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LONG-TERM ADJUSTMENT AFTER EXTREMELY .
CHALLENGING EVENTS IN A SAMPLE OF METNAMESECANADIAN SENlORS
by
Stephanie Griffiths
B.A. Hons., Mount AHison University, 1997
Thesis Submitted in Partiai Fulfilment
of the Requirements for the Degree of
Master of Arts
in the Department
of
Psychology
O Stephanie Griffiths, 2001
SIMON FRASER UNIVERSITY
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iii
ABSTRACT
The current study describes long-term outcomes in a sample of 64 Vietnamese-Canadian
seniors related to the Vietnamese civil war, refugee migration, and life in Canada. Each
participant completed questionnaires assessing: demographic features, civil war experiences,
refugee experiences, protective factors (sense of preparation for the conflict, social support,
and immigration experiences), and current distress (depression, nnxiety, negative changes in
ouilook) and well king (Me siitisfaction, personnl and familial happiness, positive changes
in outlook) ouicornes. Resul ts revealed two general patterns of adjustrnent. The firsr pa~tern
wüs charücterized by a generally high
level of current life sütisfiiction und current persona1
and familial happiness despite high levels of rill types of civil war experiences. Additioniilly,
being married, being older, and having more children in the farnity was associated witb
higher current happiness. Lower current happiness, on the other hand, was related IO being
single and reporting a smüller funily size. The second general pattern of adjustment reflected
witnessing and expriencing fewer civil war events, higher emotional distress during the war,
more refugee experiences and higher current depression. Hriving fewer children in the hmily
was also associated with higher current depression. Lower current depression was related to
wiinessing more war experiences and being older. These patterns of adjustment reflect the
general well-being of this sarnple of Vietnamese-Canadians, while also accounting for the
distress outcomes related to the extrernely challenging process of refugee migration. The
relationships between different demographic and protective factors and well king outcomes
in the sample ?re also discussed.
DEDICATION
For the Vietnamese-Canadiüns who so generausly gave of their time, experience, and
wisdom for this project. 1 admire your strength and courage.
I would like to thank Dr.Soma Ganesrtn for his invaluable efforts and insights, for his
enthusiasm about the study, and far making the effort to help me. i appreciate it greritly. And
ihank you Regsn, for introducing us in the first place. Thanks io my senior supervisor, Dr.
Marilyn Bowman for her patience and optimism throughout the duration of this project. 1 feel
very lucky to have benefited from her iinwnvering cornmitment Io her students. Lastly, 1 wiint
to thank my hmily and tnends from the boitom of my hem for their love and support - D,
you are such an important and wonderful source ofjoy in my life.
TABLE OF CONTENTS
..
Approval ..............................................................................................
..II
Dedication ..............................................................................................
iv
Acknowledgements ....................................................................................
v
Table of Contents ......................................................................................
vi
List of Tobles ........................................................................................... ix
List of Figures ...........................................................................................
x
INTRODUCTION
....................................................................................
1
1
Long term adjustment after chnllenging life events ................................................
Refugee experiences ...........................................................................
2
Individual di fferences in reactions to stress .........................................................3
Adaptive cognitive strategies ...........................-.............................................
3
Social support .........................
................................................................4
Sense of coherence .....................................................................................
5
Intervening experiences ...............................................................................
6
.
Culture and experience ................................................................................
1
Culture and communic~tingdistress .................................................................7
PTSD and distress .............................................................................
8
Modifying our understanding of coping with challenging evenis ...............................9
Measuring adjustrnent after chrillenging events
..........................................9
Rationale of the current study ............................................................... 10
METHOD
............................................................................................
-11
Choice of Vietnamese sample ....................................................................... 11
Participant selection .......................................................................... 11
vii
Participant chuacteristics ...................................................................
12
Measures of exposure to very challenging events ................................................12
Measures of types and perceived severity of expenences .......................................13
Mesure of protective factors ........................................................................14
..........................................................................
14
Perceived social support ......................................................................
14
Immigration experiences .....................................................................
15
15
Measuring long term distress outcomes .............................................................
Measures of long term well-being outcornes ......................................................16
Research questions ....................................................................................
18
18
Quality of long term outcome ...............................................................
The association between challenging events and outcornes ............................18
Proteçtive factors .............................................................................
18
Data analysis ...........................................................................................
19
Multivariate analysis .........................................................................
19
Sense of preparation
RESULTS
.............................................................................................
22
Missing data ...........................................................................................
22
-22
Genenl approxh 10 analysis .......................................................................
Characteristics of participants ........................................................................
23
Characteristics of wanime experiences ...........................................................
-25
Proteciive factors .....................................................................................
28
Sense of preparation .........................................................................
29
Perceived level of social support ...........................................................29
Immigration rxperiences ....................................................................29
Distress and resiliency outcomes ................................................................... 30
...........31
Reiationship between wartime experiences and well-being outcomes ........................33
Redundancy index .......................................................................... -34
Redundancy space ........................................................................... 34
Interpretation of two dimensions ...........................................................35
Relationship between exposure to different wartime expenences and well-king
............38
Gender and age ...............................................................................
47
Factors affecting the relationship between civil war experiences and well-being
48
Other background variables and outcomes ................................................
Protective factors .............................................................................
49
DISCUSSION
........................................................................................S O
Overall positive adjustment given frequency and type of experiences ........................50
52
Relationship between wartime experiences and outcomes .......................................
52
Types of wartime events and outcomes ...................................................
......*.....52
Wartime experiences and well-being outcomes ..........................
.
.54
Wanime experiences and distress outcomes .............................................
Stress and anxiety ...................................................................
55
Individual difference variables .....................................................................
.56
.
.
Gender and well-being ......................... ....................*.......**..........*
.56
Age and well-being ...................................................................
57
Family size and well-being ..................................................................58
Protective factors ............................................................................ .59
Limiiations of the current study ....................................................................-61
Sample size and characteristics .............................................................
61
Choice of measures ......................................................................... 61
.
....................................................62
Translation .............................
Clinical implications ..................................................................................
62
REFERENCES
.......................................................................................64
Appendix 1: Question assessing wartime experiences ...........................................76
Appendix 2: Questions assessing levels of protective factors ...................................77
Appendix 3: Examples of outcome measures ......................................................78
Appendix 4: One-wny Analysis of Variance for age and gender differences ..................80
Appendix 5: Histograms for sense of preparedness. perceived support. and immigration
experiences. respectively .............................................................82
LIST OF TABLES
Table 1:
Description of participants ...........................................................
23
Table 2:
Frequencies for additional demognphic features of participants ...............24
Table 3:
Cumulative frequency of exposure to wartime events ............................26
Table 4:
Self-reported frequency of distressing reactions to experiences ................27
Table 5:
Correlations between exposure to wartime events and self-reported reiction to
wartime experiences ..................................................................28
Table 6:
Tüble 7:
Self-ratings on pratective F~ctors..................................................
-29
Distress and resiliency outcome measiires .........................................31
Table 8:
Correlaiions berween exposure and distress and resiliency outcomes .........32
Table 9:
Rrlationships between wartime experiences and disiress and well-being
outcornes ............................................................................. 33
Table 10:
Eigenvalues .......................................................................... 35
Table II:
Correlaiions of wartime experience. distress. and well-being outcomes with
redundancy dimensions ..............................................................35
Table 12:
Dimensional loadings of variables from wür and refugee experience and
current outcomes ..................................................................... 38
Table 13:
Means of background and protective variables on redundancy dimensions ...39
Table 14:
Age differences in curren t happiness and depression ............................47
Tlibie 15:
Point-biserial correlations between age. depression. and happiness ...........48
LIST OF FIGURES
Figure 1 :
Redundancy analysis of war expeiences. distress and well-being ...........37
Figure 2:
Gender and age within the redundancy spxe
Figure 4:
...................................
40
Marital and religious status within the redundancy space .....................41
Educational history within the redundüncy space ..............................42
Figure 5:
Number of children within the redundancy space .............................
-43
Figure 6:
Civil war and refugee expenences within the redundaticy space .............44
Figure 7:
Proiective factors within the redundancy spice
Figure 3:
.................................
45
Adjustment after challenging events 1
INTRODUCTION
From early occupation by the Chinese, to colonization by the French, ta civil war
and the intervention of the United States, the Vietnarnese people have often k e n compelled
to live under extremely challenging circumstances. It was following the Ametican
in!srvention in the war between North and South Vietnam that the psychological effectsof
coping with such evenis were explored more fully. A substantive body of resewh has ken
developed using the large population of Americin vetenns from the Vietnam War, and has
contributed psychological rnodels of coping. Studies have further extended the scope of
investigation to explore negative outcomes in civilian traumas, and some have even
explored civilian reactions to wartime conditions. There have been comparatively few
empirical studies explonng the reactions of the Vietnamese people themselves to the events
of the civil war, and even fewer studies exploring long-terrn adjustment after such events.
Long term adjustment after challenging life events
The largest body of research pertaining to extremely stressful life events involves
combat veterans - from World War il, the Korean War, and especially the Vietnam War.
Some authors have reported a strong negative influence of level of combat experiences on
well-being, citing a significantlyhigher probability of lifetime adjustment problems in male
veterans who experienced moderate to heavy combat exposure, as compared with those
veterans who did not (Spiro, Schnurr & Aldwin, 1994).
Adjustment after challenging events 2
The perception of long term impairment in veteran populations resulting directly
h m intense stressors is comrnon. Recent research concerning aging and well-being,
however, suggests an important role of individuai resilience factors in the integration of
extremely challenging events (Taft, Stem, King & King, 1998; Fontana and Rosenheck
1994; Engdahl, Harkness, Eberly, Page & Belinski, 1993). It is interesting to consider
whether the role of resilience variables translates to civilian experiences with severe
stressors.
Refugee expenences
Although the population of Amencan combat veterans is probably the most
extensively studied sample of individuals coping with extremely challenging events,
research using other groups has also made important contributions to out understanding of
adjustment to such events. For instance, Mollica et al. (1990) reported that 700,000
Indochinese refugees had setiled in the United States in the previous 15 yeius. Refugee
populations must adjust to a different constellation of challenging events than combat
veterans, and often must do so in a different cultural and linguistic milieu. Exposure to
torture, displacement, and migration stress al1 pose additional significant coping challenges
(Holtz, 1998).
It is further suggested that chronic exposure to such events may lower the threshold
for th:. development of psychiatric symptoms through exacerbating premorbid conditions or
contributing new pathology (Deering, Glover, Ready, Eddleman & Alarcon, 1996). The
body of research showing significant individual variability in reactions to extremely
challenging life events, however, suggests an important role for individual variables in the
coping process.
Adjusment after challenging events 3
Individual dierences in reactionsto stress
There are a numkr of studies indicating that the interaction of personality, socid,
and community variables results in strong individual differences in reactions to the "same"
objectively stressful event (Joseph, Williams & Yule, 1995). Recent studies have identified
specific predictors of adjustment in male and female Vietnam vetenns. For example,
hardiness, defined by an intemd locus of control, a positive attitude towards change, and a
cornmitment to life goals, was one personal resource that has k e n suggested to exert a
significant mitigating effect on negative outcomes after combat exposure (Taft, Stem, King
& King, 1999; King, King, Fairbank, Keane & Adwüms,1998).
Different combinations of protective factors, that contribute to the ability of the
individual to cope with stress, are often labeled "resilience" factors. This is a genenl term
reflecting the adaptive resources of the individual, or the 'process of, capacity for, or
outcome of successful adaptation despite challenging or threatening circumstances"
(Masten, Best & Garmezy, 1991; 425). The constnict of resilience is multifaceted, and
cesearchers have identified a number of protective factors that demonstrate individual
variation in iheir effect on outcomes after challenging experiences.
Adaptive cognitive strategies
Some theoretical approaches define resiliency in t e m of the effects of cognitive
style on the coping process. Authors suggest that appraisals of challenging events as less
stressful and the use of acceptance and reframing strategies (rather than avoidance and
Adjustment after challenging events 4
denial) in caping are assoçiated with improved adjustment after challenging events (Major,
Richards, Cozzarelli, Cooper & Zubeck, 1995). A study of repatriated prisoners of war
suggested that the use of self-isolaiion, wishful thinking, and self-blarne were al1 associated
with poor long-tenn outcomes (Fairbank, Hansen & Fitterling, 1991). The cognitive
resources that may encourage successful coping with stress can and do differ between
individuals. This is important to Our understanding of responses to trauma, because if
individuals can and do Vary in the way they fmme events. then adaptive cognitive strategies
may be encouraged or acquired dunng the adjustment period.
Social support
Level of social support alsa shows individual variation, and has an intuitive value
for those coping with stress. Social support can be considered according to objective
measures, but most studies seem io rely on subjects' self-ntingsof perceived quality.
Interestingly, individual differences in responses to a challenging event were relaied to
differences in perceived of social support (Spasojevic, Heffer & Snyder, 2000, Mcûonald,
Chamberlain, Long & Flett, 1999). Resemhers have found that resilience to distress in
inner city American children at high risk for negative outcomes was partIy predicted by
level of perceived support from an adult attachment figure (Masten, Best & Garmezy,
1990).A study of Tibetan refugee children found that perceived support from an adult
attachrnent figure was rissociated with better adjustment to migration (Servan-Schreiber,
Lin & Birmaher, 1998).Studies of former prisoners of war have found that higher levels of
Adjustment after chdlenging evenis 5
perceived family and social support tendedto mitigate negative outcornes (Tail, Stem, King
& King, 1999; Engdah1 et al., 1993).
In cultures where social networks are particularly important, perceived social
support has been identified as a buffer against negative outcomes following such
challenging events as refugee migration after civil war (Blair, 2000). For instance, one
study of asylum seekers fmrn a range of ethnocultural backgrounds found that of al1 current
self-reported problems, loneliness, and boredom were most frequently reported and were
highly related to rates of depression (Silove, Sinnerbrink, Field, Manicavasagar & Steel,
1997).
Other research has suggested that the increased adaptive demands posed by stressful
events do not necessarily tûx sources of social or emotional support beyond caplicity.
Indeed, perceptions of social support may instead be increased in more stressful situations
(Zemore & Shepel, 1989).Interestingly, other researchers have found that premorbid
clipacity for interpersonal relationships (object-relatedness) was assaiiated with improved
resilience against negative outcomes in a sample of combat vetemns (Kishon-Barash,
Midlarsky & Johson, 1999).Taken together, these studies suggest that rather than straining
existing social support resources, stressful events may insteiid lead some individuais to
engage these resources in themselves and others.
Sense of coherence
Antonovsky (19731defined a sense of coherence as the extent to which an
individual perceives that Iife events are sornewhat comprehensible,controllable, and
Adjustment after challenging events 6
meaningful. Ying and Akutsu (1997) found that a sense of coherence predicted adjustment
in Southeast Asian refugees, md suggested that this pmtective factor may vary between
cultures.
A recent study of Tibetan refugees who had endured torture showed a remiirkable
lack of anxiety and depressive symptoms (Holtz, 1998).This was suggested to be partly a
function of an existing sense of preparation for their flight from Tibet. Resexch involving
Tibetan refugee children has also associated religious beliefs with improved coping after
their long and rirduous joumey (Servan-Schreiber, Lin & Bimher, 1998).
Some resexchers have suggested that extremely challenging events have a
destructive influence on the resiliency normally associated with spiritual beliefs (Wilson &
Moran, 1998). Accoràing to other studies, however, a sense of spirituality was suggested to
enhance coping if it could improve one's ability to attribute a meaning or reason to events
(Holtz, 1998). Given their histories, some cultures may be more prepared for challenging
events, and may be better equipped to attribute a sense of meaning to these events.
Intewening experiences
In studies of various refugee populations, migration experiences have been found to
predict well-being. Immigration procedures involving detention and legal proceedings
tended to be associated with intensified distress and poor coping in El Salvadoran refugees
(Michultk- Blanchard & Kalous, 1998). Amongst Tibetan refugees and survivors of
torture, heightened anxiety was significantly related to stressful events during the joumy
h m Tibet to India (Holtz, 1998).
Adjustment after challenging events 7
A study of Cambodian refugees resettled in the United States found h t , in addition
to wartime and refugee experiences, recent stressors (for example, financial problems) were
also related to current distress (Blair, 2000). Resettlement stress and loss was found to
predict depression in a simple of Khmer refugees, and the level of exposure to violence in
the country of resettlement was more strongly predictive of negative outcorne than were
wartime experiences (Berthold, 1999; Sack, Seely & Clark, 1997). Thus, in addition to premigration factors, different aspects of pst-migration challenges also contribute to
outcomes (e.g., Nicholson, 1997).
Culture and experience
Although research has suggested that culture may have a fundamental effect upon
one's psychological and physical experience of life events, it has only recently been
considered in models of coping at'ter challenging events. Cultunl identification may
influence the constnial of events, subjective qualities of experience, and adjustment after
trauma. For instance, according to self-reports of Afncan-American Vietnam veterans, their
most disuessing experiences involved identification with Vietnamese soldiers as a racial
out-group (Green, Gme, Lidy & Leonard, 1990).
Culture and communicating distress
Culture modifies not only o u perception of events, but also the expression of our
reactions to those events. Lee and Lu (1989) suggested that difficulties in adjusunent after
Adjustment after challenging events 8
challenging events have been overlooked in many Asian-Amencans because of a relucance
to access mental health care professionals. Somatic expressions of distress (Kirkmayer &
Young, 1998) tend to be regarded ris the nom for Asian populations, though this finding is
equivocal (Mollica et al., 1992).
Our expectations or perception of another culture may lead to preconceived ides
about the expression of distress following challenging life events. We may underestimate or
overestimate a population's ability to cope with life-threateningevents. For instance, ment
follow-up studies of Khmer adolescent refugees have found a remarkable lack of functional
impairment, despite a history of life-threatening experiences (Berthold, 1999; Siick, Him &
Dickason, 1999).
PTSD and disîress
The most commonly accepied conceptualization of reactions of distress following
very challenging events involves the assessrnent of the prevdence of pst-traumatic stress
disorder (WSD). The construct of PTSD was developed mainly as a result of concem about
the large American Vietnam veteran population, and entered the DSM-IIIin 1980.
Acwrding to a meta-analysis of studies assessing outcome in civilian samples, exposure to
challenging events may increase susceptibility to a specvum of anxiety and depressive
symptoms not included in the diagnostic category of PTSD (Brown, Fulton, Wilkeson &
Petty, 2000). Research exploring the validity of PTSD as a cross-culturai construct has been
equivocal, particuliuly in light of the fact that major categones of PTSD symptomatology
are sometimes found to present without evidence of functional impairment (e.g. Berihold,
1999).
Adjustment after challenging events 9
Modifying our understanding of coping with challenging events
An adequate model of adjustment after extremely chaiienging events requires
expansion in two geneml areas. Firstly, it is essential that we describe the breadth of
reactions to such events. Although the bulk of research in this area is concemed with the
identification and treatment of negative outcornes, it is important to recognize the potential
for these events to exert a positive effect on well-king. Secondly, we need to develop an
appreciation of the adaptive resources of individuals, in terms of their resilience to stress, or
the interaction of their unique constellation of protective factors with life events. Examining
long-term Juicomes may provide a perspective broad enough to attciin these goals.
Mmuring adjusîment afer challenging events
We have a limited, negatively biased understanding of the coping pmess foilowing
very challenging events, and so our assessrnent tools tend to fomalize our preconceptions
of coping after such events (e.g., Gerardi, Keane & Penk,1989). The rnajority of studies
involving self-report merisures do not allow individuals to report any well-king outcornes.
It is thus logical that those who have had negative, but not exclusively negative
experiences, would be categorized as suffering from distress, although in reality they may
have undergone both positive and negative changes as a result of their experiences. Our
assessrnent tools are overly sensithe to negative outcomes after trauma,but not sensitive
enough to the breadth and variation in outcomes.
Adjustment after challenging events 10
RPdiorsPlc of the cumnl shrdy
Based on the prernise of current negative bias in the understanding of the natureof
extremely chdlenging events and subsequent adjusmnt, this study was designed to
explore the differences in the quality and cmelates of well-king and distress outcornes
after vety challenging events in a community sample. This study is exploratory, seeking to
describe the bmdth of responses in the ability to integrnie and cope with trauma, and to
reveal the operation of individual differences.
Adjustment after challenging events 1 1
METHOD
Choie of Vietnamese sample
A substantial body of research has developed exploring the combat experiences of
American veterans of the war in Vietnam, but descriptions of the experiences of the
Vietnmese people in that civil war have ben comparatively rare (Lee & Lu, 1989).The
Vietnamese people have had varying, but typically high levels of challenging experiences
in their country of origin (Nicholson, 1997). Some studies have remarked on the resilience
of this population as compared with other Southeast Asian ethnic groups, such a
Cambodians and Hmong-Laotians (Fawzi, Pham, Lin, Nguyen, Nga, Murphy & Mollica,
1997; Mollica, Wyshak, Lavelle, Truong, Tor & Yang, 1990). Vietnamese people may have
found their experiences to be particularly distressing, but may also have higher levels of
iidaptive resources and well-king than cunent theories would assume. They might,
therefore, provide useful information regarûing ihe importance of certain resilience
resources for well-being outcomes.
PartiEipcinï seleciion
Through a Vietnamese psychiainst, 1contacted a senior citizen's organization of
Vietnamese-Canadians. 1distributed questionnaires to the membership at their monthly
meetings, some of which were returned to the director of the organization, and then to
myself over a period of nine months. 1 pmided al1 questions in both English and
Vietnamese. 1 informed those who chose to participate of their right to discontinue the
study at any time without penalty, and that the psychiaûist would be available to them if the
Adjustment after challenging events 12
study elicited any distress. The study was qproved by the Simon Fraser University Ethcs
Review Cornmittee.
P d m tc~MC&&~S
The sample for the current study consisted of 64Vietnamese Canadian seniors, with
an average age of 65 years. Sixty-seven percent of the sample was male, 72% were manied,
and they reported an average of 10 yem of education in Vietnam. Given that the
participants were contacted through a senior's social group, they may represent a segment
of relatively physically healthy and high-functioning Vietnamese-Canadian elderly.
Measures of exposure to very challenging events
Work with Indochinese American samples (Mollica et. al., 1992, 1990) has
suggested that current adjustment to challenging experiences needs to be measured not only
with culturally sensitive instruments, but also with ri consideration of the effects of
intervening experiences. For instance, subsequent stress during migration and resettlement
may exacerbate the effects of initial wartime experiences, while successful settlement may
mitigate these experiences. The current sample has endured the civil w x , refugee camps, or
resettlement in Canada, so it is important to include possible effects of these experiences.
Three questions assessed whether participants experienced wartime events (and for how
long), whether they migraied as refugees,and whether they spent time in a refugee camp.
Adjustrnent afier challenging events 13
Measures of types and perceived sevetity of experiences
Mollica et al. (1992) suggested h t the fiequency of certain types of challenging
events must be assessed in temis of the capacity in which they were experienced. They
hypothesized that witnessing, experiencing, or hearing about distressing events, al1 have
different effects on subsequent adjustment.
Pre-tcsting with a comprehensive instrument thnt had k e n designed to measure the
wartime experiences typical of Southeast Asian populations (Harvard Trauma
Questionnaire; Mollica et ai., 1992) suggested that some individuals in the curreni sampb
could not remember specific experiences with enough accumcy for an empirical study
depending on such memories. Some of those who were capable of remembering their
experiences with relatively greater accuncy reported experiencing displacement, starvation,
confinement, npe, and torture. They reportai witnessing torture, npe, and murder of
family members. Others, in contrast, reported few or no life-threatening experiences during
the civil war. The lack of reliability of memory for specific events suggested that it was
more appropriate to distinguish the different levels of distressing experiences in only b m d
tem.
Structured to be consistent with the Harvard Trauma Questionnaire, five genenl
questions assessed the perceived severity of distressing experiences during the civil war
(Appendix 1). Participants were asked to rate the frequency of distressing events as they
were experienced, witnessed, or heard about on a 1-5 scale where one represented "none"
and five represented "very many.'*They were also asked to rate the level of physical and
Adjustment after challenging events 14
emotional distress associated with those civil war experiences on a 1-5 scde where one
represented "none" and five reptesented "severe."
Measures of protectivefactors
A number of other questions have been fonnulated and included on an explontory
bais, stemming from findings of related research.
Sense of prepmîion
Sense of coherence (Antonovsky, 1973; Ying & Akutsu, 1997). or a sense of
preparation (Holtz, 1998) for challenging events has been suggested to mitigate negative
outcomes. Participants were asked whether they had anticipated the events of the civil wu,
whether they could attribute a reason/cause to the wiu, and whether they could see one now,
looking back (Appendix 2). They rated each of these ihree questions on a 1-5 scale, where
one represented "no, not at dl", and five represented "yes, very much so."
Perceived social supporî
The central importance of a support network has been suggested to contribute to
resilience and weH-king (Sewan-Schreiber, Lin & Birmaher, 1998; Masten & Garmezy,
1991; Cowen, Wyman, Work & Parker, 1990). In light of the importance of the extended
family and traditions of commund interdependence in Asian cultures (Blair, 2000), it was
important to measure the perceived value of different sources of support in coping with the
evenis of the Vietnam Wu. Four questions were included to assess the level of perceived
social support from family, community, and spiritual faith during the war, and from ohers
in Canada upon immigration (Appendix 2). Participants nted supportiveness for each
Adjustment after challenging evenis 15
question on the same 1-5 d e , where one r e p n t e d "no,not at all", and five represented
"yes, very much m."
Immigraiion experiences
Reseiuchers have rilso identified the important effect of subsequent migration
experiences on disial outcornes for immigrants and refugees (e.g., Holtz, 1998).Of
particular interest is the effect of immigration to Canada on long-tem outcomes.
Participants were asked to evalusite whether immigration helped them to cope with what
happened during the civil wat, whether the immigration process was difficult, whether it
was perceived as the only choice, whether it was difficult to find employment here, and
whether the choice hm been regretted (Appendix 2). Ratings were completed on the same
1-5 scale of severity, where one represented "no, not at all", and five represented "yes, very
much so."
Maures of long tarm distress outcornes
Given the lack of consensus in the literature regarding the types of mure specific
distress responses asociated with challenging events (Shdev, Freedman, Pei, Bandes &
Srihar, 1997), it seemed irnponant to include a masure rismsing current levels of general
depression and anxiety as most representative of current distress. The Indochinese Hopkins
Symptom Checklist - 25 item version (1987) has been previously translated into
Vietnamese (Indochinese HSCL-25;Appendix 3) and haç been well received by Southeast
Asian patients (Smith-Fawzi, Murphy, Pham, Lin, Poole & Mollica, 1997). The instrument
Adjustment after challenging events 16
includes eleven items assessing anxiety symptoms, and fourteen items assessing depressive
symptoms.
In clinical settings, the Indochinese HSCL-25 has been found effective in measuring
symptom levels by virtue of its neutrd tone and design, matching tenns to feelings that
could not be expressed as easily in open-ended interviews (Mollica et al., 1992). Symptoms
are self -rated with respect to how troubling they are for the individual, ranging from "not at
di"(1) to "extremely" (4). It is a stnightforwrvd measure, where the total score for each of
the two scales is averaged across the number of items on each scale, and a cutoff score of
1.75 is suggested to denote clinically significant symptoms.
Measures of long-term weU-being outcornes
As opposed [O measures of distress, assessments of well-king and positive change
arising from challenging events are relatively rare. A 1988 Greek ferry accident spumd
Joseph et al. (1993) to develop the Changes in Outlook scale to assess changes in existentid
beliefs d e r Me-altering or life-threatening experiences (Appendix 3). Twenty-six items
include simple statements reflecting both positive and negative statementsabout such topics
as one's faith in human nature, the value of relationships, and regretting the occurrence of
the challenging events. Individuals are asked to rate their agreement with each statement on
a scale nnging h m "strongly disagree" (1) to "strongly agree" (6). Measures of intemal
consistency were estimated ai .83 for the Positive changes d e , and .90 for the Negative
changes scale. In order to determine concurrent validity, Joseph, Williams and Yule (1993)
comparai the Changes in Outlwk Scale with measures of negative adjustment (feelings of
Adjustrnent after challenging events 17
depression, weakness, and hupelessness). They administered it with the Impact of Evem
Scde (LES), the General Health Questionnaire, the Rosenberg self-esteern scde, a justworld scale, a rneasure of level of crisis support, and a measure of locus of control.
lnkrestingly, there was an association between more severe perceptions of the event
as reported on the ES and more reported positive changes in outlook. In the Greek feny
sample, the relationship between reported positive and negative changes was not an inverse
function, raising the possibility that ssiressful events may elicit both negative and positive
changes. The sale has not k e n previously used with Asian cultural groups, but was chosen
for the study because it allows for a range of responses after an especially stressful event,
measuring both positive and negative changes in existentid beliefs.
Two sets of questions were used to mesisure satisfaction with life and happiness.
The Satisfaction with Life Survey (Diener, Emmons, Larsen & Griffin, 1985) hss proven
reliable and valid ris a quick rating of personal satisfaction with life (Appendix 3).
Pmicipiints nted dl €ive satisfaction stiitements on a 1-5 scale where one represented
"strongly disagree" and five represented "strongly agree."The total score is assumed to
reflect generai life satisfactionand has ken found to show convergent validity with other
masure of quality of life and satisfaction (Clark, Bormann, Cropanzano &James, 1995;
Pavot & Diener, 1993).
Participants were also mked to rate their current happiness on the generat questions
including; the happiness of their children, their grandchildren, their family, and the
importance of their family's happiness on a 1-5scrile where one represented "not happy at
di",and fiverepresented "very happy" (Appendix 3). The total score an the five items is
assumed to reflect gened happiness of oneself and important significant oihers.
Adjustmnt after challenging events 18
Research questions
Given pnor research findings, it is possible to genemte a number of general
researcli questions relüted IO the current study.
QuaMy of lorrg term uirtcome
Firstly, as reported in pmvious reseûrch (Joseph, Williams & Yiile, 1995), it is
likeiy that challenging events elicit both positive and negative outcomes. Given that the
current study is designed to measure both positive and negative outcomes, it is likely that
botfi will be reported. Given the inclusion of a community sample, considerable positive
ouicornes mriy be reparted, rissuming participants have had a chance to integrate wartime
events.
The assocaàtion between challe~igirigeveiits anà outcomes
Second,cumnt mdels tend to assume that outcomes ;ire most strongly and directly
related to the frequency and severity of challenging events (Solomon & Davidson, 1997).
As the relritionship between events and outcomes may also be iit'fected by ri number of
variables with individual difterences, we might expect the correlations between events and
outcomes to be low. The correlations between subjective experiences and outcomes,
however, may be higher, as subjective experiences moy be affected by individual
differences in personal resources, beliefs, and temperament.
Adjustment after challenging events 19
Mective fmors
Finally, as reported in studies of resilience to stressfui events, protective moderating
factors significantly predict individud adjusmnt (Masten, Best & Gamezy, 1990). Some
of the salient variables contributing to well-being in refugee or immigrant simples have
been identified as sense of preparation for the events, perceived level of support, and
quality of immigration experiences. Self-rritings for these variables may show that they
affect the relationship between experiences on outcornes.
Data analysis
Descriptive statistics were genemted for most variab!es. Standard bivariate
correlation techniques were used to explore the relationship between specific pairs of
variables. They were interpreted in the folIowing way: magnitudes less than 0.25
represented a srnall correlation, 0.26 to 0.39 represented ;imedium correlation, and over 0.4
represented a large correlation. One-way Andysis of Variance (ANOVA) was used to
determine group differencesfor specific variables. Banfermni corrections were applied to
ANOVAs exploring gender differences across subsets of variables (such as the predictor set
and dependent set). Otherwise, the fiunilywise e m r for post-hoc contnsts was set at 0.05.
MultivPriaie analysis
Given the limited interpretability of bivariate correliitions, redundancy analysis was
used to assess the relationship among differeni subsets of variables. This particular anaîytic
technique was deemed more appropriate hm traditional multiple regression techniques
because of the large number of variables of interest and the relatively small sarnple size. As
Adjusiment after challenging events 20
with canonical correlation analysis, redundancy analysis involves maxirnizing the
correlation between linear composites of variable sets (Bilodeau & Brenner, 1999; Cliff,
1987). Unlike cannonical correlation analysis, which assumes symmetncal composites,
redundancy analysis is an asymmetrical correlation technique. This allows us to define a
directional hypothesis, in other words, we can specify subseis of predictors and dependent
variables (Israels, 1984).
A directional hypolhesis is presumed in the cumnt study, with wartime experience
variables construed as predictors, and disîress and well-king outcornes viewed as
dependent variables. As explained by Wollenberg (1977) then, redundancy analysis
describes composites of predictors that mriximize the explained variance in composites of
the dependent variables, in addition to accounting for the relationships within multivariate
dependent sets. The composites tepresent the dimensions of overlap between two variables
sets.
The overlap in these two sets is quantified by the redundancy index, which is the
average squared multiple correlation of the dependent variables with the predictors (Israels,
1984).Redundancy analysis then decomposes this index into more f;uniliiu eigenvalues.
The correlation of individual variables with each dimension can be interpreted in a sirnilar
manner to loadings derived in factor analysis or pnnciple components andysis
(Wollenberg, 1977). Thus, with a sample size of less than 100, only correlations beyond +/.30 will be considered statistically meaningful (Dillon & Goldstein, 1984).
If the first two redundancy composites account for a suitable proportion of variance,
variable loadings cm be plotted as vectors. Logically, longer vectors correspond to larger
loadings (Israels, 1987). The location of the categories of pertinent demographic and
Adjustment after çhallenging events 2 1
protective factors within the redundancy space can aiso be plotted to evaluate their
relationship to the predictors and dependent variables.
When categorical vuiiibles are ploned in redundancy space, confidence circles must
be added to data points in order to evaluate whether group differences are significant. The
squared distance for projections of caiegorkal variables into the redundancy space follows
a chi-squared distribution on 2 degrees of freedom (Lem, Morineau & Warwick, 1984).
Confidence circles for the present demognphic and protective factors can thus be
colculated uring the chi-squared critical point set at the 95' prcentile (5.99). When divided
by the sample size for each group, the radius of the confidence circle is defined. The
significance of group differences for demographic and protective factors with respect to the
redundancy composites can be evaiuated through obsewing the overlüp between confidence
circles. Circles with considerable overlap suggest thai their ongins are not significantly
different from one another, whereas circles with no overlap suggest significantly different
origins.
Adjustment after challenging events 22
RESLJLTS
Missing data
Out of twenty-nine variables, seven participants had missing data for one variable
because they did not provide an estimate of the duration of their experience of civil war
events. Given that this variable was inçluded for solely descriptive purposes, these
participants were excluded only from analyses of that variable.
G e n e d approach to analysis
Given the paucity of standardized instruments assessing refugee experiences, many
of the questions in the study were exploratory in nature. As such, descriptive anaiyses were
most appropriate for the majority of the items completed by participants. The results section
wili first ptesent a description of the sample, followed by descriptions of measures of civil
wrir
and refugee experiences. Subsequent tables describe participant self-ratings on
questions assessing protective factors as well as distress iuid resiliency outcomes. The
correlations between wiutime experiences and these outcomes are presented. Lastly,
multivariate analyses of the relationships between wartime experiences, protective factors,
and distress and resiliency outcomes are presented.
Adjustment dter challenging evenis 23
Characteristlcs of the participants
Sixty-fourVietnarnese-Canadians completed the package of questionnaires, and
were included in the study. Descriptions of the participants are shown in Table 1 and Table
2. There were no significant age or gender differences with respect to groups on other
demographic variables (one-way Andysis of Variance (ANOVA), see Appendix 4).
Table 1:
Descri'kn of partici'nts.
Variable
N
Mean
SD
Min
Max
Age (Y-)
64
65.1
7.2
44
81
Children
64
4.0
2.6
O
Il
Educational level
(years in Vietnam)
64
10.3
5.4
O
20
Educational Ievel
(years in Canada)
64
0.2
0.6
O
3
Time in refugee camp 64
(yem)
1.1
1.3
O
4
57
Time in wartime
conditions (months)
16.1
9.2
2
40
The average age of the sample (65.1 years, S.D. = 7.16) indicated an appropriate
age gmup for the assessment of long-term adjustrneni after very challenging events that
= 1.3) of
occurred in Vietnam miuiy years ago. Reports of an average of 1.1 years (S.D.
intemment in a refugee camp, and 16.1 months (S.D. =9.2) enduring aversive events
Adjustment after challenging evenu 24
related to the civil war also suggests that many participants have encounted such
chdlenging events.
Table 2:
Fmquenciesfor additional dernogrophicfeatures of participants.
Variable
N
Percent of Sample (rounded)
Gender
Males
Females
43
21
67
33
46
7
2
9
72
11
3
14
39
9
4
2
10
61
14
6
32
17
12
2
50
27
19
3
24
39
38
61
Maritu1 Status
Mamied
Single
Divorced
Widowlwidower
Reiigious Afiliation
Buddhist
Christian
Ancestor Worship
Other
None
Occupational Szat~rs
Civilian
Soldier
Civil servant
Panmilitary
Language Status
Fluent in 2+ Ianguages
ESL training in CDA
3
16
Most of the participants were men (67%). most were mmied, and most reported a
spiritual practice of some type (84%).
Adjusunent after challenging events 25
Participants reported whether or not they were exposed to any or dl of three types
of wartime events. Table 3 reflecis the cumulative frequency of exposure to three kinds of
aversive events, those related to: living under conditions of civil war, refugee migration,
and living in refugee camps. There were no significant age differences in exposure to these
différent kinds of events (see Appendix 4). An exiunination of gender differences in
exposure to the three kinds of events showed significani differences only in self-report of
living under conditions of civil w u (F = 41.68, p < 0.001). OvemII, 77% of the male
participants, and only 10% of the fernale participants reporîed this type of exposure.
Adjustment after challenging events 26
Table 3:
Cumulativefiequency of exposure to wartrhe ewn&
Variable
N
Percent of Sample (rounded)
ho expositre:
16
25
One type of exposure only:
Lived under aversive
wartime conditions only:
Migrated as a rafugee
only:
Spent tirne in a refugee
camp only:
Two types ofexposure:
Wutirne conditions and
refugee migration:
Wartime conditions and
refugee camp:
Refugee migration and
refugee camp:
12
O
O
1
1
12
Al1 rhree types of evenrs:
22
34
Total:
64
100
The variation in exposure reported by participants is notable, such that 25%
reported no exposure, 22% had experienced iwo of rhe three types of events, while 34%
reported exposure to al1 three types of evenis.
Participants described the level of distress experienced during events related to the
civil war, shown in Table 4. They were asked to rate the frequency of distressing events that
they heard about, witnessed, and experienced. They were then asked to rate the levels of
physicd and emotional distress associated with those experiences. AI1 ratings used the same
1-5 scale, where 1 represented "none", and 5 represented Very many" distressing events or
"very strong" physical and emotional distress. There were no significant age or gender
Adjusment after challenging events 27
diffetences between the Enqucncy of self-reprted distresshg cxperiences across these çive
questions (ANOVA Tables in Appendiic 4).
Table 4:
se^-repoifedjkquency of distressing nacw tu exptriences
N
Mean
SD
Min
Max
Distressing events
heiird about
64
4.0
0.7
2
5
Distressing events
witnessed
64
3.7
0.8
1
5
Distressing events
Experienced
64
3.0
1.2
1
5
Physical distress
64
1.6
0.9
1
5
Emotional distress
64
3.5
1.O
1
5
Variable
Civil war
As one would predict, participants report4 a higher frequency of distressing events
that they heard about than disnessing events h t they witnessed or experienced. Of interest,
self-reported emotiona! distress elicited by the events exceeded self-reported physical
distress. The relationship between participants' self-report of exposure to the three kinds of
wartirne experiences and self-reported frequency of distressing experiences during the war
was explored with point-biserial correlations (Table 5).
Adjustment after challenging events 28
C o m W n s between exposure to wartime events and se&repooried remlion to watüme
exphences.
Variable
Living under wartime
conditions
Refugee
migration
Living in a
refugee camp
Distressing
evenb heard about
0.18
O. 10
Distressing
events witnessed
0.23
0.0 1
Distressing
events experienced
0.18
-0.09
-0.06
Physical distress
0.25*
O. 18
0.15
0.35**
0.33**
Emotional distress
0.36**
Note: * Q c 0.05 (2 - tailed)
** p < 0.0 1 (2 tailed)
0.05
-
In terms of responses to these different wartime experiences, there was a medium
correlation between emotional distress and al1 types of experiences, while living under
conditions of civil war showed a medium correlation with only physical distress.
Protective Factors
Participants rated themselves on questions related to three different protective or
resiliency factors, as shown in Table 6. No age or gender differences were found on any
cornparisons using one-way Analyses of Variance, so data for both genders were combined.
Adjustment after challenging events 29
Table 6:
Serf-rotliiggs on proleclivef~turs.
Mean
SD
Min
M;
Sense of preparaiion 64
9.6
3.3
3
15
Perceived support
11.1
3.3
4
18
Variable
N
64
Sense of preparahgon
Three questions (each rated on a 1-5 scale) assessed the sense of preparation for the
civil war felt by participants. High scores (to a maximum of 15) indicated îhat the
participant reprted a sense of prepamtion for the war, and an understanding of its
occurrence. The average score over the three questions of participants was 9.6 (S.D. = 3.3).
Pemeived lewl of social support
Participants rated the perceivecl level of support h m such sources as family,
community, and spiritual faith on four questions (each rated on a 1-5 scale for a maximum
of 20). Higher scores indicated a stronger sense of socid support dunng the civil war and
subsequent migration. The average score over the four questions of participants was 1 1.1
(S.D.= 3.3).
lnrntimon
experiences
Five questions (each rated on a 1-5 scala for a maximumof 25) assessed the quality
of participants' experiences in their immigration to Canada; higher scores indicated more
positive migration experiences. The participants' average score over the five questions of
was 15.9 (SD.
= 3.2).
Adjustment after challenging events 30
It is interesting that the majority of participants' seif-reportecl protective factors fell
above the rnidpoint of the scales (frequency histograms are found in Appendix 5).
Distress and resiliency outcornes
To evaluate both positive and negûtive aspects of current adjustment, psirticipanffi
mted thernselves on a number of q u ationnaires. Anxiety and depression were assessed
-
using the Hopkins Symptom Checklist 25 items (HSCL-25,
Moilica et al., 1990).The
Changes In Outlook Scale (CIO, Joseph, Williams & Rule, 1993) measured both negative
and positive changes in philosophical beliefs since the civil war, while the Satisfaction with
Life Scale (SWLS,Diener, Emmons, Larsen & Griffin, 1985), and five genetal exploratory
questions assessed self-mted personal and familial happiness. An examination of age
differences for the six different outcome variables showed differences only for happiness.
In particular, older participants tended to provide higher niings of happiness. There were
no significant gender differences on any distress and resiliency uutcomes (see Appendix 4),
so these outcome measures for genders are combined in Table 7.
Adjustment after challenging events 3 1
T&
7:
Distress and resiliency outcome measures.
Variable
N
Mean
SD
Min
Mis
HSCL-25 (anxiety)
64
1.5
0.4
1.O
2.4
HSCL-25 (depression) 64
1.5
0.5
1.O
3.7
CIO (positive)
64
4.1
0.7
1.9
6.0
CIO (negative)
64
2.1
0.8
1.O
5.1
SWLS
64
17.5
4.2
5
25
General happiness
64
21.0
3.6
10
25
The average self-reported rating for current miety symptoms of 1.5 (S.D. = 0.4),
was of a sirnilar magnitude as the average mting for current depressive symptoms of 1.5
(S.D. = 0.5). It is significant that boih measures of distress fell below the suggested clinical
cutoff of 1.75 (Mollica et al., 1992). It is also important thai a paired samples -test
indicated significantly more positive than negative changes in outlook (r = 16.68, Q < .001).
High scores on both the SWLS and broad questions assessing personal and familial
happiness indicated generally positive current adjustment.
Relationship between exposure to different wartime experiences and weU-king
Participants pmvided self-ratings for exposure to three kinds of challenging life
events, and for both distress and resiliency outcomes. Point-bisenal correlations were
Adjustment after challenging evenu 32
calculated to explore the nature of the relationships between these exposures and outcomes
re!ated to current well-king (Table 8).
Cmlalions h e e n exposure and distress and resiliency outcomes.
Variable
Living under wartime
conditions
Refugee
migration
Living in a refuge
CmP
HSCL -25
(Anxiety)
HSCL - 25
(Depression)
CIO (positive)
.15
.O3
O
. 1
CIO (negative)
-.O9
.25*
.26*
-.44**
-.44**
Genenl happiness
-.O2
Noie: * p < 0.05 (2 - tailed)
** p < 0.01 (2 - tailed)
Medium correlations between self-report of both refugee migration and time spent
in a rebgee camp and negative changes in outlook were noted. Additionally, there were
large negative correlations with these two exposures and current persona1 and familial
happiness. Of note, having lived under wartime conditions was not a significant correlate of
current well-being or distress.
Adjustment ;ifter challenging events 33
Relstionship between wartime experiences and distress and weU-being outcomes
In order to evaluate the relaiionship between wartime experiences and current wellking outcomes, Spearman's &J was calculated (see Table 9).
Table 9:
ReMonships beîween wariime expmfences ami dkiwss and well-being outcomes.
Variable
Heard about Witnessed
(events)
(events)
Experienced Physical
(events)
distress
Emotional
distress
.22
.31*
.26*
.5 1**
.32*
HSCL-25
Depression
.10
.Il
.IO
.36**
.27*
CIO
Positive
-.O8
-.O4
-.16
-.14
.O4
CIO
Negative
-.12
-.13
-.12
.24
.14
SWLS
-.16
-.22
-.31*
-.25*
Happiness
-.16
-.17
-.14
-.O8
-.22
-.a**
HSCL-25
Anxiety
Note: * p c 0.05 (2 - tailed)
** p < 0.01 (2 - tailed)
Distress reiictions, more than piuticular t y p of wartime expenences, were
associated with distress and well-being outcomes. There was a large correlation between
physical distress during the war and current anxiety symptoms, a medium correlation with
current depressive symptoms, and a medium negative correlation with satisfaction with life.
Emotional distress dunng the war showed a large negative correlation with cumnt
happiness, moderate correlations wiih cumnt anxiety and depression, and a moderate
Adjustment after challenging events 34
negative conelation with satisfaction with life. Self-report of distressing events witnessed
and experienced showed medium correlations with current anxiety. This pattern suggests a
significant relationship between both emotional and physical distress elicited by wartime
events and level of current distress, in ternis of anxiety ;tnd depression. Hearing about
wartime experiences showed no significant correlations with cumnt distress and well-being
outcomes, and changes in outlook (CIO) were not correlateci with any rneasures of wartime
experiences. Scatterplots of experience ratings and outcome measures fail to show strong
linear relationships for most of the correlations between wartime experiences and outcome
measures, with the previously mentioned exceptions.
Redundancy index
The redundancy index was .236, indicating that 24% of the variance in outcome
measures (changes in outlook, anxiety, depression, life satisfaction,cumnt personal and
familial happiness) could be accounted for by linear dependence on the predictor set
(hearing about, witnessing, experiencing civil w u events, experiencing physical and
emotional distress).
Redundancy spce
According to the eigenvalues presented in Table 10, the first two dimensions
sumrnarize 63%of the overlap between the two variable sets.
Adjustment &er challenging events 35
Table 10:
- -
Dimension
1
Eigenvalue
0.44
The loadings of wutirne experiences and outcome varinbles on redundancy
dimensions are included in Table 11.
Table 11:
Correlations of wam*meexpience, dimss and well-being outcornes witir
redundancy dimensions.
Variable
L d i n g on first
redundancy dimension
dimension
Physical distress during war
Emotional distress during the war
No experience with events of civil war
Exprienced events
Heard ribout events
Cumnt happiness
Witnessed events
Experiencing events of civil war
Did not migrate as a refuge
Did not spend time in a refugee camp
Positive Changes in Outlook
Negative Chimges in Outlook
Satisfaction With Life
Anxiety (HSCL-25)
Depression (HSCL-25)
.86
.73
-
-.57
.56
.56
.45
-38
.35
-33
-.3
-1
-.29
Loading on second
redundancy
-.10
.30
-.15
-.56
-
-.29
-.12
-.56
.O3
-.45
-.43
-.25
-.27
.22
.O4
.O 1
.O7
.18
.31
-.16
Adjusant after challenging events 36
A plot of these loadings presented graphically in Figure 1. The predictors plotted in
redundancy spacc are: 1) level of civil wat events heard about, 2) level of civil war events
witnessed, 3) level of civil wac events experienced, 4) physicai distress during the civil war,
and 5) emotional distress during the civil war. The dependent variables included in the
redundancy analysis are: 1) negative changes in outlook (CIO),2) positive changes in
outlook (CIO).3) current anxiety, 4) current depression, 5) Satisfaction With Life Scale
(SWLS),and 6) cumnt happiness.
Adjustment aftet chaiienging events 37
Adjusünent after challenging events 38
Variables with high loadings on the fmt dimension were: types of wartime
experiences (hearing about, witnessing, and experiencing wartime events), physical distress
and emotional distress during the war, and current happiness. Variables with high loadings
on the second dimension were: refugee experiences, witnessing and experiencing wartime
events, emotional distress during the war, and current depression. These two most dominant
patterns are presented in Table 12.
Dimensional loadings of variablesfronr wrrr and rcfugee experience and current
outcornes.
First dimension
Second dimension
Wartime experience
high civil war experiences
high hearing about war events
high witnessing war events
high experiencing war events
high physical distress during conflict
high emotiond distress during conflict
high refugee experiences
Outcome variables
high current happiness
high emotional distress during conflict
low witnessing war events
low experiencing warîirne events
high =fugee experiences
high current depression
Factors affecting the relationship between civil war experiences and weU-beiig
Means on the First and second dimension were calculated for the categories of
background variables that might be expected to affect the relationship between predictors
and outcome variables. Self-ratingson proteciive factors were split into low, moderate, and
high levels for sense of preparation and perceived social support, and low and high levels
for immigration experiences. The means for al1 caiegoncal variables are included in Table
Adjustment alter challenging evenis 39
13. Graphicd representations of the means of demographic and protective variables in
-
redundancy space are found in Figures 2 7.
Table 13:
Mmm of backgmumi and prorective YlViObIes on duRdartcy dimensions.
Variable
Means on tirst
redundancv dimension
Means on second
redunhncv dimension
Demographic variables:
Male
Femlr:
Age 60 yervs or less
Age 61-70 yerus
Age 7 1-80 yem
Mamed
Single
Religious affiliation
No religious affiliation
5 y e m or less education
6- 10 yem of education
1 1- 15 yem of education
More than 15 y m of education
Less than 2 children
Less than 6 children
Six or more children
Proteetive factors
Sense ofpreparation:
b w sense of preparation
Modemte sense of prepmiion
High sense of prepmtion
Perceived support durittg conflic?:
Low perceived support
Modemte perceived support
High prceived support
Qualiîy of immigration e.rperiences:
Paor immigration experiences
-.54
Positive immigration experiences
.13
-.12
Adjustment after challenging events 40
Adjustment after challenging events 41
Figure 4: Educational history within the iedundancy space.
-0.7
Dimension 1
Adjustment afler challenging events 43
Adjustment after challenging events 44
Figure 7: Protective factors within the redundancy space.
0.8
low imm
high sense prep
0.8
mod social
support
low social
support
u 0 . 6
mod sense
Dimension 1
Adjustment after challenging evenis 46
The background variables whose categories were clearly separated on the first
dimension were: gender, maritai status, age, educational history, and number of children.
Roteciive factors whose levels were ciearly delineated on the first dimension included
sense of preparation, perceived sacial support, and immigration experiences. Specifically,
lower levels of al1 civil war experiences together with lower current happiness was
associated with king female, single, older than 70 years of age, having less than five years
of education, and more than six children. They were also related to reponing a low sense of
prepmtion for the conflict, low perceived support, and p r immigration experiences.
Higher civil wiu experiences and higher cumnt happiness, on the other hand, were related
to modemte perceived support.
Background variables whose categories were clearly separated on the second
dimension were: age, educational history, and number af children. Protective factors whose
levels were clearly delineated on the second dimension included a sense of preparation, and
perceived social support, In particular, witnessing and experiencing more civil war events
and reporting lower current depression was associated with being older than 70 years of
age, having a modente educational history (6-10 y m ) , having more than six children, a
modente sense of preparation, and low perceived support during the conflict. Reporting
having witnessed and experienced fewer wûrtime events, more refugee experiences, and
higher current depression, on the other h d , was related to reporting fewer than three
children and having an educational history of more than fifteen years.
WhiIe redundancy malysis provides a global understiinding of the patterns of
relationship between two sets, it does not provide detailed information about the
Adjustment after challenging events 47
relationship between pairs of variates. In following sections, results from such detailed
analyses will be pmvidd.
Genàer and age
The correlation between gender and age was not significant, so their relationships
with the outcornes of current happiness and depression were assessed independently. There
were gender differences in self-reported happiness (j= -2.2, p = 0.03),where women
reported significantly higher levels of cumnt happiness than men. This finding seems to
contradict Figure 2 showing fernale gender corresponding to lower scores on the sarne
dimension showing high scores for current happiness. It should be noted, however, that
high scores on experiences during the civil war had the highest loadings on the first factor,
and women reported significantly fewer civil war experiences than men. tt may be that the
mean for femole gender on the first redundancy variate, in reflecting their distribution
relative to the pattern of variables loading on the first dimension, actually speaks to their
low scores on distressing wartime experiences, nther than lower current happiness.
A one-way ANOVA (Table 14)showed an age effect for both depression and
happiness. Point-biserial correlations are included in Table 15.
Table 14:
Age difletences in cutrent happiness and depression.
Variable
Curreni happiness
Current depression
F-value
P-level of significance
Adjustment after challenging events 48
Increasing age was assaciated with significantly higher current happiness and
significantly lower current depression. Cornparhg group means using Tukey's HSD
technique indicated significantly lower current happiness for those 60 years of age or
younger compared with the those aged 61 to 70 and those over 70, but no significant
differences between the two older groups. This seerns contrary to the low mean for those
over 70 on the first dimension, which is characterized by a high loading of current
happiness. As with gender, it is likely the case that the mean for those over 70 reflects their
self-reported pattern of wartime experiences, specifically less physical distress during the
civil war (which had a pnrticularly high loading on the fint dimension). Depression was
significantly higher for the younger group when comprired with the two older groups, but
again no significant differences emerged between h e two older groups.
Table 15:
Point-biserial comkibns between age, depression, und happiness.
Variables
Happiness
Depression
Age
0.57**
-0.34**
Note:
** p < 0.0 1 (2 - tailed)
Despite a large positive correlation between age and happiness and a medium
negative correlation between age and depression, the estimated effect sizes were modest
(0.36 for happiness and 0.16 for depression).
M e r imckpund vuriuùles and outcornes
There were significant differences in current happiness according to marital status,
with those who were rnanied neporthg greater happiness (t = 2.1, p = 0.04). A one-way
ANOVA also showed significantdifferences in current happiness associated with number
Adjustment after challenging events 49
of children (F= 5.8, p = 0.01), with those reporting more children also reporting higher
current happiness. Post-hoc contrasts showed significantly lower current happiness reporied
by individuals with less than three children, but no significant differences in current
happiness between groups having three to five or more than five children. Although the
point-bisenal correlation between number of children and current happiness was moderate
( r = 0.36, p < 0.01). the estimated effect size (0.14) was small. Further analyses of variance
showed no significant relationships between family size and depression, marital status and
depression, and level of education, happiness, and depression.
Mective factors
A one-way ANOVA showed significant differences in current happiness associated
with social support during the conflict (F = 3.8, p = 0.03). Post-hoc contrasts suggested a
counterintuitive pattern, where hose reporting low perceived social support during the
conflict showed significantly higher cwrent happiness than those reporting modente social
support during the conflict. Differences in current happiness between those reporting higher
social support during the conflict and those reporting low and moderate social support were
not significant. It should be noted, however, ihat the point-biseriai correlation between
social support and happiness (-0.21)iuid the esiimated effect size (0.09) were small.
Andysis of variance showed no significant differences in happiness associated with sense
of preparation or immigration experiences, and none of the protective factors were
associated with significant differences in current depression.
Adjustment after chailenging events 50
DISCUSSION
Overall positive adjustment &en frequency and type of experiences
The self-reported frequency of distressing events experienced by participants during
the civil war, as well as the physical and emotional distress elicited by those events, was
variable. The nature of these experiences was not specifically assessed, although pre-testing
with a more detailed questionnaire suggested many would be considered life-threatening
(for example, witnessing others king murdered). The frequency of these types of selfreported experiences for many individuals would be congruent with commonly assumed
precursors for long term distress outcomes following extremely challenging events (Mollica
et al., 1992).
Contrary to this assumption, however, the participants in the sample reported a
genenlly high level of genenl satisfaction with life, and high current personal and familial
happiness. Furthemore, on a measure of changes in philosophical beliefs following
expenences in the civil war, participants reported significantly stronger positive than
negative changes. Rather than discounting the bulk of research suggesting high levels of
distress following extremely challenging events (e.g., Nicholson, 1997; Mollica et al.,
1990), these findings broaden the scope of our understanding of the coping process. They
are largety consistent with resettlement resemh with Vietnamese populations in Norway
showing that "it is possible to cope with important and complex îasks in exile...[even with]
painful memories of the p s t and other distressing symptoms" (Hauff & Vaglum, 1997, p.
Adjustment after challenging events 51
414). In other long-tem follow-up studies, such as those including Holocaust survivors,
reseiuchers have found a sirnilar pattern of current positive adjustment and well-king
despite symptorns of distress (Sadavoy, 1997).
It is important to consider the possibility that the pattern of adjustment in this
sample may be representative of normative long-term responses after extremely challenging
events. Some authors hypothesize that coping with such events should be considered fmm
the perspective of lifespan development (Spim, Schnurr & Aldwin, 1997). They suggest
devoting considenbly more attention to the potentid role of individual difference variables
in shaping adjustment after challenging events. The current sample is a community sample,
as opposed to the clinical samples often indu&d in research studies of reiictions to
challenging events (e.g., Deering, Glover, Reiuiy, Eddleman & Aliucon, 1996).It may be
that individual difference variables in community populations who are not seeking
treatment services contribute to higher well-king outcomes than are conunonly reported in
studies of clinical samples.
Additionally, the period of time that has elapsed since exposure to civil war events
may have mitigated immediate negative outcomes folluwing those events (Aldwin,
Levenson & Spiro, 1994; Fontana & Rosenheck, 1994). Other long-term follow-up studies
of American Vietnam vetemns (Spiro, Schnurr & Aldwin, 1997) have described the
presence of robust well-king outcomes, contmdicting the common assumption that a linear
relationship exists between stressful events and distress outcornes (Berghem, Brmner,
Southwick, Charney & Krystal, 1997).
Adjustment after challenging events 52
Reiationship between wartbne experienm and outromes
There is a complex and interesting relationship between types of wartime events,
wartime experiences, and distress and well-being outcomes.
Types of warthe events and outcomes
In contrast to generally positive adjustment, refugee migration and living in a
refugee camp were correlated with lower satisfaction with life and more negative changes
in outlook. Although these are not psychiairic symptoms, experiencing less general
personal satisfaction with life and holding fewer positive philosophical beliefs may indeed
have functional consequences. It might, for instance, affect the ability or willingness of
Vietnamese immigrants to make social connections in their new country, which other
studies have suggested as an important precursor to positive adjustment (Hauff & Vaglum,
1994).In the redundancy analysis, not king forced to migrate as a refugee, and not
spending time in a refugee camp was distributed in a similar manner as lower current
depression. This finding is consistent with research suggesting that the process of forced
migration as a refugee poses considerable challenges to personal coping resources, above
and beyond the challenge of wartime stressors (Blair, 2000; Nicholson, 1997; Sack, Seeley
& Clarke, 1997; Silove et al., 1997).
Wrutime experiences and well-king outcomes
The relationship between the Frequency of chailenging civil war experiences and
current persona! and familial happiness suggests a countenntuitive pattern. Higher scores
on ail five measures of wartime experiences were related to higher current happiness. In
Adjustment after challenging events 53
contrat, lower scores on witnessing and experiencing events of the civil war, but higher
emotiond distress during the conflict were related to higher current depression.
As has been suggested in other studies, individual difference variables, rather than
objective level of exposure to an extremely stressful event, may play an important role in
determining long-term outcomes (Taft, Stem, King & King, 1999; Aldwin, Levenson &
Spim, 1994). It may be that the level of emotional distress experienced during very
challenging events is a more useful predictor of long-terni adjustment that any objective
measure of exposure to stressors. Indeed, other studies of Vietnamese populations have
found that certain especially emotionally distressing experiences (such as tirne spent in
forced "education" camps) predicied disiress outcomes (Hauff & Vaglum, 1994).
The correspondence between higher levels of al1 types of wartime experiences,
greater physical and emotional distress during the wu, and higher current personal and
familial happiness could have a number of explanations. in their review of extremely
stressful events and the elderly, Weintmub and Ruskin (1999) suggest that successful
negotiation of the stressor at the time it occurs is associated with future well-being. In other
words, this could indicate an immunization effect, whereby more ment stressors are
successhlly negotiated because of coping skills developed during remote experiences,
leading to greater happiness. Research reiated to the constructs of both hardiness and sense
of coheretice construe stressful events in a more positive light, as challenges to be met by
the coping resources of the individual (e.g., Antonovsky, 1973).
It may also be the case that irnmigrating to Canada and making great personal
sacrifices to ensure the safety of family members may increase individuals' expectations
that they would become happy. Some long-term coping studies do suggest a sense of
Adjustment after challenging events 54
increased gratitude and an awareness of cunent resources developing as a result of past
stresses or deprivations (e.g., Spiro, Schnurr & Aldwin, 1997). It may also be the case that
immigrating to Canada and making great persona! sacrifices to ensure the safety of f d y
members may increase expectations that they would therefore be happy. As a result, an
individual's estimation of the happiness of his or her family members may be elevated
because the expectations of familial happiness are higher.
In other studies, marital status h a been identifid as a diable predictor of wellking in elderly samples (Weintnub & Ruskin, 1999; Kehn, 1995), and is certainly
assoçiated with higher personal and familial happiness in the current sample. These
findings, taken together, may reflect the salutogenic effects of family relationships for
members of the current sample in their ability to cope with extremely stressful events.
Wumorneexpiences and distress oirlcornes
Numerous researchers have suggested that frequent and distressing experiences
exert negative long-term effects or symptoms (Brown, Fulton, Wilkeson & Petty, 2000,
Sack, Seeley & Clarke, 1997). Given that the average self-reportecl levels of anxiety and
depression were below suggested clinical cutoff scores, however, actual functional
problerns were not indicated for the majority of this sample. The prevalence of clinically
significant depressive symptoms (22%) in this m p l e is considerably higher than other
estimates of 8- 10% prevalence in community samples of Vietnamese refugees (Hinton,
Jenkins, McPhee, Wong, hi,Le, Du & Fordham, 1998).Even so, the high number of selfreported well-being outcornes suggest ihat even in the presence of anxiety and depressive
mood symptoms, positive adjustment is possible. Other studies of Viemamese refugees, for
instance, show general well-king and coping efficacy even in the presence of symptoms of
A d j u s a n t after challenging evenn 55
disbess (Hauff & Vaglum, 1997), This is also consistent with tesearch studies of d e r
cultural groups (such as the Khmer) showing that clinically signif~cantpsychiatrie
symptoms can be reported without evident functiod impairnent (Sack, Him & Dickason,
1999; Berthold, 1999; Hauff & Vglurn, 1997).
The hypothesis that adaptive long-tenn reactions to exüemely stressful events
involve both distress and well-being autcomes is not a commonly held tenet in the literature
on coping with extremely challenging events, although it is beginning to be addressed. In
addition to studies showing b t h distress and well-king outcomes in American veterans
(Spiro, Schnurr & Aldwin, 19971, there is a small but signifiant body of litennire that
discusses coping with extremely stressful events in ternis of a negotiable challenge to the
individual's coping resources. Rather than exhausting an individuai's protective factors,
these researchers believe that stressful experiences allow these msources to be realized and
enhanced (Park,1998). This highlights the importance of exploring ihe pmess of long-
term adjustment afier such events and ensuring that the breadth of outcomes is recognized
for each individual.
sîress and anxieo
In addition, it may be important io rnodifj our undersîanding of those who do show
long terni distress outcomes and impaired hinciioning after very challenging events. Such
difficulties are typically subsumed by the North American diagnostic taxa of anxiety
disorden. Given the orthogonal lmding of outcome mewures of depression and happiness
in the current study, however, these outcorne measures may be more useful than anxiety in
summarizing long-tem variation in individuai responses to extremely stressful events. It is
interesthg to note other researchers have deve1oped depression - happiness d e s as
Adjustment after challenging events 56
reptesentative of the continuum of affective responses to life events (McGreal & Joseph,
1993). Resemh including samples of Vietnamese refugees awaiting placement in Vietnsun
has found that depression as rneasured by the Hopkins Symptorn Checklist-25 item version
is a reliable indicator of distress (McKelvey & Webb,
1997). Furthermore, studies of
Vietnamese refugee samples in the United States have highlighted depression as an
identifiable and important correlate of post-migration stressors (Hinton et al., 1998).
Individuai differerne variables
The dishbution of demographic and protective factors in redundancy space
provides an interesting description of their relationships with wartime experiences and
outcornes. Other studies of coping with extrernely stressful events in Vietnamese samples
~ P suggested
S
that demogmphic variables exert a significant effat on well-king (Tm,
1993).
Gender and well-being
Although the bulk of North AmeFicm resemh suggests a much higher prevalence
of clinical depression for women than men, this assumption does not appear to generdize
across cultures or genentions. An international review of epidemiological studies of
depression fwnd ihsit in less developed countries and in older genentions, gender
differences in prevalence of depression have not been significant (Culbertson, 1997). In the
cumnt siudy, in fact, women reported significantly greater happiness and did not report
higher current depression hm men,suggesting that comrnody-held assumptions about
gender differences in distress and well-being may not translate effectively to dl siunples.
Adjustment after challenging events 57
In fact, other community studies of depression in Viemamese refugee populations
have found lower prevalence of depression (Hauff & Vaglum, 1993) as well as other mental
health problems (Matsuoka, 1993) for women than men. The authors suggested that fernale
gender operated as a pmtective factor because it was associated with an increased
propensity for making social and occupational connections with the host population. It may
be that female rehgees and immigrants are both more sacially flexible and more
immediateiy employable (e.g., as domestic labour) than male refugees, which contributes to
well-king.
Age and well-being
The current study found that those younger than sixty years of age reported
significantly less current happiness and significantlygreater current depression than those
older than sixty yem of age. Physical health studies are more typical of the researcli
literature on the well-king of elderly populations, and a number of studies suggest that
with increasing age, decreûsing physical heaith becornes the most significant predictor of
well-king (Krirel, 1997). In contrast, the current study replicates the findings of research
with other East Asian populations, suggesting that, ai least in soçieties with strong values of
filial piety, increasing age can show strong associations with well-being outcomes (Pei &
Pillai, 1999). In a hierature review of common cultural thernes of Southeast Asian refugees,
kinship solidruity emerged as partîcularly characteristic of these cultures (Frye, 1995). It
may be that elderly individuals from these cultures benefrt significantly from strong family
relationships.
It may also be that bis partidly reflects cohort differences in general adjustment or
differences in expectations of satisfaction. As previously mentioned, epiderniological
Adjustment after challenging evenis 58
studies of depression suggest increasing prevalence in younger cohorts (Culbertson, 1997).
Other studies exploring the prevalence of depression in Vietnamese refugee samples has
replicated this finding that increasing age is associaied with lower depression (Beiser &
Fleming, 1986). It may be that older generations hold lower expecilitions for happiness, and
their current levels of satisfaction are more likely to rneet or exceed those expectations.
This may translate into higher self-perceptions of happiness for older generations.
Conversely, younger individuals miiy show lower self-peived hiippiness as a result of
incongruent expectations for happiness and the mual possibilities within North American
society.
Altematively, the relationship between age and current happiness may reflect an
association between age at the time of the stressful events and future adjustment. Some
mearchers suggest that the life experience associated with age itself is a protective factor
when coping with extremely stressful events (Weintraub & Ruskin, 1999). According to
this theory, ihose who were older when they experienced wartime events might show
greater long-term well-being.
Family site aiid well-bei~ag
This may also be the most intuitive explanation for the higher distress outcornes in a
subsample of individuals characterized by family structure including fewer children, which
is ftequently assumed to be economically advantageous, and thus a protective factor
(McKelvey, Webb & Mao, 1993).The expectations of this particular group may have k e n
the highest upon entenng Canada, and as such may have been most likely to be
disappointed by the limited opportunities afforded by immigrant status in a new country.
Adjustment after challenging events 59
Numerous studies including refugee populations have suggested that resettlement stressors
play a predictive role in current adjustment (Nicholson, 1997).
This implies that we need to reconsider our assumptions about the protective
benefits of certain demographic variables. It may be more important to evaluate
demographic variables in terms of the degree of congruence between expectations and
probable achievements. For instance, higher soçiœconomic status rnay not be a protective
factor for rehgees because it may result in unrealistic expectations (for instance, pertaining
to standard of living) in a new country of resettlement.
The finding that a larger nurnber of children in the family is related to higher
happiness contmts some research including elderly community-dwelling North American
populations, suggesting that family size does not predict self-reported well-king and
satisfaction (Kehn, 1995). In other cultural groups, however, particularly those with smng
intergenerational ties and frequent contact between young and old rnembers, family
relationships are particularly important for psychological well-king (Pei & Pillai, 1999). It
may indeed be the case that larger families are a protective factor for elderly Vietnamese,
particuliuly when coping with highly stressful events.
Proteciivefactors: psychological
Given the research evidence supporting the importance of a sense of coherence or
meaning for integrating extremely stressful events (Ying & Akutsu, 1987) and for
predicting satisfaction in later life (Sagy, Antonovsky & Adler, 1990), it is surprising that ii
sense of prepamtion did not seem highly related to positive adjustment. It is most likely that
the questions included in this study to assess this constmct were in fact measuring an
awareness of possible justifications for the civil war. This sense of meaning may be a more
Adjustment after challenging events 60
logical, but less personal, sense of coherence, which appears to be unrelated to distress and
well-king outcomes.
Similarly, it was surprising that the quality of immigration experiences was weakly
related to outcome measures. The bulk of recent research involving various refugee
populations has found that negative immigration experiences contribute to distress
outcomes (Silove et al., 1997). It is possible, however, that other factors such as immediaie
employrnent problems and financial stressors are more strongly related to distress and wellking outcomes. Such a relationship has been suggested in other studies which show strong
associations between ment stresses (within the past year) and major depression in
Cambodian refugee populations (Blair, 2000).
The curvilinear relationship between levels of social support during the war and
current happiness was somewhat surprising. Rather than a linear association between level
of social support during the war and current happiness, it appeared that a modente level of
social support was most strongly related to moderate current happiness, while low social
support was associated with higher happiness. Because most research supports a fairly
strong relationship between social support and well-king following very challenging
events (Servan-Schreiber, Lin & Birmaher, 1998), it may be important to consider other
explanations for the current findings. It is most likely that the relationship between social
support and happiness has been made spurious by the high loadings of civil war
experiences on the first dimension. It is possible that lower levels of civil war experiences
corresponded strongly to a lower need for social support during the war, resulting in the
lower mean on the first dimension. Altematively, perceptions of low social support at the
time of the conflictcould be associated with more negative perceptions of Vietnam at the
Adjustment after challenging events 61
time of the war, and may related to higher current happiness in Canada as a country of
residence.
Limitations of the current study
Sanrple size and chamcteristics
Although the pattern of associations between variable sets described in redundancy
analysis was suggestive of significant relationships between wartime experiences,
protective factors, and current well-being outcomes, further quantitative analyses showed
consistently small effect sizes assaciated with al1 of the significant multivariate
relationships. Given the large error terms evident in the ANOVA calculations, it is likely
that the sample had insufficient power to detect what might have been significant
population differences.
Given that participants for the study were voluntarily recruited from a senior
citizen's group, a certain segment of the population of Vietnamese-Canadian seniors may
have been oversampled. Even though a number of participants reported clinically
significant symptoms of distress, it may k the case that the current sample represents a
particularly healthy population with relatively high well-king. Indeed, the current study
may have unintentionally excluded those who, because of limitations or heatth concems,
could not participate in the seniors' p u p .
Choiee of measures
Adjusiment after challenging events 62
The selected variables included in the current study accounted for approximately
24% of the variance in well-king and distress outcomes. It is likely that other variables,
such as personality fearures, that would be expected to affect outcome variables, were not
included in the study. With the considerable period of time elapsed since the civil war,
multiple variables would be expected to affect current adjustment. On one hand, it is
important to assess long term responses to stressful events in order to evaluate normative
pmesses of integration and coping. On the other hand, the more remote the event, the
greater the range of intervening variables likely to impact the coping response. It is difficult
to design a study of long - term coping that encompasses the full range of predictive factors,
and particularly when measuns must be trandated, some potentinlly important measures
rnay be sacnficed for the sake of efficiency.
TmnsIrih'on
Although measures were either standardized translations, or translated and backtranslated versions of questionnaires, it is possible that minor translation errors may have
occurred. It may also be the case that subtle nuances of certain common English phrases or
concepts do not iranslate completely into Viemamese, which rnay have changed the implied
meaning of certain questions or phrases.
Participants reported genenlly high levels of well-being outcomes, despite some
clinically significant symptoms of depression. The finding that refugee experiences are
associated with higher distress outcomes is consistent with previous research. The
Adjusûnent after challenging events 63
relationship between more civil war experiences and strong well-king outcomes, on the
other hand, is counter-intuitive. In addition, the association between female gender and
higher happiness, as well as incmased age, higher happiness, and Iower depression is not
typicrtl of the health and coping Litenture. Both larger family size and being rnarried were
also found to be iissociated with higher happiness in the sample.
The pattern of well-king of Lhis particular gmup of participants has implications
for Our understanding of adjustment and health in the elderly. it is signifiant that this
sample has endured exuemely stressful events in the pt,and currently reports high levels
of well-king. This my be a more accurate reflection of expectable well-king outcomes in
community populations. It miiy riiso reflect the adjustment of a parlicularly healthy, socially
active segment of Vietnamese-Candian seniors. In either case, the finding that family size
and marital stritus are related to well-king highlights the importance of close social support
networks ruid social activities for this popuhtion. This suggests thai we may need to shift
the focus of treaiment of distress in elderly Vietnamese-Canadianstowards incorporating
family and community networks.
It also appem that detnographic variables, such as isge and gender, operate
differently thm in Nonh A m r i c m samples. This implies that Our understanding of the
ielationship between certain individual characteristics and welI-king rnay need to account
for both individd and cultuml differences. In other words, effeçtive treatment may need to
recognize and capitalize on the imporiance of specific demographic variables for certain
cultures.
Adjustment after challenging events 64
REFERENCES
Abueg, F.R. & Chun, K.M. (1996) Tnumatization stress among Asians and AsianAmericans. In A.J. Marsella et ai. (Eds.) Ethnocultural aspects of wst-traumatic stress
disorder: issues. research, and clinical aamlications(pp. 285-299). Washington, D.C.:
American Psychological Association.
Alarcon, R.D.,Deering, C.G., Glover, S.G., Ready, D.J.& Eddieman, H.C. (1997).
Should there be a clinical typology of pst-traumatic stress disorder? Australian and New
Zealand Joumal of Psvchiatrv. 31(2), 159-167.
Aldwin, C., Levenson, M. & Spim, A. (1994). Vulnerability and resilience to
combat exposure: can stress have lifelong effects? Psvcholo~vand Aging. 9( 1),34-44.
Beiser, M. & Fleming, S.A. (1986). Measuring psychiatrie disorder among
Southeast Asian refugees. Psvcholo~icalMedicine. 16,627-639.
Berghem, T., Bremner, J.D., Southwick, S.M., Chmey, D.S.& Krystal, J.H.
(1997). Neurobiological perspectives on trauma and aging. Journal of Geriauic Psvchiatry,
30( 1), 27-59.
Berthold, M.S. (1999). The effects of exposure to community violence on Khmer
refugee adolescents. Joumal of Traumatic Stress. 12(31455-471.
Bilodeau, M. & Brenner, D. (1999). Them of multiviate statistics. New York:
Spnnger-Verlag New York, Inc.
Blair, R.G.(2000). Risk factors iissociated with PTSD and major depression among
Cambodian refugees in Utah. Health and Social Work. 25( 1123-30.
.
Adjustment after challenging events 65
Brown, E.S.,Fulton, M.K.,Wilkeson, A. 8t Petty, F. (2000).The psychiatrie
sequelae of civilian trauma. Comorehensive Psyhiatry. 41(11 19-23.
Caihoun, L.G. & Tedeschi, R.G. (1998). Pos~umaticgrowth: future directions. In
R.G. Tedeschi, C.L. Park & L.G.Calhoun (Eds.) Posttraumatic growth: positive changes in
the aftermath of crisis (pp. 213-258). New Jersey: Erlbaum Associates.
Clark, K.K., Bormann, C.A., Cropnzano, R.S. &James, K. (1995). Validation
evidence for three coping measures. JoumaI of Personalitv Assessment. 6332 434-455.
Cliff, N. (1987). Analyin~multiviuiate data. San Diego: Harcourt Bmce
Jovanovich, Publishers.
Cowan, P.A., Cowan, C.P. & Schulz, M.S.(1996).Thinking about risk and
resilience in families. In E.M.Hetherington & E.A. Blechman (Eds.) Stress. coping. and
resiliencv in children and families (pp. 1-38). New Jersey: Lawrence Erlbaum Associates.
Cowan, E., Wyman, P., Work, W. & Parker, G. (1990).The Rochester Child
Resilience Project: overview ruid summary of first year Eindings. Develo~mentand
P s v c h o p a t h o l o ~193-212.
Culbertson, F. (1997). Depression and gender; An international review. American
Psvcholo~ist.
52( 1),25-3 1.
Davidson, J. (2000). Pharmacotherapy of pst-traumatic stress disorder: Treatment
options, long-term foilow-up, and predictors of outcome. Journal of Clinical Psvchiatrv,
6 1(5), 52-59.
Deering, C.G., Glover, S.G., Ready, D., Eddleman, H.C. & Alarcon, R.D. (1996).
Unique patterns of comorbidity in pttraumatic stress disorder from different sources of
trauma. Comorehensive Psvchia-.
37(5), 336-346.
Adjustment dter challenging events 66
Diener, E., Emmons, R., Larsen, R. & Griffin, S. (1985).The Satisfaction with Life
Scale. Journal of Personalitv Assessment. 49,7 1-75.
Dillon, W.R. & Goldstein, M. (1984).Multivariate analysis: Methods and
anplications. New York: John Wiley & Sons.
Engdahl, B.E., Harkness, A.R., Eberly, R., Page, W. & Bielinski, J. (1993).
Structural models of captivity muma, resilience, and trauma response among former
prisoners of w u 20 to 40 years after release. Social Psvchiatrv and Psvchiatric
Epidemioloev. 28, lO9-1 15.
Fairbank, J.A. ,Hansen, D.J. & Fitterling, J.M. (1991).Patterns of appraisal and
coping across different stressor conditions among former prisoners of war with and without
posttraumatic stress disorder. Journal of Consultine and Clinical Psvcholoev.
- - 59(2),274-
281.
Fawzi, M.C., Pham, T., Lin, L., Nguyen, T.V., Ngo, D., Murphy, E. & Mollica, R.F.
(1997). The vaiidity of pst-traumatic stress disorder among Vietnamese refugees. Journal
ofTnumittic101-108.
Flannery Jr., R.B. & Flannery, G.I. (1990).Sense of coherence, life stress, and
psychological distress: a prospective methodological inquiry. Journal of Clinical
Psvcholoev. 46(4B 4 15-420.
Foa, E.B.(2000). Psychosocial treatment of pst-traumatic stress disorder. Journal
of Clinical Psvctiiahy. 61(5143-5 1.
Fonagy, P., Steele, M., Steele, H., Higgitt, A. & Target, M. (1994). The Emanuel
Miller Mernorial Lecture 1992:The theory and pmctice of resilience. Journal of Child
Psvcholoev and Psvchiatrv. 35(2), 23 1-257.
Adjustment after challenging events 67
Fontana, A. & Rosenheck, R. (1994). Traumatic war stressors and psychiatric
symptoms among World War II, Korean, and Vietnam war veterans. Psvchologv and
king. 911L 27-33.
Frye, B.A. (1995). Use of cultural themes in promoting health among Southeast
Asian refugees. American Journal of Health Promotion, 9(4), 269-280.
Gerardi, R., Keane, T.M.,Penk, W. (1989). Utility: sensitivity and specificity in
developing diagnostic tests of combat-related pi-traumatic stress disorder (PTSD).
Journal of Clinical Psvcholo~v,45(51695-703.
Goenjian, A.K., Steinberg, AM.,Najarian, L.M., Fairbanks, L.A., Tashjian, M. &
Pynoos, R.S. (2000). Prospective study of pst-traumatic stress, anxiety, and depressive
reactions after earthquake and political violence. American Journal of Psvchiatrv, 157(65,
895-91 1.
Goldsmith, H.H., Buss, K.A. & Lemery, K.S.(1997). Toddler and childhood
temperament: expmded content, stronger genetic evidence, new evidence for the
importance of environment. Develo~r!Ientûl~svchomthoiogv.33(61891-905.
Green, B.L., Grace, M C ,Lindy, J.D. & Leonad, AC. (1990). Race differences in
response to combat stress. Journal of Traumtic Stress. 3(3), 379-393.
Hauff, E. & Vaglum, P. (1997). Establishing social contact in exile: A prospective
community cohort study of Vietnamese refugees in Norway. Social Psvchiatrv and
Psychiairic E~idemiology,32(7), 408-415.
Hauff, E. & Vaglum, P. (1994). Chronic posttraumatic stress disorder in
Vietnamese refugees. Journal of Nervous and Mental Disease. 182(2), 85-90.
Adjustment after challenging events 68
Hauff, E. & Vaglum, P. (1993). Vietnamese boat refugees: The influence of war
and flight traumatization on mental health on arriva1 in the country of resettlement: A
community cohort study of Vietnamese refugees in Norway. Acta Psvchiatrica
Scandinavia. 88(3), 162-168.
Hinton, L., Jenkins, C.N., McPhee, S., Wong, C., Lai, K.Q.,Le, A., Du, N. &
Fordham, D. (1998). A survey of depressive symptoms among Vietnamese-American men
in three locales. Journal of Newous and Mental Disease. 186(112677-683.
Holtz, T.H. (1998). Refugee trauma versus torture trauma: a retrospective contmlled
cohort study of Tibetan refugees. The Joumal of Nervous and Mental Disease, 186(1 12434.
Humphreys, L., Westerink, J., Giamtano, L. & Brooks, R. (1999). An intensive
treatment program for chronic pst-traumatic stress disorder: 2-year outcome data.
Austdian and New Zealand Joumal of Psvchiatw, 33(6), 848-854.
Israels, A. (1984). Redundancy andysis for qualitative variables. Ps~chometrika,
49132 331-346.
Israels, A. (1987). Redundancy analysis. In Eigenvalue techniaues for aualitaiive
d;ita (pp. 179-222). Leiden: DSWO Ress.
Joseph, S. & Williams, R. (1995). Psychosocial perspectives on pst-traumatic
stress. Clinical Psycholoev Review, 15(6)., 5 15-544.
Joseph, S., Williams, R. & Yule, W. (1993).Changes in outlook following disaster:
the preliminiuy development of a measure to assess positive and negative responses.
Journal of Traumatic Stress. a22 271-279.
Adjustment after challenging events 69
Karel, M.J. (1997). Aging and depression: Vulnerability and stress across
adulthood. Clinical Psvcholorzv Review. 17(8), 847-879.
Keane, T.M. & Wolfe, 1. (1990). Comorbidity in pst-traumatic stress disorder: an
analysis of comrnunity and clinical studies. JournaI of A ~ ~ i i Social
e d Psvchologv, 20,
1776-1788.
Kehn, D.J.(1995). Predictors of elderly happiness. Activities, Ada~tation& Agina
19(3), 11-28.
King, L.A., King, D.W., Fairbank, LA., Keane, T.M.& Adams, G A . ( 1998).
Resilience-recovery factors in pst-traumatic stress disorder among female and male
Vietnam veterans: hardiness, postwar social support, and additionai stressful life events.
e
o
f 420434.
Kinzie, D.J., Manson, S.M., Vinh, D.T.,Tolan, N.T., Anh, B. & Pho, T.N. (1982).
Developrnent and validation of a Vietnarnese-language depression rating scale. Amencan
Journal of Psvchiatrv. 139(1Oh 1276-1281.
Kirmayer, LA. & Young, A. (1998). Culture and somatization: clinical,
epidemiological, and ethnographic perspectives. Psvchosomatic medicine. 60,420-430.
Kishon-Barash, R., Midliusky, E. & Johnson, D.R. (1999). Altruism and the
Vietnam war veteran: The relationship of helping to symptomatology.Journal of Traurnatic
SU~SS.
12(41655-662.
Krell, R. (1993). Child survivors of the Holocaust - strategies of adaptation.
Canadian Journal of Psvchiatrv. 38,384-389.
Adjustment aAer challenging events 70
Lebart, L., Monneûu, A., & Wanvick, K.M. (1984). Multivariate descriptive
statistical analvsis: Comswndence analvsis and ~ l a t e dtechniaues for l m e matrices. New
York: Wiley.
Lee, E. & Lu, F. (1989). Assessment and treatment of Asian-American suwivors of
m s violence. Joumal of Tmumatic Stress. 2( 1),93- 120.
Lewis, C.A., Shevlin, M.E.,Bunting, B.P. & Joseph, S. (1995). Confirmatory factor
analysis of the Satisfaction with Life Scale: replication and methodological refinement.
Perceptual and Motor Skills. 80( 11304-306.
Lyons. J.A. (1991). Stntegies for assessing the patentid for positive adjustment
following trauma. Journal of Tmumatic Stress, 4( 1), 93- 111.
MacDonald, C., Chamberlain, K., Long, N. & Flett, R. (1999).Post-traumatic stress
disorder and interpersonal functioning in Vietnam war veierans: A mediational model.
Journal of Traumatic Stress. 12(41701-707.
Major, B., Richards, C., Cozzarelli, C., Cooper, ML. & Zubek, J. (1998). Personal
resilience, cognitive appraisals, and coping: an integrative mode1 of adjustment to abortion.
Journal of Personalitv and Social Psvcholo~v.74132 735-752.
Mûsten, A.S., Best, K.M. & Garmezy, N. (1990). Resilience and development:
contributions from the siudy of children w ho overcome adversity.Development and
P s v c h o ~ a t h o l 425-444.
o~~
Matsuoka, J. (1993). Demographic characteristics as deierminants in qualitative
difference in the adjustment of Viemamese refugees. Journal of Social Service Research,
17(3L 1-2 1.
Adjustment after challenging events 7 1
McCubbin, H.I., McCubbin, M.A., Thompson, A.I. & Thompson, E.A. (1998).
Resiliency in ethnic families: a conceptual mode1 for predicting family adjustment and
adaptation. In H.I. McCubbin, E.A. Thompson, A.I. Thompson & J.E. Fromer (Eds.)
Resiliencv in Native American and immigrant families (pp. 3-48).Thousand Oaks, C.A.:
Sage Publications.
McGreiil, R. & Joseph, S. (1993).The depression-happinessscale. Psvcholoe;icd
Rewrts. 73, 1279-82.
McKelvey, R. & Webb, J. (1997). Comparative levels of psychological distress in a
pre-migratory tefugee population. Austnlian and New Zealand Journal of Psychiatw. 3 1,
543-548.
McKelvey, R. Webb, J. & Mao, A. (1993).Prernigratory risk factors in Vietnamese
Amernians. Amencan Journal of Ps~chiritrv,150432470-473.
Mghir, R. & Raskin, A. (1999).The psychological effects of the war in Afghanistan
on young Afghan refugees from different ethnic backgrounds. International Joumal of
Social Psvchiatw. 45( 12 29-36.
Michultka, D., Blanchard, E.B. & K;ilous, T. (1998).Responses to civilian wiu
expenences: Predictors of psychological functioning and coping. Journal of Traumatic
Stress. 1 113L 571-577.
Mollica, R.F., Caspi, Y.Y., Bollini, P. & Truong, T. (1992).The Hmiud Trauma
Questionnaire: validating a cross-cultural instrument for rneasunng torture, trauma, and
pst-traumatic stress disorder in Indochinese refugees. The Journal of Nervous and Mental
Disease. 180(2), 1 1 1- 1 16.
Adjustment after challenging events 72
Mollica, R.F., Wyshak, G., Lavelle, J., Tmong, T,Tor, S. & Yang, T.(1990).
Assessing symptomchange in southeast Asian refugee suwivors of mass violence and
torture. American l w d of Psvchiae. 14711 1 83-88.
Mollica, R.F., Wyshak, G.,de-Marneffe, D. & Khuon, F. (1987). Indochinese
-
versions of the Hopkins Symptom Checklist 25 items: A scmning instrument for the
psychiatrie c m of refugees. A
m
e
h
J 87-93.
Nicholson, B.L. (1997). The influence of pre-migrationand post-ernigration
stressors on mentd health: A study of Southeast Asim refugees. Sacial Work Resêarch,
Zlll), 19-3 1.
Ortega, A.N. & Rosenheck, R. (2000). Posttraumatic stress d i s d e r among
Hisprinic Vietnam veterans. Amencan loumal of Psvchiatrv. 157(4), 615-619.
Page, W.F.,
Engdithl, B.E. & Eberly, R.E. (1997). Persistence of PTSD in former
prisoners of war. In C.S.Fullerton & R.J. Ursano (Eds.) Post-traumatic stress dimrder:
acute and long-tenn resrionses to trauma and disaster (pp. 147-158). Washington, D.C.:
American Psychiatrie Press.
Park, CL. (1998).Implications of posttraumatic growth for individuals. In R.G.
Tedeschi, C.L.Park, & L.G. Calhoun (W.)
Positraumtic erowth: psitive changes in the
aftennath of crisis (pp. 154- 177). New Jersey: Lawrence Erlbaum Associates.
Park, CL,Cohen, L.H. & Murch, R.L. (1996). Assessment and prediction of stressrelatedgrowth. Journal of Personalitv. 6 4 1),7 1-105.
Pavot, W. & Deiner, E. (1993). Review of the Satisfaction wiih Life Scale.
Psvchotoeicai Assesment. 5(2),164-172.
Adjustment after chdlenging events 73
Pei, X. & Pillai, V. (1999). Old age support in China: The role of state and the
family. Intemaiional Joumal of Agin~!and Human Develo~ment.49(31,197-212.
Sack, W.H.,Him, C. & Dickrison, D. (1999).Twelve-year follow-up study of
Khmer youths who suffered massive war trauma as chilàren. Joumal of the American
Academv of Child of Adolescent Psvchiatry. 38(9), 1173-1179.
Sack, W.H.,Seeley, J.R. & Clarke, G.N. (1997).Does WSD transcend cultural
biuriers? A study from the Khmer adolescent refugee project. Journal of the American
Academv of Child and Adolescent Psvchiatrv. 36( 1149-54.
Sadavoy, J. (1997).A review of the late-life effects of prior psychological trauma.
American Joumal of Geriatric Psvchiaîry. 5,287-301.
Sagy, S., Antonovsky, A. & Adler, 1. (1990).Explaining life satisfaction in later
life: The sense of coherence model and activity theory. Behavior. Health & Aning. 1( 1), 1 1-
25.
Servan-Schreiber, D., Lin, B.L. & Birmaher, B. (1998).Prevalence of posttraumatic stress disorder and major depressive disorâer in Tibetan refugee children. Journai
of the Arnerican Academv of Child and Adolescent Psvchiatry. 37GL 874-879.
Shalev, A.Y., Freedman, S., Pen, T., Brandes, D., Sahar, T., OIT, S.P.& Pittman,
R.K. ( 1998).Prospective study of pst-traumatic stress disorder and depression following
trauma. Amencan Joumal of Psvchiatrv. 155(5h 630-637.
Shalev, A.Y., Freedman, S., Pen, T., Brandes, D. & Sahar, T. (1997).Predicting
PTSD in tnuma survivors: Prospective evaluation of self-report and clinician administered
instruments. British Joumal of Psvchiatrv. 170,558-564.
Shalev, A.Y., Bonne, O. &EthWS. (19%). Treatment of pst-traumatic stress
disorder: A review. Psvchosornatic Medicine. 58,165-182.
Silove, D., Sinnerbrink, I., Field, A., Manicavasagar, V. & Steel, 2.(1997).
Anxiety, depression, and PTSD in asylum-seekers: Associations with pre-ernigration
trauma and pst-emigration stressors. British Journal of Psvchiatrv. 170C42 351-357.
Smith-Friwzi, MC, Murphy, E., Pham. T., Lin, L., Poole, C. & Mollica, R.F.
(1997). The validiiy of screening for pst-irautnatic stress disorder and major depression
and Vietnamese former political prisonen. Acta Psvchiatrica Scandinavica, 95(2), 87-93.
Solomon, S. & Davidsun J. (1997). Trauma: Revalence, impaiment, service use,
and cost. Journal of Clinical Psvchiaiw. 58(Su~ol.9 1 5-1 1.
Spasojevic, J., Heffer, R.W.& Snyder, D. K. (2000). Effects of pst-traumatic smss
and acculturation on marital functioning in Bosnian refugee couples. Journal of Traumatic
Stress. 1W),
205-217.
Spiro, A., Schnurr, P. & Aldwin, C. (1997). A life-span perspective on the effects of
rnilitary service. Journal of Geriatric Psvchiatrv. 30( 1),9 1- 128.
Spiro, A., Schnurr, P. & Aldwin, C. (1994). Combat related posttraumatic stress
disorder symptoms in older men. Psycholo~vand Agine. 9(12 17-26.
Steiner, A., Raube, K., Siuck, A.E., Aronow, H.U., Draper, D., Rubenstein, L.Z. &
Beck, J.C. (1996). Measunng psychosocial aspects of well-king in older comunity
residents: performance of four short scales. The Gerontologist. 36( 1 154-62.
Taft, C.T., Stem,A.S., King, LA. & King, D.W.(1999). Modeling physical hedth
and functional hedth status: The role of combat exposure, pst-traumatic stress disorder
and personal resouce attributes. Journal of Traumatic Stress. 12111 3-23.
Adjusbnent after challenging events 75
Tedeschi, R.G.& Calhoun, L.G.(19%). The Post-traumatic Growth Inventory:
Measuring the positive legacy of trauma. Joumal of Traumatic Stress. 9(3),455-472.
Tran, T.V. (1993). Psychological traumas and depression in a sarnple of Vietnamese
people in the United States. Health & Social Work. 18(3), 184-194.
Wagner, A.W., Wolfe, J., Rotinsky, A., Proctor, S.P. & Erickson, D.J. (2000). An
investigation of the impact of pst-traumatic stress disorder on physical health. Journal of
Traumatic Stress, 13(1),41-55.
Weintraub, D. & Ruskin, P.E.(1999). Posttraumatic stress disorder in the elderly: A
review. Harvard Review of Psvchiatrv. 7,144-152.
Wilson, B.J. & Gottman, J.M.(19%). Attention - the shuttle between emotion and
cognition: risk, resiliency, and physiological bases. In E.M.Hetherington & E.A. Blechman
(Eds.) Stress, co~ingand resiliency in children and families (pp. 189-228).New Jersey:
Lawrence Erlbaum Associates.
Wilson, J.P. & Moran, T.A. (1998). Psychological trauma: Post-tnumtic stress
disorder and spirituality.Journal of Psvcholoev and Theology. 26(2), 168- 178.
Wollenberg, A.L. (1977). Redundancy analysis: An aitemative for canonical
correlation analysis. Psvchometrika. 42(2&207-22 1.
Ying, Y. & Aksutu, P.D. (1997). Psychological adjustment of southeast Asian
refugees: the contribution of sense of coherence. Journril of Cornmunitv Psvcholo~v.2X21
125-139.
Zemore, R. & Shepel, L.F. (1989). Effects of breast cancer and mastectomy on
emationril support and adjustment. Social Science and Medicine, 28(12 19-27.
Adjustment after challenging events 76
Appenàii 1: Questions awedng wartime experiences
1. How many distressing events did you:
Hear about during the conflict in Vietnam?
1
2
3
ne
vciy few
mmt
Wimess during the conflict in Vietnam?
1
2
3
Ilme
very rw
solne
Experience during the conflicf in Vietnam?
1
2
3
none
very few
YMT
2. How strong was your:
Physical distress as a resuli of those events?
1
2
3
mnr
ramcwhai s m g
Emotional distress as a result of those events?
1
2
3
none
wmwhpiymwig
5
vrry smng
5
very stmng
Adjustment after challenging events 77
Appendlx 2: Questions assesslngIeveis of protecîive factors
Did you feel prepared for what happened in Vietnam?
1
2
3
4
no. noiiuall
5
~cs."eryprcpiirrJ
At the time in Vietnam, could you see a go& reason for the war?
1
2
3
4
y=.
no. noi m oll
Can you see a reason for that war, looking back?
1
2
3
4
g m d rcaron
5
yes. a v a y g d mrwn
no. nnt iu $1
Perceived level of s
5
O very
i i m
At the time you were in Vietnam, did your family help you to cope with what was
happening?
1
2
3
4
5
yu. vrry r w h
W. IWW PL uII
At the time you were in Vietnam, did your community help you to cope with what was
happening?
1
2
3
4
5
no, niiiu $1
p.very mich
At the time yau were in Vietnam, did your religion or spiritual faith help you to cope with
what was happening?
1
2
3
4
5
yts, vciy much
no, nef af dl
Did you find enough support from others when you came to Canada?
1
2
3
4
5
ycs, vciy much
no.rociu;i11
Immigration
exwriences
Did your immigration to Canada help you to cope with what happened?
1
2
3
4
5
ycs. vciy mwh
no. MC iu dl
How difficult was immigration to Canada?
1
2
3
4
Did you feel that immigration was your only choice?
1
2
3
4
4
al1 the timc
How easy was it to find employment in Canada?
1
2
3
my ==Y
5
no. 1h;d &r choices
yes. it w;r~ihr only choicc
Do you regret your immigration to Canada?
1
2
3
5
midificult
v a y diffiiulf
5
never
4
5
vcry diflieulf
Adjusrment after challenging events 78
Appendix 3: Examples of outcorne measwes
Hopkins Symptom Checklist, Indochinese Version (Mollica et d.,1992)
Anxiety symptoms:
2. Feeling fearful:
5. Trembling:
Depression symptoms:
13. Crying easily:
18. Feeling blue:
not at al1
2
a little
3
quiie a bit
1
not at al1
2
a little
quite a bit
extremely
1
not at al1
2
a little
3
quite a bit
4
extremely
1
not at riIl
2
a litîle
3
quite a bit
L
4
extremely
3
4
4
extremely
Changes in Outlook Scale (Joseph et al., 1993).
Positive chimges:
5.1 value my relationships much more now.
1
2
3
s m g l y âiigme
13.1 have greater faith in human nature now.
1
2
3
5
Negative changes:
9.1fear death very much now.
1
2
6
suongly ü g m
rimngly diagicc
3
- % I Y &grce
15.1 desperately wish 1 could tum the dock back before it happened.
1
2
3
4
5
s m g l y lliim
The Satisfaction Wirh Life Sirwey (Diener et al., 1985).
1 = Strongly disagree
2 = Disagree
3 = Neither agree nor disagree
4 = Agree
5 = Strongly agree
1. In most ways, my life is close to my ideal.
2. The conditions of my life are excellent.
3.1 am satisfied with my life.
4. So far, f have gdten the important things 1 want in life.
5. If I could Live mv life over. 1 would change almost nofhing.
Adjustment &r challenging events 79
Questions assessing current personal and familial happiness.
How happy are you now?
1
2
whippy u
l
How happy are your childien?
1
2
-happy
3
aiail
How happy are your grandchildren?
1
2
3
noi happy )idl
How would you rate the happiness of your frunily?
1
2
3
noihappyudl
How important is your farnily's happiness to you?
1
2
3
na4 imptnîmt ît îII
Adjustment after challenging events 80
Appendix 4: One-way Analysis ofVariance tables for age and gender Weronccs
Age differences acmss variables
Variable group
F-value
p-level of significance
Age vs.
Exposure to wartime events
Migration ris a refugee
Spending time in a refugee
Camp
Age vs.
Events heard about
Events witnessed
Events experienced
Physical distress
Emotional distress
Age vs.
Sense of preparation
Perceived support
immigration experiences
Age vs.
HSCL - 25 (anxiety)
HSCL - 25 (depression)
CIO (positive)
CIO (negative)
SWLS
Happiness
3.91
O.OO*
Note: Bonferroni correction applied for ANOVA for each variable group.
* p c O.ûû8
Adjustment after chdlenging events 81
Variable p u p
Gender vs.
Enduring civil w x experiences
F-value
plevel of significance
Refugee migration
Refugee camps
Gender vs.
Events heard about
Events witnessed
Events experienced
Physical distress
Emotional distress
Ge~idervs.
Sense of preparation
Perceived support
Immigration cxperiences
Gender vs.
HSCL - 25 (anxiety)
HSCL - 25 (depression)
CIO (positive)
CIO (negative)
SWLS
Happiness
4.90
0.03
* Note: Bonferroni correction applied for AVONA for each variable group
Adjustment after challenging evenis 82
Appendix 5: H i i m for sense of preparedness,perceived support, and
immigration experiences, respectively
SENSPREP
SUPPORT