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The coping process of a parent who has an adult child with schizophrenia Lana, Rose Teresa Dalla 1996

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THE COPING PROCESS OF A PARENT WHO HAS AN ADULT CHILD WITH SCHIZOPHRENIA by ROSE TERESA DALLA LANA A., The U n i v e r s i t y o f B r i t i s h Columbia, 1992  THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS  in THE FACULTY OF GRADUATE STUDIES  School  of Family  and  Nutritional  Sciences  We a c c e p t t h i s t h e s i s as c o n f o r m i n g to the required  standard  THE UNIVERSITY OF BRITISH COLUMBIA March, 1996  (c) Rose T e r e s a D a l l a Lana, 1996  In  presenting this  degree at the  thesis  in  University of  partial  fulfilment  of  of  department  this thesis for or  by  his  or  requirements  British Columbia, I agree that the  freely available for reference and study. I further copying  the  representatives.  an advanced  Library shall make  it  agree that permission for extensive  scholarly purposes may be granted her  for  It  is  by the  understood  that  head of copying  my or  publication of this thesis for financial gain shall not be allowed without my written permission.  Dejaartment  of  •» >^ g  The University of British Columbia Vancouver, Canada  Date  DE-6 (2/88)  11  Abstract This exploratory  study i n v e s t i g a t e d the coping p r o c e s s of parents  who  have a d u l t sons or daughters with s c h i z o p h r e n i a .  was  framed by  i n d i v i d u a l s t r e s s and  to family context.  The  coping t h e o r y w i t h  attention  It investigated predictive relationships  among i l l n e s s c h a r a c t e r i s t i c s , demographics, i n d i v i d u a l family  l e v e l resources, s i t u a t i o n a l appraisals,  strategies.  The  sample was  comprised of 109  f a t h e r s r e c r u i t e d through n o t i c e s S c h i z o p h r e n i a n e w s l e t t e r , and groups.  and  coping  i n newspapers and  the  self-addressed, or by m a i l .  the mother or the f a t h e r of a person with s c h i z o p h r e n i a considered e l i g i b l e for p a r t i c i p a t i o n .  procedure.  The  perspective.  with the dependent  a standard m u l t i p l e  r e s u l t s showed support f o r the  A p a r e n t s ' coping process was  determinant and  interactive.  the  appraisals,  variables  chosen t h e o r e t i c a l  shown t o be  multi-  Both i l l n e s s c h a r a c t e r i s t i c s and  i l l n e s s a f f e c t e d the parent's l i f e )  s t r a t e g i e s ; i n d i v i d u a l and  variables  regression  demographics were p r e d i c t i v e of primary a p p r a i s a l s of how  variables  r e l a t i o n s h i p s among these r e l e v a n t  were f u r t h e r analyzed u s i n g  was  properties.  examined to i d e n t i f y those  t h a t were s i g n i f i c a n t l y a s s o c i a t e d  Either  Measures used f o r  assessment were those with e s t a b l i s h e d psychometric  The  32  through p e r s o n a l appeals t o support  r e t u r n envelopes, were d i s t r i b u t e d p e r s o n a l l y  A c o r r e l a t i o n s matrix was  and  mothers and  Q u e s t i o n n a i r e s , along with stamped,  of i n t e r e s t .  inquiry  and  (perceptions of  family resources predicted  secondary a p p r a i s a l s  of c o n t r o l l a b i l i t y ,  coping primary and  ways of  c o p i n g ; p r e d i c t i v e r e l a t i o n s h i p s a l s o e x i s t e d among primary appraisals,  secondary a p p r a i s a l s , and ways of coping.  The  Ill importance parental  of  a direct  coping  process  influence was  of  family  indicated.  members  on  the  iv Table of Contents Page Abstract  i i  T a b l e o f Contents  iv  L i s t of F i g u r e s  vi  L i s t of T a b l e s  vii x  Acknowledgements Chapter I.  Introduction  1  Purpose II.  3  S c h i z o p h r e n i a and the Family: A Study o f Diversity Variability  III.  IV.  V.  VI.  VII.  5 i n P e r c e p t i o n s : H i s t o r i c a l Overview..  5  D i v e r s i t y w i t h i n the I l l n e s s  14  Family D i v e r s i t y  17  T h e o r e t i c a l Framework: S t r e s s and Coping  21  C l a r i f i c a t i o n of Concepts  25  Review of E m p i r i c a l F i n d i n g s  49  L i m i t a t i o n of Past Research  66  Methodological  69  Issues i n S t r e s s Research  Study R a t i o n a l e  74  Study I n q u i r y  77  Method  81  Sample C h a r a c t e r i s t i c s  82  A n a l y s i s Strategy  96  Results  98  U n i v a r i a t e Analyses  98  V  Chapter  VIII.  Page M u l t i v a r i a t e Analyses  104  Discussion  119  Limitations  144  Strengths  149  Implications  151  Conclusion  157  References  159  Appendices  175  Appendix A  Definitions  175  Appendix B  Questionnaire  17 6  Appendix C  Sub-scales  191  Appendix D  Shapes of Value D i s t r i b u t i o n s . . . .  195  Appendix E  Figures  197  Appendix F  Tables  2 03  vi L i s t of F i g u r e s Figure  Page  El.  A Model of Family S t r e s s , Coping, and A d a p t a t i o n  197  E2.  A R e p r e s e n t a t i o n of the Coping Process  198  E3.  I l l n e s s C h a r a c t e r i s t i c s as P r e d i c t o r s  199  E4.  Demographic C h a r a c t e r i s t i c s as P r e d i c t o r s  200  E5.  I n d i v i d u a l and Family Resources as P r e d i c t o r s  201  E6.  The P r e d i c t i v e Power of Primary and Secondary A p p r a i s a l s  202  Vll  L i s t of Tables Table  Page  Fl.  C h a r a c t e r i s t i c s of Parents  203  F2.  C h a r a c t e r i s t i c s of Daughters and Sons  204  F3 .  R e l i a b i l i t i e s o f Measure  205  F4.  F u n c t i o n i n g L e v e l of Daughters and Sons: Means and Standard D e v i a t i o n s of L i f e S k i l l s  F5.  Means, Standard D e v i a t i o n s , and S i g n i f i c a n t  206 Differences  of Resources and A p p r a i s a l s f o r Mothers and F a t h e r s . . . F6.  Means, Standard D e v i a t i o n s ,  and S i g n i f i c a n t  Differences  of Ways of Coping f o r Mothers and Fathers F7.  Means, Standard D e v i a t i o n s , i n Parents' "Family  F8.  F10.  208 Differences  a p p r a i s a l s and coping by "Sex o f C h i l d " and  Influence"  Means, Standard D e v i a t i o n s , i n Parents'  F9 .  and S i g n i f i c a n t  209 and S i g n i f i c a n t  Differences  a p p r a i s a l s and coping by "Have Other C h i l d  w i t h D i s a b i l i t y and " M a r i t a l Status o f Parent"  210  C o r r e l a t i o n s Among Demographic V a r i a b l e s  211  V a r i a b l e s S i g n i f i c a n t l y C o r r e l a t e d with Measures o f Primary A p p r a i s a l  Fll.  213  S i g n i f i c a n t c o r r e l a t i o n s of Demographic, Resource, and I l l n e s s V a r i a b l e s with Ways o f Coping  F13.  212  V a r i a b l e s S i g n i f i c a n t l y C o r r e l a t e d w i t h Measures o f Secondary A p p r a i s a l  F12.  2 07  214  S i g n i f i c a n t c o r r e l a t i o n s of Primary and Secondary A p p r a i s a l s with Ways of Coping  215  Vlll  Table F14.  Page Standard M u l t i p l e Regression of V a r i a b l e s on the Primary A p p r a i s a l "Lack of I n f o r m a t i o n "  F15.  216  Standard M u l t i p l e Regression of V a r i a b l e s on the Primary A p p r a i s a l " R e l a t i o n s with the Community"  F16.  Standard M u l t i p l e Regression of V a r i a b l e s on the Primary Appraisal  F17.  218  "Problems i n D a i l y F u n c t i o n i n g "  219  Standard M u l t i p l e Regression of V a r i a b l e s on the Primary Appraisal  F19.  " R e l a t i o n s w i t h i n the Family"  Standard M u l t i p l e Regression of V a r i a b l e s on the Primary Appraisal  F18.  217  "Worry about the Future"  220  Standard M u l t i p l e Regression of V a r i a b l e s on a  Secondary  A p p r a i s a l of the S i t u a t i o n as "Changeable" F20.  221  Standard M u l t i p l e Regression of "Self-Esteem" on a Secondary A p p r a i s a l of the S i t u a t i o n as "Having t o be Accepted"  F21.  222  Standard M u l t i p l e Regression of a "Lack of I n f o r m a t i o n " on a Secondary A p p r a i s a l of the S i t u a t i o n as "Needing t o Know More"  F22.  223  Standard M u l t i p l e Regression of V a r i a b l e s on a  Secondary  A p p r a i s a l of the S i t u a t i o n as "Having t o Hold Back"... F23.  Standard M u l t i p l e Regression of Demographic and A p p r a i s a l V a r i a b l e s on " C o n f r o n t a t i o n a l " Coping  F24.  Standard M u l t i p l e Regression of Demographic, and  F25.  224  Resource,  A p p r a i s a l V a r i a b l e s on " D i s t a n c e " Coping  Standard M u l t i p l e Regression of Demographic,  225  226 Resource,  and A p p r a i s a l V a r i a b l e s on " S e l f - C o n t r o l " Coping  227  ix Table F2 6.  Page Standard M u l t i p l e Regression of Demographic, Resource, and I l l n e s s V a r i a b l e s on Coping by "Seeking S o c i a l Support"  F27.  Standard M u l t i p l e Regression of Demographic,  228 Resource,  I l l n e s s , and A p p r a i s a l V a r i a b l e s on Coping by "Accepting R e s p o n s i b i l i t y " F28.  229  Standard M u l t i p l e Regression of Demographic, Resource, I l l n e s s , and A p p r a i s a l V a r i a b l e s on "Escape-Avoidance"  F29.  Coping  Standard M u l t i p l e Regression of Demographic,  230 Resource,  and A p p r a i s a l V a r i a b l e s on " P l a n f u l Problem-Solving".. F30.  Standard M u l t i p l e Regression of Demographic,  231  Illness,  and A p p r a i s a l V a r i a b l e s on Coping by "Positive Reappraisal"  232  X  Acknowledgements I wish t o express my g r a t i t u d e t o the s u p e r v i s o r o f my t h e s i s committee, Dr. B r i a n de V r i e s , f o r h i s v a l u a b l e guidance and h i s e n t h u s i a s t i c support of my work.  I a l s o thank t h e other  members o f my t h e s i s committee, Dr. Margaret Arcus and Dr. B o n i t a Long, f o r t h e i r h e l p f u l suggestions and recommendations f o r t h e improvement o f t h i s study.  The s u p p o r t i v e atmosphere o f t h e  f a c u l t y o f the School of Family and N u t r i t i o n a l S c i e n c e s a l s o encouraged  my e f f o r t s .  My a p p r e c i a t i o n i s d i r e c t e d as w e l l t o  the S c h i z o p h r e n i a S o c i e t y and the personnel o f many heath  units  who a s s i s t e d i n the d i s t r i b u t i o n of the q u e s t i o n n a i r e s , and i n v e r y l a r g e measure t o the parents who so w i l l i n g l y  participated  i n t h i s study and so generously shared t h e i r e x p e r i e n c e s .  1 Chapter  I  Introduction S c h i z o p h r e n i a i s a fundamental d i s t u r b a n c e of p e r s o n a l i t y , the mere mention of which tends t o evoke p u b l i c misapprehension.  That the d i s t u r b a n c e i s l i t t l e  understood  i s no wonder; i t s m a n i f e s t a t i o n s are d i v e r s e and t o comprehend. thought  I t s most prominent symptoms are  difficult formal  d i s o r d e r , a u d i t o r y h a l l u c i n a t i o n s , d e l u s i o n s , and  i n a p p r o p r i a t e or f l a t a f f e c t ; i t s most frequent symptom, noted  i n almost  insight  a l l persons with the i l l n e s s ,  i s l a c k of  (Straube & Oades, 1992).  Whatever the s i g n s , s c h i z o p h r e n i a i s c o n s i d e r e d t o be a devastating disorder.  To have a f a m i l y member w i t h  a f f l i c t i o n has been d e s c r i b e d as an experience u n r e s o l v e d , prolonged g r i e f  of  (Schulz, House, & Andrews,  1986), worse than i f t h a t r e l a t i v e had a t e r m i n a l (Torrey, 1983).  this  illness  D e s c r i p t i o n s of the f a m i l y o r d e a l are a  l i t a n y of anguish: d e s p a i r , l o s s , sadness,  pain, g u i l t ,  anger, and resentment  Wasow, 1985) .  The  (Creer & Wing, 1974;  f a m i l y r e l a t i o n s h i p with s c h i z o p h r e n i a , moreover,  i s not always regarded with sympathy; p e r c e p t i o n s of p a r e n t a l involvement (Johnson,  1990;  onslaught,  Torrey, 1983).  Despite t h i s  emotional  parents predominate as c a r e g i v e r s t o persons  mental i l l n e s s 1992).  i n c l u d e blame, shame, and d y s f u n c t i o n  ( L e f l e y , 1987c; Tausig, F i s h e r , & T e s s l e r ,  The g e n e r a l q u e s t i o n prompting t h i s study was,  do p a r e n t s cope with such an Coping  with  "How  experience?"  i s a process whereby people attempt,  through  c o g n i t i v e and b e h a v i o u r a l e f f o r t s , t o manage demands they  2 p e r c e i v e t o be t a x i n g or exceeding t h e i r r e s o u r c e s & Folkman, 1984).  (Lazarus  Although an assessment of c o p i n g  focuses  on the management of s p e c i f i c demands, such an e v a l u a t i o n a l s o must a t t e n d t o s o c i a l context and t o c l u s t e r i n g of secondary  stressors  ( P e a r l i n , 1991).  In order, then, t o  respond t o the q u e s t i o n of p a r e n t a l coping w i t h s c h i z o p h r e n i a , one must understand  the circumstances w i t h i n  which these coping e f f o r t s t r a n s p i r e .  One  must a p p r e c i a t e  both f a m i l y r e s o u r c e s and the demands of the  situation,  i n c l u d i n g the v a r i a b i l i t y t h a t e x i s t s i n f a m i l y ( h e t e r o g e n e i t y i n f a m i l y s t r u c t u r e , f a m i l y type, and f a m i l y circumstance)  and v a r i a t i o n i n i l l n e s s  symptoms, and s e v e r i t y ) .  ( i n stage,  An e x p l o r a t i o n of t h i s  course, diversity  i s r e q u i r e d , not t o suggest a p i c t u r e of u n p r e d i c t a b l e chaos, but t o p r o v i d e a c o n t e x t u a l backdrop f o r p o s s i b l e s c e n a r i o s of experience w i t h i n which coping e f f o r t s ensue. I t has been suggested t h a t "coping i s best  understood  when viewed w i t h i n the l a r g e r context of the s t r e s s p r o c e s s " ( P e a r l i n , 1991,  p. 267).  In t h i s study, a dynamic model of  f a m i l y a d a p t a t i o n t o s t r e s s i s used as a  meaningful  framework t h a t l o c a t e s p a r e n t a l coping w i t h i n a complex s t r e s s p r o c e s s and organizes the v a r i a b i l i t y of f a m i l y circumstance and response noted i n the  literature.  I n d i v i d u a l s t r e s s and coping theory i s u t i l i z e d t o f o c u s on p a r e n t a l coping e f f o r t s and t h e i r The  correlates.  s i g n i f i c a n c e of such i n f o r m a t i o n on p a r e n t a l c o p i n g  becomes apparent when we understand  t h a t f o r many a d u l t s  w i t h s c h i z o p h r e n i a , parents are important c a r e g i v e r s and a  3 main source of s o c i a l support  ( L e f l e y , 1987c).  Parental  c o p i n g i n these circumstances has i m p l i c a t i o n s f o r t h e mental h e a l t h of a l l f a m i l y members. Purpose The purpose of t h i s study i s t o examine p a r e n t a l c o p i n g e f f o r t s and t h e i r r e l a t i o n s h i p s t o v a r i o u s a s p e c t s o f f a m i l y circumstance.  Informed by coping l i t e r a t u r e , t h i s  study  i n t r o d u c e s a broadened context w i t h i n which t o c o n s i d e r mothers' and f a t h e r s ' attempts  t o manage t h e i r  situations,  l i n k i n g t h e i r endeavors t o p a r e n t a l a p p r a i s a l s o f demands and r e s o u r c e s .  To f a c i l i t a t e such an a p p r e c i a t i o n o f  p a r e n t a l coping, I present a b r i e f h i s t o r i c a l  overview,  i n d i c a t i n g t h e v a r i o u s ways i n which the f a m i l y and s c h i z o p h r e n i a have been l i n k e d over time.  I then  address  the d i v e r s i t y t h a t i s e v i d e n t i n both f a m i l y and i l l n e s s . Next, a model o f f a m i l y a d a p t a t i o n t o s t r e s s i s o u t l i n e d t h a t i s a b l e t o i n c o r p o r a t e the r e l a t i o n s h i p s t h a t have been found w i t h i n t h i s d i v e r s i t y and t h a t i s a b l e t o s i t u a t e i n d i v i d u a l coping w i t h i n the f a m i l y c o n t e x t .  To i l l u m i n a t e  the p a r e n t a l coping process and t o f a c i l i t a t e a c l a r i f i c a t i o n of concepts, a model of i n d i v i d u a l a p p r a i s a l , and coping i s employed.  stress,  The e m p i r i c a l f i n d i n g s  i n t h e l i t e r a t u r e on f a m i l y response t o s c h i z o p h r e n i a i s i d e n t i f i e d w i t h i n t h i s l a t t e r framework. The d e s i g n of the study then i s d e t a i l e d a l o n g w i t h i t s s p e c i f i c r e s e a r c h q u e s t i o n s , i t s methodology and i t s results.  I address t h e study's l i m i t a t i o n s and s t r e n g t h s  and suggest some i n t e r p r e t a t i o n s o f the f i n d i n g s .  Some  i m p l i c a t i o n s f o r s o c i a l s c i e n c e and f o r f a m i l y networks are d i s c u s s e d .  The  for f u r t h e r research i n t h i s  support  conclusion includes area.  suggestions  5 Chapter I I S c h i z o p h r e n i a and the Family: A Study of D i v e r s i t y P e r c e p t i o n s of s c h i z o p h r e n i a , and the f a m i l y ' s r e l a t i o n s h i p t o the i l l n e s s , have changed d r a m a t i c a l l y over time.  D i v e r s i t y a l s o i s evident i n the i l l n e s s , i t s  symptoms and s e v e r i t y , as w e l l as i n f a m i l i e s , t h e i r  type  and s t r u c t u r e . V a r i a t i o n i n P e r c e p t i o n s : H i s t o r i c a l Overview During  c o l o n i a l times, mental d i s t u r b a n c e  was  c o n s i d e r e d t o be punishment f o r past t r a n s g r e s s i o n s (Deutsch,  1949); f a m i l i e s were expected  mental i l l n e s s ,  as with any a c t of God,  ( T e r k e l s e n , 1990). the m e n t a l l y  ill  t o contend w i t h with  Family r e s p o n s i b i l i t y f o r the c a r e of  p l a c e d a great s t r a i n on the f a m i l y u n i t  which s o c i e t y r e q u i r e d t o be p r o d u c t i v e and independent  forbearance  (Hatfield,  economically  1987a).  During the f i r s t h a l f of the n i n e t e e n t h century,  there  was  a s h i f t i n s o c i a l p e r c e p t i o n of mental d i s t u r b a n c e .  It  was  thought t o r e s u l t from c h a o t i c s o c i a l c o n d i t i o n s r a t h e r  than d i v i n e r e t r i b u t i o n  (Terkelsen, 1990).  p h i l o s o p h i c a l s h i f t was  accompanied by the e s t a b l i s h m e n t  i n s t i t u t i o n s i n which the mentally given r e l i e f f a m i l y was  from s o c i a l s t r e s s e s .  of  c o u l d be i s o l a t e d  During t h i s p e r i o d ,  and "the  looked on as an i n d i r e c t , p a s s i v e agent t o the  onset of mental i l l n e s s . was  ill  This  I f the p r i n c i p l e cause of  the d i s a r r a y of American s o c i e t y , the f a m i l y was  insanity at  f a u l t f o r not having s h i e l d e d the p a t i e n t s u f f i c i e n t l y ( T e r k e l s e n , 1990,  p. 6).  Family c o n t a c t was  "  discouraged;  6 the i s o l a t i o n of the p a t i e n t was  deemed important  lest  r e l a t i v e s r e i n f e c t the p a t i e n t with germs of a n x i e t y . By the t w e n t i e t h century,  the p e r c e p t i o n of  f a m i l y ' s r o l e i n mental i l l n e s s had p a s s i v e agent t o o f f e n d i n g agent.  the  s h i f t e d from t h a t of During r e c e n t decades,  o t h e r views of f a m i l y involvement have a r i s e n as w e l l .  A  r e c e n t search of the s o c i a l s c i e n c e l i t e r a t u r e by Gubman and Tessler  (1987) has  i d e n t i f i e d three themes i n t w e n t i e t h  century  analyses of the f a m i l y - s c h i z o p h r e n i a r e l a t i o n s h i p :  f a m i l y i n t e r a c t i o n and communication as c a u s a l agent, f a m i l y as r e h a b i l i t a t i o n agent, and Family  f a m i l y as burden-bearer.  as Causal Agent  P s y c h o a n a l y t i c a l l y based t h e o r i e s i m p l i c a t e d the i n the e t i o l o g y of the i l l n e s s .  A t t e n t i o n was  f a m i l y i n t e r a c t i o n , on mother-child relationships.  The  and  family  focused  on  spousal  i n t e r a c t i o n approach f i r s t appeared i n  the l i t e r a t u r e with Hadju-Gines' (1940) d e s c r i p t i o n of mothers of s c h i z o p h r e n i c women as c o l d and continued  sadistic,  and  l a t e r with Fromm-Reichmann's (1948)  c h a r a c t e r i z a t i o n of them as r e j e c t i n g and ( T e r k e l s e n , 1990). "schizophrenogetic  Unfortunately,  schizophrenogetic  the term,  mother ...(became) the b a t t l e c r y upon  which the f a m i l y was  i m p l i c a t e d as a major f a c t o r i n d r i v i n g  f a m i l y members i n t o the fearsome world ( F a l l o o n , Boyd, & M c G i l l , 1984,  p. 4).  of  schizophrenia"  Aspects of treatment  approaches based on t h i s paradigm are s t i l l p r e v a l e n t ( T e r k e l s e n , 1983).  today  7 The work of L i d z , C o r n e l i s o n , F l e c k , and T e r r y  (1957)  found f a m i l i e s with a s c h i z o p h r e n i c member t o have d i s t o r t e d r o l e s t r u c t u r e s , m a r i t a l d i s c o r d , and communication difficulties.  L i d z and h i s c o l l e a g u e s concluded t h e  s e v e r e l y d i s t u r b e d m a r i t a l and p a r e n t a l r e l a t i o n s h i p s c o n t r i b u t e d t o t h e development of t h e i l l n e s s al.,  1984).  More r e c e n t l y , L i d z and F l e c k  acknowledged a g e n e t i c component regard  (Falloon et  (1985) have  t o s c h i z o p h r e n i a , but  i t as "a p r e d i s p o s i t i o n t o symbolic  d i s t o r t i o n " (p.  190) t h a t together with i n t r a f a m i l i a l i n f l u e n c e s , c o n t r i b u t e t o t h e e t i o l o g y of t h e i l l n e s s . Bowen (1961) a l s o s t u d i e d i n t e r a c t i o n p a t t e r n s i n f a m i l i e s o f p a t i e n t s diagnosed with s c h i z o p h r e n i a . viewed s c h i z o p h r e n i a as the m a n i f e s t a t i o n , a process  He  i n one member, o f  t h a t i n v o l v e d the e n t i r e f a m i l y system.  " i n t e n s e c o n f l i c t and emotional  He noted  turmoil" i n the family, a  s t a t e he d e s c r i b e d as " u n d i f f e r e n t i a t e d ego mass" ( c i t e d i n F a l l o o n e t a l . , 1984, p. 8 ) . Communication t h e o r i e s a l s o have p l a c e d emphasis upon f a m i l y i n t e r a c t i o n i n the e t i o l o g y of s c h i z o p h r e n i a . double b i n d hypothesis 1956)  focussed  (Bateson,  Jackson, Haley, & Weakland,  on t h e communication p a t t e r n s i n f a m i l i e s  t h a t c r e a t e a s p e c i a l type of l e a r n i n g context  f o r children,  r e q u i r i n g them t o deny c e r t a i n aspects o f r e a l i t y e t a l . , 1984).  The  (Falloon  T h i s theory saw s c h i z o p h r e n i a as a l e a r n e d  response t o incompatible  messages and as a s p e c i f i c  of communication r a t h e r than a mental i l l n e s s .  pattern  8 S t u d i e s o f communication deviance, Wynne and Singer  such as those o f  (1963) focussed a t t e n t i o n on abnormal  communication s t y l e s of parents,  t h a t were c o n s i d e r e d t o  cause d i f f i c u l t i e s i n a c h i l d ' s a b i l i t y t o focus a t t e n t i o n and understand meaning.  These d i f f i c u l t i e s were thought t o  impair t h e development o f e f f e c t i v e r e a l i t y t e s t i n g and p e r c e p t u a l a b i l i t y , thus p r e d i s p o s i n g t h e c h i l d t o schizophrenia  ( F a l l o o n e t a l . , 1984).  communication deviance  saw d i s o r d e r e d communication as t h e  core problem of f a m i l i e s with mentally (Hatfield,  This theory of  ill  relatives  1987a).  More r e c e n t g e n e t i c and b i o l o g i c a l s t u d i e s , however, suggest s c h i z o p h r e n i a has an i n h e r i t e d component (see Straube & Oades, 1992).  Twin and adoptive  revealed a d e f i n i t i v e genetic l i n k  s t u d i e s have  ( F a l l o o n e t a l . , 1984),  and p h y s i o l o g i c a l i n v e s t i g a t i o n s have found s t r u c t u r a l and f u n c t i o n a l b r a i n a b n o r m a l i t i e s i n persons with (Straube  & Oades, 199 2; Torrey,  schizophrenia  1983).  C u r r e n t l y , the consensus among most s c h i z o p h r e n i a experts,  i s t h a t a p r e d i s p o s i t i o n t o i n t e r a c t with t h e  environment i n a s p e c i a l way i s i n h e r i t e d , making t h e i n d i v i d u a l v u l n e r a b l e t o the d i s o r d e r ( H a t f i e l d , The  1987a).  i l l n e s s has been c h a r a c t e r i z e d as "a dynamic i n t e r p l a y  among p a t i e n t , f a m i l y , and the f l u x of l i f e  events"  (Gottesman, 1991, p. 166). The most e f f e c t i v e means t o reduce t h e r i s k o f s c h i z o p h r e n i a i n those who a r e g e n e t i c a l l y predisposed  i s considered t o be a s u p p o r t i v e ,  n u r t u r i n g , problem-solving  f a m i l y environment; i n  9 e s t a b l i s h e d cases o f s c h i z o p h r e n i a ,  t h e f a m i l y environment  i s thought t o i n f l u e n c e t h e course of t h e c o n d i t i o n e t a l . , 1984). schizophrenia  (Falloon  Although the evidence of a g e n e t i c b a s i s f o r may r e l i e v e some f a m i l i e s o f t h e g u i l t and  shame a s s o c i a t e d with t h e i r r o l e as c a u s a l agents o f t h e illness  (Terkelsen,  be r e s p o n s i b l e mentally  ill  1990), f a m i l i e s a r e s t i l l  considered t o  f o r the successful r e h a b i l i t a t i o n of the  ( L e f l e y , 1987c).  Family as R e h a b i l i t a t i o n Agent Research i n t o t h e b i o l o g i c a l parameters o f schizophrenia permitted  and t h e development of n e u r o l e p t i c drugs have  community care of persons with s c h i z o p h r e n i a .  f a m i l y as c a r e g i v e r t o t h e mentally  ill  has been  The  recognized,  as s u p e r v i s i o n of d e i n s t i t u t i o n a l i z e d p a t i e n t s has i n c r e a s i n g l y f a l l e n upon f a m i l i e s (Atkinson, al.,  1986).  1986; Schulz e t  Whereas t h e p r o v i s i o n of a s s i s t a n c e and  support i s a normative f a m i l y a c t i v i t y , t h e e x t r a o r d i n a r y care t h a t i s r e q u i r e d by a f a m i l y member who has schizophrenia  c a l l s f o r great amounts of time and energy i n  a caregiving r o l e that i s unanticipated Schulz,  (Biegel, Sales, &  1991) and t h a t r e q u i r e s knowledge and support f o r  i t s execution. concentrated expression  P r o f e s s i o n a l concern, however, has  more on l e v e l s of f a m i l y s t r e s s and emotional  and t h e i r e f f e c t on the r e h o s p i t a l i z a t i o n o f t h e  f a m i l y member than on the f a m i l y ' s need f o r i n f o r m a t i o n and a s s i s t a n c e with p r o v i s i o n of care The  ( L e f l e y , 1992).  maintenance on medication of p a t i e n t s i n t h e  community does not preclude  a reoccurrence  of s c h i z o p h r e n i c  A s t r e s s v u l n e r a b i l i t y model has  episodes.  schizophrenia  been a p p l i e d t o  ( G o l d s t e i n & Strachan, 1987).  i n t o p a t i e n t r e l a p s e have focussed  Investigations  on the n e g a t i v e  features  of f a m i l y r e l a t i o n s h i p s ; the term, expressed emotion has  been used t o d e s c r i b e the r e l a t i v e s ' emotional response  t o the p a t i e n t , t h e i r expressions and  (EE)  emotional overinvolvement  high-EE of at l e a s t one  1984).  One  hostility,  ( F a l l o o n & M c G i l l , 1985) .  f a m i l y member has  a s s o c i a t e d w i t h more frequent ( L e f l e y , 1992;  of c r i t i c i s m ,  The  been found t o  r e l a p s e of the  be  patient  Vaughn, Snyder, Jones, Freeman, & F a l l o o n ,  very r e c e n t examination of the r e l a t i o n s h i p s  among the components of expressed emotion and  patient  symptomatology, however, produced a p a t t e r n of r e s u l t s c o n s i s t e n t w i t h a more complex p e r s p e c t i v e i n t e r a c t i o n than t h a t provided d i a t h e s i s / s t r e s s perspective Grolnick,  & Lehman, 1993).  by the  of  family  traditional  (see Cole, Kane, Zastowny, Cole et a l . found p a t i e n t  outcome, the number of weeks the p a t i e n t remained out h o s p i t a l , t o be e s s e n t i a l l y determined by p a t i e n t at discharge The may  and  not a f f e c t e d by the EE  episode of s c h i z o p h r e n i a  index.  i s recovering  i s reminiscent  mentioned contagion theory has  function  n o t i o n t h a t the emotional environment of the  be hazardous f o r a person who  of  from  family an  of the above  of the e a r l y 19th  century.  It  led to misapplication i n c l i n i c a l practice (Falloon,  1986) ; e m o t i o n a l l y  i n v o l v e d f a m i l i e s have been viewed  dysfunctional, requiring therapeutic 1990), a p e r s p e c t i v e which has  intervention  as  (Johnson,  added t o f a m i l i e s ' f e e l i n g s  11 of g u i l t and shame (Torrey,  1983).  F a l l o o n and M c G i l l  (1985) have suggested t h a t t h i s p e r c e p t i o n schizophrenia  of the f a m i l y -  r e l a t i o n s h i p i s y e t another example o f a  l i n e a r c a u s a l h y p o t h e s i s being  a p p l i e d t o a complex  interactional variable. A r e c e n t c o n s i d e r a t i o n of the concept, expressed emotion, has q u e r i e d  i t s a p p l i c a t i o n t o whole f a m i l i e s , as  w e l l as i t s t r a i t versus s t a t e nature, and has q u e s t i o n e d the a d v i s a b i l i t y of a focus on r e l a p s e as the s o l e outcome variable,  i g n o r i n g the p a t i e n t ' s s o c i a l f u n c t i o n i n g and  q u a l i t y of l i f e little  (see L e f l e y , 1992).  Lefley asserts that  i s known of the c o r r e l a t e s of low l e v e l s of expressed  emotion.  I t may r e f l e c t t o l e r a n c e and p a t i e n c e ;  a l s o may i n d i c a t e excessive  however, i t  permissiveness or apathy  r e s u l t i n g i n understimulation  and s o c i a l withdrawal.  I t has  been suggested t h e r e may be antecedent d i f f e r e n c e s i n p a t i e n t s t h a t a r e c o r r e l a t e s of both r e l a t i v e s ' emotion and p a t i e n t p r e d i s p o s i t i o n t o r e l a p s e  expressed  (Lefley,  1992), and t h a t h i g h l e v e l s of expressed emotion may be an understandable f a m i l i a l r e a c t i o n t o extremely s i t u a t i o n s and behaviors (Lamb, 1990).  difficult  Although  parental  overinvolvement may worsen the course of s c h i z o p h r e n i a , t h e enduring p o s i t i v e i n t e r e s t of r e l a t i v e s i s thought t o prevent t h e a f f e c t i v e b l u n t i n g and s o c i a l withdrawal o f t h e patient  ( E l - I s l a m , 1979), and the s t i m u l a t i o n o f high-EE  households may be considered social rehabilitation perception  a contribution to his/her  ( F a l l o o n & M c G i l l , 1985).  This  o f r e c i p r o c a l i n f l u e n c e i n the f a m i l y - i l l n e s s  12 r e l a t i o n s h i p h i g h l i g h t s the c o n s i d e r a t i o n  of f a m i l y  as  burden b e a r e r . Family as Burden Bearer The  d i f f i c u l t i e s experienced by f a m i l i e s c a r i n g f o r a  member w i t h s c h i z o p h r e n i a  were long i n being  p a r t l y because of the i s o l a t i o n and mentally i l l  and  recognized,  s t i g m a t i z a t i o n of  t h e i r r e l a t i v e s , as w e l l as  the  m i s i n t e r p r e t a t i o n of the f a m i l y t h e o r i e s of i l l n e s s (Katschnig  & Konieczna, 1987).  Introducing  the  etiology  the concept of  " f a m i l y burden" i n the community care of persons w i t h schizophrenia,  Grad and  Sainsbury (1963) found  family  members t o experience severe problems of management, w i t h s o c i a l and and  work i n t e r f e r e n c e and  f i n a n c i a l status  n e g a t i v e e f f e c t s on  (Thompson & D o l l , 1982).  Recognizing  t h a t f a m i l i e s a l s o s u f f e r e d an emotional t o l l , Hamilton  Hoenig  (1966) d i s t i n g u i s h e d between o b j e c t i v e  s u b j e c t i v e burden. They d e f i n e d . s u b j e c t i v e  health  and  and  burden as what  r e l a t i v e s f e l t about the p a t i e n t s ' presence i n the home and t h e i r f e e l i n g s of being burdened. studied reported general  greater  The  f a m i l i e s t h a t were  o b j e c t i v e burden (80%), d e f i n e d  household d i s r u p t i o n and  f i n a n c i a l l o s s , than  s u b j e c t i v e f e e l i n g s of being burdened  (60%).  Many  i n v e s t i g a t i o n s of the f a m i l y experience w i t h have u t i l i z e d t h i s s u b j e c t i v e / o b j e c t i v e  schizophrenia  d i s t i n c t i o n , with a  f u r t h e r d e l i n e a t i o n of the a f f e c t i v e aspects of  the  s u b j e c t i v e dimension (Thompson & D o l l , 1982).  Emotional  r e a c t i o n s of f a m i l y members have been found t o  include  anxiety,  g u i l t , depression,  as  irritation,  and  anger  (Creer  &  13 Wing, 1974).  The s u b j e c t i v e burden of p a r e n t s w i t h a d u l t  c h i l d r e n who have s c h i z o p h r e n i a  has been compared t o t h a t o f  a d u l t c h i l d r e n w i t h parents who have Alzheimer's (see L e f l e y , 1987b; Wasow, 1985). "despair,  sorrow"  Both i n c l u d e f e e l i n g s o f  l o s s , sadness, p a i n , exhaustion, p i t y ,  resentment, h e l p l e s s n e s s ,  disease  guilt,  embarrassment, f e a r , and c h r o n i c  (Wasow, 1985, p. 714).  Other s t u d i e s have found t h a t f a m i l i e s d e a l i n g w i t h schizophrenia drain"  l i v e with "severe p h y s i c a l and p s y c h o l o g i c a l  ( H a t f i e l d , 1978, p. 358), household d i s r u p t i o n , and  tense f a m i l y r e l a t i o n s h i p s ( F a l l o o n , Hardesty, & M c G i l l , 1985), and i n t r a f a m i l i a l c o n f l i c t  (Creer & Wing, 1974) .  Thompson and D o l l (1982) found the most common items h a v i n g t o do w i t h f a m i l i e s ' o b j e c t i v e burden r e f l e c t e d t h e inconveniences of t h e c a r e - g i v i n g r o l e , whereas f e e l i n g s o f overload,  embarrassment, and entrapment expressed t h e  s u b j e c t i v e dimension.  These authors concluded t h a t t h e r e i s  a u n i v e r s a l experience of s o c i a l and emotional c o s t s f o r f a m i l i e s coping  with the mentally  I t i s i n t e r e s t i n g t o consider u n i t , by d e f i n i t i o n , contains illness,  ill. that while the family  the f a m i l y member w i t h t h e  s t u d i e s of t h e f a m i l y and s c h i z o p h r e n i a  exclude t h i s person.  generally  One i n c l u s i v e study found a d i f f e r e n c e  between a t t i t u d e s of w e l l f a m i l y members and p a t i e n t s ; 92% of p a r e n t s compared t o 25% of p a t i e n t s schizophrenia (Schulz  identified  as a d i s o r d e r a s s o c i a t e d w i t h extreme burden  e t a l . , 1982).  Such a d i s p a r i t y i n p e r c e p t i o n s  14 might warrant  f u r t h e r i n v e s t i g a t i o n s i n c e i t would seem t o  have i m p l i c a t i o n s f o r " f a m i l y " coping. Although the p s y c h o s o c i a l c o s t s may  be u n i v e r s a l ,  the  f a m i l y experience i s not uniform; w i t h i n surveys, a c o n s i d e r a b l e range of responses t o q u e s t i o n s of burden i s apparent  (Johnson,  1990).  Between surveys, as w e l l ,  the  o v e r a l l p e r c e p t i o n s of burden vary from " g e n e r a l l y m i l d t o moderate" ( C r o t t y & Kulys, 1986) ( W i n e f i e l d & Harvey, 1993).  to "considerable"  I t would be u s e f u l t o c o n s i d e r  the circumstances under which g r e a t e r burden i s p e r c e i v e d . Variability  of  Circumstance  Both " f a m i l y " and " s c h i z o p h r e n i a " are terms t h a t i n c l u d e a wide range of v a r i a b i l i t y . The i n v e s t i g a t i o n s  into  f a m i l y burden need t o account f o r the stage and course of the i l l n e s s  (Gubman & T e s s l e r , 1987;  s e v e r i t y of the i l l n e s s  R o l l a n d , 1989), the  ( F a l l o o n e t a l . , 1984), and  h e t e r o g e n e i t y of f a m i l i e s  (McFarlane,  the  1990).  D i v e r s i t y w i t h i n the I l l n e s s S c h i z o p h r e n i a i s an i l l n e s s t h a t v a r i e s i n onset, symptoms, course, and s e v e r i t y . i s age of onset.  I t s most p r e d i c t a b l e aspect  Three-quarters of a l l cases begin i n the  16 t o 2 5 age group with onset approximately 5 y e a r s f o r men  than f o r women (Torrey, 1983).  earlier  I t i s important t o  note, however, t h a t v u l n e r a b i l i t y f o r s c h i z o p h r e n i a extends throughout Two  the l i f e course  (Cohler & Ferrono,  1987).  syndromes of s c h i z o p h r e n i a can been d i s t i n g u i s h e d ,  the acute syndrome with f l o r i d or p o s i t i v e symptoms and c h r o n i c syndrome with negative or d e f i c i t symptoms,  each  the  15 w i t h i t s own c h a r a c t e r i s t i c s and i m p l i c a t i o n s f o r course and outcome (Wing, 1987b).  P o s i t i v e symptoms i n c l u d e d e l u s i o n s ,  h a l l u c i n a t i o n s , and thought  i n t e r f e r e n c e ; n e g a t i v e symptoms  i n c l u d e emotional withdrawal, b l u n t i n g of a f f e c t , p o v e r t y o f thought and speech,  apathy,  and u n d e r a c t i v i t y  M c G i l l , & Hardesty,  1985).  The syndromes can appear  s e p a r a t e l y o r t o g e t h e r and i n v a r y i n g degrees The  (Falloon,  of s e v e r i t y .  i l l n e s s more o f t e n begins i n s i d i o u s l y w i t h n e g a t i v e  symptoms t h a t a r e d i f f i c u l t t o d i s t i n g u i s h e x a g g e r a t i o n s o f normal, behaviours 1983) .  from  adolescent and a d u l t f e e l i n g s and  (Hardesty, F a l l o o n , & S h i r i n , 1985; T o r r e y ,  Acute onset with f l o r i d symptoms i s e a s i e r t o  recognize.  S c h i z o p h r e n i a symptoms vary i n s e v e r i t y ;  can be s l i g h t l y , moderately, disabling  they  s e v e r e l y , or a b s o l u t e l y  (Gottesman, 1991).  One cannot speak about the " n a t u r a l " course o f schizophrenia  (Wing, 1987a).  A great v a r i e t y of  developmental  courses can be encountered,  although i t i s  most t y p i c a l l y one of r e m i s s i o n and e x a c e r b a t i o n ( F a l l o o n & McGill,  1985).  In most cases, a c h r o n i c onset i s f o l l o w e d  by a more c h r o n i c course and an acute onset w i t h a more f l u c t u a t i n g course, but many v a r i a t i o n s have been observed (Straube & Oades, 1992). L o n g i t u d i n a l s t u d i e s of p a t i e n t outcome v a r y i n r e p o r t e d r e c o v e r y r a t e s a c c o r d i n g t o the k i n d s o f p a t i e n t s s e l e c t e d f o r follow-up.  G e n e r a l l y i t i s thought t h a t one-  t h i r d of a l l p a t i e n t s diagnosed with s c h i z o p h r e n i a w i l l completely r e c o v e r , o n e - t h i r d w i l l improve but not  16 completely r e c o v e r , and the f i n a l t h i r d w i l l not (Torrey, 1983).  Research data suggest  c h r o n i c i l l n e s s t h a t may (Harding, 1991).  improve  schizophrenia i s a  remit or a m e l i o r a t e over  A review of s i x major long-term  time studies  has shown t h a t one-half or more of the p a t i e n t s s i g n i f i c a n t l y improve and/or recover, w h i l e the i l l n e s s an e p i s o d i c nature i n the other h a l f has been suggested, r e c o v e r e d may functioning  (Harding,  1991).  It  however, t h a t those p a t i e n t s c o n s i d e r e d  not r e t u r n to a l e v e l of p r e d i s e a s e (Gottesman, 1991), and even a r e s t o r a t i o n of  p a t i e n t s t o t h e i r premorbid  l e v e l s of f u n c t i o n i n g may  g r o s s d e f i c i t s i n s o c i a l r o l e performance ( F a l l o o n , & Hardesty,  has  leave  McGill,  1985).  Some w r i t e r s take i s s u e with the concept (see Jimenez, 1988).  Although  of c h r o n i c i t y  such a c o n c e p t i o n may  be  a c c u r a t e f o r some people with s c h i z o p h r e n i a , "the assumption of c h r o n i c i t y accompanying a d i a g n o s i s of severe mental d i s o r d e r , p a r t i c u l a r l y s c h i z o p h r e n i a , c a r r i e s w i t h i t an i n e v i t a b l e sense of hopelessness  and  diminished  e x p e c t a t i o n . . . . ( I t ) precludes the n o t i o n of r e c o v e r y  and  t h e r e f o r e has c r i t i c a l  policy"  (Jimenez,  1988,  pp.  i m p l i c a t i o n s f o r p r a c t i c e and  628-629).  I t c o u l d be suggested  that  such an assumption a l s o would have i m p l i c a t i o n s f o r p a r e n t a l response  t o a d i a g n o s i s of s c h i z o p h r e n i a i n an a d u l t c h i l d .  T h i s h e t e r o g e n e i t y of symptoms, course of i l l n e s s , outcome  has prompted the unanswered q u e s t i o n of whether  s c h i z o p h r e n i a i s one d i s e a s e or a group of l o o s e l y diseases  and  (Straube & Oades, 1992).  connected  It i s generally believed,  17 however, t o be e s s e n t i a l l y one e n t i t y with a whole continuum of m a n i f e s t a t i o n s  (Gottesman, 1991).  I t can be seen t h a t  the consequences of t h e d i s o r d e r f o r t h e f a m i l y would  differ  a c c o r d i n g t o t h e d i f f e r e n t m a n i f e s t a t i o n s of t h e i l l n e s s (Cole e t a l . , 1993; Gubman & T e s s l e r , 1987). Family  Diversity  Even with s i m i l a r i t i e s i n the degree and type o f o b j e c t i v e burden, f a m i l i e s have been seen t o respond d i f f e r e n t l y , an o b s e r v a t i o n t h a t i s not s u r p r i s i n g c o n s i d e r i n g t h e h e t e r o g e n e i t y of f a m i l i e s The  (McFarlane,  f a m i l y system can be d e f i n e d very b r o a d l y w i t h  boundaries review,  i n c l u d i n g many generations.  In t h i s  1990).  extensive  literature  f a m i l y w i l l be r e s t r i c t e d t o parents and s i b l i n g s of  the person with s c h i z o p h r e n i a .  I n t e r e s t i n g l y , a study  i n c l u d i n g data from e p i d e m i o l o g i c a l f i e l d surveys and clinical  i n t e r v i e w s found t h a t of a l l r e l a t i v e s  (parent,  spouse, c h i l d , s i b l i n g , and extended f a m i l y member) o f persons w i t h mental h e a l t h problems, t h e h i g h e s t measures o f d e p r e s s i o n and a n x i e t y , although not of p s y c h o s o c i a l d y s f u n c t i o n , were r e p o r t e d by parents 1980).  Because of probable  (see Arey & Warheit,  age of onset o f s c h i z o p h r e n i a ,  f a m i l y members coping with f i r s t symptoms and d i a g n o s i s , e s p e c i a l l y t h a t of young men, are most o f t e n those o f f a m i l y of o r i g i n  ( F a l l o o n e t a l . , 1984).  Because an i l l n e s s  such  as s c h i z o p h r e n i a reduces a person's p r o b a b i l i t y of marriage, p a r e n t s and/or s i b l i n g s may remain the f a m i l y c a r e g i v i n g u n i t f o r those with e a r l y onset, whether o r not r e s i d e n c e i s  18 shared Torrey,  ( C a r p e n t i e r , Lesage,  Goulet, Lalonde, & Renaud,  1992;  1983).  These f a m i l i e s vary i n form and a c r o s s time. s i n g l e versus  Only a  dual-parent d i s t i n c t i o n has been u t i l i z e d i n  the l i t e r a t u r e on f a m i l y response t o s c h i z o p h r e n i a ; separated, d i v o r c e d , and remarried f a m i l y forms, its  each w i t h  p a r t i c u l a r i n t e r a c t i o n a l dynamics, have not been  differentiated.  These f a m i l i e s of o r i g i n may  be composed of  m i d - l i f e p a r e n t s with other school-aged c h i l d r e n , those w i t h o t h e r c h i l d r e n who  have been "launched", or o l d e r p a r e n t s  c o p i n g w i t h i s s u e s of t h e i r own  aging.  Because f a m i l y r o l e  r e l a t i o n s h i p s vary a t these d i f f e r e n t l i f e  stages,  a d a p t a t i o n problems and coping r e s o l u t i o n s a l s o w i l l (Biegel et a l . ,  differ  1991).  At any stage of f a m i l y development, however, a d a p t a t i o n to  s t r e s s f u l l i f e events may  be mediated  by p e r s o n a l  c h a r a c t e r i s t i c s of f a m i l y members as w e l l as by f a m i l y strengths  (McCubbin & McCubbin, 1991).  Some f a m i l y types  are c o n s i d e r e d t o be more r e s i l i e n t t o e x t e r n a l demands. McCubbin and McCubbin (1991, p. 6) d e f i n e a f a m i l y ' s t y p o l o g y as "a s e t of b a s i c a t t r i b u t e s about the f a m i l y system which c h a r a c t e r i z e s and e x p l a i n s how  a f a m i l y system  t y p i c a l l y a p p r a i s e s , operates and/or behaves". Lavee,  and McCubbin (1988) have developed the  Olson, Circumplex  Model of Family Systems based on t h r e e major f a m i l y dimensions:  cohesion, a d a p t a b i l i t y or f l e x i b i l i t y ,  communication.  Cohesion  and  i s d e f i n e d as the emotional  t h a t f a m i l y members have toward  bonding  one another; f l e x i b i l i t y i s  19 defined  as t h e a b i l i t y o f the f a m i l y  system t o adapt t o  changing r o l e r e l a t i o n s h i p s and r e l a t i o n s h i p  rules;  communication i s considered t o be a f a c i l i t a t i n g f a c t o r i n the  family's  movement along the dimensions of c o h e s i o n and  flexibility. Families  can be c a t e g o r i z e d  i n t o four types depending  on t h e i r l e v e l s of cohesion and f l e x i b i l i t y :  (a) f l e x i b l e -  s e p a r a t e d - h i g h i n a d a p t a b i l i t y and low on cohesion, (b) s t r u c t u r e d - s e p a r a t e d - low i n both a d a p t a b i l i t y and cohesion,  (c) f l e x i b l e - c o n n e c t e d  cohesion,  (d) structured-connected - low i n a d a p t a b i l i t y and  h i g h i n cohesion are  - h i g h i n a d a p t a b i l i t y and  (Lavee & Olson, 1991).  These f a m i l y  types  c o n s i d e r e d t o d i f f e r i n the resources a v a i l a b l e f o r  response t o s t r e s s f u l l i f e events and normative t r a n s i t i o n s (Olson e t a l . , 1988). Families  a l s o vary i n socio-economic s t a t u s ,  ethnicity,  and  experience, a l l of which w i l l a f f e c t t h e i n f l u e n c e o f  the  i l l n e s s on the f a m i l y .  In a d d i t i o n ,  a family  i s not an  amorphous mass with a u n i f i e d r e a c t i o n t o a s t i m u l u s .  The  s c h i z o p h r e n i a of a f a m i l y member w i l l be experienced d i f f e r e n t l y according to d i f f e r e n t family r e l a t i o n s h i p s , that Tessler,  i s , mother, f a t h e r ,  1987; L e f l e y ,  or s i b l i n g  (Gubman &  1993).  Before examining some e m p i r i c a l relationships within  role  support f o r t h e  this variability,  i t would be h e l p f u l  t o c o n s i d e r t h e o r e t i c a l approaches t o the study o f s t r e s s and  c o p i n g on both the i n d i v i d u a l and f a m i l y  consideration  levels.  Such a  w i l l p r o v i d e a t h e o r e t i c a l focus f o r study.  T h i s d i g r e s s i o n h o p e f u l l y w i l l add c l a r i t y through understanding concepts.  an  of the coping process and a d e f i n i t i o n of  S t r e s s and coping theory o f f e r s a language f o r a  d i s c u s s i o n of the l i t e r a t u r e i n a t h e o r e t i c a l r e l e v a n t a l l o w s f o r a meaningful  way,  o r g a n i z a t i o n of e m p i r i c a l f i n d i n g s ,  s i t u a t e s i n d i v i d u a l coping w i t h i n the f a m i l y c o n t e x t , i d e n t i f i e s some areas of weakness i n past r e s e a r c h .  and  21 Chapter I I I T h e o r e t i c a l Framework: S t r e s s and Coping The  focus of t h i s study i s coping.  a d v i s e s , coping i s best understood s t r e s s process.  As P e a r l i n  (1991)  when viewed w i t h i n t h e  The r e l a t i o n s h i p s t h a t have been found  e m p i r i c a l l y t o e x i s t w i t h i n the v a r i a b i l i t y of f a m i l y and i l l n e s s , t h e r e f o r e , may be most meaningful  when o r g a n i z e d by  s t r e s s and coping theory. Although the concept of s t r e s s i s w i d e l y used, been d e f i n e d v a r i o u s l y as stimulus and as response Lazarus, 1985).  i t has (Monat &  T h i s study f o l l o w s the d e f i n i t i o n o f  Lazarus and Folkman (1984, p. 19), t h a t s p e c i f i e s p s y c h o l o g i c a l s t r e s s t o be "the r e l a t i o n s h i p between t h e person and t h e environment t h a t i s a p p r a i s e d by t h e person as t a x i n g o r exceeding h i s or her r e s o u r c e s and endangering h i s o r her w e l l - b e i n g . " c o p i n g as a person's The  Lazarus and Folkman c o n c e p t u a l i z e  e f f o r t s t o manage such  f a m i l y coping response  stress.  i n i n s t a n c e s o f a young  c h i l d ' s p h y s i c a l i l l n e s s or d i s a b i l i t y , and c a r e g i v i n g i n aging, have been widely i n v e s t i g a t e d Horowitz,  ( f o r reviews see  1985; K n a f l & D e a t r i c k , 1987), and a number o f  s t r e s s and coping models have been a p p l i e d t o c a r e g i v e r experience  (see B i e g e l e t a l . ,  Mullan, Semple, & S k a f f , 1990).  1991; L e f l e y , 1990; P e a r l i n , These v a r i o u s models have  agreed on many of t h e r e l e v a n t concepts. When choosing a t h e o r e t i c a l model, i t i s important t o keep i n mind t h e purpose f o r which i t i s intended. study r e q u i r e d a model t h a t would s a t i s f y a double  This purpose:  22 (a) t o o r g a n i z e  and make more comprehensible the  variability  t h a t i s apparent i n the l i t e r a t u r e on the f a m i l y response t o schizophrenia, the f a m i l y The  and  (b) t o l o c a t e i n d i v i d u a l coping  within  context.  R e s i l i e n c y Model of Family S t r e s s , Adjustment,  Adaptation  (McCubbin & McCubbin, 1991)  i s able  to  i n c o r p o r a t e , w i t h i n a developmental framework, much of v a r i a b i l i t y t h a t has  been found t o be r e l e v a n t t o the  experience with schizophrenia.  and  coping.  resources  family  focus on i n d i v i d u a l  I t attends t o the a p p r a i s a l of demands  f e a t u r e d by Lazarus and  t h e i r work, and  the  T h i s model i s compatible  w i t h the t h e o r i z i n g of s c h o l a r s who s t r e s s and  and  Folkman (1984) i n  accommodates the p i l e up of demands  and  secondary s t r e s s o r s a r i s i n g from the s i t u a t i o n a l context t h a t i s emphasized by P e a r l i n (1989). p l a c e s the  Particularly, i t  i n d i v i d u a l w i t h i n the f a m i l y context  important r o l e r e l a t i o n s h i p s , v u l n e r a b i l i t i e s ,  with i t s and  strengths. The  fundamental assumptions of f a m i l y l i f e upon which  t h i s model i s based are the  following:  (1) f a m i l i e s face hardships and n a t u r a l and p r e d i c t a b l e aspect the l i f e  changes as a of f a m i l y l i f e  cycle;  (2) f a m i l i e s develop b a s i c s t r e n g t h s  and  c a p a b i l i t i e s designed t o f o s t e r the growth development of f a m i l y members and and  over  and  the f a m i l y u n i t  t o p r o t e c t the f a m i l y from major d i s r u p t i o n s  i n the face of f a m i l y t r a n s i t i o n s and  changes;  23 (3) f a m i l i e s develop b a s i c and unique and  strengths  c a p a b i l i t i e s designed t o p r o t e c t the f a m i l y  from unexpected or non-normative s t r e s s o r s and s t r a i n s and t o f o s t e r the f a m i l y ' s  adaptation  f o l l o w i n g a f a m i l y c r i s i s or major t r a n s i t i o n and change; and (4) f a m i l i e s b e n e f i t from and c o n t r i b u t e t o t h e network o f r e l a t i o n s h i p s and resources  i n the  community, p a r t i c u l a r l y d u r i n g p e r i o d s  of family  s t r e s s and c r i s e s (McCubbin & McCubbin, 1991, p. 3) . The  R e s i l i e n c y Model of Family S t r e s s , Adjustment, and  Adaptation  (McCubbin & McCubbin, 1991) attempts t o d e s c r i b e  the f a m i l y experience of s t r e s s a t two phases o f response: the i n i t i a l phase.  adjustment p e r i o d and the l a t e r  adaptation  In t h i s way the model not only i n t e g r a t e s t h e  heterogeneity  o f f a m i l i e s and t h e i r s i t u a t i o n s , and t h e  i n t e r a c t i o n among these f a c t o r s , but a l s o accommodates t h e v a r i a b i l i t y of these components over time.  The model  i l l u s t r a t e s t h a t f a m i l y adjustment and a d a p t a t i o n  to a  s t r e s s f u l s i t u a t i o n (X) i s determined by t h e i n t e r a c t i o n among t h e p i l e - u p o f demands (A) and f a m i l y v u l n e r a b i l i t y (V), f a m i l y type appraisals  (T), a v a i l a b l e resources  (C) and adaptive,  (B),  situational  problem s o l v i n g coping (PSC)  (see F i g u r e E l ) . The  model i n d i c a t e s a h i g h l y i n t e r a c t i v e p r o c e s s w i t h  r e c i p r o c a l i n f l u e n c e s among the components.  Adaptation a t  time one can become a s t r e n g t h or a v u l n e r a b i l i t y a t time  24 two.  I t has been cautioned elsewhere, however, t h a t any  model o f t h e s t r e s s process should be regarded as "an h e u r i s t i c d e v i c e r a t h e r than as a l i t e r a l r e f l e c t i o n o f r e a l i t i e s and t h e pathways t h a t j o i n them, many o f which a r e s t i l l u n c l e a r " ( P e a r l i n e t a l . , 1990, p. 591). The R e s i l i e n c y Model of Family S t r e s s , Adjustment, and Adaptation  (McCubbin & McCubbin, 1991) addresses t h e  d i s t i n c t i o n between i n d i v i d u a l as opposed t o f a m i l y r e s o u r c e s , p e r c e p t i o n s , and responses.  group  I t v a l u e s both  l e v e l s o f response and sees them, i n a systems p e r s p e c t i v e , as i n e x t r i c a b l y l i n k e d .  Elsewhere, as w e l l , f a m i l y  stress  t h e o r y attends t o t h e importance of both i n d i v i d u a l and f a m i l y l e v e l s o f demands and c a p a b i l i t i e s P a t t e r s o n & Garwick,  1994).  (see Boss, 1988;  T h i s model, t h e r e f o r e , can be  c o n s i d e r e d a u s e f u l framework w i t h i n which t o view t h e f a m i l y experience with s c h i z o p h r e n i a , a framework which i s a b l e t o l o c a t e i n d i v i d u a l and f a m i l y coping e f f o r t s w i t h i n a complex, i n t e r a c t i v e s t r e s s response. As mentioned  above, the work of McCubbin and McCubbin  (1991) on s t r e s s and coping i s compatible w i t h t h a t o f o t h e r scholars.  Although each approach has a d i f f e r e n t f o c u s ,  t o g e t h e r they share many s i m i l a r concepts.  I suggest  through my study t h a t these d i f f e r e n t approaches to  i n f o r m and e n r i c h one another.  can be seen  The work o f these o t h e r  s c h o l a r s , t h e r e f o r e , i s i n c l u d e d i n order t o f a c i l i t a t e conceptual  clarification.  25 C l a r i f i c a t i o n of Concepts Pearlin  (1985) a s s e r t s t h a t our i n t e r e s t i n c o p i n g f a r  exceeds our knowledge about i t .  He suggests t h a t because i t  has been approached from a v a r i e t y of p e r s p e c t i v e s and d i s c i p l i n e s , the knowledge gained has not been cumulative. As an example of conceptual d i f f e r e n c e , c o n s i d e r the following.  Haan (.1985) d i s t i n g u i s h e s coping as an.ego  p r o c e s s separate from defense mechanisms and e v a l u a t e s i t more f a v o r a b l y ; White (1985) views coping and defense  both  as l e g i t i m a t e but separate s t r a t e g i e s of a d a p t a t i o n under d i f f i c u l t c o n d i t i o n s ; whereas Lazarus and Folkman (1984) p e r c e i v e defense as one of many coping  strategies.  In t h e i r t h e o r i z i n g about the coping p r o c e s s , McCubbin and McCubbin (1991) i n c l u d e areas of emphasis s i m i l a r t o and compatible w i t h those found i n the s o c i a l - p s y c h o l o g i c a l approach of Lazarus and Folkman (1984), p e r s p e c t i v e s of P e a r l i n  (1989a),  i n the  sociological  and P e a r l i n and  Schooler  (1978), and i n the work of other f a m i l y t h e o r i s t s .  I t would  be h e l p f u l , then, t o examine the concept of coping a t both the i n d i v i d u a l and f a m i l y l e v e l s , as i t i s e x p l i c a t e d these s c h o l a r s .  An attempt  concept by examining  w i l l be made t o c l a r i f y  d e f i n i t i o n s , f u n c t i o n s , and  by  the  assessment  of coping. Coping:  Compatible  Definitions  Lazarus and Folkman (1984, p. 141) c o p i n g as " c o n s t a n t l y changing  define individual  c o g n i t i v e and b e h a v i o r a l  e f f o r t s t o manage s p e c i f i c e x t e r n a l and/or i n t e r n a l demands t h a t are a p p r a i s e d as t a x i n g or exceeding the r e s o u r c e s of  26 the person".  In "unpacking"  t h i s d e f i n i t i o n , t h e above  authors note t h e f o l l o w i n g c h a r a c t e r i s t i c s :  (a) c o p i n g i s a  p r o c e s s t h a t changes i n response t o the s i t u a t i o n , (b) c o p i n g i s a d e l i b e r a t e a c t i v i t y with a s p e c i f i c focus r a t h e r than a g e n e r a l i z e d automatic response, attempt  and (c) c o p i n g i s any  t o manage t h e s i t u a t i o n and i s not t o be confounded  w i t h outcome or mastery.  In t h i s r e s p e c t , coping can  i n c l u d e "minimizing, a v o i d i n g , t o l e r a t i n g , and a c c e p t i n g t h e s t r e s s f u l c o n d i t i o n s " as w e l l as attempts  t o master them  (Lazarus & Folkman, 1984, p. 142). T h i s d e f i n i t i o n o f coping i s comparable t o t h a t o f McCubbin and McCubbin (1991, p. 22) i n which c o p i n g i s seen as "a s p e c i f i c e f f o r t individual attempts  behavior  (covert or overt) by which an  (or a group of i n d i v i d u a l s such as t h e f a m i l y )  t o reduce or manage a demand on the f a m i l y system".  S i m i l a r l y , f a m i l y system t h e o r i s t s , P a t t e r s o n and Garwick  (1994, p. 137), d e f i n e f a m i l y coping as "a s p e c i f i c  e f f o r t by an i n d i v i d u a l or f a m i l y t h a t i s d i r e c t e d a t m a i n t a i n i n g or r e s t o r i n g the balance between demands and resources."  They see coping behaviours, along w i t h  r e s o u r c e s , as f a m i l y c a p a b i l i t i e s .  These s c h o l a r s do not  p e r c e i v e coping t o be s t r e s s o r s p e c i f i c .  They see f a m i l i e s  c o n t i n u o u s l y managing a p i l e u p of demands w i t h not a s i n g l e source r e s p o n s i b l e f o r the imbalance  between demands and  r e s o u r c e s , even though one source may be most prominent and the one t h a t i s a p p r a i s e d as the problem. Boss (1988, pp. 60-61) d e f i n e s f a m i l y coping as "the c o g n i t i v e , a f f e c t i v e , and b e h a v i o r a l process by which  27 i n d i v i d u a l s and t h e i r f a m i l y system as a whole manage r a t h e r then e r a d i c a t e s t r e s s f u l events or s i t u a t i o n s . "  She i n s i s t s  t h a t t o be c o n s i d e r e d coping or management, t h i s  process  must have no d e t r i m e n t a l e f f e c t s on any f a m i l y member. In t h e i r i n v e s t i g a t i o n o f i n d i v i d u a l s ' coping t o normative l i f e - p r o b l e m s , P e a r l i n and Schooler 3) d e f i n e coping as "any response t o e x t e r n a l t h a t serves t o prevent, distress."  avoid, or c o n t r o l  responses  (1978, p.  life-strains  emotional  Coping responses may be e i t h e r i n d i v i d u a l s '  a c t i o n s or t h e i r p e r c e p t i o n s , elements o f which may be s o c i a l l y learned  ( P e a r l i n , 1989a).  I n t e g r a l t o these  d e f i n i t i o n s o f coping are the concepts o f demands o r s t r e s s o r s , resources,  and a p p r a i s a l .  Demands/Stressors Lazarus and Folkman (1984) c o n s i d e r a s t r e s s o r t o be any  environmental s i t u a t i o n or event t h a t i s construed by  the i n d i v i d u a l as t a x i n g or overwhelming h i s or her resources  and endangering h i s or her w e l l - b e i n g .  s c h o l a r s , not a l l demands are s t r e s s o r s . p e r c e i v e d as such by the i n d i v i d u a l .  For these  They must be  One's p e r c e p t i o n o r  a p p r a i s a l o f the s i t u a t i o n , t h e r e f o r e , i s a c r i t i c a l f a c t o r . P e a r l i n and Schooler  (1978, p. 3) c o n s i d e r s t r e s s o r and  s t r a i n t o be interchangeable enduring  concepts t h a t i n d i c a t e "those  problems t h a t have the p o t e n t i a l f o r a r o u s i n g  threat." undesired,  P e a r l i n (1989a) addresses two types o f s t r e s s o r s : non-normative events,  and c h r o n i c s t r a i n s .  He  emphasizes the s o c i a l c h a r a c t e r of e v e n t f u l s t r e s s , p o i n t i n g out t h a t many s t r e s s f u l events are rooted i n a person's  28 s o c i a l and economic s t a t u s . He d e f i n e s c h r o n i c s t r a i n s as those enduring problems,  c o n f l i c t s , and t h r e a t s t h a t  face i n t h e i r d a i l y l i v e s .  He a s s e r t s t h a t these  people  latter  s t r a i n s , which occur w i t h i n s o c i a l r o l e s , a f f e c t people because  t h e r o l e s themselves are important.  He suggests  t h a t these primary s t r e s s o r s r a r e l y occur s i n g l y ; one event or s t r a i n tends t o t r i g g e r other secondary s t r a i n s . C l u s t e r s o f s t r e s s o r s may develop.  Irt a d d i t i o n , s t r e s s o r s  e x p e r i e n c e d by one person can become problems f o r o t h e r s who share t h e same r o l e s e t s . T h i s s o c i o l o g i c a l approach  i s compatible w i t h t h a t o f  f a m i l y - s t r e s s t h e o r i s t s (see Boss, 1988; McCubbin & McCubbin 1991;  P a t t e r s o n & Garwick,  1994).  McCubbin and McCubbin  (1991) a s s e r t t h a t t h e r e are a t l e a s t f i v e broad types of s t r e s s o r s which c o n t r i b u t e t o a p i l e up of demands on t h e f a m i l y system and t o f a m i l y v u l n e r a b i l i t y : (a) t h e i n i t i a l s t r e s s o r and i t s h a r d s h i p s , (b) normative t r a n s i t i o n s , i n c l u d i n g f a m i l y l i f e c y c l e changes, the consequences  (c) p r i o r s t r a i n s , (d)  of f a m i l y e f f o r t s t o cope, and (e) both  i n t r a - f a m i l y and s o c i a l ambiguity. thought t o r e s u l t from an absence  S o c i a l ambiguity i s of s o c i a l programs and  p o l i c i e s t h a t guide f a m i l y response i n s t r e s s f u l s i t u a t i o n s . In t h e i r f a m i l y systems approach t o c h r o n i c P a t t e r s o n and Garwick  illness,  (1994) see s i m i l a r demands a r i s i n g  from f o u r a s p e c t s of the i n t e r s e c t i o n of i l l n e s s and f a m i l y systems.  (a) There are the c h a r a c t e r i s t i c s of t h e c h r o n i c  c o n d i t i o n : t h e degree and type o f i n c a p a c i t a t i o n , the degree of v i s i b i l i t y of the c o n d i t i o n , the p r o g n o s i s and course o f  29 the  illness,  person who  and  the amount of d i s t r e s s experienced by  is i l l .  impact of the  the  (b) There are demands a r i s i n g from  the  i l l n e s s on the f a m i l y : f i n a n c i a l s t r a i n s ,  l o s s e s of f a m i l y p r i v a c y and s e r v i c e p r o v i d e r s , and  f a m i l y time, problems w i t h  caregiver s t r a i n s .  (c) There  demands a s s o c i a t e d with developmental i n t e r a c t i o n s .  are Chronic  i l l n e s s can a f f e c t the developmental course of i n d i v i d u a l s w i t h i n the f a m i l y and  of the f a m i l y as a whole.  a l s o can be s t r e s s a r i s i n g from other  (d) There  f a m i l y sources t h a t  c r e a t e s d i f f i c u l t i e s i n managing the c h r o n i c  illness.  These d i f f e r e n t approaches have i n common the importance of the environment, or context, i d e n t i f i c a t i o n of s t r e s s o r s . well,  i n the  There are s i m i l a r i t i e s ,  i n the ways t h a t resources  have been  as  conceptualized.  Resources Lazarus and something one  Folkman (1984) c o n s i d e r  the environment.  i n t o those of the person and  Personal  energy), p s y c h o l o g i c a l  p o s i t i v e t h i n k i n g and competencies  to  resources  can be p h y s i c a l  an i n t e r n a l locus of c o n t r o l ) ,  The  (health  ( p o s i t i v e b e l i e f s , such as  (problem-solving  m a t e r i a l resources.  They  those of  and  social s k i l l s ) .  a v a i l a b i l i t y of r e s o u r c e s  and  Resources  of the environment are such t h i n g s as s o c i a l support  considered  be  draws upon and uses t o counter demands.  c a t e g o r i z e resources  and  resources  and  is  t o i n f l u e n c e one's a p p r a i s a l of the s i t u a t i o n as  w e l l as one's choice of coping P e a r l i n and s o c i a l resources  Schooler  response.  (1978) a l s o d i s t i n g u i s h between  and p s y c h o l o g i c a l resources,  and  also  30 d e f i n e r e s o u r c e s not as what people do, but as what i s a v a i l a b l e t o them i n developing t h e i r coping They see s o c i a l r e s o u r c e s represented by i n t e r p e r s o n a l networks which may support.  repertoires.  people's  be p o t e n t i a l sources  of  " P s y c h o l o g i c a l resources are the p e r s o n a l i t y  c h a r a c t e r i s t i c s t h a t people draw upon t o h e l p them w i t h s t a n d t h r e a t s posed by events and o b j e c t s i n t h e i r environment" ( P e a r l i n & Schooler, 1978, authors  p. 5).  In t h e i r a n a l y s i s ,  focus on the p e r s o n a l i t y c h a r a c t e r i s t i c s of  these  self-  esteem, s e l f - d e n i g r a t i o n , and mastery. F a m i l y - s t r e s s t h e o r i s t s c o n s i d e r r e s o u r c e s t o be i n d i v i d u a l and c o l l e c t i v e s t r e n g t h s or a s s e t s t h a t can drawn upon i n response  be  t o a demand or t o m u l t i p l e s t r e s s o r s  (see Boss, 1988;  McCubbin & McCubbin, 1991;  Patterson &  Garwick, 1994).  They are o b t a i n a b l e from t h r e e p o t e n t i a l  s o u r c e s : i n d i v i d u a l f a m i l y members ( f o r example, i n t e l l i g e n c e , self-esteem, and sense of mastery), unit  (communication s k i l l s ,  cooperation,  c o h e s i o n ) , and the community  the f a m i l y  flexibility,  (supportive r e l a t i o n s h i p s ) .  Relevant t o a c o n c e p t u a l i z a t i o n of f a m i l y l e v e l r e s o u r c e s i s the above d i s c u s s i o n of f a m i l y type.  Family  c o h e s i o n has been i d e n t i f i e d as an important dimension  of  f a m i l y dynamics (Olson e t a l . ,  1988)  f a m i l y response  In a n o n - c l i n i c a l p o p u l a t i o n ,  to stressors.  with i m p l i c a t i o n s f o r  more c o h e s i v e f a m i l i e s have been found t o have lower of s t r a i n and h i g h e r l e v e l s of w e l l - b e i n g than do families  (Olson e t a l . , 1988).  levels  separated  F l e x i b i l i t y , by i t s e l f ,  not been found t o have d i r e c t i n f l u e n c e on f a m i l y  has  31 resiliency;  an i n t e r a c t i o n  between f l e x i b i l i t y low f l e x i b i l i t y  e f f e c t , however, has been found  and cohesion.  Connected  and separated f a m i l i e s  families  with h i g h  have been seen t o be more v u l n e r a b l e t o s t r e s s al.,  with  flexibility  (Olson e t  1988). Stress vulnerability  a l s o i s seen t o be i n f l u e n c e d  one's s o c i a l support system.  by  Because s o c i a l support i s  c o n s i d e r e d t o be a h i g h l y important r e s o u r c e ,  special  a t t e n t i o n t o i t i s warranted. Social  support.  differentiated  Social  support i s g e n e r a l l y  from s o c i a l network.  Whereas s o c i a l network  i s concerned with numbers and p a t t e r n s of s o c i a l relationships, distinction.  s o c i a l support i m p l i e s a  qualitative  Lazarus and Folkman (1984) emphasize t h a t t o  be c o n s i d e r e d a resource, the nature of the s o c i a l relationship  i s important.  i t a l s o must be u t i l i z e d .  I t must be p e r c e i v e d as  helpful;  These s c h o l a r s have shown t h a t  type of support-seeking changes from one stage t o another of a s t r e s s f u l encounter,  from i n i t i a l  information seeking to  l a t e r emotional support seeking. Pearlin  (1989) acknowledges the d i s t i n c t i o n  one's t o t a l i t y of p o t e n t i a l  s o c i a l r e s o u r c e s and one's  s o c i a l support, s e e i n g s o c i a l support as the r e s o u r c e s t h a t one a c t u a l l y problems.  between  social  uses i n d e a l i n g w i t h  He s t r e s s e s the importance,  life  however, of  the study of s o c i a l supports more c l o s e l y  linking  t o the study of  s o c i a l networks, and of c o n s i d e r i n g i t s i n t e r a c t i o n a l nature.  32 P a r t i c u l a r l y i n f a m i l i e s such a t t e n t i o n i s warranted. Family members g e n e r a l l y a r e important sources o f support t o each o t h e r and y e t they o f t e n a r e exposed t o t h e same s t r e s s f u l circumstances.  Revenson (1994, p. 123), i n h e r  d i s c u s s i o n o f m a r i t a l coping with c h r o n i c i l l n e s s ,  calls  a t t e n t i o n t o t h e r e c i p r o c a l r e l a t i o n s h i p o f husband and w i f e . "One must look not only a t the p a s s i v e r e a c t i o n o f one spouse t o t h e other's coping behavior, but a t how each spouse d i r e c t l y or c o v e r t l y i n f l u e n c e s the o t h e r spouse's c o g n i t i o n s , emotions, and a c t i o n s .  For example, i t i s not  enough t o know t h a t one p a r t n e r was t r y i n g t o be s u p p o r t i v e ; it  i s a l s o c r i t i c a l t o whether t h a t support was p e r c e i v e d as  h e l p f u l by t h e r e c i p i e n t " .  Eckenrode (1991, p. 5) suggests  t h e r e may be "a c e r t a i n degree of synchrony  or o r c h e s t r a t i o n  t h a t takes p l a c e as each person seeks t o cope w i t h a common s t r e s s o r . " G o t t l i e b and Wagner (1991, pp. 167-168) d e s c r i b e c o p i n g and support e f f o r t s i n c l o s e r e l a t i o n s h i p s when both p a r t n e r s have been exposed t o the same s t r e s s o r : Both t h e supporter and the would-be r e c i p i e n t become i n v o l v e d i n t h e process o f comparing t h e i r emotional r e a c t i o n s t o the event and responding t o one another's coping e f f o r t s .  They must  c o n c u r r e n t l y d e a l w i t h the demands imposed by t h e s t r e s s o r and those imposed by each o t h e r ' s c o p i n g responses.  Each f a c e s the c h a l l e n g e of modulating  h i s / h e r own ways of coping i n order t o a v o i d d i s r u p t i n g the p a r t n e r ' s coping e f f o r t s and t o g a i n h i s / h e r support.  At the same time, as  33 providers  of support, each must be c a r e f u l not t o  a l l o w h i s / h e r own  needs f o r emotional r e g u l a t i o n  t o d i c t a t e the types of support extended t o the recipient. Appraisal S i t u a t i o n a l a p p r a i s a l i s an element of the s t r e s s p r o c e s s t h a t i s deemed t o be h i g h l y important i n both i n d i v i d u a l and f a m i l y s t r e s s theory.  Although d i f f e r e n t  s t r e s s t h e o r i s t s a s s i g n v a r i o u s terms t o t h i s concept, as, p e r c e p t i o n ,  a p p r a i s a l , d e f i n i t i o n , or assessment,  such Boss  (1988) suggests t h a t a l l terms i n d i c a t e the meaning of the event or s i t u a t i o n f o r an i n d i v i d u a l or f a m i l y . The concept of a p p r a i s a l has been c l a r i f i e d most t h o r o u g h l y by Lazarus and Folkman (1984). consider  These  scholars  i n d i v i d u a l c o g n i t i v e a p p r a i s a l t o be "an  p r o c e s s t h a t determines why  evaluative  and t o what extent a p a r t i c u l a r  t r a n s a c t i o n or s e r i e s of t r a n s a c t i o n s between the person the environment  is stressful"  (1984, p. 19).  and  They  d i s t i n g u i s h between two types of c o g n i t i v e a p p r a i s a l : primary a p p r a i s a l , t h a t evaluates person-environment  the s i g n i f i c a n c e of the  r e l a t i o n s h i p , and secondary a p p r a i s a l ,  t h a t a s s e s s e s one's resources and options  available to  change i t . Primary a p p r a i s a l s t h a t i d e n t i f y s t r e s s f u l s i t u a t i o n s i n c l u d e those of harm/loss, where the damage has occurred;  already  those of t h r e a t , which concern a n t i c i p a t e d harms  or l o s s e s ; and those of challenge, f o r g a i n or growth.  which i n c l u d e a p o t e n t i a l  These a p p r a i s a l s are accompanied by  34 c h a r a c t e r i s t i c emotions.  "Harm/loss a p p r a i s a l s  ...  can  generate f e e l i n g s of sadness, anger, g u i l t , and  relief,  depending on the meaning of the harm or l o s s t o  the  individual.  Threat a p p r a i s a l s can generate f e e l i n g s of  worry, f e a r , and  anxiety.  Challenge can generate f e e l i n g s  of eagerness, hopefulness, and 1991,  p. 241).  These a p p r a i s a l s are not mutually  the same s i t u a t i o n may and  excitement" (Folkman e t a l . ,  a challenge.  be p e r c e i v e d  as both a l o s s or t h r e a t  With such complex a p p r a i s a l s , people  l i k e l y t o r e p o r t c o n f l i c t i n g emotions. i s perceived  exclusive;  Whether a s t r e s s o r  as a l o s s , a t h r e a t , or a c h a l l e n g e ,  has  shown t o have a s i g n i f i c a n t e f f e c t on the c h o i c e of strategy  (McCrae, 1984).  Reappraisals  s i t u a t i o n or the r e c e i p t of new  occur w i t h a changing  information.  t h a t takes i n t o account which coping the l i k e l i h o o d t h a t a given coping  options  process  are a v a i l a b l e ,  option w i l l  accomplish  what i t i s supposed t o , and the l i k e l i h o o d t h a t one  can  a p a r t i c u l a r s t r a t e g y or set of s t r a t e g i e s  effectively" and  been coping  A secondary a p p r a i s a l " i s a complex e v a l u a t i v e  apply  are  (Lazarus  & Folkman, 1984,  p. 35).  The  meaning  emotional q u a l i t y of every encounter or s i t u a t i o n i s  shaped by the convergence of primary a p p r a i s a l and appraisal  secondary  (Folkman et a l . , 1991).  " D e f i n i t i o n of the s i t u a t i o n " i s at the h e a r t of perspectives  the  on which f a m i l y s t r e s s t h e o r i s t s have b u i l t  (Hansen & Johnson, 1979).  Hill  (1971) was  the f i r s t  family  t h e o r i s t t o focus on the "meaning of the event" and  later  Reiss  of  (1981) h i g h l i g h t e d the f a m i l y ' s " c o n s t r u c t i o n  35 reality"  (Boss, 1988).  Reiss & O l i v e r i ,  A l t e r n a t i v e l y , f a m i l y t h e o r i s t s (see  1983) have suggested t h e f a m i l y ' s  s u b j e c t i v e d e f i n i t i o n of an event should be r e p l a c e d by t h a t of t h e community w i t h i n which the f a m i l y  lives.  S i m i l a r l y , Boss (1988, p. 19) s t r e s s e s t h a t backgrounds g i v e us d i v e r s e p e r c e p t i o n s . "  "diverse  She a s s e r t s t h a t  the meaning f a m i l i e s g i v e t o an event i s the key t o t h e i r a p p r a i s a l s o f t h e s i t u a t i o n , i n f l u e n c i n g both t h e i r v u l n e r a b i l i t y and t h e i r responses. Boss contends t h a t  family  p e r c e p t i o n s f r e q u e n t l y d i f f e r from those of i n d i v i d u a l f a m i l y members and i n s i s t s t h a t an a p p r e c i a t i o n o f both i s necessary t o understand f a m i l y s t r e s s . McCubbin and McCubbin (1991) i n c l u d e f a m i l y on t h r e e l e v e l s : stressor,  appraisals  (a) the f a m i l y ' s a p p r a i s a l o f t h e s p e c i f i c  (b) s i t u a t i o n a l a p p r a i s a l s t h a t i n c l u d e t h e  f a m i l y ' s assessments of t h e i r demands r e l a t i v e t o t h e i r c a p a b i l i t i e s , and (c) g l o b a l a p p r a i s a l s , a more s t a b l e assessment o f how the f a m i l y views i t s i n t e r r e l a t i o n s h i p s among f a m i l y members, as w e l l as i t s r e l a t i o n s h i p t o t h e l a r g e r community.  At the f i r s t l e v e l , f a m i l y a p p r a i s a l i s  the d e f i n i t i o n the f a m i l y makes of the s e r i o u s n e s s o f t h e stressor.  I t i s "the f a m i l y ' s s u b j e c t i v e d e f i n i t i o n o f t h e  s t r e s s o r , accompanying hardships and t h e i r e f f e c t on t h e family  (McCubbin & McCubbin, 1991, p. 11).  This  family  o u t l o o k can vary from seeing a s t r e s s o r as a c h a l l e n g e t o be met  o r as an u n c o n t r o l l a b l e s i t u a t i o n .  At the t h i r d  level,  a g l o b a l a p p r a i s a l , or f a m i l y schema, i s a f a m i l y ' s s e t o f b e l i e f s o r assumptions about how i t s members r e l a t e t o one  36 another and  t o the community.  McCubbbin and McCubbin a s s e r t  t h a t although a p p r a i s a l s are h e l d i n d i v i d u a l l y , they can shared by a group and,  s i m i l a r t o R e i s s and  above, b e l i e v e they are formed and  Oliveri  shaped by the  be  (1983)  social  context. More r e c e n t l y , McCubbin, Thompson, Thompson, E l v e r , McCubbin (1994) have drawn up a h i e r a r c h i c a l o r d e r i n g  and  of  f i v e l e v e l s of a p p r a i s a l processes f o r f a m i l i e s i n c r i s i s . L e v e l 5.  Family schema.  An overarching,  i n f o r m a t i o n a l s t r u c t u r e of shared values, expectations,  generalized beliefs,  goals,  and p r i o r i t i e s through which e x p e r i e n c e s  are  filtered. L e v e l 4.  Family coherence.  A d i s p o s i t i o n a l world view t h a t  expresses the f a m i l y ' s confidence  t h a t the world i s  comprehensible, manageable, and meaningful [ f o l l o w i n g Antonovsky  (1979, 1987)].  family i s able to u t i l i z e L e v e l 3.  I t shapes the degree t o which the i t s potential  Family paradigms.  B e l i e f s and  by the f a m i l y t h a t guide i t s p a t t e r n s s p e c i f i c domains of f a m i l y L e v e l 2.  resources. expectations  shared  of f u n c t i o n i n g i n  life.  Situational appraisal.  The  family's  shared  d e f i n i t i o n of the s t r e s s o r , i t s a s s o c i a t e d h a r d s h i p s ,  and  the demands f o r change p l a c e d upon the f a m i l y system. L e v e l 1.  Stressor appraisal.  the s t r e s s o r and  The  family's d e f i n i t i o n  of  i t s severity.  McCubbin et a l . (1994) suggest t h a t g e n e r a l l y f a m i l i e s respond t o s t r e s s f u l s i t u a t i o n s by r e l y i n g upon t h e i r paradigms, or u s u a l p a t t e r n s  of f u n c t i o n i n g .  In  family  crisis  37 s i t u a t i o n s , however, a l l l e v e l s of a p p r a i s a l are a c t i v a t e d t o promote changes i n r o u t i n e s , r o l e s , and e x p e c t a t i o n s ,  and  t o a t t a c h t o the experience a sense of meaning. Patterson  and Garwick (1994) emphasize t h r e e  f a m i l y meanings, r e p r e s e n t i n g and  three  l e v e l s of  l e v e l s of a b s t r a c t i o n  s t a b i l i t y , t h a t shape f a m i l y response.  They suggest  t h a t " f a m i l i e s , as a whole, c o n s t r u c t and share meanings about  (a) s p e c i f i c s t r e s s f u l s i t u a t i o n s , (b) t h e i r i d e n t i t y  as a f a m i l y , and (c) t h e i r view of the world" the f i r s t  level,  (p. 138).  On  "the meanings the f a m i l y a s c r i b e s t o what  i s happening t o them  (demands) and t o what they have f o r  d e a l i n g w i t h i t ( c a p a b i l i t i e s ) are c r i t i c a l a c h i e v i n g balanced f u n c t i o n i n g "  (p. 1 3 2 ) .  factors i n Individual family  members, the f a m i l y as a whole, as w e l l a"s the community, are sources of demands and c a p a b i l i t i e s and t o g e t h e r  shape  the meaning of a s i t u a t i o n . In h i s s o c i o l o g i c a l p e r s p e c t i v e  of s t r e s s , P e a r l i n  (1989) a t t e s t s t o the importance of meanings a t t a c h e d  to  circumstances t h a t render them powerful s t r e s s o r s f o r some i n d i v i d u a l s but not others. values  He b e l i e v e s t h a t a person's  shape the importance and meaning of an e x p e r i e n c e .  In other words, an experience i s p e r c e i v e d  t o be a t h r e a t  when i t a t t a c k s what one d e f i n e s "as important, d e s i r a b l e or t o be c h e r i s h e d " Influences  ( P e a r l i n , 1989, p. 2 4 9 ) . on a p p r a i s a l .  Lazarus and Folkman  suggest two, p e r s o n a l  f a c t o r s t h a t i n f l u e n c e one's  a p p r a i s a l : commitment,  or what i s important t o an  i n d i v i d u a l , and b e l i e f s  (1984)  ( s i m i l a r t o P e a r l i n ' s , 1989,  values  38 and  s o c i a l r o l e importance).  B e l i e f s about p e r s o n a l  are s a i d t o be g e n e r a l l y s t r e s s reducing  and  control  "existential  b e l i e f s enable people t o c r e a t e meaning and m a i n t a i n hope i n difficult  circumstances" (Lazarus  Family t h e o r i s t s and values  and  & Folkman, 1984,  s o c i o l o g i s t s consider  t o be  b e l i e f systems t o be h i g h l y i n f l u e n t i a l i n  1989a).  One's values  and  1988;  b e l i e f system are  thought  i n f l u e n c e d by one's membership i n a s o c i a l group  (Boss, 1988; Reiss  80).  social  shaping the meaning of the s i t u a t i o n (see Boss, Pearlin,  p.  McCubbin & McCubbin, 1991;  & Oliveri,  P e a r l i n , 1989a;  1983).  Relevant s i t u a t i o n a l f a c t o r s i n f l u e n c i n g a p p r a i s a l the n o v e l t y ,  p r e d i c t a b i l i t y , and p r o b a b i l i t y of the  the temporal f a c t o r s of imminence and d u r a t i o n , ambiguity of the e v e n t / s i t u a t i o n , and t o the l i f e c y c l e Johnson  (Lazarus  in relation  Hansen  (1979), i n t h e i r r e c o n c e p t u a l i z a t i o n of  s t r e s s theory,  event,  the  i t s timing  & Folkman, 1984).  and  family  a s s e r t t h a t the c o g n i t i v e and/or  evaluative  uncertainty  i n s i t u a t i o n s i s among t h e i r most s t r e s s f u l  qualities.  Some i n i t i a l s t r e s s experienced by  members i n d i f f i c u l t  family  s i t u a t i o n s can r e s u l t from such  ambiguity p r e c l u d i n g c o n s i s t e n t coping McCubbin & McCubbin, 1991).  e f f o r t s (Boss,  Lazarus and  Folkman  1988;  (1984),  however, suggest t h a t ambiguity w i t h i n a s i t u a t i o n has d u a l nature; i t can  are  a  i n t e n s i f y one's a n x i e t y but a l s o can  be  used t o reduce t h r e a t by a l l o w i n g d i f f e r e n t i n t e r p r e t a t i o n s of a s i t u a t i o n .  39 Appraisal operationalized. although the f a m i l y ' s p e r c e p t i o n  Boss (1988) a s s e r t s  of the s i t u a t i o n i s the  most important p a r t of the s t r e s s equation, least studied.  I t may  i t has  be h e l p f u l t o c o n s i d e r  which the concept of a p p r a i s a l has various  that  been the  the ways i n  been o p e r a t i o n a l i z e d  scholars.  Folkman, Lazarus, Dunkel-Schetter, DeLongis, and  Gruen  (1986) o p e r a t i o n a l i z e primary a p p r a i s a l as "the stakes person has  i n a s t r e s s f u l encounter."  Lazarus, 1980)  and  (see Folkman &  a review of the l i t e r a t u r e ,  a p p r a i s a l f a c t o r s are i d e n t i f i e d :  a  From a review of  s u b j e c t s ' responses to open-ended questions  esteem,  by  s i x primary  (a) t h r e a t s t o  (b) t h r e a t s to loved one's w e l l being,  self-  (c)  the  t h r e a t of not a c h i e v i n g an important goal at work, (d) harm t o one's own  h e a l t h , s a f e t y , or p h y s i c a l w e l l - b e i n g ,  f i n a n c i a l s t r a i n , and  (f) l o s i n g r e s p e c t  (e)  f o r someone e l s e .  Secondary a p p r a i s a l i s o p e r a t i o n a l i z e d by Folkman e t a l . as "coping  options."  Subjects  i n d i c a t e the extent  t o which  they p e r c e i v e the s i t u a t i o n to be one  t h a t they  change or do something about,  t o accept,  t o know more before  (b) had  they c o u l d a c t , or  from doing what they wanted to do.  (d) had  (a)  could  (c) needed  t o h o l d back  This o p e r a t i o n a l i z a t i o n  then, attempts to capture the i n d i v i d u a l ' s p e r c e p t i o n s the c o n t r o l l a b i l i t y of the Walker (1985, p. 832)  of  situation. a s s e r t s "those who  s t r e s s c o n t i n u e t o p o s t u l a t e the e x i s t e n c e  and  study  family  importance of  the f a m i l y ' s d e f i n i t i o n of the event, even though i t has t o be o p e r a t i o n a l i z e d or measured."  There have, however,  yet  40 been some r e c e n t attempts i n t h i s regard.  For example,  McCubbin and McCubbin (1991) d i s c u s s the f a m i l y ' s d e f i n i t i o n of the s e r i o u s n e s s of the s t r e s s o r i n terms of a p p r a i s a l " or "reframing." conceptual  Yet t h e r e appears t o be some  o v e r l a p because coping s c a l e s developed  McCubbin and c o l l e a g u e s i n c l u d e items such as and  "positive  by  "reframing",  " m a i n t a i n i n g an o p t i m i s t i c d e f i n i t i o n of the  situation."  P a t t e r s o n and Garwick (1994), as w e l l , i n a q u a l i t a t i v e a n a l y s i s of f a m i l i e s and c h r o n i c i l l n e s s ,  speak of the  f a m i l y ' s a t t r i b u t i o n of meaning i n terms of  selective  a t t e n t i o n t o p o s i t i v e aspects of the s i t u a t i o n , minimizing  l i m i t a t i o n s or problems.  while  There does not appear  t o be the maintenance of a c l e a r d i s t i n c t i o n between the concepts  of a p p r a i s a l and  coping.  At the more a b s t r a c t l e v e l s of f a m i l y a p p r a i s a l , McCubbin and McCubbin (1991), McCubbin et a l . (1994), P a t t e r s o n and Garwick (1994), f o l l o w i n g Antonovsky 1987), d i s c u s s "sense of coherence."  and  (1979,  Sense of coherence a t  the i n d i v i d u a l l e v e l has been o p e r a t i o n a l l y d e f i n e d by Antonovsky  (1979) as  environment),  (a) c o m p r e h e n s i b i l i t y (a p r e d i c t a b l e  (b) manageability  (c) meaningfulness  (available resources),  (demands worthy of engagement).  study of army f a m i l i e s ' a d a p t a t i o n t o r e l o c a t i o n , McCubbin, and P a t t e r s o n  and  In a Lavee,  (1985) o p e r a t i o n a l i z e d coherence as  a composite of f a m i l y members' commitment t o the Army m i s s i o n , t h e i r sense of p r e d i c t a b i l i t y , and the p e r c e p t i o n of " f i t "  between the f a m i l y and the Army l i f e s t y l e .  Family  coherence a l s o has been o p e r a t i o n a l i z e d as the degree t o  41 which f a m i l i e s c a l l upon t h e i r a p p r a i s a l s k i l l s acceptance, refraining, and b e l i e f i n God) s t r e s s f u l events and s i t u a t i o n s  ( i n terms of  t o manage  (McCubbin, L a r s e n , & Olson,  1982) . In t h e i r work on f a m i l i e s and c h r o n i c Patterson  and Garwick  illness,  (1994) have attempted  through  q u a l i t a t i v e methods t o understand the meanings t h a t  family  members share about the i l l n e s s and i t s impact on t h e i r lives.  These s c h o l a r s p o i n t out the need f o r new  o p e r a t i o n a l i z e f a m i l y system v a r i a b l e s . work of R e i s s , paradigm"  They mention  S t e i n g l a s s , and Howe (1993) i n which  the  "family  i s o p e r a t i o n a l i z e d through f a m i l y i n t e r a c t i o n i n a  l a b o r a t o r y , p r o b l e m - s o l v i n g task. f u r t h e r s t u d i e s of how about  methods t o  They a s s e r t we  need  f a m i l i e s share and c o n s t r u c t meanings  i l l n e s s and d i s a b i l i t y .  T h i s a s s e r t i o n i s not f a r  removed from t h a t of Walker (1985, p. 833) "what i s important i s not the ' f a m i l y ' s  who  stresses that  ' d e f i n i t i o n of the  s t r e s s o r but an understanding of i n d i v i d u a l p e r s p e c t i v e s regarding  s t r e s s f u l s i t u a t i o n s , how  these  perspectives  r e l a t e t o behavior, and the i n f l u e n c e s of members' perspectives  i n combination."  T h i s b r i e f overview i n d i c a t e s t h a t both i n d i v i d u a l and f a m i l y s t r e s s t h e o r i s t s have attempted t o capture s i t u a t i o n a l a p p r a i s a l , a t one l e v e l or another, perceptions  of demands and resources,  through  perceptions  c o n t r o l l a b i l i t y , and a t t e n t i o n t o meanings.  of  Whereas the  o p e r a t i o n a l i z a t i o n s of a p p r a i s a l by Folkman e t a l . (1986) and Antonovsky  (1979) maintain the d i s t i n c t i o n between the  42 concepts  of a p p r a i s a l and coping, other o p e r a t i o n a l i z a t i o n s  appear t o c o n t a i n some conceptual o v e r l a p . Coping Compatible d e f i n i t i o n s of coping were reviewed l e n g t h above.  A t t e n t i o n now  at  i s d i r e c t e d t o coping  f u n c t i o n s , assessment methods, and outcomes. Coping  Functions.  In t h e i r study of responses  normative l i f e - s t r a i n s , P e a r l i n and Schooler  to  (1978)  i d e n t i f i e d c a t e g o r i e s of coping d i f f e r e n t i a t e d by the of t h e i r f u n c t i o n . coping responses: situation,  They noted t h r e e d i f f e r e n t f u n c t i o n s of (a) those t h a t were aimed a t m o d i f y i n g  (b) those t h a t were intended t o c o n t r o l  meaning of the problem, and  (c) those responses  f u n c t i o n e d t o c o n t r o l the emotional response situation,  the  the  that  t o the  "to accommodate t o e x i s t i n g s t r e s s without  overwhelmed by i t "  nature  ( P e a r l i n & Schooler, 1978,  being  p. 7 ) .  These coping f u n c t i o n s are present i n the  coping  e f f o r t s d e s c r i b e d by McCubbin and McCubbin (1991) and P a t t e r s o n and Garwick (1994).  F i v e examples are g i v e n of  these p r o b l e m - s o l v i n g  (a) d i r e c t a c t i o n t o reduce  efforts:  demands, (b) d i r e c t a c t i o n to a c q u i r e a d d i t i o n a l r e s o u r c e s , (c) m a i n t a i n i n g and r e a l l o c a t i n g e x i s t i n g  resources  ( m a i n t a i n i n g and e n r i c h i n g s o c i a l networks),  (d) managing  the t e n s i o n a s s o c i a t e d with ongoing s t r a i n s , and  (e)  r e a p p r a i s i n g a s i t u a t i o n i n order to make i t more manageable (lowering performance e x p e c t a t i o n s ) . Lazarus and Folkman (1984) agree t h a t an  important  d i s t i n c t i o n i n the f u n c t i o n s of coping i s between the  43 e f f o r t s t h a t a r e d i r e c t e d a t managing o r a l t e r i n g t h e problem  (problem-focussed coping) and those e f f o r t s aimed a t  r e g u l a t i n g one's emotional response t o i t (emotion-focussed coping).  S t r a t e g i e s of emotion-focussed c o p i n g can be  cognitive  (a d e l i b e r a t e r e a p p r a i s a l of t h e s i t u a t i o n ) o r  behavioural support).  ( e x e r c i s e or seeking i n f o r m a t i o n and s o c i a l Problem-focussed  g r e a t e r than, problem  coping i s s i m i l a r t o , but  solving  (Lazarus & Folkman, 1984) . I t  i n c l u d e s s t r a t e g i e s t h a t a r e d i r e c t e d a t both t h e environment  and t h e s e l f .  An example of t h e l a t t e r i s  c o g n i t i v e change t h a t a s s i s t s t h e i n d i v i d u a l i n managing t h e problem.  Folkman e t a l . (1991) note t h a t i n g e n e r a l ,  problem-focussed  coping i s a p p r o p r i a t e i n s i t u a t i o n s  that  have a p o t e n t i a l f o r change, whereas emotion-focussed i s more a p p r o p r i a t e i n s i t u a t i o n s with  coping  little  controllability. In h i s d i s c u s s i o n of f a m i l y coping, K l e i n suggests problem  (1983) a l s o  s o l v i n g and coping d i f f e r mainly i n degree.  Whereas a f a m i l y s o l v e s i t s problems by e l i m i n a t i n g o r completely overcoming  them, a f a m i l y copes w i t h more  s e v e r e l y s t r e s s f u l s i t u a t i o n s by a c c e p t i n g and managing them. Coping Assessment.  Some coping s c a l e s a r e designed f o r  wide a p p l i c a b i l i t y , whereas others a r e intended t o measure c o p i n g o n l y w i t h i n a p a r t i c u l a r context (Cohen,  1987).  Lazarus and Folkman (1984) developed a Ways o f Coping C h e c k l i s t c o n t a i n i n g 67 g e n e r a l coping items t h a t  indicate  what an i n d i v i d u a l t h i n k s , f e e l s , or does i n response t o a  44 specific situation.  F a c t o r a n a l y s i s by Folkman e t a l .  (1986) has y i e l d e d the f o l l o w i n g e i g h t s c a l e s d i f f e r e n t i a t e d by type of response:  c o n f r o n t i v e coping, d i s t a n c i n g , s e l f -  c o n t r o l , s e e k i n g s o c i a l support, a c c e p t i n g r e s p o n s i b i l i t y , escape-avoidance, reappraisal.  p l a n f u l problem s o l v i n g and  positive  Some i n v e s t i g a t o r s have added items t o the  Ways of Coping S c a l e t o more a c c u r a t e l y assess c o p i n g s t r a t e g i e s w i t h i n a p a r t i c u l a r context P e a r l i n and Schooler  (Cohen, 1987) .  (1978) examined 17  coping  s t r a t e g i e s , r e p r e s e n t i n g the t h r e e f u n c t i o n s mentioned above, i n the f o u r r o l e areas of marriage, household  economics, and occupation.  parenting,  Although the f u n c t i o n s  of c o p i n g were found t o be the same i n a l l areas, the s t r a t e g i e s used and t h e i r e f f e c t i v e n e s s v a r i e d a c c o r d i n g t o s o c i a l context.  For example, whereas the m a n i p u l a t i o n of  g o a l s and v a l u e s was  an e f f e c t i v e coping s t r a t e g y i n the  o c c u p a t i o n a l and economic areas, i t was of f a m i l y r e l a t i o n s h i p s .  In marriage  c o n t i n u i n g commitment and involvement  not so i n the area  and parenthood, i n these  a  relationships  i s less l i k e l y to r e s u l t i n d i s t r e s s . McCubbin and c o l l e a g u e s have developed the assessment of f a m i l y coping i n s p e c i f i c  inventories for situations.  These measures concentrate on coping s t r a t e g i e s i n c r i s e s , i n cases of s e r i o u s c h i l d i l l n e s s , or i n s p o u s a l s e p a r a t i o n . Because of t h e i r s p e c i f i c i t y , they are not as w i d e l y a p p l i c a b l e t o a v a r i e t y of s i t u a t i o n s . Thoits  (1991) g i v e s us a good example of the way  which the work of v a r i o u s s t r e s s t h e o r i s t s can be  in  brought  45 t o g e t h e r t o f a c i l i t a t e a more complete understanding o f a phenomenon.  T h o i t s has examined coping through s u b j e c t s '  w r i t t e n d e s c r i p t i o n s of t h e i r responses t o emotional e x p e r i e n c e s , accounts which were coded a c c o r d i n g t o a model of c o p i n g the author developed.  Flowing from the work of  P e a r l i n and Schooler (1978) and Lazarus and Folkman (1984) , c o p i n g responses are seen t o be e i t h e r c o g n i t i v e or behavioural.  A l s o borrowing from these s c h o l a r s , the model  d i s t i n g u i s h e s between responses t h a t are problem-focussed and emotion-focussed.  T h e r e f o r e her model d i f f e r e n t i a t e s  c o p i n g responses on two dimensions, the mode of response ( b e h a v i o u r a l or c o g n i t i v e ) , and the t a r g e t of the response ( s i t u a t i o n - f o c u s s e d or emotion-focussed). Thoits'  Based upon  (1984) work on the nature of emotion, the  emotion-  f o c u s s e d s t r a t e g i e s are f u r t h e r d i v i d e d i n t o those concerned w i t h p h y s i o l o g i c a l changes, emotional l a b e l s .  Thoits  e x p r e s s i v e g e s t u r e s , and  (1991) p o i n t s out t h i s model i s  a b l e t o accommodate a l l the coping s t r a t e g i e s t h a t have been i d e n t i f i e d i n p r e v i o u s r e s e a r c h , and has been shown t o be u s e f u l i n comparing  gender d i f f e r e n c e s i n c o p i n g .  Coping Outcomes.  In her overview of the measurement of  coping, Cohen (1987) i d e n t i f i e s t h r e e areas of outcome e f f e c t s : p s y c h o l o g i c a l , s o c i a l , and p h y s i o l o g i c a l .  The  p s y c h o l o g i c a l e f f e c t s are emotional r e a c t i o n s , g e n e r a l w e l l being, and t a s k performance;  s o c i a l outcomes i n c l u d e changes  i n i n t e r p e r s o n a l r e l a t i o n s h i p s and s o c i a l r o l e  performance;  and p h y s i o l o g i c a l e f f e c t s vary from s h o r t term  physiological  r e a c t i o n s t o long term h e a l t h changes.  Cohen p o i n t s out  46 t h a t a p a r t i c u l a r coping mode can have d i f f e r e n t e f f e c t s i n the t h r e e outcome domains. S i m i l a r l y , Lazarus and basic adaptational somatic h e a l t h .  Folkman (1984) i d e n t i f y  outcomes: s o c i a l f u n c t i o n i n g , morale,  They see s o c i a l f u n c t i o n i n g as both  manner i n which an i n d i v i d u a l f u l f i l l s h i s or her r o l e s , and  a l s o as one's s a t i s f a c t i o n with  relationships.  Morale i s considered  multidimensional  and  the  social  interpersonal  t o be a  concept t h a t i s concerned w i t h how  see themselves and t h e i r c o n d i t i o n s of l i f e . between coping  three  people  The  link  and h e a l t h i s based on the premise t h a t  a p p r a i s a l s of s i t u a t i o n s as s t r e s s f u l are accompanied s t r o n g emotional s t a t e s .  by  These i n t e n s e emotions are assumed  t o be c a u s a l f a c t o r s i n i l l n e s s . Pearlin  (1989) i d e n t i f i e s m u l t i p l e i n d i c a t o r s t h a t have  been chosen as outcome measures i n s o c i o l o g i c a l s t u d i e s the s t r e s s process:  p h y s i c a l h e a l t h , a v a r i e t y of dimensions  of mental h e a l t h , s o c i a l r o l e f u n c t i o n i n g , and maintenance of s o c i a l r e l a t i o n s h i p s .  the  P e a r l i n (1991) c a l l s  a t t e n t i o n t o the d i s t i n c t i o n between d i r e c t and e f f e c t s of coping.  He  states that generally,  indirect researchers  look a t the dependent v a r i a b l e , such as d e p r e s s i o n , a s c e r t a i n coping t h a t i f coping  effectiveness.  He  of coping e f f i c a c y .  we may  miss an a c c u r a t e  out  other,  indirectly influence  suggests t h a t by r e s t r i c t i n g our  d i r e c t e f f e c t s of coping,  to  P e a r l i n (1991) p o i n t s  e f f o r t s i n h i b i t the development of  secondary s t r e s s o r s , they can depression.  of  this  focus  to  assessment  47 The  McCubbin and McCubbin (1991) model views f a m i l y  adjustment and efforts,  adaptation  as outcomes over time of  i n a s t r e s s f u l s i t u a t i o n , t o achieve a "new  of balance and  fit"  between demands and  (McCubbin & McCubbin, 1991,  p. 15).  s u c c e s s f u l f a m i l y adaptation  level  capabilities  When i n t e r a c t i o n of  r e l e v a n t components r e s u l t s i n p r o d u c t i v e  results  family  the  problem s o l v i n g ,  t o the s t r e s s f u l s i t u a t i o n  ( r e s t o r e d f u n c t i o n a l s t a b i l i t y and/or improved  f a m i l y s a t i s f a c t i o n ) ; when the f a m i l y i s unable t o respond i n a c o n s t r u c t i v e manner, a c r i s i s s i t u a t i o n ensues.  These  authors emphasize t h a t "a f a m i l y  carry  the s t i g m a t i z i n g value failed,  * i n c r i s i s ' does not  judgement t h a t somehow the f a m i l y  has  i s d y s f u n c t i o n a l , or i s i n need of p r o f e s s i o n a l  counseling"  (McCubbin & McCubbin, 1991,  Patterson  and  p.  14).  Garwick (1994) a l s o c o n c e p t u a l i z e  the  outcome of f a m i l y e f f o r t s t o achieve balanced f u n c t i o n i n g f a m i l y adjustment and  adaptation.  They see good outcomes  r e f l e c t e d i n (a) p o s i t i v e p h y s i c a l and mental h e a l t h f a m i l y members, (b) optimal members, and  as  r o l e f u n c t i o n i n g of  of  family  (c) the maintenance of a f a m i l y u n i t t h a t  can  accomplish i t s l i f e c y c l e t a s k s . The  t h e o r e t i c a l overview above f a c i l i t a t e s a c l e a r  comprehension of what i s meant by the key and  "coping";  concepts, " s t r e s s "  i t g i v e s a shared language f o r a meaningful  d i s c u s s i o n of the e m p i r i c a l l i t e r a t u r e .  The  overview w i t h  i t s i n t e g r a t i o n of v a r i o u s t h e o r e t i c a l approaches, has  shown  t h a t d i f f e r e n t t h e o r i s t s d i s c u s s the s t r e s s p r o c e s s i n compatible ways.  I t has  shown t h a t whether the approach i s  48 social-psychological sociological  ( i . e . , Lazarus & Folkman,  ( i . e . , P e a r l i n , 1989; P e a r l i n & Schooler  or s p e c i f i c a l l y f a m i l y focussed & McCubbin, about coping  1991; P a t t e r s o n  ( i . e . , Boss, 1988;  1978),  McCubbin  & Garwick, 1994), t h e o r i z i n g  i n s t r e s s f u l situations categorizes  elements of the process as demands, i n t e r v e n i n g and outcome.  1984),  significant constructs,  Such a c a t e g o r i z a t i o n i s able t o accommodate  the r e l e v a n t f a c t o r s i d e n t i f i e d by the l i t e r a t u r e on f a m i l y response t o c h r o n i c i l l n e s s  (see B i e g e l e t a l . , 1991; Cole &  R e i s s , 1 9 9 3 ; H a t f i e l d , 1987b; Johnson, 1990; R o l l a n d ,  i  1989).  49 Chapter IV Review of E m p i r i c a l F i n d i n g s As p r e v i o u s l y mentioned, a t h e o r e t i c a l understanding the s t r e s s process  enables  of  us t o a p p r e c i a t e t h e e m p i r i c a l  r e l a t i o n s h i p s found w i t h i n the v a r i a b i l i t y o f f a m i l y and illness.  A t h e o r e t i c a l focus a l s o a l e r t s one t o r e s e a r c h  limitations.  Applying  f a m i l y experience  s t r e s s and coping theory t o t h e  with s c h i z o p h r e n i a , I c a t e g o r i z e d t h e  v a r i a b i l i t y as f o l l o w s : 1.  Demands  (a) s i t u a t i o n a l s t r e s s (b) s o c i e t a l s t r e s s (c) i a t r o g e n i c s t r e s s 2. I n t e r v e n i n g  Constructs  (a) c a r e g i v e r c h a r a c t e r i s t i c s : i n d i v i d u a l and f a m i l y (b) c h a r a c t e r i s t i c s of person with (c) s o c i a l support  and community  schizophrenia  resources  (d) f a m i l y and i n d i v i d u a l p e r c e p t i o n s of s c h i z o p h r e n i a (e) t h e coping e f f o r t s of f a m i l y members - attempts t o manage the s i t u a t i o n 3. Outcome (a) p h y s i c a l and mental h e a l t h , s o c i a l f u n c t i o n i n g 4. L i m i t a t i o n s of past  research Demands  Lefley cumulative  (1990) c o n c e p t u a l i z e s three main sources o f s t r e s s i n f a m i l i e s of persons with  s i t u a t i o n a l , s o c i e t a l , and i a t r o g e n i c .  schizophrenia:  She sees t h e  50 v a r i a b i l i t y of context as an important i n f l u e n c e on f a m i l y response. S i t u a t i o n a l Stress In point  a s s e s s i n g f a m i l y response t o s t r e s s ,  "the  starting  ... i s not the occurrence of a s t r e s s o r event but the  seemingly normal s t a t e of f a m i l y d i s o r d e r " (Lavee, McCubbin, & Olson, 1987,  p. 871).  (Aldous & K l e i n , 1988)  A g a i n s t t h i s "background n o i s e " of normative t r a n s i t i o n s and  f a m i l i e s of persons with s c h i z o p h r e n i a may  events,  experience  ongoing problems i n the areas of employment, housing, h e a l t h , c h i l d r e a r i n g , and marriage  ( M c G i l l , 1990)  that  t o g e t h e r w i t h the i l l n e s s , c o n t r i b u t e t o the demands upon the f a m i l y . Other s i t u a t i o n a l s t r e s s may  r e s u l t from the  i n t e r s e c t i o n of the i l l n e s s with the developmental the f a m i l y .  stage of  The onset of c h r o n i c i l l n e s s can cause a  "permanent stuckness" a t the phase of development a t which it  occurs  (Rolland, 1989,  p. 449).  E x p e c t a t i o n s are t h a t  young a d u l t s w i l l not only e s t a b l i s h t h e i r t h e i r own  independence,  source of income and coherent s e t of v a l u e s , but  a l s o prove a b l e t o get along with o t h e r s , e s t a b l i s h i n t i m a c y , and develop a s o c i a l network (Ireys & Burr, 1984). The onset of s c h i z o p h r e n i a e a r l y i n adulthood, t h i s developmental independence,  trend.  interrupts  While c o n t i n u i n g t o d e s i r e  persons with s c h i z o p h r e n i a f i n d i t d i f f i c u l t  t o i n t e r a c t w i t h others and t o maintain employment (Torrey, 1983) .  They remain dependent upon o t h e r s , o f t e n p a r e n t s  and/or s i b l i n g s , both f i n a n c i a l l y and e m o t i o n a l l y , whether  51 or not they remain  i n the p a r e n t a l home.  Parents are  r e q u i r e d t o r e a d j u s t t h e i r e x p e c t a t i o n s f o r t h e i r son or daughter  and n e g o t i a t e new  role relationships  ( I r e y s & Burr,  1984), working t o e s t a b l i s h a balance between s t i m u l a t i o n and  p a s s i v e acceptance  ( F a l l o o n , M c G i l l , & Hardesty,  At the same time, they must n e g o t i a t e l i m i t s on Middle-aged  parents may  1985).  behaviour.  be r e q u i r e d t o resume an  p a r e n t i n g r o l e a t a time when perhaps  active  they were a n t i c i p a t i n g  freedom from the r e s p o n s i b i l i t i e s of c a r i n g f o r o f f s p r i n g , a circumstance t h a t may  create d i f f i c u l t i e s f o r parents i n  r e l a t i n g t o t h e i r peers  ( H a t f i e l d , 1987b).  Mothers i n  p a r t i c u l a r have expressed concern and disappointment the l a c k of independence of t h e i r m e n t a l l y i l l children  (Cook, 1988).  M i d - l i f e parents may  adult  find  caught between the continued dependence of these and r e s p o n s i b i l i t i e s t o e l d e r l y parents  over  themselves children  (Hatfield,  1990).  A study of persons with s c h i z o p h r e n i a i n 1956  showed  t h a t t h r e e - q u a r t e r s of p a r e n t a l c a r e g i v e r s were over the of 60 and 40% over the age of 70 o l d e r p a r e n t s may  (Wing, 1987a).  age  Although  have a d j u s t e d t o the continued dependence  of an a d u l t c h i l d with s c h i z o p h r e n i a , they are " a t a time i n l i f e when they have the l e a s t energy t o i n v e s t i n t h i s of e m o t i o n a l l y and p h y s i c a l l y d r a i n i n g e f f o r t . may  type  T h i s demand  be an unrecognized mental h e a l t h r i s k f o r o l d e r persons"  ( L e f l e y , 1990,  p. 146).  An assessment of burden f e l t  by  e l d e r l y r e l a t i v e s of persons with s c h i z o p h r e n i a has shown a dependence on parents of pensionable age, w i t h c o n s i d e r a b l e f i n a n c i a l and emotional burden (Stevens, 1972).  In  52 a d d i t i o n , o l d e r parents may who  be p a r t i c u l a r l y concerned about  w i l l p r o v i d e care and support t o the son or daughter  w i t h s c h i z o p h r e n i a when they, themselves, are gone (Grunebaum, 1986;  H a t f i e l d , 1987b; L e f l e y , 1987b).  D e s p i t e the i l l n e s s of an a d u l t c h i l d , f a m i l y members c o n t i n u e t o have t h e i r own  needs t h a t must be met.  Studies  have shown d i v i s i v e e f f e c t s of s c h i z o p h r e n i a on the f a m i l y , with c o n f l i c t s , members and 1974;  j e a l o u s y , and d i v i d e d l o y a l t i e s among f a m i l y  s t r a i n e d spousal r e l a t i o n s h i p s (Creer & Wing,  Vaughn et a l . , 1984). S i b l i n g s must d e a l with the c o n f u s i o n , f e a r , and  f e e l i n g s of entrapment r e s u l t i n g from a d i a g n o s i s of s c h i z o p h r e n i a i n a s i s t e r or brother have s p e c i f i c needs t h a t may  (Carlisle,  1984). They  d i f f e r from those of  other  f a m i l y members (Landeen e t a l . , 1992), developmental needs t h a t o f t e n are not being met siblings s t i l l  (Carlisle,  1984).  Young  at home have been found t o be a f f e c t e d i n  d i f f e r e n t ways by the mental i l l n e s s of a b r o t h e r or some f e l t more focus and e x p e c t a t i o n s from p a r e n t s , f e l t n e g l e c t e d and  (Carlisle,  1984).  They have  embarrassment at the p e c u l i a r behaviours s i b l i n g and The  others  l o n e l y , while the m a j o r i t y r e p o r t e d  took s i d e s and s h i f t e d a l l e g i a n c e s i n the conflicts  sister;  f e a r f o r t h e i r own  they  inevitable  expressed of the m e n t a l l y i l l  mental h e a l t h (Torrey, 1983).  impact of s c h i z o p h r e n i a on a d u l t s i b l i n g s '  has been found t o range from p e r v a s i v e t o d i s c r e t e , t h r e e p a t t e r n s of s i b l i n g response:  lives with  ongoing c o l l a b o r a t i o n  w i t h other f a m i l y members, c r i s i s o r i e n t e d , and  detached  53 (Gerace, C a m i l l e r i , & Ayres, 1993).  Older m a r r i e d  siblings  have r e g i s t e r e d concern about t h e h e r e d i t a r y r i s k f o r t h e i r own c h i l d r e n ; they d e s i r e i n f o r m a t i o n about t h e p r o g n o s i s o f s c h i z o p h r e n i a , and express concerns over t h e s i b l i n g ' s a b i l i t y t o l i v e independently and t o have an adequate of  f i n a n c i a l support  (Landeen e t a l . ,  appear t o be w e l l founded  1992).  level  T h e i r concerns  f o r i t has been shown t h a t  s i b l i n g s r e p l a c e p a r e n t a l c a r e g i v e r s over t h e l i f e  course  (Horwitz, 1993) . In  h e r d e s c r i p t i o n of l i v i n g w i t h a s i s t e r who has  s c h i z o p h r e n i a , Margaret Moorman of  (1992) r e v e a l s h e r f e e l i n g s  hopelessness i n a c h i e v i n g any balance between h e r  s i s t e r ' s consuming need and t h a t of the f a m i l y .  She  e l o q u e n t l y speaks o f her deep sadness and f e a r as h e r "private iceberg." Other aspects of s i t u a t i o n a l s t r e s s vary a c c o r d i n g t o the stage and s e v e r i t y of t h e i l l n e s s and types o f symptoms expressed.  Some f a m i l y members r e p o r t f i n d i n g a g r a d u a l ,  i n s i d i o u s onset g r e a t l y d i s t r e s s i n g  ( C a r l i s l e , 1984;  Moorman, 1992), whereas r e s e a r c h on f a m i l y e x p e r i e n c e o f first  episode s c h i z o p h r e n i a has i d e n t i f i e d f l o r i d  a s s o c i a t e d w i t h h i g h l e v e l s of d i s t r e s s  symptoms  (McCreadie e t a l . ,  1987) . Reviews o f r e s e a r c h on f a m i l y burden show i t t o be s t r o n g l y r e l a t e d t o the l e v e l and type of symptomatology (for  reviews see B i e g e l e t a l . ,  s t u d i e s reviewed  1991; Johnson, 1990).  found g r e a t e r f a m i l y d i s t r e s s t o be  a s s o c i a t e d with b i z a r r e thought and behaviour, and  Some  54 a g g r e s s i v e , uncooperative behaviour, and other r e s e a r c h showed n e g a t i v e symptoms of s o c i a l withdrawal t o be of more concern.  Other r e p o r t s suggest t h a t the u n p r e d i c t a b i l i t y of  p a t i e n t responses, p a r t i c u l a r l y those of an o f f e n s i v e or t h r e a t e n i n g nature are most d i f f i c u l t t o t o l e r a t e Horn, Powell, & Gibbons, Runions  1984;  Falloon & McGill,  (Gibbons, 1985).  and Prudo (1983) found t h a t by f a r the most f r e q u e n t  problems were those concerned with n e g a t i v e symptoms ( f l a t t e n i n g of a f f e c t , poverty of speech, l o s s of v o l i t i o n ) , whereas the problems most d i f f i c u l t t o manage i n c l u d e d those w i t h i n s i g h t compliance and p o s i t i v e symptoms h a l l u c i n a t i o n s , thought  (delusions,  disorder).  I n t e r e s t i n g l y , d i f f e r e n c e s i n p e r c e p t i o n s of most bothersome behaviours were noted between f a m i l y c a r e g i v e r s and mental h e a l t h p r o f e s s i o n a l s ; although nurses p e r c e i v e d s u i c i d a l behavior t o be most d i s t r e s s i n g t o f a m i l i e s , f a m i l i e s themselves  i n d i c a t e d the r e l a t i v e ' s i n a b i l i t y t o  a c h i e v e h i s or her p o t e n t i a l t o be of most concern 1987) .  the  (McElroy,  Evidence f o r the e f f e c t of d u r a t i o n of i l l n e s s i s  a l s o e q u i v o c a l with some s t u d i e s showing d e c r e a s i n g l e v e l s of burden over time and others i n d i c a t i n g t h a t  burden  c o n t i n u e s and s t r e s s l e v e l s i n c r e a s e (Gibbons e t a l . , Johnson,  1990).  A l l s t u d i e s i n d i c a t e t h a t whatever the  symptoms, t h e i r number and s e v e r i t y s t r o n g l y p r e d i c t of f a m i l y  1984;  levels  burden.  P o s s i b l y connected t o the s e v e r i t y and course of the i l l n e s s i s r e s i d e n c e of the person with s c h i z o p h r e n i a . the time of onset, most young people l i v e w i t h t h e i r  At  55 f a m i l i e s ; i f r e j e c t i o n by the parents occurs, a f t e r s e v e r a l episodes disturbance  i t i s usually  of i l l n e s s and a s s o c i a t e d behaviour  ( F a l l o o n e t a l . , 1984).  Parents  f e e l a burden  of c a r e , however, whether or not the son or daughter r e s i d e s w i t h them.  In f a c t , one  study r e p o r t e d t h a t more b e h a v i o r a l  problems and g r e a t e r need f o r s e r v i c e s was  expressed  by  p a r e n t s whose o f f s p r i n g l i v e d o u t s i d e the home ( C a r p e n t i e r e t a l . , 1992). Other r e s e a r c h found t h a t p a t i e n t s who moved out of the home and who  l i v e d alone continued  burden f o r the f a m i l y whereas those p a t i e n t s who s u p e r v i s e d accommodations presented Sainsbury,  1963).  had  t o be a  were i n  no problems (Grad &  Despite the h e t e r o g e n e i t y  amount of f a m i l y contact, most people with  i n type  and  schizophrenia  r e l y on the f a m i l y of o r i g i n f o r a sense of connectedness and b e l o n g i n g  (Doane, 1991), as w e l l as a sense of  purpose and p r o t e c t i o n (McGlashan, 1987); they  life  maintain  c o n s i d e r a b l e f a c e - t o - f a c e contact, and o f t e n overwhelm p a r e n t s ' a b i l i t y t o cope (Carpentier e t a l . , 1992). Societal  Stress  Lefley  (1990) c o n s i d e r s s o c i e t a l s t r e s s t o come from  c u l t u r a l a t t i t u d e s toward mental i l l n e s s , negative  expectancies  t h a t g e n e r a l ignorance  of recovery.  stigma,  I t has been suggested  i n s o c i e t y about s c h i z o p h r e n i a  t o s o c i e t a l f e a r of persons connected with t h i s (Dearth,  Labenski,  and  Mott, & P e l l e g r i n i ,  1986).  illness Isolating  d e b i l i t a t i n g e f f e c t s of the stigma of mental i l l n e s s f a m i l i e s are widely r e p o r t e d Steinwachs et a l . , 1992;  leads  and  on  (McFarlane e t a l . , 1993;  Wahl & Harman, 1989;  Wasow, 1983).  56 T h r e e - q u a r t e r s of a l l members of the N a t i o n a l A l l i a n c e f o r the M e n t a l l y  111  i d e n t i f i e d stigma as having a l a r g e  u n f a v o r a b l e impact on t h e i r mentally  i l l r e l a t i v e s , and  h a l f of the members b e l i e v e d f a m i l i e s i n g e n e r a l n e g a t i v e l y a f f e c t e d (Wahl & Harman, 1989). h a l f to three-quarters  of them f e l t i t had  impact on aspects of t h e i r own  life,  one-  were  Although little  awareness of  one-  or  no  negative  p u b l i c r e a c t i o n s t o t h e i r i l l r e l a t i v e c o u l d be construed a s o c i e t a l c o n t r i b u t i o n t o the concerns of the  as  family.  Less i n d u s t r i a l i z e d c u l t u r e s are thought t o be more accepting  of mental p a t i e n t s , not t o blame them f o r t h e i r  c o n d i t i o n , and  t o accommodate them more r e a d i l y w i t h i n  s o c i e t y ; China, which has very strong stigma a t t a c h e d mentally  i l l and  Kleinman, 1988;  t h e i r f a m i l i e s , i s one Torrey,  1983).  exception  members are thought to i n f l u e n c e p a r e n t s '  the  (Lin &  Cultures that s t r e s s  interdependence r a t h e r than the independence of  to  the  family  expectancies f o r  o f f s p r i n g , with i m p l i c a t i o n s f o r f a m i l y adjustment t o schizophrenia.  Such interdependent f a m i l i e s are more l i k e l y  t o accept the need of the p a t i e n t f o r a s a f e haven, e i t h e r a t home or i n other community care, and  less l i k e l y  to  e n t e r t a i n the high-expectancy o b j e c t i v e of independent living,  an e x p e c t a t i o n  anxiety  so c e n t r a l t o the i l l n e s s  Iatrogenic  t h a t may  ( L e f l e y , 1987a).  Stress  Much of the t h i n k i n g and therapies  exacerbate the f e e l i n g s of  language of the  "new"  family  seems to be mired down i n o l d e r t h e o r i e s t h a t have  presumably been d i s c r e d i t e d ( H a t f i e l d , 1987a).  Clinicians  57 s t i l l p e r c e i v e f a m i l i e s w i t h i n a d e f i c i t framework; i f p a t i e n t r e l a p s e occurs, f a m i l i e s a r e blamed and made t o f e e l guilty  (Johnson,  1990; L e f l e y , 1990).  Misunderstanding t h e  complex i n t e r a c t i o n s of the f a m i l y , some t h e r a p e u t i c approaches  erode the overburdened  f a m i l y system  with  r e c r i m i n a t i o n r a t h e r then s u p p o r t i n g i t with a s s i s t a n c e ( L e f l e y , 1990).  C l i n i c a l experience has l e d T e r k e l s e n  (1983) t o r e c o n c e p t u a l i z e the communicational a b e r r a t i o n s , noted i n f a m i l i e s of persons with c h r o n i c s c h i z o p h r e n i a , as adverse e f f e c t s of f a m i l y therapy.  Family  satisfaction  w i t h mental h e a l t h p r o v i d e r s i s low; f a m i l y members do not f e e l they a r e r e c e i v i n g enough i n f o r m a t i o n , support, o r p r a c t i c a l management techniques t o enable them t o cope w i t h caregiving Goldberg,  (Brooker, T a r r i e r , Barrowclough,  Butterworth, &  1992; Hanson & Rapp, 1992; H a t f i e l d , 1979;  Johnson, 1990; McElroy,  1987).  Intervening Constructs C a r e g i v e r c h a r a c t e r i s t i c s , both i n d i v i d u a l and f a m i l y , a l o n g w i t h community s e r v i c e s , s o c i a l support, and p e r c e p t i o n o f the s i t u a t i o n i n t e r a c t with the c o p i n g e f f o r t s of f a m i l y members and i n f l u e n c e t h e i r e x p e r i e n c e s w i t h schizophrenia.  As w e l l , c h a r a c t e r i s t i c s of t h e person w i t h  s c h i z o p h r e n i a have been found t o be an important  influence  on t h e f a m i l y experience. Caregiver Characteristics: Individual  level  C a r e g i v e r demographics and p e r s o n a l i t y have been i n c l u d e d as independent  characteristics  v a r i a b l e s i n r e s e a r c h on  the f a m i l y experience with s c h i z o p h r e n i a .  A random sample  58 of 125 f a m i l i e s who had a p o s t - h o s p i t a l member a t home found c a r e g i v e r burden t o be u n r e l a t e d t o s o c i a l c l a s s , education, Doll,  and t h e age or sex of t h e r e l a t i v e  1982).  clinical  race,  (Thompson &  Data from l a r g e e p i d e m i o l o g i c surveys and  i n t e r v i e w s , however, showed race, sex, and s o c i a l  c l a s s t o be r e l e v a n t t o c a r e g i v e r experience;  b l a c k s and  females scored h i g h e r on the v a r i o u s symptom s c a l e s , and r e l a t i v e s i n low socioeconomic  groups were t h r e e times  more  p r e v a l e n t i n t h e high range of d e p r e s s i o n , a n x i e t y , and psychosocial dysfunction  (Arey & Warheit, 1980).  Financial  c o s t s i n c u r r e d by t h e f a m i l y can be c o n s i d e r a b l e . low on t h e socioeconomic  Families  s c a l e are e s p e c i a l l y v u l n e r a b l e t o  t h i s type of s t r e s s o r (Glynn & Liberman, 1990). In a s m a l l study of 3 0 households, parents were  found  t o be a c u t e l y aware and concerned with t h e downward m o b i l i t y of t h e i r m e n t a l l y 1987) .  ill  sons and daughters (Gubman & T e s s l e r ,  C o n s i d e r i n g the p o s s i b i l i t y o f h i g h e r  i n p a r e n t s o f higher socioeconomic  expectations  standing, d i s t r e s s  over  the o f f s p r i n g ' s f a i l u r e t o f u l f i l l h i s or her p o t e n t i a l c o u l d be g r e a t e r f o r these parents, although  the c a p a b i l i t y  of p r o v i d i n g f i n a n c i a l a s s i s t a n c e would be l e s s o f a problem.  The a b i l i t y of the parents t o develop  realistic  e x p e c t a t i o n s f o r t h e f u n c t i o n a l c a p a c i t i e s of t h e i r c h i l d r e n w i t h s c h i z o p h r e n i a i s considered t o be a p r o t e c t i v e f a c t o r i n s h i e l d i n g them a g a i n s t s t r e s s (Glynn & Liberman, 1990). Other p r o t e c t o r s , i d e n t i f i e d by r e l a t i v e s o f persons w i t h s c h i z o p h r e n i a , a r e p e r s o n a l p h y s i c a l h e a l t h , energy, optimism, a b i l i t y t o maintain o u t s i d e i n t e r e s t s , and sense  59 of humour (Dearth e t a l . , 1986).  Because of the  genetic  component i n s c h i z o p h r e n i a , v u l n e r a b i l i t y i n a s m a l l percentage of r e l a t i v e s can come from a c o i n h e r i t e d p r e d i s p o s i t i o n t o mental i l l n e s s  (Glynn  & Liberman, 1990).  P e r s o n a l i t y c h a r a c t e r i s t i c s of f a m i l y members do seem to has  i n f l u e n c e t h e i r experience  with the i l l n e s s .  found t h a t the p e r s o n a l a t t r i b u t e of r e s i l i e n c e a c t s as  a p r o t e c t i v e f a c t o r i n r e l a t i v e s of persons who psychotic disorders s c h i z o p h r e n i a and  ( L e f l e y , 1990).  i n f o r m a t i o n about medication  be h i g h l y important  P a t r i l a & Sadoff,  have  Because e d u c a t i o n  h e a l t h s t a t u s of the r e l a t i v e are c o n s i d e r e d to  1992;  (Atkinson, Torrey,  1986;  and  by  c o u l d be c o n s i d e r e d  a resource.  1983), the a b i l i t y  Chronic  about  the  caregivers  Hatfield,  i n c l i n a t i o n of a f a m i l y member t o seek out t h i s  to  Research  1990; and  information  s t r a i n does appear  be s i g n i f i c a n t l y r e l a t e d to d i s t r e s s among c a r e g i v e r s  r e l a t i v e l y low  i n mastery ( L e f l e y , 1987b).  A  significant  c o r r e l a t i o n a l s o has been found between the r e l a t e d concept, l o c u s of c o n t r o l , and r e l a t i v e s ' expressions comment ( L e f l e y , 1992).  R e l a t i v e s who  of  critical  were more c r i t i c a l  the p a t i e n t tended t o b e l i e v e i n the importance of f a c t o r s i n c o n t r o l l i n g events and behaviors;  internal  they b e l i e v e d  i n the p a t i e n t s ' a b i l i t y t o c o n t r o l t h e i r symptoms and p r e s s u r e them a c c o r d i n g l y .  Knowledge about the  r e f l e c t e d i n r e l a t i v e s ' expectations p a t i e n t behavior, resource.  could be considered  of  would  illness,  and a t t r i b u t i o n s f o r an important  coping  60 Caregiver  C h a r a c t e r i s t i c s : Family L e v e l  P r e - c r i s i s l e v e l of f a m i l y f u n c t i o n i n g appears t o be  a  f a c t o r c e n t r a l t o a f a m i l y ' s a b i l i t y t o cope w i t h schizophrenia.  Not  only the absence of negative  attitudes  but a l s o e f f e c t i v e communication, problem-solving and  f l e x i b l e r o l e r e l a t i o n s h i p s , are c o n s i d e r e d  b e n e f i c i a l strengths  ( B i e g e l et a l . , 1991;  skills, to  be  Falloon & McGill,  1985). Recent i n t e r v e n t i o n s with f a m i l i e s have focused e f f o r t s t o b o l s t e r f a m i l y resources knowledge about s c h i z o p h r e n i a  1990;  M c G i l l , 1985;  and  Cole et a l . , 1993; H a t f i e l d , 1990;  by i n c r e a s i n g f a m i l y  and promoting e f f e c t i v e  communication, problem-solving, Bentley,  coping  skills  (see  F a l l o o n , Hardesty, &  MacFarlane et a l . , 1993)  s a l u t a r y impact on both the p a t i e n t and the f a m i l y . Bentley  (1990) and  increased  Doane (1991) have advised,  i n t e r p e r s o n a l contact  f a m i l i e s may  i n c r e a s e s t r e s s , and  not be  al.,  1992;  (separated)  appropriate. caregiver  S i n g l e parents have been found  t o e x p e r i e n c e g r e a t e r burden of care and of s e r v i c e s and  Both  f o r these f a m i l i e s an  Family s t r u c t u r e a l s o i s r e l e v a n t to the ( L e f l e y , 1992).  with  however, t h a t  f o r disengaged  i n t e n s i v e i n t e r v e n t i o n schedule may  experience  on  be  i n greater  support than married parents  need  (Carpentier  et  F a l l o o n et a l . , 1984).  C h a r a c t e r i s t i c s of the Person with There i s a l a c k of i n f o r m a t i o n between f a m i l y burden and  Schizophrenia on the a s s o c i a t i o n  sex of the mentally  Johnson's (1990) review of r e s e a r c h  ill  person.  found o n l y t h r e e  studies  61 r e p o r t i n g on t h i s r e l a t i o n s h i p : Grad and Sainsbury and Thompson and D o l l l e v e l o f burden,  (1963)  (1982) found no sex d i f f e r e n c e s i n  whereas Hoenig and Hamilton  (1969) found  t h a t male p a t i e n t s presented a g r e a t e r burden t o t h e f a m i l y . A more r e c e n t study by W i n e f i e l d and Harvey (1993) has r e p o r t e d g r e a t e r d i s t r e s s i n those c a r i n g f o r females schizophrenia.  F i n d i n g s may be confounded  r e l a t i v e s surveyed a r e the spouses persons w i t h s c h i z o p h r e n i a .  with  by t h e f a c t  that  and t h e p a r e n t s o f  Family support o f female  p a t i e n t s i s more l i k e l y t o be spousal o r s i b l i n g whereas f a m i l y support o f males i s more o f t e n p a r e n t a l (Atkinson, 1986).  Spouses and parents may p e r c e i v e burden d i f f e r e n t l y .  Seeman's (1986) review of the l i t e r a t u r e found  that  daughters w i t h s c h i z o p h r e n i a , r a t h e r than sons, tend t o be l e s s a g g r e s s i v e , l e s s l i k e l y t o commit s u i c i d e ,  less  likely  t o be i n v o l v e d with t h e law, and more l i k e l y t o adhere t o a treatment regime.  Seeman's i n q u i r y found t h a t f o r women,  frequency o f acute episodes i s lower, d u r a t i o n o f h o s p i t a l i z a t i o n i s s h o r t e r , and q u a l i t y o f r e m i s s i o n i s superior.  The r e l a p s e r a t e f o r men has been found i n o t h e r  r e s e a r c h t o be more than t r i p l e the r a t e f o r women (Vaughn et a l . ,  1984).  These d i f f e r e n c e s would seem t o l i g h t e n t h e  burden f o r parents of daughters with s c h i z o p h r e n i a . S o c i a l Support and Community S e r v i c e s Diminished s e l f - w o r t h leaves one e s p e c i a l l y v u l n e r a b l e t o e x p e r i e n c i n g symptoms of s t r e s s ; i n t e r v e n t i o n s o f c o p i n g a s s i s t a n c e and s o c i a l support b o l s t e r s e l f esteem and h e l p prevent t h i s n e g a t i v e experience  (Pearlin,  Lieberman,  62 Menaghan, & Mullan,  1981). The  s o c i a l stigma and  community  n e g l e c t p e r c e i v e d by f a m i l i e s of the mentally i l l i s o l a t i n g and s t r e s s promoting. help/mutual  can  be  Parents o f t e n f i n d i n s e l f -  support groups the i n f o r m a t i o n a l and  emotional  s o c i a l support t h a t they r e q u i r e (Atkinson, 1986; Yamatami, 1986;  Johnson, 1990).  psychoeducation  i n t e r v e n t i o n s , p a r t i c u l a r l y those w i t h a  problem-solving  component, a l s o have proven h e l p f u l t o  families  (Cole e t a l . , 1993;  Multigroup,  Biegel &  supportive,  McFarlane et a l . , 1993).  In a d d i t i o n t o f a m i l y s o c i a l support, the  extrafamilial  s o c i a l support network of the f a m i l y member w i t h schizophrenia i s related to family well-being; a s i g n i f i c a n t r e l a t i o n s h i p has been found between the a v a i l a b i l i t y of a c o n f i d a n t f o r t h a t person and lower f a m i l y p e r c e p t i o n s of burden  ( C r o t t y & Kulys, 1986).  F a m i l i e s look t o the c a r e -  g i v i n g system t o p r o v i d e comprehensive, a f f o r d a b l e treatment  long-term,  and r e h a b i l i t a t i o n programs f o r  r e l a t i v e s w i t h s c h i z o p h r e n i a (Glynn & Liberman, 1990). U n f o r t u n a t e l y , an e s s e n t i a l , yet o f t e n overlooked i n g r e d i e n t i n these community care programs i s the nurturance  of the  p a t i e n t s ' support systems ( F a l l o o n e t a l . , 1984). Family and I n d i v i d u a l P e r c e p t i o n s of S c h i z o p h r e n i a "A f a m i l y ' s b e l i e f s about i l l n e s s and about what c o n s t i t u t e s an a p p r o p r i a t e response actions"  (Cole & R e i s s , 1993,  a l s o serve t o shape i t s  p. x i ) .  As mentioned above,  the onset of s c h i z o p h r e n i a i s o f t e n d i f f i c u l t t o r e c o g n i z e and  i t s symptoms extremely  diverse.  T h i s ambiguity  makes  63 the development of an e f f e c t i v e , c o n s i s t e n t response difficult  f o r t h e f a m i l y (Cole e t a l . , 1993).  Once a d i a g n o s i s of s c h i z o p h r e n i a has been made, t h e f a m i l y p e r c e p t i o n of the s i t u a t i o n w i l l depend upon t h e c u l t u r a l m i l i e u ( L e f l e y , 1987c; R e i s s , 1981), and t h e f a m i l y ' s p r i o r and ongoing experience ( T e r k e l s e n , 1987).  with mental  illness  As p r e v i o u s l y mentioned, the s o c i a l  c o n t e x t w i t h i n which the f a m i l y i n t e r a c t s w i l l i n f l u e n c e t h e a p p r a i s a l s made and shared  by f a m i l y members.  Because of  the g e n e t i c component t o s c h i z o p h r e n i a , the f a m i l y may have had  another r e l a t i v e with the i l l n e s s .  s c h i z o p h r e n i a and impressions experience present  gained  Knowledge about  from t h i s  past  w i l l a f f e c t the f a m i l y ' s p e r s p e c t i v e o f t h e i r  s i t u a t i o n , as w i l l the extent t o which t h e f a m i l y  has been a b l e t o cope with the exacerbations i n t h e i l l n e s s over time. s i t u a t i o n , then,  and r e m i s s i o n s  The f a m i l y ' s p e r c e p t i o n o f t h e  c o u l d be considered  a process  of a p p r a i s a l  and r e a p p r a i s a l s . Coping E f f o r t s Coping s t r a t e g i e s t h a t f a m i l i e s e x h i b i t a r e both c o g n i t i v e and b e h a v i o r a l ; they i n c l u d e a c c e p t i n g , d i s t a n c i n g , and s e t t i n g l i m i t s  ( S p a n i o l , 1987).  l e a r n t o accept the l i m i t a t i o n s and a d j u s t expectations achieve  Relatives  their  f o r the person with s c h i z o p h r e n i a , s t r i v i n g t o  an adaptive balance  o f s t i m u l a t i o n and l a i s s e z -  f a i r e ; they separate themselves from behaviors  they  cannot  change and l e a r n not t o argue about the d e l u s i o n s ; they s e t f i r m l i m i t s around behaviors  they do not l i k e , knowing t h a t  64 s t r u c t u r e can communicate c a r i n g 1987a).  ( S p a n i o l , 1987; Wing,  These coping s k i l l s are acquired  gradually,  often  through t r i a l and e r r o r , sometimes through support group i n t e r a c t i o n , other times through education programs i n p r o b l e m - s o l v i n g techniques. Hatfield  (1990) suggests t h a t i n a d d i t i o n t o b e h a v i o r a l  s o l u t i o n s t o d e a l with o b j e c t i v e burden, i n t r a p s y c h i c c o p i n g i s r e q u i r e d t o come t o terms with the p a i n f u l f e e l i n g s a s s o c i a t e d w i t h s u b j e c t i v e burden.  P o s i t i v e coping  s t r a t e g i e s i n c l u d e the p r o t e c t i o n by f a m i l y members o f t h e i r own and each o t h e r s ' p h y s i c a l h e a l t h and emotional w e l l being, and t h e i r procurement of empathic support from p r o f e s s i o n a l s and others i n s i m i l a r circumstances. Outcomes As has been shown, the f a m i l y experience w i t h schizophrenia  w i l l depend upon a v a r i e t y of p e r s o n a l and  situational characteristics.  Research has i n v e s t i g a t e d  r e l a t i o n s h i p s between these s i t u a t i o n a l determinants and various  outcome measures, such as i n d i v i d u a l f e e l i n g s o f  being burdened  (Potasznik  1982), measures of anxiety  & Nelson, 1984; Thompson & D o l l , and depression  (Abramowitz &  Coursey, 1989; Arey & Warheit, 1980; M a t t l i n , Wethington, & Kessler,  1990), negative a f f e c t , and comprehensive measures  of p h y s i c a l and emotional w e l l - b e i n g 1993) . has  (Winefield  & Harvey,  S o c i a l functioning i n f a m i l i e s of the mentally  long been s c r u t i n i z e d .  ill  H o s t i l i t y , anger, and c o n f l i c t  have been g e n e r a l l y noted, as w e l l as s t r u c t u r a l change. Creer and Wing (1974) found, i n some cases, t o t a l breakup o f  65 f a m i l y u n i t y , w h i l e other f a m i l i e s seemed a b l e over time t o devise  a regime w i t h i n which the p a t i e n t c o u l d f u n c t i o n and  the f a m i l y c o u l d achieve r e l a t i v e  stability.  In one o f the few s t u d i e s t o focus on coping i n f a m i l i e s o f t h e mentally coping  ill,  H a t f i e l d (1981) r a t e d  e f f e c t i v e n e s s through three component f a c t o r s : (a)  emotional mastery  ( a b i l i t y t o manage emotions w i t h minimal  d i s t o r t i o n of r e a l i t y ) , appraisal,  information  (b) c o g n i t i v e s k i l l seeking,  (realistic  and c a p a c i t y t o manage  d i s t u r b i n g s i t u a t i o n s ) , and (c) need f u l f i l l m e n t s o c i a l involvement).  (adequate  Her data suggested a p o s i t i v e  a s s o c i a t i o n between e f f e c t i v e coping being  family  and c a r e g i v i n g mothers'  o l d e r and b e t t e r educated. An  adaptive  framework from s t r e s s and coping  theory  leads t o d i f f e r e n t i n t e r p r e t a t i o n s of behavior i n f a m i l i e s of t h e m e n t a l l y 1990). research and  i l l from t h a t of d y s f u n c t i o n  C r i t i c a l remarks and h o s t i l i t y  (Hatfield,  noted i n the, EE  can be viewed as l e g i t i m a t e r e a c t i o n s t o d i s r u p t i v e  embarrassing behaviors ( L e f l e y , 1992).  overinvolvement, o v e r p r o t e c t i o n ,  Emotional  and f o c u s i n g on t h e p a t i e n t  t o t h e e x c l u s i o n of the r e s t of the f a m i l y members, can be regarded as adaptive conditions  s t r a t e g i e s employed i n h i g h l y  (Cook, 1988; L e f l e y , 1987a).  psychological separation  stressful  P h y s i c a l and/or  of f a m i l y members from t h e p a t i e n t  can be seen as a s u r v i v a l mechanism whereby t h e f a m i l y seeks t o m a i n t a i n i t s i n t e g r i t y i n the face o f overpowering demands ( S p a n i o l , 1987).  66 L i m i t a t i o n s of Past Research L i t t l e past r e s e a r c h a s p e c i f i c coping  on f a m i l i e s and s c h i z o p h r e n i a has  focus; s t u d i e s t h a t have c o n s i d e r e d t h e  f a m i l y response t o the d i s o r d e r have ignored context theory.  the family  and/or not been grounded i n s t r e s s and coping Many i n v e s t i g a t i o n s have been d i r e c t e d t o expressed  emotion and c a r e t a k e r  burden.  P e r t a i n i n g t o these  i n v e s t i g a t i o n s , the l i t e r a t u r e has p o i n t e d problems and omissions.  t o a number o f  I t has i n d i c a t e d t h e need f o r  l o n g i t u d i n a l designs i n v o l v i n g l a r g e r and more representative  samples, u t i l i z i n g measures w i t h e s t a b l i s h e d  r e l i a b i l i t y and v a l i d i t y  ( B i e g e l e t a l . , 1991); t h e  importance o f g r e a t e r a t t e n t i o n t o theory  (Goldstein &  Strachan, 1987); the need f o r comparative s t u d i e s t o c o n t r a s t t h e impact of mental i l l n e s s w i t h other t y p e s o f disabilities  (Gubman & T e s s l e r , 1987); and the n e c e s s i t y f o r  c o n t r o l groups and f o r b a s e l i n e r a t e s o f f a m i l y i n t e r a c t i o n (Helmersen, 1983). Scholars  have suggested t h a t i n q u i r i e s i n c l u d e t h e  p o s i t i v e dimensions of the f a m i l y experience: t h e p o s i t i v e q u a l i t i e s o f i n t i m a t e support  ( F a l l o o n & M c G i l l , 1985;  Spaniol,  1987), the good times as w e l l as the bad (Gubman &  Tessler,  1987), the p o s i t i v e c o n t r i b u t i o n s of t h e p a t i e n t t o  family functioning  ( F a l l o o n , Hardesty, & M c G i l l , 1985;  Stevens, 1972), and the f e e l i n g of i n t h e f a m i l y t h a t can r e s u l t  closeness  and s o l i d a r i t y  (Dearth e t a l . , 1986).  Assumptions of homogeneity have pervaded many i n v e s t i g a t i o n s i n t o the f a m i l y experience w i t h  schizophrenia  67 (Steinwachs et a l . , 1992).  I t has been proposed t h a t a  c o n s i d e r a t i o n of the f a m i l y response t o s c h i z o p h r e n i a a t t e n d t o the f a m i l y ' s coping 1987;  strengths  (Gubman & T e s s l e r ,  H a t f i e l d , 1987b; L e f l e y , 1987a; Wasow, 1983)  informed by f a m i l y l i f e course s o c i a l s c i e n c e Cohler,  1986;  L e v e l s of  I r e y s & Burr,  should  and  be  (Cook &  1984) .  Analysis  F i n a l l y , t h e r e has been c o n f u s i o n in research  of l e v e l of a n a l y s i s  on the f a m i l y experience with  schizophrenia.  Whereas much of the l i t e r a t u r e speaks of " f a m i l y " burden, " f a m i l y " coping,  and  " f a m i l y " response, assessments have  been e l i c i t e d at the i n d i v i d u a l l e v e l .  question  arises  as t o whether t h e r e i s such a phenomenon as " f a m i l y "  coping  or i s i t simply  The  a c o l l e c t i o n of i n d i v i d u a l s who  are  coping  i n v a r i o u s degrees of synchronism? As p r e v i o u s l y d i s c u s s e d , t h a t " f a m i l y " coping aspects.  family stress scholars  i n c l u d e s both i n d i v i d u a l and  Boss (1988, p. 60)  assert  group  c l a r i f i e s t h i s i s s u e by s t a t i n g  "the c o g n i t i v e a p p r a i s a l of a s t r e s s f u l s i t u a t i o n or event, the emotional r e a c t i o n t o i t , and the b e h a v i o r a l  responses  t o both the a p p r a i s a l and the emotion a l l happen w i t h i n i n d i v i d u a l f a m i l y member, a l b e i t w i t h i n a systems  the  context."  S i m i l a r l y , Antonovsky (1994), i n a d i s c u s s i o n of "sense of coherence" at the c o l l e c t i v e l e v e l , suggests t h a t whereas can be aware of the i n f l u e n c e of the c o l l e c t i v e on one's sense of coherence, i t i s a d i f f e r e n t matter t o speak of a c o l l e c t i v e as p e r c e i v i n g the world as coherent.  we  68 Family s t r e s s theory  i s a m u l t i - l e v e l e d approach t h a t  sees r e c i p r o c a l i n f l u e n c e s between i n d i v i d u a l and Explorations  of family  of d i s t i n c t but 1983;  s t r e s s and coping  r e q u i r e assessment  i n t e r r e l a t e d l e v e l s of a n a l y s i s  Walker, 1985).  family.  (Menaghan,  C e r t a i n l y , i f one were i n t e r e s t e d i n  the group l e v e l of a n a l y s i s , a f a m i l y s t r e s s model such as t h a t of McCubbin and McCubbin (1991) would be  appropriate.  In a d d i t i o n , i f one were t o assess outcome measures of p s y c h o l o g i c a l , s o c i a l , and p h y s i c a l w e l l - b e i n g  (at the  i n d i v i d u a l l e v e l ) , a t t e n t i o n t o the t o t a l number of s t r e s s o r s would be The coping  valuable.  focus of t h i s study, however, i s the  process.  family  T h i s s p e c i f i c focus r e q u i r e s  a t t e n t i o n t o i n d i v i d u a l a p p r a i s a l s and  coping  parental close strategies in  response t o a p a r t i c u l a r s t r e s s o r , a l b e i t w i t h i n a f a m i l y context.  In t h i s study, then, the r e s i l i e n c y model of  s t r e s s , adjustment, and 1991)  adaptation  (McCubbin & McCubbin,  i s employed as a u s e f u l framework with which t o s e t  t h a t context,  i . e . , w i t h i n which t o p l a c e the t o t a l i t y  the f a m i l y experience with s c h i z o p h r e n i a , the  family  of  as i t appears i n  l i t e r a t u r e ; i n t h i s study, the McCubbins' model a l s o i s  used t o l o c a t e p a r e n t a l coping w i t h i n the broader context the f a m i l y s t r e s s  process.  As p a r e n t a l coping context,  i s embedded w i t h i n the  so i n d i v i d u a l coping theory  w i t h i n f a m i l y s t r e s s theory. the concept of coping by Lazarus and  of  I t has  family  can be seen t o f i t been shown above t h a t  as e x p l i c a t e d at the i n d i v i d u a l l e v e l  Folkman (1984) i s compatible w i t h t h a t  of  69 f a m i l y s t r e s s s c h o l a r s . A l l d e f i n e demands, s i t u a t i o n a l a p p r a i s a l s , coping, terms.  and  resources,  outcomes i n congruent  U n l i k e other t h e o r i s t s , however, Lazarus and  Folkman  not o n l y emphasize the importance of s i t u a t i o n a l a p p r a i s a l , but a l s o a t t e n d t o i t s o p e r a t i o n a l i z a t i o n and measurement a t the i n d i v i d u a l l e v e l , keeping i t c o n c e p t u a l l y coping.  distinct  from  In i t s a t t e n t i o n t o s i t u a t i o n a l a p p r a i s a l ,  t h e r e f o r e , t h i s study of the coping mothers and  e f f o r t s of i n d i v i d u a l  f a t h e r s w i l l f o l l o w Lazarus and  Folkman.  To  r e i t e r a t e , t h i s a p p r a i s a l at the i n d i v i d u a l l e v e l w i l l been considered  w i t h i n i t s s o c i a l context  of f a m i l y  and  community. Methodological Further  Issues i n S t r e s s Research  discussion i s required  concerning  m e t h o d o l o g i c a l i s s u e s i n the u t i l i z a t i o n of s t r e s s coping  theory.  A t t e n t i o n w i l l be d i r e c t e d toward  and the  problem of c i r c u l a r i t y and/or redundancy of v a r i a b l e s and the d i s t i n c t i o n between mediating and moderating  to  functions  of v a r i a b l e s . Circularity Lazarus, DeLongis, Folkman, and Gruen (1985) have examined the problem of confounding and stress research.  circularity  These authors d i s c u s s the q u e s t i o n  redundancy/confounding among v a r i a b l e s . They address emphasis of Dohrenwend, Dohrenwend, Dodson, and  in of the  Shrout  (1984) on the v a l u e of t r e a t i n g s t r e s s o r s as environmental i n p u t s t h a t are independent of the p s y c h o l o g i c a l response or a p p r a i s a l of the person, i n order t h a t the same p r o c e s s i s  70 not b e i n g measured i n both independent and variables.  Lazarus e t a l . (1985, p. 776)  dependent respond  s t r e s s i s b e s t regarded as a complex rubric,  like  "that emotion,  m o t i v a t i o n , or c o g n i t i o n , r a t h e r than as a simple v a r i a b l e . " They acknowledge t h a t s t r e s s i s an "unclean" v a r i a b l e t h a t depends on a person-environment  interaction.  They suggest  the c i r c u l a r i t y t h a t i s i n e v i t a b l e with a r e l a t i o n a l d e f i n i t i o n of s t r e s s can be l i m i t e d through an u n d e r s t a n d i n g of antecedents and consequences  of s i t u a t i o n a l  appraisals.  Person v a r i a b l e s such as, v a l u e s and b e l i e f s , s e l f - e s t e e m , and sense of c o n t r o l , i n t e r a c t w i t h the environmental s i t u a t i o n t o generate a p p r a i s a l s of harm/loss, t h r e a t , or c h a l l e n g e ; i n t u r n , these a p p r a i s a l s generate  consequent  responses. A s i m i l a r d i s c u s s i o n e x i s t s i n the c a r e g i v i n g literature.  I t has been suggested t h a t c a r e g i v e r burden,  as  a s t r e s s o r , and c a r e g i v e r w e l l - b e i n g are t a u t o l o g i c a l l y linked  (see George, 1994;  George & Gwyer, 1986).  Stull,  K o s l o s k i , and Kercher (1994), however, have e m p i r i c a l l y shown t h a t measures of c a r e g i v e r w e l l - b e i n g and  caregiver  burden, u t i l i z e d e i t h e r as p r e d i c t o r or outcome v a r i a b l e s , tap d i f f e r e n t domains of experience. Other confounding of v a r i a b l e s i s addressed by T h o i t s (1982) who  c a l l s a t t e n t i o n t o the i n t e r a c t i o n e f f e c t s of  l i f e events and s o c i a l support.  She p o i n t s out t h a t support  and l i f e events have r e c i p r o c a l e f f e c t s on each o t h e r , even t h a t "support ... may  be a product of - i f not, i n some  cases, o p e r a t i o n a l l y i d e n t i c a l with - the o c c u r r e n c e o f  71 c e r t a i n types of l i f e events" (p. 148). l o n g i t u d i n a l research  As T h o i t s  i s needed t o d i s e n t a n g l e  suggests,  their  influence. M e d i a t o r s and  Moderators  In d i s c u s s i o n s  of the s t r e s s process, those  t h a t are c o n s i d e r e d t o intervene  constructs  between the demands  outcomes of a s i t u a t i o n have been l a b e l e d v a r i o u s l y mediators and/or moderators. r e f e r s to intervening  Pearlin  constructs  (1989a, pp.  and as  149-150)  c o l l e c t i v e l y as mediators  because "they have been shown to govern (or mediate) e f f e c t s of s t r e s s o r s on s t r e s s outcomes."  the  McCubbin  and  McCubbin (1991) r e f e r t o f a m i l y r e s o u r c e s and c a p a b i l i t i e s as f a c t o r s t h a t p l a y a r o l e i n " b u f f e r i n g the impact of change or unexpected l i f e events"  negative  (p. 3)  and  mention t h a t s o c i a l support i s most o f t e n viewed as  "one  the primary b u f f e r s or mediators between s t r e s s and  health  breakdown" (p. 19).  Frese (1986) maintains t h a t c o p i n g  f u n c t i o n as both a moderator and  of  can  a mediator depending upon  the nature of i t s r e l a t i o n s h i p with both s t r e s s o r and  stress  reaction. Baron and  Kenny (1986) p o i n t out t h a t although i t i s  not uncommon f o r s o c i a l p s y c h o l o g i c a l terms moderator and  r e s e a r c h e r s t o use  mediator i n t e r c h a n g e a b l y , i t i s  important t o d i s t i n g u i s h between moderator and functions  of t h i r d v a r i a b l e s .  between "(a)  the  mediator  These authors d i f f e r e n t i a t e  the moderator f u n c t i o n of t h i r d  variables,  which p a r t i t i o n s a f o c a l independent v a r i a b l e i n t o subgroups t h a t e s t a b l i s h i t s domains of maximal e f f e c t i v e n e s s  in  72 r e g a r d t o a g i v e n dependent v a r i a b l e , and (b) t h e mediator f u n c t i o n o f a t h i r d v a r i a b l e , which r e p r e s e n t s t h e g e n e r a t i v e mechanism through which the f o c a l v a r i a b l e i s able t o i n f l u e n c e the dependent interest"  (Baron & Kenny, 1986, p. 1173).  independent variable of  They s t a t e  that  moderators e x p l a i n when c e r t a i n e f f e c t s w i l l h o l d whereas mediators t e l l us why and how they occur.  Baron and Kenny  f u r t h e r c l a r i f y t h a t "moderator v a r i a b l e s always f u n c t i o n as independent v a r i a b l e s , whereas mediating events s h i f t  roles  from e f f e c t s t o causes, depending on the focus o f t h e analysis"  (p. 1174).  Folkman and Lazarus (1988) agree t h a t  moderator v a r i a b l e s are antecedent c o n d i t i o n s  that  interact  w i t h o t h e r independent v a r i a b l e s t o produce some outcome whereas a mediator i s c o n s i d e r e d t o a r i s e d u r i n g t h e encounter and i n f l u e n c e the r e l a t i o n s h i p between t h e antecedent and outcome v a r i a b l e . The mediator-moderator d i s t i n c t i o n i s important s t a t i s t i c a l l y as w e l l as c o n c e p t u a l l y .  With moderation, t h e  r e l a t i o n s h i p between two v a r i a b l e s changes as a f u n c t i o n o f the moderating or t h i r d v a r i a b l e . therefore,  S t a t i s t i c a l analyses,  must i n c l u d e the i n t e r a c t i o n e f f e c t s o f t h e  p r e d i c t o r and t h e moderator mediating v a r i a b l e functions  on the outcome v a r i a b l e . as a pathway between t h e  p r e d i c t o r and outcome v a r i a b l e s . m e d i a t i o n e f f e c t s would equations t o determine  A  A s t a t i s t i c a l a n a l y s i s of  include a s e r i e s of regression (a) t h a t the independent  a f f e c t s both the mediator and the dependent  variable  v a r i a b l e , and  (b)  that  variable.  the  mediator  also  influences  the  dependent  74 Chapter V Study The  Rationale  purpose of t h i s study i s t o examine, w i t h i n t h e i r  s i t u a t i o n a l context, the coping e f f o r t s of mothers f a t h e r s who  and  have an a d u l t c h i l d with s c h i z o p h r e n i a ,  and  to  determine what f a c t o r s are p r e d i c t i v e of d i f f e r e n t c o p i n g choices.  Rather than t a k i n g a c l i n i c a l approach or  p e r c e i v i n g these f a m i l i e s i n terms of d y s f u n c t i o n , embrace a " s a l u t o g e n i c " looks  (Antonovsky, 1987)  i n s t e a d at i n d i v i d u a l and  orientation that  family strengths  r e s o u r c e s as coping mechanisms t h a t enable one adversity.  i t will  and  to withstand  Rather than being a study of c a r e g i v i n g and i t s  burden, i t i s a study of the coping process and i t s correlates. With i t s b a s i s i n f a m i l y s t u d i e s , my  inquiry  acknowledges the permanence of the p a r e n t a l r o l e and  the  i n f l u e n c e of the f a m i l y system upon i n d i v i d u a l f a m i l y members.  I consider  f a t h e r s who  the coping responses of mothers  have a c h i l d with s c h i z o p h r e n i a  as  parental  e f f o r t s t o manage a s i g n i f i c a n t f a m i l y s t r e s s o r . by s t r e s s and  and  Informed  coping theory, t h i s study i n c l u d e s a broad  c o n t e x t w i t h i n which t o consider  mothers' and  fathers'  management of t h e i r s i t u a t i o n s . I draw upon l i t e r a t u r e from t h r e e areas t h a t inform e n r i c h each other.  Family s t r e s s theory emphasizes  and  the  importance of f a m i l y system v a r i a b l e s w i t h i n whose i n f l u e n c e the  i n d i v i d u a l f a m i l y member operates.  Individual  and  c o p i n g theory e x p l i c a t e s the a p p r a i s a l and  stress  coping  75 process  and how  i t i s r e l a t e d t o demands and r e s o u r c e s  v a r i o u s types of s i t u a t i o n s .  The  l i t e r a t u r e on  in  family  response t o s c h i z o p h r e n i a informs us of the d i v e r s i t y t h a t can e x i s t w i t h i n t h i s one  situation.  Thus, p a r e n t a l  can be i n v e s t i g a t e d by drawing on a model of  coping  individual  s t r e s s and coping theory t h a t i s e n r i c h e d by an a t t e n t i o n t o family  context.  The purpose of the above d i s c u s s i o n of coping and i t s r e l a t e d c o n s t r u c t s was c o p i n g process  intended t o e x p l i c a t e and c l a r i f y  the  as i t i s e n v i s i o n e d by s c h o l a r s i n a s s o c i a t e d  f i e l d s of study.  To f a c i l i t a t e an understanding  c o n s t r u c t s as they are u t i l i z e d i n t h i s study, d e f i n i t i o n s i s presented  of  the  a list  of  i n Appendix A.  As d i s c u s s e d above, i t i s considered  important  to  d i s t i n g u i s h between mediators and moderators i n d i s c u s s i o n s of the s t r e s s process.  G e n e r a l l y , what has  been  i n v e s t i g a t e d i n p r e v i o u s s t u d i e s are the mediating  effects  of a p p r a i s a l and coping on some outcome c r i t e r i o n ,  such as  well-being.  T h i s e x p l o r a t o r y study attempts t o understand  what f a c t o r s are important  in predicting a  s i t u a t i o n a l a p p r a i s a l s and coping c h o i c e s . d i s t i n c t i o n between mediation  parent's Thus,  the  and moderation i s not a  s a l i e n t p o i n t t h a t i s i n c l u d e d i n the study  design.  U n l i k e many i n v e s t i g a t i o n s t h a t c o n s i d e r a p p r a i s a l and coping study  i n d i f f e r e n t types of s t r e s s f u l s i t u a t i o n s , s p e c i f i e s the s i t u a t i o n , namely, having  this  an a d u l t c h i l d  w i t h s c h i z o p h r e n i a ; i t suggests t h a t the v a r i a b i l i t y t h i s circumstance  permits  a v a r i e t y of s i t u a t i o n a l  within  76 a p p r a i s a l s and coping responses.  T h i s study i n v e s t i g a t e s  these a p p r a i s a l s and coping s t r a t e g i e s and t h e i r Moreover, t h i s study seeks t o p l a c e t h i s coping w i t h i n t h e f a m i l y context. (1991),  important  correlates. process  F o l l o w i n g McCubbin and McCubbin  f a m i l y system v a r i a b l e s a r e c o n s i d e r e d t o  i n f l u e n c e p a r e n t a l p e r c e p t i o n s and coping  responses;  t h e r e f o r e , t h i s study i n v e s t i g a t e s p a r e n t a l p e r c e p t i o n of such i n f l u e n c e . To t h i s end, t h e v a r i a b i l i t y of the i l l n e s s ,  along w i t h  demographics and resources a t both the i n d i v i d u a l and f a m i l y system l e v e l s , are considered t o be a s s o c i a t e d w i t h a p a r e n t ' s primary  and secondary  s i t u a t i o n a l a p p r a i s a l s , and  t o be p r e d i c t i v e of p a r e n t a l coping s t r a t e g i e s . process  This  i s represented i n F i g u r e E2.  Through such an a p p l i c a t i o n of theory, I hope t o c o n t r i b u t e t o a more complete understanding coping process through "How  of t h e p a r e n t a l  an i n v e s t i g a t i o n of the q u e s t i o n ,  i s t h e v a r i a b i l i t y of the s i t u a t i o n r e l a t e d t o t h e  c o p i n g e f f o r t s of parents who have an a d u l t c h i l d  with  schizophrenia?" P a r t i c u l a r l y , t h i s study i n v e s t i g a t e s r e l a t i o n s h i p s among (a) p e r s o n a l and s i t u a t i o n a l v a r i a b l e s , p e r c e p t i o n s of what i s a t stake p e r c e p t i o n s of c o n t r o l l a b i l i t y (d) coping s t r a t e g i e s .  (b) p a r e n t a l  (primary a p p r a i s a l ) , (c) (secondary  Although  a p p r a i s a l ) , and  i t i s assumed t h a t t h e r e  are outcome v a r i a b l e s i n the coping process  (personal w e l l -  being and s o c i a l f u n c t i o n i n g , as w e l l as feedback from coping t o t h e primary  s t r e s s o r , t o r e s o u r c e s , and t o  77 s i t u a t i o n a l a p p r a i s a l s ) , i t i s beyond t h e scope o f t h i s study t o assess such i n f l u e n c e .  As p r e v i o u s l y mentioned,  the aim o f t h i s study i s t o i n q u i r e i n t o p r e d i c t o r s o f p a r e n t a l coping; i t s purpose i s not t o e v a l u a t e c o p i n g effectiveness. The above review of s t r e s s and coping l i t e r a t u r e has shown t h a t a number of s c h o l a r s share the t h e o r e t i c a l p e r s p e c t i v e t h a t one's coping s t r a t e g i e s a r e i n f l u e n c e d by a v a r i e t y of p e r s o n a l and s i t u a t i o n a l f a c t o r s .  There i s a l s o  agreement t h a t coping s t r a t e g i e s focus e i t h e r on t h e problem, or on the way one f e e l s about t h e problem. Although  c o p i n g theory may not be developed  sufficiently for  the g e n e r a t i o n of formal p r o p o s i t i o n s and s p e c i f i c hypotheses, t h e above review of s t r e s s and coping t h e o r y suggests some q u e s t i o n s t o be addressed c o n c e r n i n g t h e a s s o c i a t i o n s of s i t u a t i o n a l v a r i a b l e s with coping c h o i c e s . I t i s not c l e a r how these p r e d i c t o r s of coping might be i n t e r c o r r e l a t e d , and which v a r i a b l e s have t h e s t r o n g e s t r e l a t i o n s h i p s with coping s t r a t e g i e s . Study I n q u i r y Based upon the t h e o r e t i c a l and e m p i r i c a l l i t e r a t u r e reviewed above, p a r e n t a l coping s t r a t e g i e s can be c o n s i d e r e d t o be a s s o c i a t e d with t h e f o l l o w i n g f a c t o r s : (a) c h a r a c t e r i s t i c s of the i l l n e s s , characteristics  (b) demographic  (e.g., parent's m a r i t a l s t a t u s , f i n a n c i a l  s t a t u s , age, sex, number of dependents; c h i l d ' s sex, age, p l a c e o f r e s i d e n c e ) , (c) i n d i v i d u a l and f a m i l y r e s o u r c e s ( p a r e n t a l mastery and self-esteem, f a m i l y cohesion and  78 a d a p t a b i l i t y , s o c i a l support), (perceptions appraisals  (d) primary  of what i s at s t a k e ) , and (perceptions  appraisals  (e) secondary  of c o n t r o l l a b i l i t y ) .  This  study  i n v e s t i g a t e s the i n t e r c o r r e l a t i o n s among these v a r i a b l e s w e l l as the r e l a t i o n s h i p s between them and of c o p i n g .  The  f o l l o w i n g general  forms  q u e s t i o n s are proposed  w i t h examples of study expectations e m p i r i c a l and  the v a r i o u s  as  given the  foregoing  t h e o r e t i c a l review.  Study Questions Question 1. predict parental  How  w e l l do  illness characteristics  a p p r a i s a l s of the s i t u a t i o n and  parental  coping s t r a t e g i e s ?  E m p i r i c a l s t u d i e s would l e a d me  expect t h a t g r e a t e r  symptom s e v e r i t y would be  w i t h "more a t stake"  to  associated  and would be r e l a t e d p o s i t i v e l y t o  emotion-focussed coping s t r a t e g i e s .  These s t u d i e s  also  would suggest t h a t time s i n c e onset of i l l n e s s would  be  p o s i t i v e l y r e l a t e d to a secondary a p p r a i s a l of the s i t u a t i o n as "one  t h a t must be accepted" and  negatively  r e l a t e d to  the  number of coping s t r a t e g i e s u t i l i z e d . Question 2. parental the  What demographic c h a r a c t e r i s t i c s p r e d i c t  a p p r a i s a l s and  literature,  coping?  I expect t h a t  From my  (a) age  understanding of  of the parent w i l l  be  p o s i t i v e l y r e l a t e d t o a primary a p p r a i s a l of "worry about the  future",  (b) sex of the c h i l d w i l l be p o s i t i v e l y r e l a t e d  t o primary s t r e s s o r "manifestations is,  of the  illness",  daughters w i l l have higher l e v e l s of l i f e s k i l l s ,  (c) p a r e n t a l  that and  c o - r e s i d e n c e with c h i l d w i l l be p o s i t i v e l y  79 r e l a t e d t o primary a p p r a i s a l s of "problems i n d a i l y f u n c t i o n i n g " and "poor r e l a t i o n s h i p s w i t h i n t h e f a m i l y . " Q u e s t i o n 3. predict parental Theoretically,  What i n d i v i d u a l and f a m i l y  resources  a p p r a i s a l s and coping s t r a t e g i e s ?  i n d i v i d u a l personal  and f a m i l y  system  c h a r a c t e r i s t i c s along with the a v a i l a b i l i t y o f s o c i a l support a r e g e n e r a l l y presumed t o a f f e c t one's response t o a stressful situation. self-esteem  I expect t h a t p a r e n t a l mastery and  w i l l be p o s i t i v e l y r e l a t e d t o a secondary  a p p r a i s a l of the s i t u a t i o n by parents as one they can "change o r do something about."  I expect t h a t  c o h e s i o n and f l e x i b i l i t y w i l l be n e g a t i v e l y  family  related to  "problems i n d a i l y f u n c t i o n i n g " and "poor r e l a t i o n s h i p s within the family." Q u e s t i o n 4.  What p r e d i c t i v e r e l a t i o n s h i p s e x i s t among  primary a p p r a i s a l s  (what i s a t s t a k e ) ,  secondary  ( c o n t r o l l a b i l i t y of the s i t u a t i o n ) , and coping  appraisals  strategies?  Theory would suggest t h a t a secondary a p p r a i s a l o f t h e s i t u a t i o n as one t h a t can be changed w i l l be p o s i t i v e l y r e l a t e d t o problem-focussed coping s t r a t e g i e s , whereas a secondary a p p r a i s a l of the s i t u a t i o n as one t h a t has t o be accepted w i l l be p o s i t i v e l y r e l a t e d t o emotion-focussed strategies. Questionnaire A questionnaire these q u e r i e s  was assembled i n order t o respond t o  (see Appendix B ) .  Following  Damrosch and Lenz  (1984), demographic items were d i v i d e d i n t o s u b s e c t i o n s i n  80 order t o a v o i d an appearance of over i n t r u s i v e n e s s . The c a t e g o r i e s were as f o l l o w s : 1.  Demographics o f the person with s c h i z o p h r e n i a  2.  The f u n c t i o n i n g l e v e l o f the person w i t h s c h i z o p h r e n i a  3.  Primary a p p r a i s a l parent's  (how the i l l n e s s has i n f l u e n c e d t h e  life)  4.  Secondary a p p r a i s a l  5.  Parent's ways of coping  6.  Overt i n f l u e n c e of f a m i l y members on p a r e n t ' s a p p r a i s a l s and coping  (controllability)  strategies.  7.  Demographics of the parent  8.  Personal resources  9.  Social  (mastery and self-esteem)  support  10. Family cohesion and f l e x i b i l i t y  81 Chapter VI Method Recruitment Respondents were r e c r u i t e d through n o t i c e s i n t h e n e w s l e t t e r o f t h e Schizophrenia S o c i e t y , i n one o f t h e major Vancouver newspapers, i n two community newspapers, and v i a the Schizophrenia  i n f o r m a t i o n n o t i c e b o a r d on t h e i n t e r n e t .  A d d i t i o n a l l y , requests f o r p a r t i c i p a n t s were made by telephone  t o c o o r d i n a t o r s of mental h e a l t h f a c i l i t i e s i n  l a r g e and s m a l l urban centers i n t h e p r o v i n c e o f B r i t i s h Columbia, and some p e r s o n a l p r e s e n t a t i o n s were made t o support groups f o r f a m i l i e s who a r e d e a l i n g with schizophrenia.  Requests were made t o both mothers and  f a t h e r s , a s k i n g f o r t h e p a r t i c i p a t i o n of e i t h e r parent person with s c h i z o p h r e n i a .  Approximately  of a  3 00  q u e s t i o n n a i r e s , which i n c l u d e d assurances o f c o n f i d e n t i a l i t y , were d i s t r i b u t e d along with addressed,  r e t u r n envelopes.  stamped,  Respondents were o f f e r e d t h e  o p p o r t u n i t y of o b t a i n i n g an account of t h e main c o n c l u s i o n s of t h e study through t h e separate r e t u r n o f a s e l f - a d d r e s s e d postcard. A t o t a l of 149 q u e s t i o n n a i r e s were completed and r e t u r n e d , f o r a r e t u r n r a t e of approximately  50%, along  83 r e q u e s t s  latter  f o r study c o n c l u s i o n s .  Of these  with  r e q u e s t s , 80 were from B r i t i s h Columbia, 1 from O n t a r i o , and 2 from t h e U n i t e d S t a t e s .  Of the 149 q u e s t i o n n a i r e s , 8  c o u l d not be i n c l u d e d i n the analyses; 1 respondent was not a parent,  1 a d u l t c h i l d was diagnosed  with b i - p o l a r  82 d i s o r d e r , and 6 q u e s t i o n n a i r e s contained s u b s t a n t i a l m i s s i n g data. Sample C h a r a c t e r i s t i c s The  sample o f 141 parents i s d e s c r i b e d i n T a b l e F l  a l o n g w i t h means and standard d e v i a t i o n s o f p a r e n t a l c h a r a c t e r i s t i c s , separated by sex o f parent where s i g n i f i c a n t d i f f e r e n c e s were noted.  P a r e n t a l age was f a i r l y  normally d i s t r i b u t e d and a l l m a r i t a l c a t e g o r i e s were represented.  Years of formal education of these  a l s o approximated a normal d i s t r i b u t i o n .  parents  As can be seen,  t h e r e was a l s o a broad r e p r e s e n t a t i o n of f a m i l y incomes. These parents i d e n t i f i e d t h e i r e t h n i c / c u l t u r a l backgrounds as B r i t i s h ,  i n c l u d i n g I r i s h and S c o t t i s h  (12%), Canadian (26%), A s i a n  (36%), European  (5%) and Other  (5%).  The  'Other' category i n c l u d e d S y r i a n , U k r a i n i a n , E a s t I n d i a n , Jewish,  and Dukhobors.  For almost  10% of these p a r e n t s , t h e  c h i l d w i t h s c h i z o p h r e n i a was an only c h i l d , but most p a r e n t s had between 1 and 3 other c h i l d r e n  (76%).  Approximately  of o t h e r c h i l d r e n l i v e d i n the p a r e n t a l home. note,  18%  Of p a r t i c u l a r  23% of parents s a i d t h a t i n a d d i t i o n t o t h e i r son o r  daughter w i t h s c h i z o p h r e n i a , they had another p h y s i c a l o r mental d i s a b i l i t y or i l l n e s s ;  c h i l d with a  12% o f p a r e n t s  s p e c i f i e d a d d i t i o n a l dependents. C o n s i d e r a b l e v a r i a b i l i t y a l s o was found  i n the  c h a r a c t e r i s t i c s o f the person with s c h i z o p h r e n i a ( d i s p l a y e d i n Table F2).  Ages of the sons and daughters  normally d i s t r i b u t e d  were f a i r l y  (M = 32.7 years, SD = 7.6).  Time s i n c e  the onset o f the i l l n e s s ranged from l e s s than one year (2%)  83 t o 35 y e a r s years  (.7%).  ( SD = 7.9  The mean l e n g t h of i l l n e s s was  ); the median was  10 y e a r s .  12.4  The r e p o r t e d  number of h o s p i t a l i z a t i o n s v a r i e d from a minimum of 0 t o a maximum of 20  (M = 4.6,  SD = 4.1).  The v a s t m a j o r i t y of  these a d u l t c h i l d r e n were b i o l o g i c a l o f f s p r i n g never been married  (88%).  significant difference  (95%) and  had  I t i s of i n t e r e s t t h a t the o n l y  (at p_ < .001  l e v e l ) i n the  c h a r a c t e r i s t i c s of sons and daughters was  found i n m a r i t a l  s t a t u s , as noted i n Table 2, with sons much more l i k e l y t o have never been married.  T h i r t y - t w o percent of these a d u l t  c h i l d r e n l i v e d w i t h the parent, 31% l i v e d on t h e i r own,  19%  l i v e d i n a co-op or group housing arrangement, and 5% were p s y c h i a t r i c i n p a t i e n t s ; only 1.4%  l i v e d with a  spouse.  F i n a n c i a l l y , almost h a l f of these persons w i t h s c h i z o p h r e n i a r e l i e d on s o c i a l a s s i s t a n c e and/or d i s a b i l i t y income (48%), 5.6%  had some type of employment, 5.6%  were f i n a n c i a l l y  supported o n l y by the parent, and 3 6% r e c e i v e d income from another source i n a d d i t i o n t o p a r e n t a l f i n a n c i a l  support.  Measures In a d d i t i o n t o demographics, the f a c t o r s were the f o l l o w i n g :  investigated  (a) the f u n c t i o n i n g l e v e l of the person  w i t h s c h i z o p h r e n i a ; (b) resources (e.g., esteem,  mastery,  f a m i l y cohesion and a d a p t a b i l i t y , and s o c i a l s u p p o r t ) ; (c) primary a p p r a i s a l , o p e r a t i o n a l i z e d as the impact of the i l l n e s s on the respondent's  life;  (d) secondary  the c o n t r o l l a b i l i t y of the s i t u a t i o n ; and  a p p r a i s a l or  (e) coping, the  s t r a t e g i e s used t o manage e i t h e r the s i t u a t i o n or the the respondent  f e l t about the s i t u a t i o n .  The measures  way  84 chosen t o a s s e s s these v a r i a b l e s were s e l e c t e d on the b a s i s of  t h e i r broad a p p l i c a b i l i t y as w e l l as t h e i r  psychometric  p r o p e r t i e s , t o be a p p r o p r i a t e f o r use i n a v a r i e t y of f a m i l y situations.  Table F3 l i s t s these measures and  reliabilities;  their  Appendix C l i s t s the q u e s t i o n n a i r e items  c a t e g o r i z e d by s u b - s c a l e . Demands The s e v e r i t y of the primary demand, the i l l n e s s , a s s e s s e d by the L i f e S k i l l s P r o f i l e , LSP P a v l o v i c , & Parker, 1989). to  The LSP  (Rosen,  Hadzi-  i s a measure developed  a s s e s s g e n e r a l l e v e l s of f u n c t i o n and d i s a b i l i t y i n  persons w i t h s c h i z o p h r e n i a . specific,  I t i s b r i e f and i s composed of  j a r g o n - f r e e items, a s s e s s i n g d i s t i n c t  behaviours,  and t h e r e f o r e i s capable of being completed  by f a m i l y  members as opposed t o persons with c l i n i c a l  training.  has 39 items t h a t comprise  c o n t a c t , communication, and r e s p o n s i b i l i t y . items  It  5 factor-analytically derived  s u b - s c a l e s , namely, s e l f - c a r e , nonturbulence,  for  was  social One  of t h e s e  ( r e f e r r i n g t o the c h i l d ' s o f f e n s i v e smell) was d e l e t e d  t h i s study i n c o n s i d e r a t i o n of p a r e n t s ' s e n s i b i l i t i e s .  These L i k e r t - t y p e s c a l e s have been l a b e l e d i n p o s i t i v e terms i n the b e l i e f t h a t a focus on s t r e n g t h s as opposed t o d e f i c i t s would be more h e l p f u l t o s u b j e c t s . c a t e g o r i e s range from "not t r u e " Rosen e t a l . (p. 333)  The  response  (1) t o "very t r u e " (4).  s t r e s s t h a t " s i n c e the measure was  designed t o assess s c h i z o p h r e n i c f e a t u r e s , per se, few  items  ... have any d i s t i n c t s p e c i f i c i t y t o  not  ... v e r y  85 schizophrenia."  T h i s aspect of the s c a l e c o n t r i b u t e s t o the  wide a p p l i c a b i l i t y f o r which t h i s study i s s t r i v i n g . Rosen e t a l . (1989) r e p o r t t h a t each s u b - s c a l e s c o r e i s moderately and p o s i t i v e l y a s s o c i a t e d with each o t h e r ; c o n s i d e r e d these s c a l e s t o be cumulative,  they  reporting a total  s c a l e s c o r e t h a t i n d i c a t e d a person's g e n e r a l l e v e l of f u n c t i o n i n g , with a higher score i n d i c a t i n g h i g h e r f u n c t i o n . For the most p a r t , t h i s study a l s o found  a moderate,  p o s i t i v e a s s o c i a t i o n between s u b - s c a l e s ; l e v e l s of a s s o c i a t i o n ranged from r = .27 contact) t o r = .75 behaviour). found  The  ( r e s p o n s i b i l i t y and  ( r e s p o n s i b i l i t y and  nonturbulent  i n t e r n a l c o n s i s t e n c y of each s c a l e  was  t o be h i g h with Cronbach's Alpha v a l u e s as f o l l o w s :  self-care  .72,  communication  nonturbulence .72,  .81,  respectively).  s o c i a l contact  and r e s p o n s i b i l i t y  f i n d i n g s of Rosen et a l . of .88,  .90.  social  .85,  .77 .79,  .70,  (comparable t o the .67,  and  .77,  I n t e r n a l c o n s i s t e n c y f o r the t o t a l s c a l e  Rosen e t a l . have suggested  was  the s c a l e ' s v a l i d i t y i s  i n d i c a t e d by the s c a l e ' s s e n s i t i v i t y t o c l i n i c a l  realities  (a n e g a t i v e a s s o c i a t i o n between age and both t u r b u l e n t behaviour  and  i r r e s p o n s i b i l i t y ) , as w e l l as an a s s o c i a t i o n  between h i g h s c a l e scores and s t a b i l i t y i n l i v i n g arrangements. Resources Mastery and self-esteem.  Mastery and  s e l f - e s t e e m have  l o n g been c o n s i d e r e d by s t r e s s and coping t h e o r i s t s t o be r e l e v a n t t o one's coping response.  These c o n s t r u c t s have  been w i d e l y used i n v a r i o u s c a r e g i v i n g c o n t e x t s .  Pertinent  86 t o t h i s study, L e f l e y  (1987b, 1990,  1992)  has noted  their  i n f l u e n c e on r e l a t i v e s ' r e a c t i o n s t o the mental i l l n e s s of a f a m i l y member. Mastery was and S c h o o l e r The  7-item  measured with a s c a l e developed  by  Pearlin  (1978) f o r use with a community a d u l t sample.  s c a l e assesses the extent t o which one  regards  one's l i f e chances as being g e n e r a l l y under one's c o n t r o l or as f a t a l i s t i c a l l y determined.  In a study by Folkman,  Lazarus, Gruen, and DeLongis (1986) the i n t e r n a l c o n s i s t e n c y of t h e s c a l e  (alpha) was  .75.  Cronbach's Alpha f i g u r e of Self-esteem was developed  The present study found a  .69.  measured with a 6-item s c a l e  by P e a r l i n and Schooler  Rosenberg (1965),  also  (1978), f o l l o w i n g  f o r use with a community a d u l t sample.  In the p r e s e n t study, i t s i n t e r n a l c o n s i s t e n c y was be  found t o  .75. In other s t u d i e s , measures of s e l f esteem and mastery  have been found t o be h i g h l y c o r r e l a t e d Lazarus, Gruen, & DeLongis, a moderate c o r r e l a t i o n and mastery.  1986).  (r = .65)  (Folkman,  In t h i s study, however,  (r = . 45) was  found between esteem  In both s c a l e s , respondents  indicated  e x t e n t t o which they agreed with statements,  using  the response  c a t e g o r i e s r a n g i n g from " s t r o n g l y d i s a g r e e " (1) t o " s t r o n g l y agree"  (6), with h i g h e r scores i n d i c a t i n g g r e a t e r l e v e l s of  esteem and mastery. Family a d a p t a b i l i t y and cohesion.  Family c o h e s i o n  a d a p t a b i l i t y are c o n s i d e r e d important s t r e s s r e s o u r c e s both t h e o r e t i c a l l y  resistant  (e.g., B i e g e l e t a l . ,  1991;  and  87 McCubbin & McCubbin, 1991) M c G i l l , 1985).  and e m p i r i c a l l y  (e.g., F a l l o o n &  T h i s study assessed p a r e n t a l p e r c e p t i o n s of  f a m i l y a d a p t a b i l i t y and cohesion u s i n g FACES I I (Olson, Portner, & B e l l ,  1982).  T h i s measure i s the second v e r s i o n  i n a s e r i e s of s c a l e s developed by David Olson and h i s c o l l e a g u e s t o measure f a m i l y cohesion and  adaptability.  A d a p t a b i l i t y , with i t s 14 items, assesses the e x t e n t t o which the f a m i l y system  i s f l e x i b l e and a b l e t o change i t s  power s t r u c t u r e and r o l e r e l a t i o n s h i p s i n response t o s i t u a t i o n a l and developmental  stress.  The  16-item  Cohesion  s c a l e measures the degree t o which f a m i l y members are connected  i n terms of emotional bonding.  Respondents were  asked t o i n d i c a t e the extent t o which items a p p l i e d t o t h e i r f a m i l y , w i t h response c a t e g o r i e s ranging from "almost (1) t o "almost always"  (5).  never"  Both s c a l e s are s c o r e d i n the  p o s i t i v e d i r e c t i o n with higher scores i n d i c a t i n g h i g h e r l e v e l s of cohesion and  adaptability.  FACES I I (Olson, Portner, & B e l l , i n a n a t i o n a l survey of over 1000  Olson and T i e s e l  FACES I I s c o r e s .  has been used  "non-problem" c o u p l e s  f a m i l i e s a c r o s s the f a m i l y l i f e c y c l e . update,  1982)  and  In a FACES I I  (1991) a f f i r m the l i n e a r nature of  Olson, B e l l , and P o r t n e r (n.d.) r e p o r t the  f o l l o w i n g psychometric p r o p e r t i e s : Cronbach Alpha f i g u r e s of .87 f o r cohesion, and reliabilities  .78 f o r a d a p t a b i l i t y ;  test-retest  (4-5 weeks) of .83 f o r cohesion, and  a d a p t a b i l i t y ; and a c o r r e l a t i o n between cohesion a d a p t a b i l i t y of .65.  Olson e t a l . found t h i s  between the two dimensions  .80 f o r  and  correlation  not t o be p r o b l e m a t i c .  They  88 combine cohesion and a d a p t a b i l i t y scores i n a unique way a r r i v e a t a " f a m i l y type." have been demonstrated. t h a t the dimensions 1982)  to  Concurrent v a l i d i t y i s s a i d t o  Olson and h i s c o l l e a g u e s r e p o r t  of FACES II  (Olson, P o r t n e r , & B e l l ,  have been found t o c o r r e l a t e h i g h l y w i t h a g l o b a l  measure of f a m i l y h e a l t h assessed by the D a l l a s S e l f - R e p o r t Family Inventory cohesion  (.93)  (Hampson, Hulgus, & Beavers,  and a d a p t a b i l i t y  1991):  (.79).  The p r e s e n t study found very h i g h  internal  c o n s i s t e n c i e s f o r both cohesion and a d a p t a b i l i t y s c a l e s w i t h Cronbach's Alpha = .91  (cohesion) and alpha =  .87  ( a d a p t a b i l i t y ) , as w e l l as a very h i g h c o r r e l a t i o n between the two dimensions.  important  of f a m i l y s t r e n g t h , t h e i r h i g h c o r r e l a t i o n  p r e c l u d e d the i n c l u s i o n of both i n the a n a l y s e s . not t o c o n s i d e r them t o be simply cumulative reasons:  .82)  Although t h i s study c o n s i d e r s  c o h e s i o n and a d a p t a b i l i t y t o be separate dimensions  (r =  I  decided  f o r two  (a) t h i s study wished t o honor the requirements  of  Olson e t a l . (1982) i n the a p p l i c a t i o n of t h e i r measure, and (b) I wished t o r e t a i n the more widely dimensions  comprehensible  of cohesion and a d a p t a b i l i t y t h a t have been noted  i n the l i t e r a t u r e , r a t h e r than s p e c i f y a " f a m i l y t y p e " . A number of respondents  (those parents who  lived  alone)  noted d i f f i c u l t y i n responding t o some items of the adaptability scale.  A l s o , a d a p t a b i l i t y was  c o r r e l a t e d more  s t r o n g l y than cohesion with the i n d i v i d u a l r e s o u r c e s of esteem and mastery t h a t were i n c l u d e d i n the a n a l y s e s .  89 Based upon these e t h i c a l and methodological  concerns,  c o h e s i o n was chosen as a f a m i l y r e s o u r c e v a r i a b l e . S o c i a l Support.  S o c i a l support i s a u b i q u i t o u s  i n a p p l i c a t i o n s o f s t r e s s and coping t h e o r y .  concept  It is  considered a p a r t i c u l a r l y h e l p f u l resource i n s i t u a t i o n s t h a t a r e c h a r a c t e r i z e d by f e e l i n g s of c o n f u s i o n , and misunderstanding  isolation,  (Atkinson, 1986; Johnson, 1990).  The measure of e x p r e s s i v e s o c i a l support used study i s one of m u l t i p l e measures developed al.  in this  by P e a r l i n e t  (1990) from t h e i r conceptual scheme f o r t h e study o f  caregiver stress.  T h e i r framework i s a product both o f many  y e a r s o f r e s e a r c h i n t o the s t r e s s process and o f c o n s i d e r a b l e e x p l o r a t o r y r e s e a r c h among f a m i l y c a r e g i v e r s . The measures were c o n s t r u c t e d from a multiwave study o f 555 c a r e g i v e r s t h a t began with open-ended e x p l o r a t o r y i n t e r v i e w s out o f which a s t r u c t u r e d q u e s t i o n n a i r e was formed, p r e t e s t e d , and r e v i s e d . The manner i n which t h e measures were developed  as w e l l as t h e i r psychometric p r o p e r t i e s  p r o v i d e an o v e r a l l sense of confidence t h a t they a r e s e r v i c e a b l e and r e l i a b l e  (Pearlin et a l . ,  1990).  This  e x p r e s s i v e s o c i a l support measure, i n a L i k e r t - t y p e response format,  i s composed of 8 items t h a t t a p the p e r c e i v e d  a v a i l a b i l i t y o f a person who i s c a r i n g , uplifting,  and a c o n f i d a n t .  trustworthy,  Respondents were asked  e x t e n t o f t h e i r agreement with the statements  using  f o r the response  c a t e g o r i e s r a n g i n g from " s t r o n g l y d i s a g r e e " (1) t o " s t r o n g l y agree"  (4), with h i g h e r scores r e f l e c t i n g p e r c e p t i o n s o f  more s o c i a l support.  The  internal r e l i a b i l i t y  of the  90 s c a l e was  h i g h (alpha = .87), matching t h a t r e p o r t e d by  P e a r l i n et a l . .  No v a l i d i t y data are a v a i l a b l e .  F o l l o w i n g P e a r l i n e t a l . (1990) the a v a i l a b i l i t y of i n f o r m a t i o n a l and i n s t r u m e n t a l support was item index.  measured by a  4-  These 4 items i n q u i r e about the a v a i l a b i l i t y of  (a) support programs/groups f o r the parent, about the i l l n e s s f o r the parent,  (b) i n f o r m a t i o n  (c) a c o n f i d a n t / s u p p o r t  person f o r the a d u l t c h i l d with s c h i z o p h r e n i a , and program f o r the a d u l t c h i l d .  (d) a day  The responses t o these items,  w i t h t h e i r coding i n b r a c k e t s , was:  yes  know (1).  considered to i n d i c a t e a  A h i g h e r index score was  (2), no or I don't  g r e a t e r amount of i n s t r u m e n t a l support from the community. Primary A p p r a i s a l Whereas Folkman, Lazarus, Dunkel-Schetter, e t a l . (1986) developed a s c a l e t o i n v e s t i g a t e s u b j e c t s ' primary a p p r a i s a l s i n a v a r i e t y of s t r e s s f u l encounters,  I  investigated appraisals within a s p e c i f i c situation.  As  p r e v i o u s l y mentioned, a premise of t h i s study i s t h a t the v a r i a b i l i t y t h a t i s apparent f a m i l y c o n t e x t may  i n the i l l n e s s and w i t h i n the  result in different  situational  appraisals. S i m i l a r l y t o Folkman, Lazarus, Dunkel-Schetter, e t a l . (198 6), primary a p p r a i s a l was i d e n t i f y what the respondent stressful situation.  assessed w i t h items t h a t c o n s i d e r s t o be a t stake i n the  These items, which e v a l u a t e the  of the i l l n e s s on the respondent's  life,  impact  were a s s e s s e d by a  q u e s t i o n n a i r e developed as p a r t of a l a r g e c r o s s - n a t i o n a l study of s e l f - h e l p groups (Chesler, Chesney, Gidron,  91 Hartman, & Sunderland, 1988). s t u d i e s examining the parents.  I t followed  from  earlier  impact of a c h i l d ' s c h r o n i c  I t i s reported  illness  t o o v e r l a p with most of the domains  addressed by s u b j e c t i v e burden s c a l e s f o r f a m i l i e s of mentally Potasznik  ill,  f o r example those of P i a t t  and Nelson  being  retained.  factors:  environment,  was  with only items l o a d i n g near or above The  r e t a i n e d 21 items loaded  .50  onto 5  and problems i n  (b) r e l a t i o n s h i p with the  community  (c) problems i n d a i l y f u n c t i o n i n g ,  r e l a t i o n s h i p s w i t h i n the f a m i l y , and future.  and  (1991), the 24-item s c a l e  (a) l a c k of i n f o r m a t i o n  communication,  (1985)  the  (1984).  In a study by Gidron f a c t o r analyzed  on  (d)  (e) worry about  Gidron d i d not r e p o r t r e l i a b i l i t i e s  the  f o r these  sub-  scales. For t h i s study, the item mental i l l n e s s and my  family"  " r e a c t i o n s of s o c i e t y towards ( l o a d i n g onto " r e l a t i o n s h i p  w i t h the community environment") has following three schizophrenia, and  items:  been separated  i n t o the  (a) r e a c t i o n s of s o c i e t y toward  (b) r e a c t i o n s of s o c i e t y toward my  (c) r e a c t i o n s of s o c i e t y toward my  family,  son/daughter.  These  s e p a r a t e items were presumed to load onto the same f a c t o r as the o r i g i n a l item. (a) l o s s  In a d d i t i o n , two  of time and  new  items were added:  energy at work (presumably  onto "problems i n d a i l y f u n c t i o n i n g " ) , and  loading  (b) r e l a t i o n s  w i t h spouse or former spouse (presumably l o a d i n g onto " r e l a t i o n s h i p s w i t h i n the f a m i l y " ) . t o i n d i c a t e , on a 6 - p o i n t ,  Respondents were asked  Likert-type scale  (strongly  92 d i s a g r e e = 1, s t r o n g l y agree = 6) , the extent t o which each item was  one of concern, with h i g h e r s c o r e s i n d i c a t i n g  h i g h e r l e v e l s of concern.  In t h i s study,  internal  r e l i a b i l i t i e s f o r the f a c t o r - a n a l y z e d s u b - s c a l e s were as f o l l o w s : r e l a t i o n s with the community, 5 items .72); r e l a t i o n s w i t h i n the f a m i l y , 4 items problems f u n c t i o n i n g , 6 items i n f o r m a t i o n , 7 items f u t u r e , 2 items 24 items  (alpha =  (alpha =  .66);  (alpha = .75); l a c k of  (alpha = .79); and worry about  the  ( c o r r e l a t i o n = .41); t o t a l aggregate  scale,  (alpha = .90).  Secondary  Appraisal  Secondary  a p p r a i s a l was  assessed w i t h f o u r d i s c r e t e  items t h a t d e s c r i b e coping o p t i o n s .  These items, which are  t h e o r e t i c a l l y based, were o r i g i n a l l y developed by Lazarus and L a u n i e r (1978) and f i r s t used by Folkman and (1980) w i t h a yes/no format.  Lazarus  Folkman, Lazarus, and  c o l l e a g u e s have u t i l i z e d t h i s secondary a p p r a i s a l m u l t i p l e times on l a r g e study samples,  their  assessment  changing the  response  format t o a 5-point L i k e r t s c a l e , scored i n the p o s i t i v e direction.  As p r e v i o u s l y mentioned, these items a s s e s s the  e x t e n t t o which respondents saw the s i t u a t i o n as one you c o u l d change or do something  about,"  "that  " t h a t you had t o  a c c e p t , " " i n which you needed t o know more b e f o r e you c o u l d act,"  and " i n which you had t o h o l d y o u r s e l f back from d o i n g  what you wanted t o do" et  al.,  1986).  (Folkman,  Lazarus, Dunkel-Schetter,  T h i s study u t i l i z e d a 6-point  response  c a t e g o r y from " s t r o n g l y d i s a g r e e " (1) t o " s t r o n g l y (6).  agree"  Of these s i n g l e item a p p r a i s a l s , o n l y two were found  93 to  be s i g n i f i c a n t l y c o r r e l a t e d .  Seeing the s i t u a t i o n as  i n which "I needed t o know more before I c o u l d a c t "  was  s i g n i f i c a n t l y c o r r e l a t e d with "having t o h o l d myself from doing what I wanted t o do" Ways of  one  back  (r = .32, p_ < .001) .  Coping  Because of i t s g e n e r a l i t y , the Ways of Coping Lazarus & Folkman, 1984) s t r e s s f u l circumstance  (WOC;  can be used t o assess c o p i n g i n any (Tennen & Herzberger,  s e p a r a t e f a c t o r analyses of a r e v i s e d WOC Lazarus, Dunkel-Schetter,  1985).  Three  by Folkman,  et a l . (1986) produced  similar  f a c t o r p a t t e r n s (alpha scores i n b r a c k e t s ) : c o n f r o n t i v e coping  (.70), d i s t a n c i n g (.61), s e l f - c o n t r o l l i n g  s e e k i n g s o c i a l support  (.76), a c c e p t i n g r e s p o n s i b i l i t y  (.66), escape-avoidance  (.72), p l a n f u l  (.68), and p o s i t i v e r e a p p r a i s a l In  (.70),  a c r i t i q u e of the WOC  problem-solving  (.79).  s c a l e , Tennen and  Herzberger  (1985) note t h a t a number of i n v e s t i g a t i o n s have demonstrated the s c a l e ' s i n t e r n a l c o n s i s t e n c y , c o n s t r u c t , and c o n c u r r e n t v a l i d i t y . retest r e l i a b i l i t y  may  These authors p o i n t out t h a t t e s t -  not be a p p r o p r i a t e f o r a measure of a  c o p i n g process t h a t i s seen t o change a c c o r d i n g t o s i t u a t i o n a l demands and p r e v i o u s coping e f f o r t s .  Also  because the s c a l e i s a s e l f - r e p o r t measure, Tennen and Herzberger  suggest t h a t i n t e r - r a t e r r e l i a b i l i t y  estimates  cannot be o b t a i n e d . In WOC  some s t u d i e s , i n v e s t i g a t o r s have added items t o the  t o assess coping more a c c u r a t e l y i n a p a r t i c u l a r  context  (Cohen, 1987).  illness  T h i s study i n c l u d e d items, noted i n  94 the l i t e r a t u r e , t h a t d e s c r i b e p a r t i c u l a r ways t h a t cope w i t h an i l l n e s s of a f a m i l y member.  relatives  These items a r e :  " t a l k e d t o someone i n a s i m i l a r s i t u a t i o n "  (presumably  l o a d i n g onto "seeking s o c i a l s u p p o r t " ) ; "made arrangements for  t h e f u t u r e " and "read books and a r t i c l e s t o l e a r n more  about t h e s i t u a t i o n "  (presumably  l o a d i n g onto  "planful  p r o b l e m - s o l v i n g " ) ; and "adjusted my e x p e c t a t i o n s f o r t h e f u t u r e , " "concentrated on the c h i l d ' s p o s i t i v e to  contributions  t h e f a m i l y , " and "we grew or changed as a f a m i l y i n a  good way" (presumably  l o a d i n g onto " p o s i t i v e r e a p p r a i s a l " ) .  T h i s l a t t e r item p a r a l l e l s an item a l r e a d y i n t h e WOC (Folkman, "I  Lazarus, Dunkel-Schetter, e t a l . ,  1986) t h a t reads  changed or grew as a person i n a good way."  found t h e f o l l o w i n g i n t e r n a l r e l i a b i l i t i e s scales  f o r these sub-  (alpha s c o r e s i n b r a c k e t s ) : c o n f r o n t i v e coping, 6  items  (.49), d i s t a n c i n g , 6 items  items  (.52), seeking s o c i a l support, 7 items  a c c e p t i n g r e s p o n s i b i l i t y , 4 items items  T h i s study  (.56), s e l f - c o n t r o l l i n g , 7  (.32), escape-avoidance, 8  (.61), p l a n f u l problem-solving, 8 items  p o s i t i v e r e a p p r a i s a l , 10 items were s c o r e d i n t h e p o s i t i v e  (.79),  (.79).  (.70). and  A l l the coping scales  direction.  I had c o n s i d e r e d t h e p o s s i b i l i t y o f combining  t h e sub-  s c a l e s i n t o two aggregate s c a l e s r e p r e s e n t i n g problemf o c u s s e d v e r s u s emotion-focessed coping.  Similar to  f i n d i n g s o f a p r e v i o u s study on maternal coping (see S e l t z e r , Greenberg, c o p i n g appeared  & Krauss, 1995), t h e i n d i v i d u a l forms o f  t o have unique r e l a t i o n s w i t h t h e  independent v a r i a b l e s ; these important a s s o c i a t i o n s might be  95 masked by composite s c o r i n g .  Therefore, i n d i v i d u a l  sub-  s c a l e s c o r e s were analyzed. Parents were i n s t r u c t e d as f o l l o w s : "We p a r t of the q u e s t i o n n a i r e i n which we  come now  t o the  ask you t o i n d i c a t e  the v a r i o u s ways i n which you p r e s e n t l y cope w i t h your situation.  The word coping use here r e f e r s t o any  attempt  t o manage your s i t u a t i o n , as you have d e s c r i b e d i t above, whether or not you f e e l t h i s e f f o r t i s s u c c e s s f u l . c a r e f u l l y read each item and  i n d i c a t e , by c i r c l i n g  Please the  a p p r o p r i a t e category number, the extent t o which you have used i t w i t h i n the past t h r e e months".  The responses  for  t h i s 4-point L i k e r t s c a l e range from "not used" (1) t o "used a g r e a t d e a l " (4). Overt Family  Influence  In a c c o r d w i t h r e c e n t l i t e r a t u r e on s p o u s a l i n f l u e n c e on coping and f a m i l y c o n t e x t u a l v a r i a b l e s (e.g. G o t t l i e b & Wagner, 1991), an i n q u i r y was  d i r e c t e d t o o v e r t i n f l u e n c e of  f a m i l y members on a p p r a i s a l and coping i n order t o f a c i l i t a t e an i n t e r p r e t a t i o n of p a r e n t s ' c h o i c e s of coping strategies. (1) or No  F i r s t , respondents  were asked t o respond  Yes  (2) t o the q u e s t i o n , "Have any f a m i l y members  i n f l u e n c e d your views of your s i t u a t i o n or your c o p i n g responses?" respondents  Next, i n an open-ended response were asked t o i n d i c a t e i n two  (a) "which family  format,  or t h r e e  sentences  members have done or s a i d something t o  i n f l u e n c e e i t h e r the way  you see your s i t u a t i o n or the  you choose t o cope with i t " ,  and  situation  responses  and/or your coping  (b) "how your views of  way your  have changed because  96 of what they have done or s a i d " .  Responses t o p a r t  "b" were  then content coded i n t o the f o l l o w i n g s i x c a t e g o r i e s : f e e l i n g c l o s e r t o f a m i l y members, (b) a c c e p t i n g and/or encouragement,  advice  (c) being pushed t o a c t i o n , (d)  r e a l i z i n g p e r s o n a l growth, (e) a c h i e v i n g acceptance, and (f) e x p e r i e n c i n g family  (a)  a realistic  c o n f l i c t / a disruption of  relationships. Analysis  Strategy  In order t o respond t o the study q u e s t i o n s and t o determine the p r e d i c t i v e r e l a t i o n s h i p s among t h e many v a r i a b l e s assessed, I decided upon the f o l l o w i n g strategy.  analysis  My i n t e n t was t o r e t a i n as much v a r i a b i l i t y as  p o s s i b l e w h i l e e l i m i n a t i n g any redundant o r n o n s i g n i f i c a n t v a r i a b l e s from the f i n a l a n a l y t i c procedures. would proceed i n a s e r i e s o f steps.  To begin with, I would  examine a l a r g e c o r r e l a t i o n matrix c o n t a i n i n g continuous v a r i a b l e s assessed.  The a n a l y s e s  Variables  c o n s i d e r e d redundant would be e l i m i n a t e d ;  a l l the  t h a t c o u l d be variables  showing  s i g n i f i c a n t a s s o c i a t i o n s with the dependent v a r i a b l e s o f i n t e r e s t would be r e t a i n e d  f o r further analysis.  t e s t s would be run t o determine s i g n i f i c a n t  Next, t -  associations  between c a t e g o r i c a l v a r i a b l e s and dependent v a r i a b l e s o f interest.  F i n a l l y , those v a r i a b l e s i d e n t i f i e d as  s i g n i f i c a n t i n the above procedures would be e n t e r e d standard m u l t i p l e variables.  regression  These r e g r e s s i o n s  into  equations with the dependent would i d e n t i f y those v a r i a b l e s  among i l l n e s s c h a r a c t e r i s t i c s , demographics, r e s o u r c e s , and  97 a p p r a i s a l s t h a t c o u l d be designated as p r e d i c t o r s w i t h i n the coping  process.  98 Chapter  VII  Results U n i v a r i a t e Data Analyses Missing  Values  U n i v a r i a t e analyses were conducted  t o assess s c a l e  d i s t r i b u t i o n s , and t o i d e n t i f y m i s s i n g or o u t l y i n g v a l u e s . For the most p a r t , m i s s i n g values appeared t o be randomly distributed.  M i s s i n g values on sub-scale items were  r e p l a c e d w i t h the mean score f o r the remainder of the  sub-  scale. T h i s procedure of  primary  was  not a p p r o p r i a t e f o r two  sub-scales  a p p r a i s a l , "problems i n d a i l y f u n c t i o n i n g " and  "worry about the f u t u r e " .  Each sub-scale had one  a c o n s i d e r a b l e number of m i s s i n g responses.  item w i t h  In the former  s u b - s c a l e , t h e r e were 52 m i s s i n g cases a t t a c h e d t o the "I worry about my  spouse's h e a l t h ( i f a p p l i c a b l e ) . "  An  i n v e s t i g a t i o n showing these m i s s i n g cases a t t a c h e d t o m a r r i e d and unmarried have been u n c l e a r . scale,  respondents,  both  t h i s item  D e l e t i o n of t h i s item from the  may  sub-  "problems i n d a i l y f u n c t i o n i n g , " r e s u l t e d i n a 6-item  s c a l e w i t h improved r e l i a b i l i t y . own  suggested  item  parents/spouse's  The  item " R e l a t i o n s w i t h  parents have worsened" was  cases. A c c o r d i n g t o Gidron  respondents  whose own  I  found,  not a p p l i c a b l e t o many o l d e r  parents were no longer a l i v e .  It  i n a p p r o p r i a t e t o r e p l a c e t h i s item with the mean s c o r e the other two  28  (1991), t h i s item c o n t r i b u t e d t o  the 3-item s u b - s c a l e "worry about the f u t u r e . " however, t h a t the item was  missing  was on  items because of the g r e a t d i f f e r e n c e i n means  99 (1.88  f o r the problem item versus 5 . 1 4  items).  T h i s item a l s o was  w i t h o n l y two  f o r the o t h e r  deleted r e s u l t i n g i n a  two  sub-scale  items.  Distributions Preliminary  analysis revealed  that variables, f o r  most p a r t , were normally d i s t r i b u t e d . s l i g h t skewness and/or k u r t o s i s .  The  the  Some s c a l e s evidenced scale that assessed a  p a r e n t ' s worry about the f u t u r e e x h i b i t e d the most s i g n i f i c a n t skewness (Skewness - -1.39,.SE Skewness = . 2 0 ) . A l a t e r check of the s c a t t e r p l o t of r e s i d u a l s p r e d i c t e d DV  scores  d i d show t h a t i n some i n s t a n c e s ,  assumptions of the r e g r e s s i o n analyses, normality  and  against  specifically  h o m o s c e d a s t i c i t y , were not met.  transformations  No  of data were undertaken, however.  Tabachnick and  Fidell  transformations  (1989) acknowledge t h a t data  are not u n i v e r s a l l y recommended because  transformed v a r i a b l e s are sometimes more d i f f i c u l t interpret.  to  They a l s o p o i n t out t h a t f a i l u r e t o meet  assumptions o f m u l t i p l e r e g r e s s i o n does not a n a l y s i s so much as weaken i t . The  Appendix D.  The  range, means, and  s c a l e s are r e p o r t e d Daughters and  i n Table F4  Sons), and  and  i n v a l i d a t e the  shapes of  d i s t r i b u t i o n s of s c a l e v a l u e s are d i s c u s s e d  Appraisals,  the  the  at l e n g t h  in  standard d e v i a t i o n s  (Functioning  i n Table F5 and  Coping of Mothers and  F6  Level  of  of  (Resources,  Fathers).  I t i s of i n t e r e s t to note t h a t the forms of c o p i n g most often reported  by t h i s group of parents were s e e k i n g  support, p l a n f u l problem-solving, and  social  positive reappraisal.  100 They r e p o r t e d  l e s s use of c o n f r o n t a t i o n a l  coping, a type o f  c o p i n g t h a t would correspond t o t h e "expressed emotion" t h a t i s mentioned i n t h e l i t e r a t u r e as d e t r i m e n t a l b e i n g o f persons w i t h  t o the w e l l -  schizophrenia.  M u l t i v a r i a t e Analyses Correlations The  q u e s t i o n s posed by t h i s study concerned t h e  i d e n t i f i c a t i o n of i l l n e s s , demographic, and r e s o u r c e v a r i a b l e s t h a t were p r e d i c t i v e of a p p r a i s a l s The  and c o p i n g .  a n a l y s i s s t r a t e g y mentioned above was f o l l o w e d  s e r v i c e of t h i s e f f o r t .  i n the  A c o r r e l a t i o n matrix was examined  t o i n v e s t i g a t e i n t e r r e l a t i o n s h i p s among t h e v a r i a b l e s i n order  (a) t o e l i m i n a t e  redundant v a r i a b l e s and, (b) t o  choose from among those t h e o r e t i c a l l y r e l e v a n t  variables,  the ones t h a t were s i g n i f i c a n t l y c o r r e l a t e d w i t h measures o f a p p r a i s a l and coping.  In a d d i t i o n , t - t e s t s were conducted  t o i n v e s t i g a t e the a s s o c i a t i o n s  of c a t e g o r i c a l  variables  (gender, m a r i t a l s t a t u s , r e s i d e n c e of c h i l d , o v e r t influence,  family  and having another c h i l d with d i s a b i l i t i e s )  measures o f i l l n e s s , resources, a p p r a i s a l s ,  with  and coping.  S i g n i f i c a n t r e s u l t s f o r these c a t e g o r i c a l v a r i a b l e s a r e reported  i n T a b l e s F4 t o F8.  T a b l e F9 shows s i g n i f i c a n t c o r r e l a t i o n s t h a t were noted among some of the demographic v a r i a b l e s d e s i g n a t e d f o r further analysis.  S i g n i f i c a n t i n t e r r e l a t i o n s h i p s can be  noted among "age of parent," "age of c h i l d , " and "time  since  onset o f t h e i l l n e s s , " with the l e v e l s of s i g n i f i c a n c e r a n g i n g from r = .60 t o r = .81.  In order t o e l i m i n a t e any  101 redundancies,  "age  of parent" was  v a r i a b l e t h a t would capture these  chosen as a r e p r e s e n t a t i v e interrelated  c h a r a c t e r i s t i c s of the s i t u a t i o n . T a b l e F10  i d e n t i f i e s those v a r i a b l e s  a s s o c i a t e d w i t h primary a p p r a i s a l s . c o e f f i c i e n t s w i t h l e v e l s of  significantly  Correlation  s i g n i f i c a n c e are i n c l u d e d ; f o r  each c a t e g o r i c a l v a r i a b l e , values d i s p l a y e d are the d i f f e r e n c e s i n means between the groups, tailed  l e v e l s of s i g n i f i c a n c e .  along w i t h the  2-  I t i s of i n t e r e s t t o note  the absence of v a r i a b l e s whose a s s o c i a t i o n s w i t h  primary  a p p r a i s a l s might have been expected a c c o r d i n g t o the l i t e r a t u r e reviewed  above, f o r example, primary a p p r a i s a l s  were not s i g n i f i c a n t l y a s s o c i a t e d with e i t h e r the p a r e n t ' s e d u c a t i o n , m a r i t a l s t a t u s , or f a m i l y income. T a b l e F l l i d e n t i f i e s those v a r i a b l e s t h a t were s i g n i f i c a n t l y a s s o c i a t e d with secondary  appraisals.  the v a r i a b l e s l i s t e d were i d e n t i f i e d as  significant  c o r r e l a t e s of a secondary  Most of  a p p r a i s a l of the s i t u a t i o n as  one  i n which parents f e l t they had t o h o l d back from d o i n g what they wanted t o do.  I t can be noted, however, t h a t of the  f i v e s u b - s c a l e measures of the son's/daughter's f u n c t i o n i n g , o n l y nonturbulent behaviour and had t h i s i d e n t i f i c a t i o n .  l e v e l of  responsibility  I t can be seen t h a t the v a r i a b l e s  l i s t e d were a s s o c i a t e d i n d i f f e r e n t ways w i t h the o t h e r measures of secondary  appraisal.  For example, mastery,  e x p r e s s i v e support, and r e l a t i o n s h i p s w i t h i n the f a m i l y were c o r r e l a t e d with seeing the s i t u a t i o n as one t h a t c o u l d be changed, whereas o n l y s e l f - e s t e e m had a s i g n i f i c a n t  102 r e l a t i o n s h i p w i t h an a p p r a i s a l of the s i t u a t i o n as one t h a t must be accepted.  L o g i c a l l y , a secondary  needing t o know more before a c t i n g was  a p p r a i s a l of  significantly  a s s o c i a t e d w i t h a primary a p p r a i s a l of a l a c k of i n f o r m a t i o n and problems i n communication. T a b l e s F12  and F13  i d e n t i f y those v a r i a b l e s t h a t were  s i g n i f i c a n t l y a s s o c i a t e d with a parent's coping I t can be seen t h a t demographics, r e s o u r c e s , a p p r a i s a l s , and secondary  strategies.  primary  a p p r a i s a l s were c o r r e l a t e d  d i f f e r e n t l y w i t h d i f f e r e n t types of coping; the g r e a t e s t number and s t r e n g t h of a s s o c i a t i o n s e x i s t e d between t h e s e v a r i a b l e s and v a r i o u s forms of emotion-focussed as, s e l f - c o n t r o l , seeking s o c i a l support, and avoidance status  strategies.  coping,  such  escape-  I n t e r e s t i n g l y , parent's m a r i t a l  (married = 1, not married = 2), which was  found above  t o be n o n s i g n i f i c a n t l y a s s o c i a t e d with measures of s i t u a t i o n a l a p p r a i s a l , was  seen t o be  significantly  c o r r e l a t e d w i t h v a r i o u s types of coping. which was  Age  of the parent,  noted above t o be s t r o n g l y c o r r e l a t e d w i t h  time  s i n c e onset of i l l n e s s , g e n e r a l l y had s t r o n g e r a s s o c i a t i o n s w i t h a s p e c t s of coping than d i d the l a t t e r v a r i a b l e . d i s t a n c e s t r a t e g i e s , however, the time s i n c e onset was t o have the s t r o n g e r a s s o c i a t i o n and t h e r e f o r e was  With found  the  v a r i a b l e c o n s i d e r e d t o be more a p p r o p r i a t e f o r f u r t h e r a n a l y s i s of t h i s form of coping.  To r e i t e r a t e ,  s i g n i f i c a n t a s s o c i a t i o n s helped i d e n t i f y those  these variables  t h a t were a p p r o p r i a t e c h o i c e s f o r r e g r e s s i o n a n a l y s e s .  103 Some i n t e r e s t i n g observations F10  t o F13.  are apparent from T a b l e s  C e r t a i n v a r i a b l e s are seen t o reoccur  s i g n i f i c a n t c o r r e l a t e s of both a p p r a i s a l s and  as  coping,  namely, sex of the parent, the r e s p o n s i b i l i t y and n o n t u r b u l e n t behaviour of the daughter/son, and r e s o u r c e s of esteem, mastery, and  expressive  the  support.  v a r i a b l e s are more s p e c i f i c i n t h e i r a s s o c i a t i o n s . example, p a r e n t ' s m a r i t a l s t a t u s i s s i g n i f i c a n t l y  Other  For correlated  o n l y w i t h coping, not with a p p r a i s a l s , whereas the  resource,  c o h e s i o n , i s seen only to be s i g n i f i c a n t l y a s s o c i a t e d  with  appraisals. It  i s a l s o i n t e r e s t i n g t o note those a p p r a i s a l s  and  forms of coping t h a t most f r e q u e n t l y are c o r r e l a t e d w i t h other f a c t o r s .  Four of the f i v e primary a p p r a i s a l s , have  s i g n i f i c a n t a s s o c i a t i o n s with demographics, c h i l d ' s skills,  and  perception  resources.  One  secondary a p p r a i s a l ,  of having to hold back, a l s o has  life  the  multiple  a s s o c i a t i o n s t h a t reach l e v e l s of s i g n i f i c a n c e .  As  well,  c e r t a i n forms of coping, p a r t i c u l a r l y a c c e p t i n g r e s p o n s i b i l i t y and  escape-avoidance, are  c o r r e l a t e d w i t h demographics, resources, skills, An  and  both primary and  child's  life  secondary a p p r a i s a l s .  absence of p a r t i c u l a r s i g n i f i c a n t a s s o c i a t i o n s  i s notable. about the  also  U n l i k e the other four primary a p p r a i s a l s , worry  f u t u r e has  child's l i f e skills.  no s i g n i f i c a n t a s s o c i a t i o n s Each of two  with  secondary a p p r a i s a l s ,  namely, viewing the s i t u a t i o n as one and  significantly  t h a t must be  needing t o know more before a c t i n g , has  only  accepted one  104 s i g n i f i c a n t c o r r e l a t i o n , with s e l f - e s t e e m and information  respectively.  i n p a r t i c u l a r areas.  coping and  resource f a c t o r ;  coping, s e e k i n g s o c i a l support, and s i g n i f i c a n t associations  positive  coping) i s not  s i g n i f i c a n t l y c o r r e l a t e d w i t h any  of the  four  appraisals. Regression  b a s i c q u e s t i o n of m u l t i p l e multiple regression (1989).  c o r r e l a t i o n , the  regression  answer  the  standard form of  i s the method advised by Tabachnick  Independent v a r i a b l e s , r e t a i n e d  from  above a n a l y s e s , were entered s i m u l t a n e o u s l y i n t o  and  the  multiple  equations t o p r o v i d e a more a c c u r a t e assessment  of t h e i r a s s o c i a t i o n s power.  distance  ( u n l i k e o t h e r forms of  To assess r e l a t i o n s h i p s among v a r i a b l e s , and  Fidell  not  with measures of primary  seeking s o c i a l support  Multiple  For  reappraisal  a p p r a i s a l ; and  secondary  well,  p o s i t i v e r e a p p r a i s a l are  c o r r e l a t e d s i g n i f i c a n t l y with any  have no  of  C e r t a i n forms of coping, as  lack s i g n i f i c a n t associations example, c o n f r o n t i v e  a lack  and  to i n d i c a t e t h e i r p r e d i c t i v e  Three s e r i e s of m u l t i p l e r e g r e s s i o n s  t o c l a r i f y the  following:  were conducted  (a) the amounts of v a r i a n c e  in  primary a p p r a i s a l s t h a t can be a t t r i b u t e d t o demographics and  resources,  (b) the v a r i a n c e  i n secondary a p p r a i s a l s  i s a t t r i b u t a b l e to demographics, r e s o u r c e s , and appraisals,  and  primary  (c) the a c c o u n t a b i l i t y of demographics,  r e s o u r c e s , primary a p p r a i s a l s , the v a r i a n c e  that  i n coping.  and  secondary a p p r a i s a l s  Whereas the  independent  are d e s i g n a t e d as p r e d i c t o r s , no c a u s a l intended or indeed i s p o s s i b l e .  inference  for  variables is  For an a c c u r a t e assessment  105 of  the importance  of the independent  variables,  attention  must be g i v e n t o the i n t e r c o r r e l a t i o n s among them, as w e l l as t h e i r Beta v a l u e s and l e v e l s of s i g n i f i c a n c e . M u l t i p l e r e g r e s s i o n s e r i e s 1.  Tables F14 through  F18  d i s p l a y the r e s u l t s of r e g r e s s i o n equations i n which demographic, resource, and i l l n e s s  (life skills)  were r e g r e s s e d on each of the f i v e primary  variables  appraisals.  G e n e r a l l y , a t l e a s t f o u r of the f i v e l i f e s k i l l s measures were c a n d i d a t e s f o r e n t r y i n t o each of the equations, with other v a r i a b l e s .  These l i f e s k i l l s s u b - s c a l e s ,  however, were moderately  to h i g h l y i n t e r c o r r e l a t e d ; f o r  example, the c o r r e l a t i o n of nonturbulence was  r = .75.  utilized,  and  responsibility  The cumulative l i f e s k i l l s measure  was  t h e r e f o r e , t o capture the range of l i f e  skills  i n f l u e n c e w h i l e a v o i d i n g the m u l t i c o l l i n e a r i t y of the scales.  along  sub-  The t a b l e s d i s p l a y the c o r r e l a t i o n s between the  v a r i a b l e s , the unstandardized r e g r e s s i o n c o e f f i c i e n t s the s t a n d a r d i z e d r e g r e s s i o n c o e f f i c i e n t s  (B),  (Beta), F v a l u e s  and the s i g n i f i c a n c e of F f o r each p r e d i c t o r , as w e l l as  R,  R squared,  of  a d j u s t e d R, F, s i g n i f i c a n c e of F, and degrees  freedom f o r each equation. In  equation number one  (see Table F14), I e n t e r e d  demographics [age and sex of parent sex of c h i l d  (male = 1, female = 2 ) ] ,  c h i l d , and r e s o u r c e s community support)  (male = 1, female = 2), life  s k i l l s of the  (esteem, mastery, cohesion,  and  as p r e d i c t o r s of a primary a p p r a i s a l of a  l a c k of i n f o r m a t i o n and problems i n communication. A l t o g e t h e r 32%  (adjusted 28%)  of the v a r i a b i l i t y i n t h i s  106 primary a p p r a i s a l was e i g h t independent  p r e d i c t e d by knowing the s c o r e s on the  variables.  R f o r r e g r e s s i o n was  s i g n i f i c a n t l y d i f f e r e n t from zero, F = 7.65, two to  of the independent  p_ < .001.  variables contributed s i g n i f i c a n t l y  the v a r i a n c e e x p l a i n e d , c h i l d ' s l i f e s k i l l s  and community support  Only  (Beta = -.19).  (Beta =  -.21)  Both h i g h e r l e v e l s of  c h i l d ' s l i f e s k i l l s and g r e a t e r a v a i l a b i l i t y of community support p r e d i c t e d l e s s p a r e n t a l concern over a l a c k of i n f o r m a t i o n and problems i n communication.  Although  o t h e r IVs had been shown independently t o be a s s o c i a t e d w i t h the DV,  the  significantly  when entered i n combination  other i n t e r r e l a t e d variables, t h e i r s i g n i f i c a n c e  with  was  diminished. In  the second  equation  (Table F15), sex of parent,  c h i l d ' s l i f e s k i l l s , and the resources of esteem, mastery, c o h e s i o n , and community support, were r e g r e s s e d on the primary a p p r a i s a l , concern over r e l a t i o n s w i t h the community.  V a r i a n c e e x p l a i n e d was  M u l t i p l e R was  27%  (adjusted 24%).  s i g n i f i c a n t l y d i f f e r e n t from zero, F =  p_ < .001.  Again, c h i l d ' s l i f e s k i l l s was  predictor  (Beta = -.21), f o l l o w e d by mastery  and sex of parent  (Beta = .18).  8.36,  the s t r o n g e s t (Beta =  -.19)  Less p a r e n t a l concern  r e l a t i o n s w i t h the community, t h e r e f o r e , was  over  p r e d i c t e d by  h i g h e r l e v e l s of c h i l d ' s l i f e s k i l l s , h i g h e r l e v e l s of p a r e n t a l mastery, and by being the f a t h e r of the person  with  schizophrenia. T a b l e F16 d i s p l a y s the r e s u l t s of the t h i r d e q u a t i o n i n which the l i f e s k i l l s and sex of the c h i l d , r e s o u r c e s ,  and  107 having another  c h i l d with a d i s a b i l i t y , accounted  ( a d j u s t e d 34%)  of the v a r i a b i l i t y i n the primary  concern over r e l a t i o n s w i t h i n the f a m i l y . c o e f f i c i e n t was  f o r 38% appraisal,  The r e g r e s s i o n  s i g n i f i c a n t l y d i f f e r e n t from zero, F =  10.09, p_ < .001.  Of the e i g h t I V s  entered i n t o the  equation, o n l y t h r e e were s i g n i f i c a n t p r e d i c t o r s .  Lower  l e v e l s of p a r e n t a l concern over r e l a t i o n s w i t h i n the f a m i l y were p r e d i c t e d by h i g h e r l e v e l s of mastery h i g h e r l e v e l s of c h i l d ' s l i f e s k i l l s h i g h e r l e v e l s of f a m i l y cohesion A full primary  46%  (adjusted 43%)  .00.  -.33),  (Beta = -.24),  and  (-.19).  of the v a r i a n c e of the  a p p r a i s a l , problems i n d a i l y f u n c t i o n i n g , was  e x p l a i n e d by equation f o u r (Table F17). .68 was  (Beta =  The m u l t i p l e R of  s i g n i f i c a n t l y d i f f e r e n t from zero, F = 16.38, p_ <  Four of the seven IVs entered were s i g n i f i c a n t  p r e d i c t o r s of fewer problems i n d a i l y f u n c t i o n i n g : h i g h e r l e v e l s of mastery  (Beta = -.36),  i n c r e a s e d age of p a r e n t  (Beta = -.23), h i g h e r l e v e l s of esteem (Beta = -.16), h i g h e r l e v e l s of c h i l d ' s l i f e s k i l l s Only  18%  (adjusted 16%)  (Beta =  five  (Table F18).  R f o r r e g r e s s i o n was  d i f f e r e n t from zero with F = 7.38, the presence predictor  e x p l a i n e d by  p_ < .001.  equation  Interestingly,  the s t r o n g e s t  Having a f a m i l y member who  does something t o change the way  primary  significantly  of o v e r t f a m i l y i n f l u e n c e was  (Beta = -.24).  -.14).  of the v a r i a n c e i n the  a p p r a i s a l , worry about the f u t u r e , was  and  says or  the parent views or copes  w i t h the s i t u a t i o n i s p r e d i c t i v e of h i g h e r l e v e l s of worry about the f u t u r e (p_ < .001).  Lower l e v e l s of s e l f - e s t e e m  108 (Beta = -.18)  and  being a mother (Beta = .17)  s i g n i f i c a n t l y contributed The  also  t o h i g h e r l e v e l s of t h i s concern.  data i n the t a b l e s reviewed so f a r show t h a t  between 18%  and  4 6% of the v a r i a b i l i t y i n primary  appraisals  can be a t t r i b u t e d t o demographics, i l l n e s s c h a r a c t e r i s t i c s (life skills), The  and  both i n d i v i d u a l and  family  resources.  i n t e r c o r r e l a t i o n s among the independent v a r i a b l e s  such t h a t when regressed  simultaneously on each dependent  v a r i a b l e , t h e i r l e v e l s of s i g n i f i c a n c e are reduced. e q u a t i o n i d e n t i f i e s between two  and  four v a r i a b l e s  r e t a i n t h e i r l e v e l s of s i g n i f i c a n c e and significant predictors. frequent  f o r worry about the  Multiple regression  illness  Tables F19  through  and primary a p p r a i s a l v a r i a b l e s were  on secondary a p p r a i s a l s .  In equation number 6  three  the v a r i a n c e  of the secondary a p p r a i s a l , "the  IVs accounted f o r 15%  (adjusted  14%)  p_ <  Only mastery, however, with a Beta v a l u e of  r e t a i n e d a l e v e l of s i g n i f i c a n c e l e s s t h a t  .05.  l e v e l s of mastery, then, p r e d i c t e d a stronger the s i t u a t i o n as one something about.  of  situation is  I can change or do something about" (F = 8.36,  .001).  F22  equations i n which  (Table F19),  one  appraisals  future.  s e r i e s 2.  show the r e s u l t s of r e g r e s s i o n  regressed  that  Resource v a r i a b l e s are the most  c h a r a c t e r i s t i c s are p r e d i c t i v e of a l l primary  demographic, resource,  Each  emerge as  p r e d i c t o r of primary a p p r a i s a l s ;  excepting  are  .21,  Higher  perception  t h a t the parent could change or  do  of  109 The  r e g r e s s i o n of t h e i n d i v i d u a l r e s o u r c e  self-esteem  on t h e secondary a p p r a i s a l , "the s i t u a t i o n i s one I have t o a c c e p t , " was t h e weakest equation The  of t h i s group (Table F20).  s i n g l e independent v a r i a b l e t h a t had been  identified  p r e v i o u s l y as s i g n i f i c a n t l y a s s o c i a t e d with t h i s secondary a p p r a i s a l , accounted f o r only 5 % (adjusted 4 %) o f t h e v a r i a n c e i n t h e secondary a p p r a i s a l , with an F v a l u e o f 6.90,  p_ < 01.  Higher l e v e l s of s e l f - e s t e e m were p r e d i c t i v e  of a s t r o n g e r p e r c e p t i o n of t h e s i t u a t i o n as one t h a t had t o be  accepted. The  secondary a p p r a i s a l , "I needed t o know more b e f o r e  I c o u l d a c t " a l s o had only one IV r e g r e s s e d upon i t (Table F21).  T h i s p r e d i c t o r , a primary a p p r a i s a l of a l a c k o f  i n f o r m a t i o n and problems i n communication accounted f o r t h e 12%  (adjusted 11%) o f v a r i a n c e e x p l a i n e d , with an F v a l u e o f  18.86, p. < .001. A g r e a t e r concern over a l a c k o f i n f o r m a t i o n , then, p r e d i c t e d a stronger p e r c e p t i o n of needing t o know more. By c o n t r a s t , Table F22 shows there were e i g h t IVs, p r e v i o u s l y i d e n t i f i e d as s i g n i f i c a n t , entered equation  into the  e x p l a i n i n g 33% (adjusted 29%) of t h e v a r i a n c e o f  the secondary a p p r a i s a l , "I had t o h o l d back from doing what I wanted t o do" (F = 8.14, p_ < .001). were demographics, resources, appraisals.  Among these v a r i a b l e s  l i f e s k i l l s and primary  A l l t h e primary a p p r a i s a l s were c a n d i d a t e s f o r  e n t r y because of s i g n i f i c a n t a s s o c i a t i o n s w i t h t h e dependent v a r i a b l e ; moderate t o high i n t e r c o r r e l a t i o n s among them, g e n e r a l l y between r = .50 and r = .70, made t h i s  inclusion  110 inadvisable.  Rather, the aggregate measure of  a p p r a i s a l was  utilized.  aggregate primary predictor  primary  Of the v a r i a b l e s entered,  a p p r a i s a l measure emerged as a s i g n i f i c a n t  (Beta = .36, p_ < .001).  The  interrelationships  between t h i s s i g n i f i c a n t c o n t r i b u t o r and the other entered  o n l y the  (resources, demographics, and  l i f e s k i l l s ) had  demonstrated i n the previous s e t of equations. e q u a t i o n showed t h a t a higher l e v e l of concern the i l l n e s s had a f f e c t e d the parent's  IVs been  This over the ways  l i f e predicted a  s t r o n g e r p e r c e p t i o n of the s i t u a t i o n as one  i n which the  parent had t o h o l d back from doing what was  wanted.  In the equations  i n v e s t i g a t i n g the p r e d i c t o r s of  secondary a p p r a i s a l s , the v a r i a n c e e x p l a i n e d ranges from o n l y 5% t o 33%.  S i g n i f i c a n t p r e d i c t o r s of secondary  a p p r a i s a l s are resources primary  appraisals.  s i t u a t i o n as one  (self-esteem and mastery)  and  Only a secondary a p p r a i s a l of the  i n which the parent had t o h o l d back had  s i g n i f i c a n t a s s o c i a t i o n s with m u l t i p l e v a r i a b l e s . M u l t i p l e r e g r e s s i o n s e r i e s 3.  R e s u l t s of the  r e g r e s s i o n of i l l n e s s , demographic, resource, and a p p r a i s a l v a r i a b l e s on each of the measures of coping are d i s p l a y e d i n T a b l e s F2 3 through F3 0. from 13% t o  Amounts of v a r i a n c e e x p l a i n e d range  42%.  F i v e IVs i n c l u d i n g demographics, two  primary  a p p r a i s a l s , and a secondary a p p r a i s a l , were r e g r e s s e d c o n f r o n t i v e coping 11%)  (Table F23), accounting  of the v a r i a n c e i n the DV  (F = 4.46,  f o r 14%  on  (adjusted  p_ < .001). Only  marital status contributed s i g n i f i c a n t l y to confrontive  Ill c o p i n g w i t h a Beta value of .18 and a s i g n i f i c a n c e l e v e l o f P < .03.  Being never married, separated, d i v o r c e d , o r  widowed p r e d i c t e d a g r e a t e r use of c o n f r o n t i v e coping. Equation number 11 (Table F24) demonstrated t h a t two IVs, i n c r e a s e d time s i n c e i l l n e s s onset  (Beta = .22) and a  s t r o n g e r secondary a p p r a i s a l of having t o h o l d back (Beta = .17), emerged as t h e s i g n i f i c a n t p r e d i c t o r s o f a g r e a t e r use of  d i s t a n c e coping.  Four IVs were r e g r e s s e d on t h e DV  a c c o u n t i n g f o r 13% (adjusted 11%) o f i t ' s v a r i a b i l i t y  (F =  5.26, p_ < .001) . T a b l e F25 shows m a r i t a l s t a t u s again t o be a s i g n i f i c a n t p r e d i c t o r of coping. married,  Being not m a r r i e d  (never  separated, d i v o r c e d , or widowed) p r e d i c t e d g r e a t e r  use o f c o p i n g through s e l f - c o n t r o l .  Although  seven IVs were  r e g r e s s e d on s e l f - c o n t r o l coping, only m a r i t a l s t a t u s c o n t r i b u t e d t o the 24% (adjusted 20%) of v a r i a n c e e x p l a i n e d w i t h a s i g n i f i c a n c e l e v e l l e s s or equal t o .05. The F v a l u e for  t h e r e g r e s s i o n equation e q u a l l e d 5.72 w i t h a  s i g n i f i c a n c e l e v e l of p < .001 Coping by seeking s o c i a l support i s shown i n T a b l e F26 to  have a number of s i g n i f i c a n t p r e d i c t o r s .  A l t o g e t h e r , 27%  (adjusted 24%) of t h e v a r i a b i l i t y i n seeking s o c i a l  support  was p r e d i c t e d by knowing the a v a i l a b i l i t y o f e x p r e s s i v e support  (Beta = .38), the m a r i t a l s t a t u s o f t h e p a r e n t  = .20), t h e l i f e  skill,  nonturbulent behaviour,  (Beta = -.20), and the age of the parent for  r e g r e s s i o n was 9.92, p_ < .001.  (Beta  of the c h i l d  (Beta = -20).  F  A g r e a t e r use o f c o p i n g  through seeking s o c i a l support, t h e r e f o r e , was a s s o c i a t e d  112 w i t h an i n c r e a s e d a v a i l a b i l i t y of e x p r e s s i v e support,  being  younger and not married, and having a c h i l d w i t h more turbulent  behaviour.  In equation 14 (Table F27), more p a r e n t a l coping by a c c e p t i n g r e s p o n s i b i l i t y was p r e d i c t e d by a s t r o n g e r secondary  a p p r a i s a l of having t o h o l d back from doing what  the parent wanted t o do (Beta = .22) and by a lower the c h i l d ' s l i f e  skill,  nonturbulence  l e v e l of  (Beta = -.19).  The  amount o f v a r i a n c e e x p l a i n e d was 26% (adjusted 23%) w i t h F = 7.81, p_ < . 001. Although  e i g h t IVs were r e g r e s s e d on  escape-avoidance  coping, t h e v a r i a n c e was e x p l a i n e d s i g n i f i c a n t l y by t h r e e predictors. of  Table F28 demonstrates t h a t 42% ( a d j u s t e d 39%)  t h e v a r i a n c e c o u l d be p r e d i c t e d by knowing t h e s c o r e s on  the aggregate  primary a p p r a i s a l measure (Beta = .27), t h e  l e v e l o f mastery (Beta = -.19).  (Beta = -.22), and the age of t h e p a r e n t I n t e r e s t i n g l y , both mastery and primary  a p p r a i s a l s were s i g n i f i c a n t p r e d i c t o r s d e s p i t e t h e i r i n t e r c o r r e l a t i o n of -.50. of  Being o l d e r , having h i g h e r  mastery, and having lower  l e s s use o f escape-avoidance  levels  l e v e l s o f concerns p r e d i c t e d strategies.  F for regression  e q u a l l e d 11.97, p_ < .001. T a b l e F29 shows t h a t 25% (adjusted 21%) o f t h e v a r i a n c e in  c o p i n g through p l a n f u l problem-solving  in  equation 16 (F = 7.16, p_ < .001).  i s accounted f o r  There a r e f o u r  s i g n i f i c a n t p r e d i c t o r s of a g r e a t e r use of p l a n f u l problems o l v i n g : a g r e a t e r a v a i l a b i l i t y of e x p r e s s i v e support -  .24), , being not married  (Beta  (Beta = .20), a g r e a t e r worry  113 about the f u t u r e (Beta = .18) a p p r a i s a l of needing All to  and a s t r o n g e r  t o know more (Beta =  .23).  s i x IVs entered i n t o equation 17 were demonstrated  be s i g n i f i c a n t p r e d i c t o r s of coping through  reappraisal  (Table F30), with 31%  variance explained.  positive  (adjusted 28%)  of the  The parent's g r e a t e r use of coping  through p o s i t i v e r e a p p r a i s a l was mother (Beta = .24),  associated with  (b) being not married  h i g h e r l e v e l s of the c h i l d ' s l i f e .20), and  secondary  skill,  (d) t h r e e separate secondary  (a) b e i n g a  (Beta = .19),  sociability  (c)  (Beta =  appraisals, a greater  need t o know more before a c t i n g (Beta = .22), a s t r o n g e r p e r c e p t i o n of the s i t u a t i o n changeable (Beta = .22), and s t r o n g e r view of the s i t u a t i o n as one t h a t must be (Beta = .18). of  F f o r r e g r e s s i o n e q u a l l e d 10.04  s i g n i f i c a n c e , p_ < The  equations  a  accepted  with a l e v e l  .001.  j u s t reviewed  r e v e a l t h a t p r e d i c t o r s of  coping are m u l t i p l e and v a r i e d ; demographics,  illness  c h a r a c t e r i s t i c s , r e s o u r c e s , primary a p p r a i s a l s , and secondary  a p p r a i s a l s account  variability  f o r between 13% and 42%  i n d i f f e r e n t forms of coping.  I t i s of  t h a t the demographic, m a r i t a l s t a t u s of parent not-married  of the interest  (married = 1,  = 2), which has not been s i g n i f i c a n t l y  a s s o c i a t e d w i t h any type of s i t u a t i o n a l a p p r a i s a l , i s demonstrated t o be a s i g n i f i c a n t p r e d i c t o r of many forms of coping.  114 L i f e S k i l l s . Demographics, Resources, and A p p r a i s a l s  as  Predictors In order t o respond most d i r e c t l y t o the  questions  posed by t h i s study, however, a s l i g h t r e o r i e n t a t i o n toward the r e g r e s s i o n on  r e s u l t s i s required.  Rather than  i d e n t i f y i n g the p r e d i c t o r s of v a r i o u s  focussing  appraisals  and  forms of coping, study responses must be d i r e c t e d toward d e t e r m i n i n g the p r e d i c t i v e power of i l l n e s s c h a r a c t e r i s t i c s , demographics, resources, and E6  appraisals.  i l l u s t r a t e , u s i n g Beta values,  Figures  E3  the d i r e c t i o n and  through strength  of the p r e d i c t i v e power of i l l n e s s , demographic, r e s o u r c e , and  appraisal variables, respectively.  The  relationships  diagrammed are those t h a t r e t a i n e d a l e v e l of s i g n i f i c a n c e l e s s or equal t o  .05  w i t h i n the r e g r e s s i o n  equations.  are diagrammed i n accordance with the s t r e s s and model reviewed above. described  diagrams w i l l be  coping  briefly  i n response to the study q u e s t i o n s .  Question 1. predict parental coping  The  They  How  w e l l do  appraisals  illness characteristics  of the s i t u a t i o n and  parental  strategies?  Figure  E3  shows t h a t l i f e s k i l l s of the  with schizophrenia of c o p i n g  negatively  The  but not  and  of secondary  c h i l d ' s nonturbulent behaviour i s  p r e d i c t i v e of two  coping s t r a t e g i e s f o r p a r e n t s ,  s e e k i n g s o c i a l support (-.20) and responsibility  or daughter  are p r e d i c t i v e of primary a p p r a i s a l s  (Beta v a l u e s i n b r a c k e t s ) ,  appraisals.  son  (-.19).  acceptance of  I n t e r e s t i n g l y , higher l e v e l s of a  c h i l d ' s s o c i a b i l i t y i s p r e d i c t i v e of more p a r e n t a l  coping  by  115 p o s i t i v e r e a p p r a i s a l (.20). skills  A lower l e v e l o f c h i l d ' s l i f e  (cumulative) i s p r e d i c t i v e of g r e a t e r  concern over (a) l a c k of i n f o r m a t i o n communication .21),  parental  and problems i n  (-.21), (b) r e l a t i o n s w i t h t h e community (-  (c) r e l a t i o n s w i t h i n the f a m i l y  problems i n d a i l y f u n c t i o n i n g  (-.14).  (-.24), and (d) Another  illness  c h a r a c t e r i s t i c , g r e a t e r time s i n c e onset, p r e d i c t s use  o f d i s t a n c e coping Question 2.  greater  (.22).  What demographic c h a r a c t e r i s t i c s p r e d i c t  p a r e n t a l a p p r a i s a l s and coping? F i g u r e E4 i n d i c a t e s t h a t age and sex o f parent  (father  = 1, mother = 2) a r e p r e d i c t i v e of both primary a p p r a i s a l s and  coping.  Age i s n e g a t i v e l y r e l a t e d t o a concern over  problems f u n c t i o n i n g support  (-.23), and t o coping  by seeking  social  (-.20) or by u s i n g escape s t r a t e g i e s (-.19).  Mothers more t h a t f a t h e r s p e r c e i v e concerns i n t h e i r r e l a t i o n s w i t h the community  (-.18) and they have  l e v e l s o f worry about the f u t u r e  (.17).  higher  Mothers a r e more  l i k e l y than f a t h e r s t o cope through p o s i t i v e r e a p p r a i s a l (.24).  M a r i t a l status  (1 = married, 2 = not married) i s  p r e d i c t i v e of s e v e r a l coping  strategies.  Not being  married  ( d i v o r c e d , separated, widowed) i s p r e d i c t i v e o f more coping through c o n f r o n t a t i o n s o c i a l support  (.18), s e l f c o n t r o l (.21),  seeking  (.20), and p l a n f u l problem-solving  (.20).  Demographics do not appear as p r e d i c t o r s o f secondary appraisals. Question 3.  What i n d i v i d u a l and f a m i l y  p r e d i c t p a r e n t a l a p p r a i s a l s and coping  resources  strategies?  116 F i g u r e E5 shows t h a t mastery i s h i g h l y p r e d i c t i v e o f c e r t a i n primary a p p r a i s a l s .  Higher l e v e l s of mastery  p r e d i c t lower l e v e l s of concern over r e l a t i o n s w i t h t h e community  (-.19), r e l a t i o n s w i t h i n t h e f a m i l y  problems f u n c t i o n i n g  (-.36).  (-.33), and  As might be expected, mastery  p o s i t i v e l y p r e d i c t s a secondary a p p r a i s a l o f t h e s i t u a t i o n as one t h a t you could change or do something about and  i s negatively  p r e d i c t i v e of coping through escape-  avoidance s t r a t e g i e s  (-.22).  Self-esteem, which i s c o r r e l a t e d w i t h mastery .46),  (.21),  i s a l s o p r e d i c t i v e of problems f u n c t i o n i n g  (r =  (-.16),  even w i t h both v a r i a b l e s entered i n t o t h e r e g r e s s i o n equation.  Self-esteem a l s o p r e d i c t s worry about the f u t u r e  (-.18) and a secondary a p p r a i s a l of the s i t u a t i o n as one t h a t has t o be accepted  (.22), but has not s i g n i f i c a n t  p r e d i c t i v e power d i r e c t l y a s s o c i a t e d w i t h coping s t r a t e g i e s . The  a v a i l a b i l i t y of expressive  support  p r e d i c t s coping by seeking s o c i a l support p l a n f u l problem-solving  (.24).  significantly  (.38) and by  The s i g n i f i c a n c e o f  community support as a p r e d i c t o r i s noted only  inits  n e g a t i v e r e l a t i o n s h i p with a primary a p p r a i s a l o f l a c k o f information The  (-.19).  f a m i l y resource,  cohesion, was found independently  t o be s i g n i f i c a n t l y c o r r e l a t e d with s e v e r a l a p p r a i s a l s . most i n s t a n c e s ,  when regressed  In  on these a p p r a i s a l s i n  combination w i t h other i n t e r r e l a t e d v a r i a b l e s , i t s l e v e l s o f s i g n i f i c a n c e were not r e t a i n e d .  In r e g r e s s i o n w i t h one  primary a p p r a i s a l , however, i t proved t o be a s i g n i f i c a n t  117 contributor  t o the v a r i a n c e  t o be n e g a t i v e l y  explained.  Cohesion was  p r e d i c t i v e of a primary a p p r a i s a l of  concern over r e l a t i o n s w i t h i n the f a m i l y Overt f a m i l y  (-.19).  i n f l u e n c e has been p l a c e d  arbitrarily  w i t h i n the r e s o u r c e category f o r l a c k of a more designation.  found  appropriate  T h i s v a r i a b l e has been i d e n t i f i e d as a  s i g n i f i c a n t p o s i t i v e p r e d i c t o r of a parent's worry about the future  (.24) .  Question 4. primary a p p r a i s a l s  What p r e d i c t i v e r e l a t i o n s h i p s e x i s t among (what i s at s t a k e ) ,  secondary  appraisals  (the c o n t r o l l a b i l i t y of the s i t u a t i o n ) , and forms of coping? Figure  E6 shows t h a t primary a p p r a i s a l s p r e d i c t  secondary a p p r a i s a l s  and coping.  a p p r a i s a l of l a c k of information communication  both  L o g i c a l l y , a primary and problems i n  s i g n i f i c a n t l y p r e d i c t s a secondary  appraisal  of the s i t u a t i o n as one i n which one needed t o know more before acting  (.35), whereas a primary a p p r a i s a l of worry  about the f u t u r e p r e d i c t s p l a n f u l p r o b l e m - s o l v i n g (.18). The aggregate primary a p p r a i s a l measure i s p o s i t i v e l y p r e d i c t i v e of a secondary a p p r a i s a l of the s i t u a t i o n as  one  i n which p a r e n t s f e l t they had t o h o l d back from d o i n g what they wanted t o do  (.3 6) and of coping through the use of  escape-avoidance s t r a t e g i e s  (.27).  Secondary a p p r a i s a l s , more o f t e n than primary appraisals, coping.  are demonstrated  t o be s i g n i f i c a n t p r e d i c t o r s  A secondary a p p r a i s a l of the s i t u a t i o n as  changeable p r e d i c t s coping through p o s i t i v e  reappraisal  (.22); a secondary a p p r a i s a l of the s i t u a t i o n as one  that  of  118 must be accepted a l s o p r e d i c t s coping through p o s i t i v e reappraisal  (.18).  Secondary  a p p r a i s a l of needing t o know  more b e f o r e a c t i n g p r e d i c t s both p o s i t i v e r e a p p r a i s a l and p l a n f u l p r o b l e m - s o l v i n g (.23).  The remaining  (.22)  secondary  a p p r a i s a l , having t o h o l d back from doing what they wanted, p r e d i c t s c o p i n g by d i s t a n c i n g responsibility  (.22).  (.17)  and a c c e p t i n g  119 Chapter  VIII  Discussion The genesis of t h i s study was the g e n e r a l q u e s t i o n , "How do parents cope when they have a son or daughter w i t h schizophrenia?"  A r e a d i n g of both c l i n i c a l and f a m i l y  studies l i t e r a t u r e revealed considerable v a r i a b i l i t y w i t h i n this situation.  A review of t h e o r e t i c a l frameworks d e a l i n g  w i t h c o p i n g e s t a b l i s h e d t h e r e were c e r t a i n concepts  utilized  by both i n d i v i d u a l and f a m i l y coping models t h a t c o u l d assess t h i s v a r i a b i l i t y ; t h e r e were demands, r e s o u r c e s , and a p p r a i s a l s c o n s i d e r e d i n t e g r a l t o the coping p r o c e s s .  An  i n v e s t i g a t i o n of t h i s g e n e r a l q u e s t i o n , then, needed t o a t t e n d t o these concepts,  t o o p e r a t i o n a l i z e and measure  them, a l o n g w i t h an assessment of coping s t r a t e g i e s ,  ina  s u b s t a n t i a l sample of parents. Coping t h e o r i e s have l e d t o the c o n c e p t u a l i z a t i o n o f p r o c e s s by way of models but have not l e d t o t h e d e r i v a t i o n of c l e a r hypotheses.  In t h i s study, I proposed some  e x p l o r a t o r y q u e s t i o n s which, i f answered, not o n l y might i n c r e a s e our a p p r e c i a t i o n of p a r e n t a l coping w i t h a c h i l d who has s c h i z o p h r e n i a , but a l s o might p r o v i d e i n s i g h t s  into  p a r e n t a l coping i n g e n e r a l and perhaps f u r t h e r our g l o b a l understanding  of coping by e m p i r i c a l l y i d e n t i f y i n g some  p r e d i c t o r s w i t h i n the process. I ventured  Along with these  questions,  some e x p e c t a t i o n s of f i n d i n g s based on t h e  t h e o r e t i c a l and c l i n i c a l l i t e r a t u r e review.  This  i n t e r p r e t a t i o n of the study's r e s u l t s , then, w i l l  consider  each q u e s t i o n t h a t was posed, how i t was answered, and  120 whether my  e x p e c t a t i o n s were met;  explanations  f o r the f i n d i n g s .  I w i l l venture  some  I w i l l p o i n t out  important  r e l a t i o n s h i p s and p a t t e r n s of i n f l u e n c e t h a t may the coping model t h a t drove the r e s e a r c h .  The  speak t o  discussion  w i l l c o n t i n u e with a c o n s i d e r a t i o n of the l i m i t a t i o n s s t r e n g t h s of the study, for  and any  and  i m p l i c a t i o n s t h e r e may  be  t h e o r e t i c a l and p r a c t i c a l a p p l i c a t i o n . Question Question  1  1 q u e r i e d the p r e d i c t i v e power of  characteristics  illness  ( c h i l d ' s l i f e s k i l l s and time s i n c e o n s e t ) .  R e c a l l t h a t the l i t e r a t u r e showed d i f f e r i n g consequences of the d i s o r d e r f o r the f a m i l y a c c o r d i n g t o d i f f e r e n t m a n i f e s t a t i o n of the i l l n e s s  (Cole et a l . , 1993;  Gubman &  T e s s l e r , 1987), with g r e a t e r f a m i l y d i s t r e s s accompanying p o s i t i v e symptoms i n g e n e r a l  (Runions & Prudo, 1983), and  p a r t i c u l a r , symptoms of an o f f e n s i v e or t h r e a t e n i n g ( B i e g a l e t a l . , 1991;  Gibbons et a l . , 1984;  F i g u r e E3 shows t h a t as was for  expected, l i f e  in  nature  Johnson, 1990). skills  (except  s o c i a b i l i t y ) do p r e d i c t a l l but one of the p a r e n t a l  a p p r a i s a l s of what i s at stake.  Cumulatively,  they are  the  s t r o n g e s t p r e d i c t o r of p a r e n t a l concerns about a l a c k of i n f o r m a t i o n and problems i n communication and r e l a t i o n s with the community.  P a r t i c u l a r l y , the l i f e s k i l l s  r e s p o n s i b i l i t y and nonturbulence of the c h i l d i n f l u e n t i a l i n these p a r e n t a l assessments, having  of are  independently  the h i g h e s t c o r r e l a t i o n s with primary a p p r a i s a l s as  noted i n Table F10.  A c h i l d ' s s o c i a b i l i t y , however, has  s i g n i f i c a n t a s s o c i a t i o n only with a parent's  a p p r a i s a l of  a  121 r e l a t i o n s h i p s w i t h the community.  U n l i k e the  child's  t u r b u l e n t and i r r e s p o n s i b l e behaviour, h i s / h e r g e n e r a l i n a c t i v i t y w i t h l i t t l e s o c i a l involvement  and few  friends  promotes l e s s d i s r u p t i o n i n f a m i l y r e l a t i o n s h i p s  and  problems i n d a i l y f u n c t i o n i n g , but s t i l l  upon  r e l a t i o n s h i p s w i t h f r i e n d s , neighbours,  impacts  and s o c i e t y i n  general. I n t e r e s t i n g l y , the c h i l d ' s l i f e s k i l l s have no s i g n i f i c a n t r e l a t i o n s h i p s with a parent's worry about the future.  As we  f u t u r e " was  saw  above, the sub-scale "worry about the  s i g n i f i c a n t l y skewed t o the l e f t .  For the most  p a r t , the parents i n t h i s sample i n d i c a t e d h i g h l e v e l s of t h i s concern.  I t appears  t h a t r e g a r d l e s s of s e v e r i t y of  symptoms, the parent i s concerned  about the c h i l d ' s f u t u r e  and w o r r i e d about the e f f e c t on the r e s t of the f a m i l y s h o u l d the parent d i e . There were few s i g n i f i c a n t a s s o c i a t i o n s between c h a r a c t e r i s t i c s and secondary Table F l l .  illness  a p p r a i s a l s , as noted above i n  Although nonturbulence  o t h e r v a r i a b l e s on the secondary  was  regressed along with  a p p r a i s a l , having t o h o l d  back, i t d i d not emerge as a s i g n i f i c a n t  predictor.  Whereas f o r the most p a r t the c h i l d ' s l i f e  skills  s t r o n g l y i n f l u e n c e a parent's primary a p p r a i s a l s i n s i m i l a r ways, they are independently and l e s s f r e q u e n t l y p r e d i c t i v e of  coping.  As was  expected,  lower l e v e l s of l i f e  p r e d i c t more use of emotion-focussed  skills  forms of coping, a  f i n d i n g t h a t f o l l o w s suggestions by Folkman e t a l . (1991) t h a t emotion-focussed  coping i s a p p r o p r i a t e when demands are  122 l e s s amenable t o change. behaviour  For example, a c h i l d ' s t u r b u l e n t  i s p r e d i c t i v e o f more p a r e n t a l coping by s e e k i n g  s o c i a l support, i n c l u d i n g t a l k i n g t o someone t o f i n d out more about t h e s i t u a t i o n , and g e t t i n g p r o f e s s i o n a l h e l p . T h i s t u r b u l e n t behaviour, then, appears t o be t h e more d i f f i c u l t behaviour f o r parents t o understand  and t o manage.  T h i s f i n d i n g corresponds t o t h a t of Rosen e t a l . (1989) i n which t u r b u l e n t behaviours were ranked by parents among t h e h i g h e s t t h a t were "hard t o take". The  c h i l d ' s t u r b u l e n c e and i r r e s p o n s i b i l i t y a r e  s i g n i f i c a n t l y r e l a t e d t o a parent's coping by a c c e p t i n g responsibility.  Only turbulence, however, i s found t o be a  s i g n i f i c a n t p r e d i c t o r because of the i n t e r c o r r e l a t i o n .75)  between these behaviours.  (r =  I t i s i n t r i g u i n g to consider  the meaning of these s i g n i f i c a n t r e l a t i o n s h i p s .  Accepting  r e s p o n s i b i l i t y by the parent i n c l u d e s coping by s e l f c r i t i c i s m , by a p o l o g i z i n g or doing something t o improve a r e l a t i o n s h i p , and by r e s o l v i n g t h a t t h i n g s would be d i f f e r e n t next time.  One wonders whether parents  feel  somehow they have f a i l e d , perhaps by not being c o n s i s t e n t enough o r tough enough, or not s e t t i n g f i r m enough guidelines.  One wonders i f t h i s c o u l d be an e x p r e s s i o n o f  the adverse e f f e c t s of f a m i l y therapy r e f e r r e d t o by Terkelsen  (1983), or the i a t r o g e n t i c damage t o f a m i l y  members r e p o r t e d by L e f l e y  (1990).  A l t e r n a t i v e l y , the l i n k  between t h e c h i l d ' s nonturbulent behaviour and p a r e n t s ' f e e l i n g s of r e s p o n s i b i l i t y might be confounded by t h e i r j o i n t r e l a t i o n s h i p with problems i n d a i l y f u n c t i o n i n g .  123 P a r e n t ' s acceptance of r e s p o n s i b i l i t y may be d i r e c t e d toward t h e s e d a i l y h a s s l e s . These r e l a t i o n s h i p s do appear t o v e r i f y the e x t e n s i o n  of an a c t i v e p a r e n t a l r o l e beyond t h e  c h i l d r e a r i n g y e a r s r e f e r r e d t o i n the l i t e r a t u r e Ascher-Svanum & Sobel,  (e.g.,  1989; H a t f i e l d , 1987b; I r e y s & Burr,  1984) . Other i l l n e s s c h a r a c t e r i s t i c s t h a t independently a r e p r e d i c t i v e o f coping  a r e the c h i l d ' s s o c i a b i l i t y ,  s i n c e onset of the i l l n e s s .  A higher  and time  l e v e l of s o c i a b i l i t y  ( c h i l d ' s ) i s p r e d i c t i v e of a parent's g r e a t e r use o f coping through p o s i t i v e r e a p p r a i s a l of the s i t u a t i o n , i n c l u d i n g such s t r a t e g i e s as b e l i e v i n g t h e f a m i l y has changed i n a good way, a d j u s t i n g expectations concentration  f o r the f u t u r e , and  on the c h i l d ' s c o n t r i b u t i o n t o t h e f a m i l y .  Perhaps t h e c h i l d ' s warmth and s o c i a l c o n t a c t  enables t h e  p a r e n t t o more r e a d i l y c o n s t r u c t the s i t u a t i o n w i t h i n a p o s i t i v e frame.  I n t e r e s t i n g l y , the l a s t item mentioned  encouraged some v o l u n t e e r e d  comments t h a t ranged from  "You've got t o be k i d d i n g " and "(my daughter's c o n t r i b u t i o n i s ) my granddaughter" t o the poignant "I thought t h a t i f he had  d i e d , t h e r e would be an emptiness in.my world."  This  l a t t e r comment r e i n f o r c e s the r e p o r t by Greenberg, Greenley, and  Benedict  (1994) t h a t persons with mental  illness  c o n t r i b u t e p o s i t i v e l y t o t h e i r f a m i l i e s by p r o v i d i n g companionship, l i s t e n i n g t o problems, and p r o v i d i n g news about f a m i l y and f r i e n d s . Time s i n c e onset of the i l l n e s s i s t h e s t r o n g e s t p r e d i c t o r of p a r e n t a l use of d i s t a n c e coping,  being  124 p o s i t i v e l y r e l a t e d t o such s t r a t e g i e s as,  ignoring  the  s i t u a t i o n , r e f u s i n g t o get too s e r i o u s about i t , and t r y i n g t o look on the b r i g h t s i d e of t h i n g s . r e p o r t s t h a t p a r e n t s l e a r n by t r i a l  Spaniol  and  (1987)  e r r o r what works t o  manage t h e i r s i t u a t i o n s , and notes t h a t d i s t a n c i n g i s a coping  s k i l l parents u t i l i z e .  Perhaps the p a r t i c i p a n t s of  t h i s study have learned over time t h a t d i s t a n c i n g t e c h n i q u e s are ways of coping  they f i n d most  appropriate.  Folkman, Lazarus, Pimley, and Novacek, (1987) i n comparing age  d i f f e r e n c e s i n coping,  a l s o found o l d e r  p a r t i c i p a n t s t o use more d i s t a n c i n g s t r a t e g i e s i n response t o t h e i r a p p r a i s a l s of t h e i r s i t u a t i o n s as l e s s changeable. I t makes one l e a d one  suspect  t h a t a v a r i e t y of l i f e e x p e r i e n c e  may  t o the r e c o g n i t i o n t h a t some s i t u a t i o n s are e i t h e r  not amenable t o change or too d i f f i c u l t t o change; i n such c i r c u m s t a n c e s , d i s t a n c i n g , and  other  emotion-focussed  s t r a t e g i e s , might be the most adaptive (Lazarus  forms of  coping  & Folkman, 1984).  P a r t i c i p a n t s w r i t e of c a r i n g f o r themselves by busy p h y s i c a l l y and mentally. finally  One  mother mentioned t h a t  r e a l i z e d she c o u l d not change her son but  change h e r s e l f ; another commented t h a t at f i r s t the S c h i z o p h r e n i a share her other  S o c i e t y to l e a r n about the  experience with others,  keeping  but now  a c t i v i t i e s t h a t maintain her own  she  she  could  joined  i l l n e s s and  to  participates in  mental h e a l t h .  comments f i t w i t h the f i n d i n g s of H a t f i e l d (1981) t h a t f a m i l y members c a r i n g f o r the mentally  she  i l l , those who  These of were  o l d e r tended t o have g r e a t e r need f u l f i l l m e n t i n terms of  an  125  adequate p e r s o n a l l i f e w i t h e g o - i n v o l v i n g t a s k s .  Parental  s e l f - c a r e may be a way i n which the parent d i s t a n c e s her o r h i m - s e l f from the i l l n e s s and i t s impact,  and works w i t h  what i s c o n t r o l l a b l e . Both i n t h i s study and i n the c l i n i c a l  literature,  p a r e n t s r e p o r t t h a t over time, they manage t o come t o a r e a l i s t i c acceptance of the i l l n e s s ; they r e a l i z e t h e l i m i t a t i o n s i t has f o r t h e i r o f f s p r i n g and they a d j u s t t h e i r expectations accordingly.  One parent r e p o r t e d t h a t ,  mother, I wanted him ' w e l l ' again.  Now  "As h i s  I accept t h e  p a t i e n t , my son, the way he i s and enjoy what I can and empathize w i t h him."  Other comments, as w e l l , speak t o a  " r e a l i z a t i o n t h a t the outcome of the i l l n e s s may not be t o my l i k i n g " and "an acceptance of a 'new'  i l l person."  C o n t r a r y t o my e x p e c t a t i o n s , however, t h e r e was no s i g n i f i c a n t r e l a t i o n s h i p between time s i n c e onset of t h e i l l n e s s and a parent's secondary a p p r a i s a l of the s i t u a t i o n as one t h a t must be accepted.  There appears,  then, t o be an  important d i f f e r e n c e between acceptance of the i l l n e s s w i t h its  l i m i t a t i o n s f o r t h e i r c h i l d and acceptance of t h e  s i t u a t i o n i n i t s t o t a l i t y , as captured i n t h i s study by p a r e n t s ' primary a p p r a i s a l s , f o r example, by a l a c k of i n f o r m a t i o n , r e l a t i o n s h i p s w i t h i n the f a m i l y , and so f o r t h . In  sum, i l l n e s s c h a r a c t e r i s t i c s  (life  s k i l l s ) are  p r e d i c t i v e of a l l but one of the primary a p p r a i s a l s , no secondary  a p p r a i s a l s , and t h r e e separate ways of c o p i n g .  Nonturbulence  and r e s p o n s i b i l i t y are the c h i l d ' s l i f e  skills  w i t h the s t r o n g e s t and most frequent i n f l u e n c e upon p a r e n t a l  126 a p p r a i s a l s and coping, a f i n d i n g t h a t i s i n a c c o r d w i t h p r e v i o u s s t u d i e s i n which o f f e n s i v e and u n c o o p e r a t i v e behaviour was p o s i t i v e l y r e l a t e d t o h i g h e r l e v e l s o f f a m i l y distress.  Time s i n c e onset o f the i l l n e s s i s t h e s t r o n g e s t  p r e d i c t o r o f d i s t a n c e coping.  In accord w i t h my p r i o r  e x p e c t a t i o n s , lower l e v e l s o f l i f e w i t h emotion-focussed  rather that  s k i l l s are a s s o c i a t e d problem-focussed  strategies. Question 2 Question 2 considered the p r e d i c t i v e power o f demographic c h a r a c t e r i s t i c s  (Figure E4).  T h i s study shows  t h a t p a r e n t ' s age, sex, and m a r i t a l s t a t u s are s i g n i f i c a n t p r e d i c t o r s o f primary a p p r a i s a l s and coping, but not o f secondary  appraisals.  Age of the parent i s n e g a t i v e l y  r e l a t e d t o a primary a p p r a i s a l of problems i n d a i l y f u n c t i o n i n g , problems such as concern over one's own p h y s i c a l , mental,  and f i n a n c i a l h e a l t h , and d i f f i c u l t y  keeping up w i t h work and home chores. because l a t e r i n l i f e ,  Perhaps t h i s i s  t h e r e tends t o be a r e d u c t i o n i n  f a m i l y , work, and f i n a n c i a l h a s s l e s (Folkman e t a l . , In  1987).  a d d i t i o n , i t i s important t o remember t h a t age o f p a r e n t  and time s i n c e onset of the i l l n e s s are h i g h l y c o r r e l a t e d (r = .60). The g r a d u a l acceptance of the c h i l d ' s i l l n e s s and the p a r e n t a l a t t e n t i o n t o t h e i r own care t h a t was mentioned above may bode w e l l f o r the p a r e n t s ' concerns over t h e i r mental  and p h y s i c a l c o n d i t i o n .  own  Comments v o l u n t e e r e d by  p a r e n t s i n t h i s study speak t o t h e i r gradual adjustment t o t h i s i l l n e s s w i t h i t s u n c e r t a i n t i e s and d i s r u p t i o n ,  while  127 they c o n t i n u e t o experience a profound emptiness i n the c h i l d ' s  sadness a t the  life.  Parent's age i s n e g a t i v e l y p r e d i c t i v e of c o p i n g by s e e k i n g s o c i a l support or by u s i n g  escape-avoidance  s t r a t e g i e s , such as wishing the s i t u a t i o n would go away, f a n t a s i z i n g , or t r y i n g t o f e e l b e t t e r by e a t i n g , d r i n k i n g , and so f o r t h . persons was  Less seeking of s o c i a l support by o l d e r  a l s o noted by Folkman e t a l . (1987) i n t h e i r  study of age d i f f e r e n c e s i n coping.  Age  related  differences  must be i n t e r p r e t e d c a u t i o u s l y because the d i f f e r e n c e s may  be cohort r e l a t e d  (Folkman et a l . ,  1987).  noted  I would  suggest, however, t h a t i n t h i s study, the common f a c t o r s of the i l l n e s s and the p a r e n t a l r o l e , along w i t h the r e l a t e d adjustment  time  of f a m i l y members t h a t has been noted i n  the e m p i r i c a l l i t e r a t u r e , would take precedence  over  h i s t o r i c a l d i f f e r e n c e s i n cohorts. C o n t r a r y t o my  e x p e c t a t i o n s , age of parent was  not  p o s i t i v e l y r e l a t e d t o a primary a p p r a i s a l of worry about the future.  Although the age range of the parents encompassed  f o u r decades, worry about what would happen t o f a m i l y members when the parent was  gone appeared  t o be as g r e a t a  concern t o the younger parents as t o those whose deaths would n o r m a t i v e l y be considered t o be "on time" Hagestad & Neugarten, 1985).  T h i s h i g h l e v e l of  (see concern  c o u l d be a t t r i b u t e d t o the s a l i e n c e of the p a r e n t a l r o l e w i t h i t s norms of p r o t e c t i o n and Although  support.  sex of the parent was  s i g n i f i c a n t l y associated  w i t h most of the primary a p p r a i s a l s and forms of c o p i n g  128 (with mothers' h i g h e r scores i n d i c a t i n g g r e a t e r concern  and  more f r e q u e n t use of coping s t r a t e g i e s ) , when m u l t i p l e , i n t e r r e l a t e d v a r i a b l e s were entered i n t o the r e g r e s s i o n e q u a t i o n s , sex of parent emerged as a s i g n i f i c a n t  predictor  of o n l y two primary a p p r a i s a l s and one coping s t r a t e g y . Mothers were shown t o have s i g n i f i c a n t l y h i g h e r  concerns  over r e l a t i o n s with the community and worry about the f u t u r e , and t o use p o s i t i v e r e a p p r a i s a l as a c o p i n g s t r a t e g y more o f t e n than f a t h e r s .  Lazarus and Folkman (1984) suggest  t h a t one's a p p r a i s a l s are i n f l u e n c e d by what i s important an i n d i v i d u a l ; P e a r l i n social roles.  (1991) emphasizes the importance  Women's s o c i a l i z a t i o n , and p a r t i c u l a r l y  mother r o l e , r e q u i r e a responsiveness t o o t h e r s ' needs & C o l t e n , 1991) .  Caregiving to mentally i l l  adults  t h i s c u l t u r a l l y p r e s c r i b e d nurturant r o l e beyond the r e a r i n g years  (Ascher-Svanum & Sobel, 1989).  commented t h a t she was because she was  g l a d her daughter  happen when she was  delusional  her  illness  I t can be seen t h a t p a r e n t s , active  p a r e n t i n g r o l e w i t h t h e i r a d u l t o f f s p r i n g and are  concerned  i s going t o p r o v i d e f o r the c h i l d ' s needs when the  parent i s gone.  her  w o r r i e d what would  and p a r t i c u l a r l y mothers, continue t o p l a y an  who  child-  gone; y e t another wrote t h a t u n t i l  mainly her r e s p o n s i b i l i t y .  (Gore  mother  husband r e t i r e d , she f e l t t h a t coping with her son's was  the  extends  attempting t o decrease  son's dependency upon her because she was  of  l i v e d w i t h her  a b l e t o t a l k her out of her  s t a t e ; another mentioned she was  One  to  129 Mothers more than f a t h e r s coped by p o s i t i v e r e a p p r a i s a l ; they used such techniques as p r a y e r , something about themselves,  changing  b e l i e v i n g they have b e n e f i t t e d  from the experience, and c o n c e n t r a t i n g on the c o n t r i b u t i o n s t o the f a m i l y .  child's  One mother v o l u n t e e r e d t h a t  she l e a r n e d t o admire the courage of persons  with  s c h i z o p h r e n i a , s a y i n g i t strengthened her l o v e and a d m i r a t i o n f o r her  daughter.  Parent's m a r i t a l s t a t u s was strategies.  p r e d i c t i v e o n l y of c o p i n g  Being married or remarried  (as opposed t o  separated, d i v o r c e d , widowed and never married) p r e d i c t e d l e s s use of f i v e coping s t r a t e g i e s : c o n f r o n t a t i o n , s e l f c o n t r o l , seeking s o c i a l support, p l a n f u l problem s o l v i n g , and p o s i t i v e r e a p p r a i s a l .  I t i s i n t e r e s t i n g t o s p e c u l a t e on  the reason f o r t h i s f i n d i n g .  I t does not appear t h a t a  m a r r i e d parent has l e s s with which t o cope, f o r t h e r e i s no r e l a t i o n s h i p between m a r i t a l s t a t u s and primary a p p r a i s a l s of what i s a t stake.  Could i t be t h a t a married  parent  r e l i e s on a spouse f o r some of the coping t h a t i s needed t o manage the s i t u a t i o n ; or perhaps through day-to-day s p o u s a l i n t e r a c t i o n , married parents g a i n from one another support and/or problem s o l v i n g o p p o r t u n i t i e s ? of t h i s mutual help i s suggested p a r t i c i p a n t s who  social  An i n t i m a t i o n  i n w r i t t e n comments by the  mention t h a t with t h e i r spouse, "we  t h i n g s over and make d e c i s i o n s t o g e t h e r " and we t a l k the problems out t o g e t h e r " .  talk  "we're a team,  Certainly,  i n response  t o the i n q u i r y i n t o o v e r t f a m i l y i n f l u e n c e , spouses were o f t e n mentioned as being s u p p o r t i v e as w e l l as b e i n g  130 i n f l u e n t i a l i n changing a p a r t i c i p a n t s views or ways of coping.  S i n g l e parents are without t h i s p o t e n t i a l  assistance.  coping  T h i s i n t e r p r e t a t i o n would f i t w i t h o b s e r v a t i o n s  t h a t a m a r i t a l d i s r u p t i o n i s not o n l y the d i s s o l u t i o n of a d y a d i c r e l a t i o n s h i p but a l s o the l o s s of a s o c i a l system may  ( L i n & Westcott,  support  1991), and I would suggest  i t also  be the l o s s of a p o t e n t i a l management p a r t n e r . My  o t h e r e x p e c t a t i o n s r e g a r d i n g the p r e d i c t i v e power of  demographics were not f u l f i l l e d . literature,  In accord w i t h the  I had expected t h a t daughters would have h i g h e r  l i f e s k i l l s s c o r e s , p a r t i c u l a r l y h i g h e r l e v e l s of n o n t u r b u l e n t behaviour and r e s p o n s i b i l i t y  (e.g., Seeman,  1986) ; on the c o n t r a r y , daughters' scores were s l i g h t l y not s i g n i f i c a n t l y lower than sons' s c o r e s . f a m i l y support of females  but  Considering that  i s more l i k e l y t o be s p o u s a l  (Atkinson, 1986), daughters with p a r e n t a l support i n t h i s study may  be those whose s e v e r i t y of symptoms caused  d i s s o l u t i o n of t h e i r marriage parental care.  and t h e i r subsequent r e t u r n t o  The data show t h a t daughters  l i k e l y t o have been married.  the  The daughters  s c h i z o p h r e n i a i n t h i s study, t h e r e f o r e , may  were more with not  be  r e p r e s e n t a t i v e of most women with s c h i z o p h r e n i a . Another u n f u l f i l l e d e x p e c t a t i o n was r e s i d e n c e w i t h c h i l d was  t h a t p a r e n t a l co-  not s i g n i f i c a n t l y r e l a t e d t o  primary a p p r a i s a l s as I had expected;  i t was  not a s s o c i a t e d  w i t h more concern over r e l a t i o n s h i p s w i t h i n the f a m i l y or problems w i t h d a i l y f u n c t i o n i n g . e q u i v o c a l on t h i s i s s u e .  The  literature  Arey and Warheit's  was  (1980) study of  131 f a m i l y support o f persons w i t h mental i l l n e s s found  higher  l e v e l s o f a n x i e t y and d e p r e s s i o n i n f a m i l y members when t h e r e was c o - r e s i d e n c e ; a l t e r n a t i v e l y C a r p e n t i e r e t a l . (1992) found t h a t p s y c h o l o g i c a l d i s t r e s s i n f a m i l y members did  n o t d i f f e r s i g n i f i c a n t l y whether the p a t i e n t l i v e d a t  home o r not.  F a l l o o n e t a l . (1984), however, suggest t h a t  o f f s p r i n g w i t h s c h i z o p h r e n i a may be excluded from t h e household  f o l l o w i n g d i s r u p t i v e episodes.  In t h i s study, t h e  l a c k o f an a s s o c i a t i o n between c o - r e s i d e n c e and problems i n d a i l y f u n c t i o n i n g may have been found because d i s r u p t i v e o f f s p r i n g had a l r e a d y been asked t o leave the f a m i l y residence.  Those a d u l t c h i l d r e n remaining  i n t h e household  may have been those who were more amenable. Question .3 Question t h r e e i n q u i r e d whether i n d i v i d u a l and f a m i l y r e s o u r c e s would s i g n i f i c a n t l y p r e d i c t a p p r a i s a l s and c o p i n g (see F i g u r e E5).  Mastery,  self-esteem, community  support,  and c o h e s i o n were a l l s i g n i f i c a n t p r e d i c t o r s of primary appraisals.  I n t e r e s t i n g l y , mothers and f a t h e r s d i d not  d i f f e r s i g n i f i c a n t l y on any of the resource measures. Higher l e v e l s of mastery p r e d i c t e d l e s s concern  over  r e l a t i o n s w i t h the community, r e l a t i o n s w i t h i n t h e f a m i l y , and problems i n d a i l y f u n c t i o n i n g ; a view o f t h e s i t u a t i o n as "one t h a t c o u l d be changed" (as had been expected); and l e s s use o f escape-avoidance  coping s t r a t e g i e s .  concerns t h e extent t o which people regard t h e i r  Mastery life  chances as being under t h e i r own c o n t r o l as opposed t o being f a t a l i s t i c a l l y determined  ( P e a r l i n & Schooler, 1978) .  High  132 l e v e l s of mastery  i n c l u d e s t r o n g b e l i e f s , such as "what  happens i n the f u t u r e mostly depends on me"  and " t h e r e are  t h i n g s I can do t o change many of the important t h i n g s i n my life."  I t i s reasonable t o assume t h a t these b e l i e f s would  enable p a r e n t s t o view aspects of t h e i r s i t u a t i o n s as manageable and t o r e l y l e s s on coping by u s i n g avoidance s t r a t e g i e s , such as wishing the s i t u a t i o n away.  Of  interest  i s the p o s i t i v e c o r r e l a t i o n found between the n o n t u r b u l e n t behaviour of the c h i l d and the parent's l e v e l of mastery = .32).  (r  The most probable d i r e c t i o n of i n f l u e n c e would be  from behaviour t o mastery,  t h a t i s , the c h i l d ' s  offensive  and r e c k l e s s behaviour would a f f e c t the p a r e n t a l b e l i e f s of controllability. Higher l e v e l s of s e l f - e s t e e m p r e d i c t e d l e s s  concern  over problems i n d a i l y f u n c t i o n i n g and l e s s worry  about  the  f u t u r e ; i t p r e d i c t e d a s t r o n g e r p e r c e p t i o n of the s i t u a t i o n as one t h a t had t o be accepted (contrary t o my expectations).  prior  Self-esteem r e f e r s t o p o s i t i v e b e l i e f s  about  o n e s e l f , such as "I f e e l I have a number of good q u a l i t i e s " and " I am a b l e t o do t h i n g s as w e l l as most p e o p l e " ( P e a r l i n & Schooler, 1978). contentment  I t suggests a c e r t a i n  with the s e l f , a contentment  enables one t o accept the s i t u a t i o n . s e l f - e s t e e m i s c o r r e l a t e d with mastery  t h a t somehow  As p r e v i o u s l y  noted,  (r = . 4 6 ) , but u n l i k e  mastery,  i t i s a s s o c i a t e d with the s o c i a b i l i t y of the son or  daughter  (r = .27).  Again a reasonable assumption  would be  f o r the d i r e c t i o n of i n f l u e n c e t o flow from the c h i l d ' s behaviour t o p a r e n t a l s e l f - e s t e e m .  133  Higher l e v e l s of the f a m i l y resource,  cohesion,  p r e d i c t e d l e s s concern over r e l a t i o n s w i t h i n the f a m i l y ( i n accordance w i t h e a r l i e r e x p e c t a t i o n s ) .  Parents who  perceive  t h e i r f a m i l i e s t o have g r e a t e r emotional bonding express fewer w o r r i e s c h i l d r e n and  over how  the s i t u a t i o n i s a f f e c t i n g the  over a l a c k of time and  energy f o r the  Cohesion i s weakly a s s o c i a t e d with both esteem mastery  (r = .25).  other  family.  (r = .29)  and  L i k e mastery, i t i s a s s o c i a t e d w i t h  n o n t u r b u l e n t behaviour of the c h i l d  (r = .28).  the  It is  apparent from the responses t o the i n q u i r y i n t o f a m i l y i n f l u e n c e that parents'  perceptions  of the c o h e s i v e n e s s of  t h e i r f a m i l i e s have been a f f e c t e d both n e g a t i v e l y p o s i t i v e l y by the impact of the i l l n e s s .  and  Parents w r i t e  that  the c r i t i c i s m of f a m i l y members and t h e i r r e f u s a l t o accept the i l l n e s s has  distanced  them from one  a l s o i n d i c a t e t h a t the support and f a m i l y members makes them f e e l  another; p a r e n t s  encouragement g i v e n  by  loved.  T h i s acknowledgement h i g h l i g h t s the i s s u e of r e c i p r o c a l i n f l u e n c e . One  wonders about the d i r e c t i o n of  between l e v e l s of resources Do r e s o u r c e s  influence  and r e l a t i o n s w i t h i n the  family.  f a c i l i t a t e f a m i l y f u n c t i o n i n g or does  d i s r u p t i o n w i t h i n the f a m i l y d e p l e t e resources? s e c t i o n a l design  of t h i s study p r e c l u d e s  this  The  cross-  determination.  I t would seem, however, t h a t by c o n t r o l l i n g f o r time s i n c e the onset of the i l l n e s s , t h i s study might a r r i v e a t a more accurate  understanding of the i n t e r a c t i o n .  Data show,  however, t h a t the a s s o c i a t i o n s between time s i n c e onset other  r e l e v a n t v a r i a b l e s were n e g l i g i b l e .  and  C o r r e l a t i o n s with  134 time s i n c e onset were as f o l l o w s : mastery (r = .01), esteem (r = .10), cohesion (r = .05), r e l a t i o n s w i t h i n the f a m i l y (r = -.05). The two  s o c i a l support r e s o u r c e s , e x p r e s s i v e and  community support, behaved d i f f e r e n t l y as p r e d i c t o r s . Community support was  s i g n i f i c a n t l y r e l a t e d t o a primary  a p p r a i s a l of a l a c k of i n f o r m a t i o n and problems i n communication, w i t h h i g h e r l e v e l s of support p r e d i c t i n g of t h i s concern.  less  The community support measure a s s e s s e d the  a v a i l a b i l i t y of organized support and i n f o r m a t i o n group activity;  i t i s g r a t i f y i n g t h a t t h i s i n f o r m a t i o n access  appeared t o p r e d i c t improved communication. e x p r e s s i v e support was  Alternatively,  r e l a t e d t o two d i f f e r e n t c o p i n g  s t r a t e g i e s , w i t h g r e a t e r a v a i l a b i l i t y of support p r e d i c t i n g g r e a t e r use of coping through seeking s o c i a l support p l a n f u l problem-solving.  The  l i n k between s o c i a l  and  support  and p r o b l e m - s o l v i n g can be n o t i c e d i n the n a r r a t i v e s of the parents.  With v a r i o u s f a m i l y members they speak of t a l k i n g  t h i n g s over, a c c e p t i n g advice, making d e c i s i o n s t o g e t h e r , and a c t i n g on suggestions r e g a r d i n g a l t e r n a t i v e  housing,  r e s p i t e c a r e , and day programs f o r t h e i r son or  daughter.  They a l s o mention s h a r i n g and l e a r n i n g from the e x p e r i e n c e s of p a r e n t s i n l i k e - s i t u a t i o n s .  Incidentally, self-esteem  and the a v a i l a b i l i t y of e x p r e s s i v e support were c o r r e l a t e d (r = .30).  T h i s r e l a t i o n s h i p may  v a l i d a t e the a s s e r t i o n of  P e a r l i n e t a l . (1981) t h a t s o c i a l support b o l s t e r s esteem; a l t e r n a t i v e l y i t may  self-  show t h a t i n d i v i d u a l s w i t h  h i g h e r s e l f - e s t e e m seek more emotional support or t h a t  such  135 support i s v o l u n t e e r e d self-esteem  more o f t e n t o i n d i v i d u a l s w i t h  high  (Dunkel-Schetter, Folkman, & Lazarus, 1987).  Overt f a m i l y i n f l u e n c e was a l l o c a t e d t o t h e r e s o u r c e c a t e g o r y f o r want of a more a p p r o p r i a t e I n t e r e s t i n g l y , parents'  perceptions  designation.  t h a t a f a m i l y member has  done o r s a i d something t o change t h e way they view o r cope w i t h t h e i r s i t u a t i o n p r e d i c t s a higher the f u t u r e . reassuring,  l e v e l o f worry about  T h i s f a m i l y i n f l u e n c e appears t o be not always a f i n d i n g t h a t corresponds t o the o b s e r v a t i o n s  of G o t t l i e b and Wagner (1991) mentioned p r e v i o u s l y . respondents r e p o r t e d  Many  t h a t f a m i l y members helped them t o a  r e a l i s t i c acceptance of the i l l n e s s ; t h i s may have been accompanied by r e a l i s t i c a l l y decreased e x p e c t a t i o n s  f o r the  c h i l d ' s f u t u r e independence.  being  Other parents mention  urged t o make a l t e r n a t i v e housing arrangements f o r t h e c h i l d ; y e t others r e p o r t r e c e i v i n g c r i t i c i s m , support, and a d i s c o u n t i n g  lack of  of the i l l n e s s by f a m i l y members.  One mother mentioned her other c h i l d r e n have made i t c l e a r they w i l l not p r o v i d e  her l e v e l of support f o r t h e s i b l i n g  when t h e parent i s gone. those o f other  These accounts a r e s i m i l a r t o  s t u d i e s i n which there was found t o be an  ongoing c o l l a b o r a t i o n o f s i b l i n g s w i t h other  f a m i l y members  (see Gerace e t a l . , 1993) and i n which p a r t i c i p a n t s expressed concerns over the f u t u r e independence and f i n a n c i a l support of t h e i r s i b l i n g 1992) .  (see Landeen e t a l ,  Worry about the f u t u r e may be a response t o such  influence.  These f i n d i n g s seem t o i n d i c a t e t h a t through  o v e r t f a m i l y i n f l u e n c e , f a m i l y members n e g o t i a t e  new  136 " d e f i n i t i o n s of the s i t u a t i o n "  (Menaghan, 1983).  Such  n e g o t i a t i o n s may speak t o the i s s u e r a i s e d by P a t t e r s o n and Garwick (1994) of t h e need f o r s t u d i e s on how f a m i l i e s and c o n s t r u c t meanings about  share  illness.  Both money and knowledge a r e r e s o u r c e s t h a t can a f f e c t one's o p t i o n s f o r coping  (Folkman e t a l . ,  1991).  As noted  above, t h e r e was a wide range of both income and e d u c a t i o n . The data showed t h a t many parents a s s i s t e d t h e i r sons and daughters  f i n a n c i a l l y ; one mother shared her sense o f h u r t  t h a t she was unable t o h e l p her son i n t h i s way. 50% o f respondents  J u s t over  agreed t o some degree t h a t t h e i l l n e s s  has c r e a t e d f i n a n c i a l problems f o r the f a m i l y .  Yet  s u r p r i s i n g l y , n e i t h e r f a m i l y income nor parent's l e v e l o f e d u c a t i o n were s i g n i f i c a n t l y r e l a t e d t o any o f t h e a p p r a i s a l s o r t o coping.  One wonders i f t h i s f i n d i n g would  h o l d were t h e r e not the e x i s t i n g system of h e a l t h and s o c i a l s e r v i c e s i n B r i t i s h Columbia, a system t h a t has been found t o o f h i g h e r q u a l i t y than t h a t o f any o f t h e American s t a t e s (Torrey, Bigelow,  & Sladen-Dew, 1993), a l b e i t l e s s than some  might wish. In sum, t h e r e a r e s i x i n d i v i d u a l and f a m i l y r e s o u r c e s t h a t a r e p r e d i c t i v e of a p p r a i s a l s and coping: mastery,  self-  esteem, e x p r e s s i v e support, community support, cohesion, and overt family influence.  Mastery  and s e l f - e s t e e m each  p r e d i c t m u l t i p l e primary a p p r a i s a l s and one secondary appraisal.  The other resources are more s e l e c t i v e i n t h e i r  i n f l u e n c e , p r e d i c t i n g e i t h e r primary a p p r a i s a l s o r c o p i n g . I n t e r r e l a t i o n s h i p s were noted among the r e s o u r c e v a r i a b l e s  137 and  between p a r e n t a l  behaviours of the  resources and  some l i f e  skill  child. Question 4  Question four inquired i n t o s i g n i f i c a n t among primary a p p r a i s a l s , (see F i g u r e  E6).  relationships  secondary a p p r a i s a l s ,  and  Secondary a p p r a i s a l s , more o f t e n  primary a p p r a i s a l s , were demonstrated t o be p r e d i c t o r s of coping.  coping than  significant  There were fewer l i n k s between  secondary a p p r a i s a l s and  coping, however, than t h e o r y would  l e a d us t o expect. I n d i v i d u a l l y , the primary a p p r a i s a l , worry about future,  d i r e c t l y predicted  greater  use  the  of p l a n f u l problem-  s o l v i n g , i n c l u d i n g such s t r a t e g i e s as c o n c e n t r a t i n g  on what  t o do next, r e a d i n g books or a r t i c l e s t o l e a r n more about the  s i t u a t i o n , and making some arrangements f o r the  future.  child's  T h i s r e l a t i o n s h i p i s p a r t i c u l a r l y understandable i n  the c o n t e x t of the above d i s c u s s i o n of f a m i l y  influence.  i n d i c a t e s t h a t whereas these data r e f l e c t the  intrafamilial  c o n f l i c t found i n other s t u d i e s  (Creer  & Wing,  It  1974;  F a l l o o n , Hardesty, & M c G i l l , 1985), they show t h a t i n t r a f a m i l i a l i n f l u e n c e , though not always r e a s s u r i n g , move p a r e n t s t o The  action.  primary a p p r a i s a l , lack of i n f o r m a t i o n ,  p r o c e s s t h a t c o u l d be d e s c r i b e d information  can  chain.  as a c o g n i t i v e  A l a c k of i n f o r m a t i o n  initiates a or  predicts  a  secondary a p p r a i s a l of needing t o know more, which i n t u r n p r e d i c t s coping by p l a n f u l problem-solving and reappraisal.  Positive reappraisal includes  positive  believing  138 o n e s e l f or one's f a m i l y has b e n e f i t t e d from the adjusting expectations  f o r the f u t u r e , and  the c h i l d ' s c o n t r i b u t i o n s t o the f a m i l y .  experience,  concentrating  on  It's interesting  t o c o n s i d e r the l i n k between an a p p r a i s a l of needing t o know more, and  coping  through p o s i t i v e r e a p p r a i s a l .  r e f l e c t the o b s e r v a t i o n  by Lazarus and  It  may  Folkman (1984) t h a t  ambiguity i n s i t u a t i o n s can be used t o reduce t h r e a t  by  a l l o w i n g d i f f e r e n t i n t e r p r e t a t i o n s of a predicament. Folkman, Lazarus, Dunkel-Schetter, et a l . (1986) found t h a t i n encounters appraised  as r e q u i r i n g more  information,  s u b j e c t s a l s o used p l a n f u l problem-solving, seeking  i n addition to  more s o c i a l support, and u s i n g more s e l f - c o n t r o l .  Cumulatively,  primary a p p r a i s a l s p r e d i c t e d a secondary  a p p r a i s a l of having to hold back from what one T h i s secondary a p p r a i s a l p r e d i c t e d coping accepting  responsibility.  wants t o  do.  by d i s t a n c i n g  and  D i s t a n c i n g techniques,  such as  r e f u s i n g t o get too s e r i o u s about the s i t u a t i o n , appear t o be very d i f f e r e n t from a c c e p t i n g  r e s p o n s i b i l i t y by  something t o improve a r e l a t i o n s h i p or promising t h i n g s would be d i f f e r e n t next time. could  The  i n f l u e n c e h i s / h e r choice of coping  p a r e n t has  oneself  of the  strategy.  parent Age  of  been seen t o be p o s i t i v e l y r e l a t e d t o time s i n c e  the onset of the i l l n e s s coping),  age  doing  and  functioning.  (and i n d i r e c t l y t o  distance  n e g a t i v e l y r e l a t e d t o problems i n d a i l y Older parents,  t h e r e f o r e , might more r e a d i l y  choose d i s t a n c e coping whereas younger parents might accept r e s p o n s i b i l i t y for t h e i r d a i l y hassles.  Folkman, Lazarus,  Dunkel-Schetter, et a l . (1986) a l s o found s u b j e c t s t o use  a  139 v a r i e t y o f techniques i n response t o an a p p r a i s a l o f h a v i n g t o h o l d back; they used more c o n f r o n t a t i o n a l coping, c o n t r o l , and escape-avoidance.  self-  The data i n t h i s study a l s o  p o i n t e d t o a s i g n i f i c a n t r e l a t i o n s h i p between a secondary a p p r a i s a l o f having t o h o l d back and  escape-avoidance  c o p i n g ; when entered simultaneously i n t o t h e e q u a t i o n w i t h the cumulative primary a p p r a i s a l measure, however, t h e l a t t e r was i d e n t i f i e d  as the more s i g n i f i c a n t  predictor.  Both secondary a p p r a i s a l s of the s i t u a t i o n as one t h a t c o u l d be changed and as one t h a t had t o be accepted p r e d i c t e d coping through p o s i t i v e r e a p p r a i s a l , which a c c o r d i n g t o Lazarus and Folkman (1984), i s an emotionf o c u s s e d form of coping.  My p r i o r e x p e c t a t i o n s , t h e r e f o r e ,  were not completely supported.  Theory  suggests, and I had  expected, t h a t s e e i n g the s i t u a t i o n as one t h a t c o u l d be changed would p r e d i c t some form of problem-focussed  coping.  Folkman, Lazarus, Dunkel-Schetter, e t a l . (1986) a l s o  found  p o s i t i v e r e a p p r a i s a l , along with c o n f r o n t a t i o n a l c o p i n g and p l a n f u l p r o b l e m - s o l v i n g , t o be used i n encounters a p p r a i s e d as changeable;  they found t h a t s u b j e c t s used d i s t a n c i n g and  escape-avoidance accepted.  i n s i t u a t i o n s a p p r a i s e d as having t o be  I n t e r e s t i n g l y , Carver, S c h i e r , and Weintraub  (1989) suggest t h a t p o s i t i v e r e a p p r a i s a l  (which they  call  p o s i t i v e r e i n t e r p r e t a t i o n and growth) i s not l i m i t e d t o managing d i s t r e s s  ( t h e r e f o r e i s not o n l y  but should enable the person t o continue coping actions.  S e l t z e r , Greenberg,  emotion-focussed) problem-focussed  and Krauss  (1995)  140 c o n s i d e r i t a problem-focussed  form of coping.  One  might  conclude t h a t i t s s t a t u s i s i n q u e s t i o n . In a c c o r d with t h e o r e t i c a l p r o j e c t i o n s , v i e w i n g s i t u a t i o n as changeable  had a s i g n i f i c a n t  c o r r e l a t i o n w i t h escape-avoidance  coping  the  negative (r = -.22)  but  because of i t s i n t e r c o r r e l a t i o n with other v a r i a b l e s , p a r t i c u l a r l y mastery, i t  was  not found i n the r e g r e s s i o n  e q u a t i o n t o be a s i g n i f i c a n t p r e d i c t o r of t h i s form of coping. O v e r a l l , the l i n k s between a p p r a i s a l s and c o p i n g were fewer than t h e o r y would suggest.  Folkman, Lazarus,  Dunkel-  S c h e t t e r , e t a l . (1986) had found, each of the a s s e s s e d stakes  (primary a p p r a i s a l s ) and coping o p t i o n s  (secondary  a p p r a i s a l s ) t o have s i g n i f i c a n t coping c o r r e l a t e s . a n a l y s e s , however, the procedure used was  In t h e i r  a multivariate  a n a l y s i s of v a r i a n c e f o r repeated measures, t o compare c o p i n g s c o r e s i n s e v e r a l encounters  f o r each p a r t i c u l a r  stake and each coping o p t i o n . In t h i s p r e s e n t study, stakes  (primary a p p r a i s a l s ) and coping o p t i o n s  the  (secondary  a p p r a i s a l s ) were r e g r e s s e d on ways of coping s i m u l t a n e o u s l y with other v a r i a b l e s  (e.g., c h i l d ' s l i f e  demographics, r e s o u r c e s ) .  skills,  These data show two  of the  primary a p p r a i s a l s independently t o have p r e d i c t i v e r e l a t i o n s h i p s , one with a secondary coping. secondary  a p p r a i s a l and one  Cumulatively, primary a p p r a i s a l s p r e d i c t a p p r a i s a l and one form of coping.  Each  with  one secondary  a p p r a i s a l has a p r e d i c t i v e r e l a t i o n s h i p w i t h one or more forms of coping.  I t i s important t o r e i t e r a t e t h a t many  141  r e l a t i o n s h i p s between the r e l e v a n t v a r i a b l e s  lost  s i g n i f i c a n c e i n the standard m u l t i p l e r e g r e s s i o n because of the  i n t e r c o r r e l a t i o n s of the  procedure  independent  variables. Summary of To  Findings  summarize these f i n d i n g s , some g e n e r a l p a t t e r n s  be noted i n the presence and predictive relationships. life skills  absence of  significant  Whereas c u m u l a t i v e l y ,  a child's  are p r e d i c t i v e of a parent's primary  r e s p o n s i b i l i t y and  can  appraisals,  nonturbulence appear t o be the more  i n f l u e n t i a l behaviours.  Life skills,  however, are  notably  absent as p r e d i c t o r s of the primary a p p r a i s a l , worry about the f u t u r e .  Of the demographic v a r i a b l e s , age  parent p r e d i c t both primary a p p r a i s a l s  and  and  Mastery and  i s directed  self-esteem  the r e s o u r c e s t h a t were found to be p r e d i c t i v e of primary and  mastery p r e d i c t e d  had  are  several  secondary a p p r a i s a l s , r e t a i n i n g t h e i r  s i g n i f i c a n c e i n equations with other v a r i a b l e s .  appraisals,  of  coping, whereas  the p r e d i c t i v e power of parent's m a r i t a l s t a t u s only towards coping s t r a t e g i e s .  sex  one  form of coping.  Of the  only viewing the s i t u a t i o n as one  t o h o l d back was  and  secondary i n which  you  primary  a p p r a i s a l s ; the other secondary a p p r a i s a l s had  form of coping.  well,  s i g n i f i c a n t l y i n t e r r e l a t e d with  demographics, r e s o u r c e s , l i f e s k i l l s ,  associations.  As  fewer  They each were p r e d i c t i v e of at l e a s t  one  In a d d i t i o n to the v a r i a b l e s t h a t were  i d e n t i f i e d as p r e d i c t o r s ,  i t i s important t o a t t e n d  to  the  s i g n i f i c a n t r e l a t i o n s h i p s noted i n the c o r r e l a t i o n m a t r i x ,  142 the  s i g n i f i c a n c e of which diminished i n the  regression  e q u a t i o n s because of the m u l t i c o l l i n e a r i t y of the Previously  i t was  mentioned t h a t no c a u s a l i t y can  a t t r i b u t e d t o these p r e d i c t i v e r e l a t i o n s h i p s , t h e r e was  a b r i e f discussion  example, i t was  predict  interpretation  above  problems i n d a i l y f u n c t i o n i n g .  of the  the  family  I t a l s o c o u l d be  and  said  that  Coping theory acknowledges a  "network of r e c i p r o c a l e f f e c t s " ( P e a r l i n & Schooler, 18)  that requires  longitudinal  studies  1978,  to disentangle.  choose t o i n t e r p r e t the p r e d i c t i v e r e l a t i o n s h i p s t o the  r e s o u r c e s are considered important  upon a p p r a i s a l s aware t h a t influence  according  and  coping, w h i l e at the  same time I remain  coping i s an ongoing process of and  influences  reciprocal  reappraisal.  There appears t o be a reasonable f i t between the the  data gathered i n t h i s study.  some i n s t a n c e s , more than o n e - t h i r d appraisals resources and  I  t h e o r e t i c a l model of coping reviewed above i n which  demands and  and  data.  concerns are r e l a t e d t o a g r e a t e r  p e r c e p t i o n of mastery.  p.  Yet  shown t h a t h i g h e r l e v e l s of mastery  l e s s concern over r e l a t i o n s w i t h i n  fewer problems and  and  be  of d i r e c t i o n of i n f l u e n c e .  a g a i n , c a u t i o n i s advised i n the For  variables.  family  and  coping was  The  of the v a r i a b i l i t y  The  amounts of  and  29%,  and  4 were between 30%  variability  19%,  and  in  individual  of 5% t o a h i g h of 46%;  o t h e r percentages, 5 were between 11%  in  and  ( i l l n e s s c h a r a c t e r i s t i c s , demographics,  e x p l a i n e d range from a low  between 20%  data show t h a t  a t t r i b u t e d t o demands  l e v e l resources).  model  of  the  5 ranged  39%,  and  1  was  143 42%.  Although these amounts of v a r i a n c e  are not  comparable  because they have d i f f e r e n t p r e d i c t o r s , the m a j o r i t y  of  these percentages are acceptable amounts of v a r i a n c e  for  s o c i a l s c i e n c e r e s e a r c h w i t h i t s complex m u l t i v a r i a t e nature. In a d d i t i o n t o amounts  of v a r i a b i l i t y e x p l a i n e d ,  the m u l t i - d e t e r m i n a n t nature of the model of s t r e s s  the and  c o p i n g i s a b l e t o account f o r m u l t i p l e sources of t h i s variability. "appraisals  Folkman et a l . (1991, p. 242) ... are i n f l u e n c e d by  s o c i o l o g i c a l , health,  and  and  that  psychological,  contextual  v a r i a b l e s " and  c o p i n g i s i n f l u e n c e d by a v a i l a b l e r e s o u r c e s psychological,  assert  (social,  physical, institutional, cultural,  political)  a l s o i s determined by the person's a p p r a i s a l of  demands of a p a r t i c u l a r s i t u a t i o n .  The  that  the  data show support  f o r t h i s multi-determinant model. With simultaneous entry equations, the  into multiple  i n t e r r e l a t i o n s h i p s among the  regression independent  v a r i a b l e s o f t e n r e s u l t e d i n t h e i r l o s s of s i g n i f i c a n c e w i t h the dependent v a r i a b l e of i n t e r e s t . between secondary a p p r a i s a l s and  P a r t i c u l a r l y , the  coping, which had  s i g n i f i c a n t , were e c l i p s e d by other s t r o n g e r  been  relationships.  Whereas secondary a p p r a i s a l s were s i g n i f i c a n t l y w i t h a l l but one  links  associated  forms of coping, they were i d e n t i f i e d  p r e d i c t i v e of only four of the e i g h t s t r a t e g i e s .  as  Illness  c h a r a c t e r i s t i c s , demographics ( p a r t i c u l a r l y m a r i t a l s t a t u s ) , and  r e s o u r c e s were a l l i d e n t i f i e d as other s i g n i f i c a n t  p r e d i c t o r s of coping s t r a t e g i e s .  144 Much of the v a r i a b i l i t y , however, was  not e x p l a i n e d .  O b v i o u s l y , t h e r e were many i n f l u e n t i a l f a c t o r s t h i s c o u l d not i n c o r p o r a t e .  study  An in-depth q u a l i t a t i v e i n q u i r y w i t h  p r o b i n g q u e s t i o n s might h e l p s o l v e t h i s p u z z l e of unexplained variance. L i m i t a t i o n s and  Strengths  Limitations T h i s study d e a l t with a complex coping p r o c e s s of m u l t i p l e concepts and r e c i p r o c a l i n f l u e n c e s , y e t i n i t s c r o s s - s e c t i o n a l d e s i g n i s a mere snapshot  of t h i s  ongoing  p r o c e s s ; as such, i t i s unable t o f u l l y capture i t s r i c h n e s s or understand  i t s complexity.  Folkman, Lazarus,  Dunkel-  S c h e t t e r , e t a l . (1986) c a u t i o n t h a t whereas i t i s tempting t o i n f e r , as theory suggest, t h e r e i s a temporal  ordering i n  the c o p i n g process, a c r o s s - s e c t i o n a l study d e s i g n p r e c l u d e s such an assumption.  A d d i t i o n a l l y , while attempting  to  i n c r e a s e our understanding of the c o r r e l a t e s of s i t u a t i o n a l a p p r a i s a l s and coping s t r a t e g i e s , t h i s study i s l i m i t e d i n the number of v a r i a b l e s i t c o n s i d e r s , and i s unable i n v e s t i g a t e a l l of the i n t e r a c t i o n s among them. important  to  Many  f a c t o r s and i n t e r r e l a t i o n s h i p s have been  necessarily  excluded.  A l i m i t a t i o n of t h i s study i s i t s s e l f - s e l e c t e d Although  a s p e c i f i c e f f o r t was  of d i f f e r e n t c u l t u r e s , i t was who  nature.  made t o i n c l u d e p a r t i c i p a n t s r e s t r i c t e d t o those  c o u l d read and w r i t e E n g l i s h .  parents  The m a j o r i t y of p a r e n t s  were c o n t a c t e d though support groups or through a s s o c i a t i o n s with mental h e a l t h u n i t s .  their  Those mothers and  145 f a t h e r s who responded t o t h e request f o r p a r t i c i p a n t s might be an u n r e p r e s e n t a t i v e group of parents who have an a d u l t c h i l d with schizophrenia.  Inferences from t h e sample  s t a t i s t i c s t o t h e p o p u l a t i o n t h e r e f o r e a r e not p o s s i b l e o r a r e tenuous a t b e s t . The unequal number of sons (111) and daughters (30) r e q u i r e s an attempt a t e x p l a n a t i o n .  Schizophrenia  affects  males and females with equal frequency but males a r e more l i k e l y t o be younger and s i n g l e a t f i r s t d i a g n o s i s (Cetingok, Chu, & Park, 1990). As mentioned above, t h e daughters  i n t h i s study were much more l i k e l y than sons t o  have been married.  When a c h i l d marries, t h e p a r e n t - c h i l d  r o l e r e l a t i o n s h i p changes (Greene & Boxer, 198 6). e x p e c t a t i o n s a r e f o r t h e parent t o r e l i n q u i s h  Social  control  (Aldous, 1978); t h e spousal u n i t becomes t h e primary of  mutual support.  daughters  I t would be l o g i c a l t o venture t h a t more  w i t h s c h i z o p h r e n i a would be l i v i n g w i t h  spouses and no longer considered the primary of  source  their  responsibility  parents. The unequal numbers of mothers (109) and f a t h e r s (32)  i n t h i s i n q u i r y i s common t o s t u d i e s of f a m i l i e s o f t h e m e n t a l l y i l l (see Arey 1992) .  & Warheit,  1980; T a u s i g e t a l . ,  As noted above, t h e care o f m e n t a l l y i l l o f f s p r i n g  i s o f t e n regarded by mothers as a n a t u r a l e x t e n s i o n o f t h e i r parental The  role. s e r i e s of m u l t i p l e r e g r e s s i o n s n e c e s s i t a t e d by t h e  m u l t i p l e dependent v a r i a b l e s i n c r e a s e s t h e l i a b i l i t y o f committing  a Type I e r r o r , t h a t i s , r e l a t i o n s h i p s may be  146 shown t o be s i g n i f i c a n t merely by chance. to  One  might d e c i d e  lower the s i g n i f i c a n c e l e v e l t o a v o i d t h i s problem.  Because of the e x p l o r a t o r y nature of t h i s study, however, t h i s danger must be balanced a g a i n s t the problem by a Type I I e r r o r i n which important disregarded.  presented  r e l a t i o n s h i p s might be  A s i g n i f i c a n c e l e v e l of p_ <, .05 was  retained.  As mentioned above, not a l l of t h e . v a r i a b l e s , independently  and/or i n combination,  met  the assumptions of  m u l t i p l e r e g r e s s i o n of normality, l i n e a r i t y , homoscedasticity.  and  The analyses, t h e r e f o r e , are weakened.  Again c a u t i o n i s advised i n the i n t e r p r e t a t i o n of the  study  results. The  study attempted t o use measures w i t h e s t a b l i s h e d  r e l i a b i l i t y and v a l i d i t y .  There i s the i s s u e , however, of  o p e r a t i o n a l i z a t i o n of the c o n s t r u c t s .  There was  an  e x p l a n a t i o n g i v e n above r e g a r d i n g the c h o i c e of r e s o u r c e s t o be assessed;  i t was  based upon those r e s o u r c e s t h a t were  t h e o r e t i c a l l y and e m p i r i c a l l y c o n s i d e r e d t o be r e l e v a n t t o the coping p r o c e s s .  F o l l o w i n g Folkman, Lazarus,  S c h e t t e r , e t a l . (1986), w i t h s i n g e items.  One  secondary  Dunkel-  a p p r a i s a l s were assessed  can not be assured t h a t the  p a r t i c i p a n t s had a s i m i l a r understanding  of the p h r a s i n g of  the a p p r a i s a l q u e s t i o n s . For example, when they were  asked  i n d i c a t e t h e i r l e v e l of agreement with the statement  "my  s i t u a t i o n i s one t h a t I have t o accept", d i d they have a shared understanding i n s t r u c t i o n s had  of " s i t u a t i o n ? "  Although  my  i n c l u d e d the e x p l a n a t i o n t h a t i t was  s i t u a t i o n , as you have d e s c r i b e d i t above," they may  "your have  147 been c o n s i d e r i n g d i f f e r e n t aspects of t h i s s i t u a t i o n when they r e p l i e d t o the q u e s t i o n . The o p e r a t i o n a l i z a t i o n of primary a p p r a i s a l s , as w e l l , needs t o be addressed.  Folkman, Lazarus,  Dunkel-Schetter,  e t a l . (1986) c o n s i d e r e d primary a p p r a i s a l s t o be "what a t stake i n a s t r e s s f u l encounter". factors:  was  They assessed s i x  (a) t h r e a t s t o s e l f - e s t e e m (6 i t e m s ) , (b) t h r e a t s  t o l o v e d one's w e l l - b e i n g (3  items), and f o u r s i n g l e  items,  (c) not a c h i e v i n g an important g o a l at work, (d) harm t o h e a l t h or p h y s i c a l w e l l - b e i n g , (e) a s t r a i n on f i n a n c i a l r e s o u r c e s , and else.  own  your  (f) l o s i n g r e s p e c t f o r someone  I c o u l d f i n d no mention of i n t e r r e l a t i o n s h i p s among  t h e s e items, although these r e l a t i o n s h i p s can be seen t o be possible.  In my  study, I wished t o assess what was  a t stake  i n the s t r e s s f u l s i t u a t i o n of having a son or daughter schizophrenia.  with  I t seemed l o g i c a l t o assess the ways i n  which the i l l n e s s had a f f e c t e d d i f f e r e n t aspects of t h e i r l i v e s , what P e a r l i n The  (1989) would c a l l secondary  stressors.  s c a l e chosen assessed f i v e f a c t o r s , each w i t h m u l t i p l e  items:  (a) l a c k of i n f o r m a t i o n , (b) r e l a t i o n s h i p w i t h the  community,  (c) r e l a t i o n s h i p s w i t h i n the f a m i l y , (d) problems  i n d a i l y f u n c t i o n i n g , and  (e) worry about the f u t u r e .  f i v e f a c t o r s were i n t e r r e l a t e d .  The data show t h a t f o r most  p a r e n t s t h e r e were m u l t i p l e stakes w i t h i n t h e i r While t h i s s c a l e may  These  situations.  accurately represent parents'  s i t u a t i o n s , one wonders i f i t i s t r u e t o the concept primary a p p r a i s a l as i t i s conceived i n Lazarus Folkman's (1984) model of coping.  and  of  148 S e l f - c a r e f o r r e l a t i v e s i s an important advocated  by support systems f o r f a m i l y members c o p i n g w i t h  schizophrenia  (see Alexander,  1991).  take v e r y good care o f themselves in  principle  Parents a r e a d v i s e d t o  e m o t i o n a l l y and p h y s i c a l l y  o r d e r t h a t they might p a r t i c i p a t e f u l l y i n t h e i r  r o l e s and f i n d enjoyment i n l i f e .  social  The Ways o f Coping  Scale  (Lazarus & Folkman, 1984) d i d not appear t o be have a c a t e g o r y t h a t adequately captured t h i s aspect o f c o p i n g . These s o r t s o f s t r a t e g i e s , such as e x e r c i s e , hobbies, and a c t i v i t i e s , have been c a t e g o r i z e d as " s e l f - d i s t r a c t i o n " (Carver e t a l . ,  1993), "disengagement" (Carver e t a l . ,  1989), and "avoidance"  (Amirkhan, 1994).  None o f t h e s e  c a t e g o r i e s appear t o capture the p o s i t i v e , a c t i v e nature o f these c o p i n g e f f o r t s , t h a t e s s e n t i a l l y b o l s t e r or r e p l e n i s h one's p e r s o n a l r e s o u r c e s .  T h i s d e f i c i e n c y may have  r e s t r i c t e d the p a r t i c i p a n t s  7  coping c h o i c e s .  There i s always a concern i n a q u e s t i o n n a i r e whether the responses the s i t u a t i o n .  a c c u r a t e l y r e f l e c t how t h e p a r t i c i p a n t d e f i n e s For example, one f a t h e r i n d i c a t e d  little  concern over s o c i e t y ' s r e a c t i o n s t o t h e i l l n e s s , t o t h e f a m i l y , o r t o t h e c h i l d with s c h i z o p h r e n i a ; y e t he v o l u n t e e r e d t h a t t h e i l l n e s s of h i s c h i l d i s kept  private  "so t h a t f r i e n d s and r e l a t i v e s w i l l not look down on h e r . " T h i s man's e t h n i c i t y brought a g a i n s t mental i l l n e s s .  t o t h e f o r e China's  stigma  Again i t seems probable t h a t an  i n t e r v i e w process w i t h probing q u e s t i o n s would have y i e l d e d v a l u a b l e i n f o r m a t i o n ; the f a t h e r may have been a b l e t o c l a r i f y t h e seeming i n c o n g r u i t y o f h i s responses.  149 Strengths T h i s study adopts some of the recommendations noted p r e v i o u s l y f o r r e s e a r c h i n the area of s c h i z o p h r e n i a and t h e f a m i l y , namely, t h a t i t should have a t h e o r e t i c a l  grounding,  address t h e v a r i a b i l i t y i n f a m i l y experience w i t h t h e illness,  a t t e n d t o f a m i l i e s ' coping s t r e n g t h s , and u t i l i z e  measures w i t h e s t a b l i s h e d r e l i a b i l i t y and v a l i d i t y .  This  i n q u i r y i s t h e o r e t i c a l l y grounded i n theory on i n d i v i d u a l s t r e s s and coping e n r i c h e d with the a t t e n t i o n t o f a m i l y c o n t e x t t h a t i s a f f o r d e d by f a m i l y s t r e s s t h e o r y .  It  a t t e n d s t o t h e h e t e r o g e n e i t y o f both f a m i l y and i l l n e s s ; i t s c e n t r a l premise illness,  i s that v a r i a b i l i t y i n manifestations of the  i n d i v i d u a l f a m i l y members, and f a m i l y c o n t e x t s ,  r e s u l t s i n d i f f e r e n t s i t u a t i o n a l a p p r a i s a l s and c o p i n g strategies.  T h i s study attends t o p o s i t i v e  coping  s t r e n g t h s , s e e i n g both i n d i v i d u a l and f a m i l y system r e s o u r c e s as f a c i l i t a t o r s of the coping p r o c e s s . i n c l u d e s p o s i t i v e dimensions  It  of p a r e n t a l experience,  accommodating e x p r e s s i o n s of f a m i l y s o l i d a r i t y and growth. The measures t h a t were used i n i t s assessments have e s t a b l i s h e d r e l i a b i l i t y and v a l i d i t y , w i t h o n l y one i d i o s y n c r a t i c index employed, namely, the index o f community support. Another s t r e n g t h of t h i s study i s i t s a t t e n t i o n t o l e v e l s of analysis. response  Whereas i t does speak o f " f a m i l y "  t o s c h i z o p h r e n i a when r e v i e w i n g the e m p i r i c a l  l i t e r a t u r e , the study design has an e x p l i c i t focus on t h e i n d i v i d u a l l e v e l o f coping.  A l l responses  a r e those o f t h e  150 i n d i v i d u a l , but most importantly, the i n d i v i d u a l w i t h i n t h e family context.  Family context i s assessed w i t h demographic  v a r i a b l e s and i n d i v i d u a l p e r c e p t i o n s of f a m i l y s t r e n g t h s and influence. T h i s study attempts among concepts.  t o maintain a c l e a r  distinction  I t i s suggested here t h a t because i t s focus  and outcome of i n t e r e s t i s coping, t h i s study w i l l a v o i d t h e c i r c u l a r i t y t h a t c r i t i c s have argued independent  i s p r e s e n t when t h e  v a r i a b l e i s "burden" and the dependent v a r i a b l e  i s "well-being". An a d d i t i o n a l s t r e n g t h i s i t s i n t e g r a t i o n of l i t e r a t u r e from t h r e e d i f f e r e n t but r e l a t e d f i e l d s o f endeavor which can i n f o r m and e n r i c h each other.  The f i r s t area o f  l i t e r a t u r e drawn upon i s t h a t of s c h i z o p h r e n i a and t h e family.  T h i s l i t e r a t u r e informs us of the g r e a t d i v e r s i t y  i n a l l aspects of the i l l n e s s .  I t i s an area o f m u l t i p l e  p e r s p e c t i v e s , one of which d i r e c t s a t t e n t i o n t o a c o n s i d e r a t i o n of f a m i l i e s ' e f f o r t s t o cope w i t h t h e disorder.  Second, f a m i l y s t r e s s theory d e a l s w i t h t h e  s t r e s s process i n a l l i t s complexity. important  I t a l e r t s us t o  f a m i l y system i n f l u e n c e such as t h e s t r e n g t h s and  c a p a b i l i t i e s of f a m i l i e s , t o r e c i p r o c a l r e l a t i o n s h i p s among v a r i a b l e s , and t o the feedback  over time which i s so  important  course of many s t r e s s o r s .  i n t h e developmental  It  s i t u a t e s i n d i v i d u a l s w i t h i n i n f l u e n t i a l and v a r i a b l e f a m i l y contexts.  T h i r d , i n d i v i d u a l s t r e s s and coping t h e o r y w i t h  i t s c l e a r l y d e f i n e d concepts, f a c i l i t a t e s a focus on these i n d i v i d u a l s , t h e i r s i t u a t i o n a l a p p r a i s a l s , and c o p i n g  151 responses.  I t has e l a b o r a t e d methods of a p p r a i s a l  assessment, and has demonstrated r e l a t i o n s h i p s between these a p p r a i s a l s and coping s t r a t e g i e s w h i l e keeping the conceptually d i s t i n c t .  concepts  What promotes an i n t e g r a t i o n of  these areas i s a f a m i l y p e r s p e c t i v e which i s c o g n i z a n t of f a m i l y d i v e r s i t y , the s a l i e n c e of f a m i l y r o l e s , and  the  importance of viewing the i n d i v i d u a l w i t h i n the f a m i l y context. T h i s study informs our understanding of coping i n g e n e r a l , v e r i f y i n g the multideterminant nature of the coping model. I t a l s o has i m p l i c a t i o n s f o r coping w i t h i n the f a m i l y context, h i g h l i g h t i n g the importance of f a m i l y system variables. Implications In a d d i t i o n t o support f o r the model of coping as a h i g h l y i n t e r a c t i v e multi-determinant process, the data suggest p o s s i b l e i m p l i c a t i o n s f o r a g e n e r a l understanding of coping.  I t must be recognized, however, t h a t these data  come from p a r e n t s who  were d e a l i n g w i t h a s i t u a t i o n  d i r e c t l y a f f e c t e d the whole f a m i l y .  that  These i m p l i c a t i o n s  may  not apply t o coping i n s i t u a t i o n s where t h e r e i s l i t t l e involvement  of other f a m i l y members.  The suggestions i m p l i e d by these data appear t o p e r t a i n t o t h r e e somewhat d i f f e r e n t l e v e l s of s p e c u l a t i o n : the i n d i v i d u a l l e v e l of a p p r a i s a l s and coping c h o i c e s , the f a m i l y system l e v e l of f a m i l y s t r u c t u r e and  intrafamilial  i n f l u e n c e , and the s o c i e t a l l e v e l of gender s o c i a l i z a t i o n .  152 1.  On t h e i n d i v i d u a l l e v e l , a parent's p e r c e p t i o n o f  the s i t u a t i o n as changeable was not p r e d i c t i v e o f problemf o c u s s e d coping as theory would suggest,  but t o i n c r e a s e d  p o s i t i v e r e a p p r a i s a l (an emotion-focussed t o Folkman & Lazarus,  1984).  strategy according  T h i s may l e n d support t o  Carver e t a l . ' s (1989) c o n t e n t i o n t h a t p o s i t i v e r e a p p r a i s a l enables one t o undertake problem-focussed 2.  coping.  A t t h e l e v e l of t h e f a m i l y system, both f a m i l y  s t r u c t u r e and f a m i l y dynamics were shown t o be i n f l u e n t i a l i n t h e coping p r o c e s s . important  M a r i t a l s t a t u s was shown t o be an  v a r i a b l e d i r e c t l y a f f e c t i n g one's coping c h o i c e s ,  w i t h s i n g l e parents making more use of m u l t i p l e forms o f coping.  I n a d d i t i o n , these data show t h a t p a r e n t s '  a p p r a i s a l s and t h e i r coping c h o i c e s are m o d i f i e d by t h e d i r e c t i n f l u e n c e o f a f a m i l y member.  I t may be important t o  c o n s i d e r t h i s f a m i l y i n t e r a c t i o n i f one's coping c h o i c e s a r e t o be understood. understand  Walker (1985) does suggest t h a t t o  a f a m i l y ' s response  understanding  t o s t r e s s , we need an  of t h e i n d i v i d u a l p e r s p e c t i v e s o f f a m i l y  members i n combination. 3.  A t t h e s o c i e t a l l e v e l , these data may speak t o t h e  ongoing d i s c u s s i o n of gender d i f f e r e n c e s i n coping.  Thoits  (1991) comments t h a t t h e g e n e r a l l y r e p o r t e d h i g h e r l e v e l s o f p s y c h o l o g i c a l d i s t r e s s i n women have been e x p l a i n e d i n a number of ways.  In a d d i t i o n t o women's g r e a t e r  e x p r e s s i v i t y , t h e e x p l a n a t i o n s i n c l u d e : (a) women f a c e more s t r e s s o r s i n general  (e.g., Aneshensel  & Pearlin,  1987), and  (b) they l a c k coping resources, such as h i g h s e l f - e s t e e m and  153 mastery, o r a p p r o p r i a t e Schooler,  1978).  coping  responses ( P e a r l i n &  I t a l s o has been suggested t h a t women  e x p e r i e n c e u n c o n t r o l l a b l e s o c i a l f o r c e s , such as sexism and l i m i t e d access t o power t h a t l i m i t t h e i r coping (e.g., Banyard & Graham-Bermann, 1993).  process  Concerning p o i n t  (a), both men and women i n t h i s study faced o b j e c t i v e l y t h e same type o f s t r e s s o r .  Within  mothers d i d p e r c e i v e higher  t h i s s i t u a t i o n , however,  l e v e l s of concern i n f o u r o f t h e  f i v e primary a p p r a i s a l s , t h a t i s , mothers p e r c e i v e d be a t stake than d i d f a t h e r s  (see t a b l e 5).  more t o  Both f a t h e r s  and mothers had s i m i l a r l e v e l s of concern over r e l a t i o n s h i p s within the family, a f i n d i n g that i s consistent with the d i s c u s s i o n by Gore and C o l t e n  (1991) i n which they r e l a t e d  t h a t women were no more r e a c t i v e than men t o t h e s t r e s s e s i n family l i f e .  There were aspects,  however, w i t h i n  this  s t r e s s f u l s i t u a t i o n t o which mothers were more r e a c t i v e than f a t h e r s , p a r t i c u l a r l y t o r e l a t i o n s h i p s with t h e community and worry about t h e f u t u r e .  The e x p l a n a t i o n  ventured here  i s t h a t t h e gender d i f f e r e n c e i n l e v e l s o f concern i s due t o s o c i a l r o l e importance.  As d i s c u s s e d  above, women's  s o c i a l i z a t i o n , and p a r t i c u l a r l y t h e mother r o l e , generates a set of values may  t h a t a l e r t s mothers t o concerns t h a t  others  not r e c o g n i z e . There were no gender d i f f e r e n c e s i n secondary  a p p r a i s a l s . Mothers and f a t h e r s d i d not d i f f e r  appreciably  i n t h e i r assessments o f c o n t r o l l a b i l i t y o f t h e s i t u a t i o n ( c o n s i s t e n t with t h e f i n d i n g s of T h o i t s ,  1991).  154 Regarding coping resources, data from t h i s study show no s i g n i f i c a n t d i f f e r e n c e s i n p s y c h o l o g i c a l o r s o c i a l resources  (except f o r income) f o r women and men.  Mothers  d i d r e p o r t lower income, but as s t a t e d above, income was not shown t o be s i g n i f i c a n t l y r e l a t e d t o any aspect o f a p p r a i s a l or c o p i n g . Corresponding t o t h e f i n d i n g s of T h o i t s (1991), which showed t h a t women used more coping s t r a t e g i e s than men when d e a l i n g w i t h d i s t r e s s , t h i s study found t h a t mothers r e p o r t e d g r e a t e r use of a l l forms of coping, both problemf o c u s s e d and emotion-focussed,  except f o r d i s t a n c i n g .  d i f f e r e n c e s were s l i g h t but s i g n i f i c a n t .  The  I t has been  suggested t h a t women use more s t r a t e g i e s because t h e t e c h n i q u e s they use a r e l e s s e f f e c t i v e  (see P e a r l i n &  Schooler, 1978); a l t e r n a t i v e l y , I suggest t h e i r g r e a t e r use might be seen as an a p p r o p r i a t e response t o mothers' primary a p p r a i s a l s of more a t stake.  The data from t h i s  study,  then, showed no gender d i f f e r e n c e s i n t h e a v a i l a b i l i t y o f c o p i n g r e s o u r c e s , o r i n any of t h e secondary such as t h e c o n t r o l l a b i l i t y of t h e s i t u a t i o n .  appraisals, Mothers  p e r c e i v e d more concerns than d i d f a t h e r s and responded g r e a t e r use o f both problem  and emotion-focussed  with  coping  strategies. Along w i t h p o s s i b i l i t i e s f o r a more informed understanding of coping theory, the r e s u l t s o f t h i s may have i m p l i c a t i o n s f o r parents.  study  These f i n d i n g s might  c o r r o b o r a t e p a r e n t s ' experiences and may inform t h e s e r v i c e p r o v i d e r s f o r these f a m i l i e s .  155 1.  The c h i l d ' s b e h a v i o u r a l c h a r a c t e r i s t i c s t h a t have  the s t r o n g e s t i n f l u e n c e on a p p r a i s a l and coping were shown t o be i r r e s p o n s i b i l i t y and t u r b u l e n c e .  Higher l e v e l s o f  t h e s e behaviours were r e l a t e d t o h i g h e r l e v e l s o f concern r e g a r d i n g l a c k of i n f o r m a t i o n , problems w i t h t h e community, r e l a t i o n s h i p s w i t h i n the f a m i l y , and problems w i t h  daily  f u n c t i o n i n g , and were a s s o c i a t e d with i n c r e a s e d c o p i n g by s e e k i n g s o c i a l support, a c c e p t i n g r e s p o n s i b i l i t y , and u s i n g escape-avoidance warranted  strategies.  f o r these f a m i l i e s .  E x t r a care and s e r v i c e s seem I t may be more d i f f i c u l t f o r  t h e s e p a r e n t s t o cope through p o s i t i v e r e a p p r a i s a l as they might i f t h e i r c h i l d had h i g h e r l e v e l s of warmth and s o c i a l contact. 2.  Self-esteem and mastery appear t o be s t r o n g c o p i n g  facilitators. developed  With some a s s i s t a n c e these r e s o u r c e s may be  by the i n d i v i d u a l . Because e x p r e s s i v e support has  been shown t o be p o s i t i v e l y r e l a t e d t o s e l f - e s t e e m , and t h e d i r e c t i o n o f i n f l u e n c e i s u n c l e a r , the a v a i l a b i l i t y o f both of t h e s e r e s o u r c e s c o u l d be b o l s t e r e d .  Outreach  programs  may be a d v i s a b l e f o r those parents who f e e l d i s i n c l i n e d t o a t t e n d mutual support 3.  groups.  S i x t y percent of parents r e p o r t e d d i r e c t  influence,  p o s i t i v e and n e g a t i v e , from f a m i l y members t h a t a f f e c t e d t h e ways they viewed and/or coped with t h e i r s i t u a t i o n s . comments suggested  t h a t even i f the i n f l u e n c e was  The  critical,  the c o n f l i c t o f t e n spurred the parent t o some p o s i t i v e action.  I t may be u s e f u l f o r parents t o be aware o f such  156 p o s s i b l e outcomes and h e l p f u l f o r s e r v i c e p r o v i d e r s t o attend t o t h i s family i n t e r a c t i o n . 4.  S e r v i c e p r o v i d e r s might f i n d i t h e l p f u l t o take a  m u l t i - f a c e t e d approach i n t h e i r work with p a r e n t s ,  using the  f i v e primary a p p r a i s a l s as s p e c i f i c areas o f concern t h a t require attention.  T h i s approach c o u l d f o l l o w a model o f  i n t e r v e n t i o n suggested by Folkman e t a l , (1991).  They  propose t h a t people can be a s s i s t e d i n t h e i r e f f o r t s t o cope w i t h a d i f f i c u l t s i t u a t i o n by s e p a r a t i n g t h i s s i t u a t i o n , o r g l o b a l s t r e s s o r , i n t o s p e c i f i c s t r e s s o r s ; these can then be c a t e g o r i z e d i n t o changeable and unchangeable a s p e c t s . example, t h e g l o b a l s t r e s s o r , having s c h i z o p h r e n i a , c o u l d be separated concerns:  For  a son o r daughter with  into the following  l a c k o f i n f o r m a t i o n , problems i n d a i l y  f u n c t i o n i n g , r e l a t i o n s with the community, r e l a t i o n s h i p s w i t h i n t h e f a m i l y , and worry about the f u t u r e . concerns i d e n t i f i e d by t h e parents for  could a l s o be i n c l u d e d ,  example, t h e i r sense of sadness over t h e i r  q u a l i t y of l i f e .  For each of these concerns,  be encouraged t o i s o l a t e s p e c i f i c aspects they important.  Other  child's parents  could  consider  These c o u l d be c a t e g o r i z e d a c c o r d i n g t o whether  they a r e seen as changeable or unchangeable.  Various  emotion-focussed s t r a t e g i e s might be d i s c u s s e d t o manage t h e s p e c i f i c s t r e s s o r s with l i t t l e p o t e n t i a l f o r change; v a r i o u s problem-focussed e f f o r t s c o u l d be c o n s i d e r e d t o manage changeable aspects of t h e s i t u a t i o n .  By breaking  a global  s t r e s s o r down i n t o i t s s m a l l e r , more manageable a s p e c t s ,  157 m u l t i p l e forms o f coping, each with a s p e c i f i c f o c u s , c o u l d be  utilized. F a m i l i e s i n other types of s t r e s s f u l s i t u a t i o n s  also  might be regarded b e n e f i c i a l l y w i t h i n a s t r e s s and c o p i n g framework.  The need has been i d e n t i f i e d t o examine t h e  e f f e c t s upon f a m i l y l i f e o f a c h i l d ' s d e v i a n t (Bahr, 1987; Geis & Binder, 1991).  behaviour  Parents w i t h d e l i n q u e n t  c h i l d r e n have experiences t h a t appear t o p a r a l l e l those o f p a r e n t s who have o f f s p r i n g with mental i l l n e s s .  They must  d e a l w i t h a l e g a l system i n which a l a c k of i n f o r m a t i o n and problems i n communication may be a problem; t h e r e may be difficult  r e l a t i o n s h i p s with the community as w e l l as w i t h i n  the f a m i l y , problems with d a i l y f u n c t i o n i n g and worry about the f u t u r e .  I r r e s p o n s i b i l i t y and/or t u r b u l e n t behaviour o f  the c h i l d might w e l l be i n f l u e n t i a l aspects of t h e situation.  Parents a r e o f t e n seen t o be r e s p o n s i b l e f o r  t h e i r c h i l d ' s delinquency  (Geis & Binder, 1991) and y e t  j u v e n i l e s are released into t h e i r parents'  custody.  F o c u s s i n g on t h e coping process of such f a m i l i e s might a m e l i o r a t e t h e i r d i s t r e s s and b e n e f i t t h e c h i l d ' s rehabilitation. Conclusion Parents who have an a d u l t c h i l d with s c h i z o p h r e n i a have been regarded over time as c a u s a l agents, as r e h a b i l i t a t i o n agents, then as burden bearers.  T h i s study has viewed these  p a r e n t s as managers of d i f f i c u l t  but v a r i a b l e  In  situations.  t a k i n g t h i s p e r s p e c t i v e , I found t h a t parents made use o f  many forms o f coping t h a t were r e l a t e d t o t h e v a r i a b i l i t y o f  158 their situations.  An understanding of t h i s v a r i a b i l i t y  may  f a c i l i t a t e a b e t t e r p r o v i s i o n of s e r v i c e t o these p a r e n t s . T h i s i n q u i r y found t h a t parents were v e r y w i l l i n g t o share t h e i r experiences, adding t h e i r comments t o e n r i c h the c o n t e n t and h e l p e x p l a i n the f i n d i n g s of the study; many expressed g r a t i t u d e f o r such an o p p o r t u n i t y .  Their  c o o p e r a t i o n leads one t o s p e c u l a t e whether a q u e s t i o n n a i r e was  the c o r r e c t d e s i g n format.  An i n t e r v i e w would have  g i v e n these parents g r e a t e r o p p o r t u n i t i e s t o t e l l stories.  their  Such a format, however, would have l i m i t e d  numbers of p a r t i c i p a n t s , and r e s t r i c t e d them t o g e o g r a p h i c a l area.  the  one  The number of i n c l u d e d v a r i a b l e s ,  and  t h e r e f o r e the v a r i a b i l i t y , assessed by the study would have been g r e a t l y  reduced.  T h i s study h i n t e d a t the power of  intrafamilial  i n f l u e n c e i n shaping the coping p r o c e s s .  T h i s i s an area of  f a m i l y i n t e r a c t i o n f o r which f u r t h e r study has been recommended (see P a t t e r s o n & Garwick, 1994;  Walker, 1985).  G o t t l i e b and Wagner (1991) have such s t u d i e s planned. endorse these e f f o r t s and would propose they be w i t h i n a m u l t i c u l t u r a l context.  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J o u r n a l o f Chronic Diseases, 36, 337-343. Wasow, M. (1985). Chronic s c h i z o p h r e n i a and Alzheimer's d i s e a s e : The l o s s e s f o r parents, spouses and c h i l d r e n compared. J o u r n a l of Chronic Diseases, 38, 711716. White, R. W. (1985). S t r a t e g i e s o f a d a p t a t i o n : An attempt a t systematic d e s c r i p t i o n . In A. Monat & R. S. Lazarus (Eds.), S t r e s s and coping: An anthology, 2nd Ed. (pp. 121-144). New York: Columbia U n i v e r s i t y P r e s s . W i n e f i e l d , H. R., & Harvey, E. J . (1993). Determinants of p s y c h o l o g i c a l d i s t r e s s i n r e l a t i v e s o f people with c h r o n i c s c h i z o p h r e n i a . S c h i z o p h r e n i a B u l l e t i n . 19, 619-625. Wing, J . K. (1987a). P s y c h o s o c i a l f a c t o r s a f f e c t i n g the long-term course of s c h i z o p h r e n i a . In J . S. S t r a u s s , W. Boker, & H. D. Brenner (Eds.), P s y c h o s o c i a l treatment of s c h i z o p h r e n i a : M u l t i d i m e n s i o n a l concepts, p s y c h o l o g i c a l , f a m i l y , and s e l f - h e l p p e r s p e c t i v e s (pp. 13-29). Lewiston, NY: Hans Huber. Wing, J . K. (1987b). Long-term s o c i a l a d a p t a t i o n i n s c h i z o p h r e n i a . In N. E. M i l l e r & G. D. Cohen (Eds.), S c h i z o p h r e n i a and aging: Schizophrenia, p a r a n o i a , and s c h i z o p h r e n i f o r m d i s o r d e r s i n l a t e r l i f e (pp. 183-199). New York: G u i l f o r d . Wynne, L., & Singer, M. T. (1963). Thought d i s o r d e r and f a m i l y r e l a t i o n s of s c h i z o p h r e n i c s , I : A r e s e a r c h s t r a t e g y . A r c h i v e s of General P s y c h i a t r y . 9. 191-198.  175 Appendix A D e f i n i t i o n s per Lazarus and  Folkman (1984)  Stress: The r e l a t i o n s h i p between the person and the environment t h a t i s appraised by the person as t a x i n g or exceeding h i s or her resources and endangering h i s / h e r w e l l being. Coping: C o n s t a n t l y changing c o g n i t i v e and b e h a v i o r a l e f f o r t s t o manage s p e c i f i c e x t e r n a l and/or i n t e r n a l demands t h a t are a p p r a i s e d as t a x i n g or exceeding the r e s o u r c e s of the person. Demand/Stressor: Any environmental s i t u a t i o n or event t h a t i s construed by the i n d i v i d u a l as t a x i n g or overwhelming h e r / h i s r e s o u r c e s and endangering h e r / h i s w e l l - b e i n g . Resource: Something one draws upon and uses t o counter demands. Resources can be c a t e g o r i z e d i n t o those of the person ( p o s i t i v e b e l i e f s and competences) and those of the environment ( s o c i a l support and m a t e r i a l r e s o u r c e s ) . Appraisal: An e v a l u a t i v e process t h a t determines why and what e x t e n t a p a r t i c u l a r t r a n s a c t i o n or s e r i e s of t r a n s a c t i o n s between the person and the environment i s stressful. Primary a p p r a i s a l : An e v a l u a t i o n of the s i g n i f i c a n c e of person-environment r e l a t i o n s h i p .  to  the  Secondary a p p r a i s a l : A complex e v a l u a t i v e p r o c e s s t h a t takes i n t o account which coping options are a v a i l a b l e , the l i k e l i h o o d t h a t a given coping o p t i o n w i l l accomplish what i t i s supposed t o , and the l i k e l i h o o d t h a t one can apply a p a r t i c u l a r s t r a t e g y or set of s t r a t e g i e s e f f e c t i v e l y .  176 Appendix B THE COPING PROCESS OF PARENTS WHO HAVE AN ADULT CHILD WITH SCHIZOPHRENIA We r e q u i r e p a r t i c i p a n t s f o r a study of the c o p i n g e f f o r t s used by parents who have an a d u l t c h i l d w i t h s c h i z o p h r e n i a . Our use of the term " a d u l t c h i l d " i s simply r e c o g n i t i o n t h a t parents continue t o c o n s i d e r t h e i r o f f s p r i n g as t h e i r c h i l d r e n r e g a r d l e s s of age. A l l o w us t o share w i t h you some o b j e c t i v e s of t h i s p r o j e c t . T h i s study i s p a r t of a Master's t h e s i s i n the department of Family Studies at the U n i v e r s i t y of B r i t i s h Columbia. We r e g a r d parents who cope with having a son o r daughter w i t h s c h i z o p h r e n i a as we would parents who d e a l w i t h any d e v a s t a t i n g f a m i l y s t r e s s o r . By "coping" we mean any attempt t o manage a d i f f i c u l t s i t u a t i o n or t o manage the f e e l i n g s aroused by s t r e s s f u l circumstances, r e g a r d l e s s of i t s effectiveness. From t h i s study we hope t o l e a r n more about the i n f l u e n c e s upon p a r e n t a l coping e f f o r t s so as t o b e t t e r understand how t o o f f e r coping a s s i s t a n c e . T h i s study asks you t o express your views of your s i t u a t i o n and the ways i n which you respond t o i t . We hope your r e f l e c t i o n upon your ways of coping may v e r i f y f o r you t h a t your e f f o r t s are understandable responses t o your particular situation. By p r o v i d i n g you an o p p o r t u n i t y t o r e c e i v e feedback on the main c o n c l u s i o n s of the study, we hope t o share w i t h you a g r e a t e r understanding of c o p i n g with s t r e s s f u l s i t u a t i o n s . P l e a s e be assured t h a t as we read your responses t o t h i s q u e s t i o n n a i r e we w i l l have no knowledge of your i d e n t i t y ; your c o n f i d e n t i a l i t y i s assured. At the c o n c l u s i o n of the study a l l data c o l l e c t e d w i l l be destroyed. The time needed t o complete the q u e s t i o n n a i r e i s approximately 1 hour. We are very i n t e r e s t e d i n the ways t h a t you see and respond t o your s i t u a t i o n , as i t has been w i t h i n the l a s t t h r e e months, so p l e a s e take your time t o c a r e f u l l y respond, on your own, t o the q u e s t i o n s . As soon as you have completed the q u e s t i o n n a i r e , p l e a s e r e t u r n i t t o us i n the l a r g e , stamped, addressed envelope. I f you wish t o r e c e i v e a b r i e f account of the main f i n d i n g s of t h i s study a t i t s completion, p l e a s e r e t u r n the e n c l o s e d stamped, s e l f - a d d r e s s e d p o s t c a r d SEPARATELY from the q u e s t i o n n a i r e . T h i s request attends t o our concern t o t r e a t your data with c o n f i d e n t i a l i t y . You may d e c i d e not t o p a r t i c i p a t e . . We hope, however, t h a t you w i l l agree t o a s s i s t us i n our e f f o r t s t o add t o a g e n e r a l understanding of p a r e n t a l coping so as t o i n c r e a s e our understanding of e f f e c t i v e coping a s s i s t a n c e . The r e t u r n of t h i s completed q u e s t i o n n a i r e w i l l assure us of your consent t o p a r t i c i p a t e . Rose D a l l a L a n a  B r i a n de V r i e s  PhD  177 QUESTIONNAIRE  SECTION 1:  INFORMATION ABOUT YOUR CHILD  To begin, we would l i k e some i n f o r m a t i o n c o n c e r n i n g your c h i l d who has been diagnosed with s c h i z o p h r e n i a . Please check t h e a p p r o p r i a t e answers as they apply t o your son/daughter with s c h i z o p h r e n i a .  1.  Sex o f c h i l d .  2.  R e l a t i o n s h i p t o you. biological child  male  adopted c h i l d  3.  H i s / h e r year of b i r t h .  4.  His/her m a r i t a l status.  5.  never married  married  separated  divorced  Does your c h i l d  female  step-child  (or common-law) widowed  l i v e with you a t present?  I f no, p l e a s e i n d i c a t e h i s / h e r c u r r e n t  Yes  No  living  arrangements. 6.  7. 8.  Approximate l e n g t h of time s i n c e onset o f i l l n e s s .  Number o f h o s p i t a l i z a t i o n s s i n c e d i a g n o s i s . Son's/daughter's source(s) of income. P l e a s e check a l l that  apply.  employment  social  assistance  parent(s)  other - p l e a s e s p e c i f y  disability  178 S E C T I O N 2:  CHILD'S  GENERAL L E V E L  OP  FUNCTIONING  We would now l i k e you t o t e l l us your impressions of your daughter's/son's g e n e r a l l e v e l s of f u n c t i o n i n g as i t has been o v e r a l l w i t h i n the l a s t t h r e e months, t o the b e s t of your knowledge. Please respond t o the 38 items below, u s i n g the c a t e g o r i e s provided. I f you f e e l t h a t the statement i s not t r u e , you would c i r c l e N T ; i f you f e e l t h a t i t i s o n l y s l i g h t l y t r u e , you would c i r c l e S T ; moderately t r u e i s i n d i c a t e d by M T , and very t r u e by V T . P l e a s e c i r c l e one response o n l y .  N not  T true  S T slightly  M T moderately true  true  V very  T true  NT  ST  MT  VT  NT  ST  MT  VT  NT  ST  MT  VT  NT  ST  MT  VT  5.  He/she n e g l e c t s p h y s i c a l problems. NT  ST  MT  VT  6.  He/she has u n s o c i a b l e h a b i t s .  NT  ST  MT  VT  7.  She/he bathes r e g u l a r l y .  NT  ST  MT  VT  8.  She/he d i s p l a y s r e c k l e s s behaviour • NT  ST  MT  VT  9.  He/she shows v i o l e n c e t o o t h e r s .  NT  ST  MT  VT  10.  He/she i s capable  NT  ST  MT  VT  11.  He/she has problems with o t h e r household members.  NT  ST  MT  VT  12.  D i s p l a y s o f f e n s i v e behaviour  NT  ST  MT  VT  13 .  Is capable  NT  ST  MT  VT  14.  Has  NT  ST  MT  VT  15.  She/he shows warmth t o o t h e r s .  NT  ST  MT  VT  16.  He/she abuses a l c o h o l and/or drugs .NT  ST  MT  VT  17.  She/he i s i n t r u s i v e toward o t h e r s . NT  ST  MT  VT  1.  My  c h i l d wears c l e a n c l o t h e s .  2.  He/she i s capable  3.  She/he i n t r u d e s on conversations  4.  She/he chooses a good d i e t .  of  budgeting.  other's  of employment.  of food p r e p a r a t i o n .  been i n t r o u b l e with  police.  179  NT not true  ST s l i g h t l y true  M T moderately true  V T very true  NT  ST  MT  VT  She/he i s angry toward o t h e r s .  NT  ST  MT  VT  20.  He/she has some s o c i a l o r g a n i z a t i o n involvement.  NT  ST  MT  VT  21.  She/he takes o f f e n s e r e a d i l y .  NT  ST  MT  VT  22 .  He/she i s g e n e r a l l y a c t i v e .  NT  ST  MT  VT  23 .  She/he d i s p l a y s odd ideas i n t a l k . NT  ST  MT  VT  24.  He/she shows reduced  NT  ST  MT  VT  25.  He/she shows poor compliance w i t h medication.  NT  ST  MT  VT  26.  She/he i s v i o l e n t t o h e r / h i m s e l f .  NT  ST  MT  VT  27.  She/he has f r i e n d s h i p s .  NT  ST  MT  VT  28 .  He/she i s w e l l groomed.  NT  ST  MT  VT  29.  H i s / h e r speech i s d i s o r d e r e d .  NT  ST  MT  VT  30.  Has some d e f i n i t e  NT  ST  MT  VT  31.  She/he uses b i z a r r e or inappropriate gestures.  NT  ST  MT  VT  32 .  Withdraws from s o c i a l c o n t a c t .  NT  ST  MT  VT  33 .  He/she d e s t r o y s  NT  ST  MT  VT  34.  He/she g e n e r a l l y has d i f f i c u l t y with c o n v e r s a t i o n .  NT  ST  MT  VT  35.  She/he takes others  NT  ST  MT  VT  36.  She/he l o s e s p e r s o n a l  NT  ST  MT  VT  37.  She/he i s uncooperative h e a l t h workers.  NT  ST  MT  VT  38.  Is r e l i a b l e with own  NT  ST  MT  VT  18.  Shows r e s p o n s i b l e  19.  behaviour.  eye c o n t a c t .  interests.  property.  possessions. property. with  medication.  180  SECTION 3:  HOW THE ILLNESS HAS INFLUENCED YOUR LIFE  Now we would l i k e you t o read c a r e f u l l y t h e f o l l o w i n g l i s t of items t h a t d e s c r i b e some concerns t h a t have been i d e n t i f i e d by parents as ways i n which t h e i l l n e s s o f t h e i r c h i l d r e n has i n f l u e n c e d v a r i o u s aspects of t h e i r l i v e s . P l e a s e c i r c l e o n l y one response i n d i c a t i n g t h e e x t e n t t o which YOU agree o r d i s a g r e e with each of t h e f o l l o w i n g statements. The c a t e g o r i e s are as f o l l o w s :  1 strongly disagree  2 moderately disagree  3 slightly disagree  1. I am concerned about my c h i l d ' s f u t u r e .  4 5 6 s l i g h t l y moderately strongly agree agree agree  1  2  3  4  5  6  2. I have d i f f i c u l t y a c c e p t i n g the s i t u a t i o n . 1  2  3  4  5  6  3  4  5  6  3. I worry about my spouse's health(if a p p l i c a b l e ) . 1 2 4.  5. 6.  7. 8.  9.  10.  11.  The r e a c t i o n s of s o c i e t y toward s c h i z o p h r e n i a concern me.  1  2  3  4  5  6  I have d i f f i c u l t y keeping up w i t h chores a t home. 1  2  3  4  5  6  Not knowing who and where t o go t o f o r h e l p i s a problem.  2  3  4  5  6  I worry about t h e e f f e c t on my o t h e r c h i l d ( r e n ) . 1 2  3  4  5  6  I am concerned about r e l a t i o n s w i t h my f r i e n d s and neighbours.  1  1  2  3  4  5  6  I am concerned t h a t i f something happens t o me, i t w i l l be d i f f i c u l t f o r the r e s t of my f a m i l y . 1  2  3  4  5  6  Reactions of society toward my f a m i l y concern me.  1  2  3  4  5  6  Lack o f understanding o f p r o f e s s i o n a l language used by s e r v i c e p r o v i d e r s i s a problem. 1  2  3  4  5  6  181 1 strongly disagree  2 moderately disagree  3 slightly disagree  4 5 s l i g h t l y moderately agree agree  12  Relations with r e l a t i v e s not i n the household are a concern. 1  13.  I l a c k time or energy f o r the f a m i l y .  1  2  I have g u i l t f e e l i n g s about my c h i l d .  1  2  14. 15.  Relations with p r o f e s s i o n a l s are a problem. 1  2  16.  I l a c k time and energy a t work.  1  2  I am concerned t h a t my c h i l d i s not g e t t i n g the proper treatment.  1  2  I worry about my mental h e a l t h .  1  2  R e l a t i o n s w i t h my spouse (or former spouse) have s u f f e r e d . 1  2  Lack of i n f o r m a t i o n about the i l l n e s s i n g e n e r a l i s a concern. 1  2  17.  18. 19.  20.  own  21.  R e l a t i o n s w i t h p u b l i c agencies are a source of concern. 1 2  22.  I worry about my physical health.  1  2  23.  T h i s i l l n e s s has c r e a t e d f i n a n c i a l problems f o r our f a m i l y . 1  2  own  24.  There i s a l a c k of i n f o r m a t i o n about my child's s p e c i f i c condition. 1 2  25.  R e l a t i o n s w i t h parents/spouse's p a r e n t s have worsened. 1 2  26.  R e a c t i o n s of s o c i e t y toward my son/daughter concern me.  1  2  6 strongly agree  182 SECTION 4: THOUGHTS ABOUT YOUR SITUATION In o r d e r t o h e l p us more completely understand how you see your s i t u a t i o n , as you have d e s c r i b e d i t above, would you p l e a s e i n d i c a t e your l e v e l o f agreement with the f o l l o w i n g statements. The c a t e g o r i e s are as f o l l o w s : 1 strongly disagree  2 moderately disagree  3  slightly disagree  1.  My s i t u a t i o n i s one i n which t h e r e are t h i n g s t h a t I can change o r do something about. 1  2.  My s i t u a t i o n i s one t h a t I have t o accept.  4 5 s l i g h t l y moderately agree agree  6 strongly agree  1  3.  My s i t u a t i o n i s one i n which I needed t o know more before I could act. 1  4.  My s i t u a t i o n i s one i n which I had t o h o l d myself back from doing what I wanted t o do. 1  SECTION 5: YOUR WAYS OF COPING We come now t o the p a r t o f the q u e s t i o n n a i r e i n which we ask you t o i n d i c a t e the v a r i o u s ways i n which you p r e s e n t l y cope w i t h your s i t u a t i o n . The word coping used here r e f e r s to any attempt t o manage your s i t u a t i o n , as you have d e s c r i b e d i t above, whether o r not you f e e l t h i s e f f o r t i s s u c c e s s f u l . P l e a s e c a r e f u l l y read each item and i n d i c a t e , by c i r c l i n g the a p p r o p r i a t e category number, the extent t o which you have used i t w i t h i n the past t h r e e months. The  c a t e g o r i e s are: 1 not used  2 used somewhat  3 used quite a bit  4 used a great deal  1. J u s t concentrated on what I had t o do next - the next step.  1  2  3  4  2. I d i d something which I d i d n ' t t h i n k would work, but a t l e a s t I was doing something.  1  2  3  4  183  not  1  used  2  3 used somewhat  4  used q u i t e a bit  3. T r i e d t o get the person r e s p o n s i b l e t o change. 1  used a great deal  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  3  4  4. T a l k e d t o someone t o f i n d out more about the s i t u a t i o n . 5. C r i t i c i z e d  or l e c t u r e d myself.  6. T r i e d not t o burn my but  bridges,  l e a v e t h i n g s open somewhat.  7. Hoped a m i r a c l e would happen. 8. Went along w i t h f a t e ; i t ' s j u s t bad l u c k . 9. Went on as i f nothing was wrong.  10. T r i e d t o keep my f e e l i n g s t o myself.1  2  11. I looked f o r the s i l v e r l i n i n g , so t o speak; t r i e d t o look on the  b r i g h t s i d e of t h i n g s .  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  16. T r i e d t o f o r g e t the whole t h i n g .  1  2  3  4  17. I got p r o f e s s i o n a l h e l p .  1  2  3  4  1  2  3  4  3  4  3  4  12. S l e p t more than u s u a l . 13. I expressed anger t o the person who caused the problem. 14. Accepted sympathy and understanding from someone. 15. I was i n s p i r e d t o do something c r e a t i v e .  18. I changed or grew as a person i n a good way. 19. I a p o l o g i z e d or d i d something t o improve a r e l a t i o n s h i p . 20. I made a p l a n of a c t i o n and followed i t .  1 1  2 2  21. I l e t my f e e l i n g s out somehow.  1  2  3  4  22. R e a l i z e d I brought the problem on myself.  1  2  3  4  184  not  1 used  2 used somewhat  23. I have b e n e f i t t e d t h e experience.  3 used q u i t e a bit  4 used a great deal  from 1  24. I t a l k e d t o someone who something concrete about the problem.  2  3  4  1 2  3  4  2  3  4  1 2  3  4  1 2  3  4  1  2  3  4  1  2  3  4  1 2  3  4  3  4  c o u l d do  25. T r i e d t o make myself f e e l b e t t e r by e a t i n g , d r i n k i n g , smoking, u s i n g drugs or medication, e t c . 1 26. Took a b i g chance or d i d something very r i s k y . 27. I t r i e d not t o a c t too h a s t i l y or f o l l o w my 28. Found new  f i r s t hunch.  faith.  29. Rediscovered what i s important i n l i f e . 30. Changed something so t h i n g s would improve. 31. I avoided being w i t h in general.  people 1  2  32. D i d n ' t l e t i t get t o me; r e f u s e d t o t h i n k too much about i t .  1  2  3  4  33. I asked a r e l a t i v e or f r i e n d I respected f o r advice.  1  2  3  4  34. Kept o t h e r s from knowing how bad t h i n g s were.  1 2  3  4  35. Made l i g h t of the s i t u a t i o n ; r e f u s e d t o get too s e r i o u s about i t .  1 2  3  4  36. T a l k e d t o someone about I was f e e l i n g .  1  2  3  4  1  2  3  4  38. Took i t out on other people.  1  2  3  4  39. Drew on my p a s t experiences; I was i n a s i m i l a r s i t u a t i o n before.  1 2  3  4  37. Stood my  how  ground and  fought f o r what I wanted.  185  not  used  2  4 quite bit  used a great deal  40. I knew what had t o be done, so I doubled my e f f o r t s t o make t h i n g s work.  1  3  4  41. Refused t o b e l i e v e t h a t i t was happening.  1  3  4  3  4  3  4  used somewhat  used a  42. I made a promise t o myself t h a t would be d i f f e r e n t next time.  things 1  43. Came up w i t h a couple of d i f f e r e n t ways t o d e a l with the problem. 1 44. I t r i e d t o keep my f e e l i n g s from i n t e r f e r i n g with other t h i n g s too much.  1  2  3  4  45. I changed something about myself.  1  2  3  4  l  2  3  4  1  2  3  4  2  3  4  2  3  4  46. Wished t h a t the s i t u a t i o n would go away or somehow be over with. 1 47. Had f a n t a s i e s about how  things  might t u r n out. 48. I prayed.  49. I went over i n my mind what I would say or do. 50, I thought about how a person I admire would handle t h i s s i t u a t i o n and used t h a t as a model. 1 51, We changed or grew as a f a m i l y i n a good way. 1 52.  Made some arrangements f o r my c h i l d ' s f u t u r e .  53  Read books and a r t i c l e s t o l e a r n more about the s i t u a t i o n .  54.  A d j u s t e d my e x p e c t a t i o n s f o r the f u t u r e .  55.  Concentrated on c h i l d ' s c o n t r i b u t i o n s t o the f a m i l y . 1  56.  I t a l k e d t o someone in a similar situation.  1  186  SECTION 6: FAMILY INFLUENCE Sometimes p a r e n t s i n d i c a t e t h a t t h e i r thoughts or f e e l i n g s about a s t r e s s f u l s i t u a t i o n and the ways they choose t o respond t o i t are i n f l u e n c e d by what a f a m i l y member has done or s a i d . Have any f a m i l y members i n f l u e n c e d your views of your s i t u a t i o n or your coping responses?  Yes  No  I f yes, i n a few b r i e f sentences would you p l e a s e t e l l us 1) which family member(s) have i n f l u e n c e d your views o f your s i t u a t i o n and/or your coping responses, and 2) how your views of your situation and/or your coping responses have changed because of what they have done or s a i d . 1) Which f a m i l y members have i n f l u e n c e d your views of your s i t u a t i o n and/or your coping responses?  2) How have your views of your s i t u a t i o n and/or your c o p i n g responses changed because of what they have done or s a i d ?  SECTION 7:  INFORMATION ABOUT YOURSELF  At t h i s p o i n t i t would be h e l p f u l f o r us t o understand something about you and your unique p e r s o n a l s i t u a t i o n . P l e a s e remember your c o n f i d e n t i a l i t y i s a s s u r e d . 1.  Your year of b i r t h  2.  You a r e :  3.  Number of years of your formal e d u c a t i o n  4.  To what e t h n i c or c u l t u r a l group(s) do you belong?  male  female  187 5.  Your m a r i t a l s t a t u s i s : m a r r i e d o r common law remarried  6.  7.  separated  widowed  divorced  never m a r r i e d  Your t o t a l annual f a m i l y income i s : l e s s than $15,000  $45,001 - $60,000  $15,000 - $30,000  $60,001 - $75,000  $30,001 - $45,000  over $75,000  Do you have any other c h i l d r e n  (other than your  child  with schizophrenia)? Yes  (please l i s t the age f o r each below)  No  Son(s) a g e ( s ) : Daughter (s) age(s) : If  any of the above children/dependents  you at the present 8.  time, please  circle  their  with  ages.  Do you have another c h i l d with any p h y s i c a l o r mental d i s a b i l i t y or i l l n e s s ?  9.  are living  Do you have any other Yes  Yes dependents?  No  P l e a s e e x p l a i n your r e l a t i o n s h i p t o these o t h e r dependents:  No  188 S E C T I O N 8:  GENERAL  BELIEFS  Now we would l i k e you t o help us understand your g e n e r a l b e l i e f s about y o u r s e l f and l i f e . Please i n d i c a t e the e x t e n t t o which you agree or d i s a g r e e with the f o l l o w i n g statements. The c a t e g o r i e s are: 1 strongly disagree 1.  2 3 4 moderately s l i g h t l y s l i g h t l y disagree disagree agree  I have l i t t l e c o n t r o l over the t h i n g s t h a t happen t o me.  5 moderately agree  1  2  3  4  E  2.  I f e e l t h a t I have a number of good q u a l i t i e s . 1  2  3  4  f  3.  There i s l i t t l e I can do t o change many of the important t h i n g s i n my l i f e . 1  2  3  4  £  I am a b l e t o do t h i n g s as w e l l as most other people. 1 2  3  4  f  Sometimes I f e e l t h a t I'm being pushed around i n l i f e . 1 2  3  What happens t o me i n the f u t u r e mostly depends on me. 1 2  3  4  £  On the whole, I am w i t h myself.  2  3  4  £  2  3  4  £  I f e e l t h a t I'm a person of worth, a t l e a s t on an equal plane with others. 1 2 3  4  5  4. 5. 6. 7. 8.  9.  10.  satisfied 1  There i s r e a l l y no way s o l v e some of the problems I have.  I can 1  I often feel helpless in d e a l i n g w i t h the problems of l i f e . 1  2  11.  I take a p o s i t i v e toward myself.  2  12.  I can do j u s t about anything I r e a l l y set my mind t o do.  13.  4 !  attitude 1  A l l i n a l l , I'm i n c l i n e d t h a t I'm a f a i l u r e .  1 2 to f e e l 1 2  strongly agree  189 SECTION  9:  HELP  AND SUPPORT  L e t ' s t u r n now t o t h e help and support you g e t from f r i e n d s and r e l a t i v e s . T h i n k i n g about your f r i e n d s and f a m i l y , o t h e r than your c h i l d w i t h s c h i z o p h r e n i a , p l e a s e i n d i c a t e the e x t e n t t o which you agree or d i s a g r e e w i t h t h e f o l l o w i n g statements. The c a t e g o r i e s a r e :  1 strongly  1. 2. 3. 4. 5. 6. 7. 8.  disagree  2 disagree  3 agree  4 strongly  agree  There i s r e a l l y no one who understands what I am going through. SD  D  A  SA  The people c l o s e t o me l e t me know t h a t they care about me.  SD  D  A  SA  I have a f r i e n d o r r e l a t i v e i n whose o p i n i o n s I have confidence. SD  D  A  SA  I have someone who I f e e l I can t r u s t .  SD  D  A  SA  I have people around me who help me t o keep me s p i r i t s up. SD  D  A  SA  There a r e people i n my l i f e who make me f e e l good about myself.  SD  D  A  SA  I have a t l e a s t one f r i e n d o r r e l a t i v e I can r e a l l y c o n f i d e i n . SD  D  A  SA  I have a t l e a s t one f r i e n d or r e l a t i v e I want t o be with when I am f e e l i n g down o r discouraged. SD  D  A  SA  COMMUNITY  SUPPORT  There a r e support programs and/or support groups f o r r e l a t i v e s o f persons with s c h i z o p h r e n i a a v a i l a b l e . Yes  No  Don't know  2. There a r e i n f o r m a t i o n and/or education programs a v a i l a b l e f o r r e l a t i v e s o f persons w i t h s c h i z o p h r e n i a . Yes  No  Don't know  There i s a day program a v a i l a b l e f o r my son/daughter. Yes  No  Don't know  4. My son/daughter has a c o n f i d a n t / f r i e n d or support person. Yes  No  Don't know know  S E C T I O N 1 0 : UNDERSTANDING HOW YOUR F A M I L Y WORKS  You've come t o t h e f i n a l s e c t i o n . Thank you f o r your perseverance. Over time, f a m i l i e s n a t u r a l l y v a r y i n l e v e l s of togetherness and a d a p t a b i l i t y . We'd l i k e you t o share w i t h us some o f your views about how your f a m i l y p r e s e n t l y operates. P l e a s e c i r c l e t h e a p p r o p r i a t e number which i n d i c a t e s t h e extent t o which t h e f o l l o w i n g items a p p l y t o your f a m i l y .  (Note.  T h i s assessment was conducted  Olson, P o r t n e r , and B e l l , reproduced  u t i l i z i n g FACES I I o f  1982, which i s not a b l e t o be  here).  Thank you f o r your p a t i e n c e and c o o p e r a t i o n i n completing the q u e s t i o n n a i r e . Your h e l p i s very much a p p r e c i a t e d . P l e a s e check back t o make sure you have not l e f t any q u e s t i o n s unanswered. I f you have a d d i t i o n a l comments you would l i k e t o make on t h e ways i n which you cope w i t h your s i t u a t i o n , p l e a s e use the space p r o v i d e d below and t h e r e v e r s e o f t h i s page. Some examples a r e : What has helped you most t o cope? How have your coping e f f o r t s changed over time?  191 Appendix C Questionnaire  Items C a t e g o r i z e d A c c o r d i n g t o Sub-Scale  Illness characteristics - Life Skills Profile 1989) Self-care: Wears c l e a n c l o t h e s . Capable o f budgeting. Chooses good d i e t . N e g l e c t s p h y s i c a l problems. Has u n s o c i a b l e h a b i t s . Bathes r e g u l a r l y . Capable o f employment. Capable o f food p r e p a r a t i o n . W e l l groomed. Nonturbulence: D i s p l a y s r e c k l e s s behaviour. Shows v i o l e n c e t o o t h e r s . Has problems with other household members. D i s p l a y s o f f e n s i v e behaviour. Has been i n t r o u b l e with the p o l i c e . Abuses a l c o h o l and/or drugs. Is i n t r u s i v e toward o t h e r s . Shows r e s p o n s i b l e behaviour. Is angry toward o t h e r s . Takes o f f e n s e r e a d i l y . Is v i o l e n t t o h e r / h i m s e l f . Destroys p r o p e r t y . Sociable: Shows warmth t o o t h e r s . Has some s o c i a l o r g a n i z a t i o n involvement. Is g e n e r a l l y a c t i v e . Has f r i e n d s h i p s . Has some d e f i n i t e i n t e r e s t s . Withdraws from s o c i a l c o n t a c t . Communication: Intrudes on other's c o n v e r s a t i o n s . D i s p l a y s odd ideas i n t a l k . Shows reduced eye c o n t a c t . Speech i s d i s o r d e r e d . Uses b i z a r r e o r i n a p p r o p r i a t e g e s t u r e s . G e n e r a l l y has d i f f i c u l t y with c o n v e r s a t i o n . Responsibility: Shows poor compliance with medication. Takes o t h e r s p o s s e s s i o n s . Loses p e r s o n a l p r o p e r t y . Is uncooperative with h e a l t h workers. Is r e l i a b l e with own medication.  (Rosen e t a l . .  192 Primary a p p r a i s a l - How the i l l n e s s has i n f l u e n c e d your  life  (Gidron, 1991) Lack o f i n f o r m a t i o n and problems i n communication: Not knowing who and where t o go t o f o r h e l p . Lack o f understanding o f p r o f e s s i o n a l language used by s e r v i c e providers. R e l a t i o n s w i t h p r o f e s s i o n a l s a r e a problem. Concern t h a t my c h i l d i s not g e t t i n g proper treatment. Lack o f i n f o r m a t i o n about the i l l n e s s i n g e n e r a l . R e l a t i o n s w i t h p u b l i c agencies a r e a problem. Lack o f i n f o r m a t i o n about my c h i l d ' s c o n d i t i o n . R e l a t i o n s h i p w i t h t h e community: R e a c t i o n o f s o c i e t y toward s c h i z o p h r e n i a concern me. R e l a t i o n s w i t h my f r i e n d s and neighbours a r e a concern. R e a c t i o n o f s o c i e t y toward my f a m i l y concern me. R e l a t i o n s w i t h r e l a t i v e not i n the household a r e a concern. R e a c t i o n s o f s o c i e t y toward my c h i l d concern me. Problems i n d a i l y f u n c t i o n i n g : D i f f i c u l t y keeping up w i t h chores a t home. Have g u i l t f e e l i n g s about my c h i l d . Lack time and energy a t work. Worry about my own mental h e a l t h . Worry about my own p h y s i c a l h e a l t h . I l l n e s s has c r e a t e d f i n a n c i a l problems f o r f a m i l y . Relations within the family: I have d i f f i c u l t y a c c e p t i n g t h e s i t u a t i o n . Worry about t h e e f f e c t on my other c h i l d ( r e n ) . Lack time and energy f o r the f a m i l y . R e l a t i o n s w i t h my spouse (or former spouse) have  worsened.  Worry about t h e f u t u r e : I am concerned about my c h i l d ' s f u t u r e . I am concerned t h a t i f something happens t o me i t w i l l be d i f f i c u l t f o r t h e r e s t of my f a m i l y .  Ways o f Coping (Folkman, Lazarus, Dunkel-Schetter. e t a l . . 1986) Confront: D i d something which I d i d n ' t t h i n k would work, but a t l e a s t I was doing something. T r i e d t o g e t t h e person r e s p o n s i b l e t o change. Expressed anger t o the person who caused t h e problem. L e t my f e e l i n g s out somehow. Took a b i g chance or d i d something very r i s k y . Stood my ground and fought f o r what I wanted. Distance: Went a l o n g w i t h f a t e ; i t ' s j u s t bad l u c k . Went a l o n g as i f n o t h i n g was wrong.  193  Looked f o r the s i l v e r l i n i n g , so t o speak; t r i e d t o look on the b r i g h t s i d e of t h i n g s . T r i e d t o f o r g e t the whole t h i n g . Didn't l e t i t get t o me; r e f u s e d t o t h i n k too much about i t . Made l i g h t of the s i t u a t i o n ; r e f u s e d t o get too s e r i o u s about i t . Self-control; T r i e d not t o burn my b r i d g e s , but leave t h i n g s open somewhat. T r i e d t o keep my f e e l i n g s t o myself. T r i e d not t o a c t too h a s t i l y or f o l l o w my f i r s t hunch. Kept o t h e r s from knowing how bad t h i n g s were. T r i e d t o keep my f e e l i n g s from i n t e r f e r i n g with o t h e r t h i n g s too much. Went over i n my mind what I would say or do. Thought about how a person I admire would handle t h i s s i t u a t i o n and used t h a t as a model. Seek s o c i a l support: T a l k e d t o someone t o f i n d out more about the s i t u a t i o n . Accepted sympathy and understanding from someone. Got p r o f e s s i o n a l h e l p . T a l k e d t o someone who c o u l d do something concrete about the problem. Asked a r e l a t i v e or f r i e n d I r e s p e c t e d f o r a d v i c e . T a l k e d t o someone about how I was f e e l i n g . * T a l k e d t o someone i n a s i m i l a r s i t u a t i o n . Accept r e s p o n s i b i l i t y : C r i t i c i z e d or l e c t u r e d myself. A p o l o g i z e d or d i d something t o improve a r e l a t i o n s h i p . R e a l i z e d I brought the problem on myself. Make a promise t o myself t h a t t h i n g s would be d i f f e r e n t next time. Escape-avoidance: Hoped a m i r a c l e would happen. S l e p t more than u s u a l . T r i e d t o make myself f e e l b e t t e r by e a t i n g , d r i n k i n g , smoking, u s i n g drugs or medication, e t c . Avoided being with people i n g e n e r a l . Took i t out on other people. Refused t o b e l i e v e t h a t i t was happening. Wished t h a t the s i t u a t i o n would go away or somehow be over w i t h . Had f a n t a s i e s about how t h i n g s might t u r n out. P l a n f u l problem-solving: J u s t c o n c e n t r a t e d on what I had t o do next- the next s t e p . Made a p l a n of a c t i o n and f o l l o w e d i t . Changed something so t h i n g s would improve. Drew on my p a s t experiences; I was i n a s i m i l a r s i t u a t i o n b e f o r e . Knew what had t o be done, so I doubled my e f f o r t s t o make t h i n g s work. Came up w i t h a couple of d i f f e r e n t ways t o d e a l w i t h the problem. * Made some arrangements f o r my c h i l d ' s f u t u r e . * Read books and a r t i c l e s to l e a r n more about the s i t u a t i o n .  194 Positive reappraisal: Was i n s p i r e d t o do something c r e a t i v e . Changed or grew as a person i n a good way. I have b e n e f i t t e d from the experience. Found new f a i t h . R e d i s c o v e r e d what i s important i n l i f e . Changed something about myself. Prayed. We changed or grew as a f a m i l y i n a good way. * A d j u s t e d my e x p e c t a t i o n s f o r the f u t u r e . * Concentrated on the c h i l d ' s c o n t r i b u t i o n s t o the f a m i l y .  Esteem ( P e a r l i n & Schooler, 1978) I f e e l t h a t I have a number of good q u a l i t i e s . I am a b l e t o do t h i n g s as w e l l as most other people. On the whole, I am s a t i s f i e d with myself. I f e e l t h a t I'm a person of worth, a t l e a s t on an equal p l a n e with others. I take a p o s i t i v e a t t i t u d e toward myself. A l l i n a l l , I am i n c l i n e d t o f e e l t h a t I'm a f a i l u r e .  Mastery ( P e a r l i n & Schooler, 1978) I have l i t t l e c o n t r o l over the t h i n g s t h a t happen t o me. There i s l i t t l e I can do t o change many of the important t h i n g s i n my l i f e . Sometimes I f e e l t h a t I'm being pushed around i n l i f e . What happens t o me i n the f u t u r e mostly depends on me. There i s r e a l l y no way I can s o l v e some of the problems I have. I o f t e n f e e l h e l p l e s s i n d e a l i n g with the problems of l i f e . I can do j u s t about anything I r e a l l y s e t my mind t o do.  Note. * i n d i c a t e s i d i o s y n c r a t i c  items  195 Appendix D The Shapes of Value  Distributions  Demographics Except f o r f a m i l y income, d i s t r i b u t i o n s of v a l u e s f o r the demographic v a r i a b l e s approached n o r m a l i t y . Observed v a l u e s of " t o t a l f a m i l y income" were s l i g h t l y and s i g n i f i c a n t l y skewed t o the r i g h t . Except f o r a value of 35 years f o r "formal e d u c a t i o n " (recoded t o one above the next h i g h e s t v a l u e as suggested by Tabachnick and F i d e l l , 1989), t h e r e were no o u t l i e r s ( d e f i n e d as 3 SDs above the mean), L e v e l of f u n c t i o n i n g measures Observed v a l u e s of " s e l f c a r e " and " s o c i a b l e " s u b - s c a l e s were approximately normally d i s t r i b u t e d . D i s t r i b u t i o n s were s i g n i f i c a n t l y skewed t o the l e f t i n the s u b - s c a l e s "nonturbulent behaviour" (Skewness = -.854, SE Skewness = .212), "communication s k i l l s " (Skewness = -.642, SE Skewness = .207), and " r e s p o n s i b i l i t y (Skewness = -.875, SE Skewness = .206), i n d i c a t i n g a " t a i l " towards lower v a l u e s . K u r t o s i s v a l u e s l a c k e d significance. In t h i s sample then, the g r e a t e r number of sons and daughters were c o n s i d e r e d t o be r e s p o n s i b l e , communicative, and calm, whereas the others-were ranked i n v a r y i n g degrees of lower f u n c t i o n . The d i s t r i b u t i o n of observed v a l u e s f o r the t o t a l s c a l e , the " L i f e S k i l l s P r o f i l e , " had a s m a l l but s i g n i f i c a n t skew t o the l e f t (Skewness = -.524, SE Skewness = .220) a l o n g w i t h a s l i g h t l y p l a t y k u r t i c shape which l a c k e d significance. Primary a p p r a i s a l measures The observed d i s t r i b u t i o n s of f o u r of the primary a p p r a i s a l s u b - s c a l e s , namely, " l a c k of i n f o r m a t i o n , " " r e l a t i o n s h i p w i t h the community," "problems f u n c t i o n i n g , " and " r e l a t i o n s h i p s w i t h i n the f a m i l y , " d i s p l a y e d n o n s i g n i f i c a n t p o s i t i v e skewness and n o n s i g n i f i c a n t negative k u r t o s i s . T h i s p a t t e r n was a l s o e v i d e n t i n the d i s t r i b u t i o n of the cumulative s c a l e " a l l the concerns." The d i s t r i b u t i o n of the sub-scale "worry about the f u t u r e , " however, demonstrated a c l e a r departure from n o r m a l i t y . I t had s t r o n g n e g a t i v e skewness (-1.387, SE Skewness = .204) and s i g n i f i c a n t p o s i t i v e k u r t o s i s (1.754, SE K u r t o s i s = .406). The m a j o r i t y of cases were c l u s t e r e d toward the h i g h e r v a l u e s , an i n d i c a t i o n t h a t indeed t h i s was an area of g r e a t concern f o r most of the p a r e n t s i n the sample. Secondary a p p r a i s a l D i s t r i b u t i o n s of values f o r two of the s i n g l e - i t e m secondary a p p r a i s a l s , "I c o u l d change or do something about the s i t u a t i o n " and "I had t o h o l d back from doing what I wanted t o do," were n e g a t i v e l y skewed ( n o n s i g n i f i c a n t ) with s i g n i f i c a n t p l a t y k u r t i c shapes. K u r t o s i s values f o r the former were -1.325 w i t h a SE K u r t o s i s of .406; v a l u e s f o r the l a t t e r were K u r t o s i s = -1.361 w i t h a SE K u r t o s i s of .408. The n e g a t i v e skew of "I had t o accept the s i t u a t i o n " was s i g n i f i c a n t (Skewness = -1.293, SE Skew = .205) but i t s p o s i t i v e k u r t o s i s was not. D i s t r i b u t i o n of the secondary a p p r a i s a l , "I needed t o know more I c o u l d a c t , " was  196 s i g n i f i c a n t l y skewed t o the l e f t (-.636, SE Skewness = .206) w i t h a s i g n i f i c a n t n e g a t i v e k u r t o s i s ( K u r t o s i s = -.944, SE K u r t o s i s = .408) . Resource measures The d i s t r i b u t i o n of v a l u e s of the "esteem" s c a l e was s i g n i f i c a n t l y skewed t o the l e f t (Skewness = -1.526, SE Skewness = .207) w i t h a s i g n i f i c a n t p o s i t i v e k u r t o s i s ( K u r t o s i s = 3.419, SE K u r t o s i s = .411), i n d i c a t i n g a l e p t o k u r t i c d i s t r i b u t i o n of the o b s e r v a t i o n s with a c l u s t e r of cases i n the upper v a l u e s and a " t a i l " toward the lower end of the s c a l e . More respondents i n t h i s sample expressed h i g h l e v e l s of "esteem" than would normally be expected. The i n d i v i d u a l resource, "mastery," however was approximately normally d i s t r i b u t e d with s l i g h t , n e g a t i v e skew and p l a t y k u r t i c shape, both of which l a c k e d s i g n i f i c a n c e . D i s t r i b u t i o n s of observed v a l u e s of " e x p r e s s i v e support" and "community support" were skewed t o the l e f t w i t h s i m i l a r l e v e l s of s i g n i f i c a n c e (3.89 and 3.85). Observations of "cohesion" were d i s t r i b u t e d i n a comparable p a t t e r n but w i t h a lower s i g n i f i c a n c e l e v e l f o r skewness (2.60). Ways of c o p i n g s c a l e s "Seeking s o c i a l support" and " p o s i t i v e r e a p p r a i s a l " were s i m i l a r l y d i s t r i b u t e d with p l a t y k u r t i c shapes t h a t d i d not reach l e v e l s of s i g n i f i c a n c e . D i s t r i b u t i o n s of " d i s t a n c i n g , " " a c c e p t i n g r e s p o n s i b i l i t y , " and "escape-avoidance" were s i m i l a r w i t h s i g n i f i c a n t l e v e l s of p o s i t i v e skewness (Skewness = .736, .602, .786, r e s p e c t i v e l y ) . The s u b - s c a l e s , " c o n f r o n t , " " p l a n , " and " s e l f - c o n t r o l , " along with the two cumulative s c a l e s , "problem-focussed" and "emotion-focussed," were those t h a t most c l o s e l y approached a normally shaped d i s t r i b u t i o n w i t h low, i n s i g n i f i c a n t l e v e l s of skewness and k u r t o s i s .  197  Appendix E  Legend (A) pile-up of demands  (B) available resources  (V) family vulnerability  (C) situational appraisal  (T) family type  (PSC) problem-solving coping  (X) family adjustment and adaptation  Figure E l . A Model o f Family Stress. Coping, and Adaptation (Following M c C u b b i n and M c C u b b i n . 1991)  Primary  Figure E2 A Representation of the Coping Process (following Lazarus and Folkman. 1984)  199  Primary Appraisals  .21  21  Lack of Information  Relations with community  - . 24  I—Relations within Family  Worry about the Future Coping Life Skills  . 14  Confront  Problems Functioning  7,7^. Distance  Self-care <  Self-Control  CommunicatK Responsibility -  Seek Social Support  Nonturbulence •  Accept Responsibility Escape  Sociablility -  Planful Problem-Solving °  Time since Onset Secondary Appraisals Could Change Situation Had to Accept Situation Needed to Know More Had to Hold Back Figure E3. Illness Characteristics (Life Skills) that Predict Appraisals and Coping.  Positive Reappraisal  200  Primary Appraisals Lack of Information Relations with Community Relations within Family Problems Functioning Demographics  Worry about the Future  Coping Confront  Age of Parent  Distance Self-Control  Sex of Parent  Seek Social Support Accept Responsibility  Marital Status of Parent  Escape Planful Problem-Solving Positive Reappraisal Secondary Appraisals Could Change Situation Had to Accept Situation Needed to Know More Had to Hold Back  Figure E4. Demographic Characteristics That Predict Appraisals and Coping  201  Primary Appraisals — Lack of Information  Relations with Community  Relations within Family  Coping Confront Distance Self-Control £3—Seek Social Support Accept Responsibility  Expressive Suppo  - . 22 Escape  Community Support  Planful Problem-Solving Cohesion  Secondary Appraisals Could Change Situation  Overt Family Influence  Had to Accept Situation Needed to Know More Had to Hold Back  Figure E5.  Individual and Family Resources That Predict Appraisals and Coping  Positive Reappraisal  202  Coping  Secondary Appraisals Can Change Situation—'  Confront  Have to Accept . 1 8 Situation  Distance  Self-Control  Seek Social Support  Primary Appraisals  Accept Responsibility  Lack of Information Escape  Relations with Community Relations within Family Problems Functioning  Positive Reappraisal  Worry about Future Planful Problem-Solving  Figure E6. Predictive Relationships A m o n g Primary Appraisal. Secondary Appraisals and Coping  203  Appendix F Table F l Demographic Characteristics of Parents  Sample Size Mothers  109  Fathers  32 Marital Status  Married/Remarried  108  Widowed  13  Divorced/Separated  19  Formal Education (4-22 years) M  13-16  SD  3.06 Number of Other Children (0-8)  M  2.97  SD  1.6 Have Other Child with Disability  Yes  35  No  106 Have Other Dependents  Yes  17  No  122  Missing  2  Characteristics with Significant Differences by Sex of Parent Mothers  Fathers  t test p <  Age (39-88 years)  M 59.00. SD9.29  M.66.65 SD9.77  .00  Family Income (a)  M 2.93 S D 1.34  M_3.66SD1.47  .01  Note.(a)l=<$15,000, 2=$15,001-30,000, 3=830,001-45,000, 4=545,001-60,000, 5=$60,001-75,000, 6=>$75,000.  204 Table F2  Characteristics of Daughters and Sons with Schizophrenia  Daughters  Sons  30  111  With Parents  11  35  Elsewhere  19  76  Never Married  22  104  Other  8  7  Sample Size (141)  Significance Chisquare  Residence  .60  Marital Status  .00 Significance^ test  Age (17-51)  M 33.07 SD7.19  M_32.72 _SD 7.75  p<.83  Time Since Illness Onset (1-35 years)  M J 2 . 9 0 SD7.41  M 12.27  SD7.96  p<.70  Number 20)  M4.71  M4.52  SD4.22  E<.82  Hospitalizations  (0-  SD2.92  Table F3 Reliabilities of Measures  Scale  Selfcare Nonturbulence Sociability Communication Responsibility Life Skills Profile (cumulative)  Self-Esteem Mastery Cohesion Adaptability Expressive Support  Lack of Information Relations within Family Relations with Community Problems Functioning Worry about the Future Cumulative Primary Appraisals  Number of Items  Illness Characteristics 9 12 6 6 5 38  Resources 6 7 14 16 8  Primary Appraisal 7 4 5 6 2 24  Cronbachs Alpha  .72 .81 .70 .72 .77 .90  .75 .69 .91 .87 .87  .79 .66 .72 .75 Correlation .90  Ways of Coping 6  .49  Distance Self-Control Social Support Accept Responsibility  6 7 7 4  .57 .52 .79 .32  Escape/Avoidance' Planful Problem Solving Positive Reappraisal  8 8 10  .61 .70  Confront  .79  206 Table F4  Functioning Level of Daughters and Sons: Means. Standard Deviations, and Significant Differences  Sub-Scale  Range (1-4)  Group  Daughters  Sons  (30)  (111)  Significance  Min  Max  M  SD  M  SD  M  SD  Uestp<  Self-care  1.33  3.78  2.62  .59  2.69  .53  2.59  .62  .43  Nonturbulence  1.25  4.00  3.21'  .57  3.01  .64  3.23  .57  .05  Social Contact  1.17  4.00  2.46  .68  2.47  .07  2.44  .67  .73  Communication  1.33  400  3.02  .66  2.88  .68  3.06  .66  .20  Responsibility  1.13  3.20  2.54  .67  2.82  .78  3.17  .81  .04  207 Table F5 Means. Standard Deviations, and Significant Differences of Resources and Appraisals for Mothers and Fathers Variable  Range  Mothers  Group  Significance  Fathers  Resources Min  Max  M  SD  M  SD  M  SD  t test p<  Self-Esteem(l-6)  2.33  6.00  5.29  .70  5.34  .72  5.26  .54  .63  Mastery (1-6)  1.29  6.00  4.09  .90  4.07  .88  4.24  .97  .34  Cohesion (1-5)  22.0  79.0  58.38  11.98  58.21  12.12  58.17  10.72  .98  Espressive Support (1-4)  1.63  4.00  3.38  .54  3.41  .56  3.24  .70  .15  Community Support(4-8)  4.00  8.00  7.08  .92  7.10  .90  6.97  .10  .50  Primary Appraisal (1-6) Lack of Information  1.00  6.00  3.18  1.25  3.29  1.25  2.71  1.16  .02  Relationship with Community  1.00  6.00  3.57  1.13  3.68  1.00  3.16  1.18  .02  Relationship with Family  1.00  6.00  3.34  1.36  3.49  1.28  3.12  1.56  .17  Problems Functioning  1.00  5.83  2.98  1.35  3.13  1.30  2.39  1.34  .01  Worry about the Future  1.00  6.00  5.13  1.04  5.25  .96  4.73  1.09  .01  •  Secondary Appraisals (1-6) Can Change Situation  1.00  6.00  3.75  1.85  3.70  1.85  3.94  1.85  .52  Have to Accept Situation  1.00  6.00  4.79  1.54  4.89  1.46  4.47  1.76  .18  Need to Know More  1.00  6.00  4.22  1.78  4.25  1.78  4.09  1.75  .66  Have to Hold Back  1.00  6.00  3.74  1.87  3.77  1.83  3.28  1.91  .11  Note. Higher scores indicate higher levels of resources, primary appraisal concerns and situational beliefs.  208  Table F6 Means.Standard Deviations, and Significant Differences of Ways of Coping for Mothers and Fathers  Way of Coping  Range  . Group  Mothers  Fathers  Significance  Min  Max  M  SD  ' M  SD  M  SD  ttest p_<  Confront  1.00  3.17  1.97  :48  2.04  .44  1.77  .54  .00  Planful Problem-Solving  1.00  4.00  2.54  .64.  '2.72  .52  2.37  .72  .00  Problem Focussed  Emotion Focussed Distancing  1.00  4.00  1.96  .53  1.97  .52  1.95  .61  .85  Self-Control  1.00  3.71  2.32  .52  2.39  .47  2.14  .61  .02  Seek Social Support  1.00  4.00  2.56  .77  2.73  .71  2.31  .81  .01  Accept Responsibility  1.00  3.25  1.79  .59  1.85  .53  1.59  .72  .03  Escape/Avoidance  1.00  3.38  1.72  .52  1.77  .53  1.55  .46  .08  Positive Reappraisal  1.00  3.90  2.48  .65  2.59  .51  2.12  .76  .00  Note. Higher scores indicate greater use of coping strategy.  209 Table F7 Means. Standard Deviations, and Significant Differences in Parents' Appraisals and Coping by Categorical Variables "Sex of Child" and "Overt Family Influence" Sex of Child  Parents' Appraisals and Coping  Primary Appraisal "Lack of Information"  Primary Appraisal "Relations Within the Family  Secondary Appraisal "Have to Hold Back"  "Distance" Coping  "Accept Responsibility" Coping  Parents' Appraisals and Coping  Primary Appraisal "Worry about the Future"  "Self-Control" Coping  "Planful Problem-Solving" Coping  Note. Significance levels are 2-tailed.  Daughters  Sons  t-tests_p_ <  M  3.57  3.05  .04  SD  1.32  1.22  M  3.86  3.28  SD  1.38  1.32  M  4.43  3.55  SD  1.65  1.88  M  2.15  1.92  SD  .58  .52  M  2.15  1.92  SD  .56  .58  .04  .02  .04  .02  Overt Family Influence Yes  No  t-tests p<  M  5.45  4.87  .00  SD  .78  1.29  M  2.41  2.21  SD  .53  .49  M  2.74  2.51  SD  .53  .63  .03  .02  210 Table F8 Means. Standard Deviations, and Significant Differences in Parents' Appraisals and Coping by Categorical Variables "Have otherChild with Disability" and "Marital Status of Parent"  Parents' Appraisals and Coping  Primary Appraisal "Relationships in Family"  Parents' Ways of Coping  "Confrontive" Coping  "Self-Control" Coping  "Planful Problem-Solving " Coping  "Positive Reappraisal" Coping  "Seek Social Support" Coping  Note. Significance levels are 2-tailed.  Have Other Child with Disability Yes  No  t-tests g <  M  3.86  3.25  .02  SD  1.15  1.39  Marital Status of Parent Married  Not Married  t-test p<  M  1.92  2.17  .01  SD  .46  .48  M  2.27  2.55  SD  .52  .42  M  . 2.57  2.87  SD  ,57  .52  M  2.42  2.69  SD  .65  .61  M  2.55  2.91  SD  .75  .70  .01  .01  .04  .02  211 Table F9  Significant Correlations among Demographic Variables  Variables  1  2  3  4  5  6  7  8.  1. AgeofParent  1.00  .81**  .20  .60**  .26  -.04  -.23*  -.18  2. Age of Child  - —  1.00  .25*  .77**  .33**  -.09  -.26*  -.25*  1.00  .32**  .35**  .09  -.02  -.14  4. Time Since Onset of Illness  1.00  .32**  -.01  -.22*  -.21  5. Residence of Child  -—  1.00  .11  -.18  -.31**  1.00  .33**  .06  1.00  .26*  3. Number of Hospitalizations  .  6. Parents Education Level 7. Total Family Income 8. Number of Other Children at Home  Note. Residence of child: With parent = 1, Elsewhere = 2. *< .01, **<.001.  '  1.00  212 Table F10 Variables Significantly Correlated with Measures of Primary Appraisal Primary Appraisals Variables  Lack of Information  Relation with Community  Relations with Family  Problems Functioning  Worry about the Future  Demographics Sex of Child (a)  -.52, p< .04 -.24*  Age of Parent Sex of Parent (a)  -.59, p<.04  .58 p<03  .  .56 p<.02  33**  .74 p<.00  .52 p<.01  .60, p<.02  Have Other Child with Disability (a) Child's Life Skills Selfcare  -.28**  -.25*  -31**  -.24*  -.22*  -.26*  Sociability Communication Skills  -.28**  -.23*  -.27**  Responsibility  -.36**  -.30**  -.38**  .  Nonturbulent Behaviour  -.33**  .  j**  -.38**  -.33**  Life Skills Profile (cumulative)  .  -.35**  -.40**  -.34**  37**  3  34**  Resources Esteem  . 3i**  -31**  -.32**  -.43**  -.25*  Mastery  -31**  -.36**  -.49**  -.53**  -.26*  Community Support  -.32**  -.23*  -.23*  Cohesion  -.28**  -.26*  -.38**  .  32**  Overt Family Influence Note. Dashes indicate non-significant association. (a) values displayed are the differences in means between the groups with a 2-tailed significance level. 2-tailed significance *<01, **<001.  .58, p<.00  213  Table F l l Variables significantly Correlated with Secondary Appraisals  Secondary Appraisals  Variables  Could Change  Have to Accept  Need to Know  Have to Hold Back  Situation  Situation  More  Age of Parent  —  —  ~  -.24*  Sex of Child (a)  --  -  --  -.88,p<.02  Esteem  --  .21*  -  -.25*  Mastery  .33**  —  ~  -.35**  Expressive Support  .22*  Community Support  ~  ~  —  -.26*  Cohesion  ~  ~  ~  -.24*  Nonturbulence  —  —  --  -.32**  Responsibility  -  --  -  -.31**  Lack of Information  —  ~  .35**  .44**  Relations with Community  —  -  —  .33**  Relations with Family  -.29**  -  --  .41**  Problems Functioning  ~  -  ~  .54**  Worry about Future  -  —  ~  .24*  Resources  —  .  -  Child's Life Skills  Primary Appraisals  Note. Dashes indicate non-significant association. (a) values displayed are the differences in means between the groups with a 2-tailed significance level. 2-tailed significance *<.01, **<.001.  214 Table F12 Significant Correlations of Demographic. Resource, and Illness Variables with Measures of Coping Measures of Coping Variables  Confront  Distance  Self-  Social  Accept  Control  Support  Responsibility  Escape  Plan  Positive Reappraisal  Demographics Age of Parent  -  -  -  -.24*  --  -.28**  Sex of Parent (a)  .27 p<.01  -  .25 p<.02  .42p<.01  .26p<.03  Time Since Onset  ~  .26**  Marital Status of Parent (a)  -.25 p<.01  -  -.28 p<.01  -.36 p<.02  —  —  Sex of Child (a)  —  .23p<.04  -  —  -.28p<.02  .23p<.03  Esteem  —  —  —  —  -.22*  -.36**  Mastery  —  —  -.26*  —  —  -.48**  Expressive Support  —  —  —  .34**  —  —  Community Support  —  -.24*  —  ~  ~  -.25*  Overt Family Influence (a)  -  -  .20 p< .03  —  —  —  Nonturbulent Behaviour  ~  -  ~  -.22*  -.34**  -.22*  Responsibility  ~  ~  ~  ~  -.26*  Sociability  -  ~  ~  -  —  .35 p<.01  .47p<.00  -.30 g<.01  -.27, p<.04  Resources  .23*  .23 p<.02  Child's Life Skills  -  -  Note. Dashes indicate non-significant association. (a) values displayed are the differences in means between the groups with 2-tailed significance level 2-tailed significance level * < .01, ** < .001;  .22*  215 Table F13 Significant Correlations of Primary and Secondary Appraisals with Measures of Coping  Measures of Coping Variables  Confront  Distance  SelfControl  Social Support  Accept Responsibility  Escape  Plan  Positive Reappraisal  Primary Appraisals Lack of Information  .23"  .30*  .34*  Relations with Community Relations with Family  .26*  Worry About the Future  .24*  Problems Functioning  .39*  .23"  .35"  .29*  .50*  .30*  .39*  .23*  .60*  Secondary Appraisals Can Change Situation  -.24*  .25*  Have to Accept Situation  .23"  Need to Know More  .29*  Have to Hold Back  .24*  .21*  Note. Dashes indicate non-significant association. 2-tailed significance level *<.01, **<.001.  .28*  .40*  .42"  216 Table F14 Standard Multiple Regression of Demographic. Resource, and Life Skills Variables on Primary Appraisal. "Lack of Information and Problems in Communication  Correlation  1. 2. 3. 4. 5. 6.  Variables  1  2  3  4  5  6  7  8  9  Lack of Information Sex of Child Age of Parent Sex of Parent Life Skills Profile Esteem  1.00 -----  .17 1.00  -.23 -.01 1.00 -----  .19 -.09 -.31 1.00  -.40 -.09 .12 -.10 1.00  -.29 -.18 .15 .04 .21 1.00  -.33 -.11 .04 -.02 .30 .45  -.33 -.09 .04 .06 .38 .20  -.27 -.12 .08 .00 .22 .29  -----  1-00  .25 100  .24 .20  7. Mastery 8. Community Support 9. Cohesion  1  0  0  Equation Number 1 . Dependent Variable"Lack of Information"  Variables Entered Cohesion Sex of Parent Sex of Child Community Support Age of Parent Mastery Life Skills Profile Esteem  :  B  Beta  F  -.01 .43 .31 -.25 -.02 -.17 -.51 -.17  -.11 .14 .10 -.19 -.14 -.12 -.21  1.99 3.39 1.83 5.36 3.24 2.14  7.65 Significance F = .00 DFRegression 8 Residual 132  -.09  6.43 1.18  Significance F .16 .07 .18 .02 .07 .15 .01 .28  R = .32 Adjusted R = .28 R=.56  217 Table F15  Standard Multiple Regression O f Demographic. Resource. And Life Skills Variables On Primary Appraisal "Relations With The Community"  Correlation  Variables  2  3  4  5  6  7  .21 1.00  -.37 -.10 1.00  -.30 .04 .21 1.00  -.37 -.08 .30 .45 1.00  -.25 .06 .38 .20 .25 1.00  -.26 .00 .22 .29 .24  1  Relations with Community(PA) Sex of Parent Life Skills Profile Esteem Mastery 6. Community Support 7. Cohesion  1. 2. 3. 4. 5.  1.00  .20 1.00  Equation Number 2 Dependent Variable"Relations With The Community"  Variables Entered  B  Beta  F  Significance F  Cohesion Sex of Parent Community Support Esteem  -.01 .48 -.10 -.21  -.11 .18 -.08 -.12  2.06 5.69 .906  Life Skills Profile Mastery  -.48 -.24  -.21 -.19  .15 .02 .34 .14 .01 .03  F = 8.36 Significance F = .00 DFRegression 6 Residual 134  2.17 6.62 5.04  R=.27 Adjusted R_= .24 R = .52  218 Table F16 Standard Multilple Regression O f Demographic. Resource. And Life Skills Variables On Primary Appraisal "Relations Within The Family"  Correlation  Variables 1. Relations Within the Family 2. Sex of Child 3. Other Child With Disability 4. Life Skills Profile 5. Esteem 6. Mastery 7. Expressive Support  1  2  1.00 - —  .18 1.00 - —  3  4  5  6  7  8  9  -.19 .02 1.00  -.41 -.09 .13  -.33 -.18 .03  -.49 -.11 .12  -.27 -.18 .10  -.24 -.09 -.03  -.37 -.12 .29  -----  LOO -----  .21 1 00 -----  .30 .45 1-00  .16 .30 .29 1 00  .38 .20 .25 .24  .22 .29 .24 .42  —-  100  .20 100  8. Community Support 9. Cohesion  Equation Number 3 Dependent Variable "Relations Within the Family"  Variables Entered  B  Beta  F  Significance F  Sex of Child Community Support Other Child with Disability Mastery  -.02 .28 -.01 -.21 -.50  -.19 .08 -.01  5.27 1.43  Life Skills Profile Expressive Support Esteem  -.63 -.04 -.10  .02 .23 .92 .36 .00 .00 .85 .52  Cohesion  10.09 DF  Significance F_= .00 Regression 8 Residual 132  -.07 -.33 -.24 -.02 -.05  .01 .84 17.04 9.39 .04 .41  R = .38 Adjusted R = .34 R=.62  219 Table F17 Standard Multiple Regression O f Demographic. Resource. And Life Skills Variables On Primary Appraisal "Problems in Daily Functioning"  Correlation  Variables 1. 2. 3. 4.  Problems Functioning AgeofParent Sex of Parent Life Skills Profile  1 1.00  2 -.34. 1.00 -----  5. Esteem 6. Mastery 7. Expressive Support  3  4  5  6  7  .23 -.31 1.00 -—  -.35 .12 -.10 1-00  -.43 .15 .04 .21  -.53 .04 -.08 .30  -.26 .06 .12 .16  -.31 .08. .00 .22  -----  1-00 -----  .45 1 00  .31 .29 10°  .29 .24 -42  8. Cohesion  8  1  0  0  Equation Number 4 Dependent Variable "Problems Functioning"  Variables Entered  B  Beta  F  Significance F  Cohesion Sex of Parent Life Skills Profile Esteem  -.01 .42 -.37 -.32  -.11 .13 -.14 -.16  2.45 3.58 4.21 4.71  .12 .06 .04 .03  AgeofParent Expressive Support Mastery  -.03 -.10 -.53  -.23 -.04 -.36  11.39 .374 22.72  .00 .54 .00  F_= 16.38 DF  Significance F = .00 Regression  7  Residual  133  R = .46 Adjusted R = .43 R_= .68  220 Table F l 8 Standard Multiple Regression of Demographic and Resource Variables on Primary Appraisal "Worry About the Future"  Correlation  1  Variables 1. 2. 3. 4. 5.  Worry About the Future (PA) Sex of Parent Esteem Mastery Family Influence  1.00  .21 1.00  -.24 .04 1.00  -.27 -.07 .45 1.00  -.27 -.16 -.04 .07 1.00  Equation Number 5 Dependent Variable "Worry About the Future  Variables Entered Family Influence Esteem Sex of Parent Mastery  F_= 7.38 Significance F = .00 DF Regression Residual 132  4  B  Beta  F  Significance F  -.51 -.29 .44 -.19  -.24 -.18 .17 -.15  8.75 4.24 4.46 3.01  .00 .04 .04 .09  R=.18 Adjusted R = .16 R=.43  221 Table F l 9  Standard Multiple Regression of Resource and Primary Appraisal Variables on Secondary Appraisal "Situation is One I Could Change Or Do Something About"  Correlation  Variables 1. 2. 3. 4.  1  Could Change Situation (SA) Mastery Expressive Support Relations Within Family (PA)  1.00  2  3  4  .33 1.00  .24 .29 1.00  -.31 -.49 -.26 1.00  Equation Number 6 Dependent Variable "Situation is One I Could Change Or Do Something About"  Variables Entered Relations Within Family Expressive Support Mastery  B  Beta  F  Significance F  -.24 .40  -.18 .13  3.69 2.37  .06 .13  .43  .21  5.20  .02  F = 8.36 Significance E - 00 DF  Regression Residual 137  R = . 15 3  Note. PA indicates Primary Appraisal; SA indicates Secondary Appraisal  Adjusted R = .14 R=.39  222 Table F20  Standard Multiple Regression O f The Resource "Self-Esteem" On Secondary Appraisal "Situation Is One I Have To Accept"  Correlation  Variables  1  1. Have to Accept Situation (SA) 2. Esteem  2  1.00  .22 1.00  Equation Number 7 Dependent Variable "Situation Is One I Have To Accept"  Variables Entered Esteem  F = 6.90 Significance F = .01 DF Regression Residual 139  1  Note. S A indicates Secondary Appraisal  B  Beta  F  Significance F  .49  .22  6.90  .00  R=.05 Adjusted R_= .04 R=.22  223 Table F21  Standard Multiple Regression O f Primary Appraisal "Lack O f Information And Problems In Communication" On Secondary Appraisal "Needed To Know More Before I Could Act"  Correlation  Variables  1  1. Needed To Know More (SA)  1.00  .35  2. Lack O f Information (PA)  1.00  Equation Number 8  Dependent Variable "Needed To Know More Before I Could Act"  Variable Entered Lack O f Information  18.86 DF  B  Beta  F  Significance F  .49  .35  18.86  .00  Significance F = .00 Regression 1 Residual 139  Note. PA indicates Primary Appraisal; SA Indicates Secondary Appraisal  R=.12 Adjusted R = .11 R=.35  224 Table F22 Standard Multiple Regression O f Demographic. Resource. Life Skills And Primary Appraisal Variables On Secondary Appraisal. "Had To Hold Back From Doing What I Wanted To Do"  Correlation  Variables 1. 2. 3. 3. 4. 5. 6. 7. 8.  Had To Hold Back (SA) Age of Parent Sex of Child Esteem Mastery Community Support Cohesion Nonturbulence Cumulative P A  1 1.00  2  3  4  5  6  7  8  9  -.24 1.00  .19 -.02  -.24 .15  -.36 .04  -.27 -.03  -.24 .08  -.33 .22  .53 -.27  1.00  -.18 1.00  -.11 .45 1.00  -.09 .20 .25 1.00  -.12 .29 .24 .20 1.00  -.16 .19 .34 .35 .27 1.00  .16 -.40 -.50 -.21 -.34 -.42 1.00  Equation Number 9 Dependent Variable "Had To Hold Back From Doing What I Wanted To Do"  Variables Entered Cumulative P A  B  Beta  F  Significance F  15.03 1.98  .00  .65  .36  Sex of Child Age of Parent Community Support Cohesion Esteem Nunturbulent Behaviour  .47 -.03 -.23  .10 -.13 -.11 -.04 .04  Mastery  -.25  -.01 .10 -.15  -.05 -.12  F = 8.14 Significance F_= .00 DF Regression Residual 132  Note. P A indicates Primary Appraisal; SA indicates Secondary Appraisal  .25 .20 .33  .16 .09 .15 .62 .65 .57  1.85  .18  2.93 2.06  R = .33 Adjusted R = .29 R=.58  225 Table F23  Standard Multiple Regression O f Demographic and Appraisal Variables On "Confrontive" Coping  Correlation  Variables 1. 2. 3. 4. 5. 6.  Confrontive Coping Sex of Parent Marital Status of Parent Lack of Information (PA) Problems Functioning (PA) Had to Hold Back (SA)  1  2  3  4  5  6  1.00 -—  .24 1.00  .22 .22 1.00  .22 .19 .07 1.00  .21 .23 .03 .61 1.00 -—  .23 .13 -.02 .44 .54 1.00  Equation Number 10  Dependent Variable "Confrontive" Coping  Variables Entered  B  Beta  F  Significance F  Had to Hold Back (SA) Marital Status of Parent  .04 .21  .16 .18  2.67 5.02  .11 .03  Sex of Parent Lack of Information (PA) Problems Functioning (PA)  .17 .03 .01  .15 .09 .04  3.29 .76 .11  .07 .39 .74  F_= 4.46 Significance F = .00 DF Regression Residual 135  5  Note. P A indicates Primary Appraisal; SA indicates Secondary Appraisal  R = . 14 Adjusted R_=. 11 R=.38  226 Table F24  Standard Multiple Regression O f Demographic. Resource. And Appraisal Variables On "Distance" Coping  Correlation  Variables 1. 2. 3. 4. 5.  1  Distance Coping Time Since Onset Sex of Child Community Support Had to Hold Back (SA)  1.00  2  3  4  5  .20 1.00 -—  .18 .03 1.00  -.22 -.03 -.09 1.00  .21 -.16 .19 -.27 1.00  Equation Number 11 Dependent Variable "Distance" Coping  Variables Entered Had To Hold Back (SA) Time Since Illness Onset Sex of Child Community Support  F = 5.26 S i g n i f i c a n c e ^ .00 JDF  Regression  B  Beta  F  .05 .02 .16 -.09  .17 .22 .12 -.16  4.11 7.05 2.15 3.64  Significance F .05 .01 .15 .06  R= 4  Residual 136  Note. SA indicates Secondary Appraisal  .13  Adjusted R =. 11 R=.37  227 Table F25  Standard Multiple Regression of Demographic. Resource. And Appraisal Variables On "Self-Control" Coping  Correlation  Variables 1. Self-Control Coping 2. 3. 4. 5.  Sex of Parent Marital Status pf Parent Mastery Worry about the Future(PA)  1 1.00  2  3  4  5  6  7  8  .22  .24  -.28  .22 1.00  -.07 .06 1.00  .25 .21  .35 .22  -.19  1.00  .05 -.27 1.00  .05 -.53 .46 1.00  .30 .12 -.00 -.35 .23 .52 -.08 1.00  6. Problems Functioning (PA) 7. Overt Family Influence 8. Had to Hold Back (SA)  -.16 -.07 .07 -.27 -.07 1.00  Equation Number 12  Dependent Variable 'Self-Control" Coping  Variables Entered Had to Hold Back(SA) Marital Status of Parent Overt Family Influence Sex of Parent Mastery Worry about the Future (PA) Problems Functioning (PA)  B  Beta  F  Significance F  .04  .15 .21 -.12  2.69 7.26 2.07 1.03 2.33 .39 1.57  .10 .01 .15 .31 .13 .53 .21  .26 -.12 .10 -.08 .03 .05  .08 -.14 .06 .14  5.72 Significance F = .00 DF Regression Residual 129  Note. P A indicates Primary Appraisal; SA indicates Secondary Appraisal  R = .24 Adjusted R = .20 R=.49  228 Table F26  Standard Multiple Regression O f Demographic. Resource. And Life Skills Variables On "Seek Social Support" Coping  Correlation  Variables  1  2  3  4  5  6  1. Seek Social Support  1.00  -.22  .24  .20  .34  -.22  2. 3. 4. 5. 6.  - —  1.00 -—  -.31 1.00  .08 .22 1.00  .06 .12 -.03 1.00 —  .22 -.16 -.10 .15 1.00  Age of Parent Sex of Parent Marital Status of Parent Expressive Support Nonturbulent Behaviour  Equation Number 13 Dependent Variable "Seek Social Support  "Variables Entered Nonturbulent Behaviour Marital Status of Parent Expressive Support Age of Parent Sex of Parent  F = 9.92 Significance F = .00 DF  Regression Residual 135  B  Beta  F  Significance F  -.26 .35 .48 -.02 .09  -.20 .20 .38 -.20 .05  6.95 6.61 25.32 6.02 .42  .01 .01 .00 .02 .52  R_= .27 5  Adjusted R = .24 R=.51  229 Table F27  Standard Multiple Regression O f Demographic. Resource. Life Skills. And Appraisal Variables On "Accepting Responsibility" Coping  Correlation  1.  Variables 1. 2. 3. 4.  Accept Responsibility Coping Sex of Parent Sex of Child Esteem  1.00  2  3  4  5  6  7  .19 1.00  .20 -.09 1.00  -.21 .04 -.18 1.00  -.35 -.16 -.16 .19  .38 .23 .14  .41 .13 .19 -.24  5. Nonturbulent Behaviour 6. Problems Functioning (PA) 7. Had to Hold Back (SA)  1.00  -.43 -.33 1.00  -.33 .54 1.00  Equation Number 14  Dependent Variable "Accept Responsibility" Coping  Variables Entered Had to Hold Back (SA) Sex of Parent Sex of Child Esteem Nonturbulent Behaviour Problems Functioning (PA)  B  Beta  F  Significance F  .07  .22  6.10  .02  .15 .15 -.04 -.19 .06  .11 .11 -.04 -.19 .13  1.90 1.94 .27 5.53 1.85  .17 .17 .60 .02 .18  7.81 Significance F = .00 DF  Regression Residual 134  Note. P A indicates Primary Appraisal; SA indicates Secondary Appraisal  R = .26 Adjusted R = .23  R=.51  230 Table F28 Standard Multiple Regression O f Demographic. Resource. Life Skills. And Appraisal Variables On "EscapeAvoidance" Coping  Correlation  1  Variables 1. Escape/Avoidance 2. 3. 4. 5. 6. 7. 8. 9.  1.00  Age of Parent Esteem Mastery Community Support Nonturbulent Behaviour Cumulative PA's Could Change Situation (SA) Had to Hold Back (SA)  7  8  -.22  .55  -.22  .42  .22 .19 .34 .35 1.00  -.27 -.40 -.50 -.29 -.42 1.00  -.12 .12 .33 .16 -.08 -.19 1.00  -.24 -.24 -.36 -.27 -.33 .53 .07 1.00  2  3  4  5  6  -.28  -.37  1.00  .15 1.00  -.48 .04 .45 1.00  -.25 -.04 .20 .25 1.00  —  9  Equation Number 15 Dependent Variable "Escape-Avoidance" Coping  Variables Entered  B  Had to Hold Back (SA)  Beta  F  Significance F .08 .22 .01 .27 .22 .21 .01 .00  .04  .15  3.12  Could Change Situation (SA) Age of Parent Esteem  -.03 -.01 -.07  -.09  1.56 6,93 1.24  Community Support Nonturbulent Behaviour Mastery Cumulative PA's  -.05  -.19 -.09 -.09 .10 -.22  E=  11.97 DF  .09 -.13 .14  Significance JL= .00 Regression 8 Residual 132  Note. PA indicates Primary Appraisal; SA indicates Secondary Appraisal  .27  1.53 1.61 6.35 8.57  R=.42 Adjusted R = .39 R=.65  231 Table F29 Standard Multiple Regression O f Demographic. Resource. And Appraisal Variables On "Planful Problem-Solving" Coping"  Correlation  1. Planful Problem-Solving 2. 3. 4. 5.  2  3  4  5  6  7  .26 1.00  .21 .22 1.00  .24 .13 -.04 1.00  .24  -.20 -.16 -.07 -.06 -.27  .23 .02  1  Variables  1.00  Sex of Parent Marital Status of Parent Expressive Support Worry About the Future (PA)  .21 .05 -.07 1.00  6. Overt Family Influence 7. Need to Know More (SA)  1.00  -.07 .00 .07 .02 1.00  Equation Number 16 Dependent Variable "Planful Problem-Solving"  Variables Entered Need to Know More (SA) Expressive Support Overt Family Influence Marital Status of Parent Sex of Parent Worry About the Future (PA)  B  Beta  F  Significance F  .08 .24 -.13  8.98 9.6 1.82  .00 .00 .18  .27  .23 .24 -.11 .20  .18 .10  .13 .18  6.27 2.43 4.84  .01 .12  F = 7.16 Significance F = .00 DF  Regression  .03 E_= .25  6  Residual 130  Note. PA indicates Primary Appraisal; SA indicates Secondary Appraisal  Adjusted R = .21 R = .50  232 Table F30  Standard Multiple regression O f Demographic. Illness. And Appraisal Variables On "Positive Reappraisal" Coping  Correlation  1. 2. 3. 4. 5. 6. 7.  2  3  4  5  6  7  .31 1.00  .18 .22 1.00  .22 .02 -.10 1.00  .25 -.05 -.05 .14 1.00  .22  .30 .04 -.06 .01 .16 .20 1.00  1  Variables  1.00  Positive Reappraisal Sex of Parent Marital Status of Parent Sociability of Child Could Change Situation (SA) Have to Accept Situation (SA) Need to Know More (SA)  .11 -.11 -.03 -.03 1.00  Equation Number 17 Dependent Variable "Positive Reappraisal" Coping  Variables Entered Need to Know More (SA) Sociability of Child Sex of Parent Could Change Situation (SA) Have to Accept Situation(SA) Marital Status of Parent  F = 10.04 DF  Significance F_= .00 Regression 6 Residual 133  Note. SA indicates Secondary Appraisal.  B .08 .19 .37 .08 .08 .29  Beta .22 .20 .24 .22 .18 .19  F 9.12 7.54 10.46 8.57 6.00 6.22  Significance F .00 .01 .00 .00 .02 .01  R = .31 Adjusted R = .28 R=.56  

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