Be/m. Rex. Thu. Vol. 29,No. 2,pp.105-112, 1991 Printed in Great Britain. All rights reserved
SELF-REPORTED
0005-7967/91 $3.00+ 0.00
Copyright G 1991Pergamon Pressplc
FEARS (FSS-II) OF SUBJECTS 50 YEARS AND OVER
AGED
ANDR~E LIDDELL,‘.* DAVID LOCKER’ and DAVID BURMAN’ ‘Department of Psychology, Memorial University of Newfoundland, St John’s, Newfoundland, Canada AlB 3X9 and 2Department of Community Dentistry, University of Toronto, Toronto, Canada (Received 9 October 1990)
Summary-From
studies of fears in children and adolescents, it was concluded that fears decrease with age and that girls show more fears than boys at the approach of adolescence. Community studies of adult fears as well as psychopathology have suggested a decrease in fears and phobic and anxiety symptoms with age. However, little is known of the distribution of fears in older adults. In view of this, the FSS-II was administered to a group of individuals aged 50yr and over, as part of a larger epidemiological investigation of the oral health and treatment needs of older adults within Metropolitan Toronto. The results supported the hypothesis that the gender differences which ermerge at adolescence hold up into old age. The predicted age decrease in fearfulness was also supported.
iNTRODUCTION More
is known
about
the fears
of children
and adolescents
than
those
of individuals
at the upper
of the life span. In the most comprehensive review of studies of fears, phobias and rituals, Marks (1987) concluded that it is common for young children to show specific fears of great intensity. These come and go for no obvious reason and are not related to other pathology. It was also observed that fears decline with age, especially in boys, who show fewer fears than girls at the approach of adolescence. Agras, Silvester and Oliveau (1969) found three different patterns of incidence and prevalence when they interviewed a representative sample of individuals living in the Greater Burlington area of Vermont regarding 40 commonly feared situations. Fears of doctors, injections, darkness, and strangers showed a high childhood incidence but a sharply declining prevalence; fears of animals, heights, storms, enclosed places and social situations also showed a high childhood incidence but a slowly declining prevalence. The third pattern applied to fears of death, injury, illness and separation which showed a slowly declining incidence extending to the sixth decade and a prevalence peak in the late adult life. From a 133 fear items questionnaire administered to Ss aged between 15 and 89 and residing in northwestern Indiana and northeastern Illinois, Kirkpatrick (1984) noted different ‘intense’ fear pattern between men and women. Each fear item was rated on a 7-point scale from l(none) to 7(terror). A fear was deemed ‘intense’ when the percentage of terror responses to an item was > 10% in one of six age categories (15517, 18-24, 25-34, 35-44, 45-54 and 55 and over). Women admitted to significantly more intense fears than men and, while men’s terror responses generally showed a decrease after the youngest age groups to a very low levels in older Ss, women showed four different patterns of responding over the age span. In women Ss, terror decreased for untimely or early death, death, being punished by God, and dead people but increased for deep water, looking down from high buildings, fire, and strange dogs. In addition, other intense fears increased than decreased while others decreased than increased over the life span: death of a loved one, illness or injury to loved ones, and ideas of possible homosexuality decreased than increased; roller coasters, harmless snakes, swimming alone, and high places on land increase than decreased. The above studies were conducted with non-psychiatric populations and, as Kirkpatrick (1984) cautioned, intense fear is not to be equated with phobia. Nevertheless, similarities emerged from community studies of phobic and anxiety disorders (or symptoms) in showing a greater prevalence of such problems in women than men and greater pathology during middle life than in the very young or old (Marks, 1987). For instance, in a large general survey conducted in the U.S.A. by end
*To whom BRT m--A
all correspondence
should
be addressed.
105
106
ANDR~E LIDDELL~~ al.
interviewers who obtained data by means of a symptom checklist, it was found that phobias, other than agoraphobia, where checked most often by those under the age of 35 yr (Ulenhuth, Balter, Mellinger, Cisin & Clinthorpe, 1983). However, no study has focused exclusively on the distribution of fears among older adults. Fenr surrey schedules
The construction of fear survey schedules stemmed from a wish to identify and evaluate the prevalence of specific fears. It is not surprising to find a close connection between this type of fear assessment and behaviour therapy. A decade after the first formal reference was made to a fear survey schedule (FSS-I) by Lang and Lazovik (1963), Hersen (1973) reviewed its development. The FSS-I was comprised of 50 common fears based on an unpublished study by Akutagawa (1956). It was replaced by the FSS-III designed primarily for clinical use as an adjunct to behavioural treatment (Wolpe & Lang, 1964). The 7.5 items of the FSS-III were divided into the following subcategories: animal, tissue damage/illness, death or associated stimuli, classical phobias, social stimuli, noises, and miscellaneous others. The reason the FSS-II postdated the FSS-III was that its author (Geer, 1965) had carried out initial work on that scale before the publication of the FSS-III, Unlike its predecessor, the FSS-II was designed primarily for use in research. It consists of 51 items empirically derived to show high internal consistency. Geer (1965) reported a low negative correlation with social desirability and items of the measure were validated by comparing low-, medium-, and high-fear Ss on behavioural avoidance tests. The available norms and subsequent data for the FSS-II were derived primarily from college students. During the following years, a number of other fear schedules were devised by augmenting or combining existing schedules. Factor analyticaf studies of the various versions of fear schedules have shown considerable similarities and the number of major factors identified appeared to be a function of the number of items included in the analyses. When factor analysis was carried out on the responses of men and women treated separately, the factors isolated appeared somewhat different (Hersen, 1973). For instance, Bernstein and Allen (1969) using the FSS-II found that, for male college students, five factors accounted for 61% of the variance-death and illness (16.23%), social interaction (12.48%), negative social evaluation (11.73%), live organisms (11.03%), and violence (9.51 Oh); for females college students, five factors emerged according for 61.7% of the variance-social interaction (13.64%), death-illness-injury (13.32%), live organisms (12.61%), negative social evaluation (11.71%), and water (10.46%). Previously, Rubin, Katkin and Weiss (1968) had also reported gender differences in factors extracted after administering the FSS-II to college students. However, they did not specify the amount of variance accounted for each factor. In a recent comparison of Fear Survey Schedules derived from the FSS-III, Arrindell (1987) concluded that there is considerable overlap between the measures in question. He noted that these schedules had 75 items in common, 51 of which were said to be distributed across five robust scales: social fears, agoraphobic fears, bodily injury, death and illness fears, fears of sexual and aggressive scenes, and fears of harmless animals. Hersen (1971) administered the FSS-II and the FSS-III to the same group of psychiatric in-patients. Correlations between the results were found to be significant. Therefore, it appears that, under certain circumstances, FSS-II and FSS-III can be used interchangeably making them both useful tools to study human fears. In view of the dearth of information regarding the fears of older individuals, it was decided to target these individuals with regard to the intensity and components of their fears. From the available evidence, it was hypothesized that fears would diminish with age in such individuals but that women would show more fearfulness than men regardless of age. METHOD Ss who took part in a large epidemiological investigation of the oral health and treatment needs of older adults within the Metropolitan area of Toronto were asked to complete the FSS-II as part of a longer series of questionnaires designed to evaluate dentat attitudes and experiences, including dental anxiety (Locker, Liddell & Burman, 1991). The FSS-II was used as a control to partial out the effect of general fearfulness from that of dental anxiety. Identification of Ss was done by means of a telephone survey based on random digit dialling (Dillman, 1978). Where the randomly
Self-reported
fears (FSS-II)
107
generated telephone numbers identified a private household containing more than one person aged 50 yr or over, a randomization procedure was used to select one of them as S. Initially, Ss were asked to complete a short telephone interview aimed at obtaining basic sociodemographic data along with information regarding oral status (dentate vs edentulous). During this first telephone interview, they were also asked to attend a clinic or be visited for a detailed personal interview and clinical examination, and to complete the questionnaire which included the FSS-II. If Ss refused to participate in the examination, they were nevertheless asked for their cooperation with the dental attitudes and experiences questionnaire which was subsequently mailed to them. Those who agreed to be examined were given the dental attitudes and experiences questionnaire at the time of the examination. All questionnaires were completed at home and returned by mail. RESULTS 2007 Individuals completed the telephone interviews from 2577 households contacted and found to have an eligible member (Locker et al., 1991). A sample of 5 12 Ss over the age of 50 yr completed the FSS-II with enough information for analysis. Characteristics
of the sample
There were 212 men and 300 women. Their ages ranged between 50 and 89 yr with a mean age of 62.95 yr (SD = 8.42). Regarding martial status, 259 individuals were married or living with a partner, 102 were widowed, another 82 were separated or divorced, and 66 never married while three respondents did not provide this information. Regarding education, 24.9% had received less than high school education, 23.6% completed high school, another 20.8% had pursued some post-secondary education, 29.9% were university graduates, and 4 individuals did not return the information. Household income level was recorded in steps of $10,000 beginning with less than $10,000 and ending with more than $100,000; 5.9% lived with incomes less than $10,000, a further 46.1% had incomes between $10,000 and $50,000, 18.2% were in the $50,000 but less than $100,000 range, 6.4% in the $100,000 and above category, with 23.4% saying that they did not know or were unwilling to divulge the information. A total of 309 Ss were born in Canada while 203 others were not. They came from a variety of ethnic backgrounds with 53.3% from the U.K. The Ss were asked if they had a number of medical conditions including emotional disorders diagnosed by a doctor; 4% of Ss admitted to emotional disorders and one person left the question blank. FSS-II Total scores. Following from Geer (1965) a score of 1 was assigned to the response ‘none’ and the values 2-7 were consecutively assigned to the points on the scale described as ‘very little’, ‘a little’, ‘some’, ‘much’, ‘very much’, and ‘terror’. Scores obtained on each of the 51 items of the FSS-II were summed for each S and put into an ANOVA to test for the effect of sex and age (categorised as 50-64, 65-74 and 75+ yr) on general fearfulness (Fig. 1). Women scored significantly higher on the total FSS-II scores than men [F(l, 511) = 30.43, P < O.OOl]and there 200
180 z ;; 160 x l-l 7
140
z 120
100 65-74 Age(Yr)
Fig. 1. Distribution
of FSS-II
scores over age groups
by gender.
ANDRE& LIDDELL et al.
108
was a significant decrease in fears with age [F(2, 511) = 5.63, P < 0.011. There was a small but significant negative correlation between FSS-II scores and eduation (p = -0.21, P < 0.001) and income (p = -0.22, P < 0.001). The less educated and those with lower income levels tended to admit to more fears than the others. The scores of those who had been diagnosed as suffering from emotional disorders (Mean = 202.65; SD = 43.67) were significant higher than those who had not (Mean = 169.71; SD = 45.23) [F(l,510) = 11.68, P < O.OOl]. D@erences between individual items of the FSS-II. Some individuals omitted to rate some fears. However, the missing values appeared scattered evenly and made up only a small proportion of the answers on each fear item. The fears most often left blank referred to arguing with parents (12%), driving a car (4%), and losing a job (4%). It can be assumed that these items had less meaning for an older population than for the type of individuals on which the survey was standardized. On the majority of other fears, the response rate was over 98% ANOVAs were carried out with the scores of each of the fear items by sex and age (Table 1). There was a significant gender difference on 28 out of 51 fears, women scored higher than men on all but the fear of God. Thirteen fears significantly decreased with age. Fears on which there was a mean rating of 4+ denoting ‘much’ fear were listed by gender (Table 2). While women had more fears listed in that category (16) than men (9), Spearman’s p for the ranking of the 8 fears they had in common was 0.93 (P < 0.001). Means of fears exceeding 4 by age categories were similarly listed (Table 3). Seven fear items were to remain high in the 75+ yr group, namely, death of a loved one, illness/injury to loved ones, rollers coasters, being with drunks, auto accidents, seeing a fight, and snakes. Components
of fear
Factor analysis was carried out on the FSS-II responses of men and women taken separately. For men, 6 factors accounting for 49% of the total variance emerged: failure/negative evaluation, Table
I.
FSS-II items on which there is a significant gender and/or age ditTerence Sex
4
8 9 IO II
I2 13 14 15 19 20 21 23 24 25 26 27 28 30 31 33 34 35 36 38 39 41 42 43 44 45 46 47 48 50 51
Being a passenger in a car Dead bodies Suffocating Bang a passenger in a plane Worms Arguing with parents Rats and mice Life after death Hypodermic needles Being criticized Meeting someone for the first time Roller coasters Death Being in a light Crowded places Heights Bang a leader Swimming alone lll”ess Being with drunks Illness or injury to loved ones Driving a car Meeting authority Closed places Boating Spiders Thunderstorms God Snakes Speaking before a group Seeing a fight Death of a loved one Dark places Strange dogs Deep water Being with a member of the opposite sex Stinging insects Loosing a job Auto accidents
**
AK
* ** ***
**a ** *** ** 1 ** * *t* *** **
***
* ** *** *** * *** ** *** ** *** it* *** ***
‘M *** *** 111 * *** *** *a* * **:I ***
M indicates M higher than F: ‘P < 0.05; **P < 0.01; ***P < 0.001
1 **
Self-reported fears (FSS-II)
109
Table 2. FSS-II items on which mean of ratings exceeded 4 (much) by gender with rankings given items common to both
4 5 6 10 15 20 27 28 32 39 41 42 43 46 49 50 51
Suffocating Failing a test Looking foolish Rats and mice Roller coasters Being in a fight Being with drunks Illness or injury to loved ones Mental illness Snakes Speaking before a group Seeing a fight Death of a loved one Deep water Untimely or early death Loosing a job Auto accidents
Male
Female
4.55 (3) 4.08 (8) 4.14(7)
4.76 (4) 4. I I (7) 4.06 (8) 4.37 5.26 4.65 (5) 4.86 5.58 (2) 4.15 4.90 4.05 4.53 5.84(l) 4.39 4.52 (6)
4.20 (6) 5.28 (2)
5.60 (I) 4.22 (5) 4.15 4.53 (4)
5.23 (3)
animals, social interaction, water, agoraphobic symptoms, and death and dying (Table 4). On the other hand, women showed somewhat different factors accounting for 48.4% of the total variance: animals, failure/negative evaluation, agoraphobic symptoms, social interactions, death and dying, and personal loss (Table 5). DISCUSSION
The results supported the hypothesis that the gender differences which emerge at adolescence appear to hold up into old age. The predicted age decrease in fearfulness was also supported. It is unfortunately not possible to make comparisons between the total FSS-II scores of this sample and others based on undergraduate students, since education and income level appeared to influence levels of fear. Furthermore, methods of scoring had not been uniform in previous studies. However, the FSS-II demonstrated criterion validity in discriminating between individual with diagnosed emotional disorders and those who were not. Predictably, women scored higher than men on more than half of the fear items. Fear of being punished by God was also found to be higher in men than women by Kirkpatrick and Berg (1981). They explained this finding in terms of social acceptability. We agree that it may seem more acceptable to men to be ‘God fearing’ than to be afraid of small harmless animals. Conversely men’s image of God may be more frightening than that of women’s who may see a kinder and more forgiving God. This image may also be different according to type of religious teaching received but the data does not exist, in this study, for such comparisons. Of the 13 items seen to decrease with age, 7 related to death, illness, or injury suggesting that age and exposure bring adaptive resignation (maturity or realism) towards the inevitable. Similar fear were found to show a slowly declining incidence extending to the sixth decade by Agras et al. (1969) and a more accelerated decline by Kirkpatrick (1984) when studying intense fears only. Based on studies of the reaction Table 3. FSS-II
4 5 6 IO I5 20 27 28 32 39 42 43 46 49 50 51
items on which mean ratings exceeded 4 (much) by age groupings
Suffocating Failing a test Looking foolish Rats and mice Roller coasters Being in a fight Being with drunks Illness or injury to loved ones Mental illness Snakes Seeing a fight Death of a loved one Deep water Untimely or early death Loosing a job Auto accidents
I (50-64 yr)
2 (65-74 yr)
4.85 4.22 4.18
4.60
4.71 4.55 4.34 5.46 4.03 5.75 4.42 4.14 4.85
4.07 4.53 4.58 4.71 5.52 4.30 4.64 4.27 5.80 4.06 4.49 5.25
3 (75+ Yr)
4.80 4.57 5.22 4.20 4.27 5.45
4.40
ANDR~E LIDDELL et al.
110
Table 4. Factor
structure
of FSS-II
Factor
for males
Item
Factor
loading
I-Failurejnegative evaluation (27.5% of variance)
Failing a test Looking foolish Illness of injury to loved ones Being criticized Bemg misunderstood Making mistakes Death of a loved one Being in a fight Suffocating Mental illness Not being a success Arguing with parents
0.70 0.66 0.66 0.62 0.60 0.57 0.56 0.55 0.55 0.52 0.51 0.50
II-Animals (5.7% of variance)
Spiders Rats and mice Snakes Thunder Blood Worms
0.69 0.64 0.63 0.56 0.53 0.52
III-Social interaction (4.8% of variance)
Meetmg someone for the first time Meeting authority Being with a member of the opposite Being a leader Driving a car
0.68 0.64 0.59 0.58 0.53
IV-Water (4.4% of variance)
Boating Deep water Swimming alone
V-Agoraphobic symptoms (3.4% of variance)
Being alone Being a passenger Heights Crowded places
VI-Death and dying (3.1% of variance)
God Life after death Death Untimely or early death
Table 5. Factor
structure
0.54 0.53 0.52 0.50
in a car
0.65 0.58 0.56 0.50
for females
Item
I-Animals (27.6% of variance)
II-Failure/negative (5.3% of variance)
0.68 0.67 0.62
of FSS-II
Factor
sex
evaluation
Ill-Agoraphobic symptoms (5.0%) of variance)
Factor
loading
Spiders Snakes Stinging insects Rats and mice Dogs Worms Thunder
0.67 0.66 0.65 0.60 0.59 0.55 0.52
Looking foolish Failing a test Being critiazed Being misunderstood Making mistakes Not being a success Loosing a job
0.75 0.72 0.69 0.65 0.63 0.61 0.51
Heights Being a passenger Closed places Being a passenger Driving a car
0.57 0.56 0.54 0.54 0.53
in a plane in a car
0.71 0.68 0.62 0.60 0.54 0.53
IV-Social interaction (4. I % of variance)
Being a leader Meeting someone for the first time Speaking before a group Meeting authority Bang self-conscious Being with a member of the opposite
V-Death and dying (3.4% of variance)
Death Dead bodies Life after death
0.7 I 0.70 0.61
VI-Personal loss (3.0% of variance)
Injury or illness to loved ones Death of a loved one Auto accidents
0.75 0.71 0.60
sex
Self-reported fears (FSS-II)
111
of civilian population to air attacks during WW II (Rachman, 1978), Kirkpatrick (1984) also invoked an habituation paradigm to explain his results. Although women have more intense fears than men, the ranking of the most intense of these fears related to illness of death of loved ones for both sexes. These fears were also shown to remain strong into old age. Kirkpatrick (1984) accounted for a substantial proportion of adult age differences in fears by referring to what Rachman (1978) characterized as a sense of mastery or ‘control over the probability of reducing the likelihood of an aversive event and/or its consequences’ (Rachman, 1978, p. 10) and perceived probability and consequences. Kirkpatrick proposed the following explanation regarding the relationship between probability and consequences: “fear with increase with the increased probability that a rarely-occurring event will take place; furthermore, the greater the perceived aversiveness of the consequences of a feared event, the higher the fear” (Kirkpatrick, 1984, p. 147). Older individuals have little control over the lost of loved ones and such loses often cause more difficult adjustments than is required of younger individuals. These fears are also the ‘life events’ Holmes and Rahe (1967) found to be rated with greatest intensity and to need most readjustment. Of the other four fears which remained high throughout old age, the strength of fears of roller coaster and snakes may suggest an underlying biological basis since their logic cannot be considered as strong as that of the first mentioned fears. In any case, fairground operators have learned to case in on the fear of roller coaster and the mystique surrounding snakes appears universal. The stability of fears relating to being with drunks, seeing a fight, and auto accidents may be a function of the individual’s diminishing physical prowess (sense of mastery), making these situations even more threatening than they were previously. A prominent gerontologist, Atchley (1988) discussed how older individuals adapt to changes which come from aging. Some changes due to aging are gradual and require no new skills to adjust. However, others are likely to involve change in the individual’s situation and environment, in addition to changes to the self. Sudden discrete changes are those most taxing to one’s coping skills and perception of effectiveness. Understandably, these are the situations oider people seem to fear most. The factors which emerged from this study are similar to those of previous studies. There were parallels with three of the five fears reported by Arrindell (1987)-social fear, agoraphobic fears, and harmless animals. As with earlier studies, there were gender differences in the composition of the factors as well as with their relative importance. With both men and women, the first factor was seen to account for over half of the variance accounted for in the analysis. Other studies with younger Ss have reported variances relatively evenly distributed across their factors (Bernstein & Allen, 1969). The factor which accounted for most of the variance was not the same for men and women, For men, it was failure/negative evaluation and for women, it was animals; the second factor was animals for men and failure/negative evaluation for women, reversing the order, Although, failure/negative evaluation has six items common to both sexes, for men, more items were part of the factor. It appeared that men included personal losses (illness or injury to loved ones and death of a loved one) with other failures while these clustered into a different factor, labelled personal loss, for women. It may be that men see their loved ones more as extension of themselves than women do, or that men’s greater feelings of autonomy in society also makes them generalize their responsibilities beyond what is expected from common sense. Fears of animals were prepotent in women. It is tempting to conclude that women are more susceptible to the type of fears (Marks, 1969) called ‘prepotent’ fears (Marks, 1969) and Seligman (1970) called ‘prepared’. Unlike the study of Bernstein and Allen (1969) water did not appear as a separate factor for women but it did for men. However, this was not one of the robust factor noted by Arrindell (1987) and these differences may be specific to the groups sampled.
CONCLUSION This study fills an important gap in our understanding of the fears of Ss 50 yr and over. Fears decrease with age and women remained more fearful than men throughout the life span. The fears of both older men and women appear to be largely related to the demands of their life situation.
AND&E LIDDELL et al
112 Acknowledgement-We
are grateful
to Dr Ronan
O’Carroll
for his helpful comments
on an early draft of the manuscript.
REFERENCES Agras. S., Sylvester, D. & Oliveau, D. (1969). The epidemiology of common fears and phobia. Comprehensive Psychiatry, IO, 151-156. Akutagawa, D. (1956). A study in construct validity of the psychoanalytic concept of latent anxiety and test of a projection distance hypothesis. Unpublished doctoral dissertation, University of Pittsburgh. Arrindell, W. A. (1987). Self-reported fears of American, British and Dutch university students: A cross-national comparative study. Advances in Beharriour Research and Therapy, 9, 207-245. Atchley, R. C. (1988). Socialforces and aging (5th edn). Belmont, Calif.: Wadsworth. Bernstein, D. A. & Allen, G. J. (1969). Fear Survey Schedule (II): Normative data and factor analysis. Behaviour Research and Therapy, 7, 403-407. Dillman, D. (1978). Mail and telephone surveys: The total design mezhod. New York: Wiley. Geer, J. H. (1965). The development of a scale to measure fear. Behaoiour Research and Therapy, 3, 45-53. Hersen, M. (1971). Fear scale norms for an in-patient population. Journal of Clinical Psychology, 27, 375-378. Hersen, M. (1973). Self-assessment of fear. Behauiour Therapy, 4, 241-257. Holmes. T. H. & Rahe. R. H. (1967). The social readiustment rating scale. Journal off’svchosomatic Research, II, 213-218. Kirkpatrick, D. R. (1984) Age,‘gender and patterns of common intense fears among adults. Behauiour Research and Therapy, 22, 141L150. Kirkpatrick, D. R. & Berg, A. J. (1981). Fears of a heterogeneous, nonpsychiatric sample: A factor analytic study. Paper presented at the Meeting of the American Psychological Association, Los Angeles. (Eric Document Reproduction Service No. ED 210 620.) Lana. P. J. & Lazovik, A. D. (1963). The experimental desensitization of an animal phobia. Journal of Abnormal and Social &ychology, 66, 519-525. Locker, D., Liddell, A. & Burman, D. (1991). Dental fear and anxiety in an older adult population. Community Dentisrry and Oral Epidemiology. In press. Marks, E. M. (1969). Fears and phobias. New York: Academic Press. Marks, I. M. (1987). Fears, phobias and rituals. New York: Oxford University Press. Rachman, S. J. (1978). Fear and courage. San Francisco: Freeman. Rubin, B. M., Katkin, E. S. & Weiss, B. W. (1968). Factor analysis of a fear survey schedule. Behaoiour Research and Therapy, 6, 65-75. Seligman, M. E. P. (1970). On the generality of the laws of learning. Psychological Retriew, 77, 406-418. Ulenhuth, E. H., Baiter, M. B., Mellinger, G. D., Cisin, I. H. & Clinthorpe, J. (1983). Symptom checklist syndromes in the general population: Correlations with psychotherapeutic drug use. Archioes of Genera/ Psychiatry, 40, 116771173. Wolpe, J. & Lang. P. J. (1964). A fear survey schedule for use in behaviour therapy. Behauiour Research and Therapy, 2. 27-30.
SELF-REPORTED
0005-7967/91 $3.00+ 0.00
Copyright G 1991Pergamon Pressplc
FEARS (FSS-II) OF SUBJECTS 50 YEARS AND OVER
AGED
ANDR~E LIDDELL,‘.* DAVID LOCKER’ and DAVID BURMAN’ ‘Department of Psychology, Memorial University of Newfoundland, St John’s, Newfoundland, Canada AlB 3X9 and 2Department of Community Dentistry, University of Toronto, Toronto, Canada (Received 9 October 1990)
Summary-From
studies of fears in children and adolescents, it was concluded that fears decrease with age and that girls show more fears than boys at the approach of adolescence. Community studies of adult fears as well as psychopathology have suggested a decrease in fears and phobic and anxiety symptoms with age. However, little is known of the distribution of fears in older adults. In view of this, the FSS-II was administered to a group of individuals aged 50yr and over, as part of a larger epidemiological investigation of the oral health and treatment needs of older adults within Metropolitan Toronto. The results supported the hypothesis that the gender differences which ermerge at adolescence hold up into old age. The predicted age decrease in fearfulness was also supported.
iNTRODUCTION More
is known
about
the fears
of children
and adolescents
than
those
of individuals
at the upper
of the life span. In the most comprehensive review of studies of fears, phobias and rituals, Marks (1987) concluded that it is common for young children to show specific fears of great intensity. These come and go for no obvious reason and are not related to other pathology. It was also observed that fears decline with age, especially in boys, who show fewer fears than girls at the approach of adolescence. Agras, Silvester and Oliveau (1969) found three different patterns of incidence and prevalence when they interviewed a representative sample of individuals living in the Greater Burlington area of Vermont regarding 40 commonly feared situations. Fears of doctors, injections, darkness, and strangers showed a high childhood incidence but a sharply declining prevalence; fears of animals, heights, storms, enclosed places and social situations also showed a high childhood incidence but a slowly declining prevalence. The third pattern applied to fears of death, injury, illness and separation which showed a slowly declining incidence extending to the sixth decade and a prevalence peak in the late adult life. From a 133 fear items questionnaire administered to Ss aged between 15 and 89 and residing in northwestern Indiana and northeastern Illinois, Kirkpatrick (1984) noted different ‘intense’ fear pattern between men and women. Each fear item was rated on a 7-point scale from l(none) to 7(terror). A fear was deemed ‘intense’ when the percentage of terror responses to an item was > 10% in one of six age categories (15517, 18-24, 25-34, 35-44, 45-54 and 55 and over). Women admitted to significantly more intense fears than men and, while men’s terror responses generally showed a decrease after the youngest age groups to a very low levels in older Ss, women showed four different patterns of responding over the age span. In women Ss, terror decreased for untimely or early death, death, being punished by God, and dead people but increased for deep water, looking down from high buildings, fire, and strange dogs. In addition, other intense fears increased than decreased while others decreased than increased over the life span: death of a loved one, illness or injury to loved ones, and ideas of possible homosexuality decreased than increased; roller coasters, harmless snakes, swimming alone, and high places on land increase than decreased. The above studies were conducted with non-psychiatric populations and, as Kirkpatrick (1984) cautioned, intense fear is not to be equated with phobia. Nevertheless, similarities emerged from community studies of phobic and anxiety disorders (or symptoms) in showing a greater prevalence of such problems in women than men and greater pathology during middle life than in the very young or old (Marks, 1987). For instance, in a large general survey conducted in the U.S.A. by end
*To whom BRT m--A
all correspondence
should
be addressed.
105
106
ANDR~E LIDDELL~~ al.
interviewers who obtained data by means of a symptom checklist, it was found that phobias, other than agoraphobia, where checked most often by those under the age of 35 yr (Ulenhuth, Balter, Mellinger, Cisin & Clinthorpe, 1983). However, no study has focused exclusively on the distribution of fears among older adults. Fenr surrey schedules
The construction of fear survey schedules stemmed from a wish to identify and evaluate the prevalence of specific fears. It is not surprising to find a close connection between this type of fear assessment and behaviour therapy. A decade after the first formal reference was made to a fear survey schedule (FSS-I) by Lang and Lazovik (1963), Hersen (1973) reviewed its development. The FSS-I was comprised of 50 common fears based on an unpublished study by Akutagawa (1956). It was replaced by the FSS-III designed primarily for clinical use as an adjunct to behavioural treatment (Wolpe & Lang, 1964). The 7.5 items of the FSS-III were divided into the following subcategories: animal, tissue damage/illness, death or associated stimuli, classical phobias, social stimuli, noises, and miscellaneous others. The reason the FSS-II postdated the FSS-III was that its author (Geer, 1965) had carried out initial work on that scale before the publication of the FSS-III, Unlike its predecessor, the FSS-II was designed primarily for use in research. It consists of 51 items empirically derived to show high internal consistency. Geer (1965) reported a low negative correlation with social desirability and items of the measure were validated by comparing low-, medium-, and high-fear Ss on behavioural avoidance tests. The available norms and subsequent data for the FSS-II were derived primarily from college students. During the following years, a number of other fear schedules were devised by augmenting or combining existing schedules. Factor analyticaf studies of the various versions of fear schedules have shown considerable similarities and the number of major factors identified appeared to be a function of the number of items included in the analyses. When factor analysis was carried out on the responses of men and women treated separately, the factors isolated appeared somewhat different (Hersen, 1973). For instance, Bernstein and Allen (1969) using the FSS-II found that, for male college students, five factors accounted for 61% of the variance-death and illness (16.23%), social interaction (12.48%), negative social evaluation (11.73%), live organisms (11.03%), and violence (9.51 Oh); for females college students, five factors emerged according for 61.7% of the variance-social interaction (13.64%), death-illness-injury (13.32%), live organisms (12.61%), negative social evaluation (11.71%), and water (10.46%). Previously, Rubin, Katkin and Weiss (1968) had also reported gender differences in factors extracted after administering the FSS-II to college students. However, they did not specify the amount of variance accounted for each factor. In a recent comparison of Fear Survey Schedules derived from the FSS-III, Arrindell (1987) concluded that there is considerable overlap between the measures in question. He noted that these schedules had 75 items in common, 51 of which were said to be distributed across five robust scales: social fears, agoraphobic fears, bodily injury, death and illness fears, fears of sexual and aggressive scenes, and fears of harmless animals. Hersen (1971) administered the FSS-II and the FSS-III to the same group of psychiatric in-patients. Correlations between the results were found to be significant. Therefore, it appears that, under certain circumstances, FSS-II and FSS-III can be used interchangeably making them both useful tools to study human fears. In view of the dearth of information regarding the fears of older individuals, it was decided to target these individuals with regard to the intensity and components of their fears. From the available evidence, it was hypothesized that fears would diminish with age in such individuals but that women would show more fearfulness than men regardless of age. METHOD Ss who took part in a large epidemiological investigation of the oral health and treatment needs of older adults within the Metropolitan area of Toronto were asked to complete the FSS-II as part of a longer series of questionnaires designed to evaluate dentat attitudes and experiences, including dental anxiety (Locker, Liddell & Burman, 1991). The FSS-II was used as a control to partial out the effect of general fearfulness from that of dental anxiety. Identification of Ss was done by means of a telephone survey based on random digit dialling (Dillman, 1978). Where the randomly
Self-reported
fears (FSS-II)
107
generated telephone numbers identified a private household containing more than one person aged 50 yr or over, a randomization procedure was used to select one of them as S. Initially, Ss were asked to complete a short telephone interview aimed at obtaining basic sociodemographic data along with information regarding oral status (dentate vs edentulous). During this first telephone interview, they were also asked to attend a clinic or be visited for a detailed personal interview and clinical examination, and to complete the questionnaire which included the FSS-II. If Ss refused to participate in the examination, they were nevertheless asked for their cooperation with the dental attitudes and experiences questionnaire which was subsequently mailed to them. Those who agreed to be examined were given the dental attitudes and experiences questionnaire at the time of the examination. All questionnaires were completed at home and returned by mail. RESULTS 2007 Individuals completed the telephone interviews from 2577 households contacted and found to have an eligible member (Locker et al., 1991). A sample of 5 12 Ss over the age of 50 yr completed the FSS-II with enough information for analysis. Characteristics
of the sample
There were 212 men and 300 women. Their ages ranged between 50 and 89 yr with a mean age of 62.95 yr (SD = 8.42). Regarding martial status, 259 individuals were married or living with a partner, 102 were widowed, another 82 were separated or divorced, and 66 never married while three respondents did not provide this information. Regarding education, 24.9% had received less than high school education, 23.6% completed high school, another 20.8% had pursued some post-secondary education, 29.9% were university graduates, and 4 individuals did not return the information. Household income level was recorded in steps of $10,000 beginning with less than $10,000 and ending with more than $100,000; 5.9% lived with incomes less than $10,000, a further 46.1% had incomes between $10,000 and $50,000, 18.2% were in the $50,000 but less than $100,000 range, 6.4% in the $100,000 and above category, with 23.4% saying that they did not know or were unwilling to divulge the information. A total of 309 Ss were born in Canada while 203 others were not. They came from a variety of ethnic backgrounds with 53.3% from the U.K. The Ss were asked if they had a number of medical conditions including emotional disorders diagnosed by a doctor; 4% of Ss admitted to emotional disorders and one person left the question blank. FSS-II Total scores. Following from Geer (1965) a score of 1 was assigned to the response ‘none’ and the values 2-7 were consecutively assigned to the points on the scale described as ‘very little’, ‘a little’, ‘some’, ‘much’, ‘very much’, and ‘terror’. Scores obtained on each of the 51 items of the FSS-II were summed for each S and put into an ANOVA to test for the effect of sex and age (categorised as 50-64, 65-74 and 75+ yr) on general fearfulness (Fig. 1). Women scored significantly higher on the total FSS-II scores than men [F(l, 511) = 30.43, P < O.OOl]and there 200
180 z ;; 160 x l-l 7
140
z 120
100 65-74 Age(Yr)
Fig. 1. Distribution
of FSS-II
scores over age groups
by gender.
ANDRE& LIDDELL et al.
108
was a significant decrease in fears with age [F(2, 511) = 5.63, P < 0.011. There was a small but significant negative correlation between FSS-II scores and eduation (p = -0.21, P < 0.001) and income (p = -0.22, P < 0.001). The less educated and those with lower income levels tended to admit to more fears than the others. The scores of those who had been diagnosed as suffering from emotional disorders (Mean = 202.65; SD = 43.67) were significant higher than those who had not (Mean = 169.71; SD = 45.23) [F(l,510) = 11.68, P < O.OOl]. D@erences between individual items of the FSS-II. Some individuals omitted to rate some fears. However, the missing values appeared scattered evenly and made up only a small proportion of the answers on each fear item. The fears most often left blank referred to arguing with parents (12%), driving a car (4%), and losing a job (4%). It can be assumed that these items had less meaning for an older population than for the type of individuals on which the survey was standardized. On the majority of other fears, the response rate was over 98% ANOVAs were carried out with the scores of each of the fear items by sex and age (Table 1). There was a significant gender difference on 28 out of 51 fears, women scored higher than men on all but the fear of God. Thirteen fears significantly decreased with age. Fears on which there was a mean rating of 4+ denoting ‘much’ fear were listed by gender (Table 2). While women had more fears listed in that category (16) than men (9), Spearman’s p for the ranking of the 8 fears they had in common was 0.93 (P < 0.001). Means of fears exceeding 4 by age categories were similarly listed (Table 3). Seven fear items were to remain high in the 75+ yr group, namely, death of a loved one, illness/injury to loved ones, rollers coasters, being with drunks, auto accidents, seeing a fight, and snakes. Components
of fear
Factor analysis was carried out on the FSS-II responses of men and women taken separately. For men, 6 factors accounting for 49% of the total variance emerged: failure/negative evaluation, Table
I.
FSS-II items on which there is a significant gender and/or age ditTerence Sex
4
8 9 IO II
I2 13 14 15 19 20 21 23 24 25 26 27 28 30 31 33 34 35 36 38 39 41 42 43 44 45 46 47 48 50 51
Being a passenger in a car Dead bodies Suffocating Bang a passenger in a plane Worms Arguing with parents Rats and mice Life after death Hypodermic needles Being criticized Meeting someone for the first time Roller coasters Death Being in a light Crowded places Heights Bang a leader Swimming alone lll”ess Being with drunks Illness or injury to loved ones Driving a car Meeting authority Closed places Boating Spiders Thunderstorms God Snakes Speaking before a group Seeing a fight Death of a loved one Dark places Strange dogs Deep water Being with a member of the opposite sex Stinging insects Loosing a job Auto accidents
**
AK
* ** ***
**a ** *** ** 1 ** * *t* *** **
***
* ** *** *** * *** ** *** ** *** it* *** ***
‘M *** *** 111 * *** *** *a* * **:I ***
M indicates M higher than F: ‘P < 0.05; **P < 0.01; ***P < 0.001
1 **
Self-reported fears (FSS-II)
109
Table 2. FSS-II items on which mean of ratings exceeded 4 (much) by gender with rankings given items common to both
4 5 6 10 15 20 27 28 32 39 41 42 43 46 49 50 51
Suffocating Failing a test Looking foolish Rats and mice Roller coasters Being in a fight Being with drunks Illness or injury to loved ones Mental illness Snakes Speaking before a group Seeing a fight Death of a loved one Deep water Untimely or early death Loosing a job Auto accidents
Male
Female
4.55 (3) 4.08 (8) 4.14(7)
4.76 (4) 4. I I (7) 4.06 (8) 4.37 5.26 4.65 (5) 4.86 5.58 (2) 4.15 4.90 4.05 4.53 5.84(l) 4.39 4.52 (6)
4.20 (6) 5.28 (2)
5.60 (I) 4.22 (5) 4.15 4.53 (4)
5.23 (3)
animals, social interaction, water, agoraphobic symptoms, and death and dying (Table 4). On the other hand, women showed somewhat different factors accounting for 48.4% of the total variance: animals, failure/negative evaluation, agoraphobic symptoms, social interactions, death and dying, and personal loss (Table 5). DISCUSSION
The results supported the hypothesis that the gender differences which emerge at adolescence appear to hold up into old age. The predicted age decrease in fearfulness was also supported. It is unfortunately not possible to make comparisons between the total FSS-II scores of this sample and others based on undergraduate students, since education and income level appeared to influence levels of fear. Furthermore, methods of scoring had not been uniform in previous studies. However, the FSS-II demonstrated criterion validity in discriminating between individual with diagnosed emotional disorders and those who were not. Predictably, women scored higher than men on more than half of the fear items. Fear of being punished by God was also found to be higher in men than women by Kirkpatrick and Berg (1981). They explained this finding in terms of social acceptability. We agree that it may seem more acceptable to men to be ‘God fearing’ than to be afraid of small harmless animals. Conversely men’s image of God may be more frightening than that of women’s who may see a kinder and more forgiving God. This image may also be different according to type of religious teaching received but the data does not exist, in this study, for such comparisons. Of the 13 items seen to decrease with age, 7 related to death, illness, or injury suggesting that age and exposure bring adaptive resignation (maturity or realism) towards the inevitable. Similar fear were found to show a slowly declining incidence extending to the sixth decade by Agras et al. (1969) and a more accelerated decline by Kirkpatrick (1984) when studying intense fears only. Based on studies of the reaction Table 3. FSS-II
4 5 6 IO I5 20 27 28 32 39 42 43 46 49 50 51
items on which mean ratings exceeded 4 (much) by age groupings
Suffocating Failing a test Looking foolish Rats and mice Roller coasters Being in a fight Being with drunks Illness or injury to loved ones Mental illness Snakes Seeing a fight Death of a loved one Deep water Untimely or early death Loosing a job Auto accidents
I (50-64 yr)
2 (65-74 yr)
4.85 4.22 4.18
4.60
4.71 4.55 4.34 5.46 4.03 5.75 4.42 4.14 4.85
4.07 4.53 4.58 4.71 5.52 4.30 4.64 4.27 5.80 4.06 4.49 5.25
3 (75+ Yr)
4.80 4.57 5.22 4.20 4.27 5.45
4.40
ANDR~E LIDDELL et al.
110
Table 4. Factor
structure
of FSS-II
Factor
for males
Item
Factor
loading
I-Failurejnegative evaluation (27.5% of variance)
Failing a test Looking foolish Illness of injury to loved ones Being criticized Bemg misunderstood Making mistakes Death of a loved one Being in a fight Suffocating Mental illness Not being a success Arguing with parents
0.70 0.66 0.66 0.62 0.60 0.57 0.56 0.55 0.55 0.52 0.51 0.50
II-Animals (5.7% of variance)
Spiders Rats and mice Snakes Thunder Blood Worms
0.69 0.64 0.63 0.56 0.53 0.52
III-Social interaction (4.8% of variance)
Meetmg someone for the first time Meeting authority Being with a member of the opposite Being a leader Driving a car
0.68 0.64 0.59 0.58 0.53
IV-Water (4.4% of variance)
Boating Deep water Swimming alone
V-Agoraphobic symptoms (3.4% of variance)
Being alone Being a passenger Heights Crowded places
VI-Death and dying (3.1% of variance)
God Life after death Death Untimely or early death
Table 5. Factor
structure
0.54 0.53 0.52 0.50
in a car
0.65 0.58 0.56 0.50
for females
Item
I-Animals (27.6% of variance)
II-Failure/negative (5.3% of variance)
0.68 0.67 0.62
of FSS-II
Factor
sex
evaluation
Ill-Agoraphobic symptoms (5.0%) of variance)
Factor
loading
Spiders Snakes Stinging insects Rats and mice Dogs Worms Thunder
0.67 0.66 0.65 0.60 0.59 0.55 0.52
Looking foolish Failing a test Being critiazed Being misunderstood Making mistakes Not being a success Loosing a job
0.75 0.72 0.69 0.65 0.63 0.61 0.51
Heights Being a passenger Closed places Being a passenger Driving a car
0.57 0.56 0.54 0.54 0.53
in a plane in a car
0.71 0.68 0.62 0.60 0.54 0.53
IV-Social interaction (4. I % of variance)
Being a leader Meeting someone for the first time Speaking before a group Meeting authority Bang self-conscious Being with a member of the opposite
V-Death and dying (3.4% of variance)
Death Dead bodies Life after death
0.7 I 0.70 0.61
VI-Personal loss (3.0% of variance)
Injury or illness to loved ones Death of a loved one Auto accidents
0.75 0.71 0.60
sex
Self-reported fears (FSS-II)
111
of civilian population to air attacks during WW II (Rachman, 1978), Kirkpatrick (1984) also invoked an habituation paradigm to explain his results. Although women have more intense fears than men, the ranking of the most intense of these fears related to illness of death of loved ones for both sexes. These fears were also shown to remain strong into old age. Kirkpatrick (1984) accounted for a substantial proportion of adult age differences in fears by referring to what Rachman (1978) characterized as a sense of mastery or ‘control over the probability of reducing the likelihood of an aversive event and/or its consequences’ (Rachman, 1978, p. 10) and perceived probability and consequences. Kirkpatrick proposed the following explanation regarding the relationship between probability and consequences: “fear with increase with the increased probability that a rarely-occurring event will take place; furthermore, the greater the perceived aversiveness of the consequences of a feared event, the higher the fear” (Kirkpatrick, 1984, p. 147). Older individuals have little control over the lost of loved ones and such loses often cause more difficult adjustments than is required of younger individuals. These fears are also the ‘life events’ Holmes and Rahe (1967) found to be rated with greatest intensity and to need most readjustment. Of the other four fears which remained high throughout old age, the strength of fears of roller coaster and snakes may suggest an underlying biological basis since their logic cannot be considered as strong as that of the first mentioned fears. In any case, fairground operators have learned to case in on the fear of roller coaster and the mystique surrounding snakes appears universal. The stability of fears relating to being with drunks, seeing a fight, and auto accidents may be a function of the individual’s diminishing physical prowess (sense of mastery), making these situations even more threatening than they were previously. A prominent gerontologist, Atchley (1988) discussed how older individuals adapt to changes which come from aging. Some changes due to aging are gradual and require no new skills to adjust. However, others are likely to involve change in the individual’s situation and environment, in addition to changes to the self. Sudden discrete changes are those most taxing to one’s coping skills and perception of effectiveness. Understandably, these are the situations oider people seem to fear most. The factors which emerged from this study are similar to those of previous studies. There were parallels with three of the five fears reported by Arrindell (1987)-social fear, agoraphobic fears, and harmless animals. As with earlier studies, there were gender differences in the composition of the factors as well as with their relative importance. With both men and women, the first factor was seen to account for over half of the variance accounted for in the analysis. Other studies with younger Ss have reported variances relatively evenly distributed across their factors (Bernstein & Allen, 1969). The factor which accounted for most of the variance was not the same for men and women, For men, it was failure/negative evaluation and for women, it was animals; the second factor was animals for men and failure/negative evaluation for women, reversing the order, Although, failure/negative evaluation has six items common to both sexes, for men, more items were part of the factor. It appeared that men included personal losses (illness or injury to loved ones and death of a loved one) with other failures while these clustered into a different factor, labelled personal loss, for women. It may be that men see their loved ones more as extension of themselves than women do, or that men’s greater feelings of autonomy in society also makes them generalize their responsibilities beyond what is expected from common sense. Fears of animals were prepotent in women. It is tempting to conclude that women are more susceptible to the type of fears (Marks, 1969) called ‘prepotent’ fears (Marks, 1969) and Seligman (1970) called ‘prepared’. Unlike the study of Bernstein and Allen (1969) water did not appear as a separate factor for women but it did for men. However, this was not one of the robust factor noted by Arrindell (1987) and these differences may be specific to the groups sampled.
CONCLUSION This study fills an important gap in our understanding of the fears of Ss 50 yr and over. Fears decrease with age and women remained more fearful than men throughout the life span. The fears of both older men and women appear to be largely related to the demands of their life situation.
AND&E LIDDELL et al
112 Acknowledgement-We
are grateful
to Dr Ronan
O’Carroll
for his helpful comments
on an early draft of the manuscript.
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