Stress online: Developing a reliable and valid interactive online method for measuring stressful life events and difficulties.

Stress is known to be a major contributor to illness and a significant obstacle to wellbeing. It is common in the general population, particularly adolescence and amongst those disadvantaged, and likely to increase at times of economic austerity as well as at key life transitions such as leaving home. To understand stress, it is important to differentiate its objective properties in terms of adverse life events and difficulties and stress responses such as physical or emotional illness or problem adaptation (such as at university). Objective stressors can arise in many forms. Some life events/difficulties are common across communities, such as unemployment or housing problems, while others are more personal such as in partner or parenting relationship problems. For all stressful experience personal context is key to understanding its specific harmful effects. Severe life events and related difficulties are consistently associated with the onset and relapse of common mental illnesses (eg depression), and serious physical conditions (eg cardiovascular disease or diabetes). Latest research seeking to examine how biological factors combine with stress in different disorder outcomes utilising large sample sizes. Here, brief checklist life events scales have been used, but create methodologically problems (because too brief, too subjective, and lacking in context and timing information). Intensive interview methods are superior in providing much richer information but are time consuming, complex and costly, which restricts their use. A new approach using latest technology is proposed which can take the best of both approaches in researching the effects of stress on illness and providing a tool for healthcare practice and in education for improving wellbeing.

The new online Computerised Life Event Assessment Record (CLEAR) will be developed to mimic characteristics of the face-to-face intensive interview approach, but administered remotely at much lower cost. It will be delivered online using latest web-based data capture technology, and consist of detailed questions on recent life events and difficulties in a broad range of categories, including both closed and open questions, completed by both tick box and text box responses which move from initial screening questions, to detailed probes specific to the category, including severity, timing and sequence of events. Aids will involve a derived personalised calendar, and help tools (reminders of key relationships included, or giving examples of types of events) and graphic displays of key information. The full electronic trail of data provided will be verified by an expert reviewer for the final scorings. Only then will the data be ready for either computerised statistical analysis (research) or clinician interpretation (practice). A laptop version will be developed for those without online access.

The study aims to test the reliability and validity of the CLEAR instrument in various ways and in two different samples. The tool will be developed based on an existing unique archive of life stress interviews, it will look at the comparability of both online and face-to-face interviews with the same individuals, will examine CLEAR response stability over time, and analyse the expected relationship of stressful events to social disadvantage, depression, physical illness and student academic performance. A subset of an existing national sample of Depression and Case Control adults (DeCC), and a newly selected sample of first year undergraduate student will be used to test the measures' robustness and association with problem outcomes in two lifestages. An International Scientific Advisory Board of academics and clinicians associated with the project will ensure use of the tool in ongoing longitudinal health research studies, in clinical and health practice and student monitoring. The measure will enhance the understanding of stress through improved research and clinical practice.

Who will benefit from this research and how?
i) Practitioners involved in interventions/treatments focused on managing/reducing life stress and its impacts on emotional disorder. This will include practising psychiatrists, psychologists (clinical and health psychologists, psychotherapists and counsellors), and social workers.
- How benefited: the research findings identifying specific relationships between stress and emotional and physical disorder will aid clinician understanding of the role of stress. In addition, clinicians frequently need to document stressors both at initial assessment and between clinical sessions in order to understand the onset and maintenance of stress-related disorders. For example CBT, counselling and and Interpersonal Therapy is focused on managing stress responses in different domains such as relationships, work, finances etc. The provision of easily collected calendars of stress with details of category, severity and timing will help to focus therapeutic strategy and care provision.
ii) Medical practitioners involved with treatment planning for individuals with physical conditions impaired by high stress levels.
- How benefitted: research findings will add to understanding characteristics of life events and difficulties associated with illness. Providing an easy assessment of patient life stress will aid with providing support and managing treatment plans.
iii) Providers of university education can utilise the findings on stress and academic attainment in 1st year undergraduates to specify the likely stressors occurring for young people entering university for the first time. This will document areas of difficulty and show how these impact on academic performance, satisfaction and course drop-out. The tool can be incorporated into student counselling services.
- How benefited: Aid to targeting student support services and for standardising 'mitigating circumstances' in relation to exam and course work performance.
iii) Wider public and policy understanding of the effects of stress and its management on illness and problem adapatation.
- How benefited: findings of the study will be disseminated to the general population with the new online tool potentially useful in the wider population to identify common stressors. The tool can be adapted for psycho-educational use in relation to feedback of stress profiles with advice about stress management for the public at large.