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RELIGIOSITY/SPIRITUALITY AS A MEDIATING STRATEGY
BETWEEN FAMILY COHESION AND MATERNAL DEPRESSION
IN AFRICAN AMERICAN MOTHERS OF
SCHOOL AGE CHILDREN WITH SPECIAL NEEDS

presented by
Maresa Murray, M.A.

has been accepted towards fulﬁllment
of the requirements for

Doctoral degree in Philosophy

 

in Family and Child Ecology

 

 

   

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RELIGIOSITY/SPIRITUALITY AS A MEDIATING STRATEGY
BETWEEN FAMILY COHESION AND MATERNAL DEPRESSION
IN AFRICAN AMERICAN MOTHERS OF
SCHOOL AGE CHILDREN WITH SPECIAL NEEDS
By

Maresa Murray, M. A.

AN ABSTRACT OF A DISSERTATION

Submitted to
Michigan State University
in partial fulﬁllment ofthe requirements
for the degree of
DOCTOR OF PHILOSOPHY
Department of Family and Child Ecology

ZOOI

Dr. Harriette P. McAdoo

ABSTRACT
RELIGIOSITY/SPIRITUALITY AS A MEDIATING STRATEGY
BETWEEN FAMILY COPIESION AND MATERNAL DEPRESSION
IN AFRICAN AMERICAN MOTHERS OF
SCHOOL AGE CHILDREN WITH SPECIAL NEEDS
By
Maresa Murray, M.A.

There are large numbers of African American families who face daily challenges of
special needs children. Recently, single parenting has been recognized as a problem that
deﬁes categorization by color. The combined experience of being African American,
female, and having a child with special needs creates a unique set of lifestyle issues for the
families. This study is concerned with examining the African American single mother’s
religiosity/spirituality, home environment, and depression levels as she raises her child with
special needs. This research, which used a longitudinal research design, was drawn from
a larger research project entitled “Ethnic Minority Family Report” (McAdoo, 2001) and
ﬁmded through the National Institute for Child and Human Development (NICHD).
There were several research questions, which guided this study.

1) Do married African American mothers have higher levels of family cohesion than
single African American mothers?

2) Do African American mothers from more cohesive families have higher levels of
religiosity/spirituality?

3) Do African American mothers with higher levels of religiosity/spirituality have

lower levels of depression?

Maresa Murray, MA.

4) Do African American mothers with more cohesive families and more
religiosity/spirituality have lower levels of depression?

5) Do African American mothers with less cohesive families with higher levels of
religiosity/spirituality have lower levels of depression than African American
mothers with less cohesive families and lower levels of religiosity/spirituality?

The Statistical Package for the Social Sciences (SPSS) was used to analyze the
current data. An analysis of variance was first conducted to assess the relationship
between marital status (external stressor variable) and maternal reports of family cohesion
(stressor variable). Secondly, Pearson product moment correlations were used to
determine the relationship between family cohesion (stressor variable) and maternal
reports of religiosity/spirituality (independent resource variable). Pearson product
moment correlations were subsequently used to further assess the relationship between

religiosity/spirituality (independent resource variable) and maternal depressive symptoms

(response variable).

Copyright by
Maresa Murray

2001

ACKNOWLEDGEMENTS

It is my pleasure to honor those who have given immeasurable contribution to the
production of my dissertation. Above all else, I am thankful to God for bestowing me
with all spiritual blessings, allowing me to have a privileged upbringing, and securing my
ﬁiture destiny. God has allowed my parents, James Arthur Murray and Anzilia Wilkins
Murray, to supply me with unlimited universal, ﬁnancial, and educational support. They
have always made certain that I had the ﬁnancial and educational opportunities that they
did not. In addition, they purposely modeled the reality of the “crossover” for African
American families, which makes tangible the culmination of educational and ﬁnancial
freedom in America.

Specifically, I'd like to thank my mother for sharing her single-minded focus, and
showing me the importance of attaining the highest goal regardless of the circumstances. I
am very grateful that she encouraged my independence at an early age, as it has become a
crowning jewel of my personality. She is the most resourceful, strong-minded, and
tenacious person I know, and I am honored to call her my mother.

Moreover, I am thankﬁil that my father ﬂawlessly modeled the importance of
having an openly generous heart, while remaining dedicated to the completion of my
accomplishments. He has taught me that it is more important to have a liberated heart
than to “always be right.” He is the most balanced, perceptive, and easy-spirited man I
know, and I am honored to call him my father.

In this same light, I acknowledge my favorite aunt, uncle and cousins, Marita,
Larry, Lamell, and Tinia Campbell, for always extending their nuclear family to embrace

me and spark my interest in diverse cultures in worldwide travel.

Finally, I would like to thank John Shametsky, as his support was vital in keeping
the concept of “bum-out” at bay during the completion of this dissertation. He was
instrumental in helping me unlock and discover the endless reservoir of treasures in my
“self”.

This is only the beginning, and the best is yet to come.

 

TABLE OF CONTENTS
LIST OF TABLES ................................................................................................ Ix
LIST OF FIGURES ............................................................................................... x
CHAPTER 1
Introduction
Statement of the Problem ........................................................................... 1
Signiﬁcance of the Problem ........................................................................ 2
Theoretical Model ...................................................................................... 3
Theoretical Framework .............................................................................. 6
CHAPTER 2
Review of Literature
African American Female Depression ......................................................... 11
African American Religiosity/Spirituality .................................................... 14
African American Marital Status ................................................................. 16
Family Cohesion ......................................................................................... 19
African American Parents of School Age Children with Special Needs ........ 20
School Age Children with Special Needs .................................................... 23
CHAPTER 3
Methods
Research Questions .................................................................................... 25
Hypotheses ................................................................................................ 26
Research Design ......................................................................................... 27
Instrumentation
Variables .................................................................................................... 28
Parent Demographic Factors . ..................................................................... 31
Procedure .................................................................................................. 31
Sample Description .................................................................................... 32
Data Analysis ............................................................................................. 39
CHAPTER 4
Results ......................... . ............................................................................. 4O
Reliability ................................................................................................... 45
CHAPTER 5
Discussion
Marital Status and Cohesion ....................................................................... 46
Cohesion and Religiosity/Spirituality .......................................................... 47
Religiosity/Spirituality and Depression ........................................................ 48

vii

 

TABLE OF CONTENTS continued

Marital Status, Cohesion, and Religiosity/Spirituality

as Predictors of Depression ............................................................. 49
Conclusion ................................................................................................. 50
Limitations ................................................................................................. 5 1
Implications ............................................................................................... 52
APPENDIX A
Religiosity/Spirituality ................................................................................ 55
APPENDIX B
Family Environment Scale .......................................................................... 57
APPENDIX C
BDI ............................................................................................................ 63
BIBLIOGRAPHY ................................................................................................. 66

viii

 

 

 

LIST OF TABLES

Table 1 ................................................................................................................. 35-36
Demographic Characteristics of Single and Married Mothers and their Children

Table 2 .................................................................................................................. 37
BDI Depressive Symptomology in African American Mothers

Table 3 .................................................................................................................. 38
Descriptive statistics for cohesion and religiosity by marital status

Table 4 .................................................................................................................. 41
ANOVA for family cohesion by marital status

Table 5 .................................................................................................................. 4]
Correlation between cohesion and religiosity/spirituality

Table 6 .................................................................................................................. 42
Correlations between religiosity/spirituality and depression by marital status

Table 7 .................................................................................................................. 43
Multiple regression analysis predicting depressive symptomatology by cohesion and
religiosity/spirituality

Table 8 .................................................................................................................. 44
T-test for family cohesion & religiosity/spirituality by depression

LIST OF FIGURES

Figure 1

Theoretical Map of Family Stress Theory ................................................... 4
Figure 2

Conceptual Model-Family Stress Model ..................................................... 27

Chapter 1

Introduction

There are a growing number of African American mothers who have school age
children with special needs, yet very few research studies have sought to explore the ways
in which the mothers perceive and experience life. This research seeks to explore the role
of religiosity/spirituality as a mediating strategy between family environment and
empowerment in African American mothers of school age children with special needs.
Aﬁ’ican American mothers who are raising school age children with special needs face
unique challenges in achieving healthy environments for their families and empowerment
for themselves. The disproportionate number of African American children in special
education and special needs classrooms suggests that there are large numbers of mothers
facing this challenge daily. Religiosity/spirituality is one ecological factor likely to
influence mother-child interaction and, subsequently, the child’s development, the family

environment, and the mother’s empowerment.

Statement of the Problem

Past research ﬁndings show signiﬁcant linkages between depression, race, family
environment, and stress (Carr, Gilroy, & Sherman, 1996). More recently, Brown, Brody,
and Stoneman (2000) found that African American women are at greater risk for

depression when under socioeconomic stress, when their child exhibits high levels of

difﬁcult behaviors, and when conﬂict with a marital/partner is high. They found that
marital spousal support has a stronger association with maternal depression than does
conﬂict.

Turner, Lloyd, and Roszell (1999) cite Kaplan’s ﬁndings that suggest a very strong
relationship between depression and self-esteem. Since that initial ﬁnding, other major
studies have conﬁrmed a signiﬁcant inverse correlation between depression and self-
esteem (Pearlin & Lieberman, 1979; Rosenberg, 1985).

African American children are among the fastest growing population in the United
States and a disproportionately large percentage of all children in special education
programs (Peterson & Zill, 1986). Recently, single parenting has been recognized as a
problem that deﬁes categorization by color. It identiﬁes the relationship between family
environment and religiosity/spirituality; the impact of religiosity/spirituality on the level of
empowerment; and the impact of family environment on the level of empowerment. The
purpose of this study of African American mothers of school age children with special
needs is to examine the relationship between religiosity/spirituality, family environment,

and empowerment in their lives.

Signiﬁcance of the Problem

There are large numbers of African American families who face daily challenges of
special needs children. Recently, single parenting has been recognized as a problem that
deﬁes categorization by color. Unmarried mothers are a growing presence as divorce and

pregnancies without marriage increase in all segments of society (McAdoo, I995).

Empirical studies are needed to address the issues of this increasing family type: an
Aﬁican American single mother of school age children with special needs.

This research will contribute to society in at least two ways. First, it will widen the
research base for educators and researchers to better understand the speciﬁc experience of
being an Aﬁ'ican American mother of children with special needs. It will also help the
revision of existing and future programs that are targeted at assisting mothers who have
children at higher risk for special needs. The family environment has been given less
attention as a factor in families with special needs children. A parent who is raising a
school age child with special needs, with the added inﬂuence of religiosity/spirituality in
creating and maintaining the family environment, may have healthier behaviors toward the
child and herself, than a parent without the protective factor of religiosity/spirituality

available to her.

Theorem] Model

Based on McCubbin’s (1983) original family stress theory and the ﬁirther adaptation of
this theory by Pauline Boss (1994), the map in Fig. 1 depicts the mediating effect of
religiosity/spirituality on the stressor of a child’s disability. The family environment may
serve as a protective factor in families facing the unique challenge of raising a school age
special needs child (Moos, 1974; Moos & Moos, 1994). The result of the stressor
interfacing with the mediator leads to level/degree of the mother’s response to the event.
High levels of stress are categorized as despair, and low levels of stress are known as self-

esteem.

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As shown in Figure 1, the dominant stressor for the mother is the family’s cohesion
(shown as “A” on the theoretical map). There is a series of external contextual factors
that act as a “stress complex.” This means that several smaller potential stressors are
fueled together in a funnel effect to have a larger damaging impact on the mother.
Included in the stress complex is the mother’s marital status, low education level, low
socioeconomic status, gender discrimination, and institutional racism. This stress complex
negatively contributes to the sense of helplessness about her child’s disability.

The mediating concept is religiosity/spirituality (shown as “B” on the theoretical
map). This is an internal contextual concept that includes the mother’s cultural and
religious resources. These resources include cultural values, collectivism, church as
extended family, prayer, religious commitment, recreation, and assistance from the African
American community/church.

The degree of the mother’s family cohesion level illustrates the extent to which
religiosity/ spirituality was an intervening variable against the stress (shown as “C” on the
theoretical map). A high degree of stress is categorized as despair, and a low degree of
stress is known as self-esteem.

The family’s environment, to include religiosity/spirituality, may serve as a
protective factor in families headed by African American women with school age special

needs children (Moos, 1974; Moos & Moos, 1994).

 

Theoretical Framework

Fgmily Stress Theory.

In this theory, family stress is deﬁned as an upset in the steady state of the
family. It includes anything that may disturb the family, cause uneasiness, or exert
pressure on the family system (Boss, 1994). Not all stressed families are in crisis,
however, many avoid crisis by managing to hold the degree to a tolerable level, a
process called coping. Neither have all families in crisis had long-term stress; they
may have been doing well until a disaster struck.

It seems, therefore, that some factors operate in the stress process that
inﬂuence outcome. Although individual strengths, family strengths, and social
supports have recently been identiﬁed as predictors of stress outcomes, it is
suggested that the end result of the stress process is inﬂuenced by an even broader
external context. This, in turn, inﬂuences the family’s internal context, and thereby
the meaning they give to a particular stressful event.

This revised family stress theory is based on the original model (McCubbin,
1974). His framework, called the ABC-X model, of family stress theory focused
on three variables: A, the provoking event or stressor; B, the resources or
strengths the family has at the time of the event; C, the meaning that the family
(individually and collectively) attaches to the event. These three variables remain a

foundation of current family stress theory.

6

The family’s perception, however, is mediated by the context in which the
stressful event or situation occurs. The family’s context is considered from a
social-psychological and biological perspective on both macro- and micro-levels of
analysis. The external context of the stressor event or situation is comprised of six
indicators: historical, economic, constitutional, religious, and cultural.

The historical context refers to the time when a stressor event takes place.
Some examples of a stressor in a historical context are: during the World War II,
after the Vietnam conﬂict, after the women’s liberation movement, before the civil
rights movement, or during the Depression of the 1930’s.

The economic context refers to the state of the larger environment’s
economy. It could also refer to a major shift in the family’s economic environment
resulting from sudden economic gains such as lotteries or inheritances or losses
such as gambling.

The constitutional context of the family is the biological health and physical
strength (or lack thereof) of the members of that unit. Some individuals, and
therefore families, due to strong genes and a good environment, are simply
stronger than others. They have more stamina and resilience, which inﬂuence the
energy and perseverance they have to activate and maintain the coping process. A
strong constitution makes it easier to act in defense of oneself and one’s family
when a stressor event occurs.

The religious context also inﬂuences how a family perceives an event-
especially regarding attempts to control or accept a situation of stress and who is

to blame for what is happening and thus the level of guilt carried by the family.

 

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Individuals in certain religions in America believe that even the lack of rain or the
birth defect of a child is their fault; others believe that there is a larger plan, and so
they accept what happens, even a disaster, as God’s will. Such varying beliefs are
part of the family’s external context, as they are instilled from outside.

The cultural context, which encompasses some of the former dimensions,
makes up a major part of the external context in that it provides the guidelines by
which families deﬁne events of stress and their coping resources. The larger
culture of which the family is a part provides the rules by which the family operates
at the micro-level. Sometimes. however, the family may at the same time belong
to a subculture that conﬂicts with mainstream culture, for example, ethnic groups.
The cultural incongruence between internal and external contexts may help answer
the question of why these families are highly stressed and often in crisis.

The six dimensions of the family’s external context inﬂuence the internal
context. The internal context of the family in stress is made up of three
dimensions: the sociological, the psychological, and the philosophical.

The sociological context is the structure and function of the family
regarding its boundaries, role assignments, and perceptions of who is in and who is
outside those boundaries. Boundary ambiguity is a major variable in this regard.

The psychological context is the family’s ability (or inability) to use defense
mechanisms when a stressful event occurs. The mechanisms of denial were
presented to illustrate the point. In the long run, the use of denial adds
psychological ambiguity to the sociological ambiguity in a stressed family and

thereby blocks resolution and reorganization.

The philosophical context of the family is its values and beliefs on a
microlevel. The rules of the individual family can, for example, be different form
those of the larger culture to which it belongs. Certainly, minority families in
American culture have experienced this difference. When the larger culture, for
example, provides government support for the institutional care of elderly parents,
but not within the family, the external and internal contexts are in conﬂict, so that
even more stress has been created.

Both macro and micro levels of analysis are conceptually placed in the
background. At the macro level of analysis, external context of the stressor event
or situation is comprised of six indicators: historical, economic, developmental,
constitutional, religious, and cultural. The six dimensions of the family’s external
context inﬂuence the internal context. The internal context of the family in stress
is made up of three dimensions: the sociological, the psychological, and the
philosophical.

Even on a micro-level of analysis, rules for responses may be different.
Within one community, some families believe that illness is to be accepted,
whereas others believe that illness is to be overcome with modern science and
technology. Some families believe that ﬁghting back is the appropriate behavior,
whereas others believe in passive resistance or acceptance. Although these beliefs
and values are inﬂuenced by the larger cultural and religious context, the family’s
philosophy most directly inﬂuences its perception of a stressful event.

Furthermore, the internal context, more than the external context, is in the control

of the individual family. Even within the same cultural or religious context,
families differ in their individual philosophies.

Variables are measured using the Boss (1994) Family Stress model
focusing on three aspects: A, the provoking event; B, the resources or strengths
the family has at the time of the event; C, the meaning that the family (individually
and collectively) attaches to the event. These three variables remain a foundation
of current family stress theory.

A review of literature has identiﬁed the following as relevant variables: (A)
level of Special Needs (stressor variable); (B) religiosity/spirituality level (resource
variable); (C) level (response variable); African American maternal characteristics:

age, educational level, and income level.

10

Chapter 2

Review of Literature

African Ameﬁgn Female Depression

While literature is sparse pertaining to African American parents of school-aged
children with special needs, there is a large amount of literature on depression African
Americans. Turner, Lloyd, and Roszell (1999) cite that much research has been
conducted that emphasizes the “stress process” model in relation to depression. It
illustrates the signiﬁcance of stress exposure and resources that may buffer the stress such
as religiosity/spirituality and be a between stress and the mental health outcome of
depression.

Efforts have been made to understand the nuances and complexities of depression.
Since women are, on average, more depressed than men (Brown, Brody, & Stoneman,
2000), there is a substantial amount of literature that focuses on understanding the
relationship between women and depression. There are efforts for researchers to account
for sex differences in depression, and the emerging thrust to recognize women’s speciﬁc
circumstances across race and class. They cite Gordon-Bradshaw’s (1987) ﬁnding that
the overrepresentation of African American women with disproportionately low levels of
education and in low status occupations is further evidence of how the interaction of
gender and race affects the quality of life for women. Brown, Brody, and Stoneman cite

research studies by Gibbs and Fuery (1994) and Smith and Stewart (1983) that noted

11

African American women are at greater risk for depression due to the “triple jeopardy” of
racism, sexism, and poverty.

McLoyd, Jayaratne, Ceballo, and Borquez (1994) validated earlier research that
found that African American women’s vulnerability to depression is exacerbated by
economic strain. They cite that African American women’s depression is consistently
linked to low income, unemployment, limited education, and divorced or separated marital
status. Brown, Brody, and Stoneman (2000) cite evidence that economic strain is
compounded by daily hassles and subsequent stress that make life a demoralizing process.

The association between marital dynamics and depression has been well
documented by Glass and Fujimoto (1994). They found that women whose husbands
were emotionally supportive and, more importantly, offer support with household tasks
are less likely to report symptoms of depression. Marital discord, whether manifested as
physical or in milder forms of tension, is consistently linked to women’s depression.
Brown, Brody, and Stoneman (2000) found that child conduct disorder was more highly
associated with mother’s depression than the other family dynamics. In addition, the
associations between marital dynamics and child conduct disorder were stronger than the
marital spousal dynamics and maternal depression.

Earle, Smith, Harris, and Longino (1998) implore researchers to analyze the
marital status category for African American samples. This is based on the ambiguous
“unmarried category” which may include women who were never married, divorced,
widowed, living with a partner, and may even include extremely estranged marriages.

They contend that it necessary to move beyond the traditional “married” and “single”

12

dichotomized categories, in order to account for various contextual factors that may
account for the variance in behavioral outcomes.

While excluding African American women, researchers have explored the
relationship between depression and multiple role participation in Caucasian middle-class,
middle aged women participating in traditional roles, such as parent, spouse, and worker
(Staples & Boulin-Johnson, 1993). In an effort to understand multiple social roles in the
lives of Aﬁican American women, Cochran, Brown, and McGregor (1999) conducted a
study that took into account the women’s propensity to provide care for immediate,
extended, and ﬁctive kin.

Earle, Smith, Harris, and Longino (1998) note the signiﬁcant link between
depression and marital dissolution in African American women. They cite studies (Ensel,
I986; Gove & Shin, 1989) that concluded previously married women were more likely to
manifest the symptoms of depression than are the married and never married. Earle,
Smith, Harris, and Longino (1998) also note the work of Williams, Takenchi, and Adair
which link marital dissolution with an elevated risk of psychiatric illness like depression.
This heightened vulnerability may be a result of gender or age of the previously married
woman, as well as other factors such as race, socioeconomic status, and health status.
They also cite previous research that reported a greater tendency toward depression on
the part of respondents who assess their health to be fair or poor, have less education, or
are unemployed.

In their study, Earle, Smith,. Harris, and Longino (1998) found that women were
more likely to report symptoms of depression than men. They found more depression in:

respondents who were unsatisﬁed with their marriages, the unmarried women and men

than the married ones, those who were less affluent and educated, and those who were
unemployed. Their results did not indicate that age was a signiﬁcant predictor factor, yet
there was a link between depression and some of the associated variables of aging, such as
loss of a marital partner and declining health and/or income. In summary, research studies
have found that African American women are more depressed than men, with greater

potential for compounded stresses.

 

Africgn American Religiosity/Spirituality

The importance of religion and the church in c0ping in the lives of African
Americans has been well documented (McAdoo, 1995; Pipes, 1992). These researchers
have documented the strategies that African American mothers have used to c0pe with
strains of life, childrearing, and mobility issues which include family support, reciprocal
exchange patterns, strong achievement orientation, and role ﬂexibility. Religiosity/
spirituality has also been identiﬁed as a powerful inﬂuence in mediating the stresses of the
mother, and in increasing the ability of parents to cope with many dimensions of life.
These coping strategies are successful when two parents are unable to maintain a marital
relationship, when children face achievement problems in school, and when ﬁnancial
stressors impact the family.

Tolson and Wilson (1990) found that two-parent households tended to have higher
levels of religiosity/spirituality, than single headed households. Methodological ﬂaws such
as utilizing incorrect statistical measures or negating relevant cultural agents have resulted

in a limited body of knowledge about the climates of African American families (Tolson &

l4

Wilson, 1990), less about the climates of African American families with school age
special needs children, and even less about the environment of families headed by Aﬁican
American women. Thus, research is cited from studies focusing on a broader
representative sample of African American families and two-parent families.

A signiﬁcant component in the lives of African American families was a moral-
religious orientation which is used as a source of support, resulting in better coping
strategies for those families (Harry, 1995). Parents identify religiosity/spirituality and
spirituality as a source of strength for them in understanding their school age child’s
disability, which parallels the large body of literature demonstrating the vital role
religiosity/spirituality plays in the lives of African American families (Taylor, Chatters,
Tucker & Lewis, 1990). Research shows that families with a strong and present
religiosity/spirituality are more likely to create an environment that helps advance
deveIOpment in their school age children with special needs. Moos and Moos (1994)
proposed that the family environment is inﬂuenced by several parental factors, i.e. family
structure, emotional, ﬁnancial and human resources available to parents. Religiosity/
spirituality in families with school age special needs children are not as well deﬁned. In
two-parent households, those with a parent and spouse, or a parent and grandparent,
higher levels of religiosity/spirituality were present (Tolson and Wilson, 1990) than were
present in single-headed households. This follows for families with school age special
needs children headed by African American women.

Brown and Gary ( 1985) found that religious participation is a source of support
with anxiety-related problems. Other studies have shown that the church provides

emotional well-being (Neighbors & Jackson, 1984), and that women are more religiously

15

involved than men (Taylor, Thorton, & Chatters, 1987). Religiosity/spirituality in
Aﬁican American families has been shown to be a strength of Black families (Billingsley,
1992; Randolph, 1995). Research shows that families with strong religiosity/spirituality
are more likely to create a family environment that aids the development of children. No
evidence exists to refute that same implication for African American mothers of school age
special needs children, but, rather, supports religiosity/spirituality as a vital coping strategy

available to mothers.

Aﬁign Americgm Marital Status

Hill Collins (1998) asserts that the best way to understand the changing African
American family structure is to acknowledge the impact of global development and social
changes. The growth of female-headed households in the African American community is
one such issue that needs to be further understood. Prior to 1960, the vast majority of
African American families (80 percent) were two-parent families. While 20 percent of
Aﬁican American family households with children were headed by women in 1960, 33
percent ﬁt this proﬁle by 1970, 49 percent by 1980, and a majority of 57 percent were
female-headed by 1990. Rather than understanding this drastic increase in female-headed
households as a moral decline in the African American community, Hill Collins suggests
that a structural change of this magnitude is better understood in relation to the larger
American societal context.

Cherlin, (1998) asserted that African American mothers who were once married

are very likely to use the support of extended kin and others as they parent their children.

16

This lends support to the idea that there is undiscovered strength in the lives of Aﬁican
American mothers who were once married and, now that they are single, have managed to
maintain extended kinship support utilization. Cherlin cites a study by Rossi that
measured the strength of people’s feelings toward extended kin. They found that African
Americans felt much stronger obligations to aunts, uncles, nieces, nephews, and cousins
than did Caucasians in the sample. When African Americans faced adversity, they were
more likely to seek help from kin than Caucasians. Cherlin stated that African American
mother’s partners are often incorporated into the kinship networks not on the basis of
being the biological father, but rather on whether they provide support for the children.

Cherlin further asserts that the development to which African American families
had to respond was a society-wide shift in values. The society-wide shift was the
weakening of the institution of marriage. Marriage became weaker in part because of the
growing independence of African American women, which made it less necessary to get
married.

Cochran, Brown, & McGregor (I999) cite the 1994 study from the National
Center for Health Statistics that states that many African American women are not
married because of the low life expectancy and availability of African American men. The
report also states that the life expectancy of African American men is signiﬁcantly lower
than that of Caucasian men. This decreases the probability that midlife and older African
American women will be married or have men available to marry after the death of or
divorce from a spouse. Therefore African American women are less likely to occupy the
marital role and less likely to have the economic and psychological beneﬁts associated

with marriage than are Caucasian women (Cochran, Brown, & McGregor 1999).

I7

Cochran, Brown, & McGregor (1999) found that the most important roles
associated with low levels of depression were those pertaining to marital status and
employment. Older African American women reported signiﬁcantly higher levels of
depression than Caucasian women. African American women were less likely Caucasian
women to occupy the roles of marriage and employment, which associated with less
depression.

Researchers have compared the similarities and differences of married and single
parent households. Low incomes, the absence of a male partner, and a large number of
children have been shown to contribute to stress and therefore less supportive home
environments (Harman & Luster, I991). Belsky (I981, I984) prOposed that the marital
relationship is the primary support system for many parents and that mothers who
experience high levels of marital support are likely to provide more supportive
environments for their children. Other researchers tested that theory and found similar
ﬁndings (Goldberg & Easterbrooks, 1984; Simons, Whitbeck, Conger, & Melby, 1990).
Taylor (2000) reported that households and communities with the highest maltreatment
rates were those with conditions including female-headed households, poverty, and
unemployment.

Brown, Brody, and Stoneman (2000) found that marital spousal support
signiﬁcantly interacted with the socioeconomic of African American women. Marital
spousal support was negatively correlated with women’s depression under conditions of
high socioeconomic risk. It was unrelated when socioeconomic conditions were less

stressﬁJl.

l8

EaLmily Cohesion

Research suggests that many families who have young school age children with
special needs experience greater levels of stress than families with school age children who
do not have special needs (Bubolz & Whiren, I984; McCubbin, 1989; Dyson, 1991).
Working women who rear their children alone have been found to have high stress levels,
(McAdoo, 1978; Compass and Williams, 1990) higher than those of their counterparts
(Compass & Williams, 1990; McLanahan, Wedemeyer, & Adelberg, 1981; Olsen &
Banyard, 1993). Because fewer school age children with special needs are being placed in
residential settings and most remain at home beyond the age of twenty-two, and because
the mother is usually the primary caretaker, the case management of her child’s
development falls primarily to her (N emzhoff, 1992). A review of literature suggests that
stress is a function of ongoing “undesirable situations,” involving any environmental
demand that taxes or exceeds one’s resources to cope with or overcome it (Watts-Jones,
1990). Of the countless theories put forth in the 19705, and in advising women with
school age special needs children, neither theoreticians nor therapists consider that the
mother of a school age child with disabilities, in order to find services for her child, may be
forced into an aggressive role and that may put her in conﬂict with a more passive notion
of femininity with which she was reared (Nemzoff, 1992), adding stress to an already
stressful family environment.

In order to identify stress factors, Watts-Jones (1990) examined a sample of
African American mothers between the ages of 23-50. The chronic stressors were

inadequate resources, work-related issues, relationship conﬂict/dissatisfaction, role

19

functioning, racism/ethnicity, and personal health. A signiﬁcant correlation was found
between depression and stress. The study suggest that mothers assuming the role of
provider and homemaker will experience extreme strain, given their lack of time to fulﬁll
multiple role expectations. In addition, due to conﬂicting demands upon her time,
emotions, and ﬁnances, she usually cannot meet all the expectations she sets for her family
and work. A rash of “how to” books, intended to help parents access and negotiate the
system that might aid in rearing school age children with Special needs, instead suggested a
“partnership” that would lead to more work -— and inherently more stress — for the
mother. Together these books made unrealistic demands on mothers with school age
special needs children (Nemzoff, 1992).

Those who live in poverty are at high risk for anxiety, depression, and health
problems (Belle, 1990). In addition, other stressors include poverty (Cope & Hall, 1985),
economic marginality (Mednick, 1987; VoyDanoff & Donnelly, 1989), inadequate
housing, unemployment, role and relationship stressors, and crime (D’Ercole, 1988).

A growing number of studies have been conducted which assess the relationship
between the family home environment, stress, and parental behavior. Franco and Levitt
(1998) conducted a study of 185 ﬁfth—graders of African American, Caucasian, and
Hispanic descent. They found that children who reported more support from their
family/parents were more likely to have higher levels of validation and caring. This
supports earlier ﬁndings from Antonucci (1994) who found that supportive family
relations provide the child with emotional security to develop relationships with others.

Another primary study was conducted by Belsky (1984. He found that the most

inﬂuential factors in shaping parenting behavior are the parents’ personal resources,

20

sources of stress and support, and the characteristics of the child. The study concluded
that parents provide unsupportive care if they lack personal resources, experience high
levels of stress and low social support, and perceive the child as difficult. Speciﬁc'
characteristics of the parent that may inﬂuence care-giving practices include empowerment
and depression. Contextual factors that may inﬂuence parenting include the marital status
and the quality of the relationship, social support from the family’s social network, work-
related stressors, ﬁnancial resources, and other sources of stress and support.

In a more recent study conducted by Luster & Baharudin (1998), African
American and Caucasian mothers who provided better quality home environments were
older at the time of their ﬁrst births, were more highly educated, and had higher levels of
empowerment. In the sample of 347 African American mothers and 551 Caucasian
mothers, mothers of both ethnic groups who had higher levels of family income, had fewer
children, and had higher marital quality also provided more supportive home
environments. Higher levels of empowerment and family income were shown to be
predictive of the home environment scores of the Caucasian sub-sample, but not the

African American sub-sample.

Aﬁican American Parents of School Age Children with Special Needs

Boyce et al. (1995) noted in their review, that single mothers raising a child with

special needs reported less close and cohesive family environments than married couples

raising a child with special needs. In addition, low levels of cohesion were found in

Aﬁican American couples that were raising an adopted child with special needs

21

(Rosenthal, Groze & Curiel, 1990). Yet, low levels of cohesion were interpreted by
these authors as being healthy family dynamics in that the levels suggested the boundaries
of the nuclear family were not rigid, but ﬂuid. In these cases, it seems that African
American families were utilizing more than the support of their immediate family, and
accessing help from extended kin and friends. Harry (1995) proposed that the presence of
these close kinship ties, is what allows African American parents to have greater
acceptance levels of their children's special needs. Thus, the protective factor of being
embedded in a family unit which is supportive and cohesive, aides in fostering healthy
socializing environments for children.

Research demonstrates support resources help to empower individual family
members to become more capable and competent and thus able to act on their own behalf
(Dunst, Trivette, Starnes, Hamby, & Gordon, 1993). Antonovksy (1987) introduced the
concept of salutogenesis, the focusing on family strengths and healthy c0ping strategies
rather than on pathology (Nemzhoff, 1992). In 1989, the Journal of MegalRem
published an entire issue on family coping, thus opening the door to the formulation of
theories of successful coping (Nemzhoff, 1992) in families with school age special needs
children.

Empowerment in African American women tends be a result of skillful application
of economic, social, and emotional resources. As previously discussed, the roles of
religiosity/spirituality and the Black Church have been legitimized as empowering agents
for African American women. Other identiﬁed empowerment strategies involve
community/service systems, positive internal attitudes (Coren, DeChillo, & Friessen,

1992) and the use of family/extended family (McAdoo, 1991). An extensive support

22

network among family members and ﬁctive kin, who become as family, is true for people
of all socioeconomic statuses (Farley & Allen, 1987; McAdoo, 1988). The extended
family network can be especially helpful in empowering mothers, as it offers options in
schooling or career (Martin & Martin, 1978; McAdoo, 1995).

Resources have been shown to buffer stress, and ﬁiendships/secondary
relationships with other women, family members, and coworkers have been helpful in
empowering single mothers (Garﬁnkel & McLanahan, 1986). Women survive and are
empowered by adopting certain patterns of support from the family situations in which
they ﬁnd themselves (McAdoo, 1995). When family is available and the relationship with
the kin is harmonious, the family can be a source of support toward empowerment. Single
mothers tend to be more involved with their parents, and this pattern is extended to

increased interaction with kin (Marks & McLanahan, 1993).

School Age Children with Special Needs

In times of transition or when a crisis occurs families experience increased levels of
stress to which they must adapt if the family system is to maintain equilibrium. The birth
of a child with special needs can cause a crisis situation in a family (McCubbin, 1989).
Literature reﬂects that many families who have young school age children with special
needs experience greater levels of stress than families with school age children who do not
have special needs (Bubolz & Whiren, I984; McCubbin, 1989; Dyson, 1991). Mothers
who continue to ask why their child is disabled from 3 to 5 years later from the child’s

birth experienced lower levels of well-being. But when “absolved” from their friends and

23

family, as in being told the disability was not their fault, mothers of disabled school age
children were better able to cope (Leskinen, 1994).

Glidden (1993) asserts that research has “generally failed to disentangle three
elements” referring to the mixing of demands, stresses, and strains of school age children
with special needs. The result of such leads to inconsistent ﬁndings. Although there is
agreement that families of school age children with special needs have increased demands
that lead to potential stressors (Garbarino, 1976), there are inclusive and contradictory

ﬁndings about the impact of having school age children with special needs (Dyson, 1991).

24

 

 

Chapter 3

Methods

Research Questions

There were several research questions that guided this study.

1)

2)

3)

4)

5)

Are there differences in the levels of family cohesion among married, single-never
married, and single-not currently married African American mothers raising children
with special needs?

What is the relationship between family cohesion and the levels of
religiosity/spirituality in African American mothers raising children with special needs?
What is the relationship between levels of religiosity/spirituality and depression levels
in African American mothers raising children with special needs?

Are there differences in the depression levels of African American mothers who have
high levels of family cohesion and high levels of religiosity/spirituality than those who
have less cohesive families and lower levels of religiosity/spirituality?

Are African American mothers who live in less cohesive families, but have high levels
of religiosity/spirituality less depressed than African American mothers who live in

more cohesive families but have low levels of religiosity/spirituality?

25

 

Hypotheses

H12

H23

H33

H53

Married African American mothers will have higher levels of family cohesion than
single mothers.

African American mothers from more cohesive families will have signiﬁcantly
higher levels of religiosity/spirituality than those mothers from less cohesive
families.

African American mothers with higher levels of religiosity/spirituality will have
lower levels of depression than mothers with low levels of religiosity/spirituality.
African American mothers with less cohesive families and low levels of
religiosity/spirituality will have higher levels of depression than mothers with
highly cohesive families and high levels of religiosity/spirituality.

African American mothers with less cohesive families but high levels of

religiosity/spirituality will have lower levels of depression than mothers with high

cohesion but low levels of religiosity/spirituality.

2. f

Conceptual Model

 

 

 

 

 

Family Religiosity/ Depression
Cohesion Spirituality
[A] [B]
STRESSOR RESPONSE
RESOURCE

 

 

 

 

 

 

 

 

 

 

i

Marital Status

 

EXTERNAL

FACTOR ﬁgure 2. Conceptual Model-Family Stress Model

 

 

 

Research Design

This research was drawn from a larger research project funded through the
National Institute for Child and Human Development (N ICHD), which used a longitudinal
research design. The research project was entitled “Ethnic Minority Family Report”
(McAdoo, 2001). The purpose of the broader study is to explore the c0ping mechanisms,
family environment, socialization practices, and educational concerns that are faced by
Aﬁican American and Mexican American families who have children with special needs.
Assessment of the study’s participants occurred over a three-year period. This study uses

data from the ﬁrst year of data collection.

27

 

 

Instrumentation

Variables

Independent

Parent Marital Status: Parent marital status was an item that was included in the
Ethnic Families Research Project Instrument (McAdoo, 1994). The measure has been
found to have construct validity through the use of this item in preliminary studies and
subsequent follow-up studies. Parent marital status is deﬁned as the current marital
situation or family situation as described by the participant. Responses include: married;
never married; widowed; divorced; separated; or living with a partner. For the purposes
of this analysis, these categories were recoded to include 3 categories: married; single-
never married; and single-not currently married.

Age: Age is the current age of the respondent parent as measured in years. The
question asked was: “How old were you on your last birthday?” Age is coded as a
continuous variable.

Edgation Level: Education refers to the highest level of education attained by the
participant. The question asked is, “What is the highest grade of school completed?” The

responses range from 0 = no education, to 21 = post Ph.D., J .D. or equivalent.

28

Intervening.

Cohesive FaLmilLClimate Level: Cohesive family climate is how the

 

respondent views the degree of commitment, help and support provided by family
members for one another (Moos and Moos, 1994). Reliabilities for the Cohesion
Subscale were calculated. The subscale yielded an alpha of .61. This modest
reliability prompted several items to be statistically deleted. Based on their low
correlations with the scale, items 11 and 41 were therefore deleted. Subsequently,
the Cronbach Alpha increased to .67. The mean score for the subscale was 5.0
(SD=1.8). The majority of the mothers reported that their families were quite
cohesive. Considerations include (a) family members help and support each other
a lot; (b) we seem to be passing time at home; (c) we put a lot into what we do at
home; ((1) there is a sense that we are together as a family; (e) we don’t step
forward to do things that need to be done at home; (f) we back each other up a lot;
(g) we don’t have much family “spirit;” (h) we get along really well with each
other; and (i) everyone in our family gets a lot of time and attention from each

other. Responses are dichotomous and include l=yes and 0=no.

Religiosity/ Spirituality: This construct measures how religious/spiritual the
respondent feels they are. Initially the religiosity subscale from the Family
Environment Scale was to be used in this analysis. The moral-religious subscale
however was found to be unreliable with this sample. It yielded an alpha of .420.

An alternate item was used to assess how religious respondents felt they were.

29

 

 

This item is asked in the Ethnic Families Research Questionnaire. It asks
respondents how religious or spiritual they are. Responses include: l=not
religious or spiritual at all; 2=somewhat religious or spiritual; and 3=very religious

or spiritual.

Dependent.

 

Maternal Degession Level: The Beck Depression Inventory (BDI) is a
widely used 21 item self-report measure used to assess depression symptoms
(Beck, 1978). The internal reliability for the BDI showed that it was extremely
reliable. The measure yielded a C ronbach Alpha of .90. The mean for the
instrument was 1 1.9. The depression score is the sum of the weighted responses
for each item, which can range from 0 to 3. Items assess changes in sleep,
appetite, interest in sex, guilt, sadness, and other indicators of depression. A score
of 4 or less indicates absence or a minimal degree of depression; a score of 17 or
higher indicates clinical depression. The BDI has been extensively validated
among elderly subjects and shows adequate reliability (Gallagher, Breckenridge,
Steinmetz, & Thompson, 1983; Gallagher, Nies, & Thompson, 1982). Internal

consistency reliability (coefﬁcient alpha) was .76.

30

Parent Demographic Factors

Parent factors were measured using the Ethnic Families Research Project
Instrument (McAdoo, 1994). Measures of parents’ marital status, age, education, and
income level were used. The measures have been found to have construct validity through

the use of these items in preliminary studies and subsequent follow—up studies.

Procedure

This research was supported by NICHD Grant #3ROlHD31893-2051 and the
College of Human Ecology, Michigan State University. The sample consisted of parents
of children who were seen by the schools as in need of special services because of learning
problems, and was drawn from two mid-western school districts and community centers
through school and parental referrals, mailing lists, and ﬂyer handouts (NICHD, Ethnic
Minority Final Report, 1999).

In one urban site, permission was obtained through the local school districts to send
out letters to all of the parents who had children in the appropriate age range in the special
education classes. Letters were prepared and stamped by project staff, but were addressed
and mailed by the school system. The team could only wait to be contacted by parents.
Once the families contacted the project and identiﬁed themselves, it was possible to
contact them and obtain their consent to participate. The school system allowed only the
use of the term “children with special learning needs” and not “mentally retarded.” This

criteria was used on the letters that were sent to the parents.

31

 

Community involvement was then used as a follow-up to ensure that the parents
contacted the research staff. In the smaller urban area, the school systems and the social
service agencies were contacted for referrals to targeted families. The difficulty with
obtaining families to participate in the small school system was not found in the larger
school system. Contacts at the Black Child and Family Institute were instrumental in
getting parents to return the letters. Booths were set up at local cultural fairs and
festivals, and informational brochures were distributed around the communities. The male
members of the staff played ball with the young men who were encouraged to have their
parents return the forms or to call the project center. Research staff went to all of the
neighborhood markets and left leaﬂets explaining the project and asking families who had
received letters to contact the ofﬁce.

Each family received a payment of $25 each year when the interview was
completed. Interviews were conducted one year apart. Two and sometimes three
graduate students, in which a male was always included, were sent to the homes in the
most run-down and high risk areas and neighborhoods. Interviewers were never allowed
to visit a family by themselves, unless the parent was to meet them at the Black Child and

Family Institute.

Sample Description

This current sample was selected from the larger sample of Ethnic Minority
Families. This current sample is comprised of 126 African American women (n=126).

Marital status is a central variable in this study, but was originally coded using 6 values. It

32

 

 

was re-coded to include 3 categories: married; single-never married; and single-not
currently married (widowed, divorced, living with partner, separated). Frequencies were
run to obtain the demographic information of the respondents (see Table 1).

These demographics show numerous important variations between these cohorts
of married (n=21), single-never married (n=56), and single, not currently married (n=49)
mothers. The mean score for these three groups of mothers ranged from 30.6 (for single-
never married mothers) to 37.5 (for single-not currently married mothers). Single never
married mothers tended to be the youngest group, with 80% of this group being between
the ages of 20 and 35. Whereas single, not currently married mothers tended to be slightly
older, with a little over half of this group being between the ages of 36 and 60. Single-not
currently married mothers were also more likely to have a child with a disability that was
not their biological child. Approximately 95% of married and never married mothers were
the child of interests’ biological mother. Only 76% of the mothers not currently married
were the biological mothers of the children discussed in this study. Twenty four percent
of this group of mothers served in the role of stepmother, foster mother, aunt, or adoptive
mother.

Education was another interesting demographic category. Although 63% of all the
mothers in this sample had completed at least 12‘“ grade, there were differences between
the levels of education by marital status. Married mothers had the highest levels of
education with 71% having completed 12’” grade and beyond. Both groups of single
mothers however had a higher percentage of mothers who completed post secondary

schooling. Although I out of 6 of the mothers in this sample had at least a high school

33

 

 

education (24% having a post secondary education), approximately 1 out of every 4
mothers was unemployed.

Moreover, 80% to 90% of the single mothers had an annual income below
$20,000. Sixty seven percent of married mothers had annual incomes below $20,000.
The mean number of children for this sample was 3. Mothers had anywhere from 1 to 7
children. Single, not currently married mothers however tended to have more children
(M=3.7), who were older (M=9.2) than their never married and married counterparts.
Children ranged in age from 6 to 13 and were in grades ranging from kindergarten to 8th
grade. The majority of the children in this sample were male (65%). Single, not married
mothers tended to also have more male children than female. The apparent differences in
demographic shifts here appear to be directly related to the marital status of mothers.
Single, not currently married mothers were typically once married and thus tend to be
older, and have more children (including step children). Never married mothers are
younger, and thus have fewer children.

Mothers were asked to report their child’s educational or medically diagnosed
disability/special need. There was a high rate of co-morbidity in this sample. Mothers
identiﬁed the majority of the children in this sample as having at least 2 special needs.
Table 1 lists these disability types. Sixty to seventy six percent of mothers listed learning
disability as their child’s diagnosis. Hyperactivity and attention deﬁcit disorder were the
next most frequent disability type. Aphasia and developmental disorders were listed as the
4’” and 5’” most common disability type in this sample. Between two and nine percent of
the sample reported that their child had been diagnosed with either mental retardation or a

neurological condition (See Table l).

34

 

 

 

 

 

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36

To gain further insight into this sample. descriptive statistics were also calculated to
assess the levels of depression, religiosity, and cohesion for married, single- never marri
and single-not currently married mothers. BDI Depressive Symptomology is presented
ﬁrst in Table 2. Although half of the mothers in this sample exhibited no signs of
depression, half of the mothers exhibited borderline to very severe symptoms of
depression. Interestingly married mothers had the lowest mean score for depression
(M=9.6). It appears that a higher percentage of married mothers had low levels of
depressive symptoms (40% of married mothers exhibited borderline or mild depression).
On the opposite end of this continuum, only 10% of married mothers had what is
considered to be high levels of depressive symptoms (moderate or severe depression)

compared to 21% of never married mothers and 24% of single-not married mothers (see

 

ed,

 

 

 

 

Table 2).
Table 2
BDI Depressive Symmmologv in African American Mothers (n=126).
um mk- MIC;
(n=21) Never Married Not Married
(n=56) (n=49)
_/_ M s_D 34) M s_ °_/q M s_
Level ongnession 9.6 7.7 13.0 9.5 12.4
No Depression (score: 0-9) 50.0 50.0 9'23.]
Borderline Depression (score=10-14) 25.0 14.4 14.2
Mild Depression (score=15-20) 15.0 14.0 8.1
Moderate Depression (score=21-30) 10.0 10.8 16.]
_Very Severe Depression (score :3 l) 0 10.8 8.1

 

37

 

Descriptive statistics were then calculated to examine the levels of family

cohesion and religiosity/spirituality for married, single-never married, and single-not

currently married African American mothers. These statistics are reported in Table 3.

Interestingly married mothers had the highest mean religiosity/spirituality score (M=2.6).

Sixty percent of married mothers reported having high levels of religiosity/spirituality.

Contran'ly, single- never married mothers had the lowest mean score for

religiosity/spirituality (M=2.0). Twenty one percent of this group of mothers said that

they were not religious or spiritual at all (21%). No mothers who were married or single-

not currently married said that they were not religious/spiritual at all (see Table 3).

 

 

 

 

 

Table 3.
Descriptive statistics for cohesion and religiosity by marital status (n=126L
Married Single- Never Single- Not Married
(n=2 1) Mgrried (n=56) 4:49)
24) M. 5.12 K, M S_D Z) M g;
Religiosig/Spirituality 2.6 .50 2.0 .70 2.4 .50
(1) Not religious at all 0 21.4 0
(2) Somewhat religious 40.0 53.6 59.2
(3) Very religious 60.0 25.0 40.8
FamilyCohesion' 5 .0 1.7 4.6 1.8 5.6
1.7

 

'3 . . . . . . . .
Note. Family cohesnon scores ranged from l-7. Higher scores were indicative of higher levels of

family cohesion.

38

 

 

 

_D_ata___Anal1§i_s

The Statistical Package for the Social Sciences (SPSS) was used to analyze the
current data. An analysis of variance was first conducted to test H1. This analysis
examined differences between the levels of family cohesion by marital status. Secondly,
Pearson product moment correlations were used to test H2. This analysis assessed the

relationship between family cohesion and maternal reports of religiosity/spirituality.

 

Pearson product moment correlations were also used to test H3, This analysis tested the
relationship between religiosity/spirituality and maternal depressive symptoms.

In order to test H4 and the collective inﬂuence of family cohesion and levels of
religiosity/spirituality on maternal depressive symptoms, a multiple regression was
performed. This analysis allowed for the examination of the independent and collective
inﬂuences of cohesion and religiosity/spirituality on depressive symptoms. Beta
coefﬁcients are presented and the amount of variance explained by this model is reported.
Finally, an analysis of variance was performed to test H5 and to examine the differences
between mothers with the independent stress variable of low cohesion and the resource of
high religiosity/spirituality with those with high cohesion and low religiosity/spirituality.

Relationships here were considered signiﬁcant at the .05 level of signiﬁcance (p<.05).

n:-

39

 

Chapter 4

Balms

H1: Married African American mothers will have higher levels of family cohesion than
single mothers.

It was hypothesized that married mothers would report more cohesive family
environments than single mothers. ANOVAS were run to examine the difference between
the levels of cohesion of married, single-never married, and single-currently not married
mothers. The analysis of variance showed that there is indeed a difference between the
cohesion levels based on marital status (F=3.4, p<.05). Tukey’s tests were run to ﬁirther
differentiate the mean cohesion scores for married and single mothers. The mean scores
are presented in Table 4. Based on this analysis, married mothers (M=5.0) tended to have
slightly more cohesive families than single-never married mothers (M=4.6). The group
with the highest level of cohesion however was the single-not currently married mothers
(M=5.6). Thus single-not currently married mothers had significantly higher levels of
cohesion than the single-never married mothers and married mothers (see Table 4). This

hypothesis was therefore not supported.

40 .' '

 

Table 4
ANOVA for familchohesion by marital status (n=126;

 

Family Cohesion

 

at M. E .2

Marital Status 1 18 3.4”“ .04
Married 5.0
Single- Never Married 4.6
Single- Not Married 5.6

 

Note. *p<.05

H2: African American mothers from more cohesive families will have signiﬁcantly
higher levels of religiosity/spirituality than those mothers from less cohesive
families.

It was hypothesized that mothers who reported their family environments to be
more cohesive would also report having higher levels of religiosity/spirituality. Pearson
coefﬁcients were calculated to determine the relationship between cohesion and
religiosity/spirituality. This hypothesis was not supported. There were no signiﬁcant
associations found between married or single mothers from more cohesive families and

those with higher levels of religiosity/spirituality (r =-.03, ns) (see Table 5).

Table 5
Correlation between cohesion and reliﬁgjosity/sriritualigg (hf—126).

 

Cohesion

- .2
Religiosity/Spirituality -.03 ns

 

 

4l

 

H3: African American mothers with higher levels of religiosity/spirituality will have
lower levels of depression than mothers with low levels of religiosity/spirituality.
It was hypothesized that mothers who reported that they were very religious or
spiritual would actually exhibit fewer or no depressive symptoms. The results here
support this hypothesis for one group of mothers only. Mothers who were married and
described themselves as having a high level of religiosity/spirituality have moderately
lower levels of depression than woman with low levels of religiosity/spirituality (r = -.47,
p<.05). For single mothers (never married and currently not married) there was no

association between their levels of religiosity/spirituality and depression (see Table 6).

Table 6
Correlations between religiosity/spiritualigg and depression by marﬁal status (n=126).

 

 

Religiosity/ Spirituality

 

 

 

Married Single, Never Married mle. Not Mmed
(n=21 ) (n=56) (n=49)
I I.) I .11 E 2
Depression -.47* .04 -.17 ns -.10 ns

 

Note. *p<. 05

H4: African American mothers with less cohesive families and low levels of

religiosity/spirituality will have higher levels of depression than mothers with

highly cohesive families and high levels of religiosity/spirituality.

42

 

It was hypothesized that the combination of a close-knit family and a strong
religious/spiritual orientation, would predict lower levels of depression in both single and
married mothers. Multiple regressions were conducted to predict this relationship. This
hypothesis was supported for single-never married mothers. Single, never married
mothers’ levels of depression were predicted by their levels of cohesion (l3= -.260, p<.05)
and religiosity/spirituality (B = -.240, p<.05). Single-not married and currently married
mothers’ levels of depression were not, in fact, predicted by their levels of family cohesion

or their own religiosity/ spirituality (see Table 7).

Table 7
Multiple regression analysis predicting_depressive symptomatology by cohesion and

religiosity/spirituality (n=126).

 

 

 

 

 

 

 

 

 

Depression
Married Single, Never Married Single. NotMarried
(n=21 ) (n=56)+ (n=49)
0 5.1; 2 .11 5E 12 0 Si 2
Cohesion - .96 ns -.26 .08 * -.32 .86 ns
.31
Religiosity/ - 3.4 ns -.24 2.2 * -.11 3.0 ns
Spirituality .49
Note. *R2=.11, *p' .05
H53 African American mothers with less cohesive families but high levels of

religiosity/spirituality will have lower levels of depression than mothers with high

cohesion but low levels of religiosity/spirituality.

43

It was hypothesized that the added resource of having high levels of religiosity/
spirituality despite low levels of family cohesion would buffer against high levels of
depression. To test this hypothesis two groups were therefore created: (1) mothers with
low cohesion and high religiosity/spirituality and (2) mothers with high cohesion and low
religiosity/spirituality. T-tests were conducted to examine differences in the depression
levels between the two groups by marital status. This hypothesis however was not
supported. In fact the opposite proved to be true for single, never married mothers.
Never married mothers with low levels of cohesion exhibited more depressive symptoms
despite their high levels of religiosity/spirituality (M=18.3). Mothers with highly cohesive
families however, but low levels of religiosity/spirituality tended to exhibit fewer
depressive symptoms (M=10.8). No other significant differences were found (see Table

8).

Table 8
T-test for family cohesion & religiosit}'/§pi_ritiialit}' bv depression (n=12tj

 

 

 

 

 

 

 

 

Depression
Swab: $9121.62
Never Married Not Married
Married (n=56) (n=49)
(11:21)
1%. t 12 M t 12 M. E 2
Cohesion & Religiosity/
Spirituality
(1) Low Cohesion & High 10.7 -2.3 ns 14.4 -.70 ns 18.3 -2.2 *
Religiosity/ Spirituality
(2) High Cohesion & Low 9.3 12.1 10-8

Religiosity/ Spirituality

 

 

 

Etc. Low and high scores for cohesion were divided at the mean (M=5.5). High scores for

religiosity/spirituality required a score of 2 and above.*p;g . 05

 

44

Reliabilit

The second step was examining the cohesion and moral-religious sub scales in the
family environment scale. The negatively worded items in the sub- scale were re—coded
and the items were sum scored. Reliabilities were then run on each sub-scale. The ﬁnal
subscale for the cohesion subscale included 7 items. Items 11 and 41 were deleted from
the subscale. The ﬁnal alpha for the cohesion subscale with the deleted items was .675.
The moral-religious subscale however was found to be unreliable with this sample. It only
yielded an alpha of .420. An alternate item was used to assess how religious respondents
felt they were. Reg177 asks respondents how religious or spiritual they are (0=not
religious or spiritual at all & 3=very religious or spiritual). The psychometric properties of
the BDI were also examined. Reliabilities were run on the BDI and yielded an alpha of

.902.

45 ’

 

 

Chapter 5

Discussion

Marital Status and Cohesion

The initial intent of this study was to examine the relationship between marital and
cohesion. Married mothers had higher levels of cohesion than those that never married,
which supports earlier ﬁndings from Boyce et a1 (1995) stating that single mothers raising
a child with special needs tended to report less close and cohesive family environments
than married couples raising a child with special needs. These ﬁndings indicate that there
might be additional resources being utilized by mothers who were divorced, widowed, or
living with a partner that allow assist them in having more cohesive families. Cherlin’s
study (1998) provided support in its conclusion that African American mothers who were
once married are very likely to use the support of extended kin and others as they parent
their children. This is an interesting concept in that it conﬁrms the works of McAdoo
(1995) and Billingsley (1992)in their assertion that African American families have
historically and continue to utilize supportive entities of extended family and ﬁctive kin
networks in order to remain empowered and resilient. African American mothers that
were divorced, widowed, or living with a partner were skillful in embracing these

alternative forms of help in raising their school age children with special needs.

46

Cohesion and Religiosimgiaiﬁtuamy

 

This study explored the relationship between family cohesion and
religiosity/spirituality. The results suggest that married and unmarried mothers from more
cohesive families have higher levels of religiosity/spirituality. These findings were similar
to Tolson and Wilson (1990) who found that two-parent households tended to have higher
levels of religiosity/spirituality than single headed households. These ﬁndings suggest that
there is no association between their family cohesion level and their level of religiosity/
spirituality. Some researchers contend that one of the effects of religiosity/spirituality is
the promotion of family cohesion in the home environment. The ﬁndings do not support
that assertion. This study suggests that cohesion remains independent from religiosity/
spirituality in the lives of African American mothers with school-aged children with special
needs.

This concept may be better understood in the context of alternative understandings
of African American families. Stacks (1988) stated that African American families may be
very cohesive and sometimes enmeshment sometimes not linking with other resources.
They tend to be close knit and which may lead to enmeshment in some cases. As such, the
family unit relies upon support from identiﬁed family members, both biological and
extended kin, as a primary resource. In this case, enmeshment or closed families may be
shut off from outside that receive from potential resources, such as religiosity/spirituality.
Cohesion in this way denotes that they rely on resources within the family, which might
inﬂuence them not to feel the need to receive support from external religiosity/spirituality

resources. In addition, this pattern might block other potential resources that are potential

47

 

supportive factors for African American mother of school-aged children with special

needs.

Religiosity/Spirituality and Depression

It was hypothesized that mothers who reported that they were very religious or
spiritual would actually exhibit fewer or no depressive symptoms. For single mothers
(never married and currently not married) there was no association between their levels of
religiosity/spirituality and depression. As noted in the literature, Brown and Gary (1985)
found that religious participation is a source of support with anxiety-related problems.
Other studies have shown that the church provides emotional well-being (Neighbors &
Jackson, 1984) and that women/mothers are more religiously involved than men/fathers
(Taylor, Thorton, & Chatters, 1987). In addition, religiosity/spirituality in African
American families has been shown to be a strengthening unit in African American families,
serving to bring the spousal bond closer, as well as the bond between parents and children
(Billingsley, 1992).

Billingsley asserts that one of the effects of religiosity/spirituality in the lives of
African Americans is that it ﬁJl‘thCl‘ binds together the spousal relationship within a family.
From the results of this study, it may be understood African American married mothers
who are highly religious and have received a signiﬁcant amount of support from their
husbands have lower levels of depressive symptoms. These ﬁndings support literature that
states that spousal support and religiosity/spirituality are primary buffers against stress and

depression.

48

 

 

Marital Status. Cohesion. Ed Reﬁosity/Spirituality as Predictors of Depression

It was expected that mothers with less cohesive families and low levels of
religiosity/spirituality will have higher levels of depression than mothers with highly
cohesive families and high levels of religiosity/spirituality. This hypothesis was supported
for single never married mothers. In support of these ﬁndings, researchers have compared
the similarities and differences of married and single parent households. This study
supports research by Brown, Brody, and Stoneman (2000) who found that marital spousal
support was negatively correlated with women’s depression under conditions of high
socioeconomic risk. In addition, Hannan & Luster (1991) the absence of a male partner,
low income, and a large number of children have been shown to contribute to stress and
therefore less supportive home environments.

Single never married mothers with low levels of cohesion and religiosity/
spirituality might have higher levels of depression simply because they lack solid support
systems with which to buffer the stress. 1t is interesting to contrast this group with those
who were married, or were once married and are now single. The fact that the latter two
groups are now, or once were, used to receiving help from a partner might make the
difference for single never married mothers who have never had the potential support ﬁ'om
a partner. Researchers have clearly identiﬁed spousal marital support as a potential buffer
from stress, such as depression. As such, this might be a pertinent support strategy that

helped single never married mothers have lower levels of depressive symptoms.

49

 

 

Although this was true when cohesion and religiosity/spirituality are both high,
the ﬁndings from this study indicate that religiosity/spirituality alone cannot be a buffer.
Instead, it is the combined effect of these two variables that buffer depression for never
married mothers. The stressor of having low cohesion was not buffered by
religiosity/spirituality. However, religiosity/spirituality is a very important factor.
Approximately 90% of the mothers in this sample reported that they were somewhat to
very religious. These ﬁndings indicate that religiosity/spirituality is most effective as a

resource when home environmental factors are not as stressful.

Conclusion

Results from this study conﬁrm an assertion made by Marks (1993) who
encouraged social scientists to move away from strict linkages between understanding
outcomes based on demographics. With this in mind, some of the ﬁndings in this study
have deﬁed conventional traditional demographic interpretation, while other ﬁndings
support past research.

In addition to Mark’s suggestion that social scientists stretch the bounds of
demographic interpretations, Earle, Smith,. Harris, and Longino (1998) implore
researchers to analyze the marital status category for African American samples. This is
based on the ambiguous “unmarried category” which may include women who were never
married, divorced, widowed, living with a partner, and may even include extremely
estranged marriages. They contend that it necessary to move beyond the traditional

“married” and “single” dichotomized categories, in order to account for various contextual

 

factors that may account for the variance in behavioral outcomes. For example, it is
conceivable that there will be different contextual influences for women who are widowed,
rather than those who never married. as they have different people with different roles
impacting their respective lives. As such, this study utilized three categories with which to
analyze the marital status variable: 1) Married; 2) Never Married; and 3) Separated,

Widowed, Divorced, and Living with Partner. '

Limitations

 

This study recognizes that there are several limitations, which may hinder its ability
to be generalized to other samples. First, this research assumes that the respondents
answered all questions to the best of their ability, but the limitations of recall bias are
acknowledged. A second limitation is that the data set and the scope of this research do
not allow additional relationships to be examined. Thirdly, this sample includes a large
number of low-income families. Although this number may be somewhat representative of
the economic makeup of the broader community from which the sample was drawn, the
ﬁndings may not be representative of communities where there are a larger number of
families with middle and upper level incomes. Lastly, this study has both a modest sample
size and result coefficients. However, modest signiﬁcant results indicate that stronger

associations may be made if a larger sample size is utilized.

Sl

 

more

The implications from this study are far reaching. This study was conceptualized
using the Family Stress Theory, which allows a framework with which we may better
understand the process of stress management. By examining potentially salient variables
validated from past researchers, this study was able to validate past ﬁndings and broaden
the literature base to include African American mothers of school-aged children with
special needs. The implications of such are extremely important given the dearth of
literature focused on understanding the stressors, coping strategies, and responses in this
very speciﬁc, and previously overlooked, sample of mothers.

When social scientists have a better understanding of the complex and multi-
leveled factoral relationships affecting African American mothers of school-aged children
with special needs, they are able to conduct further research more comprehensively. New
ﬁndings from this study may challenge other researchers to potentially generate newer
studies, thus ﬁrrther expanding the limited research base. As the research base develops,
social scientists have the ethical responsibility to share the results in the forms of, at least,
research and teaching.

The beneﬁts of research are obvious in that it helps bring better understanding to a
segment of our American population that faces alternative realities. In turn, one of the
greatest implications this study has on teaching is that social scientists may explore these
ﬁndings with potential practitioners, school principles, guidance counselors, community
leaders, and pastors, who have a “hands on” relationship with African American mothers

of school-aged children with special needs. One of the purposes of this study was to bring

a better understanding of this population to social scientists. More importantly, the
ultimate goal is for the social science community to use ﬁndings like these for the purpose
of improving empowerment in the lives of African American mothers of school-aged
children with special needs. The implications of such include the possibility for the
mothers utilizing resources to buffer stress, and ultimately improving their quality of life.

Current trends in the United States government and educational systems indicate
an ongoing need to better educate parents and children on how to improvement in their
lives at home. Speciﬁcally, parenting and after school programs for school age children
with special needs are being used as the bridge between stressors affecting Aﬁican
American parents and the resources that can lead toward their empowerment. Findings
from this study may provide parents a different lens through which they may examine their
daily experiences and lead them to positive options for their family.

As supported by Boyce, et al (1995), there were signiﬁcant associations between
marital status, cohesion, and depression that suggest a need to further explore the
relationship. If social scientists expand the marital status variable beyond the
dichotomized categories of “Married” and “Never Married,” it is possible that some
variance may be accounted for in the behavioral patterns of those who are divorced,
widowed, or living with a partner. This study suggests that an analysis of this speciﬁc
group may lead the research community to a clearer understanding of the present day role
of extended family and ﬁctive kin in the lives of African American mothers of school age
children with special needs. The empirical implications of researchers utilizing this
approach when examining marital status will not only yield a more speciﬁc understanding

of the outcomes for currently single African American mothers, but it will also broaden the

53

limited research base of African American families of school age children with special
needs. In addition, it is important to employ a holistic approach in not just addressing
spiritual needs, but the importance of family cohesion as well. Further exploration may
yield a more intricate understanding of the influential factors affecting cohesion in the
home environment of African American mothers of school age children with special needs.
This study also has implications for religious communities whose mission is to

serve the community in the most effective way possible. Currently, many faith based
organizations are broadening their services to include parenting education and after school
programs for members of the community. As such, faith based organizations may get a
clearer understanding of the actual experiences of their community as they raise school age
children with special needs. This is a particularly salient concept, as many faith-based
organizations are making a concerted effort to reach the previously overlooked population
of single never married mothers. Studies such as this one can be a primary link of

understanding between the religious community and African American families.

54

 

APPENDIX A

RELlGlOSlTY/SPIRITUALITY

55

RELIGIOSITY/ SPIRITUALITY SURVEY

How religious would you say you are:
Not religious at all
Somewhat religious
Very religious

How important is your religion to you
Not important
Somewhat important
Very important

What is the importance of spirituality or religion in your life?

Looking at your reﬁgigus beliefs since your child was six years old, are these beliefs the
same, less, or more.

Less than they were

About the same

More committed than they were

Do you encourage/discourage your child to participate in your religious activities?
No religious affiliation
I actively discourage religious participation .
Yes, child participates, but 1 don’t particularly encourage it

I actively encourage religious participation

56

 

APPENDIX B

FAMILY ENVIRONMENT SCALE

57

 

 

'1

 

 

FAMILY ENVIRONMENT SCALE

Please give your honest feelings and opinions. If it is difficult to circle either True (T) or
False (F), answer in terms of what you or your family feel or do most of the time. Please
don’t skip any items! There are no wrong answers. Please indicate whether the statement
is more true or more false for your family.

 

1. Family members really help and support one another. T F
2. Family members often keep their feelings to themselves. T F
3. We ﬁght a lot in our family. T F
4. We don’t do things on our own very oﬁen in our family. T F
5. We feel it is important to be the best at whatever you do. T F
6. We often talk about political and social problems. T F
7. We spend most weekends and evenings at home. T F
8. Family members attend church, synagogue, or Sunday School T F
fairly often.

9. Activities in our family are pretty careﬁilly planned. T F
10. Family members are rarely ordered around. T F
11. We often seem to be killing time at home. T F
12. We say anything we want to around home. T F
13. Family members rarely become openly angry. T F
14. In our family, we are strongly encouraged to be independent. T F
15. Getting ahead in life is very import6ant in our family. T F
16. We rarely go to lectures, plays or concerts. T F
17. Friends oﬂen come over for dinner or to visit. T F
18. We don’t say prayers in our family. T F

T F

19. We are generally very neat and orderly.

58

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

There are very few rules to follow in our family.
We put a lot of energy into what we do at home.

It’s hard to “blow off steam” at home without upsetting
somebody.

Family members sometimes get so angry they throw things.
We think things out for ourselves in our family.
How much money a person makes is not very important to us.

Learning about new and different things is very important
in our family.

Nobody in our family is active in sports, Little League,
bowling, etc.

We oﬁen talk about the religious meaning of Christmas,
Passover, or other holidays.

It’s often hard to ﬁnd things when you need them in our
household.

There is one family member who makes most of the decisions.
There is a feeling of togetherness in our family.

We tell each other about our personal problems.

Family members hardly ever lose their tempers.

We come and go as we want to in our family.

We believe in competition and “may the best man win”.

We are not that interested in cultural activities.

We oﬁen go to movies, sports events, camping, etc.

We don’t believe in heaven or hell.

59

 

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

56.

57.

58.

Being on time is very important in our family.
There are set ways of doing things at home.
We rarely volunteer when something has to be done at home.

If we feel like doing something on the spur of the moment, we
oﬁen just pick up and go.

Family members often criticize each other.

There is very little privacy in our family.

We always strive to do thingsjust a little better next time.
We rarely have intellectual discussions.

Everyone in our family has a hobby or two.

Family members have strict ideas about what is right and wrong.
People change their minds oﬁen in our family.

There is a strong emphasis on following rules in our family.
Family members really back each other up.

Someone usually gets upset if you complain in our family.
Family members sometimes hit each other.

Family members almost always rely on themselves when a
problem comes up.

Family members rarely worry about job promotions, school
grades, etc.

Someone in our family plays a musical instrument.

Family members are not very involved in recreational activrties
outside work or school.

We believe there are some things you just have to take on faith.

60

 

59.

60.

61.

62.

63.

64.

65.

66.

67.

68.

69.

70.

71.

72.

73.

74.

75.

76.

77.

Family members make sure their rooms are neat.

Everyone has an equal say in family decisions.

There is very little group spirit in our family.

Money and paying bills is openly talked about in our family.

If there’s a disagreement in our family, we try hart to smooth
things over and keep the peace.

Family members strongly encourage each other to stand up
for their rights.

In our family, we don’t try hard to succeed.
Family members often go to the library.

Family members sometimes attend courses or take lessons for
some hobby or interest (outside of school).

In our family each person has different ideas about what is
right or wrong.

Each person’s duties are clearly deﬁned in our family.
We can do whatever we want to in our family.

We really get along well with each other.

We are usually careful about what we say to each other.

Family members often try to one-up or out-do each other.

It’s hard to be by yourself without hurting someone’s feelings
in our household.

“Work before play” is the rule in our family.

Watching TV. is more important than reading in our family.

Family members go out a lot.

61

 

78.

79.

80.

81.

82.

83.

84.

85.

86.

87.

88.

89.

90.

The Bible is a very important book in our home.
Money is not handled very carefully in our family.
Rules are pretty inflexible in our household.

There is plenty of time and attention for everyone in our
family.

There are a lot of spontaneous discussions in our family.

In our family, we believe you don’t ever get anywhere by
raising your voice.

We are not really encouraged to speak up for ourselves in
our family.

Family members are oﬁen compared with others as to how well
they are doing at work or school.

Family members really like music, art, and literature.

Our main form of entertainment is watching TV. or
listening to the radio.

Family members believe that if you sin you will be punished.
Dishes are usually done immediately aﬁer eating.

You can’t get away with much in our family.

62

 

APPENDIX C

BDI

63

 

 

 

BDI

Date

 

 

Name:
Occupation:

This questionnaire consists of 21 groups of state
circle the number (0, l, 2 or 3) next to the one sta
have been feeling the past week. including today.

Marital Status

 

 

 

 

Age Sex

Education:

 

merits. After reading each group of statements carefully,
teinent in each group which best describes the way you
If several statements within a group seem to apply

equally well, circle each one. Be sure to read all the statements in each group before making your choice.

 

 

 

1.

WNHO

eon—o tau—o

DIN—o

 

I do not feel sad.
I feel sad.

I am sad all the time and I can‘t snap out of it.

I am so sad or unhappy that 1 can‘t stand it.

I 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 1 cart see is a lot
of failures.
I feel I am a complete failure as a person.

I get as much satisfaction out of things as 1
used to.

1 don’t enjoy things the way 1 used to.
Idon’t get real satisfaction out of anything
anymore.

I am dissatisfied or bored with everxthing.

I don’t feel particularly guilty.

I feel guilty a good part of the time.
I feel quite guilty most of the time.
I feel guilty all of the time.

I don’t feel I am being punished.
I feel I may be punished.
[expect to be punished.

I feel 1 am being punished.

I don’t feel disappointed in myself.
I am disappointed in myself.
I am disgusted with myself.
I hate myself.

 

64

8.

10.

ll.

12.

13.

0
l

I don’t feel I am any worse than anybody else.
in critical of myself for my weaknesses or
mistakes.

I blame myself all the time for my faults.

I blame myself for everything bad that

happens.

1 don’t have any thoughts of killing myself.
I have thoughts of killing myself, but I would
not carry them out.
I would like to kill myself.
I would kill myself ifI had the chance.

I don’t cry any more than usual.

I cry more now than I used to.

I cry all the time now.

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

I am no more irritated now than I ever am.

I get annoyed or irritated more easily than I
used to.

I feel irritated all the time now.

1 don‘t get irritated at all by the things that
used to irritate me.

1 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 eould.
1 put off making decisions more than I used to.
I have greater difficulty in making decisions

than before.
I can’t make decisions at all anymore.

 

 

 

 

 

 

 

 

14.

15.

16.

17.

18.

UNt—o

UN—‘O

I don’t feel I look any worse than 1 used to.

I am worried that I am looking old or
unattractive.

I feel that there are permanent changes in my
appearance that make 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.

Iwake tip 1-2 hours earlier than usual and find
it hard to get back to sleep.

I wake up several hours earlier than 1 used to
and cannot get back to sleep.

I don’t get more tired than usual.

1 get tired more easily than 1 used to

I get tired from doing almost anything.
I am too tired to do anything.

My appetite is no worse than usual

My appetite is not as good as it used to be.
My appetite is much worse now.

I have no appetite at all anymore.

 

19.

20.

21.

0

0

0

I haven’t lost much weight, if any, lately.
I have lost more than 5 pounds.

Ihave lost more than 10 pounds.

I have lost more than 15 pounds.

I am purposely trying to lose weight by eating
less. Yes No

1 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.

1 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.

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

1 am less interested in sex than I used to be.
1 am much less interested in sex now.

1 have lost interest in sex completely.

 

65

Subtotal Page 2

Subtotal Page 1

 

Total Score

ﬂ.

 

 

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69

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