Psychological Well-Being by Ingrid E., Ed. Wells (z-lib.org)

88 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. being. The causes of well-being can be expected to differ in relation to age, conditions of life, educational level, occupation or social class. Well-being is not determined by any single factor, but has a multidimensional character [Martire, Stephens and Townsend, 2000]. Culture and personal influence have been shown to have an important effect on well-being. Type of personality has also been found to be significant, especially in the tendency to adapt to negative events, without ignoring the influence of other demographic variables such as gender or occupation. This latter factor has more of a temporary nature and is related to the person‘s stage of life at the time. One of the main objectives of epidemiological research is to identify and describe the different variables associated with psychological well-being. For this reason, we describe here the influence of some sociodemographic factors. 4.1. Psychological Well-Being and Age Well-being can vary greatly in relation to age, gender and culture. When we study changes in the elements of well-being, some factors change significantly with age, while others remain stable [Villar, Triado, Resano et al., 2003]. Some authors, such as Ryff and Keyes [1995] consider that elderly people experience less personal growth, and also suggest that mastering the environment and autonomy increase as people reached the older stages of life. Mastering the environment tends to be better in the middle-aged and elderly than in young people, but remains stable from middle-age to older ages. A similar pattern can be observed with the dimension autonomy, but in this case the increase in this parameter from young people to middle age is less acute. According to these authors, the dimensions self acceptance and positive relations with others do not seem to vary with age. Ryff [1989a] also claims that standard dimensions of well-being, such as purpose in life and personal growth, tend to become less important with age, with this situation becoming most extreme in elderly people. An individual‘s perception of himself changes with time, becoming more related to temporary differences as he grows older and less related to interpersonal comparisons. Young people, the middle-aged and the elderly all have different perspectives of themselves, depending on whether they are evaluating or describing the present, the past or the future. All these perceptions are important to fully understand psychological well-being. Hence, the experience an individual acquires during a lifetime can change the ideals to which he aspires and the way he assesses his own well-being [Birren and Renner, 1980]. Young people perceive themselves as making significant progress since their adolescence and having great expectations for the future, so the scores in their self-assessments for the dimensions purpose of life and personal growth are higher [Ryff, 1991]. People in middle age tend to remain in a continuous process of improvement from the past to the present and maintain high levels of well-being in the different dimensions that constitute this well-being. Finally, elderly people constantly consider themselves in relation to the past and do not perceive sensations of developing towards the future. From a positive perspective, elderly people tend to master the environment better than other age groups. To summarize, research such as that conducted by Ryff [1991] observed that as people grow older the difference between their ideals and their perception of reality seems to diminish.

Psychological Well-Being, Assessment Tools and Related Factors 89 4.2. Psychological Well-Being and Gender It has already been described how psychological well-being can be positively related to factors such as satisfaction with life and self-concept or self-esteem. Several studies have assessed the differences in psychological well-being and self-concept between the genders, although the different measures used and the discrepancies between the results obtained make it difficult to draw any clear conclusions [Pinquart and Sörensen, 2001]. Some of the studies in the meta-analysis by Pinquart and Sörensen [2001], which included participants ranging from adolescence to old age, concluded that there was no difference in well-being between the genders. In some case, self-esteem and well-being was found to be slightly higher among men than women. It was also found in all the studies included in this meta-analysis that older women present lower levels of satisfaction with life, happiness and self-esteem than men. On the other hand, other researchers have observed that the protagonism of gender issues as a predictor of psychological well-being, often diminishes as other factors come into play [Inglehart, 2002]. Hence, the differences observed between men and women in well-being and self-esteem are less significant in younger stages of life, since this is when there are also less differences between the genders in financial situation, state of health and other factors referred to previously [Pinquart and Sörensen, 2001]. Similarly, if we take into account that the differences between aspirations and success achieved have been proposed as an important source of psychological well-being [Brandtstädter, Wentura, and Greve, 1993], gender differences in well-being could be greater in older people because women experience a greater decline in their ambitions as they grow older. Another possible explanation for the difference between the genders is the existence of different sources of psychological well-being and self-esteem in both cases. Women are more closely associated with events in social systems, while men are more affected by their professional environment [Whitbourne and Powers, 1994]. Women, therefore, are more socially integrated and have higher scores in positive relationships with others than men [Pinquart and Sörensen, 2000]. The increased differences between the genders with age could also be due to differences in their circumstances, such as the greater risk of suffering from chronic illnesses in older women or the higher risk of being widowed. In a series of studies reviewed by Pinquart and Sörensen [2001] in his meta-analysis, the influence of men and women‘s marital status on well-being was studied. It was found that well-being and self-esteem were higher in married men, while the opposite was true in unmarried men. However, in this same research the authors reported that reliable conclusions could not be drawn about marital status and well- being. One possible explanation for the tendency observed could be the effect of solitude and its repercussions on social relationships, and the presence in the studies analyzed of only a small proportion of unmarried people. It has been argued that this disadvantage of the women is associated with the differences between sociodemographic variables such as social integration or financial independence [Pinquart and Sörensen, 2000]. In general, women still have less opportunities than men in the job market and lower rates of stable employment, resulting in women having lower incomes throughout their lives and lower pensions when they are older. The concept of gender is known to incorporate social factors associated with the different patterns of socialization of men and women, in relation to family roles, professional expectations, types of occupation and social culture, and also affects the processes of health

90 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. and illness [Rohlfs, Borrell and Fonseca, 2000]. It is, therefore, important to take these characteristics into consideration when evaluating the psychological well-being of any person. In spite of an increase in women‘s participation in remunerated work in recent years, they still have most of the family responsibilities, and an unequal share of the domestic tasks and the care of children. To have to fit in this double workload, in other words to be a mother (with the domestic tasks this entails) and at the same time to have a paid job, can affect their health and well-being [Rohlfs Borrell and Fonseca, 2000; Artazcoz, Borell and Benach 2001]. Research by Martire, Stephens and Townsend [2000], studied the influence of gender on well-being in almost 300 women. It was found that well-being was affected by age, and that this effect increased with the women‘s social role. A woman‘s family and professional responsibilities can represent an important overload if considered simultaneously. The traditional role of the woman as a carer of children, the elderly and the ill, contributes to this overload in the family environment. These relationships of responsibility that develop in the family are considered as important determinants of psychological well-being [Kowal, Kramer, Krull et al., 2002; Wright and Cropanzano, 2000]. The study by Escriba-Agüir and Tenias-Burillo [2004] analyzed the effect of gender and the work environment on the psychological well-being of the staff in two hospitals. The results showed that being a woman and spending more than 30 hours on domestic tasks had a negative effect on psychological well-being. Also, in this study women had a lower level of well-being than men. In relation to the influence of a woman‘s professional life on levels of well-being, a strong association was found between women‘s satisfaction with their work and their satisfaction with life, although it was not established which caused the other. In fact, unemployment was associated with low levels of well-being and also conflict at the work place. Being close to retirement was also considered to have stressful effects and to influence well-being in women. Similarly, the study by Sanchez-Uriz, Gamo, Godoy et al. [2006], on the psychological well-being of healthcare staff found a higher prevalence of psychological discontent in women than men. Another study carried out in Australia [Dennerstein, Lehert and Guthrie, 2002] on 226 women assessed the level of satisfaction and other variables during one period of life, the menopausal process. They found that well-being increased significantly after passing from initial stages of the menopause to the later stages. The factor with the greatest effect on well- being was high levels of well-being at the start of this transition stage. They observed during this transition period that well-being varied greatly with other factors such as changes in marital status, satisfaction with work, day-to-day problems and life events. The authors concluded that psychological well-being improves as women enter the final stages of the menopausal transition, and that this is significantly affected by psychosocial effects. 4.3. Psychological Well-Being and Marital Status In relation to this socio-demographic variable, it was found that being part of a family situation with equal status in the decision-making and a good conjugal relationship had a favorable overall influence on health and psychological well-being. The results of the study by Escriba-Agüir and Tenias-Burillo, 2004] confirm this, and show that a good relationship with one‘s partner improves psychological well-being. They even claimed that persons who proved to have had a good conjugal relationship are less likely to have poor mental health.

Psychological Well-Being, Assessment Tools and Related Factors 91 Other studies also focus on possible interrelations between different factors, such as the study by Mroczek and Kolarz [1998], which described the importance of some sociodemographic variables and personality factors in relation to age and well-being. More specifically, these authors found higher incidences of well-being in older married adults, compared with those who were single. 4.4. Psychological Well-Being and Socioeconomic Level Another aspect with important repercussions on psychological well-being is socioeconomic situation, which also includes some objective conditions such as access to housing, a healthcare system, education, employment and recreational activities [Diener, 2000]. A more precarious lifestyle was associated with higher levels of psychological anxiety [Kaplan, Roberts, Camacho et al. 1987], although there are few results about the impact of a possible socioeconomic benefit with time on the more positive aspects of psychological functioning. In spite of this, it could be suggested that financial success or failure in combination with environmental resources, could have an important effect on a person‘s feelings of achievement, mastery of the environment and self-acceptance, and these tend to develop as a person gets older [Haan, Kaplan and Syme, 1989]. The research by Ryff [2001] on the impact of economic level on the degree of well-being showed a clear relationship between socioeconomic level and some dimensions of well-being, such as self-acceptance and personal growth. This was also found to be clearly linked to an individual‘s goals and objectives (purpose in life). The results of several studies show that people with a lower socioeconomic level, determined both by educational characteristics (level of studies) and by a person‘s usual work activity, have a lower level of psychological well-being [Marmot, Fuhrer, Ettner et al., 1998]. The analysis of several works by this author showed that, in general, health is poorer in people at the lower end of the population‘s economic distribution. There was also evidence for a social gradient in the whole population, with lower levels of psychological well-being associated with lower social status. These conclusions suggest that there is a combination of factors, such as working environment, social conditions outside the working environment, health and individual behavior that can be related with general state of health and the level of psychological well-being. In a recent study by Kaplan, Shema and Leite [2008], data collected over several years of follow-up provided information about the association between average level of income, the rate at which income changes, and a series of indicators of the financial situation of the population studied and the different measures of psychological well-being. The author suggested that these results are consistent with the financial situation, except for the case of autonomy. As a whole, when the financial situation is more favorable, represented by a positive economic balance, psychological well-being also improves. When this financial situation becomes worse, and with it the perceived amount of income, the level of psychological well-being also becomes worse. These results provide information about the impact of the economic situation on psychological well-being at a given moment, and how this changes with time. It was observed that a higher level of income and increases in this income with time, were associated with higher scores in dimensions of well-being such as: purpose in life, self-acceptance, personal growth and mastery of the environment. Also, scores were found to be lower for these same dimensions in people with a lower average

92 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. income and less financial benefits over time. A correlation was even observed between periods when the benefits were more numerous and a higher level of psychological well- being. Ultimately, this research showed that psychological well-being was strongly influenced by financial income and by changes in income over the years. Research carried out by Diener and Diener [1995] showed that changes in a person‘s income were more important for their psychological well-being than absolute levels of income. It was also observed that levels of satisfaction are higher in people with incomes above the average income for the reference population [Diener and Diener, 1995; Diener and Suh, 1997]. These authors conducted studies on psychological well-being in 29 different countries in different continents and found a correlation between average level of satisfaction and people‘s purchasing power. Other studies have also observed a positive association between the level of education, the income and psychological well-being of elderly people [Cheng, Chi, Boey et al., 2002]. If we consider that a person‘s job is usually closely related to his socioeconomic level, the characteristics of each job, which are correlated with social class, have an increasing influence on psychological well-being over time [Kohn and Schooler, 1978]. Hence, in the study of Sanchez-Uriz, Gamo, Godoy et al. [2006] it was observed that members of staff working shifts had a higher prevalence of psychological distress. A feeling of stagnation in the same work post, with little opportunity to change and the absence of a professional career linked to promotion at work, were other variables related with increased psychological stress. Another factor with important repercussions on socioeconomic level is a person‘s house or place of residence. The impact of a person‘s residential area on their health is being increasingly acknowledged, and there is evidence for the effects of neighborhood, independently of the individual characteristics of the residents. In the study by Phillips, Siu, Yeh et al. [2005], the authors suggest that living conditions can constitute an important factor affecting psychological well-being in the elderly. More specifically, these authors studied the effect of a person‘s degree of satisfaction with their housing (conditions of the accommodation and the district they live in) on psychological well-being. The results showed this to be influenced by internal conditions of the accommodation (characteristics of the rooms, habitability, comfort), and also by external conditions (environment). Hence, Steptoe and Feldman [2001] observed that the presence of negative environmental conditions in the neighborhood were associated with a perception of poor health and with psychological anxiety, independently of age, gender and social capital. 4.5. Psychological Well-Being and Social Relations One of the dimensions of psychological well-being is the ability to maintain positive relationships with other people [Ryff and Singer, 1998]. People need to have stable social relationships and to have friends they can trust. In fact, numerous studies carried out over the past few years [Berkman, 1995; Davis, Morris and Graus, 1998] have found that social isolation, loneliness and a loss of social support are associated with an increased risk of illness or reduced life expectancy. Well-being is clearly influenced by social contact and interpersonal relationships. It has also been shown to be associated with contacts in the community and active patterns of friendship and social participation [Blanco and Diaz, 2005]. Finally, there is also an association between well-being and positive relationships with others

Psychological Well-Being, Assessment Tools and Related Factors 93 [Keyes, Shmotkin, and Ryff, 2002]. In summary, we can conclude that a degree of interaction does exist between social and psychological factors. Social aspects influence psychological ones through the meaning these have for an individual, and psychological aspects can affect social aspects through the stance a person adopts [Breilh, 1989]. This is a theoretical concept that should be taken into consideration when studying and evaluating quality of life and well- being. Regarding the social factor, Ryff [2001] considers that there is sufficient evidence to assert that positive social relationships can predict a specific psychological functioning. He observed that the presence of positive relationships was associated with pleasure and a positive mood. In studies by Kevin, Hershberger, Russell et al. [2001] and Cutrona, Russell, Hessling et al. [2000] demonstrated a relationship between social integration, health, social support and well-being. These authors insist on the importance of being able to count on consistent sources of support. Similarly, research by Diener and Diener [1995], show the importance of social and cultural context in a person‘s assessment of his own well-being. As mentioned previously, the degree of individualism and collectivism of a society is a cultural variable that can affect the relationships between well-being and sociological variables. Although there are few clear data about this, possibly in collectivist cultures there is a better sense of group cohesion and social support that improves well-being. However, in the more individualist cultures, people value more their own well-being and the freedom to choose how to achieve [Diener, Diener and Diener, 1995; Suh, Diener, Oishi et al., 1998]. When examining the relationship between gender and well-being we have already mentioned that social and environmental characteristics are closely associated with life and with happiness in men, while in women this association can be found with social relationships or integration with others [Piquart and Sörensen, 2001]. Another important factor, especially in elderly populations is the influence of social environment and support. It has been shown that the presence of family and social networks to support old people contribute to increasing their levels of well-being [Litwin, 2006]. In this sense, previous studies, such as the one carried out by Beyene, Becker and Mayen [2002], in elderly Hispanic populations, showed clear repercussions of the extent and quality of social support on the level of psychological wellbeing. Another study carried out on an elderly population in Hong Kong, also refers to the contribution that family support of elderly people makes to increasing the level of psychological well-being [Weng, 1998]. Another important factor in the level of well-being in elderly people is satisfaction with the people they live with. This aspect is very important for the health and well-being of the elderly, for whom the family becomes a protective factor for their health [Krause, 1988). The family acquires an important role at this time in life and becomes an essential source of well- being [Parreño, 1990; Organización Panamericana de la Salud, 1994b]. From the perspective of a person‘s relationships with others, their religious beliefs also play an important cultural role. Different types of participation in religious activities are associated, to varying degrees, with all the dimensions of psychological well-being (positive relations with others, self-acceptance, autonomy, mastery of the environment, purpose in life and personal growth) [Frazier, Mintz and Mobley, 2005].

94 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. 5. PSYCHOLOGICAL WELL-BEING AND HEALTH In parallel with the considerable economic and social development in Western countries, there has been a growing interest in studying the determinants of quality of life. It has been shown that economic development alone is not a good indicator of progress, since the latter must be able to respond to the need people have for satisfaction with life over their whole life-span, to have the ability and competence to achieve this satisfaction, and to have the power to control their environment and life conditions. Quality of life is not only manifest through objective conditions of social well-being, but also includes other subjective aspects. From this perspective, it is an integrating concept that incorporates happiness, well-being, satisfaction with life, health etc. as evaluable dimensions [Martinez Garcia and Garcia Ramirez, 1994]. When the World Health Organization established a definition for health that went beyond merely health as an absence of illness, it introduced a modern concept, constructed on the presence of well-being, and the meaning of human development, in relation to factors such as: purpose in life, quality relationships with others and opportunities to develop one‘s potential. Although it is well known that negative emotions and distress can cause declines in levels of physical and physiological health, little importance has been attributed to the protective and beneficial effects of positive emotions and well-being on health [Howell, 2009]. If directional influences are also taken into account, the relationship between well-being and health is even more complicated. Being healthy makes people happy and being happy strengthens a person‘s health. There are numerous studies in the literature, including longitudinal observational studies and also experimental ones, which focus on the possible impact of well-being on objective health results and can help us to discern these causal influences. In a work that integrates the findings of 150 studies, Howell, Kern and Lyubomirsky [2007], evaluated the impact of well-being on objective health results, and concluded that well-being has a positive impact on these. Well-being is positively related to the short and long-term results, and to the control of illnesses and symptoms. The probability of survival was higher in the group with a higher level of well-being and mortality was higher in the group with a low level of well-being. A comparison of the different effects of distress and well-being on health results produced similar findings: high levels of well-being were more likely to result in an improved functioning and high levels of distress negatively affected functioning. A similar magnitude of effects was found in both longitudinal observational and experimental studies and for different health results (in the short term, the long term and in the control of illness/symptoms). These results show that the effect of subjective well-being on health is not only due to a negative effect of distress, but also because well-being has a positively health-inducing effect. A reduction in illness associated with well-being has significant implications for medical and psychological interventions, and an important aspect of improving health should focus on increasing happiness and the frequency of positive emotions. Lyubomirsky, Sheldon and Schkade [2005] consider it possible to permanently increase a person‘s level of happiness. These authors propose that chronic happiness in a person depends on three main types of factors: genetic, circumstantial and practical factors, and activities significant for happiness. The latter type of factors gives a person the chance to maintain an increased level of happiness.

Psychological Well-Being, Assessment Tools and Related Factors 95 As Friedman, Hayney, Love et al. [2007] pointed out, both hedonic and eudaimonic well- being have been associated with health results. Positive feelings have been associated with a low morbidity, and with an increased longevity [Pressman and Cohen, 2005; Lyubomirsky, King, and Diener, 2005]. More specifically, they have been found to be associated with a reduced incidence of stroke [Ostir, Markides, Peek et al., 2001], of general functional independence [Ostir, Markides, Black et al., 2000], or less acute rises in stress-induced fibrinogen levels [Steptoe, Wardle and Marmot, 2005], lower levels of cortisol in saliva, a lower heart rate and systolic blood pressure [Steptoe and Wardle, 2005]. Higher levels of eudaimonic well-being are associated with lower cortisol levels and less musculoskeletal symptoms [Lindfors, 2002]. Some measures of eudaimonic well-being are positively associated with levels of HDL-cholesterol and with healthy sleeping patterns, and negatively associated with the diurnal cortisol gradient in saliva, body weight, waist-hip ratio, glycosylated hemoglobin and total cholesterol and plasma levels of soluble interleukin-6 receptors [Ryff, Singer and Love, 2004]. Although there is a degree of conceptual and statistical overlap in hedonic and eudaimonic indices of well-being, significant differences between them have been demonstrated empirically. Purpose-of-life scales measure the degree of meaning people assign to daily activities and life changes, which have been related to lower levels of cortisol in saliva, lower waist-hip ratio and higher levels of HDL cholesterol [Ryff, Singer and Love, 2004]. As Steptoe and ez Roux [2008] mentioned, the mechanism by which happiness affects future health has not been well established. We explained previously that happiness has been associated with a reduced release of diurnal cortisol, with attenuated inflammatory responses and patterns of heart rate variability indicative of a healthy autonomic heart rate control. These associations are independent of socioeconomic characteristics and negative affective states. One possibility is that frontal and limbic cerebral mechanisms, which regulate the neuroendocrine and autonomous functions, could be involved. Happiness is also associated with a better social cohesion and strong social support. 5.1. Well-Being and Society If happiness, as Fowler and Christakis [2008] suggested, is transmitted by social connections, this could indirectly contribute to a social transfer of health, in other words, some psychosocial determinants of health could be spread by social contact. Social links, especially of friendship, are often established between individuals with a lot in common, including personal attributes and also living and work environments. Many of these characteristics are associated with health results and psychological states. These patterns of behavior can disseminate with time to different people through both nearby and more distant social contacts. Social epidemiology has established the importance of social communication for health, and both beneficial and adverse effects on health can be transmitted through the social network [Steptoe and ez Roux, 2008]. This inter-relationship is especially important in the family environment. For example, chronic diseases are often painful and in the long-term can affect the family and the home environment. The spouses of chronic patients have also been found to suffer more problems in their physical health than the spouses of healthy individuals. However, as Bigatti and

96 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. Cronan [2002] pointed out, studies in this area have mainly focused on spouses who act as carers, in other words, those who assist their husbands or wives in activities of daily living (bathing, feeding, dressing, toileting). They demonstrated that spouses play a crucial role in the level of adaptation of chronic patients to their condition, especially in relation to the reversal of roles and life patterns established in the couple with time. This impaired physical health among the spouses of chronic patients has been widely reported in the literature, and was also observed in those functioning as informal carers. They tend to have a higher prevalence of chronic illnesses, infections and physical problems such as backache, arthritis, impaired hearing, insomnia, diabetes, ulcers, anemia, hypertension, cataracts and heart disease than would be expected in this population. Consequently, the population group corresponding to spouses of chronic patients have an above-average use of the services. The literature has suggested that the spouses of chronic patients suffer from emotional discontent, resulting from the burden associated with their stressful situation, in this case their partner‘s chronic illness. Their emotional reactions to the spouse‘s illness can range from anger and resentment, insecurity, incompetence, guilt, anxiety, despondency, worry, physical and emotional stress, fatigue and many more, which lead to an overall dissatisfaction with life. Bigatti and Cronan (2002) compared the physical and mental health and the use of healthcare services among the husbands of patients with fibromyalgia, compared with the husbands of healthy women. Participants from the fibromyalgia group reported poorer levels of health and emotions, and had higher scores in depression, loneliness and subjective stress than members of the control group. The husbands in the fibromyalgia group who reported an increased impact of illness, and whose wives had a worse quality of sleep and lower levels of self-efficiency, presented more psychological difficulties. No differences were found in the costs of healthcare incurred by both groups. These findings suggest that chronic illnesses can have a negative impact on the physical and mental health of the spouses. 5.2. Biological Relationships between Well-Being and Health It is very important to identify the physiological substrate of this association. In fact, the core hypothesis to positive health is that the experience of well-being contributes to the effective functioning of multiple biological systems, which can help the body to avoid illness or, when illness appears, can help it to recover quickly [Ryff, Singer and Love, 2004]. On the other hand, it is not clear if hedonic and eudaimonic well-being have similar or different biological correlations. Both imply positive psychological functioning and would therefore be expected to have similar biological connections. However, eudaimonic well-being evokes an active and hard-working organism, often striving against adversity, which could promote a greater biological activation of the organism than hedonic well-being. The key to positive health is that well-being is accompanied by an optimum functioning of multiple biological systems. In the long term, this biopsychosocial interaction will prevent illnesses and will help the body to maintain its functional capacities and, hence, prolong periods of quality-of-life. One initial step to testing this hypothesis is to study whether individuals with well-being have lower levels of biological risk for multiple physiological systems, and higher levels of ―good‖ biological markers, such as HDL cholesterol. Although the influence of psychosocial factors on cardiovascular, neuroendocrine and immune function have been studied for some time, research has mainly focused on negative effects, showing

Psychological Well-Being, Assessment Tools and Related Factors 97 how psychosocial adversity increases biological risk. The work by Ryff, Singer and Love, [2004], however, focuses on the opposite perspective question, whether well-being is associated with reduced biological risk. The findings of this study carried out on a sample of 135 women over 60 years old, show that high levels of eudaimonic well-being are associated with lower diurnal levels of cortisol in saliva, of proinflammatory cytokines, less cardiovascular risk and longer periods of REM sleep compared with individuals with lower levels of eudaimonic well-being. On the other hand, hedonic well-being was only minimally correlated with biological markers. The study by Howell, Kern and Lyubomirsky [2007] revealed potential biological pathways that could explain the association between well-being and health, suggesting that it could directly strengthen the immune system and neutralize stress. Well-being had a greater impact on health promotion due to its effects on the immune system and tolerance to pain, and was not significantly related to increases in cardiovascular and physiological reactivity. These findings indicate the existence of potential biological pathways, through which well- being could directly reinforce immune functioning and neutralize the impact of stress. These authors propose a model that could give a simplified explanation for the connection between emotions and health. When a physically or emotionally stressful factor comes into play this produces a disagreeable situation. However, this can activate the central nervous system and trigger a response characterized by physiological changes, such as increases in blood glucose levels, heart rate and blood pressure, and the release of stress- related hormones, such as cortisol and epinephrine. This response can directly or indirectly affect the functioning of the immune system, which can continue activating the central nervous system, leading to a chronic state of tension and an increased susceptibility to illness. Hence, the cardiovascular, neuroendocrine and immune systems can work together and mutually influence each other. Some evidence for this model comes from research into animals, supported to some degree by a few studies in humans. However, it is a relatively simple model and the real situation is undoubtedly much more complex. While stress activates the sympathetic nervous system an opposite reaction can diminish its activity and promote optimum functioning. Negative personality traits such as neuroticism and hostility, are related to an increased risk of mortality and poor health results, while positive traits, such as optimism, extroversion, conformity and awareness are associated with a reduced mortality and a better health. Pressman and Cohen [2005] proposed two models which correlate positive feelings with illness. In the direct effects model, positive feelings can directly affect healthy practices, reducing the activity of the autonomous nervous system, controlling the release of stress hormones, influencing the opioid system and immune responses and also affective social networks, with a consequent impact on health and illness. In the stress neutralization model, positive feelings can improve the effects of stressful events, increasing resistance and reinforcing fight responses. Consequently, well-being can affect health by reinforcing short-term responses (such as the immune response and tolerance to pain) and long-term functioning (such as an improved cardiovascular profile and longevity), or by neutralizing the stressful effects in the short-term (marked by high level stress responses and cardiac reactivity), and illness in the long-term (for example by slowing down disease progression and increasing survival). These two mechanisms probably operate together, depending on the individuals and the situation in each case [Friedman, Hayney, Love et al., 2007].

98 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. The possibility of a relationship between plasma levels of antiinflamatory cytokines and psychological well-being has been studied. Plasma levels of interleukin-6 (IL-6) were lower in women with a higher score for positive relationships, while levels of soluble interleukin-6 receptors (sIL-6R) were lower in women with higher scores for purpose of life, even after controlling for a series of sociodemographic and health factors. These results, together with a lack of significant connections with other measures of well-being or distress, suggest that selective patterns of association exist between inflammatory processes in advanced stages of life and psychological factors, especially those related to positive bonds with others and a degree of commitment. IL-6 belongs to a family of inflammatory factors involved in age- related disorders, such as Alzheimer‘s disease, osteoporosis, rheumatoid arthritis, cardiovascular disease and some forms of cancer. Since concentrations of this cytokine in peripheral blood also increase with age, it has become a key focus for research into age- related inflammatory diseases. IL-6 regulation is sensitive to a wide range of psychological influences: negative psychological experiences can be a risk factor for high levels of circulating IL-6 in at-risk elderly individuals [Friedman, Hayney, Love et al. 2007]. The study by Friedman, Hayney, Love et al. [2007] examined the relationship between different measures of psychological well-being or distress and cytokine levels in older women. On the basis of previous research into circulating IL-6 levels, the authors try to prove the hypothesis that distress could be associated with high levels of IL-6 and sIL-6R, and that well-being could be associated with low levels. In fact, the only measures that were significantly associated with IL-6 and sIL-6R were levels of eudaimonic well-being; neither hedonic well-being nor distress were associated with inflammatory factors after controlling for health and sociodemographic factors. These results suggest that, in general, in healthy older women biological markers of inflammation are more closely related to some aspects of eudaimonic well-being than to differences in positive or negative affective states. This suggests that some aspects of well-being in the elderly could be related to a series of illnesses associated with ageing. The finding that plasma levels of IL-6 were lower in women with higher scores for positive relationships with others is consistent with studies showing that social integration and support predict a reduced morbidity and mortality, and can provide a buffer against the repercussions of stressful life events on health. By contrast, plasma levels of sIL-6R have a significant negative association with scores on the purpose of life and mastery of the environment scales. 5.3. Physical Activity and Well-Being There is an abundance of evidence in the literature to support the popular belief that physical activity is associated with psychological health. This was shown in a meta-analysis by Netz, Wu, Becker et al. [2005], which included 36 studies that analyzed the relationship between organized physical activity and well-being in elderly adults without clinical alterations. These authors found an effect size three times greater in study groups compared to the control. Aerobic exercise and moderately intense physical activity were the most beneficial to psychological well-being. Physical activity had marked effects on self-efficiency and improved cardiovascular condition, strength and functional capacity were all associated with a general improvement in well-being.

Psychological Well-Being, Assessment Tools and Related Factors 99 5.4. Psychological Well-Being and Illness There is increasing interest in the desire to study psychological adaptation to situations of illness, especially in more serious situations such as cancer. Although in the past this disease was almost always considered to be a terminal illness, an improvement in treatment and techniques for early diagnosis have increased survival in many patients. However, since both diagnosis and treatment can cause considerable distress in many people, it is easy to explain the interest in studying the psychological adaptation of these individuals [Manne and Schnoll, 2001]. Special emphasis in this area has focused on establishing the psychosocial preoccupations of individuals who survive cancer. Both diagnosis and treatment of cancer and its sequelae are adverse experiences. For most individuals, it causes important degrees of stress and for some a diagnosis of cancer is traumatic. Cancer survivors present a greater degree of psychological distress caused by emotional problems and a poorer social well-being, compared to those without a history of cancer. However, a model has been described [Carver, 1998] in which survival with impairment occurs after the initial decline in functioning following the adverse experience, as a continuation of compromised functioning, but that these individuals can also manifest a degree of resistance, with a return to normal or even a thriving functioning, exceeding the original level of functioning. Costanzo, Ryff and Singer [2009] set themselves the goal of studying psychological affectation, resistance or thriving in cancer survivors among the general population, comparing them with individuals without a history of cancer. They studied 4 psychological domains: distress, defined as symptoms of mental health and mood, psychological well- being, social well-being and spirituality. Data were obtained from the National Survey of Midlife Development in the United States (MIDUS) [2009], designed to study health and well-being in middle age. MIDUS is a national study of the combined influence of numerous factors (behavioral, social, psychological, biological, neurological) on health and well-being as people pass from early adulthood to middle-age and then to old age. In the first stage, MIDUS I, from 1995-1996, 7108 adults aged between 25 and 74 years old participated. One member, aged between 25 and 74 years old, was randomly chosen from each household contacted, and was invited to carry out a telephone interview and to fill in 2 self-administered questionnaires. Around 70% agreed to participate in the telephone interview and 89% of these also completed the self- administered questionnaires. These patients were followed up in 2005-2006 (MIDUS II), 4963 of them carried out another telephone interview and 81% of these also completed 2 self-administered questionnaires. The individuals participating in MIDUS also completed a broad battery of psychological tests, thus making it possible to compare individuals with a history of cancer and those without a history of cancer for a range of psychological results. There was also the opportunity to compare psychological functioning, before and after the diagnosis, in individuals diagnosed with cancer between the two evaluations. Psychological well-being was evaluated with 4 of the 6 domains of well-being considered to be the most relevant to cancer: mastery of the environment, personal development, positive relationships with others and self-acceptance. Changes in patients‘ psychological state before and after diagnosis were evaluated in patients who had survived cancer between the two interviews. Individuals surviving cancer had more negative feelings and less positive feelings both before and after

100 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. diagnosis. Positive feelings were affected by time: both cancer survivors and the control group showed an increase in positive feelings with time. There were no interactions between a diagnosis of cancer and time elapsed, implying that cancer did not affect the trajectory of feelings over time. Similarly, survivors of cancer had poorer well-being than controls both before and after diagnosis. Time also significantly affected 3 out of 4 of the domains of well- being: mastery of the environment, personal development and positive relations with others. Mastery of the environment and positive relations with others increased significantly for both groups, while personal development decreased for both groups. There was no difference in this pattern between the groups with or without cancer. However, this deterioration in psychological state reflects only a partial view, since the results also show that cancer survivors function as well as the control group in several psychological domains, including social well-being, spirituality and personal development. Moreover, neither the measures of social well-being nor the measures of spirituality were reduced after the diagnosis. In fact, the survivors had higher levels of spirituality and social progress and a belief that society is improving, both for themselves and for others. However, the control group also improved in these areas, supporting a model of resistance rather than ―thriving‖. This study did not observe a better functioning of cancer survivors compared to controls in any domain. The longitudinal study shows an increase in positive feelings, mastery of the environment and positive relationships with others after the diagnosis, combined with an improvement in social actualization and spirituality. However, the group without cancer showed the same improved trajectory, suggesting therefore that these changes are more likely to be associated with the passing of time or external events than with the cancer itself. The findings in this study verify important areas of psychological affectation and resistance among cancer survivors. Although the data do not support the existence of post- traumatic development after a diagnosis of cancer, with higher levels of personal development, social well-being or spirituality, some degree of resistance among survivors can be found. Cancer survivors are not only resistant in spite of the cancer, but also against greater mood alteration and psychiatric symptoms. Moreover, although cancer survivors show a poorer function in these measures of distress, these reduced levels of well-being tend to be found more among young survivors. Older cancer survivors seem to cope as well, or even better, than those without cancer, so age can be considered as an important factor of resistance against cancer. When other health problems are taken into consideration, the effect of obesity on psychological well-being is perhaps one of the most interesting. In this sense, community studies suggest that, in spite of these individuals experiencing moderate levels of dissatisfaction with their bodies, few obese children are depressed or have low self-esteem. However, individuals seeking treatment do present lower levels of well-being than the general population, or controls of normal weight [Wardle and Cooke, 2005]. On the other hand, successful weight-reducing treatments have been shown to increase self-esteem [Blaine, Rodman and Newman, 2007]. Changes in psychological well-being have been studied in other endocrine diseases such as diabetes [Debono and Cachia, 2007], or rheumatic diseases such as rheumatoid arthritis [Treharne, Lyons, Booth et al., 2007], and emphasize the importance of educating patients to increase self-empowerment and to develop coping strategies.

Psychological Well-Being, Assessment Tools and Related Factors 101 5.5. Ageing, Health and Well-Being Provided that the elderly maintain the functional capacity to be independent and to perform daily activities, they regard themselves as healthy. Similarly, some psychosocial characteristics, such as the possibility of receiving help from their surroundings and the availability of natural social networks help to improve this perception, to some degree independently of the illness. The way in which the elderly evaluate their satisfaction with life depends on certain life situations and the individual‘s psychosocial characteristics. Hence, the perception of satisfaction with life is not only linked to the concept of attaining goals and achieving one‘s expectations, but also to the life events characteristic of this age. Ultimately, the quality of life perceived by the elderly depends on the life satisfaction they manifest, and their own self- assessment of their health. Therefore, a positive mood, perceiving oneself as having the capacity and competence to solve problems, having the skills and an adequate level of health to maintain one‘s lifestyle, to evaluate positively what one has achieved in life and to know how to be of use to oneself and to others, are all factors that help a person to assess his life in terms of good quality [Martinez Garcia and Garcia Ramirez, 1994]. 5.6. Well-Being and Mortality A recent meta-analysis of longitudinal observational studies found that measures of happiness, joy and related concepts were associated prospectively with reduced mortality, both in initially healthy individuals and also in those with an established illness [Chida and Steptoe, 2008]. These effects were independent of the initial state of health, age, demographic factors and risk factors, and persisted after negative affective states, such as anxiety and depression had been controlled for. These results indicate that happiness is more beneficial than merely an absence of these afflictions. A two year cohort study on 2282 Mexican subjects, aged between 65 and 99, without functional limitations, showed a direct association between positive sentiments at the start of the study and morbidity, functional state and survival at two years, independently of functional state, sociodemographic variables, chronic illnesses, body mass index, smoking and alcohol consumption and negative feelings at the start of the study. Individuals with strong positive sentiments had half the probability of suffering alterations in activities of daily life (OR: 0.48; 95% CI: 0.28-0.93) and of dying during the two year follow-up (OR: 0.53; 95% CI: 0.30-0.93), compared with those with lower scores in positive affects. These results support the idea that positive feelings, or emotional well-being, is different to an absence of depression or negative feelings. Positive feelings seem to protect individuals against physical deterioration in older ages.

102 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. 6. PSYCHOLOGICAL WELL-BEING AND PERSONALITY FACTORS On the whole, the concept of psychological well-being is linked to the subjective perception a person has of his own achievements and the extent to which he is satisfied with his past, present and future actions. In this sense, it refers to the positive opinion and constructive thoughts a person has about himself [Diener, Suh, Lucas et al. 1999]. Taking into account that psychological well-being entails accepting one‘s self, maintaining positive relationships with other people, being autonomous, adequately managing the environment, having clear priorities and goals in life, and the feeling of undergoing a continuous process of personal development [Ryff and Keyes, 1995] we may, therefore, wonder whether personality influences psychological well-being. There has been repeated evidence over the past few decades that personality variables are closely related with psychological well-being [Costa and McCrae, 1996]. Neuroticism and extrovertism are associated with negative and positive affect, respectively. In other words, people with neurotic tendencies (emotionality, impulsivity, rage and fear) are more predisposed to negative affect. By contrast, people who regard themselves as extrovert (vigor, tempo, sociability), experience more positive effect in a wider range of circumstances and situations, are more content, laugh more and feel happier than introverts [Diener, Sandvik, Pavot et al. 1992]. Research studies based on the Big Five personality factors tend to replicate the original results reported by Costa and McCrae [1984], in both correlational and experimental studies [Larsen and Ketelaar, 1991]: the neuroticism factor is a strong predictor of negative affect, while positive effect is predicted by the dimension of extroversion and agreeableness [DeNeve and Cooper, 1998]. Generally, people with neurotic tendencies are systematically more distressed. By contrast, extroversion affects positive emotions, while neuroticism independently influences negative emotions. Therefore, people who frequently express feelings of well-being will tend to be characterized by emotional stability and extroversion. Indeed, in people who were classified in relation to these two personality factors, it was possible to predict their future levels of well-being ten years later [Costa and McCrae, 1980]. Moreover, it was found that extroverts experience more events objectively classified to be positive than introverts. The correlation between extroversion and subjective well-being ranged from 0.40 to 0.60 [Diener and Diener, 1996]. Why is this the case? Firstly, a genetic explanation has been proposed and assumes that extroverts are more sensitive than introverts towards signals of reward, which are regulated by the Behavioral Activation System. On the other hand, people with neurotic tendencies are more sensitive to signals of punishment, regulated by the Behavioral Inhibition System. Extroverts learn to be happy more quickly, but not so readily to become sad. The opposite can be observed in people with neurotic tendencies: they quickly become sad but find it more difficult to become happy. Ultimately, depending on the circumstances extroverts are prepared to react with intense positive affect and neurotics with intense disagreeable emotions [Larsen and Ketelaar, 1991]. A second explanation for the increased psychological well-being of extroverts is that they have a greater ability to create situations that will make them happy. There is some evidence

Psychological Well-Being, Assessment Tools and Related Factors 103 to suggest that extroverts do tend to chose environments that they can later enjoy [Diener, Sandvik, Pavot et al., 1992] and that they feel better in the social settings they have selected, but not in others imposed upon them [Emmons, Diener and Larsen, 1986]. Clearly, it is easier for the extrovert to experience positive emotions, but he is also more likely to be involved in situations that facilitate these positive emotions. This has been demonstrated in recent studies into the relationship between social interaction and well-being in long-lived people [Landau and Litwin, 2001]. In addition to extroversion, other personality variables also affect psychological well- being. Friendly and conciliatory people have higher levels of satisfaction than antagonistic people who are easily offended. People who are responsible and meticulous seem to be more satisfied than people who couldn‘t care less, although these factors have less of an influence on well-being and extroversion and neuroticism. These results have come from the Big Five model which studies five personality factors: neuroticism, extroversion, openness, agreeableness and conscientiousness. Three of these are associated with well-being (extroversion, friendliness and responsibility), another is associated with unhappiness (neuroticism), and the last factor is not associated with either [Avia and Vazquez, 1998]. In addition to the above-mentioned personality factors, we cannot ignore the fact that over the past decade there has been consistent evidence for a relationship between a greater Emotional Intelligence, understood as the ability to understand and manage one‘s own emotional states, and a higher level of psychological well-being and a better psychological adjustment to the environment [Mayer, Roberts and Barsade, 2008]. People with a greater emotional intelligence have a better mastery of the tasks they are set and as a result experience a higher level of psychological well-being. These people also experience less negative and more positive feelings, are more agreeable, have less difficulty identifying and describing their feelings, are less likely to present somatic symptoms, and are better at tolerating stress. The ability to manage one‘s emotions appears to be an effective way of preventing some emotional alterations. Moreover, people with high emotional intelligence find it easier to express their emotions and show higher degrees of empathy or the ability to understand emotions felt by other people [Davies, Stankov and Roberts, 1998]. Ultimately, the ability to manage emotions adequately is associated with a better psychological adjustment to the environment and, hence, to a higher level of well-being. On the other hand, less emotional intelligence is related with a lower personal level of well-being and depression [Fernández- Berrocal and Ramos, 2002]. 7. FUTURE RESEARCH Over the past few years, a wide range of research studies have focused on psychological well-being in different professional and scientific settings. In the health sciences, progress in medicine has led to a significant increase in life-span, but has also given rise to the appearance of numerous chronic illnesses. This has resulted in a special relevance being assigned to the term ―Health-Related Quality of Life‖. Numerous scientific research studies use the term today to refer to the patient‘s perception of the effects of a given illness, or the administration of a treatment, in different life settings, and especially the consequences this

104 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. may have on their physical, emotional and social well-being. Thanks to these studies, healthcare professionals now have a better all-round perspective of individuals afflicted with disorders as diverse as Alzheimer‘s disease, patients with terminal cancer or AIDS, disabilities or traumatic disorders caused by violent situations. Traditionally, research into mental health has focused more on psychological dysfunction, than on other more positive aspects of human functioning. However, this view is very narrow, since defining mental health as an absence of illness ignores human needs and abilities to prosper and the protective effects associated with living well [Ryff and Singer, 1996]. Being well-lived is not defined as a lack of negative experiences, but instead as living these experiences to the full, and successfully managing the challenges and difficulties that arise [Ryff and Singer, 2003]. It is well known that negative emotions and distress cause a decline in levels of physical and physiological health but, until recently, little emphasis was placed upon the protective and beneficial effects of positive emotions and well-being on health [Howell, 2009]. A reduction in illness, and its association with well-being, has important implications for possible psychological and medical interventions, hence an important approach for health promotion would be to increase an individual‘s happiness and the frequency of positive emotions. As mentioned previously, positive feelings are associated with a low morbidity and increased longevity [Pressman and Cohen, 2005; Lyubomirsky, King, and Diener, 2005]. Measures of physical and psychological functioning, and in general those of health and quality of life, are more interesting to researchers than doctors, and used more by them [Valderas, Kotzeva, Espallargues et al. 2008]. In spite of the fact that these measures may be comparable, in terms of the reliability and viability with the clinical measures usually used in practice [Patrick and Chiang, 2000], healthcare professionals are still skeptical about their significance and applicability. There is some evidence that these measures could improve the diagnosis and recognition of problems, and communication between professionals and patients, but there is no evidence to support their systematic use [Marshall, Haywood and Fitzpatrick, 2006]. In spite of this, the usual measures of morbidity are being replaced by new ways of evaluating the results of interventions, and the goals of healthcare today focus on improving the patient‘s quality of life, and not merely eliminating or curing illness. Some important research in this line has been carried out in people with cancer, AIDS, asthma, multiple sclerosis and many other diseases. Also, from the perspectives of psychiatry and psychology, studies into quality of life are being carried out in order to evaluate the results of programs and treatments for chronic patients, such as those with schizophrenia or major depression. In some of these studies into specific diseases, the importance of a person‘s degree of autonomy on their well-being has not been emphasized sufficiently. Today, it is important to move the concept of psychological well-being closer to that of functional capacity. If satisfaction with life is considered as being closely associated with the possibility of taking decisions and choosing between different options, opportunities will arise to study how individuals with disabilities can improve their level of satisfaction by being able to express their preferences, wishes, goals and aspirations, and by participating more in the decisions that affect them. Regarding the elderly population, they consider themselves to be healthy if they can maintain the functional capacity to be autonomous and to perform daily activities on their own. Similarly, some psychosocial characteristics such as the ability to help the environment and the availability of natural social

Psychological Well-Being, Assessment Tools and Related Factors 105 networks help to improve this feeling of being to some extent independent of processes of illness. The needs, aspirations and ideals associated with well-being vary depending on the developmental stage, so the perception of satisfaction is influenced by several age-related factors. Because of this, studies have tended to focus on specific periods in the developmental cycle, especially on childhood and old age. Research focusing on childhood and adolescence study the repercussions of special situations (for example, chronic illnesses such as asthma or diabetes) on perceived satisfaction with life. In these cases, contrary to the usual situation, emphasis must be placed on the point of view held by the child himself and not by his parents, teachers or carers. Research into the elderly has mainly focused on the influence degree of well-being has on physical health and the services received by the elderly, although less importance has perhaps been given to the influence of social support, or recreational or leisure activities. One of the dimensions of psychological well-being is the ability to maintain positive relationships with other people [Ryff and Singer, 1998], and people‘s need to maintain stable social relationships. On the whole, people‘s well-being reflects complex social processes, with multiple components, which must be measured by a system of indicators of variable validity in different times and contexts. From both conceptual and operative frames of reference, more research is required over the next few years into the psychological well-being of people from an all-round perspective. Researchers must endeavor to overcome conceptual ambiguities and to investigate more operative formulas that can identify, with greater precision, human or social aspects with a decisive involvement in the condition of psychological well-being, such as education, health, satisfaction with work, work and family relationships, life expectancy and, among other aspects, people‘s moral values and aspirations. The search for desirable and sustainable levels of psychological well-being, although with variable interests and points of view, is a widespread concern in our society. There is increasing interest and attempts to conceive and measure it from an all-round perspective. Analysis of the factors associated with psychological well-being is one of the ways of moving closer to the concept, taking into consideration that these factors vary in relation to cultural differences. Well-being has a multidimensional character [Martire, Stephens and Townsend, 2000] and the identification and description of the different variables associated with it, especially sociodemographic and personality variables, are among the main objectives of epidemiological research. The concept of psychological well-being must focus on the most essential aspects of human existence, especially in the area of health, where it almost undoubtedly acquires its greatest operativity. In this context, in spite of some partial and rather inconclusive definitions, not always emerging with the expected significance, psychological well-being is being increasingly used upon as a powerful instrument to analyze and implement public policies. It is being employed to articulate, from an all-round perspective, the approaches of social inclusion and equity, human development and sustainable development. Moreover, it could also help to guide the provision of services towards more people-focused practices. This can be found within a context of increasingly well-informed citizens, with a greater capacity to demand and to manage, guided by positive values and legitimate social aspirations, striving to improve their quality of life. The area of subjective well-being must be significantly developed in several directions. In the first place, an attempt must be made to approach the concept of psychological well-

106 Jesús López-Torres Hidalgo, Beatriz Navarro Bravo, Ignacio Párraga Martínez et al. being with standardized and valid, but also more sophisticated, instruments. It is also necessary to recognize the multifactorial nature of emotions and well-being. Scales have been obtained with good psychometric properties, but these have hardly incorporated any non self- informed measures [Diener, Suh, Lucas et al. 1999]. It would, therefore, be desirable, and certainly much more complicated, to complement the evaluation of well-being with more objective measures of biological determinations, facial expressions, life experiences, cognitive states etc. The central hypothesis to positive health is that the experience of well- being contributes to the effective functioning of multiple biological systems, which can help to protect the individual from illness or, when illness appears, to help him to recover rapidly [Ryff, Singer and Love, 2004]. Although it has sometimes been considered that well-being in individuals can only be studied through the replies they themselves make, arguing that it is an internal and subjective phenomenon, there are no solid reasons to exclude other kinds of variables. As these other measures converge towards self-reported ones, the conclusions will be reinforced. If, however, these tend to diverge the researchers must formulate hypotheses to explain these tendencies. Psychological well-being is highly influenced by the nature of subjective experiences, but is also related to measurable aspects of physical, mental and social functioning. An attempt should be made to expand on knowledge in the area, to include factors related to both objective and subjective aspects of well-being in individuals, groups, communities and societies. From the different interpretations of psychological well-being, there is an underlying, and so far unresolved, argument about the types of relationships that exist between objective and subjective factors of well-being in people. On the other hand, it would be desirable to carry out more longitudinal and experimental studies into the determinants of psychological well-being, rather than always resorting to the transversal types of studies used to date. In this way, instead of just basing our knowledge on mere associations or correlations between variables, we can move closer to the causal factors of well-being, to prognostic factors and also to verifying the efficacy of different interventions to improve well-being. REFERENCES Allport, G. W. (1952). The mature personality. Pastoral Psychology., 2, 19-24. Andrews, F. M. and Withney, S. B. (1976). Social indicators of well-being: America´s perception of life quality. New York.: Plenum. Andrews, F. M. and McKennell, A. C. (1980). Measures of self-reported well-being. Social Indicators Research., 8, 127-156. Artazcoz, L., Borrell, C., and Benach, J. (2001). Gender inequalities in health among workers: the relation with family demands. J. Epidemiol.Community Health, 55, 639-647. Austin, J. T. and Vancouver, J. F. (1996). Goal constructs in psychology: Structure, process, and content. Psychological Bulletin, 120, 338-375. Avia, M. D. and Vazquez, C. (1998). Optimismo inteligente. Madrid: Alianza Editorial. Badia, X., Gutierrez, F., Wiklund, I., and Alonso, J. (1996). Validity and reliability of the Spanish Version of the Psychological General Well-Being Index. Quality of Life Research, 5.

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In: Psychological Well-Being ISBN 978-1-61668-180-7 Editor: Ingrid E. Wells, pp.115-134 © 2010 Nova Science Publishers, Inc. Chapter 3 SEXUAL SATISFACTION AS A FUNCTION OF PARTNERSHIP ATTRIBUTES AND HEALTH CHARACTERISTICS: EFFECT OF GENDER Ann-Christine Andersson Arntén and Trevor Archer Department of Psychology, University of Gothenburg, Göteborg, Sweden ABSTRACT Two hundred and fourteen employees, 136 men and 78 women, responded to Subjective Stress Experience Questionnaire, Stress and Energy Scale, Hospital Anxiety and Depression Scale, Job Stress Survey, Partnership Relations Quality Tests (e.g. Sexual life Satisfaction, and Partnership Relation Quality), and Positive and Negative Affect Scale. Health-promoting advantages of sexual life satisfaction in counteracting illhealth associated with different types of stress were observed. Men participants‘ Sexual life Satisfaction was predicted by intercourse frequency, accordance with desired frequency, intercourse satisfaction, frequency of sexpartners, women‘s participants‘ Sexual life Satisfaction was predicted by intimate communication, caressing and cuddling, and desire. Level of Sexual life Satisfaction and gender influenced coping (e.g. cognitive, emotional, social), depression anxiety, Partnership Relation Quality, thoughts of divorce, negative affect, general stress, and dispositional optimism. Regression analyse showed that work-stress was predictive and sexual life satisfaction was counter-predictive for depression, anxiety, general stress and psychological stress and thereby buffering the negative effects of work stress. Keywords: Sexuality, stress, affect, anxiety, depression, partnership relation, gender, health.

116 Ann-Christine Andersson Arntén and Trevor Archer INTRODUCTION Current notions of individuals‘ lives would appear to revolve, to a significant extent, around three major domains: interpersonal (love) relations (here conceptualized as sexuality), work and health. Sexuality, long since accepted as an essential feature of life, has critical importance for health, quality of life and general well-being (Nusbaum et al., 2000; Howard 2006; Lauman et al., 1994; Ventgodt, 1998). Additionally, sexuality influences also our perceptions and relations to partners, meaningful others and ourselves (Nusbaum et al., 2000). There exists a reciprocal deterministic relationships between high levels of intimacy and high levels of adaptation and attachment within a couple, i.e. partnership quality (Moore et al., 2001; Howard et al., 2006; Fasching et al., 2007), over both genders. Beutel et al. (2002; 2008) have confirmed these associations indicating a strong positive correlation between sexual enjoyment and partnership satisfaction, and a less strong correlation of the latter with sexual activity. Andersson Arntén et al. (2008a, 2008b) found significant links between inferior partnership relation quality and certain health markers, including anxiety, depression and stress, as well as with high quality of sexuality predicting almost 50% of partnership relation quality (Andersson Arntén et al., 2008c). Sprecher et al. (1995), in citing several studies indicating that partners enjoying high levels of sexual activity and/or a satisfied sexuality together express greater satisfaction with their entire relationship, concluded from their own results that communication, sexual expression and companionship were important factors predicting satisfaction. Taken together, these findings underline the strong associations between couples‘ sexuality and the quality of their partnership relations. One essential aspect of sexuality pertains to which factors mediate individuals‘ experiences of their own sexuality and sexual enjoyment. Addis et al. (2006), in a study of women between 40-69 years, defined three areas: sexual frequency, sexual satisfaction and sexual problems. There are several advantages linked to a positive and active sexuality, including pleasure and physical relaxation, a feeling of coherence, opportunity for intimate communication, increased feelings of self-worth and contribution to individuals‘ self-identity (Nusbaum, 2000). Self-identity is associated with personality characteristics. For example, it follows that ―openness‖ contributes to a higher level of sexuality and partnership satisfaction while interpersonal problems reduced both (Beutel et al., 2002; Beutel et al., 2007). In adults, there is a correlation between marital stability, good mental and physical health and positive personality characteristics, all of which protect against mortality risk (Blair et al., 1989). Sexuality, or rather problems associated with it, appears to provide a marker for different forms of health/illhealth, with sexual distress linked to forms of illhealth (Addis, 2006). Sexual problems often coexist with depression, lack of self-respect, relationship problems or unpleasant sexual experiences (Ventgodt, 1998). Thus, Howard (2006) implies that the best predictors for sexual distress are general lack of emotional well-being and the lack of emotional relationship between individuals participating in the sexual act. Beutel et al. (2002) has shown that both sexual satisfaction and satisfaction with partner relationship were at risk in cases where men were dissatisfied with own health, reporting somatoform (physical) complaints and interpersonal problems. There exist marked gender differences pertaining to sexuality and sexually-related problems, e.g. men report greater sexual desire than women (Beutel et al. 2007). On the other hand, several studies indicate gender differences pertaining to lack of sexual interest, wherein

Sexual Satisfaction as a Function of Partnership Attributes… 117 women indicate a greater lack of sexual desire than men (Laumann, 1994; Ventgodt, 1998; Beutel et al. 2007), the most common sexual problem among women incremental with age. Premature ejaculation, the most common sex-related problem among men, appears not to be age-related (Ventgodt, 1998). It appears likely that men report sexually-related problems more frequently than women (Clayton 2001). Nevertheless, sexual dysfunction is more common among women than men (Addis et al. 2006). Sexual dysfunction among women significantly affects womens‘ self-confidence, quality-of-life, and causes emotional distress that may culminate in relationship problems (Lauman et al. 1994), an association that exists for men too. In addition to this, it appears likely that sexual behaviour promotes health thereby contributing also to general well being. Among men, frequency of intercourse is inversely related to mortality whereas among women enjoyment of intercourse was inversely related to mortality (Smith 1997) and sexual dissatisfaction was linked to increased mortality risk. In general, the risk of mortality among individuals with high rate of orgasm was halved in relation to those with a low rate, over death from all causes. Men with a higher frequency of orgasm had 50% lower risk of mortality than men with lower frequency of orgasm (Smith 1997). Furthermore, Palmore (1982) found a direct, positive relationship between sexuality activity and longevity and that men‘s intercourse frequency and women‘s earlier enjoyment of intercourse were predictors for increased longevity. This relationship was confirmed by Seldin et al. (2002), who found too that frequency of orgasm for married women was moderately protective against mortality risk. Brody et al. (2000) reported a direct physiological association with sexual activity, e.g. the link between penile-vaginal intercourse (FSI) and lower diastolic blood pressure. Moreover, some results indicate a positive correlation between sexual activity and positive effects on the immune system (Stein, 2000; Charentski and Brennan 2001) as well as reduction of cancer risk, breast cancer in women (Murell, 1995; Petriodu et al. 2000; Le, et al. 1989;Janerich, 1994; Rossing, et al. 1996) and in men (Petridou, et al 2000), prostate cancer (Giles, et al. 2003; Leitzmann et al. 2004). Another factor that is strongly connected with well being and health is sleep. Sexual activity, e.g. sexual release and orgasm, positively correlates with better sleep (Crooks and Baur, 1983; Odent 1999; Ellison 2000). Psychological health is linked strongly with sexual functioning. For example, Ferguson, (2001) observed that reduced sexual functioning was associated with clinical depression: 50- 90% of the depressed patient group, with or without medication, expressed some form of sexual dysfunction. Only 50% of the depressed women and 75% of the depressed men had been sexually active during the previous month and within the depressed patient group 40% of the men and 50% of the women expressed reduced sexual desire. Other psychological faxctors, such as stressors, interpersonal relations, body image and sexual self-awareness are linked to sexual functioning (Clayton, 2001; Addis et al. 2006). Subjective health self- perceptions may exert critical effects in deciding sexual and partnership satisfaction (Beutel et al., 2002; Fasching et al., 2007). On the other hand, individuals expressing sexual activeness appear to enjoy a higher quality-of-life than those less active and the population average (Ventgodt, 1998). Both men and women who had partners expressed a quality-of-life that was over the population mean (ibid). Other dimensions that do not require that individuals having a partner, such as well-being, satisfaction with life and happiness, appear higher in individuals having an active sexuality (ibid).

118 Ann-Christine Andersson Arntén and Trevor Archer In summary, an active sexual life ensures several positive effects that may be directly or indirectly associated with physical and psychological well-being. Stress Marked associations between general stress and sex-related factors, such as intimate comunication, intercourse frequensy and satisfaction, have been described (Andersson Arntén et al., 2008c). Beutel et al. (2007) indicated that emotional problems, stress and poor health, in turn, influenced women‘s sexual desire. Andersson Arntén et al. (2008c) described marked associations between ‖work-stress‖ and sexually-related factors, whereby elevated work- related stress reduced ―own-initiative‖, ―satisfaction and orgasm during intercourse‖ and ―partner‘s initiative‖. Collins et al. (1992) showed correlations between success rates and psychological stress as well as coping styles during fertilization. Finally, Fasching et al. (2007) demonstrated that anxiety due to difficulties such as coping with lethal illness, physical dysfunction and altered body image exerts a critical influence upon partnership and sexual situations. Positive and Negative Affect Positive and negative affect influences sexual processes. Among men, positive or negative affect is considered to be a factor influencing whether or not sexual performance is successful or unsuccessful (Barlow, 1986; Meisler and Cary, 1991; Hartmann, 2005). Level of positive affect was shown to be higher among sexually well-functioning men compared with sexually dysfunctional men, possibly due to the former responding with positive mood in the sexual situation (Rowland et al., 1995). Mitchell et al. (1998) found that positive and negative mood induction has differential effects on sexual function (functioning). Positive mood was associated with penile-enlargement and subjective sexual arousal whereas negative was linked to a significant reduction of penile-enlargement. The authors imply that mood influences arousal which in turn influences sexual physiological responses. Thus, elevation in negative mood may constitute a key component of dysfunctional sexual performance and ability, concurrent with the facilitatory role of positive mood on arousal and successful sexual performance (Mitchell et al., 1998). Arguably, sexuality is direct or indirectly associated with well being and positive affect whereas the work place is linked to stress and potential threat to health and well-being, one purpose of the present study is to examine whether or not the endowment of positive qualities from sexuality may provide a ‗buffering‘ effect against negative affective states or tendencies toward illhealth that may be generated by stress at the work place. In the present study, it is hypothesised that:- (i) there exists a positive association between degree of sexual life satisfaction (SLS) and different markers for health/illhealth (e.g. positive affect, energy/negative affect, subjective stress reactions, anxiety, depression). (ii) there exists a positive association between degree of SLS and individuals‘ personal profiles (e.g. dispositional optimism, coping strategies).

Sexual Satisfaction as a Function of Partnership Attributes… 119 (iii) There exists a negative association between general stress and work stress and quality of sexuality. Against these hypotheses, the presence of gender effects and which particular sex-related factors are linked to ―sexual satisfaction‖ in men and women is investigated. METHODS AND MATERIALS Participants One two hundred and fourteen participants (136 men and 78 women) equally divided between four different occupational categories, sales personnel, construction foremen, teachers, administrative personnel, took part. The response rate among participants was about 80 percent at each workplace, resulting in 214 subjects. The mean age of the whole population of participants was 39.55 years (SD = 8.43), with men aged 37.86 years (SD = 7.31) and women aged 42.90 years (SD = 9.62). The mean amount of education after basic school was 4.92 years (SD = 2.88), with 5.1% of the men and 2.6% of the women not receiving any education after basic school. Among men, 41.9% had high school education and 53.0% further education whereas the equivalent for women was 20.6% and 77.8%, respectively. Design The study consisted of independent variables: ―Work Stress (JSS)‖, ―Sexual life satisfaction (SLS)‖, and ―Gender‖, and the dependent variables ―Subjective Stress Experience (SSE): psychological (SSPSYK) and somatic (SSSOM) stress‖, ―Stress and Energy‖ (SE), ―Anxiety‖ and ―Depression‖, and ―Positive (PA) and Negative (NA) affect‖ as well as dispositional optimism (LOT). The dependent variables were chosen from the perspective of examining the effects of experienced work stress from the notion that health/illhealth may be manifested through several different expressions: affect (PANAS), emotion (Stress and Energy), psychological and somatic stress reactions (SSE), anxiety and depression (HAD) as well as the influence of dispositional optimism (LOT). Analyses were performed accordingly: 1) regression analysis in order to study which factors predicted SLS, 2) one-way ANOVA with SLS divided into three groups, i.e. ―Low‖, ―Medium‖ and ―High‖, to confirm that SLS influences health and individuals‘ personal profiles, and 3) regression analysis with application of hierarchical method, to examine the extent SLS may buffer the effects of JSS on health factors, was used. Instruments Positive affect and negative affect scale (PANAS). The PANAS-instrument provides a self-estimation of ‖affect‖, both positive and negative. It consists of 10 adjectives for the NA

120 Ann-Christine Andersson Arntén and Trevor Archer dimension and 10 adjectives for the PA dimension. The test manual (Watson, Clark, and Tellegen, 1988) postulates that the adjectives describe feelings (Affect) and mood level. Participants were instructed to estimate how they felt during the last few days. The response alternatives were presented on a five-grade scale that extended from where 1 = not at all to 5 = very much. For each participant the responses to the 10 negatively-charged adjectives were summated to provide a total NA-result for NA affect, and similarly the responses to the positively-adjectives were summated to provide a total PA-result for PA affect. The PANAS instrument has been validated through studies analyzing conditions associated with general aspects of psychopathology (Huebner and Dew, 1995), as well as a multitude of other expressions of affect (Watson and Clark, 1984). Cronbach´s testing for the total scale indicated Alpha = 0.83. Cronbach´s testing for PA indicated Alpha = 0.83. . Cronbach´s testing for NA indicated Alpha = 0.83. Hospital Anxiety and Depression (HAD). The instrument is derived to measure depressive and anxiety symptoms (Zigmond and Smith; 1983; Herrman, 1997). It consists of 14 statements to which participants respond by marking one of either three or four response alternatives. For example, ―I can sit still and feel relaxed‖ with response alternatives: ―Definitely‖, ―Generally‖, ―Seldom‖, ―Never‖, or, ―I look forward with gladness towards this and that‖ with response alternatives: ―As much as before‖, ―Less than before‖, ―Hardly ever‖. Half of the statements were constructed to illustrate depressive symptoms whereas the other half to illustrate anxiety-related symptoms. Participants´ responses thereby provided two results, one pertaining to depressive symptoms, the other to symptoms of anxiety. Cronbach´s testing for the total scal indicated Alpha = 0.69. Cronbach´s testing for depression indicated Alpha = 0.68. Cronbach´s testing for anxiety indicated Alpha = 0.80. Subjective Stress Experience (SSE). The instrument is derived from a diagnostic manual designed to assess different reactions to stress (Lopez-Ibor, 2002). Participants were required to estimate the extent to which different statements concurred with how they felt on an ordinary working day. The first part of the instrument consisted of 23 statements wherein participants were required to respond to the extent to which they experienced, for example, ―Nausea or abdominal pain‖ or ―Overreaction to inconsequential inner stimuli/easily frightened‖, or, ―Muscle tension‖, or, ―Sleep problems caused by worry‖. The test contained statements concerning symptoms implicating autonomic activation, mood changes, tension as well as other non-specific symptoms associated with stress responses. Participants‘ estimations were carried out using a Visual Analogue Scale (VAS) whereby they marked a cross on a 10-cm line (1 at one end and 10 at the other) whereby 1 = ―do not agree at all 2‖ and 10 = ―agree completely‖. The results of the test provided a total estimation for somatic stress (SSSOM) and one for psychological stress (SSPSYK). Cronbach´s testing for the total scale indicated Alpha = 0.95. Cronbach´s testing for SSPSYK indicated Alpha = 0.92. Cronbach´s testing for SSSOM indicated Alpha = 0.89. Partner relationship questionnaire. The questionnaire consists of 45 questions regarding individuals‘ partner relationships that are designed to provide a comprehensive outline of these relationships, including sexual relations. The questionnaire contains two types of scales, multiple choice alternatives and an estimation scale from 1 – 10. Examples of questions are, as follows: ―How often do you and your partner discuss current events?‖ with response alternatives provided in those cases as multiple choice alternatives that vary from ―Never or Almost never‖, ―Seldom‖, ―Sometimes‖, ―Often‖, to ―Very often‖, and ―How often does petting and stroking occur between you and your partner?‖, with multiple choice response

Sexual Satisfaction as a Function of Partnership Attributes… 121 alternatives that vary from ―Never‖, ―Seldom‖, ―Less than once a week‖, ―More than once a week‖ to ―Everyday‖ (Möller, 2004). Examples of questions applying an estimation scale from 1 – 10 are, as follows: ―How much enjoyment do you get out of sexual intercourse?‖ whereby 1 represents ―No enjoyment at all‖ to 10 ―Very intensive enjoyment‖. This study was built upon 12 of the questions from the questionnaire, including items concerning: intercourse frequency; accordance with desired frequency; intercourse orgasm; intercourse satisfaction; intimate communication; caressing and cuddling; sexual desire; sexual pleasure; partners and own sexual initiative; frequency of sex-partners last month; and sexual life satisfaction. Other aspects of the questionnaire, family set-ups, housing, and question related to the couples‘ experience of partnership relation quality factors not directly connected to sexual satisfaction were left outside the scope of the present study. Cronbach´s testing indicated Alpha = 0.84. Stress and Energy (SE). The SE-instrument is a self-estimation scale that assesses individuals‘ experience of their own stress and energy (Kjellberg and Iwanowski, 1989). The test is divided into two sub-scales that express each participant‘s level of mood in the two dimensions: ―experienced stress‖ and ―experienced energy‖. Response alternatives are ordered within six-graded scales that extend from 0 = ―not at all‖ to 5 = ―very much‖. The instrument has been validated through studies concerning occupational burdens and pressures (Kjellberg and Iwanowski, 1989). The SE-scale has been constructed from the earlier used checklist, Mood Adjective Check-List (Nowlis, 1965), which was modified by Kjellberg and Bohlin (1974) and Sjöberg, Svensson and Persson (1979). Kjellberg and Iwanowski (1989) reduced the list to 12 adjectives in the two dimensions, stress and energy, which provides the latest version applied here. Cronbach‘s testing for the total scale indicated Alpha = 0.76. Cronbach´s testing for energy indicated Alpha = 0.77. Cronbach´s testing for stress indicated Alpha = 0.92. Job Stress Survey (JSS). The JSS instrument presents a general measure of stress at work. In the test, participants are questioned about the level of seriousness of certain stressors according to how individuals perceive them and how often these stressors have been experienced during the last six months (Spielberger and Vagg, 2002). Through the expediency of assessing the level of seriousness of the stressors as well as their frequency a distinction is made between condition and characteristic under measurement. The participants first estimate the level of seriousness of certain stressors on a 9-graded scale. Following this, they were instructed to assess on a scale from 0 to 9+ how often each incident had occurred during the last six months. The result was tabulated on nine different scales: three of these being index scales, three grading scales and three frequency scales. These scales were summon up in to a total score but can also be separated into three different stress sources: work stress (ASI), work burden (ABI) and lack of organisational support (BSI). Cronbach´s testing indicated Alpha = 0.90 Life orientation Test (LOT). The LOT-instrument is a self-estimation instrument that assesses an individual‘s degree of dispositional optimism. The instrument is based on a general model, regarding self-regulated behaviour, that indicates that optimism exerts meaningful behavioural consequences based on the model (Scheier, and Carver, 1982b; 1985). It was constructed originally to study the extent to which the personality trait optimism was associated with the ability to develop suitable ‗coping strategies‘ in connection with severe psychological and physical handicaps (e.g. tinnitus). The instrument consists of 12 statements from which each participant is instructed to assess the extent to which each of

122 Ann-Christine Andersson Arntén and Trevor Archer these statements fits in with him/her as an individual. The response alternatives are presented on a five-graded scale extending from 0 = ―strongly disagree‖ to 4 = ―strongly agree‖. LOT is a suitable scientific instrument with an estimated internal consistency of 0.76 (Cronbach‘s alpha) and a Test-Retest reliability of 0.79 (Pearson‘s r), indicating that the test result is stable over time. The LOT test requires about 5 minutes for completion. Testing has provided separate norms for men and women: men show a mean of 21.30 (SD = 4.56) and women 21.41 (SD = 5.22). Cronbach‘s testing indicated Alpha = 0.65. Health and Background questionnaire. The questionnaire is used to assemble background data regarding health and health-related information about the participants. It consists of questions regarding gender, age, education, smoking habit, exercise, aches and pains, sleep problems, time spent watching TV, and amount of activity associated with occupation. Examples of questions include: ―How often have you experienced sleep problems during the past year?‖ Response alternatives in this case provided for a choice between five different options including: ―Constantly‖, ―2-3 times a week‖, ―Once a week‖, ―Once a month‖, or ―Never‖. Each participant was instructed to mark the alternative that was most appropriate for himself/herself. Procedure Five places of work, both private and public, were contacted with regard to participation of employees in an investigation upon aspects of health. Four places of work, representing both private and public sectors, accepted to allow the study. Permission to carry out the study was sought through Heads of personnel, union representatives and persons in positions of responsibility who adjudged whether or not the material could compromise the integrity of the personnel. One place of work choose not to allow the investigation provided the following reasons: ―This compromises personal integrity‖, and ―We don‘t have the time‖. Employees at each respective place of work were informed first by their respective Heads about the study and then asked whether or not they wished to participate. All participation was on a volunteer basis and took place at the usual work place during working hours. Most of the participants were tested in groups of maximally five persons although some were tested singly. Prior to testing, participants were ensured total anonymity as well as the fact that each set of responses was unidentifiable among all the other sets of responses. In order to avoid the possible effects of ordering of each instrument, the order in which each instrument/questionnaire occurred was randomly distributed in each envelop. Each participant picked an envelop randomly out of the box containing them. The maximum amount of time allocated for subjects to complete all the questionnaires was 45 minutes (all participants were finished before the allocated time). At the start of testing, participants were informed about the purpose and background of the study and that it was above all on a volunteer basis. It was emphasis that all details of work place and personal identity were to be omitted since total anonymity was essential. On completion of all the instruments, each participant was instructed to replace all questionnaires in the envelope. All the envelopes were collected and stored until the employees from each of the places of work had completed the tests.

Sexual Satisfaction as a Function of Partnership Attributes… 123 Analyse In order to analyse whether or not different degrees of SLS affected the self-reported measures of coping strategies, health/illhealth, thoughts of divorce, and personality factors as positive and negative affect and together with dispositional optimism, the individual scores on this variable were assigned to three groups on the basis of subjects‘ own responses to the questionnaire:- Group 1 (―Low SLS‖) reported low levels on the sexual related questions on the PRQ instrument, Group 2 (―Medium SLS‖) reported intermediate levels and Group 3 (―High SLS‖) reported high levels. The distributions within these groups was performed through applications of SPSS procedures ‖rank cases‖ whereby the number of groups was confined to three. RESULTS Sexual Life Satisfaction A descriptive analysis of sexual life satisfaction between men and women shows that women, in general, have a lower degree of sexual life satisfaction (m = 6.02, sd = 2.94) compared to men (m = 6.67, sd = 2.43) giving a Cohen‘s d of -0.24. This result implies a minor difference between the groups of gender. Linear regression analysis was performed to examine the extent to which intercourse frequency, accordance with desired frequency, intercourse orgasm, intercourse satisfaction, intimate communication, ‗caressing and cuddling‘, desire, pleasure, partners and own initiative, frequency of sex-partners last month may predict Sexual life satisfaction (SLS). The result indicated that SLS (F(10,174) = 32,67, p<0.001, Adjusted R2 = 0.65) was significantly predicted from intimate communication (stand. p = 0.001), intercourse frequency (stand. p < 0.001), accordance with desired frequency (stand. p < 0.001), ‗caressing and cuddling‘ (stand. p < 0.01), and intercourse orgasm, (stand. p < 0.05). Further analyses were performed on men and women, respectively. These analyses indicated that SLS among men: F(10,112) = 24,49, p<0.001, Adjusted R2 = 0.70, was predicted significantly from intercourse satisfaction (stand. p < 0.05), intercourse frequency (stand. p < 0.001), accordance with desired frequency (stand. p < 0.001), and frequency of sex-partners during last month (stand. p < 0.001) whereas the result for women indicated that SLS: F(10,61) = 9,81, p<0.001, Adjusted R2 = 0.62, were predicted significantly from Intimate communication (stand. p < 0.005), ‗caressing and cuddling‟ (stand. p < 0.01), and desire (stand. p = 0.051). Table 1 presents the Standardized Standardized weights) and Significance values for the linear regression analyse, both in total and according to gender, with SLS as dependent variable, and intercourse frequency, accordance with desired frequency, intercourse orgasm, intercourse satisfaction, intimate communication, number of intercourses this month, ‗caressing and cuddling‘, desire, pleasure, partners and own initiative, frequency of sex- partners last month as independent (Predictor) variables.

124 Ann-Christine Andersson Arntén and Trevor Archer Table 1. Standardiserad Standardized weights) and Significance values for the linear regression analyse, both in total and according to gender, with Sexual life satisfaction as dependent variable, and intercourse frequency, accordance with desired frequency, intercourse orgasm, intercourse satisfaction, intimate communication, number of intercourses this month, desire, pleasure, partners and own initiative, frequency of sex- partners (last month) as independent (Predictor) variables All participants Male participants Female participants Predicting variables Standardised Significance Standardised Significance Standardised Significance Intercourse Beta ( Beta ( Beta ( frequency Accordance with 0.338 0,001 0.389 0.001 0.129 0.440 desired freq. Intimate 0.210 0,001 0.276 0.001 0.070 0.573 communication Intercourse orgasm 0.201 0.001 0.106 0.152 0.323 0.005 Caressing and cuddling 0.120 0.033 0.038 0.507 0.172 0.136 Desire 0.167 0.009 0.078 0.300 0.326 0.007 Pleasure Intercourse 0.097 0.119 -0.014 0.821 0.248 0.051 satisfaction 0.088 0.394 0.035 0.724 0.251 0.335 Partners initiative 0.098 0.361 0.206 0.042 -0.208 0.423 Own initiative Freq. sex. partners 0.081 0.204 0.056 0.419 0.145 0.202 0.005 0.938 0.021 0.730 -0.045 0.654 0.052 0.333 0.149 0.016 -0.043 0.716 In order to analyse whether or not different degrees of SLS affected the self-reported measures of health/illhealth, coping strategies and positive and negative affect, as well as dispositional optimism, the individual scores on this variable were assigned to three groups on the basis of subjects‘ own responses to the questionnaire:- Group 1 (―Low SLS‖) reported low levels of sexual life satisfaction on the PRQ instrument, Group 2 (―Medium SLS‖) reported intermediate levels and Group 3 (―High SLS‖) reported high levels. One-way ANOVA with SLS as independent variable and with coping strategies (cognitive, emotional, physical, social, and spiritual ) stress, energy, anxiety, depression, psychological and somatic subjective stress experience, dispositional optimism (LOT), Partnership Relation Quality, Thoughts of divorce, and Negative and Positive affect as dependent variables indicated significant effects for the following variables: Emotional coping: F(2,195) = 3.67; p < 0.05, whereby post hoc testing (Bonferroni‘s test, 5% level) indicated that the ―High SLS‖ group (M = 45.91, SD = 7.80), expressed a significantly higher level of emotional coping compared with the ―Low SLS‖ group (M = 42.71, SD = 7.38), whereas the ―Medium SLS‖ group was intermediary (M = 43.88, SD = 6.04). Social coping: F(2,195) = 2.98; p < 0.054, whereby post hoc testing (Bonferroni‘s test, 5% level) indicated the ―High SLS‖ group (M = 40.52, SD = 5.36), expressed a significantly higher level of social coping compared with the ―Low SLS‖ group (M = 38.29, SD = 6.18), whereas the ―Medium SLS‖ group was intermediary (M = 39.46, SD = 4.45). Depression: F(2,205) = 8.94; p < 0.001, whereby post hoc testing (Bonferroni‘s test, 5% level) indicated that the ―Low SLS‖ group (M = 4.37, SD = 2.61), expressed a significantly

Sexual Satisfaction as a Function of Partnership Attributes… 125 higher level of depression compared with both the ―Medium SLS‖ (M = 3.06, SD = 2.38), and the ―High SLS‖ (M = 2.82, SD = 2.13) groups. Anxiety: F(2,205) = 5.69; p < 0.005, whereby post hoc testing (Bonferroni‘s test, 5% level) indicated that the ―Low SLS‖ group (M = 6.39, SD = 3.66), expressed a significantly higher level of anxiety compared with the group ―Medium SLS‖ (M = 4.91, SD = 2.92). the ―High SLS‖ group was intermediary (M = 5.67, SD = 3.38), PRQ: F(2,178) = 113.84; p < 0.001, whereby post hoc testing (Bonferroni‘s test, 5% level) indicated that the ―High SLS‖ group (M = 54.11, SD = 4.18) expressed a significantly higher level of partner relation quality compared with both the ―Low SLS‖ group (M = 40.00, SD = 7.38), and the ―Medium SLS‖ group (M = 49.23, SD = 4.03). The ―Medium SLS‖ group expressed significantly more PRQ than the ―Low SLS‖ group. Thoughts of Divorce: F(2,189) = 10.88; p < 0.001, whereby post hoc testing (Bonferroni‘s test, 5% level) indicated that the ―Low SLS‖ group (M = 6.87, SD = 3.07) expressed a significantly higher level of thoughts of divorce compared with both the ―Medium SLS‖ group (M = 2.06, SD = 1.52), and the ―High SLS‖group (M = 1.67, SD = 1.31). Negative affect: F(2,205) = 5.61; p < 0.005], whereby post hoc testing (Bonferroni‘s test, 5% level) indicated that the ―Low SLS‖ group (M = 2.10, SD = 0.62) expressed a significantly higher level of negative affects compared with both the ―Medium SLS‖ group (M = 1.77, SD = 0.51), and the ―High SLS‖group (M = 1.87, SD = 0.56). Positive affect: F(2,205) = 3.58; p < 0.005, whereby post hoc testing (Bonferroni‘s test, 5% level) indicated that the ―High SLS‖ group (M = 3.79, SD = 0.52) expressed a significantly higher level of positive affect compared with the ―Low SLS‖ group (M = 3.56, SD = 0.59), and that the ―Medium SLS‖ group was intermediary (M = 8.33, SD = 1.31). There were no significant effects due to stress or subjective stress reactions nor for dispositional optimism, energy, cognitive, physical or spiritual coping. Gender Analysis Men: The analysis indicated that the ―Low SLS‖ group expressed a significantly higher level of depression, F(2,129) = 3.13; p < 0.05, stress, F(2,129) = 4.35; p < 0.05, and thoughts of divorce, F(2,118) = 6.10; p < 0.005, compared with the ―High SLS‖ group, and that the ―Medium SLS‖ group was intermediary. The result indicated also that the ―High SLS‖ group and the ―Medium SLS‖ group expressed a significantly higher level of PRQ, F(2,110) = 61.81; p < 0.001, compared with the ―Low SLS‖ group. Further, it was indicated that the ―Medium SLS‖ group expressed a significantly lower level of PRQ, compared with the―High SLS‖ group. Women: The analyses produced a greater number of significant effects than was the case for the men. It was indicated that cognitive, F(2,70) = 4.48; p < 0.05, emotional, F(2,70) = 6.65; p < 0.005, och social F(2,70) = 7.49; p = 0.001, coping were significantly affected by degree of SLS whereby the ―High SLS‖ group expressed a significantly higher level of coping compared with the ―Low SLS‖ group while the ―Medium SLS‖ group was intermediary. With regard to depression, F(2,73) = 4.97; p < 0.01, and thoughts of divorce, F(2,68) = 4.16; p < 0.05, the ―Low SLS‖ group indicated significantly greater levels than the ―High SLS‖ group whereas the ―Medium SLS‖ group was intermediary (see Table 2).

126 Ann-Christine Andersson Arntén and Trevor Archer Table 2. Mean (± SD) scores for Coping Strategies; cognitive (cricog), emotional (crime), social (crisoc); depression; anxiety, dispositional optimism (LOT), Partnership Relation Quality (PRQ), thoughts of divorce and negative affect (PANAS), by each of the three sexual-life satisfaction (SLS) Male participants Female participants Low SLS Medium SLS High SLS Low SLS Medium High SLS ( group 3) (group 1) (group 2) ( group 3) (group 1) SLS 28.55 + 4.55 (group 2) (n=29) 49.72 + 8.57 cricog 28.81 + 8.54 28.53 + 3.66 28.62 + 3.18 25.11 + 4.92* 27.44 + 2.83 (n=29) 42.59 + 4.98 (n=37) (n=36) (n=52) (n=28) (n=16) (n=29) 43.35 + 6.00 42.69 + 5.94 46.56 + 5.55 2.83 + 2.39 criem 43.79 + 6.49 41.86 + 8.93** (n=29) 7.45 + 3.61 (n=37) (n=36) (n=52) (n=28) (n=16) (n=29) 39.30 + 5.65 38.86 + 4.89 40.81 + 4.12 14.28 + 7.55 crisoc 39.37 + 5.26 36.96 + 6.70** (n=29) 22.93 + 3.41 depression (n=37) (n=36) (n=52) (n=28) (n=16) (n=29) 3.92 + 2.13* 3.00 + 2.42 2.81 + 2.01 4.90 + 3.04* 3.19 + 2.37 54.88 + 3.93 (n=28) anxiety (n=37) (n=37) (n=58) (n=31) (n=16) 5.65 + 2.93* 4.86 + 2.96 4.78 + 2.89 8.45 + 3.90● 5.00 + 2.90 1.76 + 1.57 (n=29) (n=37) (n=37) (n=58) (n=31) (n=16) 2.00 + 0.58 11.26 + 7.26* 10.73 + 7.18 10.81 + 5.91 (n=29) general 7.67 + 5.37 13.32 + 6.18 stress (n=38) (n=37) (n=57) (n=31) (n=16) 22.59 + 4.13 22.44 + 3.92 dispositional 22.05 + 4.55 22.51 + 4.33 19.80 + 5.43* optimism (n=38) (n=37) (n=57) (n=30) (n=16) PRQ 40.92 + 48.56 + 4.06** 53.72 + 4.28 39.00 + 8.15**,●● 50.56 + 3.93 6.61**,●● (n=55) (n=24) (n=16) (n=32) thoughts (n=26) 2.09 + 1.53 1.62 + 1.68 3.27 + 2.63* 2.00 + 1.55 2.90 + 2.32** of divorce (n=29) (n=34) (n=58) (n=26) (n=16) negative 2.01 + 0.58 1.79 + 0.52 1.81 + 0.55 2.21 + 0.66● 1.72 + 0.51 affect (n=38) (n=37) (n=57) (n=31) (n=16) * p < 0.05, versus High Sexual-Life Satisfaction group, Bonferroni‘s tests. **p < 0.01, versus High Sexual-Life Satisfaction group, Bonferroni‘s tests. ●p < 0.05, versus Medium Sexual-Life Satisfaction group, Bonferroni‘s tests. ●●p < 0.01, versus Medium Sexual-Life Satisfaction group, Bonferroni‘s tests. Anxiety: F(2,73) = 4.87; p < 0.01, and Negative affect: F(2,73) = 3.80; p < 0.05, whereby post hoc testing (Bonferroni‘s test, 5% level) indicated that the ―Low SLS‖ group expressed a significantly higher level of anxiety compared with the group ―Medium SLS‖ the ―High SLS‖ group was intermediary. PRQ: F(2,65) = 50.85; p < 0.001, whereby the ―High SLS‖ group and the ―Medium SLS‖ group expressed a significantly higher level of PRQ compared with the ―Low SLS‖ group. Table 2 presents the mean (± SD) scores for Coping Strategies; cognitive, emotional, social; depression; dispositional optimism (LOT), Partnership Relation Quality (PRQ), Thoughts of divorce and Positive and Negative affect (PANAS) as a function of ―Low‖, ―Medium‖ and ―High‖ sexual life satisfaction for the men and women. Sexual Life Satisfaction, Work Stress and Health Linear regression analysis hierarchical method, was performed to examine the extent to which work stress (JSS) in the first block and sexual life satisfaction (SLS) in the second block, may predict each of the variables: depression, anxiety, energy, stress, psychological

Sexual Satisfaction as a Function of Partnership Attributes… 127 subjective stress experience and somatic subjective stress experience, negative affect, and positive affect. Sexual life satisfaction was a significant predictor for positive affect and a significant counterpredictor for depression, anxiety, stress (SE) and negative affect. Work stress (JSS) was a significant predictor for anxiety and depression, stress (SE), psychological and somatic stress, and negative affect, and a significant counterpredictor for positive affect. Sexual life satisfaction was a significant predictor for positive affect and a significant counterpredictor for depression, anxiety, stress (SE) and negative affect. Table 3. Standardiserad Standardized weights) and Significance values for the linear regression analysis with depression, anxiety, stress, negative affect, positive affect, psychological subjective stress experience and somatic subjective stress experience, respectively, as dependent variables, (i) JSS and (ii) SLS as independent variables Dependent variables Independent (predicting) variables Depression: F(2,196) = 12.84, p<0.001, JSS SLS Adjusted R2 = 0.11 Anxiety: F(2,196) = 14.38, p<0.001, Stand. Beta ( Stand. Beta ( . Adjusted R2 = 0.12 Stress: F(2,196) = 12.90, p<0.001 0.23*** -0.23*** Adjusted R2 = 0.17 Negative Affect: F(2,196) = 20.06 p<0.001 0.31*** -0.16* Adjusted R2 = 0.16 Positive Affect: F(2,196) = 2.52 p<0.083 0.29*** -0.16* Adjusted R2 = 0.02 Psychological stress: F(2,198) = 17.24, p<0.001 0.35*** -0.19** Adjusted R2 = 0.14 Somatic stress: F(2,198) = 9.70 p<0.001 n.s. 0.15* Adjusted R2 = 0.08 0.38***. n.s 0.30***. n.s * p<0.05; ** p<0.01; *** p<0.001; n.s.: not significant. DISCUSSION The findings of the present study may be summarised as follows: -(1) Linear regression analyses performed to ascertain which factors predicted Sexual life satisfaction indicated that, among the whole population of participants, five factors were predictive, namely: intercourse frequency, accordance with desired frequency, intimate communication, „caressing and cuddling‟, and intercourse orgasm. (2) Among the men, Sexual life satisfaction was predicted by intercourse frequency, accordance with desired frequency, intercourse satisfaction and frequency of sexual partners whereas among the women, Sexual life satisfaction was predicted by intimate communication, „caressing and cuddling‟, and desire. (3) Degree of Sexual life satisfaction, i.e. whether high or low, influenced participants‘ self-reports of health related variables whereby high levels were associated with positive affect, emotional coping

128 Ann-Christine Andersson Arntén and Trevor Archer and social coping whereas low levels were associated with negative affect, anxiety, depression and thoughts of divorce. Additionally, high levels of Sexual life satisfaction were linked to a high level of partner relationship. (4) Among men, low levels of Sexual life satisfaction were associated with anxiety, depression, general stress and thoughts of divorce, as well as low levels of partner relationship; among women, low levels of Sexual life satisfaction were associated with reduced cognitive, emotional and social coping, reduced dispositional optimism and reduced quality of partnership relations concomitant with elevated negative affect, anxiety, depression and thoughts of divorce. These findings confirm the notion that affective expression is linked to commitment, communication, and dyadic (couple) satisfaction, cohesion and consensus, with (Moore et al. 2001). (5) Sexual life satisfaction predicted positive affect and counterpredicted anxiety, depression, stress (SE) and negative affect. (6) Work stress predicted anxiety, depression, stress (SE), psychological and somatic stress, and negative affect. Thus, sexual life satisfaction appears to buffer the negative and unhealthy effects that work stress reactions have on, negative affect, stress, anxiety and depression, as well as promoting positive affect. According to the life-span developmental approach, sexuality (Dalton and Galambos, 2008; Lerner, 2004), is maintained throughout the life-cycle and filtered through a network of contexts, including family, peers, school, society/culture, norms, etc. An examination of the psychological functions that the behaviour in question, e.g. sexuality, may serve to reveal several findings salient to present purposes (Cooper et al., 1998). Shrier et al. (2007) observed that adolescents experienced more positive and less negative affect following sexual intercourse compared to other parts of their daily routines. It would appear too that, in view of the affective benefits, adolescents and young adults utilize sexuality, functionally, to regulate their affective status (Meston and Buss, 2007), particularly in the case of individuals expressing low self-esteem (Cooper et al., 2000; Dawson et al., in press). Recently, Schrier et al. (2008) investigated positive and negative affect following penile-vaginal intercourse in sexually-active adolescents aged 18 ± 1.8 years. Cubic spline regression analyses indicated that positive affect began to increase before sex, peaked at the time when sex was reported and then returned to baseline. Negative affect did not differ from baseline before sex but decreased after sex; both types of affect were modulated by companionship, reinforcing notions that merge sexuality, communication and affective status. The gender differences observed from the instrument, Sexual life satisfaction, for men, as opposed to women, have been discussed from evolutionary (Klausman, 2002), biological (Morris et al. 2004; Gur et al. 2002; De Bellis et al. 2001; Suzuki et al. 2005) and cultural (Leaper, 2000; Lips, 2001; Carroll, 1996) perspectives. Irrespective of whichever perspective, whether evolutionary, biological, or cultural, is applied to explain the differences between men and women, the present findings lend support to all three of the above-mentioned notions: thus, sexual life satisfaction was predicted by intimate communication, „caressing and cuddling‟, and desire in the women, and by intercourse frequency and frequency of sexual partners in the men. Nevertheless, despite the between-gender differences, the presence of within-gender ought not to be overlooked. Sexuality and sexual motivation, although in some respects primitive and banal, seem linked to sexual imagery, sexual arousal, search and consummation of sexual activities, as well as providing a source of energy (Pfaus, 1990). Yet, sex-related problems are distressingly common in the general population (Nusbaum et al., 2000; Dunn et al., 1998; Aschka et al., 2001; Nicolosi et al. 2004; Laumann et al. 2005), and may be primary or

Sexual Satisfaction as a Function of Partnership Attributes… 129 secondary to neuropsychiatric or somatic conditions, substance use/abuse, or psychophysiological alterations (Ferguson, 2001; Hartmann et al., 2005; Harmann et al., 2004; Moreira et al., 2005). One major set of somatic symptoms in depressive disorders pertains to marked problems with sexuality in both men and women (Clayton, 2001). It was reported that 40% of the men and 50% of the women presenting major depression reported reduced libido och problems with sexual arousal (Montejo 2001). These problems may even be exacerbated by use of antidepressant medications, that affect different phases of the sexual cycle, and which may exert a negative effect upon treatment compliance as well as quality-of- life and risk for relapse (Zajecka 2001). From a health perspective, it appears that only frequency of penile-vaginal intercourse is associated with health advantages and improved emotional awarenes in women (Brody and Preut 2003). Penile-vaginal intercourse frequency correlated significantly and positively with markers for experienced relational quality, including satisfaction, intimacy, trust, passion, love and Global Relation Quality, presumably a consequence of high levels of relationship quality being linked to more penile-vagina intercourse and vice versa (Costa and Brody, 2007). Brody (2006) found that experimental stress-induced blood-pressure reactivity was reduced and recovery-from-stress was facilitated among subjects that had had intercourse but not among subjects that had not had penile- vagina intercourse. Sexuality appears an important prerequisite for sexual satisfaction. Berga et al. (2003) showed that women presenting functional hypothalamic amenorrhea, a condition exacerbated by psychological stress and subtle metabolic imbalance, could achieve restoration of ovarian activity following cognitive behaviour therapy. Subjective health was found to contribute to increased sexual satisfaction whereas fatigue was linked to the opposite effect (Beutel et al. 2002). Contrary to what was expected, Morkoff and Gillilland (1993) found that the desired frequency of sexual intercourse increased with daily hassles for both husbands and wives. Consistent with this, McCarthy (2003) found that sexual activity often may serve to reduce tension as couples are exposed to stressors in every day life. Taken together, the consensus of evidence available seem to reinforce the notion the positive sexuality offers very real health advantages in the way that sexual life satisfaction seems to buffer the negative effects of work stress upon health and thus either directly or indirectly support well being. Taken together, the consensus of evidence available seem to reinforce the notion the positive sexuality offers very real health advantages. Certain drawbacks to the present findings, pertaining to the relatively low numbers of participants, ought to be indicated. In addition, some form of interview may have provided a more in-depth understanding of influence and implications of sexuality for individual with regard to stress and illhealth. Future studies ought to examine each partner‘s responses in comparison with the other. Semi-longitudinal investigations, applying for example, dairy notes, may offer insights as to how sexual life satisfaction and stress influence aspects of health. REFERENCES Addis, I.B., Van Den Eeden, S.K., Wassel-Fyr, C.L., Vittinghoof, E., Brown, J.S., and Thom, D.H. (2006). Sexual activity and Function in Middle-Age and Older Women. Obstretics and Gynaecology; 107: 755-764.

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In: Psychological Well-Being ISBN 978-1-61668-180-7 Editor: Ingrid E. Wells, pp.135-155 © 2010 Nova Science Publishers, Inc. Chapter 4 THE PSYCHOLOGICAL WELL-BEING OF RUSSIAN AND UKRAINIAN ADOLESCENTS IN THE POST-PERESTROIKA PERIOD: THE EFFECTS OF THE MACRO- AND MICRO-LEVEL SYSTEMS Eugene Tartakovsky 1 The Bob Shapell School of Social Work, Tel-Aviv University, Israel ABSTRACT From the beginning of the 21st century, most of the republics of the former Soviet Union enjoyed a period of rapid economic growth and relative political stability which, however, in some countries, was accompanied by restrains of civil rights (Baker and Glasser, 2007; Shevtsova, 2005). This is in sharp contrast to the previous period of perestroika, which was characterized by drastic democratic reforms, but also by political turmoil, economic instability, and social unrest (Yakovlev, 1996). The effect of the recent socio-economic changes on the psychological well-being of the citizens of the former Soviet Union has not yet been investigated, and this study aims to partially fill this gap. In the present article, we compare macro-level socio-economic indexes in Russia and Ukraine in 1999 and 2007 and analyze socio-economic changes that occurred in the two countries during these years. We compare the psychological well-being of adolescents who attended high schools in Russia and Ukraine in 1999 with that of adolescents who attended high schools in these countries in 2007. Finally, we examine the demographic, 1 An earlier version of this article was published in Social Psychiatry and Psychiatric Epidemiology (2010) 45:25–37. With kind permission of Springer Science and Business Media. Bio: Eugene Tartakovsky, Ph.D., is an Assistant Professor at the School of Social Work at Tel-Aviv University. He received an M.A. in clinical psychology from the Hebrew University in Jerusalem and a Ph.D. from the University of Ben-Gurion in Beer-Sheva, Israel. His major research interests include the psychology of immigration and cross-cultural psychology. Address: The Bob Shapell School of Social Work, Tel-Aviv University, P.O.B. 39040, Tel-Aviv 69978, Israel. E- mail: [email protected].

136 Eugene Tartakovsky socioeconomic, and psychological variables that affect the adolescents' psychological well-being. THEORIES AND EMPIRICAL FINDINGS RELATED TO THE CONNECTION BETWEEN SOCIOECONOMIC CONDITIONS AND PSYCHOLOGICAL WELL-BEING All psychological theories assume that better socioeconomic conditions are associated with the higher psychological well-being of individuals; however, two theories specifically relate to this issue. Conservation of resources theory assumes that individuals strive to obtain, retain, and protect resources, because they have both instrumental and symbolic values for them (Hobfoll, 1989). These resources include objects, conditions, personal characteristics, and finances. Accumulation of these resources leads to higher psychological well-being. On the other hand, when these resources are threatened with loss, when they are lost, or are not gained, individuals experience distress (Hobfoll and Lilly, 1993). More beneficial socioeconomic conditions permit individuals to obtain and retain more resources and to decrease the probability of their loss. Therefore, better socioeconomic conditions in the individual's family and in the country in general should be associated with higher psychological well-being. Ecological systems theory assumes that the interplay between the inborn characteristics of an individual and the surrounding ecosystem determines the individual‘s development and well-being (Bronfennbrenner, 1989). The ecosystem includes several interactive levels: the family, community, country, and the global world. Ecological systems theory stresses the importance of social systems larger than the family, mainly the community and society, for the well-being of individuals. Ecological systems theory assumes that the well-being of children and adolescents depends on the quality of their social environment, which includes relationships with the parents and other significant adults, peers in the neighborhood and in school, and teachers in school (Garbarino, 1999). Therefore, socioeconomic conditions in the country together with the socioeconomic conditions in the family may affect the quality of the adolescents' environment and thus affect their well-being. Two models were suggested to explain the association between the parents' socioeconomic status (SES) and the children's psychological well-being (Van IJzendoorn et al., 2006). The family stress model assumes that the SES affects the parents' psychological well-being and through this influences parenting practices, which, in turn affect the children's development. The investment model assumes that higher SES enables parents to acquire materials, experience, and services that are beneficial to children's well-being and development. Empirical studies confirmed that low-status social groups had higher rates of difficult, harsh, and traumatic life events, and their physical and mental health was lower than that among higher SES groups (Aneshensel, Rutter and Lachenbruch, 1991; Van IJzendoorn et al., 2006). Individuals with lower income reported lower psychological well-being and happiness than those who had a higher income (Hayo and Seifert, 2003). The adversary effect of low SES on parenting was also confirmed empirically. Poor families had higher incidences of inadequate caretaking, and an increased use of harsh punishment. The psychological well-

The Psychological Well-Being of Russian and Ukrainian Adolescents … 137 being of children and their secure attachment to their mothers were associated with their parents' income (see a review in Van IJzendoorn et al., 2006). However, the effect of the family's SES was selective. It was strongest for the preschoolers and early school adolescents, and it was relatively weak for high school adolescents. In addition, adverse economic conditions had a stronger effect on children's school achievements and cognitive development as compared to children's socioemotional development (Van IJzendoorn et al., 2006). Cross-cultural studies demonstrated that psychological well-being differed across countries (Diener et al., 1995; Gibbons, 2004; White, 2007). The highest well-being was found in Western European countries, the USA, Australia, and Canada, while the lowest psychological well-being was found in the countries of the Former Soviet Union, Eastern Europe, China, and some African and South American countries (Diener, Diener and Diener, 1995; Gibbons, 2004; White, 2007). The socioeconomic variables that had the strongest correlation with psychological well-being cross-culturally were the level of economic development (as measured by the GDP per person) and the quality of the health and education systems. Other variables associated with higher psychological well-being included democracy and human rights, the value of individualism, and socioeconomic equality in the country (Diener et al., 1995; Grob et al., 1996). Few studies have investigated time trends in psychological well-being. A study in the USA, in which social competences and emotional and behavioral problems of children and adolescents were measured by the Youth Self-Report in 1976, 1989, and 1999, found that from 1976 to 1989, social competences decreased and problem scores increased, while from 1989 to 1999, a reverse tendency was found (Achenbach, Dumenci and Rescorla, 2003). Although the differences were significant, the effect size of the changes was small (1-4%). Nevertheless, the authors argued that the economic decline at the end of the 1980s was responsible for the decreased social competency and increased psychological problems in American adolescents (Achenbach, 2004). A similar study conducted in the United Kingdom found that behavioral and emotional problems of adolescents measured in 1974, 1986, and 1999 steadily increased (Collishaw et al., 2004). However, the authors found no connection between the increase in psychological problems and changes in socioeconomic indicators (The Nuffield Foundation, 2004). Finally, a study conducted in the Netherlands in 1983 and 1993 found no significant change in children's and adolescents' psychological well-being (Verhulst, Van der Ende, Rietbergen, 1997). These cross-country inconsistencies in the time- trends do not reveal any causative factor (The Nuffield Foundation, 2004). No study of time- trends in psychological well-being was ever conducted in the countries of the former Soviet Union (FSU). The present research aims to address this gap. SOCIO-ECONOMIC CONDITIONS AND PSYCHOLOGICAL WELL-BEING IN THE FSU IN THE 1990S Economic conditions in all countries of the FSU declined in the 1990s compared with the pre-perestroika period (Shteyn et al., 2003). State support of industry and agriculture stopped, while the market did not succeed in creating enough new jobs. Devaluation of the local currency and inflation led to numerous bankruptcies and the inability of many employers, including the state, to pay employees. Inequalities in income distribution increased, social