The Stress Test - Results
What causes stress? Why do some people suffer from depression and anxiety more than others?
Biological, social, circumstantial and psychological factors are all important triggers when it comes to mental health problems, but how does the relationship between these different elements work?
In June 2011, BBC Lab UK, with assistance from Radio 4's All in the Mind launched a groundbreaking experiment designed to look at this very issue.
More than 30,000 of you completed the survey, making it one of the largest studies of mental health ever.
What did we discover?
We anticipated that a family history of mental health difficulties, social deprivation and traumatic or abusive life experiences were more likely to lead to higher levels of anxiety and depression - and we were proved right.
Negative life events such as abuse and bullying, in early years or adulthood, were the strongest factors when predicting those who were prone to depression and anxiety.
A family history of mental health problems, low levels of income, poorer education and relationship problems also played a significant role.
But the journey from these causes to mental health problems involved a person's psychological functioning - specifically whether they were able to cope with life's difficulties, known as 'adaptive coping', how much they dwelled on their problems, known as 'rumination' and how much they blamed themselves - determined, to a very large extent, how depressed or anxious they became.
Why is it a new finding?
End Quote Prof Peter Kinderman
Life events, abusive events in childhood, social circumstances and a family history of mental illness can all lead to mental health problems”
The results suggest that these thinking styles - especially rumination and self-blame - play a very specific role in the development of mental health problems and are not just consequences of those problems.
One previous model suggested that biological, social and circumstantial factors cause mental illnesses, and it is only after that happens that psychological changes appear - so people start to 'ruminate' when they've become ill.
But our results don't support this.
Instead, they suggest that psychological factors actually play a causal - or, more precisely, mediating - role.
Life events, abusive events in childhood, social circumstances and a family history of mental illness can all lead to mental health problems.
But our results show that they lead to these problems if they cause people to ruminate or to blame themselves for the bad things that happen. They are much less likely to cause mental distress if people don't ruminate or self-blame.
What did we measure?
Visitors to the BBC's Lab UK Stress Test filled in a 20-minute questionnaire online.
We collected lots of demographic data, including:
- Ethnic group
- Gross annual or weekly household earnings
- Highest level of formal schooling
- Occupational status
- Parents' income
- Relationship status
- Number of children
People were also asked about their family history of mental health diagnoses, how often they saw their family and friends and participated in social activities, childhood experiences of abuse and bullying and any negative life events they had experienced in the last year.
The psychology of stress
The human brain has been described as the most complex object in the universe. And, because we all have unique experiences from which we develop our personalities, the complexity of human emotional life is immense.
The word "stress" is an unusual one. It is used to describe negative or difficult emotions, or even mental ill-health. It's useful to think about three broad groups of causes of emotional difficulties - biological factors, social factors and life events.
Biological factors are very important. The structure and functioning of the brain - the nerves, synapses, and neurotransmitters - are vital to mental health. But human beings are much more than their biology...
They were also asked how they responded to stressful situations.
This measured their tendency to use either positive coping strategies (e.g. talking to others, problem solving), rumination (continually dwelling on problems) or dangerous activities (e.g. drinking alcohol) in response to stress.
In addition, those who took part were asked how they decided who or what would take credit or blame when they had to deal with events or challenging situations. Did they look to chance, blame others or see themselves as the source of the solution or problem?
The Stress Test used clinical measures of anxiety and depression and asked respondents about their general wellbeing.
The researchers then analysed the data using sophisticated statistical techniques, which helped them build a model of how family history, life circumstances and thinking styles all contribute to causing stress in a person's life.
Who took part?
A total of 32,827 respondents aged 18-85 took part in the online Stress Test.
The average age was 40 and a half years, 61.4% were female and 92.5% white British or white other.
Although the test was accessible from all over the world, the majority of respondents - 82.7% - were from the UK.
Most of those taking part were also in a relationship, had children and were employed.
What does it mean for the future?
These findings are important as they suggest that psychological factors play an important role in the journey towards mental health problems.
Life events and other biological risk factors can lead to depression and anxiety if they cause changes to our psychological functioning - so if we ruminate or blame ourselves rather than find positive ways to cope.
WHAT IS CBT?
Cognitive behavioural therapy is:
- a way of talking about how you think about yourself, the world and other people
- the way your actions affect your thoughts and feelings
CBT can help you to change how you think (cognitive) and what you do (behaviour).
Unlike some other talking treatments, it focuses on the 'here and now' instead of the causes of distress or past symptoms.
That's important, theoretically - especially for clinical psychologists - as it suggests that psychological phenomena are not just a consequence of mental illnesses but they have real roles when it comes to the causes of mental health issues.
More importantly, it means we can do something to help.
These results suggest that if we can interrupt our psychological processes, we might be able to help people recover from - or never develop - mental health problems.
Of course, evidence-based psychological therapies such as cognitive behavioural therapy (CBT) do exactly this - they help a person learn how to identify and then change these kinds of unhelpful styles of thinking.
Some of the techniques that help people spot when they are 'stuck' and then shift their attention - approaches such as 'mindfulness' - are also very successful.
This study helps us make sense of the complicated links between events, how we think about those events, and then the emotional consequences.
It also leads us to reconsider our own thinking styles... and that could help both prevent and treat any possible stress or mental health problems.