Corrglates of SunnvaJ for the

CommunRy ^ e d t^ntaJ Heatth Patient

.W nne M. Walker

A thesfe m partial fuffiBmert

of the requimments for the ciegree of

MASTER OF lENCE

Saint UnWrWly

( \ ■ //Approved:_____ i s

G. Pretty ^Thœfo A ch ^r

T fW s CfommHfoe &temtar

Approved:■ 2) L C ^ rV. RartiamentT h e^ Comrr#% Menfoer

I^ e : .1) t / ^

N^on^ Lâjfary S CsstBia

Caiac^ TÎKS SenÂ% Servkje ifes Biéses cæias^w^Ottawa. Caoatla KIA0N4

The author has granted an bmvocaWe non- exctisive Ecence allowing the Natscr«3 Lâîray of Carfâda to repfodttce, kj£Bi,<Sstit)uteorsea<30$*%BSi3flhÈs h*ar*;%es8;l3y arry nieeams a%%d ir; any form (x fonmt, making üis th^is avaSaWe to mtK^^ted pææ%%.

L%wWK&aaoMxdéune&BatoeênbtocdMeet msi excWséœ A bf^cm ak Cam ia de r^MxWm. cft^rtouer ou verKlre des coaxes de sa thèsede €gijæ^^ et stxm fwmeque ce soit pour mettre des exemj^ares de cette thèse à la dispostton des p^sœwœ int&BSSées.

Tire auütctf reEârre owten^^ ol flre copyi^ht in Ms rer thesis. Nathffl' toe ttre^ rrer sutretar^ etdracts frcmt ît may tre prmîed cr oürenw^ r^ txitKred witixHit hWher per-nrâssion.

L’fflrtetff ccstserve la propriété <fcj tèoft cfautetr qta pn^è^ sa thèse. ISB (a ttrese ra des extrais stdrelantiefô de cefle-d ne doivait Ctre fenpranés <ki autrement repnxk^ sans ajn airtonsation.

ÎSBH 0-315-74452-9

Canada

ACKNOWLEDGEMENTS

i wouW 0(8 to e%pm% my cWp%t g raü ti^ and @ )pTWatmn to my

advi^r, Dr. Grs^ Pre%, for her unW ir^ emxiufagement, rsS snS ^ mjpport

arWgWdæ^e. Iw o i^ s ^ ii to to th a n k th e n ^ m b ^ o f m y th^^com m itt^

Dr. Vic Raitamsm ard Dr. Vfc Catano foftW r^m r^pa&m arai carnirror^s.

Aanks to my hiaband Has^m my parems Mary and Sam for their

Iwe, pa^(%8 amf umters^mSng. Without them, 1 cœjW m)t realize the W a­

rrant of tNs pn)jm±

F in ^ . i %^h to thai^ kWtae: VWter amd Diarm Ewerth>rtWr es^W m e

amdhelp.

Table of Contents

ACKNOWLEDGEMENTS ................ „„j

L8T OF TABLES AND FK5URFS.... »................. iv

ABSTRACT ......... 1

INTROOlKrnON ..... 2

VARIABLES DERNING COMMUNrrY SURVIVAL ...........................4

Empk^ment ....... «................».......»................................... »5

R«acfivfem —................ — .............»................ 6

Sumn^fy ____ ...._................. ».............. 7

PREDATORS OF RECIDIVISM ....................... ...„8

ScK^ J^nrographkî Facâofs ...... »..................................... 8

PrwkHS F^^ïitettzation ......... 10

DÎÊ^no^ —............. - ....... .12

&jmnmîy ...............................................................»....... „...»..13

PeR^ïtion of PsydxhSOG^ Enviionnfwnt .....................................15

^mptomotogy ...... »............ »........ 21

aiïTtnsry ................ »...»..... 23

SAT1SFACTK)N AS AN INDEX OF SURVIVAL ...........»...... 25

....................................... ........27

PrWctofsof...................... .................»...— ..........»............... .29

&imnmry ...........»...... %)

h/ETHODOL^llCAL ISSUES ........ ....».................».31

......... * . . . . . . . . . . . . . . . . . . . . . . . . . .

METHOD ..... ...%

I . . . . . . . . . . . . —•• — —-Ti—ri---------- -——•—— "—'— ^6.......37

i

................ - .......... — ........ - ......—......40

■■■**■*•**##»#««»*#####****"••»**••#**»• »**#*#*###***«#«"#**#**«"#«"44 2

R^ULTS ..... ....................................................... .. .».....................44

E)weiptive A r^ y ^ of the (XiWoms V arW ^ —..... 44

{^sdff^ys Afmiyssoftf^ P n ^ c ^ r V a f^ c .^ ---------.«45

PsydxHSOC^ OirW e to CommmAy SurvW --- 46

R ^Iir^ R sy t^ t^ k s i VW -W f^ to Community &iiwv^ ______47

Reîaîir^ PhysicaJ VW-Wirg to D>mmuraly &mmml ...... — «.49

Rœâcgvism ......... «.................

PrK&aing Safôfœ:tion ........... ......................

RelalWshiïS^nwgŒitcmneXWaWw ___

Reiattonshf^Amm^PrBtMorVWaMes . . .»

» .

^tttoïAWogtoW tosuK ........ ...............

M ^uremonts of Ouüame ......................

^0æummento of PrWctof VsnaW^ ...........

Com^L^n ...... .....

W E F E B E I^^ ...... «......

H.....*..».......

ApfWfKixA .........................................—...

__

A ï ^ m É x C _______

^jpœttfecD — _____

A ^ ï m ^ E .............

48

51

..«. ...52

........... 5 3

56

«.....«.59

.........62

...___67

«..,.«.71

«..«..79

.m

#»**##*#«#**##»*###*#*##*«

m *-#44 «# ** V*##*## >S3

•*«• # a M«« « « n > » » X* » 8 '

**•**■*■» e ■<-"h* 4 *•* FÎÎ

IV

List of Tables

Table 1. Spearman Rto Comalafion RWMx for Ret^Svismof Psy%Wo0<^ Well-Being, Physica!

WeW-B#^ amf P^roption of Ps^dw-StxâW Environment 48

Tabte 2. % gm sson Rœidts Stowing Relatomhip of Precfictorto RK^fivsm............... .. ............................................51

Table 3. F tegres^n R%Wts Showing Relationship of PrecSctorVariaM^to & iM s:!ion....... ...... «................ 53

TW^ 4. ^ ^ a n a n Correlaton Matrix tor the Dimermions andSui^%dæ of the COPES.... «..... »................... 55

Table A-1. L s i ^ of Time ï^rtidpanîs Were at Residence ..........79

TWe D-1, f^aajnto of Cenbal Tetoency ami Vahabüity for Out-œme ami Prec&^r Nferto^es ..... 83

Table E-1. Frm^ency of Scor% of Psychological and Ph)^WBæ^g. ..w. w .w ...................... 84

Table F-1, A v e r^ Value of &thstoSion for Psychological Weli-......................w.......85

ABSTRACT

of SwEYlvai fef tti9

Oammunitv B as^ Mentarf htealth Patient

J.M. WalkdT

The p u rp i^ d the f ^ ^ n t ^ x iy was to ej^iore ttommurtity survW of

comrmjnity h ^ d nr^ntal fW th f^ients in tom% of a)cW aito

fæaom b ^ d on the theoretical framework of %da! %ok%y. TW measures of

community ac^^tnmnt were i ^ d : rec^& r^ and ^W sf^^n . The

cpes#on wffî tito extent to whidi these outoonto couto p r ê t â t

dmnto' [»rcep&ms of tW r f%ydw-soc^ emnrwment (æ nto^ured tl%

Commimity Ortentod Pn^ræ rs E nvironné Scde), amf their amf

|diy^%W w eN ^ng (ee n % ^ re d tfto Levd of Owe Survey), ^xty-two

r%idento in i^rto Cam FadM% were intenhmmd. Bemttts ir^^^sd

that r% à g v ^ cmjfd be i^rtls^y prWctod from w#-bdng aito

jiK^tfdiants’ j»rraption of titoir fsycfro-sodd enviroftment. ^rtonomy, arpport,

ontor arto o i^ m ^ ^ n , arto invc^rement a i ts c d æ vmw parWly pr^&Am of

^^stodiofL ftocor% h^)m vm rer^A % lÈd)dtheLBeofsatm toG % n^an

outmme m esure. Mdhtxtologlcal ^ l e s and reœmmemWorm tor torther

f^eard rare(^ to% W .

BITR0DUCTKH4

There been a trend over the thn^ of sWfSng the of

tr^tm ent for tite chrenkajly mentally ill from ho^Ae^ to community

pn^mmmœ, T l# h æ gen^Et«f con^jw:^)le r^æ nch on the correWes of

sunm ^ [e.g. tKiure in the wmn%inity] for the (S sc h a r^ hœpital patient in ttm

comnforAy {S^t»n ami GWyr^d, 1974 ; Wilier ami BSggen .1976 ; Iwsaer and

1976 ; S ^ n . %im and BarWty, 19%). fkmrever, fittte progress h ^ been

in kfonb^r^ t N ^ fmâors W ch iiÆuem» œmmunity survival {Anthony,

Coiren emd VWo, 1978 ; PaWo, KatSec ami Artotefe-Rorez, 1986 ; Avim»! and

Spw^dey ,1 %7), An testre that is prevWent thrm^hout the literature is the

q u ^ t iw ^ e ^^ £ ty of nrethmfofogies which ^ e % survival on the of

bo^iAai rKKhng^ms, (immunity tenure, ami en ^y m en t after cfischarge.

Anthony et a l (1978) ami foforAvmon ami Sf^Kdiley (1987) rnhnxatmi foe use

of S4^3p]ementafy imfox^ to otfrer dmer^fors of survival, sifoh as the

ammmt of ress exfforimiced by tM rrrentaHy jU.

TheiXM^amrW refeofdsfoargW [^yxfoi^hc ;^tiems in wmmumty setth^s

Buell, Sharratt ami Althoff (1972), in a revimaf of

sttKS^ on po^-(^foarge W arn ing , fourni that the percentage of

rek ^ A a^ m i {^fonfo v a h ^ aœ ordr^ to foe anfount of time between release

and folfow-up. of (Clients 12 nfontf% after d s fo a r^ showed that 40 to

50 h a i b ^ n rAx^^talized. ^ d . a f ^ ^ e d that tfre^ %ures

c m i f o t e i ^ i ^ a t ^ ^ r a t e . FWter, Goehng, Lamree and Wasylenki (1981)

W nd dn#ar r ^ g s . T h ^ W e d at r ^ m ^ ^ n r ^ for f ^ W s

in Mstro|KSüüi Toronfo. ThWr resulfo imGcegW a rate of rmâMsm of 30 to 40

f^cem s& 6 nW hs, 25 to 55 percmt ^ 1 year m%i % fo 75 frercent 3fo 5

m

■g}

i

2

I

w

I i 1 1 1 1 1

I

M

B

M

ISf

4prec&tors. Hence ttm of oirmnt procecbir^ omtinyes to

i» c ^ ^ ^ n e d on tiia t^sls of their prt^rtyf^. Wan and Ozcan (1 1}

tW F^ychWrk servâ» res^uch on the færh^mmrg* of mental fmalth

centers tSd devekq) umvœsally critena.

Tf% pt^po^ of ^%fy to furOter the ^seæment tiiose faaors that

inSuewe retâSt^m ami anvival within the commumty imihKSr ;^Ao-ax3al

environnrnr^ fachxs mid smWrn^on im kx^ By indmHng the a ^ ^ m e n t of

ü i ^ varWœ* svaluatkin of menW hemth cam «%jfd in turn tmcome mom

0ffm:®v0.

Variables Defining Community Survival

In tiie employment (%K)hra±, 1976 ; Anthony, Cohan and Vitalo, 1978 ;

hikstmr ami Keith, 1973 ; P r ^ and Dis4ofsmo,1S ) ami mt^Svism (B%hn^.

1976 ; Arrthtwiy et aL,1978 ; Mtmhsr et al.,1979 ; Gelier.ISSS ; Drake and

W ^ ^ .1 ^ } imve bemi the moa commoNy usmi varWes Va

comrmjnity airvtval, Satisfecfion fWiUer mid holler,1978 ; Pryer, Dimefano ami D in n in 9 ,1 9 ^ } h ^ ^ } t^ n iâ ^ to evaluate ^rvTv^ Other m e^ jn ^ as

of Me (DWarto and Anthony.l^l ) Imve tmen usW. but not œ fr^pmntly.

Gi sL (1^1} n^nWnmi t h ^ outoome mea%n% were irmrWent

cto%3lF#)r%ofps|#Mrto^eami{aycho-sm^mWaWonamitWmom

arto vmW mitoome r m ^ r ^ shoWd ham been utHizKi. Fisdieret

W.a^iWntmn%itltot them w@s a W ( of (torment reWts ami meÜ%)dok%y

intM ^mtore. At6^erarW ^ofW seoW conm nrnasur% Btominat^thæe

nW tockd;#^ ei^^ain the irtoor^ent r%uito.

Anthony ot W. (1972) ^«Ses

emptoynwTt % W of kinc^Nf%. m t^ ImgcaWd that WMhne

em^oyment wth time. That ^ at a 6 nwnth Mow-up, ^ to 50

^Tcent of the W t W-tmm enr#;yment; St 12 months r^rcer^

were emptoy^ kiMme aiKf after 3 to 5 y ^ s , the em^^^fed VMB

only 25.

FW ier &. a!. (1961) tooked at en ^y m en t mt% for {^Ssnts Wm

psychMhw h t^ iW s m MetrofxHWi TwonW. AMr a 6 month W kw -i^ only 38

pement w re en#VGd WMinm. Thm rate was in accotcWw» with ^ mp@#d

by Antfwny et (1972).

(1976) (3 # % ^ the ime of en^Woynmnt ^ a tis as mt of

(^:h8fgefw%Ammr^. Sf% argued tfmt tl% term "Employment ^atis" «as

(gffWttodeRne. Not r e î œ ^ f ro n ts were ^jle to work extend

factors, as eiamïfnic oom #)ns k#mm%d 0% a ^ W # y of the nmrW.

B ad#m A a^^W dtW if#^ir^ex im sto l% t^d6d:@ ,8com pæ W nW m A :t

have t ^ n nW e tmtwrnen the patmnts' emf^oynant fur»^n!r^ before æ%i after

ho^aWWron. S i n ^ H y , (19%)a r g u % f # m t a ^ c W r m t

n e c ^ ta te w^rrœs. PTyeramjDWeW%(19%) rWnWnWtfrntmmamedala

onp%W w^)W en#)yn%ntwM W a k rm ^ a n d sp ii^ fW tD b e b ^ c tB a te

(Wk)%orKmnÈ;fBg%m. emj^jyitard a p p ^ s to ta by

% m (k% sM ctiM se% W n^tottaf^W ^W næW s,& % ^m acorW (W W asa

m ^ u f e of «mmunity survW fortfa p n ^ n t

6Rgcttfhrism

tor mental health reeso^) Ims bœn the

pmvWent mœsure of (X)st-cWiaf!^ tom:&)nli%. The index ret^Svtom

W WwipnMtontmnBytvmtonm. TM meg^re is mgtomi%ton to

ctohng a to&]«Hjp f^ftod. Examf^of a ixW that tl^ n m ^ .eof im^ude ( 1 ^ ) eW T ^ ^ ran d Mamtorsdi^ (1982). Cm:n

shxW (Aromc sduaxphmnto pahento In terns of tl% length of inpaHeni stoy In

rela^n to ad ^ ÿ ien t ho^^WzaW arto <^nW and functtonir overa 2

year peftod. Resufto incB^^that length of inpaüent stay cSd not result in a

higher rWwqaaRzatton rate.

æid Maitoera^sto comtmjnity @$stment of chronica!^

mmitolly 0 i^m n^ in a consrunxty aiM)wt program. Four measure of

comimimty acÿ^ment were isKf WutBng a r&Aotomms m e ^ re of

p^cWatrio hcspWatiom within the prevtois 12 months. Results iixficated that

poor oomn%m% ad^ishnent oxito be pre(W»j from ^ r b a ^ Bving skKs,

behmrtor arto trWts that oftond othem, arto from somsflc proWems.

The second meaajre of rwstfivism is Ae prqKX&m of time during îî» fottow- up pertod that tfs ^>ent in the comnmnAy dter c^chw^. Eramplesofau(W W tt^fÜ Tton^% rreof rKâgv^indutto amrssartoCarpentor

(1S74), % m ss and Carpenter (1977), aito Growm, f&Kto# arto %izich

(1977). Sm^agtoCarpwTtBr(l974)8xwtmWWprm&A>rsof mitoometor

a:^^)p*vw6s to vmnds to tm gersml arto

^tefm^iâal. The outoons m æ ^ re rx H ^ t^ of the amount of ÜRS spent out

7of hcs^la! th8 Wow-up ;%nod of 2 years. Re^itts ttmt outcome

not a singte pn^sss but was com posé of r e r ^ p r o c ^ ^ , Sbm ^arKi

Carpenter (1977) the sWy. Tf% 1974 wtcome m e ^ r e was r e t ^ j

but with a 5 ^ r folh^up. Resu&s weie simiWr as there was a high correWon

between the 2-year outcome varW es ar%l tMIr S^ear counterparts. Strains et

al. th^ bnw in h o s f ^ only i^utiaily mReaml to ^ outo)rt%

fun<^iomig of an

Growe, K^ss, RutM and StrtzkA (1977) attem ]:^ to pretfct œmnxmity

tenure of t^x^mrged hospAal patients. Oukxjrrte vms m e^urtd tim

nurrWr of weeks of r%n-hcspWiai^n after dWmrge over a 10 m or^ perW.

Armtm of tin» out of h o sp ^ e»mpjted from (^cM rge to

re^imsskm date. If a p^tont h ^ muftipEe eufmis^ons aixi during

the kMkfw-up pmrW, only tf» first rmdrmsson o)n^ief% i Theauthmrs

suggeaed tW community tenure was ortiy one oite.ion of outi»n».

Surnam e

The pnot^n» r e ^ £ v ^ as a n ^ ^ i e of cxrtœme hav^ large^ bwn

a r ^ A of confmn«ting vmW)les. ThW may vary % # fæAors w d i ss

length of h t^ p ^ stay, numWr of previous dass, and p # s W

hWtii (BWrrach. 1976). Therefote, t h ^ fss^sra rm ^ be oantmlW in onWrW

get meanlr^ful inWnation edxAjt ^ik£ss whIdi have

rec^fvsm as an m ^ ^ r e have i ^ d (Bfkrent precMons, varyh^

msth(x^^(^pes,and im & g ^ a m b ^ n e o fd a g n o d rc c ^ ^ m ^ These

prdWems vmre in v ^ ti^ W furtlw in the pn^n tstiK ^ to t^m iop a rmsra v £ ^

amfreW)lBnWm^A%yL

Predictors of Recldlvtsm

^KWDemooraW^ factors

Several sUfcSes have exarrdned o^nw^raphk: factors æ pr^Mors of

rfôàSv^. TÎW r^rtts of tf^ e irtt&aîed that «xâd demographk: fœaors cM m i n%amiy precact ret^Svism.

Serban ami Gtdynski (1974) exanrânœf æxâai-demographkî factors of chronic

and ®aüe aifBzophrenic paüente in ortterto prKÏcî rehospitaltzation. The

fmaors stud«j were Khxation, emfrioyment, oaxif^tlon arxi marital status.

A ra ly ^ of the rela^iship t^tween ©æ^ of the precfictor variaWes mid

readim^on sWia irxksbd tfml marW statis arxi ocoipab'on vmrB n i t e ^ y

reWœl to reWmWon tor hie chronic group only. The aidhors postulated that

the dvorfic paherfô had Imi^ned skBk becaiæ of tfm lenghi of their

Ütness arxf amcxmt of hc^pWizalion. & r t ^ et al. suggested that ttie pretSdive

value of K^al-demogn^^ ^ r s (aukf therefore only be determined by

kingilmAml sW es of patients.

FrankHn, Kittradge and Thrasher (1975) stixTied fifty-two irariabfes of

cfis*argW jsyditetric f^fien.s over a f^rkxi of 6 to 13 months in an effort to

praM reht^pHaBiratlon. Variable %e, gender, education, næ».

mahW sWm at first ^ay, i^ace n ^ ie r ^ ard aiment tr^hnent

R ^ tts Bmt m s result of an In ter^ :^

^ im a peisor^ wiviTonmwW dors sxA ss. oxxmmic d jendtent mxi

[xiof^lNrmge.

9Fontaim amj Dowds (1975) W mini^red a qu^tkmnaim Hoarding

informatà}D on sfxa^ Ability, ett^alion, dimnidty, amj ^Jb^ctlve (£s3 r^ to 52

l^ t^ ii^m p a ltan ^ their £^r^!vefs ami nuji^j^ staff. High chronk^ ami high

symptorm»k^ ttm oNy vahaWœ ktantifimi œ signi^ant pradk^srs of

fBho^^üzation. Fontana ami I^)wck pm@ad an indhmWI ^ ! y k) t»

r^W tW d to æ Mving a combiné»! of hgh chmnkAy mW high

sut^dive eatress.

FWo, f^Sec Aftw^ikt-Floraz (1986) rmxxds of 150 parents

cëæhaîgad from a ganmaJ N)^)W in Calory. %!&:* demogr^hK, dinka)

ami for adm ^lon in ra^Am k> m N ^ a W ^ o n patterns

vmm examined. ^nder, mahtai staha, and c# ^ n o s is% ^ fourni to imve

no effmâ on N ^it^za& m pattens

Wan ami Ozcæi (1991) examinai 144 ;mWn& in sWe hos^^Ws.

Sodai-ctemographb fadors were sW ed to prmM first acknisdor^ and

rsad m ^ m sk ) F^uAssMwmjtWm)n%sm^ai-{WiogrEg)Wo^A)rs

( r ;^ ami %e) wem ^n ifkan t pnmWors of Srd imw mWssion.

(WK%f5#k;fm^%5W8rBi:^nl&:mtt prm&aorshmvsverof n^im W ^^ito

Them is a general œ n ^ n am in the Stsiatum th a demograpf^ fa^HS

am not i # c a d prm&^ns of nmÈüvëm. Ths to be a r^sonable

cof^i^HKi æ tf^ stmüœ rev^N ^ con^:^T:d^ In tem ^ of

c o m p * ^ ^ ami ^ r^o fM m » -u p fm rW , yd pm&æmi c o i^ d e d

S w ^ a a l analyse b e N ^ n stm W varW weB hkmsver, W i ^ o f n u ^ p ^

10lifm rm grœ^n to analyze the c to w^pmvafent This altowed for evictence of the unique variartoe oorfoibutW esK* fsKtor rattwr than the

vaiiatos common to many tetors. &îdakfon^raphfo fetors will therefore itot

be cor^jtofKî in the præent stifoy.

tfegjawfiratten

Several stiafies bare examined tfto relaifonship between redcBvto arto

prmrfoia ho^^teSzafion. The r^ults are confliding. Buell and Anthony (1973)

examined 78 psychiatrfo patieras c^±arged from a sMe hospital. Analyse for

reddvfom on cteiro^r^jtw chmac^rfoücs that the mafor precGdor of

rm&ëvfom w&s numtmr of previoia ht^aWzaOons. The reimining

char&aerfotfos shmwed or rm letomship to r^Mvism.

OiSd]^ arfo &3mmer {19^) ttomi^red one group of rw^Svtds who tW

returned to hc^ltal within %) d a ^ after di^harge with a control group of

(gKAargdd fmtienfo wfto tW not mturnad within tha tinto frame. R ^ifo

IndkatKi that iBcabnitted fstiente cGfforaj sgnMktontfy from the control gmi^ by

ort^ a Ngher fot^nce of prevkxrs N^pitafeatfons arfo asigniffoantfy higher

irx^nce of prmrkxs day admiœiofto.

Mller and Wilier (1976) utiflzed a Self-A^essment Guide on 108 imtients

<^diarg«i from a fK Mfal 3 months after dWrarge. NumWr of

prevfous hr^xtalzatfoito m s a mffoarft, W not the mod poteift, praëctor of

refK^iâalJzdioa TW toftorsa^esW thatacomtm atfon of varW)^fo

necto^mytomWw æ ofrto pr^Worm of redcBvto

11^ucOœ rKWts t&j not ümi a corraWon be#men ho^^W zalW

ami reckg^m Wiiler æKl B î ^ n (1976} ami Byers, Cohen and

H a n ^ ^ ^ e r (1978). V#er ami B^ien (1976) exanWnW the rWsBomWp

Wtween mimmumty mÿfstnwnt ami rm^iv^m i^ng the SeK^^ÿatment

GiA^. was measirmi fay leht^^Wzaüon whhJn 6 n inths after

c ^ d ia r^ . Mam e W te ami in te ra c t F valit^ for aQ on the

c^jestionnaûe ter N^)iWzaKon e;q>ertem» were itet slgiifcant

Byers, Cohen ami Hamhtmrger (19^) ej^minmi 129 patiente <g%Mrgmi <»'

re lees^ on a trW vWt form a ^ a te h%piW Itetween 1971 ami 1 9 ^ TM

outeome vanaM% were: r^termsWon te a ment^ hc^plte! witfun 1 yearaRer

total nunteer of days n t in the commuràty within 1 y ^ fe fown/

c^diarge arte n u n ^ r of (% s te test r ^ i n ^ ^ n . R ^fteim Sc^ed that the

pmtMor v^iabfe of number of pmvtei@f%spWteaîtens%^ not

te mdcteftem. Tfte ajttteis s i % ^ W tW rmteëvWn te a tten^ttex phenootenon

whh* coiid ortiy be s j^ ^ n sd by examining an irserstetion of many teeters.

T h ^ (tei nm spedfy whk^ featers.

S W % pr^kKS hc^ilt^zWitms æ a of were

pievaiem in tee 1970^ The contec^r^ r%u(te may be te varWom

in tite Index of rehospita&catem, diftehrg teSow-up ;%fk%te ami the ir^dusten of

heten^eneous grouf^ The stuÆ% m ^ g e ^ j tW ^ABvtem te rmt a s n ^

|:m oc^ W r a t i ^ a i n t e r % ^ t e n W w m n^verW W orn. A#hot#h

prWotte t e ^ a ^ a b o n f ^ r y t ^ n shown in %nte te tm a

s%r#cantprmW m^(^rmmte^n,it(te6sm^@ iv8f^ouf iMtenstemBi^ofttte

p n x ^ s W oommudtyac^W on. T W K itf ^ ^ n o ta q ï te in th e ^ te ^ w

12a imîœnt to become a diiWc necMvia.

ts^^talka&jn therefore Wl mtbe usmf as a pretWorvarWe in the

present study.

DmgrWs t ^ n t^^xithe^ed to a prœWor of redtWsm. SM&es

have examiné if patient grouf^ sW ^ed by différent cS^m ^a entera have

dt^rent p iet& ^-oi^m e reia&oiahi|a. Re%^ im&ated that d^nosm

rat a ^ti&ant prWdor of rer^fivam.

A\Wn ard (1987) panted out that Wr have repxtmj

whether dm gra^ vms coneMW Wth re^missan rates. Buell ami Antfany

(1973) stated tW a^tiKtphrerto were more likely to be neadmittmJ to ht^pitoJ

toan non-sîhjzophrentos. Kovrewr, they cfid nrX fW this relationship to be

sîatsffî^ly significant in pr%ficting reddivlsm.

FWter etaL (1981 ) a ^ s ^ 505 p^drlalric pafients uang fi low-up

of 1.3 arto 6 months a ^ r tSsdtarge. Resdto inr&atml that there rm

mgnifkant d1%renœ in reWmls^on rates for diagnostic subgroui^. Pablo,

KasS^ sffto ArWeda-Florez (1986) afeo found that d ^ rœ ss was not

sgniWnfiy reWW to rm ^ ian .

G^er (19%) exærfined 12 i^ychtotrlc (Obento wth a of 276 etommsk)%.

Qetof found a %r#rnm dfferer^ in the re t in s for remtoWon betw^n

.œhlajphrerÉîarKii»îS3ra%c6sîrdef groujs. The author ctorsdurfod however

13that there m) Offerer»» in rate of m ^W saon between tt% two

subgimips. Ht^nms-Et^r eukJ Riger (1 3} exam iné the reta&si^tHp

b e tw ^ scK^ n#mmrk compo^tion, tm^xWza#in ami menW ffînœs. Patente

were given a DSM-III ( g ^ n o ^ and a meaarm m s to evakmte pW en^

ovetafl tevel of functionif^. ;r%5c^%! tW imitfmr tfm

severity of rmnW iMr%% nor any signifiant relatkmship to

nurrWr h o ^ ^ adrr^slor^

haa f i t t ^ n sfmwn to signiftcantiy predct either in

(ëagm^^üc bgfoups it be that cM gno^ as a

p re (M o r% f^ ^ s too general a term. For emmple, patients with a partWiar

d a g n o ^ nmy l^ re in^mired fondmn in one )here (te. symptoms) Wt perform

we8 in a rK ^ r (m. wori^. Thia ss a prKWorvmWWe may imve

wrxWylr^ comfx^te f^Æ3rs timt a R ^ ootome. AW oW i^m lsyte W to f

reWxIiQr of d i ^ m ^ Wtween {^nk^rs. D ie^% ^ wW rwt cor^kr% f in the

p r ^ n t süxJy both b % a i^ of its W to f (%%Mive ^n ifeance aral the nature of

i^^m rd ity .

^ m t m

A Btemture ^ a rd i that the pr%Wors t f ^ have been rmrimwMi far

imve treen the m t^ prmralent varW:Ws exairJnW m r«&SvWm Wta^s. ft

^^lears Üiaî there are In ten ^n g % :^re titat RnA tire omrerWi oon^rer^t#^ m

%re9 as tire genera v # % of s W e s tire^ \rerW)W. More^redWNy,

nd ï^ients are cor^tentiy DW rerg^ fretier^ m ^ ire

to trace orœ m f^rree nrey ire lovrer^ foravarWyof 3daJ ar%f prerssrrel

14maœns. Ako, foOow-tg) pernods ^ o s s stutSes have been h’ hty vanW^

r e l ^ ^ ami ft^ow-yp dates. With ra i^ hi thersqaeutk:

pmcmAims, the In ee^ed use of {^ydit^câive drugs ard rented changes in

length of h t ^ i ^ stey, wm^mraWBty of rg a^ rg W patients separated by only a

f&M y ^ rs n ^ be edWaed.

in geneiiEd th e ^ pH%Wors tan to achrance arr urxtorstonding of the prw%s of

ffîj i iTtont, mtfwtftoysnqWy ktontify biusd categoric of paiento wtK> are at

fW( of art^cptont ho^Wts^lzatton. Utbe systenWc intommtion is ær^aWe from

g ^ e ;xW<^r5 al%ut dir^aU aid tritons tW pr^Sspose a patient to

a diror% Drake ard WaHach (1S88) a r g i^ that e a ± patient

a unkÿ^ bW groufd of valu^ and Wrets wHh which they viewed their

environment Varkn® fectors ard su f^ rts were therefore perc^ivœl and

w eights ifKhvicWly to arrive at a g i^n meanir^ for each f^hent When

varW es are treaW ^ œnstants, com;araWity a m o r ^ studio is lowered as

redcËvîsm is a œ m ^ex interaction of ir^W onal, commurvty and Indvkiua)

fssSxm. Ailler and WBtor (1976} condided W t œncentrating on diagrmstic

determinmts of reho^xtM zs^n resulted hi hx) n^mw a toos. TMy edvorat^

to d p n x ^ K ^ i^fB important detenminants of redcRvrsm. Anthony ard

BuW (1974) drmlarfy arguW t t ^ Inv^t^ato^ the ftHK^ing of a i^tiem after

r e ! ^ ^ VÊSS a n w e appm a^ in precWng a id undeistancRi^

than atten#ng to outcsme from ctomo^i^totc vartoblæ.

A rmre œ n ^ W ^ v e œq^arWon of f^toiabto rm dm ^ion may W%üî

tftototore frtmi an that liKâjdes a l ard f^ychok^jkdt f ^ r s . The

{X ^n t WÜ cor^ to f th^ ai^xmato.

15

ARN%^h there may be rrmny vsrW % tW im e an impact upon a dwoNc

psydW hc paSenfô com im ii^ sufvW, @&m&)n ami emHnmmem^

hav« e m e r ^ as a g ra te r Nnportam^e than pmvtoi^thougrn. Tim

^W y m:t^}gy e x a n * ^ tt% l m |^ of {j^rysk^ ami envimnments

on WfmvWr of Tim th%m&ai ^ a œmxpW^jKüion of tf%

imW of k)f% temi patiente to be in environments tW a ^ ^ r t

perm)mU growth, WnxritenaWy enhandr^ ; qtek%d ami psychologW wdl-

Wr%.

The impma tW trw m em environmente have on paient behavior i ^ been

weO (tocunmmed. Canton ami Sdtvartz (1954) mainMned Ümî ^n#ormA)gy

rmyim caused t^envimnnmnL Cam@ (1958) EKhwated th# a fxdentte

W ^ n o r n x ^ tm tfKX^in of an te tfm drtxinmtemms In whteh im is

FteMKport ( 1 ^ ) theorized that sodo-erwironnmnt^ inWmms were

tfmnW%ms cap^ite of etm^vely dwigmg im&^tea) in terns of s m ^ Mf^wter.

FirWy, Grob (1965) WentiW that ap p n ^ a te nfflei® were e ^ f iv e in

e W W n g umWmWe f^dem dm m A er^m .

There te a co r^ rsim in tee Sterature that tim pmydm-mmtel environment In

whteh i^ e n te fwx^ten ims a rmidai on trwtment outœnrn (fisses,

1974b). hfoos (1974b) ^ 0 rr^rWnmi 6ml beimvter te arte # e d e d by

ttm envinmntent œ ftefcdved ttte in S.

S m ^ te carted by Motte (197^) @ the muHtel^^nary miteÿ of tee

i n ^ a of phy^tel arte socW em^nmnmr^ on Item i^W zK tee

16impoMafwe of the so<^ en\dronment and M impaa on psychological t^aors

&fch ss seh-%teem arW per»)nd devebpment. ms^ogy on

the ktentiScation of d^Kuaakml reafamra sixA £S phy^al illness ard

(fepms^on and their re ta in to environmental facaors. A t^ ic assum^on of

s tx ^ W th a hurrmn hehavmr c a n w W undersfôod apart from tM

emfironmenW wnmxt hi whkA it (Kans. Thi% [Kx^jrate pr%Wor% of mAcome

<^nnot t3e nW e a ^ ly from in^rmaüon about incBvWu^: information about their

envrmnmeras is ^ e n W . It is that milieia have

important p h y ^ j ^ ^ amJ health related effmas (Cobb, Frerch, Kahn and

&%rm, 1%3; 1%8). A ^W m atic conceptiMzation of envtronmems

nmkes it ;%3ssiWe h) test more di^erentated hyprtheses about the efieds of

sp^sRc emnrennmnta! d m e r ^ r s on ghren p h ^ o lt^ k ^ im&res (Kiritz amf

Rfeos. 1974).

In an a tten d h> ktentify the uiKferlyii^ prepress tW environmental imparts

Mve wt tretmvior, kkMs (1984) postured a oir^eptua) model of stxrt^ eortogy.

The mode! oon^:^rW tfre link tretween stre^fyj life dRximstamres and

a tkpW m to tre aff^rted mt environments ^%tem and a personal system as

ereS as by r^twork r%ourc%, and ^>prWsd and coping resmrces. The

environment ^rstem w æ compt^Ki of phydcal f e ^ n ^ , pdicy arW program

fK ^rs, tW aggregede cWmrteristics of indvkluais in a setting, as well as stxsal

cTimate fartons. Tfre (»rsor^ system in d u c t stKso-demt^rapnkî fSKrttws of an

b idM W as as p er^ n d as self-esWm, (%rgr#vB ^ # y ,

amf fwxrtmnal t^sablMy, th m x t^ ^ s t r ^ o r s arW Qte

e n ^ rm m W m d pKsoW ^rtm s reW%f to %rdt stresaxs, sh^>«j

netvKWk ream tc^ arW ^ well æ their e#etrtivene%. Ths

17L#WWy has m on and f^ycWogkal w@R-being, further

IK ï^ iia re d t tm îth ^ p fx œ ^ were tmr^Kaional arKf tW mdpmcW W dW dt

oooirred eæA

SodsI do% not minimize tfm importar^e of ImSvtdud

since son® Wvk&Ws are irrare pmne to exprès cerWn tot^n^»rs 0$.

Eggreeson) than others. In WcAlon, imgvkWi (Ssp(^tM)% may have thWr

eff%^ in interactions wAh the erwimnmemal cd%#ons. Knowledge of fHotsat^

WfWorW 8 ^ titufir^ e t^ â s of dfWrent environment arrar^em er^ k a

centra in ufK^r^arKir^ b e lm ^r (kkx%, 1974b).

ScKâd s )^ n % analyds (an ta uHBzKi Vo k^nttly t h t ^ environnant

reWe to w r s t e or unfavor^e treatment o u ^ n a s ard poss^My to

pfB(W (atomne t ^ « l m the (ëffererW imfmA of mWeu ^tting on

groups of faüena{%^»a,1972). ^ ) ( a and Sdwartz (19^), nW r^ned thW

far&spants’ pertaption of tJair psycho-^^ai environment m s re te t^ &

t^ ^ ^ v e kxtexss of ouaome as {X)mmur% Wnure.

M(xa (1974b) a s s % ^ two h (^ W t-t^ W prograrrs. Em:h program

( t â i t s . The V%rd n x a p W e Scale (a axaal (ÆnWe sa le ) acWnWtered

£d 6,12 arxf 18 montit in ten ts. The ab^^ute cSscr^arK^ and the exam

tatw em an WvkLml^ ^ r ta p ta n of the t r ô n a n t m ^ u æW the ramaHw

faic^aton of Ms neWrema groc^ was Outecare e^ht

cpastkm w W in^m inM f s w ^ tW n ^ a s p f ^ ^ a l t ^ ^ . t e r ^ m m d

c ^ e e d o n . R^AsirkBcaW dtW pat^rtsvW wvievmdthdrfXogamt^W üm

normaüve perception of tW r referema group, tentW to fwl more Wme aiKf

ISd sp r^ e d T l^ ateo «sn^^aifwcl of havir^ fewer ffierafe, of exç^rtôîKir^ wonM pfqfsW h%Rh, a poorer mmwe toward sWf, aiKi pwrer over^

ffi§jstrr»nt fetoœ concbaJed tfat the of environment in whidi an irtcfcviifc

fUTto&med rrtoy have opemW m a mtxtorstor in the r^atioftship hstv^n

pem^^ton of environment Euto treatment CKiteome. That ®, p lan ts wito were IKS wW int^ratod into their mBieu h ^ sgnificanUy poorer wrtcomes than those vrtto wore wefl integrated. A patient eithm fitted into tf» environment or a

d f^ jît tin# and ihtte experiem^ a ftocrer trottinent outoome.

KnWet^e of ax^ai ttomponents aliows tor the detenrunatton of theeffet^s of Afferent environnante upon patients. Patient types (toWd

suWet^ntiy tte adeqi^eiy nWdted with tre^ment %ttir%s that meet their

ne«to. in way. majonuim fit Wtween patient arto tieatnrent emnronment

may treobtoinW.

&&X)S (1974b) devtoed tire Community OrientW Progrante Sc^e (COPES) to

a% e^ ctxnrnurtity teychiatito treatment progmnte (is. community care

honte®). The CX^ES Ims t ^ n utffized as an Irxtox of cfient sati^maton by

prwtoing a cteta2ed ancti^s of fartktif^nte' perception of their environment

Rtoste arto Brmtet (1978) towto that the COPES wæ inctofteftoent of the

périmai of the raters and refieAed tite s tx ^ dintete of tre^ment

pn^raiï®.

IMdng tire OWES, (1974b) mewttairted tM an Wvidual's perce#ton

of h^mwironmenlwœntore NgMyartocor^tontiy rWaWtomrtotmtetimn

pattent tmdgrourto dmmasrte^s, aafiing or pmgmm sûre. MtxtektontifiW

ISprt^ran^ that emf^matzed pmWem st^ n g , W e )q )r^ ^ n of a t^ r ,

autwomy, ohem s^n, onctor m d on^f^atton, staff

comrol W Tsùm CommtsWy, patW s who viewed thmr

environment n ^ W f y were 1 ^ W s f i^ and Md pcrorer fum tfoniT .

CXher shK@% Nwe earoWned ttw r e W o i^ ^ between pero^j^n of f^ydro-

SEK^ environment amj communSy 5ie\ WEd. Pattern (1977) ImdarnentKl an

versron d the to group hwne environnants. F W det^ ln

ajMK^fôro-psftàapdofy environments were le% IW y to t^ re^W tted h)

Oian r%àknîs In non-ajMroftwe-mdrontanan environments. Path^i

c o n d iK ^ th d th e ty ^ of oup honm W8& nrore pretMive of rK&ëvism ttmn

or im^^nctent varW^es.

K ^ s , Grovm amd %izldi (1977) utBizmf the Ward Atnu^>here Scale to udy

14 t%^)W wards WdMwro p aü e :^ Tl% r^ul^W roatedÜ i^ p a in ts h e e ^

on %hlyorgankWwarcknmy hmrolnterrmli;^ w m eo fth e ^ x ^ s tro a jn e o f

the erord ard hromfore tmro deyKf In W comnmmty lo iter tlran if th ^

h&i not t ^ n mi an organizmf want

hWfT% Bergnron amf BaditWi (19^) e^roWrW 31 dirorw

pK dledslntheD W hddG dum t^w roral year frorimi IW ro id 1985.

The patWnWhWaBWW In community tro ^ m e n t^ n ^ ^ m W by

roN^Kt^z^mW twroen 1W W 1 ^ . S W y -m ie ^ ro e n tN d a c ^ n o ^ o f

s d i^ p W i# , 19 pmc&iû W æi c& ort^ arsi 13 pen»it W orgwiro

Waln^frKWwm. % si^W x& % tK itW psyd#îrk;^^^w lroK w e(ë@ G tA W

1 » in die com nw% and wtro were tkpem W t w h t ^ ^ ta ie were

m h^pW zW for rsm-psych^tnc ressors (61 percent). Of the patierts

29 f»rcer« %mre refx^^W zed ftjr psycht^ symptoms, 10 ftoîï»nt for

sibstamto a k s e , 19 ftonwit for nW cel ffir^s, 32 percent for ab^r^to of m x ^

aji^xxts, arto 10 ftoicem for a comblrtotion of mecScalilfoess atto the ^ t^ n c e of

atoWai^^torts. The au th fxs^ .^ t^ ted that tfæ patiente viewed psyc^iatrfo

£te a p^cN)-ax#W supftort network arto the rate of retâgvtem was

iTMznsetssMj tgflüh&s pwarceplâon.

Drake and WWWt (1988) fxrüents’ living prefererKte In relahon to

ref^^^aW Gon. Patiente enroWd in sm aAercare pn^ram in M ^ a r^ u ^ tte

were evsüu^jl (N=167). Ati partfoffmnte were Bving in the ctommurêty and h ^ a

DSM-IIJ (Sggno^ of aAWphrenfo (81 penteit), (gs)r%ter (10

ftentent), t^x)ter c e n te r (20 ftorcent), or ;^rsorte% Æaxder (9 punter#). The

meat a # a s s 40.1 ^ a rs . Only 9 {tercent oftfte partfoipants were mamW, 60

Itercent atere ^ngte arto 28 pencent r^ re ^ p a s te d , (^rorcrnl or wkfowW. Past

h t^ tW a ^ o n history wss m e rite d as total time s|tent In hr^tW and ranged

foom a W ntofiüte to % ^ a rs , Cfinioans were askW to rate the partk^sante'

WlitotW toward h o ^ ^ as a ptocte to Eve ttomp^ed to oirrent hoiteing in the

comrmnAy. T fte were a^grted to two categoric: "peters to W to

fs^îitor (24 percer^ ^ “prefeis to Ihre in tfte œmnumity* (76 per^nt). The

were fogowed for 12 rmnths. Forty-three perttent *tera

retR^Aafiz^ at or«te (torir^ ^ period. Tltere «ras no gniAterâ retetton

beh«sen arto r^ fo i is ^ n . Lhdr^ preforertos^msfRMever a strong

p a W o f of reNtef^Wza&m for ttte full sampte arto the s^izophrerm: parents.

T h ^ was rtot a raakx^ttp between i\nng ^xefereftod ato

lef^tef^^ahon for p e^ râs wfto s^izcaSe^hra c ^ x d ^ or (Baxcfor.

21Living prsfersm» unmW%! to rehf^^taSzatbn tor the patiento %#;

persor^St/c^jfctoTs. Dmke and W ^ach s i^ g e e t^ toe {C ents 's^îUâtos

toward their environnants ap f^ rW to infh^rKS a r b s ^ ^ n t hosji^toSzaltof^

Pere^stion of psytrfw-soda! environnant been retotWy igr%rW in

previous s W ^ it woiAj fmvever^ tW there s a general w r^er^m in

the sW % that cW actoress to^ variable tosa ^ e n to ' pert^ptton of toeir

axâal erwironment is prMWve of ret^Svtom. The p n ^ rd sW y -wffl erqstom thto

relationship turtoer the CCPES to measure indWickato' ftotcepOon of

their environment The a-theortolcal nature of tire (X)PES arto cremreftiu^

inadKÿjmses of mreragir^ imivtouai areres are «)unme of crencem (Emerson

and Pretty, 1985}. Bmtormto (1976) hmvever tor the integration of

reatits from ^^istkrej s tipes wth tirese of quaHtatore refrerts on the oortoitions

of reWsW p a in ts in order to tireir adaptabâïity to (immunity fife. Tture

tire deschptiveswKtiysesthatcan ire provkfW by toe COPES may be vakMrle in

determinlr^ outoœne.

gymptofitolbgY

In general, the méthodologie of reddivtem Ml to c^mminate

betvreen preventive and ameliorative re^reatment TNs h ^ contoumW toe

tottow-up ptolure. WMe recktivrem ra t^ are fr^irentiy i ^ d ^ a n re^ ire of

improvonrent nMnWned" ovrer tinre, thtree are re-to^ted tor nMr^rrence

puifK ^s are comntor^ r%a cfiatiirggitgshisclftcHit ifihoserne-trestied

Imptovenrent rret m ^ t ^ W Aron^re arto N ^rom , 1 ^ ) . Hire,

{tetier^ groufW into may vay at any jrelnt in time in

22terms of tl^ r arKi psydwfoglcai sympton®. (The imptfcatfon ofcBaqgrs^ being general a term hss previously teen Increase inm*% of riKâ&^m r r ^ reR%t the number of patients mantaning th®T

improvement as wsB ss ti%se for wiKsm improvement was not rmintWrW. Ths study wia rmke th® cBsfirx on by emminirg physW ar%f (sy<^wk%W sy m ^ n s as prwA^)fS of redcHvism. StucS^ are ^sarse œmsming sym^onwk^ as a precSdor of rec^fiv^ (rattsr, the foos has tsen on

symp%rmol{%y as an mjteome variable ræultir^ from srxW ^aors). fn studies

that fKwe a& tres^ sym#)mok%y it h ^ W ena^nifkant pW(&)f of reddvism.

In a previoî^ mentk)nW utiy, Fonteim and Dowcte (1975) proSW an iiKflvstud QWyh)t% m&ÈnittW to ho^Ntol as hænr% a combinatton of Ngh

drronto^ arto t^h ^ms^>nm^ogy with Imv sub^aive cfistress. BachræA (1976)

mantior^ physca) functtoryng as a predctor of reddvism. Bachræ^

oorKWed a U terine seardi of toitow-up stucSes of patients ndeas^ from state

menW hr%;%Ws to (tommun% She com^rcW that rWdivism cfid vary vnth

&rdt (EK&XB æ physW Itoafth arto symf^moicgy.

RWier et ai. (1981) cfiaa^ed symptomofogy as a strong preds^r of

reWmWon. They examiné 744 cfîs^iargœi jstiento from 12 ..ospitsis in

Ontoito. There was no e«^usion criterion tor subjsds. There was a foitow-up perkto of 6 morAM wNch œr^^m j of ot^rver ratings arto æh-re^tod

(ÿ^tionrWr%. W igW in thto a Genera HWh Qwsttonnaire whW*

(to f^W of 28 c^^& sm arto 4 sul%cW% titot axardrW sorr^to m#oms,

anxiety arto ir^mnta, t^stom^on, arto severe depr^lon. The aitftors

(tomAxW tW symj:m%iMA a strong ; ^K&aor of neadm^on to N^fAaL

2 3

¥\tesytenJd, Goôrir^, L am ^, FW%»r arai Fmermn (1985) s tu c ^ 747

pWienk in TbnxA). Six n^jntl^ after F^tian^

were Werwewed akxA tW rsym ;^m okw and fumabn»^

repeated 2 years after c^t^iarge. imft^ated thaï symptomoîogy

re i^ ^ to the rate of r ^ ^ y ^ n . The aulîKrrs

sym ^om ok^ as ami thot^ht d ^ n ^ r r k s i ^

rirmtmi üie atxS^æ of parents to use aRercam servkas.

Summary

R appems fmm Rm Sterature that redcSv^ ys a œm^Wex phemxnemm. Fmv

oomarrred on the prm&aors of rm^ëvmm, Nmever there was a general

agreement tW ^tdal (W^gnsgrhk W o rs amj were not ^gr#% nt

pnBdkÈDn fü%dthe!Wgna&xu%a9cü;BeN%&usfH%%%BW&aa&}nvüas(&aaa%}nabkL tt

1 ^ b ^ n hj^xrth^zml that rm^ivism '& a r ^ j l t of an inWraülon b e h ^ n

vahms f^rsonal and em ^nm enW W o rs W mSr^ tnterperson^ mMor%M;B

ami rwtmrrks. R fdtowsth^ any attempt to devr^op armera

œmpreher^ve erqrlanagon of re d rg ^ ^ rrn^ W d r ^ dlnkal and

W ^rs. The p e r c e p t of erwRonment symptcmmios^ h a ^

Wen Oieorsmi to be intrica^ty relatmi W Whavmr ar%i a rb ^ u e rR %rrvfyal In

thewm nW ty. TW e W Wso e rr^ rW evldm%» tW shows t h ^ varWrWs me

p rm ^ :^ 'n^w iltiterekrre We^^ntinmi In tW p r ie n t stinjy

LWng as an w kom e m ^Rrra Wm bwn crW zW am im & as^ i.

F ran k s K ^ a d ^ æKi Thn^Wr (1975) i»3j}^ out ttiat {Merits Wen

readrmtted to W c a se the a and ^ a r r e

24emnronmsft in % ntn^ to the oAen cSffioitt ami tteprived Bfe th ^ nmy ha^ fived

bi ttie ojmnwnity. rmy not ha\re n eœ ^r% in#^% l the dients'

ievel of po^-cgsdtan^ M^omng. F^Wo et al. (19%) o#3zed tira past use of

rM^gvbm æ an lm&:#or of tmatnrant effW ven^. Stixëes on m acW ^n tW

not « « ra^n t^ kbnüfy Ora prœenting pmWem orc^gno^that

nMK&T don. It wffî tfraretore to cbstenrtirra prot^d^ c a i^ ofreWn^Won. %btoe tW. aigumith^n^im^aonasatreatmeNWliaewœ

only n^ningful v»hen tiie rimdm^mn we® tor the %tme n^son. They

Mvttoaied controSng tor cEagiraetic cflfierem^ when œn^iering let^Svism ^

an fflitoome meæure. *^sote, Aioj^n ami f^tm m (1983) pointml out that tira

L®e of reddvtom as an outcranra n^su re was vaW H toe e^uir^jtton was made

t t^ a fratrâm was ht^^^lzed only H he v$^ rrat fum:^orûng weO. J&ratraetaL

defined the rate of red cg v ^æ tira anraunt of time s rant in h o ^ :^ or

the toW manberof f in ^ a trarmm to re^Wttod. This n ^ ^ r e has le^

interprefive confirm tiran psydionratrto or dinkrai rafin^ This Jmxtos et aL

etovooated tira d an irtosx of reddivlsm for m ^u h r^ outmjme, a i t s

reW ^ and vaTto if nr^sunng c£ent fumAtonir as to cfient

depenctorray on toe

The prient stody craradered retMvism as an oubrame m ^ure . Three

m ourns d r^fivtom were iraed - tofratient rK fivism, outoafient

and MbI r^ c ^ ^ n . Iqaalient reckfivWn (tofiW % tira nuntoer of

fsyci^tfto adrrWoira to to^ibtd avançai by number of nrantira toe (rartoxfrant

fras trami attira fH ^nt a c to r s W;rai#nt redtfivtom wm ctofirrad ss tira

luimber of \^ ts to a frayd^trto hœpid aver^ra^ tira numtrar d

montira the {rartk^^ iras been at tira p r^ n tr^ e m ra . Atotol redtfivtom

aIncWx WES EKMng inpegem aM ouï^müenÊ %oms. Pget

eiîK ^n of q i^ r a n a ï^ vaMty of varWWe wem aooxmW for by

oonsic^rir^ the level of fur^^ming (W h phy^al amf

p@y(^%A^af) in sdcStion to r%«gvisnt No nW e ümt

rW(ë%^meii ^%8.

Satisfectlon as an Index of Survival

Anfitony, (^hen \^talo (1978) achmcaW fw the desmlopment of ac^jltkjnal

im&stofs of oirtcofi^. Few f^ve a c k f r ^ ^ this. Thi@ StSe fMogre^

h£@ been nrncW toward the c^vel;^xmnt of vWW, reBaWe ^ m^ëve

m e ^ i r ^ ThW m rat % Imply tW of ret&gvWm are of no ^ u e ,

rEdhertl»^ træ£tkmal ir^kahxs be supplemented by imtexes whidi

æ sess dhertÈmensmr^ of community m$stn%nt mxA as ^tM aaion,

The mmluation d peiarnal ^ ta ^ d io n ^ an W ax of arrvW h ^ mA Wen

comnwnly used (Emeram ami Pre%, 1^5). \ftfitiiin the {i^ychWhc Bteiature,

satmfadim s t m ^ were frwi^ntly com & ^^ on inf^ient or re^ard i

p^:%Wons* ^ w on x^dm rwd f ro n ts (^nnett arW F e k ^ ln . 19W).

Zas^^my m«i Lehn%n ( 1 ^ ) pointed out that stud% of s a tW a c ^ in the

of nwAed h^lth am spar%. Ho%^mr, W sf^^km % an ou%ome mesarm hœ

b^HEKivotaied. W h w & a n m n a rd J o ^ (1975) for e;@ m pie% j#^W

(Sent aW ad m n W wMely oveiktoked in W eWuaUon d nwtW

prw m n^ TWy s ^ W tW most imMduais wMt nrnnW hW A

p ro b W % l^ a tW d % ^ ln % W io n o fa w f% ^ lD c a m ^ A G m , B p e in ts

emm cBssaWed widt s e iv ^ they vmmmt a t ^ \s seek W p elsW ^re.

26TherefOTB if an «as a Wage n u n ^ r of dîenîs it cb@s

netsssaniy t i ^ wars them, W im e et al. ajv%at%l for the

of WmpW nmtNxk of r m ^ h r ^ fmüent tk W io n . Kalman (19%)

hMxrÜïWzW th£d s ^ i s ^ ^ n f^ychiathc cars might enhance

mth rK om m ent^ tMr^^eutk: pnx^cW%. It would Dow tW ths wmikf

uftimatWy e n t ^ i^ comnwmty teniflre.

Z^towny et W. (1668) th ^ sa^ ^ d io n may be one ofti% moa

imi»}f1ant w toxne m e ^ n K of community Jivhral ^ it may int&ate ( jgüity of

S^. Zætowny ^ W. also j:^ n t^ out tmmers to iming ^W ac^on as an oukwne

m e^ire . Th%e inducted : the dMfkajlty of ttevelopng an ir^trument for

m es^hng patient ttefæâion, ami r e ^ r ^ and sam^ing das.

^ttetec^on ss an tmtex of survK^ Ims ateo been cntkâzed. In a s b ^ by

Pryer, Distefano ami Dinning (1982), a ate^Æ on questionnaire we®

admintetermi to 135 patiente in a psydiiatnc hospit^. The c^iestionnaire wm a

45 item yK-no formal that examined tr^tnmnt se rv k ^ and environment

tedors. TIte numtter of tevorabte n ^ io r^ K was u ^ ^ a m esure of

W stet^on. T h e c ^ ^ fw th e p te tW t^ m d e t^ e m te ^ ^ n to ü te h œ p W

for KXJte treatn^nt for a idrrlmum of 7 arfo, at the time of t ^ n g , a

ajffident imprwement in sympfomotogy in order to be considered for c^jfarge.

TTm rating for^ttefac^m wss fourni fo W constetent Wth other s tu r ^ of

h t^ iW z K ld te r^ ASrr^ithfolfowHjpw^msKteof 112

pWente wfte were rd e ^ W witWn 2 months of comfWWng the inW

It was fourni t i t ^ f o e r e w ^ m ^ t i & ^ c ^ m m ^ in

W s f^ # m t^ t% ^n the 25 sublet^ who been rehosplMzW. The W M rs

27condiK ^ that c^am satW&akan with trnatnwm v t^ not a piK&aor of

su n W as denned by outcoma m ^ ^ re s of rehoepWiz^ofi and wnpkyn%nt

BW sum tm n^otj^îW KAfon

Atthoi^h die of üisfæ:tbn as an mjtcon^ tm&ati»' has Wan wkWy

EKMxatW, there m mj c o ro n a s In tiia Btemture on n^thoWlogy to m ^^tre Ü

Kalman (1383} eW zW toe ntothoddogy ad^ctton sW W mdnWNng th ^

were cMkajR to interpret aW to namlW. Patterns tentWto W wreffyfx^Are

^tout tre^met%,amj there w^queatonaWeva&Sty and reW #y of the

instnnnentotltotwere i^d in ^^ stu cW s. DWIano aW AntWny (1%1) poinW

œjt that on ^t^atâton erf qi^tonatW r s l ^ j to suivtv^ as

they nwWy tW W^actWxt with

FW (1973) a t^ ^ to d tWt one metheto o f ^ ^ ^ r ^ dtent saWfæ^n

be tw etosefvation of ff-p^ent mtenat^on and n to^rfr^ æ the

t^ure, Weÿtency mto contoxt of verfal arto mn-iretW toter^atoraL Pad W lw

%%g%ted tW mexe res^reh shoiM W done Wore any ctondt^ors earn be

drawn on the InWence of community n^tomre cm ^em %WK#)n.

Wier æto MWr (1376) exan^r^ 72 paSeiW in a ho^As! in

Toronto. The w e r w in hwAai wæ days. WitMnatowctoysof

a to ^ c m , pW m^ererelntenW redarto WredWtot W

them to hcspW, arto to des^toe tWr wmic and sWdtors. f^W ntov^e

2Binmrvm%^ well as amj quœA)n«i i! they t h o i ^ hospttafîzasmn

b ^ n Wpful. TW then ampWtKi a 24 %em (%ent SWskKakm

S c ^ (W sed by üm AW%an Departn^nt of A^nW H%lth in 1973. A 3 n%nth

f(^ow-ijf> inWMm* wt@ ondKaed ami tfm Comiminlty Ad^i^tment Scale wEs

K fW n^m d ( V ^ r amj 197S). At this |»»nt, parents were aWmd if their

pnA#m fW n^^ved by h%;xWmti(m. tndi^nce of reh i^p i^^îton

overaSfmnthpermdwasnoted. Ar^yses were coixW ed that isedCBent

S afe fæ ^n re& j^ at d^Aarge, ^ n e r^ sat^acdon at cisdmrge and

p fd ^m n ^ ^ u ^ n at follow-up as the pr^W or vaiis^es. R ^ i t s imScated that

the C^rd Satisfadion related rmïfe h> work and ret^fivtsm. The

general on sad^Bdon Imd little rdatk)n \o the oüier mncome

m e ^ i r ^ The autfws si^gestdf a n ^ for a dearer dednition of sads^Æmi.

The most common to memuhng s E d s ^ ^ n fms Wen the iseo f

one w severd gkAmI (ÿtWor% Qe. ‘Ikjw were you! (LaMinka, Œjend,

Mæfea arxf Wolf, 1986). However, there fe controversy over thte metWd. Ware,

E^vi^^erary and ^ewart (1978) c r ^ k s ^ H as inac^uate h) m e£^re a

m uW rm r^m al phermn%non.

M vixsÈm of the of g ld ^ ques&srs to mea^ire satisfacdon indude

Urc^jhart, Butow, S^meney, Sfear ami Fnam ^ (19%). Urquhart et al.

Edndn^red a j^ e n t satisfW on qimsdonr^re to ^ 1 mrtj^ents. The

cp^& m n#e had niw lten% covenr^ vahois ^ p e d s of p ^en t W ^ t^ o n vwth

tr^bm nt(8M ^am m :9oft^dc,sW œ urt^saüsfactk)nw lth them pi^

trWmead t r % h r ^ mW r^Kls, woud rK%xnmend cHr^

tr^h w r^ hdped (W w% prc^^nm, wersa sa^^r& m , treatn^nt WpW).

8!

B

II II

I ’

I 1

I 1

I I 1

:i !!hI

1

5

30B s n i^ ami (19%) e)mmimd 124 sskA p#en& In a comnumity

ti^£ltym t^$om »5y^usfHiortQth8stix!y. A IS-iteni c^^ËonnEâtBwsæ

niaa«lto thôpatfeî^a^dî^ (l)whythey hæJKHjgttt W p (2)whaB%fth^hW

loumj lim helpW (3) what of the fadHty ^ r e nHKt im^xirtant in

(WWniî#% W r attitLK:^ about it and (4) whether they had any other contæ^

v # i nw W hWthservk:%. Sat^^^üon w£S reâed on a attitiKËnat

from 1 &i10l^s%fontM;a^n^'r%pofsætotW)(ÿj^M)rs ( l)^ s th e

contsaa hdpfti or imWpW (mW from 1 "very hsipfuf thrwjgh 5 "very unhdpW

and (2) was the ctHiteid sufBdent (ratW from 1 "WttertWi mffk^nfthrwrgh 5

"vmrae tMn W &%ntl. TM %im of th ^ e two n ^ p w ^ s gave a sabsW^on

ra#r%. E ^ r W s arat ^ n t feaWres of tneahiwnt (îe. cost of rvk%s) were

8iK)exanBn%L Of the 44 f^rcertf of the who respond^ ti> the

tortionnaire, apf»o;dm£âdy or% third reports s a W a ^ n , one third

c ^ r t^ W lo n and one third were u r^ re . S a^ ^ak m was strongly

correlated with the f^ents* ;% n»0on of their rapport with the ^rvtce prowtfer.

FaBent d^wAerWrcs, ds^nos^ and s y ^ m msues cSd not mgnif^ttiy prW d

sdæfacÆon, There w ^ a d g n lB r^ pomtive œrreWon b^vmen symptomokagy

and^#W^mtfmt^r%tRnWtodfoun%tam%and(S%8tisfadi{m.

Sumimtv

SaM^aWn &s an outcome varWrk îm been the Bteratuie

do% rwt W c ^ a OK^^ent n^hod of cWMng or m^^rfng t t^ vaiW)^.

T T w e^^adearÜ ïofinW W IonofthefedO îB thatdetM ^^^on. Tfm

;K)^rAdW ycGr^!^edW W a(^nasan ouKx)rmm^^ae. T W ^ r ^ o f

sa^W #km0sanb%^daxnmunëysjrvivalwæm^sui%by œrreWk%W

CO

I

1

1 I II I II

21.

I

1 I s

32Tutm, YaJe, Potejan arKi Doom (1976) dscx^ad the use of

measirœ of imprcwenidfil. mwaums were ofWn vaW afWr@W)leœA8yü%o!ï%fïÉ%ibùAb^%ofmemterandofthe;a^l fVb et aL tW inferred thaf if ma* varied in tW rvdkgfy.^ncwnpaf^rs

smong (BfM entdi:^ mesmims were q i ^ b f ^ e .

water ami (1976) pîtinted cart that there was a W t of reeimnt in the

BteralurecocwerrWr^whatoor ihjtedcomnainity@c%fmm@nt. C ^ te re ta i ( 1 ^ ) n#ar^ ait^ted tiias stitcS^ on func^oning varW in their

ctefinitkm of caitccmte. TMrefore wmptete comparons of the variertîlw

su rv ^d have not been ptesible.

In tite pre^m aixfy, the prWente d extern^ validity iwre dWt wrBt umng

^ cstterte-n^ting r^ ten te in afl Re^tentW Care Fm^ittes in the H^fax- Dartmotrth area, tegarc^e^ of ^ e , tength oftinw aS. resktenc» or other

ctefTtegr; )fwfKaors, The irw^k^m of Wl siA^cA In thte manner Wiowter

the geiteWzE^n erf rfta ^ aii similar environment.

With r^pm ^to intemaJ vsücËîy, JmaW, Mir^m araf Nystrom (1983) poinfmj

%rt tW in telk^up ti% p n x :^ of randomiaa^n w% thrwenaf. This was of the m ^^:#ty of amJ wWter they te parüd^te

in the tofewHipor fKrf, may have utrockK^ a biss.

Av^m arte %teecrf^ (1987) & iù à ^ the mWtedt^c^ of prewots stWes. Titey nteteteteed rftet a ^ e mræll arte hetert^m ^^

samfrf^ in^TKW n ^ m rr^ of frfmSt^raite miteOfTte vmtebl^ arte tew

attmnpte te exanmte irtsnm^mte.

u

! ^ ^ 8

3 1 ffiHisae%

g

1

I 1

34

(A>2). tT Siefit, o u t] :^ ^ aW îotsi rsôÆvWm m s ^ n » am sigmfk waiy

rasgBiv^corr^tedwfahf^ï^HÿopKd wsfl-tæing. The raies ot n«âdiv^ wiB signffîcafltiy m weB-Wng ctecre^^.(A-3). h ËüWnî, ouipsSœTt arW rec^gv^ mwBums am signHk:œiÜy f ^ a W y c o m ^ W # # p h y ^ we@-Wr^ The ratœ of reddrvsm wifl ËgrAkanÜy irwiMse phy^rad weQ-being c^^i^ses.

(A-4), ITmiB fe an œJdfthm r^a^ïnship totsmen rtmœun^ of f ycfuîSogical wsMmîi^, phy^ad w^Hming and fmnmpaion o1 ps îho-æKsa] dîmaîe in the

of rK^Êv^nt The reteSve weights of these variay^ in the regre^on ^ÿmüon am r%A pre(&:W.

Faaom inW r#% sa^W ion:

(B-1). ^tmW ion ^ r#canüy (x ithmiy oorreWKl wüh partkâ^ants

peme^^x) of t f ^ ;^rdw-«)dal environment. Them mü be a significant IrKSi^^ In tlm level of î{sfecîk)n£®e®*ïÆmate component «raines. The

reWve impor r%m of cU n ^ œm^xment is not prediomâ.

(B-2). % W W on fe ixj^fively œrmiaWd with ^æyohokigkal vmB-

belng. Them W1 be a Wgm^nt in cm ^ In the Irnml of WsfacWn es

vmO-being(B-3). %ikWkm % i#cantfy pr^hmiy Mrrela^f with pi^skal well-Wr^. Them tm a mgr#mrn irær^se in the immi of W a c^ n m physW WF

{0-4). Tlwe an acKWw r^tNWiip Wwmen tfm m^^ures of p^drWr^<al

w #W r^, ami p e n ^ ] ^ of emmmnrrmrü in

#re|^R&#%iof%t^facÜon. Tim reWve W ghk of these vahabies in tim

35RelatbnsNp

(C-1). There wil] be a n ifcan t iwgaUve relatioreWp between the th r^

measures of r e ( ^ ^ m a i^ As level of the

mean number of r ^ n ^ s io n s to hosp5) wW d e c re e .

36

Sxt)r-tw«s raskfents from nir^ R^denti^ Care Facilities voluntarily (artksfatmj in ^Kty. Of tho^ partid^mnts. 50 had the cognitive mid

comirajnk^ion ^ 8 s to msfxiraj to the qu^ionnair^ Trim wss

ctetemtined tt» vf^ru hearing, and ajmprehension æction of the

Level of Care &hv . F^WentW Care FWlitiee (as defined by the R^xîrt of 11» Ta^ Force on Hom% for Care to the K® nister of Sodai Services,

June, 1984) indude any bdkfing or pîm» wriiem supervisory care or iimitmJ

personal cam vrifrMxrt profeæJon^ nursing sujmrvision is provided to 4 or more

per^ns who are ambuWory or semi-mnbuMory. the fxjpuiation of R^kWtial

Care Fm ity inlmMsnts was definmf the following;

(a). Had settlement in Hdifox CiHinly, City of Halifax, or Oty of Dartmouth,

(b). Were as having a mental il!r»ss for a period of at least 1 year.

(c). hfod t ^ n hcsfxfâSzœî ai least tmce for a ymriod no shorter than 7 cfoys for

thfocS^TK^

(4. Vfforermtoiving^jme type of tinardaiædstartoe from ekherHom^ for

Sj»dd Care, F^nify Bsnefite or hfonidftef Sodai Assistence.

There were 38 mde aifo 24 fenWe ftertidfmnts ranging in ^ from 23 to 79

^ a rs ; SD=11.792). The printery di^nW s of the were

as : 42 (%.7 jtencer^ e. h^jphrenfo, 5 (8.1 parent) affm^ve cfisorcter, 5 {

8.1 fteroent} mritetertoe dxme, 2 (3.2 {tefirenQ penamdity disoitfor, 2 (3.2

penrerti) o r^ ic brdn syndron», 2 (3.2 penrent) anxiety d^rrder, arfo 4 (6.5

37pen»nt) with no r^ n t (^ n o ss on ffie. ttie ma jrity of reWcWnts imd been M

their prient acWr^s bebween 1 to 5 years (46.8 penœnt). TW)le A-1 in

Af^mSx A ;%ovk a surmmiy of length of time s& re^^nce for foe sam}: .

ffocfcfivism: CXdp ient riK gvWm m ^um d by the number of

(HJfoetfont Msrfo fo a rrmnW hWfo ht^Aal with the nurr^rof rrrwiths the

resâfont Imd i%en Wving at W fEK#y. ini^üent m e ^ jr^ by

averaging foe numt»r of i^ychiatnc æWssons fo hœpitai wth the numi^ of

rmrAhs the r^foent had been at the An ovetaii rWcMsm irtcfox irms then obfoined aCMng the ou1|^iertt arfo inf ttient reôcBvfom %orœ

rW (#v^). The fmrfo^mnfo gave their forn^^onfoobWntffomtA^rmm (Ma

fnxn tifoirfif^ on hand at foe R%kieiW Care F&iMes.

Saflsl^fion : /fo extm%iv9 seanfo W l^ fo frrfo a rn^^ne of W s ^ ^ n gANn

a residential WHty. The s ^ s f s ^ n nrnmrrement cfov^f a ^ r revtewir

the nœtNxfo of n^^m ng vaifobie fo foe stiKSfô of LaMomca, (%era,

Mafoa amJ tAfotf (19%) ; Urqufmrt, Bufo% Sweermy, S h ^ arfo FiarfoK (1986) ;

Bennett and Feicfofofo ( 1 ^ ) . ReBabEty afo WkSty cfofo w ^ not av^bfo fn*n

these Oldies. M erged on W leWs in the piment stiK^ - WEK@on w%h

sodgd acdvM%, isfaaion mfo ermtforW MW-beb%, wfo

refont» , with he^ and oveM The

comi^W a 11 item que^onnam m ^urir^ foe^ m p^Ss of

(see E . The vmre cforWf foxn UrquWt et sL

(13%) afo were iw e r ^ for foe las^rfoarfo to control for orcforeS^ The

w®re given a Wng from 1 (terrB)!©) to 7 {cteBghted} on a Ukert scWe.

WIton a was given, a neuW aroro of 4 %sgnW. TMtoW

%om of the tor %as as a meæure of

(k»iramtn% O ^ n W Prograns Envfnmntont l e (C O i^) : The COPES m^suiWtlro (Æento" ;mr(^)tk)n of their i%kWtialfadBty (BAros, 1974). Tf% %ale^a1(%itemcp^ttonnarorecpn'ngtrue^to^rsspofs^. T hesa jee

cBvkted irtfo ten a ii^a les wlw* ^ e s s relatior^p cfimenstons, tmahmnt

pn^iam cfimsf^ns aito system mainteitera^ tSmensions.

ReWortehip <gmeT%torm a e ctefinaf by the following sub^ales :

(1 ). (nvoWment - n ^ ^ jie s how Wive mentoers are in the £tey-to-(tey

tomâhmlng of thar program, te. ^%Bng time ooi%tn tive!y, treir^ entiu^astte,

(toir^ th lr^ on ttteh own imiteW.

(2). Sup]x»ft - m^toures the extern to which memtrere are entroui^ed to be

helptol aito &topo#re hwarcte other members, ar%f how supportive toe staR te

tovrercte members.

(3). ^rontaWty - m^Kur^ the extern to whkto tfte program enator^pœ

members to 0{renly arto erqsr^ thar feWirgs operUy.

TrWmW <@matmors are defined by the toWowir su l^ i^æ :

(1). Mitoïtomy - fKm seff-ffljfBdent and Imtependenî mentoere are

erxx%m^^ to be In m^ing toër own cW ^m s ^rout to # pereorW a ^ r s aid

to thër with

(2). P rrn aW O isn ^ rn -^ ^ s^ tM to c tem to whktothe nremtrerte

environntent wtente him tmmnte ps;mhr^ NmW for r e fe ^ from the program.

39Sw* as trainif^ $or new of p te , looking to the Wjm, ami setting

ami wojI ^ toiamds goaW are co r^^red .

(3). Pefamai P n ^ m OtWnWon - the «(tent to wNch members are

encoursgmi to be œmemml witii their per^ir^ problems and f e # ^ to

seek ami um^r^ami them.

(4). ami ^@ ne^)n -n%æur%ttw extent % w t ^ a nwmWr a&m%i

ami emxKir^mi to a rp » with nr^mt^fsmKi staff to beoome qwniy ar^ry m%i to

(% ^ y other a^nœWve betmvbr.

nmintemm» cBnwr^ns are the hWh^ng sWaaaW :

(1). CWer ami - r r^ ^ .e i^ N)w in^rW nt order ami oigamatikm ^

in ffm jMt^ram in tern® of numbers (how cto they kx*), sW (wtmt cto they do to

e n c o u re oncWr) ard the resk#r%e (how 'm it k ^ } .

(2). P n^m n C W ty -n ^^ jn ^ th eex W n th }% # ^ffte menberioKn^Wratto

exfKCt in the c^tjH o^y routine of Ns pn^rmn ami how expSdtthe prop«n

ruiœ arxj fmrmijrfô are.

(3y C o n h o l - ^ ^ œ the extent to whldi the staff i® e n ^ ^ u r^ to

n®nü®fs under r®cessary controls ie., in tM forrmiiation of ruW, the œhecfeÆr^

of m^y^es ar%l in the rWWorWti;® betwemi menders amd staff.

The n o m n e ^ c ^ of the COPES w ^ (tefhW fnxn 54 oinxnunity

program® in order to repre^nt tNtee pn^rair® fftet are alternative to

iK^^^zation. InducW were 2 relmb#a&)n worksMps, 2 partial

h% pt#E #)n progran®, 11 hWWy hm æ s, 17 day cerffem, 20 tester h o n ^

an (HJti^iem groi^, arte a ^ - l ^ p urtit AteW of 7 ^

mamttefs were t e s ^ Tlte(Wa^te%tedtltep3PEStotteve8(XB;^Webff9msl

cof^^mwy (n m r^ .7 9 ) arte imxterate to high a v e r ^ item to

ccKTi^tef® (m^n=0.41) (Wr®, 1974a).

40Lew of (%ee S u n ^ : The LOGS @ a (^æ^nnaire of 101 Ren% tMî^eks to btontify thoæ piiystoai ami mental œncStois tW interfère vwth the

l ^ e r ^ ab i^ to )wUd{Htte in trWment prograrm, in ters with otheis and to

n^^^N spersx ta l R r%oncto sertoory impdrmento, s)ma&: condktons ami tiw to to ^ s Interfere with WcUon ami WdH ievete in temte of ^fly Bving maivates. From ti^ Intonrtefen, two meæuremenîs, one of f^ysKal furtofJoning ami om of ;^«:dTOto^al furKtiomi are derived. The L(X)S wæ

d e^ rW tv the New Ymfc %ate Œk» of N^nta! Health In 1975 to a ^ æ the

trWntent rtemfe of ps^^Wrfc inftefiente axoitSrtg to their phy^tei and ntentW l^fth. Ttte LCX S, c^r^ïpml tv Furman arto Lumi (1979), is itesmi on the

^sun^rtion tfmt the {Clients' furteSorteJ sfMus has greater appSœt^ity and

relevartoe hy # r^m aler^s of level of tare than cto date concerning

jsyd^trto c ^ t^ ^ s . Furman, FW)toWc and Hendnkson (1979) have reportmJ

^er^s&Küœwhkdi^ifpîrttlte valkfityofthe LCXÎS, Fat«siak(197B)

im&atmi an inter-rater reB aüity of around 0.@) tor the L(X>S.

Prttoedure

After reo^^rtr ftetm^ton from the admintotnESors of the Readerâiai Care

F s c a ^ re^tents v^re a p p r o ^ ^ ami a^ced to partidpate in a study tfmt vmuto be used tor a Meters Tltesis. It wæ expWnmi that the q u e e n s would

^ W f oplrdoite arto vifflu® tWr environment The ^ u e of cronfidenUality

%^^o»^)WnmlwiIh the being their res)tohses*Wd

rentein anonymous arto itot in OTy way affect their stetus or of Iwh^

T h t^ who %remi to ftertk^i^ (89 penront) wrore a s l^ to dgn a cror^nt fmm

tor r d ^ e of file intonW on ( ^ /^pervAx C). Intonwton is not avWMWe on

4111 to paîtIdpmB ^ cofsWersd

ami mît r s l ^ ^ l FBeamisWflnfDmmlk)n*msgatM^onaI);artk%)af^to

(ktennma or mA W y mfôc^iate mygpfW am) mxrmwrAa&m

n m ^ ^ ry to CMi WeW the g je^nnaim &

"me COPES m%l ^^^icfion r^ng SŒÜ% «%re verbaBy scMnWemdtotM

paftk%an^in#mW ^înaquW îsmducW ar%o1themskW nœ. Tl^two

(^jestimin^fes were cm jftîeri^B am ^m on^ to œntroi for order The

COPES c^^stkmmdie had an intmdiKA)ry exji^ar^^n ^ Wkws:

Tt%fB are IK) start s ^ rn e n ^ th a t ! am ataut

to rami to ^%L æe stotomento about

fm^rana. whkzh statements are

true tor yow program or r ^ t o r æ ami %Wik

itot When 1 real tito stateir^nt to you,

ansvrer true when you think the statem ents

true tsr tn s , arto t a ^ when you thir*

thesW em en ttoW seorrm ^W % .

The rWr^ Md an lnhoctoc^)fy exf^armtton ss tolW s :

PWsetookatths. (ttorto;mrtMpanthm

t^^lM ed-TeniW eSc^). Tl^to(%8mltoe

D^WW-TerrtoieScWe. Cm ry% jn^A O K,

wwmrtoymrl&esyme Wp? I am goir^ to

ask)%ji Wxxrtmm9{#BrerAtNr^in ymrr

42Ttfe. ^ 3 have to do feteil me on

the teHs how 3 WL For emmple,

if ymj were %meone who loves dîœasiaîe ks-

(39an% you might («Hnt W tle% hW . On the oWr hamf, if you hate k»-aeam,y%i fXMnt to tf you atout

eqi^r^(W edatod^^W iedw ith towolate

fee-aitom, Uito ^ woukJ îMwm to the imfcfie

of the s ^ e . Do you have any q i^ o n s abow tto s c ^ ?

A Wid qutotkmnaire (LCX3S) wæ tomin'^efto to the phtmry care^ver

within the WBty erm iiW to to the m(%t famlar with the fesktent on a dstf-

to-toy t o ^ The questiom on tto LOGS were expiainecl to the staff memtor the aiAhof was pre^nt æ the staff per»}n competed the form. The

subs^prent^ ctetenranto arto peycholog^ v^H-tomg scor^ for

j^rtidj^nt The raîœ of redcSvfem were cteterminto by the residef^’

fito whk^ m re at tto ResktontW Care FædTiîi^

Data Analysis

Tto rWatofsMpB totwreen tto outtome varitoies of the three nre^jremerts

of rec#yW and toe prto^torv&MaWtoW tto ten s u t ^ ^ s and three

tire C X ^ S , p^fctok^tol wWf-Wng arto phydtol %re&toir%

%rere Rto œneWWal anafy^ Tto tome tremWatonan^^tovrere tons i^ng^re^ctoft to tto outoome variable. F ln ^ tto

43

v a f ^ ^ vmm examWd i^ng Spwmmn Rm oormWmngU a i ^ s ^

An a p^ri anWyWs m e (Ax% iMfg logMk; r ^ r ^ o n ^Sm ats

the of varîaWeMths;%K&^m of redcRvWïL

S te p * ^ r% r% ^ n vms perA)Tm«f to eaimate the Wghîmf

contrâKiîfon vafWWe in the pmtMbn of a ^ # c tb n .

AD amiy%s were p e rW n ^ leing t)^ software f ^ r a m GUM, verWon 3.77

Royal S taW W S%»eh^ LonAm.

44RESULTS

Api^mix D, D-1 piîœenteths of i»nW terofera^ areJvœW%oftfmoukoo» vaMaM^ AnwtamlnaAonofWsTaWe mvaaWtfmî tiiera was a higti of iw W #y in aU thraa meamirK of redcBvmm.

Pœ^spsîite in the sfiafytemfed to hara sftîwzero or extremeîy high r a ^ of

recMv^m. The gns^st of %^mb#y (xaajrrW # h tlw meamire of

(tohatient ^ ra r^ vms 0 to 1%). Oftfæ 62 partksi^nto, 8(12.9

pmrcent) warn im pact nK^gvsm ranged from 0 to 20 and

12 (19.4 percemt) of tfto parW;mnto vmm inpatient ræAgvisto.

The toW rate of mfl^#d itoth inpaUent and (xhpaüent r^es. Fmir

oftltoinpaWAre(3c^to«mr8a!%(%j#KWdrm^vi^ Eghtofthe

^fWpanto haj bemi reæimitt^ to hospital æ irqaWits only, while 8 of the

I%trtid;%nto fW retond to MspW sW^y as outpahento. Of the 16 re ^ n to

who itod been in t iw pkce of r^iem to tor 1 y ^ o r l e ^ none had vmre

rmxgvlsto.

RecMvtom ctoto v /b s coil«a«f tor 6 2 participants ftowever only 50 (W.6

^nænt) 0% cogrdtive crcommumalton sWs n«%^aryto (tomi^ete the

Ane^^rmattonofW 12;^Wpantowho W tedthe^gtoto

n%;x»KltoW^h%, 1 of toem naf mt in;^lwt re^lm i^m

wNto Ttow warn outfWW raàgvisto.

45rhwg atMKacMTNB if8ud@übü9 cü saiBsdtaaNanimRe msKaaajreNdl tor igieiSO paafgcapeffB;

wtuiwsmat^torϕKmcL T}^ wttNn a ramrm! Tfe

m ^ s a ^ ^ ^ s c m B v i ^ 5 a 4 \ A ^ arBRg8of40to77. T h e t ^ f ^ p o W ^

ratir^ of a i^ a k )n was 77.

PoaMBLVkmMB

D, TW)l8 D-1 f» i^n fs the nrnaajres of c^rtr^ fôndem^ amf

v a ï ^ â ^ of the p r^& ^r d weil-b^ng, weS-

be*f%, 8f%j tf% (&nefsk)i% amf subscales perceived psydm^stx^

envlmmmnL An exaWratan of and physical %mB-beif^

m ^^n% sf% M M evand#t)L ll^ iiK s^jieran^ofscc^œ forbofh

psyd%k%W iW-bWr% amf d ty ^ a l wdl-being m m e ^ j r ^ by the LCX%S was

from 1 1k) lOiMith 1 iiK fe a ^ tevei of frim ^dng @%f 10tf»k»v8et

fn tt% pre^nt stis^ Wof A escoræ fnm tt^ LCX>S r^igmf from 1 to 3. S w

E ,T d^E -1 forthefre(pmncyof#%)r%forpsychdo#:W wWl-bdf^

a n d d iy ^ ^ w # W r% ,

1ή p ï ^ ^ ^ lange of sïorfô fr)r the CX)FES sut^E^œ was 0 fr) 10

o rm ^ m g n g ^ r e r e W # ^ l%w a views the f ^ y c N î- s ^

envlmnment Tfuæ a t^ h score im&sated that the r^pomfentpeicdved the

errvinmmern fr) f ^ e tl^ trait cësE^tbed tfæ sut^ïale amf a score

Ind&caaaadtftat arsBBîNOfidksfttcfMj raot psmcsrhfettie emfki)rwnsmt ear haavfFg; theibaS

d ^ ^ i t^ b y W a ^ s c a W . R eæ A sktlw di^M dtK jydïm vedtW rK H æ dfrw

;&È@caWsvwHBrgfnB#yd^A^bdedk&Énah8rvmfr3dg&Æ%aedsynfrnaMca^&

T h ep o s^ j^ ran ^ o fsco iifô fo fÜ ^ C C ^ ^ of rd a & )i^ i^ amf

48sysWm nWmeiwœe itns beîvwmi 0 to 30 and AM-tram an t pn^ram t^w aan 0

to 4a in sbMjy imdtes^ t}^ afl thma o1 the (XH^Swere rmmWy c^i&uW.

fteteBllgl%vctK>-»D^CHn«tetoCoiiwmwltvSufvhrai

A-1 m s Ta^e 1 W cormiatior^ WwMi the

of mcËBv^ Mth tfw amf of me C ^E S.

Sp%mmnRk)oorr^ÉkmWar^^w^perfomWasiîcbæm)tmWw@Ty

^m!nq:(k)ns )OuttW um^î^ng (gstAiution of me (Ma. An examinaSon of the

Sp%mmn Rho coTreWofm shows cor^em ry in the relationships between

of weQ-t»ing amf reWvW. None of the cBmetsIm^

of tf% C X ^S MWB 5%r^&antfy correlated w # ^tfrer inp^ent or out;Went

r^fivfem rales. Hfowever, one tfimension of the COPES s^nifàar%

wrreW ^ w # toW recàgvâm that Is. system nainterwKre was sigmficantly

n^mreJy c%)nefatmf with toW r^Jivism {r=-.28, p=.05).

Tfwe m s also ccm^erKy hi the reladonsttt^ Wtwreen tfre me^rem^irn of

and the CX7PES sub^^es. TTie or^ subsale thm vms r# a n b y

oonWaW # h ra^gvWm was sW corW (r=-28, p=.D5). None of the

subscalK were sS^ti^stnby coirelared with outwent rm&BvWm however two cri

the&dm%^(@d^^)hrediËgr#^%rethE6em^^Tt{r=-.28, p=.05)andorcW

amf onpnizathm {r=-28, p=.05). Finally, mine erf fire wsre

^ r^ a n tiy c» rre^d wtm ime of l^wever mtirfnrf cfid

iap%%R)eidi!5%)nfBGewï08{r=pJ27% p**.#). @vmithesnWlmmrfrerof |%rtk%^i%

me^gprfWmreofWMreWtsw»eBmiW. The eHmrf of rfre

Is

i l

i l

I

?Ig

s

Tablaifipeaiman Rbo Cofralatioft Matrix (or Roddtvitm Raima. Levai eri Ôaiialaotlan. Psychologitai Well-Being. PhyakaI Well-Baing and Peroaption o( Paychoaodal Enirironmani

Variable 1 2 3 4 6 6

1. Iftpabart recicfviam 1.002, Outpatient mckMam .as* 1.003 Total racMvfivn ,78" .72" 1.004. SaHstaobon -.04 22 22 1.00S. Psycholoaleal welHielna .23 , a r .31* 28 lOOG. Phÿakal well-being -.03 .20 .15 -.08 ,13 1,007. RaWonaWp -.09 -.18 -.13 .11 -.11 .028. Traatmant program -.11 -.00 -.06 -.02 ,03 .149. %atarn matntarunoe - j a -.23 28" .11* -.31* ,0210. tnvobrament - i s -A8 -.11 Jti -.17 .0711. Support -.02 -28 -.18 .18 -28* •03USpontanatiy -.12 .05 .03 -AS ,17 .05i a Autonomy a i -.08 .08 -.18 -.02 A714. PtaoGoal orienlaGon -.as -.04 -.22 .18 ,07 .1116. Peraonad problem oriantatton -.01 -.03 -.00 .21 .15 -.1418. Anger 6 aggmsion -A9 .02 -.10 .12 .01 .40*17. Order 6 otgadzakm -.11 -.28 a * •07 -.11 -.121& Prognun ctority -o s -21 -.10 .10 .21 A2i a Bbtff oontrol -.28* -.08 27 .22 35* .10

“(K0001

49They c§d however

p=.OG). Again, the smaS ^mp!e size limited the ^ n ifœ n œ of the comeWkm,

Ths negative rela&mship indkat^l tMt ds psy(^M)k^W Wl-being

detehorWed, ovemU became lovmr.

f ^ t f n p W ivste^V l^k^nqtoC om m unttvairvlvai

A-3 vms not suR%rW. TaWe 1 pn^ents the correW(%%

tlw ttiree meæuîes of recaSvism with physæal well-being. Sj^surmnRho

conelaA)nW aiW ys^ im&aW that physkal weü-being was not ^rWRcantly

œnelated wüh the wkom e m ^w r% or in^^aient rK^Wvism, ouQWent

recitfivsm ortotaJ iWc&fWm.

H)fp%;Ühesis EK3 vvEws not!5uppN3rt8d. An exæninat>on of the S f ^ n r ^ Rl^

ca>freiation matrix in TaWe 1 irxikat^ a of n i% an t o>rre!ation Wtween

ph^cal vmll-being tfm outcx>me precMor of üsfæiüoa

i liii* ■ i ii'i m t

1 i%&mî8S %w r # a n t œrreW or^ bebmwn tfm ir^œures of

nedt£\^m amithe prWctor 'W ab l^ . This in part may be 6m to the enommm

imrW)#y in the ra t^ of redcB\ im. In orcter to further ar^^yze the precfe^m of

red6vmm the lesfKrrme vahab*evKasthenek%e corskWrBd asacM totorm ia

one: e%her a p^tid^ant reWmKt to hcm f^ or a cW mit reumn to

Mspital fn tf^ c ^ , aiKt outi^ient nedcSv^ ra t^ ware cornions!

sn œ «mrtkâi^rîs sutWr% from ary kird of hc^i^^za&m %mre tm W dew i

50Th%t«±nkÿj# atxmt the f io is i^ s of the rehosprt^l^^nsslræe ft gsve no Informadon about the numWr of times a paitk^{»nt wæ

tBffijmit^to the other tend, u^ti^stediniquehœ l itsMvagA^es œ ft concentrstmj afl of its power on trying to delete (gfkrerwæ

tetw^n tm) ^ u p s of p%ple. This yes/no type of r^sonse variM>ie was arW y^ uang rey^^on. In k^stic mgi^sion, vmaMes are idertiiWi

whk^ ssQ coneWtKf the pnAeblBty of ret&gvmm ate a m e ^ re of the

m s^iite teoftheaffaâ^im ^rte pWonnæott ate V%)nr^x)tl, 1981).

Prior to perforntii^ a k#stic r^ re ^ x i, eate variaWe we© initially diedted for

a t^Êttîra& relationship wBh riKsfivism. Onty the CCPES cfimensions of

misËoreMp, sysWm n^menætce ate treatment showed such a reiatior©hlp.

This, terms were used in the arWysis for ttese \^ab!%.(f^ydrolt^cai vmll-beir a te ph^cal well-being had linear relationships).

Re^tits of tte k^stic r^ression analysis inrAated tfmt rMXtiv^ ante te

partially precfictte from j^ychologicd well-being, tre^ment and t r e a tm e r t i ^ .

Therefore i-typoth^ A-4 only partiMy s. ,ortte. TaWe 2 pre^nts the regre^ion remtits showing tte reWomhip of proctor variables to reddMsm.

Tte final re^teatm et^^on ;^mWng re(»S\rân form t t e ; x ^ A t e r ^ ^ ^ ,

p r^ n tte in ^amforcB^ fommt ©:

k^tfp) = -12.08 { ^ .^ } + (+.47%) ps^^hotogfod v^ti-teite +1.1 m (+.73^ treatment - .033^ (+.0205) trmtmentz

Tte f ^ i t s inc^^te ttet jteitidptets wfK) Kxrnte tte dimension of treatmerti

as ftigh or W teve l^ s of a pmbaWity of teing reh^ptaOzed than those who

51%oæd in mn#. WAh nWatkm to vmR-W%

1imAcaîW tW i^r&spants wfK> am mtW as being the n%> *mll tess of a

pmbaWify of retumiTg to h o s ;^ tf%n who am n%m fXXNiy.

(Wa%e, 75 percent was net expWnecL

Tabte2%gmssâon ReWi^ish^ of Pw W orV arW ^to

Var^dWeln C h a ik in Pm gi^^nM |W ion variance

weQ-b^]^ 8.94 .0)28T ra m e r# 4.34 .0370

^ef» v ^ mi^sie mgr%^m aWys^ wæ performmj to determine the

pm(WkmofstWactton from W n^aim m W s of ;%ydiok%W w # W r^

phy^taiwea-beii^arKJ the three ïfcT ^^ns of the CX)PES. T h s ^ j w ^

pnK^tomdtosep^f^totogWw#Wr%^tftoor%van8We to enter the

moctol; fmwmvm- üm wæ mA nifioant (p=0.13X A look at the

a v e r ^ vdws of saW^aton tor the thrw of p^chotogtoat weS-tto^

sNws why toe r^ re^ o n not n t o n t F, F-1 pn^nto

the av e n ^ vWue of tor t^ydtotogW w#t3mng ^ r e s . Titotorw

Stores of f^chotogW wWHtoir were t ^ e on satmW^m ^>s^aSy

(toi^tormg the antount variab^

52r^fi^ lon to detofmlne the

pnK&aton of MKSion from the froaajren^frs of j^chologtoaJ Wt-being.

phy^»lweiH»îî^ætotiœ tenaii^sd^oftheœPES. ReajiteoftiTffi a n d )^ IreScataf frmt satWac^m couto be partial from tM OWES

of autonon^, supfXHt, orctor amf ofganlzafion, and invoWmen! {R=

0.51). This, B-4 was partf^ siq^rtKl. TaWe 3 presento thens^e^ton of the ml^omNp of pTB#:tor vahabtos to TTw

final «pa&:n pfK&Aw% from the pmAaof v a h a t^

pn^ntmf In star«Ëe%gzed fmm b:

Saisfac^n = 67,51 - 2,34 (autonomy) + 1.40 -1.71 (ortter &

ogarfizatton) + 1.19 fmimiven^nt)

Cm#)n shcHikf be i ^ f in interpreting the %pafion in tW when using the

æpwhe msthrxf with a srrW sample %ze, there e a high probability of vamtoles

enterii^ t&» to dtance.

AiTtoi (^itcwne Variabtes

HyjWtf^W C-1 W3S not jpjxjrtecL The S p æ rn ^ Rho œrmlaîion^ rmtnx

shrwn in T^le 1 in c ite s toat the outcome m s ^ re of sMisfmaion was rM

sgi^toanfiy tto rre^^ iiâh inf^ienS outpafiem F^^divtsm Of tot^

rwâArWm. bqafient redrgv^ w ^ signi^ntly œrrel^W oufr^ent

p=.04).

63T â i^ 3F ^ r ^ o n Shmwrg % W o r ^ p of Pret&iWf \% rW ^ K) SaWEW^m

VahatM^ in r ^ r e s ^ n et^iaËon

R R2&ep Beta V

Airtonomy 0.30 0.(B -Z34 -3.14Si îfKîrt 0.42 0.18 1.40 2.19Orcter & organization 0.45 0.20 -1.71 -Z04hmWvenwTt 0.51 0 .^ 1.19 1.78

"T^slue A )raim rW e'st% ïavi^htln W f n ^ equation aftsr v a r i ^ ^ hæret ^ n GfAenMf**p<.05*"pc(m .

The ^mammn RIk) correWon n aiibc in Te 1 imftc^æ few s ^ N ^ n l

re!^onshi;% among pf%Mor vanabi^. Psycho^ogW welt-Wng

s^niGcaNiy n e ^ W y conet^^ wfth tire COP£S dmef^>n of Q@$em

margenamx (r=-.31, p=JB). Psyt^x^xgW vW-being w ^ Wa) nifkanSy

n e ^ W y correWfMl with the <X)PES s u i^ ^ l^ of f f a%iW {r=-35, p= 01)

and si îîKîrt {r=-^, p=.04).

Physæal mA c o r r ^ ^ with anyofW COPES

cGm e^rs. h%^Mwevm'^ni6can9ycofT^W%mthof«sia)a^ofthe

GOPES, tha % anger rnid (r=.40, p=^X Phytoi amJ

psydit^ïgkî^ weU-bæi were not coW aW .

54TWe a number of the a jt^ a W and

thecÊnœr^f® oftheCXJPES. Tabîe4 pre^fte a œrrefa&înai afâîysâs of the

refsaioreWps between the ajKl cfimer^ons of tire COPES. An

eiamimAm of tM com ^^n matrbc retma^ tfmt aS titree cSnwr^bns vrare

orrefaWd sigmftantiy with the sWacales that ctefined them.

Spearman Rho Conetatton MtOix forthe Dimenelons and SUjsoales of the OOPE8

Variatat» 1 2 3 4 8 8 7 a 9 10 11 12 13

1. ReW oM # 1.00g. TraMmentpfogmm .43* 1.03 8yekmm##tmmoa .4flr .10 1.04. intMhrnmant .7T* AT .48* 1.00& Support .84" .80* .49* .56" 1.00e. SpontMKtty 24 .12 .30* .40* 1.007. Autonomy .47* .88" .18 .42* .43* .27 1.000. PraotoBi (Htontattm .84 .68" .20 .38* .23 .00 .26 1.00B. Pem oal problem orientation .43» ,08" .08 .36* .21 AT .49* .20 1.0010. Anger BeagKwrioo .00 .48* -.10 .04 .12 -.12 -.00 .30* -02 1.0011. Order 3 organteetfcm .36* -.07 ,67" .38* .33* .11 .03 .04 -.00 -.19 1.0012L PR>ip«m darttf .SB" .77" .45* .62" .20 .18 .13 .07 -.18 .43* 1.0013, Staff OOrttnl .34 29 ,68" .33* .31* -.15 -.03 .40* .02 .21 .09 .19 1.00

*p<OS

58DiæUSSiON

Tîw pmænt sW y exmmmd œ rre fa ^ of ajfvW in deiî^BWimaBzKf nwnW

heafth An aUemfA wss maie to devekq; a mom compmtiai^ve

ejg^araSonofajnrivail^exptoringsod^andf^ft^ogk^fæ tors. The

Aeom&al franmwwk of ecoU ^ ap^ed to two measurement of

œ rnm m itya^^nem . TW K rmâBvtm amj ^ t W i o n . ^ ta rn w æ the

gxWtWwlmWiÜt^oAcontn^BummentscWdbepm&a^f byknowWct^ of diente' pen»ption of their psycho-axsal environment, vmli-

Wir^, arxf diysicai weil-heir^ amf what W reWve im^wrtanœ of these

pTK&aorswouidbe.

IT» SfkS»^ of ttve p r^ n t ixty cfe supfxjrt the hypmhe^ th^ perception of

îsydTO-axâai erwironntnt and p ^ ^ (% k a i vmK-t^ng are precSdwe of f^en t

ajTwval as ntesured redcSv^n. Phymcal weU-bdr% wæ rwt shown to t%

precWveof rMxBvtm. AUxxrgh there were a few significant correteâûxt

ijetween the prWdorvarmbles araf redd\^m, only two of these variables

e m ^ l^ ^ t»ing signified of r^Àfivism. TTmiK (sydWogW

weB-Wr% aixJ îî» COPES cfimeitton of treatment The precficfive power of

thœs Wo wah^îles however, ^ nd high as 75 forcent of the varmrx» wæ r%t

ffissiurfted ft»', ft ® m i#ntth^tlw e is an eff%:t was either not My

c^jtur^ tv ttie varWes Staged or there may be undertyirg WArxs tha

Infiuemse retàfvism, ^ are not smrrrted for.

ft vimuid ^ ^ r hixn ft» r^ !& U»t {i^c^tologsd welH^ng is nd

s%mfiar%rBW edb;tMf^f%-sx^(#ïW B%ai8 0ftrætmerA, y^in

they me sgd&ant prWctors r^gvsm . AsprMMed, æ

57W H ^ n g (kWmxiEded, W numWr of U>

(m^eæsW. R *s@ko of fn W r^W t ;mrW*:mnts*N) viewed tr^ lm w tW fher^

exImmWy Mgh or ex&em^ kw, wem aî%) W greaRer rWt of

the so{^ to expWe thW e#Ra, K i r ^ tm Wen%l tiist

;WWswN)fmve W 8ff^y%W (% W syn#xmafBn% mBk9lytosuM vehi

the commwRy 8 th ^ are ^tceà in environnante that they ;mrce*ve to e#mr

a rœ s or igrmm automxny prsKâte^ orW^&m, p e r s t ^ proWem ortei^Eâton,

am far^eram f^ressten . FaWre%>r%ognkethte;müent-envifonntentfîtntey

f iK ?^e an pattenfs HkeBhrxxf of h3

A lack of r # a n t resu ^ was hjund when aWsKâion was i ^ f as a

m e ^ r e of outcome. The pr^W or vartebl% of ;^fcf%k%bal %iW-Wir% ami

f^fC^ïtâmoffteyc^^o-sof^erMionntenî were fourMi to be corm^endy to

sahsfac^m. In BgmWmtkm, maomn^, sup;x)rt, onter ar%i « igarÉ ^m , arxt

mvoiventent were %ni%ant predxaors of ttefW on. ^0n ,tftepnM ^hm

;x)i^roftim ^vm m btesim s w t h%h as oNy ^ ;^roent of the vimarwe was

ter. TfuiSt f^rto'f^mte wW viewed their environment as h^hJy

Wth irw oM n ten ^ rs , amf mn r m ^ arW o n w a rd

orga^zadon were Bke^te be more s^ fW d rn ir^ W en tew tex W not view

thmr^nAtmmerninO^way. The% r % r ^ are d la r te tNtee (Patten,

1977). Patton corK^iK^th^resfctente of ajppOTtive-paffe^f^teryenvlJonntente

had tetter outeom ^

Tfmm wEte a kK&of ËgnlScartee betw ^n ^W acdon amf rermdvtem. In

8K ^iË:% Aee8Kahm n^ofsattefactlonasanoW com e\m rW ^,tee

reWtef^Tlp % # Is Im xa^gm nM . Grows, amf

58(1977) t w nedcSvsm W Imtepsmlant of oiMr outcome

o ite r^ Prysr, D ^ fe n o arai Dinning (1982) B arty wgu%i thm dWnt

aiGsWkm as a pmx&aof nmy be of tim oi*%rw of

f^^cSvmm. TM mmsjremenfs of in me p r ^ n t ^udy t&f

howevK^thatm gemmi, W i^utld{^nts ap^mawf to haxm a high level of

sa&fsc&m. Coition rm ^ te jpHed in evaluating sa tis f^^ n ^ an outeon»

m ^ u r e tern th^ te ta « s i te % o r^ nmy have a M b eff«± TN stecom ^

(Kutk^Wy as the h % i^ fx^W e saW teten æore (77) was obtæned

The onty s%N%ant mWionshk% that e m # ^ tehm en the pretAaor

vahaM% was Üiat of p^chok^kal *%it-teing with the (X>PES subscaies of

suf^ïoft oontnW a te the Œ)PES cBmei^m of system mdntenance. M

these warW æ tte res^wntefte' psychok^lcaJ symptonm teo re^ te .

This ^lem s to be paMWty apfxxtiw of t te teci^ eratogk^ theory wtedi

mairWte that te h to f^ n of ^sydto-soàaf enviionritont ctoes have an impart on

(%ydtok%W wWi-teing,

A major HmWon of tte p r ^ n t udy was tte smWI samjte size. Ahteugh it

was to study tte m a p % d tte { x ^ x ^ ^ n in remdenWram

fac^tite in tte catdiment a i ^ it wm not sufSdentfy large to jistify a

(to in i^r^e aito t^s. Even tte tow sgnü%am œrrWattorm ttel enwrgte shouW

te inwprette % # teutton (toe to the la rp luimter of corrWatem tW warn (tofnputte. WterBvereWuge number of a n ^ ^ e s are te tem W , attofWn

numter r^ttem are e r^ ^ k te to te s i g r # ^ dm m a atom. F^ton^of

^ r# cœ x to are h K ^ ^ i s tte t teoto ^ ^ r to N p e x ^ te t te tte r

^ x S te are c^ e d tor to vmffy any ^^aren t relationship.

The s h m ^ mm %#i the excef^n of sat^m^on andthe (Sn^r^KS ofthe CX>P£S, the m^suremei^ c tTKHj jns. S^pwtmn

RN) oooeWoW a n a ^ s m>t make any about the

cBsh&ummofthetWa, R kim tapm m rW afW y^

The an^%«ty m Ae r^ufts In the p f^ n t sWy im xx^W K ^

%en ln#m & ^fm m pfW rsh«#K ai% lm ^e^ttm t s8c@T^)Wx

phemn^wn whidi cannelWftmprec^WofexpWned mfXHj h any ^Aof kft only by eamminmg the IntmœBon of a vmlety of faotom. T l^r^i^cb>

sjpport tM soda! pen^^^m , howmw, due to the ovemWmlî^ W (

ofmgimantrKWtsaGTM ev^atton of the metttock^ogy to rranted in order to torther cto^nune if titooreScd tSË^ m t t^ s h ^ tHto meifL

There me a nunWr of nWiodotogW in the prien t stuc^ whkm vMm)wttoe)#%W. toternsoltitocto^ofd^m iK i^.ttæ rem eson^com tonto .

O teco m am to tW tW to n g g h o ftn to aÊ ^sh m f ttoendWmrgWfmm

h t^ ï^vahm l ABd f w tN i^ beingm ^,am ^new #tovm s(^dtorE^

^rîtor to more IWy to ttove requited tiWnmnt tfwi smwotto wito sms

(BschargW a m%)rt tone %o SWrstt and Ahhoff, 1972X From

toe it to mrklent noFto of toe jitoimiiMnto wiro had been at tîto l a ^ y tor

i ^ t h m 1 y ^ w e m r e to ^ K W ^ ffo d y tfK ^ n ^ k fe i^ w lro h m il^ n m

tW ferity tor m w l y^weremiKg«Lmermeofro(^gvWnwKAIImyei^n

h % (^ Άto4$par&:^mnto%mol%di%enmihW r;^^mrB^tonceW ovwa

yem. 35 pensnt W t ^ n rmu^^tdized.

60T7» coiW Mve bwn improved to account for ti^ concern by om of

two ways. First, a tærtœn le r^ of fime after c^^iarge have been sel^W to exanW wW here^ partkspait hsd re-enter^ the &ihngtImttimepmW. (Tf» tin^ f rkjd woiM ha\m to be cht^n so tt^ ^

fmd been ed 0 % PMktonoe tor m le ^ toat ten# of time). The tcorto m sf the r^gn of this idy co$Af fmve t^ n impfw«l by nWng forpart^AHtther^ of dWmrge aito tfto cWe(s} of aO %a^xpmnt to

"n^wadd have piovk^ tfto ntoxintom amcHjnt of rWÆv m intormatton on ea^ sul#± The terdirdqye of survlvm! analyst couto tftonbeen i ^ l to tW ter ttto of hme ^m*n rermins in the {tommuiAywithoid k^ng mght oftfto W tW aO thm Is knmvn about a person who hæ a zero of rsï^g\^m b that hm per^n 1 t^ n relapse-free for a certan perictooftime.

A %wr%l pn^m w%h the sWy s that in ontor to stmiy toc^rs wWi may W conWaW with a cor^ëon (in thm c s ^ reca£v^}, the fædors shouto be me^red Wore the coitoBh'on, (tot after the oxtottion been trWed. That is.one toiddsWy the tmrixdwito (tow artotiton%^ to see if toey re-enter the

in the future. If a raumed to ItoSj^ 5 may be ^rmed that toe ftofKto m & treats æto intofov%i ttotore itotog re-mtoas%l arto is itow in a ærse, a cfiffeiertf pernm thsm toe one who re^^ed.

A third l^re istfmcomWr dton of inpaËent arto mr Ktoent rat% s also atIn fEtot Bto nuntoiW \^jes of tfto rates %em to inc^:^ that they me

rr^^iringmyc^fereititlto^ Tl% shmito be e qatormf tortlmr in ontorto (totom*totoertoW8(^%di n m ^ ^

61FUWy^theWWkmof{W8g@i@amo!conoem. R^^ofth@ <Mainth8

p f^ n t âiKijf wæ coSsctod thfc^h s u b ^ c ^ raüf^ by the

(%WKtk)m, perception of envlmnn*!^ and priimiy cei%Wm(peychf^^W weB-Wng, %WI-belf ), The of su»^ n^hods to

o t^ n c ^ h ^ teen one of concern in tte Hter^re. DrW@ and VWWi (19%)

mWnWfWf ttet tefof^ nrnrW hWth {^e ite are \xh3 c^ripintzte to Wmve

e^^vWylncoiwi^encewthtWre)q)T%sedaiËu(^ Jæ»te, A n»^n ate

Nystrmn{1%3);*)lntteouttW(&iW n ^ ^ a% re# « ^ tte hlaswoftte ;%reon Üie cteta ate tte anwunt or kite of informaten to there is

a c c ^ , C Snk:^v^^^m ^i^jresarehi!ttercQ nhM jrK ^t^r^}om ^T^

wifliterretetobectete^BthrewhSet^r^^^^dorbyatendefK^h} teteve

In a sod#y cWrWWe mante r.

Fdnwirm a te % w te (1975) malnWned tfte f^nrery couW rwt t e

tesunred to te obg«^ve r ^ r e as they nay te rn teen imSfteent to tire

nature of oiteonre. They tte t patierte' own axxmnt of thWr

temimmlty t^ r e v h jn ^ sSghtiy more ;^%Wve of reht^WWWAm ^

thek fwfnwy car^hrere" aocwNs. T tetem te% reverW % m W rreb^for

preferring one tecotati over tte terer a te btei In conti^nat^ were s u f^ b r to

orreakMre. Antirergr, Coten a te V te b (1978) tevocatte fortire tee

a rb i^ a W ra tlr^ Ttey mmntalned that te in ^ of n ^ n r e both

(Ësdmigte nrentai t^ i th tetferrte a te terere In e csHtecâ item

^ni%rentiy reWW to re^& W L

Cof^dsHng tte controversy In uWte sub^^ve r^rerrete from btet

tte æn) pTimaiy tereÿveis in tire have tire

62

p8rc^^ofth9frp^fdK ﻫïdaî wîvifonji^nt ImjJïfiniûefy !ow or if a«y

tW r abjs wANn tf% woitô bs eëœ W their r^%*rs#s.

ü k sw ^ wten Ü% primmy c a r ^ ^ r s to ohttî the LOGS, their

r%pom% nay W e been th@r own fw%p@ors of the sWy. For

e > ^ T ^ ttte cm^%Wfs W e viewW th^r as beif% reWaive of

the c^^ ty of cars they are ab^hjpfovkite. Tht% if a resicknt of W ir

rK ^ W more supfx»^ or care tW i th ^ taiAf offer, the r ^ :k n t wwW have

been (WmW ir^^xt^^rWWy piœW whæh may t#nateiy reSed ^oriy on the

SmSaHy, were cho^n to r^> o i^ to the questionnaire ^

detemtinW by the pdnwy cmegivers' r^x>rse on the UX%. The adjective

rating of tfm (Kuticqmnts car^ivere nmy h ^ eliminated some i^ to n to who

were caimble of There k a ^ a se W ing oNy

tftose r e le n ts that w » ^ give appnopW er^ftor^^. A ntini-men^ âs&æ test

aWnmterKi to stil prior to tosting vwnito have elimiratw these

cowento.

M ^fr6gnaaa.ta.om M tB

The p r ^ n t stody i ^ i ret^^ism ard ss outoonto m e^nes.

Esdi vait^ïie has Its a d v a n ^ f^ ^ limltatiotm ^ c te ^ b e d In this

The cHtorton of b*h of th e ^ m e^ jr% be examined betore œming

tom ^coW W on. of p t^gg^ skWr% from swnple error mto ctoraAin

of WW-up, any inv^^S hm of p rsc^or mto oukame must tæ m%epted % #

r%erva&m ;m%@r reptation. FWtoreto («mM wtœ m e more %oir^Wy n%y

W to * to e n (a ^ t t^ # to # K ^ o f to W n 9 n tb ^ rv « # )n or nto^irentontmm'.

t! is fmm iikety ümt rmj^ of tfie unfKBC&D llity torn v a r ^ ^

unr^x^nized ttoî hmm an im j^it^ t e f ^ on outœn%.

The mcWvW raies in Üm ^afy do notW %#Tîn re tr ied esd n ^K . The

baæ rate m ^ge^ed by Anthony et sL {1972} m 40 to S) forcent of pattenls are

retM^pâWa^ 12 imnths c^E^rar^. ^iNwny et aL maintained tW

d e s f^ variety in ^|%rMiOf%, û^titutior^ suxi n^ior®, Ws redtWsm data

shtms o)mster%^. The r a ^ g v ^ rat% in tM p r ia n t sW y (k) rwt ^>pro@[

these base rates.

The base rat% of nKâdh^n ttot Anthony et ai. (1972) advcK^at^ however

may hære been relerantti) the {^^mlation used in the fK%ent study.

ChaiKtrs^na (1^7) argtmd th a mo^ of the literature refers to stiK@K in the

United SWes arxf œuki mjt to geh^ie^to to CanacR&i ho^^tate cW to

differef%% in tto fW th (%we systen% and commits %As. Even v#hin

Car^ggan tto omif^rabiSty a c n ^ stucS^ k BnAto as there are wk^

provindW cBfîerefgî^ in deinstWonaHzahon. The Nova Scotia government for

ex am ^ , h æ t ^ n an un%re approadi to th& bi Nova Stotia torir^ tto

1970's tto r^3onsib#ty of rarirg for dirortic m e r^ health patients was stotsd

fnxn the D^>artment of Heakh ti) the [^:mrtn%rA of Servbœ. Over one

half of tto dein^itutiondlzed ^x^uWion ware trar^ferred to axtiai ^rvtce

fadtities. Tli% ap^^atii aitowed for a mw^iarfem to eræure ongoing ^eytoWto

tr^im ert (Rktiirmn and Kterto, 19S3).

it h ^ b ^ n mfvoratMf Itot tto supports avalaWe in the wmmumty wffl sS&câ tto r^es of retàfitom. (1^1)fTmhiWntottotttommBab%yof

^ e m s ^ facWœ in tto ommumty was orm e%e«tinÿy important valtoto

64in6u@M f r#æ WW%Œîion. (1968} ^ iW y argued tNA Ae«)mp%%}n of paUWs in has tn tw Wnsa fBnawa! cf empWW on aaita raü^r than dwonic care. Dorwart siaJKl tW

tWs cfm%@ fmve l ^ n rsW^f to ctevelopntonts in merits health systeirss\K^ 3Sthea'^f^nofa}mmunltyrækierK»& Bas^kaitoGerson (1978) mWfWned tha Wween (me half and three c^artofs of hospitd reaWssîons couto Imve bwn avcAded if comprehensW crnnmuruîy h@j erüstedL

RnaBy, Oir^er, Fîto, Johr^m, Schwartzman and Dn«ie {1988) pointed (xit thaï

F®)^etrk; f®üerts’ W t of W man^ment arto basic Kving skills was reteîwJ to reckSvism raes. The partidpanto in the present study were sülresktents of a resktontial rare fatality (RCF). The RCF provided a structuré

miBeu and long term car© where the ax%al, mecfica) and p s^ i^ric neeete of the

iBSCtof were continuously n^nitomd. One posable assumf«ion therefore is

thw b e o u ^ of the nature of the care facility, lowor rat% of reckSvism would t)o expe<^.

From asodW ecologkai persfmctive, one ojuki toeorize toa the rates of

rerâSv^ were tow l!^:aise toere v i^ a g o ^ ï^rson-environment fit

(1974b) rrminlanKl tfsfi imSvldimls who viewed their psycho-social environment

bekw the mwn^ive ftofc^Jtton of their refererKto grwp h ^ significant fxmrer

outeomss- The me^urements of tl% COPES subæ^es in the p i^ n t study

tendW to be %#i exbeme ^ r e s . It may therefore, be vrarthwhile to

tookEdth%8 wito ^ e d bWow the rmrm of tM r ^ and examine if

they hW s^itifi^ntty l^her of redcfivsm.

D iWto the p^rdro-sœ^ environmerâ of tM the kw r a ^ ofr% M v^ toufto In the present stotfy r r^ l^re been ctoe to a n%tl%xfWo^al

65error. TW is, sW y W ed to cBfferenUate Wtween th ( ^ pe^panW wN>

fW recenUy bwn to tt» W % ami Wio hmi basa Üwe for

k>ng^. As outiinmi ^ t e r the (Wmgn cmjW t ^ n impnovmi in W ^ to ÿve

a rmre repr^Of »tive {^^ure of mckNsm. of intend s tfm fm* of

rates for th%e parW^mn^ who were aWe to r^aond to Üte

qwslkxir%âf%. The W i ^ n of t h ^ ;%u%^%nts nmy have b^emi tt e

K rmy t^we been ta iiw e^tate the vaWty of the mitf^fent r^es of

rmâë^^m with the outpatient ivktes to confirm the anrnta^ of

c o n ta i partidpants mdually hml

The n%thocWo^al prdWens inherent in m^sunng ^ m W io n have b ^ n

exp^rMf MirBer. TW lack of inWm^wi W>out the reWtSi^ v^cBty of the

m ^ u m m en ^ of W m am n n ^ fmve effedmi die ræults. That s , tfm

n^^jrem ent imed in tM p r ^ n t sW y not have given a true re tm ^ n of

satisfsH^km. Furhire r%ean^ W k to qi^#y of Rfe for more

va&^tml m e^jT K of satm^aion (2^ow ny ami Lehman, 19%). Zsstowny

ami Lehman (19%) mMxsted for reswrdi on s^Wm:Uon that m)uld

em^mgaze tN®e c8merWor% tW pKwWe fm r^#:gaion. T h ^ n a m W m d tf^

the sW y of sp^âd p«)*%iWions siK± m aajte Inp^üenfô ami dironk;

should \m œnA%W a) tW mdfm dn%fsmns of œ n emerge in

reiaüon to the smptocto of ex^tohem^ of différera p ^ r ^

LaAtor^a, OW st, ami Wdf ( 1 ^ ) rr^ntæned tW W tof% ore

v%rtob%y remlers n ^ ty nBEmires of W sfgaton vhtoally They

advrnsa^ a muhk£mer^m£d was d ^ m to n t

upon the d ^ n ^ e r ^ s arto a t brm ^M toa @ m ê

66m tWr (WfAion of their environment œîd thmr (wcepüon of need for cam. FiWy, gpvmi the œntmuWly changing {^ychoh^kat ami phy^cal status

expermm^ by itk^ nmntaiiy ill imfivklua , st >ifity of was

uniWiy. enfettering tiis pc^sibie m uW m er^re asfmds of satteWion, the

instrument to meæure it in the pmsent study may have hsul too namw a tecis. Htte nmy have er^rxtenMl a re^f% e b i^ ^ a positive hato effect

Tfm pmt^n% inherertt in n^æuiir^ satisteâten nay have i%u!W in

artifi^iy Ngh rates. In the present study there a s^temahc bias favouring

the reportir^ of more patients by the very rature th£d they wane stiH

Bving in the fm#y. This one posWble æajmption vras that due to variaWfity arW

range of (are ^t|^!ed the Mnlstry of Sωd Servkms ami the intervention of

SCK f^rkers, c^^ttehmf re^tente were given the of^rtunity to live in

aÜenWve Nn^r^. The rating of s^tefaüion may have ateo be a fum^n of

s(x:W dear#%ty, impW threat ar%l item wortfing.

M^KirenffiiTte of mwictor Vartabtea

The of the LOGS to m ^ ^ re psychdogteal ami physW wmiHming

œm^jtuaiiy stnxtd. Baker and KWi (1988) æ ivm ^^ the of such

o t^ r ^ ^ n they am based on the jWgements of the care steff

rm^ in « > n ^ widt the patient, are reWveiy quids to (»mpiete and measure the

sort of n ta n s o i^ œxaimng tmhavtor that te refsvmnt to everyctey !ivif%.

M^sey, Pokomy arvj Karmr (1989) mamtairml Aat dient furK^^mng te

genmaliy s ^ n æ rWaWly irW^mndent of and potently imporWit in

community tenure. They tiiat the lew of fum tmlng of

67psycWaük pal^n^ shoWd incWe at a miramum of comnuinfty Bvfng

^ cam sW^. pre^mm of nu%af%e Wf^wiors, %*WW%y amf

forwoWmm. TM LOCS do% GKkfmss of fmîient b e f m ^ Tlm

nmasur^ in tim pasem d y towmvar war© S m ^ in ttmir r æ ^ . ThW in

pan tm c&m m îha naîufe of tim fm iity in îhas tfm r^ktemm s only t)

tW wfh a IWîad r a r ^ of fumnbnli^ amf ara in pw » fo nrnnWdn tlm

msk^n^Eüthaî WeL

The ts© of the CC^ES in c^erm m r^ the partidiante’ fWfception of their

p^ycfm-mx^ environnmnt vtss ako concej^imlly aiund as (Wterrmnmf horn the

normative cWta (Moos, 1974a). The in the p r ^ n t shKfy sfK^^mf high

inter-conela&)!% to tw ^n sLomaWs and (Sm er^ns. Th@ tm im&alhm of

quesfem ^^ v ^ S y % item cf the COPES ^toukf conWate rm>re t^Wy

with its own than with a n y o tfw s u b a ^ . A ^atissuew astlm im A of

signifiant reiatior%h^ with (Aher varMM^ ^^«3S (1974a) mgdn^rW tfmt

invoWment, sup*x)rt amf spon^rmity %mre |%%awiy mMted to saW at^m . TTm

pi^mnt stidy found m3 agnifàsnt reia^rship betwemi ^mriatjtes. Fiml^,

tlm W ^cdve mifore tfm P arting wges th ^ (^jtion be taken In û^Tt%Wng

there^ilfo.

As tcwn m ttm St^i^ure, a HKH© p r m ^ undersfoTKSng of the naîuJB Of mjmrmjnltysurvival in^chre»^nm m aify i fo n ^ f m t T h f o s ^ ^ ^ # y

reliant œr^fohr^ cam s^emwhen mrmmimr^ foniae Mfo. a@irn;%3ttamfokmmwWW'G8fWn |M^nfo

88V#) diar®:teîfeîjcs are frore fitœly to ^3af8 to Bte in the comrramity

f e ^ n ^ s of tfw kir^fe of tteatmenî or aftercare they rK »im WanaraJOzon

(1^1) pointai out titet a œmpreher^ve ojmmurêty as^ssrrœnt of menîai

hWîh neecte sîKHikJ kteé# kten% perfomance irafeators reflating

o î^ n fe ^ îfs ! Intenrenttere sHKi imSvàiiÆÎ ïfâtient <^fac^rtettes. Tt%

corrceptireJ framewwk im f^ m e i^ in the present stuiy nmy tre adequate

shfflwn tqr the temrcys re& i^ Thte csm oniy tre determined howeva, v# i

in tite

Ttrere is a r ^ i to teitfrer search ter asrreiat^ of adaptation that

(an c^jeratonaüy define and recægniza that œmnwnky mteptatlon is a

muWmen^orW con^n^ thaï te a process of z^^menL This coræept of

outeonre has importent theoretkai arte prEKtWimp&a8or^ t t^ g ^ t s t f a î

muitifWe etioiogiæ need to tre œnsteerW ter ychiabic dteabifity. The of

reafmte^n rray be quite d iren t from the <tei^ of symptonroîï^. Each of the

dfterent arms of nmtte to be In evaUteting psybhatrte

cfimntef and treatment rmfxir^. A single memure of dteaWiity arch as

hr^KW ^^nteireefW odyasacW e mesure.

The Re^Wtml C^e Fml^ies repremnt^ a imique group ter stedy bemiree

dœ, staffing, arte n%Wi!y cost ;rer rson %rere alrr ret kienfimf in ^ <ssas.

BWn, Blimt arte Barsky (1886) frclnt^ oia it wm that rer^Svisfs

com prit cfi^ntâ sut^fix»^ (fifferfr (âiaimtsftetrcs that were carrc*^^

out m a group study They mfvtx^ed tfrerefore tW sut%mu;te of f^en ts

^Kîüte tte ejcteolfted îiteeïtendenîiy V%s#Nu, Goehng, Lamree, Fisher arte

Fimnmn (1985) howe^r s t r e s s the ter Wowir^ afi disdrarge patiente

instep of thoœ wth a i^rtkxdcu' d ^ n t^ s , Sving atimlkm or

tr^tnm nt The of sWe*#ig a cBstir%a gr%^ forthe stia^ cM not

allow fHïtt îfu! staîM W a n a i ^ amf tN f^ve been tx) mmow.

Impüd! in this a n d ] ^ the æsumption percefXksn of {^ydro '^x^

emnrcmmern, weQ-being amf phy^%d wdhbeing æ a8

n^/^x^ative varmbfæ te ^fected by care envinonnrænî. U nfortum ^

the future o ftW sW y m ak e sitin ^ x ^ sW eW as^ sc^ ^ m fi^

(^îem s in a variety g! s e tb r ^ Gn)% d b rm l (Ma is mquirW îo pnmde a

more direct t ^ d W m x ^ e c o k ^ y theory. WanarxjOaan0%1)mWnWr%d

that h) t^te, stud% of iKychiatrk; hc^xtaB z^n r»t usmj d)üwnW

from <#erent s o u n ^ hiliy erxji^h to fxxtmy a compreher^ve pkaum of

community airvivW.

Otiw sU xi^ l^ve æfvocâed for the of tongitLKfirmI in ortter to

predct community mrrvW. Fontana and Dtmtte (1975} mainWnmf tNA

reWveiy enduring ooukf be expma%f to come into play

progr^Wveiy ss ^ a B o m i effm^ t^ a m e atenualMf over time. Thus uc^ng

one pmtW arhme period may have ^mrihrety favorW one donmln of p rê to n s

ami i^nalsed afKTthsr. Dorwart {19%} for (ÆnW n ^ a r d t wâh a

fonghudnai m) tW qmstkms unar^ver^ by ædtenai s W %

maybeat^È^sed. Tim Bmited fo%® in rirte sW y (ri exartWr^ cWr%t g ro i^

in a SnUt^ rime period cte% aitew for arix}fOugh anWyste <ri

deinsAdior^zmi menW fW th p a ^ ; ^ T T ^ o m e n tsM ^ f^ ^ K X ^ io n

^ :^ f s that rray in^^te «xnmimity mrrvW. ind(:mgso,sW :hBd WaoremaA

Œ N x sin g M v eb ^h eW œ n ^an L rwedtet%exartrinmiincon^a^&m

with ( ^ n t dmractertettes in future stix ri^

70The present sWy whh m^suremer^ and n%thWok)8k)8! errors

tW m ayM vee#<^W outcon% . Therefere,Wierœultefromthepriant

sWy rmst be interpreW with cm#)n. The patterns that emerged htMsver

wanant further pursutt of these varWes in as^s^ng community tenuie.

71nEFEREHCES

AmNxny; WA, & BueB, G J. (1974). Pr^S^ng reW#tEakm%acmne dmnogmpNcdimK^fMics: a CkMS Êng PsycW %^ 21,4 2 1 - ^ .

Anthony, WA, BuoB, G J.. Stenatt, S., & Afttwff, MLE. (1972). ofpsyg^Mrmmtml^ation. f^ y cW ^ o a f & n,78,447-4S&.

A ^ n y , WA, CoMn, M.R., & VW), R. (1978). The n^ajrem en t of leW ^W wmAoom e. Sc/ËzcpWn^ a^s#T,4, % 5 - ^ .

A ^ n , W.R, & Speed^y, K.N. (1^7). The (sydi^âTkî *Wenl: ar e v ^ of KxW, s%W-f%ycN)k%W, ami ^KydWatw cofrelat^ of mjteome. A tm ik ^ ,kHffrml of 1 ^ 10-18.

LL (1976). A note on some mcent duœks of reWasmi nmnW to^îîtd f^fente In the commurtty. ^rm ksB t *kam ^ f ^ f d ^ y 1S3i1},7 75.

LL (1981). CmTtinuity of care for cironk: m e f^ patient; a cwK»ptuaf anaJys^ A n m k ^ Joum dF syd ikSry , 1449-1456.

B ^ r , R., & J.N. (19^). REHAB: a a s ^ sm e n t irstrun^nt for dnxmk: (^ydW ic 14^1), 97-111.

E L , & Gersm, S. (1978). DemstitWmWWfon ami mentd hedth servfo^ AnWcsn, 238 gSÿ, 46-53.

Bennett, MJ., FekfoWn, MX. (1986). Corrdat% of f^tient withnwitai f^&h in a f^ l th tmintemmm organlzWfon. AoWcanJ o m ^ d f^ e w i^ w htet&am, 2 ,155-162.

BiM, GJ., & AntMny, W A (1973). Deim^n^îhfc dtarœ àef^cs ^ prmMofs of r^dv ism ami ;x^-h%;Wtai empk^menL Journal o f C o m ^ j ^ P s ^ ^ k ^ , 20,361-3^.

^ e ts , ES., CoMn, S. & K forshb^^, DT). (197^. Im^maofafterc^e sefvW^ œt mc&gv W of meiW ht^ËW i^ e n ts . Ckuwrnmky

,kmna}, 14(1}, ^ 3 4 .

72

C a^^r, E.S., & Pætva, G. { l^ î) . Admisston historiés, paMerrs amisub- gnxtos (ri the i^ tvy i^ n s of a hcsptaL P sytà^^icQî^tmfy,61,m--i34.

Caton, C.LM. pSfô). Efte^l of tength of titofiritofri treatment for dironfc schiaphfB f^ Ammhem .hnmwû of P sy t^ ^ ^ , ï,æf7?, 856-861.

C«u«sa, W. {19^). V m P syd ^â m H c^^s^a sïrm S & ^à ety. Harvard Unhwn^ R n ^ Cambrée, M ^ .

Chamkï^rm, R. (198^. f^enatom c^d m rg ^: a comp@#ve ^udy.2 ^ 2 6 3 .

Cîin^r, M.D., Rne, MA, .tohrson, J„ Sdwvartzrmn, J., & Dmde, KP. {1988) Ass^sment of the i!^y<^^>imtric p n ^ m ^ of toe actoi^e behavriof æale with f»ydt@tric (^Üento. .tournai of CormiWf^ ami CSnkat P sychok^, 56 (4). 542-548,

Cotto, S., FmmA, J„ Kahn, R , & Mann, F. (1%3). An environmentel ^)prom^ to rrantaJ i^ îth . A m ^ o f^ tto w Y o rk A :m to m y o fS d 0m», 107, 5%-606.

DeMrio, D J ., & Antfwny, W A (1 %1 ). On the retotive effecîfvet^s of irtotitutioitoi ami Wtenmüve pimæmemtorthe ;%)^totricaWy

of S m ^to sim s, 37(3}, 21-33,

DiWpto, W.J., & &)imner, G. (1973). TWa^^utto W ums: pWents who n^um ^ days of h<^rW PsychiaîTic Chmr^iy, 47,371-376.

f^mnwt, R A {1988). Aten-^ffl' Wow-up stody of the efferto of d#^tulm rW [^lton. mtd C o m m a ^ F*syt ii&ty, 390}.287-^1.

Drake, RE., & WWladi, M A (1988). fefenîal paîierrts’ aîîitiKtos towards ht%#toWüon: a rm gget^ of hospAal tonurn. Anm kan Jmmmî ofPsymaÿy. 1 4 ^ } , a -3 4 .

E l^m , J.M., Btom, N., & A J. (1986) R e p ^ visitors in thef^dü^toenæ ri^^^rw oeiacrigc^ m vtow oftoec^ H o ^3 ^ mai C k m u m s^P ^à ^ù y , 37, S7-4%.

73Enwfam, EB,, & Pretty, GMH. (1985). Fnm rfmtifrk: to rm ^ :

pixx;e& WKi in coimrnmity-b^^à m sk^fjÿ^ f^W & s,.Unputrish^ mamiS3ipt U nlvef^ of Kent at C^mert>ufy, Car^tjuiy, Ef^larai

FaWsWt, E (1979). LeveWofCare. 1-E

FWren LA., Ckrem^, P.N., Laraee, WJ., & V^i^tenki, DA (1981).kl à ^ o p o ^ i TcmxhOo. Cœnmunity %wuree

Oxœultan^ of Toitmto œid S * ^ : and G)mmui#y P^fdiiaby S ^ o n Oadre W W e of F^ytdtiatiy, 1-^.

Fon^m. AF., & f^W s, EN. (1975). A s s ^ r ^ treatment (Xikonre,!!: prK&^n of reho^KW^adon. T hetknm ia ii^N erm ^am iM er^Disease, 161,23^-2^

FrartÆn, J.U, KRtrec^, LD., & Thrœher, J.H. (1975). A sunrey of fEH rs to nrei^ wwl C o n m w ^

Fimmn, W.M,, F a l ^ ^ EW., & ftenriteon, C.E, (1979). Comments on Greewmn, AWon md Wmtzr^ «WWofPsycWMc Tr^fùrmU mKtevsbmkm, f (2), 40-42.

Fum^m, W.M., & üw%f, DA (1979). The e^^sanent of patent nemk: d^tmpgon of the level of c æ s u :^ . ,knm ^ P ^ ê ^ ir ic Tn^ümat ami Bv^iskkm. f(%), 40-42.

G ^ r , J l . (19%). In out £ ^ n : pf#n*%ry »f^M on of a t efK^wfârs wjra ret^&^s, tk^^am iC km im B ^P syt^iM ry^,3 % -m

Grub, G. (1%S). TTreSWemKfdre WW^#Af#s&)fy(^MWes0RrI^FISBÙ. U nW r^ of North

Cac^na Pr^s, fa .

Grmnre, GA, K ^ , D.E, fWdf, D., & S h i^ , feâ. (197^. Commui% terme and an of f% #ne% èrcW m rgBad commun^ !Mi^.Ps^ï^s>lD^ca//^»rts,4î, 13%-13^

fWm, M., Bergman, H.C., & LL (19%). % yd^rk: amii%r^^Fd^&%à%&:^orek>f reh^K W ^A m m adiT M ^pat^ popui^H>a H o ^ ^ m d Comment 37,

74HWm@s-Ek»r, R, S. {1^}). and the conpt^^n of

nwnW pawns’ s)cW netwwk. Sc^im ^^iU a 16,157-164.

J^%bs, JJL, Amtson, K, & Nystmm, B. (1%3). FtecaSvtsm œ a fdtow-up nœîhafeAîgy. 11,224-227.

Wnmn, TP. (1983). An overview of i^ e r t saüs^aion with ps^h atrô tTMSnent Hoa^iWmdCommmfy R g n c ^ ^ 34,48-54.

Kihtz, S., & &fe< R (1974), PhysWogkal e ^ d s of sœisd environmonte. RQ% N)a%iWcM@(@cW, 35,96-114.

K ^s, D., Gro\^ G,, & M. (1977). V^sà hWment mSteu amf f»st-NBpWfuiK^onirg. ArcMmsofGensfai Psy(^vMry,34,1047-i^^L

LaKfofte E.L,(%8rst, M,T. A.R, & VW, RM (19M). Deveh^ment of a

parent æafefecSon »:^e. Resfiæcrfï/n A&ins^ ®k# 9,43-K).

Lawton, M, LqAon, M, & Cohen, J. (1 9 ^ ). JTw nw n^ tr^Ênwmn ^ u : aiHi tr ^ m sn t Non^ownState Norristown, PA.

L^tow, J. (19K). Coîmttner s ^ :# o n mtlf mental health tr^n% nt Rsyc/toÀ^cs^ &fW n, 91,244^% .

KWon, JL ( 1 ^ ) . A newmv of ;%ycho8%lnxâne r^anch on tM i^æ y- achenal tærttoal system, Afe^csne, 30,57B-6Q7.

O.T., Potomy, U ., & Kramer, B. H. (1989). The cteveltçmenî of *EK±)r4)a^ Imrel of toru^nirtg from a leW of cam ImtrumenL

45(6}, aS-9W .

May, RR, Turn A.R, YWe, C., P o t^ ^ , R, & Dbton, WJ. (1976). Sdyotophrer#-a h iownip stidy of results of treatment: II hôpital stoyo^rtw otofiveye^ of Genera/Rsyc^^&y,^ 481-486.

MPhee, C.B„ Zi^rmn, J., & Jo% R R (1975). KWrntmnrnm of j tBent a mmmy of In oomnmrwty menW hWth ntr%.

16, ^ - 4 0 4 .

WMn G.R, & B. (1978). P rM ^raof mtomtoa|%yclWrto

75

Ktoœ, R. (19^). As^ssm entofthe ;%ychos(x^ emHronnmrâs of conumir^ '-offcmtscl Joy rr^o /

^ , 9 - 1 8 .

Nfeos, a {1974a}. C t m m ^ P rt^ram Envimmanî S tx ^ h^mmLConWUf% Pm% tm^

&&)os, a (1974bX E ¥SÊ J£0t^Trem i9tnE n¥inm m efîîs:A Soi^ecokj^^ Appmæh. New York; Wilsy and Sons.

a (1%4). Cofite)â amf o # % : toward a unMyir% corœ ^iW frarrowork. A nm icæ *kKmai C om iim r^ P ^ c tw k ^ , 5-37.

a , & Bromeî. E . (1978 ). ReWon of f^ ^ n t attnWtes to pmrce*Ak)r® of^tfeabm m en^rcm rTsnt ^kmjwd of eani C&^xdP^f^iOk>gf, 46 ,350-351.

a , & &hwartz, J. (1972). Treatment environment ami treatnmnt outœme. Jounwà mid E ^ s ^ , 154,284-275.

L a , & &J. (1979). R e^anA on the psyWxisoclal tn^hnsnî ofsr^iha^ifWa: a ammary ref^rl Anmk:æi>kHmi£ü(^P^K:fMry,136^, ^ - 6 3 1 .

Okhar%ky, & (1W8). Sonm assum^akam diaM r^«!. Commm^A#*#W H ^ tfî J^ot/ms/, 4,153-156.

F ^ , a v ., K&Sec, f C £ , & AîtKï^fc-FîoiBz. J . {^9m). The ofp^ents to a gérera! hfspita! psycitahfc unh. £ ^ n e ^

P ^^cm iy, 6 1 ^ 1 9 7 .

I^ton, M. (1977). Envtofmrnms M a o fi^ ^ C a m îy C k m e t^ m F o ^ G fm ^ h k m w s , Centre tor so W r ^ a n ^ , UmverWty of W nn^ïta, Mnne(^to%, MN.

Fail. G.L (1979). ^ ^ ssm e n î tor r^ to W ai treWnmnt,nam ^m ern r ^ ^ d i mto mmWîton: a Jom nali^

A s ^ ^ r m n , 1(3), 181-184.

Pr)W, M.W., imetorm, &UC, & Dinntog, W.D. (1982^. O ie m s 's a îto fs ^ and reto^pW km t^ fsydrntrto ^ e n to .

7S

Piyer, M.W., & O^te^mo, M.K. (19^). FoJtoWHjp of (wttt^panls in a v%^:mlmMb@Wkmpn%ramafa^tehGSfWlal, H o ^^a m i C onurn^ P ^c h ^y , 37,1261-1%2.

%*mpoft, R. ( 1 ^ ) . (kmrnmr^ Tavfetodt, LoiKton.

fWynan, & Han% P. (1^3). Rental c^nstitutionaflzatton ini^onal %# a»ne region^

SefWn, G., & C.B. {1974). S^nificarK» of den%%p^Ak: (Wa$KTW%^^mBzal!onofaa6a:#mrk;;«tf«T&. Hea#wKf

117-1%.

Sow^m, J.. Kanbx; L, R^ag*^ a , & C tetx», J. (1979). TM extent, nsrture aW utiHty of consumer saWac^xm in community mentalhWA (»nters, Armkm} uW W of Cmmnufuty Psyc^ti^t^. 7,329-337.

Statmjn, A., & Sdiwaitz, M. (1954). Ttw R^fÉs^ A SbMfy ofPsj^^^rfc f t t ^ ami Tnas&nent

B a ^ New York.

S t m ^ J.S., & %ffw%er, W.T. (1974). The piWc&)n of outcofro In arffe^îhreraa. A n ^ m o f Germr^Psyd^îry, 31.37-4Z

^rauss, J.S., & Carf^nAr, W.T. (1977). PrecWon of oukæme in SïAîzqîfiren^ five year outeome and Its preda^îB. Amtmæsof G&w/^ P ^ d ^ ry M , 1^163.

T%Ëer, RC-, & RterufersA^, R. (1982). Fsjtors affec^ng m#stment to coiTBnur% Bwr^ 33,203-207.

Urtpilmrt, B., BuW, B., Sweeney, j.. Shear, M.K, & France, A. (19%). Ira^eœai ^^^fidty A m ealing ^islaSton. Psyc^rfcCk&terty, æ ,( ^ 128-134.

Wm , T.T.R, & Dzcan, YA (1991). Determinants of psydti£tfric rehtm pW z^m ia^W alarw ans^s^ CcmmWfyMenWH^f? Jt««ïtof,27,3-16.

Warn. (19%). Eff%^ Of a c c p ^ e n t ^ on ;^ e n ts ^ # ^ ^ n Cam. 1 8 , ^ - ^ .

77

Ware, J.E., Davies-Avery. A., & Stewart, A.L (1978). The messuren^nt and fmaning of p^en t saîie&aüion. Hæ&h MmScai S e rv k ^ Rmiew, 1 ,2-15,

Wæyfenki, D„ Goerirg, P., Lmcee, W., R sc^r, L, Freeman, S J J . (1985). F^yc^mtnc afteicare in a metropolitan setüng. C ^i^San Jo w r^ of P^;îvaîry,X), 3 ^ 3 % .

water, B., & Biggen, P. (19^). Comparisons of rehospW œd ar%! nonreh^pitelized î^ ^ ia tr ic patients on community SKÿustntent %lf- a^æsmenlgukte. Fte>^'^ry; 3®, 239-243.

Witer, B., & Mifier, G.H, (19^). Oi the relatter^hip of dient s a f e f a c ^ to <^nt charæaerrstics artd oirtcome treatment. Jourr^ of CSnicaf P sy ch o k ^ , 3 4 ,157-181

Wonnæartî, TH., & Wsnneeott, R J . (1981 ). R ^resshn , A seojfui coun^ in Wttey, New York.

Zastewny, T.R., Lehman, A.F. (1988). Patient satisfærtion wHh mental health % rv k ^ OfiS , 14(9), 284-289.

78

Af^ncfixes

79

Table A-1

Length of Term Partk^ants Were at R ^itence

L e i ^ of ttrr» at r ^ f e r ^ N Ftorcent

L^aüm n 1 n^nth 1 1.6

1 rronüi to l%s than 3 nin ths 2 3.2

3 nwnths to ^ than 8 ninths 5 8.1

6 im N te to ^ 5 tfmn 1 ^ a r 8 12.9

1 year than 3 years 14 22.6

3 yeaia to than 5 years 15 242

5 ^ a r s to less than 10 years 8 9.7

Over 10 years 11 17.7

60AEEEm & R

THE FOLLOWING CXJESTIONS THAT MEASURE DIFFERENT DIMENSIONS

OF SATISFACTION A% SCORED BY THE FOLLOWING SCALE:

1 2______ 3 4 5 6 _ 7Temke Mhc^ Meæed Delighted

(^uaSy SaWied SaWed &

SATISFACTION WITH RESIDENCE

How yffij fe^ about; (tfâing the atove %al@s)

a) The Rving arrangements tere_________

b) The tocKS here_________

c) The rules here_________

d) The other j^ p le wtro live here.

e) The jMtvacy you have_______

f} The anmunt of fr^dom you have .

g) How woWd ymj feel airaut the prcsp^a of staying here for a long time_________

SATISFACTION WPTH SOCIAL ACTIVITIES

Do you drat there are alot of social activiti^ fôr you W tre pad of?U p s c a l e ____________

SATISFACTK3N WITH E^TK>NAL WELL-BEING

How cto y(%j f ^ atxxd your emotkxW weU-Wr%?L f e e S r a l e ____________

81SATISFACTON WITH PSYCHCXOGICAL HELP

htow (6) you feel the ps^cNatm; help you are receiving?ÜS8 Scale__________

OVERALL SATISFACTION

Taking adl th i»^ u>gether, how wWd you your life has t ^ n ?Use Scale___________

82

AgPENDlXC

I to par^f^ite as a subject in a study which (Mnsktens my opinions

and views of my fWdem^.

This study require infomWon about me which is confidential througfwut

the araJ thereafter. Any put^kafton based on this information wH! irot

in any way kfentrfy me, txit will describe groug^ of subjects in which I may

be a m err^r, but always armnymoi^y. I give gærmission to the stixly

p rcg^ to have aixess to my medicai and social a^istanœ files.

They may Wso converse v # i my stmal worker/caregivefs regarding the

s u b ^ matter of this res^rch.

I understoKf that my decision to jmrtidpate Wl not influent in any way

the rmture ard c^ality of my f»esent N ation .

Sigr^;_

D ^ :

Witne^^L

Date:

TaWe D-1Measures of Centrai Teiufency and Variability for Outcome arfo Prm&^r Variables

VariaWe N Mean Std Dev K ^lan Mn Max

(Xriœrm Varfobles

inpatient redcRvfom 62 1.16 3 .^ 0 0 20Out|]ebent ret^Wsm 62 9.61 3 6 .^ 0 0 IS)Total r% kB v^ 10.77 37.21 0 0 180Satis^iÜon 50 58.40 6.69 57.5 40 77

Pretfetor Varisfofos

Psychofogk^ weS-being 62 1.73 .79 2 1 3P t^ icai weS'being

COPES Dlmei^ons

62 1.81 .62 2 1 3

RelationsNp 50 1 6 .^ 5.tS 16 5 25T ram ent K) 18.38 4.% 18 7 30System nminten^n^

COPES SUBK)ALES

50 20.20 3.52 m s 11 27

Invotvenœnt KÎ 5.20 2.14 5 1 10SupfK)rt S) 6.% 2.26 6 2 10Sffontaifofty 50 4.S) 1.78 5 1 3Autorwmy 50 5.10 1.74 5 2 9PracSfoal orfonWon S) 4.74 1.89 5 1 9Per%mW prob. orienfâfejn 50 4.12 2.06 4 0 8A r^ r & ^ r^ s k m 50 4.42 1.W 4 1 8Ortfor & o^anlzation 50 7.24 1.49 7 3 10Program darity æ 6.54 1.79 7 2 10SWf control S3 6.S3 7 2 10

64

Tai^E-1

Frec^ier of of Psydiotog«^ arKl Physaai WoB-Being

PsydTok^^Mwüonir^

Frequency Percent Cumulativefrequen*

Cumulativepercent

1 % 46.4 æ 48.4

2 19 30.6 49 79.0

3 13 21.0 62 100.0

ftiiKîteîningFrequency Percent Cumuialive

fTK uencyCunujiatîvepercent

1 19 30.6 19 30.62 36 58.1 55 88.7

3 7 11.3 62 im.o

85AïMjerefec F

TabieF-1

Avemge of SWWæak)n for Psydwlogkal Well-Bair^ SœnK

vW -W i^œ omN vaW of

DeviaîffînKW an

1 26 K}.68 8.39 63

2 15 5 4 ^ 8.14 56

3 9 57.67 6.80 58