Introduction to Thesis
PREDICTING SUBJECTIVE QUALITY OF LIFE:
THE CONTRIBUTIONS OF PERSONALITY AND PERCEIVED CONTROL
By
Rachel Cousins
B.B.Sc. Hons
Submitted in fulfilment of the requirements for the degree of
Doctorate of Psychology (Clinical)
Deakin University
October 2001
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|CANDIDATE DECLARATION | |
I certify that the thesis entitled:
Predicting Subjective Quality of Life: The Contributions of Personality and Perceived Control
submitted for the degree of Doctor of Psychology (Clinical) is the result of my own research, except where otherwise acknowledged, and that this thesis in whole or in part has not be submitted for an award, including a higher degree, to any other university or institution.
Full Name: RACHEL LOUISE COUSINS
Signed: ………………………………….
Date: ………………………………….
ACKNOWLEDGEMENTS
I would firstly like to acknowledge the support and encouragement of my family and friends. Thank you to my partner, Ashley, the last three years would not have been possible without his love and support. Thank you to my mother for her constant prayers, and thank you to my Grandmother, who frequently has me in her thoughts. Thank you to Alana for her support throughout my tertiary education and for all those lessons in grammar. Thank you also to Garrick for proof reading the final copy. I would also like to thank my classmates and friends who have been a great support over the years, and never seem to tire of listening to me talking about my studies.
This project could not have been undertaken and completed without the guidance of my supervisor, Professor Bob Cummins, whose positivity was a great source of motivation. Thank you.
I would also like to thank the contribution of the Schizophrenia Fellowship of Victoria and all the carers who, despite their burden, found time to participate in the study. Thank you also to the schools involved for providing me with access to participants. To all the participants who completed the questionnaires, thank you for your contribution.
Finally, thank you to all those who over the past ten years have inspired me to study psychology.
ABSTRACT
Subjective quality of life is remarkably stable within populations and it has been proposed that this us due to the operation of a homeostatic system. It has been proposed also that central to the operation of such homeostasis, and the key to system stability, is the strong relationship between subjective quality of life and personality. This prompts questions about what other psychological processes are involved in this relationship, and the literature indicates that perceived control has important links to both constructs. Hence, in order to develop further understanding about these relationships, this research primarily examines the relationships between personality, conceptualised as extroversion and neuroticism, perceived control, conceptualised as approach control and avoidant control, and subjective quality of life. Two linked studies are described.
The first examines these relationships in a sample of carers of people with mental illness, in comparison with a sample of people from the general population who do not care for someone with a disability. It was found that carers had significantly lower subjective quality of life, particularly in the domains of health and emotional well-being, significantly lower approach control and extroversion, and significantly higher neuroticism, than the comparison sample. In the carer sample, regression analyses showed that with all variables in the equation, neuroticism, approach control and avoidant control significantly predicted subjective quality of life, whilst extroversion made no significant contribution to the equation. Additionally, neuroticism significantly predicted approach control. In the comparison sample, regression analyses showed that with all variables in the equation, only approach control significantly predicted subjective quality of life, whilst neuroticism, extroversion and avoidant control made no significant contributions to the equation. Additionally, neuroticism significantly predicted approach control. It was concluded that when subjective quality of life homeostasis is being challenged, as in the carer sample, its maintenance becomes more complicated.
The second study examines these relationships in a sample of public secondary school teachers, in comparison with a sample of people from the general population. There were no significant differences between the two samples, therefore the samples were combined. The results of the regression analyses showed that with all variables in the equation, neuroticism and approach control significantly predicted subjective quality of life, whilst avoidant control approached significance and extroversion made no significant contribution to the equation. Additionally, neuroticism significantly predicted avoidant control and extroversion significantly predicted approach control. It was concluded that extroversion and approach control together impact positively on subjective quality of life and neuroticism and avoidant control together impact negatively on subjective quality of life. Moreover, further support was given for the conclusion that when subjective quality of life homeostasis is being challenged its maintenance becomes more complicated.
Overall, there is some support for a model whereby personality, primarily neuroticism, and perceived control, primarily approach control, contribute to subjective quality of life. Furthermore, the three samples used in this research represent different levels of subjective quality of life. The comparison sample in Study One had high normal subjective quality of life, the combined sample in Study Two had normal subjective quality of life and the carer sample in Study One had low normal subjective quality of life. The resultant model of relationships for each of these samples demonstrates that the management of subjective quality of life homeostasis becomes more complicated as it is challenged.
TABLE OF CONTENTS
CHAPTER 1 1
1 INTRODUCTION TO STUDY ONE 1
1.1 SUBJECTIVE QUALITY OF LIFE 2
1.1.1 The historical development of life quality research 2
1.1.2 Definitions of various indicators of life quality 3
1.1.3 The definition and measurement of subjective quality of life 5
1.1.4 Conclusion 7
1.2 PERSONALITY 8
1.2.1 Introduction 8
1.2.2 The relationships between extroversion and neuroticism, positive and negative affect, and life quality 9
1.2.3 The relationships between personality and other psychological processes that may impact on subjective quality of life 11
1.2.4 Conclusion 13
1.3 PERCEIVED CONTROL 14
1.3.1 Introduction 14
1.3.2 Developing a definition of primary and secondary control 15
1.3.3 Addressing the interaction between primary and secondary control 17
1.3.4 The literature on primary, secondary and relinquished control,and various indicators of well-being 20
1.3.5 The measurement of primary, secondary and relinquished control 21
1.3.6 Conclusion 23
1.4 INTEGRATING PERSONALITY, PERCEIVED CONTROL AND SUBJECTIVE QUALITY OF LIFE 23
1.4.1 Maintaining subjective quality of life 23
1.4.2 Rationale for a hypothesised model of personality, perceived control and subjective quality of life 25
1.4.3 Focus of the current research 27
1.5 SUBJECTIVE QUALITY OF LIFE: CARERS OF PEOPLE WITH MENTAL ILLNESS 28
1.5.1 The historical development of research into carers of people with mental illness 28
1.5.2 The impact of the caregiving role on subjective quality of life 29
1.5.3 The role of perceived control in coping with the impact of mental illness on the family and maintaining subjective quality of life 34
1.5.4 Conclusion 37
1.5.5 Focus of the current research 37
CHAPTER 2 39
2 STUDY ONE: AIMS AND HYPOTHESES 39
CHAPTER 3 40
3 STUDY ONE: METHOD 40
3.1 Sample 40
3.2 Procedure 41
3.3 Measurement Tools 42
CHAPTER 4 44
4 STUDY ONE: RESULTS 44
4.1 Aim One 44
4.2 Descriptive information 47
4.3 Aim Two 51
4.4 Aim Three 53
CHAPTER 5 58
5 STUDY ONE: DISCUSSION 58
5.1 Aim One 58
5.2 Aim Two 59
5.3 Aim Three 63
5.4 Summary 66
CHAPTER 6 68
6 INTRODUCTION TO STUDY TWO 68
6.1 APPROACH AND AVOIDANT DIMENSIONS OF PERCEIVED CONTROL 69
6.1.1 Theoretical support for approach and avoidant control 69
6.1.2 Empirical support for approach and avoidant control 71
6.1.3 The measurement of approach and avoidant control 74
6.1.4 Conclusion 76
6.2 PERSONALITY, APPROACH AND AVOIDANT CONTROL AND SUBJECTIVE QUALITY OF LIFE 76
6.2.1 The literature on approach and avoidant control and subjective quality of life 76
6.2.2 The findings from Study One on approach and avoidant control and subjective quality of life 78
6.2.3 Personality and approach and avoidant control 80
6.2.4 Integrating personality, approach and avoidant control and subjective quality of life 81
6.2.5 Focus of the current research 82
6.3 SUBJECTIVE QUALITY OF LIFE IN SECONDARY SCHOOL TEACHERS 82
6.3.1 The stressors associated with teaching 82
6.3.2 The impact of stress on teachers' subjective quality of life and the role of coping strategies 83
6.3.3 Conclusion and focus of the current research 85
CHAPTER 7 87
7 STUDY TWO: AIMS AND HYPOTHESES 87
CHAPTER 8 88
8 STUDY TWO: METHOD 88
8.1 Sample 88
8.2 Procedure 89
8.3 Measurement Tools 90
CHAPTER 9 92
9 STUDY TWO: RESULTS 92
9.1 Aim One 92
9.2 Aim Two 97
9.3 Aim Three 100
9.4 Additional analyses 102
CHAPTER 10 105
10 STUDY TWO: DISCUSSION 105
10.1 Aim One 105
10.2 Aim Two 106
10.3 Aim Three 107
10.4 Additional analyses 110
10.5 Summary 110
CHAPTER 11 112
11 SYNTHESIS AND CONCLUSIONS 112
12 REFERENCES 118
13 APPENDICES 129
Appendix A: Information Letter for Questionnaire 1
Appendix B: Questionnaire 1
Appendix C: Information Letter for Questionnaire 2
Appendix D: Questionnaire 2
Appendix E: Scales and Items of the Coping Responses Inventory
TABLE OF FIGURES
Figure 1: The direct and indirect prediction of subjective quality of life (SQOL) by personality and perceived control. 25
Figure 2: Hypothesised model of subjective quality of life, personality and perceived control. 27
Figure 3: Model of the significant relationships among the variables neuroticism, approach control, avoidant control and total subjective quality of life (SQOL) in the carer sample, including standardised regression coefficients and correlations. 64
Figure 4: Model of the significant relationships among the variables neuroticism, approach control, avoidant control and total subjective quality of life (SQOL) in the carer sample incorporating a latent construct for perceived control. 65
Figure 5: Model of the significant relationships among the variables neuroticism, approach control and total subjective quality of life (SQOL) in the comparison sample, including standardised regression coefficients. 65
Figure 6: Model of the significant relationships among the variables, neuroticism, extroversion, approach control, avoidant control, and total subjective quality of life (SQOL), in the combined sample, including standardised regression coefficients and correlations. 108
Figure 7: Model of the significant relationships among the variables for the comparison sample in Study One, representing high normal subjective quality of life (reproduction of Figure 5). 115
Figure 8: Model of the significant relationships among the variables for the combined sample in Study Two, representing normal subjective quality of life (reproduction of Figure 6). 116
Figure 9: Model of the significant relationships among the variables for the carer sample, representing low normal subjective quality of life (reproduction of Figure 3) 116
TABLE OF TABLES
Table 1: Demographic information. 41
Table 2: Two factor solution for the Perceived Control Questionnaire, with primary control items
(PC) and secondary control items (SC) identified. 46
Table 3: Means (M), standard deviations (SD) and bi-variate correlations for the variables total subjective quality of life (SQOL), approach control, avoidant control, neuroticism and extroversion for the carer sample and the comparison sample. 48
Table 4: Multivariate Analysis of Variance examining the differences between the carer and comparison samples for the variables: total subjective quality of life (SQOL), approach control, avoidant control, neuroticism and extroversion. 50
Table 5: Multivariate analysis of covariance with group (carer or comparison) as the independent variable, the seven SQOL domains as the dependent variables, and neuroticism and extroversion as the covariates. 53
Table 6: Regression of neuroticism, extroversion, approach control and avoidant control on subjective quality of life in the carer sample 54
Table 7: Regression of neuroticism, extroversion, approach control and avoidant control on subjective quality of life in the comparison sample. 55
Table 8: Regression of neuroticism and extroversion on approach control and avoidant control
for the carer sample. 56
Table 9: Regression of neuroticism and extroversion on approach control and avoidant control for the comparison sample. 57
Table 10: Background information. 89
Table 11: Description of the scales in the Coping Response Inventory 91
Table 12: Means, standard deviations (SD) and internal consistencies (Alpha) of the Coping
Responses Inventory 96
Table 13: Factor solution for the eight scales of the Coping Responses Inventory. 97
Table 14: Means (M), standard deviations (SD) and bi-variate correlations for the variables
subjective quality of life (SQOL), approach control, avoidant control, neuroticism and extroversion for the combined teacher and comparison sample (n=171). 99
Table 15: Regression of neuroticism, extroversion, approach control and avoidant control on subjective quality of life in the combined sample 101
Table 16: Regression of neuroticism and extroversion on approach control and avoidant control
for the combined sample. 102
Table 17: Means, standard deviations and bi-variate correlations for the variables subjective quality
of life (SQOL), approach control, avoidant control, neuroticism and extroversion for the two subgroups, high and low subjective quality of life. 103
Table 18: Multivariate Analysis of Variance examining the differences between the subgroups, high and low subjective quality of life, for the variables approach control, avoidant control, neuroticism and extroversion. 103
CHAPTER 1
INTRODUCTION TO STUDY ONE
The focus of Study One is to develop understanding of how subjective quality of life is maintained. The relevant literature is first reviewed. This begins by tracing the development of the subjective quality of life concept and evidence that this variable is actively maintained. Following this, the psychological processes that may contribute to the maintenance of subjective quality of life are considered. The literature indicates that personality and perceived control are important processes to consider. In particular, the personality characteristics extroversion and neuroticism have been consistently shown in the literature to predict various concepts of subjective life quality. Perceived control is also indicated in the literature to have a predictive relationship with subjective quality of life. Perceived control is conceptualised as involving primary, secondary and relinquished control processes. A model of personality, perceived control and subjective quality of life is then proposed.
The population selected to be the focus of Study One is carers of people with mental illness. Carers make an informative population in which to investigate these three variables, as they are likely to have low subjective quality of life and may be vulnerable to losses in perceived control. Hence, the stress and coping literature on carers is also reviewed. This introductory section of Study One concludes with a brief statement concerning the focus of the current research.
The aims and hypotheses highlight the three parts of the study: 1) an investigation of the factor structure of perceived control, 2) an investigation of the differences between samples of carers of people with mental illness and people from the general population, and 3) an examination of the relationships between personality, perceived control and subjective quality of life. The method section provides information about the characteristics of the two samples, the recruitment procedures and the measurement tools used. The results and discussion sections reflect the three parts of the aims and hypotheses. The results are discussed in comparison with the literature and preliminary conclusions are drawn.
1 SUBJECTIVE QUALITY OF LIFE
1 The historical development of life quality research
The quality of life concept arose from research in America on social indicators. In the 1960’s it became evident that, in order to facilitate broader analyses of the costs and benefits of various programs and policies, there was a need to develop a means for assessing social change beyond that afforded by the economic indexes already monitored (Land, 1999). Influential publications, such as “Toward a Social Report” by the Johnson administration (1969; cited in Land, 1999), addressed major social issues, such as health, income, safety, education etc., and introduced the idea of systematically reporting the state of these issues for the purpose of informing the public. These initial social indicators were objectively measured and reflected normative interest in populations or groups, such as unemployment rates or mortality rates. Then, in the 1970’s the social indicators movement gathered pace. It was at this time the concept of measuring individuals' subjective judgements of their own well-being was introduced in published works such as those by Andrews and Withey (1976), and Campbell, Converse and Rodgers (1976). The movement then slowed in the political climate of the 1980’s in America, but research on subjective quality of life had been launched as the subjective indicator of social change (Land, 1999).
From this point it was recognised that economic growth at the population level was not necessarily the only valid goal of societal progress and that the subjective life quality of populations was also a valid and relevant goal (Shea, 1976). The measurement of social indicators became focused on understanding individuals’ feelings of satisfaction with life-as-a-whole or with a number of relevant areas or domains, such as family, housing etc. It has now become well accepted that both objective variables and subjective variables are important social indicators and a large volume of research around these concepts has now developed (Cummins, 1997a).
2 Definitions of various indicators of life quality
Definitions of subjective well-being, life satisfaction, subjective quality of life are somewhat confused in the literature. For the purpose of this thesis, the following taxonomy will be adopted.
Subjective well-being is considered to have two components: a cognitive judgement of life satisfaction and an evaluation of affect (Diener, 1998). Measures of subjective well-being usually reflect these two parts. The first part, life satisfaction, can be measured in two ways. It can be measured with one question, which asks the respondent “How do you feel about your life as a whole?” (Andrews & Withey, 1976). Alternatively, it can be measured with a series of questions that gauge the respondent’s satisfaction with a variety of different life domains. However, the unitary approach to measuring life satisfaction is limited, as it yields only a crude measure of perceived well-being that lacks the variety of information about various aspects of life that a domain-based measure of life satisfaction can provide. The domain-based measure of life satisfaction is often referred to in the literature as subjective quality of life and the specific domains measured vary. Extensive argument and evaluation of the life domains that should be included in the measurement of subjective quality of life has been provided by Cummins (1997a) and will be detailed shortly.
The second part of the subjective well-being construct involves an affective evaluation. This evaluation usually comprises a measure of positive and negative emotional feelings. Yet, there are problems with the definition and measurement of positive and negative affect. The debate, over whether positive and negative affect should be viewed as bipolar opposites of the one construct or two independent constructs, is ongoing. Russell and Carroll (1999) give a detailed account of this debate and some steps towards resolution. They propose a circumplex model of positive and negative affect that incorporates six clusters of affect items defined by valence and activation. These include, positive affect/high activation (eg. excited, elated, ebullient) opposed by negative affect/low activation (eg. depressed, bored, lethargic), positive affect/medium activation (eg. happy, pleased, content) opposed by negative affect/medium activation (eg. miserable, unhappy, discontent), and positive affect/low activation (eg. calm, serene, tranquil) opposed by negative affect/high activation (eg. tense, nervous, upset). This model highlights a glaring deficiency in the measure of positive and negative affect by the Positive Affect and Negative Affect Schedule (Watson, Clark & Tellegen, 1988), which is commonly used when evaluating subjective well-being. This measure evaluates only positive affect/high activation and negative affect/high activation, leaving out the range of low activation emotions that are potentially important when considering subjective well-being. The usefulness of this circumplex model of affect is highlighted by Larsen and Diener (1992), who also point out that those researchers who use the Positive Affect and Negative Affect Schedule may not be investigating the particular emotion concept that they hope to. Hence, whilst the definition of subjective well-being is clear, as life satisfaction plus affect, its operationalisation is complicated.
A further problem with subjective well-being is that it is often confused in the literature with other terms such as psychological well-being and happiness. For example, Friedman (1993) and Francis (1999) both measure subjective well-being but refer to their measured constructs as psychological well-being and happiness respectively. More accurately, psychological well-being is a term used to reflect measures of psychological symptoms such as depression and anxiety, in conjunction with measures of life satisfaction and in some instances positive and negative affect. For example, Lipkus, Dalbert & Seigler (1996) use measures of depression, stress and life satisfaction to reflect psychological well-being. Happiness is a term more accurately used to describe a balance of positive and negative affect. For example, Mroczeck and Kolarz (1998) measure happiness using positive and negative affect, while Costa and McCrae (1980) measure happiness using the difference between positive and negative affect.
In summary, subjective well-being provides a higher order construct than subjective quality of life by incorporating life satisfaction plus positive and negative affect. However, subjective quality of life can provide a construct that is similar to subjective well-being when satisfaction with emotional well-being is included in the life domains, making an additional measure of affect unnecessary. Furthermore, the definition and measurement of positive and negative affect, commonly used in the measurement of subjective well-being, is deficient in the range of emotions encompassed as it often only measures positive affect/high activation and negative affect/high activation. Also the construct of subjective well-being is often confused in the literature with psychological well-being and happiness. This makes subjective quality of life a more attractive measure than the popularly used and confused subjective well-being.
To recap the terms used in this thesis:
• Subjective well-being will be used to refer to composite measures of life satisfaction and affect.
• Subjective quality of life will be used to refer to measures of life satisfaction involving several life domains.
• Life satisfaction will be used to refer to measures of life satisfaction derived from one global question.
3 The definition and measurement of subjective quality of life
The definition and measurement of quality of life has been comprehensively developed by Cummins (1997a):
Quality of life is both objective and subjective, each axis being the aggregate of seven domains: material well-being, health, productivity, intimacy, safety, community and emotional well-being. Objective domains comprise culturally relevant measures of objective well-being. Subjective domains comprise domain satisfaction weighted by their importance to the individual. (p. 132)
This definition is consistent with the Comprehensive Quality of Life Scale (ComQol) also developed by Cummins (1997b) and thus warrants further explanation.
Firstly, this definition highlights an important difference between objective and subjective quality of life. Objective quality of life is measured using sources of information external to the individual. For example, income or physical health. In contrast, subjective quality is measured using the individual as the source of information. For example, the individual may be asked how satisfied they are with their income or health. The degree to which these two constructs are interrelated has long been debated (Andrews & Withey, 1976; Felce & Perry, 1995). But, there appears to be a general consensus that the two are generally unrelated, as satisfaction with life is considered a separate and more important indicator of individual welfare (Edgerton, 1990).
Secondly, this definition specifies seven domains, material well-being, health, productivity, intimacy, safety, community and emotional well-being, of which quality of life is the aggregate. These seven domains represent the common areas of life used in the literature to measure quality of life. Four of these domains were shown by Campbell, et al. (1976) to be those rated as the most important of a larger set of domains found most consistently in the literature. Their results showed subjects rated most importance, expressed as a percentage, for Health 91%, Intimacy 89%, Material Well-being 73%, and Productivity 70%. In a review of fifteen key literature sources, Felce and Perry (1995) found these four domains plus emotional well-being to be the most commonly used domains of life quality. Hence, five of the seven domains used in the definition have been consistently used in the literature and are considered important aspects of life.
The two additional domains, safety and place in community, have been included to encompass a broader range of life domains. The domain ‘safety’ is intended to be inclusive of such constructs as security, personal control, privacy, independence, autonomy, competence, knowledge of rights and residential stability. Aspects of this domain are encompassed by Felce and Perry’s (1995) conceptualisation of material well-being, whereby, security is considered to be related to income, stability of tenure and housing. However, it is often included as a separate domain in the literature (Borthwick-Duffy, 1990; Schalock, Kieth, Hoffman & Karan, 1989; Stark & Goldsbury, 1990). The domain ‘place in community’ is intended to be inclusive of the constructs of (objective) social class, education, job status, community integration, community involvement and (subjective) a sense of self-esteem, self-concept and empowerment within the community, in addition to feelings associated with the objective components. Aspects of this domain are encompassed by Felce and Perry’s (1995) conceptualisation of social well-being. However, Cummins (1997a) has specified the two aspects of social well-being, intimacy and place in community, as two separate domains, which is often done in the literature (Borthwick-Duffy, 1990; Schalock, et al., 1989; Stark & Goldsbury, 1990). With these seven domains included, the definition and measurement of quality of life effectively covers a broad spectrum of life quality.
Lastly, this definition introduces the notion that subjective quality of life should be measured with reference to the value or importance that the domain has to the relevant individual. This notion, that subjective quality of life refers to the subjective evaluations of various domains weighted by a personal set of values, has been supported theoretically (Felce & Perry, 1995; Cummins, 1997a) and more recently the important role of values has been demonstrated empirically by Oishi, Diener, Suh, and Lucas (1999). These authors found that values mediated the relationship between domain satisfaction and life satisfaction. Using regression analysis they found that the stronger the values of achievement, the stronger the relation between satisfaction with grades and global life satisfaction. Similarly, the stronger the benevolence values are, the stronger the relation between satisfaction with social life and life satisfaction, and the stronger the conformity values, the stronger the association between satisfaction with family and life satisfaction. The appeal of this ‘satisfaction weighted by importance’ definition is obvious. Most people would not value each domain equally and those domains that they do value more will have a greater impact on how satisfied they are with life. Hence, the ComQol provides a score of subjective quality of life for each domain which is the product of item importance by satisfaction, and the seven domains can be summed together to provide an overall score of life satisfaction (Cummins 1997b).
4 Conclusion
Historically, social indicators have been developed to evaluate the effectiveness of programs and policies by using objective and subjective indicators to describe populations and monitor change within them. The definition and measurement of social indicators is complex and can involve a number of terms and concepts. One of these is subjective quality of life conceptualised as the product of seven domains and involving domain satisfaction weighted by importance (Cummins, 1997a, 1997b). This construct is similar in nature to the more popular subjective well-being but does not incorporate some of the problems associated with the operationalisation of subjective well-being. In particular it avoids the problems of measuring separately positive and negative emotional feelings.
With subjective quality of life established as a valid and useful social indicator, it then becomes important to better understand this measure by considering the psychological processes that contribute to an individual's satisfaction with different areas of their life. The notion that subjective quality of life is remarkably stable within populations (a point that will be later elaborated) indicates that personality, also a stable psychological process, may play an important role in the maintenance of subjective quality of life.
2 PERSONALITY
1 Introduction
There is substantial evidence that subjective well-being is predicted by personality. For the purposes of empirical research, personality refers to “characteristic response tendencies” which are considered to have both “biological and learned components” (Diener, 1998, p. 314). It is thought that around 50 percent of personality variance is attributed to genetic variance and around 30 percent is attributed to environmentally based trait variance (or learned) with the remainder attributable to measurement error (Tellegen, et al., 1988).
The evidence that personality predicts subjective well-being across time and situations has been used to support the causal role in the relationship between personality and subjective well-being (Diener, 1998). This however is questioned by those who argue that subjective well-being is, in fact, a personality trait itself (Lykken & Tellegen, 1996). Evidence from twin studies has suggested that about 80 percent of the stable variance in subjective well-being is heritable (Lykken & Tellegen, 1996). However, the most compelling argument against the notion that subjective well-being is a personality trait is that it is variable in the short-term (Diener, 1996). It has been found that major life events impact on subjective well-being for up to three months, after which subjective well-being returns to a baseline measure (Suh, Diener & Fujita, 1996). It is also argued by Diener (1996) that trait explanations of psychological constructs like subjective well-being are not sufficient, because they do not provide any understanding about the process by which traits influence subjective well-being.
However, before examining other psychological processes, it is first necessary to develop a better understanding of the relationship between personality and various constructs of life quality by considering how personality is commonly measured.
2 The relationships between extroversion and neuroticism, positive and negative affect, and life quality
A popular typology of personality traits is the five-factor model (Goldberg, 1992). These factors are neuroticism, extroversion, openness to experience, agreeableness and conscientiousness, and they have been substantiated extensively in the literature (Costa & McCrae, 1998). Yet, investigations have shown that it is extroversion and neuroticism that provide the most pervasively significant correlations with subjective well-being. Extroversion and subjective well-being correlate positively ranging from .35 to .49; and neuroticism and subjective well-being correlate negatively ranging from -.31 to -.57 (Costa & McCrae, 1980; Francis, 1999; Francis, Brown, Lester & Philipchalk, 1998; Lu & Shih, 1997). Similarly, a few researchers have investigated the relationship between extroversion and neuroticism, and subjective quality of life or life satisfaction. Morrison (1997) did this with a sample of business owners and Heaven (1989) with a sample of adolescents. The correlational results between life satisfaction and extroversion were .31 and .17, and neuroticism were -.44 and -.37, for the two studies respectively (Morrison, 1997; Heaven, 1989).
Furthermore, it is extroversion and neuroticism that have received long standing support in many typological conceptualisations of personality, including Eysenck’s factor analytic research (Eysenck & Eysenck, 1985). They are popularly conceptualised in terms of sociability (extroversion) and emotional instability (neuroticism). More specifically extroversion describes a personality disposition that reflects sociability, stimulus seeking, dominance, high activity and warmth (Diener, 1998). Neuroticism is a term used to describe a personality disposition that reflects anxiety, pessimism, irritability, bodily complaints and interpersonal sensitivity (Diener, 1998). Hence, it may be concluded that subjective quality of life is associated with sociability and emotional stability.
Further evidence for the significant relationship between extroversion and neuroticism and subjective quality of life is provided by research on positive and negative affect and life satisfaction. The relationship between these two concepts are frequently reported in the subjective well-being literature as they are the two components of subjective well-being. It has been found repeatedly that extroversion correlates highly with positive affect, ranging from .20 to .63, and that neuroticism correlates highly with negative affect, ranging from .36 to .75 (Costa & McCrae, 1980; Fogarty, et al., 1999; Francis, et al., 1998; Fujita, 1993 unpublished masters thesis provided by the author; Mroczeck & Kolarz, 1998; Wilson, Gullone & Moss, 1998). This finding is not surprising considering the common definition and measurement of extroversion and neuroticism, and positive and negative affect, used in the literature.
The measurement of extroversion and neuroticism is primarily based on the definition given previously. This is in many ways similar to the common definition and measurement of positive and negative affect using the Positive and Negative Affect Schedule. Here, positive affect refers to an affective disposition that encompasses feelings such as happiness and joy and is often assessed by feelings of interest, excitement, inspiration, enthusiasm and activity; negative affect refers to an affective disposition that encompasses unpleasant emotions such as sadness and is often assessed by subjective distress incorporating anger, fear, guilt and nervousness (Wilson, et al., 1998).
Considering the similarities in definition and measurement, and the high correlations between extroversion and positive affect, and neuroticism and negative affect, it is possible that the personality and affect constructs are measuring similar things. In fact, some authors have concluded that the constructs are interchangeable (Fogarty, et al., 1999) or indistinguishable (Fujita, 1993). This casts some doubt on whether positive and negative affect should be considered an outcome variable along with life satisfaction, or a predictive variable such as personality. Hence, investigating the relationship between positive and negative affect and life satisfaction is similar to investigating the relationship between extroversion and neuroticism and life satisfaction. The correlations reported in the literature between life satisfaction and positive affect range from .23 to .52, and life satisfaction and negative affect range from -.36 to -.48 (Brief, Butcher, George & Link, 1993; Cooper, Okamura & Gurka, 1992; Friedman, 1993; Lucas, Diener & Suh, 1996). Similar ranges to those between extroversion and neuroticism and subjective well-being.
In conclusion, it is clear that personality is strongly linked to subjective judgements about quality of life and, because personality is an enduring characteristic and subjective quality of life is more variable, it is likely this role is a predictive one. Furthermore, one approach to simplifying research in this area is to avoid the complicated positive and negative affect component of the subjective well-being construct, so that the relationship between personality and subjective quality of life or life satisfaction can be more clearly understood.
3 The relationships between personality and other psychological processes that may impact on subjective quality of life
The literature in this field introduces numerous psychological processes that may be involved with subjective quality of life. For example, McQuillen, Licht and Licht (2001) found that identity structure predicted life satisfaction. Identity structure refers to the hierarchical ordering of the multiple aspects of one's self-concept (eg husband is a higher level aspect than friend or athlete as the former encompasses the later). In another example, Pavot, Fujita and Diener (1997) found that self-aspect congruence, that is congruence between ideal and real self, was positively correlated with subjective well-being. However, congruence was negatively correlated with neuroticism and when the effects of neuroticism were controlled for, self-aspect congruence did not reliably predict subjective well-being. This finding highlights the importance of identifying psychological processes that make a unique contribution to the variance in subjective quality of life after the effects of personality are removed.
A similar psychological process that has received much attention in the literature is satisfaction with self, which is considered to be a major predictor of life satisfaction (Campbell, 1981; Argyle & Lu, 1990; Diener & Diener, 1995). However, investigating the relationship between how satisfied people are with themselves (self-satisfaction) and how satisfied they are with their life (life satisfaction) is problematic, considering the great deal of overlap between the two ‘satisfaction’ constructs. More information may be provided by reducing the global self-satisfaction construct and investigating three aspects of self-satisfaction, which are self-esteem, optimism and control (Cummins & Nistico, in press).
Self-esteem refers to a sense of self-worth or value, and this construct has been found to have a strong positive correlation with life satisfaction (Boschen, 1996; Hong & Giannakopoulos, 1994; Kwan, Bond & Singelis, 1997; Lucas, et al., 1996). In fact, in some studies the correlation has been so high that Lucas, et al. (1996) tested whether the two constructs were discriminable from each other, and found that they were. Kwan, et al. (1997) agree, and suggest that self-esteem is a useful mediator of the variance in life satisfaction attributed to personality. However, self-esteem is one of the traits that inversely contribute to neuroticism (Eysenck & Eysenck, 1985); and the two constructs correlate highly in student samples in both the U.S. (-.69) and Hong Kong (-.63) (Kwan, et al., 1997). Hence, it is likely that if the effects of neuroticism were controlled for, self-esteem may not make a unique contribution to the variance in subjective quality of life.
Optimism refers to a sense of positivity about the future and there is some evidence for a positive relationship between optimism and life satisfaction (Christensen, Parris-Stephens & Townsend, 1998; Lucas, et al., 1996). As with self-esteem, Lucas et al. (1996) tested whether the two constructs were discriminable and found that they were. However, optimism has also been found to correlate highly with neuroticism by Smith, Pope, Rhodewalt and Poulton, (1989), who conclude that it is difficult to distinguish between optimism, measured with the Life Orientation Test, from measures of neuroticism and negative affectivity. Hence, it is again likely that if the effects of neuroticism were controlled for, optimism may not make a unique contribution to the variance in subjective life quality.
Finally, control conventionally refers to a sense that one can change the environment in accordance with one’s wishes (this definition will be elaborated later) and this construct has also been found to correlate with life-satisfaction, although generally not as strongly as self-esteem (Boschen, 1996; Christensen, et al., 1998; Schulz & Decker, 1985). There is generally little research in the literature on the association between control and the personality dimensions, extroversion and neuroticism. Still, some studies have shown control correlates positively with extroversion and negatively with neuroticism (Darvill & Johnson, 1991; Morrison, 1997). Although the extent of these relationships is highly variable and likely dependent on the definition and measurement of control used. This issue clearly needs further investigation to identify whether or not control is a psychological process that makes a unique contribution to the variance in subjective quality of life. Furthermore, much of the literature on control and life satisfaction is based on populations with spinal injury (eg. Boschen, 1990; Boschen, 1996) and there is a need for investigation of normal populations to assess whether control plays a role in life satisfaction in the absence of obvious losses of control.
4 Conclusion
There is both theoretical and empirical support for the notion that personality, primarily extroversion and neuroticism, predicts subjective quality of life. There is also theoretical and empirical support for the notion that other psychological processes may have a strong association with subjective quality of life. Yet, it is not clear whether these processes would make a unique contribution to subjective quality of life if the effects of personality were controlled for. In fact, similar to self-aspect congruence, it is likely that self-esteem and optimism will not make a unique contribution. As the relationship between personality and perceived control is not well documented and its ability to make a unique contribution to subjective quality of life unknown, it is the most compelling of these processes for investigation.
3 PERCEIVED CONTROL
1 Introduction
A diverse literature suggests a sense of control is important to well-being. Such perceptions of control are defined as “the judgements we each make about the extent to which we can achieve desired outcomes and protect ourselves from the misfortunes of life” (Thompson et al., 1998, p. 584). When making these judgements, individuals will assess and use the control strategies they consider available to them. These control strategies are divided into two processes of perceived control, termed primary and secondary, by Rothbaum, Weisz and Snyder (1982). This two-process model of perceived control provides a basic understanding of the underlying structure of many terms and concepts in the control and coping literature, such as behavioural and cognitive control (see Thompson, 1981), emotion-focused and problem-focused coping (see Folkman, 1984) and learned helplessness (see Rothbaum, et al., 1982).
In fact, it was inadequacies in ideas about uncontrollability in the learned helplessness and locus of control literature that motivated Rothbaum, et al. (1982) to conceptualise two processes of control. They felt that this literature inappropriately considers inward behaviours such as passivity, withdrawal and submissiveness as a result of perceptions of uncontrollability and argued that:
the motivation to feel in control may be expressed not only in behaviour that is blatantly controlling but also, subtly, in behaviour that is not. In some cases inward behaviour may reflect a relinquishing of the powerful motive for perceived control. In other cases, however, such behaviour may be initiated and maintained in an effort to sustain perceptions of control. This effort is particularly likely when the inward behaviour helps prevent disappointment, when it leads to a perception of alignment with forces such as chance or powerful others, and when it is accompanied by attempts to derive meaning from a situation. The uncontrollability model does not explain any of these phenomena. (p. 9)
What these authors suggest is that an individual may exercise control over an event not only by manipulating the external environment, but also by manipulating their own internal environment; a perception of control that had gone largely ignored in the literature. This is exampled by the earlier definitions of control that focus on ‘changing events’ (Brickman et al., 1982) or ‘behaviours’ (Glass & Carver, 1980) and give little consideration of the role that cognitions play in control. When cognitions are acknowledged it becomes evident that passivity, withdrawal and submissiveness may in some circumstances be effective responses that serve to maintain a perception of control and do not necessarily reflect perceived uncontrollability as is suggested by the learned helplessness literature.
2 Developing a definition of primary and secondary control
To include cognitions into the concept of control, Rothbaum, et al. (1982) introduced the concept of primary and secondary control. Primary control is defined as “attempts to change the world to fit in with the self’s needs” (Rothbaum, et al., 1982, p. 8). Secondary control is defined as “attempts to fit in with the world and to ‘flow with the current’” (Rothbaum, et al., 1982, p. 8). Both primary control and secondary control may involve behaviours and cognitions. However, typically primary control is characterised by behaviour which engages the external world, and secondary control is characterised by cognitions within the individual (Schulz & Heckhausen, 1996). Although these definitions are vague, especially that of secondary control, the concepts are sound and subsequent literature has provided clearer definitions. For example, Heckhausen and Schulz (1995) have used the primary and secondary control concepts in a life span theory of control. These authors defined primary and secondary control by the target of the control. Primary control is defined as “bringing the environment into line with one’s wishes … targets the external world and attempts to achieve effects in the immediate environment external to the individual” (Heckhausen & Schulz, 1995, p. 286). Secondary control is defined as “bringing the self in line with the environment … targets the self and attempts to bring changes directly within the individual” (Heckhausen & Schulz, 1995, p. 286).
Primary and Secondary control can be further understood by considering some examples. In attempting to maintain a perception of control an individual may use primary control strategies, such as asking others for help or advice, developing new skills to deal with the situation, or working hard and investing time into the situation. In attempting to maintain a perception of control an individual may also use secondary control strategies, such as downward social comparison (remembering one is better off than others), positive re-interpretation (considering that something good will come of it) and active avoidance (ignoring the event by thinking about other things). The above quotation from Rothbaum, et al. (1982) provides examples of three other secondary control strategies: illusory control (associating with chance), vicarious control (associating with powerful others) and interpretive control (deriving meaning from the event).
Perceived control and the primary and secondary control processes that form this perception are fundamental to coping with difficult circumstances. Authors from the coping literature suggest that perceived control is necessary so that the individual is assured a situation will not become so formidable that it cannot be endured (see Thompson, 1981). Hence, Thompson (1981) defines control as “the belief that one has at one’s disposal a response that can influence the aversiveness of an event” (p. 89). This conceptualisation of control is related to the compensatory function of primary and secondary control that Heckhausen and Schulz (1995), and Schulz and Heckhausen (1996), promote in their life-span theory of control. What these authors suggest is that an individual uses primary and secondary control strategies to compensate for failure experiences. These failure experiences include: “(a) normative developmental failure experiences encountered when individuals attempt to enlarge their competencies, (b) developmental declines characteristic of late life, and (c) non-normative or random negative events” (Schulz & Heckhausen, 1996, p. 710). Furthermore, these compensation mechanisms serve to “maintain, enhance and remediate competencies and motivational resources” that are necessary for successful experiences (Schulz & Heckhausen, 1996, p. 710). Hence, primary and secondary control processes are used to cope with negative experiences or aversive circumstances, and function to maintain a perception of control that will serve to sustain competencies and motivation. Therefore, perceived control can be likened to coping when considered in response to difficult circumstances.
However, perceived control also works in a way that makes it different from coping. Primary and secondary control also have a selective function, where they serve to assist goal selection and channel resources into the selected goals (Heckhausen & Schulz, 1995). This selection concept taps into the notion that primary and secondary control processes are not used exclusively in response to aversive circumstances. In more subtle ways primary and secondary control may be used to maintain perceived control in the more general negotiation of the environment, to maintain a person-environment fit. Yet, the distinction between selection and compensation is difficult to support as goal selection and resource allocation can also be immediate responses to failure and have a compensatory role. In fact, the notion that primary and secondary control strategies may be used to achieve a person-environment fit encompasses both those circumstances where strategies are used in response to a negative circumstance and where they are simply a part of the general negotiation of the environment.
A more operational definition of control would involve a number of these concepts and definitions. By using Thompson’s (1981) idea that control is a ‘belief’, control is restricted to the realm of perception. By using Heckhausen and Schulz’s (1995) idea that a definition of primary and secondary control should focus on the target of control, the distinction between the two types of control is clearer. By including the aim of control, as person-environment fit, a better understanding of the concept is provided. Hence, primary control may be referred to as ‘the belief that one has at one’s disposal a response that can change the external environment to achieve a person-environment fit’ and secondary control may be referred to as ‘the belief that one has a one’s disposal a response that can change the internal environment to achieve a person-environment fit’.
3 Addressing the interaction between primary and secondary control
Person-environment fit can be likened to the term ‘optimal adaptation’ that Rothbaum, et al. (1982) use to describe the successful coordination of the intertwined primary and secondary control processes. Alternatively, Heckhausen and Schulz (1995) conceive the relationship between primary and secondary control not as two intertwined processes but as one, where primary control has functional primacy over secondary control. They argue that:
Because primary control is directed outward, it enables individuals to shape their environment to fit their particular needs and developmental potential. Without engaging the external world, the developmental potential of the organism cannot be realised. As a result, it is both preferred and has greater adaptive value to the individual. … (Hence,) the major function of secondary control is to minimise losses in, maintain, and expand existing levels of primary control.
(Heckhausen & Schulz, 1995, p. 286)
There are, however, problems associated with this view of primary and secondary control processes. Just as the learned helplessness theories ignore the adaptive value of cognitions (Rothbaum, et al., 1982), this theory excludes the adaptive value of secondary control in and of itself. It is conceivable that individuals need to shape both themselves and their environment to fit their particular needs and developmental potential, and that without engaging both the internal and external worlds their developmental potential cannot be realised.
Moreover, the adaptive value and preference for primary control over secondary control is likely to be restricted to specific circumstances. For example age, culture and ethnicity provide circumstances in which primary control does not necessarily have primacy over secondary control. Heckhausen and Schulz (1996) point out themselves that after the age of fifty the availability and use of secondary control strategies is greater than that of primary control strategies, and that successful aging is dependent on utilising secondary control strategies. Furthermore, the importance of changing the external environment is bound to Western cultures. Eastern cultures are likely to place more emphasis on accepting the external environment and relying on control strategies that change the internal environment. (Weiz, Rothbaum & Blackburn, 1984). Like culture, studies on ethnicity have shown that primary control does not necessarily have primacy over secondary control. African American HIV-positive male state prison inmates did not show the same association between primary control and decreased distress that white inmates showed. Furthermore, secondary control did not function as a back-up to primary control regardless of ethnicity (Thompson, Collins, Newcomb & Hunt, 1996). Thus, in some life stages, cultures and ethnic backgrounds, secondary control processes may be more adaptive and preferred than primary control processes.
Additionally, it is likely that there are other factors that may influence whether primary or secondary control is preferred. Personality may be one such factor. It is conceivable that some individuals may possess enduring characteristics or predispositions that promote their reliance on primary control over secondary and visa versa. Not all individuals will have the intrinsic motivation to always change the environment to achieve a perception of control. Some will be more resigned to accept their environment and change themselves to fit within it. The extroversion and neuroticism dimensions of personality may provide some insight into this hypothesis. For example, Alloy, Abramson and Viscusi (1981) found that negative moods reduce feelings of control. Considering the strong relationship between negative affect and neuroticism, it is possible that this personality dimension will also influence an individual’s perception of control. Likewise, positive affect or extroversion may also influence an individual’s perception of control. However, at this stage, such speculation requires empirical support.
In summary, there is good argument and evidence to suggest that primary control does not necessarily have functional primacy over secondary control. It may therefore be more useful to consider primary and secondary control as two complimentary processes where, in given individuals, circumstances, and environments, one process may be preferred and have greater adaptive value over the other, and that each process may serve to compliment the other to maintain perceived control.
This complimentary interaction between primary and secondary control cannot be considered without acknowledging a third process in perceptions of control, that is, a loss of control. While secondary control does replace much of what was traditionally thought of as perceptions of uncontrollability, the perception of uncontrollability still exists, although it is not always given attention in the literature on primary and secondary control. In fact, there are large segments of society that are at special risk for low feelings of control (Thompson & Spacapan, 1991). When primary or secondary control is perceived not to be available, an individual may relinquish control. That is, they may perceive the event as uncontrollable and abandon the motivation for control (Rothbaum, et al., 1982). Relinquished control is manifested in passivity and helplessness (Skinner, 1996). Examples of relinquished control are where an individual may respond to an event or circumstance by not doing anything, spending time by his/her-self , or letting feelings out, maybe by crying or yelling (Thurber & Weisz, 1997). Hence, primary, secondary and relinquished control are important constructs to consider in developing an understanding of perceived control.
Overall, there is a sense that primary and secondary control are closely intertwined and the use of one over the other to achieve a person-environment fit may be dependent upon a number of factors. Furthermore, some individuals may not have the motivation to use primary or secondary control to achieve a person-environment fit and may relinquish control altogether, experiencing a period of perceived uncontrollability and person-environment misfit. Hence, an individual’s perceived control may be maintained by a fluid combination of primary, secondary and relinquished control processes.
4 The literature on primary, secondary and relinquished control, and various indicators of well-being
The literature on primary and secondary control has followed two paths. There is literature, stimulated by Heckhausen and Schulz (1995), which identifies primary and secondary control processes in theories of life span development and there is literature that identifies primary and secondary control processes as useful strategies for coping with stressful or aversive situations or events. It is in this latter path that I am mostly interested.
There are a number of studies by Weisz and collegues that focus on children’s coping using primary, secondary and relinquished control strategies. For example, research has shown that children cope with everyday stress by using primary and secondary control processes (Band & Weisz, 1988). Research has also shown that when children are in stressful situations in which few primary control strategies may be available to them, secondary control is an adaptive coping mechanism. For example, children undergoing treatment for leukemia showed better adjustment if they used secondary control strategies than primary or relinquished control strategies (Weisz, McCabe & Dennig, 1994); children at summer camp showed the most frequent and effective way to cope with homesickness was to use secondary control strategies (Thurber & Weisz, 1997). These findings are congruent with the notion that secondary control is commonly used after primary control has failed or, in this case, when it is not available. However, this conclusion has not been supported with adults. For example, Burton and Sistler (1996) found that spousal caregivers of people with dementia used a combination of primary and secondary control in stressful situations. Overall, the evidence shows that primary, secondary and relinquished control strategies are used in aversive or stressful situations.
A broader range of literature shows that an individual’s perception of control is likely to have a significant impact on their subjective life quality. It has been proposed that both primary and secondary control processes are required to maintain a perception of control that is necessary for optimal adaptation (Rothbaum, et al., 1982), successful development (Heckhausen & Schulz, 1995), to feel confident that a situation will not become so aversive it cannot be endured (Thompson, 1981), and to achieve a sense of person-environment fit. Thompson and Spacapan (1991) highlight evidence that suggests perceived control: 1) is essential to emotional well-being, 2) can reduce the stress associated with stressful events or situations, 3) contributes to adaptive coping with life stressors, 4) is associated with better health outcomes, 5) promotes better ability to change behaviours, and 6) can lead to improved performance. More specifically, Weisz, Thurber, Sweeney, Proffitt and LeGagnoux (1997) found significant decreases in the symptomatology of children with mild to moderate depressive symptoms when treated with an 8-session primary and secondary control enhancement training program. Also, as highlighted earlier, control has been found to correlate with life satisfaction (Boschen, 1996; Christensen, et al., 1998; Schulz & Decker, 1985). Considering this, the relationship between perceived control and subjective quality of life is likely to be significant.
5 The measurement of primary, secondary and relinquished control
Since the development of the concepts of primary and secondary control is relatively recent, there is no widely accepted tool for their measurement. Some researchers (eg. Band & Weisz, 1988; Burton and Sistler, 1996; Thompson et al., 1996; Weisz et al., 1994) have measured primary and secondary control by obtaining responses about how difficult situations were coped with, and coding these responses as reflecting either primary or secondary control, and sometimes relinquished control. The coding system is based on the Rothbaum et al., (1982) model of primary and secondary control (Weisz et al., 1994). In general, primary control coping responses are those that involve attempts to directly interact with the environment so as to modify objective circumstances. Secondary control coping responses are those involving primarily internal responses aimed at attempting to adjust oneself (eg. one’s beliefs, hopes, goal interpretations, attributions) to objective circumstances. Finally, relinquished control consists of the absence of attempts at primary or secondary control (eg. giving up or concluding that there is nothing I can do). Thurber and Weisz (1997) have applied this coding method to an already established coping scale for children. This method of coding coping responses into primary and secondary control has been effective and allows for various sample populations to provide responses that are relevant to their own experiences. However, this also limits the generalisability of the results and the comparison of results from different samples. Furthermore, there may be coding biases, especially as some responses may contain elements of both primary and secondary control making them more difficult to categorise.
A more systematic tool for the measurement of primary and secondary control has been developed Heeps (2000). This questionnaire asks respondents to rate the degree to which they agree with statements that reflect either primary or secondary control. For example, “When I fail to meet a goal: I look for different ways to achieve the goal” (primary control), “When something bad happens that I cannot change, I can see that something good will come of it” (secondary control). The statements were developed by reviewing the variety of types of primary and secondary control described in the current literature. A total of seven primary control items and seventeen secondary control items were developed. This tool is still in the early stages of development and requires further validation and assessment of reliability. Furthermore, the tool does not include any relinquished control items.
Relinquished control has been measured by Thurber and Weisz (1997), who developed the Ways of Coping with Homesickness Questionnaire by taking a well-established questionnaire and coding the items in terms of primary, secondary and relinquished control. The items on relinquished control included “I spent time by myself”, “I just let my feelings out, maybe by crying or yelling”, and “I didn’t do anything. Nothing would have helped”. While these items were used with children, their content seems appropriate for the measurement of relinquished control in adults.
6 Conclusion
There is substantial theory and empirical evidence to suggest that perceived control may be directly associated with subjective quality of life. Primary and secondary control processes provide a contemporary conceptualisation of perceived control that has received increasing support in the literature. With the addition of relinquished control there are three control processes that interact with each other to form a perception of control that may impact on an individual’s subjective quality of life.
4 INTEGRATING PERSONALITY, PERCEIVED CONTROL AND SUBJECTIVE QUALITY OF LIFE
1 Maintaining subjective quality of life
The importance of understanding the psychological processes involved with making judgements of life quality is highlighted by the recent proposition that subjective quality of life is held under some kind of homeostatic control (Cummins, 1995, 1998, 2000). This proposition is based on meta-analytic research that has shown life satisfaction data to be consistent both between and within Western populations. The research has converted life satisfaction data from numerous studies to a percentage of scale maximum (%SM), which expresses any Likert scale value as though it had been scored on a scale measured over the range 0 to 100. In examining the distribution of data both between and within various Western populations, it has been consistently found that life satisfaction was negatively skewed and clustered around three quarters of the scale maximum. It was concluded that the average life satisfaction mean score of Western populations is 75( 2.5%SM, and that this average is held under homeostatic control.
Further support for the homeostatic model has been found by analysing the changing relationship between population means and variance across 62 studies on both Western and non-Western populations (Cummins, 2000). It was found that as means approach 70%SM, the distribution becomes increasingly leptokurtic, and therefore has lower variance. Then as the population mean values drop below 70%SM, the distribution become increasingly platykurtic as their ranges extend downward, with a consequential increase in variance. These observations were used to reinforce the conclusion that life satisfaction is not free to vary over its theoretical range of 0-100%SM, but is held under homeostatic control which attempts to maintain the life satisfaction of populations above 70%SM.
This homeostatic model compels us to question further how subjective quality of life is maintained above 70%SM. Cummins and Nistico, (in press) suggest that positively biased cognitions regarding aspects of the self may constitute an adaptive mechanism that maintains life satisfaction. The aspects of the self that the authors refer to are self-esteem, optimism and control. Cognitive biases are beliefs based in reality but with a positive bias in favour of the individual, as opposed to delusions that are incongruent with reality. Positive cognitive biases have two essential properties. They are non-specific, in that they refer to nebulous ideas that cannot readily be discerned from reality, and they are empirically unfalsifiable as there is a lack of objective referents with which to compare nebulous personal qualities. Despite the difficulties in empirically validating positive cognitive biases, there is evidence to suggest that they exist in direct relation to enhancing the self, enhancing one’s perception of control and keeping optimistic about the future (see Taylor & Brown, 1988) and that they contribute to life satisfaction (Cummins & Nistico, in press). Hence, perceived control is indicated as an important psychological process involved in maintaining subjective quality of life.
When trying to understand how subjective quality of life is maintained, personality must also be considered, given that it has been consistently shown to correlate strongly with various indicators of life quality. The literature has demonstrated that the two personality dimensions, extroversion and neuroticism, can predict subjective well-being across time and various situations. Hence, the same predictive relationship is expected of personality and subjective quality of life. By definition, personality is an enduring characteristic or predisposition and it is this quality that may contribute to the maintenance of subjective quality of life. More specifically, it is an individual’s enduring qualities of sociability and positive affect (ie. extroversion) and the absence of emotional instability and negative affect (ie. neuroticism) that maintain subjective quality of life. Furthermore, it is likely that these enduring personality characteristics will also impact on other psychological processes found to maintain life satisfaction, such as perceived control. The prediction of subjective quality of life by personality and perceived control may occur in either of two ways. Personality may indirectly predict subjective quality of life via perceived control (see Figure 1a), or personality may continue to directly predict subjective quality of life in addition to an indirect prediction through perceived control (see Figure 1b). Given the strength of the relationship between personality and subjective quality of life, I propose the latter model to be more accurate.
1(a) Indirect prediction 1(b) Direct and indirect prediction
Figure 1: The direct and indirect prediction of subjective quality of life (SQOL) by personality and perceived control.
2 Rationale for a hypothesised model of personality, perceived control and subjective quality of life
The three concepts, personality, perceived control and subjective quality of life, depicted in Figure 1, have been selected for investigation for a number of reasons.
Firstly, the definition and measurement of each of these concepts is sound. Subjective quality of life is a concept free from the problems surrounding subjective well-being which incorporates the problematic conceptualisation and measurement of positive and negative affect. Furthermore, the definition and measurement of subjective quality of life has been soundly developed by Cummins (1997a, 1997b) and incorporates the notion that judgements of satisfaction with life domains are weighted by the importance of that particular life domain to the individual. Extroversion and neuroticism are well known dimensions of personality that have long been upheld in the literature in both theory and measurement. Perceived control formed by the interaction of primary, secondary and relinquished control processes is a relatively recent conceptualisation, but it has gained impressive theoretical support and provides a basic understanding of the underlying structure of many terms and concepts in the wider control literature. The measurement of primary, secondary and relinquished control is, however, in the process of development.
Secondly, the definition and measurement of these three constructs allows for their relationships to be explored without running the risk of including constructs that are in essence identifying the same phenomena. This problem is likely to be inherent in investigations of the relationship between personality and two of the three dimensions of self-satisfaction, self-esteem and optimism, where there is a strong association between neuroticism and these two dimensions. Hence, subjective quality of life, the personality dimensions of extroversion and neuroticism, and the self-satisfaction dimension of perceived control and the primary, secondary and relinquished control processes associated with it, are ideal variables for the current investigation, as they are likely to be relatively free from confounding overlapping variance.
Finally, there is theory and evidence to suggest that the relationships between these three concepts are meaningful and contribute to the maintenance of life satisfaction. Personality has long been established to predict constructs of life quality. Perceived control has been more recently introduced as an important factor in the maintenance of life satisfaction. It is hypothesised that personality will play a dual role in influencing subjective quality of life both directly and indirectly through impacting on perceived control (see Figure 2).
Figure 2: Hypothesised model of subjective quality of life, personality and perceived control.
3 Focus of the current research
The current study will examine the hypothesised model of relationships, depicted in Figure 2, between the personality dimensions of extroversion and neuroticism, perceived control and the associated processes of primary, secondary and relinquished control and subjective quality of life. The model will be tested on a general population as well as a population of people caring for a relative with a mental illness.
5 SUBJECTIVE QUALITY OF LIFE: CARERS OF PEOPLE WITH MENTAL ILLNESS
1 The historical development of research into carers of people with mental illness
The process of deinstitutionalisation and the introduction of community focused psychiatric care has placed increasing responsibility on families for the care of people with psychiatric disabilities. In response to this, research on people with a psychiatric disability began to include their families. Initially the research focused on the negative impact the family had on the person with mental illness leading to families being viewed as the cause of mental illness throughout the 1960’s and 1970’s (Yamashita & McNally-Forsyth, 1998).
In an example of this negative view, Brown, Birley and Wing (1972) refer to the following ‘facts’ about the course of Schizophrenia: close emotional ties with family members indicated poor prognosis; patients discharged from hospital to live with family members who were highly emotionally involved with them were more likely to suffer a relapse; a raised level of tension in the home made relapse more likely. With these ‘facts’ about the negative impact of families on people with mental illness in mind, the authors then go on to investigate the relationship between family members' expressed emotion and patient relapse. Expressed emotion was measured by hostility, dissatisfaction, warmth, emotional over-involvement and the number of critical comments. Patient relapse was measured by either, a change from normal to a state of schizophrenia, or a marked exacerbation of persistent schizophrenic symptoms. The authors found that expressed emotion was independently associated with relapse and could not be explained away by the action of any other factor investigated such as age, sex, previous occupational record, length of clinical history, type of illness, etc. Concluding, “the level of relatives’ expressed emotion must be taken into account as one of the factors that cause relapse” (Brown, et al., 1972, p. 254).
While such conclusions did receive some empirical support (such as Vaughn & Leff, 1976), the adoption of these conclusions by clinicians by far outweighed that which would be warranted by the empirical evidence. The research was largely atheoretical, and while the association between high expressed emotion and relapse was clearly established, causality was not. Furthermore, there were methodological problems; the most measurable component of expressed emotion was the number of critical comments made by the family member about the patient (Brown, et al., 1972). It is possible that family members have more to be critical about with patients who are not fully recovered and who are therefore more likely to relapse. It is also possible that family members perceived the research interviews as an opportunity to express the problems they perceived in their mentally ill relative.
The notion that families were the causative agents in the development of mental illness inspired a body of research that investigated the impact that mental illness had on the family. Advocacy groups for families of people with a mental illness argued that this high expressed emotion was a direct response to the trauma of caring for a mentally ill relative. This trauma began to be investigated by researchers who referred to it as the ‘burden’ of care, and distinctions were made between objective and subjective burden; objective burden refers to the tangible or observable costs to the family and subjective burden refers to the personal suffering or negative psychological impact on the family member (Maurin & Boyd, 1990; Lefley, 1987a; Webb et al., 1998). Whilst these two concepts are closely associated, as objective burden is likely to contribute to subjective burden, it is the literature on subjective burden that is most relevant to subjective quality of life.
2 The impact of the caregiving role on subjective quality of life
A number of literature reviews have concluded that mental illness produces significant burden and distress in family members (eg. Fadden, Bebbington & Kuipers, 1987; Maurin & Boyd, 1990). The psychological distress of carers, as measured with the General Health Questionnaire is reported to be high. It was reported by Vaddadi, Soosai, Gilleard and Adlard (1997) that 79% of carers had scores indicating a significant level of emotional/psychiatric disorder. Whilst, Barrowclough and Parle (1997) found 57% of carers had significant levels of psychological distress at the time of the patient’s hospital admission and that in 30% of carers this distress remained when the patient was discharged back home. In a review of the literature by Cummins (2001) on carers of people with a range of severe disabilities, all of the 17 studies analysed reported higher than normal levels of distress in carers. A key theme in these studies was higher than normal levels of anxiety and depression.
The emotional impact of caring for people with mental illness has also been reported descriptively. In a qualitative study conducted in Iceland, Sveinbjarnardottir and Dierckx de Casterle, (1997) found that family members expressed a wide range of emotionally painful and disturbing feelings such as anger, disappointment, fatigue, distress, anxiety and sadness, all of which they found overwhelming at times. Lefley (1987b) adds bewilderment, fear, denial, rage, self-blame, pain, sorrow, empathic suffering and grieving to this list. Moreover, the introduction of mental illness into the family has been described as a traumatic and catastrophic event which primarily gives rise to a powerful grieving process (Baxter & Diehl, 1998; Collings & Seminuik, 1998; Fadden et al., 1987; Lefley, 1987b; Marsh et al., 1996; Winefield, 1998). Family members often experience feelings of grief over the loss of the former personality and the future potential of the individual with mental illness. Along with this grief often comes a significant sense of guilt or self-blame. There are four types of guilt frequently described: 1) guilt associated with the belief that they may have done something to cause the mental illness or that they did not recognised the symptoms and seek help early enough, 2) guilt about having hostile feelings toward the person with the mental illness, even though such feelings may be a legitimate response to provocative or intolerable behaviour, 3) guilt about leaving a loved one in unpleasant surrounds, such as when the person must stay in hospital or other residential services, and 4) guilt about making self-protective life decisions, such as deciding not to care for the person in the family home (Lefley, 1987b).
Clearly the emotional impact of caring for someone with a mental illness is great. So great in fact that many carers experience clinically significant levels of psychological distress, primarily anxiety and depression, as well as a more descriptive range of emotional experiences. There are a variety of elements associated with caregiving that may be a source of this burden and distress.
The burden and distress of caregiving often occurs in the context of permanent shifts in family roles and considerable unanticipated responsibility falling consistently to one carer (Perring, Twigg & Atkin, 1990). It is this individual who often finds themself in a position where the needs and wishes of the person with mental illness are constantly put before the needs of the primary caregiver and other family members (Maurin & Boyd, 1990; Webb et al., 1998). This individual may also feel isolated as they try to cope with the impact of mental illness in the family. In fact social isolation has been found to be widespread among families affected by mental illness. Fadden et al., (1987) suggest “one of the most damaging consequences of living with a relative with a persistent mental illness is the detriment to social and leisure activities” (p. 286). A huge amount of time is taken up by the caring role and carers often find it difficult to leave the house unattended for longer than a few hours at a time (Perring et al., 1990). This makes time for the pursuit of social, leisure and employment activities difficult to find, resulting in increased social isolation. Social isolation may also be a result of the stigma of mental illness (Fadden et al., 1987) and discrimination against individuals with mental illness (Sveinbjarnardottir & Dierckx de Casterle, 1997). The now somewhat historical notion that families are causative agents in the development of mental illness and schizophrenia has left in its wake a stigma that still remains (Ferris & Marshall, 1987). Many families still experience this stigma in their interactions with mental health professionals, encountering a lack of recognition or appreciation from professionals, and this can be the source of a great deal of stress for family members (Winefield, 1998).
Along with these more general problems, carers must cope with the relapsing and remitting nature of mental illness and difficult symptom behaviours. The unpredictability of the episodic characteristics of mental illness are reported to be the most difficult aspect of living with someone with such a condition (Sveinbjarnardottir & Dierckx de Casterle, 1997), as the carer is required to constantly readjust the caring role in response to this unpredictability (Collings & Seminuik, 1998). Difficult symptom behaviours include both positive and negative symptoms. Positive symptoms reflect an excess or distortion of normal functions, such as delusions, hallucinations, disorganised speech or disorganised behaviour (American Psychological Association, 1994). Negative symptoms reflect a diminution or loss of normal functions, such as affective flattening and avolition (American Psychological Association, 1994). Researchers have found mixed results for the role these symptom types play in contributing to carer burden. Webb et al. (1998) cite research that has found positive symptoms to contribute to burden (eg. Winefield & Harvey, 1993) and others that have found negative symptoms to be most burdensome (eg. Oldridge & Hughes, 1992).
Positive symptoms often result in problematic psychotic and socially unacceptable behaviours. When families are not able to manage these behaviours, the quality of life for all family members declines as they experience overwhelming tension in anticipation of the dreaded behaviours (Swan & Lavitt, 1988). When the individual with mental illness demonstrates these behaviours in the community, it adds to the families sense of social stigma, embarrassment and isolation (Lefley, 1987b). In addition, some individuals display a number of threatening, intimidating and violent behaviours, with which the family carers must deal. Caregiving families with violent members have reported significantly lower adjustment scores than families with nonviolent members (Swan & Lavitt, 1988). Furthermore, Vaddadi et al., (1997) found the type and frequency of abuse experienced positively correlated with relatives' General Health Questionnaire scores, as did the number of types of abuse.
Negative symptoms also appear to be problematic for carers. In interviews with 124 carers, Tucker, Barker and Gergoire (1998) found that depressed or anxious behaviour in the mentally ill person accounted for 43% of the variance in carers' negative scores on the Experience of Caregiving Inventory (Szmukler, Wykes & Parkman, 1998). Furthermore, the resultant tension and anxiety that carers experience in response to negative symptoms is sometimes intensified by the fear that the individual with mental illness may commit suicide (Perring, et al., 1990; Sveinbjarnardottir & Dierckx de Casterle, 1997).
Contrary to this research that suggests symptomatology and behaviour play key roles in the burden experienced by carers, other researchers have found this may not be the case. Szmukler et al., (1998) found that the ability of a wide range of individual characteristics, including features of the illness, symptomatic state and social functioning, to predict caregiver distress was poor. These authors suggest that conflicting results have often resulted from an assessment of the person’s symptomatology and behaviour using carer reports, rather than using independent assessments. This may mean that it is carers’ perception of their ill relatives’ disability, rather than actual disability, that impacts on their distress. Alternatively, it may mean that carers have a more accurate picture of their ill relatives’ disability. Still, the notion that carers’ perception of their ill relative’s disability impacts on their distress provides an interesting avenue for reducing the amount of distress carers experience.
Overall, it is clear that there are many negative elements associated with the caregiving role which may have a negative impact on carers’ subjective quality of life. In his review of the literature on carers of people with a range of severe disabilities, Cummins (2001) converted life satisfaction scores from eight studies into %SM and found the mean of the combined data was 61(5.9%SM, well below the standard score of 75(2.5%SM. These studies investigated carers of intellectually disabled children or adults and the elderly with dementia, yet from the above discussion similar results would be expected of carers of people with mental illness. Likewise, Browne and Bramston (1996) found that families of young people with intellectual disabilities had significantly lower subjective quality of life, particularly in the domains of health and productivity, than those without offspring with an intellectual disability. Hence, the negative impact of caregiving is likely to be evident regardless of the characteristics of the individuals receiving the care.
It is also important to highlight the positives of caregiving, although little work has been done on this area in the field of mental illness. Marsh et al. (1996) researched evidence for resilience, which refers to “the ability to rebound from adversity and prevail over the circumstances of our lives” (p. 4). The researchers asked 131 close relatives of people with mental illness a series of open-ended questions, which were coded to establish three variables: family resilience, personal resilience and consumer resilience. Family resilience refers to family bonds, family strengths and family growth. Personal resilience refers to personal contributions, improved personal qualities and personal growth. Consumer resilience refers to the person with mental illness and their positive personal qualities, recovery, and contributions to the family. Family resilience was reported by 87.8% of participants, personal resilience was reported by 99.2% and consumer resilience by 75.6%. Unfortunately, the research provides no information on these resilience factors in the normal population making interpretation of the findings difficult. However, the research highlights the need to maximise resilience in order to reduce carer burden and distress.
3 The role of perceived control in coping with the impact of mental illness on the family and maintaining subjective quality of life
How families respond and cope with the negative impact of mental illness in the family is vital to identifying how subjective quality of life can be maintained. Coping among carers of people with mental illness has recently gained increased attention in the literature and the effectiveness of various coping strategies in reducing burden and distress has been consistently found (for reviews see Collings & Seminuik, 1998; Maurin & Boyd, 1990).
The theory of stress and coping developed by Lazarus and Folkman (1984) has been advocated as a useful theory to apply to family burden (Maurin & Boyd, 1990). The Lazarus and Folkman (1984) model proposes that the negative effects of stress on health are mediated by the person’s coping style and their cognitive appraisals of the situation (primary appraisal) and of the resources available to them (secondary appraisal). Coping styles are the characteristic strategies an individual uses to handle stress. The model differentiates between two coping styles: problem-focused coping (the process of managing the problem itself) and emotion focused coping (the process of managing one’s emotions associated with the problem). This theory is conceptually similar to the primary and secondary processes of perceived control. Both theories address an individual’s perception of his/her ability to deal with a situation and the strategies he/she uses in response to the situation. Problem-focused coping is in many ways similar to primary control where the problem is clearly being addressed by making changes in the person’s environment. Emotion-focused coping has similarities with secondary control, as managing one’s emotions is a process of making changes within the person’s internal environment. Hence, primary and secondary control may be a useful way of investigating how carers cope with the burden of caregiving.
In an investigation of families’ reactions to their relative’s mental illness, by Yamashita and McNally-Forsyth (1998) who analysed qualitative data from two studies (a Canadian and an American sample), four key themes were found to demonstrate a developing sense of control within carers. Firstly, they found that a primary task of family members was the acceptance of the mental illness diagnosis. Family members reported that accepting mental illness, accepting the uncertainty of the situation, understanding their relative’s behaviour as part of the illness, and accepting the relative as he or she is, was a turning point in their caregiving. Furthermore, it is apparent that telling their stories about the illness and the relative’s symptoms, fostered this acceptance of the new reality of mental illness and empowered them to move on with their lives. Secondly, they found once families accepted the illness, they sought information about the illness from a variety of sources. Some family members sought information in books; others talked to knowledgable staff; some sought out other sources of information such as physicians. Thirdly, further acceptance of the illness was signalled by the families' attempt to maintain normalcy in their day to day living. Families indicated that this was an important strategy for dealing with mental illness in the family. Finally, the authors found that families realised how important it was to be open and honest about their relatives’ condition to facilitate acceptance and normalcy. In fact, families found that when they did relate to others in this way they were surprised by the understanding and support they received. This process of responding and coping with mental illness in the family outlined by Yamashita and McNally-Forsyth (1998) demonstrates many primary and secondary control strategies. The first theme, acceptance, is a secondary control process that appears necessary to enable carers to use primary control processes, such as the second and third themes, seeking information about mental illness and maintaining normalcy in their daily lives. The fourth theme, being open and honest about mental illness in the family is also a secondary control process that appears to foster further primary (normalcy) and secondary (acceptance) control.
Similarly, Stern, Doolan, Staples, Szmukler and Eisler (1999) provide evidence that carers use a range of primary and secondary control strategies, as well as relinquished control, by evaluating narrative constructions about serious mental illness in the family. These authors divided the narratives into two types, those that provided stories of restitution or reparation and those that did not; the latter they describe as being chaotic or frozen stories. The stories of restitution or reparation involved a variety of primary and secondary control themes: making use of resources like support groups (primary control), taking care of oneself (primary control), seeing positives and being amused at times (secondary control; positive re-interpretation) and viewing the mental illness as an occasion for learning and knowing more in spite of the difficulties (secondary control; interpretive control). The stories that were described as being chaotic or frozen involved themes of relinquished control: difficulty making use of resources like support groups, feeling flat and nebulous, hoping to get used to mental illness, and not knowing what more to do or how to go about it.
These qualitative studies highlight the importance of both primary and secondary control in coping with the impact of mental illness in the family. Yet, research of a more quantitative nature has largely ignored secondary control processes and focused only on themes of primary control. For example, in a sample of 225 family members of persons with serious mental illness, Solomon and Draine (1995) measured a wide array of adaptive coping strategies, which they defined as “the application of behavioural strategies to reduce actual or potential stress” (p. 1156). These adaptive coping strategies can be likened to primary control, as behavioural strategies are most likely to achieve change in the person’s external environment. The results found that social support, another form of primary control, explained the largest portion of variance (17%) in adaptive coping. More extensive adaptive coping was associated with membership in a support group for families, a larger social network and more affirming support from social network members. This indicates that primary control is an important strategy for carers of people with mental illness. However, Webb et al. (1998) did not find social support significantly related to subjective burden. In a study of 59 caregivers of patients with schizophrenia, these authors found that burden was related to the inappropriate use of primary control. They found that burden was increased in individuals who had a tendency to use problem-focused coping for dealing with negative symptom behaviours and a tendency not to use problem-focused coping for dealing with positive symptom behaviours. Hence, the effectiveness of primary and secondary control may be dependent upon the situation in which it is being applied. Furthermore, an individual’s personality or tendency to use a particular type of control strategy may result in inappropriate control strategies being used and thus hinder the effectiveness of the strategy.
4 Conclusion
In conclusion, it can be seen that the caregiving role may have a negative impact on subjective quality of life. Carers of people with mental illness experience considerable burden and distress. In fact, the introduction of mental illness into the family has often been described as a traumatic and catastrophic event that gives rise to an array of emotionally painful and disturbing feelings including anger, guilt, anxiety, sadness and grief. As carers cope with difficult symptom behaviours and the relapsing and remitting nature of mental illness, they often find themselves in a position where the needs and wishes of the person with mental illness are constantly put before their own. Consequently, carers’ opportunity for work may become limited and their social and leisure activities reduced, which may lead to social isolation. The research on coping with this negative impact of mental illness in the family indicates that both primary and secondary control strategies may be useful in the maintenance of carers' subjective quality of life.
5 Focus of the current research
The current research intends to examine the impact of the caregiving role on the subjective quality of life and perceived control of carers of people with mental illness. These data will be compared with a comparison sample of people who do not care for someone with a disability. In this comparison the effects of personality on the variance in subjective quality of life will be removed to provide a purer understanding of the differences between the two samples in their satisfaction with life. The two samples will also be used to examine the relationships, outlined in the model in Figure 2, between the variables of interest, subjective quality of life, perceived control conceptualised as primary, secondary and relinquished control strategies, and personality conceptualised as neuroticism and extroversion.
CHAPTER 2
STUDY ONE: AIMS AND HYPOTHESES
Aim One:
To develop a valid and reliable tool for the measurement of perceived control by examining the factor structure of questionnaire items reported to reflect primary control, secondary control and relinquished control.
Aim Two:
To examine the differences in perceived control and subjective quality of life between a sample of carers of people with mental illness and a comparison sample of people who do not care for someone with a disability.
• It is hypothesised that carers of people with mental illness will have lower subjective quality of life and perceived control than people who do not care for someone with a disability, after the effects of personality have been removed.
Aim Three:
To examine the relationships between personality, perceived control and subjective quality of life in a sample of carers of people with mental illness and in a comparison sample of people who do not care for someone with a disability.
• It is hypothesised that perceived control will improve the prediction of subjective quality of life beyond that afforded by personality and that personality will also predict perceived control.
CHAPTER 3
STUDY ONE: METHOD
1 Sample
The carer sample was recruited from the Schizophrenia Fellowship of Victoria (SFV), an organisation that has provided a variety of services to people with mental illness and their families for the past 21 years. From beginnings in peer support, the organisation has expanded to include face-to-face and telephone contact providing individual information and support, library services and the development and publication of resource materials, and the provision of educational courses. The sample was taken from a total of 178 questionnaires that were voluntarily completed by participants in educational courses and forums run by SFV for relatives of people with mental illness. Forty-five of those were deleted from the subsequent analyses because the respondent had indicated that they were not the primary carer of someone with a psychiatric disability. A further six were deleted due to a significant number of incomplete items. This left a total of 127 questionnaires for the subsequent analyses. Most of the carers (75%) described themselves as the primary carer of someone, usually their child (70%), with a diagnosed mental illness, mostly a psychotic disorder (58%).
The comparison sample was taken from a total of 250 questionnaires that were sent to potential participants randomly selected from a list of individuals who had previously participated in Deakin University research. A total of 139 questionnaires were returned following one reminder letter, a response rate of 56%. Seventeen of those questionnaires were returned but not completed. A further eight of those were deleted from the subsequent analyses because the respondent had indicted that they were the primary carer of someone with a disability. Subsequently, 114 questionnaires were used in the analyses.
Sample demographics are displayed in Table 1 as percentages. The two samples were reasonably comparable on the range of demographic variables examined. The only noticeable differences being in income and location. A greater percentage of the carer sample had an income less than $40,999 and a greater percentage of the comparison sample had an income greater than $41,000. The carer sample was recruited from metro and regional areas, whilst the comparison sample was only recruited from metro areas.
Table 1: Demographic information.
| |Carer |Comparison |
| |(n=127) |(n=114) |
|Sex | | |
|Male |31.7% |36.0% |
|Female |68.3% |64.0% |
|Age | | |
|20-29 years |0.8% |4.4% |
|30-39 years |5.6% |9.6% |
|40-49 years |26.4% |25.4% |
|50-59 years |44.0% |29.8% |
| >60 years |23.2% |30.7% |
|Income | | |
|$56,000 |22.2% |35.8% |
|Education | | |
|Primary educated |4.0% |3.5% |
|Secondary educated |49.6% |55.8% |
|Tertiary educated |46.4% |40.7% |
|Location | | |
|Metro |49.7% |100% |
|Hume (regional area) |22.0% | |
|Gippsland (regional area) |28.4% | |
2 Procedure
A letter of information outlining the study and ethical safeguards, and a questionnaire booklet were distributed to all participants in the study. (See Appendix A and B respectively for an example of the information letter and questionnaire given to carers, that received by the comparison sample was virtually identical, minus any specific references to carers, and therefore has not been included). Consent to participate in the study was implied by the voluntary completion of the questionnaire. The carer sample received their questionnaires when they attended an SFV educational course or forum, from the researcher, or a staff member of SFV. They completed their questionnaires prior to partaking in the educational course or forum and returned them to the researcher or to the SFV staff member, who then forwarded them onto the researcher. The comparison sample received their questionnaires via the mail and returned them directly to the researcher in the prepaid envelope provided. The names and addresses of each participant were kept separate from the questionnaires by assigning a code number that corresponded to their questionnaire. This was necessary to follow-up participants who had not returned their questionnaire within two weeks with a reminder letter, after which no further contact was made.
3 Measurement Tools
Subjective quality of life was measured using the subjective scale of the Comprehensive Quality of Life Scale developed by Cummins (1997b). A copy of this scale is included in Appendix B. This tool assesses the individual’s satisfaction with seven life domains weighted by the importance he/she places on each of these domains. The seven domains are material well-being, health, productivity, intimacy, safety, place in community and emotional well-being. The aggregate of these domains provides a total subjective quality of life score. Respondents were asked to rate the importance they place on each domain on a ten point Likert scale and how satisfied they are with each domain on an eleven point Likert scale. For example respondents were asked “How important to you is your own happiness?” and “How satisfied are you with your own happiness?” This tool was selected because it has been demonstrated to be valid, reliable and sensitive based on evidence presented in the manual. The tool has good content validity as its development has been based on sound theory and empirical review of the literature. Internal reliability has been shown in numerous studies including Cummins, McCabe, Romeo and Gullone (1994) who reported Cronbach’s alpha for the importance subscales at .65 and for the satisfaction subscale at .73. The tools sensitivity has been demonstrated through the findings reported in the manual of significant differences between various populations, such as those with high and low strength in spiritual beliefs. Furthermore, Cummins et al. (1994) found that each of the seven subjective quality of life domains significantly discriminated between groups classified as either high or low subjective quality of life.
Personality was measured using the extroversion and neuroticism scales of the Revised Eysenck Personality Questionnaire (Eysenck & Eysenck, 1991). A copy of these scales is included in Appendix B. Respondents were asked to provide yes/no responses to 12 questions on each scale. An example from the neuroticism scale is “Does your mood often go up and down?” An example from the extroversion scale is “Are you a talkative person?” The scales were selected because they are widely accepted and used personality scales that have been developed over nearly fifty years of personality research and theory development, including extensive factor analytic research by both the scales developers (see Eysenck & Eysenck, 1985) and many others, such as Royce and Powell (1983). The scale manual reports reliability with alpha coefficients for the extroversion scale at .88 for males and .84 for females, and for the neuroticism scale at .84 for males and .80 for females. Reliability has also been tested by Francis et al. (1998) for an Australian sample who reported Cronbach’s alpha on the extroversion scale at .85 and on the neuroticism scale at .80.
Perceived control was measured using a modified version of the primary and secondary control scale developed by Heeps (2000) and relinquished control items taken from Thurber and Weisz, (1997). A copy of the modified scale is included in Appendix B. The original version of the primary and secondary control scale used the same statement, “When something bad happens:” to precede all of the secondary control items and a variety of statements to precede the primary control items. This format may have produced an artificial distinction between the primary and secondary control items. Hence, the primary and secondary control scale was modified by preceding all items with the statement “When something bad happens:” There were a total of 28 items on the Perceived Control scale comprising seven primary control items, 17 secondary control items and four relinquished control items. Respondents were asked to rate the extent to which they agreed with each statement on a 10 point Likert scale. An example of a primary control item is “When something bad happens: I put lots of time into overcoming it.” An example of a secondary control item is “When something bad happens: I can see that something good will come of it.” An example of a relinquished control item is “When something bad happens: I just let my feelings out, maybe by crying or yelling”. While the scale has good face validity and its development has been based on a thorough review of the literature, the reliability of this modified version is unknown.
CHAPTER 4
STUDY ONE: RESULTS
1 Aim One
To refine the reliability and validity of the tool for the measurement of perceived control for use in the subsequent analyses, a series of factor analyses and other data reduction methods were conducted on the data from the combined carer and comparison samples, totalling 241 people. A combined sample was used in order to ensure generalisability of the results to both samples and to provide an adequate sample size for the analysis. Refer to Appendix B for item numbering and content to inform the following discussion.
The data adequately met the necessary assumptions for testing. The sample size was greater than the criterion of a minimum of five subjects per variable outlined by Tabachnick and Fidell (1996). Twelve missing cases were detected and replaced with the variable mean. The distributions of each of the variables were examined for normality, linearity, and univariate and multivariate outliers. An examination of the skewness and kurtosis statistics indicated six items were not normally distributed, items 8 and 10 being mildly negatively skewed and items 18, 24, 25 and 27 being mildly positively skewed. No transformations were made because of the mild nature of the skewness, because skewness is likely to be meaningful to the data, and because factor analysis is robust to mild violations of normality.
Examination of the scatterplots revealed the data generally met the assumption of linearity. Mahalanobis distance was used to check for multivariate outliers using a cutoff criterion of p ................
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