منابع، عوامل استرس زا و تنش روانی در میان افراد مسن در شنای هندوستان
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|34063||2009||8 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Social Science & Medicine, Volume 68, Issue 2, January 2009, Pages 243–250
Scant information exists on the complex interaction between resources and stressors and their subsequent influence on the psychological distress of older adults in India. Within the framework of resource theory, the present study examined the various pathways through which resources and stressors influence psychological distress by testing four models – the independence model, the stress-suppression model, the counteractive model and the resource-deterioration model. The independence model posits that resources and stressors have a direct relationship with psychological distress. The stress-suppression model hypothesizes that stressors mediate the influence of resources on psychological distress. The counteractive model postulates that stressors mobilize resources, which in turn influence psychological distress. The resource-deterioration model states that stressors deplete resources and subsequently exacerbate distress. In the present study, resources include social support, religiosity and mastery; stressors include life events, abuse and health problems. Psychological distress was measured using the Center for Epidemiological Studies Depression scale and Geriatric Depression Scale. Interviews were conducted among 400 adults aged 65 years and above, randomly selected from the electoral list of urban Chennai, India. The battery of instruments was translated into Tamil (local language) by back-translation. Structural Equation Modeling was conducted to test the three models. The results supported the stress-suppressor model. Resources had an indirect, negative relationship with psychological distress, and stressors had a direct, positive effect on distress. As such there is a need to identify and strengthen the resources available to older adults in India.
Older adults encounter biological, social and economic losses called stressors, which may enhance the risk for psychological distress. Older adults draw upon or utilize resources embedded in their psychosocial lives to prevent, resolve, and cope with stressors. There is growing evidence that resources compensate for losses (Steverink, Westerhof, Bode, & Dittmann-Kohli, 2001) and alleviate distress during late life (Krause, 1997, Martin et al., 2001 and Pearlin, 1989). However, the dynamic mechanisms involved in the relationship among resources, stressors, and distress are not clear. Understanding the specific pathways underlying these factors may help tailor psychosocial and community-based interventions to enhance an older adult's well-being, through the strengthening of the appropriate resources. This current study used resource theory (Ensel & Lin, 1991) as a framework, to investigate the relationship between stressors and resources and its influence on the psychological distress of older adults in Chennai, India. India ranks second in the world in terms of the number of older adults. According to Census of India (2001) there are 49,105,542 people aged 65 years and above. Furthermore, the older adult population is projected to rise from 76 million in 2000 to 179 million in 2031 and to 327 million in 2050 (Irudaya Rajan, Sankara Sarma, & Mishra, 2003). Although Indian culture stipulates that the family should take care of older people, it is widely recognized that socio-demographic changes have eroded the traditional support system of older adults, making them susceptible to psychological distress. Given these socio-demographic transitions and their adverse impact on older adults in India, it is quite surprising to note that there is a paucity of information on resources, stressors and psychological distress experienced by this segment of the population. Jamuna (2003) argued that mental health, disability, psychosocial problems, abuse and family ties deserve priority in gerontology research. In broad terms, in India, research on psychological distress during late-life depicts two parallel strands. One strand emphasizes stressors and their association with psychological distress (Patil et al., 2000, Rao, 1997 and Satapathy et al., 1997). The second strand, though meager, has focused on resources, mainly social support, and their influence on psychological distress (Nathawat, 2000, Nathawat and Rathore, 1996 and Prema, 2000). There is a need to merge these two strands to shed light on the pathways by which resources and stressors influence distress in the population of older Indian adults. For instance, studies with elderly populations in the West have shown that besides the direct relationships of stressors and resources on psychological distress, resources and stressors also interact with each other to influence psychological distress (Bisschop et al., 2004 and Jang et al., 2002). Given the complex mechanisms by which resources influence stressors and distress, researchers in India need to explore the psychosocial resources available for older adults in India. The primary goal of the current study is to investigate the direct and indirect pathways by which resources and stressors influence distress by examining these relationships in the broader social context of Indian older adults. Conceptualization Resource theory comprises three components: resources, stressors, and distress. Resources are identified as elements in the internal (psychological) and external (social) environments, either of which enhance well-being or mediate or counter the potential adverse consequences of stressful conditions or situations (Lin, 1986). Due to a considerable overlap between resources and coping, conceptual clarification is in order. Coping is the process of attempting to manage the demands created by stressful events that are appraised as taxing or exceeding a person's resources (Lazarus & Folkman, 1984). Coping denotes efforts pursued by an older adult to prevent, diminish, or tolerate stressful circumstances, whereas resources aid in this process. “Resources refer not to what people do, but to what is available to them in developing their coping repertoires.” (Pearlin & Schooler, 1978, p. 5). Folkman (1984) states that based on the availability of resources, an individual may chose coping strategies to deal with stressful circumstances. For instance, an older adult who is high in mastery may use problem-solving coping, which has been found to diminish distress (Kant, D'Zurilla, & Maydeu-Olivares, 1997). In the present study, social support, religiosity, and mastery were considered as indicators of resources. Research has consistently shown that social support offsets psychological distress (Chou, 2005, Chou et al., 2004 and Vanderhost and Mclaren, 2004). In India, social support takes on an added significance as a resource due to the socio-economic dependency of older adults on their family members, the emphasis on the family to take care of older persons, the dearth of alternate sources of care, and the reluctance of older adults to use meager alternate care services. For instance, data collected at the national level show that a significant proportion (84.4%) of older adults co-reside with their married children (Irudaya Rajan & Kumar, 2003) and that the majority of older adults are dependent on their children for their financial needs (Irudaya Rajan et al., 1999 and National Sample Survey Organization, 1998). Social support is measured in terms of structural and functional aspects. The structural aspects assess the number, type, and geographical distribution of social contacts; the functional aspects assess the different kinds of support functions, and their perceived value. Although social networks are essential for support, the mere presence of a network does not guarantee the availability of support (O'Reilly, 1988). In the present study, functional aspects of social support were measured. The positive influence of religiosity on well-being has been extensively documented among the older adult population (Ardelt, 2003, Idler and Kasl, 1992, Koenig et al., 1998, Kundu et al., 1989 and Patrick and Kinney, 2003). Researchers have found a high level of religiosity among older adults in India (Ray, Dasgupta, & Basu, 2003). In addition, Juthani (2001) and Wig (1999) have shown that religiosity plays an important role in the treatment of mental health problems. In the present study, religiosity includes both organizational (extrinsic) and non-organizational (intrinsic) components. The former refers to attendance at church, temple, or mosque and the frequency of religious behavior, while the latter denotes one's subjective belief in religion (Moberg, 2001). Mastery is defined as the perception about one's power or control over events (Pearlin & Schooler, 1978). Research has extensively documented the positive effects of mastery on physical and mental health (Roberts et al., 1994 and Zautra et al., 1995). Older Indian adults are dependent on other family members for their socioeconomic needs. The family as a system is more highly valued than the individual. Hence, older adults may attribute control over events to significant others. Additionally, older adults attribute both desirable and undesirable events to God/Karma (Dalal, 2000). For example, it is a commonplace to hear in day-to-day discourse that “everything is in the hands of God,” “we are mere tools,” and “it is God's wish”. The term stressor is used to refer to those problems, hardships, and other circumstances that have the potential to adversely affect the well-being of older adults ( Pearlin et al., 1981 and Pearlin et al., 1990). In the present study, three stressors: abuse, life events, and health status were considered. Elder abuse is a single or repeated act or a lack of appropriate action that occurs within any relationship where there is an expectation of trust, and which causes harm or distrust to an older person ( Action on Elder Abuse, 1995). Studies conducted in different parts of India have showed that elder mistreatment is widely prevalent in India and that the victims of abuse report symptoms of depression, death wishes, somatic complaints, sleeping problems, and decreased life satisfaction ( Chokkanathan and Lee, 2006 and Srinivas and Vijayalakshmi, 2001). The National Sample Survey Organization (1998) survey reported that 54.5% of older adults reported chronic illness. Several small-scale studies have showed health problems to be concomitant with distress ( Irudaya Rajan and Mishra, 2001, Joshi et al., 2003 and Nandal et al., 1987). Life events are significant negative events that have occurred in the previous year of the respondent's life. Significant negative events are those that require a certain amount of adjustment on the part of the individuals. Life events have been at the center of much stress research for the past two decades ( Pearlin & Skaff, 1995). In a meta-analysis of 25 studies, it was found that there was a modest but significant correlation between the total number of negative life events and depressive symptoms ( Kraaij, Arensman, & Spinhoven, 2002). Both prospective and cross-sectional studies have demonstrated that life events like the death of a spouse ( Kessler, 1997 and Lawton, 1996), family relationship problems, financial problems ( Krause, Jay, & Liang, 1991) and health status ( Abu-Bader et al., 2002, Chong et al., 2001, Martin, 2001, Murreell et al., 1988 and Prakash et al., 2007) are significantly associated with psychological distress of older adults. For psychological distress, depressive symptoms were considered as indicators because numerous community-based studies have identified them to be one of the most frequently occurring mental health problems among older adults ( Copeland et al., 1999, Demura and Sato, 2003 and Wetterling and Junghanns, 2004). Based on these three constructs, four models (Fig. 1) were tested in the present study: the independent model, the stress-suppression model, the counteractive model and the resource-deterioration model (Ensel & Lin, 1991). The independent model states that psychosocial resources and stressors influence stress. Inherent in this model is the assumption that psychosocial resources directly influence psychological distress and do not have any relationship with stress. Likewise, stressors directly influence psychological distress and do not have any association with resources. In sum, resources diminish psychological distress whereas stressors increase psychological distress. Statistically, evidence for the independent model is construed from a positive relationship between stressors and psychological distress, and an inverse relationship between resources and psychological distress. Based on three-way panel data derived from a representative sample of community-residing older adults, Ensel and Lin (1991) found evidence for the independent model, that resources (social support and self-esteem), through a direct pathway, decrease depressive symptoms, and that stressors (life events and health status) through a direct pathway increased depressive symptoms. The hypotheses to be tested are H1 :Resources are directly and inversely related to distress. H2 :Stressors are directly and positively related to distress. Full-size image (21 K) Fig. 1. Models for resources stressors and distress. Figure options In addition to the direct effects of stress and resources on psychological distress, the second model, the stress-suppression model, assumes that resources decrease the likelihood of stressors to occur, which in turn diminishes psychological distress. To illustrate, when there is a higher level of social support, the likelihood of older adults being abused diminishes. The third model, the counteractive model, states that stress enhances resources, which in turn increases well-being. An example of this process would be that when an older adult is afflicted with illness, his family members may take care of him and relatives may visit him/her, thereby increasing the social support of the older adult. The fourth model, the resource-deterioration model states that resources mediate the relationship between stressors and distress. Stressors deplete resources and subsequently lead to distress. For instance, death of one's spouse may diminish support. Given the cross-sectional nature of the data in the present study, the counteractive model and the stress-suppression model can be statistically assessed by examining the direct relationship between resources and stressors. A negative relationship between resources and stressors would supports stress-suppression model, while a positive relationship between resources and stressors would provide evidence for the counteractive model. Furthermore, for both the models there must be a significant indirect effect of resources on depressive symptoms. For the resource-deterioration model, in addition to the negative relationship between stressors and resources similar to that of the stress-suppression model, resources should have a direct significant inverse relationship with distress. Martin et al. (2001) in a study of middle-aged and older German adults rejected the independent, the counteractive, and the resource-deterioration models, finding evidence for the stress-suppression model. Based on these findings the hypotheses to be tested are: The stress-suppression model H3 :Resources are directly and inversely related to stressors. H4 :In addition to the direct inverse relationship between resources and stressors, there is a direct positive relationship between stressors and distress. H5 :In addition to the direct inverse relationship between resources and stressors, resources indirectly and negatively influence distress. The counteractive model H6 :Stressors are positively and directly related to resources. H7 :In addition to the direct positive relationship between stressors and resources, there is a direct positive relationship between stressors and distress. H8 :In addition to the direct positive relationship between stressors and resources, there is a direct negative relationship between resources and distress. The resource-deterioration model H9 :In addition to the direct inverse relationship between resources and stressors, resources negatively influence distress and stressors positively influence distress.