Arts, Faculty of
Social Work, School of
DSpace
UBCV
Holley, Ute
Master of Social Work - MSW
University of British Columbia
Mediating variables in the etiology of depression in mothers of preschool children have been the focus of numerous investigations since Brown, Brolchain, and Harris (1975) identified that women with a child under the age of six have a high prevalence of depression. The question that remains is why not all mothers suffer from depression under similar sets of social circumstances. Coping behaviors have been identified as one of the mediators between life strains and health status and the relationship of coping and depression remains to be an important concept in treatment and prevention of depression. A group of sixty-three mothers with at least one preschool child age five and under voluntarily completed a sociodemographic questionnaire, a self-report depression scale, and a coping disposition measure. Results indicated a significant negative linear relationship between depression and coping disposition. As depression scores increased coping disposition decreased, and inversely depression scores decreased as coping disposition increased. Findings suggest that a re-examination of present social policies and a renewed look at treatment and prevention strategies of depression in mothers of preschool children are in order.
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Depression and Coping disposition among Mothers of Preschoolchildren in the downtown EastsidebyUte HolleyB.S.W. The University of Calgary, 1988A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THEREQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WOREinTHE FACULTY OF GRADUATE STUDIESSchool of Social WorkWe accept this thesis as conforming to the required standardTHE UNIVERSITY OF BRITISH COLUMBIAApril, 1992© Ute HolleyIn presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(SignatureDepartment of Soc,,:xj. LIQ(eThe University of British ColumbiaVancouver, CanadaDate -A ^I cl al eZ . DE-6 (2/88)Depression and Coping disposition among Mothers of Preschoolchildren in the downtown Eastside.AbstractMediating variables in the etiology of depression inmothers of preschool children have been the focus ofnumerous investigations since Brown, Brolchain, and Harris(1975) identified that women with a child under the age ofsix have a high prevalence of depression. The question thatremains is why not all mothers suffer from depression undersimilar sets of social circumstances. Coping behaviors havebeen identified as one of the mediators between life strainsand health status and the relationship of coping anddepression remains to be an important concept in treatmentand prevention of depression. A group of sixty-threemothers with at least one preschool child age five and undervoluntarily completed a sociodemographic questionnaire, aself-report depression scale, and a coping dispositionmeasure. Results indicated a significant negative linearrelationship between depression and coping disposition. Asdepression scores increased coping disposition decreased,and inversely depression scores decreased as copingdisposition increased. Findings suggest that a re-examination of present social policies and a renewed look attreatment and prevention strategies of depression in mothersof preschool children are in order.iiTABLE OF CONTENTSPAGETitle Page^Abstract iiTable of Contents^List of TablesAcknowledgements^ viChapter I:^Introduction^ 1Chapter II:^Literature Review 5Role of Mothers^ 13Depression Studies 17Chapter III: Method^ 25Introduction 25Sampling design^ 25Data collection procedures^ 25Sites^ 25Measures 26Data Analysis^ 28Limitations of study^ 29Chapter IV: Results 30Population Profile^ 30Chapter V:^Discussion 37Summary 43References^ 46iiiAppendices:Appendix A.Appendix B.Appendix C.Appendix D.Appendix E.Appendix F.Sociodemographic Questionnaire^ 59The Center for Epidemiologic^ 61Studies Depressed Mood ScaleThe Sense of Coherence^ 63QuestionnaireSubject Consent Form^ 70Agency Consent Letter 73UBC Behavioral Sciences^ 75Screening Committee ApprovalCertificateivTablespageTable 1 Means and Standard Deviations of^ 34Selected Characteristics of MothersTable 2 Results of Ordinary Least Squares^ 35Equation for Predictor Variables ofDepressionVAcknowledgementThis work is dedicated to the sixty-seven mothers who madethis investigation possible.Special Thanks to the Staff of Crabtree Corner,Dr. Sharon Manson-Wilims, John, Marc, and Matthew.v iChapter IIntroductionIn examining social class and depression among womenBrown, Bhrolchain, and Harris (1975) identified workingclass women with a child under the age of six have a highprevalence of depression. They isolated four vulnerabilityfactors preceding onset of psychiatric disturbance:experience of a severe life event, lack of full- or part-time employment, having three or more children aged 14 orunder at home, loss of mother by death or separation beforethe age of 11, and lack of an intimate relationship.Similar high rates of depression in mothers were reported ina behavior study of preschool children (Richman, Stevenson,and Graham, 1982). Mediating variables identified were: apoor marriage, behavior problems in children, housingconditions, more than three stressors, and five or morechildren at home (Richman, 1978). Moss and Plewis (1977)found no social effect in depression but a breakdown ofdistress ratings found non-married mothers suffered fromhigher levels of distress than their married counterparts.Research continues to focus on the correlates of maternaldepression as it effects well-being of children (Rutter,1990) but reported results indicate inconsistent outcomes(Bromet et al., 1982).Several intermediary variables have been identified inthe etiology of depression and future inquiries need to1further present understanding of why not all mothers insimilar sets of social circumstances suffer from depression(Miller, 1982).coping behaviors have been identified as mediatingfactors between life strains and health (Dohrenwend andDohrenwend, 1973).Coping has a variety of definitions and this study usesthe definition of Menaghan (1983, p. 162) who states:Stress may be defined as perceived mismatchbetween environment and self, coping embracesactions to reduce that mismatch (directly or byaltering the interpretation of environment orself), to avoid or manage associated emotionaldistress, and to maintain or enhance the overallsense of self.Stress is manageable when coping resources are wellutilized and varied (Coyne, Aidwin, and Lazarus, 1981;Pearlin and Schooler, 1978). The need for well developedmeasurements of coping strategies has been documented(Holahan and Moos, 1986; Folkman and Lazarus, 1980).Billings and Moos (1982) suggest that depression-related outcomes of stressful life circumstances areinfluenced by the individuals' personal and environmentalresources as well as by their appraisal and copingresponses.Rotter (1966) proposes that individuals differ in howthey perceive environmental reinforcers to be under theirpersonal control. Individuals who are internals perceivethese events as being under their control, and persons whoare externals see reinforcers as being the result of fate,luck, and chance.Folkman and Lazarus (1984) have conceptualized copingas a transactional, reciprocal process between theindividual and the environment that consists of appraisaland coping. Stress arises only after there has been anindividual cognitive appraisal of a "lack of fit" betweenperceived demands and the perceived capability of meetingthese. Effective coping reduces or eliminates stresswhereas ineffective coping results in intensified stress(Lazarus and Folkman, 1984).Antonovsky (1988) has focused on understanding copingin examining how individuals cope with universal stress andstill do well. On the basis of this research he developedthe orientation to life questionnaire based on the "sense ofcoherence" concept (SOC). The sense of coherence is acoping disposition orientation. The SOC or copingdisposition is defined as (1) Comprehensible - that stimulideriving from one's internal and external environments inthe course of living are structured, predictable andexplicable, (2) Manageable - the resources are available toone to meet the demands posed by these stimuli, and (3)Meaningful - these demands are challenges worthy ofinvestment and engagement (Antonovsky, 1988, p. 19). Thesethree components are inextricably intertwined. Rather thanidentifying specific stresses he introduces a unifiedconcept of "generalized resistance resources-resistancedeficits" (GRR-RD). In each individual "wealth, ego-strength, cultural stability, and so on are GRR-RD'S" (p.20) and these may be ranked on a continuum. The higher on acontinuum the more likely it is that one will have lifeexperiences that are conducive to a strong SOC. In contrastthose individuals with fewer GRR-RD'S are likely to haveexperiences that will render a weak SOC. A strong sense ofcoherence is essential to health maintenance.The understanding of a relationship between coping anddepression remains to be an important concept in thetreatment and prevention of depression. This investigationwill focus on the relationship between depression and copingdisposition in mothers of preschool children.4Chapter IILiterature ReviewAn important observation made in the study ofdepression is that rates of depression in every age group ofwomen are higher than in men (Weissmann and Rlermann, 1979).In a review of the rates of depression in the United Statesbetween 1936 and 1973 the rate of depression occurring inwomen was twice the rate as that in men. Since rates oftreated cases do not necessarily reflect the prevalence ofdepression in the community, Weissmann and Rlermann (1979)further examined the outcomes of various community surveys.The same existing trend was identified within communities.Several theoretical frameworks have been generated toexplain the etiology of depression. The following sectionwill provide an overview of the various theoreticalexplanations for the genesis of depression. According toFreud, depression is a pathological reaction to a loss. Heargued that the over-involvement and ambivalence between theego and a lost love object leads to difficulties inresolving a loss. The loss of an object then becomes an egoloss which results in a lowered self-esteem and self-regard.The ambivalence between the ego and object is transformedinto an intra-psychic conflict (Corob, 1987).Psychoanalytic theory has been criticized for its limitedperspective of psychological difficulties (Szasz, 1961), andfor a masculine bias (Harney, 1926). The similarities that5are drawn between feminine qualities and depression areevident in psychoanalytic literature (Feldman, 1983).Learned helplessness theory is based on investigationsconducted by Seligman (1975). Seligman directed laboratoryexperiments in which he discovered, both in animals andhumans, that if they were repeatedly exposed to unpleasantstimuli outside of their control they eventually learnedthat they were helpless. In later tests the subjectsremained passive and did not attempt to gain control insituations. Learned helplessness results when individualsbelieve that the outcome of a situation is independent oftheir response to it. Seligman drew on the similaritiesbetween learned helplessness and depression. He proposesthat individuals who are not permitted to have some controlin their environment in their developmental years are morelikely to react to situations with a learned helplessness inadulthood. Due to widespread criticism that thistheoretical framework did not address individual differencesSeligman introduced a cognitive component (Abramson at al.,1978). The reformulated hypothesis states that:When people find themselves helpless, theyimplicitly or explicitly ask why they arehelpless. The causal attributions they makeinfluence the generality and chronicity of thehelplessness deficits as well as later self-esteem (Abramson, Garber, and Seligman, 1980, p.5).Depression results from the expectation of helplessnesscombined with the tendency to attribute negative events to6internal, stable, and global causes. Depression ensues whenindividuals believe that their helplessness is their ownfault (internal attribution), that they will be helpless fora long time (stable attribution), and that they will behelpless in a wide range of situations (global attribution),(Abramson, Garber, and Seligman, 1980). Findings indicate acorrelation between depression and styles of attribution butdo not explain causality (Galin, Sweeney, and Shaeffer,1981).Aaron Beck (1967, 1976) developed a cognitive model ofdepression on the basis of clinical studies. Patients werefound to be depressed when they acquired learnedmisconceptions about themselves, of the world, and thefuture and that this cognitive triad perpetuated depression(Beck, 1961, 1963). Cognitive structures or schemasoriginate in childhood and represent a person'sgeneralization about past experiences. Consequently,schemas determine the manner in which information isperceived, remembered, and later recalled. schemas arelargely inactive during asymptomatic periods but becomeactivated with the onset of depression. Necessaryconditions need be in place for the activation of negativeschema; conditions being defined as stress. It is whenthese schemas are evoked that they mould thought content,and lead to typical depressive feelings.7As the depression deepens, these schemasincreasingly dominate the cognitive processes,displace more appropriate schemas but also disruptthe cognitive processes that are involved inmaintaining self-objectivity and reality testing(Beck, 1967, p. 290).Beck's theory has found support in several investigations(Lewinsohn et al., 1981; Gotlieb, 1981; Hollon and Kendall,1980). Cognitive theory does not address social influenceswhich may assist or hinder in maintaining positive, mentalhealth. The focus tends to be exclusively on personaladjustment and not all problems can be dealt with at apersonal level. An example of a lack of social influence isa study comparing control, cognitive, and behavior therapygroups in the reduction of depression in low-income PuertoRican women. A five-week follow-up assessment revealed thatalleviation of depression had been maintained, with a slightadvantage for the behavioral approach. The differences inoutcome were attributed to mode of treatment. The cognitivetherapy group focused on the idea that depression is causedby distorted negative cognitions/expectancies, clients weretaught to challenge and modify these, and the importance ofcontrol over important outcomes was emphasized. Theinvestigators conclude that minority individuals may facesituations where they do indeed lack control over events(Comas-Diaz, 1981).Behaviorist theory is based on a tension reductionmodel of human behavior. The focus is on the concept ofreinforcement of behavior and environmental factors as8reinforcers are considered within the framework (Hammen,1989). Behaviorists consider depression to be the result ofa decrease of positive reinforcements in an individual'slife. The reduction of reinforcers may be the result ofenvironmental changes such as the loss of a loved one or alack of social skills (Lazarus, 1968). Depression ispredictive when there is little possibility that theindividual's behavior will be followed by positivereinforcement and there is a good probability that theperson will be positively reinforced when he does notexhibit the behavior. Depressed persons are lacking insocial skills, and thereby do not receive positivereinforcement from others (Lewinsohn, 1974; Lewinsohn atal., 1980). Ferster (1974) proposes that it is not only thefrequency of positive reinforcement but also the schedule ofreinforcements that are apt to produce depression. Hesuggests that a young executive is less likely to bestressed due to a variable reinforcement schedule than ahousewife who performing in a standard routine wherereinforcements are predictable and therefore less rewarding.The possibility of a genetic factor playing a role indeveloping depression has further intrigued research.Evidence indicates an:increased morbid risk of affects disorder in thefirst degree relatives of diagnosed patients ascompared with the general population and a higherconcordance rate for affects disorders inmonozygotic and dizgotic twins (Weissmann andKlermann, 1979, p. 398).9In view of these findings there is some indication thatpoints to a correlation between genetic disposition anddepressive illness. A more specific elucidation for thehigh rate of occurrence of depression in women has beenreferred to as the X-linkage theory (Weissman and Klermann,1979). This theory suggests that depression is located onthe X chromosome and if it is dominant then females havingtwo X chromosomes are more likely to be affected. Theresults of these studies have been contrary (Weissman andElermann, 1979).In psychiatry there has been a widespread interest inidentifying a link between female sex hormones anddepression. Some of the areas investigated have been pre-menstrual tension, the effect of the use of oralcontraceptives, postpartum depression, and menopause. Thereis a lack of conclusive evidence that suggest a directrelationship between hormonal structures of women anddepression (Klerman and Weissman, 1980; Penfold and Walker,1983, Steiner, 1979).Pharmacological research has resulted in aneurochemical theory of depression. The amine hypothesis ofaffects disorders proposes that there is a functionaldeficit of one or more brain neurotransmitter amines atspecific central synapses. These synapses in specific brainareas are related to vegetative and regulatory behavior.Norepinephrine, dopamine, and serotonin are the10neurotransmitter amines regulating the flow of impulses inthese brain areas.^Complex processes are involved insynthesizing, storing, releasing, re-utilizing, andmetabolizing the amine neurotransmitters. The neurochemicalpostulate has found support in research conducted with adrug called reserpine. In the treatment of hypertensionwith reserpine, a large number of patients became depressedand reserpine depleted sertonin and norepinephrine in thebrain. Monoamine oxidase inhibitor drugs are capable ofelevating brain amine levels and in animals treatment withmonoamine oxidase could inhibit or reverse symptoms ofdepression caused by reserpine (Weissmann and Klermann,1980).Psychosocial explanations for depression have focusedon the disadvantaged social status of women. For example,Gove (1972) in a study of mental illness among marriedwomen, single women, and married men found that mentalillness was more common among married women. He concludesthat depression in wives is due to role restraint. Menoccupy two roles, one as a household head and the other of awage earner, and both of these roles provide a sense ofgratification. Married women on the other hand have onlyone source of gratification which is the role of housewife.Downey and Moen (1987) found that multiple roles promotedpsychological health in women. However it was not role ofemployment that increased psychological well-being but theincome it produced. Although this theory addresses the11social and cultural role of women in North American societyit does not account for why not all unemployed, marriedwomen are depressed.Brown and Harris (1978) in identifying a link betweenwomen's daily experiences and depression found that in 83%of women traumatic life events or major ongoing difficultiespreceded depression. These "provoking events" dealt withthe experience of a loss or disappointment of a person,role, object, or an idea. They propose that loss events area deprivation of sources of value or reward. What becomesimportant about the loss is that it may lead to an inabilityto have good thoughts about oneself, and a loss of faith inone's ability to attain an important and valued goal. Theimmediate response to the loss of an important source ofpositive value is likely to be a sense of hopelessnessaccompanied by a range of feelings. A person's sense ofmastery is crucial in determining whether the hopelessnessbecomes generalized. In other words, the perception of theindividual's world is what eventually leads to depression.If an individuals perceives that there are alternativesavailable the loss will be resolved and depression will beavoided. It is only in the case of where a loss is notresolved and a specific hopelessness becomes generalizedthat depression occurs. Brown and Harris (1978) do notsuggest that the physical basis of depression should beignored but propose that these functions may be a dependentrather than an independent variable.12Physical, emotional, behavioral, cognitive, and socialfactors have been utilized to explain reason for depression.Gruber (1974) states:It is a serious error to suppose that the mainfeatures of a complex idea are adequatelycharacterized by the more elementary ideas whichmake it up. If that were the case, the discoveryof a new component idea and its introduction intoa theoretical structure would always be the mostprominent kind of event in the growth of thecomplex structure.In fact, however, very profound changes in thenature of a complex idea may depend mainly on therearrangement of its components to form a newstructure (p. 156).The intricacy of constructing a complex idea is evidenced bythe numerous investigations of depression in mothers ofyoung children.Role of MothersMothers with young children have particularly highrates of depression. Brown at al. (1975) found that 42% ofworking-class women with children under the age of six hadexperienced an affective disorder where middle-class womenand working-class women without young children at home hadlower rates of depression. In a survey of mothers ofpreschool children living in London, England, 52 percent ofwomen had moderate to severe mental distress over theprevious 12 months (Moss and Plewis, 1977). In correlatingparental status and self-reported symptoms of depressionRadloff (1975) found that depression scores increased as13children's age decreased.^Other researchers have drawnsimilar conclusions (Richmann, 1974, 1976, 1978; Berg etal., 1984; Brown, Harris, and Copeland, 1977; Mirowsky andRoss, 1989). What makes motherhood so depressing?The physical and emotional work of women in the homehas been termed "Motherwork" (Bernard, 1974, p. 116). Thiswork has several qualities. Mothering rests on theemotional and physical care of infants and children throughtouching, soothing, feeding, diaper-changing, bathing,supervising, smiling, teaching, playing, and disciplining.Boulton (1983) describes four factors that makemothering of preschoolers notably frustrating. Children inthis age group are immature both intellectually andsocially. They are limited in their ability to graspconcepts and their attention span is restricted. Childrenhave bound ability to express themselves rationally and tounderstand rational explanations. They have limitedcapacity to anticipate danger and are in need of constantsupervision. Children in this developmental stage are ego-centric and are unable to consider the needs of others.This makes parenting exceptionally demanding. As one womandescribes:With children, they need feeding when they needfeeding. Their nappies have to be washed everyday. It's as simple as that. When they cry youcan't say, ' Well I'll see you in an hour.' Thatis what hits you: the fact that it's seven days aweek, twenty-four hours a day, and they makethe rules (Boulton, 1983, p. 69).14Mothers often describe a loss of personal identity.Lopata (1971) addresses the limitations of activity on awoman's sense of individualism:The care of infants calls for repetitious action,isolation from interaction and intellectualstimulation and limitations of occasions todisplay a wide range of personality behaviors in avariety of social contexts which shows theuniqueness of self (p. 193).Mothering can be very isolating in that there are noco-workers to share the workload, to confer with, andprovide feedback (Blauner, 1964). She notes:The need for sheer activity, for socialintercourse, and for some status and identity inthe larger society keeps even unskilled workerson the job after they are economically free toretire (p. 31).Research has approached isolation to some extent bydrawing a comparison between mothers that are housewives andmothers that are employed. McCannell (1988) found thatwomen at home experienced greater difficulty in thetransition to motherhood as opposed to mothers who wereemployed on a full or part-time basis. This difference wasstatistically significant after a period of one year. Shesuggests that the rewards experienced through employment mayminimize the difficulties associated with parenting.Another possible explanation may be "that women who work arenot continuously exposed to the stress of child rearing andtherefore rate difficulties as being lower" (p. 102). Other15investigations have reported similar findings (Kessler andMcRae, 1982; Ferree, 1976, 1984; Downey and Moen, 1987).Preschool children may restrict their mother's socialand emotional support network because of their own emotionalneeds (Belle, 1980). Marital satisfaction decreases as thenumber of young children in a family increase (Pleck, 1983),and husbands are less likely to be a confidante (Brown andHarris, 1978).The traditional role of housewife and mother who is notemployed outside the home is stressful (Gove and Tudor,1973). A mother with two preschool children spends 38 hourson housework and 70 hours on childcare tasks. Overall herworking hours are 98 hours a week (Rome, 1982; Mitchelson,1985) and the connection between housework and mental well-being has been examined (Oakley, 1974; Nairne and Smith,1984; Rosenberg, 1987; Boulton, 1983). Mothers still bearmost of the day-to-day responsibility for their children(Nye, 1976; Luxton, 1983; Bernardo, Shehan, and Leslie,1987).In identifying the various aspects of mothering thereoccurring theme is one of loss. There may be a loss offinancial independence, a loss of control, a loss of socialcontact, and a loss of personal identity. Parenting is alsovery stressful and stress within this context may be definedas a loss of control. If one considers the aspects ofmotherhood and the losses that are incurred by becoming amother then it is of little surprise that women suffer from16depression more than men but these deprivations do notexplain why all mothers do not suffer from depression.Shehan (1984) for example, found no significant differencesbetween employed wives and housewives in rates ofdepression, health anxiety, or life satisfaction.Depression StudiesPoverty has long been associated with poor mentalhealth (Hollingshead and Redlich, 1958; Liem and Liam, 1978;Canadian Mental Health Association, 1987) and generatesstress in other areas of life (Daniel, Hampton, andNewberger, 1983). Women who live alone with children andwho are disadvantaged by being poor are at increased risk ofdepression (Orr and James, 1984; Pearlin and Johnson, 1977;Guttentag, Salasin, and Belle, 1980). In comparingpsychiatric as well as social-economic functioning of singleversus married mothers Weissmann, Leaf, and Livingston(1987) found a higher rate of dysthymia among single-parentfamilies. Single parent women lacked the financialresources to meet basic needs and were more likely toreceive welfare. Mothers on welfare report that they do nothave an adequate amount of money to spend on food (Baxter,1988; National Council of Welfare, 1990; Ross andShillington, 1989).Mothers suffering from depression are young (Berg atal., 1984; Reis, 1989; Cox at al., 1987). Coletta (1983)studying symptoms of depression in young mothers found that1759% of adolescent mothers were rated as depressed ascompared to 21% of the individuals in the generalpopulation, and 48% of low-income mothers.Mothers with the least education suffer from higherrates of depression (Weissman, Leaf, and Livingston, 1987;Coletta, 1983). This in turn supports that mothers havedifficulty finding employment that enables them to becomeself-sufficient (Moore, 1978).Mothers that are poor live in inadequate housing(Richmann, 1978; Hall, Williams, and Greenberg, 1985).Medical and non-medical staff in a London teaching hospitalrated housing as the most frequent problem for women aroundthe time of childbirth (Puckering, 1989). Similarly inCanada "the majority of low-income women live in some of theworst accommodation: the oldest dwellings, and the leastadequate in terms of size and amenities" (Wekerle, 1988, p.104).Depressed women suffer from poor physical health(Berkman, 1969; Richmann, Stevenson, and Graham, 1982;Weissman, Leaf, and Bruce, 1987). Belle (1982) found in asample of 43 women 42% reported a physical problem thatrequired regular treatment, and 22% had two or more problemsthat required the regular attention of a physician.Maternal responsiveness and nurturing behaviorsdeteriorate as stress increases, particularly in mothersthat are depressed (Belle, 1982). Depression in mothers hasbeen positively correlated with punitive attitudes toward18childrearing (Sunman at al., 1985), lack of knowledge ofchild development (Reis, 1988), and poor quality ofparenting (Goodman and Brumley, 1990). Behavioral problemsare more common in preschool children (Williams andCarmichael, 1985; Richman, Stevenson, and Graham, 1982; Coxet al., 1987).The role that social networks play in mediatingdepression in mothers remains unclear (Thoits, 1982).Network size for non-working mothers is associated withsocial class and network size is drastically lower for non-working mothers in the lowest social class (Hammer,Gutwirth, and Philllips, 1982). A strong supportingnetwork, especially by the father is significant inpreventing depression (Williams and Carmichael, 1985). Thesupport of a spouse acts as a buffer to depression inmothers of preschool children (D'Arcy and Siddique, 1984)which in turn supports that depressed mothers report poormarital relationships (Bromet and Comely, 1984; Birtchnell,1988; Hall, Williams, and Greenberg, 1985). Individuals assources of support may also increase levels of stress(Belle, 1982). Social support may also have no effect onindividuals' well-being. A three year long study examiningthe relationship between stressful life events, socialsupports, and psychological functiong in mothers ofpreschool children found that although depressed mothersreported more problems they also reported more resources.The number of resources did not effect the health status of19depressed mothers when compared to well mothers with fewerresources (Goodman and Johnson, 1986).Employed mothers appear to be in better mental health(Weissman and Paykel, 1974; Warr and Parry, 1982) butemployment may only act as a buffer when it is appraised asbeing meaningful by the individual (Hock and DeMeis, 1990).Mirowsky and Ross (1989) using data of 680 husbands andwives found that nonemployed wives with young children hadsignificantly higher levels of depression than those withoutchildren. For employed wives difficulty in arranging childcare and husband's participation in parenting affectedpsychological well-being. The optimal combination was foundto be employment and motherhood where the care for the youngchildren was shared by the husband. Findings in this studyindicated that "When the social roles of husbands and wivesare similar, their depression levels are similar" (p. 106).Cultural factors play a significant role in themanifestation of depression. Williams and Carmichael (1985)identified that immigrant mothers who were unable to speakthe English language and lacked a supporting social networkhad significantly higher rates of depression thanAustralian-born mothers.Chronic depression has been noted in longitudinalstudies of mothers (Wolkind et al., 1980; Belle, 1982).several models of depression have attributed thatdepressed individuals differ in how they cope withenvironmental factors (Billings and Moos, 1982).20The development of Ratter's scale of internal-externalcontrol (Rotten, 1966) which measures personal control overenvironmental events has led researchers to investigate therelationship of control and depression. Johnson and Sarason(1978) examined the link of depression and locus of control,and found students with an external locus of control weremore depressed and experienced more negative life changes.The study supported that those individuals who experiencehigh levels of change but feel that they have no controlover events are most subject to depression. In a groupintervention for unipolar depression Steinmetz, Lewinson,and Antonuccio (1983) found that those individuals withgreater perceived control at pretreatment had a positivetreatment outcome whereas locus of control was notsignificant in explaining outcome variance in posttreatmentscores.Further analyses have focused on two general categoriesof coping reactions: those that are problem focused andthose that are emotion focused. Problem focused are thoseefforts made to deal with sources of stress by changingone's personal behavior or the environment, and emotionfocused coping refers to efforts utilized to reduceemotional distress (Folkman and Lazarus, 1984). Inidentifying coping responses Pearlin and Schooler (1978)found severe depression was associated with emotion copingresponses, and that this style of coping was more oftenutilized by women. In comparison those with less severe21dysfunction employed problem solving coping. Billings andMoos (1984) in a study of depressed men and women furthersupport these findings.In linking the role of social environmental factors tounipolar depression Billings and Moos (1983) found thatdepressed persons experienced more lifestrains with personalhealth, family relationships, home, and work situations ascompared to controls. Subsequent evidence implied thatspecific aspects of social support and coping processesinfluenced adjustment among depressed individuals. In alongitudinal study of 380 clinically depressed individualsFondacro and Moos (1987) found that increased support offamily members was related to problem-solving coping amongwomen. Conversely, a decrease of family support wascorrelated to a decrease in problem-solving strategies.Efforts to control stress-related emotions, verbalexpression of unpleasant emotions, and more indirect effortsto reduce tension such as smoking were not significantlyrelated to family support among women.Coyne, Lazarus, and Aidwin (1981) in an analysis of howdepressed men and women coped with stresses in everyday lifefound that depressed individuals scored higher on "wishfulthinking", emotional support-seeking but that they did notdiffer from non-depressed controls in the amount of problemfocused coping or self-blame they utilized.Post-treatment studies have focused on the relationshipbetween coping and depression in remitted and non-remitted22patients. For example, Billings and Moos (1985) in atwelve-month follow-up study of 424 patients examined thepost-treatment phase of remitted, partially remitted andnon-remitted patients. The non-remitted group was lower onself -esteem and used alcohol as a form of emotional coping.Patients whose depressive symptoms remitted reportedincreases in the quality of significant relationships,family support, and fewer negative events. In contrast non-remitted patients continued to lack in each domain. "Suchpatients participated less actively in family and socialroles, were less likely to be employed, and earned lessmoney" (p. 323). Non-remitted patients were more likely tohave problems associated with alcohol and this indicatesthat emotion focused coping may further complicate a alreadytroublesome situation.Barth, Schipke, and Maxwell, (1984/1985) utilized acoping skills training program for school-age mothers andindicate that cognitive and interpersonal skills of mothersincreased but mental health status remained the same.The strength of the relationship between coping anddepression remains obscure. Although findings indicatedepressed individuals utilize more emotion focused copingand lack internal control outcomes have not been consistent.The definitions and measurements of depression and copingvary, mediating psychosocial factors are assessed bydisparate scales and frequently are not all encompassing.23Methodology employed has salient influence on researchoutcome (Surtees and Rennie, 1983).Theoretical perspectives on depression have dealt withego loss, learned helplessness, learned misconceptions,genetic factors, neurochemical reactions, social-environmental elements, and behavioral reinforcers.Behavioral reinforcers may also play a role in thedevelopment of coping disposition. Bandura (1977)identified that individuals can learn not only throughreinforcement contingencies but also through sociallearning. Social learning occurs through the imitation andobservation of others. Coping disposition as described byAntonovsky (1988) is learned through the observation andimitation of individuals and through reinforcement ofbehaviors (Bandura, 1977).The sense of coherence questionnaire has not yet beenutilized with a population that may be at risk of depressionand this investigation will seek to answer the ensuingquestion: Is there a relationship between depression andcoping disposition in mothers of preschool children?24Chapter IIIMethodIntroductionA descriptive survey, employing three instruments, wasutilized with a disadvantaged urban core sample of 67mothers of preschool children in the downtown east-side ofVancouver.Sampling designThe survey was based on a non-random design and motherswith at least one preschool child age five and undervoluntarily participated in the study.Data collection proceduresMothers were approached individually and requested tocomplete three questionnaires. In the socio-demographicquestionnaire a number was entered into the name category asto identify the number of the questionnaire but also toprovide anonymity for mothers. All participants wereinformed that given information remain confidential.Data were collected for a two and a half week period,three times a week, beginning February 12 to March 26, 1991.SitesCrabtree Corner is a short-term and emergency daycarecenter and 90 to 100 children use this service on a monthlybasis (Crabtree Corner-Monthly Statistical Report, 1991).The Vancouver foodbank was selected as a second sitefor data collection. The foodbank has designated Tuesdays25as a foodbank day for single parents with children age fiveand under and as it had been noted that a large majority ofsingle mothers utilized the daycare center the selection ofthis site was deemed appropriate in that it would notinfluence outcome of results. Data were gathered for 67mothers of preschool children.MeasuresThree instruments were used for data collection, asocio-demographic questionnaire, the center forepidemiologic studies depressed mood scale, and the sense ofcoherence questionnaire.(a) Sociodemographic questionnaireThe sociodemographic variables were identified on thebasis of the review of literature dealing with depression inmothers. It has face validity but was not pretested forconcurrent validity. Each subject was requested to provideinformation about: age, marital status, ethnic origin,first language spoken, number of children, number ofpreschool children, expecting another child, education,full- or part-time employment, monthly income, and monthlyincome on welfare when applicable (See Appendix A).(b) The Center for Epidemiologic Studies Depressed MoodScale (CES-D) (Refer to Appendix B)The CES-D scale is a short self-report scale that hasbeen utilized to measure depressive symptomology in thegeneral population and is widely used for research purposes.The CES-D has a good internal consistency with alphas of .85for the general population. It has demonstrated stabilitywith test-retest correlations that range from .51 to .67(Radloff, 1977). It has excellent concurrent validity andcorrelates significantly with a number of depression andmood scales.The theoretical range of scores is 0-60, four questionsbeing reverse scored. Radloff, (1977) suggests a score of16 be employed as cutoff to indicate "case" depression.Group rates are to interpreted in terms of level of symptomswhich accompany depression and not in terms of rates ofillness. A group with a high average score may be at riskof depression or in need of treatment (Devins and Orme,1985).(c) The Sense of Coherence QuestionnaireThis scale measures a sense of coherence or copingdisposition. The questionnaire is based on 29 questions ofwhich thirteen are reverse scored (See Appendix C).Although questions can be identified that addresscomprehensibility, manageability, and meaningfulness it doesnot measure interrelationship of components. The componentshave been identified separately for theoretical purposesonly. The notation to the left of each question on thequestionnaire identifies whether the question deals with thecategory of meaningfulness, comprehensibility, ormanageability. The theoretical range is 0-203 and a higherscore indicates stronger coping disposition.27The SOC has been utilized with several populations andmean coping scores reported have ranged from 132 to 160.Higher mean scores were reported for homogenous groups ofIsraeli army officers and lower mean scores for more diversepopulations (Antonovsky, 1988, p. 80). For purpose ofcomparison the mean coping score of New York stateproductions workers was utilized in this study as thispopulation was similar to the sample of mothers in terms ofabsence of higher education. The mean coping dispositionscore reported for workers was 133.The SOC has high reliability, Cronbach's alpha rangesfrom .84 to .93. The questionnaire has convergent validitywith the Internal-External Locus of Control Scale andresults indicate a significant positive correlation of .385.Discriminant validity has been suggested by a significantnegative correlation of -.212 between the SOC questionnaireand the Sarason Test Anxiety Scale. Criterion validity hasnot been established (Antonovsky, 1988).Data AnalysisThe social-demographic questionnaire was coded. TheCES-D scores were computed reversing questions 4, 8, 12, and16. The orientation to life questionnaire was scored byadding the numeric answers for each of the twenty-ninequestions, reverse scoring thirteen of these questions. TheSPSS/PC+4 statistical analysis computer program was utilizedfor statistical analysis.^Frequencies were run for alldata.^Statistics were calculated for interval data andmissing data were excluded from calculations.A multivariate analysis was utilized to identifypredictor variables for depression. Depression was enteredas the dependent variable, and coping disposition, age,income, total number children, and number of preschoolchildren act as independent variables.Limitations of studyAs sampling is purposive findings cannot be generalizedto the population at large. The coping disposition scalehas not been utilized with a population that is at risk ofdepression and investigations with similar populations needto further test presented results. This investigation is aninitial step in conceptualizing the relationship betweensymptoms of depression and coping disposition.29Chapter IVResultsSixty-seven mothers of at least one preschool child agefive and under voluntarily completed three questionnaires.Questionnaires were not included in data analysis where thedepression scale was incomplete or completed incorrectly andfour questionnaires were exluded. The same criteria wasutilized for the coping disposition measure. Fourquestionnaires were exluded all together from the study andtwo of these same four incomplete questionnaires wereaccidentally destroyed. There were no missing cases fordepression and coping measurements. Missing information forthe sociodemographic questionnaires was identified andexcluded in data analysis. The total sample size was n=63.The age of the population was close to being normallydistributed with a mean of 28.45, mode and median being 28,a range of 26, and a standard deviation of 6.Population ProfileThe population ranged in age 17 to 43 and 28 was themean age. Thirty mothers are Caucasian, and 27 are NativeIndian. The equal representation of races in thisinvestigation is dissimilar from reports in the literaturewhich often report a higher incidence of one minority group(Weissmann, Leaf, and Bruce, 1987). English was the firstspoken language for the majority of women.30The majority of mothers were single. Only fourteenwomen reported being separated or divorced. Single-parentfamilies headed by women are the poorest among all familytypes (National Council of Welfare, 1990).Fifty mothers out of a sample of 63 were unemployed andreceived social assistance. Monthly income ranged from $564to $1600, with a mean monthly income of $1005. Twenty-threepercent of the respondents failed to report income as thewording of the questionnaire led women to believe that ifthey were on welfare income was not of interest. In orderto obtain a more accurate figure for income, questionnaireswhere women indicated being on social assistance, totalnumber of children, and failed to report income, basewelfare rates in effect during the time of the study wereentered into fourteen questionnaires.The large number of mothers receiving welfare comes asno surprise. The Ontario Social Assistance ReviewCommittee, stated "Despite the inadequacy of socialassistance benefits, most single-parent families are betteroff financially receiving assistance than they would beworking for minimum wages" (National Council of Welfare,1990, p. 63). The mean monthly income of $1005 falls wellbelow the established low-income cut off for a family of twoin Canada for 1989. The income cut off is $1516 a month(Ross and Shillington, 1989, p. 6).The total number of children for women ranged from oneto seven. Nearly one-half of the population had one childand 27% reported two children. The number of preschoolchildren per family ranged from one to four, one being thenorm. One-tenth of the population were expecting anotherchild. The age and number of children are an importantconsideration in labour force participation (NationalCouncil of Welfare, 1990) as income not only needs to coverdaily living expenses but also the cost of daycare forpreschool children (National Council of Welfare, 1990).Education ranged from grade six to university level.The level of education most frequently cited was grade ten.Fifty-seven percent of the mothers had not completed high-school. Mothers with less than grade 11 are less likely tobe employed full -time (National Coouncil of Welfare, 1990)as minimum wages are not adequate to meet the livingexpenses of a family (Ross and Shillington, 1989).Depression scores ranged from 0 to 47 and the meanscore was 22. Thirty-five percent of the sample scoredbelow 16 indicating an absence of symptoms of depression.In contrast 65% of the population have scores that indicatesymptoms that accompany depression. The CES-D does notmeasure the presence of the clinical syndrome of depressionthus scores of 16 or above indicate high depressive symptomsbut are not intended to connote a diagnosis of clinicaldepression. The mean rate of symptoms of depression is notstartling as studies with similar impoverished groups havereported high rates of symptoms of depression (Hall,Williams and Greenberg, 1985; Belle 1982).32Cox et al. (1987), identified that mothers at risk ofdepression were under the age of 21 when they had theirfirst child. In this study six women were under the age of21. The majority of mothers reported having one preschoolchild, and mean age being 28 would have given birth to theirfirst child around age 23. These data indicate that a moremature population of mothers may be just as much at risk ofdepression as adolescent teenage mothers.Coping disposition scores ranged from 57 to 174, theaverage mean score being 124. A mean coping dispositionscore of 133 was reported for 111 New York State productionsworkers with a range of 62 to 189 (Antonosky, 1988). Thisscore was chosen as a score for comparison as the workerswere similar to the mothers in terms of absence of highereducation. The mean coping score of 124 is lower than thescore of comparison of 133 of the New York productionworkers and the need for further investigations with mothersof preschool children at risk of depression may allow for amore accurate comparison of coping disposition scores in thefuture.Table 1 provides a summary of selected findings.',3TABLE 1Means and Standard Deviations of Selected Characteristics ofMothersVariable Mean Standarddeviationn=Age 28.45 6.03 59Monthly 1005.26 192.24 60IncomeDepression 21.88 12.13 63ScoreCoping 124.20 23.70 63DispositionScoreNo. of 1.47 .09 63PreschoolChildrenTN= 63Cross-tabulation utilizing the chi-square statisticwere utilized for the recoded ordinal variables ofeducation, ethnic origin, with recoded interval levelvariables of age, income, and symptoms of depression. Therewere no significant results noted for either the native orcaucasian group of mothers. Similar results have beenreported in a study by Pearlin and Johnson (1977) who34examined marital status, life strains, and depression andfound that "economic strain is the pertinent condition, notrace, sex, or age" (p. 709).A simple regression was utilized to identify existinglinear relationships for predictor variables of depression.Depression was entered into the ordinary least squaresequation as the dependent variable, and coping disposition,age, income, total number of children, and number ofpreschool children are the independent variables. Table 2summarizes the results of the equation.TABLE 2Results of Ordinary Least Squares Equation for PredictorVariables of DepressionVariable B SE B Beta T Sig TCoping .3669 .0466 -.7440 -7.868 .0000Pre-school-1.0869 2.5667 -.0685 -.423 .6738Age .0567 .2088 .0277 .272 .7870Income 2.0602 .0088 .0032 .023 .9815No.ofchildren-.9338 1.4156 -.1132 -.660 .5125R 2 =.5854Adjusted R 2 =.5440R^=.765135The only significant variable contributing todepression is coping disposition p> .00001 and therelationship was negative. In other words, depressionscores decreased as coping disposition scores increased, anddepression scores increased as coping scores decreased. APearson correlation coefficient of .77 was computed and thesquare of the coefficient indicates that approximately 59%of the variation of depression scores can be explained bythe equation. The adjusted R square indicates that 54% ofthe variation is due to the independent variables enteredinto the ordinary least squares regression.The Pearson correlation coefficient of .77 is unusuallyhigh and this high correlation may be attributed to severalfactors. The sample of mothers is a very homogenous groupand this results in a lack of variance within the definedvariables. The lack of variance may contribute to a highcorrelation.^Another critical factor may be that thedepressed mood scale and the coping disposition aremeasuring the same or similar feelings. Auto correlationbetween measures will increase the Pearson correlationcoefficient.^The Sense of Coherence questionnaire hasdemonstrated discriminant validity with the Sarason TestAnxiety Scale and a significant negative correlation of-.212 has been reported (Antonovsky, 1988).36Chapter VDiscussionFindings indicate a significant negative linearrelationship between rates of depression and copingdisposition. As depression increases sense of coherencedecreases, and as depression decreases the ability to copeincreases. Six out of every ten mothers displayed symptomsof depression and a corresponding or lack thereof sense ofcoherence. What is of considerable interest is that thirty-five percent of mothers had no symptoms of depression and astrong sense of coherence. For example, one single motherof seven children, in receipt of social assistance, had nosymptoms of depression, and a high coping disposition score.Results support that a strong sense of coherence serves as amediator between life strains and mental health.How does one explain the differences in symptoms ofdepression and sense of coherence in a group of individualsthat are poor and single parents of at least one preschoolchild? Several paths may lead to developing a strong senseof coherence (Antonovsky, 1988).Understanding the genesis of the mothers lack of copingskills indicates that childhood experiences may affect theirability as adults. A sense of coherence is developed fromearly infancy onward to early adulthood. Children, likeadults need to comprehend their world, make meaning out ofit, and be able manage it (Antonovsky, 1988). Childrenlearn to cope within their environment very early on in life(Gunnar, 1980; Seligman & Peterson, 1986) and over time theinfant and child learns that his or her physical and socialenvironment are predictable. In other words stable familyroutines provide a "harmonious sense of continuity"(Antonovsky, p. 129, 1988). The young child is primarilyaffected by the perceived evaluations of the parent(Rosenberg, 1979). Parents who have:an orientation that is one of complexity andflexibility, alternatives and self-direction,meaning, consistency, choice, and a sense thatproblems are manageable and solvable (Antonosky,1979, p. 147).are likely to address the needs of the child.^In eachindividual, wealth, ego-stregth, and cultural stabiliycontribute to a strong sense of coherence. The stronger thesense of coherence of the parent "the more likely they areto shape the set of life experiences of the child so that itleads in the same direction" (Antonovsky, 1988, p. 100).The development of coping disposition may in essence berather cyclical. The stronger a sense of coherence in theparent the more presumable that the child will achieve asolid coping disposition. For example, Margalit (1985)utilized the sense of coherence questionnaire with thirty-two children that were selected from grades four to six.She compared one group of school children that wereidentified as being hyperactive with a control group andsubstantiated that the group of hyperactive students had38significantly lower sense of coherence scores, which"reflected that their environment seemed less ordered andpredictable; expected (age-appropriate) tasks seemed lessmanageable, and to a large extent seemed meaningless" (pp.361-362). A predictable environment in childhood may haveled to a secure coping disposition for the mothers of thissample.Antonovsky (1988) reasons that social support may beanother mode of achieving a strong sense of coherence. In alongitudinal study Werner and Smith (1982) examined a groupof children in Kauai that lived in chronic poverty andexperienced a series of stressful life events. The focus ofthe study was to identify a set of predictors thatdiscriminated between high-risk resilient children comparedto peers that had developed serious coping problems by agesten and eighteen.Yet there were others, also vulnerable-exposed topoverty, biological risks, and familyinstablility, and reared by parents with littleeducation or serious mental health problems whoremained invincible and developed into competentand autonomous young adults....This report is anaccount of our search for the roots of theirresilience, for the sources of theirstrength (Werner and Smith, 1982, p. 3).Seventeen years later the findings indicated thatresilient children exhibited:...a more internal locus of control, a morepositive self-concept, and a more nurturant,responsible, and achievement-oriented attitudetoward life...developed a sense of coherence intheir lives and were able to draw on a number ofinformal sources of support (p. 154).Antonovsky (1988) cautions that although informalnetworks were available to the children it is thecharacteristics of the networks that are imperative:One of Werner's key phrases is structure and rules...her emphasis on exposure of the child toextensive networks, all of whose members holdsimilar values and beliefs, likewise suggests adynamic but stable environment, with goodfeedback, which provides the basis for seeing theworld as predictable (p. 50).This may be an alternate description of how mothers in thisparticular group achieved a strong coping disposition, notonly were informal networks available but they alsopossessed the crucial properties necessary to effect astrong sense of coherence.Forty-one mothers of the sample of 63 mothers sufferedfrom symptoms of depression and comparative copingdispositions. Nearly 60% of the women had not completedhigh-school, grade ten being the most frequent response.The reported mean monthly income of $1005 falls well belowestablished poverty lines (National Council of Welfare,1990). Eighty percent of mother were welfare recipients.Data generally support the literature in that motherssuffering from symptoms of depression are likely to be poorand have low levels of education although this populationdiffers in that the majority of women were not in thecategory of "high risk" i.e. teen mothers as the mean agewas 28 years. Findings support the notion that those withfewer resources are likely to develop symptoms ofdepression. A lack of high-school education reduces thelikelihood of becoming self-sufficient. Low income may be abarrier to obtaining resources, and individual experiencesare less conducive to strengthening coping disposition.Antonovsky (1988) suggests, based on statisticalpredictions that by the time one is thirty, one has attaineda given location on the sense of coherence continuum.For the person with a weak SOC in early adulthood,life becomes a vicious circle. General resistanceresources deficits play an increasingly prominentrole, as encounter after encounter debilitates theSOC ever more. The 'loser' continues to lose, andlife becomes more and more chaotic, unmanageable,and meaningless (p. 122).Certainly the coping disposition can be strengthenedtemporarily but soon the individual returns to the mean(Antonovsky, 1988). Antonovsky (1988) does not identify onhow he arrived at these statistical predictions and oneneeds to interprete this statement with some care.For this group of mothers that are at a disadvantage interms of coping disposition and depressive symptoms thereare implications for helping professionals. The paramountfactor appears to be one of treatment and prevention bothfor mothers and children.41In all societies one's social class is one of the keyvariables that determine daily living (Antonovsky, 1979).Mothers with the least resources are least likely to have astrong sense of coherence and least likely to generate asolid coping disposition in children. One may take this astep further and define resources as options. For thispopulation options appear limited. For example, althoughmothers in this population had access to daycare the mandateof this center was short-term care, and the hours ofoperation did not address the needs of working mothers. Inthis specific instance the lack of options to increasefinancial resources exists. Mothers with fewer resourceswill continue to lack options unless social policies addressthe needs of all family members.Antonovsky (1988) warns against focusing on thecognitive aspect of a sense of coherence but refers to theimportance of involvement "as a participant in the processesshaping one's destiny as well as one's daily experience" (p.18). Social work practitioners need to identify if clientsare indeed participating in their own lives, and toencourage active involvement in what is indeed meaningfulfor the individual.The infant usually has one caretaker but increasinglywith age the child's social environment becomes much broader(Feiring and Lewis, 1989). Relatively little is known aboutthe impact of the social environment on young children(Belle, 1989). Parents who provide social environments that42are responsive to children promote their children'sdevelopment of internal control beliefs (Skinner, 1985) butif depression affects the mother's ability to provide aresponsive environment, children will have few opportunitiesto develop a strong sense of coherence. It becomes crucialto intervene at this level but "little is known on theextent to which good relationships outside the home canserve a similar protective function" (Rutter, 1990 p. 64).Although findings proved to be significant, one mustcaution that a relationship does not imply causality betweentwo variables. Findings cannot be generalized to thepopulation at large as sampling was purposive.SummaryFindings indicate that mothers who are likely to sufferfrom symptoms of depression are poor and have low levels ofeducation. A lack of high-school education leads to a lowincome which creates a barrier to obtaining resources.Individual experiences are less conducive to strenghteningcoping disposition when resources are unavailable. Womenwith fewer resources are less likely to develop a strongsense of coherence. Coping behaviors of mothers at risk ofdepression influence how children learn to cope.Social workers need to take an active approach towardidentifying the needs that are meaningful for the client,and to encourage client participation in changing presentsocial policies at the grass-roots level. Organizations43such as anti-poverty groups may offer mothers opportunitiesto voice concerns and influence political decision-making.Social work treatment will need to identify and utilizeresources that are conducive to strengthening copingdisposition so that the client's world may becomprehensible, meaningful, and manageable.The need for the prevention of a low sense of coherencein children lies in creating predictability in thechildrens' lives. The importance of routine may beemphasized in social work contact with the client andthrough parenting courses. Community resources may also beutilized to meet childrens' need for stability. Theseresources may range from support of the grandparents topreschool children programs.The link of a lack of education and poverty is evident.Social workers need to advocate for comprehensive socialpolicies that address the needs of all family members ifmothers and children are to cope better in the future.Coping behaviors are recognized as having influence onhealth and well-being. Findings in this study indicated asignificant negative linear relationship between depressionand coping disposition. Thirty-five percent of mothersreported absence of symptoms of depression, and strongcoping dispositions despite existing life strains, such aslow income, and lack of education. over half of the samplewas at risk of depression as indicated by a weak sense ofcoherence.44The complex nature of this relationship warrantsfurther systematic analysis. 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InternationalJournal of Family Psychiatry, 1, 167-181.58Appendix ASociodemographic Questionnaire59DEMOGRAPHICS QUESTIONNAIREName:Age:^Ethnic origin:^First language spoken:^Last grade of education completed^Total number of children:^Number of children age five and under:^Are you pregnant right now?:^Marital status: single^common-lawmarrieddivorced^partner/live-out^Are you employed: YesNoIf yes, full-time or part/time^What is your monthly income?:^Do you presently receive social assistance: No^Yes60Appendix BThe Center for Bpidemiologic Studies Depressed Mood Scale61THE CES•D 'SCALE: A SELF•REPORT DEPRESSIONSCALE FOR RESEARCH IN THE GENERAL POPULATION^387Table 1.. CES-D ScaleINSTRUCTIONS FOR'QUESTIONS: Below is a lisi'of the ways you mighthave felt or behaved. Please tell me how often you have felt thisway during the past week. HAND CARD A.Rarely or None of the Time (Less than 1 Day)Some or a Little of the Time (1-2,Days)Occasionally or a Moderate Amount of Time (3-4 Days)Most or All of the Time (5-7 Days) During the past week:I. I was bothered by things that usually don't bother me.2. I did not feel like eating; my appetite was poor.). I felt that I could not shake off the blues even with help from myfamily or friends.4. I felt that I was just as good as other people.S. I had trouble keeping my mind on what I was doing.6. I felt depressed.7. I felt that everything I did was an effort.8. I felt hopeful about the future.9. I thought my life had been a failure.10. I felt fearful.11. My sleep was restless.12. I was happy.13. I talked less than usual.14. I felt lonely.15. People were unfriendly.16. I enjoyed life.17. I had crying spells.18. I felt sad.19. I felt that people dislike me.1 20. I could not get "going."Appendix CThe Sense of Coherence_Questionnaire63•^Appendix: The Sense ofCoherence QuestionnaireThe notation to the left of each item represents the pro-file structure of the item, derived from the mapping sentenceused in questionnaire construction (see p. 77). C compre-hensibility, MA manageability, ME at meaningfulness. Thefour numerals represent the elements in facets A, B, C, and D,respectively.A high score represents a strong SOC. Before calculatingthe total score, the thirteen items marked R should be reversed.For those interested in using a short form of the SOC, thethirteen items marked * are recommended.These notations, obviously, are to be omitted when thequestionnaire is used.ORIENTATION TO LIFE QUESTIONNAIRE• Here is a series of questions relating to various aspects of our lives. Each question has seven possible answers. Please mark theDumber which expresses your answer, with numbers 1 and 7 being the extreme answers. If the words under 1 are right fOr you,lircle 1; if the words under 7 are right for you, circle 7. If you feel differently, circle the number which best expresses your feel-ing. Please give only one answer to each question.C R^1. When you talk to people, do you have the feeling that they don't understand you?1312 1^2^3^4^5^6^7never have always havethis feeling this feelingMA^2. In the past, when you had to do something which depended upon cooperation with others, did you have the feel-1111 ing that it:1^2^3^4^5^6^7surely wouldn't surely wouldget done get doneC^3. Think of the people with whom you come into contact daily, aside from the ones to whom you feel closest. How. 1322 well do you know most of them? •1^2^3^4^5^6you feel thatthey're strangersME R M. Do you have the feeling that you don't really care about what goes on around you?1222you know themvery well1very seldomor DEM2 3^4^5^6^7very oftenC R. *5. Has it happened in the past that you were surprised by the behavior of people whom you thought you knew1221^well?1^2^3^4^5^6^7never alwayshappened happenedMA R •6. Has it happened that people whom you counted on disappointed you?1221^1^2^3^4^5^6^7never alwayshappened happened-ME R^7. Life is:2.332 1^2^3^4^5^6^7full of completelyinterest routineME^•8. Until now your life has had:2331 1^2^3^4^5^6^7no clear goals or very dear goalspurpose at all and•purposeMA^•9. Do you have the feeling that you're being treated unfairly?1222 1^2^3^4^5^6^7very often very seldomor neverC^10. In the past ten years your life has been:2331 1^2^3^4^5^6^7full of changes completelywithout your consistent andknowing what will dearhappen next-ME R 11. Most of the things you do in the future will probably be:1313^1^2^3^4^5^6^7completely deadlyfascinating boringME R * 16. Doing the things you do every day is:1312^1^2a source of deeppleasure andsatisfaction4^5^6^7a source of-painand boredinn3C^* 12. Do you have the feeling that you are in an unfamiliar situation and don't know what to do?2232 1^2^3^4^5^6^7very often very seldomor never3MA R 13. What bat describes how you see life:2332^1^2one can alwaysfmd a solutionto painful thingsin life4^5^6^7there is nosolution topainful thingsin lifeME R 14. When you think about your life, you very often:2132^1^2^3^4^5^6^7feel how good it ask yourself whyis to be alive you exist at allC.^15. When you face a difficult problem, the choice of a solution is:1112 1^2^3^4^5^6^7always confusing^ always completelyand hard to find clearC^17. Your life in the future will probably be:2333 1^2^3^4^5^6^7full of changes completely con-without your sistent and dearknowing whatwill happennext5MA'^18. When something unpleasint happened in the past your tendency was:3211 1^2^3^4"to eat yourselfup" about it6^7to say "ok,that's that. Ihave to live withit," and go onC^• 19. Do you have very mixed-up feelings and ideas?2122 1^2^3^4^5^6^7very often very seldomor neverMA R 20. When you do something that gives you a good feeling:1113^1^2^3^4^5^6^7it's certain that it's certain thatyou'll go on something willfeeling good happen to spoilthe feelingC^•21. Dots it happen that you have feelings inside you would rather not feel?3122 1^2^3^4^5^6^7 •very often very seldomor neverME^22. You anticipate that your personal life in the future will be:2333 1^2^3^4^5^6^7totally without full of meaningmeaning or pur- and purpose1)4"eMA R 23. 'Do you think that there will always be people whom you'll be able to count on in the future?1223^1^2^3^4^5^6^7you're certain you doubtthere will be there will beC^24. Does it happen that you have the feeling that you don't know exactly what's about to happen?2233 1^2^3^4^5^6^7very often very seldomor neverMA R •25. Many people—even those with a strong character—sometimes feel like sad sacks (losCrs) in certain situations. How3131^often have you felt this way in the past?1^2^3^4^5^6^' 7ACV= very oftenC^•26. When something happened, have you generally found that:1211 1^2^3^•^4^5^6^7you overesti- you saw thingsmated °sunder- in the rightestimated its proportionimportanceMA R. 27. When you think of difficulties you are likely to face in important aspects of your life, do you have the feeling1313^that:1^2^3^4^5^6^7you will always you won'tsucceed in over succeed in over-coming the coming thedifficulties^ difficultiesME^•23. How often do you have the feeling that there's little meaning in the things you do in your daily life?1212 1^2^3^4^5^6^7very often very seldomor neverMA^•29. How often do you have feelings that you're not sure you can keep under control?3122 1^2^3^4^5^6^7very often very seldomor neverAppendix DSubiect Consent Form70THE UNIVERSITY OF BRITISH COLUMBIASchool of Social Work6201 Cecil Green Park RoadVancouver, B.C. Canada V6T 1Z1Depression and Coping in Mothers of Preschool ChildrenMy name is Ute Holley and I am a social work student atthe University of British Columbia. I am presently enrolledin the graduate program and my area of research isdepression in mothers of preschool children and how theycope. The reason I chose this area of research is that Ihope to find out what services mothers need in order to copebetter. I do not work at Crabtree Corner Daycare and if youdo not wish to participate in this study this will have noeffect on your use of the daycare center. You do not haveto answer any of the questionnaires if you do not wish to.I have attached three questionnaires. Eachquestionnaire has a number in place for a name. This is tomake certain that no one will know who filled it out. Onequestionnaire will ask you about your age, number ofchildren, income, and education. These questions can beanswered by checks or short answers. The secondquestionnaire is a measure of depression. The questionswill ask you about your feelings over the last week. Thereare 20 questions that you fill in with a number. The thirdquestionnaire is a measure of coping. There are 29questions and each can be answered by drawing a circlearound the number that you choose.71THE UNIVERSITY OF BRITISH COLUMBIASchool of Social Work6201 Cecil Green Park RoadVancouver, B.C. Canada V6T 1Z1Each questionnaire will take 20 minutes to fill out andaltogether the three questionnaires will take 60 minutes tocomplete. When you have . 'started to fill out the questionsbut find you do not want to go on answering - don't. It isokay to stop if you do not want to continue. Once you havefilled out the questionnaires it will also mean that youhave given me permission to use these questionnaires forresearch. All given information will remain confidential.When you have completed the questionnaires please returnthese to me in the reception area. If you have any morequestions about the study please call me at 325-8979. Ifyou do not understand certain questions please let me know.I can help you with these.^ThanUte HwJ.J.eyResearch is conducted under Dr. S. Manson-Willms who may becontacted at the School of Social Work at 822-2255.72Appendix EAgency Consent Letter73101 East Cordova StreetVancouver, British ColumbiaV6A 1K7(604) 689-2808February 28, 1991I, Betty MacPhee, authorize Ute Holley to have access to ourprogram ., Crabtree Corner Emergency Daycare, which isadministered by the Yonng•Wo.men's Christian Association, toconduct research on mothers of preschool children,depression and coping style as part of her thesis of theMasters of Social Work Program at the University of BritishColumbia.Betty MacPheeManager74Appendix FUBC Behavioral Sciences Screening Committee ApprovalCertificate75Dr. R.D.^ra leyDirector, •esearch Sery cesand Acting ChairmanThe University of British Columbia^B92-089Office of Research ServicesBEHAVIOURAL SCIENCES SCREENING COMMITTEE FOR RESEARCHAND OTHER STUDIES INVOLVING HUMAN SUBJECTSCERTIFICATE^of APPROVALINVESTIGATOR: Manson Willms, S.UBC DEPT:^Social Work•NSTITUTION: Crabtree Corner DaycareTITLE:^Depression and coping disposition amongmothers of preschool children in thedowntown eastsideNUMBER:^B92-089CO-INVEST:^Holley, U.APPROVED:^APR 9 1992The protocol describing the above-named project has beenreviewed by the Committee and the experimental procedures werefound to be acceptable on ethical grounds for researchinvolving human subjects.THIS CERTIFICATE OF APPROVAL IS VALID FOR THREE YEARSFROM THE ABOVE APPROVAL DATE PROVIDED THERE IS NOCHANGE IN THE EXPERIMENTAL PROCEDURES76
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Depression and coping disposition among mothers of preschool children in the downtown Eastside
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