Health Care for Women International
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International relocation: Womens’ coping methods Kathryn R. Puskar DrPH, RN, CS To cite this article: Kathryn R. Puskar DrPH, RN, CS (1990) International relocation: Womens’ coping methods, Health Care for Women International, 11:3, 263-276, DOI: 10.1080/07399339009515897 To link to this article: http://dx.doi.org/10.1080/07399339009515897
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INTERNATIONAL RELOCATION: WOMENS' COPING METHODS Kathryn R. Puskar, DrPH, RN, CS
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School of Nursing, University of Pittsburgh
This article focuses on how corporate and military wives cope with international relocation. Specifically, the coping behaviors of women who exhibited signs of depression and anxiety and those women who did not in a convenience sample of 28 military and corporate women were studied. Six instruments were used: (a) the Relocation Survey, (b) the Beck Depression Inventory, (c) the Multiple Affect Adjective Check List, (d) the CAGE Questionnaire, (e) the Sarason Life Experience Survey, and (f) the Coping Questionnaire. Coping and adaption formed the conceptual framework. The findings revealed that women who coped well used active coping behaviors and women who coped poorly used more passive coping behaviors. This study offers some direction for health care providers who may use anticipatory guidance and counseling for women prior to international moves.
My purpose in writing this paper was to examine how corporate and military wives cope with international relocation. My personal relationships with families who experienced an international move suggest that there are unique aspects in moving to a foreign country. Women who move because of their husbands' careers expressed frustration over the unavailability of jobs and feeling isolated from family and friends. Relocation can create physical, emotional, and social distress, all potential health problems that concern health care providers. Therefore, in this study I addressed the profiles of women who cope well versus those who cope poorly with an international move.
This study was supported by the Division of Nursing, Nursing Research Emphasis Grant R21NU01012-01. Health Care for Women International 11:263-276, 1990 Copyright © 1990 by Hemisphere Publishing Corporation
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While much has been written on relocation in general, there has been little research done specifically on international relocation. The two areas examined in this review are: (a) coping with relocation, and (b) international relocation. Researchers on relocation have looked at its impact on families (Brett, 1982; Shaw & Pangman, 1975). Brett found mobile families less satisfied with social relationships than nonmobile families. Shaw and Pangman, in a study of military families, found no significant relationship between emotional and behavioral problems and the frequency of mobility. Families that identified themselves highly with the organization were more able to adapt to mobility. Families experience the loss of community—familiar places and friends (Jones, 1984; Viney & Brazely, 1977). Gaylord (1979) and Seidenberg (1975) found that the wife loses a sense of self-worth and identify, while the husband maintains an identity through his job. There are factors that make international relocation different from other kinds of relocation. International relocation has a cross-cultural impact (Harris, 1986; Fontaine, 1983). Forms of communicationlanguage, TV, telephone, and newspapers—are different. Housing and school systems often are not comparable with American ones. Job opportunities are unavailable to the wife because of lack of a work permit. Familiar everyday chores, such as banking, paying bills, driving a car, heating the home, and going to movies, have to be relearned in a different culture. The distance from social support systems creates a greater emotional dependency on nuclear family members. The distance also creates a feeling of isolation from extended family and friends. Isolated from family and friends, the wife seeks emotional support within the family. The husband's job often keeps him away from home for long hours, leaving the major responsibilities for the move to the wife (Olive, Kelsey, Visser, & Daly, 1976). She is left with the responsibility of getting the family settled into the new location and softening the move experience for children while the husband's job creates demands for him. The wife is a key figure in how the entire family copes with relocation. When children have difficulties adjusting, it is often a reflection of how the mother is coping (Werkman, Farley, Butler, & Quayhagen, 1981; Gullotta & Donahoe, 1982, Gullota, Stevens, Donahoe, & Clark, 1981). Families have a strong impact on the husband's job performance (Haight, 1983; Gaylord, 1979; Renshaw, 1976; Labovitz, 1977). If the family adjusts to the new environment, then the husband can maintain his focus on the job rather than be distracted by family problems. When a family returns to their home country, an unexpected culture shock is experienced (Labovitz, 1977; Fontaine, 1983). Culture shock covers all the feelings and behaviors of people who have moved to unfamiliar countries (Brink & Saunders, 1976, p. 127). The basic stress
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for the family is the abrupt transition. Brink and Saunders (1976) identify five causes of stress inherent in culture shock: communication, isolation, mechanical differences, custom differences, and attitude or belief differences. When these causes of stress are present at the same time, the impact is magnified and culture shock results. The international experience may not be of interest to family and friends because they cannot relate to the experience (Fontaine, 1983). The husband, because of the pressures of his new job, may become angry, frustrated, and concerned over his career, leaving family responsibilities to the wife (Labovitz, 1977). So a return home from an international move creates stress requiring readjustment to the new environment. An article entitled "The Trials of Being Married to an Executive" (1983) in International Management presents a survey of executives' spouses in 13 countries. The researchers found the wives to be overburdened with the domestic details of life, a sounding-board for their husbands' problems, and generally content with the corporate lifestyle except for the constant threat of relocation. Foreign relocation was identified as a major problem of being married to an executive. Werkman et al. (1981) examined the psychological effects of foreign relocation on the adolescent. They found that the relocated teenagers were more self-reliant but less intimate in interpersonal relationships, and that these teenagers used a positive attitude as a coping strategy. International relocation requires the family to restructure life in a new environment and use involvement in decision-making and moving activities as a way of coping (Renshaw, 1976). Labovitz (1977) interviewed executives who felt unprepared for the international experience due to a lack of pre-departure counseling. Families felt isolated upon their immediate arrival at the international assignment. The overall satisfaction of international assignments was related to perceived company support and family integration rather than to location or length of stay. A positive international experience was identified when: (a) the wife became actively involved in the local community, (b) schools met parental expectations of quality, and (c) the husband maintained regular work hours and participated in family vacations and other activities. Fontaine (1983) described the selection phase, pre-departure phase, on-site adjustment phase, and the repatriation phase in an international relocation firm's approach to employees. Coping behaviors for successful adaptation were: (a) a positive attitude toward the experience, (b) involvement by the wife in the community, and (c) development of social relationships. Harris (1986) identified assessment, orientation, onsite support, re-entry counseling, and use of a native contact person to assist family adjustment in foreign assignments. Use of support groups, educational programs, and individual counseling has been advocated to
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ease relocation stress (Godden, 1986; Puskar, 1980; Marsico & Puskar, 1986).
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CONCEPTUAL FRAMEWORK This conceptualization of relocation stress in women was influenced by the work of Fried (1963), Weiss (1973), and Mallory and Peebles (1984). Fried studied families who experienced forced relocation. He suggested that the intensity of the grief reaction to the loss of residence was a function of social support, the person's previous commitment to the area, and positive feelings about neighbors. Weiss (1973) identified social isolation as a major aftermath of transition states. Social isolation is a consequence of a lack of a network of involvement with peers, such as fellow workers, neighbors, or friends. Mallory and Peebles (1984) developed the Coping Questionnaire, which included 58 short-term and 25 long-term coping behaviors. These behaviors were adapted from Sidle's (1969) and Bell's (1977) coping scales. Sidle and Bell reported that "a combination of both short- and long-term mechanisms is important in dealing with stress" (Mallory & Peebles, 1984, p. 42-C). METHOD A convenience sample of 28 internationally relocated military and corporate wives was obtained from a larger study involving 100 relocated women through a survey research design. Data were collected on relocation, depression, anxiety, coping, alcoholism, and other life experiences. A relocation was defined as an international move from the United States made within the past year. INSTRUMENTS Since no instrument existed, the Relocation Survey1 was developed by the investigator from a literature review to collect data on the experience of moving. The Relocation Survey (RS) was originally developed for relocated corporate women and later adapted for relocated military women (Puskar, 1986). The RS has been utilized with 350 women aged 35 to 70 years. It includes 44 items with five dimensions of relocation stress. The dimensions are: (a) structures of the move—type, reason,
1
Copyright © 1985 by Kathryn R. Puskar.
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distance, and cost; (b) support system—relatives, friends, and clubs; (c) reactions to move; (d) coping strategies; and (e) advice for others. Content validity of the RS has been established. The RS takes 30 minutes to complete. The Beck Depression Inventory consists of 21 categories of depressive symptoms and attitudes. Each category has a series of four to five evaluative statements, which are ranked according to severity. The items were chosen based on overt behavioral manifestations of depression (Beck, 1972). The total score range is from 0 (nondepressed) to 63 (severely depressed). The internal consistency of the BDI was determined through comparison of scores for each of the 21 categories with the total score for each individual. "With the use of the Kruskal-Wallis non-parametric analysis of variance by Ranks, it was found that all categories showed a significant relationship to the total score for the inventory" (Beck, 1972, p. 565), with a significance beyond the .0001 level for all categories except weight loss, which was significant at the .01 level. The split-half reliability with a Spearman-Brown correction was .93. A test-retest method was used to determine the validity of the BDI. The Multiple Affect Adjective Checklist (MAACL) is a list of 132 adjectives that describe the emotional state of a person on any given day (Zuckerman, 1960). It is a self-administered questionnaire that has three subscales—depression, anxiety, and hostility. The MAACL has documented reliability and validity scores and has been used with a wide range of subjects. It takes ten minutes to complete. Scoring consists of assigning one point to all positive items checked and one point to all negative items not checked. The sum of the two scores indicates the level of the participant's anxiety. The validity has been documented in numerous studies (Zuckerman & Lubin, 1965). The reliability has been found with p < .01 internally, .72, .79, and .73 for measurement of anxiety. The range for normal anxiety is 0-7; mild anxiety, 8-11; moderate to severe anxiety, 12-14; and severe anxiety, 15-21. The Coping Questionnaire developed by Mallory and Peebles consisted of 50 behaviors that include long-term and short-term coping behaviors (Mallory & Peebles, 1984). The 50 items were rated by the participants as to extent of use. The four question CAGE Questionnaire, developed by Ewing, has been recognized as an efficient screening device for alcoholism. Preliminary studies found this questionnaire to be a sensitive indicator of covert drinking problems. One yes response to four questions calls for further inquiry. Two or three yes responses indicate a high index of suspicion (Ewing, 1984; Mayfield, McLeod, & Hall, 1974). The Life Experience Survey (Sarason et al., 1978) measures the number of life events during the past 6 to 12 months and the intensity of the
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event for the respondent. Respondents rate their reaction to the event on a scale from —3 (negative impact) through 0 (neutral impact) to + 3 (positive impact). A total score is obtained indicating the sum of positive and negative changes.
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FINDINGS The 28 women in this study ranged in age from 24 to 50, with an average age of 34, and had an average of 14.6 years of education. The average age of their husbands was 37. Most of the husbands had a college education. Of the military women, most husbands were officers. Of the corporate women, husbands mainly had management positions, such as vice president, buyer, and controller. The family incomes ranged from $20,000 to $65,000. Protestants made up over half of the sample; Catholics made up one fourth; one fourth expressed no religion; one woman was Methodist; and one was Mormon. In all cases the husband was seen by the wives as supportive of the family during a move. He oriented the wife to the area, assisted in house-hunting, and handled the paperwork of selling the home. What was liked best about moving included learning about a new area, making new friends, and getting a new house. Things liked least about moving were separation from friends and family; the physical aspects of moving; temporary living arrangements; separation from husband; and dissatisfaction with specific aspects of the new area, such as location, climate, or house. Strategies used to overcome feeling like a stranger in the new area included: learning the area, becoming friends with neighbors, joining clubs, doing volunteer work, and returning to school. Forty-two percent of the women thought it took 6 to 12 months to feel integrated into the community. The women offered the following advice to other women who move frequently: make friends; get involved in the community; maintain an open attitude; learn about the area and obtain pertinent information, such as how to obtain a driver's license; enjoy the experience; be organized; learn the language; look at separation from family as temporary; and try to make arrangements to visit family. The women were divided into two groups, those who coped well with the move, n = 20 or 71.4%, having scores of 0 to 9 on anxiety and depression, and those who coped poorly with the move, n = 8 or 28.5%, having scores of 10 and above on anxiety and depression. Eight individuals exhibited mild to severe depression and mild to moderate anxiety. The women experienced a range of 4 to 14 additional life events, with an average of 7.6 events. The number of positive responses for life events ranged from 0 to 26, with an average of 6.8. Negative
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Table 1. Profile of Coping Behaviors in Women Who Experience International Relocation
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Demographic profile Age Education in years Unemployed Husband's education Number of moves Prior to marriage After marriage With military Overseas Life events Positive responses Negative responses Intensity
Women who coped well
Women who coped poorly
35.5 14.8
36.25
12
15.85 4.95 5.4
4.29 1.18 6.35 8.65 7.05 15.7
14 8 16
2.75 9.25 9.85 2.42 6.25 2.37 10.62 10.5
responses to the events ranged from 0 to 24, with an average of 8.1. The findings did not address use of drugs but did examine alcohol use. The CAGE Questionnaire showed no evidence of alcoholism in the sample. The use of prescription drugs was not examined in this study but could be addressed in future research. Women Who Coped Well The 20 women who coped well with the move were approximately 35 years old with 14.8 years of school (Table 1). Thirteen women were unemployed, four were employed full-time, and three were employed part-time. The husbands' average age was 36 with 15.85 years of education. The average number of moves for the women was 4.95 prior to marriage, 5.4 after marriage, and 4.29 with the military. The average number of overseas assignments was 1.18. A large portion of the group had returned to the United States from a foreign assignment. Women who coped well participated in military, social, church, and school clubs. The average number of life events for the women who coped well was 6.35. Positively scored events averaged 8.65. Negatively scored events averaged 7.05. Events rated positively were a change in living conditions, change in husband's work, decreased eating, outstanding personal achievement, increased family closeness, increased social ac-
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K. R. Puskar Table 2. Coping Behaviors of Women Who Experience International Relocation Coping behavior
%
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Women who coped well Seeking information Talking with friends Looking for humor Going off alone to think Making alternative plans Changing situation Getting involved in hobbies Talking with relatives Reading Women who coped poorly
50 45 45 45 45 40 35 25 25
Sleeping more Eating more Crying Getting angry with self Expecting the worst Watching TV Working it out alone Listening to music Changing reaction to move Finding a hobby Shopping
87.5 75 62.5 62.5 59 50 50 50 50 37.5 37.5
tivities, a changed work situation for the wife, and increased church activities. Negatively rated events included a decrease in social activities, separation from spouse, serious illness or injury of a close family member, a change in the work situation, and a decrease in financial status. This group of women did not focus highly on any specific coping behaviors, but rather identified various behaviors used to cope with the situation (Table 2). The breakdown of coping behaviors was: 50% got more information; 45% talked it out with friends, looked for the humorous aspects of the situation, went off alone to think, or made alternative plans; 40% tried to change the situation; 35% got involved in hobbies; 30% talked it out with relatives; 25% read for pleasure, cleaned, played with pets, didn't worry, got involved in clubs, decided upon an action, listened to music, worked it out alone, changed self and reaction to the situation, learned new skills, or got angry at others; 20% ate more, watched TV, read books, got angry with self, or went to the movies.
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Women Who Coped Poorly The profile of the eight women who coped poorly with the move is seen in Table 1. Their average age was 36 with 14 years of education. All were homemakers. The husbands' mean age was 34, with an educational average of 16 years. The number of moves made were 2.75 prior to marriage; 9.25 after marriage; and 9.85 with the military. The number of overseas assignments for this group was 2.42. Most of these women had moved to a foreign country. Most of these women participated in military, social, and church organizations. One woman did not participate in any organization. Women who coped poorly with the move had an average occurrence of 6.25 life events in the past year, with average scores of 2.37 positive and 10.62 negative. Seventy-five percent of this group viewed relocation as negative. The events that scored negatively included decreased closeness of family members; change in living conditions; serious illness, injury, or death of a close family member; change in the work situation; decrease in social activities; movement of a son or daughter out of the home; and overeating. The only positively rated event for this group was change in the husband's job. The wives' initial reactions to the move were happiness, excitement, and a preoccupation with keeping busy. The husbands' initial reactions to the move were also excitement and happiness. Eleven children, ranging in age from 3 to 18, moved with the families. Children ages 3-12 reacted to the move with happiness. Teenagers were unhappy; children in their early 20s did not move with the family. The women who coped poorly exhibited more diversional activities and fewer problem-solving behaviors (Table 2). The highest ranking behaviors included sleeping more (87.5%); eating more (75%); crying (62.5%); and getting angry with self (62.5%). The middle ranking of coping behaviors used by poor copers included preparing to expect the worst; watching TV; going off alone to think; trying to get more information, listening to music; and working it out alone. The least used coping behaviors were: getting involved in hobbies, shopping, making plans, joining clubs, taking action, and daydreaming. CONCLUSION Differences were noted between women who coped poorly and women who coped well. The women who coped poorly had been married longer and had experienced more moves in their lifetimes. They did
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not work outside the home and they were not involved in volunteer activities. A larger percentage of their children were unhappy about moving compared with the children of women who coped well. Women who coped poorly had a similar number of life events compared with the group that coped well, but the events were viewed more negatively. The events rated negatively were losses such as death of close family members and children leaving home. The distance involved in international relocation would interfere with ability to be near family members during times of crisis, such as death or illness. Women who coped well had a more positive and intense response to life events, thus supporting Werkman et al.'s (1981) and Fontaine's (1983) suggestions of the need for a positive attitude toward the situation. The coping behaviors used by the two groups were markedly different. Women who coped poorly used passive behaviors, such as eating, sleeping, crying, watching TV, getting angry at self and others, and expecting the worst. Women who coped well used active behaviors, such as problem solving, seeking support from family and friends, using humor, getting involved in creative and community outlets, and not worrying. Renshaw (1976) identified the need for involvement in decision-making and the women who coped well in this study used problem-solving or decision-making behaviors. Based on the findings from this study, I make suggestions for women who make international moves and for health care providers who counsel these women. The internationally relocated woman needs to build relationships in the new community through community involvement and to use hobbies as a way of contacting people of similar interests. An open attitude, a sense of humor, and plans to maintain contact with family remaining behind can assist in adjusting to relocation. Inherent in relocation stress are many complexities. Using the coping framework, the health practitioner who functions as a consultant to corporations and has access to mobile families could talk with families and assess the difficulty of the move. The health care provider could then act in various capacities to provide information about relocation that would help and could make referrals as needed to other existing support services. Table 3 outlines a relocation stress assessment according to Puskar and Caffo (1986) for health care providers. An employee who perceives the move positively, copes well with stress, and has a support network in place will in all probability do very well in this move. An employee, on the other hand, who has mixed or negative feelings about the job or who has additional pressures such as marital stress, a sick parent who will be left, or a child going through a difficult time is probably going to experience more severe stress in the move. If one adds limited coping skills and little or no support, this becomes a high
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Table 3. Factors Used to Assess Relocation Adaptation
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Factor Family perceptions about the move Number of previous moves Benefits or drawbacks of this move Most difficult aspects View of new location Who in the family will move easily and who will move with difficulty Other life stresses What else is going on Development tasks of children Illness or injury Concerns about job Coping skills How does the person or family usually cope with stress How effective is the usual coping strategy(s) What is the person or family currently doing to cope with the move What is missing or needed Support system Who is assisting the person or family in getting ready for the move Family Friends Company Community resources Are there support systems in the new locale (health care providers may have some information to give here) Company or military network Newcomers or Welcome Wagon Family Friends Note. Adapted from Puskar, K., & Caffo, S. (1986). Relocation: A corporate employee balancing act. Mobility 7(1), 45-47.
risk situation where the possibility of developing physical or emotional problems exists. Regardless of where the family falls on the stress continuum, the health care provider can give vital information and support. Puskar and Caffo (1986) suggest four roles: buffer, transition support, networking, and referral as ways of viewing how health care providers might function. In the buffer role, the health care provider can lessen family stress by listening and acting when and where appropriate. When the health care provider functions in the transition support role, she or he educates
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the family about the relocation process and coping strategies. The health care provider may conduct workshops on relocation prior to leaving and emphasize phases of relocation, effects of the move on children of different ages, and problems and dilemmas women (or spouses) will probably face. The transition support role involves providing an advice list on relocation skills to the family and providing helpful hints on children's coping to the parents. The age group of each child will determine what kind of support is given. The networking role refers to the health care provider being a member of the family's network during the move and suggesting sources of networking in the new locale (such as schools, churches, Newcomers, Welcome Wagon, or a company network). In the referral role, the health care provider makes appropriate referrals to mental health agencies when the assessment indicates that a crisis is imminent. Relocation is a life event that can trigger feelings of insecurity and loneliness associated with separation. Adaptation is marked by tolerance to separation from old friends, formation of new friendships and social networks, and acceptance by the community. Health care providers aware of this process can be supportive and assist the woman in relocation adaptation. The data suggest that certain internationally relocated women are at risk for developing emotional distress. Health care providers need to be aware of such women at risk. Effective coping behaviors identified in this study are strategies health care providers can offer in counseling clients. Health care providers can teach clients about the need to establish social relationships with friends and organizations to combat the loneliness of separation. In addition to teaching, health care providers can offer the use of support groups aimed at relocation adjustment. Such groups can focus on the complexities inherent in transition and discuss perceptions of the event, coping behaviors, infringement of other life stresses during the relocation, and importance of involvement in reestablishing the social network.
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Ewing, J. (1984). Detecting alcoholism: The CAGE questionnaire. Journal of the American Medical Association, 252(14), 1905-1906. Fontaine, C. M. (1983, March/April). International relocation: A comprehensive psychological approach. EAP Digest, pp. 188-192. Fried, M. (1963). Grieving for a lost home. In L. Duhl (Ed.), The urban condition (pp. 151-171). New York: Basic Books. Gaylord, M. (1979). Relocation and the corporate family: Unexplored issues. Social Work, 24, 186-191. Godden, K. (1986). Employee relocation. AAOHN Journal, 34(2), 69-71. Gullotta, T. P., & Donahoe, K. C. (1982). Preventing family distress during relocation: Initiatives for human resource managers. Personnel Administrator, 27, 37-43. Gullotta, T. P., Stevens, S. J., Donahoe, K. C , & Clark, V. S. (1981). Adolescents in corporate families. Adolescence, 75(63), 621-627. Haight, G. G. (1983). Job-transfer survivors. Across the Board, 20(11), 20-26. Harris, P. R. (1986). Employees abroad: Maintaining the corporate connection. Personnel Journal, 65(8), 107-110. Jones, S. F. (1984). It's your move: Coping with relocation. Mobility, 5, 81-85. Labovitz, G. H. (1977, Summer). Managing the personal side of the personnel move abroad. S.A.M. Advanced Management Journal, pp. 26-39. Mallory, G., & Peebles, P. C. (1984). Coping mechanisms and support systems. Nursing Management: Critical Care Management Edition, 75(3), 42-c-f-g. Marisco, T., & Puskar, K. P. (1986). Family relocation: Helping children adjust. Pediatric Nursing, 72(2) 108-110. Mayfield, D., McLeod, G., & Hall, P. (1974). The CAGE Questionnaire: Validation of a new alcoholism screening instrument. American Journal of Psychiatry, 131, 1121-1123. Olive, L. E., Kelsey, J. E., Visser, M. J., & Daly, R. T. (1976). Moving as perceived by executives and their families. Journal of Occupational Medicine, 18, 546-550. Puskar, K. R. (1986, Spring). The usefulness of Mahler's phases of the separation-individuation process in providing a theoretical framework for understanding relocation. Maternal-Child Nursing Journal, 75(1), 15-22. Puskar, K. R. (1980). Reactions of women to a geographic move resulting from husband's job transfer. Unpublished doctoral dissertation, University of Pittsburgh, Pittsburgh, PA. Puskar, K. R., & Caffo, S. (1986). Relocation: A corporate employee balancing act. Mobility, 7(1), 45-47. Renshaw, J. R. (1976). An exploration of the dynamics of the overlapping worlds of work and family. Family Process, 15, 143-165. Rodriquez, A. R. (1976). The family in the military community: Issues for the military psychiatrist. Military Medicine, 145, 316-319. Sarason, I. G., Johnson, J. H., & Siegel, J. M. (1978). Assessing the impact of life changes: Development of the Life Experience Survey. Journal of Consulting and Clinical Psychology, 46(5), 932-943. Seidenberg, R. (1975). Moving on to what? Mental Hygiene, 59(1), 6-11. Shaw, J. A., & Pangman, J. (1975). Geographic mobility and the military child. Military Medicine, 144, 413-416.
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Sidle, A., Moos, R., Adams, J., & Cady, R. (1969). Development of a coping scale. Archives of General Psychiatry, 20, 226-232. The trials of being married to an executive. (1983, October). International Management, pp. 73-79. Weiss, R. S. (1973). Loneliness: The experience of emotional and social isolation. Cambridge, MA: MIT Press. Werkman, S., Farley, G. K., Butler, C., & Quayhagen, M. (1981). The psychological effects of moving and living overseas. Journal of the American Academy of Child Psychiatry, 20, 645-657. Viney, L. L., & Brazely, P. (1977). The affective reactions of housewives to community relocation. Journal of Community Psychology, 5, 37-45. Zuckerman, M. (1960). The development of an affect adjective check list for the management of anxiety. Journal of Consulting Psychology, 24(5), 457-462. Zuckerman, M., & Lubin, B. (1965). Manual for the multiple affect adjective checklist. San Diego: T. S. Publishers.
ISSN: 0739-9332 (Print) 1096-4665 (Online) Journal homepage: http://www.tandfonline.com/loi/uhcw20
International relocation: Womens’ coping methods Kathryn R. Puskar DrPH, RN, CS To cite this article: Kathryn R. Puskar DrPH, RN, CS (1990) International relocation: Womens’ coping methods, Health Care for Women International, 11:3, 263-276, DOI: 10.1080/07399339009515897 To link to this article: http://dx.doi.org/10.1080/07399339009515897
Published online: 14 Aug 2009.
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Date: 06 November 2015, At: 05:40
INTERNATIONAL RELOCATION: WOMENS' COPING METHODS Kathryn R. Puskar, DrPH, RN, CS
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School of Nursing, University of Pittsburgh
This article focuses on how corporate and military wives cope with international relocation. Specifically, the coping behaviors of women who exhibited signs of depression and anxiety and those women who did not in a convenience sample of 28 military and corporate women were studied. Six instruments were used: (a) the Relocation Survey, (b) the Beck Depression Inventory, (c) the Multiple Affect Adjective Check List, (d) the CAGE Questionnaire, (e) the Sarason Life Experience Survey, and (f) the Coping Questionnaire. Coping and adaption formed the conceptual framework. The findings revealed that women who coped well used active coping behaviors and women who coped poorly used more passive coping behaviors. This study offers some direction for health care providers who may use anticipatory guidance and counseling for women prior to international moves.
My purpose in writing this paper was to examine how corporate and military wives cope with international relocation. My personal relationships with families who experienced an international move suggest that there are unique aspects in moving to a foreign country. Women who move because of their husbands' careers expressed frustration over the unavailability of jobs and feeling isolated from family and friends. Relocation can create physical, emotional, and social distress, all potential health problems that concern health care providers. Therefore, in this study I addressed the profiles of women who cope well versus those who cope poorly with an international move.
This study was supported by the Division of Nursing, Nursing Research Emphasis Grant R21NU01012-01. Health Care for Women International 11:263-276, 1990 Copyright © 1990 by Hemisphere Publishing Corporation
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While much has been written on relocation in general, there has been little research done specifically on international relocation. The two areas examined in this review are: (a) coping with relocation, and (b) international relocation. Researchers on relocation have looked at its impact on families (Brett, 1982; Shaw & Pangman, 1975). Brett found mobile families less satisfied with social relationships than nonmobile families. Shaw and Pangman, in a study of military families, found no significant relationship between emotional and behavioral problems and the frequency of mobility. Families that identified themselves highly with the organization were more able to adapt to mobility. Families experience the loss of community—familiar places and friends (Jones, 1984; Viney & Brazely, 1977). Gaylord (1979) and Seidenberg (1975) found that the wife loses a sense of self-worth and identify, while the husband maintains an identity through his job. There are factors that make international relocation different from other kinds of relocation. International relocation has a cross-cultural impact (Harris, 1986; Fontaine, 1983). Forms of communicationlanguage, TV, telephone, and newspapers—are different. Housing and school systems often are not comparable with American ones. Job opportunities are unavailable to the wife because of lack of a work permit. Familiar everyday chores, such as banking, paying bills, driving a car, heating the home, and going to movies, have to be relearned in a different culture. The distance from social support systems creates a greater emotional dependency on nuclear family members. The distance also creates a feeling of isolation from extended family and friends. Isolated from family and friends, the wife seeks emotional support within the family. The husband's job often keeps him away from home for long hours, leaving the major responsibilities for the move to the wife (Olive, Kelsey, Visser, & Daly, 1976). She is left with the responsibility of getting the family settled into the new location and softening the move experience for children while the husband's job creates demands for him. The wife is a key figure in how the entire family copes with relocation. When children have difficulties adjusting, it is often a reflection of how the mother is coping (Werkman, Farley, Butler, & Quayhagen, 1981; Gullotta & Donahoe, 1982, Gullota, Stevens, Donahoe, & Clark, 1981). Families have a strong impact on the husband's job performance (Haight, 1983; Gaylord, 1979; Renshaw, 1976; Labovitz, 1977). If the family adjusts to the new environment, then the husband can maintain his focus on the job rather than be distracted by family problems. When a family returns to their home country, an unexpected culture shock is experienced (Labovitz, 1977; Fontaine, 1983). Culture shock covers all the feelings and behaviors of people who have moved to unfamiliar countries (Brink & Saunders, 1976, p. 127). The basic stress
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for the family is the abrupt transition. Brink and Saunders (1976) identify five causes of stress inherent in culture shock: communication, isolation, mechanical differences, custom differences, and attitude or belief differences. When these causes of stress are present at the same time, the impact is magnified and culture shock results. The international experience may not be of interest to family and friends because they cannot relate to the experience (Fontaine, 1983). The husband, because of the pressures of his new job, may become angry, frustrated, and concerned over his career, leaving family responsibilities to the wife (Labovitz, 1977). So a return home from an international move creates stress requiring readjustment to the new environment. An article entitled "The Trials of Being Married to an Executive" (1983) in International Management presents a survey of executives' spouses in 13 countries. The researchers found the wives to be overburdened with the domestic details of life, a sounding-board for their husbands' problems, and generally content with the corporate lifestyle except for the constant threat of relocation. Foreign relocation was identified as a major problem of being married to an executive. Werkman et al. (1981) examined the psychological effects of foreign relocation on the adolescent. They found that the relocated teenagers were more self-reliant but less intimate in interpersonal relationships, and that these teenagers used a positive attitude as a coping strategy. International relocation requires the family to restructure life in a new environment and use involvement in decision-making and moving activities as a way of coping (Renshaw, 1976). Labovitz (1977) interviewed executives who felt unprepared for the international experience due to a lack of pre-departure counseling. Families felt isolated upon their immediate arrival at the international assignment. The overall satisfaction of international assignments was related to perceived company support and family integration rather than to location or length of stay. A positive international experience was identified when: (a) the wife became actively involved in the local community, (b) schools met parental expectations of quality, and (c) the husband maintained regular work hours and participated in family vacations and other activities. Fontaine (1983) described the selection phase, pre-departure phase, on-site adjustment phase, and the repatriation phase in an international relocation firm's approach to employees. Coping behaviors for successful adaptation were: (a) a positive attitude toward the experience, (b) involvement by the wife in the community, and (c) development of social relationships. Harris (1986) identified assessment, orientation, onsite support, re-entry counseling, and use of a native contact person to assist family adjustment in foreign assignments. Use of support groups, educational programs, and individual counseling has been advocated to
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ease relocation stress (Godden, 1986; Puskar, 1980; Marsico & Puskar, 1986).
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CONCEPTUAL FRAMEWORK This conceptualization of relocation stress in women was influenced by the work of Fried (1963), Weiss (1973), and Mallory and Peebles (1984). Fried studied families who experienced forced relocation. He suggested that the intensity of the grief reaction to the loss of residence was a function of social support, the person's previous commitment to the area, and positive feelings about neighbors. Weiss (1973) identified social isolation as a major aftermath of transition states. Social isolation is a consequence of a lack of a network of involvement with peers, such as fellow workers, neighbors, or friends. Mallory and Peebles (1984) developed the Coping Questionnaire, which included 58 short-term and 25 long-term coping behaviors. These behaviors were adapted from Sidle's (1969) and Bell's (1977) coping scales. Sidle and Bell reported that "a combination of both short- and long-term mechanisms is important in dealing with stress" (Mallory & Peebles, 1984, p. 42-C). METHOD A convenience sample of 28 internationally relocated military and corporate wives was obtained from a larger study involving 100 relocated women through a survey research design. Data were collected on relocation, depression, anxiety, coping, alcoholism, and other life experiences. A relocation was defined as an international move from the United States made within the past year. INSTRUMENTS Since no instrument existed, the Relocation Survey1 was developed by the investigator from a literature review to collect data on the experience of moving. The Relocation Survey (RS) was originally developed for relocated corporate women and later adapted for relocated military women (Puskar, 1986). The RS has been utilized with 350 women aged 35 to 70 years. It includes 44 items with five dimensions of relocation stress. The dimensions are: (a) structures of the move—type, reason,
1
Copyright © 1985 by Kathryn R. Puskar.
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distance, and cost; (b) support system—relatives, friends, and clubs; (c) reactions to move; (d) coping strategies; and (e) advice for others. Content validity of the RS has been established. The RS takes 30 minutes to complete. The Beck Depression Inventory consists of 21 categories of depressive symptoms and attitudes. Each category has a series of four to five evaluative statements, which are ranked according to severity. The items were chosen based on overt behavioral manifestations of depression (Beck, 1972). The total score range is from 0 (nondepressed) to 63 (severely depressed). The internal consistency of the BDI was determined through comparison of scores for each of the 21 categories with the total score for each individual. "With the use of the Kruskal-Wallis non-parametric analysis of variance by Ranks, it was found that all categories showed a significant relationship to the total score for the inventory" (Beck, 1972, p. 565), with a significance beyond the .0001 level for all categories except weight loss, which was significant at the .01 level. The split-half reliability with a Spearman-Brown correction was .93. A test-retest method was used to determine the validity of the BDI. The Multiple Affect Adjective Checklist (MAACL) is a list of 132 adjectives that describe the emotional state of a person on any given day (Zuckerman, 1960). It is a self-administered questionnaire that has three subscales—depression, anxiety, and hostility. The MAACL has documented reliability and validity scores and has been used with a wide range of subjects. It takes ten minutes to complete. Scoring consists of assigning one point to all positive items checked and one point to all negative items not checked. The sum of the two scores indicates the level of the participant's anxiety. The validity has been documented in numerous studies (Zuckerman & Lubin, 1965). The reliability has been found with p < .01 internally, .72, .79, and .73 for measurement of anxiety. The range for normal anxiety is 0-7; mild anxiety, 8-11; moderate to severe anxiety, 12-14; and severe anxiety, 15-21. The Coping Questionnaire developed by Mallory and Peebles consisted of 50 behaviors that include long-term and short-term coping behaviors (Mallory & Peebles, 1984). The 50 items were rated by the participants as to extent of use. The four question CAGE Questionnaire, developed by Ewing, has been recognized as an efficient screening device for alcoholism. Preliminary studies found this questionnaire to be a sensitive indicator of covert drinking problems. One yes response to four questions calls for further inquiry. Two or three yes responses indicate a high index of suspicion (Ewing, 1984; Mayfield, McLeod, & Hall, 1974). The Life Experience Survey (Sarason et al., 1978) measures the number of life events during the past 6 to 12 months and the intensity of the
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event for the respondent. Respondents rate their reaction to the event on a scale from —3 (negative impact) through 0 (neutral impact) to + 3 (positive impact). A total score is obtained indicating the sum of positive and negative changes.
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FINDINGS The 28 women in this study ranged in age from 24 to 50, with an average age of 34, and had an average of 14.6 years of education. The average age of their husbands was 37. Most of the husbands had a college education. Of the military women, most husbands were officers. Of the corporate women, husbands mainly had management positions, such as vice president, buyer, and controller. The family incomes ranged from $20,000 to $65,000. Protestants made up over half of the sample; Catholics made up one fourth; one fourth expressed no religion; one woman was Methodist; and one was Mormon. In all cases the husband was seen by the wives as supportive of the family during a move. He oriented the wife to the area, assisted in house-hunting, and handled the paperwork of selling the home. What was liked best about moving included learning about a new area, making new friends, and getting a new house. Things liked least about moving were separation from friends and family; the physical aspects of moving; temporary living arrangements; separation from husband; and dissatisfaction with specific aspects of the new area, such as location, climate, or house. Strategies used to overcome feeling like a stranger in the new area included: learning the area, becoming friends with neighbors, joining clubs, doing volunteer work, and returning to school. Forty-two percent of the women thought it took 6 to 12 months to feel integrated into the community. The women offered the following advice to other women who move frequently: make friends; get involved in the community; maintain an open attitude; learn about the area and obtain pertinent information, such as how to obtain a driver's license; enjoy the experience; be organized; learn the language; look at separation from family as temporary; and try to make arrangements to visit family. The women were divided into two groups, those who coped well with the move, n = 20 or 71.4%, having scores of 0 to 9 on anxiety and depression, and those who coped poorly with the move, n = 8 or 28.5%, having scores of 10 and above on anxiety and depression. Eight individuals exhibited mild to severe depression and mild to moderate anxiety. The women experienced a range of 4 to 14 additional life events, with an average of 7.6 events. The number of positive responses for life events ranged from 0 to 26, with an average of 6.8. Negative
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Table 1. Profile of Coping Behaviors in Women Who Experience International Relocation
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Demographic profile Age Education in years Unemployed Husband's education Number of moves Prior to marriage After marriage With military Overseas Life events Positive responses Negative responses Intensity
Women who coped well
Women who coped poorly
35.5 14.8
36.25
12
15.85 4.95 5.4
4.29 1.18 6.35 8.65 7.05 15.7
14 8 16
2.75 9.25 9.85 2.42 6.25 2.37 10.62 10.5
responses to the events ranged from 0 to 24, with an average of 8.1. The findings did not address use of drugs but did examine alcohol use. The CAGE Questionnaire showed no evidence of alcoholism in the sample. The use of prescription drugs was not examined in this study but could be addressed in future research. Women Who Coped Well The 20 women who coped well with the move were approximately 35 years old with 14.8 years of school (Table 1). Thirteen women were unemployed, four were employed full-time, and three were employed part-time. The husbands' average age was 36 with 15.85 years of education. The average number of moves for the women was 4.95 prior to marriage, 5.4 after marriage, and 4.29 with the military. The average number of overseas assignments was 1.18. A large portion of the group had returned to the United States from a foreign assignment. Women who coped well participated in military, social, church, and school clubs. The average number of life events for the women who coped well was 6.35. Positively scored events averaged 8.65. Negatively scored events averaged 7.05. Events rated positively were a change in living conditions, change in husband's work, decreased eating, outstanding personal achievement, increased family closeness, increased social ac-
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K. R. Puskar Table 2. Coping Behaviors of Women Who Experience International Relocation Coping behavior
%
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Women who coped well Seeking information Talking with friends Looking for humor Going off alone to think Making alternative plans Changing situation Getting involved in hobbies Talking with relatives Reading Women who coped poorly
50 45 45 45 45 40 35 25 25
Sleeping more Eating more Crying Getting angry with self Expecting the worst Watching TV Working it out alone Listening to music Changing reaction to move Finding a hobby Shopping
87.5 75 62.5 62.5 59 50 50 50 50 37.5 37.5
tivities, a changed work situation for the wife, and increased church activities. Negatively rated events included a decrease in social activities, separation from spouse, serious illness or injury of a close family member, a change in the work situation, and a decrease in financial status. This group of women did not focus highly on any specific coping behaviors, but rather identified various behaviors used to cope with the situation (Table 2). The breakdown of coping behaviors was: 50% got more information; 45% talked it out with friends, looked for the humorous aspects of the situation, went off alone to think, or made alternative plans; 40% tried to change the situation; 35% got involved in hobbies; 30% talked it out with relatives; 25% read for pleasure, cleaned, played with pets, didn't worry, got involved in clubs, decided upon an action, listened to music, worked it out alone, changed self and reaction to the situation, learned new skills, or got angry at others; 20% ate more, watched TV, read books, got angry with self, or went to the movies.
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Women Who Coped Poorly The profile of the eight women who coped poorly with the move is seen in Table 1. Their average age was 36 with 14 years of education. All were homemakers. The husbands' mean age was 34, with an educational average of 16 years. The number of moves made were 2.75 prior to marriage; 9.25 after marriage; and 9.85 with the military. The number of overseas assignments for this group was 2.42. Most of these women had moved to a foreign country. Most of these women participated in military, social, and church organizations. One woman did not participate in any organization. Women who coped poorly with the move had an average occurrence of 6.25 life events in the past year, with average scores of 2.37 positive and 10.62 negative. Seventy-five percent of this group viewed relocation as negative. The events that scored negatively included decreased closeness of family members; change in living conditions; serious illness, injury, or death of a close family member; change in the work situation; decrease in social activities; movement of a son or daughter out of the home; and overeating. The only positively rated event for this group was change in the husband's job. The wives' initial reactions to the move were happiness, excitement, and a preoccupation with keeping busy. The husbands' initial reactions to the move were also excitement and happiness. Eleven children, ranging in age from 3 to 18, moved with the families. Children ages 3-12 reacted to the move with happiness. Teenagers were unhappy; children in their early 20s did not move with the family. The women who coped poorly exhibited more diversional activities and fewer problem-solving behaviors (Table 2). The highest ranking behaviors included sleeping more (87.5%); eating more (75%); crying (62.5%); and getting angry with self (62.5%). The middle ranking of coping behaviors used by poor copers included preparing to expect the worst; watching TV; going off alone to think; trying to get more information, listening to music; and working it out alone. The least used coping behaviors were: getting involved in hobbies, shopping, making plans, joining clubs, taking action, and daydreaming. CONCLUSION Differences were noted between women who coped poorly and women who coped well. The women who coped poorly had been married longer and had experienced more moves in their lifetimes. They did
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not work outside the home and they were not involved in volunteer activities. A larger percentage of their children were unhappy about moving compared with the children of women who coped well. Women who coped poorly had a similar number of life events compared with the group that coped well, but the events were viewed more negatively. The events rated negatively were losses such as death of close family members and children leaving home. The distance involved in international relocation would interfere with ability to be near family members during times of crisis, such as death or illness. Women who coped well had a more positive and intense response to life events, thus supporting Werkman et al.'s (1981) and Fontaine's (1983) suggestions of the need for a positive attitude toward the situation. The coping behaviors used by the two groups were markedly different. Women who coped poorly used passive behaviors, such as eating, sleeping, crying, watching TV, getting angry at self and others, and expecting the worst. Women who coped well used active behaviors, such as problem solving, seeking support from family and friends, using humor, getting involved in creative and community outlets, and not worrying. Renshaw (1976) identified the need for involvement in decision-making and the women who coped well in this study used problem-solving or decision-making behaviors. Based on the findings from this study, I make suggestions for women who make international moves and for health care providers who counsel these women. The internationally relocated woman needs to build relationships in the new community through community involvement and to use hobbies as a way of contacting people of similar interests. An open attitude, a sense of humor, and plans to maintain contact with family remaining behind can assist in adjusting to relocation. Inherent in relocation stress are many complexities. Using the coping framework, the health practitioner who functions as a consultant to corporations and has access to mobile families could talk with families and assess the difficulty of the move. The health care provider could then act in various capacities to provide information about relocation that would help and could make referrals as needed to other existing support services. Table 3 outlines a relocation stress assessment according to Puskar and Caffo (1986) for health care providers. An employee who perceives the move positively, copes well with stress, and has a support network in place will in all probability do very well in this move. An employee, on the other hand, who has mixed or negative feelings about the job or who has additional pressures such as marital stress, a sick parent who will be left, or a child going through a difficult time is probably going to experience more severe stress in the move. If one adds limited coping skills and little or no support, this becomes a high
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Table 3. Factors Used to Assess Relocation Adaptation
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Factor Family perceptions about the move Number of previous moves Benefits or drawbacks of this move Most difficult aspects View of new location Who in the family will move easily and who will move with difficulty Other life stresses What else is going on Development tasks of children Illness or injury Concerns about job Coping skills How does the person or family usually cope with stress How effective is the usual coping strategy(s) What is the person or family currently doing to cope with the move What is missing or needed Support system Who is assisting the person or family in getting ready for the move Family Friends Company Community resources Are there support systems in the new locale (health care providers may have some information to give here) Company or military network Newcomers or Welcome Wagon Family Friends Note. Adapted from Puskar, K., & Caffo, S. (1986). Relocation: A corporate employee balancing act. Mobility 7(1), 45-47.
risk situation where the possibility of developing physical or emotional problems exists. Regardless of where the family falls on the stress continuum, the health care provider can give vital information and support. Puskar and Caffo (1986) suggest four roles: buffer, transition support, networking, and referral as ways of viewing how health care providers might function. In the buffer role, the health care provider can lessen family stress by listening and acting when and where appropriate. When the health care provider functions in the transition support role, she or he educates
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the family about the relocation process and coping strategies. The health care provider may conduct workshops on relocation prior to leaving and emphasize phases of relocation, effects of the move on children of different ages, and problems and dilemmas women (or spouses) will probably face. The transition support role involves providing an advice list on relocation skills to the family and providing helpful hints on children's coping to the parents. The age group of each child will determine what kind of support is given. The networking role refers to the health care provider being a member of the family's network during the move and suggesting sources of networking in the new locale (such as schools, churches, Newcomers, Welcome Wagon, or a company network). In the referral role, the health care provider makes appropriate referrals to mental health agencies when the assessment indicates that a crisis is imminent. Relocation is a life event that can trigger feelings of insecurity and loneliness associated with separation. Adaptation is marked by tolerance to separation from old friends, formation of new friendships and social networks, and acceptance by the community. Health care providers aware of this process can be supportive and assist the woman in relocation adaptation. The data suggest that certain internationally relocated women are at risk for developing emotional distress. Health care providers need to be aware of such women at risk. Effective coping behaviors identified in this study are strategies health care providers can offer in counseling clients. Health care providers can teach clients about the need to establish social relationships with friends and organizations to combat the loneliness of separation. In addition to teaching, health care providers can offer the use of support groups aimed at relocation adjustment. Such groups can focus on the complexities inherent in transition and discuss perceptions of the event, coping behaviors, infringement of other life stresses during the relocation, and importance of involvement in reestablishing the social network.
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