An examination of the associations between life problems and psychiatric disorders in a rural patient population.

The objective of this clinical study was to examine the differential effects of adversity on pathology. Data obtained from a previously described consecutive series of 707 patients was re-analysed to this effect. A series of specific life events, as well as behaviours that were likely to be secondary to psychiatric disorder, were examined. High rates of life problems such as incest, sexual assault, domestic violence, suicide attempts, and alcohol, tranquilliser and substance abuse were found in the group of patients in general. There were no major differences in the prevalence of these problems in patients with major functional disorders, anxiety disorders, short-lived minor psychiatric disorders, or in "control" patients with no primary Axis I or Axis II diagnosis. Patients with personality disorders as their major psychiatric diagnosis did, however, experience higher levels of the majority of these problems. The clinical implications of the findings are discussed. It is concluded that patients who develop chronic psychiatric illnesses are probably more psychologically or biologically vulnerable than those patients who develop short-lived disorders and who do not achieve a major psychiatric diagnosis from the practising clinician.