Mothers' Coping Styles During Times of Chronic Security Stress: Effect ...

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J. Cwikel et al. In this study we explore the coping behaviors used by mothers with chil- dren living at home in the Negev area of Israel under the chronic security.
Health Care for Women International, 31:131–152, 2010 Copyright © Taylor & Francis Group, LLC ISSN: 0739-9332 print / 1096-4665 online DOI: 10.1080/07399330903141245

Mothers’ Coping Styles During Times of Chronic Security Stress: Effect on Health Status JULIE CWIKEL and DORIT SEGAL-ENGELCHIN Center for Women’s Health Studies and Promotion, Ben Gurion University of the Negev, Beer Sheva, Israel

SHERYL MENDLINGER Northeastern University, Boston, Massachusetts, USA; and Center for Women’s Health Studies and Promotion, Ben Gurion University of the Negev, Beer Sheva, Israel

In this study, we investigated the coping behaviors used by Israeli mothers to manage various sources of stress, including securityrelated stress, based on a life-course perspective of women’s health. A random telephone survey of 302 mothers who had children under age 18 living at home was conducted in the Negev area. Measures of stress such as domestic violence, sources of tension in everyday life, and time pressure were assessed together with indicators of exposure to the Intifada for their relationship to indicators of physiological health and depression. Factor analysis revealed three distinct coping styles: social–leisure style, loosening control style, and a restlessness style which were used by 91.4%, 68.5%, and 69.5% of the sample, respectively. Security-related stress was associated with greater reported health symptoms, particularly gynecological symptoms. A history of child abuse and domestic violence and exposure to the Intifada were associated with greater depressive symptoms, but not with physical health indicators. Other sources of stress particularly affected symptoms related to gynecological function. Most mothers used a variety of coping strategies during times of chronic security stress, some of which are health promoting and others that detract from health.

Received 9 July 2008; accepted 14 April 2009. Address correspondence to Professor Julie Cwikel, Center for Women’s Health Studies and Promotion, Ben Gurion University of the Negev, Beer Sheva 84105, Israel. E-mail: [email protected] 131

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In this study we explore the coping behaviors used by mothers with children living at home in the Negev area of Israel under the chronic security stress of the second Intifada period. Research from the past two decades from the former Soviet Union (FSU), the United States, and Israel following ecological disasters and terrorist attacks has indicated that mothers with small children are a high-risk group for psychological distress compared with men (Cwikel, Havenaar, & Bromet, 2002; Kimhi & Shamai, 2006; Solomon, Gelkopf, & Bleich, 2005). At such times, mothers’ stress reactions reflect fear for their own safety together with concern for other family members, especially small children (Dekel, 2004). The coping mechanisms of mothers may affect their own health and provide a role model for their children through either health-promoting coping or aversive health behaviors such as smoking or drug use (Faucher, 2003; Lieb, Schreier, Pfister, & Wittchen, 2003; Vance et al., 1994). According to the life course perspective, women learn adult coping behaviors from caregivers, particularly their mother and other female relatives (Banyard & Graham-Bermann, 1998; Barnett, Kibria, Baruch, & Pleck, 1991; Maughan, 2002; Pearlin, Schieman, Fazio, & Meersman, 2005). Guided by the life-course perspective, we examine both early life experiences and current stressors in order to characterize the specific coping strategies used by mothers under chronic security stress conditions, an area where little research has been conducted until now. Given that many mothers around the world are exposed to chronic stressors such as poverty, war, displacement, and disaster situations, this research can provide useful insights for women’s health care practitioners. Coping is a multidimensional, dynamic process designed to alter an adverse, external event or make tolerable the emotional fallout that stressful situations engender. Originally Lazarus and Folkman differentiated between emotion-focused (also termed avoidance) and problem-focused coping (also termed approach; Blalock & Joiner, 2000; Lazarus & Folkman, 1984), with most findings indicating that women use more emotion-focused coping and men use more problem-focused coping (Billings & Moos, 1981; Vingerhoets & Van Heck, 1990). Moos and Schaefer (1993) distinguished between behavioral and cognitive methods of coping that when crossed with the approach–avoidance dichotomy produced four types of coping. According to this model, what people actually do falls under either behavioral approach or behavioral avoidance coping. Women tend to use emotional ventilation, self-care, and relaxation, whereas men use more alcohol and drugs as behavioral avoidance (Ben-Zur & Zeidner, 1996; Blalock & Joiner, 2000; Carver, Scheier, & Weintraub, 1989; Ptacek, Smith, & Dodge, 1994; Vingerhoets & Van Heck, 1990). In the Israeli case, many mothers are challenged with additional daily stressors that stem from the political and socioeconomic context in Israel. Since the onset of the Al-Aqsa Intifida in September of 2000, Israelis have been living under continuous security threats. By January 2005 there were

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764 Israeli civilian casualties of whom 306 (40%) were women. These incidents included explosions on buses, drive-by shootings, and missile attacks in urban settings and outlying settlements. For every person killed, some eight others were severely injured (Data Theory Scaling System (DTSS) Group, 2005; Somer, Ruvio, Soref, & Sever, 2005). This security situation is considered a Type IV stressor, where chronic worry over personal safety produces coping challenges and result in high levels of sadness, anxiety, and alertness (Kimhi & Shamai, 2006; Wilson, 1994). During this period, Israeli society also underwent a serious undermining of the Israeli welfare state, resulting in a sharp increase in the number of families living below the poverty line (Achdut, Cohen, & Endowed, 2004). Thus, many Israeli women faced both security problems and family economic insecurity. Researchers have found in studies of the general Israeli population during the current Intifada (Al-Aksa) that between 10%–15% of persons were exposed directly to some type of security incident and that 10% showed PTSD-like symptoms. A direct relationship between exposure and symptoms was not found, however, suggesting that exposure may be expressed not only in psychological symptoms but also in other aspects of health and health behavior (Bleich, Gelkopf, Melamed, & Solomon, 2006; Bleich, Gelkopf, & Solomon, 2003; Gidron, Kaplan, Velt, & Shalem, 2004). In recent Israeli studies, researchers demonstrated that women are more psychologically vulnerable to security incidents and threats than men (Bleich, Gelkopf, Melamed, & Solomon, 2005; Bleich, Gelkopf, & Solomon, 2003; Solomon, Gelkopf, & Bleich, 2005), similar to findings following the September 11th attack on the World Trade Center Buildings (Galea et al., 2002; Pulcino et al., 2003; Stuber, Resnick, & Galea, 2006). Those with distress symptoms in Israel were more likely to use cigarettes, alcohol, or tranquilizers in order to cope (Bleich, Gelkopf, & Solomon, 2003; Solomon, Gelkopf, & Bleich, 2005), a finding also found after the September 11th attacks (Vlahov et al., 2002). Furthermore, there may be some tendency among women to use disordered eating to cope with stressful situations, a pattern that is less likely to appear among men (Bekker & Boselie, 2002). Recent research on stress among women of reproductive age has highlighted the toll that distress takes on gynecological and reproductive health that may be complicated by a history of sexual abuse or domestic violence (Chandraiah, Richter, & Holley, 2006; Glover, Novakovic, & Hunter, 2002; Hulme, 2000; Strine, Chapman, & Ahluwalia, 2005; Toomey, Seville, Mann, Abashian, & Grant, 1995). Among women living in war zones, distress may be particularly associated with gynecological symptoms (Chaaya, Bogner, Gallo, & Leaf, 2003). We used a life course perspective together with social epidemiological methods in this study. The life course approach posits that current health status is affected by both chronic stressors from early childhood and stressors in adult life (Kuh & Hardy, 2002; Maughan, 2002; Pearlin, Schieman, Fazio,

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& Meersman, 2005). Social epidemiological methods include both physical and mental health measures and emphasize what women do to keep themselves healthy (salutogenic model) rather than only what predicts morbidity (pathological model; Cwikel, 2006). While other researchers have explored the differences between men and women coping under similar circumstances, there is little information on how mothers choose their coping strategies and how they are related to health outcomes under circumstances of chronic security stress. To address this void, we examine three research questions: (1) What is the structure of mothers’ coping strategies in times of chronic security stress? (2) How do past stressors influence current physical and mental health symptoms in conjunction with current stressors? (3) What type of health outcome is the most sensitive to chronic security stress?

METHODS Sample We conducted a random telephone survey in 2002–2003 to explore women’s health behaviors with a protocol approved by the Ben Gurion University of the Negev ethics committee. This present study is based on a secondary analysis of the survey of 302 complete interviews of women between the ages of 25 and 42, residing in the Negev Region of Israel, who had children under the age of 18 living at home (see Amir & Cwikel, 2005, for further details on the sample). The Negev Region is the southern half of the country, constituting 58% of the Israel’s pre-1967 land mass, sparsely populated with only 10% of Israel’s population. Some of the towns of the Negev region had been exposed to missile attacks during the Intifada years, but for the most part the Negev region is considered a low exposure area.

Measures We sought previously validated health measures that were specific to women and that had been used in health surveys in Israel (Cwikel & Barak, 2003; Gross & Brammli-Greenberg, 2000). Topics included perceived stressors, coping styles, health behavior, morbidity, as well as demographic variables. The instrument was pretested on 15 women and changes made in the format as needed. The stress and coping questionnaires were from the longitudinal studies (Women’s Health Australia—WHA) of young and middle-aged women (45–50) conducted in Australia (Bell & Lee, 2003; Brown et al., 1998).

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Perceived stress. Based on Perceived Stress Questionnaire for Young Women (PSQ) from WHA, Australia, these questions asked respondents to rate how much 10 different domains had made them tense or stressed in the past 12 months (Bell & Lee, 2003). These domains included the following: own health, health of other family members, work/employment, living arrangements, study, money, relationship with parents, relationship with partner/spouse, relationship with other family members, and relationships with friends. Each item was rated on a 4-point scale ranging from not at all (0) to very stressful (3). We formed an additive index from the 10 items with adequate internal reliability (α = 0.64). Respondents were also asked four questions about how tense they felt due to the security situation for themselves, their children, partner/spouse, and for other family members, and friends. These questions used the same response scale as the PSQ (α = 0.85). In addition, a single question asked about how much they felt time pressure, with a 5-point scale ranging from never (0) to every day (4). Respondents also were queried about their exposure to the security situation. One question asked if they themselves had been exposed or knew anyone personally who had been hurt or killed in terrorist-related activity in the past 2 years (since the beginning of the Intifada). Answers ranged from no, knowing someone but not personally, to personally exposed or knowing someone personally (1 to 3). This variable was multiplied by exposure to the Intifada through residence in areas that were in missile range of the Gaza Strip (e.g., Sderot), which yielded an index of exposure to security events with 6 levels (from not knowing anyone personally and not residing near Gaza [73.3%] to both knowing someone personally and/or personal exposure and residing near Gaza [2.3%]). Domestic violence and a history of sexual abuse before age 18. Exposure to domestic violence was measured by a five-item scale on domestic violence in the past year from a partner, including threats and physical and sexual violence, and validated in prior research in women’s health surveys in Israel (Cwikel & Barak, 2003; Cwikel, Lev-Weisel, & Al-Krenawi, 2003; Gross & Brammli-Greenberg, 2000; Cronbach’s alpha α = 0.73). Exposure to childhood sexual abuse was measured by one question regarding exposure to sexual abuse before the age of 18. Coping behaviors. This closed set of questions followed the PSQ in WHA and specifically examined what women do when they feel stressed in order to reduce tension on a 3-point response scale (never, sometimes, frequently/always; Brown et al., 1998). We adapted this instrument to reflect new findings such the use of shopping or binge eating as ways of coping with stress (Bekker & Boselie, 2002; Mitchell et al., 2002). Health measures. The mother’s health status was assessed by six different measures, two from the same set of questions. These included the following: Self-rated health was measured by a single variable using a 5-point Likert scale ranging from excellent to poor. In addition, two additive measures

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reflecting health symptoms felt in the past 12 months were created, each consisting of five common symptoms derived from the WHA studies (Bell & Lee, 2003). Responses were scored 0 for never or rarely or 1 for sometimes or often. Five items were considered gynecological or related to gynecological symptoms (PMS, irregular menstrual cycles, heavy menstrual bleeding, repeated urinary tract infections, and pelvic pain) and five were considered general health symptoms (allergies, headaches, chronic fatigue, back aches, and skin problems). These were summed to give a score from 0 to 5 for each scale. In addition, a question asked about the experience of pain in the past 4 weeks (no – 0, yes – 1) and for those answering in the positive, the intensity of the pain was assessed (1–5, light through very intense), which was multiplied by the degree to which this interfered with daily functioning (1—not at all to 5—interfered a great deal). An additive index of diagnosed chronic illnesses was created by adding up the number of conditions that a physician had diagnosed in the past 2 years (diabetes, heart disease, hypertension, anemia, asthma, cancer, infertility problems, or thyroid dysfunction; Bell & Lee, 2003). Depressive symptoms were measured by a six-item abbreviated version of the Center for Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977; Sherbourne, Dwight-Johnson, & Klap, 2001) that previously had been validated and clinically assessed and validated in Israeli samples (Cwikel & Segal-Engelchin, 2005). This was asked using a 4-point frequency scale (1 = never to 4 = most of the time). Internal consistency was good (Cronbach’s alpha α = 0.68). Demographic measures. Standard questions were asked about education, income difficulties (three levels: very difficult to meet basic needs, difficult to meet basic needs, not difficult), age, ethnic background (Israeli born, North-African/Middle East, Europe/American, Former Soviet Union [FSU]), employment, husband’s employment, religion, religious observance, the number of children, and the number of persons living in their home. Work status (employed, studying, not employed, etc.) was measured by a single question, and the number of hours of work was assessed by categories (1–15 hours, 16–24, 25–34, 35–40, 41–48, 49 and above) to correspond to the common work levels (e.g., half time, full time, more than full time). Additional questions were asked about their birth order and number of siblings, mothers’ ethnic background, and the number of years of education of both parents and whether or not their mother worked outside the home (0 = no, 1 = yes).

Data Analysis We used chi-square tests, correlations, and partial correlations in the case of ethnic origin. One-way ANOVAs also were calculated using a Multiple Classification Analysis (MCA) subroutine to control for age. The data analysis

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followed three stages: (1) We conducted factor analysis on coping strategies using a principal components analysis with Oblimin rotation with Kaiser Normalization in order to allow for correlated factors. Items were excluded if they were reported by fewer than 10% of the respondents. We sought a parisimonious result with factors of more than two items. Resulting coping scales were assessed for their internal consistency and reliability using Cronbach’s alpha derived from the Multiple Correspondence subroutine that is suitable for categorical variables (due to the three-point response scale; DTSS, 2005). (2) The convergent validity of the scales was tested by bivariate correlations with both demographic variables and the set of health indicators. Then, bivariate relations with health measures were tested using either t tests or correlations. (3) Only those measures that were significantly related to more than one of the coping, stress, or health indicators were retained for the final series of hierarchical regression analyses on health outcomes.

RESULTS Participant Characteristics The average age of the women in this study was 37.7 years (standard deviation, s.d. = 3.5), and the vast majority of the women were married (97%). Over half had some academic education (mean years of education, 14.2 [s.d. = 2.9]). The sample was predominantly Jewish (98%). Most reported being religious to some extent: 46% defined themselves as traditional, 12% religious, and 6% ultraorthodox; 35% defined themselves as secular. They had an average of three children each (range 1–11). The majority were Israeli born (68.2%), 13.6% came from the FSU, 12.6% were born in the Middle East or North Africa, and 5.6% were of European or American background. The immigrants from the FSU were somewhat younger, averaging 35 years of age, compared with 38 years for Israelis, 39 for women from Asia/Africa, and 37 from Europe/America (f = 9.6, df = 3, p = .000). Many came from large families of origin; in the sample there were an average of 5.8 siblings (s.d. = 3.1). Income difficulties were reported by almost half of the sample, with 12.3% reporting that it was very difficult for them to pay their basic living expenses, 30.2% saying that it was hard to meet basic expenses, and 57.5% reporting that they did not have income difficulties. The majority of women were employed (77.5%), with the modal answer being 35–40 hours a week. Those with more education were more likely to work; women working averaged 14.6 years of education compared with those who were not working (12.3 years; t = 5.0, df = 289, p = .000). Those who were not working were significantly more likely to report income difficulties as well (t = 4.6, df = 289, p = .000).

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Ten percent of the sample knew someone personally or had direct personal experience with the security-related activities, 8% knew someone who knew of someone who had been either hurt or killed in the Intifada, and 82% did not have direct exposure or know someone who had been hurt in the Intifada. Thirteen percent of the sample resided in the areas near Gaza that were under intermittent rocket fire during the Intifada. Residence near Gaza doubled the probability that they were personally exposed or knew of someone hurt or killed compared with those who resided away from this area (30.8% vs. 15.7%, chi square = 5.2, p < .05). Nearly 27% (26.7%) of the sample had either some type of exposure or residence in areas close to Gaza. Less than 20% of the women were regular smokers (18.9%). Current domestic violence in the past year was reported by 13.6% of the sample, with the majority reporting one type only (10.6%), usually verbal abuse. Only 3% of the sample reported more than one type of domestic violence. A history of sexual abuse before the age of 18 was reported by 6% of the sample, and when a history of sexual abuse was added to current domestic violence, 18.1% reported either a history of sexual abuse or domestic violence or both. The majority of the respondents (87.4%) rated their health as good, very good, or excellent, and only 1.7% reported that their health was poor and 10.9% reported that it was so-so. Most of the sample (62.3%) reported no diagnosed chronic illnesses, 28.5% reported one, and 8.3% reported two or more diagnosed chronic illnesses. The most commonly diagnosed illness was anemia (22.8%), which is consistent with health concerns of women in their reproductive years. Thyroid dysfunction was reported by 7%, high blood pressure by 6%, and all other illnesses reported less frequently.

Coping Styles Table 1 shows the results of the factor analysis and the formation of three distinct coping styles that together explain 39.3% of the combined variance. Watching television or playing on the computer, while frequently mentioned (45%), and using alternative treatments (12.6%) did not load on any of the factors and thus were not retained in the final analyses. Items excluded due to low frequency were yoga, meditation, tai chi (5%), throwing things or slamming doors (3%), taking medication (3%), and using alcohol or drugs (2%). Respondents volunteered coping strategies that were not included in the closed question set: taking time for myself (3%), getting out of the house (3%), housework (2%), having sex (2%), and prayer (2%). As shown in Table 1, the social–leisure style included four items: reading or listening to music, walking or exercising, talking with friends, or engaging in some type of creative endeavor. The vast majority of the sample (91.4%)

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TABLE 1 Principal Component Factor Weights From an Oblimin Rotation for Coping Styles When Tense Factors (% variance explained) 39.3% explained Coping behaviors (% reporting) Read or listen to music (54) Talk with friends (67.9) Walk or exercise (27.8) Write, draw, or engage in a creative activity (15.9) Eat more than usual (25.5) Buy unessential items (19.5) Decrease tasks and commitments (12.9) Take a long sleep (13.6) Smoke cigarettes (20.2) Have insomnia (31.1) Eat less than usual (22.5)

Social—leisure (15.4)

Loosening control (12.0)

Restlessness (11.9)

0.756 0.564 0.522 0.504 −0.650 −0.592 −0.569 −0.540 0.680 0.665 0.588

Note. Two items, watching TV or playing on the computer (45%) and using alternative treatments (12.6%), did not load on any factor. All items that were not reported by at least 10% of the sample were excluded. Social—Leisure and Loosening Control Factors were negatively correlated at −0.09, but this correlation was not statistically significant.

reported one of these behaviors as a means of coping. Talking with friends is a clearly social activity, allowing for ventilation and exchange of social support, in contrast to exercise, walking, drawing, and writing, which are sometimes solitary activities. It is important to note, however, that Israeli women often engage in these pursuits in group settings such as at sports clubs or community centers or in the company of close friends (e.g., good friends who walk together). Thus, they capitalize on their time and derive both social support and leisure relaxation. A second style, which we termed loosening control, comprised behaviors that reflect women’s attempts to self-care and compensate, as a means of relieving tension. The common denominator is easing up on usual selfconstraint and includes both physiological and behavioral aspects. This style included overeating, shopping for unessential items, deliberately reducing the number of tasks and commitments, and taking a long sleep (more than 7–8 hours). Some aspects include self-indulgence like eating more or impulsive buying, while other reflect behaviors that renew energies such as taking a long sleep or reducing the number of roles and obligations. Approximately two-thirds of the sample (68.5%) used at least one of these behaviors to cope with tensions. The most commonly reported behaviors were eating more than usual (25.5%) and buying unessential items (19.5%).

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The third style, defined as behavioral restlessness, was used by 69.5% of the sample. This last style was characterized by insomnia or restless sleep (31.1%), eating less than usual or losing one’s appetite (22.5%), and smoking (20.2%). Pearson’s correlation coefficients between the three styles revealed that they not significantly correlated, indicating that they are distinct, independent factors. Additive scales were formed (social–leisure, loosening control, and restlessness), and Cronbach’s alpha coefficients were calculated as 0.93, 0.94, and 0.94, respectively. In Appendix 1 the significant correlations between coping styles and other independent variables are shown. Respondent’s educational level was positively associated with social–leisure coping and negatively associated with restlessness, while the educational level of both parents also negatively was associated with restlessness. Those who had a higher number of brothers in their family of origin were more likely to use restlessness coping. The further down on the birth order, the more likely a woman was to use the restlessness style, even after adjusting for the number of siblings in the family. The number of persons living in the home was associated negatively with both social–leisure and loosening control. Those whose mothers did not work outside the home were more likely to use restlessness. Those whose husbands were unemployed were more likely to use loosening control, and the number of working hours in the week was negatively associated with social–leisure style. Styles of coping were not associated with ethnic origin, knowing someone who had been harmed in terrorist events, age, level of religiosity, religion, family status, work status, current income difficulties, a history of sexual abuse, or current domestic violence. As a test of convergent validity, the bivariate correlations of the three scales were analyzed by Pearson’s correlation coefficients (table available from the authors on request) with the other independent and dependent variables. In general, types and sources of tension were less commonly associated with the social–leisure style than with the other types, with the most correlations found with the restlessness coping style. Both loosening control and the restlessness style of coping were significantly associated with security-related worries; however, in opposite directions. Those who were worried over spouse and children were less likely to use the loosening control coping style, and those who were worried over children’s safety were more likely to use the restlessness coping style. No one item of the PSQ correlated with all three coping styles, indicating good differential validity. Worry over one’s own health was correlated with loosening control and restlessness coping styles, whereas worry about the health of a family member was associated with social–leisure type of coping. Money worries also were associated with a greater use of the restlessness coping style. Relations with parents and other family members were not significantly associated with any coping style. The combined index was significantly associated with all the different styles of coping. Time pressure was associated only

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with loosening control, albeit at a level of borderline significance (p = .07), whereas physical pain and depression were both associated with restlessness. Both gynecological and nongynecological symptoms were associated with loosening control and restlessness. Self-rated health was not associated with any specific coping style, and diagnosed chronic illness was associated only with restlessness. The hierarchical regressions included the following steps: (a) selected demographic factors (income sufficiency and years of education); (b) time pressure and sources of daily perceived stress (PSQ; a combined index of a history of child sexual abuse and current domestic violence was included in step 2 but was not retained in the final set of analyses as it was significant only with regard to depression); (c) exposure to chronic security threats by place of residence and security worries during the Intifada period; and (d) use of coping strategies. Table 2 shows the results of the hierarchical regression on gynecological symptoms that explained 12% of the variance, with statistically significant additions at all four steps. Significant independent variables were years of education (low level of education was associated with more symptoms), TABLE 2 Hierarchical Multiple Regression of Income Sufficiency and Education, Sources of Tension in Daily Life, Security Situation, and Coping Styles on Gynecological Symptoms Variable Step1 Income sufficiency No. of school years Step 2 Income sufficiency No. of school years Time pressure in daily life Sources of tension—PSQ Step 3 Income sufficiency No. of school years Time pressure in daily life Sources of tension—PSQ Exposure to security events Worry over security index Step 4 Income sufficiency No. of school years Time pressure in daily life Sources of tension—PSQ Exposure to security events Worry over security index Social–leisure coping style Loosening control coping style Restless coping style ∗p

< .05;

∗∗ p

< .01;

∗∗∗ p

< .001.

R square

B

Std. error B

.023∗

2.012 .013 −.059 1.602 .072 −.063 .022 .041 1.159 .083 −.055 −.001 .036 .010 .041 .760 .051 −.050 −.021 .019 .005 .046 .045 .097 .189

.365 .095 .023 .395 .096 .023 .050 .015 .452 .097 .023 .051 .015 .020 .019 .458 .095 .023 .050 .015 .019 .019 .032 .035 .074

.050∗∗

.066∗∗

.119∗∗∗

Beta .008 −.153∗ .045 −.163∗∗ .026 .162∗∗ .052 −.143∗ −.001 .141∗ .028 .129∗ .031 −.130∗ −.024 .076 .013 .146∗∗ .081 .161∗∗ .148∗∗

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TABLE 3 Hierarchical Multiple Regression of Income Sufficiency, Education, Sources of Tension in Daily Life, Security Situation, and Coping Styles on Depression Index Variable

R square

Step1 Income sufficiency No. of school years Step 2 Income sufficiency No. of school years Time pressure in daily life Sources of tension—PSQ Step 3 Income sufficiency No. of school years Time pressure in daily life Sources of tension -PSQ Exposure to security events Worry over security index Step 4 Income sufficiency No. of school years Time pressure in daily life Sources of tension—PSQ Exposure to security events Worry over security index Social–leisure coping style Loosening control coping style Restless coping style ∗p

< .05;

∗∗ p

< .01;

∗∗∗ p

.073

∗∗∗

.137∗∗∗

.173∗∗∗

.215∗∗∗

B

Std. errorB

9.659 −.460 −.292 7.510 −.249 −.311 .344 .164 5.877 −.120 −.312 .276 .167 .204 .018 4.606 −.139 −.237 .236 .142 .191 .022 −.139 .125 .801

1.113 .289 .070 1.172 .287 .068 .148 .045 1.326 .284 .067 .149 .045 .057 .056 1.348 .280 .070 .147 .046 .056 .056 .095 .105 .221

Beta −.090 −.238∗∗∗ −.049 −.254∗∗∗ .127∗ .203∗∗∗ −.024 −.255∗∗∗ .102 .207∗∗∗ .192∗∗∗ .018 −.027 −.193∗∗ .087 .176∗∗ .180∗∗ .022 −.079 .065 .198∗∗∗

< .001.

PSQ, worry over the security situation, and the use of loosening control and restlessness coping styles. Table 3 shows the same set of variables regressed against the depression index. The model explained 22% of the variance. In this analysis, all four steps were highly significant at p