28 B. K. Nastasi and A. P. Borja • Encourage diversity of ideas (the goal in this important to you, for example, in your home, study is to capture the diversity as well as con- school, community. And to do a drawing that vergence of perspectives) shows your relationships with these people and events—we call the drawings “ecomaps.” • Monitor discussion so that an individual • Demonstrate the ecomap, using the sample or few individuals do not dominate (e.g., below: redirect, asking others to respond; ask the per- son to hold the idea until later) Draw an ecomap and say, as you draw, • Conclude with open-ended question; “Is there 1. “For example, we all belong to families. You anything else on this topic that you would like can use a circle to represent your family.” to share that we have not covered?” 2. “Inside the circle, you can draw small circles • Close session with thank you to all partici- or other shapes to show who is in your family.” pants. Provide contact information for follow- up questions. 3. “We can use lines to show how we feel about the relationship with family members.” In- Appendix 2.F troduce and define how to depict—stressful, supportive, ambivalent (both stressful and Student Ecomap Protocol supportive). (Use the following definitions to introduce the concepts) Materials: Paper (drawing and writing), colored markers, pens/pencils, chalkboard Stressor = someone or something that creates dif- Support = ficulty or distress for you; makes you STEP 1: INTRODUCE ECOMAP—WHOLE Ambivalent = unhappy or angry or scared, etc. GROUP someone or something that provides • Say, “The purpose of today’s activities is comfort for you; makes you feel happy to talk about the people and events that are or safe or loved, etc. someone or something that creates both difficulty and comfort 6$03/((&20$3 3DUHQWV /LWWOH%URWKHU [[[ [ [ [ [ [[ [ [ [[ 0\\VHOI 0\\7HDFKHU [ [ [ [ [ [[ [ [ [ 0\\%HVW)ULHQG [ [ [ [ [[[[[[[[[[[[[[[[ [ [[ 0\\&RXVLQ 0\\$XQWLH [[[[[[ 6XSSRUWLYH [[[[[[ 6WUHVVIXO %RWK$PELYDOHQW Ecomap artwork designed by Kitt Bryce. Adapted from Nastasi et al. (2000).
2 The Promoting Psychological Well-Being Globally Project 29 4. “We can use similar drawings to show other tencies or types of stressors), provide inductive relationships, for example, in school or with definitions based on what the students say, and friends, etc.” consider how the definitions are influenced by cultural norms. 5. “We can also use drawings to show things that happen in the community or environment that Competencies: Consider the following as you affect you, for example, a community celebra- generate themes: tion, neighborhood conflict, the weather.” STEP 2: GENERATING ECOMAPS—INDI- • What are the culturally valued competencies? VIDUAL ACTIVITY Make a list of specific competencies (e.g., academic ability, social skills). You can depict 1. Each student draws his/her own ecomap to the competencies on a continuum from posi- depict important relationships in his/her life. tive to negative if that makes sense (e.g., star Encourage students to include relationships student vs. academic failure). with family, school, peer, community, and the environment. • How is each competency defined? For each competence listed in #1, provide the defini- 2. On the ecomap, ask the students to write the tion based on students’ descriptions (e.g., following: Academic ability = making good grades; being f. Who is the person/event? [label the rela- good at math, etc.). tionship] g. What are the associated feelings about the • What cultural norms are reflected in the com- person/event? petencies? (For example, one theme might be h. What makes this relationship stressful, that academic competence is especially valued supportive, or ambivalent? or most important. Social skills are important but only in relation to developing friendship.) STEP 3: GENERATING STORIES—INDI- Stressors: Consider the following as you gener- VIDUAL ACTIVITY ate themes: 1. Ask each student to select a stressful or ambiv- • What are the types of stressors that children alent relationship and depict (write or draw) a experience? story about a time when he/she felt “stressed” in the relationship. Ask them to include the • Which stressors are internal (e.g., frustration following in the story: What happened? How due to academic failure)? Which are external did you feel? What did you do? (e.g., parental conflict, peer bullying) 2. Ask each student to select a supportive or • What are the sources (or triggers) of stress? ambivalent relationship and depict (write or (e.g., parents, peers, school, weather) draw) a story about a time when he/she felt “supported” in the relationship. Ask them to Response to Stress: Consider the following: include the following in the story: What hap- pened? How did you feel? What did you do? • What are the emotional reactions (i.e., feel- ings)? Appendix 2.G • What are the cognitive reactions (i.e., Stage 2 Coding: Generating Themes thoughts)? The purpose of thematic analysis is to generate • What are the behavioral reactions (i.e., behav- subtypes of key constructs (e.g., types of compe- iors/actions)? • What are the somatic or bodily reactions (e.g., get headaches, feel tense muscles)? Supports: Consider the following as you gener- ate themes:
30 B. K. Nastasi and A. P. Borja • What are the types of social support that chil- DEMOGRAPHIC DATA: Parents dren experience? For parent participants, please gather the fol- • What are the sources of support (e.g., parents, lowing information so that we can describe the peers, school, priest, pets)? sample. Response to Support: Consider the following: Age (years): _________ Gender: ___ female ___ male • What are the emotional reactions (i.e., feel- Language: ________________ ings)? Ethnic Origin: _______________ Religion: __________ • What are the cognitive reactions (i.e., Parental/Guardian Education levels (for each thoughts)? parent/guardian): #1. (mother or other guardian) ____________ • What are the behavioral reactions (i.e., behav- #2. (father or other guardian) _____________ iors/actions)? Parental/Guardian Occupation (for each par- ent/guardian): • What are the somatic or bodily reactions (e.g., #1. _____________________ feel relaxed muscles)? #2. _____________________ Family Income: _________________ Appendix 2.H Family Status: _______ married; ________ divorced; ________ single parent DEMOGRAPHIC DATA: STUDENTS How many people live in your household? _____________ For student participants, please gather the fol- With whom do you live (for example, spouse/ lowing information so that we can describe the partner and children, parents, grandparents, sample. etc.)?_______________ School(s) children attend: School: _______________ ___________________ Age (years): _________ Number of children: ___________________ Grade: _________ Ages of children: ______________________ Gender: ___ female ___ male Language: ________________ DEMOGRAPHIC DATA: Teachers Ethnic Origin: _______________ Religion: __________ For teacher participants, please gather the fol- Parental/Guardian Education levels (for each lowing information so that we can describe the parent/guardian): sample. #1. (mother or other guardian) ______________ #2. (father or other guardian) _____________ School: __________________ Parental/Guardian Occupation (for each par- Age (years): _________ ent/guardian: Gender: ___ female ___ male #1. _____________________ Language: ________________ #2. _____________________ Ethnic Origin: _______________ Family Income: _________________ Religion: __________ Family Status: _______ married; ________ Education level: _____________________ divorced; ________ single parent What grade level(s) do you teach? __________ Number of siblings: ________________ Number of years teaching experience: ______ How many people live in your household? _____________ With whom do you live (for example, parents, grandparents, etc.)?_______________
2 The Promoting Psychological Well-Being Globally Project 31 References Nastasi, B. K., & Schensul, S. L. (2005). Contributions of qualitative research to the validitiy of intervention Baumgartner, J., Burnett, L., DiCarlo, C. F., & Buchanan, research. Journal of School Psychology, 43, 177–195. T. (2012). An inquiry of children’s social support net- doi:10.1016/j.jsp.2005.04.003. works using eco-maps. Child Youth Care Forum, 41, 357–369. doi:10.1007/S10566-011-9166-2. Nastasi, B. K., Schensul, J. J., Tyler, C. L., Araujo, R., DeFalco, K., & Kavanaugh, M. (2000). The New Borja, A. P. (2013). The ecomap: A graphic tool for Haven social development program: Social problem assessment, intervention, and research. Unpublished solving-cooperative education, Grade 6 Curriculum. preliminary examination literature review. Tulane Hartford: The Institute for Community Research University, New Orleans, Louisiana. (Developed in collaboration with New Haven, CT, Schools Social Development Department). Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing Nastasi, B. K., Moore, R. B., & Varjas, K. M. (2004). grounded theory (3rd ed.). Thousand Oaks: SAGE School-based mental health services: Creating com- Publications. prehensive and culturally specific programs. Wash- ington, D.C.: American Psychological Association. Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3rd ed.). Nastasi, B. K., Hitchcock, J. H., Varjas, K., Jayasena, A., Thousand Oaks: SAGE Publications. Sarkar, S., Moore, R. B., et al. (2010). School-based stress and coping program for adolescents in Sri Driessnack, M. (2005). Children’s drawings as facilita- Lanka: Using mixed methods to facilitate culture-spe- tors of communication: A meta-analysis. Journal cific programming. In K. M. T. Collins, A. J. Onwueg- of Pediatric Nursing, 20, 415–423. doi:10.1016/j. buzie & Q. G. Jiao (Vol. Eds.), Toward a broader pedn.2005.03.011. understanding of stress and coping: Mixed methods approaches. The research on stress and coping in edu- Erkut, S. (2010). Developing multiple language versions cation series (vol. 5, pp. 305–342). Charlotte: Infor- of instruments for intercultural research. Child Devel- mation Age Publishing. opment Perspectives, 4, 19–24. http://web.ebsco- host.com.libproxy.tulane.edu:2048/ehost/pdfviewer/ Nastasi, B. K., Jayasena, A., Summerville, M., & pdfviewer?sid=e9c363f1-9943-4e6c-8b5d-9f31bacde Borja, A. P. (2011). Facilitating long-term recov- c00%40sessionmgr113&vid=2&hid=112. Accessed 3 ery from natural disasters: Psychosocial program- July 2013 ming for tsunami-affected schools of Sri Lanka. School Psychology International, 32, 512–532. Hartman, A. (1978). Diagrammatic assessment of fam- doi:10.1177/0143034311402923. ily relationships. Social Casework, 59, 465–476. http://www.historyofsocialwork.org/1978_hart- Rempel, G. R., Neufeld, A., & Kushner, K. E. (2007). man/1978,%20Hartmann,%20diagramatic%20assess- Interactive use of genograms and ecomaps in family ment%20OCR%20(C%20notice).pdf. Accessed 3 caregiving research. Journal of Family Nursing, 13, July 2013 403–419. doi:10.1177/1074840707307917. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Summerville, M. (2013). The ecomap as a measure Thousand Oaks, CA: Sage. of psychological well-being: Results from primary school children identified as at-risk for psychologi- Nastasi, B. K. (2014). Empowering child voices through cal distress. Master’s thesis. Tulane University, New research. In C. Johnson, H. Friedman, J. Diaz, Z. Orleans, Louisiana. Franco & B. Nastasi (Eds.), Praeger handbook of social justice and psychology: Vol. 3. Youth and dis- ciplines in psychology (pp. 75–90). Santa Barbara: ABC-CLIO/Praeger.
Psychological Well-Being in 3 Children and Adolescents in Manaus, Amazonas, Brazil Patricia Sánchez Lizardi and Júlio César Carregari Introduction literature. Instead, a more frequently found term, subjective well-being, is used to convey a similar The approach of psychological well-being taken meaning (Costa & Pereira, 2007). Consistent with in this chapter is an adaptation of the conceptu- what has been found elsewhere in the literature, al model of mental health proposed by Nastasi, these two concepts have been used interchange- Varjas, Sarkar, and Jayasena (1998; see Chap. 1 ably (e.g., Ryff, 1989; Ryff & Keyes, 1995). We and Fig. 1.3). According to this model, psycho- did not find any publication in Brazilian journals logical well-being is influenced by both indi- in which psychological well-being was conceptu- vidual and cultural factors. The individual factors alized according to the model used in the present are: (a) culturally valued competences, such as book. However, we did find the concept of sub- academic, behavioral, and physical; (b) personal jective well-being and variations of it addressing vulnerability, such as personal and family his- factors of the psychological well-being model as tory, and having a disability; and (c) personal used herein. Research concerning aspects related resources, like coping mechanisms, relationship to both concepts has been published in Brazil. skills, and problem-solving skills. Cultural fac- For example, studies have investigated issues re- tors include: (a) social–cultural resources, such lated to the measurement of stress in children and as peers, community, relatives, and school; (b) adolescents (e.g., Calais, Andrade, & Lipp, 2003; cultural norms, for example, those related to Lucarelli & Lipp, 1999), the prevalence of child- gender roles and adult–child relationships; (c) hood stress (e.g., Sbaraini & Schermann, 2008), socialization agents, like media, teachers, peers, the type of stressful events present in children and parents; (d) socialization practices, such as and adolescents’ lives (e.g., Kristensen, Leon, education and discipline; and (d) social–cultural D’Incao, & Dell’Aglio, 2004; Wagner, Ribeiro, stressors, for example, violence in the environ- Arteche, & Bornholdt, 1999), children and ado- ment, parental or family conflict, and poverty. lescent coping skills (e.g., Dell’Aglio & Hutz, 2002; Siqueira & Dell’Aglio, 2010), support Research in the area of psychological well- systems for children and adolescents (e.g., Mom- being in children and adolescents in Brazil is not belli, Costa, Marcon, & Moura, 2011), the type of completely new. However, the term psychologi- stress experienced by youngsters in educational cal well-being is rarely used within the Brazilian settings (e.g., Pacanaro & Santos, 2007; Vectore & Zumstein, 2010), the quality of life of children P. S. Lizardi () and adolescents (e.g., Assumpção Jr., Kuczynski, Universidade do Estado do Amazonas, Manaus, Brazil Sprovieri, & Aranha, 2000; Camargo, Abaid, & e-mail: [email protected] Giacomoni, 2011), and their overall life satisfac- tion (e.g., Giacomoni & Hutz, 2008). J. C. Carregari Universidade de São Paulo, São Paulo, Brazil © Springer Science+Business Media New York 2016 33 B. K. Nastasi, A. P. Borja (eds.), International Handbook of Psychological Well-Being in Children and Adolescents, DOI 10.1007/978-1-4939-2833-0_3
34 P. S. Lizardi and J. C. Carregari In order to paint an accurate picture of Bra- this research has been conducted primarily in the zil’s research about psychological well-being in southern states of Brazil, which are located with- children and adolescents, it seems appropriate to in the wealthiest and most industrialized regions briefly present how this concept and subjective (Southeast and South). The other three geograph- well-being converge and diverge in their expla- ical regions of Brazil are: North, Northeast, and nation of similar psychosocial dimensions and Center–West. Conducting more studies regarding then look at the specific studies that have been psychological well-being is therefore necessary carried out in the area. for other regions of the country, so that a better understanding of intra-cultural influences and Subjective well-being has been conceptual- differences can be achieved. ized as a positive psychological dimension that integrates cognitive and affective aspects, and it Stress and Stressors among Brazilian is thought to have emerged as an area of study Children and Adolescents in the 1950s (Keyes, Shmotkin, & Ryff, 2002). Subjective well-being encompasses concepts In Brazil, some studies have been carried out such as quality of life, and positive and negative with children and adolescents to look at stress affect (Galinha & Ribeiro, 2005). For this rea- levels and the types of events associated with it. son, Veenhoven (2010) has considered subjec- In fact, Sbaraini and Schermann (2008) reported tive well-being as a synonym to the concepts of that the study of childhood stress in Brazil dates life satisfaction and happiness. However, Diener, back to the 1970s in the state of São Paulo. Since Oishi, and Lucas (2003) had stated that subjec- then, São Paulo children’s experiences of stress tive well-being included “what lay people call and stressors have been well documented, indi- happiness, peace, fulfillment, and life satisfac- cating that approximately 30–60 % of school- tion” (p. 403), considering it a more extensive children in São Paulo face some type of stressor concept. The work of Diener and colleagues con- during their school years. These authors also as- tinued this line of research, and it is, up to the sessed the stress of 883 children from a small city present, the theoretical reference for most work from Rio Grande do Sul in southern Brazil. In conducted about well-being in Brazil (Costa & order to assess the stress experienced by the par- Pereira, 2007). ticipating children, the authors reported using the Childhood Stress Scale developed by Lipp and In 1989, Ryff published a paper that led the Lucarelli and a questionnaire to be completed by research about subjective well-being into a sepa- parents. They examined the following factors as rate, but similar, area. Ryff argued that happiness, indicators of stress: family relations (e.g., rela- understood as the balance between positive and tionship with parents and siblings), social con- negative affect, was not the only aspect relevant tact (e.g., friends at school), autonomous activ- to the concept of psychological well-being. Fur- ity (e.g., cleans up after playing, performs own thermore, she considered the concept of subjec- personal hygiene), work activity (e.g., watches tive well-being to be lacking a strong theoretical siblings, does household chores), and losses and background. In this work, and in a subsequent changes (e.g., illness or death in the family or a paper (Ryff & Keyes, 1995), the concept of psy- close relative). Findings indicated that the fol- chological well-being was used interchangeably lowing groups of children experienced greater with the one of subjective well-being, and it number of stressors: girls, children older than was expanded to also include the following fac- 10 years of age, those attending public schools, tors: autonomy, environmental mastery, personal those with fair/bad family relationships, those growth, positive relations with others, purpose in with unmarried parents, children with absent fa- life, and self-acceptance. Thus, both constructs— thers, those with fair/bad social contact, and chil- psychological and subjective well-being—en- dren who lacked autonomous activities. compass aspects that have been addressed by research in Brazil and that are relevant to the work reported in this chapter. However, most of
3 Psychological Well-Being in Children and Adolescents in Manaus, Amazonas, Brazil 35 In another study, Calais et al. (2003) analyzed on parents’ bed at age 4, and mothers having a how stress levels differ by gender and level of psychiatric disorder (Martins, Costa, Saforcada, education in a group of young adults, ages 15–28 & Cunha, 2004). Martins et al. (2004) used the years. They found that stress was more predomi- Home Observation for the Measurement of the nant in women than in men, and that the younger Environment (HOME), which was developed group, ages 15–18 years, showed the most signs in the USA during the 1970s by Caldwell and of stress compared with older participants, ages Bradley (Totsika & Sylva, 2004). Once more, 19–28 years. In order to assess stress, the au- we found that measures used in Brazil lacked the thors used Lipp’s Inventário de Sintomas de input of Brazilian participants, neglecting the so- Stress (ISS, Inventory of Stress Symptoms) for ciocultural influences that invariably impact psy- people who were 15 years of age and older. In a chosocial dimensions (Hitchcock et al., 2005). complementary study, Lucarelli and Lipp (1999) analyzed the validity of the Inventário de Sinto- Potentially, one of the most relevant sources mas de Stress Infantil (ISS-I, Child Stress Symp- of stress for children and adolescents comes di- toms Inventory), which was an adaptation of the rectly from their families, especially when fami- original inventory for use with children between lies have gone through the process of separation 6 and 14 years of age. This instrument was found and remarry to form a new family unit. Contrary to have sound psychometric properties and has to this idea, researchers in southern Brazil found been used in Brazil for the assessment of stress that a large number of the adolescents they in- in children and adolescents. Items of the instru- terviewed (81 %) showed a general well-being of ment, however, were developed using the signs good to very good (according to a classification and symptoms of stress as reported in the litera- of the number of points shown on a scale mea- ture, mostly from the USA and Europe, with no suring well-being, with levels of “very good,” direct input in item creation from Brazilian chil- “good,” “so-so,” and “poor”); and they found dren and adolescents. no differences for adolescents from intact and remarried families (Wagner et al., 1999). These In an attempt to identify the frequency and findings suggest that family composition, in this impact of stressors for adolescents, Brazilian au- case a new family unit formed by two previously thors have developed specific instruments and separated families, was not a relevant source of administered them to adolescents, finding that stress for the participating adolescents. In fact, the most frequent stressors for both males and fe- they perceived that having this family unit was a males, aged 12–17 years, were school tests, fight- source of a positive general well-being in a simi- ing with friends and siblings, death of relatives, lar way that adolescents from an intact family and obeying parents’ rules (Kristensen et al., unit did. 2004). Other events that were not necessarily fre- quent but had strong effects on adolescents’ func- Coping Strategies and Sources of tioning were exposure to sexual violence, being Support prohibited from seeing parents, and being taken to a juvenile detention center or juvenile shelter. Coping strategies and sources of support also Similar to other studies, girls reported higher lev- have been investigated in Brazil, again mainly els of distress and more stressors related to inter- in the south. One such study examined fam- personal relationships when compared to boys. ily as a protective factor for adolescents facing stress by comparing the coping mechanisms of In terms of environmental factors associated adolescents living with their families to those with childhood stress and poor quality of life, living in an institution for abandoned children researchers have found eight risk factors: low (Dell’Aglio & Hutz, 2002). Researchers found monthly family income, low maternal schooling, no difference in the coping strategies between being male, having more than seven members adolescents living with their families and those living in the same house, having four or more sib- lings, having smoked during pregnancy, sleeping
36 P. S. Lizardi and J. C. Carregari living in an institution. Authors explained this ditions, that is, they associated happiness with finding by stating that adolescents living with being able to satisfy their personal needs, both their families reported frequent family conflicts, material and emotional. These authors suggested socioeconomic difficulties, violence, and pun- that the gender differences encountered might be ishment. In addition, whereas those adolescents related to cultural and traditional gender roles in living in an institution had been removed from Brazil, where men are thought to be the family these types of situations, both groups had similar providers, and women the homemakers, caring socioeconomic backgrounds, which was believed for children and family. to influence the type of learned coping strategies. In fact, institutions not only eliminated these Stressful Events in Brazilian stressful events from the lives of the adolescents Educational Settings but also provided them with social support and a structured and organized environment that met Although situations of stress, its assessment, and their basic needs. Thus, the stressful events ex- associated coping mechanisms have been ad- perienced by the adolescents living with their dressed by researchers in Brazil, children’s and families were in contrast to what is believed to adolescents’ school-related stress and stressors be a caring environment, where emotionally sup- have received less attention. However, a few portive relationships, safety, harmony, organi- studies are noteworthy. First, Lemes et al. (2003) zation, and a stable structure are present for the examined children’s stress and its impact on aca- adolescent. Furthermore, the most frequent cop- demic performance. These authors interviewed ing mechanisms utilized by the participants were 342 children, ages 7–12 years, using Lipp and support seeking, aggressive actions, acceptance, Lucarelli’s Escala de Stress Infantil, which can avoidance, direct action, doing nothing, and emo- be answered in a Likert-type scale of five choices tional expression. Authors also found that young- according to the frequency that each symptom of er children (7–10 years old) used more strategies stress was experienced. They found that 30 % of that involved looking for help or doing nothing, the interviewed children showed symptoms of whereas older ones used more direct action strat- stress. More boys reported feeling stressed, and egies, such as those attempting to eliminate or children showing the poorest academic perfor- change the stressful situation, like apologizing mance had higher levels of stress. These find- and talking about the issues or through physical ings are consistent with the results of Siqueira aggression. These findings were supported by and Dell’Aglio’s (2010) study with 155 children, the results from another study conducted with 30 aged 7–16 years. These researchers found sig- children, 7–12 years of age, where 60 % of the nificant age differences in the effects of stress on participants reported feelings of stress. Of this academic performance, with older participants 60 %, half of them lived in intact families (Mom- showing better academic outcomes than younger belli et al., 2011). The authors advised that these children, in spite of comparable reports of dis- results be used in the development of stress pre- tress. vention programs, where families are encouraged to participate in order to better their children’s In terms of stress in younger children, Vectore psychological well-being. and Zumstein (2010) evaluated a group of 16 pre- schoolers, aged 4 and 5 years, and interviewed When looking at the factors associated with their mothers to determine if their children ex- adolescents’ happiness, Camargo et al. (2011) in- perienced stress. The authors found that mothers terviewed 95 adolescents from southern Brazil, reported high scores in the Escala de Fontes Es- asking them to talk about what made them happy. tressoras na Criança de Lipp, which are consid- They found that girls related feelings of happi- ered indicative of “severe” stress, but only one ness to various forms of relating to others, like child actually demonstrated signs consistent with relating to their family and friends, whereas boys psychological stress. The two most cited sources related happiness to material goods and life con-
3 Psychological Well-Being in Children and Adolescents in Manaus, Amazonas, Brazil 37 of stress for these youngsters were fighting with zon rainforest at the confluence of the two rivers siblings and family’s economic hardship. These that are the primary tributaries to the Amazon findings suggest that children’s self-perceptions River, Negro and Solimões. Manaus is among the of stress are not always consistent with the per- top ten largest cities in Brazil with a population ception of their caregivers, which reinforces the of about two million (Brasil, Instituto Brasileiro need to closely assess the experience of stress in de Geografia e Estatística (IBGE), 2010). His- children from their own perspective. torically, Manaus has had a rich economy based on the large-scale production of rubber during the According to our review of Brazil’s literature nineteenth century, being considered one of the on psychological well-being of children and ado- most developed cities in the whole country dur- lescents, we can conclude that it is an area of re- ing that period. When the rubber economy began search that has received some attention, especial- to subside, Manaus lost its developed position, ly in relation to stress, coping, and, to a relatively leaving behind a mix of grandiosity and pover- lesser degree, the effects of stress on academic ty that is still evident in the design, infrastruc- performance. However, better methodologies are ture, and architecture of the city. Around 1960, needed that allow children and adolescents to ex- Manaus became a free-trade zone, which brought press their views in more descriptive and open- a huge number of multinational industries and ended ways. Also, all referenced studies used a wave of immigration from all areas of Brazil, constructs defined elsewhere, mostly the USA rapidly increasing Manaus’ population in an un- and Europe, which may compromise the valid- controlled manner (Araújo, 2009). According ity of the reported findings, given that the experi- to Loureiro (2003), Manaus’ population before ences reported in these other countries may not 1960 was around 150,000 inhabitants. necessarily be representative of the experiences of Brazilian children and adolescents. Finally, re- Manaus’ historic economy is not the only fac- search about children’s psychological well-being tor that contributes to its current uniqueness. Am- would greatly benefit by expanding geographi- azonas, the largest state of the country, is home cally to include participants from other regions to the largest population of indigenous people of the country to represent the sociocultural di- in Brazil, with a few groups still living within versity of Brazil. Currently, all studies found Manaus city limits, but most of them distributed were carried out with populations from southern across the whole state. Furthermore, the major Brazil, which represents the wealthiest and most group populating Manaus, the caboclos, is a mix developed area of the country. of the indigenous people with the Portuguese and other foreign nationals over the centuries, com- Consistent with the goals of this book, our prising approximately 71 % of the people in the purpose was to identify what Brazilian children North area of Brazil (Brasil, IBGE, 2010). and adolescents understood as psychological well-being and as psychologically healthy en- Manaus’ weather makes living in the city vironments. Furthermore, the target population challenging. Its average temperature is around was from Northern Brazil, an infrequently stud- 28 °C year-round with an average of 80 % rela- ied region. It is our expectation that the findings tive humidity level. The rainy season runs from presented in this chapter contribute to a better December through May, when Manaus gets most understanding of children and adolescents’ psy- of its100 inches yearly average rain. Floods in chological well-being in Brazil. the city during these months are common. Tem- peratures are lower than during the dry season, Method when the sun is intense and temperatures can rise to nearly 40 °C with very high humidity levels. The current study took place in the city of Manaus, capital of the state of Amazonas, in northern Bra- The schools in Manaus are administered by zil. Manaus is located in the center of the Ama- two entities, the municipal and the state offices of education. Both offices were approached to obtain consent for the Promoting Psychological
38 P. S. Lizardi and J. C. Carregari Well-Being Globally (PPWBG) project. Once All the participants spoke Portuguese as their their written approval was given, it was submit- first language. Regarding ethnic/race composi- ted along with the project description to the Co- tion, 38 students (69 %) reported being caboclos mitê de Ética em Pesquisa—the equivalent of an (mixed race), 10 White (18 %), 5 Black (9 %), 1 Institutional Review Board for Human Subjects Asian (2 %), and 1 did not report ethnicity/race Protection in the USA—for review and approval. (2 %). Although only half of the participants re- After approval, four schools were invited to par- ported their family monthly income, we consider ticipate in the project. All of them consented, but the sample as representative of the socioeconom- data collection occurred in only three. Schools ic distribution of the group as a whole, given that were selected because they were sites for practi- they attend the same schools, live in the same cum teaching/training for university students and neighborhoods, and reported similar types of pa- due to a preexisting relationship with the first au- rental jobs and level of education. For the study thor’s research projects. Schools were also repre- group, average family income was US $ 734.00 sentative of Manaus’ ethnic and socioeconomic per month, which was below the average family levels. All data were collected during the 2011 monthly income in urban Manaus (US $ 1486.00; Brazilian school year, which runs from March Brasil, IBGE, 2010) but higher than the monthly through December. income of families earning one minimum-wage salary (US $ 243.00; Brasil, Instituto Brasileiro Participants de Geografia e Estatistica, IBGE; 2010). The number of family members living in the same A total of 55 children and adolescents, ages 6–17 house ranged from two to nine, with most of years, participated in the study, 27 of them being them having five members. Eleven percent of the female (49 %). Participants from the schools rep- participants reported living in families formed resented the three levels of Brazil’s basic educa- by remarriages. Grandparents were frequently tion: elementary (1–5th), middle school (6–9th), mentioned (18 %) by children and adolescents as and high school (10–12th). The high school also family members living in the same house and, in offered elementary and middle school grades at many cases, were also their primary caregivers. different schedules. Data Collection Activities Students were divided into groups by age and gender according to the methods described In order to identify what children and adoles- in Chap. 2. When a group was formed by only cents understood as psychological well-being three participants, like in the case of females ages and psychologically healthy environments, data 15–17 years and males ages 9–11 years, a second were collected through focus group interviews group was formed to increase the number of in- (FGIs) and ecomap activities (see Chap. 2). FGIs, terviewees in that age range. The final composi- of about 1-h duration, were conducted first. A tion of the groups is presented in Table 3.1. second session, sometimes on the same day after Table 3.1 Composition of focus groups by gender, age, and school grade Female ( N = 27) Male ( N = 28) Age (year) Grade N Age (year) Grade N 2 6 6–8 2 4 6–8 2 and 5 3 4 4 9–11 3–5 6 9–11 7–9 8 7 and 9 7 12–14 7–9 9 9–11 15–17 7 and 9 5 12–14 15–17 11–12 3 15–17
3 Psychological Well-Being in Children and Adolescents in Manaus, Amazonas, Brazil 39 a break, was conducted to complete the ecomap thor and one of her university students from the drawing activity along with the generation of sto- Universidade do Estado do Amazonas. Minimal ries. This activity also lasted about 1 h. At the end adjustments were made to the FGI and ecomap of both sessions, children and adolescents were protocols described in Chap. 2, like paraphrasing offered a snack or candy as a token of apprecia- some questions when participants did not under- tion for their participation. Next, we describe the stand them, or on one occasion, stopping the ses- procedures for both FGI and ecomaps as con- sion at the request of the principal, given the need ducted at our study sites. of space by the school on that day. This required rescheduling and continuing on a different day. Considering that each school already had a means of communicating with parents, we ap- Interviews were recorded electronically and proached school principals to discuss the best by hand to ensure that no data were missed in ways to contact parents and enroll participants case of a voice recording failure. All recorded in the study. In the elementary school, class- interviews were transcribed by a couple of uni- room teachers sent home parent invitations and versity students whose primary language was a consent form to be signed if they agreed to Portuguese. Ecomaps were coded according to their child’s participation. In the middle school, procedures in order to determine the type and the principal called parents to obtain permission, number of relationships depicted, that is, sup- and, once parents gave verbal consent over the portive, ambivalent, or stressful. The interview phone, a written consent form was sent home transcriptions, the stories generated as part of the with the students. In the third school, the prin- ecomap activity, and the relationships depicted in cipal asked the authors to present information the ecomap were then translated into English by about the project during a school-wide parent the first author. When expressions had no direct meeting and then enroll participants if parents translation into English, like those whose content expressed interest. Once we had parental con- had strong cultural bases, common sayings, and sent, we scheduled times with the principals to slang, the authors discussed their connotations in conduct the FGIs and ecomap activities. Princi- order to clarify their meanings within the Manaus pals provided quiet spaces for the interviews. In context, thus providing the most accurate transla- all schools, the library was considered the most tion possible. appropriate location, given the room size and quietness. On a few occasions, when the library Data Coding and Analysis was not available, another room was provided or the interviews were rescheduled. The coding process as described in Chap. 2 was closely followed. All translated data were sent FGIs and the ecomap activities were conduct- to the New Orleans team for deductive coding. ed with all participating children and adolescents After stage 1, codes were returned to us from according to the group composition presented in the New Orleans team, we completed stage 2 Table 3.1. All instructions, questions, and direc- and stage 3 analyses in order to generate culture- tions for the FGIs and ecomap activities were specific themes. Stages 2 and 3 themes also were translated into Portuguese and then back-trans- sent to the New Orleans team for cross-cultural lated into English by the first author and a trained analysis utilizing data from other sites participat- translator according to the methods described in ing in this book. In this chapter, we present find- Chap. 2. However, given that the first author is ings based on stages 2 and 3 analyses. We first not a native speaker of Portuguese, she co-con- present findings based on the FGIs and the stories ducted all interviews with a native speaker of created by the participants as part of the ecomap Portuguese in case clarification for participants activity. Then, we report the findings based on was needed. Most interviews were co-conduct- the type of relationships depicted in the ecomaps. ed by both authors, the second being a native speaker and a practicing psychologist in Brazil. A few interviews were conducted by the first au-
40 P. S. Lizardi and J. C. Carregari Findings cies of a student include “studying” and “getting good grades.” In this section, we present the views and perspec- tives of Brazilian children and adolescents re- In terms of the characteristics that were val- garding their valued competencies, stressors, and ued of friends, males and females agreed that he coping mechanisms, which are assumed to reflect or she has to be trustworthy and loyal, someone social–cultural influences, and thus be culturally who “does not abandon you and stands by you at sensitive to the conceptualization of psychologi- all times.” Older participants added that a friend cal well-being and psychologically healthy envi- “helps you make good choices.” In this context, ronments. These perspectives, however, do not “good choices” was exemplified as “a friend represent normative data. They do reflect com- that talks you out of doing drugs or of stealing.” mon views, helpful in the posing of new research Regarding competences valued of youth as Bra- questions, the development of mental health pro- zilian citizens, participants mentioned charac- grams, and the designing of culturally sensitive teristics such as being respectful of the law and instruments to measure child and adolescent psy- others and being protective of the environment chological well-being. with actions such as not polluting or littering. They also expressed that the socially responsible Focus Group and Ecomap Story person behaves according to the law, does not Findings steal, is courteous with pedestrians, and is kind to animals. That person helps his or her neighbor, is The present section details themes generated not racist or holds prejudices, is respectful of oth- from the FGIs and ecomap stories. Findings ers’ sexual orientation, helps the disadvantaged, are organized according to deductive code, that fights injustice in society, and “does not [sexu- is, valued competencies, stressors, reactions to ally] prostitute” him or herself for money or other stress and coping, and sources of support. goods. The latter competency was mentioned only by the girls in the two older groups. It is Valued Competencies Participating children noteworthy that participants mentioned the topic and adolescents were asked to talk about their of prostitution, considering the efforts of various valued competencies in their roles as students, national (Libório, 2005; Ribeiro & Dias, 2009) friends, and citizens. It was found that a common and international (US Department of State, 2006) response for all participants, independent of gen- organizations to protect children and adolescents der, was being respectful, which they defined as against sexual violence in Brazil. “someone that respects others,” “respects older people, the law, teachers, parents, and friends.” Stressful Events Stressful events were described According to participants’ responses, a respectful similarly by both males and females, with some person pays attention to social conventions and differences observed by age (Tables 3.2 and 3.3). mores such as being polite, caring, and helpful Stressful events were characterized as being hurt to others. He or she was described as a person by someone, like a parent, sibling, or friend. that cares about others’ needs and opinions, helps These actions included being insulted, beaten, others, is a good listener, and is not offensive or neglected, ignored, rejected, bullied, or betrayed. aggressive. As students, both males and females Another common stressor was “the death of a of all ages reported that valued competencies loved one.” The younger groups discussed only included being obedient to the teacher, doing their parents’ death, but older children and teen- everything the teacher asks for, including home- agers also reported stress related to the death of work and assignments, as well as, behaving in the friends, relatives, and their own. For example, classroom and “being intelligent.” In addition to a 15-year-old male described the stress he felt these, females indicated that valued competen- about his own death, given that he was ill with cancer.
3 Psychological Well-Being in Children and Adolescents in Manaus, Amazonas, Brazil 41 Table 3.2 Stress or stressful events for males by age group Age group (year) Stress or stressful events: males 6–8 Being hurt by others; insulted, beaten by parents; death of parents, family, relative; family/rela- tive in accident; being neglected/ignored; mother’s crying; physical pains; others talking bad about me 9–11 Parents’ scolding; bad grades at school; a thief; family/relative being hurt; hearing gunshots; death of someone in family or a friend; natural disasters; parents’ divorce; being rejected by a loved one (grandfather); being insulted, bullied, beaten; left alone at home; scary movies; being punished by parents due to poor schoolwork 12–14 Teachers being disrespectful; bad teachers; death of a friend; parents’ economic distress; trying hard at school and still not doing well; lack of parental support; fighting with friend; prevented from doing what is wanted; being disrespected, beaten; racism, prejudice; not having friends; afraid of being shot at; being made fun of; being betrayed by best friend; lots of responsibilities/ demands at school/home 15–17 Prevented from getting what is wanted; family/relative being hurt or sad; fighting with family or friend; being terminally ill (“I have cancer”); death of a loved one; being betrayed by a friend; difficulties at school; angry at girlfriend; feeling lonely; being punished for failing grades; being disrespected; feeling self-conscious (being evaluated by others) Table 3.3 Stress or stressful events for females by age group Age group Stress or stressful events: females (year) 6–8 Insulted, beaten by parents; being ignored, disrespected; fighting with sister/friend; being bitten by dog or scratched by cat; prevented from doing what is wanted; rainstorms 9–11 Worrying about your parents’ safety; missing your parents; insulted, beaten; death of friend; scary stories or movies; tragedy in TV (accidents, beatings, kidnappings); seeing someone dying; having to do a lot of house chores; racist comments; being robbed/assaulted; being left alone; fighting with sister or brother; others talking bad about loved ones; being ignored; fighting with parents 12–14 Parents’ divorce; being physically punished; having a lot of demands at school and home; fight- ing with brother or sister; noise by people and traffic; difficulty learning; getting bad grades; feel- ing someone is doing you an injustice; fighting with teacher; being made fun of; having to go to church; feeling insecure with choices made; distrusting; upset parents; rainy weather; prevented from doing what is wanted 15–17 Friends doing drugs; death of family, friends, teachers; rejection; fights in the family; fighting with mother, friends, sister; illness in family; not getting help from family; betrayed by friends; being grounded; keeping a secret that can harm friend/relative; gossiping (about me); being offered drugs; violence at school; being discriminated against; being lied to; being prevented from doing what is wanted; not being allowed to have a boyfriend With the exception of younger-aged children having leisure time for playing or hanging out (6–8 years old), another common stressor was with friends, was perceived as a stressor by all the violence in their communities. Adolescents ages. expressed fear of thieves, hearing gunshots, or of being shot. Fighting with friends was described There were two stressors reported only by as a stressor mostly by teenagers. School difficul- girls in the 12–17 years age range. One of them ties, such as getting bad grades, being retained, or was being made responsible for someone else’s the amount of assignments and homework, were safety, like caring for younger siblings while reported by all ages, except by the 6–8 year-old parents are at work. The other stressor reported group. Seeing a loved one, like mother or father, was the rainy weather of Manaus. These partici- hurt or stressed was also a common stressor for pants perceived rainy weather as an impediment all groups. Being prevented from getting what is for going outside, as a possibility of a flooded wanted, such as a new toy or video game, or not home, and as having a higher chance of losing the use of their electronic appliances and devices
42 P. S. Lizardi and J. C. Carregari (e.g., air conditioner, TV, computer) due to an tive reactions, patterns included thinking about electrical surge. and trying to understand the stressful event, try- ing to learn from the experience in order to bet- The persons identified as sources of stress, ter cope with a similar situation at a future time, common across age and gender, were parents, and reflecting upon their own actions to improve siblings, relatives, and friends. Adolescents in their coping skills. Finally, in terms of the actions the age range of 12–17 also reported their school- taken to cope with stress, the participants shared related activities, teachers, the amount of their that they try to distract themselves from the daily activities and chores, social environment, stressful event, such as watching a movie or read- weather, and stepfamily relationships as sources ing a book, trying to talk to someone about it, or of stress. avoiding their sources of stress as much as pos- sible. Regarding the observed age differences, Reactions to Stress and Coping The manner participants in the 6–11 years age range tended to in which children and adolescents cope with and have fewer coping mechanisms than adolescents respond to stress or stressful situations did vary in the 12–17 years age range. Adolescents rang- by age, but not much by gender. In general, we ing in age from 12 to 17 years, on the other hand, discovered that both female and male partici- described more aggressive physical and verbal pants respond to stress in the following ways: (a) reactions as ways of coping with stress. through the expression of emotions, (b) through cognitive processing or thoughts about the event, Supports and/or Supportive Relationships In and (c) through actions taken to deal with the order to understand children’s and adolescents’ stressful event (Tables 3.4 and 3.5). Emotional sources of support, we looked at the persons, reactions to stress included physical reactions places, and activities that participants identified such as getting a red face, having body shakes, as providing them with comfort, and making and crying. In terms of the thoughts or cogni- Table 3.4 Responses to stress for males by age group Age (year) Responses to stress: males 6–8 Emotions: Sadness, upset, worry Expression of emotions: Crying, wanting to be alone, not wanting to talk to anyone, sad faces, swear- ing, strong heart beating Thoughts: Thinking that something else could be more challenging, “it could be worse” Actions: Insulting or hurting someone, talking to an adult 9–11 Emotions: Afraid, worry, anger, confusion, sadness, scared, upset Expression of emotions: Body shakes, preoccupied face, running away, crying Thoughts: “Sometimes you don’t want to cry because you don’t want to feel embarrassed”; “Next time I’ll study more to pass” Actions: Talking about the stressful event with an adult, “sometimes, I run after the thief”; doing something different like “go playing” 12–14 Emotions: Feeling rejected, sadness, feeling disrespected, upset, anger, afraid, feeling excluded, envy, betrayed, embarrassed Expression of emotions: Bad mood, becoming impatient, running when afraid, crying, venting on oth- ers, keeping to self, beating and insulting others, getting quiet, changing behavior Thoughts: Reflecting about own behavior and stressful event, “think what you did wrong and how to change it” Actions: Stopping contact with stressful event, like “no to talk to that person anymore”; ignoring stressful event like “ignore what the person said”; revenge, “telling secrets of friend that betrayed you”; avoidance, “feeling like not going to class” 15–17 Emotions: Sadness, depression, isolation, upset, anxiety, anger, feeling hurt Expression of emotions: Calm yourself, withdrawn, being very quiet, keep to self Thoughts: Reflect about event like “you have to be patient,” “I don’t care, I don’t want to know” Actions: Getting distracted like “I’d watch T.V. or play videogames”; being assertive; being aggressive toward others; insulting others
3 Psychological Well-Being in Children and Adolescents in Manaus, Amazonas, Brazil 43 Table 3.5 Responses to stress for females by age group Age (year) Responses to stress: females 6–8 Emotions: Upset, mad, anger, hurt, sadness Expression of emotions: Withdrawn “I want to be alone”; crying; aggression, “I would punch her face till I break it” Thoughts: None appeared Actions: Trying to correct the situation, “I would apologize” 9–11 Emotions: Upset, afraid, hurt, mad, sadness, anger, feeling embarrassed, scared, “joy when the stress- ful event is over” Expression of emotions: Being in a bad mood; aggression, “having a desire of pulling her hair and beating her”; feeling revolted; crying Thoughts: None appeared in responses Actions: “Saying that you are stressed,” “ignoring the person that is making you feel upset,” “trying to correct the event by apologizing” 12–14 Emotions: Upset, anger, sadness Expression of emotions: Yelling or screaming, becoming red and shaky, nail biting, knuckle cracking, moving legs, having strange behavior, putting head down, isolate, withdrawn, “I don’t want to talk to anyone” Thoughts: Reflecting about stressful event, “thinking about what I have to do, what I did, and what I need to change” Actions: Eating sweets, “when I’m sad I like to eat sweets;” talk to a friend, “tell him what is happen- ing;” “stay at home, just on the computer”; “do something to distract self, like “watching a movie, using the computer, reading a book, listening to music;” revenge, “I would insult that person back”; venting on others, “sometimes I end up offending someone to alleviate my stress”; “ignoring others” 15–17 Emotions: Mad, upset, sadness, disappointment, anger, feeling embarrassed Expression of emotions: Withdrawn, being in a bad mood, being very quiet, yelling, kicking the wall, keeping to self Thoughts: Reflecting about own behavior, “thinking about what I did wrong” Actions: Mistreat people, “yelling them to go away,” “stop talking to others,” talking to friends, “jok- ing around, playing music, trying to relax,” talking to an adult, “going to my room and close the door,” “asking for advice to friends,” attempt to resolve stressful event, “I try to talk things out”, or trying to correct the event, “I’d apologize” them feel protected, happy, and loved. We found tracted from the stressful event like going to the that common supports for all ages were “having movies or the shopping mall, be reassured, and someone to talk to,” either to be listened to and be accompanied. Other examples of supportive thus experience the comfort of being heard or relationships as described by boys and girls are as a means to clarify their thoughts and, hence, presented in Tables 3.6 and 3.7. acquire skills to better deal with a stressful situ- ation. For example, a 14-year-old boy said, “one Type of Relationships Depicted in Ecomaps: day my sister saw me crying and she started talk- Supportive, Ambivalent, or Stressful In addi- ing to me, and I started feeling happy”; a 14-year- tion to the information obtained through the FGIs old girl said, “I tell [mother] everything and she and ecomap stories, the relationships drawn on supports me, I feel that she trusts me and I do the ecomap itself, and the manner in which par- everything she tells me to do.” Both males and ticipants labeled them allowed us to identify the females across ages described getting help from most common feelings children and adolescents friends, siblings, and parents in school-related in Brazil experience in their close relationships activities as being supportive. For instance, a (e.g., Figs. 3.1 and 3.2). The average number of 6-year-old boy said, “I did not know how to read relationships drawn by males, independent of and my dad taught me some things, then I went age, was 9, with a minimum of 3 and a maximum to school and the teacher taught me.” Males of all of 23. For females, also independent of age, the ages also described as supportive relationships average network size was 10, with a minimum those in which they were allowed to get dis- of 3 and a maximum of 19. Thus, both male and
44 P. S. Lizardi and J. C. Carregari Table 3.6 Examples of supportive relationships for males by age group Age group (year) Examples of supportive relationships: males 6–8 “My mom saw the talent show and thought about buying me a gift. I thanked her and she hugged me. I liked that very much” “I feel hurt, wanting to cry, and another kid comes and tries to cheer me up” 9–11 “Making him [friend] think about a city without thieves, just happiness” “My mother told me to study more, and I did, and I got a ten in the homework. I liked it” 12–14 “My mother supports me very much in my studies and incentives me a lot to study and to gradu- ate. Her support is very important to me. I give my best effort at studying and with my mother’s support I feel very confident” “If he is unhappy with a friend, then you try to get them together again, then they feel happy again” 15–17 “Seeing that things are working out in your family…me doing fine at school and getting along with my brothers, a job for my father” “My friends support me in everything I do, and when I’m hurt, they support me” Table 3.7 Examples of supportive relationships for females by age group Age group Examples of supportive relationships: females (year) 6–8 “When your father takes you out, when he takes you to the park” “My mother gets very happy when I get home after school” 9–11 “When a girl called me names, I told my mother and she said to ignore her and no to call names back” “Me and my bother we play, we go to the park, we play in the swings, the little house and the slide, and we make noise and jump on the bed, and I feel very good because we are together, and that is good for me” 12–14 “A friend that gives you advice when your parents are getting separated” “A teacher that asks you if everything is o.k.” 15–17 “When she is sad we also talk about it. I think that being a good friend is being available to the person all the time” “If you have a problem at home, some teachers talk to you about it” female participants reported large network sizes. in their ecomap. So, for example, if the major- Although some participants drew friends, pets, or ity (50 % or more) of relationships were labeled contexts as part of their network, most of them stressful, the network was coded as predomi- drew relationships depicting family members, nantly ‘stressful.’ Seventy-one percent of male including extended family, such as grandpar- participants reported predominantly supportive ents, aunts or uncles, and cousins. Participants networks, 18 % predominantly ambivalent, and reported an average of five people living in their only one 12-year-old male depicted most of his home, which is consistent with the census data relationships as stressful. Seven percent of male for Manaus (Brasil, IBGE, 2010). However, it is participants did not indicate a predominant type not uncommon for extended family members to of relationship; instead, their ecomaps showed live in close proximity, either on the same street their networks as being represented by the same or in the same neighborhood. Thus, having large amount of relationships labeled as supportive and extended family networks might have influenced stressful, or supportive and ambivalent. Seventy- the drawing of large networks in the ecomap five percent of female participants drew predom- activity. inantly supportive relationships, 11 % predomi- nantly ambivalent, and 7 % predominantly stress- In order to determine the predominant type of ful. Another 7 % did not indicate a predominant relationship that best described the participant’s type of relationship; instead, they labeled their network (i.e., supportive, stressful, or ambiva- relationships as supportive and ambivalent with lent), we looked at the frequency with which each the same frequency. participant labeled the relationships they drew
3 Psychological Well-Being in Children and Adolescents in Manaus, Amazonas, Brazil 45 Fig. 3.1 Ecomap sample of a 14-year-old male. Depic- School, 5 Dog, 6 Mother, 7 Father, 8 Brother, 9 Sister, 10 tion of relationship type: supportive (straight line), am- School, 11 Home, 12 Friends. Most relationships in this bivalent (line crossed), and stressful (line by crosses). adolescent’s environment are perceived as supportive, a Ecomap labels: 1 Myself, 2 TV, 3 The sun, 4 English few as ambivalent, and only one as stressful Fig. 3.2 Ecomap sample of a 14-year-old female. Depic- 9 Music, 10 Church, 11 Candy, and 12 Rain. This ado- tion of type of relationships: supportive (straight line), lescent perceives most of her relationships as being sup- ambivalent (line crossed), and stressful (line by crosses). portive and ambivalent. She did not perceive any of her Ecomap labels: 1 Myself, 2 Sun, 3 School grades, 4 Par- relationships as being stressful ents, 5 Books, 6 Older sister, 7 Younger sister, 8 Violin,
46 P. S. Lizardi and J. C. Carregari Discussion out a fundamental aspect, that is, the perspective of the studied groups (children and adolescents) The main purpose of this study was to define on the issue being studied (their own psychologi- constructs related to psychological well-being cal well-being). We believe that in our study, we and psychologically healthy environments from have addressed that limitation. Although we did the perspective of Brazilian children and adoles- not directly ask the question, “What is psycho- cents. The understanding of psychological well- logical well-being?,” we directly asked children being in Brazil has been strongly influenced by and adolescents to tell us about the different psy- how the construct has been defined in other cul- chological domains that together we interpret as tures, mainly the USA and Europe. For example, their views on their own psychological well-be- scales measuring concepts related to psychologi- ing (Nastasi et al., 1998). cal well-being, such as quality of life and stress, have been validated with Brazilian populations, Findings of this study also indicate that psy- including children and adolescents (e.g., Lucarel- chological well-being and psychologically li & Lipp, 1999; Calais et al., 2003), but the defi- healthy environments for children and adoles- nition of the constructs measured had no input cents in Brazil means living in an environment from Brazilian participants. where stressors are minimized, and their coping skills and supportive networks are maximized. Although work exploring factors that influ- Stressful events included being hurt by someone, ence children and adolescents’ life and mental the death of a love one, violence in their com- health has been conducted in Brazil, there are munity, and school responsibilities. We also were some shortcomings that we believe need further able to observe that girls reported stressors that study. Most of the research in the area has been were gender specific, such as having more house- conducted by researchers in the southern region hold responsibilities than boys, like taking care of Brazil, with a few studies also carried out in of siblings or cleaning the house while parents the Southeast region. This may become problem- are at work. Sbaraini and Schermann (2008) had atic considering the concept of generalizability also found this gender difference, which we be- (Hitchcock et al., 2005), especially when other lieve reflects the still prevalent traditional gender regions of Brazil have a different socioeconomic, roles in Brazil. ethnic, and cultural makeup. In addition, valued competencies across ages Findings from the present study are relevant and gender were being polite, being caring and because we have addressed two main limitations helpful to others, being a good listener, and not of previous research. First, to our knowledge, we being offensive or aggressive. In their role as carried out the first study to examine children and students, participants valued being obedient to adolescent psychological well-being in the North teachers, getting good grades, and completing region of Brazil, in a city that is among the top all expected assignments and homework. Valued ten largest cities, thus representing an important characteristics in a friend included being trust- segment of Brazil’s population. Second, our ap- worthy and available to that person at all times, proach to understanding children and adoles- either to get advice or simply to be heard. Other cents’ psychological well-being reflects an eco- relevant competencies reflected sociocultural logical–developmental framework. This means values at a larger scale, such as being a good that a primary concern for us was to understand neighbor, helping the disadvantaged, respecting children and adolescent’s perspectives about others’ sexual orientation, not holding prejudice their own environments and the factors important or being racist, and not prostituting self. It is in- for their own well-being. This is different from teresting that participants mentioned the topic the approach taken by previous studies that had of prostitution, given that Brazil has received a used constructs developed elsewhere to validate significant amount of attention, nationally and instruments with Brazilian populations. As im- internationally, because of the rise in child and portant as those studies have been, they have left adolescent prostitution (Libório, 2005; Ribeiro &
3 Psychological Well-Being in Children and Adolescents in Manaus, Amazonas, Brazil 47 Dias, 2009; US Department of State, 2006), and lescents in rich discussions regarding their own because the Secretaria de Estado dos Direitos psychological well-being; however, results are Humanos has developed a specific plan to protect limited in terms of generalizability. Our findings children and adolescents against sexual violence can be considered exploratory and the bases to ( Plano Nacional de Enfrentamento da Violência ask other research questions and to propose other Sexual Infanto-Juvenil, Brasil, 2002). Regard- methods (e.g., mixed methods) to further ad- ing prejudice and racism, Brazil has for a long dress issues like the gender and age differences time considered itself a “racial democracy,” im- in stress and coping mechanisms, family struc- plying that neither racism nor prejudice exists in ture as a preventive or protective factor of stress, the country. However, this belief has been chal- socioeconomic differences in stress and coping lenged over the years by researchers who have skills, psychological well-being and racial dis- pointed out the strong relation between darker crimination, and school environment and stress. skin color and lower socioeconomic and educa- Also, instruments to measure psychological well- tional status (e.g., Telles, 2007). Other important being can be developed that use the definitions citizenry competencies were related to the pro- provided by children and adolescents, which are tection of the environment. This may be unique age and culturally appropriate. to Manaus, given that it is located at the center of the Amazon rainforest, where environment pro- Acknowledgment Patricia Sánchez Lizardi and Júlio tection is a daily reference. César Carregari, Escola Normal Superior, Universidade do Estado do Amazonas, Brazil. In terms of coping strategies, we found that Patricia Sánchez Lizardi is now with the Clínica Mexi- participants in the 6–11 years age range tend to cana de Autismo in Mexico City. She is also an affiliate to have fewer coping mechanisms than those in the the Community, Environment and Policy Division of the 12–17 years age range. Older ages, 12–17 year- Mel and Enid Zuckerman College of Public Health at the old participants, on the other hand, not only had University of Arizona. more strategies involving thinking and reflecting Júlio César Carregari is now a doctoral student in educa- about their stressors and their actions to improve tion at the Universidade de São Paulo, USP, Brazil. their coping skills, but also described having We thank Claudemara de Souza Moutinho, Lúcia Hel- more physically and verbally agressive reactions ena Soares de Oliveira, Nayara Ferreira, and Vanessa de as a way of coping. These findings are in agree- Almeida Dantas for their support in co-conducting inter- ment with those reported by Dell’Aglio and Hutz views and for their help with interview transcriptions. (2002), but unlike these authors’ findings, our participants did perceive their family as support- References ive in the face of stress, even though they also identified them as sources of stress. Araujo, E. S. (2009). Desenvolvimento urbano local: O caso da Zona Franca de Manaus (Local urban develop- These findings support the idea of developing ment: The Manaus Free Zone case). Revista Brasileira programs to protect and promote children and de Gestão Urbana, Curitiba, 1(1), 33–42. http://www. adolescents’ psychological well-being. These redalyc.org/articulo.oa?id=193114456004. programs can be developed within the schools, where psychological services are almost non- Assupmção, F. B., Jr., Kuczynski, E., Sprovieri, M. H., existent or have been limited to special educa- & Aranha, E. M. G. (2000). Escala de avaliação de tion (Ministério da Educação, 2001). Similar to qualidade de vida (AUQEI): Validade e confiabilidade Mombelli et al. (2011), our findings support the de uma escala para a qualidade de vida em crianças de idea of creating stress prevention programs that 4 a 12 anos (Quality of life evaluation scale (AUQEI): encourage families to participate in order to bet- Validity and reliability of a quality of life scale for ter children’s psychological well-being. children from 4 to 12 years-old). Arquivos de Neurop- siquiatria, 58(1), 119–127. http://www.scielo.br/pdf/ Finally, our study had a small number of par- anp/v58n1/1267.pdf. ticipants and used qualitative research methods, which allowed us to engage children and ado- Brasil. (2002). Plano Nacional de Enfrentamento da Violência Sexual Infanto-Juvenil (3rd ed.). Brasilia: SEDH/DCA. http://portal.mj.gov.br/sedh/ct/conanda/ plano_nacional.pdf. Calais, S. L., Andrade, L. M. B., & Lipp, M. E. N. (2003). Diferenças de sexo e escolaridade na manifestação de
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Psychological Well-Being 4 of Students in Estonia: Perspectives of Students, Parents, and Teachers Katri Viitpoom and Helve Saat Introduction nic Estonians. The official language is Estonian, although approximately 30 % of the population The environment and the interaction between a speaks Russian as their native language. The person and environment play an important role average income in 2012 was € 887 per month, in well-being. The conceptual model of well- with an unemployment rate of 10.2 % ( Statistics being emphasizes the importance of personal Estonia, 2012). Estonia belongs to the European and cultural factors for mental health (Nas- Union (EU), the North Atlantic Treaty Organi- tasi, Varjas, Sarkar, & Jayasena, 1998). For ex- zation (NATO), and the Organisation for Eco- ample, the connection between psychological nomic Co-operation and Development (OECD). well-being and academic achievement seems Estonia ranks high in the human development reciprocal, that is, happy pupils with healthy index (HDI) as it performs highly in measure- self-esteem learn better, and academically suc- ments of education and life expectancy (UN cessful pupils are more satisfied with and have Development Programme, 2013). For example, higher beliefs in themselves (Cowie, Boardman, on the Programme for International Student As- Dawkins, & Jennifer, 2004). Thus, identifying sessment (PISA), a triennial international sur- culture-specific factors are important to devel- vey which aims to evaluate education systems oping interventions in the school environment. worldwide by testing the skills and knowledge Engaging the voice of the child is even more im- of 15-year-old students, Estonian students per- portant, as the selected interventions ultimately formed well in all three areas assessed, that affect youth’s daily functioning in the school is, reading, mathematics, and science (OECD, (Nastasi, 2014). 2013). The Context of the Study: Estonia The compulsory educational system in Es- tonia is 9 years of comprehensive schooling for Estonia is a northern European country with 7–15-year-olds in state, municipal, public, or 1.3 million people. The majority (70 %) are eth- private institutions. Homeschooling is allowed, but it is rare. The paradox of the Estonian school K. Viitpoom () system is, that although pupils have high study Tallinn Nõmme Primary School, Tallinn, Estonia results, students dislike school (Bradshaw et al. e-mail: [email protected] 2006) and, according to OECD’s teachers survey, TALIS (OECD, 2009), Estonian teachers have H. Saat low self-efficacy. Institute of Psychology, Tallinn University, Tallinn, Estonia © Springer Science+Business Media New York 2016 51 B. K. Nastasi, A. P. Borja (eds.), International Handbook of Psychological Well-Being in Children and Adolescents, DOI 10.1007/978-1-4939-2833-0_4
52 K. Viitpoom and H. Saat Psychological Well-Being in Estonia teachers recognize and are held accountable for a psychologically healthy school climate. Few studies have focused on the psychological well-being among pupils in Estonia, and those Schools in Estonia have different programs that have analyzed well-being have demonstrated to improve pupil well-being. There are some poor results, characterizing Estonia in a negative programs for decreasing bullying that include light. That is, although academic results seem to trainings for both teachers and pupils, such be highly valued in Estonia, school climate and as the School Peace Program (www.lastekait- pupil well-being are not. For instance, research- seliit.ee/koolirahu), Big Brother/Sister (www. ers from York University gathered information bbbs.com), and the Thomas Gordon trainings about all European countries to analyze children’s for teachers and parents ( www.gordontrain- welfare (Bradshaw et al., 2006). They concluded ing.com). To be effective, programs should that Estonian children showed low individual involve repetition, long-term implementation, well-being, characterized by low satisfaction multi-modal instruction, and the involvement with life, feeling rejected, uncertainty, and loneli- of all persons who are important to pupils (e.g., ness; Estonia was depicted as the lowest on those teachers and parents), (Cowie et al., 2004). Al- indicators when compared to other European though the aforementioned programs in Estonia children. In addition, when compared to schools are beneficial to participants, it is questionable in other countries, Estonia’s schools were rated how effective these are for promoting psycho- as being the least well liked (in response to the logical well-being in school. Current programs question, “Do you like school?”). Furthermore, usually only involve a few participants and are the researchers reported a greater occurrence of not universal, nor based on student need. school violence in the Baltic countries of Estonia, Latvia, and Lithuania, compared to western and To address the lack of culturally sensitive northern European countries (Bradshaw et al., studies about youth psychological well-being in 2006). The Saving and Empowering Young Lives Estonia, we present data from the PPWBG proj- (SEYLE) international research project, con- ect (Nastasi & International Psychological Well- ducted in 2009–2011 (Lumiste, Värnik, Sisask, Being Team, 2012). These data represent the per- & Värnik, 2011), showed that 12 % of Estonian spectives of teachers, administrators, pupils, and students reported low levels of well-being based their parents about psychological well-being of on the WHO-5 Well-Being Test, a brief measure Estonian youth. of emotional well-being (Bech, 2004). Estonian girls, compared to boys, reported lower overall Methods well-being and more recent experiences of stress, emotional problems, and anxiety. Further, 12 % This research is qualitative and descriptive in na- of students reported having had suicidal thoughts, ture. Semi-structured individual and focus group and 74 % of students said they have had been in interviews were used. Questions were developed contact with bullying in school during the past by the PPWBG team and then translated to Es- 12 months. tonian with the help of an English philologist, using a back-and-forward translation method (see Researchers also have shown that schools’ Chap. 2, this volume). This section provides de- general values and teachers’ attitudes toward scriptions of the context, participants, researcher pupils play the most important role in perceived roles, and data collection procedures. school climate, pupils’ psychological well-being, academic success, and optimism (Ruus et al., 2007). Thus, pupils’ psychological well-being might be enhanced when schoolmasters and
4 Psychological Well-Being of Students in Estonia: Perspectives of Students, Parents, and Teachers 53 Table 4.1 Break down Student age (in years) Students Parents Teachers of student, parent, and teacher participants by age – Female Male – – (in years) and gender of students 9–11 8 8 37 12–14 6 5 66 15–17 7 6 77 Total 21 19 16 20 Parents and teachers were grouped by the respective age of their children/students Study Context origin, and one worked as a school psycholo- gist in the participating school. The authors also The study was conducted in one school in the were responsible for data transcription and anal- county of central Estonia. The county has long ysis. An English teacher, from the participating tradition of agricultural production, low popula- school, who was trained as an English philologist tion rates, and low crime rates. The participating by education, assisted with translation. school has an enrollment of about 300 students, with boys and girls together in all classes. All pu- Data Collection Procedures pils were native Estonian. In addition, Estonian was the primary language for the majority of pu- Pilot interviews were conducted with two 8-year- pils (with the exception of a few whose primary old students, to ensure that questions were under- language was Russian). The families of most stu- standable for elementary school students. On the dents are of average economic background. Re- basis of the pilot, the description of procedures sults of 2013 final exams placed this school in the and interview questions were adjusted for com- middle of the range for Estonian schools, with an prehension. Adjustments were minor, for exam- average score for the school of 60 on a 100-point ple, questions were shortened. scale (Postimees, 2013). Twelve focus group interviews were conduct- Participants ed with 40 students (aged 9–17 years), 16 par- ents, and 20 teachers. All groups had 6–8 mem- Participants were 40 students (aged 9–17 years1), bers, with the exception of one parent group with 16 parents, 20 teachers, 5 school administrators, three members. Individual interviews were con- and 5 health support staff members. The break- ducted with five school administrators and five down of participants by age and gender of the health support staff. Focus group and individual student is presented in Table 4.1 (parents and interviews were 45–60 min in duration. Sessions teachers were selected on the basis of the age of were taped with participants’ consent. In addition the respective child/pupil). to responding to focus group interview questions, students were asked to draw an ecomap and write Researcher Roles a story about one stressful and one supportive relationship in their lives. All procedures are de- tailed in Chap. 2. Interviews were organized and conducted by authors of this chapter who are both of Estonian Findings 1 The sample reported in this chapter is restricted to Data were analyzed using the procedures out- 9–17-year-olds from a single school. Data from younger lined in Chap. 2. This section presents findings students (ages 6–8 years) from a second school are not from all informants, that is, students, teachers, included in these analyses. parents, and administrators. Unless otherwise
54 K. Viitpoom and H. Saat indicated, the findings reflect consensus (agree- All focus groups agreed on the importance of ment) among informant groups. We first summa- good learning skills, described as being diligent rize findings related to definitions of psychologi- and self-leading, and getting good grades. A good cal well-being and strategies for fostering well- student also has good social skills, characterized being from the perspectives of school administra- by qualities such as being polite, kind, sharing tors and support staff. We then present findings knowledge, and getting along with classmates. based on the perspectives of students, parents, The expectations were similar across age and and teachers on cultural expectations, stressors, gender groups, with the exception of “being reactions to stress, and coping strategies. active,” which was mentioned only by boys and girls aged 15–17 years. Parents and teachers Administrator and Support Staff described being active as expressing an opinion Perspectives about learning a subject or actively participating in the study process. For younger students, the School administrators and health support staff emphasis was on being polite, conscientious, and responded to questions about the definition of getting good grades. psychological well-being and ways in which the school can facilitate the development of well- Students described valued competencies for being. Responses to the question, “What is psy- the roles of friend, citizen, and parent. They de- chological well-being?” yielded four main cat- scribed a friend as a person who is helpful, loyal, egories: (a) positive relationship with self, (b) protective, honest, and friendly. A good friend is optimism and perceived capability, (c) satisfac- someone who is there when you need him/her and tion with relationships, and (d) resilience. When listens to and understands you. A good citizen is asked how schools could enhance students’ psy- polite, helpful, friendly, loyal to the country, and chological well-being, administrative and support respects the law. A good parent is helpful, lov- staff generated the following ideas: (a) supporting ing, caring, and should talk things over instead of youth initiative and informal learning, (b) having physical punishment. Younger students indicated active mental health support staff in school, (c) that a good parent has time to play with his or her supporting greater home–school cooperation, (d) child, and older students described the good par- better teacher training on communication skills, ent as being interested in the child’s life, under- and (e) organizing events to raise school unity. standing the child, and setting rules for the child. Student, Teacher, and Parent Teachers and parents both reported the home Perspectives as the most important factor in the development of the child. The parental role was described as Using focus groups, we sought perspectives of guiding and encouraging the child to grow up as students, parents, and teachers about cultural ex- self-dependent. The roles of schools and educa- pectations (culturally valued competencies) and tors were described as guiding, supporting, and sources of stress for children. In this section, we encouraging pupils; helping them develop their report findings across the respondent groups and abilities. Teachers stressed that both home and note any differences in perspectives across adults school are responsible for developing social and children. skills, and that school should teach traditional values and rules. Cultural Expectations According to students, teachers, and parents, culturally valued compe- Stressors Most stressors, mentioned across the tencies of a schoolchild are learning skills, social informant groups, were associated with inter- skills, and being active in the learning process. personal relationships. Students, teachers, and parents all agreed that the most common stressor for children is problematic relationships with friends, parents, or teachers. Teachers and parents also referred to overloaded work demands as a
4 Psychological Well-Being of Students in Estonia: Perspectives of Students, Parents, and Teachers 55 source of stress for children. Students mentioned stressful. For boys, aged 9–11 years, descriptions several types of stressors. The most common was of “supportive” relationships included getting at- bullying at school. Other stressors identified by tention from a caring relative and doing some- students included: (a) being tired and overloaded thing fun with the family. Girls, aged 9–11 years, with school or homework; (b) being afraid of per- described supportive relationships as ones in forming badly in tests; (c) difficult relationships which they receive care and help from a parent or with parents, friends, or teachers; (d) death and sibling, or receive a surprise from a friend. Boys, illness; (e) academic difficulties; and (f) being aged 12–14 years, described supportive interac- in contact with an accident. Older students (ages tions as ones in which a friend or sibling shows 15–17 years) mentioned being overloaded with understanding or opportunities to share interests obligations or not having enough time as typical with another person. Girls, aged 12–14 years, stressors. In addition, older students mentioned described supportive relationships as an under- financial difficulties and being addicted to drugs standing and caring parent or trustworthy friend. as stressors for their age group. Adolescent boys, aged 15–17 years, described a supportive relationship (with (girl)friend or rela- Student Ecomaps tive) as characterized by shared interest, trust, and caring. Adolescent girls, aged 15–17 years, On the ecomaps, students identified relation- talked about friends you can trust or caring rela- ships as being supportive, stressful, or ambiva- tionships with parent or other relative. lent (both stressful and supportive; see e.g., of ecomap in Fig. 4.1). The distribution of relation- With regard to “stressful” relationships, ship types across age and gender is depicted in young boys (aged 9–11 years) described bully- Table 4.2. The percentage of supportive relation- ing, being lonely, and having difficult relation- ships for boys ranged from 56 % (ages 15–17 ships with siblings or parents. Young girls, aged years) to 73 % (ages 9–11 years), suggesting a 9–11 years, talked about friends doing something progression toward more supportive relation- “bad” and sharing things with siblings as stress- ships as boys approach adolescence. Boys also ful. Boys, aged 12–14, described teachers who do reported an increase in ambivalent (combination not understand them as “stressful.” Girls, aged of stressful and supportive) relationships as they 12–14 years, provided several descriptors related approached adolescence, with 25 % at ages 9–11 to relationship with family, friends, and teach- years and 42 % aged 15–17 years. Boys in all ers; these included parents not keeping prom- age groups reported a low percentage (2–3 %) of ises, siblings refusing to share or treating them stressful relationships. For girls, supportive rela- badly, friends who make one scared for them, tionships ranged from 48 to 58 %, with minimal and teachers who remove the student from the variations across age groups. The percentage of classroom. For adolescents (aged 15–17 years), stressful relationships, in contrast, varied across both boys and girls described stressors related to age groups. Girls aged 9–11 years reported 11 % family relationships. For example, boys talked of of relationships as stressful, compared to 52 % at a brother who bullies, a father who is strict, or ages 12–14 years and 0 % at ages 15–17 years. losing contact with a parent. Girls talked of los- Girls also evidenced variations by age for ambiv- ing trust in a parent, having conflict with parents, alent (combination of stressful and supportive) being bullied by a brother, or having a parent relationships, reporting 38 and 42 % at ages 9–11 with drinking problem. and 15–17 years, respectively, but no (0 %) am- bivalent relationships at ages 12–14 years. Students’ Reactions to Stressors: Coping Strategies and Social Supports Students also described the reasons for label- ing relationships as supportive and stressful, that During focus group interviews, students de- is, what makes the relationship supportive or scribed their reactions to stressors. Responses
56 K. Viitpoom and H. Saat Fig. 4.1 Example of Estonian student ecomap. Support- described one or both parents as stressful/ambivalent, ive relationships are denoted with straight line ( ____), compared to 73 % of those aged 12–14 years, and 85 % of stressful with x’s (xxxx), and ambivalent with both (xxxx). those aged 15–17 years. The pattern of stressful parental Age variations were evident in the percentage of parental relationships suggests increasingly stressful parent–child relationships characterized as stressful or ambivalent (i.e., relationships as children approach adolescence involving some stress); 33 % of children aged 9–11 years Table 4.2 Number and percentage of supportive, ambivalent, and stressful relationships depicted in ecomaps by gen- der and age Gender by age group (n) Supportive # (%) Ambivalent # (%) Stressful # (%) Total # Boys, 9–11 (7) 44 (73) 15 (25) 1 (2) 60 Girls, 9–11 (8) 29 (52) 21 (38) 6 (11) 56 Boys, 12–14 (5) 18 (60) 11 (37) 1 (3) 30 Girls, 12–14 (6) 27 (48) 0 (0) 29 (52) 56 Boys, 15–17 (6) 24 (56) 18 (42) 1 (2) 43 Girls, 15–17 (7) 40 (58) 29 (42) 0 (0) 69 indicated the use of emotion-focused and prob- help from family and relatives, health specialists, lem-focused coping, avoidance, and use of social friends, teachers, the Internet, and God. Friends, supports. Emotion-focused coping is exemplified in particular, were seen as helpers by girls aged by the following examples: I would cry, get mad, 12–14 years and adolescent boys and girls (aged or let my emotions burst out; or try to calm my- 15–17 years). The avoidance strategies, mostly self. Problem-focused coping was characterized reported by boys, included ignoring someone, as problem analysis (analyze the problem), stay- changing the topic, or running away from home. ing calm (try to calm myself), taking action (doing something to solve the problem), or seeking help Parents and teachers responded to questions from someone else. Students talked of seeking about how they might help a child who has a problem. Strategies they identified included:
4 Psychological Well-Being of Students in Estonia: Perspectives of Students, Parents, and Teachers 57 taking time to listen; trying to understand; trying munication skills, suggesting that teachers have to make the child speak more about the problem; expectations for students to be active in discus- seeking help from a specialist, friend, colleague, sions about academic topics. Adolescent boys or relative; and trying to stay calm as they calm (aged 15–17 years) similarly described good down the child. Teachers of students, aged 9–11 students as diligent and active rather than neces- and 12–14 years, reported that they often solved sarily academically successful; this was not the problems “right away” and saw problem solving case for younger students or adolescent girls. It as a normal part of their work. is possible that adolescent boys are given great- er recognition for being active, for example, in Discussion sports, thus explaining their perspective. Howev- er, the teachers’ valuing of active communication The purpose of this chapter was to present the in class discussion may suggest that adolescent findings from the Estonia site of the PPWBG boys not only recognize this but also are reward- project. Focus group interviews with students ed by teachers for such behavior. (aged 9–17 years) and their teachers and parents yielded qualitative data about culturally valued Stressors competencies and stressors. Student ecomaps, in combination with focus group interviews, yield- Students, teachers, and parents agreed that the ed qualitative data about stressors and supports primary stressors for children and adolescents in their social networks and reactions to stressors are problematic relationships and academic dif- (e.g., coping, use of social support). In addition, ficulties. The most common stressors reported individual interviews with school administrators by students were those related to relationship and support staff yielded data about definitions difficulties with parents, relatives, teachers, and of the construct, psychological well-being, and friends. In addition, younger students stressed suggestions for promotion of psychological well- academic difficulties, and older students stressed being of the school-age population. being overloaded with obligations. The results of this study were consistent with existing research Psychological Well-Being and confirmed that poor interpersonal relation- ships and bullying as common problems among School administrators and support staff re- Estonian school pupils (Lumiste et al., 2011), in sponded to questions about the definition of the addition to academic difficulties. construct of psychological well-being. Their responses yielded four categories, including a Social Networks positive relationship with the self, optimism and self-perceptions of capability, satisfaction with The ecomap data (Table 4.2) revealed age and one’s relationships, and resilience. Such find- gender variations in perceived stress and sup- ings can provide a starting point for discussions port within ego-centered social networks. These about how schools can support the development variations have implications for schools’ efforts of these qualities. in schools when designing intervention or pre- vention programs related to stress and coping and Culturally Valued Competencies accessing social supports. The specific needs at different development levels for boys and girls Students, teachers, and parents agreed that a should guide program development. The findings good student has good learning and social skills. also suggest assessing social networks as part of Teacher groups described a good student as being program designs (e.g., administering ecomaps active. They also stressed the importance of com- to determine needs of students within a specific school and then designing programs accordingly).
58 K. Viitpoom and H. Saat Fostering Psychological Well-Being youth workers to identify common goals and ex- plore different approaches and opportunities to Interviews with school administrators and sup- reach students and families in need. Furthermore, port staff yielded suggestions for supporting de- this study searched for initial solutions and ideas velopment of student psychological well-being. for promoting psychological well-being in only These suggestions, in conjunction with findings one Estonian school. A participatory approach to from interviews with students, teachers, and par- data collection with a broader population could ents, provide guidance for future actions. Admin- generate more generalizable findings for Esto- istrators and support staff are the school person- nian schools, which would be beneficial for plan- nel who work at a systemic level, and thus can ning interventions on a broader scale within the be expected to take a global view of the school various Estonian school systems. as an organization. They suggested efforts such as the following to foster student psychologi- References cal well-being: (a) youth initiatives and oppor- tunities for informal learning, (b) availability Bech, P. (2004). Measuring the dimensions of psychologi- of school-based mental health support staff, (c) cal general well-being by the WHO-5. QoL Newslet- greater home-school collaboration, (d) teacher ter, 32, 15–16. professional development in communication, and (e) events to foster a sense of unity or community Bradshaw, J., Hoelscher, P., & Richardson, D. (2006). in the school. Such initiatives are consistent with An index of child well-being in the European findings from students, teachers, and parents Union. Social Indicators Research, 80(1), 133–177. about culturally valued competencies, stressors, doi:10.1007/s11205-006-9024-z. and importance of social supports for coping with stress. Cowie, H., Boardman, C., Dawkins, J., & Jennifer, D. (2004). Emotional health and well-being. A practical Future Directions guide for schools. London: Paul Chapman Publishing. Although the study’s findings suggest some fu- Lumiste, K., Värnik, A., Sisask, M., & Värnik, P. (2011). ture directions for practice, we also suggest sub- SEYLE õpilaste ja õpetajate baasuuringu tulemused: sequent steps for more complete understanding vaimne tervis ja riskikäitumine. Tallinn: ERSI. of the issues and mechanisms for change. We thus make recommendations for additional research to Nastasi, B. K. (2014). Empowering child voices through inform practice and policy. First, findings from research. In C. Johnson, H. Friedman, J. Diaz, Z. this study, including actual responses, could be Franco & B. Nastasi, (Eds.), Praeger handbook of used to develop questionnaires for students and social justice and psychology: Volume 3. Youth and adult informants. This would provide methods to disciplines in psychology (pp. 75–90). Santa Barbara: gather data from a broader population and assess ABC-CLIO/Praeger. psychological well-being for a broader range of students. Second, study findings could be used for Nastasi, B. K., & International Psychological Well-Being planning effective intervention at schools and in Research Team. (2012). Promoting Psychological neighborhoods in cooperation with youth centers Well-Being Globally project. [Updated study proce- and local authorities. The participatory culture- dures]. Department of Psychology, Tulane University, specific intervention model (PCSIM; Nastasi et New Orleans. Accessed 1 July 2014. al., 1998), which has been applied across cultures and contexts, could be used in the target commu- Nastasi, B. K., Varjas, K., Sarkar, S., & Jayasena, A. nity to bring together teachers, parents, school (1998). Participatory model of mental health program- administrators, local policy makers, and local ming: Lessons learned from work in a developing country. School Psychology Review, 27(2), 260–276. http://www.nasponline.org/publications/spr/abstract. aspx?ID=1423. OECD (Organisation for Economic Co-operation and Development). (2009). How do teacher practices, beliefs, and attitudes measure up? In Education at a Glance 2009: OECD indicators. OECD Publishing. doi:10.1787/eag-2009-29-en. http://www.oecd.org/ edu/school/43072510.pdf. Accessed 1 July 2014. OECD (Organisation for Economic Co-operation and Development). (2013). PISA 2012 results in focus. http://www.oecd.org/pisa/keyfindings/pisa-2012-re- sults-overview.pdf. Accessed 1 July 2014.
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Psychological Well-Being 5 Among Greek Children and Adolescents Chryse Hatzichristou, Philia Issari and Theodora Yfanti Introduction to various sectors of their life and self (Diener, Lucas, & Oishi, 2002). Most of the subjective To see ourselves as others see us can be eye-open- well-being models that have been proposed in ing. To see others as sharing a nature with ourselves the literature adopt an individual perspective, fo- is the merest decency. But is [a] far more difficult cusing mainly on the well-being of individuals or achievement [to see] ourselves amongst others, as proposing individual characteristics that evalu- a local example of the forms human life has locally ate and constitute well-being (Bal, Crombez, taken, a case among cases, a world among worlds. Van Oost, & Debourdeaudhuij, 2003; Huebner, (Clifford Geertz, Local Knowledge) Suldo, Smith, & McKnight, 2004; Konu, Lin- tonen, & Autio, 2002). This chapter explores psychological well-being among Greek children and adolescents within Throughout the history of the Greek language, the context of the Promoting Psychological Well- we encounter different terms and conceptualiza- Being Globally (PPWBG) project (see Chap. 2). tions related, though not equivalent, to modern The well-being of children and young people notions of psychological health and well-being. is a highly important topic both nationally and Within the context of Greek philosophy, of par- internationally (Bradshaw & Richardson, 2009; ticular importance is the concept of “eudaimonia” UNICEF, 2007). Overall, well-being is a com- (Greek:ευδαιμονία), sometimes anglicized as plex and somewhat elusive concept which is eudaemonia-a word commonly translated as open to various conceptualizations, definitions, “happiness,” “welfare,” or “human flourishing” and methodological approaches (Crivello, Cam- (Robinson, 1989). Etymologically, it consists of field, & Woodhead, 2008; Dodge, Daly, Huyton, the words “eu” (“good”) and “daimōn” (“spirit, & Sanders, 2012; Hird, 2003). god, fate”). In Aristotle’s writings, the term eu- daemonia (based also on older tradition) was Concepts such as “well-being,” “life satisfac- used to signify the highest human good. In one tion” and “quality of life” have attracted much of his most influential works, the Nicomachean attention from scholars over time (Hird, 2003) Ethics (c. 350 BCE), Aristotle described the dif- and are often used interchangeably (Statham & ficulties, still pertinent to our times, in defining Chase, 2010). Also, the concept of subjective such concepts as “happiness” or “well-being.” well-being, one of the most important constructs He pointed out that even though “saying that in the field of positive psychology, is associated happiness is best is something manifestly agreed with the evaluation of individuals with regard on,” the challenge and debate begin when consid- ering what constitutes happiness. For Greek phi- C. Hatzichristou () · P. Issari · T. Yfanti losophers (i.e., Socrates, Plato, Aristotle, Stoics), University of Athens, Athens, Greece the notion of eudaemonia (happiness) is closely e-mail: [email protected] © Springer Science+Business Media New York 2016 61 B. K. Nastasi, A. P. Borja (eds.), International Handbook of Psychological Well-Being in Children and Adolescents, DOI 10.1007/978-1-4939-2833-0_5
62 C. Hatzichristou et al. bound up with the notions of “virtue” (desirable cific communities (Kafetsios, 2006; Kafetsios quality) and “excellence.” For Aristotle, eudae- & Sideridis, 2006; Kleftaras & Psarra, 2012; monia requires also action, activity, and practical Leontopoulou & Triliva, 2012; Pouliasi & virtue. In other words, it is not sufficient for a Verkuyten, 2011). In a recent European study person to possess an ability or disposition; happi- (Eurobarometer & European Commission, ness depends mainly on the cultivation of virtues 2011), Greek participants (18–44 years of age) within the context of the polis, and it is the aim of associated the construct of well-being with such practical philosophy (including ethics and politi- notions as contentment, enjoyment, and happi- cal philosophy) to consider and experience what ness (inner satisfaction, harmony between body eudaemonia really is, and how it can be achieved. and mind, emotional stability, and laughter), in- Along these lines, Aristotle considers the virtue terpersonal relationships (partnership, marriage, of friendship as especially important in achiev- social networks, love, children, friends), leisure ing happiness, for friends help each other in the (relaxation, cultural and natural experiences, attainment of the good and the sharing and enjoy- social activities, holidays, travel with family, ment of common activities (Issari, 2002, 2013; following one’s passion, recreation), and civil Issari & Anastasiades, 2010). rights (personal freedom, equality, respect for all human beings). Another term, often used in the Greek lan- guage, is that of euexia (Greek: ευεξία). Etymo- In Greece, there is a very limited body of re- logically, it consists of the words “eu” (“good”) search on children and adolescent well-being. and “exis” (“habit/state”). It implies a state of One inquiry looked at the relationship between physical health and mental and psychological the subjective well-being of parents and children health. Finally, in everyday Modern Greek lan- (Karademas, 2009). It was found that the level guage, the notion of well-being is associated with of fathers’ stress and the degree of mothers’ life a sense of feeling and being well, a good life, satisfaction was associated with children’s well- and a life well lived; it also implies being happy, being. In a dissertation study conducted in Greek joyful, or satisfied/pleased with life. schools with middle school students, Lampro- poulou (2008) found that subjective well-being In this site-specific study, our underlying as- was interrelated with important individual, fami- sumptions imply a sociocultural perspective that ly, and school factors. More specifically, the sub- views well-being as a socially contingent and jective well-being of junior high school students culturally anchored construct, changing over was directly related to relationships with the time and across historical and cultural contexts. teacher and the school climate, while the subjec- A growing number of international and Greek tive well-being of high school students was con- s tudies look at people’s well-being either directly nected to relationships with classmates, friends, or indirectly within the context of the recent so- and the classroom psychological climate. This cioeconomic crisis and its serious and negative interaction of factors at multiple levels confirmed impact on physical and mental health (Annas, the necessity for a more synthetic evaluation and 2013; Anagnostopoulos & Soumaki, 2013; approach to the study of well-being by Lampro- Axford, 2009; Economou, Madianos, Peppou, poulou (2008). Paterakis, & Stefanis, 2013; Office for Economic Cooperation and Development (OECD), 2009; Along these lines, a school-community model UNICEF, 2007; Wahlbeck & McDaid, 2012). In of psychological well-being was proposed fact, Greece was a participant in several interna- that targets the well-being of the whole school tional and European projects on well-being and c ommunity and provides the context for the pro- life satisfaction (European Commission, 2008; motion of other significant correlates of psycho- OECD, 2009; UNICEF, 2007). logical health, such as students’ academic and psychosocial development (Hatzichristou, Lamp- Present-day research on psychological ropoulou, Lykitsakou, & Dimitropoulou, 2010a). well-being in Greece is relatively limited and Core concepts of school mental health related to focuses mainly on the adult population or spe-
5 Psychological Well-Being Among Greek Children and Adolescents 63 this model include resilience, effective schools, psychological health of children and adolescents schools as caring communities, social and emo- during the recent socioeconomic crisis in Greece tional learning, and evidence-based interventions. and elsewhere. These factors are considered prerequisites for the promotion of school well-being and are integrat- Greek Context ed into the model in an operational synthesis that provides practical guidelines for the development Greece is a country in southern Europe with a and implementation of systems-level interven- population of about 11 million (Hellenic Statisti- tions in the school environment (Hatzichristou, cal Authority, 2011). Athens is the nation’s capi- 2011a, b, c; Hatzichristou et al., 2010a). tal and largest city, and one of the world’s oldest cities with a recorded history spanning around Methodology 3400 years. Today, a cosmopolitan metropolis, modern Athens is central to economic, political, The present research project attempted to capture and cultural life in Greece. In recent years, many children’s and adolescents’ voices, experiences, immigrants and refugees came to Greece, and values, perspectives, and aspirations in relation Athens has become increasingly multicultural. to well-being, stress, and coping, using a quali- The city of Athens has a population of approxi- tative and child-focused research methodology. mately 670,000 people. The urban area of Athens Child-focused research, so often neglected, af- ( Greater Athens and Greater Piraeus) extends firms children as competent social actors and beyond the administrative municipal city limits therefore valid sources of research data (Issari with a population of approximately 3.5 million & Printezi, 2011; Langsted, 1994). On the other people. The impact of the socioeconomic crisis hand, qualitative research emphasizes context has engulfed Greece in the past 3 years, and has and offers the opportunity to capture local un- considerably affected the psychosocial life of the derstandings and the diversity of children’s and people in Athens, especially those who are most adolescents’ experiences as well as the subjective vulnerable. and intersubjective meanings young people give to well-being and coping with stressful situations Study Population (Denzin & Lincoln, 1998). Researcher Characteristics Our study was conducted in schools located in both the city of Athens and the greater Athens The present project was conducted primarily by area. The sample consisted of 25 primary school four Greek psychologists who work at the Uni- students (ages 6–11 years old; 13 female, 12 versity of Athens and share an interest in the sub- male) and 23 secondary school students (ages ject of psychological well-being. The research 12–17 years old; 12 female, 11 male) from three team consisted of a professor of school psychol- different school districts. In one of the schools, ogy with extensive experience in research and located in a western suburb of Athens, the stu- intervention programs in the Greek schools, an dents who participated were of Greek origin assistant professor of counseling psychology and came from families with an average socio- with extensive experience in qualitative method- economic status. In another school, located in a ology and cross-cultural research, and two PhDs low socioeconomic area of Athens, those who in school psychology with valuable experience in participated were mainly children of Greek ori- school community projects. All four researchers gin with the exception of two secondary school adopt a sociocultural perspective regarding well- students who were immigrants from Albania and being, and they are especially concerned with the Romania. The third school was located in the Athens metropolitan area in a district near the
64 C. Hatzichristou et al. center of Athens. The students who participated children and adolescents were recorded and later in the study were Greeks and came from families transcribed and translated into English. of middle to high socioeconomic status. Data Collection Data Analysis The project has received support and approval Thematic analysis was used to code and analyze from the University of Athens including the of- the research data. Thematic analysis is a flexible, ficial approval for data collection in the schools. widely used qualitative analytic method; a foun- In addition, parent consent forms were collected. dational and useful tool for qualitative analysis The data collection was conducted with student which can potentially provide a rich, detailed, participants in eight small groups in a quiet class- and complex account of data. More specifically, room of the school suggested by the principal. it is a method for identifying, analyzing, reporting patterns, and “thematizing” meanings within the Focus Groups as Method The study utilized research material (Braun & Clarke, 2006; Hol- group-based interviews as a method of data loway & Todres, 2003; Roulston, 2001). Within collection. The focus group is especially useful this framework, it is important to underline the in exploring complex and dynamic psychoso- active role of the researcher in identifying the cial issues, such as well-being, which are open patterns and themes, selecting, editing, creating to different definitions and ways of meaning links, making decisions, or presenting to the making. As Kitzinger (1994) argued, the focus readers themes and narratives which are of inter- group method taps into people’s underlying est and support the arguments. It is thus essential assumptions and theoretical frameworks and that the investigators acknowledge and recognize draws out how and why they think as they do. these decisions and make explicit their epistemo- The data generated by this method confront the logical or theoretical positions, assumptions, and researcher with the multileveled and dynamic values in relation to the qualitative study. The re- nature of people’s understandings, highlighting searchers do not simply “give voice” to the par- “their fluidity, deviations and contradictions” ticipants, and themes do not simply “reside” in (Kitzinger, 1994, p. 172). or “emerge” from the data. As underlined by Ely, Vinz, Downing, and Anzul (1997, pp. 2 05–206; In our study, the group interview method was cited in Braun & Clarke, 2006), “if themes especially helpful in exploring the stressors and ‘reside’ anywhere, they reside in our heads from supports of youth life within the Greek sociocul- thinking about our data and creating links as we tural context. More specifically, the focus group understand them.” provided a forum for Greek students to have their voices, experiences, and concerns heard. In the present analysis, we took into account the conceptual model of children’s psychological Eight gender-specific focus groups ( 5–7 well-being proposed by Nastasi, Varjas, Sarkar, students/group) were conducted, four at the pri- and Jayasena (1998) founded on the idea that mary school level (two females, two males) and specific definitions of well-being vary from cul- four at the secondary school level (two females, ture to culture. This model looks at children’s two males). The research team consisted of one perspectives on individual and/or cultural fac- group facilitator and one person in charge of tors that influence well-being and considers that audiotaping and note-taking. During the group phenomenological perspectives of culturally interviews, the students responded to a series valued competencies can provide a window into of open-ended questions based on the interview the culture’s standard for positive or alternatively protocol proposed by the lead principal inves- negative functioning. Moreover, it takes into ac- tigator (PI) of the cross-country PPWBG (see count child-identified individual and cultural Chap. 2). The responses and overall discussion of stressors, supports, and coping responses. More
5 Psychological Well-Being Among Greek Children and Adolescents 65 specifically, the research material was analyzed The image of a “good” student, however, is both deductively and inductively by (a) coding not limited to school competence and skills (e.g., the data deductively using the broad constructs/ writing, math); it is also associated with appro- categories identified as key to understanding psy- priate behavior within the context of the school chological well-being (i.e., competencies, stress- environment such as good and ethical behavior ors, supports, and coping), and (b) describing (e.g., following the rules, no cheating in tests, no culture-specific themes, subthemes, patterns, and talking back, respect for the teacher, and so on). particularities that give meaning to the identified Elementary school girls placed emphasis on the broader categories (see Chap. 2). good relationship with other classmates or the teacher; whereas, for boys, the “good” student Research Findings avoids fighting or hitting others, distracting, criti- cizing, or playing the “tough” guy. The “good” The analysis of data collected from primary and student was described mostly in terms of perfor- secondary school students within the context of mance, specific skills, values, and behaviors with focus groups generated various cultural-specific little or no reference to internal or stable charac- themes, subthemes, patterns, and particularities teristics such as being “smart,” or “talented.” associated with four important constructs for un- derstanding well-being as proposed by Nastasi The narratives of secondary school children in et al. (1998), namely (a) valued competencies, (b) relation to academic learning focused on the sub- stressors, (c) coping responses, and (d) support ject of caring about learning, being interested in resources. Findings relevant to each construct are a subject, doing one’s best, participating in class, presented separately. being organized and working hard, and studying throughout the year and not just for the exams. Valued Competencies Students also noted the possibility for improve- ment and the value of trying and making an effort In our study, cultural-specific competencies in- to become better. Although students considered cluded academic competence, social/interper- that good grades are important, they proposed sonal competence, and civic/ethical attitude and a balance between studying and “hanging out” behavior. This section provides findings specific with friends or being involved in sports, hobbies, to each category of competence. and other things. “I have many friends and I am also a good student,” said a 13-year-old boy. In Academic Competence: Skills, Values, and other words, “you can study and not be a ‘nerd’!” Behavior Students’ accounts on academic com- added another student. Overall, adolescents’ nar- petence emphasized the importance of learning ratives in our inquiry reflected a concern for a and studying both at school and at home. Accord- balanced student life while emphasizing the im- ing to elementary school boys and girls, a good portance of peer and friend relationships, con- student pays attention to the teacher, participates firming the important role that the peer group in class, brings his or her homework and assign- plays for this particular developmental stage. ments, gets good grades, and cares about learn- ing. While at home, “good” students study; they Secondary school girls discussed the reasons do not go out to play and do not get distracted underlying poor academic competence, showing before they finish studying; they spend time empathy for students who are not doing well at doing their homework or getting help with school school. Poor performance was mainly attributed assignments, homework, holding an important to family problems and other negative experi- place within the Greek educational system. ences, such as being teased by other students or receiving criticism and scolding by a teacher, which may prevent students from caring about school. Other reasons discussed were the lack of adequate help with homework and negative influences by other people. The significance of
66 C. Hatzichristou et al. distracting or “bad” peer influence also was indi- order to be with someone else; and having shared cated by male students. Finally, secondary school interests. Girls emphasized the importance of students distinguished between a “good person” empathy between friends and the social role of and a “good student” stressing that the two do the friend (e.g., does not gossip about you, does not necessarily coincide. Such a differentiation not want exclusiveness, and keeps in touch). may imply a greater awareness and recognition Girls also noted that a bad friend does not ac- among adolescents of different aspects of a stu- cept you the way you are, makes you feel infe- dent’s life and personality. rior, imitates and copies you, gossips about you, wants exclusiveness, and does not show empathy Social/Interpersonal Competence: Skills, Val- or respect for you. ues, Behavior Elementary and secondary school children revealed important values and norms Citizen Competence: Civic Values and Behav- related to prosocial and interpersonal skills in ior Both elementary and secondary school boys describing either the “good friend” or someone and girls talked about citizenship in terms of ethi- who is not a “real” friend. Friendship was con- cal behavior and responsible attitude and actions ceptualized in terms of feelings, behaviors, expe- in relation to other people or the environment. In riences, words, or deeds. For adolescents, a bad describing the “good citizen,” they emphasized friend does not help or care about his friend, is such values as generosity, helping and caring, not loyal and trustworthy, and takes advantage and cultivating civic virtues. Students in higher of you for fun or to impress others. Secondary grades referred also to democracy, freedom of school girls emphasized not gossiping or taking speech, politics, and political action. Descrip- advantage of a friend. They also commented that tions about responsibilities toward other people “distance can test friendship” and that “a loyal and the environment are presented separately. friend can forgive another’s mistakes, weak- nesses or imperfection.” Finally, students also Responsible Attitude Toward Others Younger included in their narratives about good friends students stressed the need to be generous toward the qualities of respecting and being sincere and other people, to help the homeless and the poor not being jealous of other’s success, competitive, (e.g., giving water, food, and lodging at one’s or feeling superior. home), to help people with special needs (e.g., crossing the road), to take to the hospital some- For both girls and boys, friendship was as- one injured, to treat others well, to be friendly sociated with support and caring; sharing of with and trust the neighbors, to obey the city laws common characteristics and interests; similar and follow the driving signs. They also empha- thinking, feelings, and opinions; making each sized the need to care about what other people other happy and sharing in each other’s happi- say about us, to participate in democratic assem- ness; communication and exchanging of ideas; blies, to protest when someone says something knowing a friend for a long time and spending unfair, not to fight or go to court for small owner- time together; helping with problems and school ship matters, not to annoy others (e.g., not to take difficulties; and trust and keeping secrets. Stu- another person’s turn in line at the supermarket), dents also stressed comforting and encouraging not to take advantage of others (e.g., charging the other; being close to someone in good and high prices or advertising lies), and overall to bad times; and even accepting the other without strive to make the city a better place. conditions, that is, regardless of a friend’s change of character, good or bad behavior, as character- Adolescents’ accounts of citizen competence istics of friends. focused on caring about society, supporting de- mocracy, accepting responsibility, providing In describing friends, boys referred to spend- a good example for others so that the state can ing time playing with friends without fighting, ameliorate, helping the hungry and those in need, hitting, calling names, or making fun; laugh- not being selfish, and not engaging in criminal ing behind one’s back or abandoning a friend in
5 Psychological Well-Being Among Greek Children and Adolescents 67 acts (e.g., fighting, stealing). They also discussed on the oppressive and restricting behavior of the politics and political action in relation to the bad parent. present economic crisis, pointing out “that adults just talk about ideas without getting involved in Both for adolescent boys and girls, a good action,” and that “if you cling to the same thing teacher is fair and does not differentiate between [politics] you cannot go further or change.” Other students, cares about all his/her students, and is young participants expressed a concern regard- supportive for matters related to academic per- ing democracy and freedom of speech, quoting a formance and social–emotional issues. Younger saying often attributed to Voltaire: “I do not agree adolescents also stressed not only the need for with what you say, but I will defend to the death teachers to be strict and impose discipline when your right to say it.” needed but also to like their work and have a sense of humor. Older adolescents emphasized Responsible Attitude Toward the Environ- the importance for a teacher in class to provide ment Students’ concerns included taking care motivation and implement alternative methods of of and respecting the planet, nature, the city, teaching. public places, and the environment in general. Elementary school students made more concrete Adolescent boys and girls identified a bad comments regarding the protection of the envi- teacher as someone who does not care about the ronment. For example, they referred to such acts lesson and the students, does not teach well, dif- as recycling and participating in tree planting and ferentiates and discriminates students based on similar activities. Moreover, they were very criti- their ability or ethnicity, and can be verbally and cal of throwing garbage, polluting the sea or the physically aggressive toward students. They also beach, stepping on flowers, cutting trees, throw- described the bad teacher as one who is unkempt ing cigarettes on the ground or starting a fire and brings personal problems to school. (e.g., forests) because of neglect, polluting the air by using cars everywhere, acts of vandalism The descriptions by primary and secondary regarding public or private property, not cleaning school children of competent students, friends, after one’s dog, and so on. and citizens have potential implications for psy- chological well-being, that is, both primary and Parent and Teacher Competence: Skills, secondary students talked of the student who is V alues, Behavior Adolescents identified good not doing well at school (e.g., “bad” student), parents as those who are able to offer material the “not good” friend (e.g., not loyal or “real”), and emotional care to their children without and the “not competent” citizen (e.g., “bad” spoiling them. They also emphasized the par- citizen, unethical values and behavior). These ent’s pedagogic role by setting an example with depictions of lack of competence, reflected in his/her life and teaching the child about life and poor school performance, lack of good friends values but also helping the child at school. Older or poor interpersonal relationships, and negative boys focused on the way a good parent puts lim- consequences of poor civic behavior or societal/ its by giving advice and yelling, but not using crisis issues, are relevant to students’ well-being physical violence. Girls described the need for and were reflected in narratives about sources a caring, respectful, and trustworthy relation- of anxiety, distress, and negative feelings (i.e., ship with parents who do not limit their freedom. stressors). Adolescent boys and girls referred to a bad parent as one who does not love and care about his or Stressors her child, and how she or he is doing with friends, school, and, in general, with life. Boys stressed The major sources of anxiety or stress, portrayed that violent behavior toward a child bears conse- in students’ accounts, included school-related quences for the child’s future, and girls focused and sports competition matters, and interpersonal relationships with parents, teachers, classmates, friends, and coaches. Other stressors concerned
68 C. Hatzichristou et al. an attitude of disrespect toward public space and parents. Parental conflict (e.g., father and mother the environment, and political incompetence, in- fighting) also was a source of stress. Other stress- justice, and lack of civic virtues and responsible ful situations involved children arguing with other behavior. Students’ accounts referred also to indi- people (e.g., siblings, cousins, friends, anyone), vidual stressors such as lack of self-confidence or being made fun of (e.g., name calling), being self-blame for failing to meet one’s own or oth- looked down upon or hit by other children, being ers’ expectations. misunderstood by others, being confused or not knowing the reason that someone is angry with From the analyses of the data on stressors, them, being left out of a game by classmates, and four categories emerged: academic or sports, being left without friends or being alone without interpersonal, personal or intrapersonal, and eco- friends, especially in times of happiness. Also nomic. These categories are described separately expressed as stressful were jealousy and “friends in this section. that do not treat children nicely” or do not pay attention to their opinions. In addition, other peo- Academic Stressors and Sports Competi- ple’s opinions about them (e.g., regarding clothes, tion For primary school students, academic hair) and performing in front of people for the stressors were mainly related to grades, tests, first time (e.g., singing, dancing, theatre) were oral exams, homework, and studying; limited portrayed as stress provoking. free time to play; transition to a higher school grade; arriving late at school; teachers’ attitudes For secondary school students, interpersonal and psychological state; classmates’ behaviors; sources of stress concerned not only relation- and so on. Similarly, for older students, school ships with parents, siblings, friends and peers stressors were associated with tests and grades, but also love relationships, as expected for this teacher scolding or yelling, getting suspended, developmental age. In particular, adolescent girls disappointment with school, transition from mentioned “being in love” and lack of caring by junior high to high school, and overabundance their boyfriends as stress-provoking experiences. of obligations to attend to or work overload due Similarly, causing pain or making a friend or to concurrent activities (e.g., school exams and other people upset unintentionally, arguing with out-of-school foreign language exams). For some friends, envy between friends, or being jealous students, sports competition (e.g., losing a game) when friends hang out with other people were or being yelled at by the coach also constituted discussed as sources of stress. Other stressful sit- sources of stress. uations included being told lies, being betrayed by friends, or being rejected, judged, criticized, Interpersonal Stressors Students’ narratives or compared to others. referred to interpersonal stressors within the con- text of relationships with parents, siblings, peers Stress-related situations concerning parents and classmates, friends, and neighbors as well as varied from not having time to listen to or talk stressful situations involving “loss of people” and with adolescents, to quarrelling for no particular other stressful events. More specifically, primary reason, to parental prohibitions (e.g., not being school children’s accounts emphasized difficulties allowed to go out with friends). Overall, great with parents, such as parental yelling or scolding, emphasis was placed upon family problems, in- leaving the child alone to solve things or to do cluding parents fighting with each other and sep- things by himself or herself without considering arating or transferring their anxiety and problems that he/she might be afraid, not being willing to to their children, especially during the present buy something that the child wants, and telling time of crisis. Health problems of family mem- the child what to do. Boys also mentioned stress bers (e.g., brother’s sickness) also were a source related to parents hitting or “making the child of concern. Losing someone very close (e.g., feel inferior” (e.g., “you are not a good student separation from a friend due to distance, death of and don’t know anything”) or being rejected by grandparents or other relatives) were reported as particularly stressful.
5 Psychological Well-Being Among Greek Children and Adolescents 69 Personal Stressors Students discussed a num- Primary and secondary school children also ber of individual or internal stressors such as expressed feelings of sorrow, disappointment, changing hormones, lack of confidence, not and grief in relation to friend or peer rejection, knowing what to do in certain situations, having negative relationships with peer, being without to take a critical decision, not being successful at friends, or losing a loved one. Feelings of sad- something, fear about the future, fear that some ness were expressed in regard to hurting other dreams may not come true, making mistakes, and people’s feelings. bad habits (e.g., smoking, drugs). Adolescent stu- dents mentioned physical appearance as a source In an effort to cope with stressful situations, of stress (e.g., weight/extra kilos, being short, students also reflected cognitive, behavioral, pimples, growth of hair on the face and body, and somatic responses to stress. These responses eyes, nose). Girls also expressed concern related could be functional or dysfunctional, depend- to eating habits and food and walking alone at ing on the situation and the persons involved. night in certain areas. Examples of cognitive functional responses in- cluded discussing reactions to stress in a series, Economic Crisis Stressors Of particular impor- for example, “first I might feel sad and then over tance were stressors discussed among older stu- time, I feel better;” trying to forget one’s prob- dents who are related to the present economic lems, thinking of something positive or funny. crisis in Greece and its negative consequences. As Negative cognitive responses included engaging discussed in the next section, students reported in negative thinking (e.g., preoccupation with that the current politico-economic standstill and bad memories, self-blame) and losing trust in uncertainty are particularly stressful and anxiety friends. provoking. Other students coped using a combination of Response to Stress and Coping cognitive and behavioral responses such as think- ing and acting self-confident, not paying atten- A variety of emotional, cognitive, behavioral, or tion to what other people think or say, trying to somatic reactions were described in relation to reason and discuss concerns/disagreements with academic, interpersonal, individual, and crisis- other people, thinking and learning from their related stressors. For example, students referred mistakes, improving their studying skills, and to emotional responses, such as anxiety and fear, trying harder to do better at school. Other be- in relation to exam anticipation; embarrassment havioral coping strategies included writing a and sadness regarding bad grades; fear, embar- diary, reading a book, playing video games or rassment, shame, or sadness when failing to ful- with the cell phone, dancing, singing, listening fill parental or teacher expectations; and fear, to music, watching movies, cooking, exercising, anger, or embarrassment as a response to teacher relaxing, sleeping, praying, asking for help (e.g., or parent scolding and commands or classmates’ from friend, parent, teacher), or asking forgive- attitudes (e.g., being looked down by others as ness from friends/parents. More negative behav- a “bad” student). Transitions to higher school ioral reactions included hitting others or things, grades also were characterized by anxiety and shouting, throwing a tantrum, telling things that fear. Finally, a common reaction was pressure hurt others, crying, refusing to play with others, and anxiety due to homework in combination spending time alone in one’s room, or finding ref- with out-of-school activities (e.g., learning of uge and comfort under the bed covers, withdraw- English or other foreign language or music in- ing, or sitting in a corner. Older students talked strument), which can take away time for play or also about spending time alone, trying to make opportunities to be with friends. positive changes in their lives or behavior, mak- ing extreme changes in physical appearance (e.g., extreme haircuts, shaving heads, wearing dark colors, putting on intense makeup); and graffiti painting on public places. Students recognized
70 C. Hatzichristou et al. intense and vivid reactions to stressful situations Should I Stay or Should I Go? Finally, ado- as expressed in their own or other people’s fa- lescents raised a very important issue related cial and body language (e.g., trembling, playing to young people’s dilemmas about staying in with hands nervously, blushing, breathing quick- Greece or leaving the country. The very high ly, chewing nails, sweating, grating one’s teeth, unemployment rates are driving young people to being agitated, clasping hands, bending, looking seek graduate education or employment outside worried, anxious, sad, even passing out). Greece, and even secondary school students seem to think a great deal about this issue. “I might Reactions to Economic Crisis Stressors Older leave Greece,” said a 15-year-old boy. Similarly, students’ narratives reflected anxiety, fear, and another student noted: uncertainty in relation to economic crisis mat- ters. Certain young people clearly expressed I want to study, to fulfill my dream but I will try their concern and insecurity for both their own to continue my life in a different place, in another future and the future of the country: “How are country with better conditions. we going to live in the future given the current difficulties?” “What will happen to Greece and Yet, there are others, such as the following state- its people given the circumstances?” Others won- ment suggests, who think that leaving will not dered whether they would ever be able to leave help their country and plan to stay and try their the parental home: “Are we going to be able to best: go out in the world on our own, to work and leave our parents’ house?” At times, in their accounts, To leave…is bad for your country…if we all start students appeared to be afraid to have dreams or leaving, the country will deteriorate, instead of make plans for the future. One 15-year-old girl improving, which means that I personally want to said: stay and try to do my best in any way I can. I am afraid due to the economic crisis about what Support we are going to do in the future…it is difficult to find a job due to the crisis…. We now need to make This section presents findings regarding stu- decisions about the rest of our lives that might be dent perceptions of sources of support and their wrong…. If I study what I want will I find a job?… r esponses to support. Both primary and secondary are my dreams going to come true? school children mentioned interpersonal and per- sonal sources of support that contribute to a sense Along these lines, another student wondered: of well-being and help them cope with stress- “Those of us, who are now in the ninth grade, ful and difficult situations and events. Among what kind of profession are we going to choose? important sources of support were parents, sib- What university?” For Greek teenagers, the un- lings, grandparents, friends, teachers, classmates, certainty of the current economic situation be- relatives, the sports coach, professional help, comes even more pressing, given that the Greek self-help, as well as pets, stuffed animals, holi- educational system requires that they choose a day celebrations, and nature, especially the sun college major and a career orientation while still and the sea. in high school. Interpersonal Support Students talked about Young people sounded very disappointed, receiving and offering support which took vari- upset, and angry with politicians and made such ous forms: (a) the use of body language and comments as: “Politicians do not offer anything expression in order to show affection, console, to society” and “up to this moment a good poli- and share in others’ joy (e.g., hugging, patting tician has not been elected.” “I am angry with on the back, offering a shoulder for the other to politicians who even though they have caused a cry, touching affectionately); (b) caring, help- lot of harm, they speak on television and make ing, reassuring, respecting, (e.g., comforting promises,” “I am upset when politicians pretend that Greece will move on.”
5 Psychological Well-Being Among Greek Children and Adolescents 71 with words, listening, advising, understanding, events, coping responses to stress, and sources helping the other to express feelings and wor- of support. Greek students’ narratives revealed ries, offering/receiving a gift, telling jokes or perspectives and practices that were associated, even playing the clown to disperse sadness and to a large extent, with broader, more universal anxiety); and (c) spending time in each other’s constructs that are important for understanding company (e.g., talking, being with a friend/girl- well-being as well as culture-specific themes, friend) or doing things with a friend or family patterns, and particularities. Broad constructs in- member (e.g., going to the park/movies, playing cluded academic, interpersonal, social, and civic video games, soccer). Students also talked about competencies; academic, interpersonal, personal, engaging in self-support. and economic stressors; coping mechanisms and reactions to stress; and sources of support (Nas- Support-Self Participants mentioned different tasi et al., 1998). Overall, students’ accounts forms of self-support, that is, supporting or com- reflected a variety of familial, interpersonal, forting oneself. Students talked about sitting age- and gender-related, and culture-specific ex- alone and relaxing, walking alone in the country- pectations, roles, norms, values, and behavior as side, keeping a diary, getting a sense of personal well as context-specific circumstances which can accomplishment from managing difficult situa- hinder or enhance psychological health. tions, and overcoming obstacles and doing well at school. In the current study, Greek children and ad- olescents emphasized the value of academic Response to Support Students’ accounts c ompetence which constitutes a dominant cultur- revealed that supportive relationships contrib- al narrative within the Greek context (Georgas, ute to a sense of joy and well-being that can 1993) and stressed the importance of learning be expressed in emotional/somatic and behav- and studying both at school and at home in order ioral ways (e.g., shining face, smiling, laughing, to be “good” students. For elementary school dancing, singing, telling jokes, jumping up and children, the image of a “good” student was con- down). Certain students emphasized that a sense nected to school performance, appropriate and of joy makes you “more social” and “willing ethical behavior, and relationships. In line with to participate in everything.” In fact, you “feel gender expectations, the accounts of schoolgirls more like helping other kids/classmates,” and reflected more empathy and emphasized the im- “you can even like a child that you did not like portance of good relationships with classmates before-suddenly you can see (feel) that child as or the teacher, whereas boys stressed restraining a friend.” The following comments reflect the from distracting or hitting classmates within the views of secondary school girls: “It is important school setting. Greek students did not attribute that other people can share your joy.” “You try good academic performance to internal or stable to give the good mood and happiness to your characteristics (e.g. smart, talented), but stressed friends.” “Transfer joy to others so that they can the possibility for improvement with necessary feel good.” efforts, study skills, and behavior. Discussion Secondary school children reported the need for a balanced student life, incorporating both The present qualitative student-focused research studying and “hanging out” with friends, point- offered the opportunity to capture local phe- ing out the centrality of academic and interper- nomenology and the diversity of children’s and sonal competencies, and the particular value of a dolescents’ perspectives and experiences related friendship, for psychological well-being. An to well-being, as well as subjective and intersub- emphasis on friendship and relationships con- jective meanings young people give to stressful firms the role of peer relationships for this de- velopmental age (Rees, Bradshaw, Goswami, & Keung, 2009) and is consistent with a dialogic sense of personhood and relational narratives of
72 C. Hatzichristou et al. life which are p redominant within the Greek cul- In the current study, emotional responses ture (Issari, 2002; Issari & Anastasiades, 2010). to stressors were anxiety and fear in relation to Along these lines, interpersonal connectedness exams, and fear, shame or sadness regarding poor and interaction were reported not only as major school performance and bad grades or in failing sources of joy, fun, support, and caring (e.g., to fulfill parental and teacher expectations. Stu- spending time together, playing, helping, for- dents reported homework, which constitutes a giving, making each other happy, and sharing in major component of the Greek education, as a each other’s joy) but also as sources of stress and major stressor-provoking pressure and anxiety. adverse feelings. Homework in combination with out-of-school activities in the afternoon (e.g., foreign lan- The school environment, as a context of learn- guage, dance, or music lessons) absorb a sub- ing, plays an important role in children’s social, stantial amount of time and leave less room for emotional, and behavioral well-being (Hatzi- unstructured activities and play. Another source christou, 2011a, b, c, d; Lampropoulou, 2008, of pressure is related to the Greek educational 2009). For boys, learning in primary school has system’s requirement is that students choose a the strongest influence on behavioral aspects college major and career orientation while still in of later well-being, whereas for girls it is more high school. Such a task has become increasingly predictive of social well-being (Gutman, Brown, more difficult in today’s economic uncertainty. Akerman, & Obolenskaya, 2010). Other important stressors reported by students Sources of anxiety, distress, and negative feel- were the lack of responsible behaviors exhibited ings affecting well-being, reported in the current by politicians, fairness, justice, and issues related study, included a lack or loss of good friends or to the current economic/social crisis. Overall, problems and difficulties in relationships with older students’ accounts not only reflected po- classmates, peers, siblings, parents, or teachers litical awareness and maturity but also anxiety, (e.g., scolding, criticisms and negative opinions, fear, uncertainty, and disappointment in view of or parental prohibitions when perceived as limits the present economic conditions. Students in our to freedom and autonomy). Arguments and fric- sample sounded very upset and angry with poli- tion among parents and family discord also were ticians and clearly expressed concern for their serious concerns for primary and elementary own future as well as the future of Greece. While school children in our study. certain students reported that they were afraid to dream and make plans for the future, others Similarly, disputes, aggressive behavior, gos- raised important dilemmas on whether to stay siping, being mocked, or excluded by peers and in Greece or leave for opportunities elsewhere. classmates contributed to negative feelings and Such dilemmas have become quite common reactions, as reported in other research (Hatzi- among Greek youth in recent years (Chapple, christou, Polychroni, Issari, & Yfanti, 2012; 2012). Consistent with findings of this study, re- Issari & Printezi, 2011; Yfanti, 2013). In a dis- search on the school community (Hatzichristou, sertation study conducted in secondary schools Adamopoulou, & Lampropoulou, 2014) showed in Greece, Yfanti (2013) examined individual that children and families with economic diffi- and contextual variables in relation to types of culties experience feelings of fear, distress, and victimization. Well-being was one of the main sorrow in relation to their lives and future. Within factors that showed a statistically significant the same study, schoolteachers also reported an negative correlation with all three types of vic- increase of difficulties in children’s interpersonal timization (physical, relational, sexual). Also, and intrapersonal behavior related to family in- students involved in relational aggressive be- come reduction. haviors both as aggressors and victims showed lower levels of well-being than students who In our study, children’s accounts stressed were not involved in relational aggressive be- the interpersonal dimension of well-being and haviors or were only involved as victims.
5 Psychological Well-Being Among Greek Children and Adolescents 73 p ortrayed friends, family, and teachers as impor- social–emotional issues. These findings are con- tant sources of support. Peers, especially friends, sistent with findings reported in the literature. For are a valuable support for adolescents. For boys, instance, Lampropoulou (2008) found that Greek sharing interests/activities with friends were im- adolescents value teachers who care about them portant; for girls, sharing the same feelings (em- and have a relationship with students beyond les- pathy) was important. In addition, romantic re- sons. At the school level, the results indicated that lationships seemed to positively and negatively the subjective well-being of younger adolescents influence the psychological well-being of girls. (first- and second-grade junior high school stu- Other research has shown a significant correla- dents, aged from 13 to 14 years old) was directly tion between positive well-being indicators and related with their relationships with teachers and relationships with peers. Support from peers is school climate, while the subjective well-being a significant protective factor for depression, of older adolescents (second- and third-grade facilitates school and family adjustment (Hann, high school students, aged from 17 to 18 years 2005), and is associated with positive subjective old) was related to their relationships with class- well-being (Levitt et al., 1994; Rothman & Cos- mates and friends and classroom’s psychological den, 1995). climate. Parents and family seem to be an important re- Research has shown that students’ perceptions source and stressor for adolescents in this study. of increased social support results in higher scores On the one hand, parents support, advise, and on indicators related to performance, behavior, guide adolescents as role models but, on the other and social and emotional development (Dema- hand, they limit and restrict their freedom. Es- ray & Malecki, 2002). These researchers found pecially for girls, being independent and having a significant correlation between children’s posi- freedom to do things is a source of happiness and tive perceptions regarding support from parents, distress. A Greek survey that aimed to examine teachers, classmates, and friends, and children’s the association between children’s and parents’ social skills as reported by both the children and psychological well-being revealed that psycho- their significant others. Moreover, research con- logical well-being was related to fathers’ per- firms the importance of perceived support from ceived stress and mothers’ satisfaction with life teachers for the well-being of adolescents (De- (Karademas, 2009). According to other studies Santis, Huebner, & Suldo, 2006). that focused on determining children and young people’s own views of well-being, family was More recently, special emphasis has been found to be fundamentally important to a sense of given to the promotion of resilience and posi- well-being for children and young people (Coun- tive school climate in schools responding to terpoint Research, 2008). Along these lines, we the increased psychosocial needs caused by the consider that young children and their families present circumstances. A synthetic approach to can count on strong intergenerational family ties school community well-being has been proposed and solidarity to get help, as child-based social by Hatzichristou, Lykitsakou, Lampropoulou, services and resources become more and more and Dimitropoulou (2010b), and core concepts scarce in times of economic crisis. Within the of school mental health related to this model Greek context, family (Georgas, 1993) and in- include resilience, effective schools, schools as formal networks of help (church, neighbors, caring communities, social and emotional learn- self-help and charity initiatives) are important ing, and evidence-based interventions (Hatzi- resources during difficult times and crises situa- christou, 2011a, b, c; Hatzichristou et al., 2010b; tions (Hatzichristou, Issari, Lykitsakou, Lampro- Hatzichristou, Dimitropoulou, Lykitsakou, & poulou, & Dimitropoulou, 2011). Lampropoulou, 2009). This conceptual model for promoting school community well-being also Related to relationships with teachers, ado- has integrated the basic dimensions of a crisis lescents expect teachers not only to be sup- intervention model for the school community portive in academic/school matters but also in (Hatzichristou et al., 2011).
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Sexual Health, Gender Roles, 6 and Psychological Well-Being: Voices of Female Adolescents from Urban Slums of India Emiliya Adelson, Bonnie K. Nastasi, Shubhada Maitra, Divya Ballal and Latha Rajan Introduction munity roles, and exposure to violence are indic- ative of a male-dominated society where females Adolescents (aged 10–19) make up more than continue to be marginalized. In the Millennium one fifth of India’s population. Adolescent girls Declaration (United Nations General Assembly, constitute almost half of this population, with 2000), world leaders made a promise to help about 113 million currently living in the coun- children and adolescents in all countries to ful- try (Government of India Ministry of Home fill their potential. Many adolescents throughout Affairs, 2011). Adolescence is a critical period India have benefited from their country’s com- for all individuals throughout the world, involv- mitment to the Millennium Development Goals ing numerous biological, cognitive, and social in relation to education and labor, health, sexual transformations. The transition from childhood behavior, childbearing and maternal health, HIV, to maturity is a time of particular vulnerability violence, and gender equality. Despite the coun- and presents the possibility of serious challeng- try’s efforts, many of the goals still have not been es. In India, a country ranked 132nd out of 148 achieved. In order to meet the Millennium Devel- countries on the gender inequality index (United opment Goals, which include the empowerment Nations Development Program, 2013), adoles- of women, reduced child mortality, improved cent females face numerous serious challenges maternal health, and eradication of sexual trans- that threaten their sexual and reproductive health mitted diseases, it is necessary to effect change and psychological well-being. Gender differ- among the youth of the country. One major path- ences in nutrition, basic health care, education, way to positive change in India is the develop- employment opportunities, household and com- ment of informed interventions and policies that address sexual and reproductive health of adoles- E. Adelson () · B. K. Nastasi cent females. Department of Psychology, Tulane University, New Orleans, USA This chapter focuses particularly on psycho- e-mail: [email protected] logical well-being of adolescent girls living in urban slums in India. Many individuals in this S. Maitra population face challenges including poverty Tata Institute of Social Sciences, Mumbai, India and lack of education, and do not have access to sexual health educational opportunities that D. Ballal adolescents attending school may have. Stress- National Institute of Mental Health and Neuro Sciences, ors that impact the psychological well-being of Bangalore, India adolescent girls overlap with issues related to sexual health and gender roles. These other fac- L. Rajan tors serve as stressors that threaten psychological School of Medicine, Tulane University, New Orleans, USA © Springer Science+Business Media New York 2016 79 B. K. Nastasi, A. P. Borja (eds.), International Handbook of Psychological Well-Being in Children and Adolescents, DOI 10.1007/978-1-4939-2833-0_6
80 E. Adelson et al. well-being and increase the risk of poor mental comprehensive knowledge of HIV/AIDS (IIPS & health in the present and future (Vindhya, 2007). Macro International, 2007). The NACO National In order to work towards improved psychological Behavioural Surveillance Survey (2002) reports well-being, it is important that researchers gain that over 35 % of all reported AIDS cases in India a strong understanding of the specific stressors occur among adolescents, and the 15–24 age and protective factors impacting adolescent girls, group accounts for more than 50 % of new HIV from their perspective. infections in the country. Sexually transmitted in- fection (STI) testing and care seeking for existing Sexual Health of Adolescent Girls symptoms are not common practices for most in- dividuals (Jejeebhoy & Sebastian, 2003). About In a study on adolescent sexual behavior in India, one-third of adolescent females, mostly unmar- Jejeebhoy (2000) found that up to 10 % of all ried, with an STI have sought medical attention; females are sexually active in adolescence. Al- less than half of symptomatic males have done so though some adolescent females engage in pre- (NACO & UNICEF, 2002). marital sexual relationships by choice, mostly while in a romantic relationship they anticipate Although the minimum legal age for mar- will lead to marriage (Verma, Pelto, Schensul, & riage for girls in India is 18 years, many adoles- Joshi, 2004), a large number of girls are forced cent girls continue to be married at a young age. into nonconsensual sex. In a study of nonconsen- Almost 50 % of women are married by the age sual experiences of adolescents in urban India, of 18, and 18 % are married by the time they are Jaya and Hindin (2007) found that 42 % of girls 15 years old (IIPS & Macro International, 2007). have been touched against their will, most com- Most adolescent females participate in arranged monly by strangers. A study of 16-year-old ado- marriages that are determined by their parents lescents in Goa added to the findings, revealing and have little to no input of their own. Early that 6 % of girls were forced into sexual rela- marriage puts women at an increased risk of ac- tions (Patel, Andrews, Pierre, & Kamat, 2001). quiring an STI from their husbands and experi- The majority of nonconsensual sexual experi- encing violence within the marriage (Santhya, ences ranging from eve-teasing (a widely used Jejeebhoy, & Ghosh, 2008). In addition, women Indian euphemism for public sexual harassment that are married at an early age are less likely to or molestation) to abduction often go unreported; be empowered to make decisions for themselves therefore, the known statistics are likely under- and their families and are more likely to have estimates of the actual level of sexual violence restricted educational opportunities (Lloyd & (Ministry of Health and Family Welfare, 2000). Mensch, 2006). Adolescent females and women in India often re- spond to instances of violence or sexual coercion Reproductive Health Upon marriage, many with fear, self-blame, and feelings of humiliation adolescent females have to give up education that contribute to reluctance to seek help (Sodhi in order to meet the traditional expectations of & Verma, 2003). maintaining a household and giving birth to chil- dren in the early stages of marriage. The National The serious gap in adolescents’ knowledge Family Health Survey (2005–2006) reported of sexual and reproductive health is reflected in that 28 % of women currently aged 20–49 gave unsafe sexual behaviors and the high prevalence birth by time they were 18 years old and 24 % of sexually transmitted diseases (STDs) in India. of 18-year olds had already given birth or were For young people in premarital sexual relation- pregnant at the time of the study. Early child- ships, access to condoms and other forms of con- bearing leads to increased risk for mothers and traceptives is limited (Jejeebhoy & Sebastian, infants. Young mothers are more likely to experi- 2003). Only 28 % of adolescent females and 54 % ence birthing complications and are less likely to of adolescent males in the 15–24 age groups have receive adequate maternal and child care (Singh & Trapithi, 2013). Adolescents living in low-
6 Sexual Health, Gender Roles, and Psychological Well-Being 81 income families in urban areas of India experi- ers found that suicide is the second most common ence elevated risk of negative reproductive health cause of death among people aged 15–29. In a outcomes (Jejeebhoy, 1998). In the slum areas of study examining suicide in a slum of Mumbai, Mumbai, only 62 % of mothers receive postna- researchers found that more women committed tal care within two days of the birth compared suicide than males, and “tension,” a frequently to 72% in non-slum areas (Municipal Corpora- used term which refers to a broad range of sub- tion of Greater Mumbai, 2010). Singh, Rai, and jective distress, was identified as the most com- Singh (2012) assessed the utilization of maternal mon reason for the suicides (Parkar, Fernandes, and child health services by adolescent moth- & Weiss, 2003; Parkar, Nagareskar, & Weiss, ers in India and reported that underutilization of 2012). Despite the alarming suicide rates in India these services can lead to high maternal mortal- and the rising number of cases of depression and ity, negative pregnancy outcomes, and worsened anxiety, currently estimated to effect 40–60 mil- maternal health. lion people, mental health services are limited (Weiss, Isaac, Parker, Chowdhury, & Raguram, Abortion is legal in India under specific situa- 2001). Research findings show that there is a tions such as contraceptive failure and rape; how- gender gap in access to health care and that poor ever, individuals under the age of 18 are required women from urban slums receive the least sat- to have consent from a parent or guardian to un- isfactory services (Vindhya, 2007). For those dergo the procedure. About two thirds of all abor- women that are able to access physical or mental tions in India take place outside of authorized health care, many are treated disrespectfully and health services (Population Reference Bureau, are not provided with adequate attention or infor- 2011). Unmarried adolescent females are more mation from the health-care workers (RamaRao likely than married or older women to undergo & Anrudh, 2001). abortion procedures from unqualified providers in order to receive prompt and anonymous care. Sexual Attitudes Regarding Adolescent As a result, they are more likely to suffer abor- Girls tion-related complications (Jejeebhoy, 2000). Mental Health of Adolescent Girls India is largely a patriarchal society with conser- vative values regarding female sexuality (Sathe The aforementioned figures regarding sexual co- & Sathe, 2005; Verma et al., 2004). Expectations ercion, early marriages, and sex discrimination of women are strongly driven by social and cul- provide some insight into the challenges faced tural customs that vary depending on religion, by adolescent females living in a society fraught geographic location, caste, and class (Abraham, with gender disparities. The numerous stressors 2001). An overarching concept, transcending related to sexuality and gender discrimination all of these divides, is the idea of izzat (honor). experienced by females contribute to feelings Women are the family keepers of izzat, and fam- of helplessness, low self-esteem, and increased ily reputations are often dependent on young psychosocial stress (Gupta, 2003). Research- women’s upholding of izzat. In most Indian soci- ers in the state of Uttar Pradesh found that ado- eties, in order to maintain the family izzat, young lescent girls had poorer self-images than boys women are expected to behave modestly and re- and felt that they were burdens to their families main virgins before marriage (Chakraborty, 2010; (Jejeebhoy, 1998). Overall, women’s risk of hav- Jejeebhoy, 2006; Sodhi, Verma, & Schensul, ing depression or anxiety is two to three times 2004). Prior to marriage, girls are not supposed to higher than that of men (Vindhya, 2007). Re- express any sexuality or interest in the opposite search on psychological disorders in India shows sex and are expected to maintain innocence. Vio- a prevalence of depressive and anxiety disorders lating these traditional norms may result in loss of 6–7 % in women over the age of 18. Research- of marriageability and ruined family reputations
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