time and that attempted to explain individual differences in reactions to stressful experiences (e.g., Appley & Trumbull, 1967; Lazarus, 1966).

A number of criticisms were leveled at this life events approach (e.g., by Monroe & Roberts, 1990; Moos & Swindle, 1990; Thoits, 1983). One problem was that the predictive power of the event scores for illness tended to be low. This led to a consideration of the personal and social factors that might modify the health impact of the experience of life changes. Paykel (1978), for instance, argued that the significant factor is not simply the event, but also "the soil on which it falls" (p. 251). He suggested that factors such as social support and personality should be examined, along with the attributes of the events. These recommendations exemplified subsequent approaches adopted by researchers in this field (e.g., Hoffman, 2010; Mallinckrodt & Fretz, 1988; Roth, Wiebe, Fillingim & Shay, 1989), reflecting a narrowing of the gap between the theoretical bases of life events and psychological approaches to the study of stress. The modified approach was also consistent with changes in views expressed by Selye. For example, he eventually argued that circumstances become demands or stressors only when they are appreciated as such (Selye, 1980).20

Many other life events scales have since been developed, with some focusing on different sub-groups, such as adolescents and immigrants (see Dohrenwend, 2006). A number of the more recent versions focus exclusively on adverse events and some ask respondents to rate the stressfulness or demands for adjustment required by the event. For example, a life events measure is used in Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC),21 and different sets of life events have been developed for the three cohorts in Women's Health Australia (WHA): The Australian Longitudinal Study on Women's Health (Byles et al., 2010).22

We conclude this section on the "life events" literature by noting that many studies that do not formally use the "life events lens" nonetheless highlight the fact that life events can have cascading effects. That is, major life events tend to generate other internal or external events as suggested by the notion of "turning points". One obvious example is the impact of job loss or gain on a family's financial circumstances. In such a situation, fortunes can change substantially and the family's access to a range of goods and services can alter rapidly, as can the quality of relationships in the family, and the psychosocial wellbeing of family members (Gray, Edwards, Hayes, & Baxter, 2010; Kalil, 2009; Whiteford, 2009).

Adopting a formal life events approach is supported by the growing evidence that events that are either adverse in themselves or are perceived to be adverse, increase the risk of both physical and psychosocial disorders. Considerable research has been conducted into the processes that mediate such outcomes, in what has come to be known as "stress science" (Contrada & Baum, 2011). The following section briefly summarises key research into human stress and resilience.

2.2 Stress and resilience

2.2.1 Stress

Stress has been defined by Cohen, Kessler, and Gordon (1997) as:

a process in which environmental demands tax or exceed the adaptive capacity of the organism, resulting in psychological and biological changes that may place persons at risk for disease. (p. 3)

This definition is favoured by Contrada (2011), co-editor of a recent handbook on research into human stress (see below). According to Contrada, the definition addresses four key elements. First, it includes environmental, psychological and biological phenomena, each of which can be traced back through the history of stress research. Second, it focuses on process, a more useful concept than more static constructs such as stimulus and response. Third, the definition contains the notion that stress represents a departure from a state of homeostasis, in which there are active compensatory psychological and biological activities. And finally, it links stress with the possible development and control of health problems.

The research literature on human stress is much too extensive to summarise in a document such as this. Contranda and Baum's (2011) review of the subject has divided the research into four broad areas, each of which has a number of areas of further specialisation. These are:

  • biology, including:
    • brain networks (e.g., Dallman & Hellhammer, 2011);
    • cardiovascular system (e.g., Burg & Pickering, 2011);23
    • immune system (e.g., Ader, 2006);
    • genetics (e.g., Caspi, McClay et al., 2002; Caspi, Sugden et al., 2003);
    • molecular biology (e.g., Baum, Lorduy, & Jenkins, 2011);
  • the social context, including:
    • "tend and befriend" (e.g., Taylor, 2002);
    • support processes (e.g., Uchino, 2004);
    • social networks (e.g., Berkman & Syme, 1979);24
    • the workplace (e.g., Karasek & Theorell, 1990);
    • organisations (e.g., Di Renzo, 1998);
  • psychology, including:
    • appraisal and emotion (e.g., Smith & Kirby, 2011);
    • coping (e.g., Carver & Connor-Smith, 2010);
    • personality (e.g., Williams, Smith, Gunn, & Uchino, 2011);
    • gender (e.g., Davis, Burleson, & Kruszewski, 2011);
    • adult development (e.g., Skinner & Edge, 2002);
    • perceptions of "the other," including racism (e.g., Brondolo, Brady, Pencille, Beatty, & Contrada, 2009);
    • status (e.g., Marmot, Shipley, & Rose, 1984); and
  • physical and mental health, including:
    • eating behaviours (e.g., O'Connor & Conner, 2011);
    • drug use (e.g., Grunberg, Berger, & Hamilton, 2011);
    • exercise (e.g., Salmon, 2001);
    • pregnancy (e.g., Schetter & Glynn, 2011);
    • depression (e.g., Heim, Bremner, & Nemoroff, 2006);
    • mental health in childhood and adolescence (e.g., Hankin & Abela, 2004);
    • trauma (e.g., Dougall & Swanson, 2011);
    • heart disease (e.g., Dimsdale, 2008);
    • cancer (e.g., Baum, Trevino, & Dougall, 2011);
    • infections (e.g., Pedersen, Bovbjerg, & Zachariae, 2011);
    • HIV/AIDS (e.g., Cohen, Janicki-Diverts, & Miller, 2007); and
    • pain (e.g., Gatchel, Howard, & Haggard, 2011).

2.2.2 Resilience

Resilience has been described as the ability to "bounce back" from stressful experiences (Carver, 1998) and has been linked to positive emotionality through a variety of pathways, including openness to experiences and coping mechanisms.

A central question in the measurement of resilience (and of emotion generally) is whether to treat the construct as a transient state reflective of direct environmental input or as a stable trait that predisposes individuals to make consistently similar appraisals of emotional stimuli.

Finan, Zautra, and Wershba (2011) considered the impact of negative and positive emotions on physiological processes and health. They linked positive emotions with resilience, while finding that negative emotions or moods, such as depression, increased the risk of various illnesses. These authors cited evidence suggesting the benefits of undertaking therapy directed towards enhancing positive emotions for people who were confronting stressful experiences or were locked into depression or other negative emotions.

In similar fashion, Zautra, Hall, and Murray (2008) broadened the definition of "resilience" to include the study of the sustainability of positive engagements in the face of adversity. They suggested that the capacity to endure stressful conditions is likely to be influenced by cognitive, emotional and social processes that go beyond those typically identified when examining the recovery of homeostasis following distressing events.25

Antonovsky (1979, 1987) referred to a "sense of coherence" as a key means by which people cope more resiliently and more effectively with stressful circumstances. "Coherence" in this regard refers to a generalised sense of stability and continuity; a view that one's "internal" and "external" environments are predictable, manageable and that, despite any failures or frustrations, circumstances will turn out reasonably well. Life is seen as meaningful, and stimuli confronting the individual are seen as comprehensible (i.e., consistent, clear, ordered, structured etc.).

In attempting to assess a similar dimension, Kobasa (1979, 1982) used the term "hardiness", which refers to personality factors considered to buffer the negative impact on health of stressful events, or to decrease the "strain", reflected in psychosomatic symptoms, produced by these events.

For Milsum (1984), resilience is linked with health in the following way:

If our concept of health is to be meaningful, then its definition must emphasize the need for resilience, the ability to recover from insults and stressors and to adapt to change, whether imposed or self-chosen, rather than simply the effectiveness of our current performance. (pp. 2-3)

Milsum (1984) also suggested that health is like a reservoir that is able to provide water at its normal flow and pressure for some time after the replenishment of water has ceased. Pursuing this analogy further, pressure will eventually fall and the flow will dry up if the reservoir receives no further supplies of water. In this sense, health is best represented by the level of reserves available rather than the force of the present supply. Indeed, physical health is sometimes measured in terms of such a resilience model (e.g., use of treadmill tasks for identification of cardiovascular disease, and glucose tolerance tests for diabetes).

A similar model has sometimes informed evaluations of emotional or psychological resilience, where it has frequently been assumed that healthy adjustment is indicated by minimal signs of distress in the face of adverse experiences (e.g., Hanson & Spanier, 1983; Raschke, 1977). Such an assumption, however, has been questioned (e.g., Haan, 1977). Resilience in children, for example, has been thought by developmental psychologists (e.g., Kelly & Emery, 2003; McIntosh, 2003) to be less an independent property of the child, and more a product of the interaction of protective factors with sources of risk. Thus, Emery (2006) found that the resilience of children from divorced families was linked to a parent's genuine and accurate understanding of the child's perspectives and the parent's ability to honestly act in the child's best interests.

2.2.3 Relationship between resilience and stress

Resilience has been frequently considered to be on the antecedent side of stress and coping processes, while health has tended to be placed on the outcome side (e.g., Holahan & Moos, 1985, 1987, 1990; Kobasa, 1979). But while resilience and health are associated with each other, the metaphor of resilience as a reservoir that supplies "healthy" emotional and psychological responses is a potentially confusing one. Of greater utility are the more dynamic models proposed by systems theorists such as Bronfenbrenner (1979, 2001, 2005), whose approach is considered in more detail in section 5.1. Stress and resilience are also linked to the relationship that these events have to the things individuals hold as being important - their needs, values, commitments, motives or goals (e.g., Lazarus & Folkman, 1984; Park, 2011).

2.3 Health and illness

Perhaps not surprisingly, there are numerous overlapping concepts between the stress and resilience or vulnerability literature and the literature on health and illness. Selye's (1976) discussion of "diseases of adaptation" made reference to a range of physical disorders, as well as disorders that he termed "neuropsychiatric diseases". For Selye, such diseases fell within the realm of the psychological (or "mental") health arena, and included chronic anxiety, schizophrenia, depression and anorexia nervosa, as well as a range of psychosomatic disorders. He came to accept that outcomes are strongly influenced by the way in which events confronted by individuals are interpreted (Selye, 1980).

The links between life events and significant mental health problems are now well established. Life events in an individual's first 15 years and a history of low social support are predictors of higher susceptibility to mental health problems, with events in the previous six months being the proximal triggers for first suicide attempts and the probability of repeated attempts (Pompili et al., 2011). Similarly, there is a link between life events and bipolar disorder, though the precise nature of the events that are likely to trigger this mental health outcome are not well understood (Johnson & Roberts, 1995). There is also some evidence of an association between life events and schizophrenia from the clinical literature, especially for patients who show a pattern of more frequent relapse (Rabkin, 1980). Stressful life events are known to elevate the risk of depression (Boerner, Wang & Cimarolli, 2006), though the availability of social supports again may mediate and moderate the effects (Paykel, 1994). The ætiology of all of these disorders is, however, complex. The capacity of life events to elevate stress levels is likely to be the common factor, though biological, genetic and environmental factors will also make key causal contributions.

Some authors (e.g., Antonovsky, 1979; Gochman, 1988; Milsum, 1984) have added "social health" to these two traditionally identified broad realms of health (physical and mental), with the World Health Organization's (WHO; 1948) definition being frequently mentioned:

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (p. 1)

However, the WHO definition of health has sparked considerable controversy. Antonovsky (1979), for instance, agreed with the emphasis on the positive aspects of health, but argued that the extension of the concept of health to all realms of "wellbeing" (a term not further explained by WHO) renders the concept meaningless and impossible to study. Further, he maintained that such a broad definition brings the social dimension into the realm of medicine, to be treated in whatever way might be seen fit by the powerful.

By contrast, Milsum (1984) not only accepted the three components of health suggested by the WHO, but added another - "spiritual health". Although Milsum argued that full health cannot be achieved if any of the four dimensions is beneath a "minimally satisfactory level" (p. 6), he was nonetheless concerned that the concept of social health may lead to an over-emphasis on social conditions as the cause of an inadequate health status, and an under-emphasis on taking personal responsibility for the maintenance of health.

Broadly speaking, Lazarus and his colleagues (e.g., Lazarus & Folkman, 1984, 1987; Lazarus & Launier, 1978) also accepted the three-faceted view of health proposed by the WHO. They outlined three long-term "adaptational outcomes" of stress and coping - "somatic", "morale" and "social functioning" - which they also called somatic, psychological and social health respectively (Lazarus & Folkman, 1984). Lazarus and Folkman also used the term "morale" to denote long-term outcome concerns regarding "how people feel about themselves and their conditions of life" (1984, p. 194). "Morale" covers satisfaction with life and a general happiness or sense of positive wellbeing, as well as general unhappiness and depression. It also covers the concept of self-esteem, or "how people feel about themselves" (1984, p. 194). Low self-esteem has been linked in the literature with depression (e.g., Beck, 1967; Cameron, 1963; Pietromonaco & Markus, 1985), and high self-esteem has been associated with global happiness or satisfaction with life (e.g., Campbell, 1981; Campbell, Converse & Rodgers, 1976).

The concept of social functioning highlights the importance of a person's interaction with the social system as an attribute of health, adjustment and wellbeing. Lazarus and Folkman (1984) defined social functioning as "the ways the individual fulfills his or her various roles, as satisfaction with interpersonal relationships, or in terms of the skills necessary for maintaining roles and relationships" (p. 223). The quality of communication and social relationships, as well as functioning at work and in other social roles, were included as aspects of social functioning.

Coping issues are not necessarily restricted to stressful interpersonal encounters. They include, for example, the ability to appreciate and manage physical dangers, to apply logic, to navigate, to manage financial affairs and so on. If social functioning is regarded as an extension of coping effectiveness in stressful transactions, then "competence" in handling personal affairs would seem a more comprehensive label (see White, 1974). Healthy social functioning here concerns several matters discussed earlier as needs, along with the ability to develop positive interpersonal relationships. With such a complex, multidimensional and uncertain construct, it is not surprising that Lazarus and Folkman (1987) reported that they had not found an adequate measure of social functioning.

In work that was to foreshadow Seligman's (2006) formulation of positive psychology, Rosenhan and Seligman, (1984) distinguished between Jahoda's (1958) concept of "positive mental health" and mere "normality". Rosenhan and Seligman considered normality as nothing more than the absence of abnormality and argued that, as such, normality implies neither happiness nor a positive lifestyle. Normality was, in their view, associated with minimal levels of: suffering, maladaptiveness (or dysfunctional behaviour), irrationality or incomprehensibility, unpredictability and loss of control, unconventionality and "vividness" (i.e., behaviour that stands out as most unusual), violation of moral standards, and behaviour that causes discomfort in observers. Happiness and a positive lifestyle, on the other hand, were associated with "optimal living", which involves a realistic and positive self-concept, a capacity for growth and development, autonomy, an accurate view of reality, competence in dealing with life's tasks, and positive interpersonal relationships.26

A sense of purpose and meaning in life is also a commonly mentioned attribute of psychological health (e.g., Jahoda, 1958; Maxwell, Flett, & Colhoun, 1989; Ryff, 1989a, 1989b). Other attributes include sound reality-testing (e.g., Haan, 1977; Jahoda, 1958; Rosenhan & Seligman, 1984), an openness to experience (e.g., Coan, 1974; Rogers, 1959; Ryff, 1989a, 1989b), and a sense of community and intrinsic interest in external affairs, regardless of their implications for personal wellbeing (e.g., Adler, 1939; Coan, 1974; Jahoda, 1958; Ryff, 1989a, 1989b).

In summary, the attributes of positive psychological health commonly mentioned by researchers include an overall sense of wellbeing or satisfaction; a sense of purpose and meaning in life; a capacity for growth or personal development; sound reality-testing and openness to experience; a positive and realistic self-concept; a sense of mastery; competence in handling personal affairs, whether social or otherwise, including autonomy or self-determination and the ability to develop positive interpersonal relationships; a sense of community; and, allied to the latter, interests extending beyond the self, including concern for other people, for humankind, and for other external matters, regardless of their relevance to personal wellbeing.

Finally, the interactive effects of environments and genes is increasingly recognised as underpinning responses to stressful life events. Increasingly, it has been recognised that neither environmental risk nor DNA are destiny. Rather, there is an interplay between environmental factors and genetic pre-dispositions that is much more complex than nature versus nurture. Some of these interactions are epigenetic (literally, "above the genome"). A groundbreaking new field, epigenetics, highlights the importance of environmental influences on the expression of genes, some of which can span generations. The marks of the experience of previous generations are written on the genome and act to influence the expression of genes. Research has shown, for example, how famine in one generation, followed by an abundance of food for another, can influence the risk of obesity and heart disease across generations (Pembrey et al., 2006). To this extent, you are what your grandparents and parents ate, but for each individual, life events throw the switch. How the process plays out, however, very much depends on the individual, the social supports available to them, and the balance of physiological and psychological risk and protective factors that surround them at the time of the event.

2.4 Human need and desire

To what extent are the experiences of stress, resilience, health and illness linked to the satisfactory or unsatisfactory fulfillment of human needs and desire? Maslow (1968), who famously suggested a hierarchy of human needs (see below), linked fulfillment of these needs to quality of functioning. Allardt (1976) and Veenhoven (1984) held not dissimilar views. A key research question in this regard relates to the universality or otherwise of these needs and the extent to which they can be empirically verified.

Since at least the time of Freud (1933/1961), who proposed the existence of an innate life instinct and an opposing death instinct, various classification systems have been suggested for organising universal needs. Maslow (1954, 1968) proposed that physiological needs (e.g., homeostatic needs, sex, activity) were the most basic, followed by safety needs, then needs for belonging and love, esteem needs (including achievement, adequacy, mastery, competence, confidence, independence and freedom) and, finally, self-actualisation, which includes the desire to attain one's potential and which can take on various forms, such as seeking proficiency in work, parenting or athletics. A fairly similar classification system of needs was proposed by Efraty and Sirgy (1990) in their research into the quality of work life.

Self-actualisation needs have also been referred to as "moral needs" (Lutz & Lux, 1988), for Maslow also included here concerns about truth, service, justice, aesthetics, meaningfulness, an interest in nature for its own sake, an appreciation of the intrinsic worth and value of other people regardless of their utility in serving personal needs, and the giving of love. Such interests are directed outward - beyond personal wellbeing - though they may also link closely to a sense of wellbeing for particular individuals.

Allardt (1976) distinguished between three sets of needs on the basis of the way in which their satisfaction is assessed - "having", "loving" and "being" - a distinction that was adopted by Campbell (1981) in his discussion of matters affecting subjective wellbeing.

According to Allardt (1976), "having needs" are satisfied through the possession and mastery of material resources, but here he included not only income, housing and employment, but also "health" (measured by self-reports of chronic illnesses, psychosomatic illness, medication use, and anxiety). "Loving needs" concern "love, companionship and solidarity" (p. 230), which are defined in terms of the ways in which people relate to each other. Campbell (1981) called these "relating needs". Proposed components measured by Allardt were: community cohesion, family cohesion and friendship patterns.

For Allardt (1976), needs related to "being" concerned "what the individual is and what he does in relation to society" (p. 231). Allardt argued that these needs denote self-actualisation, represent the opposite of alienation, and relate to the ability to control one's fate, to become involved socially and politically, and to find interesting things to do. For Campbell (1981), self-esteem, a sense of controlling one's fate, self-confidence and self-fulfillment represent central aspects of "being". "Being needs" thus pertain to Maslow's (1954, 1968) "esteem" and "self-actualisation" needs. Both "being" and "loving" (or "relating") needs concern psychological matters, which overlap considerably.

Based on a series of qualitative studies, Australian social researcher Mackay (2010) suggested that human beings are driven by ten basic needs or desires, these being the desire to: be taken seriously; have a sense of place; believe in something; connect; be useful; belong; have more; have control; have things happen; and love and be loved. Interestingly, Mackay formally linked stress to the absence of only one of these desires - that of having control. Although it could be argued that a reduction in, or an absence of, any of the above needs is likely to diminish human quality of life, the need for control is possibly the need most closely linked to that of safety and survival. To return to the definition of Cohen, Kessler, and Gordon (1997), it is possibly the thwarting of such a need that is most likely to "tax or exceed the adaptive capacity of the organism" (p. 3).

This idea would be consistent with a key hypothesis developed as a result of the "Whitehall Studies" of civil servants (see Kuper & Marmot, 2003). The finding of a linear relationship between status in the organisation and a range of health-related outcomes led Marmot and his colleagues to think about the connection between being low in the chain of command and experiencing low levels of control over one's life. It was hypothesised that more adverse heart rate, stress hormone and blood pressure data were likely to be linked with an absence of control over what one did in the workplace and, perhaps somewhat counter-intuitively, that a lower heart rate, stress hormones and blood pressure resulted from not having to take orders on how to perform a task, or when to do it.

Consistent with this idea, the final section in this chapter on life events and related literature considers the impact of social disadvantage and social exclusion.

2.5 Stressful life events, social address and social exclusion

Stressful life events, while often unexpected, are more likely to be encountered by some people than others. The impacts of negative life events are often felt from the very beginning of life, through pregnancy, at birth and beyond. For example, analyses of an Australian birth cohort study found that low birth weight was related to the frequency of maternal stressful life events, which in turn were associated with mothers' social health characteristics, such as: being younger than 25 years; being single, divorced or widowed; being of lower than average equivalised income; having not completed year 12; smoking during pregnancy; having a body mass index (BMI) of less than 18.5 (i.e., underweight); being at risk of higher obstetric complications; and being Aboriginal and/or Torres Strait Islander ethnic background (Brown, Yelland, Sutherland, Baghurst, & Robinson, 2011). Social address (or socio-economic status [SES]) can make a fundamental difference to children's life chances. Its effects on a range of developmental outcomes are evident early in life (Edwards, 2005; Edwards & Bromfield, 2010). They amplify across children's development and influence their readiness to enter school (Gong, McNamara & Cassells, 2011; Smart, Sanson, Baxter, Edwards & Hayes, 2008).

Life events such as joblessness can have profound impacts on the wellbeing of families and their children. When compared with other countries in the OECD, Australia has a low level of joblessness but a relatively high level of jobless families with children (Whiteford, 2009). Family joblessness is the most salient cause of child poverty in Australia (Whiteford, 2010) and has been shown to be associated with a range of adverse developmental outcomes for children in such disadvantaged households (Baxter & Gray, 2010).

Social address markedly influences the load of risk factors that are present in children's lives, with those from disadvantaged households having a much higher average number of risks (Smart et al., 2009). In turn, there is a relationship between the number of risk factors possessed by a family, the family's background and the likelihood of experiencing a higher load of negative life events (Rydell, 2010). Rydell found that less-than-optimal life circumstances lead to a greater risk of experiencing negative life events. Single parenthood, non-European ethnicity and low maternal education were significantly correlated with higher rates of negative life events in her Swedish study. Data from the Millennium Cohort Study, in the UK, also demonstrate the links between social circumstances, adverse life events and children's socio-emotional development and likelihood of manifesting psychopathology (Flouri, Mavroveli & Tzavidis, 2010). Among homeless mothers, the load of past negative life events has been found to predict a much higher level of current traumatic stress that adversely influences their capacity to address their problems in ways that enable them to move to more secure housing (Williams & Hall, 2009).

Negative life events can also lead to social exclusion. The term "social exclusion" was first coined in France to encompass those who were excluded from the system of social insurance (Hayes, Gray & Edwards, 2008). Typically, les exclus, or the socially excluded, were lone parents, the unemployed, those with disabilities, recently arrived immigrants or the socially detached and disaffected, often living in the ghettoes around French cities (Hayes et al., 2008). Policy-makers in a range of countries have adopted the concept of social exclusion to move the discourse from a narrow focus on poverty and disadvantage to encompass a wider range of circumstances that are seen as potentially excluding. Among many definitions, the following definition from the UK Social Exclusion Unit (1997) has been widely influential:

[Social exclusion is] a shorthand label for what can happen when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown. (p. 1)

In Australia, as the term implies, the social inclusion policy approach has focused on the factors and forces that limit opportunities to: secure a job; access services; connect with others through engagement with families, friends, work, personal interests and involvement in the local community; deal with personal crises that may result from ill health, bereavement or loss of a job; and have one's voice heard (Gillard, 2008).

Often, life events change the extent of exclusion. The death of a spouse, the onset of ageing and its advancing functional limitations, disability, chronic illness, unemployment or family breakdown can isolate and exclude. Again, the impacts of such events depend on both the personal resources, capacities and resilience of individuals, and the extent of services and supports around the person. Those who are living in disadvantaged circumstances or are isolated by location or personal limitations can be particularly vulnerable to events that others may take in their stride. Much of the work of the Australian Social Inclusion Board (2011) has focused on addressing the barriers that life events can present to accessing opportunities, participating in the life of the community and, ultimately, feeling included.


16 The physiological approach can be traced further back to the work of Bernard (1859), then to Cannon (e.g., 1932, 1936) who, in describing physiological processes, borrowed the physics and engineering concepts of stress and strain (where "stress" is defined as a physical force applied to a body, which thereby produces "strain", a deformation of the body). Stresses were therefore considered to include both physical and emotional stimuli that, at critical levels, cause strain in homeostatic mechanisms. To Cannon, homeostasis included not only automatic regulation of internal systems such as body temperature and blood sugar level, but also hunger, thirst and "emergency" reactions associated with fear or rage, which prepare an organism for "flight or fight" (including the discharge of epinephrine [adrenalin]). Cannon suggested that there was a critical level beyond which the "steady state" of the internal environment is altered.

17 Selye's views changed to some extent over the years. In his 1974 and 1976 works, he argued that joy was a potential stressor in the sense that it created a demand for physiological adjustment. He used the concept "eustress" to refer to pleasant experiences that he believed might have curative effects, and "distress" which, in his view, was both unpleasant and disease-producing (Selye, 1980, p.128). However, he accepted the restriction of the term "stress" to the negative type (distress) for the purposes of brevity, since this is the form of stress that causes concern to people (Selye, 1980).

18 Items in the scale were developed through an analysis of over 5,000 "life charts" of patients that had been created by Adolph Meyer in the early 20th century. Meyer had documented the dates at which important events had occurred in the lives of his patients, alongside the dates at which illness symptoms became apparent. The items in the SRE represented events that had commonly preceded illness in these patients (Chatterjee & Arora, 2005).

19 Rahe and his colleagues have since produced other versions (see <www.drrahe.com>).

20 Some of these insights seem fairly obvious in retrospect, reflecting common idioms such as "one man's meat is another man's poison". The context in which this literature developed, however, was one in which the aim was for measurable constructs. There are strengths in this approach. But there are also limitations often associated with the number of variables that can be realistically measured at any given time.

21 LSAC is conducted in a partnership between FaHCSIA, AIFS and the ABS. The findings and views reported in this report are those of the authors only and should not be attributed to FaHCSIA or the ABS.

22 The scale used by LSAC, is a modified version of that developed by Brugha, Bebbington, Tennant, and Hurry (1985). It lists 12 categories of adverse events that were considered to entail considerable threat (e.g., personal experience of serious illness, injury or an assault; death of a parent, child or spouse; separation due to marital difficulty; becoming unemployed or seeking work unsuccessfully for more than one month). For the youngest cohort in Wave 1 (aged 18-23 years), the WHA Life Events Checklist for Young Women (comprising 35 items derived from several other life events measures) was created, along with a Perceived Stress Questionnaire for Young Women. This latter scale is designed to measure overall perceived stress as well as the perceived sources of stress for young women in Australia. The various items in the scale related to family of origin, relationships with others, personal health, work/money, and study. Some appear to represent ongoing difficulties (e.g., general health status and management on income), and others discrete events (e.g., commencement or of a close personal relationship (two items)) (see Bell & Lee, 2002).

23 According to Rosamond et al. (2008), pathology in the cardiovascular system is responsible for the largest health care burden in the Western industrialised world.

24 Health risks associated with having few social ties have been recognised since at least the time of Durkheim (1897/1951).

25 Zautra et al. (2008) referred to a variety of factors that promote resilience, such as a sense of personal agency, hope, optimism, purpose in life, agency, close social ties, and secure kin relationships and community.

26 Seligman (2006) argued, for instance, that optimism and pessimism depend on the ways in which individuals explain events, with pessimists tending to treat beneficial events as being temporary and externally induced, and adverse events as being pervasive, personally generated and long-term. In his view, optimists tend take some credit for the beneficial events they experience (sometimes unrealistically so) and consider adverse events as being externally induced and fleeting. Pessimists are also more inclined than optimists to persevere in the face of set-backs. Seligman also maintained that parents and teachers have major influences on the developing child's explanatory style, but individuals can learn to become more optimistic.