title: Investigation of stressful life events in patients with systemic sclerosis.
abstract: OBJECTIVE
  To assess the occurrence of stressful life events in the year before the initiation of systemic sclerosis.
  
  
  METHODS
  A consecutive series of 40 patients with systemic sclerosis (mean age (56.3+/-11.9) years, mean disease duration (4.3+/-3.1) years; 32 females and 8 males), including 28 with diffuse cutaneous scleroderma and 12 with limited cutaneous scleroderma, were evaluated. A control group of 40 healthy subjects free of systemic sclerosis also was included. Socioeconomic status was investigated and Paykel's interview for recent life events (a semi-structured research interview covering 64 life events) was conducted.
  
  
  RESULTS
  Patients with systemic sclerosis showed higher percentages of lower education (72.5%) and working class (82.5%), and reported more stressful life events (P<0.05), such as exits (P<0.05), undesirable events (P<0.01), and uncontrolled events (P<0.001), when compared with the control. More events that had an objective negative impact (P<0.001) were also reported in systemic sclerosis patients than in the control. These results are in accordance with a multifactorial model of pathogenesis in systemic sclerosis.
  
  
  CONCLUSIONS
  We reported a strong relationship between stressful life events and the initiation of systemic sclerosis. Our findings are consistent with current understanding of the extensive links of behavioral responses to stress with neurophysiological and biochemical processes.
authors.affiliation: Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China. lxling@mail.hz.zj.cn
authors.forename: Yue
authors.initials: Y
authors.lastname: Chen
authors.forename: Ji-Zhong
authors.initials: JZ
authors.lastname: Huang
authors.forename: Yu
authors.initials: Y
authors.lastname: Qiang
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Mao-Mao
authors.initials: MM
authors.lastname: Han
mesh_terms: D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications* / Q000473:pathology / Q000523:psychology