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Locus of Control, Gender, and Social Support

As Stress Moderators in Industrial Injury
and Adaptation to Disability

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LOCUS OF CONTROL. GENDER. AND SOCIAL SUPPORT
AS STRESS MODERATORS IN INDUSTRIAL INJURY
AND ADAPTATION TO DISABILITY

By
Elaine M. Tripi

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Counseling, Educational Psychology and Special Education
1989

imam

loo—l

ABSTRACT

LOCUS OF CONTROL. GENDER, AND SOCIAL SUPPORT
AS STRESS MODERATORS IN INDUSTRIAL INJURY
AND ADAPTATION TO DISABILITY

By

Elaine M. Tripi

The purpose of this study was to investigate from a multi-dimensional
perspective, the relationship between stress and adjustment. Specifically,
locus of control orientation (personality variable), gender (biological variable),
and social support (social situation variable) were measured to determine
direct and interaction effects in a group of industrially injured workers. The
theoretical base for this study was drawn from rehabilitation, community, and
personality psychology. Subjects for this study were 56 men and women who
were currently receiving worker’s disability compensation benefits. All subjects
were volunteers 18 years of age or older, who had sustained a work-related
injury. and had been disabled for at least six months. but no. longer than
twenty-four months. Data were collected through the use of questionnaires
during a rehabilitation evaluation. A correlational design examined all
variables of interest in the study. The findings are discussed in terms of their
implications regarding injured workers and adjustment to disability. Results
indicated that workers in this study were (a) moderately coping with their
disabilities. (b) external in their locus of control orientation, and (c) minimally
depressed.

There were no gender differences established on any of the variables.

However, gender was the only variable that had an interactive or modifier effect
on the outcome variable of depression. Females were less depressed than
males under high stress, while males experienced less depression under low
stress. There was no main effect of gender with either of the outcome variables
in this study. In addition, there was a statistically significant interaction effect of
the variables with each other in regard to depression. Specifically there was a
STRESS X GENDER X LOCUS OF CONTROL interaction, as well as a
STRESS X GENDER X LOCUS OF CONTROL X SOCIAL SUPPORT
interaction.

Locus of control had a statistically significant main effect for both coping
and depression. indicating that internal subjects experienced higher coping
and less depression regardless of the level of stress.

A statistically significant main effect was demonstrated for social support
on coping. Specifically. subjects with high social support were able to cope
under stress more effectively than subjects who had low social support.

Future research must address this complex stress process more
intensely in order to delineate and clarify issues relating to methodology and

research design.

DEDICATED
TO
GINA AND W.E.B.

ACKNOWLEDGMENTS

This research is an outgrowth of a class taught by Dr. Robert Caldwell
entitled ”Coping with Stress.‘ I initially believed this class would help me cope
with the stress of completing my doctorate. Instead. it helped me conceptualize
my research involving disabled workers.

Special thanks to my committee members; Dr. James Engelkes for his
academic assistance throughout the years, Dr. Donald Galvin for his support
and enthusiasm in this project, Dr. William Hinds for getting me through the
administrative hurdles, and my academic mentor, Dr. Robert Caldwell. His
advice and support have been immeasurable in the entire research process.

I am indebted to Yeager and Company for allowing me to utilize their
files for my data. Their cooperation was so much appreciated. I also wish to
thank the Genesis Group for allowing me to conduct my research at their facility.
Special thanks to Karen Cruise and Brian Kalt for their technical assistance.

My family has been a very critical part of my life and I want to
acknowledge the support that I have received from my mother, sisters and
brother. Knowing that we share a bond of caring and love has made me a
stronger and better human being. My love and thanks to my daughter, Gina
who has grown into a beautiful young lady during my doctoral endeavor.
Finally, I want to thank W.E.B. for always being there and loving me.

TABLE OF CONTENTS

LIST OF TABLES
LIST OF FIGURES
CHAPTER

I INTRODUCTION

Disability as a Stressful Life Event

Adaptation to Stress: Locus of Control as a Moderator
Variable

Social Support as a Moderating Variable

Gender as a Moderating Variable

Interaction of Moderator Variables

Purpose of the Study

Research Hypotheses

Research Model

Overview

ll METHODOLOGY

Introduction

Subjects

Sampling Procedures
Site/Setting
Apparatus/Interview
Instrumentation
Research Team
Procedures

III RESULTS

Introduction
Sample Characteristics on the Variables in the Study
Tests of the Major Hypotheses of the Study

IV SUMMARY AND CONCLUSIONS

Introduction

Discussion

Limitations

Conclusions

Implications for Future Research

vi

viii

ix

42

42
42
44

61

61
61
75
77
79

APPENDICES
APPENDIX A
APPENDIX B
APPENDIX C
APPENDIX D
APPENDIX E
APPENDIX F
APPENDIX G
APPENDIX H
APPENDIX I

LIST OF REFERENCES

Consent to Participate Form

Stressful Life Events Questionnaire
lntemal/Extemal Locus of Control Scale
Beck Depression Scale

Social Support Dimension Scale
Coping With Disability Inventory
Logbook

Introductory Participation Statement
UCRIHS Approval Letter

vii

80
83
96
103
109
1 17
130
132
134

136

Table 1
Table 2

Table 3
Table 4

Table 5

Table 6

Table 7

Table 8
Table 9

Table 10

Table 11

Table 12
Table 13

LIST OF TABLES

Educational levels of industially injured workers in the study. 28

Occupational distribution of industrially injured workers in 29
the study.

Income levels of industrially injured workers in the study. 31

She‘mparison of stress levels over time for subjects in the 45
y.

Summary table of sample characteristics on the variables of 47
interest in the study.

Multiple resression for locus of control with depression and 49
coping.

Multiple regression for social support with depression and 52
coping.

Multiple regression for gender with depression and coping. 55

Multiple regression for locus of control, social support, and 56
gender with depression and coping.

Summary table of results of statistical analyses of hypotheses 59
of the study.

Mean BDI scores for males and females under high and low 70
stress.

Mean BDI scores for stress, gender, and locus of control. 72

Breakdown: Mean BDI scores for stress, gender, locus of 74
control and social support.

viii

Figure 1
Figure 2
Figure 3
Figure 4

LIST OF FIGURES

Conceptual model of vulnerability hypothesis.
Conceptual model of modified vulnerability hypothesis.
Marital status of industrially injured workers participating in

the study.
Race distribution of industrially injured workers in the study.

ix

Chapterl
Mon

Stress research and studies examining adaptation to stress (i.e.,
general adaptation syndrome studies) have proven to be quite popular during
the past several decades. Pioneering work by Selye (1956) initially focused on
stress response. He has described three stages which the body passes
through in fighting to maintain/retain its natural inclination to homeostasis or
harmony. These stages constitute what is known as the l ti
Syndrome (GAS) and are listed below:

$13114: Alarm Reaction (ARS). The ARS occurs when the
body/Individual initially perceives a threat/stress is imminent. At this stage,
widespread circulatory and digestive changes occur, as well as increased
adrenal and pituitary gland secretions.

W: Stage of Resistance (RESS). At the RESS, the body
increasingly makes adjustments to the continuing threat/stressor. as production
of secretions of the adrenal and pituitary gland rises above its normal level.
Further, the body may exact a price for this adaptation by the onset of
stress-related diseases such as high blood pressure, depression, ulcers,
headaches, etc. (i.e.. diseases of adaptation).

StageJfl: State of Exhaustion (EXHS). At this final stage, the body has
finally grown incapable of responding to the demands of the stressorfthreat in a
healthy manner. Consequently. at this stage the pituitary and adrenal glands
have been strained beyond their limits. Rates of secretion that had increased at
the RESS stage can no longer be maintained. So serious is this stage that the
body’s inability to fight has led to fatigue and exhaustion. The end result can be
death itself.

Subsequent research has extended the base of knowledge relative to

2

these phenomena. Emphasis has been given to the manner in which life
events produce dysfunctional behavior and/or emotional disorder in
individuals. While most researchers agree there is a casual link between
recent life events and illness symptomatology, outcome studies tend to show
weak results. Correlation studies have suffered much of the same fate. It is
thought that the reason for this lack of robust findings is due to the presence of
other factors which may interact in this process, as well as the cumulative effect
of individualistic responses. While Selye’s theory (1973) has focused on
biological adaptation to stress, Lazarus, Cohen, Folkman. Kanner, and
Schaefer’s (1980) theory of stress has tended to focus on the psychological.
Lazarus et al., ( 1980) contend that psychological stress is dependent on the
degree to which individuals can successfully interaCt with their environment.
Lazarus proposes that the more successfully the person can transact with the
environment, the more the stress can be moderated and less stress will be felt.

Lazarus and colleagues (1980) have also offered that the link between
stresses and disease should be examined by way of a tri-Ievel analysis: the
physiological level (as proposed by Selye), the psychological , and the social. It
is assumed that a response pattern is initiated on the part of individuals when a
stressful life event occurs. Responses to that event may then be moderated by
preexisting personal dispositions and social experiences as well as certain
socioeconomic status variables. These moderators or variables that affect the
way individuals perceive and respond to stressful life events can significantly
enhance and explain the stress illness process.

Caldwell, Pearson, and Chin (1984) suggested that three classes of
variables have been shown to moderate the effect of stressful life events or
adaptation to that event. They are as follows:

1. Personality variables such as autonomy/Intemality and/or

passivity/extemality.

2. Social factors, such as social support.

3. Biologic/genetic variables. such as age or sex.

According to Mitzel (1982), disability is a chronic or long-term condition
that results from an injury or disease. A broader definition suggested by
Parmeggiani (1983) is that disability is any restriction or lack (resulting from
impairment) of ability to perform an activity in the manner considered normal for
a human being. Expression may be in the form of depression, sleep
disturbances, substance abuse disorders, as well as physical manifestations.
From whatever causative agent, and regardless as to expression. disability can
be viewed as a stressful life event (Mitzel, 1982).

Peterson and Seligman (1983) suggested that beyond the physical
expression of suffering and loss of wages, the disabled adult may also show
profound impairments extending as far as the psychological realm. While they
contend that these impairments are not necessarily pathological, Peterson and
Seligman (1983) asserted that such psychological impairments may leave the
disabled adult feeling that the situation (injury) is well beyond their ability to
cope. One can question the degree to which such feelings of passivity and lack
of control are a situational reaction to the event, or a generalized personality
response that may hinder positive adaptation (i.e.. successful utilization of
individual skills and capacities to transcend the stressful life event) (Mechanic,
1976).

Seligman (1975) in describing his theory of "learned helplessness”
postulated that people who cannot control the aversive events in their lives
become depressed. In fact. Seligman believes that the symptoms of

depression are themselves the symptoms of learned helplessness. He goes on

4
to clarify that it is not the trauma as such that produces dysfunctional behavior,
but not having control over trauma

Behan and Hirshfield (1966) and Hirshfield and Behan (1963) asserted
that many of the most perplexing and resistant examples of chronic disability
within the context of industrial accidents leading to human injury were actually
the late stages in a sequential process. These researchers have cited four key
features of this process.

1. The accident process is preceded by the development of tension and
stress, which can lead to feelings of inadequacy and depression.

2. Dependency/denial can then occur. This is an essential component
to the accident process; it incorporates the individual’s sensitivity to perceptions
of increased tension and stress, while experiencing reduced support and
approval from family members and/or social support networks previously
expected to be supportive and approving.

3. The individual adapts a previously unacceptable role equated with
weakness and failure into an acceptable role as a disabled person.

4. The individual’s continued role as a disabled person is crystallized
and stabilized, thus becoming a means of coping with life. This role is
energized by the individual’s personality characteristics and reinforced by
social and family support networks.

Weinstein (1978) later extended "the accident process" suggested by
Behan and Hirshfield (1963) and Hirshfield and Behan (1966). He outlined five
major stages.

1. mm. Tension and stress precede the accident event
leading to feelings of inadequacy and depression. This stress is the result of a
combination of a vulnerable character and specific job and/or family related

tension.

5
2. MW. Job related injury, illness, or other problems
(difficult working environment, incompatibility) are seen as 'explanation and

sanction for decline in competence and increased dysphoria‘. (p. 96)

3. WWW. Diagnosis, treatment, and failure to find
a cure add to the explanatory events.
4. Hi i f i ll“ . There is a decreased expectation of

improvement, increased dependency on family and agencies with increased
defensiveness and anger when pushed.

5. W. There is a loss of all expectation of recovery
and a new role as honorably disabled is adopted (Weinstein, 1978).

The occurrence of a disability in industrial settings is a common and
costly phenomenum. According to Wickersham (1983), Worker Disability
Compensation benefits paid in 1979 totaled 11.9 billion dollars in the USA. In
1981, as a result of work injuries, there were 95 million lost hours per week or
2.3% of the workweek lost, at a cost of 70 billion dollars. Thirty-one million
individuals were limited in daily activities because of chronic physical or mental
disabilities resulting from work related injuries. (Wickersham, 1983).

The Social Security Disability Insurance Program is the largest
insurance program in the country. In 1981, for instance, 17 billion dollars were
expended to 2.8 million disabled adult beneficiaries. These adult beneficiaries
had been assessed as having functional limitations from impairments so severe
as to hinder them from sustaining substantial gainful work activity and/or
activities of daily living.

Berkowitz (1985) estimated that 121.6 billion dollars were expended in
1982 to cover cash disability payments, (Social Security Disability, long term
disability, private disability insurance, veteran’s pensions) medical care costs,

and direct services (vocational rehabilitation, veteran’s programs, and other

6
government sponsored programs). Berkowitz (1985) indicated that there are

gaps in this information and therefore the actual costs are substantially higher.
These costs do not reflect the cost that disability has on the family of the
individual or the cost in production to the company.

Adaptation to Stress

f l r ' V r'

According to Mechanic (1976). adaptation/adjustment to a stressful life event
depends on whether the event itself presents a challenge mild enough to leave
the person with coping resources relative to that individuals skills and
capabilities. To determine such skills and abilities, Mechanic (1976) suggested
that perceptual data be obtained.

Locus of control perceptions have been investigated in several studies
related to stressful life events. The locus of control concept emerged from the
work of Rotter (1966) and his lntemal-External Locus of Control (l/E) Scale.
This concept refers to the extent that individuals believe they have control over
their lives as compared to those individuals who perceive that their lives are
determined by forces outside themselves. Those individuals responding to the
l/E Scale in such a manner as to indicate that they have control over their
lives/life events are classified as being internal while those expressing a lack of
control over their lives/life events are classified as being external.

Locus of Control is also said to be descriptive of the degree to which
individuals subscribe to the American individualistic orientation and/or the
master of their fate perspectives (internal control). It is also thought to describe
individuals who perceive themselves as “victims" of outside influences such as
fate. luck, or chance (external control) (Hamlin, 1982).

Locus of Control has also been found to be related significantly to
certain measurable concepts (such as stress) and its effect on adaptation to the

7
stressful life event. For example, Mechanic (1976) conducted a study to
examine the influence of locus of control orientations on individual responses
to events considered aversive. It was hypothesized that locus of control was a
stress moderator.

Results indicated that when participants felt they could exercise some
control over aversive events, the impact of stressors was decreased.
Accordingly, 'extemals' were found to be less able to adapt/adjust to stress in a
healthy manner. Thus the hypothesis was supported. A later study by
Anderson (1977) used 90 entrepreneurs as subjects. The purpose of the
research was to examine the relationship among several variables. Two
variables were found to be of particular relevance. For example. correlations
were calculated on stress and locus of control (using Rotter's Locus of Control
Scale). Results showed a correlation (F- .61) at the .001 level of significance
between external locus of control and stress. The subjects who scored high on
the 'extemal" dimension, experienced greater stress. Anderson also found that
'externals" used more maladaptive or defensive types of coping behavior as
compared to internals.

A later study by Sandler and Lakey (1982) investigated stress
moderating effects of locus of control beliefs. perceptions of control over
negative events, and social supports. Results indicated that locus of control
beliefs moderate the effects of stressors (i.e., the more internal an individual,
the lesser the degree of anxiety.) Additionally, internals also appeared to have
functioned with a smaller amount of social support than externals.

While scholars have basically neglected the study of locus of control
and the industrially disabled worker, Rosenbaum and Raz (1977) found some
interesting results in an all-male, 70 person, Jewish sample. Of these, 26
suffered from locomotor disabilities while 44 other subjects were non-disabled.

8
The researchers had the Minnesota Multiphasic Personality lnventory’s

Denial and Depression Subscale and the Locus of Control Survey adapted
and translated into Hebrew (the study took place in Israel).

Findings showed that:

1. The more serious the injury, the more the denial of that injury by the
disabled subjects.

2. The disabled subjects reported significantly more symptoms of
depression than the non-disabled subjects.

3. The more the subjects were found to be external, the more they
believed that individual responses were not capable of changing the
environment (although the means were still in the normal range).

4. External ratings on the Locus of Control measure may have been
due to loss of reinforcers for internal type behavior and an increasing amount of
punishers in the environment. According to the researchers, the
environment/social order may have supported dependency behavior.

There have been other studies examining locus of control and the
disabled. Kundu (1983) developed a prediction model for vocational
rehabilitation clients using locus of control, work motivation, work history and
demographic variables. Although locus of control did not prove to be
significantly related to work motivation, there was a significant relationship
between locus of control and obtaining employment. lntemal subjects obtained
employment significantly earlier than external subjects.

Moreau (1983) investigated three different groups of disabled
community college students (deaf, blind and orthopedically impaired) to
able-bodied students. Her findings showed that physically disabled students
were significame more external in their locus of control orientation than the

able-bodied control groups. Overton (1987) examined locus of control as a

9
dispositional characteristic of physically disabled athletes. She found subjects
to be more external than a group of able-bodied subjects. Furthermore, there
were no gender differences in this sample on the locus of control measure.

There is extensive research examining the locus of control construct.
Kundu (1983) suggests that over 3,000 studies now exist in the literature
utilizing this variable. Not only has this construct proven to be significant as a
predictor variable but also as a moderator variable in the stress-adjustment
process.

Adaptation to Stress
S'IS I III I' II'II

Much attention has been paid to the degree to which the existence of
social support can moderate the effects of stressful life events. With a
breakdown of the family unit and its social support system, a proliferation of
publicly supported and privately financed services have focused on replacing
that support with professionals from various disciplines.

There is wide disagreement in the literature about the definition of what
constitutes social support. The literature on social support does not present a
unitary concept. House (1985) suggested that social support involves a flow of
one or more of four things between people:

1. W (empathy, concern, caring).

2. Instrumentalij (giving money. assistance).

3. Information (advice. suggestions, directions).

4. Appraisal (feedback or social comparison relevant to a person’s self
evaluation).

Regardless of definition. however, a consistent relationship has been
found between individual physical and/or psychological health and social

support. These findings tend to be most pronounced when compared to

10
individuals who are socially isolated and have had a breakdown in physical
and/or psychological functioning.

Gottleib (1981, 1985) has hypothesized that individuals experiencing
difficulties that impair functioning, initially turn.to a personal community. This
personal community can be likened to a primary social support group. The
individual experiencing the trouble tends to go to such a community to get
feedback and/or practical assistance to remedy the distressing situation. This
personal community or primary group may have already detected that
something was amiss with the individual with/without admission or verbal
introduction (of the stressful life event). In either case, should the situation
warrant it, a wider social support system may be mobilized to help the
individual cope with the cause of the stress.

Widely recognized among health and mental health scholars and
professionals is the reality that, in general, those clients in need of such
assistance delay treatment or defer help seeking behavior based on the
following variables:

1. lack of motivation;

2. tendency to extemalize problems;

3. services are seen as too expensive, too professional, too
bureaucratic. etc.;

4. self-reliance beliefs;

5. the stigma attached to the use of psychiatric services (Gottleib. 1985).

Generally, however, individuals tend not to feel the same degree of
hesitancy regarding the utilization of social support when there is a felt need.
This reality fits well with the recognition that the first helpers experienced by
most individuals were intimates from the family or friendship circle. Even with

the breakdown of the extended family and the advent of the geographically

1 1
mobile individual (which tends to put miles between families and friends), in
times of stress most individuals still turn to their social support system for aid,
advice. and counsel (Crotty & Kulys. 1985).

Social support research has generally heralded the efficiency and
effectiveness of such support in mitigating the effects of stress/stressful life
events on individuals’ physical and mental health. Cobb (1976) stated that
among persons exposed to high stress, those with social supports of various
kinds (friends, spouses, or community relationships) have much lower levels of
symptomatology. compared with those lacking social supports. This
relationship, Cobb (1976) further stated, is due in part to the fact that the
supporting persons offer reassurance and acceptance of the stressed person
and convey information which leads the subject to believe that he is esteemed
and valued.

Research by Myers, Linenthal, and Pepper (1975) has demonstrated a
main effect for social support. Even under low stress. persons without social
support show elevated rates of symptomatology. suggesting that the condition
of low social support is itself a source of stress. Wills and Langner (1980)
suggested that the combination of predictability and reassurance makes social
support a potent insulator against stressful conditions.

Dean and Lin (1977) examined the nature and significance of social
support systems and attempted to clarify methodological and theoretical
problems. In addition to suggesting possible approaches to measurement and
design concepts, that would better delineate and clarify these sources. they
contend that increased knowledge about the stress-buffering functions of social
support has important implications for primary prevention.

12

Adaptation to Stress
n r M r 'n V '

Verbrugge (1985) in her review of gender and health indicated that sex
differences in health are principally the outcome of differential risks acquired
from roles, stress, life styles, and preventative health practices among men and
women in our society. Several studies dealing with gender and stressful life
events suggest that under similar circumstances males and females react and
adjust differently to stressful life events. Bloom and Caldwell (1981) examined
sex differences in personal adjustment surrounding the time of marital
separation. They concluded that during the preseparation period, women
reported substantially poorer psychological adjustment than men. In contrast,
during the postseparation period, men reported substantially poorer adjustment
than women.

Levenson. Hirschfield. Hirschfield, and Dzubay (1983) examined recent
life events and the occurrence of industrial injuries with regard to gender
differences. Their study on pro/post changes among White, Protestant. blue
collar male and female workers involved in industrial injuries uncovered some
interesting information.

During the pre-injury period, males and females had experienced
significant changes in life events and a higher degree of overall stress such that
life change adjustments were at the major crisis level.

Females had shown an increase in stressful life events W prior
to the injury. Meanwhile. males experienced an increase in stressful life events
gm prior to the injury. During this same period (i.e., the one year
pro-injury period) while male stress was increasing, female stress was stable.

During the post-injury period, females experienced more spousal separation

13
and more deaths of close friends. The female response was to express more
independent behavior (such as achieving more education, making job
changes. etc.). However, this may have been confounded with the need for
additional income due to spousal separation.

Meanwhile, these life events were predictive of diseases of adaptation
(such as depression) in that these changes demand a psychological
adaptation/adjustment. Study males reported increased hospitalization rates
and more income than the study females. Study females earned only 60% of
the wages reported by males. Also, low income status on the part of the study
females meant that at the post-injury period of one year they had been
disproportionately exposed to stressful life changes due to financial hardships.

This finding has also been supported by Krause (1985). For example,
Krause offers that social support networks, income status. and gender are
moderators of stressful life events to the extent that they produce statistically
significant interaction effects.

A finding in the study by Levenson and colleagues (1983) that males
showed more dependent behavior than females is contrary to that of Mechanic
(1976). Using an unspecified sample of college students seeking assistance
for psychological distress, Mechanic examined the degree of that distress and
sociocultural variables. It was found that:

1. women show a longer duration of illness and more disability when
compared to men;

2. women are more willing to report illness-related symptoms, admit to
problems, and complain more openly than men;

3. men tend to deal more heavily in denial of illness symptomatology
and have less physician contact than women;

4. men use less medication than women (with particular regard to

14
psychoactive drugs);

5. men tend to express distress in terms of aggressiveness, violence.
smoking, and alcohol or drug abuse.

Mechanic (1976) contended that these findings support the nofion that
Western culture permits women to display illness and dependent behavior
more than men. Men, Mechanic (1976) asserted, are expected to act and be
more stoic and complain to a lesser degree than women. He also offers that
because of gender specific social roles. women may be better able to accept
illness at a lesser social cost and seek more solace than their gender
counterparts. In summary. these findings also tend to hold for females and
males regardless of age, marital status. or parental status.

WWW:

Research literature consistently suggests that stress buffering variables
may prove to be of great importance in the disability process. Yet research
suggests that these variables are interactive. Previous studies have
emphasized examining each variable separately (Krause & Stryker, 1984,
Lefcourt, 1981). Only recently has there been interest in exploring the possible
interaction of these variables with each other.

Caldwell, Pearson and Chin (1984) examined social support, gender,
and locus of control within a college population. They found that gender was
an important variable. Moreover, gender and locus of control orientation
dramatically influenced social support and stress. They did not find an
interaction between locus of control and stress while accounting for adjustment.

In a study by Etzion (1984), work support was shown to be a stress
buffering variable, but men and women used different sources (i.e. friends,
family, etc). Etzion suggested that special attention should be given to the
target population, the sources of support, and gender differences.

15
Clarification of what constitutes a stress moderator, stress mediator.

stress buffer, and interaction of variables was discussed by Wheaton (1985).
He reviewed stress research and suggested models for examining stress
buffering functions. In his review, Wheaton stated that stress buffering involves
the interaction between some potential source of stress and some factor in
coping so as to define the conditions under which stress does and does not
have an impact. He goes on to explain that the total casual effect of stress
buffering is the sum of direct and indirect effects of stress through intervening
variables.

The issue of a stress moderator is further clarified by Wheaton. A
resource that modifies the effect of stress (interactive version) points to a
condition, or set of conditions, under which stress has substantially less impact.
A variable that mediates (suppresses) the effect of stress (additive version) is
generally mobilized by an increase in stress and as a result dampens its overall
causal impact (p. 354).

Wheaton (1985) suggested that certain variables may very well have
dual buffering effects, that is, not only moderate, but also suppress the effects of
stress on adaptation. He goes on to indicate that both are important and should
be examined simultaneously to have a complete model.

It is important to examine the main effects of variables as they may or
may not impact upon stress. but it is also paramount that close scrutiny be given
to interaction of variables with each other as it may have a more powerful effect
on the total model. An interaction is important because it qualifies the
interpretation of main effects. It allows the researcher to specify the conditions
under which the variables have an effect. It may enable improved prediction of
the outcomes of exposure to stressors and it may further our understanding of
the process by which people adapt to stress.

16
W

According to Tuck (1983) the majority of available literature on
industrially injured workers does not describe the complicated psychosocial
dynamics which accompany this stressful life event. Further scientific research
is needed to investigate this population and to provide effective intervention
strategies.

While a great deal of research on locus of control orientation.
adaptation/maladaption to stress, social support and gender differences has
been reported, there has been a limited amount of scholarly research regarding
the degree to which these variables can buffer the effect of stress/disability on
the mental health of the industrially injured worker.

Consequently, the purpose of this study was to examine these variables
as they do or do not moderate the industrially injured worker’s adaptation to
their disability, as well as their interaction with each other. It was proposed that
this study would add to the scholarly base of knowledge in this area. It was
expected that the results would be of interest to industrial researchers,
rehabilitation counselors, and mental health professionals concerned with
primary or secondary prevention of chronic disability, as well as government
agencies dealing with this population.

W

When a researcher is examining four variables with several possible
dimensions (e.g., social support: source or satisfaction) as well as two outcome
variables, one can imagine the possible combinations that could be formulated.
Therefore, this researcher has chosen to test those hypotheses that (a) appear
to be supported by the literature, and (b) are of interest to the researcher.

Based on the work of Rosenbaum and Raz (1977), Mechanic (1976), Anderson
(1977), as well as Sandler and Lakey (1982), there is substantial evidence to

17

show that individuals who have external locus of control orientations will have
greater experienced stress and will have higher levels of depression with more
inability to cope, as opposed to internals, who will have lower experienced
stress with lower levels of depression and higher coping ability. It was
hypothesized that there is a moderating effect of locus of control orientation with
stress level in the context of depression and inability to cope. Specifically an
individual who is internal (as measured by the Rotter Scale) will have lower
experienced stress (as measured by the Schedule of Recent Events) with lower
depression (as measured by the Beck Depression Scale), and have a higher
coping score (as measured by the Coping with Disability Inventory). This
researcher examined by means of multiple regression the relationship of stress
level, locus of control orientation and adjustment outcomes. It was further
hypothesized that there is a significant main effect of locus of control orientation
on the outcome variables as well as for stress level, and a significant interaction
effect between locus of control orientation and stress in the context of the
outcome variables (level of depression and level of coping).

The following equation illustrates the main effect and interaction of
these variables:

Equation #1 D=a+b1 S+b2 LOC+b3 (S)d.OC)
where D=score on the Beck Depression Scale

a=constant

S=stress as measured by the score on the SRE

LOC=score on the Rotter Scale

Equation #2 C=a+b1 S+b2 LOC+b3 (SxLOC)
where C=score on the Coping with Disability Inventory (CDI)

18

Wyndham
W1. Extemality will be directly related to stress level.

113291915112. Extemality will be inversely related to coping level.

W. Extemality will be directly related to depression.

MW. Locus of control moderates the effects of stress on
depression and coping.

The literature supporting the position that social support is a moderator
of stress in the context of depression and coping is complicated in that one can
examine the functional dimension of social support (i.e., sources of support) or
the structural dimension (i.e., size, satisfaction). This researcher examined
several studies that support the functional dimension of social support in
moderating the effects of stress within the context of depression and coping.
Etzion (1984) found that social support was a moderator of stress and that more
importantly different sources of support were shown to be more significant than
others. Caldwell et al. (1984) found similar findings.

It was hypothesized that individuals who have high social support will
experience less stress and therefore will have less depression and higher
coping ability. Social support has a main effect as well as a significant
interaction effect with the stress level in the context of coping and depression.
Similar equations as previously shown demonstrate the main effect and
interaction of a variable with stress on depression and coping.

W

W. Social support will be inversely related to stress level.

M5116. Social support will be directly related to coping level.

M95151. Social support will be inversely related to depression.

W. Social support moderates the effects of stress on
depression and coping.

19

Research examining gender and stress indicates that under similar
circumstances males and females react and adjust differently to stressful life
events. Studies by Levenson, Hirshfield, Hirshfield, and Dzubay (1983), Bloom
and Caldwell (1981), and Krause (1985) as well as Etzion (1984) support the
position that gender is a moderator of stress in the context of depression and
coping.

Based on the aforementioned research, this researcher hypothesized
that females will have higher levels of stress two years prior to their injury. but
have less depression and higher coping ability in the present. Men will
experience higher stress one year prior to their injury. and have higher
depression and lower coping ability in the present. There will be an interaction
effect of gender with stress in the context of depression and coping.

Again, equations demonstrating this relationship are similar to those
previously shown for locus of control and stress with regard to depression and
coping.

W

W. Females will experience higher levels of stress two years
prior to their injury as compared to males.

W. Males will experience higher levels of stress one year
prior to their injury as compared to females.

flypgtnesjsll. Females will experience less depression than males at
the time of the study.

W2. Females will have higher coping than males at the time
of the study.

11mm. Gender moderates the effects of stress on depression
and coping.

111mm. Females will have more social support in total than

20
males.

There is substantial research to indicate that there is a significant
interaction of the moderator variables with each other. The interaction of
gender. social support and stress has been demonstrated in at least three
studies: Caldwell et al. (1984), Etzion (1984) and Krause (1985).

This researcher proposed that these phenomena may be due to gender
differences in the socialization process found in our culture. Specifically, the
position promoted by Gilligan (1982) would indicate that males and females
must deal differently with the issues of autonomy and separation. These issues
first come into play with the primary care-giver, usually the mother. While males
must renounce their identification with the mother in order to identify with
maleness, females do not. They can cultivate the nurturing qualities of the
mother. As a result females see themselves in relationships or connected to
others as opposed to males who have had to become autonomous and
separate to claim their male identity. Obviously this is an oversimplification of
the development process, but one can begin to see that relationships for males
and females are different at a very early age and continue to flavor the
individual's ability to develop relationships over the life span. This dual model
of development leads the male towards independence/autonomy and the
female towards interdependence/attachment. Work by Kahn and Antonucci
(1980) as well as Tesch (1983) reviewed the concepts of role, social support,
and friendship over the life span examining this aspect of development.

With this theoretical background. this researcher proposed that there
are gender differences with a significant interaction effect regarding social
support and stress as it affects coping ability and depression.

21
mm

W. Locus of control, social support and gender have a

significant interaction effect when predicting coping and depression.
William

M15154. Extemality will be directly related to stress level.

Hypothesis}. Extemality will be inversely related to coping level.

W53. Extemality will be directly related to depression.

1131911135113. Locus of control moderates the effects of stress on
depression and coping.

W33. Social support will be inversely related to stress level.

W. Social support will be directly related to coping level.

W11. Social support will be inversely related to depression.

W. Social support moderates the effects of stress on
depression and coping.

W19. Females will experience higher levels of stress two years
prior to their injury as compared to males.

W. Males will experience higher levels of stress one year
prior to their injury as compared to females.

W- Females will experience less depression than males at
the time of the study.

W12. Females will have higher coping than males at the time
of the study.

W- Gender moderates the effects of stress on depression
and coping.

MM. Females will have more social support in total than
males.

W. Locus of control, social support and gender have a

22
significant interaction effect when predicting coping and depression.
Research—Mold

It is apparent that there is a relationship between stressful life events
and adverse changes in health. The question to be examined is what are the
dynamics of this process and what factors play important roles. According to
Gentry and Kobasa (1984) issues of examining stress and illness can no longer
be examined in simple, unidimensional terms, but must take into consideration
a second set of psychosocial factors - those that serve to buffer or cushion the
impact of stress.

Dohrenwend and Dohrenwend (1981) describe several hypotheses that
could account for the life-stress process. The vulnerability hypothesis (See
Figure 1) indicates that preexisting personal dispositions and social conditions
of an individual moderate stressful life events which can then lead to adverse
effects.

The research model used in this study will add a third dimension:
biological factors. specifically gender (See Figure 2). Specifically, a stressful
life event (industrial injury/disability) is moderated by: 1. biological factors (i.e.,
sex); 2. personal disposition (i.e. intemal/extemal locus of control); 3. social
situation (i.e., social support) which leads to adverse health changes (i.e.,
adaptation/depression).

W

This chapter addressed the need for a multidimensional stress research
model that encompassed psychosocial factors as well as biological in
examining the industrial disability process. The benefit of such a model is to
better understand the complex experience which injured workers encounter as
they they adjust and cope with their disabilities. A review of the literature

including research on locus of control, social support, and gender revealed that

23

Figure 1
Vulnerability Hypothesis

 

 

 

 

 

socrnr
srrunmms
srnrssrur I nnurnsr
LIFE HEHLTH
EUENTS runners

 

 

 

 

 

PEBSONHL

[I I SPOS ITI [INS

 

24

Figure 2
Modified Vulnerability Hypothesis

 

 

SOCIHL SITOHTION:

BIOLOGICHL

SEN/HOE

SOCIOL SUPPORT

 

 

 

 

 

rfliisussrt’is- nnumsa
' HEHLTH cnnNers:

INOUSTHIHL

 

 

 

 

 

 

annrmrron
PERSONHL /

OISPOS ITI ONS:
INTERNHUEHTEHNHL
LOCUS OF CONTROL

 

 

25
these variables can play an important role in the stress-adjustment/coping

process. In Chapter II methodology is presented. Included in this chapter is a
discussion of the subjects in this study, sampling, as well as a review of the
instrumentation and procedures utilized. Chapter III examines the statistical
results of the research including sample characteristics on the variables of
importance in the study. A discussion of the results, limitations of the study. as
well the conclusions and implications for future research compromise the
contents of Chapter IV.

Chapter II
MBLQQQIQQAL
MM!)

The previous chapter explored the need for a stress model to examine
industrial injury as a stressful life event. Variables that have an impact on the
stress-adjustment process were examined. Theory and research on
internal-external locus of control, social support and gender have been
reviewed.

In this chapter a description of the subjects is given, along with the
sampling procedures. Site and interview environment, instrumentation and
data collection procedures then follow.

Subject:

Subjects for this study were 56 individuals (37 males and 19 females)
who had experienced a work-related injury within the past 6-24 months, and
were receiving voluntary Michigan Worker's Disability Compensation
administered by Yeager and Company. The participants in this study ranged
from 19 to 69 years of age. The average being 43 years of age (X=45,
S.D.=12.89).

Most members of this study were married (59%). Twenty-seven percent
were divorced or widowed, while fourteen percent were single and had never
married. (See Figure 3)

The average education level for this group was 12.3 years while the
range extended from 6th grade to Master’s level. (See Table 1). In terms of
employment. 34% worked in the skilled trades prior to injury, 18% were factory
workers. 14% worked for the govemment (municipalities), 10% were employed
as service workers. (See Table 2).

Ninety-six percent of the subjects were American born. Forty-two

26

27

 

I. Efingle
I Divorced or Widowed

I Married living with
spouse

 

 

 

 

Figure 3. Marital status of industrially injured workers participating in the study

28
Table 1

'ni 'll'n'r wrk in

 

n=56
Education Frequency Percent
(Highest level attained)

 

6 1 1.8
7 1 1 8
8 3 5.4
9 3 5.4
10 3 5.4
1 1 2 3.6
12 22 39.3
13 6 10.7
14 5 8.9
15 3 5.4
16 3 5.4
17 3 5.4
18 1 1.8

56 100.0

29

 

 

Factory Worker
Clerical Worker
Managerial

Service Worker
Skilled Trade
Government Worker
Other

56

Percent

17.9

1.8

5.4
10.7
33.9
14.3
16.1

100.0

30
subjects were White, 12 Black and 2 Hispanic (See Figure 4).

 

I Hispanic
I Black
I White

 

 

 

 

Figure 4. Race distribution of industrially injured workers in the study.

The most frequent income bracket at the time of the study was
$0-$4,999. This reflects income not including disability amounts. Twelve and
one-half percent had income in the $20,000 to $24,999 bracket (See Table 3).

W

The pool of subjects for this study was referred by Yeager and
Company, as administrator to self-insured employers in the State of Michigan
for Worker's Compensation Disability Insurance. Yeager and Company
indicated a willingness to cooperate with the principal investigator specifically,
and the research team in general, during the course of the study.

Claims personnel were briefed on the nature and purpose of the study
and instructed to refer subjects to the researcher as part of an initial
rehabilitation evaluation. The subjects were selected based on the following
criteria:

1) they met the requirements established for disability status and were

31

 

Table 3
I II I rk

Income Level Frequency Percent

$04,999 26 46.4

$5.000-9.999 6 10.7

$10,000-14,999 3 5.4

$15,000-19,999 5 8.9

$20,000-24.999 7 12.5

$30.000-34.999 4 7.1

$35,000 and above 5 8.9
56 100.0

32
disabled within the last 6-24 months due to a work-related injury;

2) were currently disabled due to a work-related injury and were
receiving disability benefits or payments through their employers via Yeager &
Comany:

3) were mobile enough to report to the interview site;

4) appeared not to be experiencing memory problems regarding
previously occurring dates and events, etc. and verify the same;

5) were willing to participate in the study and complete all study tasks
as affinned by signing a Consent to Participate Form (See Appendix A).

i in

The setting for this research study was The Genesis Group in
Southfield, Michigan. The Genesis Group is a rehabilitation facility which
specializes in the rehabilitation of industrially injured and closed head injured
clients. The Southfield office has ample facilities conducive to the maintenance
of privacy and confidentiality within an interview situation, thus making it ideal
for a study of this nature.

The interviewing commenced on June 1, 1987. By September of the
same year it became apparent to the researcher that referrals were slowing.
The researcher met with the referral source to discuss the situation. It was
revealed that there would be difficulty in referring as large a subject pool as
originally proposed (100). Yeager agreed to allow the researcher to request
referrals from the Grand Rapids and Saginaw offices. Additional subjects were
obtained. The total secured was 56. Due to a variety of factors including time,
cost/benefit. travel, and availability of subjects. no further attempts were made
after December 31, 1987.

33
Amaratustlntam

An interview area with two rooms conducive to the interviewing of
potential subjects in an environment suggestive of privacy and confidentiality
was utilized. Each of the two interview areas contained at least two chairs (one
each for the interviewer and the client/subject). In addition, the interview area
also contained a desk for the subject to record questionnaire item responses
and a telephone.

The room was well lighted and maintained a temperature that was
seasonally comfortable. A supply of sharpened pencils with erasers was also
readily available to the subject. In addition, it should be noted that several
subjects were not feeling up to completing the form and asked to mail it back.
After the initial intake, they were excused and given stamped envelopes to
return the questionnaire (n=3, completed and returned questionnaire).

lemma

The seven instruments utilized during the study period are listed below.
With the exception of the logbook, which was recorded and maintained by the
research team throughout the study, all instruments were administered to the
subjects/respondents. These instruments were completed in one interview
session of approximately two hours duration. All subjects filled out a
questionnaire packet consisting of the consent form and five scales. The
Stressful Life Events Questionnaire was administered after consent was
secured and the other scales were presented in four random orders.

1) ngbggls - A logbook was maintained by the research team. The
purpose of the logbook was to record happenings, history. events. facts. etc.,
that may have influenced research outcome. Although the logbook cannot be
measured quantitatively, it does reflect information regarding the
cooperativeness of the subjects. (See Appendix G.)

34

2) WW (CPF) - A CPF was signed by all
subjects as validation that they understood tasks related to the study. The CPF

represents a virtual composite of research 'consent' forms. However, it was
specifically adapted for use with industrially disabled workers (See Appendix
A). The form also guaranteed confidentiality and that there was no potential for
harm as a result of study participation.

3) WWW (SLEQ) - SUbIOCtS' life SVBSS
was measured using the Schedule of Recent Experiences (Holmes & Rahe,
1967, Rahe. 1975). This 55—item questionnaire purports to examine stressful
life events across five major categories: health. work, home and family,
personal-social, and financial events that may have been experienced by
respondents within the last 24 months.

Rahe reports reliability correlations between .87 and .90 on test and
retest for the Schedule of Recent Experience. On validity studies. correlations
ranging between .50 and .75 were reported. Rahe (1975) found that when the
questionnaire was followed up by personal interview, questionnaire errors
were discovered which were usually in the direction of under-reporting on the
part of the subject. (See Appendix B.) The questionnaire is designed to be
self-administered.

Respondents were to check those stressful life events that may have
occurred to them. They were also asked to indicate the time frame (within the
last 24 months) that the stressful life event occurred. A total score was obtained
by adding all of the items checked. In addition. the questionnaire took into
account the stressful life event in relationship to the injury. The number of
events occurring after the injury, within the year prior to injury. etc. was
obtained.

Wan were obtained from this questionnaire to achieve a

35
profile of respondents/subjects. The researcher added demographic variables

to the beginning/end of the SLEO to assess socioeconomic status (i.e., race,
sex, education, income. occupation). Other demographics were those
regarding the nunber of dependent children living in/out of the respondent’s
household, number of years in present occupational position, origin of birth, etc.

These items were specifically added to this questionnaire since it is the
only instrument which was checked by the research team to minimize the
effects of error in memory/under-reporting, as suggested by Rahe (1975).
Demographic data were checked at the same time.

Particularly sensitive items (such as race and income) were added to
the end of the questionnaire. It was felt that respondents would have time to
examine all survey items and build up a higher element of trust by the time they
came to these items.

4) WI: (IIE Scale) - The Rotter
(1966) Locus of Control Scale is commonly referred to as the l/E Scale. It is a
29-item forced choice questionnaire with six filler items. It was selected as me
most accurate measure for this variable given its wide usage and acceptance in
the literature. (See Appendix C)

The Locus of Control Scale claims to measure individual beliefs across
a wide range of situations regarding generalized expectations that one can
control the outcome of certain situations. Therefore. the l/E Scale pays
particular attention to dispositional influences (intemality/extemality) affected by
past situations/behavior/experiences as they influence responses to current
situational cues.

'lntemals' are those who expect or believe they have the power to affect
situational outcomes (thereby positively influencing their ability to perform), and
'externals" are those who do not expect or believe they have such power (to

36
control outcomes). The scale is scored in the external direction (i.e., the higher

the score, the more external the individual). The scale is designed to be
self-administered. The total score is obtained by adding all questions
answered in the external mode. Scores range from 0-23.

Rotter (1966) reported internal consistency of .65 to .79. Reliability
studies reported a range varying from .49 to .83.

5) W (303) - The Beck Depression Scale is an
instrument that measures the degree to which respondents have depressive
symptoms. The BDS contains 21 item sets. Each item set contains four
possible choices of statements designed to reflect how the respondents have
been feeling during the past month. The higher the item value selected within
the set (on a scale of 0-3). the higher the depression (Beck, 1967).

The BDS scores range from 0-63. The 808 was selected for its high
reliability use in previous stress research (Sandler 8. Lakey, 1982; Caldwell,
Pearson, & Chin, 1984). (See Appendix D.)

Beck et al. (1988) reviewed research studies focusing on the
psychometric properties of the BDI for the years 1961 through June, 1986.
lntemal consistency yielded a coefficient alpha of .81 for nonpsychiatric
subjects. With respect to test-retest reliability the BDl's correlations are greater
than .60. Concurrent validity of the BDI with respect to other measures of
depression is high as well.

6) WW (SSDS) - The SSDS is a new
instrument utilized in life stress events/social support research, (Caldwell &
Reinhart, 1988).

This scale is designed to be self-administered. It claims to measure the
amount of satisfaction an individual reports from four different support network

sources including same and opposite sex friends, family, and helping

37
professionals. It also examines different kinds of support including emotional,

practical, informational, advisory, and companionship. With permission from
the author, four sources of support were adapted for this study: friends.
co-workers, family, and professionals.

Thus the SSDS focuses on specific kinds of support obtained from
those in one’s social network. the general satisfaction with the various sources
of support, how much support was received, and those individuals that
comprise the network itself. (See Appendix E). Total support is obtained by
adding items checked in each category (i.e., source, type of support).

7) Won (CDI) - The CDI is a newly
developed instrument which measures coping behavior of physically disabled
persons. The inventory is an 80 item, self-administered instrument. Subjects
describe their preference on a five point scale ranging from never/rarely to
almost always regarding various activities and statements of feelings toward
themselves and others.

Kulchami and Blom (1985) reported an alpha of .89 for the total coping
score with a sample of 46 adult American individuals with disabilities involved
in centers for independent living. The CDI has two subscales; the Process
Coping subscale and the Outcome Subscale. Cronbach’s alpha coefficients
were .79 and .84 respectively. Overton (1987) used the CDI on a group of 197
disabled athletes. The results of the reliability analyses on the CDI were
supportive of the Total Scale score as a consistent measure of coping. A
coefficient alpha of .89 and item-total correlations in the .40 and above range
were reported. Kulchami (1985) reported for his sample a S.D.=27.25. The
cut-off scores for low, medium, and high coping were 255. 283, and 311

respectively.

38
W

The research team was comprised of two members. The author was the
principal investigator (PI), and assumed all major responsibilities for the study
such as obtaining all necessary agreements from appropriate parties, training
the other research team member, and interviewing study participants.

In addition, the Pl collected, maintained, coded, and analyzed all data.
The other member of the research team assisted the PI by conducting
interviews with study subjects. ‘

Both the principal investigator and the other team member have Masters
Degrees in rehabilitation counseling. In addition, both have had many years of
experience interviewing and counseling disabled workers who have
experienmd a work-related injury.

Research team members conducted interviews at The Genesis Group
site. Each research team member interviewed subjects in a closed interview
area to maintain client/subject comfort as well as their privacy and
confidentiality.

Em

The majority of clients came to the Genesis Group during the study
period. They were to report to this office approximately six months after the
disability procedures/process at that time to ensure ongoing disability
status/benefits (although for some disabled workers this time period may have
varied somewhat with regard to the seriousness of the disability, length of the
recovery period, etc.). It was necessary for the researchers to travel to Grand
Rapids and clients’ homes to administer the balance of the questionnaire
packets.

39
W
Clients were referred to a member of the research team in the interview
area to undergo the initial rehabilitation interview. During this interview, the
research team member explained to the client their rights and obligations under
the Michigan Workers’ Disability Compensation Act as well as obtain necessary
information to determine the client’s eligibility/ineligibility for participation in the
study.
P r I
If the client did not meet the criteria for selection and/or was not willing
to participate in the study, after the standard rehabilitation interview, the client
left the area. If the client meet the criteria for selection and was willing to
participate in the study, they then signed the Consent to Participate Form (See
Appendix I). They were then given the set of questionnaires by research team
memberfinterviewer. Five and one-third percent of the eligible subjects did not
consent to participate in the study.
Mill
The interviewer explained the tasks associated with the study
(completing all questionnaires/questionnaire items) to the subject. At this time
the client/subject was also assured verbally by the interviewer that their
confidentiality and privacy would be maintained and that their disability
benefits/payments were in no way connected to the study. Any questions
posed by the subject regarding these issues were answered during this period
before the subject began to respond to the questionnaire.
Mullen!
The interviewer then instructed the subject as to how to complete each
of the questionnaires. Questions posed by the subject regarding this task were
answered by the interviewer. When it appeared the subject understood the

40

tasks so that accuracy of response appeared reasonably ensured. the
interviewer informed the subject of their departure from the area. The departure
of the interviewer at this time enabled the subject to answer all
questionnaire/items in an environment suggestive of privacy and confidentiality.
The interviewer, however, informed the subject prior to their departure that they
would be accessible immediately by extension phone should any questions
arise when the questionnaires were completed. Subjects were also told not to
leave the building until the interviewer returned in order to complete the
rehabilitation interview.
WM

After completing all questionnaires, the subject notified the interviewer
by phone. (However, when a fifteen minute time period elapsed in which the
interviewer was not summoned by the subject. the interviewer voluntarily
returned to the interview area.) After the interviewer returned to the interview
area they asked the subject if any questions/problems arose during the
completion of the questionnaire. The interviewer noted and recorded all/any
comments in a logbook for later assessment that day by the Pl. (If a
consensusftrend of problems surfaced regarding the questionnaires/items, the
Pl made took any necessary steps to ensure the ongoing lntemal consistency
and operation of the study.)

The interviewer took possession of the questionnaires at that time.
He/she then conducted a gently probing interview with the subject in regard to
the Stressful Life Events Questionnaire (See Appendix B). The reason was to
further ensure accuracy/completeness of response to all items. Subjects were
then thanked for their participation and cooperation by the interviewer. (Note:
Additional data obtained in this manner were recorded by the interviewer and
included in the total stress score.)

41
W

These procedures were repeated until the pool of subjects was
exhausted within a six month period. The interview and the completion of the
questionnaires took approximately one hour each.

ll ‘ ' I

All data were collected by the principal investigator (PI) and the
research team memberfinterviewer as it was obtained. However, the Pl
collected all data at the end of each interview and maintained it in a secure
place. The PI also scored and coded all data. Another member of the research
team recalculated all data to insure accuracy.

Chapter III
RESULTS
mm

This was an exploratory study to assess those factors that buffer
individuals in a stressful situation. Specifically, locus of control. social support
and gender were evaluated in terms of subjects’ reported stress. depression
and coping with industrial injury.

Two major areas were addressed in the analysis of the data. The first
area presented a descriptive summary of sample characteristics on the
variables of interest. These variables included the following: Locus of Control
Scale, Coping with Disability Inventory, Beck Depression Scale, Social
Support Dimension Scale, and the Stressful Life Events Questionnaire.

The second area presented the formal testing of the hypotheses which
were explored in the the study. The test statistics and analyses used in
examining the hypotheses were Pearson Product-Moment Correlation, Multiple
Regression and Host for independent samples.

9 = h-_ 1.11115 0.1!: 11.0.: o In : :1 in u: Ln

In an effort to better understand the variables in this study, as well as to
examine relationships that may present themselves. each variable is examined
separately. Frequency data are provided for each of these variables.

LmisctconlmLILQQl

Locus of control was hypothesized to be significantly related to stress
level as well as coping and depression. The mean LOC score for this sample
was 10.0 (S.D.=3.5). The range extended from 3 to 17. There was no
significant difference between male and female responses on this measure.
Subjects were moderately external, based on Owen’s sample of able-bodied
individuals as reported by Overton (1987), mean=8.3 (S.D.=3.9). The reliability

42

43
coefficient for this scale was .59.

in ' h i 'I' I

An individual’s ability to cope with stress especially from an industrial
injury is an important aspect of the total disability process. The mean CDI score
for this sample was 266.5 (S.D.=24.6), out of a possible 395. The range of
individual scores for this sample was 188 to 315 indicating considerable
variability among injured workers in coping with disability. There was no
significant gender difference. 1= -.26, (df=54) p = n.s. A CDI score of 266.55
(Question #8 was omitted on the original questionnaire.) indicates that the
subjects in this study were moderately coping with their disability. The
reliability coefficient for this scale was .89.

WHEEL)

In this study subjects’ scores ranged from 0 to 41. The most frequent
score was 8. The mean score was 9.13 (SD. = 6.49). According to Beck, the
mean BDI scores for the minimal, mild, moderate. and severe classifications are
10.9 (SD. = 8.1), 18.7 (SD. = 10.2), 25.4 (SD. = 9.6) and 30.0 (SD. = 10.4),
respectively (1967, p. 196). For this group, depression would be in the minimal
range (9.13 < 10.9).

There have been a number of studies examining the relationship of the
BDI with gender. The overall pattern according to Beck (1988) has been mixed.
Studies by Beck (1972), Nielson and Williams (1980) and Knight (1984) have
reported that women have higher BDI mean scores than men. However,
studies by Plumb and Holland (1977) and Schwab et al. (1967) have reported
there was no significant relationship between gender and the BDI. There was
no significant difference between male and female responses in this study. The
reliability coefficient for this scale was .83 suggesting a high reliability value.

44

The Social Support Dimension Scale examines the functional aspects
of social support. In this study four groups of individuals were examined:
family, friends. co-workers, and helping professionals. Subjects checked the
amount of support ranging from 0 to 3 (none, very little, average, and great)
regarding four types of support (emotional support. practical assistance.
companionship, and advice or information).

The mean score for this group of subjects was 23.84 (S.D.=6.86). The
range extended from 10 to 47. The most frequent score was 24. There were no
significant differences between male and female responses on the total score
or any of the sub-scores. The alpha value for this scale was .84.

S! [III E I g I' . ISIEQI

The total stress score for the period two years prior to injury ranged from
0 to 13. The mean was 2.96 (S.D.=3.35). The post (after injury) stress range
was from 1 to 36. The mean was 9.23 (S.D.=7.38). In examining the stress
scores one year prior to injury and the score for the period two years prior to
injury, there is a remarkable increase in stress level in the period following the
injury (6 months - 18 months). (See Table 4)

The mean score for the combined time period of two years pre-injury
and post-injury was 12.20 (S.D.=7.52). The reliability coefficient for this scale
was .90.

W

Based on a review of the literature, individuals classified as external in
their locus of control experience higher stress (Johnson & Sarason, 1978;
Lefcourt, 1981). The Pearson product-moment correlation for locus of control
and stress (with stress measured by the total number of events occurring

45

18912.4.
l r Ti f ' ’n
Mean
Post injury 9.23”
One year pre-injury 1.86“
Two years pro-injury 1.11”

Life Incidence from birth to two years
pre-injury 8.00‘
Two years pre-injury plus post-injury 12.20’

7.37
2.53
2.11

6.66
7.56

Bangs
1-36
0-11
0-12

0-27
1 -36

'There were no significant differences between male and female responses on

any of these variables.

46
between two years prior to injury and the time of the study on the Stressful Life

Events Questionnaire) was 1=-.12, p> .10. Therefore. this hypothesis was not
supported.
W
will invrlrl 'lv.

Studies have been reported that would support the notion that
individuals with external locus of control have lower coping ability (Kobasa,
1979; Sandler & Lakey, 1982). The Pearson product-moment correlation for
locus of control and coping (measured by the total number of items checked on
the Coping with Disability Inventory) was statistically significant _r=-.29, g< .05.
Therefore, this hypothesis was supported indicating that external subjects had
lower coping ability at the time of the study.

HY I

ll ir r l r ‘ n.The research literature
lends support to the fact that individuals who are external will experience more
depression (Sandler & Lakey, 1982; Mullen & Suls, 1981). A Pearson
product-moment correlation for locus of control and depression (measured by
the total score on the Beck Depression Scale) was statistically significant r=.34,
p< .01. Therefore. this hypothesis was supported.

HYEQTHESIS 4

. .10 M m: -. : h 3fi3'1 . 1 : 01 o.:- : ion 1n-
maim-

Previous research studies have supported the notion that locus of
control moderates the effects of stress on depression (Johnson & Sarason,
1978; Kobasa. 1979; Sandler & Lakey. 1982). To test this hypothesis, two
multiple regressions were computed. adding each variable separately. Stress
was measured by the Stressful Life Events Questionnaire. The results show

47

13919.5
T I h r
Mean SD. Bangs

Locus of Control (LOC) 10.0 3.5 3-17
Coping with Disability (CDI) 266.5 24.6 188-315
Beck Depression Scale (BDS) 9.13 6.49 041
Social Support Dimension Scale (SSDS) 23.84 6.86 10—47
Stressful Life Events

Post injury 9.23 7.37 1-36

One year pre-injury 1.86 2.53 0-11

Two years pro-injury 1.11 2.11 0-12

Life Incidence from birth to
two years pre-injury 8.00 6.66 0-27

48
that locus of control does not moderate the effects of stress on depression. The
same is true for coping. See Table 6. Therefore, this hypothesis is not
supported. It should be noted that there was a statistically significant main
effect of locus of control with stress in regard to depression and coping.
W
' I 'll 'nv l v I.

Work by Cassel (1974), Caplan (1974) and subsequent research
(Caldwell & Bloom, 1982; LaRocco, House & F rench, 1980) all point to the fact
that social support can mitigate the effects of stress. To test this hypothesis, a
Pearson product-moment correlation was calculated between social support
(measured by the Social Support Dimension Scale) and stress (measured by
the Stressful Life Events Questionnaire). Looking at the pre-injury period one
to two years prior to injury. the results were not statistically significant, p.13, g=
n.s. The correlation for social support with stress pre and post injury combined

revealed similar results, [=.09, p=n.s. Therefore. this hypothesis was not

supported.

i l 'l ir l i

Literature by Caldwell and Bloom (1982), Etzion (1984). and Gottleib
(1981), examine the relationship between social support and adjustment. The
consensus is that social support is helpful in coping with stress. A Pearson
product-moment correlation between social support and coping (measured by
the Coping With Disability Inventory) revealed that [=.47, F000. which
indicated that a statistically significant relationship existed.

Closely related to the above hypothesis is the relationship between
social support and depression. If one assumes that social support has a

significant positive relationship with coping, one could conclude that the

49

m
M In: ’:. :Ajmf. -0. . onu- ,'. e;.,; ‘m 11.0. .,.'n.
QEEBESSLQN

Variable 522m Sionmcame
Stress (SLEO) .0550 .082
Locus of Control .1380 .004
Stress X Locus of Control .0379 .116
QQEINQ
Stress (SLEO) .1112 .012
Locus of Control .0647 .046

Stress X Locus of Control .0025 .692

50

opposite would be true for social support and depression.
W
' l 'l i

The Pearson product-moment correlation between social support and
depression as measured by the Beck Depression Scale was r--.19, p = .15.
This relationship was not statistically significant. It appears that social support
has a significant positive relationship with coping, but no significant relationship
with depression. This hypothesis was, therefore. not supported.

W
.A. gnu 1.,q;.: : 3fi3°1.0f‘1(:‘e ._;.; i. .1.
caning-

Research on the moderating effects of social support is plentiful.
Studies by Caldwell, Pearson and Chin (1987); Etzion (1984), Cohen and Wills
(1985); and others have clarified and supported these phenomena.

Two multiple regressions were calculated adding each variable
separately. Stress was measured by the Stressful Life Events Questionnaire
(SLEQ). There were no statistically significant interactions between social
support/stress predicting depression or between social support/stress
predicting coping. See Table 7. This hypothesis was not supported. It should
be noted that there was a statistically significant main effect of social support on
coping.

W
3| 'I z ,-.:r: : u-h: lzv: . 1i : . t . :.. oor' - in:
Research on injury and gender by Levenson et al. (1983) suggests that

females experienced more stress than men two years prior to injury. During

51
marital separation, similar findings were noted (Bloom, Hodges, & Caldwell,

1982).

In order to test this hypothesis. t-tests were computed between the
stress levels of men and women during the specified time. A one-tailed t-test
for independent samples was not statistically significant, 1=.26, (df-54) p > .05.
The mean for males was 1.05. S.D.= 2.32 and the mean for females was 1.21,
S.D.= 1.69. This hypothesis is not supported.

W

n. . _, -,;. :1. . u... -.vl . -1 m. . '. . 1.

This hypothesis was tested by computing one-tailed t-test for
independent samples. The result was not statistically significant, F.19, (df=54)
Q > .05. The mean for males was 1.81, S.D.= 2.77 and the mean for females
was 1.95. S.D.= 2.04. This hypothesis was not supported.

W1
:11. . 'lI :103rlih : m-.r 'on- .n .. z .. l3 ' z . h
study

Studies examining gender differences in regard to depression have
overwhelmingly shown that women in Western cultures have higher rates of
affective and anxiety disorders than do men (Miller & Kirsch, 1987). However,
recent investigations among college students and other young homogeneous
adult populations have found equal rates of morbidity in males and females - at
least for depression - thus casting doubt on the notion that females are
universally more depressed than males (Jenkins, 1985). Clear explanations
are not found to support these mixed findings.

To test this hypothesis, the test of choice was a one-tailed t-test for
independent samples. The result was not statistically significant. tr-.32,

'r - M
I-o'l : R z or:
llEEEflflSSflQN.
lflufiflifi
Stress (SLEO)
Social Support
Stress X Social Support
SZQEOEE
lflflfiflifi
Stress (SLEQ)
SochuSkuxxxt
Stress X Social Support

.oo'nfr

YAL

I
.A "|

52

JPmAWII lz-r:.I-1 -. 0 HI 0

52m 31m
.0550 .082
.0412 .126
.0264 .216

32.903009 $199M
.1112 .012
.2133 .000
.0018 .713

53
(df=52.9) p > .05. The mean for males was 9.30, S.D.=7.4 and the mean for

females was 8.79, S.D.=4.33. The depression level was not significantly

different for men and women at the time of the study. Therefore, this hypothesis
was not supported.

 

Here again, research findings have been mixed. Depending on the
particular aspect of c0ping or strategy used, studies have not been
overwhelmingly significant regarding gender differences. According to Miller
and Kirsh (1987), ”the available evidence shows that females are more prone
to psychological distress than males are, yet do not consistently demonstrate
any underlying cognitive characteristic that would account for this difference.”
(p. 298).

The t-test for independent samples revealed t=.26, (dh54), p > .05.
There was no statistically significant difference between men and women in
regard to coping at the time of the study. The mean for males was 267.14,
S.D.=26.32 and the mean for females was 265.32. S.D.=21.70. Therefore, this
hypothesis was not supported.

W
: -: mun. . .. : :mb . 1 z . 0.1 -_:.-.:.1-1 -_ .o. mil -.

Research has shown that gender can play an important role in the
stress-Illness process. Work by Caldwell and Bloom, (1982) as well as
Levenson, Hirshfield, et al., (1983) support the notion that men and women
experience and react differently to stress. and that gender moderates stress
with regard to adjustment and coping.

Multiple regression results showed that there was a statistically
significant moderating effect of gender on the relationship between stress and

54
depression, but not between stress and coping. (See Table 8).

 

Research on gender differences in regard to social support and stress
are mixed. Belle’s review (1987) examined gender differences. As cited in
Belle (1987), Miller and lngham (1976) found that adult men had larger
networks than women while Weiss and Lowenthal (1975) discovered that the
women in their sample had more friends than did men. But yet. Caldwell and
Peplau (1982) found no differences between male and female unmarried
college students in the total number of friends.

To test this hypothesis, a one-tailed t-test for independent samples was
performed. The results were (=62. (df=54), p > .05. The mean for males was
23.43. S.D.=7.37 and the mean for females was 24.63. S.D.=- 5.84. Thus this
hypothesis was not supported, suggesting that for this sample there were no
statistically significant differences between men and women in regard to social
support at the time of the sturdy.

There is substantial evidence that moderator variables interact with
each other. (Caldwell et al., 1984; Etzion, 1984; Krause, 1985). Multiple
regression analysis placing all variables in the equation, as well as all possible
combinations, revealed no significant interactions in regard to coping. Stress
was measured by the Stressful Life Events Questionnaire. With depression,
there was a significant stress, locus of control, gender interaction. as well as a
significant stress, social support, locus of control, gender interaction. (See

Table 9.) Therefore, this hypothesis was supported. Discussion of this

55

tastes
I' I r i nf r r ' i
P E I N
We 52mm: Siam
Stress (SLEQ) .0550 .082
Sex .0013 .791
Stress X Sex .0789 .034
coarse
Mariam 132$me sum
Stress (SLEO) .1112 .012
Sex .0003 .899

Stress X Sex .0000 .980

Stress(SLEQ)
Sex
LocusofControl
SocialSupport
SXSSXLOC
SXSSXSEX
SXLOCXSEX
SXSSXLOCXSEX
SXLOC
SXSS
SXSEX

56

of 0 [0

32mm

.0550

.0013

.1418

.0070

.2252

.0511

.0170

eee . e_ : e: Wit

Si 'fi
.082
.790

.255
.504
.056

.024

it

it

.627

Table 9 continues...

Iagntialcontd)
QQELNG
Mariana
Stress
Sex
LocusofControl
SocialSupport
SXSSXLOC
SXSSXSEX
SXLOCXSEX
SXSSXLOCXSEX
SXLOC
SXSS
SXSEX

" Significant p < .05

" These variables were added in one block with S X SEX

57

.BgSZBHKEt .Skrflkamce
.1112 .012
.0003 .899
.0661 .046
.1820 .001*
.0100 .377
.0177 .239
.0128 .316
.0138 .298
.0068 .915

58
interaction is covered in the following chapter.

59

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Chapter IV
mm

This chapter will commence by discussing and interpreting the results.
A critique and discussion of the limitations of the study follow. Finally,
conclusions and implications for future research will be presented.

W

The purpose of this study was to better understand the complex
psychosocial dynamics which accompany industrial injury and resulting
disability. Specifically, a multidimensional model of stress and variables which
affect adaptation to stress. was explored. The conceptual model utilized
included social support, locus of control, and gender. There is growing support
for including more than one type of moderator variable in order to examine
possible interactions of these variables. as well as develop a strong,
conceptual model (Caldwell et al., 1984, Dean & Ensel. 1982).

The first hypothesis tested the relationship between the subjects” locus
of control orientation as measured by the lnternal-Extemal Locus of Control
Scale, and stress level as measured by the Schedule of Recent Experience.

The LOC construct has been defined both as a situational construct as
well as a dispositional construct. Lefcourt (1966) suggested that LOC can be
conceptualized as a dispositional characteristic which refers to a broad range
of situations in which an individual perceives having control over events
happening to him or her. According to Srull and Karabenick (1975) LOG can
be described as a situational variable in general. This construct is an indication
of an individual’s generalized belief that event outcomes are contingent upon
one's ability (internal) versus forces beyond control such as chance or fate
(external). This instrument has been used extensively in research. It has been

significant in predicting variables ranging from personal adjustment to job

61

62
satisfaction within various groups of subjects ranging from children to the

elderly, as well psychiatric patients, minorities and the disabled.

In this study the reliability coefficient for the LOC scale was .59. This
coefficient reflects the extent to which a measure is free of error variance.
When the coeffiecient is low as in this case, precaution must be taken in
interpreting results. However, if an instrument has low reliability, yet
demonstrates statistically significant correlations, one could argue that even
under high error variance the relationship of the variables is strong. Nunnally
(1978) stated that one of the most important uses of the reliability coefficient is
in estimating the extent to which obtained correlations between variables are
attentuated by measurement error. As the reliability increases. so does the
correlation. Certainly, one would urge that future research utilize more reliable
measures to test the relationships between variables in question.

The Schedule of Recent Experience is one of the most highly utilized
instruments in stress research. There have been numerous stress scales
derived from this measure. Controversy regarding the use of weighted and
unweighted items is still found in the literature. According to Shrout (1984)
although there has been discussion in the literature on life-event scaling for
more than a decade, there has been no conclusive proof that one method is
better than another in predicting health status. To this date the perfect life
stress questionnaire has not been discovered.

The results of the first hypothesis showed no statistically significant
relationship between externality on the locus of control measure and stress
level. This finding is contrary to much of the research literature demonstrating a
relationship between locus of control and life-event measures. Most findings in
this regard point to the fact that externals experience more stress or report
higher levels of stress (Kobasa, 1979, Sarason et al., 1978). However, Lefcourt

63
(1984) reported a relatively independent relationship between Rotter’s l-E scale

and a life-event measure in a group of fifty-nine college students. His
explanation for this phenomenum is that the life-events measure, which
requests that a subject recall past events, may be biased by the moods that are
assessed by the mood scales; and in turn, locus of control scores may likewise
reflect current moods.

Hypotheses two and three are closely related. A statistically significant
negative relationship was established for hypothesis two between the subjects’
locus of control orientation as measured by the Internal-External Locus of
Control Scale and coping level as measured by the Coping With Disability
Inventory.

In hypothesis three a statistically significant positive relationship was
established between the subjects’ locus of control orientation as measured by
the Internal-External Locus of Control Scale and depression as measured by
the Beck Depression Scale.

The CDI is a relatively new instrument. The original work by Kulchami
and Blom (1985) was designed to assess coping status. defined as an
individual’s current status with the use of coping behaviors and the level of
achievement of coping outcomes (social competence and quality of life).

Overton (1987) further analyzed the CDI. Her findings supported the
validity and reliability of the total score, however, the validity of the subscales of
this instrument, as originally proposed by Kulchami (1985) was not supported.
She admits that her findings should be viewed with caution because her small
homogeneous sample limits the generalizability of her results. Overton (1987)
stated in her review of Kulcharni’s work (1985) that this scale separated the
process of coping from the outcomes of coping. The process of COping

included coping behaviors similar to the description by Lazarus and Folkman

64
(1985) but more specific to disability. The outcomes of coping were suggestive

of increased quality of life and increased competence.

The definition of coping according to Kulchami (1985) is:

An active psychosocial process characterized by
a persistent effort to overcome, master and solve
problems, issues, and dilemmas within the
person and in the outside world, connected to or
unconnected with the disability. This process
occurs in the context of individual-environmental
transactions, such as belief systems and cultural
practices. Coping facilitates the development of
competence and quality of life, which are
behavioral outcomes, but it does not guarantee
their occurrence (p. 17).

This researcher felt that the total score on the coping with disability
inventory would by a good outcome measure to indicate an individual’s
behavioral and psychological adjustment to injury.

In regard to the Beck Depression Scale, twenty-five years of research
literature about this instrument has accumulated since it’s introduction in 1961
(Beck, Ward, Mendelson, Mock & Erbaugh, 1961). It was revised in 1971 and
copyrighted in 1978 (Beck, Rush, Shaw & Emery, 1979). The Beck scale is one
of the most popular and widely used instruments utilized in assessing the
intensity of depression in psychiatrically diagnosed patients (Piotrowski, Sherry
& Keller, 1985), but also for examining depression in nonpsychiatric
populations (Steer, Beck & Garrison, 1986).

In examining the results of hypotheses two and three. it would seem
logical that if external subjects are less effective at coping, then they would also
suffer higher levels of depression. For this group of subjects, this was the case.

The research literature examining locus of control and
coping/depression is fairly consistent. The earliest support for the control
construct with depression is the work by Johnson and Sarason (1978). Their

basic finding was that only those subjects with external locus of control

65
experienced depression in the face of stressful life events. In a somewhat

related study by Huisaini, Neff, Newbrough and Moore (1982) in seven out of
eight separate regression analyses, the subjects who had a sense of "personal
competence' were less likely to experience depression when dealing with life
events. Benassi, Sweeney and Dufour (1988) reported findings that the greater
the externality of the subject, the greater the depression experienced. Locus of
control was significantly related to depression. This relationship was
moderately strong and consistent across the studies they reviewed.

Hypothesis four stated that locus of control would moderate the effects
of stress in the context of depression and coping. That is, there would be an
interactive effect between locus of control and stress. The results did not bear
this out.

Cohen and Edward (1986) concluded that locus of control orientation is
the personality characteristic with the most consistent and strongest evidence
for stress buffering. In the present study there was a statistically significant
main effect of locus of control with depression and coping. Some investigators
equate evidence for stress buffering exclusively with a demonstrated interaction
between stress and a variable (e.g., locus of control, social support) (Gore,
1981, Thoits, 1982), while others suggest an additive version of stress-buffering
as well ( Billings and Moos, 1981, Dean 8. Lin, 1977). Wheaton (1985) clarifies
this researcher’s position on this issue. He distinguishes between types of
stress-buffering. A resource that moderates the effect of stress (interactive
version) points to a condition, under which stress has substantially less impact.
He goes on to explain that a resource that suppresses the effect of stress (main
effect version) is generally mobilized by increases in stress, and as a result,
dampens its overall causal impact. The suppressor role of a coping resource

applies equally across all levels of stress. In the case of a moderator variable,

66
because of the multiplicative nature of the effect. the reduction in distress

resulting from the resource typically will increase as stress increases.

Another type of main effect variable is one that is independent of the
level of stress. It is benficial to the indivdual under high or low stress. For
example, locus of control is not mobilized (i.e., the higher the stress, the more
internal) but rather has an independent effect under any stress level.

Hypothesis five tested the relationship between the subjects’ level of
social support as measured by the Social Smport Dimension Scale and level
of stress as measured by the Schedule of Recent Experience.

The Social Support Dimension Scale is a newly developed instrument
(Caldwell & Reinhart, 1988). There has been limited usage of this measure, but
reliability testing has demonstrated high alpha values.

The results of this hypothesis were not statistically significant indicating
that here was no relationship between social support and stress level. Three
studies were found in the literature which specifically noted that their stress and
support measures were not correlated (Habif & Lahey, Paykel et al., 1980,
Sandler, 1980). This finding helped to rule out the possibility that buffering
effects may be artifactual in light of significant buffering interactions in these
studies. It should be noted that in the present study there was a statistically
significant main effect of social support on coping. This finding covers the
content of hypothesis six. The more support one has, the higher the coping
level. Social support can provide resources such as reassurance of worth,
assistance in problem solving, and practical assistance; these resources are
critical to the development of self-concept and esteem, they help prevent
demoralization in times of stress, they increase options when dealing with
adaptation or loss, and they sometimes facilitate a more active style of coping
(Antonucci 8. Depner, 1982; Cobb, 1976; Hirsch, 1981).

67
In hypothesis seven, the relationship between social support as

measured by the Social Support Dimension Scale and depression as
measured by the Beck Depression Scale was tested. No statistically significant
relationship was established. This lack of a significant negative relationship
between social support and depression is contrary to the majority of research
examining these variables. One possible explanation may be the instrument
utilized to measure the variables. At this juncture in the research literature, a
dialogue continues regarding what constitutes support, and how it should be
measured. The Social Support Dimension Scale is relatively new and it may
not be sensitive to the particular aspect of social support that would
demonstrate a significant relationship with depression. Another possible
explanation could be the subjects” understanding of the scale as well as
possible denial in regard to depression. This group of disabled workers was
moderately coping and minimally depressed. Additionally, these phenomena
could well be peculiar to this group of individuals.

Social support did not have a statistically significant effect in regard to
moderating the effects of stress in the context of depression and coping. That
is, there was no interaction effect between stress and social support in the
context of depression or coping. There was a statistically significant main effect
of social support with coping but not with depression. In examining extensive
research studies, Payne and Jones (1987) stated that the results are mixed
regarding both the main effects as well as the interactive effects of social
support. Several researchers (Thoits, 1982; Kessler et al., 1985) almost take
for granted that evidence exists demonstrating a strong association between
social support and psychological symptoms. However, Leavy (1983) does
caution that the size of the association is weak.

Payne and Jones (1987) in their review on main effects between social

68
support and psychological symptomatology argue that the range of variance

shared between support and symptoms is O to 26% (Lin et al., 1979; Cohen et
al., 1984). They further state that evidence in smport of the interaction effect is
also not clear.

One of the possible explanations why the evidence is not clear is that
there may be measurement contamination. For example, a depressed person
may report they get poor support because they are depressed. (The symptoms
may affect the way they perceive the quality of support or the support they
actually receive.)

Hypotheses nine and ten examined stress levels one to two years prior
to injury for males and females. No differences were found to be statistically
significant for either time period. These findings are contrary to the results of
Levenson et al., (1983) regarding sex differences in industrial injury as well as
other research. The Levenson study (1983) had a much larger sample. This
could possibly explain the difference in results. Also, the present study did not
break down the sources of the stressors but utilized a total stress score.
Perhaps closer examination of these sources would demonstrate differences
between men and women. It is interesting to note that in the Levenson study
(1983) there were no gender differences post injury regarding level of stress
reported as was true in the present study.

Hypotheses eleven and twelve are closely related and therefore, will be
discussed in conjunction with each other. Hypothesis eleven tested for
differences between male and females regarding depression as measured by
the Beck Depression Scale, while hypothesis twelve tested for differences
between males and females regarding coping as measured by the Coping with
Disability Inventory. No statistically significant differences were established.

According to AI-lssa (1982) women report significantly higher rates of

69
psychological distress than men. Other researchers have demonstrated that

women adjust somewhat better than men to the death of a spouse (Stroebe 8
Stroebe, 1983), that they are less emotionally affected than men by financial
difficulties (Kessler, 1982) and cope better than men with the long-term
aftermath of separation and divorce (Wallerstein & Kelly, 1980).

Miller and Kirsh (1987) have suggested several plausible explanations
why the results are mixed regarding sex differences in the context of coping
and depression: (1) past research has overlooked the most likely domains for
the existence of these differences (is. males and females differ in their use of
aggression; "acting out" may be a significant variable to consider as a potential
mode for coping). (2) male and female responses may be biased in that males
tend to underreport their symptoms, while females may overreport. It is
possible that males may ’mask" their depression due to the socialization
process. (3) traditional theories do not tap the relevant cognitions to explain the
sex differences in depression and coping or the opposite, that the cognitive
level is not the route for sex differences. This view suggests that perhaps the
higher incidence of pathology in females may be due to some other etiological
factor, such as higher incidence of life stresses, biological predisposition, etc.

Hypothesis thirteen examined the possible interactive effects of gender
and stress as measured by the Stressful Life Events Questionnaire in the
context of coping and depression. There was a statistically significant
interactive effect with gender and stress in the context of depression, but not
with coping.

In examining the particular conditions under which the interaction takes
place, it would appear that under high stress women were significantly less
depressed (See Table 11), the opposite was true under low stress.

One possible explanation for this finding is that females have a diverse

7O

 

T-.oz1' z-. =- or: f- 1 . F ._l: he:
Stress
Stress
High Low
Females 8.4 9.22
Males 10.79 7.72

Overall population mean = 9.12.

 

 

 

 

 

Hi

._n- Low

71
set of roles, (i.e. mother, wife, worker) that require equal amounts of demands

upon them, while men place a larger emphasis on work or being the bread
winner. When work is removed from men’s lives it may cause more stress,
consequently, they may feel more hopeless than females who may experience
relief rather than depression.

Hypothesis fourteen tested the gender differences in social support as
measured by the Social Support Dimension Scale. No statistically significant
difference was established. Again, the sample was small, and perhaps the
items on the social support scale may not have been sensitive enough to detect
any difference.

The last hypothesis tested the interaction effect of gender locus of
control and social support in the context of coping and depression. There were
no interactions of variables in regard to coping. There was however a
statistically significant interaction effect of locus of control, gender and stress
with depression as well as one with gender. stress, locus of control and social
support. Examination of these interactions are helpful. It would appear that
internal women under high stress experienced the least amount of depression
(See Table 12). External men on the other hand under high stress experienced
the most depression. Internal locus of control seemed to produce the lowest
depression across the board except for internal women under low stress. This
might be explained in terms of the conceptualization of the life events included
in the stress questionnaire. There has been research to indicate that daily
disruptions or 'hassles‘ are more difficult for women than major life events
(Delongis, Coyne, Dahof, Folkman & Lazarus, 1982). Another plausible
explanation is given by Rotter (1966). He indicated that extreme intemality may
work against adjustment and could indicate significant maladjustment.

In terms of the interaction effect of stress with gender, locus of control,

Females

Hales

72

:I c-er: for l; :. e; :1... oc-_ 0 our.

Stress
High Low
Locus of control

Internal External Internal External

 

5.33 9.71 10.00 8.60

 

 

8.40 13.44 6.10 9.75

 

 

 

 

 

Entire population mean = 9.13

73
and social support, some interesting findings are noted, but difficult to explain.

The highest depression mean occurred for external men under high stress with
high support (see Table 13). The lowest depression level was for internal
women under high stress with low social support. Women experienced
generally lower depression except for two situations both with external locus of
control, but in one instance stress was low with support high and in the other
stress was high with support low. Because of the size of this sample, caution
must be taken regarding interpretation of the above findings. For example.
some of the cells have only one or two subjects.

Regarding gender differences in locus of control and stress, research
results are mixed. Toves, Schill, and Ramanaiah (1981), replicated the earliest
control study by Johnson and Sarason (1978) and found internal locus of
control to be a stress resistance resource to men only. Lefcourt (1982)
described subdividing his subjects and findings that internal/external
orientation had no impact on how women responded to stressors. The males in
the study enjoyed the buffering effect. A third study by Huisaini et al. (1982)
showed even more diverse findings. They concluded that for both men and
women, there were direct influences from life events and personal competence
on depression.

In 1978 Pearlin and Schooner examined important data on women and
control. One of their conclusions is that mastery (the extent to which one sees
one’s life chances as being under one’s control in contrast to being fatalistically
ruled) is found predominantly among the males in the study. They attribute this
difference to socialization patterns which less adequately prepare women to
deal with the stressors of life.

There were no gender differences in the present study of industrially
injured workers. Research by Overton (1987) demonstrated similar results with

74

01 0 1|. 0

 

 

. 1 ' Brzzlou n Dl A. for . -.:r o.
W
Stress
High Low
Social Support
High Low High Low
Locus of control
Int: Ext Int Ext Int Ext Int Ext
Females 6.00 10.66 4.00 9.00 8.50 7.00 11.5011.00
Hales 8.62 17.33 7.50 6.66 6.20 8.75 6.00 10.75

 

 

 

 

 

 

 

 

 

 

Entire Population Mean Score = 9.13

75
a group of disabled athletes. One of the possible explanations for this study’s

results may be that employed men and women in jobs with similar levels of
control and demand might be considered having similar roles. Additionally,
when considering industrial injury, one could conclude that the experience is
similar for boh sexes because of the unexpected nature of injury. Bamet,
Biener and Baruch (1987) felt hat the task for researchers was to identify
gender-relevant situations that are perceived as equally stressful and then
examine stress reactions.

This study utilized a correlational survey approach. According to Fox
(1969), the correlational survey is designed to estimate the extent to which
different variables are related to each other in the population of interest. The
critical distinguishing characteristic is he effort to estimate a relationship.

There are several advantages to his type of research: (a) it permits one
to measure a great number of variables and their interrelationships
simultaneously; (b) it provides information concerning the degree of
relationships between he variables being studied; (c) it is appropriate when the
research situation is not particularly suited to he experimental mehod.

Although the correlational method does serve as a useful
hypothesis-generating procedure, the results of such an investigation can
never be statements of cause and effect such as is the case of true
experiments, and therefore generalizations from his study are limited.
Hypoheses for possible research consideration are included at he end of his
section.

A furher limitation of this study was he size of he sample. The referral
source was not able to produce he number of subjects originally proposed.

Attempts were made to increase he size, but due to time constraints, cost, and

76
location of potential subjects, efforts were discontinued after 56 subjects had

been interviewed. These subjects all volunteered to participate. They were not
randomly obtained, and most likely he results are not representative of he total
population of disabled workers.

Anoher drawback of his study was he lack of a control group so hat
comparisons could be made between groups, in an attempt to discover
significant differences and similarities. Beyond the limitations already
mentioned, it is apparent that the instruments utilized required a great deal of
time and persistence to complete. Many of hese subjects requested
assistance with directions and/or reading of he material. Due to he nature of
some of he injuries, several clients asked to complete the questionnaires at
home because hey were experiencing pain or discomfort which affected heir
concentration.

Lastly, the instrumentation utilized had limitations. Overton (1987)
completed extensive investigation on he Coping with Disability Inventory. She
recommended hat his questionnaire required furher study to discover what it
is measuring in more detail. She did feel hat here was validity and reliability
for he total score as opposed to the subscales. The use of he Stressful Life
Events Questionnaire had some limitations as well hat may have affected he
accuracy and reliability of he total score. It is important to note that the
demographic portion of the SLEO had never been used before, and it is
possible hat he construction or wording biased responses from participants on
these data. In addition here have been numerous studies concerning the
nature of stressful life events. Specifically, research has focused on the
question of wheher he stressfulness of an event is a function or he amount of
change it entails, regardless of whether he change is positive or negative, or

whether only events hat involve an undesirable change are stressful

77
(Dohrenwend & Dohrenwend, 1984). Discussion and investigation into this

question is still mixed. Perhaps, further refinement of stress questionnaires in
general is necessary before a truly reliable measure can be established.

Shrout (1984) has suggested hat future research utilizing life-event
scaling should seriously consider weighting of he items. This is he only way to
discover what it is about certain life events hat makes hem more related to
illness han oher kinds of events. The difference among events is what is
achieved by weighting.

Anoher consideration is hat each new population under investigation
may have important life events hat are peculiar to heir situation. It would be
paramount to identify he characteristics of he important life events in order to
capture he complete impact they might have upon the population under
investigation.

9909105103.:

It is evident hat he stress process is a complex one. This study
examined industrial injury wihin he context of his process by taking into
account variables that positively or negatively influenced the individual’s
adjustment. This was accomplished by utilizing a multidimensional model,
incorporating biological, social, and personality moderators (gender, social
support and locus of control).

It is important to re-exam he conceptual model developed for his study.
Based on he results which were obtained from his research the following can
be stated:

( 1) Gender was he only variable examined that had an interactive or
modifier effect on he outcome variable of depression. In addition, here was a
statistically significant interaction effect of the variables with each other in
regard to depression. Specifically, here was a STRESS x GENDER x LOCUS

78
OF CONTROL interaction, as well as a STRESS x GENDER x LOCUS OF

CONTROL x SOCIAL SUPPORT interaction.

Recent work by Krause (1987) attempted to demonstrate hat social
support operates by bolstering lntemal locus of control beliefs. This very well
may explain why only one of he variables had an interaction effect singularly,
but produced several when taken in combination.

(2) A statistically significant main effect was demonstrated for locus of
control on boh coping and depression. In a longitudinal study by Huisaini and
von F rank, A. (1985), results showed hat locus of control, as a measure of
personal resources, had he most marked effect on depression.

(3) Social support demonshated a main effect on coping.

(4) There were no gender differences on any of he variables. That is
men and women experienced his life event in a similar manner.

A recent article by Ell (1986) called for a more integrative conceptual
framework to advance heory and enhance he applied value of research data.
She suggested hat researchers include social support, locus of control, and
various coping strategies in investigation.

There are some practical implications that can be derived from he
present study. If locus of control and social support have main effects on
depression and coping, hen it would be reasonable to believe that injured
workers need to feel hat hey have some control over heir lives and hat hey
have support in order to cope and adjust to heir situation. It is also important to
note that men and women have different reactions to stress. Perhaps fine
tuning our understanding of hese dynamics will allow counselors, claims
personnel, physicians, and ohers who interact wih this group, to assist more

effectively.

79
lmli 'n rF rR r

This research is only a preliminary study into the complex injury
disability process. These are several characteristics of stress research which
make his a challenging area of investigation in regard to workers’ disability.
First of all, he basic goal of research is to establish cause-effect relationships
rather han merely descriptive. It would be helpful to definitively understand
hose variables hat assist or harm individuals in an injury situation. Obviously,
he more understanding of his process, the more assistance can be given to
the individual. Certainly measurement of important variables runs into
problems of assessment, bias, and confounding. More "fine tuning" of
instruments are required in order to address hese difficult problems.

Many questions remain unanswered in regard to stress research in
general and even more are created regarding injury as a stressful life event.
Before a reliable and valid model can be formulated and tested he following

research questions need to be considered;

- What role does gender play, if any, in the adjustment of
injured workers? Are here real differences between the sexes
in this particular life stress or were the instruments not
sensitive enough to detect hem?

- Are social support and locus of control constructs too
broad?h? Should they be fractionalized when used in stress
researc

- Are there other variables that might be significant such as
income level, education, or age?

- Since stress occurs over time, would Ion itudinal studies
wih control groups demonstrate more significant resu ?

Although there probably will never be he perfect design to examine
work injury, at least an attempt has been made to increase he base of
knowledge in his arena.

APPENDICES

APPENDIX A
CONSENT TO PARTICIPATE FORM

81

.APPERHIEX.A
' Date

 

CONSENT TO PARTICIPATE

I. . understand that I have been
ashed to participate in a study regarding disabled workers who
have recently experienced a work-related injury. This will
require ay answering a set of questionnaires. but ay naae will
not be used on any of these questionnaires to protect my identity.

At the present tine. I can honestly state I anrnot
experiencing any lapses in aesory/aeaory problens that would
interfere with ay recall.of dates/events. etc.

However. I recognize that I say disniss ayself tron the study
prior to coapleting the questionnaire it I so choose for any
reason.

I further understand that participation in this study will
not produce any haraful psychological events to ay person.
Additionally. I also understand that in no way is the
continuation/teraination of ay disability benefits paid to ne

connected to this study. Finally. I understand that any

82

responses I give will not be used by the researcher in a manner

that would reveal ay identity or violate ay inherent right to

 

 

 

 

 

privacy.

Signed Witnessed by
Date _ Date

Code I Date Coapleted

 

Interviewer

APPENDIX B
STRESSF UL LIFE EVENTS QUESTIONNAIRE

84

APPENDIX B

Questionnaire. Porn 2

WHEEL madame].
1. Single now and never married 4. Female
2. Divorced/Hidowed/Separated 5. hale

3. Harried/Living with Partner
On 0
6. Number of dependent children not living in sane household

with you at present
. .

(specifyI
7. Number of dependent children living in same household with

you at present __________.
Ispecifyl

c o lo 1 c e a one
8. Factory Worker 15. Black
9. Office Worker 16. white

(non managerialladninistrativel

10. ManagerialIAdministrative 17. Hispanic
11. Service (Haiter. waitress. 18. Other
Hairdresser. etc.) (specify)

12. Skilled Trade
13. Business Owner
14. Other
0 0 B ne

19. American born

85

20. Foreign born

 

Ispecify country)
s. c o I

To answer the questions below. mark an "X” in one or more of
the columns to the right of each question. If the event in
question has occurred to you within the past two years. indicate
when it occurred by aarking the appropriate column: 0-6 aonths
ago. 7-12 months ago. etc. It say be the case with some of the
events below that you experienced then over sore than‘one of the
tiae periods listed for the past two years. It so. mark all the
appropriate columns. If the event has not occurred to you during
the last two years for has'never occurred to you) mark the last
coluan with an ’X'.

Now go through the questionnaire and mark your recent life

changes.
A. HEALEB 9
Within the time 19-24 13-18 7-12 0-6
periods listed. mos. nos. mos. nos: Over 2

have you unnamed: m ass ass up mm 11:19.!
21. An illness or injury '

which:

It) kept you in bed a
week or more. or
took you to the
hospital?

lb) was less serious
than described
above?

22. a aajor change in
eating habits?

23. a sajor change in
sleeping habits?

2‘. a change in your usual
type and/or amount of
recreation?

25. aajor dental work

WORK

86

19-24 13-18
aos. aos.
£32 532

7-12

 

Within the tine period listed.

have you:
26. changed to a new type

of work?

0-6
aos. Over 2

1391:3353st

 

 

 

 

 

 

 

27.

26.

29.

19-24
mos.
ass
changed your work hours
or conditions?
had a change in your
responsibilities at work.
such as: (check all
that apply)
IaI more '
responsibilities? ____
Ib) less I
responsibilities? __

IcI promotion?

Id) demotion?

Ie) transfer?

experienced troubles at work
[check all that apply)
la) with your boss? __
M with co-workers?

IcI with persons under

your supervision?

87

13-10

1-12

IO. .

0-6
mos. Over 2

ass Issues: lime

 

 

 

 

 

 

 

 

 

88

19-24 13—1e
I08. I03.
:32 . m

‘IdI other work
troubles?
30. experienced a major
business readjustment? ____
31. retired?
32. experienced being:

Ia) fired from work?

 

Ibl laid off from work?___
33. taken courses by sail

or studied at home to .

help you in your work? ____
HOME AND FAMILY
Within the time periods listed.
have you experienced: '
34. a change in residence

such as:

Ia) a move within the

same town or city?____

Ib) a move to a different
town. city or

state?

1-12

0-6
mos. Over 2

:22 mm lime

 

 

 

 

 

 

 

 

35.

36.

37.

36.
39.

89

19-24 13-16 7-12
mos. mos. nos.

132 £39 ESQ

a change in family

'get-togethers'?

a major change in the

health or behavior or

a family member'

(illness. accidents.

drug or disciplinary

problems. etc.)?

major change in your

living conditions Ihome

improveaents or a decline

in your home or

neighborhood)?

the death of a spouse?

 

0-6
nos. Over 2

segmenting:

 

 

 

 

the death of a:

lcheck all that apply)

In)
lbl
(c)

a child?

brother or sister?____

 

 

parents?

 

40.

61.

NOTE:

Id)

90

19-24 13—16

mos. mos.

£39 232
other close

faaily member?

the death of a close

friend?

a change in the aarital

status of your parents:

lcheck all that apply)

Ia)
Ibl

divorce?

remarriage?

(Questions 42-53 concern marriage.

For persons never married. proceed

to Item 5‘.)
42. marriage?
43. change in arguments with

spouse?

Ia)

Ib)

an increase in arguments
with your spouse? ____
a decrease in arguments

with your spouse?

7-12

I03 .

0-6
mos. Over 2

mMnAsstLer,

 

 

 

 

 

 

 

44.
45.

46.

‘7.
‘8.

91

19-24 13-16 7-12 0-6
mos.' mos. mos. mos. Over 2
as: no use mmmm;
Is). no change in arguments.
with spouse?

 

in-law problems?

 

a separation from spouse:

IaI due to work?

 

IbI due to marital

 

problems? .
a reconciliation with

spouse?

 

a divorce?

 

a gain of a new family
menber:

IaI birth of a child?

 

IbI adoption of a
child?

 

lo) a relative moving

in with you?

 

49.

SOs
51.

52.

53.

5N2

19-24 13-18 7-12 0-6

sos.
£39

wife beginning or ceasing

work outside the home? ____

wife beconing pregnant?____

a child leaving home:

Ia) due to aarriage?

IbI to attend college?

 

Ic) for other reasons?____
wife have a miscarriage
or abortion? .

birth of a grandchild? ____

rsasounu awn SOCIAL .

Within the time periods listed.

have you experienced:

54.

55.

a major personal
achievement? - ____
a change in your

personal habits Iyour
dress. friends. life-

style. etc.I? _

mos. mos. mos. Over 2

ass ass ass Tsar: Ass Essen

 

 

 

 

 

 

 

 

 

 

56.
57.

56.

59.
60.

61.

62.

63.

64.

6S.

sexual difficulties?
beginning or ceasing
school or college?
change of school or
college?

a vacation?

a change in your
religious beliefs?

93

19-24 13-16 1-12 0-6
mos. mos. mos. mos. Over 2

ass-ass ass assmnessfisssr.

 

 

 

 

 

a change in your social

activities (clubs. movies.

visiting)?

a minor violation of
the law?

legal troubles
resulting in your
being in jail?

a change in your
political beliefs?

a new. close personal

relationship?

 

 

 

 

 

so.

94

19524 13-16 7-12 0-6
mos. nos. mos. mos. Over 2

ass ass ass-sssl'smbssmg.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

an engagenent to marry?
67. a 'falling out' of a

close personal

relationship?‘ ____
66. girlfriend (or

boyfriend) problems?
69. a loss or damage of

personal property? __..
70. an accident?
71. a najor decision regarding

your immediate future?
FINANCIAL

Within the time periods

listed: have you:

72.

73.

taken on a moderate
purchase. such as a T.V..

car. freezer. etc.?

 

 

taken on.a major purchase

or a mortgage loan. such

'as a home. business.

property. etc.? _ __.. _ __

 

95

19-24 13-18 7-12 0-6

mos. mos. mos. mos. Over 2

assessessessIsaIsAssMsr
74. experienced a foreclosure

on a mortgage or loan?

 

75. experienced a major
change in finances:
Icircle all that apply)

Ia) increased income? ____

 

(b) decreased income? __

 

Ic) credit rating
difficulties?

 

76. Number of years in present job lspecify)
77. Number of years in present company Ispecify)
1022!: Inot including income from disability benefits)

(circle one)

 

_ 76. 50-54.999 _ 82. 520.000-524.999
79. $5.000-59.999 83. 525,000-529,999
80. 510,000-514,999 04. $30.000-534.999
81. 515,000-519,999 85. $35,000 and above
Code I Date Completed

 

Interviewer

APPENDIX C
INTERNAL/EXTERNAL LOCUS OF CONTROL SCALE

97

IAPFEEHDIXICI
Questionnaire. Form 3

Instrssilsnsi

This is a questionnaire to find out the way in which certain
important events in our society affect different people. Each
iten consists of a pair of alternatives lettered a or b. Zlgasg
nwmmmmmmnm
WW
' Be sure to select the one you actually believe is to be more true
rather than the one you think you should choose or the one you
would like to be true. This is a measure of personal belief:
obviously there are no right or wrong answers.

In some instances you may discover that you believe both
statements or neither one. In such cases, be sure to select the
response you strongly believe to be more true as far as you're.
concerned. Also try to respond to each item independently when
making your choice: do not be influenced by your previous
choices.

1. __a. Children get into trouble because their parents punish
them too much. .
__b. The trouble with most children nowadays is that their

parents are too easy with them.

98

Hanonf the unhappy things in people's lives are partly
due to bad luck.

People's misfortunes result from the mistakes they
make. .

One of the major reasons why we have wars is because
people don't take enough interest in politics.

There will always be wars. no matter how hard people
try to prevent them.

In the long run people get the respect they deserve in
this world.

Unfortunately, an individual's worth often passes

'unrecognised no matter how hard he tries.

The idea that teachers are unfair to students is
nonsense. ‘

host students don't realise the extent to which their
grades are influenced by accidental happenings.
Without the right breaks one cannot be an effective
leader.

Capable people who fail to become leaders have not
taken advantage of their opportunities.

No matter how hard you try some people just don't like

you.

10.

11.

12.

99

People who can't get others to like them don't
understand how to get along with others.

Heredity plays the major role in determining one's
personality.

It is one's experiences in life which determine what
they're like.

I have often found that what is going to happen will
happen.

Trusting to fate has never turned out as well for me as

making a decision to take a definite course of action.

In the case of the well prepared student there is

rarely if ever such a thing as an unfair test.

Many times exam questions tend to be so unrelated to
course work that studying is really useless.

Becoming a success is a matter of hard work. luck has
little or nothing to do with it.

Getting a good job depends mainly on being in the
right place at the right time.

The average citizen can have an influence in
government decisions.

This world is run by the few people in power. and
there is not much the little guy can do about it.

13.

14.

15.

16.

17.

18.

b.

100

When I make plans, I an almost certain that I can make
them work.

It is not always wise to plan too far ahead because
many things turn out to be a matter or good or bad
fortune anyhow.

There are certain people who are just no good.

There is some good in everybody.

In my case getting what I want has little or nothing
to do with luck.

Nany times we might must as well decide what to do by
flipping a coin.

Who gets to be the boss depends on who was lucky
enough to be in the right place first.

Getting people to do the right thing depends on

ability: luck has little or nothing to do with it.

As far as world affairs are concerned, most of us are

the victims of forces we can neither understand. nor'

control.

By taking an active part in political and social
affairs the people can control world events.

Host people don't realize the extent to which their
lives are controlled by accidental happenings.

There really is no such thing as 'luck'.

19.

2°.

21.

22.

23.

24.

101

One should always be willing to admit his mistakes.
It is usually best to cover up one's mistakes.

It is hard to know whether or not a person really
likes you.

how many friends.you have depends on how nice a person
you are.

In the long run the bad things that happen to use are
balanced by the good ones.

Nost misfortunes are the result of lack of ability,
ignorance. laziness, or all three.

With enough effort we can wipe out political
corruption.

It is difficult for people to have much control over
the things politicians do in office.

Sometimes I can't understand how teachers arrive at
the grades they give.

There is a direct connection between how hard I study
and the grades I get.

A good leader expects people to decide for themselves
what they should do.

A good leader makes it clear to everybody what their

jobs are.

102

Nany times I feel that I have little influence over
It is impossible for me to believe that chance or luck

People are lonely because they don't try to be

There's not much use in trying too hard to please
people. if they like you. they like you.
There is too much emphasis on athletics in high

Team sports are an excellent way to build character.

Sometimes.I feel that I don't have enough control
over the direction my life is taking.

host of the time I can't understand why politicians

In the long run the people are responsible for bad

government on a national as well as on a local level.

 

 

25. __a.
the things that happen to me.
__b.
plays an important role in my life.
26. __a.
friendly.
__b.
27. __a.
' school.
__b.
28. __.. What happens to me is my own doing.
_;b.
29. __a.
behave the way they do.
__b.
Code I

Date Completed

 

Interviewer

APPENDIX D
BECK DEPRESSION SCALE

104

PURPEHNDIXII)

Questionnaire. Form 4

DIRECTIONS:

On this questionnaire are groups of statements for you to

read.

After carefully reading each group of statements, pick out

the pp; statement in each group which best describes the way you

have been feeling during_thg_pg§3_ggnth. Circle the number which

corresponds to the statement you picked on the numbered response

line for each question.

1. 0

l

3. 0
1

2

I
I

do not feel sad.
feel sad.
am sad all the time and can‘t snap out of it.

am so sad or unhappy that I can't stand it.

am not particularly discouraged about the future.

I feel discouraged about the future.

I feel I have nothing to look forward to.

I feel that the future is hopeless and that things cannot
improve.

I do not feel like a failure.

I

feel I have failed more than the average person.

As I look back on my life. all I can see is a lot of

failures.

3 I feel I am a complete failure as a person.

NFOUNHOUNHOU

U

HHH

HH

1CN5

get as much satisfaction out of things as I used to.
don't enjoy things the way I used to.

don't get real satisfaction out of anything anymore.
an dissatisfied or bored with everything.

don't feel particularly guilty.

feel guilty a good part of the time.

feel quite guilty most of the time.

feel guilty all of the time.

don't feel I am being punished.

feel I may be punished.

I expect to be punished.

I
I

feel I am being punished.

don't feel disappointed in myself.

am disappointed in myself.

an disgusted with myself.

hate myself.

don't feel I an any worse than anybody else.

as critical of myself for my weaknesses or mistakes.
blame myself all the time for my faults.

blame myself for everything that happens.

don't have any thoughts of killing nyself.

have thoughts of killing myself, but I would not carry

them out.

10.

11.

12.

13.

14.

UNHO

U

HOGAN

106

I would like to kill myself.

I would kill myself if I had the chance.

I don't cry anymore than usual.

I cry more now than I used to.

cry all the time now.

used to be able to cry. but now I can't cry even though
want to.

am no more irritated now than I ever an.

HD-{HHH

get annoyed or irritated more easily than I used to.

H

feel irritated all the time now.

I don't get irritated at all by the things that used to
irritate me.

I have not lost interest in other people.

I am less interested in other people than I used to be.
I have lost most of my interest in other people.

I have lost all of my interest in other people.

I make decisions about as well as I ever could.

I put off making decisions more than I used to.

I have greater difficulty in making decisions than before.
I I can't make decisions at all anymore.

I don't feel I look any worse than I used to.

I am worried that I am looking old or unattractive.

15.

16.

17.

10.

107

I feel that there are permanent changes in my appearance
that sake me look unattractive.

I believe that I look ugly.

I can work about as well as before.

It takes an extra effort to get started at doing
something. _

I have to push myself very hard to do anything.

I can't do any work at all.

I can sleep as well as usual.

I don't sleep as well as I used to.

I wake up 1-2 hours earlier than usual and find it hard
to get back to sleep.

I wake up several hours earlier than I used to and cannot
get back to sleep.

I don't get more tired than usual.

I get tired more easily than I used to.

I get tired from doing almost anything.

I am too tired to do anything.

My appetite is no worse than usual.

fly appetite is not as good as it used to be.

My appetite is much worse now.

I have no appetite at all anymore.

l9. 0

20. 0

21. 0

N

108

I haven't lost much weight, if any. lately.

I have lost more than 5 pounds.

I have lost more than 10 pounds.

I have lost more than 15 pounds.

I am no more worried about my health than usual.

I am worried about physical problems such as aches and
pains: or upset stomach; or constipation.

I am very worried about physical problems and it's hard
to think of much else.

I am so worried about my physical problems. that I cannot
think about anything else.

I have not noticed any recent change in my interest in
sex.

I an less interested in sex than I used to be.

I am much less interested in sex now.

I have lost interest in sex completely.

 

Code I

 

Date Completed

 

Interviewer

APPENDIX E
SOCIAL SUPPORT DIMENSION SCALE

110

.APPEQUILX E

Questionnaire, Form 5
Instructions:
We would like to learn more about your interactions with
(pg; groups of people: I1) Close friends.
(2) co-workers, (3) your family. and I4)
professionals (doctors. teachers. therapists. religious leaders.
etc.). Please be careful to use the appropriate response scale

for each question. Use only one response per question.

0 1 2 3
hoderate
. Very or Great
Nsns Lillie Azszsss 0:31
In general, how much EHQIIQNAL_§QEEQBI do you receive from:

la. Friends?

1b. Co-workers?

lc. Your family?

1d. Helping professionals?
(Social Workers.
Counselors.
Psychologists.
Physicians.
Psychiatrists.

Ministers. etc.)

111

0 l 2 3
Hoderate

Very or ‘Great

fish: L131: 81339: 12:31

In general. how much EBA;TI§AL_A§§1§TAN§£ (money. food. housing.
services, etc.) do you receive from:

2a. Friends? _ _ __ __..

2b. Co-workers? __ __.._ _ _—

2c. Your family? __ __ __ _

2d. Helping professionals?

(Social Workers .

 

Counselors.

Psychologists.

Physicians.

Psychiatrists.

Hinisters. etc.) _. __ __
In general. how much W do you receive from:
3a. Friends? __ __ __
3b. Co-workers? . __.. __ __._' _—

3c. Your family?

112

O 1 2 3
Hoderate
Very or Great

Ilsnshiitlsessrsssm
3d. Helping professionals?

 

 

(Social Workers.
Counselors.
Psychologists,
Physicians,
Psychiatrists.

Hinisters. etc.)

 

 

In general. how much AQ!1§£_Q£_INIQBHAIIQN do you receive from:

4a. Friends?

4b. Co-workers?

4c. Your family?

4d. Helping professionals?
(Social Workers.
Counselors.
Psychologists.
Physicians.
Psychiatrists.

Hinisters, etc.)

 

 

113

In general. how satisfied have you been with the amount of
SflQILQflAL_SQEEQBI you have received from:
O 1 2 3
Completely Somewhat Somewhat Completely

, unsatisfied flsssiisfisd Ssiisfisd Satisfied
5a. Friends?

 

5b. Co-workers?

 

5c. Your family?

 

5d. Helping ’
professionals?
(Social Workers,
Counselors.
Psychologists.
Physicians.
Psychiatrists.

Hinisters. etc.)

 

 

In general. how satisfied have you been with amount of {BASILQAL
ASSISTANQE (money, food, housing. services. etc.) you have

received from:

114

O 1 2 3
Completely Somewhat Somewhat Completely

Dhssiisfisd stsiisfisd Satisfied Satisfied
6a. Friends?

 

6b. Co-workers?

 

 

6c. Your family?

 

 

6d. Helping
professionals?
(Social Workers.
Counselors. '
Psychologists.
Physicians,
Psychiatrists.

Ministers. etc.)

 

In general. how satisfied have you been with the amount of
W you I... received from:

7a. Friends?

 

7b. Co-workers?

 

 

115

O 1 2 3
Completely Somewhat Somewhat Completely

mem
8c. Your family?

 

8d. Helping
professionals?
(Social Wbrkers.
Counselors.
Psychologists.
Physicians.
Psychiatrists.

Ministers, etc.)

 

In general. how satisfied have you been with the amount of

W you have received tron:

9a. Friends?

 

9b. Co-workers?

 

9c. Your family?

 

116

0 1 I 2 3
Completely Somewhat Somewhat Completely
Unsatisfied Ilssstisfisd Satisfied Satisfied
9d. Helping

professionals?

(Social Workers,

Counselors.

Psychologists.

Physicians.

Psychiatrists,

Ministers. etc.)

 

Code I Date

 

Interviewer

APPENDIX F
COPING WITH DISABILITY INVENTORY

118

APPENDIX I"

Questionnaire, Form 6
Rate each of the following statements in one of the columns on
the right side of the page that best describes your preference
or leanings. Answer according to your present situation
(current feelings).
I 2 3 4 5
Never] Some- Often! Almost
3:131! 52192! 31193 22:93:81 812321
1. I obtain intonation
about my body in
relation to my
disability.

 

2. I am involved in
social. political
and/or non-work

activities.

 

3. I am aware of my
personal needs and

6011601118 e

 

4.

1 153

1 2 3 4 5

Never] Sone- Often] Almost

Basel: Sslsss times Fragment diners
As a result of my

'disability. I tend

to view life as.
having both meaning

and purpose.
I think about my

 

disability.

 

I find different
things to do during

my free time.

 

I am able to express

my anger.

 

I can tolerate anger

directed toward me.

 

10.

11.

12.

13.

14.

15.

120

1 2 3 4 5
Never] Some- Often] Almost

BarslrSsldseiinssEmsniAlm
I feel like a victim
of fate or misfortune

because of my

disability.

 

 

 

I have close love

relationships.

 

 

 

I experience emotional

$22888 .

 

 

 

I hold on to my opinions
even though others may

not agree.

 

 

 

I consider my disability

an inconvenience.

 

 

 

I feel that I have to
be on my guard in
interaction with

others.

 

I help and encourage

others.

 

16.

11.

18.

19.

20.
21.

22.

23.

121

1 2 3 4 5
Never] Some- Often/ Almost

Rarslrfisldsmiimssmsusnihlmn
I use fantasy and

imagination to develop
options and opportunities

in my life.

 

 

I an optimistic and

hopeful about my life.

 

 

I participate in social

organizations.

 

 

'I an involved in removing

disability barriers and

prejudice.

 

 

I enjoy life.

 

 

I an able to handle

frustrating

experiences.

 

 

I am able to obtain

material comforts.

 

I have a positive opinion

about myself.

 

24.

25.

26.

27.

28.

29.

30.

31.

' my body.

122

1 2 3

Never/ ' Some-

Bannisldsatimes
I accept that my body

looks and functions
differently from

others.

4 5

Often/ Almost
Erssusnidlsszs

 

 

I desire relationships
that include intimacy

and trust.

 

 

I pay close attention to

 

 

I cannot stand ambiguity

or uncertainty.

 

 

I can point to real
achievements in my
life.

 

 

 

I think of my disabilities
as the worst thing that

has happened to me.

 

 

I see myself as no longer
disabled in my day

dreams.

 

I think that my disability
has advantages.

 

32.

33.

34.

35.

36.

37.

123

1 2 3 4 5

Never] Sone- Often/ Almost

BanisSsisssiiaestresusniAlnn
I feel comfortable with

looking at myself in

the mirror.

 

I care for the people and
things in my life.

 

I am aware of the difference
between loving someone and
needing someone's

love.

 

I as comfortable when

others do not accept my

beliefs.

 

I am satisfied with

myself even though I may
be unemployed.

 

I live in the 'here and
now' rather than in the

past.

 

3°.

39.

40.

41.

‘2.

‘3.

44.

124

1 2 3 4 5
Never] - Some- Often] Almost

Barslzfieldsmiimsatmsnidlnn
I can accept compliments
and recognition from

other people.

 

 

I think my life is
challenging and

exciting.

 

 

I perceive problems
as opportunities for

growth.
I am responsible for

 

 

making other people

happy.

 

 

I like myself and

accept my failings.

 

 

I seek and obtain
specific information to

solve problems.

 

 

I base my decisions on

my future goals.

 

 

45.

46.

47.

48.

49.

SOs

51.

52.

125-

1 2 3 4 5
never] Some- Often] Almost
mmnmzmmm

I feel comfortable
about asking others
for support and

assistance.

 

 

 

I have problems in
communicating with

others.

 

 

 

I as willing to take

calculated risks.

 

 

 

I initiate interactions
with others.

 

 

 

I see opportunities in
sy life as limited.

 

 

 

I use professional
assistance when

needed.

 

 

I reflect before and

after my actions.

 

 

 

I sake efforts to overcome

and solve my problens.

 

 

 

S3.

5‘.

55.

56.

57.

$8.

59.

126

- 1 2 3 4 5
Never] Some- Often] Alnost

mmnmmmmamn
I am positively

influenced by persons

apart from my family.

 

I can laugh at myself
and with others about
life happenings that

are connected with my

disability.

 

I am cautious in my

behavior.

 

I seek advice from other

disabled persons.

 

I find myself cosplying
to the expectations of
others.

 

 

I back away from
difficult situations.

 

I like receiving
compliments and
recognition from

other people.

 

60.

61.

62.

63.

6‘.

65.

66.

127

1 2 3 4 5
Never] Some- Often] Alnost
mummmmnmnm
I understand the
nonverbal messages of

others toward me.

 

I examine alternative

solutions to problems.

 

I feel helpless in
dealing with my
disability.

 

I use self-control in
expressing my
feelings.

 

I attribute my

disability to fate.

 

I display my enotional
reactions to stressful

situations.

 

 

I try to influence the

direction of events

'toward personally

determined goals.

 

 

67.

68.

69.

70.

71.

72.
73.

128

1 2 3 4 5
Never] Some- Often] Almost
83:211. firings Ills: Ercgusnt 51!!!!
I mentally rehearse .
responses to events that
will or night happen.

 

I consider myself to be
the source of control over

events in ay life.

 

I experiment with different
ways of dealing with
disability-related

problems.

 

I evaluate sy behavior
by my own internal
standards.

 

I try to focus on other
areas of sy life that are
more rewarding when I am

troubled by my life.

 

 

I experience sadness.

 

 

I experience fear.

 

 

74.

75.

76.

77.

78.

19.

129

1 2 3 4 5
Never] Some- Often] Almost
mmmmm
I an alert to changes in
my body that may affect

my health.

 

 

I give myself presents.
treats or nurture myself

in other ways.

 

 

I take responsibility for
a problem rather than

 

 

 

blaming myself for it.
I experience grief in
relation to my

disability.

 

 

I look forward to the
future as an opportunity

for further growth.

 

 

I perceive problems as
opportunities for
growth.

 

 

 

 

Code I Date Completed

 

Interviewer

APPENDIX G
LOGBOOK

131

.APPEIHILX‘G

 

upcoesou

 

conmaeoeanam

 

acsom you uueaeaasa

xoonmod

 

Hon

 

oeoz

APPENDIX H
INTRODUCTORY PARTICIPATION STATEMENT

133

APPENDIX H

INTRODUCTORY PARTICIPATION STATEMENT

My colleagues and I are conducting research regarding industrial injury
and stress. The purpose of this study is to discover how injured workers deal
with this life event. We would appreciate it very much if you would answer
these questions as honestly and completely as possible.

Be assured that all answers are STRICTLY CONFIDENTIAL. Your
personal answers will not be divulged under any circumstances. The
questionnaires will be identified by code numbers and not by name so that no
connection can be made between any individual and their answers. Interest is
in the answers of all respondents taken as a group rather than the answers of
any one respondent. All results will be reported in general statistical form and
no reference will be made to any individual.

I anticipate that there will be no risk in to you in filling out this
questionnaire packet, nor will there be any benefits to you. Your participation
or non-participation has no bearing on your rehabilitation interview.

Thank you for your cooperation in this matter. If there should be any

questions at a later date, please feel free to call me at 559-1406.

APPENDIX I
UCRIHS APPROVAL LETTER

135

.APPEDHDIX I
MICHIGAN STATE UNIVERSITY

 

usmsmr COIHITIEE or»: result" mvou'tsc usr unsure . mcmom . «nu-toes
wuum sonnets (terms.

2» ADMISISTIATION surmise

ism m-zm July 22, 1987

Ms. Elaine H. Tripi
505 Victoria Square
Brighton, Michigan 68116

Dear Ms. Tripi:

Subject: Proposal Entitled, "The Industrially Injured Worker:
Locus of Control Orientation, Gender and Social Support
as Moderators of Stressful Life Events and Adaptation
to Disability"

UCRIHS' review of the above referenced project has now been completed. I am
pleased to advise that since the reviewers‘ comments have been satisfactorily
addressed, the conditional approval given by the Committee at its July 6,
1987 meeting has now been changed to full approval.

You are reminded that UCRIHS approval’is valid for one calendar year. If you
plan to continue this project beyond one year, please make provisions for
obtaining appropriate UCRIHS approval prior to July 6, 1988.

Any changes in procedures involving human subjects must be reviewed by the
UCRIHS prior to initiation of the change. UCRIHS must also be notified
promptly of any problems (unexpected side effects, complaints, etc.) involving
human subjects during the course of the work.

Thank you for bringing this project to our attention. If we can be of any
future help, please do not hesitate to let us know.

Sincerely,
I
+zg..ech-

Henry E. Bredeck, h.D.
Chairman, UCRIHS

jms

cc: Dr. William Hinds

”fl -' u as Allen-us" A. n»- "fly-ml Opp-ensue laurel-lane

LIST OF REFERENCES

LIST OF REFERENCES

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Academic Press.

Anderson, C. R. (1977). Locus of control, coping behaviors, and performance
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Antonnucci, T. & Depner, C. (1982). Social support and informal helping

relationships InT Wills (Ed..) WWW».
(pp. 141- 160). New York: Academic Press.

Bamet, R. C., Biener, L., & Baruch. (Eds). (1987). W. New
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Beck, A. T. (1967). i 'ni l i I
New York: Harper rand Row.

Beck, A. T. (1972). Measuring depression: The de ression inventory. In T. A.
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Beck, A..T, Rush, A..J Shaw, B..F, &Emery, J. (1979). mm
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Beck, A. T., Steer, R. A. &Jarbin, M. G. (1988). Psychometric propertiesofthe
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W5w

Beck, A..T Ward. C..H, Mendelson, M., Mark. J. &Erbaugh J. (1961). An
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Behan, R. C. 8. Hirshfield, A. H. (1963). The accident process: Toward amore
rational treatment of industrial injuries. WM

Association155. 300-306

Behan, R. C. & Hirshfield, A. H. (1966). Disability without disease or accident.
WM 12. 655-661

Belle, D. (1987). Gender differences in the social moderators of stress. In R. C.

Barnett, L. Biener, 8. G. K. Baruch. (Eds). W (pp.
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Benassi, V. A. Sweeney, Paul D, &Sufour, C. L. (1988). Is there a relationship
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13.519.661qu 91. 357-367

Berkowitz, M. (1985). W. New Brunswick, NJ: Rutgers
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137

Billings, A. G. 8. Moos, R. H. (1981). The role of the coping responses and
social resources in attentuating the stress of life events. MM

W. .4. 139-157

Bloom, B. L. 8.Caldwell, R. A. (1981). Sex differences In adjustment during the

process of marital separation WM 4.5.
693-701.

Bloom, B. L. Hodges, W. F. 8.Caldwell, R. A. (1982). Apreventive program for
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W 1.0. 251-264

Caldwell, M. A., 8. Peplau, L. A. (1982). Sex differences in same-sex friendship.
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Caldwell, R. A., 8.Bloom, B. L. (1982). Social support: Its structure and impact
327mg? disruption W. 15.

Caldwell, R. A., Pearson, J. L., 8. Chin, R. J. (1984). The stress moderating
effects of social support in the context of neg-e:7 and locus of control.
i

Caldwell, 8. Rinehart, M. A. (1988). Relationship of personality to
individual differences in the use of pa and source of social supports.

Caplan. G. (1974). WWW New York:
Basic Books.

Cassel, J. (1974). Psychosocial processes and stress": theoretical
formulation. WW. 4. 471-482

Cohen, L. H., McGovern, J., Fooskas, S., 8. Rose, S. (1984). Positive life events
and social support and the relationship between life stress and

psoyhologioal disorder W. 12.
567-87

Cohen, S., 8. Edwards, J. R. ( 1986) Personality characteristics as moderators
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