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The relationship between acculturative stress and perceived locus of control expectancies in recently… Entin, Martha 1991

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THE RELATIONSHIP BETWEEN ACCULTURATIVE STRESS AND PERCEIVED LOCUS OF CONTROL EXPECTANCIES IN RECENTLY ARRIVED REFUGEES By MARTHA ENTIN B.G.S., Simon F r a s e r U n i v e r s i t y , 1986 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES (Dept. of C o u n s e l l i n g Psychology) We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA September, 1991 @ Martha E n t i n , 1991 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of Counse l l ing Psychology The University of British Columbia Vancouver, Canada Date sppfpmhpr 30, 1991 DE-6 (2/88) A b s t r a c t Refugees o f t e n e x p e r i e n c e t r a u m a t i c l i f e e v e n t s c a u s i n g l o s s o f home, f a m i l y members, and s o c i a l s u p p o r t networks. The p r o c e s s of a d j u s t i n g t o a new c u l t u r e c h a l l e n g e s , c o n f u s e s and o f t e n i n v a l i d a t e s an i n d i v i d u a l ' s p r e v i o u s sense o f i d e n t i t y s t a t u s , and p e r c e i v e d l e v e l o f c o n t r o l . The g r e a t e r the d i s p a r i t y between the r e f u g e e c u l t u r e and the new host c u l t u r e , the g r e a t e r the d i f f i c u l t y w i l l be i n the a d j u s t m e n t , c o n t r i b u t i n g to a c c u l t u r a t i v e s t r e s s ( B e r r y , 1980; P e d e r s e n , i n p r e s s ) . How an i n d i v i d u a l responds t o t h i s s i t u a t i o n o f s t r e s s , may be i n f l u e n c e d by t h e i r p e r c e i v e d l o c u s o f c o n t r o l . Cawte's S t r e s s I n v e n t o r y S c a l e (1972) was used to measure a c c u 1 t u r a t i v e s t r e s s ( B e r r y , Kim, Minde & Mok, 1987). Levenson's (1974) I n t e r n a l P o w e r f u l O t h e r s and Chance Locus o f C o n t r o l S c a l e s were used to measure i n t e r n a l and e x t e r n a l l o c u s o f c o n t r o l . Four open-ended q u e s t i o n s were i n c l u d e d to p r o v i d e i n f o r m a t i o n r e g a r d i n g a r e a s o f d i f f i c u l t y and s o u r c e s o f a s s i s t a n c e . The p o p u l a t i o n was s e l e c t e d from E l S a l v a d o r e a n s r e f u g e e s , who have been l i v i n g i n the G r e a t e r Vancouver a r e a . It was expected that p e r c e i v e d locus of c o n t r o l would c o r r e l a t e with l e v e l s of a c c u l t u r a t i v e s t r e s s , and that d i f f e r e n c e s between gender, age and education l e v e l s and l e v e l s of s t r e s s and locus of c o n t r o l would be d i s c e r n e d . R e s u l t s of t h i s study re v e a l e d that there were no s i g n i f i c a n t d i f f e r e n c e s between males and females i n mean scores of a c c u l t u r a t i v e s t r e s s and locus of c o n t r o l . R e s u l t s of the c o r r e l a t i o n between a c c u l t u r a t i v e s t r e s s and i n t e r n a l , powerful others and chance locus of c o n t r o l were not s t a t i s t i c a l l y s i g n i f i c a n t . Contrary to the hypothesis re g a r d i n g locus of c o n t r o l , e i g h t y percent of the respondents recorded and Internal locus of c o n t r o l o r i e n t a t i o n . R e s u l t s on the a c c u 1 t u r a t i v e s t r e s s s c a l e reported e q u a l l y high mean scores f o r both males and females. iv TABLE OF CONTENTS A b s t r a c t i i Table of Contents i v L i s t of Ta b l e s v i i Acknowledgements v i i i I SCOPE OF THE STUDY 1 The Refugee Experience 1 B r i e f H i s t o r y of El Salvador 5 S t r e s s F a c t o r s i n Adapting to the Host C u l t u r e 7 B e n e f i t s of the Study i l II LITERATURE REVIEW 13 Systems of A c c u l t u r a t i v e S t r e s s 13 F a c t o r s A f f e c t i n g Refugee Adjustment. . . . 20 Language P r o f i c i e n c y 21 Cross-Cul t u r a l D i f f e r e n c e s 23 Employment 25 Use of Support S e r v i c e s 28 Education, Age and Gender V a r i a b l e s . . 29 S o c i a l Support Networks 30 Models of A c c u l t u r a t i o n 31 The A p p r a i s a l of S t r e s s f u l L i f e Events. . . 33 G e n e r a l i z e d e x p e c t a n c i e s of Locus of Control 34 Mediating F a c t o r s of I n t e r n a l - E x t e r n a l Locus of Control 37 G e n e r a l i z a b i 1 i t y of Locus of Co n t r o l Measure 41 V I I I METHOD 44 Measures 44 Data A n a l y s i s Procedures 49 Sample 49 Data C o l l e c t i o n 50 L i m i t a t i o n s of t h i s Study 51 Research Questions 52 IV RESULTS 54 Cawte's Accu 1 t u r a t i v e S t r e s s S c a l e 54 Levenson's I n t e r n a l , Powerful Others and Chance Locus of C o n t r o l S c a l e s 56 R e s u l t s of the C o r r e l a t i o n between A c c u 1 t u r a t i v e S t r e s s and Locus of C o n t r o l 57 A n a l y s i s of Variance 59 (Age, Education L e v e l s with S t r e s s ) A n a l y s i s of Open-ended Questions on Areas of D i f f i c u l t i e s and Sources of A s s i s t a n c e . . 61 Demographic P r o f i l e of P a r t i c i p a n t s . . . . 65 V DISCUSSION 67 Summary of R e s u l t s 67 Accul t u r a t i ve S t r e s s 67 Levenson's I P C Locus of Control S c a l e s . 68 C o r r e l a t i o n s between A c c u l t u r a t i v e S t r e s s and Locus of Control 70 A n a l y s i s of Open-Ended Questions 71 Demographic P r o f i l e of P a r t i c i p a n t s . . . 74 vi I m p l i c a t i o n s f o r Future Research 75 I m p l i c a t i o n s f o r C o u n s e l l i n g 77 References 81 Appendix A 91 Cover L e t t e r and Consent Form ( E n g l i s h Version) 92 Spanish V e r s i o n 93 Appendix B 94 Cawte's S t r e s s Inventory S c a l e (1972) 95 Spanish V e r s i o n 96 Appendix C 97 Levensen's I n t e r n a l , Powerful Others, and Chance Locus of Control S c a l e (1974)(Adapted). 98 Spanish V e r s i o n 101 Appendix D 104 Demographic Q u e s t i o n n a i r e / Open-Ended Questions 105 Spanish V e r s i o n 107 L i s t of Tables Tab1e Page 1 Mean scores f o r Cawte S t r e s s S c a l e 55 2 Mean Scores on I P C Locus of Control S c a l e s . . 57 3 Pearson C o r r e l a t i o n C o e f f i c i e n t s between Cawte S t r e s s Scores and Levenson's Internal Powerful Others and Chance Scores (IPC) f o r a l l cases. . 58 4 Two-way A n a l y s i s of Variance on S t r e s s by Age and Education, AGE (low th r u 37=1) and (37.1 t h r u hi=2), EDUC (Low thru 10=1) and ( 10. 1 t h r u hi=2) 59 5 Two-way A n a l y s i s of Variance on S t r e s s by Age and E d u c a t i o n , Means Scores by Groups 60 6 Two-way A n a l y s i s of Variance on S t r e s s by Age and E d u c a t i o n , AGE (low th r u 35=1)(45 thru hi=2), EDUC (Low thru 7 = 1) (12 th r u hi=2) 61 7 Most D i f f i c u l t Aspects o f Adjustment 63 8 What Has Helped With D i f f i c u l t i e s 64 9 Sources of Support 64 10 What i s M i s s i n g Most i n Present L i f e 65 v i i i Acknowledgeraents I would l i k e to express my g r a t i t u d e to Dr. Marv Westwood f o r h i s e n t h u s i a s t i c encouragement and guidance i n t h i s endeavour, and f o r h i s u n c o n d i t i o n a l support throughout my years i n Graduate s c h o o l . His was a kind and l i s t e n i n g ear, and I am g r a t e f u l . I would a l s o l i k e to thank my Committee members, Dr. Ishu Ishiyama and Dr. Timothy Leung f o r t h e i r encouraging comments and suggestions, and f o r t h e i r w i l l i n g n e s s to accommodate themselves to my schedule changes. My unbounded thanks go to Dr. Harold R a t z l a f f who acted as shepherd through the sea of s t a t i s t i c s , and to the Education Computing S e r v i c e f o r t h e i r p a t i e n c e . I am very g r a t e f u l to a l l those working i n Immigrant s e r v i c e s and language t r a i n i n g programs, who helped me make co n t a c t with El Salvadorean refugees. A very s p e c i a l thank you i s extended to the Romero f a m i l y , who introduced me to El Salvadorean c u l t u r e and who u n f a i l i n g l y aided me i n the t r a n s l a t i o n of the q u e s t i o n n a i r e s . My g r a t i t u d e a l s o goes out to a l l those El Salvadoreans whose p a r t i c i p a t i o n made t h i s study possib1e. I ntroduction 1 CHAPTER I Scope of the Study The Refugee Experience S i n c e World War I I , Canada has r e c e i v e d almost 500,000 refugees (Westwood & Lawrence, 1990). Between 1971 and 1981 over 20,000 people seeking p o l i t i c a l asylum a r r i v e d from L a t i n America alone ( A l l o d i , 1989). In El Salvador, the s m a l l e s t n a t i o n i n C e n t r a l America, i t i s estimated that s i n c e the c i v i l war began i n 1979, 50,000 p e o p l e — o n e percent of the p o p u l a t i o n — h a v e been k i l l e d , the vast m a j o r i t y of them noncombatants (Berryman, 1985; Gregory, 1984). In 1985, a minimum of 420,000 people were estimated to be refugees l i v i n g i n Honduras, Mexico, Nicaragua, Costa R i c a and the U.S. (El Salvador and Guatemala Committees f o r Human R i g h t s , 1985). In 1981, the Canadian government introduced a s p e c i a l asylum program f o r people f l e e i n g El Salvador. T h i s program enabled 5,000 E l Salvadoreans to come to Canada or, i f they were a l r e a d y i n the country, to apply f o r permanent r e s i d e n c e (Sehl & Naidoo, 1985). Canada a l s o a c c e p t s Convention refugees who leave t h e i r country due t o : a well-founded f e a r of p e r s e c u t i o n f o r reasons of race, r e l i g i o n , n a t i o n a l i t y , p o l i t i c a l o p i n i o n or membership i n a p a r t i c u l a r s o c i a l 1ntroduct ion 2 group, Cwho] are unable or by reason of such f e a r , u n w i l l i n g to a v a i l themselves of the p r o t e c t i o n of t h e i r country of c i t i z e n s h i p [Immigration Act, 1976, as c i t e d i n Sehl & Naidoo, 1985, p. 25]. In c o n t r a s t to Convention refugees who must apply f o r asylum, government-sponsored refugees are s e l e c t e d b efore t h e i r a r r i v a l i n Canada, and are supported f o r one year by the Federal Government upon a r r i v a l . They are provided with funds f o r housing, food and c l o t h i n g , and E n g l i s h language c l a s s e s . As w e l l , job t r a i n i n g programs are o f f e r e d through Canada Employment and Immigration Centres ( C h r i s P o o l , Immigrant S e r v i c e s S o c i e t y , personal communication, November, 1990). As more and more refugees seek asylum i n Canada, those working i n refugee r e s e t t l e m e n t and c o u n s e l l i n g , need s p e c i f i c knowledge re g a r d i n g refugee needs i n a d j u s t i n g to a new c u l t u r e and a new way of l i f e . Refugees a r r i v i n g i n Canada have d i v e r s e economic, e d u c a t i o n a l , s o c i a l and c u l t u r a l backgrounds. They may have experienced traumatic l i f e events a r i s i n g from war, p o l i t i c a l u p r i s i n g or famine. "Refugees are not poor people. They are s u c c e s s f u l i n d i v i d u a l s t e m p o r a r i l y without funds and o p p o r t u n i t i e s " ( S t e i n , 1986, p. 7). Most refugees have not f a i l e d w i t h i n t h e i r homeland; almost a l l were we 11-integrated i n d i v i d u a l s who had to Introduction 3 f l e e because of f e a r of p e r s e c u t i o n (from e i t h e r p o l i t i c a l s i d e ) , or had to f l e e because they l i v e d i n the danger zone between waring f a c t i o n s . Refugees leave t h e i r home c o u n t r i e s i n v a r i o u s waves; they leave at d i f f e r e n t p o i n t s i n time, f l e e i n g from d i f f e r e n t p r e s s u r e s , and coming from d i f f e r e n t backgrounds. Many refugee groups a r r i v i n g from the same country may even be s u s p i c i o u s of and h o s t i l e to each other (Nann, Johnson, & B e i s e r , 1984; C h r i s P o o l , Immigrant S e r v i c e s S o c i e t y of B.C., personal communication, November, 1990; Sehl & Naidoo, 1985; S t e i n , 1986). Refugees o f t e n experience d i s l o c a t i o n , bereavement, i d e n t i t y c o n f u s i o n , and lack of s e l f worth dur i n g t h e i r process of a c c u 1 t u r a t i n g to the new host c u l t u r e . (Chan & Indra, i987; Nann et a l . , 1984; Pedersen, i n p r e s s ) . They may develop v a r i o u s coping s t r a t e g i e s : conform completely to the host s o c i e t y ; experience c o n f l i c t and withdraw; or they may f i n d ways of i n t e g r a t i n g themselves i n t o the host s o c i e t y (Berry, 1980; Berry, Kim, Minde, & Mok, 1987; Cohon, 1981). The experience of a d j u s t i n g to the host c u l t u r e i n v o l v e s many s h i f t s , readjustments and r e - e v a l u a t i o n s of t h e i r present s i t u a t i o n , t h e i r personal background and t h e i r f u t u r e p r o s p e c t s . While refugees, coming to Canada from c o u n t r i e s a l l over the world, may d i f f e r c u l t u r a l l y and h i s t o r i c a l l y Introduction 4 from each other, there are commonalties i n t h e i r adjustment e x p e r i e n c e s . S t e i n (1986) suggests that refugee e x p e r i e n c e s occur i n s i m i l a r p a t t e r n s a c r o s s c u l t u r e s , and can be viewed as " r e c u r r i n g phenomena with i d e n t i f i a b l e and o f t e n i d e n t i c a l p a t t e r n s of behaviour and s e t s of c a u s a l i t i e s " (p. 5)7 By a n a l y z i n g refugee behaviour, s i t u a t i o n s and problems from a g e n e r a l , h i s t o r i c a l and comparative p e r s p e c t i v e , S t e i n proposes that we g a i n a broader knowledge and deeper understanding of those e x p e r i e n c e s . T h i s knowledge then enables us to o f f e r refugees more a p p r o p r i a t e support, and h o p e f u l l y , more e f f e c t i v e s e r v i c e s . E q u a l l y important to the g e n e r a l , h i s t o r i c a l and comparative p a t t e r n s o c c u r r i n g i n refugee adjustment, are the i n t r a c u l t u r a l or within-group d i f f e r e n c e s that occur (Casas, 1985; Desbarats, 1986; Pedersen, 1988; P o n t e r o t t o , 1988; Ruiz, 1981). " C u l t u r a l d i f f i c u l t i e s , such as the degree of a s s i m i l a t i o n , socioeconomic background, f a m i l y e x p e r i e n c e s , and e d u c a t i o n a l l e v e l , impact each i n d i v i d u a l i n a unique manner" (Sue & Sue, 1990, p. 197). " D i f f e r e n c e s between e t h n i c groups have even been acknowledged as being p o t e n t i a l l y as p e r t i n e n t as d i f f e r e n c e s between n a t i o n a l o r i g i n groups i n e x p l a i n i n g c e r t a i n a spects of a d a p t a t i o n " (Desbarats, 1986, p. 406). I have attempted i n t h i s study to put the e x p e r i e n c e of El Salvadorean refugees i n a ' n t r o d u c t i o n 5 h i s t o r i c a l , and comparative p e r s p e c t i v e , and at the same time, i d e n t i f y those within-group d i f f e r e n c e s that o f f e r v a l u a b l e i n f o r m a t i o n r e g a r d i n g refugee adjustment and adaptat i on. B r i e f H i s t o r y o f E l Salvador El Salvador, a country with a t u r b u l e n t h i s t o r y , has been engaged i n c i v i l war s i n c e 1979. However, armed c o n f l i c t between r i g h t wing and l e f t i s t groups has been going on s i n c e the 1920's and 1930's. During the 1960's labour and peasant l e a d e r s , s c h o o l t e a c h e r s , and church people came under s u r v e i l l a n c e and o c c a s i o n a l l y s u f f e r e d v i o l e n c e (Berryman, 1985). The C a t h o l i c Church, t r a d i t i o n a l l y a supporter of the s t a t u s quo, became i n v o l v e d i n working with the poor. "Grassroots C h r i s t i a n communities q u i c k l y became the predominant model of church p a s t o r a l work i n a l a r g e p a r t of r u r a l El S a l v a d o r " (Berryman, 1985, p. 23). The government attempted to stop the broad-based n o n - v i o l e n t o p p o s i t i o n movements, and by 1979 had engaged i n death squads and massacres. By mid-1984, i t was estimated that 50,000 p e o p l e — o n e percent of the p o p u l a t i o n — h a d been k i l l e d , the vast m a j o r i t y of them noncombatants (Berryman, 1985; Gregory, 1984). E l Salvador i s d e s c r i b e d today as: a s o c i e t y that i s more than p o o r — i t i s impoverished; a s o c i e t y that i s not j u s t Introduction 6 d i v i d e d — i t i s v i o l e n t l y t o r n a p a r t . I t i s a s o c i e t y i n w h i c h t h e m o s t b a s i c human r i g h t s o f t h e m a j o r i t y a r e s t r u c t u r a l l y a n d s y s t e m a t i c a l l y d e n i e d — s u c h f u n d a m e n t a l r i g h t s a s h a v i n g a p l a c e t o l i v e , a j o b i n w h i c h t o f u l f i l l o n e s e l f a s a human b e i n g , o r a s c h o o l i n w h i c h t o e d u c a t e o n e ' s c h i l d r e n . C f i a r t f n -B a r o , 1 9 8 9 , p . 63 E l S a l v a d o r , t h e s m a l l e s t c o u n t r y i n C e n t r a l A m e r i c a , h a s o n e o f t h e h i g h e s t p o p u l a t i o n d e n s i t i e s . O u t o f a p o p u l a t i o n o f 5 , 0 0 0 , 0 0 0 , a m i n i m u m o f 4 2 0 , 0 0 0 p e o p l e w e r e e s t i m a t e d t o b e r e f u g e e s l i v i n g i n H o n d u r a s , M e x i c o , N i c a r a g u a , C o s t a R i c a a n d t h e U.S. ( E l S a l v a d o r a n d G u a t e m a l a C o m m i t t e e s f o r Human R i g h t s , 1 9 8 5 ) . In 1 9 8 5 , C a n a d a r e c e i v e d 2 , 4 9 1 r e f u g e e s d i r e c t l y f r o m E l S a l v a d o r , e q u a l l i n g f i f t e e n p e r c e n t ( 1 5 % ) , ( t h e s e c o n d h i g h e s t g r o u p ) o f t h e t o t a l 1 6 , 7 6 0 r e f u g e e s a c c e p t e d t h a t y e a r ( S t a t i s t i c s C a n a d a , 1 9 8 5 ) . In 1 9 9 0 , C a n a d a a c c e p t e d a t o t a l o f 5 , 5 0 9 r e f u g e e s f r o m N o r t h a n d C e n t r a l A m e r i c a , 3 ,726 r e f u g e e s , o r s i x t y - e i g h t p e r c e n t ( 6 8 % ) , c a m e d i r e c t l y f r o m E l S a l v a d o r ( S t a t i s t i c s C a n a d a , 1 9 9 0 ) . T h e s e s t a t i s t i c s r e c o r d t h e o r i g i n o f r e f u g e e s b y " c o u n t r y o f l a s t p e r m a n e n t r e s i d e n c e " . A n y E l S a l v a d o r e a n s c o m i n g t o C a n a d a v i a H o n d u r a s , C o s t a R i c a , M e x i c o o r t h e U n i t e d S t a t e s w o u l d b e r e c o r d e d a s c o m i n g f r o m t h o s e c o u n t r i e s , n o t E l S a l v a d o r ; t h e r e f o r e Introduction 7 a c t u a l numbers of El Salvadorean refugees coming to Canada would be much h i g h e r . Stress Factors i n Adapting to the Host Culture Lack of language f a c i l i t y ( D o m i c , 1985; P a d i l l a , Cervantes, fialdonado, & G a r c i a , 1988), i s o l a t i o n , and lack of s o c i a l support (Hirayama & Hirayama, 1988; L i n , 1986; S c o t t & S c o t t , 1989; S i l v e r & Wortman, 1980), concern f o r l o s t or separated f a m i l y members (Boehnlein, 1987; H i n k l e , 1974), l o s s of s t a t u s , poverty, and r o l e -c o n f l i c t w i t h i n the f a m i l y , a l l c o n t r i b u t e to the refugee e x p e r i e n c i n g s t r e s s i n a d j u s t i n g to the host c u l t u r e (Berry, Kim, Minde, & Mok, 1987; B e i s e r , 1988; Chan & Indra, 1987; Nann, Johnson, & B e i s e r , 1984; S t e i n , 1986). Ex a c e r b a t i n g the above s t r e s s o r s , the refugee may a l s o be s u f f e r i n g from past trauma as a r e s u l t of war, d i s a s t e r or t o r t u r e . Symptoms of P o s t - t r a u m a t i c S t r e s s D i s o r d e r (PTSD) are o f t e n e x h i b i t e d as s u s p i c i o u s n e s s or paranoia, anger and rage, a n x i e t y and d e p r e s s i o n , g r i e f and l o s s , g u i l t , and somatic complaints, such as headaches, low back syndrome, u l c e r s or other stomach complaints, or h y p e r t e n s i o n ( H i n k l e , 1974; K i n z i e , F r e d r i c k s o n , Ben, F l e c k , & K a r l s , 1984; S c u r f i e l d , 1985; Tyhurst (1951) c i t e d i n Cohon, 1981). I n d i v i d u a l s s u f f e r i n g from c h r o n i c unresolved g r i e f experience I n t r o d u c t i o n 8 symptoms s i m i l a r to Pos t - t r a u m a t i c S t r e s s D i s o r d e r (PTSD): "insomnia, pr e o c c u p a t i o n with thoughts of the deceased [or l o s t ] , v i v i d and d i s t u r b i n g dreams, u n p r e d i c t a b l e p e r i o d s of anger, c h r o n i c a n x i e t y , s u r v i v o r g u i l t , numbing of emotions and withdrawal from o t h e r s " (Boehnlein, 1987). Refugees a r r i v i n g from "a s o c i e t y fragmented by r a p i d s o c i a l change, f o r c e d e m i g r a t i o n , low l e v e l s of h e a l t h and economy, or by nat u r a l d i s a s t e r s may expect higher i n c i d e n t s of symptoms [ p e r s o n a l i t y d i s o r d e r s , n e u r o s i s , or p s y c h o l o g i c a l c o m p l a i n t s ] , both o v e r t and concealed" (Cawte, 1972, p. 147). How i n d i v i d u a l s cope with the s t r e s s e s i n t h e i r l i v e s may depend on s o c i a l , demographic and p s y c h o l o g i c a l c h a r a c t e r i s t i c s . An i n d i v i d u a l ' s world view, namely, how a person p e r c e i v e s h i s or her r e l a t i o n s h i p to the world, w i l l a l s o have an e f f e c t . World views are h i g h l y c o r r e l a t e d with a person's c u l t u r a l u p b r i n g i n g and e x p e r i e n c e s . Gender, economic and s o c i a l c l a s s and r e l i g i o n are i n t e r a c t i o n a l components of a world view (Sue & Sue, 1990). Those people who p e r c e i v e the world as c o n t r o l l e d by t h e i r own a c t i o n s , are s a i d to have an i n t e r n a l locus of c o n t r o l expectancy. Those who b e l i e v e that chance, f a t e or powerful others c o n t r o l t h e i r l i f e are con s i d e r e d to have an e x t e r n a l locus of c o n t r o l expectancy ( L e f c o u r t , Introduction 9 1982, 1983; Levenson, 1974; R o t t e r , 1966, 1982). An i n t e r n a l or e x t e r n a l locus of c o n t r o l expectancy may i n f l u e n c e how s t r e s s o r s are p e r c e i v e d and thus managed by an i n d i v i d u a l . It i s p o s s i b l e that i f i n d i v i d u a l s p e r c e i v e themselves to have c o n t r o l i n a s i t u a t i o n , they are l e s s l i k e l y to experience the s i t u a t i o n as s t r e s s f u l ( P a d i l l a , Wagatsuma, & Lindholm, 1985). S t u d i e s i n i n t e r n a 1 - e x t e r n a 1 locus of c o n t r o l e x p e c t a n c i e s ( L e f c o u r t , 1982, 1983; Levenson, 1974; R o t t e r , 1966, 1982) have shown a r e l a t i o n s h i p between p e r c e i v e d locus of c o n t r o l and p e r c e i v e d l e v e l s of s t r e s s . In g e n e r a l , i n d i v i d u a l s with an i n t e r n a l locus of c o n t r o l were found to develop b e t t e r coping methods, and were more l i k e l y to p e r c e i v e t h e i r circumstances as l e s s s t r e s s f u l than i n d i v i d u a l s with an e x t e r n a l locus of c o n t r o l (Kobasa, 1979; Kobasa, Maddi, & Courington, 1981; L e f c o u r t , 1982, 1983; Smith, 1985). S t u d i e s i n c r o s s - c u l t u r a l d i f f e r e n c e s suggest that "the p a t t e r n of locus of c o n t r o l b e l i e f s i n v o l v e s d i f f e r e n t p a t t e r n s ,of s a l i e n c e a c r o s s d i v e r s e c u l t u r e s " (Singh & Verma, 1990, p. 725). Socioeconomic f a c t o r s have a l s o been found to e f f e c t outcomes. Stone Bender and Ruiz (1974) found that i n g e n e r a l , membership i n s o c i a l c l a s s r a t h e r than r a c i a l group was the c r i t i c a l f a c t o r i n determining p e r c e p t i o n of locus of c o n t r o l : members i n lower socioeconomic s t a t u s groups were l e s s Introduction 10 l i k e l y to experience i n t e r n a l c o n t r o l (p. 51). E a r l y r e s e a r c h on g e n e r a l i z e d e x p e c t a n c i e s of locus of c o n t r o l suggested that e t h n i c group members and women score s i g n i f i c a n t l y higher on the e x t e r n a l end of the locus of c o n t r o l continuum (Sue & Sue, 1990). Whereas i n our western " i n d i v i d u a 1-centered" c u l t u r e , emphasis i s p l a c e d on independence, s e l f - r e l i a n c e , and s t a t u s achieved through one's own e f f o r t s , i n other c u l t u r e s , f o r i n s t a n c e , an emphasis i s plaoed an graup p a r t i c i p a t i o n , c a r r y i n g on t r a d i t i o n s , and harmony with nature. T h i s e x t e r n a l o r i e n t a t i o n i s h i g h l y valued i n Asian c u l t u r e s (Sue & Sue, 1990). Internal and e x t e r n a l locus of c o n t r o l e x p e c t a n c i e s may be c u l t u r a l l y based ( L e f c o u r t , 1982; P a d i l l a , Wagatsuma, & Lindholm, 1985; Smith, 1986). However, i t i s important to observe I n t r a c u l t u r a l or within-group d i f f e r e n c e s that can pro v i d e a g r e a t e r understanding of c u l t u r a l e x p e r i e n c e s . The purpose o f t h i s study i s to e x p l o r e the r e l a t i o n s h i p between the s t r e s s of a d j u s t i n g to a new c u l t u r e and the p e r c e i v e d locus o f c o n t r o l i n r e c e n t l y a r r i v e d refugees. Socioeconomic s t a t u s , age, gender, and e d u c a t i o n a l l e v e l s w i l l a l s o be examined as i n t e r a c t i o n a l components. Introduction 11 Benefits of t h i s Study If i t were p o s s i b l e to i d e n t i f y those i n d i v i d u a l s who are more l i k e l y to have g r e a t e r d i f f i c u l t i e s a d j u s t i n g to the host c u l t u r e , i t would then be p o s s i b l e to t a r g e t c o u n s e l l i n g and support s e r v i c e s s p e c i f i c a l l y f o r these i n d i v i d u a l s . Secondly, the i n f o r m a t i o n gathered i n t h i s study r e g a r d i n g s p e c i f i c d i f f i c u l t i e s the refugees are e x p e r i e n c i n g , w i l l enable support workers and c o u n s e l l o r s to b e t t e r address those areas of d i f f i c u l t y . Based on the l i t e r a t u r e , i n d i v i d u a l s with an i n t e r n a l locus of c o n t r o l tend to use i n f o r m a t i o n more e f f e c t i v e l y , and develop more f l e x i b l e coping s t r a t e g i e s ( L e f c o u r t , 1982; 1983). Communication and s o c i a l s k i l l s , p r o b l e m - s o l v i n g s t r a t e g i e s as well as b e t t e r coping s k i l l s c o uld be taught to those people who are i d e n t i f i e d as needing e x t r a a s s i s t a n c e . When i n d i v i d u a l s begin to f e e l more adjusted to the new c u l t u r e , they may experience lower l e v e l s of s t r e s s , and may perhaps f e e l b e t t e r a b l e to p a r t i c i p a t e and be more p r o d u c t i v e i n t h e i r new l i f e . The t r a n s i t i o n to a new s o c i e t y , a c q u i s i t i o n of language, c u l t u r a l norms and customs, and the process of t r a i n i n g f o r employment are strenuous tasks r e q u i r e d i n the adjustment process. Refugees who need g r e a t e r support from the host s o c i e t y upon a r r i v a l , may be given an e x t r a boost, so that they, too, may e v e n t u a l l y c o n t r i b u t e to t h e i r new s o c i e t y . Introduct ion 12 As a r e s u l t of t h i s study, c o u n s e l l o r s and those working i n the f i e l d , may b e n e f i t from a deeper understanding of the adjustment processes that refugees undergo, and perhaps be a b l e to p r o v i d e more e f f e c t i v e c o u n s e l l i n g and support s e r v i c e s f o r t h e i r refugee c 1 i e n t s . Literature Review 13 CHAPTER II Review of the Literature Symptoms of Acculturative Stress The refugee i s placed i n a double system of r e f e r e n c e s : the context of t h e i r own c u l t u r e of o r i g i n and the context of the c u l t u r e of the host s o c i e t y . Very o f t e n these r e f e r e n c e s are c o n t r a d i c t o r y and d i s o r i e n t i n g f o r the refugee, f o r example, time p u n c t u a l i t y , the rhythm of the day, and the process of deve l o p i n g s o c i a l networks can be very d i f f e r e n t i n the host s o c i e t y (Serrano, 1988). F r e q u e n t l y , refugees lose t h e i r p r o f e s s i o n a l s t a t u s and must f i n d work that does not correspond to t h e i r l e v e l of educa t i o n or t h e i r e x p e r i e n c e . The r e s u l t i n g "under-emp1oyment" may be experienced as l o s s of s e l f - e s t e e m and i n v a l i d a t i o n (Ishiyama, 1989; Serrano, 1988). The process of f l e e i n g one's home country, and seeking asylum i n a new host country i n v o l v e s many major t r a n s i t i o n s and a d a p t a t i o n s . "Most...[refugees] had been i n a s i t u a t i o n of u n c e r t a i n t y , without assurance o f t h e i r f u t u r e s t a t u s , t h e i r o ccupations, or t h e i r c a r e e r s , and o f t e n with no knowledge of the f a t e of t h e i r f a m i l i e s , f r i e n d s , and p o s s e s s i o n s " ( H i n k l e , 1974, p. 25). Pedersen ( i n press) s t a t e s : "A person's s e l f -esteem and s e l f image i s v a l i d a t e d by s i g n i f i c a n t others who p r o v i d e emotional and s o c i a l support i n c u l t u r a l l y L i t e r a t u r e Review 14 patterned ways. Moving to a f o r e i g n c u l t u r e suddenly d e p r i v e s a person of these support systems" (p. 5 ) . Pedersen suggests that a normal response to the withdrawing of support i s "anxiety, ranging from i r r i t a t i o n and mild annoyance, to the panic of extreme pain and the f e e l i n g s of d i s o r i e n t a t i o n " (p. 4-5). The r e s u l t i n g d i s e q u i l i b r i u m can be d e s c r i b e d as a c c u 1 t u r a t i v e s t r e s s . Webster's New Co 11egiate D i e t i o n a r y (1979) d e f i n e s a c c u l t u r a t i o n as c u l t u r a l m o d i f i c a t i o n of an i n d i v i d u a l , group, or people through prolonged and continuous i n t e r a c t i o n i n v o l v i n g i n t e r c u 1 t u r a 1 exchange and borrowing with a d i f f e r e n t c u l t u r e . S t r e s s i s d e f i n e d as a s t a t e r e s u l t i n g from a s t r e s s , e s p e c i a l l y one of b o d i l y or mental t e n s i o n r e s u l t i n g from f a c t o r s that tend to a l t e r an e x i s t e n t e q u i l i b r i u m . Berry, Kim, Minde and Mok (1987) d e f i n e a c c u l t u r a t i v e s t r e s s as "a p a r t i c u l a r set of s t r e s s behaviours which occurs d u r i n g a c c u l t u r a t i o n , such as lowered mental h e a l t h s t a t u s ( s p e c i f i c a l l y c o n f u s i o n , a n x i e t y , d e p r e s s i o n ) , f e e l i n g s of m a r g i n a l i t y and a l i e n a t i o n , heightened by psychosomatic symptom l e v e l , and i d e n t i t y c o n f u s i o n . " (Berry et a l . , 1987, p. 492). The manner i n which the refugee experiences the s t r e s s e s of adjustment depends on the personal d i s p o s i t i o n of each i n d i v i d u a l , h i s or her former s o c i a l i n t e g r a t i o n , L i t e r a t u r e Review 15 and the degree to which they look forward to the f u t u r e while c o n t i n u i n g to look back to t h e i r past ( B e i s e r , 1987; Ex, 1966; Serrano, 1988). The p a t t e r n of adjustment has u s u a l l y been d e s c r i b e d as o c c u r r i n g i n s e v e r a l stages. S t e i n (1986) d e s c r i b e s four stages of adjustment: (1) the i n i t i a l a r r i v a l p e r i o d of the f i r s t few months; (2) the f i r s t and second years; (3) a f t e r four or f i v e years; and (4) a decade or more l a t e r . In the i n i t i a l p e r i o d , refugees are confronted with the r e a l i t y of what has been l o s t : t h e i r homeland, t h e i r community, t h e i r i d e n t i t y , t h e i r c u l t u r e . During the f i r s t and second years, refugees work very hard to recover some of what they have l o s t by r e b u i l d i n g some sense of community, l e a r n i n g E n g l i s h (or French), f i n d i n g work, going through r e - t r a i n i n g programs, r e e s t a b l i s h i n g f a m i l i e s . A f t e r four or f i v e y e ars, i n d i v i d u a l s have ac q u i r e d the language, found work and g e n e r a l l y e s t a b l i s h e d themselves. At t h i s time, g o a l s that have not been achieved may be abandoned, and f u t u r e hopes are t r a n s f e r r e d onto the c h i l d r e n . However, delayed r e a c t i o n to e a r l i e r traumas and r e a c t i o n s to past s i t u a t i o n s may begin to emerge ( S t e i n , 1986). While S t e i n has d e s c r i b e d the p a t t e r n s of adjustment i n a f a i r l y p o s i t i v e l i g h t , other authors record a more t u r b u l e n t p r o c e s s . Tyhurst (1951, as L i t e r a t u r e Review 16 c i t e d i n Cohon, 1981) suggests there are two c h a r a c t e r i s t i c p e r i o d s of behaviour of refugees a f t e r a r r i v a l : an i n i t i a l p e r i o d of euphoria l a s t i n g s e v e r a l months where the refugee i s concerned with b a s i c needs; and a second p e r i o d l a s t i n g much longer i n which the refugee becomes aware of s t r i k i n g d i f f e r e n c e s i n the c u l t u r e s , when a sense of l o s s and the tendency to i d e a l i z e the past i s heightened. Often symptoms of s u s p i c i o u s n e s s and paranoia, the presence of a n x i e t y and d e p r e s s i o n , and somatic complaints ( f a t i g u e , muscle or j o i n t p a i n , d i s t u r b a n c e s of s l e e p or a p p e t i t e ) may be p r e s e n t . Meszaros (196 1, as c i t e d i n Cohon, 1981) found that i n 1956, Hungarian refugees, 8-12 months a f t e r a r r i v i n g i n Canada, d i s p l a y e d common f e e l i n g s of " i n s e c u r i t y , i s o l a t i o n , s t a t e s of resentment, unhappiness, temperamental behaviour and f e e l i n g s of g u i l t or inadequacy... t e n s i o n , complaints of f a t i g u e , r e s t l e s s n e s s , poor s l e e p and d i s t u r b i n g dreams" (p. 258) . S t u d i e s of Southeast Asian refugees a l s o r e p o r t i n c i d e n t s of refugee a n x i e t y , d e p r e s s i o n , and somatic symptoms ( B e i s e r , 1987; Chan & l n d r a , 1987; Hirayama & Hirayama, 1988; Nann et a l . , 1984). "Separation from members of t h e i r immediate f a m i l y (spouse, c h i l d r e n , parents and s i b l i n g s ) was the major f a c t o r causing d e p r e s s i o n , a n x i e t y and psychosomatic problems" (Nguyen, L i t e r a t u r e Review 17 1984, p. 89). Chinese Vietnamese refugees i n Quebec experienced f e e l i n g s of uprootedness from t h e i r s o c i o -c u l t u r a l m i l i e u , a deep sense of l o s s and g r i e f , and o f t e n held o b s e s s i v e f i x a t i o n s with past e x p e r i e n c e s . Over-preocupation with the past and d e v a l u i n g the f u t u r e led many to withdraw and i s o l a t e themselves, generating f e e l i n g s of i s o l a t i o n , l o n e l i n e s s , and m a r g i n a l i t y (Chan & Indra, 1987). Southeast Asians s t u d i e d i n the U n i v e r s i t y of B r i t i s h Columbia Resettlement P r o j e c t (Nann et a l . , 1984) found that symptoms of d e p r e s s i o n were hig h e r i n males than females, i n young r a t h e r than o l d persons, i n those unemployed, and i n those who were not married. Those who expressed d i s t r e s s s o m a t i c a l l y were more l i k e l y to be female than male, o l d e r r a t h e r than younger, and people without jobs were l i k e l y to be at higher r i s k (p. 76). Often refugees w i l l seek help from a medical doctor, r e p o r t i n g somatic p a i n s , r a t h e r than seek p s y c h o l o g i c a l support and c o u n s e l l i n g . "Few p a t i e n t s presented p u r e l y emotional complaints, but r a t h e r psychosomatic complaints such as headaches, stomach p a i n or insomnia were frequent" (Cohon, 1981, p. 263). "Somatic complaints represent a c u l t u r a l means of e x p r e s s i n g p s y c h o l o g i c a l and emotional d i s t r e s s " (Nguyen, 1984, p. 88). High r a t e s of d e p r e s s i o n were found among Hmong refugees (Westermeyer, 1988). Depressed i n d i v i d u a l s were more l i k e l y to have worked as L i t e r a t u r e Review 18 farmers r a t h e r than s a l a r i e d employees, merchants or homemakers, were l e s s l i k e l y to be abl e to continue working i n t h e i r v o c a t i o n s , and had experienced l o s s of fa m i l y members (p. 67). St u d i e s of L a t i n American refugees found that higher l e v e l s of a n x i e t y and d e p r e s s i o n were found i n young, h i g h l y educated refugees who had experienced much p e r s e c u t i o n i n El Salvador, who were unable to f i n d work and had d i f f i c u l t y with E n g l i s h ( A l l o d i , 1989; Sehl & Naidoo, 1985). A study of Salvadorean and Guatemalan youth i n Vancouver (Smiley, 1989) reported that "many were e x p e r i e n c i n g emotional and p s y c h o l o g i c a l wounds due to traumatic p r e - m i g r a t i o n experiences of war and v i o l e n c e " (p. i i ) . Reported symptoms of pos t - t r a u m a t i c s t r e s s d i s o r d e r (PTSD) in c l u d e d nightmares, insomnia, i n t r u s i v e memories, lack of c o n c e n t r a t i o n , d e p r e s s i o n and a n x i e t y . Research on H i s p a n i c women i n the US, reported f i n d i n g s of " e x t r a o r d i n a r i l y high r a t e s of d e p r e s s i v e symptoms" (Vega, Kolody, V a l l e , & Hough, 1986, p. 645), and a high i n c i d e n c e of somatic e x p r e s s i o n i n women i n psychotherapy ( E p s i n , 1985). Vega et a l . (1986) found that middle-aged Mexican immigrant women who had been i n the US f o r l e s s than f i v e years, had f i v e or l e s s years of e d u c a t i o n , were poor, and who were minimally a c c u 1 t u r a t e d , were at f a r g r e a t e r r i s k f o r d e p r e s s i o n . L i t e r a t u r e Review 19 Economic pr e s s u r e s have been c l o s e l y l i n k e d with p s y c h o l o g i c a l s t r e s s and low socioeconomic s t a t u s has been c o n s i s t e n t l y a s s o c i a t e d with higher r a t e s of mental d i s o r d e r i n the general p o p u l a t i o n (Cervantes & Cast r o , 1985). Low SES was reported to be the "s t r o n g e s t p r e d i c t o r of poor mental h e a l t h " (Casas, 1985, p. 583). Major l i f e changes, which are o f t e n r e l a t e d to p h y s i c a l and mental i l l n e s s , were seen "more f r e q u e n t l y among the poor and women as compared to other groups" (Casas, 1985, p. 583). High r a t e s of de p r e s s i o n have a l s o been found i n L a t i n American males (Padi11 a, Cervantes, Maldonado, & G a r c i a , 1988)'. These males were employed, however, r o l e s t r e s s caused by l o s s of s o c i a l s t a t u s , having few economic or personal resources, and f e e l i n g a great sense of h e l p l e s s n e s s c o n t r i b u t e d to higher l e v e l s of d e p r e s s i o n . Refugees are o f t e n i n a s i t u a t i o n of u n c e r t a i n t y about the whereabouts and s t a t u s of t h e i r f a m i l y members l e f t behind or separated from them, the f a m i l y p o s s e s s i o n s l e f t behind, and the d i s t a n t p o s s i b i l i t y of r e t u r n i n g to the home country. T h e i r f u t u r e s are o f t e n u n c l e a r , with job o p p o r t u n i t i e s l i m i t e d and s o c i a l and community support s e r i o u s l y l a c k i n g ( H i n k l e , 1974; Westwood & Lawrence, 1990). The experiences of r o l e c o n f l i c t s , changing 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 language d i f f i c u l t i e s i n the new s o c i e t y , a l l a f f e c t the L i t e r a t u r e Review 20 degree of s t r e s s experienced by the refugee. Several f a c t o r s may e i t h e r a i d or hinder the refugee's adjustment to the host s o c i e t y . F a c t o r s A f f e c t i n g Refugee Adjustment Some i n d i v i d u a l s possess a v a r i e t y of coping s t r a t e g i e s that allow them to adapt s u c c e s s f u l l y to the host c u l t u r e , and thus experience low a c c u 1 t u r a t i v e s t r e s s . Others are unable to cope, l e a d i n g them to experience high l e v e l s of a c c u 1 t u r a t i v e s t r e s s . A number of f a c t o r s a f f e c t the process of refugee adjustment: (1) The i n a b i l i t y to communicate i n E n g l i s h (or French) i s o l a t e s refugees, and causes them to become dependent on other persons f o r i n t e r p r e t a t i o n and understanding; (2) D i f f e r e n c e s i n c u l t u r e , values, systems and t r a d i t i o n s r e s u l t i n c r o s s - c u l t u r a l f r u s t r a t i o n and miscommunication; (3) F e e l i n g s of being truncated from support systems, and the i n a b i l i t y to c o n t i n u e i n t h e i r c a r e e r o f t e n r e s u l t s i n low s e l f -esteem and i n v a l i d a t i o n ; (4) U n f a m i 1 i a r i t y with the p r a c t i c e of seeking " p r o f e s s i o n a l a s s i s t a n c e " , refugees o f t e n do not enter the h e a l t h care system u n t i l a p h y s i c a l or mental c r i s i s i s reached; (5) Many refugees are d i s t r u s t f u l of persons i n p o s i t i o n s of a u t h o r i t y , and thus, do not seek help o u t s i d e t h e i r community (Manitoba Employment S e r v i c e s , 1987; Westwood & L i t e r a t u r e Review 21 Lawrence, 1990). Language P r o f i c i e n c y . Language b a r r i e r s have been i d e n t i f i e d as a major source of s t r e s s f o r recent L a t i n American immigrants (Padi11 a et a l . , 1988). S t r e s s a r i s e s when a person's language s k i l l s are i n s u f f i c i e n t f o r h i s or her s u c c e s s f u l h a n d l i n g of s i t u a t i o n a l demands ( D o m i c , 1985). Needs i d e n t i f i e d by both refugees and immigrant s e r v i c e o r g a n i z a t i o n s i n c l u d e : lack of i n d u s t r i a l E n g l i s h language t r a i n i n g (ELT), and ELT f o r p r o f e s s i o n a l s ; l i m i t e d a v a i l a b i l i t y of c l a s s e s and long w a i t i n g l i s t s ; and lack of c o n t i n u i t y between c l a s s e s (Fernando & Maund, 1985). Most people f e a r being misunderstood, underestimated and s o c i a l l y r e j e c t e d , and experience great s t r e s s when having to c o n t a c t a u t h o r i t i e s , h e a l t h s e r v i c e s , shopping or even tele p h o n i n g ( D o m i c , 1985). F r e q u e n t l y , refugees f i n d d i f f i c u l t y i n c o n c e n t r a t i n g due to a p r e o c c u p a t i o n with thoughts and concerns of f a m i l y members or t h e i r former l i f e (Chan & Indra, 1987; Nguyen, 1984). Knowledge of E n g l i s h was c o r r e l a t e d with low l e v e l s of s t r e s s (Berry et a l . , 1987): Lower symptom l e v e l s of s t r e s s were recorded among Hmong refugees who a r r i v e d i n the US with p r i o r E n g l i s h s k i l l s (Westermeyer, 1986). Those Vietnamese refugees i n Canada, who could read, w r i t e and speak Chinese showed b e t t e r p s y c h o l o g i c a l adjustment due to being a b l e to connect with an L i t e r a t u r e Review 22 e s t a b l i s h e d e t h n i c group. "Refugee immigrants who can r e a d i l y f i t i n t o e x i s t i n g communities may have l e s s d i f f i c u l t y i n t h e i r adjustment" (Westermeyer, 1986, p. 54). Research s t u d i e s have found that knowledge of the language i n common with the host s o c i e t y i s a f a c t o r of the g r e a t e s t importance i n promoting adjustment (Berry et a l . , 1987; Ex, 1966). Refugees who have l i m i t e d a b i l i t y to communicate i n the host language may not be a b l e to use the s o c i a l c o n t a c t s and s o c i a l supports a v a i l a b l e to them. T h i s i s o l a t i o n can lead to higher l e v e l s of s t r e s s and f e e l i n g s of a l i e n a t i o n (Chataway & Berry, 1989; Hirayama & Hirayama, 1988; Van Tran, Wright, & Mindel, 1987). El Salvadorean refugees a r r i v i n g i n Canada o f t e n experience great d i f f i c u l t y l e a r n i n g E n g l i s h . Two circumstances have been noted. F i r s t , the courses o f f e r e d by Canada Employment Centres o f t e n are very t e c h n i c a l , c o n c e n t r a t i n g on grammar, and the o p p o r t u n i t y f o r e x p r e s s i n g o n e s e l f i s not a v a i l a b l e . Emotions and f e e l i n g s are very d i f f i c u l t to express i n a new language, and are not d e a l t with i n these c l a s s e s (Sepulveda, 1984). Second, many refugees are i l l i t e r a t e i n t h e i r own language, which exacerbates the problem of l e a r n i n g E n g l i s h (Sehl & Naidoo, 1985). F r e q u e n t l y , refugees r e l y on t h e i r c h i l d r e n to t r a n s l a t e f o r them: c h i l d r e n a s s i m i l a t e much f a s t e r i n t o the host s o c i e t y L i t e r a t u r e Review 23 through the s c h o o l s , and o f t e n gain mastery of E n g l i s h years b e f o r e t h e i r p a r e n t s . Such r e l i a n c e on t h e i r c h i l d r e n can cause c o n f l i c t w i t h i n the f a m i l y , e s p e c i a l l y i n such cases when c h i l d r e n lose r e s p e c t f o r t h e i r parents' a u t h o r i t y (Manitoba Employment S e r v i c e s , 1987). Cross-Cu1tura1 D i f f e r e n c e s . The g r e a t e r the d i s p a r i t y between the refugee c u l t u r e and the new host c u l t u r e , the g r e a t e r the d i f f i c u l t y w i l l be i n b r i d g i n g the c u l t u r a l gap (Berry, 1980; H a l l , 1981; Pedersen, i n p r e s s ) . D i f f e r e n c e s i n c u l t u r a l values and t r a d i t i o n s can cause f r u s t r a t i o n and f r i c t i o n w i t h i n the f a m i l y , as changes i n r o l e s occur. Family r o l e s become ambiguous when husband and wife r o l e s are r e v e r s e d . Many wives f i n d employment more e a s i l y than t h e i r husbands who then must take over the care of the c h i l d r e n . T h i s can r e s u l t i n l o s s of " f a c e " and s t a t u s f o r the husband ( B e i s e r , 1988; Chan & Indra, 1987; Nann et a l . , 1984). In other s i t u a t i o n s , the wife i s i s o l a t e d at home c a r i n g f o r the c h i l d r e n , with l i t t l e access to the host s o c i e t y . These s i t u a t i o n s render the l e a r n i n g of E n g l i s h and adjustment to the new c u l t u r e d i f f i c u l t (Chan & Indra, 1987; Nann et a l . , 1984). Older members of the f a m i l i e s lose t h e i r s t a t u s as heads of the household due to lack of language s k i l l s and an understanding of the new c u l t u r e . They are no longer L i t e r a t u r e Review 24 c o n s u l t e d f o r a d v i c e , and may f e e l l o n e l y and i s o l a t e d (Sue & Sue, 1990). C h i l d r e n are o f t e n expected to take over the r o l e of communication f o r the parents with the s c h o o l , h e a l t h nurse, e t c . However, c o n f l i c t may a r i s e when the c h i l d r e n become a s s i m i l a t e d f a s t e r i n t o the host c u l t u r e , l e a v i n g t h e i r parents behind ( B e i s e r , 1988; Manitoba Employment S e r v i c e s , 1987). H i s p a n i c f a m i l i e s t r a d i t i o n a l l y are a strong u n i t ; l o y a l t y and c o o p e r a t i o n are important values that are upheld. The extended f a m i l y and c l o s e f r i e n d s are o f t e n c o n s u l t e d f o r a d v i c e and help b e f o r e o u t s i d e sources are sought (Sue & Sue, 1990). C h i l d r e n are expected to r e s p e c t and honour t h e i r e l d e r s , and male and female r o l e s are c l e a r l y d e f i n e d . C o n f l i c t between husband and wife may a r i s e d u r i n g the process of adjustment, when t r a d i t i o n a l r o l e s can not be f u l f i l l e d . As with the Asian f a m i l i e s , l o s s of s t a t u s and r o l e r e v e r s a l s may cause l o s s of ' f a c e 1 i n the husband. I n t e r - g e n e r a t i o n a l c o n f l i c t s due to d i f f e r e n t r a t e s of a c c u l t u r a t i o n are common (Sue & Sue, 1990; Serrano, 1988; Undurraga, 1984). Pedersen ( i n press) suggests that "the most severe c u l t u r e shock does not r e s u l t from d e a l i n g with e x t e r n a l matters such as d i f f e r e n c e s i n food, c l i m a t e , language, manners and communication but r a t h e r from s t a t u s change and s t a t u s l o s s i n responding to the new s i t u a t i o n . " (p. 19). L i t e r a t u r e Review 25 D i f f e r e n c e s i n c u l t u r a l values and context can cause f r u s t r a t i o n and misunderstanding between the refugee and the host c u l t u r e ( B e i s e r , 1988; Pedersen, ( i n p r e s s ) ; Sepulveda, 1984). C u l t u r a l misunderstanding and c o n f l i c t may occur when persons from d i f f e r e n t c u l t u r a l o r i e n t a t i o n s assume they share the same e x p e c t a t i o n s , but d i f f e r e n c e s i n behaviours e x h i b i t e d may not i n d i c a t e that t h i s i s so (Pedersen & Pedersen, 1989). D i f f i c u l t i e s f r e q u e n t l y a r i s e i n s i t u a t i o n s where refugees are asking f o r i n f o r m a t i o n or a s s i s t a n c e . Due to language d i f f i c u l t i e s and s o c i a l d i f f e r e n c e s , o f t e n both p a r t i e s w i l l misunderstand each other and w i l l f e e l angered by the i n t e r a c t i o n ( B e i s e r , 1988; Sepulveda, 1984). Problems may a l s o a r i s e i n work s i tuat i o n s . Emp1oyment. Work i s of great importance to refugees and t h e i r f a m i l i e s , not only e c o n o m i c a l l y , but a l s o i n r e l a t i o n to l e v e l s of s e l f - e s t e e m and f e e l i n g s of success or f a i l u r e . "The i n a b i l i t y to p e n e t r a t e i n t o Canadian s o c i e t y due to lack of personal s k i l l s and r e s o u r c e s seems to be producing high l e v e l s of s t r e s s and f e e l i n g s of m a r g i n a l i t y " (Kim & Berry, 1985, p. 167). While c h i l d r e n a s s i m i l a t e i n t o the c u l t u r e v i a the school system, the main avenue f o r a d u l t s i s v i a the workplace (Sepulveda, 1984). One of the consequences of un-met E n g l i s h L i t e r a t u r e Review 26 i n s t r u c t i o n needs i s the l i m i t e d access to employment o p p o r t u n i t i e s (Fernando & Maund, 1985). The l e v e l of E n g l i s h f l u e n c y achieved before m i g r a t i o n i s a s s o c i a t e d with l e v e l s of s e l f - e s t e e m and l i f e s a t i s f a c t i o n i n the new country ( S c o t t & S c o t t , 1989). In a r e p o r t on El Salvadoreans l i v i n g i n Toronto, Seh1 and Naidoo (1985) found that language problems and lack of Canadian experience were most o f t e n c i t e d as reasons f o r d i f f i c u l t y i n f i n d i n g jobs. In g e n e r a l , refugees express a l o t of f r u s t r a t i o n about t h e i r i n a b i l i t y to use t h e i r s k i l l s and apply t h e i r knowledge and t r a i n i n g i n Canada. It has been noted that s k i l l e d workers who are not us i n g t h e i r s k i l l s have an above-average r a t e of psychosomatic i l l n e s s ( L i t t l e w o o d & Lipsedge, 1982). Refugees a l s o express f e e l i n g s of l o s t i d e n t i t i e s and low s e l f - e s t e e m (Fernando & Maund, 1985). "The process of a d j u s t i n g to a new c u l t u r a l and s o c i a l context i n e v i t a b l y c h a l l e n g e s , confuses, t h r e a t e n s , and i n v a l i d a t e s , to v a r y i n g degrees, an i n d i v i d u a l ' s p r e v i o u s l y achieved sense of i d e n t i t y and s e l f worth." (Ishiyama, 1989, p. 57). Often, i n d i v i d u a l s who do not know the language, and who do not have a p l a c e to work, f e e l an i d e n t i t y c r i s i s , "Who am I?", "Where do I belong?". When persons are cut o f f from t h e i r s o c i e t a l and c u l t u r a l norms, when the rhythm of t h e i r l i f e i s a l t e r e d , and when they have not been L i t e r a t u r e Review 27 a b l e to root themselves i n the new c u l t u r e , f e e l i n g s of inadequacy, f r u s t r a t i o n and d e s p a i r become paramount (Tes1er-Mabe, i n Proceedings from the M u l t i c u l t u r a l Health Symposium, 1989). "Work makes up most of a person's day; when that day's a c t i v i t y i s a blank, the b e r e f t f e e l i n g , the emptiness, and the l o n e l i n e s s of being unemployed can be q u i t e severe. For so many people, a l i f e without work i s l i k e a l i f e without a s e l f CBulka, 1984, p. 23]. It i s p o s s i b l e that s t r e s s f e l t by refugees i s g r e a t e s t , not f o l l o w i n g t h e i r a r r i v a l , but a f t e r some years when " i t has become c l e a r that the new l i f e i n the adopted country has f a l l e n s h o r t of e x p e c t a t i o n s " ( L i t t l e w o o d & Lipsedge, 1982, p. 90). P a d i l l a et a l . , (1988) found t h a t , among L a t i n Americans and Mexicans immigrants i n the US, 64% of the males and 83% of the females reported that not knowing E n g l i s h was the most d i f f i c u l t i s s u e . In a d d i t i o n , 48% of the males and 42% of the females reported that not having a job was the most common s t r e s s o r (p. 421). Vietnamese refugees l i v i n g i n Canada encountered s i m i l a r problems: most d i d not have r e a d i l y t r a n s f e r a b l e s k i l l s and most had l i m i t e d E n g l i s h p r o f i c i e n c y . When they d i d f i n d work, most r e c e i v e d low wages i n menial jobs (Nann et a l . , 1984). L i t e r a t u r e Review 28 Use of Support S e r v i c e s . Use of support s e r v i c e s by refugees i s o f t e n l i m i t e d by both lack of understanding of our care system, and by a language b a r r i e r ( B e i s e r , 1988). Often refugees w i l l seek help from a medical do c t o r , r e p o r t i n g somatic p a i n s , r a t h e r than seek p s y c h o l o g i c a l support and c o u n s e l l i n g . In Asian c u l t u r e s , the f a m i l y i s the main u n i t , a source of support and the foundation of i d e n t i t y . Problems are d e a l t with w i t h i n the f a m i l y s t r u c t u r e ; t h i s may help to e x p l a i n low u t i l i z a t i o n of mental h e a l t h f a c i l i t i e s among Asians refugees (Atkinson, Morten & Sue, 1979). Other reasons f o r low u t i l i z a t i o n i n c l u d e u n f a m i 1 i a r i t y with mental h e a l t h support s e r v i c e s , the stigma of mental i l l n e s s , p r e f e r e n c e f o r a l t e r n a t i v e methods of h e a l t h c a r e , and a r e l u c t a n c e to use h e a l t h care systems o u t s i d e of t h e i r own c u l t u r a l b e l i e f s and f o l k systems (Boehnlein, 1987; Delgado, 1979; Nguyen, 1984). S t u d i e s of low H i s p a n i c use of h e a l t h care systems i n the US (Cervantes & C a s t r o , 1985; G a v i r i a & S t e r n , 1980; P a d i l l a & Salgado de Snyder, 1985; Vega et a l . , 1986) suggest that " f a i l u r e to acknowledge H i s p a n i c language and c u l t u r e i s a major f a c t o r i n underuse of s e r v i c e s by H i s p a n i c s " ( P a d i l l a & Salgado de Snyder, 1985, p. 158). F r e q u e n t l y , refugees a r r i v i n g i n Canada, b r i n g with them "a kind of d i s t r u s t and f e a r i n any form of L i t e r a t u r e Review 29 o r g a n i z a t i o n which reminded them of t h e i r days... of i n d o c t r i n a t i o n , group harassment, [and] group spying 1" (Nann et a l . , 1984, p. 24). L a t i n Americans approaching government workers at Canada Manpower and at Immigration p e r c e i v e d r a c i a l d i s c r i m i n a t i o n . When they had d i f f i c u l t y e x p r e s s i n g themselves i n E n g l i s h , they encountered negative a t t i t u d e s and responses from the government employees (Sepulveda, 1984). Educat i o n , Age and Gender Variab1es. Another set of v a r i a b l e s a f f e c t i n g adjustment i n c l u d e : education, age, gender, c o g n i t i v e s t y l e , p r i o r i n t ercu1tura1 e x p e r i e n c e s , and c o n t a c t experiences i n the host c u l t u r e (Berry, Kim, Minde, & Mok, 1987). Berry et a l . (1987) found that e d u c a t i o n appears as a c o n s i s t e n t p r e d i c t o r of low s t r e s s . Those who r e c e i v e d an education of a European v a r i e t y may have r e c e i v e d some i n i t i a l a c c u l t u r a t i o n e xperiences p r i o r to t h e i r a r r i v a l . It may be probable that those people who r e c e i v e a higher e d u c a t i o n , have access to more economic and s o c i a l r e s o u r c e s with which to deal with change. However, Nann et a l . (1984) reported that among male Southeast Asian refugees, job s a t i s f a c t i o n decreased with i n c r e a s e d e d u c a t i o n . T h i s was not the case with female Southeast Asian refugees (p. 47). Cawte (Cawte, B i a n c h i , & K i l o h , 1968; Cawte, 1972) i n h i s study of A u s t r a l i a n A b o r i g i n e s using the C o r n e l l L i t e r a t u r e Review 30 Medical Index (CMI), reported increased scores f o r o l d e r persons on the p h y s i c a l h e a l t h q u e s t i o n s . I n t e r e s t i n g l y , s cores on moods and f e e l i n g s q u e s t i o n s were not g e n e r a l l y a s s o c i a t e d with higher age. Lazarus and Folkman (1984) reported that coping s t r a t e g i e s change with age, and g e n e r a l l y become more e f f e c t i v e and r e a l i s t i c with age. L e v e l s of s t r e s s , as measured on the CMI, were c o n s i s t e n t l y higher f o r women than f o r men, e s p e c i a l l y i n the "emotional complaint areas" (Cawte, 1972, p. 74). Kim and Berry (1985) reported s i m i l a r s t r e s s scores f o r females. They suggest that i t i s not c l e a r whether the scores r e f l e c t the a c t u a l e xperience of g r e a t e r s t r e s s , or whether females are more l i k e l y to r e p o r t the experience of s t r e s s than males (p. 167; S c o t t & S c o t t , 1989). S o c i a l Support Networks. Nann et a l . (1984) found that s o c i a l support a l s o a f f e c t e d adjustment and l e v e l s of s t r e s s . As a r e s u l t of f l e e i n g t h e i r country refugees experience a sense of uprootedness from the s o c i o - c u l t u r a l and e c o l o g i c a l m i l i e u s i n which they were born and r a i s e d . They become separated from a cohesive s o c i a l network of k i n , neighbours, f r i e n d s and acquaintances. F a m i l i e s that manage to stay together o f f e r each other, as well as the f a m i l y u n i t i t s e l f , p s y c h o l o g i c a l support and s t r e n g t h . Hmong refugees i n Tennessee, although aware of a v a i l a b l e s o c i a l s e r v i c e Literature Review 31 programs, tended to r e l y on t h e i r own f a m i l i e s and f r i e n d s when faced with s t r e s s f u l s i t u a t i o n s . "The Hmong are a h i g h l y organized and u n i f i e d community, f u n c t i o n i n g i n some ways l i k e a l a r g e , extended f a m i l y " (Hirayama & Hirayama, 1988, p. 103). "This strong bond i s t h e i r major source of s t r e n g t h f o r s u r v i v a l " (p. 106 ) . Studying Namibian refugees, Shisana and Celentano (1987) found that those who p e r c e i v e d higher l e v e l s of s o c i a l support tended to r e p o r t fewer symptoms and p e r c e i v e d themselves as having b e t t e r p h y s i c a l h e a l t h . They found a strong r e l a t i o n s h i p between poor h e a l t h and s t r e s s and low s o c i a l support. While there i s support f o r the h y p o t h e s i s that one's s o c i a l networks are a s s o c i a t e d with adjustment to s t r e s s f u l l i f e events, i t i s p o s s i b l e that i n d i v i d u a l s shape t h e i r own s o c i a l networks, and that b e t t e r adjusted people are b e t t e r a b l e to s u s t a i n s o c i a l r e l a t i o n s (Chataway & Berry, 1989; S c o t t & S c o t t , 1989; S i l v e r & Wortman, 1980; S t e i n g l a s s , Weisstub, & De-Nour, 1988). Models of Acculturation Several models of a c c u l t u r a t i o n have been proposed to b e t t e r understand the v a r i o u s phases of a c c u 1 t u r a t i v e s t r e s s refugee c l i e n t s may e x p e r i e n c e . Refugees may demonstrate an e n t h u s i a s t i c acceptance of the new L i t e r a t u r e Review 32 environment; d i s p l a y openly a c r i t i c a l a t t i t u d e toward the new c u l t u r e ; they may f e e l perplexed, p a s s i v e , l o s t or i s o l a t e d ; or they may experience anger, a n x i e t y , d e p r e s s i o n , low se l f - e s t e e m , and s e l f - c r i t i c i s m (Berry, 1980; Berry, Kim, Minde, & Mok, 1987; Cohon, 1981). Meszaros (1961, as c i t e d i n Cohon, 1981) i d e n t i f i e d f i v e "personal r e a c t i o n - t y p e s : 1. Over-accepting, demonstrating an e n t h u s i a s t i c acceptance of the new environment; 2. Act i ve1y c r i t i c a l . d i s p l a y i n g openly a c r i t i c a l a t t i t u d e toward the new environment; 3. I nh ib i ted, l a c k i n g e x p r e s s i o n of any a t t i t u d e toward the new environment; 4. Hypo-reactive, perplexed, p a s s i v e , f e l t l o s t and i s o l a t e d , seeking dependent s e c u r i t y ; and 5. H y p e r - r e a c t i v e , stormy and changing r e a c t i o n s with anger, a n x i e t y , d e p r e s s i o n , low s e l f -esteem, c r i t i c i s m and s u i c i d a l p reoccupations (p. 259). Berry (1980) proposes three modes of a c c u l t u r a t i o n : adjustment, r e a c t i o n , and withdrawal. These three modes of a d a p t a t i o n are s i m i l a r to the process of moving toward, moving a g a i n s t , and moving away from the host c u l t u r e . From these three modes, four a t t i t u d e s t y l e s have been i d e n t i f i e d by Berry, Kim, Minde and Mok, (1987): I n t e g r a t i on. A s s i m i l a t i o n . S e p a r a t i o n , and M a r g i n a l i z a t i o n . In I n t e g r a t i o n . an i n d i v i d u a l maintains c e r t a i n e t h n i c i d e n t i t y t i e s , while at the same time i n t e g r a t i n g i n t o the host c u l t u r e . In Literature Review 33 Assimi1 at i o n , an i n d i v i d u a l i d e n t i f i e s e n t i r e l y with the host c u l t u r e , and does not maintain any c u l t u r a l t i e s with t h e i r own group. In S e p a r a t i o n , an i n d i v i d u a l maintains t i e s with t h e i r own c u l t u r a l group, but i s separate from the host c u l t u r e . In Mare i na1i zat i on. i n d i v i d u a l s f e e l a l i e n a t e d from both the host c u l t u r e and the e t h n i c group, and experience a high degree of s t r e s s i n t h e i r l i v e s . The Appraisal of Stressful L i f e Events S t u d i e s of the r e l a t i o n s h i p between s t r e s s and i l l n e s s i n d i c a t e t h a t , "the g r e a t e r the l i f e change or a d a p t i v e requirement, the g r e a t e r the v u l n e r a b i l i t y or lowering of r e s i s t a n c e to d i s e a s e , and the more s e r i o u s the d i s e a s e that does develop." (Holmes & Masuda, 1974, p. 67). Numerous s t u d i e s have looked at the e f f e c t s of s t r e s s f u l l i f e events on p s y c h o l o g i c a l i l l n e s s (Cervantes & C a s t r o , 1985; Dyal & Dya1, 1981; Dohrenwend & Dohrenwend, 1974; Lazarus & Folkman, 1984), however, i t i s not c l e a r when exposure to u n c o n t r o l l a b l e outcomes w i l l r e s u l t i n renewed d e t e r m i n a t i o n to overcome the o b s t a c l e s , and thus f a c i l i t a t e performance, and when i t w i l l r e s u l t i n f e e l i n g s of h e l p l e s s n e s s and p a s s i v i t y that hamper performance ( S i l v e r & Wortman, 1980). Lazarus and Folkman (1984) propose that "the way a person a p p r a i s e s an encounter s t r o n g l y i n f l u e n c e s the L i t e r a t u r e Review 34 coping process and how the person r e a c t s e m o t i o n a l l y " (p. 45). The extent to which a person b e l i e v e s that he or she can shape or i n f l u e n c e a p a r t i c u l a r s t r e s s f u l s i t u a t i o n , that i s , one's locus of c o n t r o l expectancy, w i l l a f f e c t how he or she r e a c t s to i t . G e n e r a l i z e d E x p e c t a n c i e s o f Locus o f Co n t r o l Two f a c t o r s c o n t r i b u t e to the general l e v e l of s t r e s s that an i n d i v i d u a l e x p e r i e n c e s : externa 1  mediating f o r c e s , those f a c t o r s , or events, i n the environment; and i nterna1 med i a t i ng f o r c e s , which r e f e r s to an i n d i v i d u a l ' s p s y c h o l o g i c a l or p h y s i c a l d i s p o s i t i o n , values and l i f e e x p e c t a t i o n s (Smith, 1985). The d i s c u s s i o n of a c c u 1 t u r a t i v e s t r e s s addressed the ex t e r n a l f o r c e s . The i n t e r n a l mediating f o r c e s w i l l be di s c u s s e d here. In looking at what personal c h a r a c t e r i s t i c s refugees possess that may help or hinder t h e i r s u c c e s s f u l adjustment i n the new host c u l t u r e , the concept of in t e r n a 1 - e x t e r n a 1 locus of c o n t r o l may o f f e r a v a l u a b l e framework. DeCharms (1968) looked at locus of c a u s a l i t y f o r behaviour, which he named "personal c a u s a t i o n " . He proposed that persons whom he c a l l s " o r i g i n s " have a strong f e e l i n g of personal c a u s a t i o n , and who p e r c e i v e t h e i r behaviour i s determined by t h e i r own choosing; a person whom he c a l l s a "pawn" p e r c e i v e s h i s or her L i t e r a t u r e Review 35 behaviour i s determined by e x t e r n a l f o r c e s beyond h i s or her c o n t r o l . Personal c a u s a t i o n ( o r i g i n ) becomes a powerful m o t i v a t i o n a l f o r c e d i r e c t i n g f u t u r e behaviour, while the f e e l i n g that causal f o r c e s r e s i d i n g o u t s i d e o n e s e l f , i n others or i n the environment, c o n s t i t u t e s a strong f e e l i n g of power 1essness or i n e f f e c t i v e n e s s (pawn) (DeCharms, 1968). DeCharms (1968) co n s i d e r e d an o r i g i n to be i n t r i n s i c a l l y motivated, and a pawn to be e x t r i n s i c a l 1 y motivated. In R o t t e r ' s (1966) model of locus of c o n t r o l , people who have an i n t e r n a l locus of c o n t r o l p e r c e i v e that events are c o n t i n g e n t upon t h e i r own behaviour, or t h e i r own r e l a t i v e l y permanent c h a r a c t e r i s t i c s . In c o n t r a s t , when a reinforcement i s p e r c e i v e d . . . "as not being e n t i r e l y c o n t i n g e n t upon Cone's own] a c t i o n , then, i n our c u l t u r e , i t i s t y p i c a l l y p e r c e i v e d as the r e s u l t of luck, chance, f a t e , or under the c o n t r o l of powerful o t h e r s " ( R o t t e r , Chance & Phares, 1972, p. 261). R o t t e r (1982) suggests that e x p e c t a n c i e s of reinforcement are learned d u r i n g i n f a n c y , and depending on the i n d i v i d u a l ' s h i s t o r y of reinforcement, i n d i v i d u a l s w i l l d i f f e r i n the degree to which they a t t r i b u t e r e i n f o r c e m e n t s to t h e i r own a c t i o n s . As a r e s u l t , i n d i v i d u a l s develop g e n e r a l i z e d e x p e c t a n c i e s which r e s u l t i n c h a r a c t e r i s t i c d i f f e r e n c e s i n behaviour. Rott e r proposes t h a t : L i t e r a t u r e Review 36 The i n d i v i d u a l who has a strong b e l i e f that he can c o n t r o l h i s own d e s t i n y i s l i k e l y to (a) be more a l e r t to those aspects of the environment which p r o v i d e u s e f u l i n f o r m a t i o n f o r h i s f u t u r e behavior; (b) take steps to improve h i s environmental c o n d i t i o n ; (c) p l a c e g r e a t e r value on s k i l l or achievement reinfor c e m e n t s and be g e n e r a l l y more concerned with h i s a b i l i t y , p a r t i c u l a r l y h i s f a i l u r e s ; and (d) be r e s i s t i v e to s u b t l e attempts to i n f l u e n c e him C1982, p. 2101. DeCharms c o n t r a s t e d R o t t e r ' s (1966) locus of c o n t r o l e x p e c t a n c i e s with the concepts of personal c a u s a t i o n : R o t t e r s t r e s s e d the importance of pe r c e i v e d reinforcement, while DeCharms s t r e s s e d " i n t e n t i o n a l , reasoned, d e l i b e r a t e a c t i o n " (1981, p. 340). DeCharms was i n t e r e s t e d i n the experience, r a t h e r than the perception of personal c a u s a t i o n . He s t a t e d t h a t , "knowing a person's p e r c e i v e d locus of c o n t r o l of reinforc e m e n t s t e l l s us nothing about h i s experience of personal c a u s a t i o n " (DeCharms, 1981, p. 338) Ne v e r t h e l e s s , h i s d e s c r i p t i o n of personal c h a r a c t e r i s t i c s as s t a t e d above i s h e l p f u l i n understanding personal c h a r a c t e r i s t i c s of persons who have e i t h e r an i n t e r n a l and e x t e r n a l locus of c o n t r o l expectancy. L i t e r a t u r e Review 37 Levenson (1973a; 1973b; 1974; Levenson & M i l l e r , 1976) r e v i s e d R o t t e r ' s (1966) I nterna1-Externa 1 Locus of Cont r o l (I-E) S c a l e to d i f f e r e n t i a t e between e x t e r n a l i n d i v i d u a l s who p e r c e i v e that chance c o n t r o l s events, from those who p e r c e i v e that powerful others c o n t r o l events. Levenson's r a t i o n a l e f o r developing new s c a l e s "stemmed from the reasoning that people who b e l i e v e the world i s unordered (chance) would behave and think d i f f e r e n t l y from people who b e l i e v e the world i s ordered but that powerful others are i n c o n t r o l . In the l a t t e r case a p o t e n t i a l f o r c o n t r o l e x i s t s . " (Levenson, 1974, p. 377). Work by Hersch and Scheibe (1967) and Paulhus (1983) lend support to Levenson i n suggesting that p e r c e i v e d c o n t r o l may be m u l t i d i m e n s i o n a l , and that e x t e r n a l i t y i s l e s s homogeneous than i n t e r n a l i t y . Although R o t t e r maintains that the I-E S c a l e i s unidimensiona1, he does suggest that e x t e r n a l s may not be homogeneous, " d i f f e r e n t i a t i o n between d e f e n s i v e and p a s s i v e e x t e r n a l s might be made... It i s p o s s i b l e that Levenson's d i s t i n c t i o n of b e l i e f i n powerful others versus b e l i e f i n chance o v e r l a p s that of d e f e n s i v e and pa s s i v e e x t e r n a l s " ( R o t t e r , 1982, p. 279). Mediating F a c t o r s o f I n t e r n a l — E x t e r n a l Locus o f C o n t r o l The e f f e c t s of an i n d i v i d u a l ' s p e r c e p t i o n of c o n t r o l , whether one b e l i e v e s that one can determine L i t e r a t u r e Review 38 one's own f a t e , w i t h i n l i m i t s , w i l l be seen to be c r i t i c a l to the way i n which an i n d i v i d u a l copes with s t r e s s and engages i n c h a l l e n g e s . "With the locus of c o n t r o l c o n s t r u c t , we are d e a l i n g with a person as he views h i m s e l f i n c o n j u n c t i o n with the t h i n g s that b e f a l l him, and the meaning that he makes of those i n t e r a c t i o n s between h i s s e l f and h i s e x p e r i e n c e s " ( L e f c o u r t , 1982, p . 35 ) . A number of r e s e a r c h e r s have attempted to examine the manner i n which locus of c o n t r o l bears upon the e f f e c t s of d i f f e r e n t s t r e s s o r s (Anderson, 1977; Kobasa, 1979; Kobasa, Maddi, & Courington, 1981; L e f c o u r t , 1982; 1983; Mena, P a d i l l a , & Maldonado, 1985; P a d i l l a , Wagatsuma, & Lindholm, 1985). Huaini and Neff (1980, as c i t e d i n L e f c o u r t , 1983) reported that p e r c e i v e d l e v e l s of u n d e s i r a b i 1 i t y and u n p r e v e n t a b i 1 i t y of events were p r e d i c t i v e of d e p r e s s i o n or general w e l l - b e i n g . "The g r e a t e r the reported number of u n d e s i r a b l e and unpreventabIe events r e l a t i v e to the t o t a l number of l i f e events, the higher were the i n d i v i d u a l s ' l e v e l s of p s y c h i a t r i c symptomology" (p. 259). Refugees, who experience high numbers of unpreventab1e and u n d e s i r a b l e events, o f t e n r e p o r t symptoms of d e p r e s s i o n , somatic complaints or f r u s t r a t i o n and h o s t i l i t y (Chan & Indra, 1987; Cohon, 1981; Hirayama & Hirayama, 1988; Nann, Johnson, & B e i s e r , 1984). Literature Review 39 R o t t e r (1982) reported that s e l f - r e p o r t measures of locus of c o n t r o l c o r r e l a t e with s e l f - r e p o r t measures of a n x i e t y , adjustment, or s c a l e s i n v o l v i n g s e l f -d e s c r i p t i o n of symptoms. However, several s t u d i e s suggested that i n t e r n a l s may f o r g e t or r e p r e s s f a i l u r e s and unpleasant e x p e r i e n c e s , and thereby c r e a t e a p o s i t i v e r e l a t i o n s h i p between i n t e r n a l i t y and adjustment (Houston, 1972; R o t t e r , 1982). Anderson (1977) s t u d i e d coping s t r a t e g i e s , locus of c o n t r o l and p e r c e i v e d l e v e l s of s t r e s s i n owner managers of businesses a f t e r a h u r r i c a n e d i s a s t e r . E x t e r n a l s were found to have used fewer problem-solving coping methods, and more emot i o n - d i r e c t e d coping d e v i c e s (withdrawal, h o s t i l i t y ) , and were more l i k e l y to have p e r c e i v e d t h e i r circumstances as being h i g h l y s t r e s s f u l than i n t e r n a l s . I n t e r e s t i n g l y , i n t e r n a l s who improved t h e i r performance demonstrated a tendency to become more i n t e r n a l ; e x t e r n a l s who had poor performance showed a strong tendency to become more e x t e r n a l . Anderson found that performance operates as feedback that i n f l u e n c e s f u t u r e locus of c o n t r o l o r i e n t a t i o n . S i m i l a r r e s u l t s were reported by Pittman and Pittman (1979). Kobasa (1979) and Kobasa, Maddi and Courington (1981) found connections between "hardiness" and l i f e s t r e s s i n the p r e d i c t i o n of i l l n e s s . Those who lacked h a r d i n e s s (were e x t e r n a l l y o r i e n t e d , had a low degree of L i t e r a t u r e Review 40 commitment, and were l e s s r e s p o n s i v e to challenge) were the most l i k e l y to e x h i b i t a l i n k a g e between i n c i d e n c e of s t r e s s and i l l n e s s . Smith (1985) c i t e d s t u d i e s that found "that people who have an i n t e r n a l sense of c o n t r o l and who have f e e l i n g s of s e l f - e f f i c a c y have been found to respond more e f f e c t i v e l y to s t r e s s and to use t h e i r s o c i a l support groups more e f f e c t i v e l y " (p. 558). Manuck, H i n r i c h s e n , and Ross (1975, as c i t e d i n L e f c o u r t , 1982) found that i n d i v i d u a l s who reported a high number of l i f e changes a l s o scored h i g h l y on s t a t e and t r a i t a n x i e t y measures. Even i n the absence of s t r e s s f u l l i f e events, e x t e r n a l s reported f e e l i n g more anxious than i n t e r n a l s . I n t e r e s t i n g l y , Manuck et a l . found that given high i n c i d e n t s of s t r e s s o r s , locus of c o n t r o l ceased to be a p r e d i c t o r of a n x i e t y . With high s t r e s s both groups were e q u a l l y d i s t r a u g h t . However, L e f c o u r t (1982) found that "given the passage of time, i n t e r n a l s succeed i n l e a v i n g t h e i r disappointments behind them, whereas e x t e r n a l s seem to continue to c a r r y the weight of those events i n t o t h e i r f u t u r e " (p. 108). T h i s i s p e r t i n e n t to refugees' e xperiences of h i g h l y s t r e s s f u l l i f e events. Locus of c o n t r o l e x p e c t a n c i e s may a f f e c t refugee coping s t r a t e g i e s . Although at the time of extreme s t r e s s , p e r c e i v e d locus of c o n t r o l may have no a f f e c t on the l e v e l of s t r e s s experienced, the e f f e c t of the s t r e s s l a t e r on may be mediated by Literature Review 41 p e r c e i v e d locus of c o n t r o l . Generalizabi1ity of Locus of Control Measures C r o s s - c u l t u r a l s t u d i e s of locus of c o n t r o l i n d i c a t e that t h i s c o n s t r u c t i s a " r e l e v a n t v a r i a b l e i n a l l the c u l t u r e s s t u d i e d " ( L e f c o u r t , 1983, p. 21). S i m i l a r r e s u l t s were obtained as those i n the United S t a t e s , when p a r t i c i p a n t s were drawn from v a r i o u s c u l t u r e s and comparable socioeconomic l e v e l s ; however, there were d i f f e r e n c e s i n mean locus of c o n t r o l scores f o r d i f f e r e n t c u l t u r e s ( L e f c o u r t , 1982; 1983; Ro t t e r , 1982; Sue & Sue, 1990; Singh & Verma, 1990). Regardless of mean scores a c r o s s c u l t u r e s , c o r r e l a t e s of locus of c o n t r o l seem to be s i m i l a r from c u l t u r e to c u l t u r e : " E x t e r n a l i t y seems to be r e l a t e d to maladjustment, lower achievement l e v e l s , and power 1essness... I n t e r n a 1 i t y i s r e l a t e d to higher s e l f - e s t e e m , s e l f - a c c e p t a n c e , and other general i n d i c a t o r s of ad a p t i v e f u n c t i o n i n g . " ( L e f c o u r t , 1983, p. 21) The above s t u d i e s lend support f o r the v a l i d i t y of the use of a locus of c o n t r o l measure with refugees from v a r i o u s c u l t u r e s and va r i o u s socioeconomic s t r a t a . S t u d i e s on Asian Americans have pointed out d i f f e r e n c e s i n i n d i v i d u a l ' s locus of c o n t r o l . It i s t h e o r i z e d that Asian p e r c e p t i o n s of lack of c o n t r o l i s due to c u l t u r a l values (Atkinson, Morten & Sue, 1979; Literature Review 42 Smith, 1985). P a d i l l a , Wagatsuma and Lindholm (1985), i n l o o k i n g at the a c c u l t u r a t i o n experience of Japanese immigrant students, found that f i r s t g e n e r a t i o n Japanese students experienced the most s t r e s s , and were more e x t e r n a l l y o r i e n t e d than second or t h i r d g e n e r a t i o n students. P a d i l l a , A l v a r e z and Lindholm (1986) found that l a t e immigrants ( a r r i v i n g a f t e r the age of 14) experienced the h i g h e s t s t r e s s e s and scored the lowest on s e l f - e s t e e m and i n t e r n a l i t y . S i m i l a r f i n d i n g s were reported by Mena, P a d i l l a and Maldonado (1987). In both these s t u d i e s , no gender d i f f e r e n c e s were observed on l e v e l s of s t r e s s , s e l f - e s t e e m or locus of c o n t r o l (Mena et a l . , 1987; P a d i l l a et a l . , 1986). As w e l l , i n these two s t u d i e s , s e l f - e s t e e m was found to be a b e t t e r p r e d i c t o r of s t r e s s than locus of c o n t r o l . S t u d i e s with m i n o r i t y groups r e p o r t that most va r i a n c e can be a t t r i b u t e d to s o c i a l c l a s s , where members i n lower socioeconomic s t a t u s groups are l e s s l i k e l y to experience i n t e r n a l c o n t r o l ( G a r c i a &< Levenson, 1975; L e f c o u r t , 1982; R o t t e r , 1982; Smith, 1985; Stone Bender & Ruiz, 1974). Perceived c o n t r o l i s p o s i t i v e l y a s s o c i a t e d with access to o p p o r t u n i t y . "Blacks, Spanish-Americans, Indians and other m i n o r i t y groups who do not enjoy as much access to o p p o r t u n i t y as do the predominant Caucasion groups in North American s o c i e t y , are o f t e n found to hold f a t a l i s t i c , e x t e r n a l L i t e r a t u r e Review 43 c o n t r o l b e l i e f s " ( L e f c o u r t , 1982, p. 31). Several s t u d i e s suggest that L a t i n o s are f a t a l i s t i c , and g e n e r a l l y show higher e x t e r n a l locus of c o n t r o l , however, the a d a p t i v e aspects of these b e l i e f s , values and a t t i t u d e s w i t h i n a strong f a m i l y o r i e n t a t i o n (group o r i e n t a t i o n ) have not been addressed (Atkinson, Morten & Sue, 1979; Cervantes & C a s t r o , 1985). When West German, I r i s h , Americans, Mexican and Mexican-Americans were compared, no s i g n i f i c a n t d i f f e r e n c e s were found regarding f a t a l i s m (Cervantes & C a s t r o , 1985). Most i n d i v i d u a l s w i t h i n a given c u l t u r e operate or behave a c c o r d i n g to c u l t u r a l l y d i c t a t e d a t t i t u d e s and b e l i e f s . It i s the i n t r a c u 1 t u r a 1 or within-group d i f f e r e n c e s that g i v e us a deeper understanding of c u l t u r a l e x p e r i e n c e s . "The e f f e c t of a s o c i a l change, or a change i n i n t e r p e r s o n a l r e l a t i o n s , on the h e a l t h of an i n d i v i d u a l cannot be d e f i n e d s o l e l y by the nature of the change i t s e l f . The e f f e c t depends on the p h y s i c a l and p s y c h o l o g i c a l c h a r a c t e r i s t i c s of the person who i s exposed to the change" [ H i n k l e , 1974, p. 41]. G e n e r a l i z e d e x p e c t a n c i e s of i n t e r n a l - e x t e r n a l locus of c o n t r o l may help e x p l a i n why some refugees a d j u s t to a new c u l t u r e s u c c e s s f u l l y , whereas others do not. Method 44 CHAPTER I I I Method Measures T h e u s e o f l o c u s o f c o n t r o l m e a s u r e s a n d m e a s u r e s o f s t r e s s l e v e l s a n d i l l n e s s a c r o s s c u l t u r e s h a s b e e n r e p o r t e d b y n u m e r o u s r e s e a r c h e r s ( C e r v a n t e s & C a s t r o , 1 9 8 5 ; C h a n , 1 9 8 5 ; H o l m e s & M a s u d a , 19 7 4 ; L e f c o u r t , 1 9 8 3 ; W i l l i a m s & W e s t e r m e y e r , 1 9 8 6 ; S i n g h & V e r m a , 1 9 9 0 ) . T h e r e h a s b e e n some c o n c e r n r e g a r d i n g t h e g e n e r a 1 i z a b i 1 i t y o f W e s t e r n c o n c e p t s o f m e n t a l i l l n e s s a n d p s y c h i a t r i c d i a g n o s i s t o o t h e r c u l t u r e s ( C e r v a n t e s & C a s t r o , 1 9 8 5 ; L i t t l e w o o d & L i p s e d g e , 1 9 8 2 ; W i l l i a m s & W e s t e r m e y e r , 1 9 8 6 ) . C a w t e ( 1 9 7 2 ) c a u t i o n s t h a t c r o s s -c u l t u r a l t e s t i n g p e r m i t s o n l y a p a r t i a l l y v a l i d c o m p a r i s o n o f s y m p t o m f r e q u e n c i e s a c r o s s c u l t u r a l b o u n d a r i e s , b e c a u s e r e s p o n d e n t s s c o r e s a r e i n f l u e n c e d b y t h e i r own c u l t u r a l v a l u e s . H o w e v e r , C a w t e s t r e s s e s t h e i m p o r t a n c e o f f i n d i n g a d e e p e r u n d e r s t a n d i n g o f e a c h c u l t u r e ' s v a l u e s . T h e q u e s t i o n n a i r e s u s e d i n t h i s s t u d y w e r e t r a n s l a t e d i n t o S p a n i s h b y a n a t i v e E l S a l v a d o r e a n . T h i s t r a n s l a t i o n was c h e c k e d b y t h e a u t h o r , a n d was t h e n b a c k t r a n s l a t e d i n t o E n g l i s h . B a c k t r a n s l a t i o n i n v o l v e s t a k i n g a n i n s t r u m e n t i n t h e o r i g i n a l l a n g u a g e , h a v i n g a b i l i n g u a l p e r s o n t r a n s l a t e t h e t e s t i n t o t h e t a r g e t l a n g u a g e a n d t h e n h a v i n g a d i f f e r e n t b i l i n g u a l p e r s o n Method 45 t r a n s l a t e the t e s t from the t a r g e t language back to the o r i g i n a l language ( B r i s l i n (1980), as c i t e d i n Wi l l i a m s & Westermeyer, 1986). Next, a n a t i v e Spanish-speaking c o u n s e l l o r reviewed the Spanish t r a n s l a t i o n f o r any l i n g u i s t i c d i s c r e p a n c i e s , and c o r r e c t e d any d i f f e r e n c e s with the o r i g i n a l E n g l i s h v e r s i o n . S p i e l b e r g e r & D i a z -Guerrero (1976) suggest that when l i t e r a l t r a n s l a t i o n s are not p o s s i b l e , the t r a n s l a t i o n should r e t a i n the e s s e n t i a l meaning of the o r i g i n a l . Chan (1985) suggests that language, or c u l t u r a l o r i e n t a t i o n , can a f f e c t responses to s p e c i f i c items. Every e f f o r t was made to ensure that the o r i g i n a l meaning of each q u e s t i o n was maintained, while using language a p p r o p r i a t e to the sample p o p u l a t i o n . I n s t r u c t i o n s f o r completing the q u e s t i o n n a i r e s were s i m p l i f i e d to accommodate t h i s p o p u l a t i o n , however, a l l e f f o r t was made to r e t a i n the o r i g i n a l i n t e n t of the q u e s t i o n n a i r e . F o r t u n a t e l y , Spanish and E n g l i s h languages are q u i t e s i m i l a r . There are many cognates between the two languages and both languages share a common European i n f l u e n c e . The two measures used i n t h i s study were the Cawte S t r e s s Inventory S c a l e (1972) (see Appendix B) and Levenson's (1974) I n t e r n a l , Powerful Others, and Chance S c a l e s (see Appendix C ). Demographic q u e s t i o n s were asked r e g a r d i n g gender, age, whether f a m i l y members accompanied the p a r t i c i p a n t , socioeconomic s t a t u s Method 46 changes ( v i a w o r k / p r o f e s s i o n ) , e d u c a t i o n a l s t a t u s , l e v e l of E n g l i s h p r o f i c i e n c y , and length of stay i n Canada. Four open-ended q u e s t i o n s were asked r e g a r d i n g what the p a r t i c i p a n t experienced as the most d i f f i c u l t aspect of a d j u s t i n g to the new c u l t u r e ; how they managed to cope with t h e i r d i f f i c u l t i e s ; where they f e l t they r e c e i v e d support; and what they f e l t was most l a c k i n g i n t h e i r new l i f e (Appendix D). Cawte's S t r e s s Inventory S c a l e (1972; as c i t e d i n Berry, 1980; Kim & Berry, 1985; Berry et a l . , 1987) was used as a measure of a c c u l t u r a t i v e s t r e s s . The Cawte s c a l e was developed from the longer C o r n e l l Medical Index (CMI) of Brodman, Erdmann, Lorge, Gershenson, and Wolff (1952, as c i t e d i n Kim & Berry, 1985). The adapted s c a l e s were used by Cawte to a s c e r t a i n symptom l e v e l s of mental i l l n e s s i n A u s t r a l i a n A b o r i g i n e s . Cawte, (Cawte, 1972; Cawte et a l . , 1968) i n studying A b o r i g i n e mental h e a l t h , attempted to understand i l l n e s s from w i t h i n the A b o r i g i n e ' s own t r a d i t i o n a l system. His o b j e c t i v e was "to l e a r n enough of the s o c i o c u l t u r a l circumstance of the people to make the p s y c h i a t r i c data meaningful" (1972, p. 2 ) . M o d i f i e d v e r s i o n s of the C o r n e l l Medical Index have been employed i n t r a n s c u l t u r a l s t u d i e s with people who are " r e s t r i c t e d by poor communication a r i s i n g from d i s t a n c e s i n c u l t u r e , language and s o c i a l c l a s s " (Cawte et a l . , 1968, p. 71). Method 47 Kim and Berry (1985) used Cawte's S c a l e to measure s t r e s s l e v e l s i n n a t i v e peoples, Vietnamese refugees, f o r e i g n students, and e t h n i c groups i n Canada. The Cawte s c a l e c o n s i s t s of 20 h e a l t h - r e l a t e d q u e s t i o n s . The f i r s t 10 items address psychosomatic symptomology; 6 items (11, 12, 15, 16, 19, 20) address a n x i e t y ; 2 items (13, 14) address d e p r e s s i o n ; 2 items (17, 18) address i r r i t a b i l i t y . A f o r c e d - c h o i c e response of yes or no generates scores between 0 and 20; the higher the score, the higher the s t r e s s l e v e l . Berry et a l . (1987) r e p o r t the Cawte's s t r e s s s c a l e has " c o r r e l a t e d c o n s i s t e n t l y with the number ( r = .42), frequency (r = .51), and s e v e r i t y ( r = .49) of p h y s i c a l h e a l t h problems... S u b j e c t i v e r e p o r t of general h e a l t h s t a t u s a l s o c o r r e l a t e d s i g n i f i c a n t l y with the Cawte s t r e s s measure (r = .37)" (p. 508). I o r i g i n a l l y chose R o t t e r ' s (1966) 1nterna1-Externa 1 Locus of C o n t r o l S c a l e f o r t h i s study. However, during the t r a n s l a t i o n phase and the p i l o t i n g of the q u e s t i o n n a i r e , the R o t t e r S c a l e was found to be too complicated, and the q u e s t i o n s too a b s t r a c t to understand. B r i s l i n (1973, as c i t e d i n W i l l i a m s & Westermeyer, 1986) suggests p r e t e s t i n g the t r a n s l a t e d instrument to ensure that the m a t e r i a l i s understandable, and that the language used be d i r e c t , simple, c l e a r and s p e c i f i c . The wording of the Method 48 q u e s t i o n s i n R o t t e r ' s s c a l e was g e n e r a l , employed a p a s s i v e v o i c e and a complex sentence s t r u c t u r e . In c o n t r a s t , Levenson's (1974) I n t e r n a l , Powerful Others and Chance (IPC) s c a l e s employed simple language, an a c t i v e v o i c e and simple sentence c o n s t r u c t i o n . As w e l l , the m u l t i d i m e n t i o n a l aspect of e x t e r n a l i t y found i n Levenson's IPC s c a l e s , would p r o v i d e a c l e a r e r d i f f e r e n t i a t i o n i n responses of e x t e r n a l l y o r i e n t e d respondents. As a r e s u l t , the Levenson IPC s c a l e s were more a p p r o p r i a t e f o r use with the refugee p o p u l a t i o n i n t h i s study. Levenson (1973a; 1973b; 1974) adapted R o t t e r ' s (1966) Interna1-Externa 1 Locus of Control s c a l e i n t o three separate s c a l e s measuring I n t e r n a l , Powerful i Others and Chance e x p e c t a n c i e s . Each of the I, P, and C s c a l e s c o n s i s t s of e i g h t items i n a L i k e r t format ( p o s s i b l e range on each s c a l e , 0-48). A l l statements are w r i t t e n i n the f i r s t person, to measure the degree to which i n d i v i d u a l s f e e l they have c o n t r o l over what happens to them, not f o r "people i n g e n e r a l " . C o r r e l a t i o n s compared f a v o r a b l y with those obtained by R o t t e r f o r the I-E s c a l e (1966). Internal c o n s i s t e n c y e s t i m a t e s , however, are o n l y moderately high. Kuder-Richardson r e l i a b i l i t i e s ( c o e f f i c i e n t alpha) y i e l d e d r = .64 f o r the I s c a l e , .77 f o r the P s c a l e , and .78 f o r the C s c a l e . S p l i t - h a l f r e l i a b i l i t y (Spearman-Brown) Method 49 were: r = .62 (I s c a l e ) , .66 (P s c a l e ) , and .64 (C s c a l e ) . T e s t - r e t e s t r e l i a b i l i t i e s f o r a one-week p e r i o d were: r s = .64, .74, and .78 (Levenson, 1974, p. 378-9). Data Analysis Procedures T h i s i s a c o r r e l a t i o n a l study to understand what r e l a t i o n s h i p e x i s t s between l e v e l s of a c c u 1 t u r a t i v e s t r e s s and p e r c e i v e d locus of c o n t r o l i n El Salvadorean refugees. Pearson Product-Moment C o r r e l a t i o n C o e f f i c i e n t r_ was used to t e s t s i g n i f i c a n c e of the c o r r e l a t i o n between the I n t e r n a l , Powerful Others and Chance locus of c o n t r o l s c a l e s with the a c c u 1 t u r a t i v e s t r e s s s c a l e . A 2 X 2 f a c t o r i a l ANOVA was used to determine the s i g n i f i c a n c e o f v a r i a b l e s o f age and educat i o n l e v e l s on l e v e l s of a c c u 1 t u r a t i v e s t r e s s . Samp 1 e I made co n t a c t with 224 male and female refugees from El Salvador, over the age of 20, who were l i v i n g i n the Greater Vancouver area. No l i m i t a t i o n s were put on the length of stay i n Canada, as d i f f e r e n c e s i n l e v e l s of a c c u 1 t u r a t i v e s t r e s s may appear, at d i f f e r e n t i n t e r v a l s , up to a decade a f t e r a r r i v a l . As wide as p o s s i b l e sample d i s t r i b u t i o n was attempted by l o c a t i n g p a r t i c i p a n t s from numerous l o c a t i o n s around the Greater Vancouver area. I contacted immigrant s e r v i c e Method 50 o r g a n i z a t i o n s , community c e n t r e s , E n g l i s h language c l a s s e s , community h e a l t h groups, and church o r g a n i z a t i o n s . T h i r t y - f o u r female and t h i r t y - o n e male El Salvadoreans returned completed q u e s t i o n n a i r e s f o r t h i s study. Data C o l l e c t i o n The Cawte S t r e s s Inventory S c a l e (1972) and Levenson's I n t e r n a l , Powerful Others and Chance (IPC) locus of c o n t r o l s c a l e s (1974), along with demographic q u e s t i o n s were t r a n s l a t e d i n t o Spanish and d i s t r i b u t e d to El Salvadorean refugees i n v a r i o u s c e n t r e s . I contacted agencies that worked with refugees: Immigrant S e r v i c e s S o c i e t y of BC; MOSAIC; Burnaby M u l t i c u l t u r a l S o c i e t y ; The Spanish B a p t i s t Church (Pastor David Rodriguez); Vancouver community h e a l t h u n i t s , and E n g l i s h as a Second Language c l a s s e s at L i t t l e Mountain Neighbourhood House and King Edward Campus. I attended v a r i o u s groups and c l a s s e s at each of the above l o c a t i o n s and presented i n Spanish an e x p l a n a t i o n of the study and requested v o l u n t e e r s from El Salvador to p a r t i c i p a t e . I a l s o v i s i t e d people i n t h e i r homes who had consented to p a r t i c i p a t e i n t h i s study. I e x p l a i n e d that the i n f o r m a t i o n gathered i n the q u e s t i o n n a i r e was completely c o n f i d e n t i a l , that I was not with the government, and that they were f r e e to not p a r t i c i p a t e Method 51 i f t h e y c h o s e . I e x p l a i n e d t h a t t h e i r c h o i c e t o p a r t i c i p a t e o r n o t , would not a f f e c t any s e r v i c e s t h e y were e n t i t l e d t o r e c e i v e . T h e i r p a r t i c i p a t i o n would h e l p t h o s e w o r k i n g w i t h r e f u g e e s t o b e t t e r u n d e r s t a n d t h e E l S a l v a d o r e a n r e f u g e e e x p e r i e n c e . P a r t i c i p a n t s f i l l e d o u t t h e q u e s t i o n n a i r e s , and t h e c o m p l e t e d q u e s t i o n n a i r e s were r e t u r n e d t o me. In s e v e r a l l o c a t i o n s , I r e t u r n e d s e v e r a l t i m e s i n hopes o f r e t r i e v i n g c o m p l e t e d q u e s t i o n n a i r e s . In one h e a l t h u n i t , I l e f t stamped s e l f a d d r e s s e d e n v e l o p e s f o r t h e p a r t i c i p a n t s ' u s e . At o t h e r l o c a t i o n s , f o r i n s t a n c e B urnaby M u l t i c u l t u r a l S o c i e t y and Immigrant S e r v i c e s S o c i e t y o f BC, t h e q u e s t i o n n a i r e s were handed o u t by t h e d e s i g n a t e d S p a n i s h w o r k e r s t o E l S a l v a d o r e a n v o l u n t e e r p a r t i c i p a n t s and c o m p l e t e d q u e s t i o n n a i r e s were r e t u r n e d t o me en masse. In a d d i t i o n , p a c k e t s o f q u e s t i o n n a i r e s were g i v e n o u t t o i n d i v i d u a l s who a g r e e d t o p a s s them o u t t o o t h e r s whom t h e y knew. In t o t a l 224 q u e s t i o n n a i r e s were handed o u t : 118 w h i c h I p e r s o n a l l y d i s t r i b u t e d t o i n d i v i d u a l s and 106 w h i c h were g i v e n t o i n d i v i d u a l s t o d i s t r i b u t e t o o t h e r s . I r e c e i v e d 65 c o m p l e t e d q u e s t i o n n a i r e s back, a r e t u r n r a t e o f 29 p e r c e n t . L i m i t a t i o n s o f t h i s S t u d y T r a n s l a t i n g t h e two m e asures i n t o S p a n i s h may c a u s e Method 5 2 some v a l i d i t y and r e l i a b i l i t y problems. Language and c u l t u r a l values and concepts may d i f f e r from c u l t u r e to c u l t u r e , perhaps skewing r e s u l t s (Chan, 1985). However, in s t u d i e s with other c u l t u r e s , c i t e d by L e f c o u r t (1983), the use of t r a n s l a t e d q u e s t i o n n a i r e s showed good r e l i a b i l i t y and v a l i d i t y . Having v o l u n t e e r s complete the q u e s t i o n n a i r e s w i l l e f f e c t g e n e r a l i z a b i 1 i t y of f i n d i n g s . V o l u n t e e r s may not be r e p r e s e n t a t i v e of the p o p u l a t i o n ; I cannot know what the c h a r a c t e r i s t i c s are of those who d i d not r e t u r n the q u e s t i o n n a i r e s . As w e l l , r e s u l t s gathered i n t h i s study may not be g e n e r a l i z e d to other e t h n i c groups, perhaps even to other E l Salvadoreans. However, r e s u l t s gathered i n t h i s study w i l l lend some understanding of p o s s i b l e within-group d i f f e r e n c e s . Research Questions: Refugees have o f t e n been observed to express t h e i r d i s t r e s s p r i m a r i l y through somatic complaints (Chan & Indra, 1987; Nann, Johnson, & B e i s e r , 1984; Williams & Westermeyer, 1986). While the l i t e r a t u r e may suggest that El Salvadorean refugees g e n e r a l l y have an e x t e r n a l locus of c o n t r o l , i n d i v i d u a l d i f f e r e n c e s w i l l be found. 1) Do lower l e v e l s of a c c u l t u r a t i v e s t r e s s c o r r e l a t e p o s i t i v e l y with an i n t e r n a l locus of contro1? Method 53 2 ) Do scores on the e x t e r n a l s c a l e of Powerful Others c o r r e l a t e with higher l e v e l s of s t r e s s than do scores on the e x t e r n a l Chance s c a l e ? Secondary Questions: Based on f i n d i n g s i n the l i t e r a t u r e , s e v e r a l secondary hypotheses are proposed. 1) Is one gender more s u s c e p t i b l e to s t r e s s and more e x t e r n a l l y o r i e n t e d ? 2 ) Do l e v e l s of educ a t i o n a f f e c t l e v e l s of a c c u 1 t u r a t i v e s t r e s s ? 3) Are o l d e r persons more s u s c e p t i b l e to s t r e s s ? Results 54 CHAPTER IV Results It was hypothesized that there would be s i g n i f i c a n t w i t h i n group d i f f e r e n c e s , and that those s c o r i n g on the Internal locus of c o n t r o l s c a l e would score lower on the a c c u l t u r a t i v e s t r e s s s c a l e . Secondly, i t was hypothesized that El Salvadorean refugees may score higher on the Powerful Others s c a l e than on the Chance or the Internal s c a l e and would a l s o g e n e r a l l y score h i g h e r on the A c c u 1 t u r a t i v e S t r e s s s c a l e . As w i l l be seen, the r e s u l t s of t h i s study do not support these hypotheses. Secondary hypotheses, based on f i n d i n g s i n the l i t e r a t u r e , examined e f f e c t s of gender, age and educat i o n l e v e l s on a c c u 1 t u r a t i v e s t r e s s . Again, there were no main e f f e c t s or i n t e r a c t i o n s between l e v e l s of a c c u l t u r a t i v e s t r e s s and age or educa t i o n l e v e l s . R e s u l t s do not support the hy p o t h e s i s that males and females d i f f e r i n l e v e l s of s t r e s s , and d i f f e r e n c e s are not s i g n i f i c a n t between mean scores of males and females on the locus of c o n t r o l measures. Cawte's Acculturative Stress Scale T h i r t y - o n e male and t h i r t y - f o u r female El Salvadorean refugees completed the q u e s t i o n n a i r e s . Mean sc o r e s f o r males, females and t o t a l cases on the Resuits 55 Cawte Stress Scale are printed in Table 1. Mean scores for males on the Cawte Stress scale were 4.48. Mean scores for females on the Cawte Stress scale were 6.24. Results of a one-way ANOVA between the means of males and females were not s i g n i f i c a n t (F r a t i o = 2.70, p = .105 ns). Total scores of accu1turative stress ranged from 0 to 17 out of 20 questions for females, and 0 to 15 for males. Table 1 Mean scores for Cawte Stress Sea 1e Variab1e Cases Mean STD Deviation Ma 1 es Stress 31 4.48 3.72 Fema1es Stress 34 6 .24 4.75 Total Stress 65 5.40 4.35 Questions on the Cawte Stress Scales that were most frequently scored "Yes" were No. 4 (46%), "Do your muscles and joint s constantly feel s t i f f ? " , No. 10 (44%) "Do you usually have great d i f f i c u l t y in f a l l i n g asleep or staying asleep?", No. 12 (40%) "Do you wish you always have someone at your side to advise you?", and No. 17 (43%) "Does i t make you angry to have anyone t e l l you what to do?". Sixteen percent answered p o s i t i v e l y to the question, "Do you often wish you were dead and Results 56 away from i t a l l ? " (No. 14), and 32% of both males and females answered p o s i t i v e l y to No. 13, "Do you u s u a l l y f e e l unhappy and depressed?" Levenson's Internal, Powerful Others and Chance Scales R e s u l t s of the IPC s c a l e s r e v e a l e d that a t o t a l of 52 out the 65 cases (80%) scored h i g h e s t on the Internal locus of c o n t r o l s c a l e . S p l i t by gender, 79 percent of the females and 81 percent of the males scored h i g h e s t on the Internal locus of c o n t r o l s c a l e . Mean scores f o r males on the Internal s c a l e were 34.68, SD of 6.02; mean scores f o r females on the I s c a l e were 36.96, SD of 4.41. R e s u l t s of a t - t e s t on mean scores f o r males and females on both the Internal and Powerful Others s c a l e s were not s i g n i f i c a n t ( I n t e r n a l F = 2.46, p - .123 ns; Powerful Others F = .15, p = .708 n s ) . R e s u l t s supported the second hypothesis that s cores on the Powerful Others s c a l e would be higher than on the Chance s c a l e . However, the r e s u l t s were s u r p r i s i n g as no females had h i g h e s t s c o r e s on the Chance s c a l e , and only one male scored h i g h e s t on the Chance s c a l e . Only 18 percent (6 cases) of the females and 13 percent (4 cases) o f the males scored h i g h e s t on the Powerful Others s c a l e . Mean sc o r e s f o r females on the Powerful Others s c a l e were 37.33, SD of 7.79; and mean scores f o r males on the P s c a l e were 39.25, SD of 7.41 (See Table Resuits 57 2 ) . One female had equal scores on the Internal and Powerful Others s c a l e s , and one male had equal scores on a l l three I n t e r n a l , Powerful Others and Chance s c a l e s . Table 2 Mean Scores on I P C Locus of Contro1 Sea 1es. Variab1e Gender Cases** Mean STD D e v i a t i o n Internal M 25 34.68 6 .02 F 27 36 .96 4.41 Total 52 35.87 5.32 Powerfu1 M 4 39 .25 7.41 Others F 6 37.33 7 .79 To t a l 10 38. 10 7 .28 Chance M 1 36 .00 * F 0 * * T o t a l 1 36 .00 * * " . " cannot be computed ** two cases with t i e d s c o r e s not inc l u d e d Results of the Correlation between Acculturative Stress and Locus of Control. R e s u l t s of the c o r r e l a t i o n between A c c u l t u r a t i v e S t r e s s and I n t e r n a l , Powerful Others and Chance s c a l e s were not s t a t i s t i c a l l y s i g n i f i c a n t (See Table 3 ) . R e s u l t s 58 Tab l e 3 Pearson c o r r e l a t i o n c o e f f i c i e n t s between Cawte S t r e s s  Scores and Levenson's Interna1 Powerfu1 Others and  Chance Scores (IPC) f o r a 11 cases N Sea 1e C o r r e l a t i o n (r) P 52 S t r e s s & Internal .07 .302 NS locus of c o n t r o l 10 S t r e s s & Powerful Others .09 .401 NS 1 S t r e s s & Chance * * * " . " cannot be computed When t o t a l s cores f o r the 63 cases were examined (two cases were e l i m i n a t e d due to t i e d scores) c o r r e l a t i o n s between s t r e s s and i n t e r n a l locus of c o n t r o l were r = .07, p = .302 ns; and between s t r e s s and powerful others were r = .09., p = .401 ns. C o r r e l a t i o n between s t r e s s and chance co u l d not be computed as there was only one case. When the 63 cases were s p l i t by gender, c o r r e l a t i o n s f o r males (n = 25) between s t r e s s and i n t e r n a l locus of c o n t r o l were r = -.13, p = .267 ns. C o r r e l a t i o n s f o r females (n = 27) between s t r e s s and i n t e r n a l locus of c o n t r o l were r = -.20, p = .163' ns. C o r r e l a t i o n s f o r males and females between s t r e s s and powerful o t h e r s locus of c o n t r o l were computed, but are Resuits 59 not recorded here due to such a smal1 number of cases (n = 4 f o r males, and n = 6 f o r females). Analysis of Variance A two-way ANOVA was performed f o r v a r i a b l e s of age and e d u c a t i o n a l l e v e l s with l e v e l s of a c c u 1 t u r a t i v e s t r e s s . The scores were d i v i d e d i n t o two groups, using the mean f o r both age, (20 to 37 years = low; 37.1 to 65 years = h i g h ) , and e d u c a t i o n l e v e l s (0 to 10 years of s c h o o l i n g = low; 10.1 years and above = h i g h ) . No s i g n i f i c a n t main or i n t e r a c t i o n e f f e c t s were found f o r e i t h e r age or years of e d u c a t i o n ( a l l Fs < 1) (See Table 4) . Table 4 Two-way Ana l y s i s of Variance on STRESS by AGE and  EDUCATION. AGE (low t h r u 37=1) (37.1 t h r u high=2), EDUC (Low t h r u 10=1) (10.1 t h r u high=2) Source of Sum of DF Mean F S i g n i f i c a n c e V a r i a t i o n Squares Square of F Main E f f e c t s 43.25 2 21.63 1.12 .333 NS AGE 4.19 1 4.19 .22 .217 NS EDUC 41.69 1 41.69 2.16 .147 NS 2-way I n t e r a c t i o n s 2.48 1 2.48 .13 .721 NS AGE EDUC Residual 1158.02 60 19.30 (n = 64, 1 case missing) R e s u l t s 60 The two-way ANOVA dichotomized the cases i n t o four groups as f o l l o w s : low age and low e d u c a t i o n (n = 14); low age and high e d u c a t i o n (n = 18); high age and low e d u c a t i o n (n = 18); and high age and high e d u c a t i o n (n = 14) r e s p e c t i v e l y . While no main or i n t e r a c t i o n e f f e c t s were found, there i s a c o n s i d e r a b l e d i f f e r e n c e i n mean scores between low age low e d u c a t i o n groups and high age high e d u c a t i o n groups. Had there been more s u b j e c t s , t h i s e f f e c t may have shown up more c l e a r l y (See Table 5) . T a b l e 5 Two-way A n a l y s i s of Variance on STRESS by AGE and  EDUCATION Mean Scores by groups. EDUC low high AGE low 6.29 5.06 (n = 14) (n = 18) high 6.17 4.14 (n = 18) (n = 14) When age and e d u c a t i o n were d i v i d e d i n t o lowest and h i g h e s t groups, e l i m i n a t i n g the middle range, again no s i g n i f i c a n t main or i n t e r a c t i o n e f f e c t s were found ( a l l Fs < 1) (See Tab 1e 6 ) . Re s u i t s 61 Table 6 Two-way Ana l y s i s of Variance on STRESS by AGE and  EDUCATION. AGE (low thru 35=1) (45 thru high=2), EDUC (Low thru 7=1) (12 thru high=2) Source of V a r i a t ion Sum of Squares DF Mean Square F S i g n i f i c a n c e of F Main E f f e c t s 6 .67 2 3.33 . 175 .840 NS AGE 5.47 1 5.47 .287 .596 NS EDUC 3.32 1 3.32 . 174 .679 NS 2-way I n t e r a c t i ons AGE EDUC .578 1 .578 .030 .863 NS Residual 609.979 32 19.062 Analysis of Open—ended Questions on Areas of D i f f i c u l t i e s and Sources of Assistance To have a broader understanding of the experience of the E l Salvadorean p a r t i c i p a n t s , four open-ended q u e s t i o n s were asked: (1) What has been the most d i f f i c u l t aspect of a d j u s t i n g to the new c u l t u r e ? ; (2) What has helped you cope with your d i f f i c u l t i e s ? ; (3) Where do you f e e l you r e c e i v e the most support?; and (4) What do you f e e l i s missing most i n your present l i f e ? Responses to the four q u e s t i o n s were coded i n t o c a t e g o r i e s . R e s u l t s of a frequency a n a l y s i s f o r the four q u e s t i o n s are found i n Tables 7 through 10. For the f i r s t q u e s t i o n r e g a r d i n g d i f f i c u l t a s pects of R e s u l t s 62 a d j u s t i n g , e i g h t c a t e g o r i e s were found: language; c l i m a t e ; language and c l i m a t e ; language and work; language and customs; language and f a m i l y ; i s o l a t i o n and work; and other. For the second q u e s t i o n regarding what has helped the p a r t i c i p a n t s cope, nine c a t e g o r i e s were found: f a m i l y ; f a m i l y and government; f a i t h i n God; f r i e n d s h i p and community; optimism and b e l i e f i n s e l f ; l e a r n i n g E n g l i s h ; immigrant s e r v i c e s ; work; and God and f a m i l y . In response to the t h i r d q u e s t i o n r e g a r d i n g where the p a r t i c i p a n t s f e l t they r e c e i v e d the most support, nine c a t e g o r i e s were found: Canadian government; God, Church and government; f a m i l y , church and community; f a m i l y and government; immigrant s e r v i c e s ; E n g l i s h c l a s s e s ; f a m i l y d o c t o r ; government and f r i e n d s ; and God and f r i e n d s . L a s t l y , nine c a t e g o r i e s were found reg a r d i n g what they f e l t was missing most i n t h e i r present l i f e : E n g l i s h p r o f i c i e n c y ; work and money; ma t e r i a l p o s s e s s i o n s ; E n g l i s h and work; f a m i l y ' s f u t u r e ; f a m i l y and work; b e l i e f i n a b e t t e r world; t h e i r home country; and nothing m i s s i n g . In the f i r s t q u e s t i o n , e i g h t y - n i n e percent of the respondents i n c l u d e d lack of language p r o f i c i e n c y as the most d i f f i c u l t aspect of a d j u s t i n g to the new c u l t u r e ; 24.6% of those i n c l u d e d f o r e i g n Canadian customs with language i n t h e i r responses, and 15.4% in c l u d e d the Resul t s 63 climate as a d i f f i c u l t aspect of adjusting (See Table 7) . Table 7 Most D i f f i c u l t Aspects of Adjustment Va1ue Labe1 Frequency Percent 1 language 25 38.5 2 c1imate 2 3. 1 3 language and climate 8 12.3 4 language and work 5 7.7 5 language and customs 16 24.6 6 language and family 4 6.2 7 i s o l a t i o n and work 3 4.6 8 other 2 3.1 In answering the second question, 24.6% f e l t that i t was t h e i r optimism or b e l i e f in themselves that helped them to cope with th e i r d i f f i c u l t i e s , and 33.8% f e l t that t h e i r b e l i e f in God, and their connection with the Church community helped them cope (See Table 8). Responses to the th i r d question showed that 97% f e l t they received the most support from a combination of the Canadian government, the Church community, and/or their family. Forty-nine percent included f a i t h in God and the Church community in th e i r responses; 35.4% specified the Canadian government or immigrant services as th e i r sole source of assistance (See Table 9). Re s u i t s 64 Table 8 What Has Helped with D i f f i c u l t i e s Va1ue Labe1 Frequency Percent 1 f a m i l y 6 9.2 2 f a m i l y and government 2 3. 1 3 f a i t h i n God 8 12.3 4 f r i e n d s h i p s , community 11 16 .9 5 optimism, b e l i e f i n s e l f 16 24.6 6 l e a r n i n g E n g l i s h 9 13.8 7 immigrant s e r v i c e s 4 6.2 8 work 4 6.2 9 God and f a m i l y 3 4.6 missing cases 2 3. 1 Table 9 Sources of Support Value Label Frequency Percent 1 Canadian Government 18 27 .7 2 God, Church it Gov't. 23 35.4 3 f a m i l y , church, community 7 10.8 4 f a m i l y and government 7 10.8 5 immigrant s e r v i c e s 5 7.7 6 f a m i l y d o c t o r 2 3.1 7 government and f r i e n d s 1 1.5 8 God and f r i e n d s 2 3.1 ResuIts 65 Table 10 What i s Mi s s i n e Most i n Present L i f e Va1ue Labe1 Frequency Percent 1 E n g l i s h p r o f i c i e n c y 10 15.4 2 work and money 19 29 .2 3 m a t e r i a l p o s s e s s i o n s 3 4.6 4 E n g l i s h and work 6 9.2 5 f a m i l y ' s f u t u r e 9 13.8 6 f a m i l y and work 6 9.2 7 b e t t e r world 3 4.6 8 home country 6 9.2 9 nothing missing 1 1.5 missing cases 2 3.1 The two most o f t e n c i t e d a spects that were l a c k i n g i n t h e i r present l i f e were lack of work and money (29.7%) and lack of E n g l i s h p r o f i c i e n c y (15.6%) (See Table 10). Fourteen percent had concerns about t h e i r f a m i l y ' s f u t u r e , r e g a r d l e s s of whether t h e i r f a m i l y was here with them or not; 9.4% reported missing t h e i r home country. Demographic P r o f i l e of Participants The mean length of time the E l Salvadoreans p a r t i c i p a n t s had been i n Canada was 3.3 years, ranging between 2 months, and 8 years 11 months' stay i n Canada. E n g l i s h p r o f i c i e n c y l e v e l s ranged from 11% good R e s u l t s 66 p r o f i c i e n c y , Where they could read, w r i t e or speak E n g l i s h w e l l ; 66% f a i r p r o f i c i e n c y , where the respondents could speak, but could not n e c e s s a r i l y read or w r i t e E n g l i s h ; and 23% poor p r o f i c i e n c y where they could not speak, read, or w r i t e E n g l i s h at a l l . S i x t y - e i g h t percent of the 65 p a r t i c i p a n t s were not employed. Included i n t h i s category were those who were working i n the home, as a "housewife", and those a t t e n d i n g E n g l i s h c l a s s e s . Of the 32% who were working, 42% experienced a drop i n socioeconomic s t a t u s , f o r i n s t a n c e , p r o f e s s i o n a l l y t r a i n e d accountants or p r o f e s s o r s were working as j a n i t o r s , f a c t o r y workers or i n nurses-aide t r a i n i n g p o s i t i o n s . N i n e t y - f i v e percent of the respondents had f a m i l y members with them. Mean l e v e l s o f ed u c a t i o n were 10.1 years, with a range between 1 year and 19 years of s c h o o l i n g . Mean age f o r a l l respondents was 37.2 years (female mean age was 37.3, and male mean age was 37.0 y e a r s ) . Discussion 67 CHAPTER V Discussion Summary of Results Acculturative Stress The mean scores on the Cawte S t r e s s S c a l e were 4.48 f o r El Salvadorean males and 6.24 f o r El Salvadorean females. These high means c o r r o b o r a t e other s t u d i e s that have used the Cawte s c a l e with refugees (Berry, 1980; Berry, Kim, Minde & Mok, 1987) and with other immigrant p o p u l a t i o n s (Chataway & Berry, 1989). Cawte devised t h i s s c a l e to be employed i n t r a n s c u l t u r a 1 s t u d i e s with people who are " r e s t r i c t e d by poor communication a r i s i n g from d i s t a n c e s i n c u l t u r e , language and s o c i a l c l a s s " (Cawte et a l . , 1968, p. 71). The El Salvadorean p a r t i c i p a n t s i n t h i s study d e f i n i t e l y had d i f f i c u l t i e s a r i s i n g from d i f f e r e n c e s i n c u l t u r e and language. However, not a l l of them d i f f e r e d i n s o c i a l c l a s s from the Canadian host s o c i e t y . Many of the p a r t i c i p a n t s were educated and held s k i l l e d or p r o f e s s i o n a l p o s i t i o n s i n t h e i r home country. N e v e r t h e l e s s , the p a r t i c i p a n t s i n t h i s study p e r c e i v e d the Canadian c u l t u r a l and l i n g u i s t i c d i f f e r e n c e s as a h u r d l e to overcome. Past research has proposed that females g e n e r a l l y experience h i g h e r l e v e l s of s t r e s s than males (Cawte et a l . , 1968; Cawte, 1972; Kim & Berry, 1985; S c o t t & S c o t t , 1989). Although r e s u l t s i n t h i s study do show Discussion 68 gender d i f f e r e n c e s , a t - t e s t of mean scores showed there were no s i g n i f i c a n t d i f f e r e n c e s between males and females on l e v e l s of a c c u 1 t u r a t i v e s t r e s s . Two hypo t h e s i s may be o f f e r e d . One, i t i s p o s s i b l e that strong f a m i l y support and community involvement, although not measured i n t h i s study, may o f f e r emotional support that a l l e v i a t e s some of the women's s u f f e r i n g . Or, two, males may be e q u a l l y d i s t r e s s e d and are r e p o r t i n g t h e i r d i s t r e s s . S c o t t and S c o t t (1989) suggest that i t i s not c l e a r whether higher s t r e s s scores f o r females r e f l e c t a c t u a l occurrences of higher s t r e s s , or whether females may be more l i k e l y to r e p o r t t h e i r e x p e r i e n c e s of s t r e s s . The f i n d i n g s of t h i s study may have e f f e c t on programs f o r immigrants that may now emphasize female needs due to high s t r e s s l e v e l s over males' needs. These f i n d i n g s may make i t p o s s i b l e f o r male immigrants to r e c e i v e f u t u r e support and s p e c i a l programs that are now geared toward women only. Levenson's IPC Locus of Control Scales R e s u l t s of the scores on the I n t e r n a l , Powerful Others and Chance s c a l e s showed s u r p r i s i n g r e s u l t s : 80% of a l l cases scored h i g h e s t i n the Internal s c a l e . These r e s u l t s q u e s t i o n c o n c l u s i o n s d e r i v e d from the l i t e r a t u r e t h a t s t a t e that T h i r d world c o u n t r i e s are Discussion 69 g e n e r a l l y more e x t e r n a l l y o r i e n t e d ( L e f c o u r t , 1982, 1983; Sue & Sue, 1990). El Salvadoreans g e n e r a l l y have a strong f a m i l y o r i e n t a t i o n , strong r e l i g i o u s b e l i e f s , and are s u r v i v o r s of a system that i s based on a m i l i t a r y regime r u l i n g by f o r c e , which may f o s t e r a b e l i e f i n Powerful Others or Chance o r i e n t a t i o n s . We do not know what locus of c o n t r o l o r i e n t a t i o n El Salvadoreans have while l i v i n g i n t h e i r own country, nor do we have norms f o r t h i s p o p u l a t i o n . It may be argued that the El Salvadoreans i n t h i s study managed to s u r v i v e and a r r i v e here i n Canada because of t h e i r Internal o r i e n t a t i o n . And those who agreed to p a r t i c i p a t e i n t h i s study may be s e l f - s e l e c t e d because of t h e i r Internal o r i e n t a t i o n . It i s a l s o p o s s i b l e that those who d i d not r e t u r n the q u e s t i o n n a i r e s do not f i t the p r o f i l e of those i n t h i s study. As w e l l , we have no way of knowing whether the locus of c o n t r o l o r i e n t a t i o n has changed as a r e s u l t of l i v i n g i n and a d j u s t i n g to Canadian s o c i e t y . Research needs to be done l o n g i t u d i n a l l y to study whether changes i n locus of c o n t r o l o r i e n t a t i o n occur over time or i n d i f f e r e n t s i t u a t i o n s . Mean scores on the Internal s c a l e f o r females were higher, though not s i g n i f i c a n t l y , than f o r males (36.96 as compared to 34.68 f o r males). These r e s u l t s c o n t r a s t with the l i t e r a t u r e which suggests that females are Di scussion 70 g e n e r a l l y more e x t e r n a l l y o r i e n t e d than are males (Sue & Sue, 1990). However, these r e s u l t s do c o r r o b o r a t e s t u d i e s by Mena, P a d i l l a and Maldonado (1987) and P a d i l l a , A l v a r e z and Lindholm (1986) which reported that no d i f f e r e n c e s i n gender were observed on l e v e l s of s t r e s s or locus of c o n t r o l . It i s p o s s i b l e that r e s u l t s from locus of c o n t r o l s t u d i e s of North American males and females cannot be a p p l i e d to other c u l t u r e s . El Salvadoreans may g e n e r a l l y by more i n t e r n a l l y o r i e n t e d i n t h e i r own country. Dne p a r t i c i p a n t i n t h i s study, d u r i n g an informal d i s c u s s i o n , thought that perhaps those people l i v i n g i n the c i t i e s , who were more educated and who were used to a more i n d u s t r i a l s o c i e t y , would g e n e r a l l y have an i n t e r n a l o r i e n t a t i o n . Those El Salvadoreans who l i v e d i n the c o u n t r y s i d e , who were poorer, and had l e s s e d u c a t i o n and l e s s exposure to i n d u s t r i a l s o c i e t y , would probably, from h i s p o i n t of view, have an e x t e r n a l o r i e n t a t i o n . F u r t h e r research i s needed i n t h i s area to t e s t t h i s hypotheses. Correlations between Acculturative Stress and Locus of Control The c o r r e l a t i o n s between a c c u l t u r a t i v e s t r e s s l e v e l s and p e r c e i v e d i n t e r n a l locus of c o n t r o l were not s t a t i s t i c a l l y s i g n i f i c a n t . Whereas research s t u d i e s have examined c o r r e l a t i o n s between locus of c o n t r o l and Di scussion 71 l e v e l s of s t r e s s (Anderson, 1977; Kobasa, 1979; L e f c o u r t , 1982), there may e x i s t a d i f f e r e n c e i n the s t r e s s measured i n the general p o p u l a t i o n , compared with the a c c u l t u r a t i v e s t r e s s experienced by refugees and immigrants. P a d i l l a et a l . (1985) and Mena et a l . (1985) found that locus of c o n t r o l was not a good p r e d i c t o r of l e v e l s of a c c u l t u r a t i v e s t r e s s . They suggested that measures of s e l f - e s t e e m are more e f f e c t i v e . As w e l l , Manuck et a l . (as c i t e d i n L e f c o u r t , 1982) found that g i v e n high i n c i d e n t s of s t r e s s o r s , locus of c o n t r o l ceased to be a p r e d i c t o r of a n x i e t y . DeCharms (1981) suggested that there i s a d i f f e r e n c e i n the p e r c e p t i o n of locus of c o n t r o l o r i e n t a t i o n and the experience of i n t e n t i o n a l , reasoned, personal c a u s a t i o n . It may be p o s s i b l e that a q u a l i t a t i v e i n v e s t i g a t i o n i n t o the "experience" o f, r a t h e r than the " p e r c e p t i o n " o f , locus of c o n t r o l would o f f e r a b e t t e r understanding of the refugee experience, than a q u a n t i t a t i v e i n v e s t i g a t i o n as was done here. Analysis of Open-Ended Questions Recent s t u d i e s have i d e n t i f i e d language b a r r i e r s as a major source of s t r e s s f o r recent L a t i n American immigrants ( P a d i l l a , Cervantes, Maldonado, & G a r c i a , 1988). In t h i s study, e i g h t y - n i n e percent of the D i s c u s s i o n 72 respondents i n c l u d e d lack of language p r o f i c i e n c y as the most d i f f i c u l t aspect of a d j u s t i n g to the new c u l t u r e (See Table 7). Lack of language p r o f i c i e n c y p r e c l u d e s the refugee from having access to h e a l t h care s e r v i c e s and f i n d i n g employment, and hampers them i n t h e i r adjustment to the new host s o c i e t y . In answering the second q u e s t i o n , 25% f e l t that i t was t h e i r optimism or b e l i e f i n themselves that helped them to cope with t h e i r d i f f i c u l t i e s , and 34% f e l t that i t was t h e i r b e l i e f i n God, and t h e i r c o n n e c t i o n with the Church community that helped them cope (See Table 8 ) . The p a r t i c i p a n t s of t h i s study appear to have a strong sense of optimism and b e l i e f i n themselves. T h i s q u a l i t y would help them i n d e a l i n g with o b s t a c l e s and d i f f i c u l t i e s a r i s i n g i n t h e i r s i t u a t i o n s . T h e i r strong c o n n e c t i o n with the church community and t h e i r f a i t h i n God may a c t as a b u f f e r , and p r o v i d e a s o c i a l support network to which they may t u r n f o r succour and comradesh i p . Responses to the t h i r d q u e s t i o n showed that 97% f e l t they r e c e i v e d the most support from a combination of the Canadian government, the Church community, and/or t h e i r f a m i l y . F o r t y - n i n e percent i n c l u d e d f a i t h i n God and the Church community as a source of support; 35% s p e c i f i e d the Canadian government or immigrant s e r v i c e s as t h e i r s o l e source of a s s i s t a n c e (See Table 9 ) . From D i s c u s s i o n 73 the responses to the two q u e s t i o n s above, the presence of the church community and f a i t h i n God play a very important r o l e i n the d a i l y l i f e of the El Salvadorean p a r t i c i p a n t s . Often the church i s i n v o l v e d immediately upon a r r i v a l i n a i d i n g the refugee to f i n d s h e l t e r , food and r e f e r r a l s f o r work. The church community p r o v i d e s emotional support and i n c l u s i o n i n an otherwise f o r e i g n envi ronment. The two most o f t e n c i t e d a s p e c t s that were l a c k i n g i n t h e i r present l i f e were lack o f work and money (30%) and lack of E n g l i s h p r o f i c i e n c y (16%) (See Table 10). Fourteen percent had concerns about t h e i r f a m i l y ' s f u t u r e , r e g a r d l e s s of whether t h e i r f a m i l y was here with them or not, and 9% reported missing t h e i r home country. Lack of work and money and lack of E n g l i s h p r o f i c i e n c y are common themes i n the refugee experience. Often without E n g l i s h , one cannot f i n d work. Lack of money i n h i b i t s one from p a r t a k i n g i n community events, h e a l t h s e r v i c e s and ed u c a t i o n . H o p e f u l l y , the optimism and b e l i e f i n themselves coupled with the support from t h e i r community and government programs, w i l l enable these p a r t i c i p a n t s to become f u l l y p a r t i c i p a t i n g members of our s o c i e t y . Discussion 74 Demographic P r o f i l e of Participants A composite p r o f i l e of the El Salvadorean p a r t i c i p a n t s does not attempt to d e s c r i b e the people as a group, nor to d i m i n i s h i n d i v i d u a l d i f f e r e n c e s . The manner i n which a refugee experiences the s t r e s s e s of adjustment depends on the personal d i s p o s i t i o n of each i n d i v i d u a l and h i s or her former s o c i a l i n t e g r a t i o n ( B e i s e r , 1987; Ex, 1966; Serrano, 1988). From the s i x t y - f i v e p a r t i c i p a n t s i n t h i s study, a general p r o f i l e may be developed: A male or female, 37 years of age who has been i n Canada 3.3 ye a r s . T h i s person has 10 years of s c h o o l i n g , was working i n t h e i r home country but i s e i t h e r not working now, or working at an u n s k i l l e d job. T h i s person i s p r e s e n t l y studying E n g l i s h , and can speak some E n g l i s h but has d i f f i c u l t y r eading and w r i t i n g E n g l i s h . He or she has f a m i l y members with them and p a r t i c i p a t e s r e g u l a r l y i n the church a c t i v i t i e s . In g e n e r a l , t h i s person has r e c e i v e d f i n a n c i a l support from the government, i s concerned about f i n d i n g work and would l i k e to f e e l secure and e s t a b l i s h e d i n t h i s country. T h i s person i s g e n e r a l l y o p t i m i s t i c , has a strong b e l i e f i n him or h e r s e l f and a strong b e l i e f i n God. G e n e r a l l y , t h i s person e x p e r i e n c e s q u i t e a b i t of s t r e s s i n a d j u s t i n g to the new c u l t u r e , yet p e r c e i v e s h i s or her a c t i o n s having an a f f e c t on the world, and f e e l s that he or she has some Discussion 75 c o n t r o l over what happens. Implications for Future Research The r e s u l t s i n t h i s study suggest that c a u t i o n must be e x e r c i s e d i n t r a n s f e r r i n g measures and r e s u l t s from one c u l t u r e to another. The Cawte S t r e s s Inventory S c a l e (1972) was designed to be used with i n d i v i d u a l s who d i f f e r from the host s o c i e t y i n language, c u l t u r e and s o c i a l c l a s s . The q u e s t i o n n a i r e was o r i g i n a l l y s i m p l i f i e d f o r use with n o n - l i t e r a t e p o p u l a t i o n s . The Cawte S t r e s s s c a l e may not be a c c u r a t e enough, the symptoms of s t r e s s may be too u n c l e a r . New measures of s t r e s s need to be developed s p e c i f i c a l l y f o r refugees and immigrants, that can be normed on d i f f e r e n t popu1 at i ons. Locus of c o n t r o l measures need to be normed on p o p u l a t i o n s i n T h i r d world c o u n t r i e s . A l o n g i t u d i n a l study measuring locus of c o n t r o l f i r s t i n the home country and l a t e r i n the host country would c o n t r i b u t e to a g r e a t e r understanding of t h i s concept. It would be i n t e r e s t i n g to note i f any changes occurred over time, or i f locus of c o n t r o l o r i e n t a t i o n changed as a r e s u l t of being exposed to another c u l t u r e . The v a l i d i t y of the locus of c o n t r o l concept needs to be t e s t e d f u r t h e r . S p e c i f i c a l l y , El Salvadoreans l i v i n g i n Canada could be i n v o l v e d i n a l a r g e r study. It would a l s o be v a l u a b l e D i s c u s s i o n 76 to know i f the El Salvadoreans l i v i n g i n t h e i r own country would r e p o r t s i m i l a r scores to those i n t h i s study, or to those l i v i n g elsewhere i n Canada. In g e n e r a l , f u r t h e r r e s e a r c h i s needed on the L a t i n American peoples a r r i v i n g i n Canada. C o n s i d e r a b l e rese a r c h has been done on the Southeast Asian p o p u l a t i o n s , as a r e s u l t of the waves of immigration i n past y e a r s . Recently immigration from C e n t r a l America has i n c r e a s e d . It i s important that we develop s e r v i c e s that are a p p r o p r i a t e to t h i s p o p u l a t i o n , while a p p l y i n g general p r i n c i p l e s that we have learned i n the pas t . T h i s study looked at the i n t e r a c t i o n s of two s p e c i f i c v a r i a b l e s , a c c u l t u r a t i v e s t r e s s and locus of c o n t r o l . G o l d l u s t (1974) suggests that a m u l t i v a r i a t e method of a n a l y s i s would be h e l p f u l i n understanding the i n t e r a c t i v e e f f e c t s of the many v a r i a b l e s i n v o l v e d i n refugee a d a p t a t i o n to the host c u l t u r e . T h i s study l i m i t e d i t s e l f to the i n t e r a c t i o n of age, educa t i o n l e v e l s and gender with l e v e l s of a c c u l t u r a t i v e s t r e s s . F a c t o r s of s o c i a l support, l o s s of s t a t u s , and work r e l a t e d i s s u e s were not addressed. A m u l t i v a r i a t e approach to the study of the El Salvadorean p o p u l a t i o n would o f f e r a g r e a t e r understanding of t h e i r experience. Q u a l i t a t i v e i n v e s t i g a t i o n s i n t o the refugee experience of a c c u l t u r a t i v e s t r e s s would be b e n e f i c i a l . As w e l l , how i n d i v i d u a l s a p p r a i s e t h e i r s i t u a t i o n s and Discussion 77 l e a r n how to cope are important areas to i n v e s t i g a t e . If we can l e a r n how people cope with c e r t a i n s i t u a t i o n s , we may then be a b l e to more e f f e c t i v e l y serve them. Implications for Counsel 1ing C o u n s e l l o r s working with refugee p o p u l a t i o n s need to understand the refugees' experiences of a d a p t a t i o n . Many exp e r i e n c e s are s i m i l a r among refugees from d i f f e r e n t c o u n t r i e s . However, i t i s important not to u n n e c e s s a r i l y s t e r e o t y p e cases i n t o a s t a t e d p a t t e r n . I n d i v i d u a l and within-group d i f f e r e n c e s must be acknowledged. Cervantes and Castro (1985) suggest that the s t e r e o t y p i c c u l t u r a l " p e r s o n a l i t i e s " may not always be a c c u r a t e , and that c a u t i o n should be used when forming s t e r e o t y p i c judgments which may not be a c c u r a t e l y a p p l i e d to the s p e c i f i c p o p u l a t i o n . S t e r e o t y p i c d e s c r i p t i o n s and c a t e g o r i z a t i o n s may a i d i n s t a t i s t i c a l a n a l y s i s , but they may not f a c i l i t a t e the c o u n s e l l o r s ' a c c u r a t e a p p r e c i a t i o n of t h e i r refugee c l i e n t s ' s i t u a t i o n s . While the Greater Vancouver Mental Health supports the idea of o f f e r i n g c o u n s e l l i n g s e r v i c e s i n the c l i e n t ' s language, there are very few c o u n s e l l o r s i n Vancouver who speak Spanish (Sanchez, 1991). Thus, there i s a great l i m i t a t i o n to the c o u n s e l l i n g help that Discussion 78 i s now being o f f e r e d . Working with t r a n s l a t o r s can be both b e n e f i c i a l and a hindrance to the c o u n s e l l i n g p r o c e s s . In many cases, the t r a n s l a t o r i s not a t r a i n e d h e a l t h p r o f e s s i o n a l , and i s not aware of the nuances that need to be t r a n s l a t e d ( W i l l i a m s & Westermeyer, 1986). In other cases the f a m i l y members act as t r a n s l a t o r s , which may i n h i b i t what the c l i e n t i s t r y i n g to say, or the t r a n s l a t o r may come from the op p o s i t e "camp", and the c l i e n t may not f e e l t r u s t i n g of them. In some cases, the c l i e n t s may f e e l comfortable with a t r a n s l a t o r , but the c o u n s e l l o r does not ( K l i n e , Acosta, A u s t i n , & Johnson, 1980). C r o s s - c u l t u r a l t r a i n i n g of c o u n s e l l o r s and support s e r v i c e workers i s necessary to ensure e f f e c t i v e c a r e . However, i t i s a l s o very important f o r the r e s u l t s of s t u d i e s to be put i n t o p r a c t i c e and to be a p p l i e d i n s e r v i c e o r g a n i z a t i o n s so that the knowledge i s not f o r g o t t e n . (Canadian Task Force on Mental Health Issues A f f e c t i n g Immigrants and Refugees, 1988). Many important suggestions as a r e s u l t of s t u d i e s never get implemented on the f r o n t l i n e due to lack of funding and lack of a d m i n i s t r a t i v e commitment. T h i s has even happened with recommendations made i n the 1988 Canadian Task Force on Mental Health Issues A f f e c t i n g Immigrants and Refugees i n Canada (Ganesan, 1991). Di scussion 79 Two a s p e c t s important to the s u c c e s s f u l outcome of c o u n s e l l i n g i n v o l v e a) the c o u n s e l l o r ' s understanding of the refugee experience, and b) the c o u n s e l l o r ' s understanding of h i s or her own p r e v i o u s l y unrecognized b i a s e s (Atkinson et a l . , 1979; C h r i s t e n s e n , 1985). C o u n s e l l o r s need to be aware of the s t r e s s e s i n a refugee's l i f e , f e e l i n g s of bereavement and power 1essness, and the c o n f l i c t s that may a r i s e i n d e a l i n g with i d e n t i t y and f a m i l y i s s u e s . A warm empathetic a t t i t u d e held by the c o u n s e l l o r w i l l c o n t r i b u t e g r e a t l y to the c l i e n t ' s w i l l i n g n e s s to share t h e i r f e e l i n g s and p e r c e p t i o n s . In order to c r e a t e an atmosphere of mutual t r u s t and acceptance the c o u n s e l l o r must become aware of hidden (or unknown) p r e j u d i c e s he or she h o l d s . "When c o u n s e l l o r s are unable to deal with r e l e v a n t p e r c e p t i o n s r e l a t i n g to t h e i r own and the c l i e n t ' s ethnocu1tura 1 and r a c i a l i d e n t i t y , t h i s w i l l have an immediate, e s c a l a t i n g , and l a s t i n g d e t r i m e n t a l e f f e c t on the c o u n s e l l i n g r e l a t i o n s h i p . " ( C h r i s t e n s e n , 1985, p. 78). Thus, the understanding of others i n v o l v e s the understanding of o n e s e l f . When c o u n s e l l i n g EI Salvadorean people, there must be an understanding of the s i g n i f i c a n c e of the s p i r i t u a l b e l i e f s i n the c l i e n t ' s d a i l y l i f e . The church community p r o v i d e s s o l a c e and comfort, both s o c i a l l y and s p i r i t u a l l y f o r the p a r i s h i o n e r s . F a i t h i n God and D i s c u s s i o n 80 b e l i e f i n d i v i n e guidance and p r o t e c t i o n o f f e r s a s h e l t e r and i n s p i r a t i o n i n what may be an otherwise overwhelming s i t u a t i o n . The s p i r i t u a l a s p e c t s of the El Salvadoreans' l i v e s are a c e n t r a l theme i n t h e i r e x i s t e n c e and a c e n t r a l chord i n t h e i r community. F a i l u r e to understand the El Salvadorean s p i r i t u a l o r i e n t a t i o n would l i k e l y lead to a f a i l u r e i n understanding and acknowledging those coping s t r a t e g i e s which would prove most e f f e c t i v e f o r the c l i e n t . The c o u n s e l l o r who ignores the s p i r i t u a l , i s q u i t e p o s s i b l y i g n o r i n g the most b a s i c s t r a t e g y that the El Salvadorean c l i e n t r e l i e s upon on a d a i l y b a s i s . A second theme, the extended f a m i l y c o n s t e l l a t i o n , i s an important element i n the d a i l y l i f e of the El Salvadorean, and w i l l a f f e c t to what extent the i n d i v i d u a l El Salvadorean w i l l experience g r i e f and l o n e l i n e s s or support and sustenance. 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S i l v e r , R. L., & Wortman, C. B. (1980). Coping with u n d e s i r a b l e l i f e events. In J . Garber & M. E. P. Seligman (Eds.), Human he 1p1essness: Theory and  a p p l i c a t i o n s (pp. 279-348). New York: Academic Press. Singh, B. G., & Verma, 0. P. (1990). C u l t u r a l d i f f e r e n c e s i n locus of c o n t r o l b e l i e f s i n two Indian s o c i e t i e s . The Journal of S o c i a l Psycho 1ogy, 130(6), 725-729. References 89 Smith, E. M. J . (1985). E t h n i c m i n o r i t i e s : L i f e s t r e s s , s o c i a l support, and mental h e a l t h i s s u e s . The  C o u n s e l i ng P s y c h o l o g i s t . 13(4) , 537-579. Smi1ey, W. J . (1989). Sa1vadorean and Guatema1 an youth  i n e x i l e : Adapt i ng to 1i f e i n Canada. Unpublished master's t h e s i s , U n i v e r s i t y of B r i t i s h Columbia, Vancouver. S p i e l b e r g e r , C. D., & Diaz-Guerrero, R. (Eds.) . (1976). C r o s s - c u l t u r a l a n x i e t y . Washington, DC: Hemisphere Pub 1 i sh i ng . S t a t i s t i c s Canada, (1985). Immigration s t a t i s t i c s .  1985. Ottawa: Employment and Immigration Canada. S t a t i s t i c s Canada, (1990). Immigration s t a t i s t i e s ,  1990. Ottawa: Employment and Immigration Canada. S t e i n , B. N. (1986). The experience of being a refugee: I n s i g h t s from the r e s e a r c h l i t e r a t u r e . In C. L. W i l l i a m s & J . Westermeyer (Eds.), Refugee  menta1 hea1th i n resett1ement c o u n t r i e s (pp. 5-23) Cambridge, MA: Hemisphere P u b l i s h i n g . S t e i n g l a s s , P., Weisstub, E., & De-Nour, A. K. (1988). Pe r c e i v e d personal networks as mediators of s t r e s s r e a c t i o n s . American Journal of P s y c h i a t r y , 145(10), 1259-1264. Stone Bender, P., & Ruiz, R. A. (1974). Race and c l a s s as d i f f e r e n t i a l determinants of underachievement and u n d e r a s p i r a t i o n among Mexican-Americans and Anglos. Journal of Educationa1 Research. 68, 51-55. Sue, D. W., & Sue, D. (1990). Counseling the c u l t u r a l 1 y  d i f f e r e n t (2nd ed.). New York: John Wiley & Sons. Undurraga, M. S. (1984). D e s c r i p c i o n de l a e x p e r i e n c i a del t r a s p l a n t e y a l i n t e g r a c i o n a l a sociedad Canadiense de un grupo de mujeres p r o v e n i e n t e s de p a r s e s 1 atinoamericanos [ D e s c r i p t i o n of the experience of the t r a n s p l a n t e d and the i n t e g r a t i o n i n t o the Canadian s o c i e t y , by a group of women from L a t i n American c o u n t r i e s ] . In Berdichewsky, B. (Ed.) , Latinoamericanos en 1 a Columbia B r i t a n i c a [ L a t i n Americans i n B r i t i s h Columbia] (pp. 151-168). Vancouver: L a t i n American Action-Research Centre (LARC). Van Tran, T., Wright, R. J r . , & Mindel, C. H. (1987). A l i e n a t i o n among Vietnamese refugees i n the United References 90 S t a t e s : A causal approach. Journa1 of S o c i a l S e r v i c e  Research. 11. 59-75. Vega, W. A., Kolody, B., V a l l e , J . R., & Hough, R. (1986). Depressive symptoms and t h e i r c o r r e l a t e s among immigrant Mexican women i n the United S t a t e s . S o c i a l S c ience and Med i c i ne. 22, 645-652. Westermeyer, J . (1986). M i g r a t i o n and psychopatho1ogy. In C. L. Wi l l i a m s & J . Westermeyer (Eds.), Refugee  menta1 hea1th i n resett1ement c o u n t r i e s (pp. 39-59). Cambridge, MA: Hemisphere P u b l i s h i n g . Westmeyer, J . (1988). A matched p a i r s study of dep r e s s i o n among Hmong refugees with p a r t i c u l a r r e f e r e n c e to p r e d i s p o s i n g f a c t o r s and treatment outcome. S o c i a l P s y c h i a t r y and P s y c h i a t r i c  Epidemiology 23, 64-71. Westwood, M. J . , & Lawrence, S. (1990). Uprooted: Towards a c o u n s e l l o r understanding of the refugee exp e r i e n c e . I n t e r n a t i o n a l JournaI f o r the  Advancement of C o u n s e l l i n g . 13. 145-153. W i l l i a m s , C. L., & Westermeyer, J . (1986). Refugee menta 1 hea 1 th in. r e s e t t 1 ement c o u n t r i e s . Cambridge, MA: Hemisphere P u b l i s h i n g . 91 APPENDIX A Cover Letter and Consent Form (English Version) Spanish Version 94 APPENDIX B Cawte's Spanish Stress Inventory Scale (1972) Version 95 HEALTH RELATED QUESTIONS Please answer YES or NO to each of the following questions by c i r c l i n g the appropriate l e t t e r . 1. Do you have pains i n the heart or chest? Y N 2. Do you usually belch a l o t a f t e r eating? Y N 3. Do you constantly s u f f e r from bad constipation? Y N 4. Do your muscles and j o i n t s constantly f e e l s t i f f ? Y N 5. Is your skin very s e n s i t i v e or tender? Y N 6. Do you s u f f e r badly from severe headaches? Y N 7. Do you often have s p e l l s of severe dizziness? Y N 8. Do you usually get t i r e d and exhausted in the morning? Y N 9. Do you wear yourself our worrying about your health? Y N 10. Do you usually have great d i f f i c u l t y in f a l l i n g asleep or staying asleep? Y N 11. Do strange people or places make you a f r a i d ? Y N 12. Do you wish you always have someone at your side to advise you? Y N 13. Do you usually f e e l unhappy and depressed? Y N 14. Do you often wish you were dead and away from i t a l l ? Y N 15. Does worrying c o n t i n u a l l y get you down? Y N 16. Are you extremely shy or s e n s i t i v e ? Y N 17. Does i t make you angry to have anyone t e l l you what to do?Y N 18. Do people often annoy or i r r i t a t e you? Y N 19. Do you often shake or tremble? Y N 20. Do you often break our i n a cold sweat? Y N (Cawte's Stress Inventory Scale, 1972) 96 CUESTIONARIO PREGUNTAS RELACIONADAS CON LA SALUD Por fa v o r c o n t e s t e SI o NO a cada de l a s s i g u i e n t e s preguntas poniendo un c i r c u l o en l a l e t r a apropiada. 1. Tiene Ud. d o l o r en e l pecho o en e l corazon? SI NO 2. Acostumbra a e r u c t a r despues de l a s comidas? SI NO 3. S u f r e Ud. constantemente de e s t r e n i m i e n t o severo? SI NO 4. S i e n t e constantemente sus musculos y a r t i c u l a c i o n e s r i g i d a s o i n f l e x i b l e s ? SI NO 5. Es su p i e l muy s e n s i b l e o d e l i c a d a ? SI NO 6. S u f r e Ud. de f u e r t e s d o l o r e s de cabeza? SI NO 7. Ha te n i d o Ud. ataques de mareos f u e r t e s ? SI NO 8. Acostumbra a e s t a r cansado/a o se s i e n t e exhausto/a por l a s mananas? SI NO 9. La preocupacion por su salud l e cansa? SI NO 10. Acostumbra a tener grandes d i f i c u l t a d e s en c o n c i l i a r e l sueno o quedarse dormido/a? SI NO 11. Personas o lugares extranos l e hacen s e n t i r miedo? SI NO 12. Desea Ud. siempre tener a a l g u i e n a su lado dandole consejos? SI NO 13. Acostumbra a s e n t i r s e i n f e l i z o deprimido/a? SI NO 14. A menudo ha deseado e s t a r muerto/a y l e j o s de todo? SI NO 15. Le desinaman sus constantes preocupaciones? SI NO 16. Es Ud. extremadamente timido o impresionable? SI NO 17. Le enoja a Ud. tener a a l g u i e n que l e d i g a lo que t i e n e que hacer? SI NO 18. Es f r e c u e n t e que l a s personas l e molesten o l e i r r i t e n ? SI NO 19. Tiembla o se estremece Ud. a menudo? SI NO 20. Acostumbra Ud. a tener sudores f r f o s ? SI NO (Cawte, 1972) APPENDIX C Levensen's Internal, Powerful Others, and Chance Locus of Control Scale (1974) (Adapted English Version) Spanish Version Your Impressions of L i f e 98 Please read each statement c a r e f u l l y . Then ind i c a t e the degree to which you agree or disagree by placing a check-mark under the appropriate heading, between Strongly disagree and Strongly agree. There are no r i g h t and wrong answers. GIVE YOUR OPINION ON EVERY STATEMENT. If you f i n d that the descriptors do not adequately r e f l e c t your own opinion, use the one that i s c l o s e s t to the way you f e e l . STRONGLY DISAGREE SLIGHTLY SLIGHTLY AGREE STRONGLY DISAGREE SOMEWHAT DISAGREE AGREE SOMEWHAT AGREE 1. Whether or not I get to be a leader depends mostly on my a b i l i t y . 2. To a great extent my l i f e i s c o n t r o l l e d by a c c i d e n t a l happenings. 3. I f e e l l i k e what happens i n my l i f e i s mostly determined by powerful people. 4. Whether or not I get into a car accident depends mostly on how good a d r i v e r I am. 5. When I make plans, I am almost c e r t a i n to make them work. 6. Often there i s no chance of protecting my personal i n t e r e s t from bad luck happenings. 7. When I get what I want, i t ' s us u a l l y because I'm lucky. (Adapted from Levenson, 1974) 99 STRONGLY DISAGREE DISAGREE SOMEWHAT SLIGHTLY DISAGREE SLIGHTLY AGREE AGREE SOMEWHAT STRONGLY AGREE 8. Although I might have good a b i l i t y , I w i l l not be given leadership r e s p o n s i b i l i t y without appealing to those i n positions of power. 9. How many friends I have depends on how nice a person I am. 10. I have often found that what i s going to happen w i l l happen. 11. My l i f e i s c h i e f l y c o n t r o l l e d by powerful others. 12. Whether or not I get into a car accident i s mostly a matter of luck. 13. People l i k e myself have very l i t t l e chance of prot e c t i n g our personal i n t e r e s t s when they c o n f l i c t with those of strong pressure groups. 14. It's not always wise for me to plan too f a r ahead because many things turn out to be a matter of good or bad fortune. 15. Getting what I want requires pleasing those people above me. 16. Whether or not I get to be a leader depends on whether I'm lucky enough to be i n the ri g h t place at the r i g h t time. 17. I f important people were to decide they didn't l i k e me, I probably wouldn't make many f r i e n d s . 100 STRONGLY DISAGREE SLIGHTLY SLIGHTLY AGREE STRONGLY DISAGREE SOMEWHAT DISAGREE AGREE SOMEWHAT AGREE 18. I can pre t t y much determine what w i l l happen in my l i f e . 19. I am us u a l l y able to protect my personal i n t e r e s t s . 20. Whether or not I get into a car accident depends mostly on the other d r i v e r . 21. When I get what I want, i t ' s us u a l l y because I worked hard for i t . 22. In order to have my plans work, I make sure that they f i t in with the desires of people who have power over me. 23. My l i f e i s determined by my own actions. 24. I t ' s c h i e f l y a matter of fate whether or not I have a few frie n d s or many f r i e n d s . * * * 101 Appendix C SUS IMPRESIONES DE LA VIDA Por f a v o r l e a cada pregunta cuidadosamente. Despues indique el grado en e l cual Ud. e s t a de acuerdo o en desacuerdo, marcando con un cheque ( •/ ) en e l apropiado encabezamiento e n t r e TOTALMENTE EN DESACUERDO y ABSOLUTAMENTE DE ACUERDO. No hay respuesta c o r r e c t a o equibocada. DE UD. SU OPINION SOBRE TODAS LAS PREGUNTAS. S i sus d e s c r i p c i o n e s no r e f l e j a n adecuadamente b i e n sus p r o p i a s o p i n i o n e s , use una que en su forma de s e n t i r Ud. l a c o n s i d e r a mas c e r c a . TOTALMENTE EN UN POCO DE UN POCO DE ABSOLUTAMENTE EN DESACUERDO DESACUERDO DESACUERDO DE ACUERDO ACUERDO DE ACUERDO S i consigo o no ser un 1ider depende mayormente de mi hab i 1 i d a d . En gran p a r t e mi v i d a e s t a c o n t r o l a d a por acontecimientos acc identa1es. 3. Yo s i e n t o que lo que pasa en mi v i d a e s t a determinado mayormente por personas poderosas. 4. S i yo tengo o no un a c c i d e n t e en c a r r o depende mayormente de que tan buen m o t o r i s t a soy yo. Cuando yo el a b o r o planes, yo estoy c a s i seguro de hacer que e l l o s salgan b i e n . A menudo no tengo oportunidad de proteger mis i n t e r e s e s personates c o n t r a acontecimientos de mala s u e r t e . Cuando yo consigo lo que yo q u i e r o , es porque generalmente tengo s u e r t e . 102 TOTALMENTE EN UN POCO DE UN POCO DE ABSOLUTAMENTE EN DESACUERDQ DESACUERDO DESACUERDO DE ACUERDO ACUERDO DE ACUERDO 8. Aunque yo sea bi e n capaz, no me sera otorgado un cargo de responsabi1idad s i n a p e l a r a e s t o s en p o s i c i o n e s de poder. 9. El numero de amigos que yo tenga depende cuan buena persona soy yo. 10. A menudo he pensado que lo que vaya a pasar, pasara, 11. Mi vi d a e s t a mayormente c o n t r o l a d a por o t r o s que son poderosos. 12. S i yo tengo o no un a c c i d e n t e a u t o m o v i 1 i s t i c o depende de l a su e r t e . 13. Personas como yo t i e n e n poca oportunidad proteger sus i n t e r e s e s personates cuando estan en c o n f l i c t o con l o s i n t e r e s e s de f u e r t e s grupos de enorme p r e s i o n . 14. No siempre es a c o n s e j a b l e para mi planear cosas con desamasiada a n t i c i p a c i o n porque muchas cosas pasan debido a buena o mala s u e r t e . 15. Conseguir l o que yo q u i e r o r e q u i e r e que yo sea amable con l a s personas que estan por encima de mi. 16. S i yo consigo o no ser un 1ider depende de s i yo tengo l a s u f i c i e n t e s u e r t e de e s t a r en e l lugar c o r r e c t o en e l momento adecuado. 17. S i personas importantes d e c i d i e r a n que yo no l e s gustaba, probab1emente yo no h a r i a muchos amigos. 103 TOTALMENTE EN UN POCO DE UN POCO DE ABSOLUTAMENTE EN DESACUERDO DESACUERDO DESACUERDO DE ACUERDO ACUERDO DE ACUERDO 18. Yo puedo determinar bastante, lo que pasara en mi vida. 19. Yo acostumbro a poder p r o t e g e r mis i n t e r e s e s personates, 20. S i tengo o no un a c c i d e n t e a u t o m o v i 1 i s t i c o depende mayormente del o t r o m o t o r i s t a . 21. Cuan yo obtengo lo que yo q u i e r o , es porque generalmente t r a b a j e duro para e l l o . 22. Para c o n s e g u i r que mis planes se r e a l i z e n , tengo que asegurarme que c o i n c i d a n con 1os deseos de l a gente que t i e n e poder sobre mi. 23. Mi v i d a e s t a determinada por mis p r o p i a s a c c i o n e s . 24. S i yo tengo unos pocos o muchos amigos se debe en gran p a r t e a l d e s t i n o . (adapted from Levensen, 1974) APPENDIX D Demographic Questionnaire/ Open—Ended Questions Spanish Version BACKGROUND INFORMATION PLEASE ANSWER EACH QUESTION. 1. M a l e o r F e m a l e 2. D a t e o f b i r t h : (M) ( Y ) 3. A r e y o u : M a r r i e d W i d o w e d D i v o r c e d S i n g l e S e p a r a t e d Common Law_ 4. Do y o u h a v e f a m i l y m e m b e r s h e r e w i t h y o u ? F a t h e r M o t h e r W i f e H u s b a n d S i s t e r s B r o t h e r s D a u g h t e r s S o n s O t h e r s • 5. O c c u p a t i o n i n y o u r home c o u n t r y 6 . O c c u p a t i o n p r e s e n t l y 7. T o t a l y e a r s o f s c h o o l : 8. H i g h e s t l e v e l r e a c h e d i n s c h o o l 9. What l e v e l o f E n g l i s h l a n g u a g e p r o f i c i e n c y d o y o u f e e l y o u h a v e ? a) I c a n s p e a k E n g l i s h w e l l . b) I c a n s p e a k E n g l i s h a l i t t l e . c ) I c a n n o t s p e a k E n g l i s h a t a l l . d) I c a n r e a d a n d w r i t e E n g l i s h w e l l . e ) I c a n r e a d a n d w r i t e E n g l i s h a l i t t l e . f ) I c a n n o t r e a d o r w r i t e E n g l i s h a t a l l . 10. D a t e o f a r r i v a l i n C a n a d a : (M) ( Y ) P L E A S E ANSWER T H E FOLLOWING Q U E S T I O N S AS B E S T AS YOU CAN. P L E A S E WRITE YOUR ANSWERS C L E A R L Y . 107 Appendix D INFORMACION PERSONAL POR FAVOR CONTESTE CADA UNA DE LAS SIGUIENTES PREGUNTAS. 1. Masculino o Femenino 2. Fecha de nacimiento: (MES) (ANO) 3. Es Ud . : Casado/a Viudo/a Di vorc iado/a Sol t e r o / a Separado/a Acompanado/a 4. Tiene a miembros de su f a m i l i a con Ud. aq u i ? : Padre Mad re Esposa Esposo Hermanas Hermanos Hi jas Hi jos Otros 5 . Trabajo en su p a i s de o r i g e n 6. Traba jo a c t u a l _ 7. Cuantos anos estuvo en l a e s c u e l a : 8 . Cual fue e l grado e s c o l a r mas a l t o que Ud. obtuvo 9. Cual es su conocimiento del idioma i n g l e s ? : a) Puedo h a b l a r i n g l e s b i e n . b) Puedo hablar un poco de ingle's. c) No puedo h a b l a r nada de i n g l e s . d) Puedo l e e r y e s c r i b i r i n g l e s b i e n . e) Puedo l e e r y e s c r i b i r i n g l e s un poco. f) No puedo l e e r ni e s c r i b i r nada en i n g l e s . 10. Fecha que Ud. l l e g o a Canada: ( MES) ( ANO) POR FAVOR CONTESTE LAS SIGUIENTES PREGUNTAS LO MEJOR QUE PUEDA. POR FAVOR ESCRIBA CLARAMENTE LAS RESPUESTAS. 

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