Assessing Lifetime Stress Exposure Using the Stress and Adversity Inventory for Adults (Adult STRAIN): An Overview and Initial Validation

George M Slavich, Grant S Shields, George M Slavich, Grant S Shields

Abstract

Objective: Numerous theories have proposed that acute and chronic stressors may exert a cumulative effect on life-span health by causing biological "wear and tear," or allostatic load, which in turn promotes disease. Very few studies have directly tested such models, though, partly because of the challenges associated with efficiently assessing stress exposure over the entire life course. To address this issue, we developed the first online system for systematically assessing lifetime stress exposure, called the Stress and Adversity Inventory (STRAIN), and describe its initial validation here.

Methods: Adults recruited from the community (n = 205) were administered the STRAIN, Childhood Trauma Questionnaire-Short Form, and Perceived Stress Scale, as well as measures of socioeconomic status, personality, social desirability, negative affect, mental and physical health complaints, sleep quality, computer-assessed executive function, and doctor-diagnosed general health problems and autoimmune disorders.

Results: The STRAIN achieved high acceptability and was completed relatively quickly (mean = 18 minutes 39 seconds; interquartile range = 12-23 minutes). The structure of the lifetime stress data best fit two latent classes overall and five distinct trajectories over time. Concurrent associations with the Childhood Trauma Questionnaire-Short Form and Perceived Stress Scale were good (r values = .147-.552). Moreover, the STRAIN was not significantly related to personality traits or social desirability characteristics and, in adjusted analyses, emerged as the measure most strongly associated with all six of the health and cognitive outcomes assessed except current mental health complaints (β values = .16-.41; risk ratios = 1.02-1.04). Finally, test-retest reliability for the main stress exposure indices over 2-4 weeks was excellent (r values = .904-.919).

Conclusions: The STRAIN demonstrated good usability and acceptability; very good concurrent, discriminant, and predictive validity; and excellent test-retest reliability.

Figures

FIGURE 1
FIGURE 1
Latent structure of lifetime stressor data. (A) Latent class analysis revealed that two latent classes best fit the overall lifetime stressor count data. The low-stress group (n = 116) experienced 13.90 lifetime stressors (SD = 6.49) on average, whereas the high-stress group (n = 89) experienced 41.25 lifetime stressors (SD = 13.25) on average. (B) In turn, latent trajectory analysis revealed that five latent trajectories best fit the lifetime stressor count data over time. Trajectory #1 (n = 37) exhibited a substantial increase in stress exposure over time; Trajectory #2 (n = 70) exhibited a moderate increase in stress exposure over time; Trajectory #3 (n = 60) exhibited a mild increase in stress exposure over time, followed by a substantial decrease in later life; Trajectory #4 (n = 26) exhibited low levels of stress exposure through midlife, but an increase in stress exposure in later life; and Trajectory #5 (n = 13) exhibited very low levels of stress exposure over the entire life course (N = 205). Color image is available only in online version (www.psychosomaticmedicine.org).
FIGURE 2
FIGURE 2
Predictive validity of the STRAIN. Lifetime stressor count as assessed by the STRAIN strongly predicted each of the six health-related outcomes assessed, including current physical health complaints, current mental health complaints, sleep difficulties over the past month, executive dysfunction, and doctor-diagnosed general health problems and autoimmune disorders. **p < .01, ***p < .001 (N = 205). Color image is available only in online version (www.psychosomaticmedicine.org).
FIGURE 3
FIGURE 3
Lifetime stressor exposure by stressor category for males and females. (A) Examining participants' stress exposure by sex revealed that with respect to life domain females experienced more treatment/health stressors, reproduction stressors, other relationship stressors, and deaths; in contrast, males had more legal/crime stressors. (B) With respect to core-social psychological characteristics females experienced more interpersonal loss and entrapment stressors, and marginally more physical danger and humiliation stressors (N = 203). Color image is available only in online version (www.psychosomaticmedicine.org).
FIGURE 4
FIGURE 4
Likelihood of being diagnosed with an autoimmune disorder by stressor timing, type, primary domain, and core social-psychological characteristic. Risk of being diagnosed with an autoimmune disorder differed substantially by the type of life stressors experienced. More specifically, participants' risk was greater for those experiencing adulthood versus early life stressors and chronic versus acute stressors, as well as for those experiencing stressors involving possessions, reproduction, death, interpersonal loss, and physical danger. ns = not significant, *p < .05, **p < .01, ***p < .001 (N = 205). Color image is available only in online version (www.psychosomaticmedicine.org).

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