mental health

PSYCHIATRY - THEORY, APPLICATIONS AND TREATMENTS

MENTAL HEALTH SERVICES, ASSESSMENT AND PERSPECTIVES

CINDY CARLSON EDITOR

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Published by Nova Science Publishers, Inc. † New York


CONTENTS Preface Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

vii Meaning and Mental Health: The Relationships between Meaning Structures and Mental Adjustment among Cancer Patients Dariusz Krok, Paweł Brudek and Ewa Telka

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The Health Assessment and the Dimensions of Positive Mental Functioning among Elderly People Paweł Brudek, Dariusz Krok and Ewa Telka

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Adam: Case Study of a Ten-Year-Old, Undiagnosed Boy Beata Anna Piskor-Świerad

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Attention-Deficit/Hyperactivity Disorder: A Major Developmental Precursor of Oppositional Defiant Disorder Robert Eme The Measurement Error of Self-Reported Outcome Measures in Depression Kazuki Hirao


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75

vi Chapter 6

Chapter 7

Chapter 8

Contents Validity of the Arabic Version of Beck Depression Inventory-Fast Screen (BDI-FS-Ar) in War Conditions: The Psychometric Properties in Medical and Non-Medical Syrian Populations Amani Kubitary, Mohammed Alomer and Muaweah Ahmad Alsaleh The Neurobiology of Depersonalization and Derealization Freya Thiel, Carolin Gebauer and Judith K. Daniels The Treatments of Dissociative Identity Disorders Antonio D’Ambrosio

Index

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99 125 143


In: Mental Health Editor: Cindy Carlson

ISBN: 978-1-53612-209-1 © 2017 Nova Science Publishers, Inc.

Chapter 2

THE HEALTH ASSESSMENT AND THE DIMENSIONS OF POSITIVE MENTAL FUNCTIONING AMONG ELDERLY PEOPLE Paweł Brudek1,, Dariusz Krok2 and Ewa Telka3 1

Department of Psychology, John Paul II Catholic University of Lublin, Lublin, Poland 2 Department of Psychology, The Opole University, Opole, Poland 3 Department of Radiotherapy, Cancer Center and Institute of Oncology, Gliwice, Poland

ABSTRACT We are witnesses to very dynamic and global changes in demography which result from the fact that societies are rapidly aging and the average lifespan expectancy is increasing. Experts estimate that by 2020 elderly people will make up to 30% of the global population (World Population Aging, 2015). According to lifespan psychology, late adulthood is a period of substantial changes in the psychological life of human beings. This fact implies the necessity to develop a dedicated psychological approach towards this age group, where the typical factors determining their mental functioning will be investigated and elaborated upon. Health assessment is one of the major predictors of elderly people’s physical and mental diseases. The theoretical framework for the chapter 

Corresponding Author: [email protected].


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Paweł Brudek, Dariusz Krok and Ewa Telka was constituted by the theory of gerotranscendence authored by the Swedish scholar Lars Tornstam. According to his theory, gerotranscendence is a natural process which covers a series of transformations within human spirituality, personality and interpersonal relations. The changes resulting from that process are usually tied to an increase in the different dimensions of life satisfaction. The results of the research conducted by the authors were presented in this chapter. People (N = 167) in late adulthood (60-75 years old), who differ in the global estimation of their health took part in the research. Its primary goal was to identify the differences in the personal meaning profile, the level of wisdom and social support among groups of seniors with different levels of health assessment. Three groups of elderly people were selected: (1) negative assessment health (n=42); (2) moderate assessment health (n=60); (3) positive assessment health (n=65). Three psychological methods were applied: the Personal Meaning Profile – PMP (P.T.P. Wong), the Three-Dimensional Wisdom Scale – 3D-WS (M. Ardelt), the Berlin Social Support Scale – BSSS (U. Schulz, R. Schwarzer). The findings demonstrated that the subjects interviewed with various health assessments differed between each other when it came to wisdom and personal meaning, both on the level of general outcomes and their dimensions. No statistically significant differences in most types of social support were found. The obtained differences referred mainly to people with totally different health assessments.

INTRODUCTION Recently, we have been witnessing the dynamic process of the aging of the world population. Current demographic data, coming mostly from the report entitled World Population Aging, published by the UN in 2015, indicate that within the next 15 years the number of the elderly will increase by an astonishing 56%. Consequently, the number of senior citizens will rise from 901 million to 1.4 billion. The expected changes constitute the main point of concern for economic and social policies, as well as for healthcare (Wadensten, & Carlsson, 2001, 2003; Wadensten, 2005, 2007, 2010; Steuden, 2011; Mortimer, & Green, 2015; Rycroft-Malone, et al., 2016). The period of senescence is dominated by a varied experience of loss manifested inter alia in the field of health, vigour, agility and physical attractiveness (Sinclair, Ryan, & Hill, 2015; Steuden, 2011, 2016). As a consequence of aging, pensioners frequently experience a range of medical conditions which impact the different spheres of their lives (Baltes, & Mayers, 2001; Lazarus, & Lazarus, 2006,


The Health Assessment and the Dimensions …

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Schaie, & Willis, 2011). When referring to these conditions experts usually speak of a vast range of geriatric syndromes which, if not diagnosed and treated, can render a person disabled and hence, cause them lose their independence (Schluter, Ward, Arnold, Scrase, & Jamieson, 2016; White, Kivimäki, Jokela, & Batty 2016). This situation makes it necessary for scholars to search for various factors to support and maintain the health of an individual in the senile period. Psychological literature clearly shows that the so-called subjective health assessment (Idler, & Yael, 1997; Arthur, Jagger, Lindesay, & Matthews, 2002) is an influential variable in the process. Accordingly, it seems reasonable to seek for the psychological variables whose importance increases towards senescence and which can have an impact on people’s self-evaluation when it comes to their psycho-physical fitness. By and large, the following research project builds on the theory of gerotranscendence developed and advocated by the Swedish scholar Lars Tornstam (1989, 1992, 2005, 2011), who indicated which variables can possibly have a significant impact on senior citizens’ selfevaluation with regards to the status of their health. The term ‘gerotranscendence’ refers to a natural, culture-independent developmental process which is manifested through “(…) a shift of metaperspective from a material and rational reasoning towards a more transcendental one, which usually results in improved satisfaction in life” (Tornstam, 2005, p. 60). The process, therefore, involves a far-reaching change in an individual’s perception of the world. An elderly person experiences a series of changes tackling the psychosocial sphere of existence which manifest themselves on three levels: the cosmic dimension, the Self and social/personal relationships. The Self undergoes a gradual redefinition, along with social relationships and views on important existential problems (Tornstam, 2011; Braam, Bramsen, Tillburg, Ploeg, Deeg, 2006; Steuden, 2011; Brudek 2016). Based on the key concepts of gerotranscendence and on specialized literature devoted to the topic of aging, we can draw a conclusion that among the factors which strongly affect an individual’s health selfassessment are: the sense of meaning in life (the cosmic dimension), wisdom (the Self) and social support (the level of interpersonal relations). The gerotranscendence-induced mental transformations which tackle the cosmic dimension bring people a deeper understanding of existential matters (Tornstam, 2005, 2011). While reflecting upon their life, an elderly person searches for valid and stable values which will help them answer what the meaning of their life is (Lazarus, & Lazarus, 2006; Steuden, 2011; Oleś, 2012). Thanks to this reflection, a person can discover that their life has a


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Paweł Brudek, Dariusz Krok and Ewa Telka

meaning, that they are important to others and that existence as such is a great gift which has to be protected and developed (Wong, 1989, 1998, 2010, 2014). In other words, a person approaching the last stage of their life becomes more sensitive to the different values that govern their life and discovers what things are most important in their life and hence, what is worth their efforts and dedication (Frankl, 2009; Popielski, 2008; Jacobsen, 2007). Indubitably, health is such a value (Lau, Harman, Ware, 1986; Porter 2010). However, Wong (2000) aptly notices that successful aging does not only involve one’s ability to minimize the risk of serious illness and being active (Kahn, 1995). One has to take into consideration the different existential and spiritual aspects of successful aging. The question about the meaning of one’s existence plays a key role in the improvement of the quality and the length of one’s life. While the body grows weaker, a person who feels that their life is meaningful and does not consider their senility a burden but rather maintains goals and aims for the present and for the future is more apt to adapt to the challenges of growing older. The development of a positive attitude towards life helps people discover their inner spiritual strength and helps them deal with the psychological effects of health deterioration. This factor is an important predictor of the health condition and quality of life in the elderly (Wong, 1989; Borg, Hallberg, Blomqvist, 2006; Makai, Brouwer, Koopmanschap, Stolk, Nieboer, 2014; Steptoe, Deaton, Stone, 2015). According to Tornstam (1989, 2005, 2011), gerotranscendence at the level of the Self helps a person acquire wisdom (cf. Ardelt, 1997, 2011; ZającLamparska, 2011; Steuden, 2014, 2016). Both specialized literature and anecdotal evidence gathered from people indicate that the last stage of a person’s life is associated with wisdom (Clayton, & Birren, 1980; Adams, 1991; Sternberg, 1986; Baltes, 1993; Ardelt, 1997; Steuden, Brudek, & Florczyk, 2016; Florczyk, Brudek, & Steuden, 2016). Over the past thirty years, the topic of wisdom has gained popularity among social scientists. Despite its’ short history (Kuzmann, & Baltes, 2005), psychological research projects into the topic of wisdom has resulted in large numbers of theoretical frameworks to measure the phenomenon (Birren, & Svensson, 2005; Sobeck, & Robinson, 2005; Brugman, 2006; Staudinger, 2008, Yang, 2008, Meeks, & Jeste, 2009; Bangen, Meeks, & Jeste, 2013). Amidst these frameworks, the concept of wisdom developed by Monika Ardelt deserves assiduous attention (1997, 2000, 2003, 2011). In her theorem, wisdom is a complex structure which depends on the interplay of the cognitive, the reflective and the affective. The cognitive dimension of wisdom reflects an individual’s general understanding of life and the deeper meaning



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of various intra- and interpersonal phenomena (Ardelt, 2003, p. 278). The reflective dimension relates to a person’s clear perception of reality, maintaining a healthy distance from oneself and the ability to evaluate facts objectively, considering different points of view. Moreover, factors like fears, projections, wishes or dreams tend to have no impact upon senile people’s judgments (Ardelt, 2004, pp. 275-276). The third – affective – dimension refers to a person’s ability to feel compassion and to a person’s ability to achieve well-being through the overcoming of egocentric tendencies. It also embraces positive emotions and kindness towards people around (Ardelt, 2003, p. 278; cf. Steuden, Brudek, & Izdebski, 2016). Ardelt claims that her theoretical model complies with both the synchronic and the diachronic understanding of wisdom. Her operationalization of the concept took the form of the Three-Dimensional Wisdom Scale (3D-WS) (Ardelt, 2003). The simplicity of Ardelt’s description is a definite advantage of the theory since it allows the scholar to provide a rigid distinction between a wise person and one who is only altruistic or intelligent (Ardelt, 2000; Steuden, 2014). The fact that Ardelt’s research projects focused mostly on senile people (1997, 2003, 2011) carries great significance for this publication. The studies conducted so far unequivocally link senile people’s wisdom to their subjective well--being (Ardelt, 1997, 2003; Etezadi, & Pushkar, 2013; Grossmann, Na, Varnum, Kitayama, & Nisbette, 2013; Le, 2011; Ardelt, & Jeste, 2016). Wisdom, if developed properly, makes it possible for a person to evaluate themselves in an objective, holistic and meticulous way, to become distant from everything imperfect, wrong and irrevocably lost and to turn towards the positive aspects of life, one’s past achievements and the time that is still left (Steuden, 2011b; Brudek, & Steuden, 2016; Steuden, Brudek, & Izdebski, 2016). What is more, wisdom helps people deal with stress, which in this period is caused mostly by numerous losses (Baltes, & Baltes, 1990; Baltes, 1993; Ardelt, 2011; Straś-Romanowska, 2011). Last, but not least, seniors who score high on the wisdom scale tend to evaluate their health positively (Ardelt, 1997, 2003, 2011; Brudek, 2014). Senility is the last of the many stages of a person’s life. Before becoming senile, one has already acquired much experience and general knowledge which certainly contributes to their overall wisdom (Ardelt, 1997, 2000, 2003; Steuden, 2011a, 2014). Also, a person must have gone through a plethora of different problematic situations involving finances, living conditions, accommodation, family problems, loneliness and different kinds of loss (Lang, Rieckmann, Baltes, 2002; Oleś, 2012, Brudek, Steuden, 2016). People approaching senescence often have to face stressors, which make them seek


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the support and help of others in order to maintain their own psychological balance (Sęk, & Cieślak, 2012). The importance of social support for health and psychological equilibrium is described thoroughly in psychological literature (cf. Okabayashi, Liang, Krause, Akiyama, & Sugisawa, 2004; Chen, Hicks, & While, 2014; Gilles, Clemence, Courvoisier, & Sanchez, 2015; Krok, 2015, 2016; Minagawa, & Saito, 2015, Belanger, Ahmed, Vafaei, Curcio, Phillips, & Zunzunegui, 2016). The social dimension of gerotranscendence overarches all the situations when an individual has to seek for and maintain interpersonal relations in order to receive the support necessary to be proactive in calming stressful situations. People who are maturing towards gerotranscendence, i.e., persons aged 60 and over, frequently review their bonds with people around them and gradually quit shallow relationships in favour of deep, long-lasting ones, which a person considers worth maintaining (Tornstam, 2005, 2011). These strong bonds, in turn, result in a greater level of social support a person receives and contributes to the improvement of health and subjective wellbeing (Su, & Ferraro, 1997; Melchiorre et al., 2013; Steptoe, Shankar, Demakakos, & Wardle, 2013; Fredriksen-Goldsen, Kim, Shiu, Goldsen, & Emlet, 2014; Krause, 2016). Keeping in mind the aforementioned remarks, the present research project is aimed at investigating the differences between senile people who differ in their subjective health assessment, perceived sense of life, wisdom and social support. The following research hypotheses were taken into consideration: H1. Those who differ in their subjective health assessment also differ in the perceived meaning of life. H2. Differences in subjective health assessment correlate with differences in wisdom. H3. Differences in subjective health assessment correspond to the amount of social support a person receives.

METHOD Participants and Procedure The project involved 167 respondents (70 women and 97 men) from various cities of Poland, including Augustów, Częstochowa, Gdańsk, Gliwice, Koszalin, Lublin, Łódź, Opole, Ostrołęka, Poznań, Sieradz, Słupsk,



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Warszawa, Zakopane. The average age of the women was M=64.30 (SD=4.16), while in the case of the men the average age was M=66 (SD=5.59). The respondents came from different environments. The majority were citizens of big (31.7%) and medium-sized cities (28.7%). People who lived in the countryside constituted 40% of the research population. When it concerned education, 37.7% of the respondents had a high school diploma, while 13.8% of people graduated only from primary school. Vocational school graduates (20%) constituted another large group within the research population. All participants were married. The bulk of the research population (95.8%) had been married for 20-50 years. The average couple had been together for M=39.91 years (SD=7.9). Around 5% of the respondents had no children, 43.1% had two and 28.8% had three. The two latter groups made around three quarters of the total population. Due to the peculiar character of the variables, special attention was paid to research design. On the one hand, the research project examined wisdom, sources of social support and the perceived meaning of life. On the other hand, it also examined people’s health evaluation, which is generally considered to be of an intimate character. Therefore, the study was anonymised. The research instruments included: (1) a general notice describing the aim of the study and providing the reader with instructions on how to fill-in the questionnaire, (2) a form containing questions about demographic issues and a subjective health assessment, (3) three research methods were used to evaluate the individual variables. The research procedure had the approval of the Research Ethics Committee at John Paul II Catholic University of Lublin.

Measures Personal Meaning Profile (PMP) In order to describe the perceived meaning of life in individuals, it was necessary to use the Personal Meaning Profile questionnaire, authored by P.T.P. Wong (1998) and translated into Polish by D. Krok (2009). This instrument allows the scholar to specify the logical underpinnings of the life of an individual. According to Wong (1989, p. 517), the perception of personal meaning is a specific cognitive system rooted in ethical values which is capable of making one’s life subjectively meaningful and giving them satisfaction. The questionnaire consists of 57 statements which belong to one of seven dimensions: Achievement (ACH), Relationship (RLT), Religion (RLG), Self-transcendence (ST), Self-acceptance (SA), Intimacy (INT), Fair


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treatment or perceived justice (FT). The score from all of the aforementioned subscales can be added-up to create a single coefficient of personal meaning profile. Consequently, the questionnaire shows the extent to which the individual aspects of human life are present in a given case. The Personal Meaning Profile Questionnaire is a valuable tool which has gained worldwide recognition among experts (Klaassen, & McDonald, 2002; Mascaro, Rosen, & Morey, 2004; Krok, 2009, 2011; Brudek, 2015). The scale has a satisfactory psychometric potential. For the individual subscales in the Polish version of the questionnaire, the alpha-Cronbach coefficient usually ranges between .65 and .91. The accuracy of the instrument was tested by correlating the scale with the Purpose in Life scale. The Pearson correlation coefficient took values ranging between .65 and .77. The analyses indubitably show that the Polish version of the questionnaire carries a satisfactory psychometric potential.

Three-Dimensional Wisdom Scale (3D-WS) In order to characterize the participants with regards to their wisdom, the authors used the Three-Dimensional Wisdom Scale authored by M. Ardelt (2003), and translated into Polish by S. Steuden, P. Brudek and P. Izdebski (2016). The instrument measures wisdom, which is understood as a personality trait encompassing three dimensions: the cognitive, the reflective and the affective one. The original scale has 39 items reflecting each of the three dimensions with 14 items for the first, 13 items for the second and 12 items for the third of the aforementioned categories. The answers are given on a 5-point scale; where 1 means ‘I definitely agree’ while 5 stands for ‘I definitely disagree’. In certain cases, reverse-scoring is applied. By summing-up the score for each of the three dimensions we arrive at the raw results for each component of wisdom. The final result is an arithmetic mean calculated from the three dimensions. The alpha-Cronbach coefficient for the individual dimensions scores range between .71 and .85. Accuracy tests revealed positive correlations between the overall score and self-control (.63), psychological well--being (.45), sense of purpose in life (.61) and subjective health assessment. Negative correlations have been found between the overall score and symptoms of depression (-.59) and the fear of death (-.56) (Ardelt, 2003). The Three-Dimensional Wisdom Scale is a useful device to measure life wisdom and is used extensively in psychological investigation (Ardelt, 2004, 2005, 2011; Bergsma, Ardelt, 2012; Asadi, Amiri, Molavi, Noaparast, 2012; Brudek, 2015).



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Berlin Social Support Scales (BSSS) The Berlin Social Support Scales is a method developed by U. Schulz and R. Schwarzer (2003). It is used to measure the cognitive and the behavioural aspects of social support. The questionnaire contains 38 items, each of which falls into one of the 5 main scales, which specify the type and level of social support. The sub-scales include: Perceived Social Support (8 items), Received Social Support (11 items), Need for Support (4 items), Support Seeking (5 items), Protective Buffering (6 items). The individual questions are answered on a 4-point scale (1 – definitely not true; 2 – somewhat true, 3 – true; 4 – definitely true). The sum of points for each category describes the level each type of social support achieves in an individual. The instrument can be used to diagnose both sick and healthy people. The method has a good psychometric potential. For the German version of the questionnaire, the Cronbach-alpha coefficient ranges from .63 to .85. The theoretical structure of the questionnaire was confirmed through a factor analysis. The following chapter makes use of the Polish translation of the BSSS, prepared by A. Łuszczyńska, M. Kowalska, M. Mazurkiewicz and R. Schwarzer (2006). The investigation to specify the psychometric potential of the questionnaire was conducted in three groups of patients (n=211) and one group of healthy people (n=421) aged 18-72. The results confirmed the consistency of the model and the factor analysis corresponded to the individual scales. In order to ensure the accuracy of the instrument, results were obtained with the help of the BSSS and were correlated to the scales of well-being (quality of life, depression), pain, the duration of the disease and healthseeking behaviour and plans. The data acquired over the course of the proceedings allows us to conclude that the Polish version of BSSS constitutes an efficient tool for measuring social support in senile people. The Personal Data Questionnaire In order to retrieve demographic data from the participants a simple personal data questionnaire was used. The form contained 9 questions asking about various demographic data including age, sex, the number of years married, place of residence, education, the number of children and a subjective health evaluation. When it concerned the questions about age and the number of years a person had been married, participants had to write the necessary numbers. Sex was marked as ‘M’ - for a man and ‘K’ - for a woman. Answering the question about the respondent’s place of residence, the participants had to choose one of several options: a village, a small town (up to 50,000 inhabitants), a mid-size town (50-100,000 inhabitants) and a large city


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(above 100,000 inhabitants). The question about education was close-ended and contained the following options: primary school, vocational school, high school and university. The questionnaire contained questions about the number of children and a subjective health assessment. The latter question required participants to write down a number while the former, close-ended question contained the following answers: very bad, bad, difficult to say, good, very good.

RESULTS The empirical data was gathered and subjected to a statistical analysis, the results of which are presented in the following section. In order to investigate the differences in wisdom, personal meaning profile and social support in people with different subjective health assessment, the authors decided upon the following procedures: (1) to implement a multivariate analysis of variance (MANOVA) for the individual dimensions of the personal meaning profile, wisdom and social support; (2) to implement the one-way analysis of variance (ANOVA) for the answers coming from the personal data questionnaire, the Personal Meaning Profile and the Three-Dimensional Wisdom Scale. Before the statistical analysis began, the answers from the questionnaires were checked for compliance with the statistical tests1. Therefore, in the further stages of the analysis the MANOVA and the ANOVA tests were used along with Turkey’s post hoc analysis (alternatively Dunnett’s T3 test was used when the variance of data was not uniform enough). The results are presented in the following table: The obtained results revealed significant statistical differences (p≤.05) between people with different types of subjective health assessment. The differences were noticeable in: (1) four out of seven scales of the Personal Meaning Profile questionnaire, (2) all three dimensions of the Three-Dimensional Wisdom Scale, (3) one out of five types of social support (i.e., protective buffering), which is described in the section devoted to the Berlin Social Support Scales.

1

Due to the restricted length of the article we cannot elaborate upon the exact results which indicated that the (M)ANOVA method is appropriate for the collected data. Suffice it to say that all the necessary criteria have been fulfilled. The authors are willing to present the exact data on request.



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Table 1. The results obtained from the groups of people with different subjective health assessment with regards to the Personal Meaning Profile (PMP), the Three-Dimensional Wisdom Scale (3D-WS) and the Berlin Social Support Scale (BSSS)

PMP

VARIABLES Achievement Relationship Religion Selftranscendence Self-acceptance

BSSS

3D-WS

Intimacy

Health Assessment NAH MAH n=42 n=60 M SD M SD 5.16 .97 5.12 .94 5.33 .94 5.28 .99 5.86 .68 5.61 .94

(M)ANOVA

4.55 .012* 1.54 .217 2.23 .110

post hoc Tukey η2 (T3 Dunnett) test .05 MAH:PAH* .02 --.03 ---

5.12 .90 4.92 1.04 5.34 .81 3.26 .041*

.04 MAH:PAH**

5.59 .77 5.42 .93 5.67 .73 1.56 .214

.02 --NAH:PAH* .08 MAH:PAH** .05 MAH:PAH* .05 MAH:PAH*

PAH n=65 M SD 5.55 .72 5.55 .76 5.93 .89

F

5.78 .78 5.60 1.13 6.20 .75 7.07

p

.001***

Fair treatment 4.80 .95 4.77 1.15 5.23 .94 3.81 .024* General result 5.38 .72 5.24 .86 5.63 .63 4.54 .012* Lambda Wilksa λ=.85; F=1.86(14,316); p=.030; η2=.08 Cognition 2.71 .59 2.87 .51 3.10 .62 5.94 .003** dimension Reflection 3.31 .49 3.43 .55 3.59 .52 3.92 .022* dimension Compassion 3.20 .48 3.41 .53 3.54 .52 5.70 .004** dimension General result 3.07 .40 3.24 .43 3.40 .47 7.50 .001*** Lambda Wilksa λ=.91; F=2.74(6,324); p=.013; η2=.05 Perceived social 3.27 .53 3.34 .56 3.49 .51 2.47 .088 support Received social 3.14 .53 3.05 .62 3.17 .52 .78 .459 support Need for support 3.21 .61 3.06 .69 3.15 .56 .68 .507 Support seeking 3.39 .47 3.38 .48 3.54 .42 2.44 .090 Protective 2.94 .42 2.81 .49 2.57 .66 6.55 .002** buffering Lambda Wilksa λ=.85; F=2.63(10,320); p=.004; η2=.08

.07 NAH:PAH** .05 NAH:PAH* .07 NAH:PAH** .08 NAH:PAH*** .03 --.01 --.01 --.03 --.07 NAH:PAH***

NAH – negative assessment health; MAH – moderate assessment health; PAH – positive assessment health; *** p≤.001; ** p≤.01; * p≤.05.

If we focus on the Personal Meaning Profile we will discover that the respondents differ in the overall result (F(2,164)=4.54; p≤.05; η2=.05) and in the following dimensions: Achievement (F(2,164)=4.55; p≤.05; η2=.05), Self-


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transcendence (F(2,164)=3.26; p≤.05; η2=.04), Fair treatment (F(2,164)=3.81; p≤.05; η2=.04) and Intimacy (F(2,164)=7.07; p≤.001; η2=.08). Turkey’s test revealed that, in the case of the first three sources of meaningful life, significant statistical differences arise between people who evaluate their health positively and those who evaluate their health as neither particularly good nor particularly bad. Consequently, a conclusion can be drawn that, compared to the people who evaluate their health as neither good nor bad, the individuals who evaluate their health as good or very good (1) are more determined to fulfil their goals, (2) are more open to contacts with people as well as towards ethical and metaphysical values and are more willing to leave good memories in the minds of the people around them (3) they often consider justice as the main principle that governs the world and classify different occurrences as the manifestation of justice in the world. When it comes to the Intimacy subscale, the post hoc tests revealed statistically significant differences between the respondents who evaluated their health as good or very good and those who evaluated their health as bad or neither good nor bad. Unlike people from the latter group, people from the former group are likely to be ready to build their interpersonal relationships on values such as friendship, mutual understanding, love or emotional intimacy. The subjective health assessment seemingly corresponds also to wisdom, understood both globally (F(2,164)=7.49; p≤.001; η2=.08) and in its specific dimensions. An in-depth analysis of the Turkey’s test allows us to discover that statistically significant differences exist between people whose health assessment is very negative and those whose health assessment is very positive. People who assess their health as good or very good (1) are more willing to look for the truth as well as for the deeper meaning of various phenomena and events while respecting the borders of human cognition, (2) have a clear understanding of their reality, do not take themselves too seriously and tend to take into consideration many points of view while interpreting facts. Scarcely are their judgments affected by emotional factors like their own fears, projections or wishes, and (3) are more likely to overcome egocentric tendencies in favour of other people’s needs. Four out of five dimensions of social support show no statistical significance (p>0.05). The only type of social support that turned out to be noteworthy was protective buffering (F(2,164)=6.55; p≤.01; η2=.07). Dunnett’s post hoc tests revealed that the differences were found only between people whose health assessment was radically different. A conclusion can be made that people who score high when it comes to the subjective health assessment are



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less likely to hide their problems or avoid discussing problematic situations than people who evaluate their health as poor.

DISCUSSION The aim of the present chapter was to categorize senile people based on their subjective health evaluation and describe the differences between the individual groups with special regards to factors like the personal meaning profile, wisdom and social support. The main research question was how elderly people (60 to 75 years of age) representing different types of subjective health assessments (poor, moderate, good) differ when it comes to other psychological variables. The results allowed the authors to prove all three research hypotheses as correct. Concerning the first hypothesis (H1), the study revealed that differences in the subjective health assessment correlate to differences in the personal meaning profile. The differences tackle the sources of meaningful life (which is closely connected to the fulfilment of personal goals), respect for spiritual values, maintaining interpersonal relationships and a conviction about the state of justice in the world. No statistically significant correlations were found between the subjective health assessment and the perceived meaning of life, social competence, religious beliefs and the acceptance of both the positive and the negative aspects of oneself. To a large extent the expectations regarding the outcome of study were proven correct. Psychological literature stresses the fact that the late adult period is dominated by different kinds of loss which also intrudes onto the psychological and the physical areas of life (Baltes, & Baltes, 1990; Ryff, 1995; Baltes, & Mayer, 2001; English, Carstensen, & 2015; Reed, & Carstensen, 2015) and has a serious impact on the life of the elderly, who frequently have to redefine their aims and plans (Lazarus, & Lazarus, 2006; Steuden, 2011). To reinforce the point, what was considered important, at one point in time, may not be as important and the elder must reprioritize their life due to health issues (Almeida, Piazza, Stawski, & Klein, 2011; Steuden, 2016). This, in turn, triggers changes in the personal meaning profile (Wong, 1989, 2013; Reker, & Woo, 2011; McDonald, Wong, & Gingras, 2012). In the early and mid- adulthood stages, one could consider crucial such priorities as getting a proper education, obtaining a well-paid job, starting a family or bringing up children. In the senile period, when a person is aware of the fact that their earthly existence is approaching its end, they can enjoy the effects of


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their hard work; focus on relationships with those closest to them and on spiritual values (Tornstam, 2005, 2011; Brudek, Steuden, 2016). A study authored by Brudek and Ciuła (2013) revealed that religious and patriotic values are qualities which are most respected by senile people aged 60-75. As far as the second hypothesis (H2) is concerned, the differences in subjective health assessment are frequently accompanied by differences in wisdom (both in the global sense and in the individual dimensions of 3D-WS). Therefore the second hypothesis was completely confirmed. Consequently, a conclusion can be made that a positive subjective health assessment correlates with the willingness to seek out the truth and with the tendency to sacrifice one’s egocentric needs in favour of other people’s needs. The results remain consistent with what is written in specialized literature. As reported by Ardelt (1997, 2003), a wise person is aware of the positive and negative sides of their personality and recognizes the intellectual limitations which are natural in human beings. They are also aware of the uncertainties that life can entail. Moreover, a wise person has a clear understanding of reality, does not take themselves too seriously, can interpret events in an objective way, without the affective filter, and is capable of empathy (Ardelt, 2011, 2016; Ardelt, & Edwards, 2016; Ardelt, & Jeste, 2016). Senile people seem to possess the knowledge which is crucial for an objective assessment of their health and which enables them to undertake necessary health maintenance actions (Erikson, 1982; Brudek, 2014; Steuden, 2014; Owens, Menard, Plews-Ogan, Calhoun, & Ardelt, 2016; Steuden, Brudek, & Izdebski, 2016). The third hypothesis (H3) assumed that the differences in subjective health assessment correspond to the differences in the levels of social support and was proven only partially correct. The only statistically significant difference was spotted in the sphere of protective buffering. The claim that people who evaluate their health as poor are more likely to hide information about potential diseases and other health-related problems from other family members turned out to be incorrect. Trying to interpret the results in the light of psychological literature, let us refer to Tornstam’s theory of gerotranscendence. In his writings, Tornstam (2005, 2011) claims that gerotranscendence results inter alia in a greater awareness of the Self, a decrease in ego-centricism and in being more open towards others. An individual who is approaching the state of gerotranscendence acquires new abilities that help them combat both internal and external stressors (Read, Braam, Lyyra, & Deeg, 2014; Brudek, 2016; Duan et al., 2016; Mausi et al., 2016; Wong, Low, & Yap, 2016).



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Deterioration in health encourages senile people to seek for inner strength instead of relying on people (Tornstam, 2011; Weiss, 2014; Chivukula, Fernandes, & Agarwal, 2016). By no means do senile people deny other people’s support. Instead, seniors make their peace with the fact that health deterioration is a natural part of the process of aging (Tornstam, 2005; Rajani, 2015). In this situation, people tend to solve their problems independently (yet not without other people’s help) and limit the number of people who support them in overcoming bodily and intellectual dysfunctions (Erikson, 1982; Tornstam, 1996; Bee, 2004; Reed, & Carstensen, 2015).

IMITATIONS OF THE STUDY Despite the results being valuable from the empirical point of view, the research project has a number of limitations which have to be borne in mind, so that the results of the investigation will not lead to overgeneralizations. 1. The project was a cross-sectional study, which itself carries the following limitations: it is difficult to establish a cause-effect relationship between the diagnosed dependencies; there is a large probability that errors (statistical errors, memory problems or random variations) and distortions could have happened. Therefore it is advised to continue research work into subjective health evaluation in elderly people with the help of longitudinal methods. This approach would help scholars understand the changes that take place in subjective health evaluation and its significance for the well-being of the elderly. 2. The research sample was not representative of the Polish population of senior citizens. The research sample was varied when it comes to socio-demographic variables such as: sex, education, place of residence, the number of years married. Still, the research sample did not correspond to the Polish reality of people aged 60 to 75. Therefore it seems indispensable to run a similar project on a representative group of Polish elderly people. Global demographic tendencies further encourage this idea. 3. While confronting the results of the present study with the results of research projects conducted approach, one has to be careful. It has to be borne in mind that cultural and historical-geographical factors can influence the outcome of an analysis.


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