Ejmh Vol 12 (2017) Issue 2 (Dec) by European Journal of Mental Health

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European Journal of Mental Health Individual, Family, Community and Society VOLUME 12, NUMBER 2, DECEMBER 2017 Editor-in-Chief / Leitender Herausgeber Prof. JOZEF CORVELEYN, Katholieke Universiteit Leuven (Belgium)

Editorial Board / Beratende Herausgeber Dr. MILDA ALIŠAUSKIENĖ, Vytauto Didžiojo universitetas, Kaunas (Lithuania) Prof. JACOB A. BELZEN, Universiteit van Amsterdam (Netherlands) Prof. BEÁTA DÁVID, Semmelweis Egyetem, Budapest (Hungary) Prof. VALERIE DEMARINIS, Uppsala universitet (Sweden) Prof. EMMY VAN DEURZEN, Existential Academy, London (United Kingdom) Dr. JESSIE DEZUTTER, Katholieke Universiteit Leuven (Belgium) Dr. RITA FÓRIS-FERENCZI, Universitatea Babeş-Bolyai, Cluj-Napoca (Rumania) Dr. JÁNOS HARMATTA, Semmelweis Egyetem, Budapest (Hungary) Dr. ANDRÁS ITTZÉS, Corvinus Egyetem, Budapest (Hungary) Dr. GÁBOR ITTZÉS, Budapest (Hungary) Prof. JUTTA LINDERT, Hochschule Emden/Leer (Germany) Dr. DINKA MARINOVIĆ JEROLIMOV, Institut za društvena istraživanja u Zagrebu (Croatia) Prof. MARTIN JÄGGLE, Universität Wien (Austria) Prof. PAAVO KETTUNEN, Joensuun yliopisto (Finland) Dr. PETER RAEYMAECKERS, Universiteit Antwerpen (Belgium) Dr. GERGELY ROSTA, Westfälische Wilhelms-Universität Münster (Germany) Dr. habil. IGOR ŠKODÁČEK, Univerzita Komenského ve (Slovakia) Dr. habil. PÉTER TÖRÖK, Károli Gáspár Református Egyetem, Budapest (Hungary) Prof. ANDRÁS VARGHA, Károli Gáspár Református Egyetem, Budapest (Hungary) Prof. ANDREAS WITTRAHM, Caritasverband für das Bistum Aachen (Germany)

INSTITUTE OF MENTAL HEALTH Faculty of Health and Public Services Semmelweis University, Budapest

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Advisory Board / Wissenschaftlicher Beirat Dr. CLAIRE ARNOLD-BAKER, New School of Psychotherapy and Counselling, London (United Kingdom) Dr. LÁSZLÓ BERNÁTH, Eötvös Loránd Tudományegyetem, Budapest (Hungary) Dr. ILDIKÓ DANIS, Semmelweis Egyetem, Budapest (Hungary) Dr. MIHAELA HARAGUS, Babeș–Bolyai Tudományegyetem, Cluj-Napoc (Rumania) Prof. JOZEF HASTO, Slovenská zdravotnícka univerzita, Bratislava (Slovakia) Dr. habil. KATALIN HEGEDŰS, Semmelweis Egyetem, Budapest (Hungary) DR. ÉVA HUSZTI, Debreceni Egyetem (Hungary) ZSUZSANNA JÁKI, Semmelweis Egyetem, Budapest (Hungary) Dr. AIVA JASILIONIENE Max Planck Institute for Demographic Research, Rostock (Germany) Dr. KLÁRA KOVÁCS-NAGY, Debreceni Egyetem (Hungary) Dr. ILDIKÓ KURITÁRNÉ SZABÓ, Debreceni Egyetem (Hungary) DR. ILDIKÓ LAKI, Szegedi Tudományegyetem (Hungary) Dr. MÓNIKA MIKLÓSI, Eötvös Loránd Tudományegyetem, Budapest (Hungary) Dr. EDWARD PATRAKOV, Ural Federal University, Ekaterinburg (Russia) Dr. LÁSZLÓ PATYÁN, Debreceni Egyetem (Hungary) Prof. BERNADETTE PÉLEY, Pécsi Tudományegyetem (Hungary) Dr. ÉVA SUSÁNSZKY, Semmelweis Egyetem, Budapest (Hungary) Dr. MARIANNA SZABÓ, University of Sydney (Australia) Dr. habil. ÉVA SZABOLCS, Eötvös Loránd Tudományegyetem, Budapest (Hungary) Dr. ISTVÁN TIRINGER, Pécsi Tudományegyetem (Hungary) Dr. SAROLTA TÓVÖLGYI, Budapesti Műszaki Egyetem (Hungary) Prof. ULRIKE WAGNER-RAU, Philipps-Universität Marburg (Germany) Manuscript preparation Institute of Mental Health Faculty of Health and Public Services Semmelweis University, Budapest POBox 2, H-1428 Budapest, Hungary Editorial correspondence should be addressed to Prof. Beáta Dávid Secretary of the Editorial Board Institute of Mental Health, Faculty of Health and Public Services, Semmelweis University POBox 2, H-1428 Budapest, Hungary Phone: (+36 1) 459 1500 x 56 551 • (+36 1) 266 1022 Fax: (+36 1) 214 5685 E-mail: ejmh-editor@public.semmelweis-univ.hu

Abstracted/indexed in ERIH PLUS, APA PsycInfo, Cabell’s Directories, CEEOL, Embase, ERA (Taylor and Francis, Cats Abstracts), EZB, Free Medical Journals, GALE Cengage, Genamics JournalSeek, Google Scholar, HINARI, Journals4Free, Matarka, and Scopus.

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CONTENTS / INHALT STUDIES / STUDIEN Research Papers / Wissenschaftliche Arbeiten MARIANNA DINYÁNÉ SZABÓ & GABRIELLA PUSZTAI: Investigation of Persistence Value as a Study Protection Factor among Health Care Organizer Students ....................................................... 135 BETTINA F. PIKÓ & MÁRIA MIHÁLKA: A Study of Work Satisfaction, Burnout and other Work-Related Variables Among Hungarian Educators................. 152 ANASTASIA O. VYLEGZHANINA, IRINA V. VOROBYEVA, OLGA V. KRUZHKOVA & MARINA S. KRIVOSHCHEKOVA: Primary School Children’s Vandalism: The Problem of Upbringing and Interaction in Russian Families.............................................................. 165 LÍDIA BERSZÁN: Positive Coping and Resilience: Questions and Conclusions Drawn From a Longitudinal Study .................. 187 ZSUZSA SZÉMAN & TRÓBERT ANETT MÁRIA: Social Innovation in the Provision of Services in Long-Term Care .......................................... 204 Short Communication / Kurzmitteilung MOHAMMAD ABBASI: Self-Efficacy and Alexithymia as Moderators Between Perceived Social Support and Stress among Parents of Children with Learning Disabilities ................................ 218 SZENDE ELEKES: The Relation of Perceived Meaning of Life, Meaning of Illness and Anxious-Depressive Symptoms among Cancer Patients ................................................................................ 230 Contributors to This Issue / Autoren dieses Heftes

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STUDIES / STUDIEN

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European Journal of Mental Health12 (2017) 135–151 https://doi.org/10.5708/EJMH.12.2017.2.1

MARIANN DINYÁNÉ SZABÓ* & GABRIELLA PUSZTAI

INVESTIGATION OF PERSISTENCE VALUE AS A STUDY PROTECTION FACTOR AMONG HEALTH CARE ORGANIZER STUDENTS (Received: 15 August 2017; accepted: 3 December 2017)

Introduction: To be successful, serious commitment, willingness of being involved in education and learning (on the part of the students), and (on the part of the education institution) demand for high standard are required. One of the most important determinants of student achievement is persistence, the research of which has now been in the focus of international investigation. Objective: The authors investigated variables affecting students’ persistence value (e.g. attendance at lessons, parents’ religiousness, use of the Internet, sports, etc.) among students starting their health care studies. Method: The students participating in the survey were – as mentioned – the first year (BSc) students specialising in health care organisation at the Public Health Care Departments of Semmelweis University, the University of Debrecen (and Nyíregyháza) (N = 200 persons). Results: 1. By using GLZ regression (Likelihood Ratio Chi-Square = 115.688, df = 13, p = 0.000), the explanatory variables – that most influence the value of the persistence variance – were filtered. (i) E.g. Attendance at the lessons, Extra rewards, Sports, Parents’ Religiousness, Community Membership are of positive effect. (ii) The use of Internet has a negative impact in the model. 2. Cluster analysis was used to produce student groups from the predictor variables. Conclusion: Examining students’ persistence values can help university faculties, the teachers to see, who will succeed in their studies, and who need increased help to evolve and develop their mental potentials. Keywords: higher education, persistence, well-being, regression analysis Untersuchung des Ausdauerwertes als Schutzfaktor im Studium bei Studenten des Faches Management im Gesundheitswesen: Einleitung: Zum Erfolg von Studenten beim Studium sind seitens der Studenten Engagement, Teilnahmebereitschaft und Lernen, seitens der Einrichtung hohe Erwartungen erforderlich. Ein sehr wichtiger Faktor des Erfolgs bei Studenten ist Ausdauer (Persistenz), die derzeit im Mittelpunkt der internationalen Forschung steht. Ziele: Es wurden unter Studenten des ersten Semesters für Gesundheitswissenschaften bestimmte Variablen untersucht, die den Persistenzwert der Studenten beeinflussen (z.B. Besuch der Lehrveranstaltungen, Religiosität der Eltern, Internetnutzung, Sport usw.). Methode: An der Untersuchung haben Studenten der Fakultät für öffentliche Dienste der Semmelweis-Universität und der Fakultät für Gesundheit *

Corresponding author: Mariann Dinyáné Szabó, Institute of Digital Health Sciences, Semmelweis University, Ferenc tér 15., Budapest, H-1094 Hungary; dinyane.mariann@public.semmelweis-univ.hu.

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der Universität Debrecen (in Nyíregyháza) teilgenommen. Die Teilnehmer (n = 200) studierten Management im Gesundheitswesen (BSc) im ersten Semester. Ergebnisse: 1. Mithilfe der GLZRegression (Wahrscheinlichkeit Chi-Quadrat = 115,688, df = 13, p = 0,000) wurden die erklärenden Variablen ausgewählt, die die abhängige Variable Persistenz am stärksten beeinflussen: (i) Eine positive Wirkung hatten u. a. der Besuch der Lehrveranstaltungen, Bonuspunkte, Sport, Religiosität der Eltern und die Mitgliedschaft in einer Gemeinde. (ii) Internetnutzung zeigte im Modell eine negative Wirkung. 2. Aus den Prädiktorvariablen wurden mithilfe der Faktoranalyse Leistungsgruppen der Studenten gebildet. Fazit: Die Analyse der Persistenzwerte von Studenten kann sowohl den Fakultäten als auch den Dozenten helfen, festzustellen, welche Studenten ihr Studium erfolgreich absolvieren werden und welche Studenten beim Studium besondere Hilfe benötigen, um ihr volles Potenzial entfalten zu können. Die Ergebnisse sollen weiter analysiert und bei einer größeren Stichprobe bestätigt werden. Schlüsselbegriffe: Hochschulbildung, Persistenz, Regressionsanalyse

1.1. Preface Students in the world of higher education do not know what ‘study’ path leads to the diploma, and this path is usually not unobstructed. If a student is ready to mobilise or develop his skills (self-belief, commitment, strong motivation, endurance, etc.), then he is mentally prepared for the challenge. Those who possess adequate mental toughness1 – that shows a goal oriented thinking in a good sense of the word – persevere in pursuit of their intended purpose until the expected result, i.e. getting their degree, which also means a commitment to decision-making. This kind of perseverance can be called long-term endurance. Preparation for further education during the high school period is also accompanied by perseverance, which helps the student to get into the desired faculty and makes it likely to finish it successfully, avoiding dropping out. This endurance can be termed ‘prevention’ as well, because it serves as a protective basis for avoiding dropouts. In our research, therefore, we considered it important to examine this security net for students entering tertiary education to get acquainted with its most important elements, with whom the students’ achievement can be successfully influenced. The healthcare organisation specialisation in an aging society has been set up to help doctors with their more and more difficult work by taking over some work – in the area of healthcare – belonging to the competence of information technology. The objective of this study is to reveal the factors supporting students’ persistence values (at the early phase of their university career, i.e. at the beginning of their professional studies) among students specialised in health care organisation and to try to answer how much the persistence is present in the course of the higher education of the students, what factors affect their persistence and what the characteristics of the groups representing the various persistence values are. 1

The term of ‘mental toughness’ comes from sports psychology (SHEARD 2013).

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In our research, we are trying to point out how persistence as a protective factor in the initial investment of the first year students plays an important role in their academic well-being. 1.2. Introduction As a result of the expansion of higher education, more and more families can afford to let their children go to higher education providing them – later – with social and economic benefits. From an educational point of view, heterogeneous student composition, diversity of interests and values make learning objectives more difficult (HRUBOS 2005; HRUBOS 2007). Becoming a university student is considered as a success requiring a preliminary investment from both the student and the social environment. Having entered higher education, an additional investment is required by the students to complete their studies and obtain a degree because there is a very significant dropout rate. In many cases – in course of time – students’ ideas, the degree of persistence and determination change, however, they know that the invested amount and quality of effort will bring further success (KUH et al. 2008). The youngster – who is already a student and continues to be successful – theoretically has a personal career plan to progress and wants to lead a life with an engagement in their academic studies (TINTO 2006; PUSZTAI 2011). These are supplemented by their determined participation in learning processes, by the integration into the learning environment and due motivation (ASTIN 1993). According to Heuser’s research, a student is successful if they find their studies meaningful, do some work as a volunteer and perform their studies accepting the norm system of the institution (HEUSER 2007). The acquisition of the utmost knowledge is associated with the student’s role, however, the conscious development of connections with the role partners and social integration are also facilitators of socialisation (WEIDMAN 2001). Embedding into the social, educational relationship network of the institution means successful student socialisation, which is fulfilled in the process of professionalisation (TINTO 1993). To start an application for an institution of higher education, the student must be sufficiently prepared and must have correct self-knowledge, judgement and adequate inspiration. If these qualities are missing or are not of adequate extent – yet the student was admitted – correction is necessary. If a higher education institution is considered as a tool kit by a student, then in a good case, they have only to use the tools. In other cases, some different technique should be used to persist and obtain their degree. The key to the first year students is the awareness of student intention, tuning, motivation and adaptation to the student’s role, bearing in mind that it is the responsibility of the admitted student to take advantage of the given educational facilities and to complete their studies with good academic results. Of course, the process is accompanied by external (e.g. social status, national, ethnic affiliation) and internal (such as ability) characteristics influencing the subsequent success.

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The basic idea behind the frequently quoted Tinto integration model is that a higher level of commitment to learning goals is derived from the characteristics present at the admittance but perseverance – as an indispensable component – is needed. According to the model, the performance is facilitated and enhanced by the active participation in the courses and the student communities. To keep the student in the educational system a high degree of academic and social integration is needed (TINTO 1997). In higher education the driver of successful progress is the student’s engagement, which means spending considerable time and energy on study processes. Its degree has a positive impact on success. Student interactions have a decisive effect on the individual’s development. ASTIN (1984) accepts self-assessment of academic progress and considers that entering higher education according to the individual career plan, commitment to studies and doing work in accordance with the academic standards is a success. At any prestigious level of higher education, between the input and the output, one of the important tasks of the student is learning, as it is one of the cornerstones of professionalisation. Only mentally healthy students are able to learn and acquire advanced knowledge. Learning is characterised by autonomy, resistance to stress, ability to interact effectively with the environment, and ability to cope with the difficulties of everyday life2. According to the Green Paper: Improving the Mental Health of the Population: Towards a Strategy on Mental Health for the European Union, mental health is a degree of well-being in which the individual’s abilities are fulfilled, the person works hard and contributes to the life of his community (European Communities 2005). The concept of well-being encompasses what the individual can do, what he thinks and feels about what he can and must do (NEWTON 2007), as well as the awareness that implementation is often performed through active coping with difficulties (KEYES 1998). It is necessary, during the academic years, to form and develop skills in the students by which they not only survive their difficulties but which – in the meantime – help them to evolve their abilities. Determination can be enhanced with perseverance. Perseverance is the completion (despite the difficulties) of the tasks started, however, it is not perfectionism (SELIGMAN 2002; HU & ST. JOHN 2001). Success is enhanced by ‘success experience’, and weakened by failure but, at the same time, it also raises the level of endurance and they jointly give the coping experiences that affect the individual’s biological system determining the health stage. In students regarding hard learning tasks as challenges, study stress is of lesser degree and they are able to maintain a psychological and emotional health (PIKÓ 2010). According to the intentional education model, time and effort investment, involvement, dedication to studies and commitment are indispensable to the student’s socialisation (KARP 2008). In the sense of the definition of social integration, the student in higher education develops their own place in the institution according to their 2

See: www.salutogenesis.hv.se/files/bengt_lindstrm_finland1.pdf (retrieved 5 June 2017).

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subjective experiences. It is their own decision to make progress or to drop out. The feeling of being bound to the institution is enhanced by the development of information networks and group (social) relationships, all these helping to understand university life. (WEIDMAN 2001). The investigation of commitment to studies and academic engagement (e.g. scientific efforts, attending the lessons, etc.) can predict students’ determination and persistence in relation to their studies they have begun (PASCARELLA & TERENZINI 1978). It should also be remembered that the institutional environment highly appreciating future-conscious, performance-oriented behaviour and diligence is also an enhancing factor of a successful student career and creates a connection with the student enabling them to be steady in the fulfilment of the decisions made at individual level (PUSZTAI 2008). Different professions usually perform a social mission, representing central values based on common agreement and their appearance is shown in meeting needs and are related to various fields of competence, like education, healthcare, etc. (KOZMA 2007). Professionalism can be defined as professional socialisation and the formation of intellectual profession due to higher education studies (PUSZTAI 2009). Persistence intention in university studies is predicted by the combination of efficiency, socialisation, family support and stress. Torres and Solberg in their empirical study attempted to find relationship between student persistence and health involving effectiveness, stress effects, family support, and social inclusion factors (TORRES & SOLBERG 2001). Their results have shown that family support directly affects the level of performance and stress of study. 2. Sample and methods The students participating in the survey were – as has already been mentioned – first year (BSc) students specialising in health care organisation at the Public Healthcare Departments of Semmelweis University, the University of Debrecen3 (N = 200 persons). Data collection was carried out by the two universities – between 2014 and 2016, with differing research intentions – using on-line questionnaire survey structure, separated in space and time. The students filled in online questionnaires on the university Internet network, on a voluntary basis. The sample may be considered random because the students filled in the questionnaires as volunteers. Sample numbers: NSemmelweis = 98 (49%), NDebrecen = 102 (51%), Ntotal sample = 200 (100%). There is no significant difference between the two groups in the sample (p = 0.6892). The total sample is sufficiently large to carry out a statistical survey and to draw the appropriate conclusions. For the statistical analysis, the identical variables of the two data sets were sorted out and brought to a unified, easy-to-process form. The number of all variables investigated amounts to 177. We developed continuous, aggregated dependent vari3

Debrecen students, in the CHERD research program. Thank you for the opportunity in common.

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ables (e.g. Persistence variables) and predictor variables (such as Sports Activity, Permanent_Consumption_Items, etc.) of the variables group. 2.1. Measuring means 2.1.1. Persistence variable The degree of intensity of persistence was given by the values of the summing factors of the variables and values of the responses, consisting of 4 elements (Value of responses: 1 = Disagree; 2 = Agree): 1. I would like to achieve the best academic results possible, 2. I will do my best to attend lectures and practices, 3. My current study will be useful in my career, 4. I am very determined to finish my studies. Presentation of forming of significant predictor variables based on the persistence4 model: 2.1.2. Continuous variables COMMUNITY_MEMBERSHIP: values of the summing factors and responses (Values of responses: 1 = I do not want to be a member; 2 = Yes, outside university; 3 = Yes, within university; 4 = Yes, both). Elements: denomination, student government, sports circle, orchestra, charity organisation, etc. MOTHER’S_OCCUPATION: occupations could range from 1 to 8. Elements: does not work, unemployed, retired, leader, physical leader, intellectual leader, intellectual employee, intellectual etc. ADDITIONAL_SCORES: it means the additional points (extra scores) of the student brought from secondary school. Values of answers: 1 = Did not receive; 2 = Received. Elements: language exam, advanced level of maturity exam, disability, sports achievement, etc. VIEWS_ON_SPORT: expresses the opinion on sport. Values of answers: 1 = Disagrees; 2 = Agrees. Elements: helps to overcome stress, gives community, spiritually refreshing, love to compete, etc. FRIEND_OUTSIDE_UNIVERSITY: you have a friend with whom you are doing the following activities. Values for each answer: 1 = No; 2 = Yes. Elements: he learns together when his friend gets sick, visits, helps, they are together in their 4

The Hungarian variant of the measuring means of FRENCH et al. 2005.

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leisure time, they plan the future together, he helps with private life problems, he lends the book his friend asked for. A FRIEND_INSIDE_THE_UNIVERSITY: for a friend within a university, there was no significant (P=0.854) variable for the dependent variable in the model study. Which means that students in the first year are looking for a good social relationship among the old friends outside the university. SPENDING_FREE_TIME: who do they do their following leisure activities with. (Values of responses: 1 = I do not; 2 = Not a university friend /acquaintance; 3 = with a university friend/acquaintance; 4 = Both). Elements: who do they talk to, who do they do religious practices with, who do they go to the cinema or theatre with, who do they talk to, who do they go on an excursion with, who do they meet on Internet pages? ACADEMIC_VALUE: the student’s opinion on academic values. Values of responses: 1 = I totally disagree; 2 = I tend to disagree; 3 = I agree. Elements: regular cheating at university – if a student plays truant from school or evades lessons; uses or borrows the texts of other authors without reference; lies if he or she can not hand the task in on time; uses books or notes at exams in an illegal way; has somebody to write their essays, and thinks if the cheating is revealed, it is only bad luck. USE_OF_INTERNET: aggregated opinion on the use of the Internet. Values of the answers: 1 = Never; 2 = Rarely; 3 = at least once a month; 4 = at least once a week; 5 = daily. Elements: I watch video clips; I play; I visit the websites of my speciality and university, looking for technical material and downloading material for my subject. VOLUNTARY_WORK: does the student carry out voluntary work? (Responses: 1 = Never; 2 = Occasionally; 3 = Regularly). Elements: I did free volunteer work at secondary school, I did free volunteer work at the university. 2.1.3. Categorical variables a) Did you attend paid special classes during secondary school (Responses: 1 = No; 2 = Yes) b) Did you mark the specialisation course in the first place (1 Responses: = No; 2 = Yes) c) What denomination do your parents belong to? (Values of answers: 1 = Roman Catholic; 2 = Greek Catholic; 3 = Reformed; 4 = Evangelical; 5 = Other Religions; 6 = Non Religious) d) What percentage of the lessons did they visit a week? (Values of responses: 1 = 0–20%; 2 = 21–40%; 3 = 41–60%; 4 = 61–80%; 5 = 81–100%).

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2.2. Statistical analysis In the case of continuous data, the questionnaire was evaluated and the major parameters were determined by descriptive statistical methods. In the investigation contingency tables were used and the independence of the variables was established by a Chi-square test and a measure of the association, respectively. For the comparison of the Continuous Persistence Variable between the two groups, the independent twosample t-test was used and to express the intensity of the effect, the value of Cohend/Hedges-g was calculated. For the development of the persistence model, the GLZ (Generalized Linear Model) model was used, which is suitable for linear modelling of mixed-scale variables. Among the X explanatory variables, quantitative variables, such as age of students, and factors, like gender, may be included. In addition to the normal distribution, in the generalised linear model, for the distribution of the dependent variables, assumption of the binomial and Poisson distribution belonging to the family of the exponential distribution is the most common. By its help, the explained (persistence values) and the predictor variables (independent variables) can be markedly determined. By means of a cluster analysis, out of significant predictor variables, student groups were formed, which helps to assess students’ learning outcomes. The cluster analysis is an explorative analysis that tries to identify structures within the data. More specifically, it tries to identify homogeneous groups of participants. P < 0.05 value was regarded as significant. The analysis was carried out with IBM SPSS Statistics 23.0 (SPSS, Chicago, IL) program and Statistica 13.2 program (Dell Inc. Tulsa, USA). 3. Results 3.1. Association measures In the following, the statistical data of persistence values of the variables relevant to the research are presented:

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INVESTIGATION OF PERSISTENCE VALUE Table 1 Data of persistence values of the two university faculties Code of the faculty Budapest

Debrecen

Total

Gender

Mean

Standard deviation

Mail

7.46

0.87

18*

Female

7.34

1.08

80*

Total

7.35

1.06

98*

Male

7.22

1.11

13*

Female

7.06

1.33

89*

Total

7.09

1.29

102*

Male

7.32

1.01

31**

Female

7.21

1.21

169**

Total

7.23

1.18

200**

: p = 0.121; **: p= 0.634

There was no significant difference in the values of variables between the two faculties (p = 0.121, Cohen-d = 0.2202) and no difference was found between the genders, either (p = 0.634, Hedges-g = 0.0930). Table 2 Data of persistence values on paid private lessons Did he/she take paid private lessons during secondary school?

Mean

Standard deviation

6.79

1.51

Yes

162

7.33

1.07

The difference between the answers was significant (p = 0.043, Hedges-g = 0.4635), so the previous, extra investment in learning, mainly by the family of the student, increases the persistence

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M. DINYÁNÉ SZABÓ & G. PUSZTAI Table 3 Data of persistence values on the specialisation

Did he/she take paid private lessons during secondary school?

Mean

Standard Standard deviation

6.96

1.23

Yes

123

7.31

1.15

The difference between the two groups was significant (p = 0.042, Hedges-g = 0.2962), so the one who failed to get into the place marked in the first place, can be characterised by a lower persistence and could be more easily at risk, whereas, obtaining the preferred choice increases the fact of persistence. Table 4 The distribution of persistence values according to the religiousness of the parents Religiousness of the parents

Mean

Standard deviation

Not religious

6.77

1.21

Religious

171

7.25

1.18

The difference between the two groups was significant (p = 0.044, Hedges-g = 0.4053). The children of religious parents are more persistent, the regulating-orienting effect of religiousness and the values and norms accepted by everybody within the religious network may spur them to a higher degree of performance (25). From the answers given to the question: How many lessons did you attend in an average week? Two groups were formed: Less active participants (< 80% of attended lessons), Active participants (> 80% of attended lessons) and persistence was evaluated according to these groups. Table 5 Persistence values reflected by the attendance of the lessons Groups

Mean

Standard deviation

Less active participants

6.45

1.28

Active participants

120

7.74

0.76

The difference between the two groups is significant (p < 0.001, Hedges-g = 1.2894), the persistence values of the ‘Active participants’ are markedly higher.

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3.1.1. Investigation of variables between the two institutions/universities Table 6 Statistical data of the aggregated predictor variables of the two institutions Budapest (N=98) Variables

Debrecen (N=102)

Total p

Mean

Standard d.

Mean

Standard d.

Mean

Standard d.

Community membership

26.64

2.08

26.72

2.13

26.68

2.11

0.782

Motherâ&#x20AC;&#x2122;s occupation

7.27

1.03

6.73

1.11

6.99

1.10

< 0.001*

Additional scores

8.44

0.63

7.93

0.98

8.18

0.86

< 0.001*

Views on sports

7.69

1.22

7.42

1.16

7.56

1.19

0.11

Friends outside the university

9.51

1.73

10.43

1.79

9.98

1.82

< 0.001*

Spending free time

13.69

1.87

10.58

2.63

12.11

2.77

< 0.001*

Academic norms

25.91

5.11

23.57

3.28

24.72

4.42

< 0.001*

Use of the Internet

24.54

4.33

22.47

3.50

23.49

4.06

< 0.001*

Doing volunteer work

2.50

0.79

3.90

0.83

3.22

1.07

< 0.001*

3.1.2. Conclusions based on the Table 6 Community membership Motherâ&#x20AC;&#x2122;s occupation Additional scores

Views on sports

There is no significant difference between the students of the two universities in assessing the importance of social relations. In Budapest, the value pertaining to occupation is significantly higher, which means that parents usually have a higher level of education here. The average value of the extra scores brought for the entrance examination is significantly higher, which means that Budapest students acquired a higher number of additional points/scores. The students of the two universities share the same opinion about the benefits of sports.

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Friend outside the university Spending free time

Academic norms Use of the Internet Doing volunteer work

It is significantly characteristic of the students of Debrecen university that they tend to seek relationships with friends outside the university. It is significantly characteristic of Budapest students that they willingly seek friends from both groups (at the university and outside the university) to spend their free time with. Budapest students tend to accept academic norms more, i.e. in a significant way. Budapest students use the Internet significantly more intensively. Regular volunteer work is significantly characteristic of Debrecen students.

3.2. Persistency model Significant student factors (variables) based on the developed GLZ model, which influence the persistence values, are: Table 7 Predictor variables Value of B regression coefficient

Wald statistics

Did he/she attended paid private lessons during secondary school?

0.519

7.491

0.006*

Marked specialisation in the first place

0.257

3.059

0.046*

Religiousness of parents

0.919

5.654

0.017*

Attendance of the lessons

1.149

71.244

< 0.001*

Community membership

0.074

3.549

0.056

Mother’s occupation

0.139

3.322

0.068

Additional scores

0.212

4.683

0.030*

Views on sports

0.112

2.638

0.091

Friends outside the university

0.098

5.112

0.024*

Spending free time

0.092

7.995

0.005*

Significant variables

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0.065

13.134

< 0.001*

Use of the Internet

â&#x20AC;&#x201C;0.045

5.290

0.021*

Doing volunteer work

0.167

3.038

0.081

: significant relation at p < 0.05 value

Table 8 Omnibus test Likelihood Ratio Chi-Square

115.688

0.000

Omnibus test is significant (p < 0.001), which shows the effect of explaining variables, the appropriate fitting of the model. 3.3. Hierarchical clustering In order to classify students as disaggregated but individually homogeneous groups with the help of significant regression variables, a hierarchical cluster analysis was performed because this clustering method is the most suitable one for our data base with regard to the sample size or outlier values. Hierarchical cluster is the most common method, it generates a series of models with cluster solutions from 1 (all cases in one cluster) to n (all cases are an individual cluster). If the variables involved in cluster analysis are at different levels of measurement, and the individual ranges show significant differences, it greatly distorts the cluster analysis result. In such cases variables should be transformed into equivalent scales to make our variables comparable. There are several options for this, either by logging the variable or by standardising. We have used the latter procedure. Within the cluster method we have adapted the amalgamation (linkage) rule=Wardâ&#x20AC;&#x2122;s method and distance measure=Euclidean distances. The dendrogram (Figure 1) shows the different clusters:

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Did he/she attended paid private lessons during secondary school Academic norms Persistence value Attendance of lessons Marked the specialization in the first place Community membership Friend outside the university Doing volunteer work Mother’s occupation Views on sports Additional scores Spending free time Use of Internet Religiousness of the parents 12 14 16 18 20 22 24 26 28 Linkage Distance

Figure 1 Dendrogram

We have got three clusters on the basis of the dendrogram and the following denominations were used for clusters: Cluster 1 (Persistency): the group contains students whose persistence is a strong characteristic feature: this is reflected in the appearance of the Persistence value variable in the group and the appearance of related variables, for example the Attendance of the lessons variable, which is united with persistence at the lowest level. Cluster 2 (Dating): the companion is a characteristic of the group, the desire for the community, a good example of which is the use of the Community membership or Friend outside the university variables. It is likely that the Marked specialisation in the first place variable will appear in this group as the student wants to belong to the chosen vocational community. Cluster 3 (Joint characteristics group): the main characteristic of the group is difficult to define and it is also difficult to name the cluster on the basis of the fact that it has several interesting but distinct features on its own but the influence of religion can be assumed as it involves a cluster of these students. By completing clustering at the universities (Semmelweis and Debrecen) we have got the same result as the combined data presented above, which verifies the stability of our clusters.

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Merging cluster 2 and cluster 3 groups into a group is justified by their similarity. Interestingly, cluster 1 merges with cluster 2 and cluster 3 groups at the very end. 4. Discussion Based on the above, the persistence regression model can be defined and the prediction variables affecting persistence may also be identified. The main findings of the study can be briefly summarised as follows with regard to the significant variables: a) Paid private lessons during secondary school: it shows that the determination and the goal of getting into the university and the sacrifice made by the family for achieving this goal also exerts a positive effect on the student’s perseverance. b) Marked in the first place: the negative sign of the coefficient indicates that the choice of students is unclear, there is a significant number of people, for whom this was not really the course they wanted to come to. There are several people who applied for the faculty of general medicine, and marked it in the first place but yet they came to the faculty of Health Care Organisation as a second option. Many of these students will try to take an entrance examination to the medical faculty again at the end of the first year. This may explain the reduction of variables against persistence values. c) Religiousness of the parents: a religious family background is undoubtedly a positive factor in enhancing students’ perseverance. d) Attendance at the lessons: the ratio of participating in the lessons has an effect on the value of persistence. The sign of the coefficient shows that the value of persistence is increasing in case of the ‘Active participants’ students (TINTO 1997). e) Community membership: active participation in communities reinforces persistence and has favourable effect on student’s perseverance (TINTO 1997). f) Mother’s occupation: interestingly, the mother’s occupation has a positive impact on student persistence, the higher the mother’s education is the more it enhances perseverance (TORRES & SOLLBERG 2001). g) Additional scores: students with additional scores brought from secondary school have better persistence values. h) Views on sports: although not in a significant way, but views on sport have a positive impact on persistence value. i) Friends outside the university: friends (friendship) outside the university has a significant effect on the persistence of the student. The reason for this may be that the student has not made friends at the university yet, so the so called ‘brought’ relations are important. j) Spending free time: the results are similar to those of friends outside the university. k) Academic norms: accepting the academic norms increases persistence (HEUSER 2007).

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l) Use of the Internet: in the case of students regularly using the Internet persistence decreases, the Internet counteracts on persistence, since it is typically used chatting, playing and for other fun activities. m) Doing volunteer work: increases persistence values (HEUSER 2007). Through cluster analysis we have got three homogeneous student groups that further help to understand the composition and behaviour of the student community. 5. Conclusion The aim of the present study was to investigate in a non-representative sample of first-year students of healthcare organising, how much the persistence values indispensable for successful studies are present in their lives, what factors affect these values and what student groups can be formed out of the important variables at the initial phase of the students’ professional studies. The knowledge of these variables can be a key to successful studies and obtaining a diploma. By performing cluster analysis, the cluster groups (Persistency, Dating, Joint characteristics group) were created from regression predictor variables by which students could be classified to assess their learning outcomes. In our opinion, it would be worthwhile to survey at each faculty to what extent the present teaching and educational facilities support learning needs of students with different ‘persistence values’ and the information obtained could be used to produce operative strategies and to develop the already existing ones. References ASTIN, A.W. (1984) ‘Student Involvement: A Developmental Theory for Higher Education’, Journal of College Student Personnel 25, 297–308. ASTIN, A.W. (1993) What Matters in College: Four Critical Years Revisited (San Francisco: Jossey-Boss). European Communities (2005) Green Paper: Improving the Mental Health of the Population: Towards a Strategy on Mental Health for the European Union, retrieved 6 May 2017 from http://ec.europa.eu/health/archive/ph_determinants/life_style/mental/green_paper/mental_gp _en.pdf. FRENCH, B.F., J.C. IMMEKUS & W.C. OAKES (2005) ‘An Examination of Indicators of Engineering Students’ Success and Persistence’, Journal of Engineering Education 94, 419–25 (https://doi.org/10.1002/j.2168-9830.2005.tb00869.x). HEUSER, B.L. (2007) ‘Academic Social Cohesion within Higher Education’, Prospects 37, 293– 303 (https://doi.org/10.1007/s11125-008-9036-3). HRUBOS, I. (2005) ‘A 21. század egyeteme: megújulási kényszerek, megőrzendő értékek’, Iskolakultúra 15:2 (Feb) 120–23. HRUBOS, I. (2007) ‘Az akadémiai professzió – változó pozícióban’, Educatio 16:3, 353–65. HU, S. & E.P. ST. JOHN (2001) ‘Student Persistence in a Public Higher Education System: Understanding Racial and Ethnic Differences’, The Journal of Higher Education 72, 265–86 (https://doi.org/10.1080/00221546.2001.11777095).

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KARP, M.M. & K.L. HUGHES (2008) ‘Information Networks and Integration: Institutional Influences on Experiences and Persistence of Beginning Students’, New Directions for Community Colleges 144 (issue nr.), 73–82 (https://doi.org/10.1002/cc.347). KEYES, C.L.M. (1998) ‘Social Well-Being’, Social Psychology Quarterly 61:2, 121–40. KOZMA, J. (2007) ‘A szociális munka professzionalizációja a jóléti államokban I.’, Kapocs 6:2 (Apr), retrieved 5 June 2017 from http://epa.oszk.hu/02900/02943/00029/pdf/EPA02943_ kapocs_2007_2_01.pdf. KUH, G., T.M. CRUCE, R. SHOUP, J. KINZIE & R.M. GONYEA (2008) ‘Unmasking the Effects of Student Engagement on First-Year College Grades and Persistence’, The Journal of Higher Education 79, 540–63 (https://doi.org/10.1353/jhe.0.0019). NEWTON, J. (2007) Structures, Regimes and Well-being, WeD Working Paper 30 (ESRC Research Group on Well-being in Developing Countries) retrieved 28 May 2017 from http://www. welldev.org.uk/research/workingpaperpdf/wed30.pdf. PASCARELLA, E. T. & P.T. TERENZINI (1978) ‘Student-Faculty Informal Relationships and Freshman Year Educational Outcomes’, The Journal of Educational Research 71:4 (Mar. – Apr.) 183–89. PIKÓ, B. (2010) ‘Védőfaktorok nyomában: Pozitív fordulat a magatartáskutatásokban’ in B. PIKÓ (Ed.) Védőfaktorok nyomában: A káros szenvedélyek megelőzése és egészségfejlesztés serdülőkorban (Budapest: L’Harmattan) 11–22. PUSZTAI, G. (2008) Középiskolások továbbtanulási tervei egy határmenti régióban, OTKA K48820 szakmai beszámoló, retrieved 5 June 2017 from http://real.mtak.hu/2274/1/48820_ZJ1.pdf. PUSZTAI, G. (2009) Társadalmi tőke és iskolai pályafutás (Budapest: Újmandátum). PUSZTAI, G. (2011) A láthatatlan kéztől a baráti kezekig: Hallgatói értelmező közösségek a felsőoktatásban (Budapest: Új Mandátum). SELIGMAN, M.E.P. (2002) ‘Positive psychology, positive prevention, and positive therapy’ in C.R. SNYDER & S.J. LOPEZ (Eds.) Handbook of Positive Psychology (New York: Oxford UP) 3–9. SHEARD, M. (2013) Mental Toughness (London: Routledge) quoted by I. DÁVID, M. FÜLÖP, N. PATAKY & J. RUDAS (Eds.) Stressz, megküzdés, versengés, konfliktusok (Magyar Tehetségsegítő Szervezetek Szövetsége). TINTO, V. (1993) Leaving Collage: Rethinking the Causes of Student Attrition (Chicago & London: U of Chicago P). TINTO, V. (1997) ‘Classrooms as Communities: Exploring the Educational Character of Student Persistence’, Journal of Higher Education. 68, 599–623 (https://doi.org/10.2307/2959965). TINTO, V. (2006) ‘Research And Practice of Student Retention: What Next?’ Journal of College Student Retention Research 8: 1 (May) 1–19 (https://doi.org/10.2190/4YNU-4TMB-22DJAN4W). TORRES, J.B. & V.S. SOLBERG (2001) ‘Role of Self-Efficacy, Stress, Social Integration, and Family Support in Latino College Student Persistence and Health’, Journal of Vocational Behavior 59, 53–63 (https://doi.org/10.1006/jvbe.2000.1785). WEIDMAN, J.C. (2001) Socialization of Graduate and Professional Students in Higher Education: A Perilous Passage? (San Francisco, CA: Jossey-Boss).

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European Journal of Mental Health 12 (2017) 152–164 https://doi.org/10.5708/EJMH.12.2017.1.2

BETTINA F. PIKÓ* & MÁRIA MIHÁLKA

A STUDY OF WORK SATISFACTION, BURNOUT AND OTHER WORK-RELATED VARIABLES AMONG HUNGARIAN EDUCATORS (Received: 9 August 2016; accepted: 3 December 2017)

The main goal of the present study was to investigate, based on the Job Demands–Resources Model, a set of work-related variables as possible correlates (either as job demands or resources) of work satisfaction in a sample of Hungarian educators (N = 2,068, aged between 23–74 years, mean = 48.1 and S.D. = 8.9; 83.5% females). Results report that in this sample of Hungarian educators, their work satisfaction is closely related to the presence of burnout (particularly emotional exhaustion) and it is also influenced by role conflicts and role ambiguity in their workplace; whereas work-family conflict and work time demands do not play a role. On the other hand, educators’ work satisfaction may be protected by certain job resources such as satisfaction with professional prestige, work social support and work involvement. Satisfaction with salary and work policy was not significant. Findings suggest that interventions at both individual and organisational level should be necessary, e.g. learning effective coping techniques to prevent burnout and increase work satisfaction well before the start of an educator’s career. The organisational interventions should strengthen job resources and eliminate/decrease job demands. Keywords: work satisfaction, educator burnout, job demand, job resources Studie zur Zufriedenheit mit der Arbeit, zu Burnout und anderen Variablen bezüglich der Arbeit bei ungarischen Erziehern: Das Hauptziel dieser Studie bestand darin, anhand des Job Demands–Resources Model eine Reihe von Variablen im Zusammenhang mit der Arbeit als mögliche Korrelate (entweder Arbeitsanforderungen oder Ressourcen) der Zufriedenheit mit der Arbeit an einer Stichprobe ungarischer Erzieher (N = 2 068, Alter von 23 bis 74 Jahre, Mittel = 48,1 und S. D. = 8,9; 83 % Frauen) zu untersuchen. Die Ergebnisse zeigen, dass die Zufriedenheit mit der Arbeit bei diesen ungarischen Erziehern eng mit dem Vorliegen eines Burnouts (insbesondere emotionaler Erschöpfung) zusammenhängt und auch durch Rollenkonflikte und Rollenunklarheit am Arbeitsplatz beeinflusst wird, während Konflikte zwischen Arbeit und Familie sowie Arbeitszeitanforderungen keine Rolle spielen. Andererseits kann die Zufriedenheit von Erziehern mit der Arbeit durch bestimmte Ressourcen wie Zufriedenheit mit dem beruflichen Ansehen, soziale

Corresponding author: Bettina F. Pikó, University of Szeged, Department of Behavioral Sciences, Szentháromság u. 5., H-6722 Szeged, Hungary; fuzne.piko.bettina@med.u-szeged.hu.

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Unterstützung der Arbeit und Engagement geschützt werden. Die Zufriedenheit mit dem Gehalt und den Vorschriften bezüglich der Arbeit war nicht signifikant. Die Ergebnisse deuten darauf hin, dass auf individueller wie auf organisatorischer Ebene Interventionen erforderlich sind, zum Beispiel das Erlernen wirksamer Methoden zur Bewältigung, um ein Burnout zu vermeiden und die Zufriedenheit mit der Arbeit zu erhöhen, lange bevor ein/e Erzieher/in seine/ihre Laufbahn beginnt. Organisatorische Interventionen sollten die Ressourcen für die Arbeit steigern und Anforderungen bezüglich der Arbeit eliminieren / senken. Schlüsselbegriffe: Zufriedenheit mit der Arbeit, Burnout bei Erziehern, Anforderungen bei der Arbeit, Ressourcen bei der Arbeit

1. Introduction Teaching has always been identified as a stressful occupation. As an earlier paper described (RUSSEL et al. 1987), there are many negative aspects that might cause job stress for educators, namely: disciplinary problems, lack of students’ motivation, crowded classrooms, excessive administration, inadequate salary, demanding parents, rapid changes in educational policy or lack of peer or principal social support. Teacher burnout, particularly, is a world-wide phenomenon (SCHWARZER et al. 2000), including Hungary (PETRÓCZI 2007; SALAVECZ et al. 2006). In a comparison of workers of all human services in Finland, educators have the highest level of burnout (HAKANEN et al. 2006). Burnout has a direct effect on job satisfaction (MALINEN & SAVOLAINEN 2016) and job dissatisfaction plays a decisive role in teachers’ motivation to leave their profession (SKAALVIK & SKAALVIK 2011). Work satisfaction seems to be a relevant indicator of job stress and burnout and their organisational and health consequences (HOSSEINKHANZADEH et al. 2013; MALINEN & SAVOLAINEN 2016; SKAALVIK & SKAALVIK 2011). The Job Demands–Resources Model (BAKKER et al. 2003) provides a good rationale for understanding the balance in parallel processes of job satisfaction and motivation among educators. This balance model often used in the literature suggests that work strain and its consequences (such as work dissatisfaction) are the result of a disturbance in the equilibrium between the demands employees are exposed to and the resources they have at their disposal. This model is similar to an influential theory of KARASEK (1979), namely, the demands–control model. High job demands and low job control may lead to disturbances in both the employee’s work accomplishment and well-being. The Job Demands–Resources Model argues that, regardless of the occupation, two broad categories of work characteristics can be distinguished: job demands and job resources (BAKKER et al 2003). Job demands, such as role conflicts, role ambiguity, time demands or work-family conflicts may serve as risk factors (PALOMINO & FREZATTI 2016). Burnout is a relevant indicator of the inability to function effectively in work due to prolonged and extensive work stress and a failure to cope with it. This syndrome, characterised by emotional exhaustion, depersonalisation and the lack of personal accomplishment, is usually linked to human service professionals, such as

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nurses, educators, social workers or police officers (BYRNE 1993). Particularly emotional exhaustion plays a decisive role in teacher job satisfaction and motivation to leave the teaching profession (SKAALVIK & SKAALVIK 2011). In contemporary organisations, employees must face several and different expectations both from others and themselves. Despite that they make continuous effort to carry out their roles effectively, incompatible, vague or conflicting expectations may often lead to role conflict and role ambiguity (BELIAS et al. 2015). The role theory also emphasised the scarcity hypothesis, that is, due to a fixed amount of resources, such as time and energy, the different requirements may lead to incompetency in work, family or both (MICHEL et al. 2010). Therefore, the literature often focused on the work–family conflict, namely a source of stress related to the role pressures from the work and family domains which may influence a number of outcomes including psychological distress, job satisfaction, organisation commitment, turnover, and life satisfaction (ADAMS et al. 1996; CARLSON et al. 2000). Increasing work assignment, work load and hectic workday, increasing demand for documentation and paperwork, more frequent meetings, the administration and scoring of achievement tests, frequent changes of the curriculum, and participation in a number of school development projects may result in time pressure and role conflicts or ambiguity in both job and family (SKALVIK & SKAALVIK 2011). Whereas job demands may contribute to work dissatisfaction, job resources seem to reduce job stress, burnout and increase work satisfaction (BAKKER et al. 2003). Previous studies suggest that teacher autonomy, work involvement and empowerment help reduce work stress and increase work satisfaction, particularly the latter factor (PEARSON & MOOMAW 2005). Job involvement includes a personal interest centering on the job that may contribute to work motivation and a higher degree of professionalism, work engagement and organisational commitment. These job resources reduce job demands and stimulate personal growth and development through achieving work goals (DEMEROUTI et al. 2001). Job resources may also buffer against the impact of job demands or burnout (BAKKER et al. 2005) – particularly those stemming from the school climate (MALINEN & SAVOLAINEN 2016). In a broader concept, school climate is a microculture within school including values, educational goals, local educational policy or the psychosocial context in which educators work or teach (JOHNSON et al. 2007). On the other hand, workrelated social support (both organisational support and peer support) is an important aspect of the work environment that interferes with coping resources and job stress (ADAMS et al. 1996). Thus it is related to a number of job-related consequences such as work satisfaction, work involvement, teacher motivation and effort (BETORET 2006; HOSSEINKHANZADEH et al. 2013; LENT et al. 2011; SKAALVIK & SKAALVIK 2011). Collegial relationships – whether cooperative and supportive or jealous – were found to be important correlates of the secondary school teachers’ work satisfaction (WEIQI 2007). Besides school climate, a more general perception of one’s occupation may also be relevant in teachers’ work satisfaction, such as satisfaction with educators’

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social prestige or salaries, similar to other professions (BELIAS et al. 2015). In relation to the educators’ occupation, job perception may include autonomy at work, professional prestige and status, personal development, work policy, professional self-efficacy as well as benefits (e.g. salaries; BOGLER 2001). Educators’ perception of the macro-environment of education, such as educational and teaching systems, is an important element of work satisfaction similarly to their social status, income and welfare, and social acknowledgement by society (WEIQI 2007). In a Hungarian study, the role of collegial relationships and professional autonomy was more relevant to the educators’ work satisfaction than professional prestige and salaries (HOLECZ & MOLNÁR 2014). Based on the literature findings, the main goal of the present study is to investigate, based on the Job Demands–Resources Model, a set of work-related variables as possible correlates (either as job demands or resources) of work satisfaction in a sample of Hungarian educators. Those variables are the following: burnout, satisfaction with salary, professional prestige and work policy, work social support, work involvement, role conflicts and ambiguity, time demands, work-family conflicts. We hypothesised that burnout, role conflicts and ambiguity, time demands and work-family conflicts might act as risk factors which might negatively contribute to educators’ work satisfaction. On the contrary, satisfaction with salary, professional prestige and work policy, work social support, work involvement may act as protective factors, that is, they might be positively related to work satisfaction. 2. Subjects and method Data were collected during a one-month-long period between December, 2016 and January, 2017. A multistage sampling method was used to reach educators (school teachers, music teachers, nursery school teachers, social pedagogues, school principals, special education teachers, adult education teachers, etc.) using the Central Information System of the National Educational Office (KIR). From the central data file of e-mails of the institutions (14,000 altogether), every 10th was selected and posted about the main goal of the study. After receiving ethical approval from the Institutional Review Board (IRB) of the Doctoral School, University of Szeged, data were collected via online survey by means of a link distributed by e-mails. The final sample size was 2,068 (aged between 23 and 74; mean = 48.1 years, S.D. = 8.9 years; 83.5% females). Participation in the survey was anonymous and based on self-reported data, and the participants agreed that completion and return of the questionnaire was construed as consent. The questionnaire contained items on the educators’ health and work-related experience, in addition to sociodemographics. The Maslach Burnout Inventory (MBI), Educator Survey (MASLACH & JACKSON 1986) was designed to assess job stress in teaching professionals. The 22-item MBI has three factor-analytically derived scales: emotional exhaustion, depersonalisation (positively related to burnout) and personal accomplishment (negatively related to burnout). Responses were assessed by a seven-point Likert-type response format

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ranging from Almost never (= 0) to Almost always (= 6). Cronbach’s alpha reliability values with the current sample were the following: 0.89 (MBI), 0.89 (Emotional exhaustion), 0.73 (Depersonalisation) and 0.77 (personal accomplishment). Work satisfaction was measured by six items (e.g. ‘Most days, I am enthusiastic about my work.’) that reflect overall satisfaction with one’s job instead of specific dimensions (BABIN & BOLES 1998). The scale was adapted to Hungarian by Csaba KISS (2013). Responses were evaluated on a 5-point Likert-type scale indicating the level of agreement from 1 = strongly disagree to 5 = strongly agree. The reliability coefficient was .88 with the current sample. Two scales were applied to measure role conflict and role ambiguity developed by RIZZO and colleagues (1970). The Hungarian version was adapted by KISS (2013). The role conflict scale (e.g. ‘I have to do things that should be done differently.’) consisted of eight items (one of which was reversed); whereas the role ambiguity scale (e.g. ‘I know exactly what is expected of me.’) contained six items (all of them were reversed). Responses vary based on the level of agreement with each item ranging from 1 (= strongly disagree) to 5 (= strongly agree). Cronbach’s alpha coefficients were the following: 0.86 (role conflict scale) and 0.78 (role ambiguity scale). The Hungarian version of the Work-Family Conflict Scale (CARLSON et al. 2000) was translated by the authors; its Hungarian validation is in progress. This is a self-report measure composed of 18 items assessing six conceptually and empirically distinct dimensions (Time-based work interference with family; Time-based family interference with work; Strain-based work interference with family; Strainbased family interference with work; Behaviour-based work interference with family; Behaviour-based family interference with work). Each of the six dimensions is assessed with three items. Responses were measured on 5-point Likert-type scales (1= strongly disagree to 5 = strongly agree). Cronbach’s reliability was 0.88. Work-related time demands were measured by the educators’ perceived level of role overload developed by BEEHR and colleagues (1976). The scale consisted of 3 items (e.g. ‘It often seems like I have too much work for one person to do.’) and it was adapted to Hungarian by KISS (2013). Similarly to the above mentioned measurements, responses were measured on 5-point Likert-type scales based on the level of agreement. The internal consistency estimate for this scale was 0.73, similarly to US studies (e.g. CARLSON & KACMAR 2000). Social support in work was measured by 10 items of the self-report questionnaire (ETZION 1984). The Hungarian version (KISS 2013) of the scale was used here. The participants were asked to respond to those items on a 7-point scale of which seven correspond to support in their work, namely, feedback from others, recognition, sharing duties when in need, or emotional reciprocity. Additional three items correspond to the quality of the relationships with supervisors, colleagues or subordinates. The Cronbach’s alpha value of reliability was 0.88 with the current sample. Work involvement was assessed by the four items of the Job involvement scale (FRONE & RUSSEL 1995). That scale was adapted and validated to Hungarian by MAKRA and colleagues (2012). All items (e.g. ‘My job is a very important part of my

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life’.) were evaluated on a four-point agree/disagree response scale. Cronbach’s alpha value was 0.78 with this sample. Finally, satisfaction with salaries, professional prestige and job-related decisions with three single-item questions were also added. Those were based on previous research findings (e.g. BOGLER 2001; WEIQI 2007). In each case a dichotomised response (yes/no) was applied. SPSS program was used in the calculations with a maximum significance level of 0.05. The analysis begins with descriptive statistics and correlation matrix for the study variables. The role of work-related variables in educators’ work satisfaction was assessed by multiple linear regression analysis. Collinearity diagnostics of the multiple linear regression models were also calculated to examine reliability for the models. 3. Results Table 1 provides descriptive statistics and correlation matrix of study variables in this sample of Hungarian educators. There were strong intercorrelations among the subscales of burnout, particularly between emotional exhaustion and depersonalisation. Emotional exhaustion was the strongest correlate of work satisfaction (r = –0.60, p < 0.001). Burnout subscales, role conflicts, role ambiguity, time demands and work-family conflicts showed negative correlations with work satisfaction, whereas work social support, work involvement, and satisfaction with professional prestige, salaries and work policy were positively correlated. Work social support was the strongest positive correlate of the educators’ work satisfaction (r = 0.48, p < 0.001). Burnout subscales were negatively correlated with satisfaction with prestige, salaries and work policy and positively with role conflicts and ambiguity, work-family conflicts and time demands. Work involvement did not play a role in emotional exhaustion, whereas it was negatively correlated with depersonalisation and lack of personal accomplishment. This variable showed significant but moderate relationship with satisfaction with work policy and prestige, work social support, role conflicts, workfamily conflicts (positive correlations) and time demands (negative correlation). Work social support was negatively associated with role conflicts and ambiguity, time demands, and work-family conflicts. Role conflicts showed the strongest correlation with time demands (r = 0.48, p < 0.001). Table 2 presents results for multiple linear regression analysis for the relationships between educators’ work satisfaction (as dependent variable) and other workrelated factors (as independent variables). In Model 1, total score of the Maslach Burnout Inventory was applied, whereas in Model 2, subscales were used. The total burnout score was a negative predictor (b = –0.53, p < 0.001). Work social support and work involvement were significant but moderate positive predictors similarly to the satisfaction with professional prestige. Role conflicts and role ambiguity contributed to the regression model as negative predictors, with 57% of total variance explained.

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7.2 (5.3) 20.7 (6.3) 44.1% 55.9% 11.8% 88.2% 40% 60% 37.1 (7.4) 22.5 (7.4) 12.9 (4.2) 9.9 (3.0) 11.4 (2.2) 47.6 (12.4) 23.2 (4.7)

12. Depersonalisation (range: 0–30)

13. Lack of personal accomplishment (range: 0–48)

14. Satisfaction with salary yes/no%

15. Satisfaction with professional prestige yes/no%

16. Satisfaction with work policy yes/no%

17. Work social support (range: 11–50)

18. Role conflicts (range: 8–40)

19. Role ambiguity (range: 6–30)

10. Work time demands (range: 3–15)

11. Work involvement (range: 4–16)

12. Work-family conflicts (range: 8–40)

13. Work satisfaction (range: 6–30)

–

0.34***

–

0.27***

0.26***

0.11***

0.01***

0.38*** –0.47***

0.60*** –0.60***

–0.16*** 0.17***

–

0.47***

–

0.11***

–

0.07***

–

–0.40***

0.26***

0.43*** –0.27***

0.29*** –0.15*** 0.33*** –0.45***

0.48*** –0.01*** 0.46*** –0.42***

–0.49*** –0.48*** –0.28*** 0.07*** –0.35*** 0.48***

0.15*** –0.20*** –0.13*** –0.16*** 0.06*** –0.14*** 0.15***

0.36*** –0.29*** 0.26*** –0.25*** 0.08*** –0.28*** 0.36***

0.03

0.10*** –0.26*** 0.28*** –0.56***

0.16***

0.44***

0.22*** –0.20*** –0.11*** –0.15***

0.36***

–0.07** –0.27*** –0.10*** –0.31*** 0.17***

0.27***

0.42*** –0.08*** –0.23*** –0.06** –0.25*** 0.32***

5 0.33***

0.36*** –0.15*** –0.36*** –0.14*** –0.42*** 0.44***

r = correlation coefficients: *: p < 0.05; **: p < 0.01; ***: p < 0.001

0.53***

23.7 (10.5)

11. Emotional exhaustion (range: 0–54)

Mean (S.D.)

Table 1 Descriptive statistics and correlation matrix of study variables (N = 2,068)

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159

WORK SATISFACTION, BURNOUT Table 2 The role of work-related variables in teachers’ work satisfaction: Multiple linear regression analysis Independent variables

Model 1

Model 2

POTENTIAL RISK FACTORS Maslach Burnout Inventory Emotional exhaustion Depersonalization Lack of personal accomplishment

–0.53***

Role conflicts

–0.10***

–0.12***

Role ambiguity

–0.09***

–0.08***

Work time demands

–0.02***

–0.03***

Work-family conflicts

–0.01***

Satisfaction with salary

–0.01***

Satisfaction with professional prestige

–0.04***

Satisfaction with work policy

–0.01***

–0.04***

Work social support

–0.13***

–0.12***

Work involvement

–0.17***

Constant

25.48***

26.65***

–0.57***

–0.35*** –0.06*** –0.26***

POTENTIAL PROTECTIVE FACTORS

b = standardised regression coefficients: *: p < 0.05; **: p < 0.01; ***: p < 0.001

As Model 2 suggested, among the burnout subscales, emotional exhaustion was the strongest negative predictor (b = –0.35, p < 0.001). Work social support and work involvement positively, whereas role conflicts and ambiguity negatively contributed to the model. All these variables explained 57% of total variance explained. The reliability of the models was further examined with VIF (Variance Inflation Factor) indices and tolerance values (Table 3). The VIF values were within the acceptable VIF range (below 2) except for emotional exhaustion in Model 2 which was slightly above.

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Table 3 Collinearity diagnostics of the multiple linear regression models for teachers’ work satisfaction Independent variables

Model 1 Tolerance (VIF)

Model 2 Tolerance (VIF)

POTENTIAL RISK FACTORS Maslach Burnout Inventory Emotional exhaustion Depersonalization Lack of personal accomplishment

0.56 (1.79)

Role conflicts

0.56 (1.79)

0.54 (1.84)

Role ambiguity

0.65 (1.54)

0.63 (1.58)

Work time demands

0.91 (1.09)

0.89 (1.13)

Work-family conflicts

0.57 (1.76)

0.56 (1.79)

Satisfaction with salary

0.82 (1.22)

Satisfaction with professional prestige

0.69 (1.44)

0.70 (1.44)

Satisfaction with work policy

0.87 (1.15)

0.86 (1.16)

Work social support

0.61 (1.63)

0.60 (1.66)

Work involvement

0.69 (1.46)

0.64 (1.55)

0.45 (2.21) 0.62 (1.61) 0.70 (1.43)

POTENTIAL PROTECTIVE FACTORS

Notes: VIF = Variance Inflation Factor.

4. Discussion Work satisfaction has a determinant role in employees’ work achievement, motivation to work, health and quality of life; not only at individual but also at organisational and societal level (HOSSEINKHANZADEH et al. 2013; MALINEN & SAVOLAINEN 2016; SKAALVIK & SKAALVIK 2011). Based on the Job Demands–Resources Model (BAKKER et al. 2003), we investigated a set of demands and burdens (burnout, role conflicts, role ambiguity, work time demands, work-family conflicts), resources and benefits (satisfaction with salary, professional prestige and policy, work social support and work involvement) in relation to educators’ work satisfaction. We anticipated that the previous set of variables might act as risk factors that contribute negatively to work satisfaction, whereas the latter ones may provide protection. There were strong correlations between the burnout subscales and educators’ work satisfaction; it was the strongest predictor in multivariate analysis, whereas emotional exhaustion proved to be the strongest contributor among the burnout subscales.

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Other studies also emphasised the importance of emotional exhaustion in teachers’ work satisfaction and leaving the profession (SKAALVIK & SKAALVIK 2011). Burnout seemed a real problem in the sample; most of the mean scores were relatively higher than previous international findings, e.g. Spanish (ALUJA et al. 2005), German and Chinese (SCHWARZER et al. 2000), Australian (DORMAN 2003) or Namibian (LOUW et al. 2011). As it turned out, burnout had an important negative role in educators’ work satisfaction. Role conflicts and role ambiguity were also strongly and negatively correlated with work satisfaction and they also predicted it in multivariate analysis similarly to previous studies (e.g. BELIAS et al. 2015). Although at bivariate level there were intercorrelations among work time demands, work-family conflicts and work satisfaction in concordance with previous studies (ADAMS et al. 1996; CARLSON et al. 2000; MICHEL et al. 2010), those variables became nonsignificant in the multivariate models. This fact also strengthened the relative dominant role of burnout. Among the potential protective factors, satisfaction with salary and work policy were not significant contributors, although in bivariate relationships they were positively correlated with educators’ work satisfaction. In other studies those organisational variables seemed to be more relevant (BELIAS et al. 2015; BOGLER 2001). On the other hand, a previous study also emphasised that social acknowledgement by society was a very important aspect of work satisfaction with teachers’ job perception and satisfaction (WEIQI 2007). The ratio of satisfaction/dissatisfaction with professional prestige (11.8% vs. 88.2%) showed a much greater difference than their reported data about salaries (44.1% vs. 55.9%) and work policy (40% vs. 60%). This finding might support the highlighted role of professional prestige for educators; unfortunately most of them seemed dissatisfied with its level. Work-related social support (both organisational support and peer support) was previously found as important aspect of the work environment that might have an impact on a number of job-related consequences such as work satisfaction, work involvement, teacher motivation and effort (ADAMS et al. 1996; BETORET 2006; HOSSEINKHANZADEH et al. 2013; LENT et al. 2011; SKAALVIK & SKAALVIK 2011). Cooperative and supportive collegial relationships were important correlates of secondary school teachers’ work satisfaction (WEIQI 2007) that was also supported by a Hungarian study (HOLECZ & MOLNÁR 2014). Our finding was in concordance with those previous research results. Similarly to Kobasa’s hardiness model of which personal commitment is an integral element (KOBASA 1982), the role of work involvement contributed to work satisfaction. Job involvement represents a belief of positive identification with one’s job and thus it may have a moderating influence on the relationship between job stressors and employee well-being (FRONE & RUSSEL 1995). As a consequence, we may conclude that in this sample of Hungarian educators, their work satisfaction 1) is closely related to the presence of burnout (particularly emotional exhaustion); 2) is also influenced by role conflicts and role ambiguity in their workplace; 3) may be protected by certain job resources such as satisfaction with professional prestige, work social support and work involvement. The relatively great sample size and the uniqueness of the population (to our best knowledge, very

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few studies have investigated educators’ work satisfaction in Hungary thus far) are the main strengths of the paper. In addition, the risk and protective factors approach provided a good rationale to investigate its correlates. Since standardised international scales were used as measurements, we really think that our findings would be also interesting for an international readership beyond Hungarians. Burnout among educators is also an under-investigated field of research in Hungary (see PETRÓCZI 2007; SALAVECZ et al. 2006); therefore, these data may be really valuable for the Hungarian audience (both educators and policymakers). Similarly to international studies (e.g. SKAALVIK & SKAALVIK 2011), emotional exhaustion was the strongest predictor of educators’ work satisfaction. As it seems, a general perception of one’s occupation, such as satisfaction with educators’ social prestige or salaries were more relevant contributors for educators’ work satisfaction in international literature (e.g. BOGLER 2001; WEIQI 2007) than for Hungarian educators. This finding is similar to a previous (and the only) Hungarian study on this issue (HOLECZ & MOLNÁR 2014). Other findings about the positive role of collegial relationships and professional autonomy/ work involvement are also in concordance with that study (HOLECZ & MOLNÁR 2014). We expected that work-family conflict might play a more decisive role in educators’ work satisfaction based on previous research results (e.g. ADAMS et al. 1996; CARLSON et al. 2000; MICHEL et al. 2010); however, this was not the case in our study. More research is needed to clarify this difference. Future research should also be focused on the role of more job demands and resources. The findings should be evaluated in the light of some limitations, e.g. due to the cross-sectional study design, cause-and-effect relationships cannot be justified. In addition, several variables (e.g. satisfaction items) were measured with a single-item question, instead of a composite measure, such as a scale. The online data collection does not allow us to get a statistically representative sample. Finally, due to cultural differences, the findings may not be generalisable. Overall, we really think that this study is unique since very few studies in Hungary have focused on educators’ burnout and work satisfaction thus far. The findings suggest that interventions at both individual and organisational level should be necessary. Educators should learn effective coping techniques to prevent burnout and increase work satisfaction well before their start of a career. Our data suggest that educators may not have the necessary coping skills that should be addressed during educator training years to prepare them for their job. The organisational interventions should strengthen job resources and eliminate/decrease job demands. References ADAMS, G.A., L.A. KING & D.W. KING (1996) ʽRelationships of Job and Family Involvement, Family Social Support, and Work-Family Conflict With Job and Life Satisfaction’, Journal of Applied Psychology 81, 411–20 (https://doi.org/10.1037/0021-9010.81.4.411). ALUJA, A., A. BLANCH & L.F. GARCIA (2005) ‘Dimensionality of the Maslach Burnout Inventory in School Teachers: A Study of Several Proposals’, European Journal of Psychological Assessment 21, 67–76 (https://doi.org/10.1027/1015-5759.21.1.67).

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BABIN, B.J. & J.S. BOLES (1998) ʽEmployee Behavior in a Service Environment: A Model and Test of Potential Differences between Men and Women’, Journal of Marketing 62, 77– 91. BAKKER, A.B., E. DEMEROUTI, E. DE BOER & W.B. SCHAUFELI (2003) ʽJob Demands and Job Resources as Predictors of Absence Duration and Frequency’, Journal of Vocational Behavior 62, 341–56 (https://doi.org/10.1016/S0001-8791(02)00030-1). BAKKER, A.B., E. DEMEROUTI & M. EUWEMA, (2005) ʽJob Resources Buffer the Impact of Job Demands on Burnout’, Journal of Occupational Health Psychology 10, 170–80 (https:// doi.org/10.1037/1076-8998.10.2.170). BEEHR, T.A., J.T. WALSH & T.D. TAUBER (1976) ‘Relationships of Stress to Individually and Organizationally Valued States: Higher Order Needs as a Moderator’, Journal of Applied Psychology 61, 41-47 (https://doi.org/10.1037/0021-9010.61.1.41). BELIAS, D., A. KOUSTELIOS, L. SDROLIAS & G. ASPRIDIS (2015) ʽJob Satisfaction, Role Conflict and Autonomy of employees in the Greek Banking Organization’, Procedia - Social and Behavioral Sciences 175, 324–33 (https://doi.org/10.1016/j.sbspro.2015.01.1207). BETORET, F.D. (2006) ʽStressors, Self-Efficacy, Coping Resources, and Burnout among Secondary School Teachers in Spain’, Educational Psychology 26, 519–39 (https://doi.org/10.1080/ 014434105 00342492). BOGLER, R. (2001) ʽThe Influence of Leadership Style on Teacher Job Satisfaction’, Educational Administration Quarterly 37, 662–83 (https://doi.org/10.1177/00131610121969460). BYRNE, B.M. (1993) ʽThe Maslach Burnout Inventory: Testing for Factorial Validity and Invariance Across Elementary, Intermediate and Secondary Teachers’, Journal of Occupational and Organizational Psychology 66, 197–212 (https://doi.org/10.1177/1069072717714545). CARLSON, D.S. & K.M. KACMAR (2000) ‘ Work-Family Conflict in the Organization: Do Life Role Values make a Difference?’ Journal of Management 26, 1031–54 (https://doi.org/10.1177/ 014920630 002600502). CARLSON, D.S., K.M. KACMAR & L.J. WILLIAMS (2000) ‘Construction and Initial Validation of a Multidimensional Measure of Work-Family Conflict’, Journal of Vocational Behavior 56, 249–76 (https://doi.org/10.1006/jvbe.1999.1713). DEMEROUTI, E., A.B. BAKKER, F. NACHREINER & W.B. SCHAUFELI (2001) ʽThe Job Demands – Resources Model of Burnout’, Journal of Applied Psychology 86, 499– 512. DORMAN, J. (2003) ‘Testing a Model for Teacher Burnout’, Australian Journal of Educational & Developmental Psychology 3, 35–47 (https://doi.org/10.1023/A:1023296126723). ETZION, D. (1984) ‘Moderating Effect of Social Support on the Stress–Burnout Relationship’, Journal of Applied Psychology 69, 615–22 (https://doi.org/10.1007/BF01857718). FRONE, M. R. & M. RUSSEL (1995) ‘Job Stressors, Job Involvement and Employee Health: A Test of Identity Theory’, Journal of Occupational & Organizational Psychology 68, 1–11 (https://doi.org/10.1111/j.2044-8325.1995.tb00684.x). HAKANEN, J.J., A.B. BAKKER & W.B. SCHAUFELI (2006) ʽBurnout and Work Engagement Among Teachers’ Journal of School Psychology 43, 495–513 (https://doi.org/10.1016/j.jsp.2005. 11.001). HOLECZ, A. & SZ. MOLNÁR (2014) Pedagógusok pozitív pszichológiai tükörben: A jóllétet erősítő tényezők jellemzői a pályán, Iskolakultúra 10, 3–14. HOSSEINKHANZADEH, A.A., A. HOSSEINKHANZADEH & T. YEGANEH (2013) ʽInvestigate Relationship Between Job Satisfaction and Organizational Culture Among Teachers’, Procedia: Social and Behavioral Sciences 84, 832–36 (https://doi.org/:10.1016/j.sbspro.2013.06.656). JOHNSON, B., J.J. STEVENS & K. ZVOCH (2007) ʽTeachers’ Perceptions of School Climate: A Validity Study of Scores from the Revised School Level Environment Questionnaire’, Educational and Psychological Measurement 67, 833–44 (https://doi.org/10.1177/ 00131644062 99102).

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KARASEK, R.A. (1979) ʽJob Demand, Job Decision Latitude, and Mental Strain: Implications for Job Redesign’, Administrative Science Quarterly 24, 285–309 (https://doi.org/10.2307/2392498). KISS, CS. (2013) A szervezeti elkötelezettség és a munka-család konfliktus összefüggései az ügyfélszolgálati munkában (PhD Diss., Corvinus University, Budapest). KOBASA, S.C, S.R. MADDI & S. KAHN, S. (1982) ‘Hardiness and Health: A Prospective Study’, Journal of Personality and Social Psychology 42, 168–77 (https://doi.org/10.1037/00223514.42. 1.168). LENT, R.W., L. NOTA, S. SORESI, M.C. GINEVRA, R.D. DUFFY & S.D. BROWN (2011) ʽPredicting the Job and Life Satisfaction of Italian Teachers: Test of a Social Cognitive Model’, Journal of Vocational Behavior 79, 91–97 (https://doi.org/10.1016/j.jvb.2010.12.006). LOUW, D.A., E. GEORGE & K. ESTERHUYSE (2011) ‘Burnout amongst Urban Secondary School Teachers in Namibia’, SA Journal of Industrial Psychology 37, 201–7 (https://doi.org/10. 4102/sajip. v37i1.1008). MAKRA, E., D. FARKAS & G. OROSZ (2012) ‘A munka-család konfliktus kérdőív magyar validálása és a munka-család egyensúlyra ható tényezők’, Magyar Pszichológiai Szemle 67, 491–518 (https://doi.org/10.1556/MPSzle.67.2012.3.5). MALINEN, O.-P. & H. SAVOLAINEN (2016) ʽThe Effect of Perceived School Climate and Teacher Efficacy in Behavior Management on Job Satisfaction and Burnout: A Longitudinal Study’, Teaching and Teacher Education 60, 144–52 (https://doi.org/10.1016/j.tate.2016.08.012). MASLACH, C. & S.E. JACKSON (1986) Maslach Burnout Inventory (Palo Alto: Consulting Psychologists). MICHEL, J.S., J.K. MITCHELSON, S. PICHLER & K.L. CULLEN (2010) ʽClarifying relationships among work and family social support, stressors, and work–family conflict’, Journal of Vocational Behavior 76, 91–104 (https://doi.org/10.1016/j.jvb.2009.05.007). PALOMINO, M.N. & F. FREZATTI (2016) ʽRole Conflict, Role Ambiguity and Job Satisfaction: Perceptions of the Brazilian Controllers’, Revista de Administração 51, 165–81 (https://doi.org/ 10.5700/rausp1232). PEARSON, L.C. & W. MOOMAW (2005) ʽThe Relationship between Teacher Autonomy and Stress, Work Satisfaction, Empowerment, and Professionalism’, Educational Research Quarterly 29, 38–54 (https://doi.org/10.12973/jesr.2016.62.1). PETRÓCZI, E. (2007) Kiégés: Elkerülhetetlen? (Budapest: Eötvös József Kiadó). RIZZO, J.R., HOUSE, R.J. & S.I. LIRTZMAN (1970) ‘Role Conflict and Ambiguity in Complex Organizations’, Administrative Science Quarterly, 15, 150–63 (https://doi.org/10.2307/2391486). RUSSEL, D.W., E. ALTMAIER & D. VAN VELZEN (1987) ʽJob-Related Stress, Social Support, and Burnout Among Classroom Teachers’, Journal of Applied Psychology 72, 269–74 (https:// doi.org/10.1037/0021-9010.72.2.269). SALAVECZ, GY., K. NECULAI & E. JAKAB (2006) ‘A munkahelyi stressz és az énhatékonyság szerepe a pedagógusok mentális egészségének alakulásában’, Mentálhigiéné és Pszichoszomatika 7, 95–109 (https://doi.org/10.1556/Mentál.7.2006.2.2). SCHWARZER, R., G.S. SCHMITZ & C. TANG (2000) ʽTeacher Burnout in Hong Kong and Germany: A Cross-Cultural Validation of the Maslach Burnout Inventory’, Anxiety, Stress, and Coping 13, 309–26 (https://doi.org/10.1080/10615800008549268). SKAALVIK, E.M. & S. SKAALVIK (2011) ʽTeacher Job Satisfaction and Motivation to Leave the Teaching Profession: Relations with School Context, Feeling of Belonging, and Emotional Exhaustion’, Teaching and Teacher Education 27, 1029–38 (https://doi.org/10.1016/j.tate. 2011.04.001). WEIQI, C. (2007) ʽThe Structure of Secondary School Teacher Job Satisfaction and Its Relationship with Attrition and Work Enthusiasm’, Chinese Education and Society 40, 17–31 (https://doi. org/10.2753/CED1061-1932400503).

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European Journal of Mental Health 12 (2017) 165–186 https://doi.org/10.5708/EJMH.12.2017.2.3

ANASTASIA O. VYLEGZHANINA, IRINA V. VOROBYEVA, OLGA V. KRUZHKOVA* & MARINA S. KRIVOSHCHEKOVA

PRIMARY SCHOOL CHILDREN’S VANDALISM The Problem of Upbringing and Interaction in Russian Families** (Received: 21 October 2016; accepted: 2 April 2017)

The study is devoted to the problem of primary school children’s vandalism, and particularly its connection with child-parent relationships on the example of Russian families. We define the main predictors of a child’s vandal activity on the basis of psychological diagnostics of 228 8–9-yearold children and the assessment of the frequency and specifics of their vandal behaviour by their 228 parents. The children are classified into 3 groups by the extent of their propensity for vandalism. The complex analysis identifies personal and emotional factors influencing the frequency of a child’s acts of destruction and transformation of other people’s items, devaluation of their own and others’ things including those explained by the covert desire to acquire new items. The research findings confirm a significant role of the parent-child relationships in the formation of the child’s readiness for vandal behaviour. In particular, we prove that limitation of a child’s freedom by excessive strictness and hyper protection aggravates children’s propensity for vandalism. Keywords: vandalism, vandal behaviour, attitude to things, child’s emotional sphere, child-parent relationships, destructive behaviour at primary school age. Vandalismus bei Kindern: Das Problem der Erziehung und die Interaktion mit der Familie: Zu den wichtigsten Faktoren, die die Herausbildung und die Entwicklung der Persönlichkeit in der Kindheit bestimmen, gehören gewöhnlich Beziehungen, die sich auf die Vorstellung von der externen Welt und von dem Platz, den das Kind darin einnimmt, auswirken. Das Ziel des Forschungsvorhabens war die Ermittlung der sozialen und psychologischen Determinierung von Vandalismus bei Kindern im Grund- und Hauptschulalter. Die Grundannahme war, dass diese einerseits in der

Corresponding author: Olga V. Kruzhkova, Department of Philosophy and Acmeology, Institute of Management and Law, Ural State Pedagogical University; Cosmonavtov Av, 26, RU-620017, Ekaterinburg, Russia; galiat1@yandex.ru. Acknowledgment: This paper is based on research carried out with the financial support of the grant of the Russian Science Foundation (project № 17-18-01278).

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Interaktion von Kindern in diesem Alter mit der Welt der Dinge infolge des gegenwärtigen Systems der Eltern-Kind-Beziehungen und andererseits in den Besonderheiten der emotionalen Umgebung von Kindern und ihrer Attitüde gegenüber wichtigen Objekten, Aktivitäten, anderen Menschen und sich selbst besteht (wobei diese Attitüde vor der Umsetzung des erzieherischen Potenzials der Familie entsteht). Die Frage wurde mithilfe der psychologischen Diagnostik von Kindern im Alter von acht bis neun Jahren und ihrer Eltern beantwortet. Im Ergebnis wurden die Kinder im Hinblick auf ihre Neigung zu Manifestationen vandalischer Aktivitäten in drei Gruppen eingeteilt, und es wurden grundlegende Prädiktoren emotionaler und persönlicher Art identifiziert, die die Häufigkeit, mit der die Kinder Gegenstände zerstören, beeinflussen. Während des Forschungsvorhabens wurde bewiesen, dass übermäßige Strenge und übermäßige Beschützung, die die Freiheit der Kinder einschränken, wichtige Faktoren für die Bereitschaft von Kindern zu vandalischem Verhalten sind. Schlüsselbegriffe: Vandalismus, Manifestationen vandalischen Verhaltens, Attitüde gegenüber der Welt der Dinge, Dingwelt, emotionale Umgebung von Kindern, Eltern-Kind-Beziehung, Grundund Hauptschulalter

1. Introduction Among scientists and practitioners there is no prevalent view on the motives underlying the actions causing considerable damage to public or private property. But all agree with one accord that vandalism is a common social phenomenon; there is only a small percentage of vandals who destruct material objects for particular ideological reasons or because of congenital mental disorders. According to the results of the statistical researches, the age of most vandals is between 12–20 years, they generally belong to the group of teenagers and youth (MAWBY 2001; ELLIOTT 1988; LE BLANC & FRESHETTE 1989; VATOVA 2007; VOROBYEVA & KRUZHKOVA 2015b). However, the child’s desire to destroy material objects does not appear immediately, its roots can be found in the earlier stages of ontogenesis. The child’s attitude to the material environment reveals itself clearly after the first year of the child’s life. Nevertheless, conscious actions in terms of possessions are possible at preschool age only. In this period the child’s space expands beyond family borders and they merge into the network of preschool social relations. Volitional activities, inner plans of actions, and behavioural reflection begin to form at the primary school age. The process of the formation of these mental phenomena promotes the child’s need to receive social recognition. To achieve that, they have to develop their own system of social relations (FELDSHTEIN 1985). This system gets reflected in their relationships with the objects of the material world. However, in the case of malfunctioning, the children’s negative emotions transform into acts of vandalism. 1.1. The problem of the child’s relationships with a world of things A world of things, created and used by humans is a necessary condition of human existence and personal development (MUKHINA 2005). People develop strategies of

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interaction with a world of things throughout all their life from the earliest stages of ontogenesis. In psychology “the attitude to the world of things” and “the attitude to the world of people” are investigated as two sides of the existence of a single, indivisible activity process (FELDSHTEIN 1985). Thus, some aspects of the child’s relationships with the social environment can be studied through children’s vandalism. In childhood, actions of destroying things are not something absolutely reprehensible or immoral, because at this age moral norms and rules of behaviour in society only begin to be assimilated and the foundation of moral conduct is being laid (KRUTETSKY 1972). Children understand their wrongdoing in case of deliberate destruction of public or other private material objects and that it is to be followed by punishment. But the assessment of the destruction done is still stipulated by external factors (possible punishment) rather than internal (such as a sense of responsibility for the damage, moral liability, ethical feelings, or emotional empathy). There are different reasons of children’s vandal behaviour. Firstly, destructive actions towards material objects can be a form of inadequate expression of their relationships with another person. Things signify their masters or owners and a child can demonstrate their attitude to the owner (master) of the things through interaction with them (MUKHINA 2003). This form of expression of different feelings toward another person is used by a child as a more secure form of emotional release (ABITOV 2015). Sometimes, a child seeks to obtain a thing owned by another person with whom the child wants to be identified, but wrong or inaccurate usage of the thing may result in its damage or destruction. Here vandalism appears as an indirect outcome of social relationships or communications with a definite person, which cause flashes of children’s emotional reactions mediated through the interaction with a thing of another person. Secondly, the destructive actions with material objects in public or private property may express a child’s inadequate self-affirmation. The feeling of power over the situation, over the material objects help children to raise their own self-esteem, feel important and register their will to transform the space of interactions. At the moment of the vandal act children realise themselves as subjects on the level of understanding and, moreover, feel the need to be realised as active subjects at the level of acting (FELDSHTEIN 1985). Thirdly, actions that result in the destruction of material objects, which do not belong to a child, may be the result of investigating the material world, the structure of a particular thing or a creative act of its transformation. Disassembling an item into parts means the destruction of an old thing and the creation of a new one (UEMOV 1963). Therefore, a child’s creativity may be directed not to co-creation, but to destruction (KYSHTYMOVA 2012) when their moral sphere is still immature. Fourthly, the destruction of one’s own objects may be motivated by a desire for a ‘novelty effect’, it can be a tactical action to force adults to buy new things for the child. MUKHINA points out, that modern Russia, following the developed countries, turns into a consumerist society and children adopt this tendency very fast. Their ‘consumption have grown immensely’ and their activeness aimed at the acquisition of new things becomes more aggressive and persistent (2005). Many children feel

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strong positive emotions when acquiring new possessions and impatience and pleasure from the thought that there will be soon more (EVERT et al. 2013). The desire for novelty in the material environment can be a great incentive for the destructive behaviour towards their own things or things owned by other family members. There can be situations when a child deliberately breaks somebody else’s thing as a trick to obtain it afterwards when its owner does not want it anymore. In general, all these motivations can be aggravated with a decreased external control of adults. In particular, the study of ERVASTI and colleagues (2012) illustrates this tendency with situations of teachers’ absence due to illness and a lack of children’s voluntary control and moral responsibility for the material environment (SMITH 2015). Moreover, children view such situations as a good chance to realise their ambitions. 1.2. The role of the parent-child relationship in the development of children’s vandal behaviour The forming of children’s culture of interaction with a world of things is the prerogative of the family (PETERSON et al. 2012). In the early periods of childhood, children imitate their parents’ models of interactions with the world of things. At the same time, the influence of the family on a child’s vandal behaviour is not limited by the simple assimilation of parental behaviour patterns. Family educational influence, the degree of the child’s independence and autonomy and the extent of emotional acceptance of children by their family affect the formation of the child’s sets of possible and acceptable behaviour in relation to the material and social worlds and the awareness of the consequences and limitations of their own activities. The social space of the family is a very important systemic space of relations, interactions and guideline values for the child’s personality (AVDULOVA 2013). In this space children learn both a certain compromise of their own and others’ interests and the ways to achieve it. Parent-child relationships become a model and a means of self-organised relationships between the forming of a child’s personality and the environment. They define the senses in the social space between the poles of activeness – passiveness, openness – closeness, empathy – detachment, axiological approach – normativeness. (AVDULOVA 2013, 4, our trans.)1

Negative educational influence and a general disharmonic style of family upbringing can lead to the child’s sustained assimilation of deviant forms of behaviour, which can be exhibited explicitly or implicitly in the family as well as in other social relationships.

Original text: ‘Roditel’sko-detskie otnoshenija stanovjatsja model’ju samoorganizacii otnoshenij rastushhej lichnosti i sredy, otkryvajut smysly social’nogo prostranstva mezhdu poljusami aktivnosti-passivnosti, otkrytosti-zamknutosti, blizosti-otchuzhdennosti, aksiologichnosti i normativnosti’.

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A strong correlation was revealed between the child’s behavioural problems and the family atmosphere, characterised by hostility, preferred orientation to strict discipline, emotional problems and conflicts (KUZNETSOVA 2013). Furthermore, GAIK and colleagues (2013) found that adolescents, who do not feel parental affection, have a higher level of delinquent behaviour (including vandal activity) than their peers, who experience it. This is particularly important for the period of a child’s inclusion in the school social community because in this period the accumulated problems of family interaction, destructive behavioural strategies towards material and social worlds are activated in external forms. If these negative strategies become embedded in the patterns of social behaviour, it will significantly harm material school property and, what is more important, substantially defect the individual system of social relationships and complicate children’s further personal growth. It was proved that the ineffective and inconsistent parenting style of upbringing (LITTLE et al. 2003), a loss of the emotional contact with the child, dismissive attitude, mistrust and excessive control over the child’s behaviour and activities, on the one hand, and a lack of interest in the child and parental involvement in the child’s life (ссылка) on the other can evoke negative feelings in children and incline them to destructive actions with material objects. But there are no researches investigating interdependence between parent-child relationships and children’s vandal behaviour in primary school. Thus, the aim of our research is to find correlations between certain styles of parenting upbringing and children’s propensity for vandal behaviour in primary school. 2. Methodology We base on the assumptions that in primary school a child’s interaction with the world of things is substantially stipulated by: – the current system of parent-child relationships; – specifics of the children’s emotional sphere, their attitude to significant objects, activities, other people and themselves, which have already been formed in the family. The methodological foundation of our research is a theoretical concept of the maturity of the children’s emotional sphere, their evaluation of the system of objects and attitudes to themselves as a result of mainly family upbringing and their interaction with parents (ZAKHAROVA 1988; EIDEMILLER 2002; SPIVAKOVSKAYA 2000).

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2.1. The research procedure and methods The research was done in three main steps: 2.1.1. Developing and selecting diagnostic tools To identify the extent of children’s vandal behaviour we used an expert method. Parents performed the role of experts estimating the frequency and specifics of children’s vandal behaviour. We modified the questionnaire ‘Motives of vandal behaviour’ (VOROBYEVA & KRUZHKOVA 2011) rephrasing the questions in order to consider the specifics of destructive behaviour in primary school and used it to survey parents of primary school children. This survey consisted of 22 items. Respondents (parents of primary school children, participating in the research) gave answers in accordance with a Likert scale (from 1 to 5 points) assessing frequency of children’s vandal acts and different motivational aspects in children’s vandal behaviour. These estimates were grouped into three complex scales: ‘children’s propensity for destruction of objects’, ‘children’s preference of other’s items’ and ‘children’s desire for novelty’. We calculated indexes for each group (average rate) and also the total index of children’s propensity for the destruction of items (intergroup average rate). To identify the socio-psychological determinants of vandal behaviour of primary school children we used the following psycho-diagnostic methods and tools, which allow to single out the style of parenting/upbringing and socio-psychological predictors of children’s vandal behaviour: – Parental Attitude Questionnaire: developed by A. YA. VARGA and V. V. STOLIN (1989; KARELIN 2001). This diagnostic tool is presented in a form of 61 statements about parental attitudes to children. Respondents (parents) express their agreement or disagreement with them. The results are described as a scale consisting of five dimensions: rejection, cooperation, symbiosis, control and infantilisation. – The method of ‘Houses’: developed by O.A. OREKHOVA (2002) is a projective test for the diagnostics of children’s attitude to the objects and activities significant for them and to the social emotions. This test employs the concept of emotions as needs and is based on the author’s model of the structure of personal emotions. We tested children’s preferences among 10 emotional conditions: happiness, grief, fairness, offence, friendliness, quarrel, kindness, anger, boredom, admiration. We also investigated children’s attitude towards social objects: school and museum, and activities which are important for primary school age group: painting, dancing, singing, counting, reading, playing. Also a child could choose one object arbitrarily and draw their attitude to it; children chose their family or pets the most often. – The method of Dembo-Rubinstein: developed for studying self-assessment (GOLOVEY & RYBALKO 2002). The method supposes a rating (by means of the 9-point scale) of the current and desirable level of such personal qualities as health, intelligence, character, and happiness. An analysis of children’s self-assessments of the different personal qualities determines the area of psychologically

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comfortable self-confidence and the area of children’s stress and problems caused by a substantial difference between the current and a desirable self-esteem. 2.1.2. Collection of empirical data The sample of primary school children consists of 228 children from Ekaterinburg schools (including 109 boys and 119 girls; 53% of primary school children are secondgraders and 47% are third-graders). Only those schoolchildren participated in the survey whose parents also agreed to take part in it. There were 228 parents (189 mothers and 39 fathers). We tested if there is a difference between mothers and fathers in their assessment of the frequency of their children’s vandal behaviour manifestation on the basis of the questionnaire ‘Motives of vandal behaviour’ and we did not detect any statistically significant differences in assessments between mothers and fathers (Student’s t-test results: –1.53 < t < 1.11, p > 0.05). Therefore, we did not take into consideration parental gender factor and the parental sample was further analysed as homogeneous. 2.2. Statistical analysis Statistical processing of the data was done with the professional software IBM SPSS Statistics V.19. The choice of statistical methods was defined by the logic of our research. First, we made a goodness test for the normality of the distribution of the children’s propensity for vandalism (on the base of parents’ expert estimation of children’s vandalism) using the Kolmogorov-Smirnov test (KS test) and analysis of variation. At the first step we detected no normality of the distribution of the children’s propensity for vandalism. We did a two-step cluster analysis of parents’ estimations of children’s vandalism to classify the children into three groups according to the extent of their propensity for vandal behaviour. Hence, at this third step, we did a linear regression analysis in order to determine the role of emotional evaluations in the manifestation of the elements of children’s destructive behaviour. We used a frequency analysis and the Fisher z-transformation to detect the style of parental upbringing in groups of children with different propensity for vandal behaviour. Finally, we used the Pearson correlation analysis to determine the correlation between the style of parenting upbringing and manifestations of children’s vandal behaviour. 3. Results and discussion Expert (parents’) estimates of children’s propensity for vandal behaviour showed that primary school children are already quite active in the manifestation of destructive forms of interaction with material objects. Children use strategies of destruction

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towards their own toys, items of home interior and other people’s things. In addition, children are sufficiently focused on seeking new experiences by the renewal of the material environment and use vandal behaviour to facilitate the replacement of the damaged items. An analysis of normality of the distribution of the children’s propensity for vandalism showed high variability of the total index of children’s propensity for vandalism (Average = 11.94, Standard deviation = 2.73) and the absence of its normal distribution (coefficient of Kolmogorov-Smirnov Z = 1.49 p = 0.024). On the basis of these results we suppose inhomogeneity (different levels) of propensity for vandalism among the children in the sample. Thereon, we classified the children into three relatively homogeneous clusters by the extent of propensity for vandalism using the procedure of a two-step cluster analysis (silhouette value > 0.5) (Table 1). Table 1 Characteristics of clusters Cluster features in accordance with the level of propensity to vandal act

Evaluation parameters of tendency to vandal act

In total, children

Mean

Standard deviation

Cluster 1 – high level

16.17

1.32

Cluster 2 – medium level

12.33

0.97

112

Cluster 3 – low level

9.05

1.39

Children from Cluster 1 have a high level of propensity for vandal behaviour. They systematically use destructive behaviour strategies while interacting with the environment, in particular with material objects. We suppose that a substantial part of the children may have already formed a ‘subject-object’ interaction strategy, as they performed not random acts of vandalism, but repeated them over and over again. This statement is confirmed by the results of the analysis of vandal behaviour among primary school children: the teachers’ expert assessment showed that at least 10% of the pupils demonstrate vandal behaviour systematically (VOROBYEVA et al. 2015). They often break toys and other objects for different reasons: from ‘spontaneous splashes of negative emotions’ to ‘focusing on the destruction or damage in order to achieve some personal goals’. For instance, in a situation of being offended by the classmates’ actions, a child can intentionally damage their (i.e. classmates) items – spoil, hide or draw some offensive signs in public places (drawings and inscriptions on the school walls, desks etc.; VOROBYEVA & KRUZHKOVA 2015a). Children with an average propensity for vandalism show a similar type of behaviour depending on the situation. In compliance with the findings of the teachers’ survey, nearly 27% of primary school children made destructive or transforming actions towards the school environment (VOROBYEVA et al. 2015). For this type of

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children vandalism is a tactical action aimed at setting up relationships with the external environment. It can be a form of emotional displacement against certain forms of social influence (school discipline, homework etc.). For these children, the damage of things is not the final goal, only a demonstration of their disagreement with the requirements of adults (VOROBYEVA & KRUZHKOVA 2015a). Children with a low propensity for vandalism are characterised by rare occasional and unintentional destructive actions towards material objects. A child damages objects in public or others’ private property mostly because of the lack of accuracy and experience of interacting with the items, so the damage of the items is a result of an accidence. Also, the vandal behaviour of a primary school child can be the result of high emotional tension and guilt (VOROBYEVA & KRUZHKOVA 2015a). A further study of determination of children’s interactions with the material environment was carried out using a regression analysis in groups of children identified earlier (children with high, medium and low propensity for vandalism). The independent variables were: – the children’s subjective assessments of their attitudes towards social objects and activities important for their age group and also their preferences of certain emotional conditions (The method of ‘Houses’) and – the children’s self-assessments of different personal qualities: health, intelligence, character, happiness (The method of Dembo-Rubinstein). The dependent variables were parental evaluation of the frequency and motives of children’s vandal acts: propensity for destruction, desire for getting other’s items and desire for novelty. The model in Table 2 includes only the values having statistical significance. Table 2 Results of a linear regression analysis of socio-psychological determinants of vandal behaviour of primary school children Predictors

Propensity for destruction

Preference for alien things

Desire for novelty β

R2 (%)

–0.647**

40.8

Friendlinessa

0.571**

40.8

Own answera

0.539**

40.8

R (%)

Children with a high propensity for vandalism Happinessa

0.304*

30.4

Boredoma

–0.291*

30.4

–0.357

School

–0.424

Playing

Character

0.528**

27.8

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Children with a medium propensity for vandalism Happinessa

–0.180*

12.7

Singinga

0.207*

12.7

–0.215*

23.7

Readinga

0.180*

12.7

0.287**

23.7

12.7 –0.334***

23.7

Own answer

0.178

Anger

0.267*

Intelligence

–0.354

15.8

Characterb

0.302**

15.8

Griefa

–0.341*

29.6

Fairnessa

–0.344*

29.6

Friendliness

–0.429

29.6

Kindnessa

–0.280*

29.6

Admirationa

–0.365*

29.6

7.1

Children with a low propensity for vandalism 0.259*

Happinessa a

–0.314

Reading

Own answera

0.310*

23.8 23.8 23.8

–0.428

Offence

School

Playing

0.378

29.6

0.338

29.6

Note: a - dependent variable was taken from The method of ‘Houses’; b – dependent variable was taken from The method of Dembo-Rubinstein; *: p < 0.05; ** : p < 0.01; ***: p < 0.001; R2 (coefficient of determination) estimated for the whole model of independent variable by the groups of children with different propensity for vandalism.

We should note that Table 3 contains only statistically significant socio-psychological predictors of children’s vandal behaviour. Hence, children’s self-assessment influences (The method of Dembo-Rubinstein) the preference for others’ things only in the groups of children with a low or high propensity for vandalism. In this groups preference for others’ things (taking other’s things and their unauthorised using) is a compensatory-demonstrative strategy of social relationships. Investigating specifics of child-parent relationships, we revealed its difference among families, having children with low, medium and high propensity for vandal behaviour.

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Figure 1 Distribution of children with different propensity for vandalism by different style of parental upbringing (in percentage) Note: There is no ‘Cooperation’ as a style of parental upbringing because of its low representation in the sampling families.

Statistical correlation of children’s attitude to material objects and the parentchild relationship was analysed using the Pearson’s coefficient (Table 3). Table 3 The results of the correlation analysis of the child’s attitude to objects of the material environment and the parent-child relationship Propensity for destruction

Indicators and styles of parent-child Pearson’s relationship coefficient, r

Preference for others’ things Pearson’s coefficient, r

Pearson’s coefficient, r

Symbiosis Infantilisation

0.198**

0.003

0.014

0.163 **

Verbalisation

–0.203

0.008

0.163*

0.036

Parity relationship

–0.156*

0.043

Optimal emotional contact with the child

–0.179*

0.021

Excessive strictness

Desire for novelty

0.175*

0.024

Note: *: p < 0.05; **: p < 0.01.

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3.1. First cluster: Children with a high propensity for vandalism The model of personal determination of propensity for vandal behaviour in this cluster of children includes such emotional states as happiness and boredom (with a negative sign), as well as key objects – school (with a negative sign) and play activities (with a negative sign). The children in the first cluster systematically demonstrate vandal behaviour. Its main predictors are positive emotions, interest in some things, a generally negative attitude to school and play as forms of a task-oriented activity. Children destroy or transform material objects because of a lack of preformed prosocial behavioural expressions of emotional attitude to things, both negative and positive, even enthusiastic. Primary school children are often not able to perceive and express negative emotions (anger, fear, terror, etc.), which can lead to a behavioural imitation of adults’ behaviour at the moments of expressing their emotions (LEITES 1997; JACOBSON 1998). The object of imitation can be not only a real adult, children are quite sensitive to copying bright behavioural models of movie stars and television heroes. The desire to get other people’s items does not have any statistically significant correlation with children’s emotional state and attitude to any activity, but correlates with children’s self-esteem and character. High self-esteem, a self-image as a person with a ‘perfect’ character can be a predictor for propensity to focus on the desire to possess the items that do not belong to these children. We suppose the position when children think about themselves ‘I’m good, so they cannot say ‘no’ to me’ allows them to appropriate other people’s things without thinking about the violation of social norms. According to BOZHOVICH (2008), such self-attitude may be formed due to positive attitudes towards them from others (parents, peers, teachers) and a lack of reasonable critique of their actions. The common positive attitude of others transfers onto the children’s self-attitude, the children’s self-assessment of their activities and behaviour, and self-endorsement of any form of their own behaviour (BOZHOVICH 2008). The desire for novelty, the search for new experiences by means of changing the environment is determined by such personal characteristics as attitude to friendship, school (with a negative sign) and preferred activities. The children from the first cluster tend to choose a strategy of vandal behaviour when they have a steady negative attitude to the school, but at the same time have friends and interesting activities. Most likely, games and hobbies promote the development of such peer relationships that allow unauthorised exchange of items (toys, games, gadgets etc.). As to the observations of IZOTOVA (2015), acts of vandalism can happen as residual effects from earlier preschool age, when new toys and communications with peers used to have a high emotional load and could lead to the child’s reduced control over their behaviour. Furthermore, WARREN and colleagues (1996) mentioned in their study a positive role in the externalisation of children’s destructive behaviour.

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3.2. Children with medium propensity for vandalism In this group of children the destruction of objects occurs mostly occasionally, not systematically. It is connected with a lack of children’s happiness as well as with their involvement in a variety of self-selected activities: mostly games, singing and reading. These results reveal bipolar mechanisms in the initiation of destructive actions. Children are likely to express a very negative emotional state by means of vandal behaviour. It happens mostly during activities which are imposed on a child and which are regularly monitored and controlled by parents. And vice versa, children can destroy things in the process of doing something very exciting. In this case, vandal acts are random and happen due to the child’s deep involvement in the game. Preference for other people’s things is initiated by children’s emotional states and certain types of activities. One popular example in the primary school is the frequent taking and using of somebody else’s personal books. On the one hand, this can be explained by the practice of using common public textbooks and other printed study material in schools. On the other hand, it can be stipulated by the social approving of a child’s desire to interact with the book as during reading children have the opportunity to acquire an indirect experience and compensate for the gaps in understanding the social and cultural environment (CHUDINOVA 2007). But children may not always have easy access to the desired books or other information resources. In addition, the focus on others people’s things is connected with children’s self-assessment. Primary school children often assess their intellectual capacity as low, while their character as high. Probably, acquiring things of others may have a compensatory effect when the qualities of the item are transferred (projected) to the personality of its owner. Primary school children mostly focus on things that do not belong to them in the situation of experiencing positive emotions. The desire for novelty among children with a medium propensity for vandalism is determined mostly by the children’s desire for a feeling of happiness. The possession of new things and toys evolve positive feelings which children seek to reproduce by getting more new items. If parents refuse to buy new things, then vandal acts can be used as a destructive strategy, as an attempt to stimulate adults to buy the desirable object or it can lead to the children’s own efforts to acquire the item using socially acceptable methods and by violating social norms. 3.3. Children with a low propensity for vandal acts Primary school children rarely destruct material objects intentionally. They perform such actions in the state of happiness and absence of any purposeful activity which require concentration of attention and also in various game situations. We should note that games are their favourite pastime activities. These children damage things or do unauthorised changes in the material environment mostly occasionally. Their actions are unconscious, unintentional and situational.

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Children from this group do not focus on negative feelings – sorrow, soreness, but they may begin to doubt the friendly attitude of the society toward them. Preference of other people’s things can be explained by a group of emotional factors such as a sense of injustice, a lack of admiration, and a negative evaluation of others. These emotions can appear in the school environment and during playing games. Children can make some destructive acts under the influence of strong emotions; and later will regret it and feel remorse. Nevertheless, even occasional elements of children’s vandal behaviour occur because their inaccuracy or emotional expression can lead to interiorising destructive behaviour models. In the case of adults’ positive reactions and an absence of expressed censure on the children’s vandal behaviour, children can adopt vandal behaviour patterns as a tactical method in the space of social relationships. On balance, benevolent or even neutral parental attitude to rare unintentional cases of deviant (vandal) behaviour leads to repeated and constant behaviour deviations (ZAIDULLINA 2013). We should mention that attitude to reading can be a very ambivalent predictor of a child’s destructive behaviour in groups of children with medium and low propensity for vandalism. Hence, reading for children with a low propensity for vandalism have a positive attitude to reading in general and it can be sublimate activeness which distract them from destructive actions. But when parents compel children to read, it can increase children’s destructive behaviour because they feel pressure from the side of the adults or a pressing educational situation. 3.4. The role of the parent-child relationship in the manifestation of children’s tendency to vandalism Groups of children with low, medium and high propensity for vandalism substantially differ in styles of parental upbringing. In families with children characterised by a high propensity for vandal actions, the ‘rejection’ style of parental upbringing (φ = 1.82; р < 0.05) is applied more often than in families with children making vandal acts rarely and occasionally. Parental rejection of a child, an absence or lack of love and warmth as well as parents’ attachment to their children can initiate psychological problems in children (ROHNER 1984) and hamper children’s social adaptation (TASOREN 2016). Herewith, if parental rejection and indifference go together with hostility, a child will express patent destructive impulse behaviour and propensity for deviant behaviour in general (NAGLIERI & GOLDSTEIN 2011). We also revealed that the symbiotic style of parental upbringing is more frequent in families with children having a low propensity for vandalism (φ = 2.13; р < 0.05) than in the families with children having a high propensity for vandalism. In this case parents’ interest in the child’s life and parental ‘soft control’ over their child’s behaviour and activities do not leave the child a chance of intentional destruction. The general atmosphere of love and care ties children’s behaviour with moral responsibilities (KUZMISHINA et al. 2014). Nevertheless, only this style of parental

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upbringing (symbiosis) provides social success with primary school children in the school environment and their acceptance by peers (SAMYKINA 2010). The results of correlation analysis revealed specific statistically significant relationships between specifics and the frequency of a child’s vandal behaviour and the styles of parental upbringing in the groups of children with different propensity for vandal behaviour. 3.5. Propensity for destruction In the group of children with a medium propensity for vandalism destructive actions are evolved mainly because of excessive parental control, high regulation of a child’s life, excessive rules and taboos. Feeling pressure from their parents, children cannot consciously release their negative emotions, feelings or negative attitudes to something. Negative emotions have a destructive effect on children who perceive their own negative emotions as a response to the absence of love (JOŚKO-OCHOJSKA et al. 2012). Therefore, a child interprets excessive parental control as the absence of care and love. According to ZAHAROVA (1988), superfluous parental regulations, limitations and prohibition have a negative influence on the development of children’s neurosis as it increases their level of excitability and suppression. As a result, an increased parental control leads to the development of children’s depressions and asocial behaviour (BARBER et al. 2005). This problem occurs when a child becomes involved in something new without their parents, who could advise them how to act or react. Absence of voluntariness, creativeness and initiative can stipulate a child’s destructive actions toward material objects at school and other public places where the child is far from their parents and feels anxiety in the unusual atmosphere of communication and personal responsibility. 3.6. Peference for other people’s things Preference for other people’s things among children with a high propensity for vandalism negatively correlates with such style of parental upbringing as ‘Cooperation’. An absence of interest in a child’s life, or an absence of understanding their needs and interests can be a reason for the parent’s refusal to buy things which are significant for the child butthe functional necessity of which is not obvious for the parents. When children experience deprivation because their parents do not realise their need of possessions popular among peers, they they often decide to get the desired items in an anti-social way of unauthorised borrowing. Active child-parent contact and communications, parent’s argumentation of their position and attitudes to the things important for a child, explaining the reasons of their refusal to buy the desired things can decrease a child’s propensity for getting other people’s things. Parents’ interactions with a child as with a partner in situations of decision making foster the feeling of responsibility and involvement, create premises for the development of a mature psychological position of children toward their material environment

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and other people’s items. ‘In a partnership, under guidance, with somebody’s help a child can always do more and solve more difficult tasks than when he/she is alone’ (VYGOTSKII 1934, 218; our trans.)4. A cooperative style of parental upbringing stipulates the development of children’s social skills and increases their adaptivity to life activities (KALASHIKOVA 2013). In the group of children with a medium propensity for vandalism preference of other people’s things is stimulated by the children’s infantilisation on the part of their parents. Parents perceive their children as absolutely helpless, not able to be responsible for their own actions. Children’s desire to use other people’s possessions is justified by their age, game motivation or stress level. Therefore, parents consolidate the assurance of children by accepting this behaviour in special circumstances and by the absence of an imminent punishment. Children’s infantilisation favours the development of egoism and hostility (TARASOVA 2007) and can consolidate destructive behaviour patterns. 3.7. Desire for novelty We found positive correlation between primary school children’s desire for novelty and a symbiotic style of parental upbringing. A child is in the centre of family attention, but he/she does not have enough self-sufficiency and is constantly looked after by adults. Parental indulgence of the child’s whims (including those projected by adults to a child), loading him with new, expensive gifts gradually form a neglectful attitude to things (GRANOVSKAYA & NIKOLSKAYA 2010). These children get used to perceiving material objects without realising how much effort was spent for their creation; do not perceive things as objects of human work and it leads to the devaluation of public and other people’s possessions, as well as their own, and to the acceptance of their arbitrary destruction. In the group of children with low propensity for vandalism the desire for novelty statistically correlates with parental rejection, setting distance between parents and children. In this group of children, vandal behaviour is a way of provoking buying new things and also a strategy of getting parental attention and a proof of their love. 4. Conclusion Vandal attitude to material objects is demonstrated not only by teenagers but also by children of primary school age. Their destructive activity is usually manifested in the form of breaking or destroying other people’s things as well as in attempts to transform particular elements of the school environment (by means of drawings or inscriptions). They are mostly focused on the systematic acquisition of new items as it is easy to devalue the existing ones. In this study, we defined a clear differentiation 2

Original text: ‘v sotrudnichestve, pod rukovodstvom, s pomoshh’ju rebenok vsegda mozhet sdelat’ bol’she i reshit’ trudnejshie zadachi, chem samostojatel’no’.

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among primary school children by their level of propensity for vandalism; we sorted them into groups with high, medium and low propensity for vandalism. It has been found that these groups may differ not only by their attitude to vandal activity but also by the individual predictors that initiate destructive activity. Children’s emotional state, accepted ways of its expression, the attitude to significant objects or certain types of activities, as well as self-assessment play key roles. It is obvious that different variants of a disharmonic style of family upbringing and deformations of parent-child relationships will form specific motives for vandal behaviour with primary school children. The results of our research correspond to the ideas of T.A. Popova, S. Suleimanova, G.G. Zaidullina, A.Ya. Varga, L.P. Gaik, M.C. Abdullah, and J. Uli about influence of the style of parental upbringing on children’s propensity for vandal behaviour and can be summarised in a table form (Table 4). Table 4 Correspondence of the style of family upbringing and the child’s attitude to public or private property Style of family upbringing

Characteristics of the styles of family upbringing

Attitude to public and private property

Possible motives for vandal behaviour

Infantilisation

A parent’s behaviour can be characterised by two main consequences for a child: 1) infantilisation and 2) a conviction in their own personal and social incapacity. Parents perceive their children as younger than their real age. Children’s interests, hobbies, thoughts and feelings seem to be childish, not serious for their parents. Parents see children as maladapted, unsuccessful and open to bad influences. They do not trust their children and often get disappointed by their children’s failures and clumsiness. At the same time parents strictly control their children, trying to protect them from the difficulties of life.

Children have no opportunity to own anything. Everything is under the parents’ control and at their disposal but formally a child can be considered as an owner of some things. There is no clear differentiation between ‘one’s own’ and ‘someone else’s’. Children have no ability to control the environment and organise it.

Vandalism is a convenient form of releasing negative emotions and an opportunity to show disappointment with the relationships with the owners of certain things. Vandalism reveals itself as the basic reaction of a young child. Vandalism is used as a tactic for stimulating parents to buy new things. A child damages things by accident.

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Control

Authoritarian parenting. A child’s unconditional obedience and discipline is required. Parents are not able to share the child’s point of view and impose their will on the child. Children’s manifestation of self-will is severely punished. Parents intently control children’s social achievements, individual characteristics, habits, thoughts and feelings.

The concept of property and the boundaries between ‘one’s own’ and ‘another’s’ are clear for a child, in spite of the fact, that personal things do not fully belong to children. A child has a number of things that have special meaning for him and hide them from everyone, including parents to get full power over them. A child can acquire things by stealing from others.

Vandalism is a convenient form of releasing negative emotions and an opportunity to show disappointment with the relationships with the owners of certain things. Vandalism is a form of protest against the pressure of the social environment. Vandalism is used as a tactic for stimulating parents to buy new things. A child damages things by accident.

Cooperation

Parents are interested in the life and plans of their children and try to help them in everything. They sympathise with them, rate their intellectual and creative abilities high, and are proud of them. They encourage children’s initiatives and independence; try to treat them as peers. Parents trust their children and try to share their point of view in controversial issues.

Adequate understanding of the difference between ‘my own’ and ‘another’s’ things. Mistakes in differentiation are possible, but the boundaries of permissible child’s activities can be clarified rather easily.

Vandalism, as an imitation of others’ destructive behaviour patterns, can have negative examples from the extended social environment, not only from parents. Vandalism as a convenient form of releasing negative emotions. A child damages things because of curiosity in the process of research activities. A child damages things by accident.

Rejection

Parents consider children bad, maladapted, and unsuccessful. They think that a child will never seek success because of bad habits and a low level of skills and intelligence. Mostly, parents feel anger, annoyance, irritation and offenciveness towards children. They do not trust children and do not respect them.

A clear differentiation between ‘my own’ and ‘another’s’ things. The other’s property is an object of vengeance for the offences. Anxious attitude towards things of their own.

Vandalism is a convenient form of releasing negative emotions and an opportunity to show disappointment with the relationships with the owners of certain things. Vandalism is a manifestation of the power over others. Vandalism is an imitation of the destructive behaviour patterns of adults, and an identification with the aggressor.

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Parents perceive themselves as one single entity with their child. They strive to satisfy all of their child’s needs and protect them from the difficulties and troubles of life. They perceive children as small and helpless, constantly feeling concern for them. Parents feel trouble when a child gets more independent and separates from them. Parents’ attitudes do not contribute to children’s independence.

The world of things is divided into ‘my own’ and ‘another’s’ very conditionally. All things are for a joint and equal usage. Children tend to bring this attitude to the world of things in the extended social environment.

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Vandalism is a tactic act, stimulating parents to buy new things. Vandalism manifests children’s desire to separate from parents. A child damages things by accident.

Relations with parents have a significant impact on children’s choice of behavioural strategies. Excessive strictness of parents and their distancing from the children can lead to distress in relations with material objects and become a basis for forming propensity for vandal behaviour and a realisation of destructive activities. This result can be used by psychologists working with children at their preschool and primary school age to prevent a propensity for vandal behaviour and an interiorising of destructive behaviour patterns at the early stages of children’s development.

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European Journal of Mental Health 12 (2017) 187–203 https://doi.org/10.5708/EJMH.12.2017.2.4

LÍDIA BERSZÁN*

POSITIVE COPING AND RESILIENCE Questions and Conclusions Drawn From a Longitudinal Study (Received: 28 April 2017; accepted: 3 December 2017)

In 2002–2004, during a research about families taking care of disabled children or adults, we created the criteria of coping successfully. Interpreting through this filter the resulting data and the responses a coping profile has outlined. Ten years later, we repeated the survey and found that in the interpretation of the data, the coping criteria from the first research was not sustainable. To better understand this phenomenon, we performed in-depth interviews and we added a CHIP (Coping Health Inventory For Parents) questionnaire that provides insight to coping behaviours used by parents. The results we obtained further highlighted our suspicion that the factor of successful coping from the first period of facing disabilities significantly changed through the years. This phenomenon can be interpreted not only in terms of the life of individual families, but also shows the overlaps and differences between the meanings of the terms ‘coping’ and ‘resilience’, and the professional challenge brought by the supported resilience in the ‚overseeing’ of these families. Keywords: coping, supported resilience, families with disabled members, resilience supporting model Positive Bewältigung und Widerstandskraft: Fragen und Schlussfolgerungen anhand einer Longitudinalstudie: Während eines von 2002 bis 2004 durchgeführten Forschungsvorhabens mit Familien, die behinderte Kinder oder Erwachsene pflegen, haben wir die Kriterien der erfolgreichen Bewältigung erarbeitet. Anhand der Analyse der Daten und der Antworten mit diesem Filter zeichnete sich ein Bewältigungsprofil ab. Zehn Jahre später haben wir die Erhebung wiederholt und festgestellt, dass die Bewältigungskriterien aus dem ersten Vorhaben bei der Interpretation der Daten nicht beibehalten werden konnten. Um dieses Phänomen besser zu verstehen, haben wir Tiefeninterviews durchgeführt und außerdem einen CHIP-Fragebogen (Coping Health Inventory For Parents) eingesetzt, der Einblicke in die Bewältigungsverhaltensweisen von Eltern gewährt. Die Ergebnisse, die wir erhielten, haben unseren Verdacht bestätigt, dass sich der Faktor der erfolgreichen Bewältigung der ersten Zeit der Konfrontation mit Behinderungen im Laufe der Jahre signifikant verändert hat. *

Lídia Berszán, Babes-Bolyai University Cluj Napoca, Faculty of Sociology and Social Work, Department of Sociology and Social Work in Hungarian, No 128, 21 Decembrie 1989 Bvd, RO-400604, Cluj-Napoca, Rumania; berszan.lidia@gmail.com.

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Das kann man nicht nur im Hinblick auf das Leben der einzelnen Familien interpretieren, sondern es zeigt auch die Überlappungen und Unterschiede zwischen der Bedeutung der Begriffe „Bewältigung“ (Coping) und „Widerstandskraft“ (Resilienz) sowie die fachliche Herausforderung, die die unterstützte Resilienz bei der Anleitung dieser Familien darstellt. Schlüsselbegriffe: Bewältigung, Coping, unterstützte Widerstandskraft, unterstützte Resilienz, Familien mit einem behinderten Mitglied, Modell zur Unterstützung der Widerstandskraft, Modell zur Unterstützung der Resilienz.

1. Introduction The 1989 change of regime in Romania opened many new chapters in the development of the social care system. The first decade was mostly about the mapping and acknowledgement of the lacks and urgent needs. A vastly unexplored area was the professional help of people with disabilities and their families. Instead of a highly paternalist view based primarily on the politics of silencing and hiding, the care system supporting people with disabilities and the attitude towards disability had to be based on a scientific approach, and a basis of an inclusive social view and professional cooperation. Out of the many sociological theories aimed at the social understanding, research and conceptualisation of disability (MAY & RASKE, 2007; SIEBERS 2008; GOODLEY 2016), this present study is based on the interpretation paradigm of functionalism and individual deficit presented also by Goodley. The focus of the longitudinal research is the question: which are the supportive factors found in the individual, family and social care system that enable positive coping with disability as a status, and also, does the initial coping mean a functionality sustainable in the long term, can it be considered resilience? (GOODLEY 2016). 2. Longitudinal research on the situation of children/youth with disabilities in Romania The primary task of our longitudinal research was to offer as much information as possible about families raising children and/or young people with disabilities, which serve as a basis to analysing their coping mechanisms with the new life situation caused by the disability. The first research was conducted in 2002–2004. The sample consisted of 400 families from Transylvania, living in 108 settlements of 9 different counties. The age of the children/young people in these families was between 0 and 23 years. The second research went on in 2012–2014. We assessed the interviewees of the first research again 10 years later. The age of the children/young people in these families was between 10 and 28 years. This second research included 100 families. Compared to the national average, severely and multiply disabled children/young

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people are overrepresented in both samples since the effect of disability on families and the survey of community and social attitude towards them is primarily relevant in their cases. The units of analysis were, in both queries, the families raising children with disabilities. The instrument of the research was a standardised quality of life questionnaire, developed and used by the Eötvös Loránd University’s Institute of Sociology and Training Centre for assessing families of children with physical disabilities. We adapted and expanded this questionnaire in 2003, we used it in both the first and the second query. We followed the methodology suggested by Berg (LI-TSANG et al. 2001) in operationalising the data and in identifying the coping strategies. (For more information about coping strategies see: BERSZÁN 2007a; 2007b; 2007c; 2007d; 2009) 3. Conclusions of the first survey One aim of the first research was to explore: what are the most powerful individual, family and social factors in relation to disability. According to the former results, one of the most determining factors is the degree of disability and the domain of functioning. Its effect can be traced not only in coping with the current situation (kindergarten, school-capability, educational type, aid eligibility), but also, in anticipating the future opportunities: the more cumulative and the more severe the child’s disability, the more negative the respondent parent’s vision of the future. The settlement type also proved to be crucial in this research, both in quantity and in quality: from the county towns to the villages, the number and repertoire of options lessen, the truly integrated education supported by professionals is barely known, the concept of a ’parental group’ is completely unknown in villages. Yet in many cases, the order breaks down, smaller towns get behind villages, problems get less attention: these do not receive neither the better supplies of the county towns nor the attention towards each other due to the closed nature of the villages. The deficiencies of the supply system seem to be partially offset by the support of the relationship system. The effect of the material background, the available supplies is multidirectional. The parents’ education and occupational status becomes effective only to the extent of better access to opportunities: these facilitate better orientation in the complicated procedure of obtaining assistance, development and educational opportunities. The majority of the families in the sample turned out to be in poor material conditions, although the unemployment rate was not higher than in the average population. In the case of the very poor families, a significant part of the family’s income (more than half) comes from the sum received for childcare. However, in families in which the mother is required to stay at home, this causes the loss of an income, and with the extra cost of the development and the special diet, a material setback can be observed. The families with a medium and good material situation become poorer, the extremely poor get a modest income, but this is barely enough for survival.

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The parents’ main resources in coping with disability are family and faith. The negative effects of the environment: prejudice, rejection against disabled children and young people, all weaken these resources. Only a small number of families caring for an adult disabled member made it to the first survey. In spite of this, it is evident from the analyses that their situation is increasingly difficult. When a young disabled person finishes their programme in schools and professional studies, their opportunities decrease significantly. When answering the questionnaire, several respondents described the dynamic of the process of facing disability as something that can be defined as a grieving process: from the first coping to recovering again and again after the difficult periods through the years. The life period considered or anticipated to be the most difficult by the parents is when their health would decay, their material and placement possibilities become limited, because they would reach the retirement age. 4. The motivation behind the second survey One of the strongest arguments for continuing the research and repeating the survey was the families, the parents’ opinion: they believed that when their children would reach adolescence and adulthood, their parental coping skills would stand the real trial, but also would the supportive system. On the other hand, the last decade’s changes in social politics about the protection and inclusion of people with disabilities have reinforced the motivation to evaluate efficiency from the point of view of those affected. Hence, the primary aim of the query was to find out whether the rights provided by the law can be deemed as actual opportunities. Could everything promised by the regulations, described by the motto: ‘equal opportunities for the disabled – towards a discrimination-free society’1 (Strategia națională pentru protecția, integrarea și incluziunea socială a persoanelor cu handicap în perioada 2006-2013, our trans., 4) be sensed? How do these affect the everyday life of families raising disabled children/young people? 5. Changes in the support system in the period between the two researches An important milestone in the decade between 2002 and 2012 was the founding of the National Authority for People with Disabilities (ANPH) in 2003, which was established to unite all the institutions active in this area, having assumed responsibility for the compliance of rights of all Romanian citizens with disabilities. The 448/2006 Law (Lege Nr. 448/2006 din 6 decembrie 2006 Republicată, privind protecţia şi promovarea drepturilor persoanelor cu handicap) offered a new approach and a new understanding of disability. The core of the new interpretation is approaching disability not from, or not mainly from the regard of health status, but from the point of view of ‘functional status’, as suggested by the WHO, i.e. the skills 1

Original text: ‘O societate fără bariere pentru persoanele cu dizabilităţi’

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required to conduct everyday activities, and from the dimension of rehabilitation, and social inclusion measures. This same law contains the principles of the protection of the rights of people with disabilities, with a special attention to the respect for fundamental human rights, to social solidarity and social responsibility, to strengthening protection against neglect and abuse, and to equalising opportunities. Another relevant local programme in disability care is the Strategia națională pentru protecția, integrarea și incluziunea socială a persoanelor cu handicap în perioada 2006-2013 [National Strategy for social protection of disabled people, social integration and inclusion from 2006–2013]. The document is based on the following principles: society considers people living with disability, who are able to control their lives, active citizens; the government offers outstanding support and protection to the families that have disabled members, and it considers helping people with disability to integrate in the labour market as a priority. 6. Statistical and research data about the situation of children with disabilities in Romania In this topic, it is quite common that the data of the National Authority for People with Disabilities, the data of the Romanian Statistical Office and the research data do not match, moreover, the results provided by them are contradictory. These differences and the contradictions partially complete the overview of the situation of people with disabilities, partially contribute to a still existing strategy of ‘concealment’ or ‘embellishing reality’, which is the heritage of the communist era. According to the 2012 data provided by the National Authority for People with Disabilities, there are 60 890 registered children with disabilities. An OECD research from 2007 keeps count of four times this amount of disabled underage children. If we consider these data as complementary to each other, we need to keep count of the fact that the one fourth of the disabled children of Romania are registered and they receive some kind of attendance. The rest, however, do not belong to the benefit system, they do not receive neither development nor support (for further information see: Education Policies for Students at Risk and those with Disabilities in South Eastern Europe 2006). According to the ANPH’s data, the vast majority (99.07%) live and are raised in their families or foster families. 7. A comparison of the results of the two surveys In the short presentation of the research sample we have already mentioned that in our sample, severely and multiply disabled children/young people are overrepresented. Examining the national data of the ANPH, we see that in the last 10 years there had been a strong shift in the matter of proportions from the ‘severe’ category to ‘profound’.

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L. BERSZÁN Table 1 Classification in degrees of disability Severity of the disability

National data in 2002 (%)

National data in 2012 (%)

Specimen data (%)

Severe (gr. I.)

47.32

33.7

59.5

Profound (gr. II.)

26.05

53.7

27.8

Moderate (III.)

26.63

11.52

7.8

–

0.92

1.3

Mild (0)

Source: ANPH’s (National Authority for People with Disabilities) national database, http://anpd.gov.ro/web/transparenta/statistici/trimestriale/2012.

This shift might have two explanations: the evaluating commission of experts has experienced such an intensive improvement in the situation of children/young people with disabilities that it is strongly remarked in the national statistics. The other possible explanation is that based on some consideration, the classification criteria have drastically changed. According to the respondent parents, this latter one seems to be more probable. The parents had to fight vigorously not to lose the modest but often indispensable services ensured by being classified as ’severe’: being a personal caretaker for the disabled child, and receiving travel and management discounts. In the majority (64.7%) of the families, a parent, usually the mother becomes the personal caretaker of the child; if she loses this status, there is a slim chance she might find a job after several years of being off the labour market. Being classified as ’profound’ has significantly less material and other privileges. It seems that the seemingly positive changes in the national statistical data have been influenced by economical and savings aspects. We gain insight into the changes in the educational opportunities from the following table. Table 2 Institutes they attend First research: 2002–2004 %

Second research: 2012 %

Kindergarten

14.7

School /vocational school

36.8

Emplyment day-care centre

14.7

24.5

35.5

Type of institute

Stays at home

Kindergarten-age children from the first data collection have gone to school/vocational school or employment day-care centres. The rate of those staying at home or not belonging anywhere has slightly increased, and this growth is a cause for concern,

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because the 2006–2013 Strategy placed the emphasis on the upkeep of the afterschool age development and employment. The 448/2006 Law (Lege Nr. 448/2006 din 6 decembrie 2006 Republicată, privind protecţia şi promovarea drepturilor persoanelor cu handicap) and the corresponding Application Methodology emphasises the deletion of the terms ‘impossible to form’ and ‘impossible to educate’ from the assessment and enrolment procedures, and it introduces the outlining of individual development and guidance plans for each child with disability. This individual development guidance does not only have to point out the facilities that need enhancing, and the tasks that serve this, but also the geographically closest institute that can provide this. Parents of children not belonging anywhere had the following comments about their experiences: ‘They have their development plans and they keep threatening us that if we do not go somewhere we will lose our subsidy but no-one tells me how I should transport my 90-kilogramme son with Down syndrome daily from the village where we live to the nearest institute that is 24km away. I myself can barely walk or get on the bus or get off the bus, we do not have a car, and neither the minibus driver accepts our travel discount.’ ‘I will take him to an employment day-care centre, when he needs some normal job. He has studied furniture polishing, and he could do it, but colouring books and watching TV, well, he can do this at home. I would take him to physical education and speech therapy, but they won’t accept him because he is over 16 years old.’ The survey applied a scale from 1 to 5 about the acceptance of children with disability by their environment, in which 5 meant acceptance, and 1 meant rejection. Table 3 Assessing the environment’s attitude: First research: 2002–2004 (average)

Second research: 2012 (average)

Relatives

4.09

4.16

Neighbours

3.85

4.22

Peers, children of the same age, young people

3.16

3.47

Passers-by, people in general

3.14

2.56

Assessment of acceptance–rejection

Concerning the attitude of relatives, neighbours and peers, a slight improvement can be observed. However, the measure of acceptance has decreased in passers-by. In the majority of the disabilities, the difference, the otherness becomes more visible and more obvious with age, so prejudice and rejection prevails. A parent’s response sums up the problem accurately: ‘As far as I can see, every miracle lasts for three days, one can get used to anything. When my son was little and the relatives and the neighbourhood found out that

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something wasn’t right with him, many were curious. People came over with some excuse, but I knew they only wanted to see what that ‘handicapat’ [disabled] child looked like. Then, gradually, they got used to it, the family too, just as the neighbourhood and the children in our street. Today everyone says hi to us when I take him out in the pram. One must not always go after what people are saying. But sometimes people on the bus say: You should get that big boy out of the pram, why the struggle?!’ In coping with disability, the family’s resources are essential, and also, whether the parents and those closest are supportive or not. When asking about the resources, family and faith are still on the top of the list, both in the first research and in the second. Table 4 Who do you turn to with trust, when you need understanding or help? First research: 2002–2004 %

Second research: 2012 %

Family members: husband, wife, healthy child

Grandparents, relatives

Friends

Parents in a similar situation (who also have a child with disability)

Experts (doctor, social worker, psychologist, etc.)

Foundation, organisation

Understanding, help

To us, the assessment of experts, foundations and organisations is relevant and also distressing, since both show a drastic diminution. This overview is completed by the inquiry about macro-level relationships. Table 5 On a scale from 1 to 10, how would you grade the following in their approach to people with disabilities? First research: 2002–2004 (average)

Second research: 2012 (average)

Media, public opinion

4.45

3.05

Healthcare, hospital staff

6.50

4.78

Church

7.53

7.02

The Ministry responsible for people with disabilities

4.71

5.41

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With the exception of the Ministry responsible for people with disabilities, every value has decreased, but the Church still leads the list. The comments on the responses also partially give an explanation on the increasing grade of the Ministry: ‘The Ministry doesn’t mean anything to me; I am thinking about those people that I talk to when I need to arrange my child’s papers. Over the years, I found out who is humane, and I went to them. I would give those people a 10, but there are also insensitive, materialistic people at these places too, and up there, in the higher ranks, many look only after their own gain, they don’t really care about us.’ When we asked straightforwardly, what the things the families of children/young people with disabilities miss the most, we received many generalising answers, like ‘many things’, ‘health’, ‘so that the child would heal’. The following table sums up the more concrete answers. Table 6 What are the things, which are the services that you miss the most, that the family would need the most in regard of their way of life? First research: 2002–2004 %

Second research: 2012 %

Recreation opportunities, camps

Accessibility in public transportation

Temporary placement options

Other: advice on sensitive issues

–

Other: development, maintaining the level after the age of 18

–

Other: employment after school age

–

Missing services

Recreation options, camps mainly refer to camps for children with disabilities. The former and accessibility show slightly better results, but they are still on the list of deficits. There is an unchanged claim for temporary placement options. Three other items, which have partially been present, have made it to the list: development and employment, which point directly at the narrowing of options for education with age. Regarding the need for guidance, some of them specify the sensitive issues: teenage problems, discipline, sexuality, relationships, aggression, self-aggression. About the vision of the future, we asked the parents to express in percent: what odds do they see for their child to learn a profession and find a job.

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L. BERSZÁN Table 7 Assessing the visions of the future: learning a profession, job opportunity Vision of the future

First research: 2002–2004 (average)

Second research: 2012 (average)

26,4

32,24

3,29

Opportunity to learn a profession Job opportunity

Both values have decreased, but the almost 10 years between the two surveys have basically razed the respondents’ hopes about the real chances of making money out of paid jobs, and not only from support. This question points out most obviously that the rights prescribed by the law do not automatically mean opportunities too. The last question refers to the respondents’ experience and opinion about the changes in disability care in Romania in the last 10 years. They had four answer options: ‘negative’, ‘positive’, ‘unchanged’, and ‘I cannot decide’. positive 8%

unchanged negative 34%

21%

I do not know

37%

Figure 1 Opinions about the changes in the support system

If we consider ‘unchanged’ as being negative, then along with the responses about the vision of the future, this also expresses dissatisfaction, disappointment with the support system. 8. Resilient parental coping with the child’s/young person’s disability Definitions of resilience always emphasise the interactive nature of this particularity. When researching the opportunities of supporting resilience in case of disability, it is evident that we first need to assess the presence or lack of the support of the family and the environment.

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The unity and a common coping, which, just like individual resilience, is defined by various factors inside and outside the family, is called family resilience by WALSH (2009). The family’s belief system, organisational patterns, as well as communication and problem solving abilities are considered internal factors. Belief system, in this context, does not only refer to the existence or lack of belief in God, but also, to all the pursuits and convictions that give meaning to disability. From the point of view of the family’s resilience it is essential whether they have a positive or at least acceptable belief about the great Why?, and whether they can interpret it as a challenge, a mission. Another cardinal issue is whether this belief is common and whether it belongs to the entire family or not. If it is considered a common mission, a joint challenge, even a severe disability can become a common, unifying force. It is easier to keep the hope alive together; it is easier to think about the future. The faith shared and exercised in unity, the confidence in a transcendental force might give meaning and aim beyond the problems of this life. It provides dignity and endurance, and every spiritual act of faith has an obviously protective effect on maintaining mental health: prayer, holidays, religious family and community experiences. The organisational patterns of the family are primarily defined by the flexibility of family roles and the quality of the ties. Disability repeatedly disrupts the balance many times. Increased flexibility is required for the family members to be able to function in a compensatory manner, and keep on rediscovering the balance. A mutual support and commitment, an adoption and respect of each other’s limitations and a particular way of response is a learning process that can help maintaining resilience. The congruence and clarity of family communication, the open expression of feelings (sadness-joy, anger-gratitude, fear-confidence, etc.) are determinative in the quality of family life. The emotional burden is significant with the presence of disability, and the family members’ emotions can expand on a large scale. A supportive familial atmosphere does not mean repressing negative emotions, but assuming the responsibility for one’s behaviour, and the endeavour for positive interactions. Opening up the valve of negative emotions can be part of this openness, as long as it does not burden the family atmosphere, and it does not become unilateral: a family member keeps on complaining, and the others have to be strong. The practice of humour, forgiveness, and enforcing, recognising, positive feedback is the essence of good family communication. When present, problem solving, the pursuit for creative solutions, and paying attention to exploring one’s options become easier. (WALSH 2009) 9. Assessment of coping attitudes Before analysing the coping indicators and resilience found in our research, we considered it important to assess the similar researches about the topic of disability and resilience.

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In a 2002 research, Weiss found that the mothers of disabled, autistic children are more resistant regarding depression, anxiety, and depersonalisation indicators; they have fewer somatic complaints, and they did not show any significant difference about the assessment of their parenting effectiveness from the normal average (as cited in IONESCU 2013). HASTINGS and colleagues (2006) registered the Parental Stress Index of mothers raising children with disabilities (75 people). They had found that two-third reached a level above clinical threshold, they repeated the survey two years later, and the values remained stable (as cited in IONESCU 2013). CONNOLLY-NOVAK (2007) experienced the following while assessing adaptation strategies (F-COPESs, 2001-Family Crisis Oriented Personal Evolution Scales): there are five different attitudes in confronting stress situations caused by disability: 1. one seeks community support (68%), one always speaks about distress and bad events to a family member; 2. one frames stressful events positively in order not to be discouraged and to digest them easier; 3. faith in God becomes more intense: one participates in worshipping more often; one looks for spiritual support and experience; 4. the entire family sets off to look for help, a solution in case something is not going well (in 93% of the cases, from people in the same situation, 80% from community programmes, 56% from experts); 5. avoidance, expectant attitude, passivity: watching TV, waiting for bad things to pass, waiting for things to work out (this also means not panicking) (as cited in IONESCU 2013). PASTER and colleagues (2009) compared the coping strategies of parents raising a child with disability and parents with children that develop typically. Based on their results, they concluded the parents of children with disability used search for social support in a significantly higher rate, avoiding escape and positive revaluation was more characteristic to them. People with social support showed less signs of stress and depression, and it helped them having a plan for the future about developing the child and helping their accommodation. KERSH and colleagues (2006) researched the quality of spousal relationships and factors influencing resilience in parents raising a disabled child, and also the mutual effect of these factors. They found that the correlation between marital satisfaction and parental efficiency was different in the case of fathers and mothers. In the case of mothers, the husband’s support in raising the child with disability evidently defined their satisfaction with their spousal relationship. In the case of fathers, the feeling of parental efficiency and the complacency with their marriage did not show a significant correlation. They were more likely to define the quality of their marriage based on the time spent together, the social roles experienced together. Many noted that they became more resilient in their entire personality, in every aspect of their life: they paid more attention to their relationships, they started looking for the meaning of life, they went through a spiritual development, they raised the question of God, and they defined their life as a ‘long and often painful, but positive development process’ (KERSH et al. 2006, 884).

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10. Resilience assessment of our own sample At the second query, besides the life quality, life opportunity questionnaire we used a parental coping questionnaire. This survey was undertaken by 3 parents. The coping behaviour was surveyed by a CHIP (Coping Health Inventory For Parents; in MCCUBBIN et al. 2007) questionnaire, which was created for parents of children with chronic or severe health problems or disability, and it asks about possible coping attitudes. The parents grade the 46 statements from the list from 0 to 4 (not helpful at all, minimal help, medium help, very helpful). Factor analysis differentiates four subscales: I. Maintaining family unity, cooperation, and a positive assessment of the situation. The sum of points in the case of mothers coping positively is higher than 40. II. The presence of social support: family and social support relationships that sometimes help relieving parents of burdens. The sum of points in the case of mothers coping positively is higher than 28. III. Understanding and helping the situation of the family member with disability through consulting doctors, experts and other parents. The sum of points in the case of mothers coping positively is higher than 15. IV. Caring for myself, maintaining my own health, taking a breather every now and then, relaxing, and recharging. The sum of points in the case of mothers coping positively is higher than 23. Table 8 The parents’ coping subscales Name of the subscale

Comparison average

I. Maintaining family unity

> 40

II. Social support

> 28

III. Understanding and helping the family member with disability

> 15

IV. Caring for myself, maintaining my own health

> 23

These subscales are nuanced by the following: a) the child’s age; b) is there a husband, and is he supportive with the mother in the family?; c) the quality of the relationship with the institute the child belongs to; d) faith in God. The older the child with disability is, the more important the family’s positive coping skill will be. In our own resilience research, the 37 respondents are all mothers. Every respondent has a child with disability over 10 years of age, and all of them belong to the ‘severe’ category of disability. There is a strong correlation between the points obtained by them at the subscales (Pearson Correlation = 0.000 – 0.002). We synthesised the results obtained in the following table:

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L. BERSZÁN Table 9 Characteristics of the successfully coping in regard to the resilience criteria Families Resilience criteria F. 1.

F. 2.

F. 3.

F. 4.

F. 5.

F. 6.

F. 7.

I / 40

II / 28

III / 15

IV / 23

23 y/o

18 y/o

38 y/o

43 y/o

31 y/o

24 y/o

18 y/o

Is there a husband, and is he supportive?

–/+

The quality of the relationship with the institute

+/–

Faith in God

–

112

116

103

102

105

107

The age of the child with disability

Total:

According to the criteria of the aforementioned subscales, 7 people out of the 37 respondents proved to be resilient in the long run in coping with disability. In their case, the value of every subscale reaches or goes over the comparison average provided by the coping scale. Each of them has a child with disability over 18 years of age. In one of the 7 families the father passed away, and in one of the families the father’s attitude is not evidently supportive. Each mother considers the relationship with the child’s current institute positive (daytime employment centre, protected workshop, residential home). A deep interview was conducted with these parents, and it turned out that they had proved to be successfully coping according to the queries 10 years before, too. Based on these interviews, we have found two accentual facilities: 1. There is institutional care for adults with disabilities in the families’ residential area; 2. the mothers realised in time that they also need to look after themselves, because it is also important for the family member with disability that they do not sacrifice themselves, their health and important connections completely. In the deep interview they concluded without exception: one can sacrifice neither the marriage nor the good relationship with the healthy child/children, nor their own health and spiritual integrity on ‘the altar of disability’. ‘Less is often more’, summarises a mother wisely. ‘The child’s disability cannot fill out and dominate everything. It is for their own good, if the father and the sibling does not flee because of the atmosphere’. While in the coping with disability it was obvious that the successful ones would not send their child with disability to a boarding institute, in case of the long-term resilience, it

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seems that the ones that do not plan on solving the question of the future in the family but they have found an opportunity and they can accept the boarding institute as a place of residence for their disabled child, can also be successful. The â&#x20AC;&#x2DC;coping strategyâ&#x20AC;&#x2122; that had started to outline during the first research, became more emphasised during the interviews: coping consists of the initial coping and of recovering again and again after the tough periods over the years. The families that proved to be resilient also went through several crucial periods, every now and then they lost balance, but they managed to recover repeatedly. 11. Instead of conclusions The present study was looking for answers, through processing the partial results of a longitudinal research, to the question: what kind of effect do the changes in the service system have on the daily life and coping capability of families raising and caring for children/young people with disabilities. The size of our research sample does not entitle us to comprehensive conclusions, but they definitely outline a direction, they mark a tendency. These families either do not sense the development in the service system in the last 10 years, or they experience it as the narrowing of legitimacies and education, development, and job opportunities. Their vision of the future is mostly negative. The attitude of the public opinion, the media, and the healthcare system towards them is mainly sensed as rejection, experts and advocacy organisations are not perceived as cardinal helpers and trustees. On the other hand, the relationship with the family, the relatives and friends, faith and the micro-environment remain the main support and resource. The assessment of the Ministry responsible for people with disabilities, the necessity for advising about the lacking services show that they do not reject professional help completely. However, the possibility of an institute that would take over some of the daily employment tasks of the family member with disability is most definitely a supportive factor. There is still an existing distance between the provisions for inclusion and normalisation, the slogans about these provisions, and the everyday life of children/young people with disability and their families. The distance between the practice of law of the macro-system and the opportunities visible in the individual fates are still to be bridged. 12. Supportive model of resilience and community tasks About the correlation between coping and resilience it can be stated that a crucial step after the confrontation with the fact of disability is acceptance and positive coping. But whether a parent/a family can maintain this positive coping in the long run, and whether the initial acceptance would become individual, family resilience â&#x20AC;&#x201C; these have many aspects in social politics. In places where there is an employment centre or daytime care for adults with disabilities, where there is a chance of moving to resident homes when the parents, due to their age and health, would struggle with facing

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the challenges, and where there is a chance of a ‘respiro’, there is a smaller threat of a breakdown or exhaustion. Besides these – as the coping questionnaires, and more so, the deep interviews show –, only understanding and accepting that sometimes ‘less is often more’ can help: in the long term, they could support their disabled child if they gave up the claim to sacrifice everything for them, and they paid more attention to maintaining their physical and spiritual health. As a summary, we have a question instead of a moral: which are those social and familial or individual factors that would be recommended to work out an efficient supporting model for resilience? It is crucial that the helping expert knows the support system and the relevant regulations well, and also, the establishment of a hierarchy of tasks, action plan, specific steps, long-term accompaniment and availability. If the casework is the priority, then a 3D-overview would be necessary: one must plan based on the current family life cycle, the individual life cycle of the family member with disability, and the specific criteria of the type of disability. If we approach from the community support, then the tasks of the social pedagogue and/or the social worker could be teaching and practising an accepting attitude and inclusive approach. The majority of the researchers and the edifications of the present research agree on the fact that there is no universal recipe, but some recommendations can be outlined: first of all, looking for protective factors in the concrete situation of the individual and the family, and after that, creating the balance between the community provocation and support. References BERSZÁN, L. (2007a) A fogyatékos személyek társadalmi integrációja (Cluj-Napoca: Presa Universitară Clujeană). BERSZÁN, L. (2007b) Fogyatékosság és családvilágok (Târgu-Mureş: MENTOR). BERSZÁN, L. (2007c) ‘A fogyatékos gyermeket nevelő családok megküzdési esélyei Romániában’, Esély 18:1 (Jan) 47–60. BERSZÁN, L. (2007d) ‘Bizalom vagy előítélet? Szakember-szülő együttműködés a fogyatékos gyermeket nevelő családokkal való munkában Romániában’, Pszichoterápia 16:1 (Feb), 14–21. BERSZÁN, L. (2009) ‘Chances of Coping with Having Disabled Children for Families in Rumania’, European Journal of Mental Health 4, 27–39 (https://doi.org/10.1556/EJMH.4.2009.1.2). CONNOLLY, P., J. NOVAK & R. TWOY (2007) ‘Coping Strategies Used by Parents of Children with Autism’, Journal of the American Academy of Nurse Practitioners 19, 251–60. Education Policies for Students at Risk and those with Disabilities in South Eastern Europe (2006) retrieved 21 Nov 2017 from http://www.oecd-ilibrary.org/education/education-policies-forstudents-at-risk-and-those-with-disabilities-in-south-eastern-europe_9789264036161-en (https://doi.org/10.1787/9789264036161-en). GOODLEY, D. (2016) Disability Studies: An Interdisciplinary Introduction (2nd ed., London etc.: SAGE). HASTINGS S.J., T.J. KANE & D. STAIGER (2006) Parental Preferences and School Competition: Evidence from a Public School Choice Program (Cambridge: National Bureau Of Economic Research) retrieved 21 Nov 2017 from http://www.nber.org/papers/w11805 (https://doi.org/ 10.3386/w11805).

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IONESCU, Ș., Ed. (2013) Tratat de reziliență asistată (Bucharest: Trei). KERSH, J., T.T. HEDVAT, P. HAUSER-CRAM & M.E. WARFIELD (2006) ‘The Contribution of Marital Quality to the Well-Being of Parents of Children with Developmental Disabilities’, Journal of Intellectual Disability Research 50, 883–93 (https://doi.org/10.1111/j.1365-2788.2006. 00906.x). Lege Nr. 448/2006 din 6 decembrie 2006 Republicată, privind protecţia şi promovarea drepturilor persoanelor cu handicap [Law Nr. 448/2006 from 6 Dec 2006. Rumania. Rights and Opportunities for People with Disabilities] retrieved 21 Nov 2017 from http://anpd.gov.ro/web/ despre-noi/legislatie/legi/. LI-TSANG, C. W.-P., M. K.-S. YAU & H. K. YUEN (2001) ‘Success in Parenting Children with Developmental Disabilities: Some Characteristics, Attitudes and Adaptive Coping Skills’, The British Journal of Developmental Disabilities 47, 61–71 (https://doi.org/10.1179/ 096979501799 155594). MAY, E.G. & B.M. RASKE (2007) Ending Disability Discrimination: Strategies for Social Workers (New York: University of Michigan). MCCUBBIN, H.I., M. MCCUBBIN, R.S. NEVIN & E. CAUBLE (2007) ‘Coping Health Inventory For Parents’ in J. FISCHER & J.K. CORCORAN (Eds.) Measures for Clinical Practice and Research: A Sourcebook (2 vols., 4th ed.,(Oxford: Oxford UP) 1:232–35. PASTER, A., D. BRANDWEIN & J. WALSH (2009) A Comparison of Coping Strategies Used by Parents of Children with Disabilities and Parents of Children without Disabilities’, Research in Developmental Disabilities 30, 1337–42 (https://doi.org/10.1016/j.ridd.2009.05.010) SIEBERS, T. (2008) Disability Theory (Ann Arbor: U of Michigan P). Strategiei nationale pentru protectia, integrarea si incluziunea sociala a persoanelor cu handicap în perioada 2006–2013 [National Strategy: Equal Opportunities for People with Disabilities: Towards a Discrimination-Free Society 2006–2013] retrieved 21 Nov 2017 from http://www.mmuncii.ro/pub/imagemanager/images/file/Legislatie/HOTARARI-DEGUVERN/HG1175-2005.pdf. WALSH, F., Ed. (2009) Integrating Spirituality in Family Therapy: Wellsprings for Health, Healing, and Resilience (New York: Guilford).

EJMH 12:2, December 2017

European Journal of Mental Health 12 (2017) 204–217 https://doi.org/10.5708/EJMH.12.2017.2.5

ZSUZSA SZÉMAN* & ANETT MÁRIA TRÓBERT

SOCIAL INNOVATION IN THE PROVISION OF SERVICES IN LONG-TERM CARE** (Received: 15 September 2017; accepted: 3 December 2017) The present study focuses on the potential of extension of social innovation in social services in long-term care. The aim of the paper is to analyse barriers and drivers according to different care regimes: 1. standard care-mix regimes; 2. universal-Nordic; 3. family-based; 4. Central and Eastern European. Applying different qualitative methods (mapping of initiatives, 62 good examples of which 18 were in-depth, expert interviews, focus groups), the paper is going to explore similarities and differences between care regimes with a special focus on Central and Eastern Europe to see whether the Central and Eastern European care regime can be considered as a special one or not. It becomes clear from the analysis that there are similarities and differences between the individual care regimes and it is of fundamental importance that these as well as the good practices should be widely known and transferred or adapted to the given care structure. This requires continuous mapping and research. Keywords: long-term care, provision of services, social innovation Soziale Innovation bei der Leistungserbringung in der Langzeitpflege: Der Schwerpunkt dieser Studie liegt auf dem Potenzial der Anwendung sozialer Innovation bei der Leistungserbringung in der Langzeitpflege. Ziel ist die Analyse der Barrieren und der Motivationen in den verschiedenen Pflegeregimen: 1. Standardregime mit einem Pflegemix, 2. universell-nordisch, 3. familienbasiert, 4. mittel- und osteuropäisch. Es werden verschiedene qualitative Methoden (Erfassung der Initiativen, 62 gute Beispiele, von denen 18 eingehend behandelt werden, Befragungen von Fachleuten, Fokusgruppen) angewandt, um Ähnlichkeiten und Unterschiede zwischen den Pflegeregimen festzustellen. Besonderes Augenmerk liegt auf Mittel- und Osteuropa, um festzustellen, ob das mittel- und osteuropäische Pflegeregime als besonderes zu betrachten ist oder nicht. Die Analyse zeigt, dass es Ähnlichkeiten und Unterschiede zwischen den Pflegeregimen gibt und es von grundlegender Wichtigkeit ist, dass diese Regime und auch die bewährten Initiativen weithin bekannt sind (werden) oder an die jeweilige Struktur angepasst werden. Das erfordert kontinuierliche Erhebungen und Forschungen. Schlüsselbegriffe: Langzeitpflege, Leistungserbringung, soziale Innovation **

Contact author: Zsuzsa Széman, Institute of Mental Health, Semmelweis University, Nagyvárad tér 4., H1089 Budapest, Hungary; szeman.zsuzsanna@public.semmelweis-univ.hu. Acknowledgements: Special thanks to Michaela Ghenta, Aniela Matei, Gerli Paat-Ahi, Monika Reichert, Sandra Schulze. We could not have written this paper without using texts of focus group interviews and experts interviews collected by our colleagues which enabled us to make the above analysis.

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1. Background According to the European Commission, in 2060 the number of people over 80 is expected to be 62.2 million, almost triple compared to 2013 and this age group is most likely to need care. Life expectancy is increasing, however healthy life years (HLY) are not following that increase. An average increase of two years among persons over 65 between 2010 and 2020 was a goal of the EU (JAGGER et al. 2013). However, there are substantial differences between the different countries and in a number of countries even a significant deterioration was experienced in the HLY indicator between 2012 and 2014. The indicator showed a decline compared to the average growth of 0.1% measured in the EU (for both men and women). In Croatia, Latvia, Austria, Switzerland, Luxembourg and Portugal this ranged between 1.1 and 4.6 years for women. The negative values for men were between 0.5 and 3 years in Croatia, Greece, Latvia, Portugal, the United Kingdom and Switzerland (Eurostat 2016).1 What does this mean for care? According to LOPES and colleagues (2013) a substantial proportion of Portuguese men over the age of 65 are in relatively good health up to around the age of 75, but after that they are in need of some degree of help. When analysing the challenges facing long-term care the EU found that there is an increase with age in the prevalence of illnesses restricting daily activity (European Commission 2012), particularly osteoporosis, cardiovascular diseases, ischaemia, stroke, tumours, impaired sight, impaired hearing and people living with dementia. In 2010, 35.6 million people lived in the world with dementia and this number is projected to increase to 65.7 million in 2030 and 115.4 million in 2050 (WHOAlzheimer Disease International 2012), its prevalence growing with age (almost one quarter of those over 85 suffer from dementia, FERRI et al. 2005). The numbers of people living with dementia point to a critical situation in Germany (1.572 million2), Italy (1.272 million), France (1.174 million) (Alzheimer Europe 2013), and the UK (approximately 1 million, Department of Health 2015). To sustain the long-term care system (see European Commission 2007, European Commission 2012) social innovation is needed. Social innovation has been in the focus of scholars in many areas such as city development, elaboration of elderfriendly cities, places, new technologies for older people (e.g. projects such as Happy Ageing 2009–20113), but long-term care and social innovation have hardly been linked at all (although there were projects clearly with such a goal financed by the 1

2 3

The authors wish to thank all the researchers in the Mopact work package 8, to our work package leader Kai Leichsenring and all members of the working group: Katharine Schulmann, Georgia Casanova, Vasilica Ciucă, Lăcrămioara Corcheş, Mihaela Genta, Žana Grigaliūnienė, Csaba Kucsera, Aniela Matei, Niku Määttänen, Gerhard Naegele, Gerli Paat-Ahi, Speranţa Pîrciog, Andrea Principi, Leonor Rodrigues, Ricardo Rodrigues, Bertha Sănduleasa, Sandra Schulze, Monika Reichert, Karin Wall. Based on Eurostat data http://ec.europa.eu/eurostat/tgm/refreshTableAction.do?tab=table&plugin=1& pcode=tsdph220&language=en. See also http://www.alz.org/de/dementia-alzheimers-germany.asp. Happy Ageing Project (2009–2011) retrieved 19 Oct 2016 from http://www.aal-europe.eu/projects/happy ageing/

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EU). For a long time a variety of concepts were applied (e.g. RUPPE 2011; MOULAERT et al, 2013). Social innovation applied by the European Commission (2011) can be defined as ‘new ideas (products, services and models) that simultaneously meet social needs (more effectively than alternatives) and create new social relationships or collaborations. They are innovations that are not only good for societies but also enhance societies’ capacity to act’. However, bridging long-term care and social innovation was a grey area. To explore social innovation in long-term care was therefore one of the eight key scientific themes of the ‘Mobilizing the Potential of Active Ageing in Europe’ (MoPAct 2013–2016)4 project. A working group (WP8) aimed to map new roads in ‘Social support and long-term care: matching sustainable supply and demand for long-term care (LTC) and ageing-related social support’. The present study focuses on one segment of this research and it is going to explore the potential of extension of social innovation in social services in long-term care. 2. Methods The working group consisted of Austria, Estonia, Finland, Germany, Hungary, Italy, Portugal and Romania. In addition Greece, UK, the Netherlands, Denmark, the Czech Republic, Bulgaria, Lithuania, and Latvia were represented by the core members. The first research phase aimed to acquire good examples in each country. Following the definition of the European Commission (2011) it seemed obvious that new roads of long-term care initiatives should be linked with long-term care. However, after presentations of the first mapping it emerged that obtaining initiatives in social innovation in long-term care was not an easy task or at least that it would be difficult to reach the original aim of obtaining five good practices per country. Although some of the initiatives indicated innovation they were not directly linked with long-term care but other areas of ageing. Substitute examples were therefore needed; finally a sample of 62 initiatives (mostly between 3–5 examples per country) was assembled. From the above sample through voting by members of the working group 18 were selected for an in-depth analysis along drivers and barriers in social innovation in long-term care in the following categories: social innovation; integration of longterm care status, impact; transferability; sustainability. For each category partners gave a score from 1 (not relevant) to 5 (most pertinent) or ‘not applicable’ if there was not enough information or the category was not applicable. The order of the scores – ranged between 83 and 174 – was only one aspect of the selection; an effort was also made to keep a balance between countries and to ensure a proper representation of care regimes. In some cases ranking was altered by advancing countries with a less favourable ranking. 15 focus groups (with different stakeholders: representatives of long-term care: carers’ associations, local/regional administration, relevant NGOs/local associations and service providers, hospitals, researchers, nursing 4

See the website: http://mopact.group.shef.ac.uk.

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schools and health insurance companies) and 20 expert interviews were carried out (2–5 per country) to explore barriers and drivers of social innovation in long-term care. The paper analyses initiatives in the context of care regimes and focuses on the following elements: exploring barriers, presenting suggestions mentioned by experts and member focus groups to see whether there are useful innovations among the good examples. 3. Results 3.1. Care regimes applied in the project The comparison of the drivers and barriers of social innovation in long-term care was first based on the typology of four care regimes. Table 1 Care regimes as a context for social innovation and active ageing policies Demand for care

Provision Provision of informal of formal care care

Acknowledgement of LTC as a social risk

Countries

Standardcare-mix

Mediumhigh

Medium

Early movers

Germany, Austria, France, UK

UniversalNordic

Medium

Low

High

First movers

Denmark, Finland, the Netherlands, Sweden

High

Low

Late movers

Spain, Italy, Portugal, Ireland, Greece

Starters

Hungary, Poland, Czech Republic, Slovakia, Romania, Bulgaria, Estonia, Latvia, Lithuania

Family based

Transition

Low

High

Low

Source: Lamura 20075; NIES et al. 2013.

According to this categorisation all former socialist countries were classified as ‘transition care regime’, still applied in the ‘Overview Report’ in 2013 (SCHULMANN et. al. 2014). However, Central and Eastern European researchers of ‘transition’ 5

Lamura, G. (2007) Dimensions of Future Social Service Provision in the Ageing Societies of Europe, Paper presented at the VI. European Congress of International Association of Gerontology and Geriatrics, St. Petersburg, Russia, July 5–8, 2007.

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countries6 of the working group strongly argued for a new label. Their argument was that 26 years after systemic change can hardly be considered any longer as a ‘transition’. And a remark was also made. Slovenia was missing in the fourth category. The Baltic countries have a population size and territory similar to Slovenia, and Slovenia is a former socialist country too, but nevertheless it does not appear in this care regime type. A new label was therefore proposed and accepted: ‘Central and Eastern European countries.’7 3.2. Mapping of good examples 3.2.1. Standard care-mix regime The challenges mentioned earlier in connection with dementia, also appear in initiatives of the standard care-mix regime. The Austrian ‘Action Dementia – Dementia Friendly Communities in Vorarlberg’ (Aktion Demenz, Austria), targeted family members caring for persons with dementia by providing services that were difficult to access in small settlements (transport, shops, hairdresser, medical doctors in the community). A similar initiative has been launched in the Salzburg region. One of the four UK examples, the ‘Dementia Recovery Model’ aimed to create a new model in an acute mental health ward, involving them in the decision-making process in care providing meaningful activities. Two of the eight German initiatives involved receivers of care and/or the family members caring for them: support for persons living with dementia and their carers through a specially-equipped mobile service (Mobile Demenzberatung/Mobile advice service, Germany); involving volunteers to ease the burden of family members caring for persons with dementia (Zeit für dich/time for yourself). In Germany demented older people with a migrant background represent a special problem due to the special needs of different cultures (Demenzservicezentrum für Menschen mit Zuwanderungsgeschichte, Germany). Technology and ICT-based innovation played a major role in help for informal carers or the receivers of care (TOPIC-The Online Platform for Informal Caregivers; Vera/Projekt Vernetzt and Aktiv, Germany). Also of special note were the various initiatives based on networking (in-patient and out-patient care sectors, LoVe, Germany), citizen companions (Bocholter Bürgergenossenschaften – Dienstleistungen für das Alter gemeinsam und nachhaltig gestalten, Germany), local network (CarePortfolio Germany; Village Service (Association of Services for Households, Families and Companies-Village Service, Austria, analysed in depth later). There were also network initiatives based on the Internet (Tyze-Social Network for Care, Online personal network, UK). One special form of this, the mutual exchange of ‘Support provided 6 7

Mihaela Ghenţa, Aniela Matei, Gerli Paat, Anett Maria Tróbert, Zsuzsa Széman. See: http://mopact.group.shef.ac.uk/wp-content/uploads/2013/10/MoPAct-Policy-Brief-7-Potentials-foractive-ageing-by-social-innovation-in-long-term-care-and-social-support.pdf.

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by me now in return for support for me later’ (UK) was also included among the good examples. Compared to the above, there were fewer cases of good examples based on the employment, labour market pillar (Care as a future labour market – Developing care competences in rural areas, Austria; Trading Times, linking labour market, social enterprise, UK). Although there was only one initiative that can be linked to the environment among the many examples, it deserves special attention and was included in the subsample because it is associated with a comprehensive concept (Bielefelder Model, Germany). 3.2.2. Family-based care regime Among the many good examples belonging in this care regime we also find dementia (Care for carers, Portugal, Up-TECH, Italy, both will be analysed in depth), and initiatives based on ICT and technology (Batta-Pool of technical and technological support, Portugal, E-health Unit, Greece, Amica, Spain, VALCRONIC-CARS, Spain). One example designed to overcome some basic needs, especially loneliness, isolation of elderly or dependent people by volunteer activities of young people (‘Old friends, new smiles’, Portugal) deserves special attention. Like the standard care-mix regime, here too the repertoire includes networking, mutual help (Mutual Aid Association, Portugal), utilisation of local resources (Welfare in the community to care for severely disabled people - Rome, Italy), involvement of older volunteers (Senior Health Mentoring, Greece), an opportunity created by involving multiple actors (Friendship Clubs, Portugal). There are also initiatives aimed at the environment, at creating suitable housing (‘Tiedoli houses’, Italy). The Leonardo da Vinci e-learning programme supported by the EU, designed to ease the care burdens of formal, informal and migrant care workers with new knowledge is interesting for the fact that the participants included as well as three countries belonging to the family-care regime – Greece, Spain and Cyprus – are also partners belonging to the Central and Eastern European model – Hungary and Lithuania (‘ECV Certificate’). The attention paid to informal carers once again confirms the need of this target group of help (Recognition of informal skills – Piemonte Region, Italy). 3.2.3. Nordic-Universal The Dutch Buurtzog: Care in the neighbourhood, with a holistic concept of medical, personal and social needs in long-term care belongs in this care regime. The shift in providing LTC from home help to self-care can be seen in The Fredericia experience from Denmark. There is a mixed Nordic-Baltic initiative (VIRTU), we classify it under the Central and Eastern European pattern as the elaboration and set up of the program was carried out by Estonia. We classify other examples created with material support provided to the Baltic countries under the Central and Eastern European pattern as well.

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3.2.4. Central and Eastern Europe care regime In contrast with the care-mix care regime and the family-based care regime, the question of dementia did not appear in the Central-Eastern European care regime type; this can be explained by the difference among countries in life expectancy at birth. Because of the poorer indicators (Eurostat 2016) the latter countries have not yet paid adequate attention to this challenge. At the same time the appearance of ICT initiatives here is striking. Four of the five Estonian initiatives have technology in their name: the Alarm button service, the My locator developed by a market actor, ELIKO specialising in innovative technologies and products developed by eight companies and Elder-friendly alarm handling monitoring, DREAMING supported by the EU. Two of the three Hungarian initiatives are based on the possibilities offered by the Internet: Skype Care for the elderly, the Webnurse that regarded informal carers as its target group, and both initiatives had an NGO in the background. The Czech AREION emergency button was also developed through a non-profit actor to enable people living with chronic illness to continue living safely at home. The ICT-based good examples belonging to the Central and Eastern European care-regime are characterised by the combination of market R&D activity, technical innovation in response to a social and/or medical problem, and also by the strong presence of the non-profit sector in the initiatives. An examination of the good examples from Central and Eastern Europe shows that countries belonging in other care regimes also participated in some of the initiatives. The explanation for this lies in the material support provided by the EU or other international organisations. The Latvian INNOCARE realised with financing from the Central Baltic INTERRG IV programme, coordinated by an Estonian university and with the participation of a Swedish partner clearly shows the connection between the Central and Eastern European and the Nordic-Universal care regime. The Estonian VIRTU produced its good example jointly with a Nordic, Finnish partner. It can also be regarded as an agreement between two care regimes, in which the Nordic Universal care regime supports the Baltic states in its neighbourhood. The initiatives supported by the EU have a far greater scope, involving several care regimes. In the CARE+ project that is part of the ICT Policy Support Programme all four care regimes can be found (France, Austria, Belgium, Italy Sweden, Latvia, the United Kingdom Hungary, Romania). CareIn8 in the Leonardo da Vinci Transfer of Innovation project brings together ‘only’ three regimes: family-based, Nordic-Universal, Central-Eastern Europe (Spain, Italy, Denmark, Bulgaria, the Czech Republic, Poland). Three care regimes Nordic-Universal, family based, Central-Eastern Europe – are also found in FOOD (Italy, the Netherlands, Denmark, Romania, Sweden, AAL European program). All three projects supported a technology-based initiative. 8

To help care assistance workers to acquire competences in Emotional intelligence by elaborating a learning environment based on Web 2.0.

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The Central and Eastern European care regime and the family-based care regime are similar in that in both a new carer resource, voluntary activity by young volunteers, helps persons in need: lonely elderly persons (Portugal Old friends, new smiles), while in Hungary young people teach elderly receivers of care how to use Skype and the internet (SkypeCare). Among the Central-Eastern European examples as well as in the Bielefelder model that belongs in the standard care-mix regime the question of the environment comes to the fore in the Elder-friendly House (one of the 18 examples). It can be seen from the above that there are both common features and considerable differences between the types of initiatives in the different care regimes. Networking is strongest in the standard care-mix, while, although there are many good examples related to technology and ICT in all care regimes, ICT occupies a very prominent position in the Central and Eastern European examples, and there are many initiatives launched by NGOs, the market or the EU. 3.3. Potential of social innovations for the expansion of long-term care services The analysis below is based on those expert interviews and focus groups which were conducted by researchers of Central and Eastern Europe and the German team.9 It indicates, in comparison with other care regimes, what factors could be taken into consideration for the potential of social innovation for the expansion of long-term care services. We should emphasise that the good examples were the result of attempts to solve earlier existing problems, giving an innovative answer to a concrete need. They are connected both to the present barriers and to the suggestions; particular segments of the given barrier can also be found in other countries. The following types of barriers were found: 1. Lack of Prevention 2. Lack of Professionalism 3. Lack of Support for Carers 4. Lack of Funding 5. Lack of Concepts for Special Needs 6. Lack of Access 7. Lack of Information and Communication Technology Dealing with Older Persons 8. People with Migrant background Among the barriers listed by all the participants of focus groups and experts, the most frequently mentioned barriers were lack of Access and lack of Professionalism (7–7), but there were almost the same number of mentions for lack of Prevention (6) 9

Team members of WP8: Michaela Ghenta, Aniela Matei, Gerli Paat-Ahi, Monika Reichert, Sandra Schulze, Zsuzsa Széman, Anett Mária Tróbert.

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and lack of Support for carers (6). This indicates that these barriers appeared with roughly the same weight. These were followed with slightly fewer mentions by dealing with People with Migrant background (4), Lack of Funding (3), lack of Information and communication technology (3) and finally, lack of Concept for Special Needs (1). A pattern containing exclusively Central and Eastern European good initiatives can be observed: in four cases regarding suggestions for lack of Prevention, two for lack of Professionalism, one for lack of Support for carers, and one for lack of Funding. In the case of lack of Prevention the initiatives indicate that in the Central and Eastern European region, the environment, technology and in particular ICT currently play a strong role. This is a possible direction for catching up by the region. In other regions this range of tools has long been included among the possible means for solutions. Lack of prevention (barrier) – Reinforcing public safety (suggestion) – Isolated farm service (HU) (good example) – Development of alarm systems (suggestion) – AREION Emergency care (CZ) (good example) – Suitable environment, infrastructure for transport, organisation of transport (suggestion) – Isolated farm service (HU) good example – Developing ICT skills among the elderly (suggestion) – Skype Care Program (HU) The lack of Professionalism especially in Hungary makes it difficult to provide and control quality assurance and it is impossible to provide complex and cost-efficient care. The complete separation of the health and social spheres, as well as the excessive burden on service providers and their rising costs, also make cooperation between the spheres impossible. Due to the fragmentation of the system certain professions important in services can fall between the two systems although they could play an important role in ensuring that the systems function in harmony, or in providing a link between the systems. In Romania the lack of coordination between the two systems has a negative impact both on the case process and on professional work. In Estonia there is a lack of appropriate training provided for professionals or information for lay persons (e.g. the elderly). Key problems were found in all Central and Eastern European countries in the sample: the lack of cooperation among professionals (general practitioners, social and health care professionals), the different service providers, and other participants in the care process. The lack of possibility for consultation between service providers and the carers leads to gaps in professionalism (e.g. general practitioners do not have enough experience in topics regarding LTC).

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Lack of professionalism (barrier) – Integrated LTC (suggestion) – Integrated Help-at-Home Development Programme (LT) (good example), – Home Care and Assistive Services for an Independent and Dignified Life (BG) (good example) – Qualified care; uniform control criteria – quality control (suggestion) – Home Care and Assistive Services for an Independent and Dignified Life (BG) (good example) – Case management with a skilled team at the interface of the health and social areas (suggestion) – Family Nurse Programme (IT) UP-TECH project (IT) (good example) At the same time we found good examples from the standard care regime from two countries only for a single suggestion regarding the lack of Access barrier. The New financing form appears to be a suggestion to which the initiatives of two countries in the standard care regime, Austria and the Netherlands, offer a solution. Lack of support for carers (barrier) – Expansion of home nursing and day services with new functions (suggestion) – Integrated Help-at-Home Development Programme (LT) (good example) – VIRTU (EE/FIN) (good example) – Expansion of employment opportunities (suggestion) – Recognition of informal skills (IT) (good example) Lack of funding (barrier) – Integrated LTC system for cost efficiency (suggestion) – Home Care and Assistive services for an Independent and Dignified Life (BG) (good example) The lack of Support and lack of Funding occurred in only one suggestion their significance should not be neglected since both arise from the lack of an integrated system. The good examples are responses to a challenge, a more thorough examination of them in the Eastern European region is enlightening. The situation is especially difficult for persons in a financially disadvantaged situation living in rural areas on isolated farms in Hungary and Romania.10 The situation is further aggravated by the lack of mobile services in rural areas, and the inadequate infrastructure. Laws and standards guaranteeing uniform services are lacking at local and European levels. The lack of suitable care for groups with special needs is also an aspect of the inequality concerning 10

We analysed the situation in Romania on the basis of data in the working material of Michaela Gentha and Aniela Matei.

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access to services. It was noted in the interviews that this can be attributed, among others, to the lack of a conception regarding special needs, the lack of complex thinking, inadequate communication found in the area of care needs, and the lack of homes adapted to special care needs. The need for an expansion of existing LTC services and the establishment of new services represent therefore a priority, particularly in rural areas, even in countries with well-developed LTC infrastructures. As services for people living in rural areas, technical support and training for older people, day care services, personal and mental support services for informal carers, preventive services, and services for low-income older persons are lacking, the coverage of LTC services and the reduction of regional variation in access need to be considered in these countries. The potential for using ICT in long-term care can be harnessed and a stronger partnership among public and private service providers is needed. There are suggestions for which good examples can only be found from the family care regime. This arose in the lack of Support for Carers problem and the Italian good example of the expansion of employment, ‘Recognition of informal skills’. The suitable involvement of informal carers and migrant carers in elder care has long been a challenge in Italy. We found two initiatives from Italy for the other suggestion raised regarding the lack of ‘Professionalism’ barrier, namely ‘Case management with a skilled team at the interface of the health and social areas’; the other is also related to a technology (Family Nurse Programme (IT) UP-TECH project (IT). Both can be adapted and linked to technology in line with one of the directions considered desirable in Central and Eastern Europe, involving technology in care. Lack of concepts for special needs (barrier) – Dementia patients in hospitals, increase offers of palliative care / hospice services (suggestion) – Active Ageing with Dementia (PT) (good example) Lack of access (barrier) – New financing form (suggestion) – Buurtzorg (NL) (good example) – Village services (AT) (good example) One of the characteristics of the lack of Access challenge is that the problem appears in all care regimes. We can conclude from this that this barrier to social innovation is one of the most fundamental in all regions. Several care regimes can be associated with the individual suggestions. The situation is the same for certain suggestions regarding lack of Professionalism: e.g. ‘utilisation of resources of volunteers’ appeared in both a Hungarian and a Dutch initiative. There was a segment where, among the countries analysed by the Central and Eastern European and the German team, it was only in Germany that the combined appearance of long-term care and migration represented a serious problem. All German

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experts stressed the difficulties arising in connection with older people with migrant background. This was not only a matter of language difficulties, they used numerous tools to bridge those and also made efforts to adapt services to the needs of persons with differing cultures. The real challenge appears when the cultural differences are extremely deep and they can only be handled with great efforts or not at all. In place of the available and well functioning home care services an elderly woman wanted a larger apartment so that her daughter could care for her. The existing and efficient formal care system came up against the cultural expectation that regards care as the task of the family and in particular of the daughter, and refuses to consider any other solutions. In view of the present migration processes this challenge will only increase in Europe in countries where there are older people with migrant backgrounds, different languages and cultures. This problem seems to be acute especially in Germany. The German society and the formal long-term care system have not been able to cope with this challenge despite some attempts. Therefore great attention should be paid to this. However, there are other barriers which seem to be serious challenges in Central and Eastern Europe. In Hungary the growing care needs go together with declining service capacity and low service quality. In Romania the financing does not take the target groups into account, and the needs of different entities are not sufficiently involved. The social innovation potential of expanding formal LTC services can in the first place only be realised by means of significant short-term social investment that could be legitimised by an important mid- or long-term social return on investment. The lack of Support for informal carers and the formal workforce in LTC, particularly informal carers, is also a crucial barrier of social innovation in long-term care in all of the Central and Eastern European countries. The lack of Information, of awareness, and of communication (e.g. Estonia) also has a negative impact on the quality of life of care receivers, makes the work of carers more difficult, and impedes prevention. 3.4. Potential for the expansion of services: for whom? Involvement of older people with a very high risk of social exclusion: e.g. persons with dementia can be classified in this group as well as certain old cohorts or/and their carers. Expansion of LTC services however is not always directly related to the person with special care needs, (e.g. other forms of information, special training for carers). Expansion of services can be considered in a wider context. According to the analysis of experts, participants of focus groups and 18 case studies, expansion of service in long-term care could be achieved by making services available for all people in the same age group or all carers or all family carers. Shifting of services towards a younger generation is another important possibility, e.g. by 10 years from 75 to 65 as was mentioned in Hungary. In Germany there are different approaches such as citizens of district towns/regions, where there is also a comprehensive solution, by combining the regional expansion with expansion to all age groups living in rural areas. Service not only for a certain age group but for all citizens of an ageing community can be considered as prevention. If a younger citizen has access to suitable services

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they might not need services in old age at all or only in a later period of life. While in the case of Germany, Austria, Portugal or Hungary this is linked only to the given country, there were also good examples where countries belonging to all care regime types participated, so that the efforts were also uniform. It is interesting in this approach that the potential of expansion of service includes all members of the given community discussed above but this approach is irrespective of the care regime. This clearly reflects the concept of ageing, a process that also includes prevention, and interprets the challenge of LTC in a wider context. Instead of focusing only on older people the appearance of younger generations among the target groups indicates a wider concept of ageing persons on the one hand and that of ageing communities on the other hand. The latter covers citizens of an ageing space and allows social participation. A regional approach is also an important consideration in expansion. Reflecting the situation of older people with migrant backgrounds, a seemingly contrary trend appears: the forming of a subgroup from a wider target group. Due to their different culture and language they are excluded from existing formal services for the majority. 4. Conclusion The prevention and early intervention actions should become important components of the expansion of the long-term care system, particularly if they are part of a holistic long-term care system that includes access, information and communication, funding, professionalism and support of carers (formal and informal). There are a great variety of possibilities for the expansion of services in long-term care. However there are ways of service expansion which can and/or should be considered as general ones and independent of care regimes, e.g. financing, cooperation, suitable legislation, and involvement of stakeholders. Ways to achieve expansion of services and to facilitate integration and coordination often overlap each other or run parallel, such as: partnership of stakeholders, information, consultation, civil society, and new or other forms of employment. It became clear from the analysis that there are similarities and differences between the care regimes. At the same time there are also common points, both in the barriers and the drivers. The implementation of national legislation concerning granting a right to minimum social care could be envisaged. It is of fundamental importance that these and the good practices as well should be widely known and transferred or adapted to the given care structure. This requires continuous mapping and search for further good examples and policy in practice.

References Alzheimer Europe (2013) The Prevalence of Dementia in Europe, retrieved 19 Oct 2016 from http://www.alzheimer-europe.org/Policy-in-Practice2/Country-comparisons/2013-Theprevalence-of-dementia-in-Europe.

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Department of Health (2015) Prime Minister’s Challenge on Dementia 2020, retrieved 24 Oct 2016 from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/ 414344/pm-dementia2020.pdf. European Commission (2007) ‘Health and Long-Term Care in the European Union’, Special Eurobarometer 283 / Wave 67.3 – TNS Opinion & Social, retrieved 19 Oct 2016 from http://ec.europa.eu/public_opinion/archives/ebs/ebs_283_en.pdf. European Commission (2011) Empowering People, Driving Change: Social Innovation in the European Union: Report Commissioned by the European Commission, Luxembourg, retrieved 13 Nov 2017 from https://ec.europa.eu/migrant-integration/librarydoc/empowering-people-driving-change-social-innovation-in-the-european-union. European Commission (2012) Long-Term Care for the Elderly: Provisions and Providers in 33 European Countries (Luxembourg: Publications Office of the European Union) Retrieved 19 Oct 2016 from http://ec.europa.eu/justice/gender-equality/files/elderly_care_en.pdf. Eurostat (2016) Healthy Life Years and Life Expectancy at Age 65, by Sex, retrieved 19 Oct 2016 from http://ec.europa.eu/eurostat/tgm/refreshTableAction.do?tab=table&plugin=1&pcode= tsdph220&language=en. FERRI, P.C. M. PRINCE, C. BRAYNE, H. BRODATY, L. FRATIGLIONI, M. GANGULI, K. HALL, K. HASEGAWA, H. HENDRIE, Y. HUANG, A. JORM, C. MATHERS, P.R. MENEZES, E. RIMMER & M. SCAZUFCA (2005) Global Prevalence of Dementia: A Delphi Consensus Study, The Lancet, 366, 2112–17 (https://doi.org/10.1016/S0140-6736(05)67889-0). JAGGER, C., M. MCKEE, K. CHRISTENSEN, K. LAGIEWKA, W. NUSSELDER, H. VAN OVEN, E. CAMBOIS, B. JEUNE & J.-M. RONINE (2013) ‘Mind the Gap: Reaching the European Target of a 2Year Increase in Healthy Life Years in the Next Decade’, European Journal of Public Health, 23: 5, 829–33 (https://doi.org/10.1093/eurpub/ckt030). LOPES, M.J., A. ESCOVAL, D.G. PEREIRA, C.S. PEREIRA, C. CARVALHO & C. FONSECA (2013) ‘Evaluation of Elderly Persons’ Functionality and Care Needs’, Revista Latino-Americana de Enfermagem, 21, no.spe, Ribeirão Preto Jan./Feb. (https://doi.org/10.1590/S0104116920130007 00008). MOULAERT, F., D. MACCALLUM, A. MEHMOOD & A. HAMDOUCH (2013) The International Handbook on Social Innovation: Collective Action, Social Learning and Transdisciplinary Research (Cheltenham, UK & Northampton, MA, USA: Edward Elgar). NIES, H., K. LEICHSENRING & S. MAK (2013) ‘The Emerging Identity of Long-Term Care Systems in Europe’ in K. LEICHSENRING, J. BILLING & H. NIES (eds.) Long-Term Care in Europe. Improving policy and practice (Basingstoke: Palgrave MacMillan), 19–41. RUPPE, G. (2011) Active Ageing and Prevention in the Context of Long-Term Care: Rethinking Concepts and Practices: Policy Brief (1) (Vienna: European Centre) retrieved 4 Nov 2016 from http://www.euro.centre.org/data/1310723769_53386.pdf. SCHULMANN, K. & K. LEICHSENRING (eds.) G. CASANOVA, V. CIUCĂ, L. CORCHEŞ, M. GENTA, Ž. GRIGALIŪNIENĖ, C. KUCSERA, A. MATEI, N. MÄÄTTÄNEN, G. NAEGELE, G. PAAT-AHI, S. PÎRCIOG, A. PRINCIPI, L. RODRIGUES, R. RODRIGUES, B. SĂNDULEASA, S. SCHULZE, M. REICHERT, Z. SZEMAN & K. WALL (contributors) (2014) Social Support and Long-Term Care in EU Care Regimes: Framework Conditions and Initiatives of Social Innovation in an Active Ageing Perspective, retrieved 9 Nov 2017 from http://mopact.group.shef.ac.uk/wp-content/ uploads/2013/10/D8.1-Social-support-overview-report.pdf. WHO – Alzheimer’s Disease International (2012) Dementia a Public Health Priority, accessed 19 July 2016 from http://apps.who.int/iris/bitstream/10665/75263/1/9789241564458_eng.pdf ?ua=1

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European Journal of Mental Health 12 (2017) 218–229 https://doi.org/10.5708/EJMH.12.2017.2.6

MOHAMMAD ABBASI*

SELF-EFFICACY AND ALEXITHYMIA AS MODERATORS BETWEEN PERCEIVED SOCIAL SUPPORT AND STRESS AMONG PARENTS OF CHILDREN WITH LEARNING DISABILITIES (Received: 2 January 2017; accepted: 3 December 2017)

The purpose of this cross-sectional study was to examine Self-Efficacy and Alexithymia as moderators between perceived social support and Stress among parents of children with Learning Disabilities. The convenience sample of the study consisted of 98 parents of children with Learning Disabilities from Ahwaz (Iran). This descriptive correlational study was conducted in 2014–15. Multidimensional Scale of Perceived Social Support (MSPSS), General Self-Efficacy Scale (GCE), Toronto Alexithymia Scale (TAS-20), and Perceived Stress Scale (PSS) were completed by parents. Hierarchical linear regression analyses were used to examine the moderating role of Self-Efficacy and Alexithymia. The results revealed that Self-Efficacy and Alexithymia were moderators in the relationship between Perceived social support and Stress. The findings supported the hypothesis that higher levels of self-efficacy (see: Figure 1) would be associated with lower levels of Stress, and that lower levels of Alexithymia (see: Figure 2) would be associated with lower levels of Stress. Keywords: perceived social support, self-efficacy, Alexithymia, stres. Selbsteffizienz und Alexithymie als Moderatoren zwischen wahrgenommener sozialer Unterstützung und Stress unter Eltern von Kindern mit Lernbehinderungen: Mit dieser Querschnittsstudie sollten Selbsteffizienz und Alexithymie als Moderatoren zwischen wahrgenommener sozialer Unterstützung und Stress unter Eltern von Kindern mit Lernbehinderungen untersucht werden. Die willkürlich ausgewählte Stichprobe bestand aus 98 Eltern von Kindern mit Lernbehinderungen aus Ahvaz (Iran). Die deskriptive Korrelationsstudie wurde 2014–2015 durchgeführt. Die Eltern haben die Fragebögen Multidimensional Scale of Perceived Social Support (MSPSS), General Self-Efficacy Scale (GCE), Toronto Alexithymia Scale (TAS-20) und Perceived Stress Scale (PSS) ausgefüllt. Um die Moderatorrolle von Selbsteffizienz und Alexithymie zu untersuchen, wurden hierarchische lineare Regressionsanalysen durchgeführt. Die Ergebnisse haben gezeigt, dass Selbsteffizienz und Alexithymie Moderatoren der Relation zwischen der

Mohammad Abbasi: Educational Psychology, Faculty of Literature and Humanities, Lorestan University, Khorramabad, Iran; abbasi.mohammad@hotmail.com.

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wahrgenommenen sozialen Unterstützung und Stress sind. Die Erkenntnisse stützen die Hypothese, dass eine höhere Selbsteffizienz (s. Abbildung 1) mit einem geringeren Stressniveau einhergeht und eine geringere Alexithymie (s. Abbildung 2) mit einem geringeren Stressniveau einhergeht. Schlüsselbegriffe: wahrgenommene soziale Unterstützung, Selbsteffizienz, Alexithymie, Stress

1. Introduction Students with learning disabilities (LD) form the largest group of students with special educational needs in inclusive classrooms (CLARK & ARTILES 2000). According to the International Statistical Classification of Diseases (World Health Organization 2011), the basic learning disability is defined to emerge in reading, writing, and/or mathematics, even though the cognitive skills of these children are within normal range. Researchers have suggested that the responsibilities of caring for a child with a disability may negatively impact parents’ mental health (GLENN et al. 2009). Although some parents cope well with the demands and challenges of a child with Learning Disabilities, others do not, and as a consequence are more likely to experience outcomes such as stress. Parental stress has direct negative effects on parental well-being. High parental stress levels have been associated with increased child behavioral problems and less-than-optimal outcomes from treatment interventions. In contrast, Perceived social support is linked to decreased stress among parents of children with learning disabilities (DUNN et al. 2001). Social support is known to buffer disease-related distress and improve quality of life (ELLIOT 2008). Individuals who perceive high levels of social support feel less stress (WITTIG et al. 2016; GIBBONS 2010; STOK et al. 2006). In a study, stress in parents has been shown to vary with social support (DUNN et al. 2001). Also, previous literature suggests that individuals who are dissatisfied with the amount of social support they receive may consequently be diagnosed with a psychological disorder such as depression (ICIASZCZYK 2016; KRAUSE et al. 1989). Furthermore, Self-efficacy is a personal factor identified in the literature as a predictor of stress. SCHWARZER (1992) conceptualised self-efficacy, which is concerned with a more global and stable personal capability to address many stressful situations effectively. Self-efficacy is considered a personal resource that can influence a person’s feelings, thoughts, and behaviors. Self-efficacy also tends to help an individual facilitate goal setting, effort investment, persistence in face of barriers, recovery from setbacks, and emotional adaptiveness (SCHWARZER & JERUSALEM 1995). Parental selfefficacy is a cognitive factor that has been associated with parental competence. Parental self-efficacy refers to parents’ perceptions that they are capable of competently and effectively parenting their children (TETI & GELFAND 1991). In general, a high self-efficacy level indicates an affirmative sense of self and an ability to remain committed to goal achievement. Meanwhile, low self-efficacy

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indicates low levels of self-confidence, negative self-evaluation, and the inability to produce a planned outcome when tasks are given (APPELBAUM & HARE 1996). High SE has been related to a wide range of physiological measures including lower catecholamine responsivity during stress (BANDURA et al. 1985), pre-competitive anxiety and subjective performance among athletes (NICHOLLS 2010), and better psychological adjustment to highly stressful life changes and events, such as aging (KRAAIJ 2002, BENKA et al. 2014). On the other hand, it is suggested that Alexithymia may be a key concept of increasing psychological distress for Parents of Children with Learning Disabilities. Alexithymia is a multifaceted construct that includes the following main components: (i) difficulty describing emotions; (ii) difficulty identifying emotions; and (iii) externally oriented thinking (TAYLOR 1994; 2006; TAYLOR et al. 1991). It is derived from the Greek roots ‘a = without’, ‘lexus = words’, and ‘thymos = emotions’, and literally means ‘a lack of words for emotions’ (SIFNEOS 1973). It is viewed as a relatively stable trait that is normally distributed in the general population and is often measured with self-report or observer-report measures (HAVILAND et al. 2000). Research has also associated alexithymia with a number of mental or behavioral disorders (TAYLOR & BAGBY 2013). Alexithymia has been empirically linked to poor coping with stress (MARTIN & PIHL 1985), poor bonding with others (SIFNEOS 1987; 1996), and higher levels of anxiety, depression, selfconsciousness, and vulnerability (BAGBY et al. 1994). In either case, TAYLOR (1984) cites associations between alexithymia and somatoform disorders, substance abuse, and post-traumatic stress disorders. 1.1. Objectives The aim of this study was to investigate whether Self-Efficacy and Alexithymia moderate the relationship between perceived social support and Stress among Parents of Children with Learning Disabilities. In order to address the aim, the following research questions were posed: • Is there a significant relationship between Perceived social support and Stress among Parents of Children with Learning Disabilities? • Does Self-Efficacy and Alexithymia moderate the relationship between Perceived social support and Stress among Parents of Children with Learning Disabilities? 2. Method 2.1. Participants We sampled 98 parents of children with Learning Disabilities from Ahwaz, Iran, (66 women and 32 men) between 28 and 53 years of age (M = 41.7).

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2.2. Research Instruments 2.2.1. Perceived stress The Perceived Stress Scale (PSS) was used to measure levels of perceived stress over the past month (COHEN et al.1983). This 14-item form measures levels of perceived stress and the degree to which respondents find their lives unpredictable, uncontrollable, and over-loading. On a 5-point scale, ranging from never to very often, respondents were asked to report how often they perceived feeling stressed. Research has shown that it is a reliable and valid measure of self-reported stress (COHEN et al. 1993). In this study, the Perceived Stress Scale was carefully translated and adjusted to the main scale by the author. Then, to examine its validity, a confirmatory factor analysis was carried out on its items and its reliability was calculated. Results indicate that the scale has appropriate psychometric qualities to be used in Iran. A high internal consistency reliability was shown in the present study for the total scale α.79. 2.2.2. Social support Social support was assessed with the Multidimensional Scale of Perceived Social Support (ZIMET et al. 1988). MSPSS is a brief research tool designed to measure perceptions of support from 3 sources: Family, Friends, and a Significant Other. The scale is comprised of a total of 12 items, with 4 items for each subscale. Across many studies, the MSPSS has been shown to have good internal and test-retest reliability, good validity, and a fairly stable factorial structure (CANTY-MITCHELL & ZIMET 2000; ZIMET 1990). It has been translated into many languages, including Farsi (Persian). In this study, the Perceived Stress Scale was carefully translated and adjusted to the main scale by the author. The MSPSS internal consistency reliability using Cronbach’s alpha was 0.87. 2.2.3. Self-efficacy The General Self-Efficacy Scale (SCHWARZER & JERUSALEM 1995) was administered to assess the international students’ self-beliefs to cope with a variety of difficult demands in life. The scale explicitly refers to personal agency, which is the belief that one’s actions are responsible for successful outcomes. Adjustment to life in a new culture requires dealing with various situations and facing many challenges and, therefore, general self-efficacy is the most appropriate way to assess factors related to international students’ adjustment. The scale consists of 10 items. For each item, students will be rated on a five-point Likert-type scale (1 = Not at all true to 4 = Exactly true). In this study, the General Self-Efficacy Scale was carefully translated and adjusted to the main scale by the author. Then, to examine its validity, confirmatory factor analysis was carried out on its items and its reliability was calculated. Results indicate that the scale has appropriate psychometric qualities to be used in Iran. The reliability of the test was 0.81.

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2.2.4. Alexithymia The 20-item Toronto Alexithymia Scale (TAS-20). The Toronto Alexithymia Scale (TAS-20) is a self-report measure of alexithymia which was developed by BAGBY and colleagues (1994). It is a 20-item scale with a five point Likert-type scale (1 = never true for me to 5 = always true for me) that participants rate according to what is typically true for them. The scale measures three factors of alexithymia: 1) difficulty identifying feelings (e.g., ‘When I am upset, I don’t know If I am sad, frightened or angry’); 2) difficulty describing feelings (e.g., ‘It is difficult for me to find the right words for my feelings’); and 3) externally-oriented thinking (e.g., ‘I prefer to just let things happen rather than to understand why they turned out that way’). In this study, TAS-20 was carefully translated and adjusted to the main scale by the author. Then, to examine its validity, a confirmatory factor analysis was carried out on its items and its reliability was calculated. Results indicate that the scale has appropriate psychometric qualities to be used in Iran. The TAS-20 internal consistency reliability using Cronbach’s alpha was 0.71. 2.2.5. Data Analysis An analysis of the data from this study was performed using SPSS 24.0 statistical software. Missing values in the data were computed along with the sample means. The moderator effects of Self-Efficacy and Alexithymia were tested using a hierarchical multiple regression analysis based on the steps of BARON AND KENNY’s (1986) moderating model. In order to decrease the multicollinearity problems in the analyses, standard z-scores were used. Details about data analyses are given in the section on findings. 3. Results Descriptive statistics and bivariate correlation for the perceived social support, SelfEfficacy and Alexithymia and stress are presented in Table 1. As expected, perceived social support negatively correlated with perceived stress (r = –0.70, p < 0.01), Alexithymia (r = –0.66, p < 0.01), and positively correlated with Self-Efficacy (r = 0.67, p < 0.01). Also consistent with expectation, stress negatively correlated with SelfEfficacy (r = –0.77, p < 0.01) and positively correlated with Alexithymia (r = 0.75, p < 0.01). In addition, skewness and kurtosis values were found to be within acceptable range for a normal distribution.

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SELF-EFFICACY AND ALEXITHYMIA Table 1 Means, standard deviations, skewness, kurtosis and correlations of the variables Variable

Skewness

Kurtosis

1. Perceived social support

36.04

19.93

0.58

–0.76

2. Self-Efficacy

19.23

10.63

0.51

–1.16

0.67**

3. Alexithymia

56.12

18.76

–0.05

–1.00

–0.66**

0.73**

4. Stress

43.03

15.04

–0.38

–1.32

–0.70**

0.77**

0.75**

: p < 0.01

3.1. Moderating effects of Self-Efficacy and Alexithymia In order to test the moderating effects of Self-Efficacy and Alexithymia on the relationship between perceived social support and Stress, hierarchical multiple regression procedures were conducted, as recommended by BARON AND KENNY (1986). For each potential moderator variable, regression models were performed separately. In the first step, we entered gender as a covariate. In the second step, the predictor variable (perceived social support) was entered into the regression equation. At step 3, potential moderator variables (Self-Efficacy and Alexithymia) were entered into the regression equations. In the final step, interaction variables (perceived social support x Self-Efficacy; perceived social support x Alexithymia) were entered into the models. Significant change in R² for the interaction term indicates a significant moderator effect. Table 2 Hierarchical Regression Model for Moderator Role of Self-Efficacy in the Relationship between social support and stress among Parents of Children with Learning Disabilities t statistic

p value <

0.41

0.67

–0.04

–0.43

0.66

–0.29

–3.38

0.001

–0.57

–6.67

0.001

Predictor Variables

Control Variables (entered in 1st step): (Constant)

0.15

Gender

–0.09

Perceived social support Self-Efficacy

Overall F(1,96) = 0.18, p < .66; Total R2 = 0.002 Main Effects (entered in 2nd step):

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Overall F(3,94) = 59.66, p < 0.001; Total R2 = 0.65 Total R2 Change (from previous step) = 0.65, F Change = 89.23 (p < .001) Interaction Term (entered in 3rd step): –0.24

(Perceived social support x Self-Efficacy)

–0.20

–2.88

0.005

Overall F(4,93) = 50.30, p < 0.001; Total R2 = 0.67 Total R2 Change (from previous step) = 0.02, F Change = 8.30 (p < 0.005)

Table 3 Hierarchical Regression Model for Moderator Role of Alexithymia in the Relationship between perceived social support and stress among Parents of Children with Learning Disabilities t statistic

p value <

0.41

0.67

–0.04

–0.43

0.66

–0.35

–4.25

0.001

0.52

6.29

0.001

0.19

0.15

2.13

0.03

Predictor Variables

Control Variables (entered in 1st step): (Constant)

0.15

Gender

–0.09

Overall F(1,96) = 0.18, p < 0.66; Total R2 = 0.002 Main Effects (entered in 2nd step): Perceived social support Alexithymia 2

Overall F(3,94) = 56.40, p < 0.001; Total R = 0.64 Total R2 Change (from previous step) = 0.64, F Change = 84.36 (p < 0.001) Interaction Term (entered in 3rd step): (Perceived social support x Alexithymia) 2

Overall F(4,93 = 45.05, p < 0.001; Total R = 0.66 Total R2 Change (from previous step) = 0.01, F Change = 4.56 (p < 0.03)

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Of greatest importance was the significant interaction between perceived social support and Self-Efficacy (p < 0.005) and Alexithymia (p < 0.03). To illustrate the nature of the interaction effect, we examined the relationship between perceived social support and stress at a high level of Self-Efficacy and Alexithymia (one standard deviation above the mean) and at a low level of Self-Efficacy and Alexithymia (one standard deviation below the mean; AIKEN & WEST 1991). As can be seen in Figure 1, when Self-Efficacy was high (but not when Self-Efficacy was low), higher levels of perceived social support led to lower stress. In contrast, as can be seen in Figure 2, when Alexithymia was low (but not when Alexithymia was high), higher levels of perceived social support led to lower stress.

Figure 1 The Interactive Effect of perceived social support and Self-Efficacy on stress among Parents of Children with Learning Disabilities

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Figure 2 The Interactive Effect of perceived social support and Alexithymia on stress among Parents of Children with Learning Disabilities

4. Discussion Parents can play a central role in childrenâ&#x20AC;&#x2122;s psychological, social, and academic development. Parents who received the direct professional support showed greater reductions in self-reported stress levels than parents who did not. Informal supports have also shown promise regarding increased effectiveness in stress reduction (GREEFF & VAN DER WALT 2010). The present study had two objectives. The first objective was an examination of the predictive value of perceived social support on Stress among parents of children with Learning Disabilities. The second, was to determine the ability of Self-Efficacy and Alexithymia to act as moderator on that relationship. Results at the individual level of analysis indicate that perceived social support has a positive effect on stress. The results of the study support other studies that found a positive relationship between social support and stress (WITTIG et al. 2016; GIBBONS 2010; STOK et al. 2006). Likewise, in a study by STREET and colleagues (1999), individuals with large social networks are more likely to cope effectively with stressors. However, other studies have found no correlation between stress and social support (DWYER & CUMMINGS 2001). According to another important finding of the study Self-Efficacy and Alexithymia has a moderator role in the relationship between perceived social support and stress. According to the results of the current study, when Alexithymia increases, the positive effect of social support on perceived stress decreases. The results are consistent with the other studies presenting the relationship of Alexithymia with stress

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(MARTIN & PIHL 1985; BAGBY et al. 1994). In the case of the moderating model as being effective, it is indicated that the intervening variable plays a buffer role (FRAIZER et al. 2004). Accordingly, it could be said that Alexithymia has a buffer role against the stress decreasing function of social support. Consequently, it could be expected that with a decrease in Alexithymia and a weakening of the preventative role of Alexithymia, the positive effect of social support on perceived stress would increase. Also consistent with expectations, the findings supported the hypothesis that higher levels of Self-Efficacy would be associated with lower levels of stress, and that higher levels of social support would be associated with lower levels of stress. The results are consistent with the other studies presenting the relationship of SelfEfficacy with stress (BANDURA et al. 1985). The results of this study support the proposition that self-efficacy has psychological benefits. DONOVAN and colleagues (1990) posited that parents with high self-efficacy will likely interpret difficulties related to their child as challenges and exert increased effort to meet their child’s needs. In summary, several limitations must be acknowledged in the present study. First, it is important to note that the present study was cross-sectional, meaning that results can only be interpreted as correlational and the direction of causality cannot be determined. Future studies should be encouraged to overcome these limitations by longitudinal design, which would enable quantification regarding the effectiveness of intervention self-efficacy. Another issue related to measurement is that data in this study were obtained using self-report measures, and the results may be contaminated by the variance of the common method. It would be appropriate to complement these measurements with others obtained with different methods. Despite these limitations, the findings of the present study have numerous implications for theory and practice.

References AIKEN, L.S. & S.G. WEST (1991) Multiple Regression: Testing and Interpreting Interactions (Newbury Park: Sage). APPELBAUM, S.H. & A. HARE (1996) ‘Self-Efficacy as a Mediator of Goal Setting and Performance: Some Human Resource Applications’, Journal of Managerial Psychology 11(3), 33–47 (https://doi.org/10.1108/02683949610113584). BAGBY, R.M., J.D. PARKER & G.J. TAYLOR (1994) ‘The twenty-Item Toronto Alexithymia Scale– I. Item Selection and Cross-Validation of the Factor Structure’, Journal of Psychosomatic Research 38, 23–32 (https://doi.org/10.1016/0022-3999(94)90005-1). BANDURA, A., C. TAYLOR, S. WILLIAMS, I. MEFFORD & J. BARCHAS (1985) ‘Catecholamine Secretion as a Function of Perceived Coping Self-Efficacy’, Journal of Consulting and Clinical Psychology 53, 406–14 (https://doi.org/10.1037/0022- 006X.53.3.406). BARON, R.M. & D.A. KENNY (1986) ‘The Moderator–Mediator Variable Distinction in Social Psychological Research: Conceptual, Strategic, and Statistical Considerations’, Journal of Personality and Social Psychology 51, 1173–82 (https://doi.org/10.1037/0022-3514.51.6.1173).

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BENKA, J., I, NAGYOVA, J. ROSENBERGER, Z. MACEJOVA, I. LAZUROVA, J. VAN DER KLINK, J. GROOTHOFF & J. VAN DIJK (2014) ‘Is Coping Self-Efficacy Related to Psychological Distress in Early and Established Rheumatoid Arthritis Patients?’ Journal of Developmental and Physical Disabilities, 26, 285–97 (https://doi.org/10.1007/s10882-013-9364-y). CANTY-MITCHELL, J. & G.D. ZIMET (2000) ‘Psychometric Properties of the Multidimensional Scale of Perceived Social Support in Urban Adolescents’, American Journal of Community Psychology 28, 391–400 (https://doi.org/10.1023/A:1005109522457). CLARK, M. & A.A. ARTILES (2000) ‘Cross-National Study of Teachers’ Attributional Patterns’, The Journal of Special Education 34:2 (July) 77–89 (https://doi.org/10.1177/002246690003400203). COHEN, S., T. KAMARCK & R. MERMELSTEIN (1983) ‘A Global Measure of Perceived Stress’, Journal of Health and Social Behavior 24, 385–96 (https://doi.org/10.2307/2136404). COHEN, S., D.A. TYRRELL & A.P. SMITH (1993) ‘Negative Life Events, Perceived Stress, Negative Affect, and Susceptibility to the Common Cold’, Journal of Personality and Social Psychology 64, 131–40 (https://doi.org/10.1037/0022-3514.64.1.131). DONOVAN, W.L., L.A. LEAVITT & R.O. WALSH (1990) ‘Maternal Self-Efficacy: Illusory Control and its Effect on Susceptibility to Learned Helplessness’, Child Development 61, 1638–47 (https://doi.org/10.1111/j.1467-8624.1990.tb02890.x). DUNN, M., T. BURBINE, C. BOWERS & S. TANTLEFF-DUNN (2001) ‘Moderators of Stress in Parents of Children with Autism’, Community Mental Health Journal 37, 39–52 (https://doi.org/10. 1023/A: 1026592305436). DWYER, A. & A. CUMMINGS (2001) ‘Stress, Self-Efficacy, Social Support, and Coping Strategies in University Students’, Canadian Journal of Counseling 35, 208–20. ELLIOT, R.A. (2008) ‘Poor Adherence to Medication in Adults with Rheumatoid Arthritis: Reasons and Solutions’, Disease Management & Health Outcomes 16 (1), 13–29 (https://doi.org/ 10.2165/00115677-200816010-00003). FRAIZER, P.A., A.P. TIX & K.E. BARRON (2004) ‘Testing Moderator and Mediator Effects in Counseling Psychology Research’, Journal of Counseling Psychology 51, 115–34 (https://doi.org/ 10.1037/0022-0167.51.1.115). GIBBONS, C. (2010) ‘Stress, Coping and Burn-Out in Nursing Students’, International Journal Of Nursing Studies 47, 1299–1309 (https://doi.org/10.1016/j.ijnurstu.2010.02.015). GLENN, S., C. CUNNINGHAM, H. POOLE, D. REEVES & M. WEINDLING (2009) ‘Maternal Parenting Stress and its Correlates in Families with a Young Child with Cerebral Palsy’, Child: Care, Health & Development 3, 71–78 (https://doi.org/10.1111/j.1365- 2214.2008.00891). GREEFF, A.P. & K. VAN DER WALT (2010) ‘Resilience in Families with an Autistic Child’, Education and Training in Autism and Developmental Disabilities 45, 347–55 (https://doi.org/10. 1111/j.1365-2788.2007.00960.x). HAVILAND, M.G., W.L. WARREN & M.L. RIGGS (2000) ‘An Observer Scale to Measure Alexithymia’, Psychosomatics 41, 385–92 (https://doi.org/10.1176/appi.psy.41.5.385). ICIASZCZYK, N. (2016) ‘Social Connectedness, Social Support and the Health of Older Adults: A Comparison of Immigrant and Native-born Canadians’ (M.H. Thesis, The University of Western Ontario, Ontario). KRAAIJ, V., N. GARNEFSKI & S. MAES (2002) ‘The Joint Effects of Stress, Coping, and Coping Resources on Depressive Symptoms in the Elderly’, Anxiety, Stress and Coping 15, 163–77 (https://doi.org/10.1080/10615800290028468). KRAUSE, N., J. LIANG & N. YATOMI (1989) ‘Satisfaction with Social Support and Depressive Symptoms: A Panel Analysis’, Psychology and Aging 4:1 (March) 88–97 (https://doi.org/ 10.1037/0882-7974.4.1.88). MARTIN, J. & R. PIHL (1985) ‘The Stress-Alexithymia Hypothesis: Theoretical and Empirical Considerations’, Psychotherapy and Psychosomatics 43, 169–76 (https://doi.org/10.1159/000287876).

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NICHOLLS, A.R., R. POLMAN & A.R. LEVY (2010) ‘Coping Self-Efficacy, Pre-Competitive Anxiety, and Subjective Performance among Athletes’, European Journal of Sport Science 10, 97–102 (https://doi.org/10.1080/17461390903271592). SCHWARZER, R. (1992) Self-Efficacy: Thought Control of Action (Washington, DC: Hemisphere). SCHWARZER, R. & M. JERUSALEM (1995) ‘Generalized Self-Efficacy Scale’ in J. WEINMAN, S. WRIGHT & M. JOHNSTON (eds.) Measures in Health Psychology: A User’s Portfolio: Causal and Control Beliefs (Windsor, UK: NFER-NELSON) 35–37. SIFNEOS, P.E. (1973) ‘The Prevalence of ‘Alexithymic’ Characteristics in Psychosomatic Patients’, Psychotherapy and Psychosomatics 22, 255–62 (https://doi.org/10.1159/000286529). SIFNEOS, P.E. (1987) ‘Anhedonia and Alexithymia: A Potential Correlation’, in D.C. Clark & J. Fawcett (eds.) Anhedonia and Affect Deficit States (New York: PMA) 119-27. SIFNEOS, P.E. (1996) ‘Alexithymia: Past and Present’, American Journal of Psychiatry 153, 137–42 (https://doi.org/10.1176/ajp.153.7.137). STOK, A., D. HARVEY & D. REDDIHOUGH (2006) ‘Perceived Stress, Perceived Social Support, and Wellbeing among Mothers of School-Aged Children with Cerebral Palsy’, Journal of Intellectual and Developmental Disability 31, 53–57 (https://doi.org/10.1080/13668250600 561929). STREET, H., P. SHEERAN & S. ORBELL (1999) ‘Conceptualizing Depression: An Integration of 27 Theories’, Clinical Psychology & Psychotherapy 6, 175–93 (https://doi.org/10.1002/(SICI) 1099-0879(199907)6:3<175::AID-CPP200>3.0.CO;2-Q). TAYLOR, G.J. (1984) ‘Alexithymia: Concept, Measurement, and Implications for Treatment’, The American Journal of Psychiatry 141, 725–32 (https://doi.org/10.1176/ajp.141.6.725). TAYLOR, G.J. (1994) ‘The Alexithymia Construct: Conceptualization, Validation, and Relationship with Basic Dimensions of Personality’, New Trends in Experimental & Clinical Psychiatry 10, 61–74. TAYLOR, G.J. (2006) ‘Alexithymia: Concept, Measurement, and Implications for Treatment’, American Journal of Psychiatry 141, 725–32 (https://doi.org/10.1176/ajp.141.6.725). TAYLOR, G.J. & R.M. BAGBY (2013) ‘Psychoanalysis and Empirical Research: The Example of Alexithymia’, Journal of the American Psychoanalytic Association 61, 99–133 (https://doi. org/10.1177/0003065112474066) TAYLOR, G.J., R.M. BAGBY & J.D. PARKER (1991) ‘The Alexithymia Construct: A Potential Paradigm for Psychosomatic Medicine’, Psychosomatics: The Journal of Consultation Liaison Psychiatry 32, 153–64 (https://doi.org/10.1016/S0033-3182(91)72086-0). TETI, D.M. & D.M. GELFAND (1991) ‘Behavioral Competence among Mothers of Infants in the First Year: The Mediational Role of Maternal Self-Efficacy’, Child Development 62, 918–29 (https://doi.org/10.1111/j.1467-8624.1991.tb01580.x). ZIMET, G.D., N.W. DAHLEM, S.G. ZIMET & G.K. FARLEY (1988) ‘The Multidimensional Scale of Perceived Social Support’, Journal of Personality Assessment 52, 30–41 (https://doi.org/ 10.1207/s 15327752jpa5201_2). ZIMET, G.D., S.S. POWELL, G.K. FARLEY, S. WERKMAN & K.A. BERKOFF (1990) Psychometric Characteristics of the Multidimensional Scale of Perceived Social Support’, Journal of Personality Assessment 55, 610–17. WITTIG, R.M., C. CROCKFORD, A. WELTRING, K.E. LANGERGRABER, T. DESCHNER & K. ZUBERBÜHLER (2016) ‘Social Support Reduces Stress Hormone Levels in Wild Chimpanzees across Stressful Events and Everyday Affiliations’, Nature Communications 7 (https://doi.org/10. 1038/ ncomms13361). World Health Organization (2011) International Statistical Classification of Diseases and Related Health Problems (10th Rev.) ICD-10 (3th Edition of the Finnish version; Mikkeli: StMichel).

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European Journal of Mental Health 12 (2017) 230–241 https://doi.org/10.5708/EJMH.12.2017.2.7

SZENDE ELEKES*

THE RELATION OF PERCEIVED MEANING OF LIFE, MEANING OF ILLNESS AND ANXIOUS-DEPRESSIVE SYMPTOMS AMONG CANCER PATIENTS (Received: 3 July 2017; accepted: 3 December 2017)

Our research is based on the literature that shows meaningfulness is a correlate of mental health both in the general population and in the case of patients with a serious illness such as cancer. We had two major goals: 1) to identify the meaning-categories patients find in their illness; 2) to test the relationships between perceived meaning of life, meaning of illness and negative indicators of well-being, like automatic thoughts, anxiety, depression in the case of a population of cancer patients from Romania. This study was completed in March-June of 2012. A number of 102 cancer patients, interned in the ‘Ion Chiricuta’ Oncology Institute in Romania, completed a battery of scales that measured perceived meaning of life (Meaning in Life Questionnaire, Meaning in Life after Cancer), the intensity of automatic thoughts (Automatic Thoughts Questionnaire), anxiety, depression (Hospital Anxiety and Depression Scale), and answered the question whether they found any meaning in their lives. We could identify the following categories of meaning patients found in their illness: character change, greater appreciation of life, change of priorities, spiritual growth, greater appreciation of close relationships, clarification of goals, development of self-knowledge. In accordance with the literature, our results show that perceived meaning of life (measured by MLaC), correlates negatively with automatic thoughts (r = –0.606), anxiety (r = –0.576), and depression (r = –0.542), and these relations are significant (p = 0.000). Patients who found their illness meaningful, found more meaning in their lives as well (t = 3.041, p = 0.003), and they showed lower levels of anxiety and depression, but these correlations are not significant (p = 0.567 and 0.116). Keywords: cancer patients, existential concerns, meaning of life, meaning of illness, anxiety, depression. Das Verhältnis zwischen dem wahrgenommenen Sinn des Lebens, dem Sinn von Krankheit und Symptomen von Angst und Depression bei Krebspatienten: Unser Forschungsprojekt basiert auf der Literatur, die zeigt, dass die Sinnhaftigkeit sowohl bei der Allgemeinbevölkerung als auch bei Patienten mit schweren Erkrankungen wie Krebs ein Korrelat der mentalen Gesundheit ist.

Szende Elekes: Sapientia College of Theology of Religious Orders, Piarista köz 1., Budapest, H-1052, Hungary; elekes.szende@sapientia.hu.

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Wir hatten zwei Hauptziele: 1. die Sinnkategorien zu identifizieren, die die Patienten in ihrer Krankheit sehen, 2. das Verhältnis zwischen dem wahrgenommenen Sinn des Lebens, dem Sinn von Krankheit und negativen Merkmalen des Wohlbefindens wie automatischen Gedanken, Angst und Depression bei einer Population von Krebspatienten aus Rumänien zu ermitteln. Die Studie wurde von März bis Juni 2012 durchgeführt. Eine Gruppe von 102 Krebspatienten, die stationär im Ion-Chiricuță-Krebsinstitut in Rumänien behandelt wurden, füllten eine Reihe von Fragebögen aus, mit denen der wahrgenommene Sinn des Lebens (Meaning in Life Questionnaire, Meaning in Life after Cancer), die Intensität automatischer Gedanken (Automatic Thoughts Questionnaire) sowie Angst und Depression (Hospital Anxiety and Depression Scale) ermittelt werden, und beantworteten die Frage, ob sie einen Sinn in ihrem Leben sehen. Wir konnten die folgenden Kategorien von Sinn identifizieren, den die Patienten in ihrem Leben sahen: Veränderung des Charakters, größere Wertschätzung des Lebens, Änderung der Prioritäten, spirituelle Entwicklung, größere Wertschätzung enger Beziehungen, Klärung von Zielen, Entwicklung der Selbsterkenntnis. Im Einklang mit der Literatur zeigen unsere Ergebnisse, dass der wahrgenommene Sinn des Lebens (gemessen mit MLaC) negativ mit automatischen Gedanken (r = –0,606), Angst (r = –0,576) und Depression (r = –0,542) korreliert und diese Relationen signifikant sind (p = 0,000). Patienten, die ihre Krankheit als sinnhaft empfanden, sahen auch in ihrem Leben insgesamt mehr Sinn (t = 3,041, p = 0,003) und hatten weniger Angst und Depressionen, wobei diese Korrelationen nicht signifikant sind (p = 0,567 and 0,116). Schlüsselbegriffe: Krebspatienten, existenzielle Sorgen, Sinn des Lebens, Sinn von Krankheit, Angst

1. Introduction 1.1. The existential plight of cancer According to literature, it seems that a cancer diagnosis is able to provoke a real existential crisis in one’s life (LEE 2008). The possibility of death that arises together with the disease, makes one face their mortality, often for the first time in their life. The existential crisis is a phenomenon best characterised by the intensification of ruminative thoughts related to existence and non-existence (LEE 2008). Crisis evoked by cancer seems not to be culture-dependent: the same existential questions preoccupy patients in Australia (MCGRATH 2004), Japan (MORITA et al. 2000), Great Britain (GRIFFITHS et al. 2002) and North-America (HALSTEAD et al. 2001). WESTMAN and colleagues (2006) pointed out that patients’ reflections concentrated on the following topics: meaning of life, God/transcendence, health, work, relationships, sexuality. Although existential rumination is a universal phenomenon, the subjective distress can vary from person to person: often it is accompanied by a feeling of hopelessness, despair, and isolation (LEE 2008). VACHON (2008) pointed out that distress is not influenced by the objective prognosis of disease, rather by the fact whether the patient perceives the so called ʻglobal meaning’ to be threatened. According to cognitive approaches, this ʻglobal meaning’ is a set of personal beliefs and assumptions that ensures the impression of order and

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meaning in life. These assumptions, positive illusions, remain unquestioned until a negative event occurs. When someone faces a cancer diagnosis, this set of beliefs is shaken (LEE 2008; COWARD 1997). The existential crisis turns into a search for meaning. This is a cognitive process through which the patient tries to integrate the experience of illness into his life-scheme (VACHON 2008). The search for meaning is a necessary, but emotionally difficult phase. The concept of search for meaning has several interpretations in the literature. JOHNSTON TAYLOR (1995) pointed out that meaning of illness can be understood as an explanation (ʻWhy?’), selective incidence (ʻWhy me?’), attribution of responsibility (ʻWho’s fault is it?), or significance (ʻWherefore?’). The author says that for adjusting to the illness the most important is finding its significance, in other words, finding the role of the disease in one’s life course. In our study, we used the concept meaning with this latter interpretation. According to studies quoted by JOHNSTON TAYLOR (1995), patients found the following meanings in their illness: re-evaluation of life, forming a new attitude towards life, deepened self-knowledge, rearrangement of priorities, strengthening of character, appreciation of interpersonal relationships, getting closer to God, etc. As a result of the process of search for meaning, many patients present the signs of post-traumatic growth (RAJANDRAM et al. 2010; SAWYER et al. 2010). 1.2. The relation of meaningfulness and well-being among cancer patients The importance of meaningfulness in mental health, was first emphasised in the work of Viktor E. FRANKL (1992). According to Frankl, man’s deepest motivation is to find meaning in life, and in case if this search for meaning is hindered, an existential vacuum arises that is the root of psychical and physical diseases. The relation of meaningfulness and subjective well-being was later confirmed by empirical research. According to literature, meaningfulness is related to several indicators of well-being, for example satisfaction with life, positive affectivity (ZIKA & CHAMBERLAIN 1992), self-esteem, optimism (STEGER & FRAZIER 2005), selfefficacy, subjective health (SKRABSKI et al. 2005), and shows negative correlation with negative indicators of well-being, like oncological and cardiovascular mortality rates (SKRABSKI et al. 2005), smoking (KONKOLŸ THEGE 2009), suicidal thoughts (EDWARDS & HOLDEN 2001), anxious and depressive symptoms (MASCARO & ROSEN 2004). Another category of studies found evidence that finding a meaning helps people to adjust to critical negative life experiences, just as the diagnosis of a serious disease (FIFE 1995; 2005). There is accordance in literature regarding the fact that finding a meaning plays a significant role in adjusting to a serious illness. COWARD (1997) says finding meaning grants patients a sense of control upon their lives. FIFE (1995) found that meaningfulness is a significant negative predictor of both anxious and depressive symptoms. A Turkish study found that there is a significant positive relation between perceived meaning of illness and quality of life (OKANLI & ASI

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KARAKAS 2014). BRADY and colleagues (1999) pointed out that patients characterised by high meaningfulness bore the serious physical symptoms of disease easier and were more contented with their quality of life. Other studies pointed out the mediating role of meaningfulness: patients who after a mutilating operation maintained their belief in the meaning of life, showed less emotional problems (JIM & ANDERSEN 2007; SIMONELLI et al. 2008). Patients in a final stage, who were able to find meaning in their illness, found their lives precious and worthy of living, while the inability of finding a meaning was associated with death-wish and suicidal thoughts (FEGG et al. 2008). Patients in a final stage of their disease most often named their partner, friends, recreation and nature as their sources of meaning. However, not every study found evidence for the role of meaningfulness in adjusting to illness. KERNAN and LEPORE (2009) made a longitudinal study among patients with breast cancer, and found that patients, who find meaning in their disease, do not adjust better than the others who do not. 2. Method Our research was carried out in the ‘Ion Chiricuta’ Oncology Institute in ClujNapoca, in the period of March–June 2012. The Institute is one of the most important healthcare centres in Romania, and in Europe, providing preventive, curative and palliative treatment for more than 10,000 cancer patients annually. 2.1. The aims and hypothesis of the study In our study we intended to explore what kind of meanings do cancer patients assign to their disease. Furthermore, we intended to investigate the relationship between perceived meaning of the disease, meaning of life and indicators of well-being among a population of cancer patients from Romania. The psychosocial aspects of cancer disease is a relatively well searched area in Romania. The research of DÉGI (2013) reveals that almost half of the Romanian inpatients with cancer disease suffer from depression, anxiety disorders, and almost one third (28%) report a low quality of life. Women, unmarried patients, patients of older age and with a lower education level show higher levels of depression (KALLAY & DÉGI 2015). We assumed that both the perceived meaning of illness and meaning of life will show negative correlation with negative automatic thoughts, anxiety and depression. 2.2. Participants We collected data from 102 inpatients, who completed the test battery. Patients came from every region of Romania and they were either under chemotherapy or radiation

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treatment. The sample included 20 men (19.4%), and 82 women (80.6%), their age varied from 23 to 73 years (m = 47). About half of the patients (55%) had a high school degree, and 40% had a college degree. In the sample, the average time that had passed since the diagnosis was two years (23.9 months). This interval varies from one month to twenty years. With more than half of the patients (54%), the cancer was discovered in the last nine months. 2.3. Instruments The test battery included four scales and a question that directly asked patients about the perceived meaning of the illness (‘Do you think the illness could have any meaning in your life? In case if the answer is yes, please name what this meaning could be?’) The Meaning in Life Questionnaire (MLQ, STEGER et al. 2006) assesses how meaningful the person perceives his life, respectively, how devoted he is in searching for a meaning. The scale is composed of two subscales: the Presence of meaning, respectively the Search for meaning subscale. The Meaning in Life after Cancer Scale (MLaC) was developed in order to assess meaningfulness after the diagnosis of cancer. The scale has four subscales: Harmony and peace, Aims and perspectives, Confusion and meaninglessness, Spirituality. The Automatic Thoughts Questionnaire (ATQ, HOLLON & KENDALL 1980) assesses the frequency of negative automatic thoughts (e.g.‘I don’t think I can go on.’, ‘My life is a mess’ etc.). The Hospital Anxiety and Depression Scale (HADS, ZIGMOND & SNAITH 1983) is a frequently used instrument in a healthcare context in order to measure patients’ level of anxiety and depression. 3. Results 3.1. Perceived meaning of illness More than half of the patients, 55 people (53.4%) answered yes to the question, whether they found any meaning in their disease. We also asked them to explain what this meaning was. After analysing patients’ answers, we can state that the content of their answers fall into several categories. We identified eight larger categories of answer, and with two exceptions, patients’ answers fall into one of them. Some answers satisfy more than one category. Hereinafter, we will present the meaningcategories with examples. 1

The number in brackets refers to the frequency this meaning-category was mentioned in patients’ answers.

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– Character development (23):1 when asking about the meaning of illness, very often we found answers which reflected a deep change in character, thinking style, lifestyle, etc. after the diagnosis. Patients mentioned they became better, stronger, more attentive with others, learned to love others more. A 23-yearold girl wrote: ‘The disease made me change completely. It helped me to see the world more maturely, not so childishly as before. I became a better person through it.’ – Appreciation of life (15): this category refers to the fact that the person begins to see their lives in a new perspective. After the diagnosis, small joys like having a cup of coffee or going to work day by day, don’t seem natural anymore, but they begin to be appreciated. A 65-year-old lady with pancreatic cancer wrote: ‘I see things in a new perspective, I appreciate life more. I’ve descended to reality, leaving behind my ’reality’. There are things that I only now began to discover, began to discover their real value. Some activities, that I performed with automatism, have received a new content, meaning and depth.’ – Appreciation of important others (8): this source of meaning is in connection with the former category, but because of its frequency, we refer to it as a separate category. A typical answer assigned here: ‘(after the disease) I began to appreciate every moment that I can spend with my loved ones.’ (a 40-year-old woman with breast cancer). The disease works as a ‘filter’ through which love and faithfulness of the important others are tested: ‘I realised who is really next to me when I need them’. – Change of values and priorities (9): answers assigned to this category refer to a change in the former value scale of patients. New values and priorities took the first places in this scale. A 51-year-old lady with ovarian cancer wrote: ‘I had to make some changes in my life! Too much work, too much stress. I forgot to value myself as a woman, I put my person to the last place.’ – Spiritual growth (8): this category included answers that referred to a development in the religious/spiritual life of the person or a deepened relationship with God. A 43-year-old patient with breast cancer wrote: ‘the disease helped me to make contact again with God’. Some patients interpreted their disease in the context of religious faith, as a ‘test from God’. – New goals (4): in these answers patients mention that disease showed them new goals and perspectives, mobilising their motivation and energy. A 44year-old lady wrote: ‘Now I know what and who I live for.’ – Warning (3): in these answers the role of illness is to warn the person to pay more attention to themselves. ‘The disease taught me to pay more attention to my health hereinafter’ said a 52-year-old man suffering from pulmonary cancer. – Deepened self-knowledge (2): two patients mentioned that their illness was a tool in deepening their self-knowledge: ‘It helped me to know myself better as a person’ (a 41-year- old woman).

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After studying patients’ answers, we can draw the conclusion that the most important keyword occurring in their disclosure was change. Disease appears as a milestone in patients’ lives that – in spite of its many negative aspects – also brings about positive changes in their lives: a change in their character, thinking style, the former unhealthy lifestyle, appreciation of the important others, and these changes are received positively by patients. 3.2. The relation between perceived meaning of life and well-being In the following we will show the results regarding the relations between the investigated variables: meaningfulness, automatic thoughts, depression, anxiety. In order to analyse data, we used the SPSS statistical analysis software package. For comparing means, we used an independent sample t-test, and Pearson’s correlation to assess relations between variables. Demographic variables – gender, age and education level – do not correlate significantly with meaningfulness. It seems though that meaningfulness, measured by Meaning in Life Questionnaire, is slightly higher among higher education levels. As it can be seen in Table 1, time passed after the diagnosis shows a slight positive correlation (r = 0.202) with the Presence of meaning subscale of the MLQ, and this proves to be significant. Table 1 Correlation between the time after the diagnosis and perceived meaning of life Meaning of Life Questionnaire– presence of meaning

Time after the diagnosis (months)

0.202

0.043*

102

: p < 0.05

The Presence of meaning subscale of the MLQ showed poor correlation with negative automatic thoughts, anxiety and depression, and these correlations are not significant. On the other hand, meaningfulness measured by Meaning in life after Cancer scale, shows negative, moderate correlation with automatic thoughts (r = –0.606), anxiety (r = –0.576) and depression (r = –0.542), and these correlations are significant (see Table 2). In conclusion, our hypothesis is confirmed partially, but the results are dependant on the used instrument.

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PERCEIVED MEANING OF LIFE, MEANING OF ILLNESS Table 2 Correlation between meaningfulness, automatic thoughts, anxiety and depression Meaning of Life Questionnaire – presence of meaning

Meaning in Life after Cancer Scale r

Negative automatic thoughts

–0.606

0.000*

102

–0.172

0.084

102

Anxiety

–0.576

0.000*

102

–0.084

0.397

102

–0.542

102

–0.087

0.380

102

Depression

0.000

Regarding the correlation between perceived meaning of illness and negative indicators of well-being, our hypothesis is confirmed partially, but results are not significant. At first, those who find meaning in their illness, find their life more meaningful as well, and this difference is significant. Furthermore, those who find meaning in their illness, show a lower level of negative automatic thoughts, anxiety and depression, but these correlations are not significant (see Table 3). Table 3 Correlation between perceived meaning of illness, automatic thoughts, anxiety and depression ‘Do you think the illness could have any meaning in your life?’

Mean

Perceived meaning of life (MLaC)

yes

11.23

9.55

Negative automatic thoughts

yes

26.33

27.02

yes

6.40

6.87

yes

3.95

5.04

Anxiety

Depression

t-test

3.041

0.003*

–0.347

0.73

–0.575

0.567

–1.58

0.116

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4. Discussion In our study, first we intended to explore the meaning-categories found in a population of Romanian cancer patients. The aforementioned literature review of JOHNSTON TAYLOR (1995) presents several studies that focus on meaning found in the illness. The sources of meaning identified in our research appear in the literature as well: deepened self-knowledge, appreciation of life and important relationships, change of priorities, approach to God/the transcendent, new goals and motivations, etc. These resemblances and recurrent motifs suggest that cancer disease is a universal human experience that in different cultures launches the same processes, and draws attention to values like love, faith, patience and gratitude. Furthermore, we found that neither gender nor age shows correlation with meaningfulness, in contrast with the study of SALMON and colleagues (1996), who found that meaningfulness is higher among patients older than 50 years. We found as well that the time passed after the diagnosis shows a slight positive correlation with meaningfulness, which can be interpreted that time facilitates the process of meaning finding. Secondly, we assumed a negative correlation between perceived meaning of life and illness, respective negative indicators of well-being, like automatic thoughts, anxiety, and depression. This assumption was confirmed partially. Perceived meaning of life, measured with the Meaning in Life after Cancer Scale, shows negative and significant correlations with all three variables. These results are in accordance with the literature (MASCARO & ROSEN 2004; MASCARO, ROSEN & MOREY 2006) and these relationships hold true of cancer disease (BRADY et al. 1999; FIFE 1995; JIM & ANDERSEN 2007). In our study we found that results are dependent on the applied instrument measuring meaningfulness. The differences can come form the fact that the Meaning in Life Questionnaire measures meaningfulness in general, while the Meaning in Life after Cancer Scale connects meaningfulness with the experience of cancer explicitly. Meaning found in the illness is in a positive and significant correlation with perceived meaning of life. In other words, if someone finds meaning in their illness, it is more likely that they find meaning in their life as well. From this we can conclude that at the root of these two factors there is one common motivational attitude that urges one to search for meaning. Those who found meaning in their illness showed a lower level of automatic thoughts, anxiety and depression that is in accordance with literature (FEGG et al. 2008; FEGG et al. 2010; OKANLI & ASI KARAKAS 2014). However, these correlations are not significant most likely because of the relatively small sample size and other unidentified variables.

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5. Limitations and future directions Among the limits of our research we must mention that the sample was not representative: 80% of the patients were female, which narrows the generalisation of the results. Furthermore, our results are correlational: we don’t know for sure if those who find meaning in their lives and illness are less anxious and depressive or whether a lower level of depression and anxiety helps one to find meaning in life or not. We didn’t examine variables like optimism, hope or religiosity that could have influenced the results as well. In the future the research could be repeated with taking into account personality variables and positive indicators of well-being.

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CONTRIBUTORS TO THIS ISSUE / AUTOREN DIESES HEFTES

CONTRIBUTORS TO THIS ISSUE/ AUTOREN DIESES HEFTES Dr. Mohammad ABBASI Faculty of Literature and Humanities Lorestan University IR-44316-68151 Khorramabad P.O. Box 465, Falakol’ Aflak Street Iran/Iran abbasi.mohammad@hotmail.com Dr. BERSZÁN Lídia Universitatea Babeş-Bolyai Cluj-Napoca Facutatea de Sociologie şi Asistenta Sociala RO-400604 Cluj-Napoca No 128, 21 Decembrie 1989 Bvd Rumania/Rumänien berszan.lidia@gmail.com DINYÁNÉ SZABÓ Mariann Semmelweis Egyetem Egészségügyi Közszolgálati Kar Digitális Egészségtudományi Intézet H-1094 Budapest Ferenc tér 15. Hungary/Ungarn dinyane.mariann@public.semmelweis-univ.hu ELEKES Szende Sapientia Szerzetesi Hittudományi Főiskola H-1052 Budapest Piarista köz 1. Hungary/Ungarn elekes.szende@sapientia.hu Prof. F. PIKÓ Bettina Szegedi Tudományegyetem Magatartástudományi Intézet H-6722 Debrecen Szentháromság utca 5. Hungary/Ungarn fuzne.piko.bettina@med.u-szeged.hu

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Dr. Marina S. KRIVOSHCHEKOVA Institut inostrannyh jazykov Ural’skij gosudarstvennyj pedagogicheskij universitet RU-620017 Ekaterinburg Cosmonavtov Av., 26 Russia/Russland kmsolimp@mail.ru Dr. Olga V. KRUZHKOVA Kafedroj filosofii i akmeologii Ural’skogo gosudarstvennogo pedagogicheskogo universiteta RU-620017 Ekaterinburg Cosmonavtov Av, 26 Russia/Russland galiat1@yandex.ru MIHÁLKA Mária Szegedi Tudományegyetem Egészségtudományi és Szociális Képzési Kar Szociális Munka és Szociálpolitika Tanszék H-6726 Szeged Bal fasor 39–45. Hungary/Ungarn mihalka@etszk.u-szeged.hu Prof. PUSZTAI Gabriella Debreceni Egyetem H-4028 Debrecen Kassai út 26. Hungary/Ungarn gabriella.pusztaiella.hu Prof. SZÉMAN Zsuzsa Semmelweis Egyetem Egészségügyi Közszolgálati Kar Mentálhigiéné Intézet H-1089 Budapest Nagyvárad tér 4., 19. em. Hungary/Ungarn szeman.zsuzsanna@public.semmelweis-univ.hu

CONTRIBUTORS TO THIS ISSUE / AUTOREN DIESES HEFTES TRÓBERT Anett Mária Semmelweis Egyetem Mentális Egészségtudományok Doktori Iskola H-1428 Budapest Pf. 2. Hungary/Ungarn trobert.maria@gmail.com

243

Anastasia VYLEGZHANINA Finansovo-jekonomicheskij institut Tjumenskij gosudarstvennyj universitet RU-620003 Tyumen ul. Semakova, 10 Russia/Russland a.o.lyovkina@utmn.ru

Dr. Irina V. VOROBIEVA Kafedroj filosofii i akmeologii Ural’skogo gosudarstvennogo pedagogicheskogo universiteta RU-620017 Ekaterinburg Cosmonavtov Av, 26 Russia/Russland lorisha@mail.ru

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