Assessing Stressful Life Events in Relation to Liability and Compensation

Abstract

Objective: The aim of this paper is to outline limitations in the assessment of the relationship between stressful experiences and psychological disorder in the medico-legal setting. Method: A research-derived approach to more objectively assessing stressful life events and disorder is discussed in the light of limitations or biases which may arise in the evaluation of the clinical significance of stressors in psychological disorder particularly in a medico-legal context. Results: There may be considerable bias in the assessment of stressful experiences in a medico-legal setting. In addition to the purely subjective approach used in the appraisal of stressful life events it may be useful to (i) apply common sense and population-based appraisal as an initial basis for assessing the significance of a stressor; (ii) use evidencebased findings to support the link between stressors and disorder; and (iii) apply recognized criteria of causality where applicable. Conclusions: Conflicting psychiatric opinions in the medico-legal setting may arise both from psychiatrists' positional biases, from the often complex relationships that may exist between stressors and depression, and from a failure to use evidence-based findings to support psychological explanations.