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Universitatea „Al. I. Cuza”, Ia[i Holt Rom=nia
Departamentul de Sociologie Programul pentru Promovarea
[i Asisten]\ Social\ Asisten]ei Sociale
Revista de cercetare
[i interven]ie social\
Volume 48
March 2015
Review of Revue de
Research and Recherche et
Social Intervention
Intervention Sociale
www.rcis.ro
Expert Projects, 2015
1
REVISTA DE CERCETARE {I INTERVEN}IE SOCIAL| - VOLUMUL 48/2015
REVISTA DE CERCETARE SI INTERVENTIE SOCIALA

Director: Prof. dr. Vasile Miftode
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Editor: Prof. dr. Stefan Cojocaru, Alexandru Ioan Cuza University Iasi, Romania
International Advisory Board: Arun Kumar Acharya, Universidad Autonoma de
Nueva Leon, Mexico; Vicky Buchan, Colorado State University, SUA; Dr. Lindi
Endicott - Planned Parenhood SUA; Prof.dr. Karl Garber - ENSP Rennes France;
Prof.dr. Victor Groze, Case Western Reserve University, Cleveland, Ohio, SUA;
Patrick LeGuierric, Université de Tours, France; Prof.dr. Einar Helander - Lisabona,
Portugal; Gérard Neyrand, Université de Toulouse, France; Nadji Rahmania, Université
des Sciences et Technologies de Lille, France; Catherine Sellenet, Université de Nantes,
France; Dr. Sorin Cace, Institute for Quality of Life Research, Romania; Maria Socoro
Cristina Fernando, Asuumption University, Thailand; Pere Amoros (University of
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Revista de cercetare [i interven]ie social\
Realities in a kaleidoscope
Distinguishing between Consequences of Neglect and Poverty on Problem

Behavior among Preschool Children
María José PINO, Carlos HERRUZO, Javier HERRUZO ................................................. 5
The Relation between Personality Traits, Social Support and Traumatic
Stress
Marius Ciprian CEOBANU, Cornelia MAIREAN ............................................................ 17
Resources of Resilience amongst the Urban Population
Cristina OTOVESCU , Adrian OTOVESCU, Gabriela MOTOI,
Dumitru OTOVESCU ................................................................................................... 32
Relationships between Fashion Enterprises Resilience under Market
Disruption and Employees’ Creative Involvement
and Wellbeing Degree
Carmen Luiza COSTULEANU, Diana DUMITRESCU,
Stejarel BREZULEANU, Nicolae BOBITAN ................................................................ 50
Suddenly – War. Intervention Program for Enhancing Teachers
and Children’s Resilience Following War
Miri SHACHAM ................................................................................................................ 60
Impact of Divorce and Mother’s Psychological Well-Being
on Children’s Emotional, Behavioral, and Social Competences
Anda Maria JURMA .......................................................................................................... 69
Application of Data Envelopment Analysis to Evaluating
Elderly Social Welfare Performance
Suh Chen HSIAO, Luke HSIAO ......................................................................................... 83
Stress, Resilience and Life Satisfaction in College Students
Ana-Maria CAZAN, Camelia TRU}A ............................................................................... 95
3
Impact of Residence on Dental Fear and Anxiety in Romanian Children

Réka GYERGYAY , Irina ZETU, Melinda SZÉKELY,
Mariana P|CURAR, Cristina BIC|, Krisztina MÁRTHA ........................................ 109
The Mediation Role of Resilience on the Relationship between Workplace
Bullying and Romanian Employees’ Strain
Teodora MAIDANIUC-CHIRILA .................................................................................... 120
Exploration of the Critical Success Factors in Online
Evidence-Based Public Policy Learning Behaviors
I-Jan YEH ........................................................................................................................ 134
Willingness to Seek Psychological Help among Turkish Adults
Nursel TOPKAYA ............................................................................................................. 149
The Investigation of Primary School Students’ Perception
of Quality of School Life and Sense of Belonging
by Different Variables
Ramin ALIYEV, Erhan TUNC .......................................................................................... 164
Theories about...
Perverse Effects of Change in the Romanian Academic Field

Dumitru STAN .................................................................................................................. 183
Psycho-Social Aspects in Children with Cystic Fibrosis
Dana Teodora ANTON-PADURARU, Anamaria CIUBARA, Egidia MIFTODE ............ 204
Ethical Implications of Bio-Psycho-Social Transformations
Entailed by the Aging Process
Ilinca UNTU, Roxana CHIRITA, Diana BULGARU-ILIESCU,
Bogdan DANIEL CHIRILA, Anamaria CIUBARA,
Stefan Lucian BURLEA .............................................................................................. 216
4
Working together
www.rcis.ro
Distinguishing between Consequences

of Neglect and Poverty on Problem Behavior
among Preschool Children
María José PINO1, Carlos HERRUZO2, Javier HERRUZO3
Abstract
The aim of this study is to distinguish between consequences of neglect and

poverty on problem behavior among preschool children. 72 children randomly
chosen from the city of Granada (Andalucía, Spain), have been classified in three
homogeneous groups according to demographic variables. Children in Group 1
(24 subjects) lived in slums (poverty) and suffered from neglect. Children in
Group 2 lived in the same slums but did not suffer from neglect. Group 3 consisted
of children from other neighborhoods of the city and did not suffer from neglect.
Behavioral problems were evaluated with the Inventory for Client and Agency
Planning (ICAP) behavioral problems scale. 50% of the subjects in Group1
(neglected children) showed internalized behavior problems, and 0% in groups 2
and 3. Also 46% of Group1 showed the externalized one, and 12.5% of Group 2
and 8% of Group 3. It is concluded that neglected pre-school children (1-5 years)
showed many behavior problems, mainly internalized and also externalized.
However, neither the non-neglected children from a socially deprived environment
(poverty), nor the children from the control group showed behavior problems. As
a result, we can relate the behavior problems to neglect and not to social status or
sociocultural environment.
Keywords: neglect, poverty, externalizing behavior problems, internalizing.
1
University of Córdoba, Faculty of Sciences of Education, Department of Psychology. Headmaster
of the Unit for Specific Needs (Disability) of University of Cordoba, SPAIN. E-mail: mjpino
@uco.es
2
University of Cordoba, Research Group on Risk Behaviors and Health, Cordoba, SPAIN. E-mail:
Carlosrojo999@hotmail.com
3
University of Cordoba, Faculty of Sciences of Education, Department of Psychology. Headmaster
of the Counselling Services of University of Cordoba, SPAIN. E-mail: jherruzo@uco.es
5
Introduction
Child neglect is the most prevalent form of child maltreatment, which has been
repeatedly identified in many studies (Slack et al., 2011). It is defined as the
failure of a parent or other person with responsibility for the child to provide
needed food, clothing, shelter, medical care, or supervision to the degree that the
child’s health, safety, and well-being are threatened with harm (Child Welfare
Information Gateway, 2011; USDHHS, 2012). Child neglect is a worldwide
problem widespread in families around the globe (Farah, Amara & Glyn, 2010).
In the United States, about 7.4 out of every 1000 children in the general population
experience neglect and as is shown in the most recent National Incidence Studies
(NIS-4), child neglect constituting 61% of all identified child maltreatment vic-
tims (Sedlak et al., 2010). In Europe we find similar numbers (Stoltenborgh,
Bakermans-Kranenburg, van Ijzendoorn & Alink, 2013; WHO, 2007). As Ni-
kulina, Widom, & Czaja, (2011) or Sinha, Trocmé, Fallon, & MacLaurin, (2013)
assert, although neglect is the most frequent subtype of maltreatment, the amount
of attention devoted to it by public child welfare agencies and researchers is low.
Today it is broadly accepted that childhood victimization has significant con-
sequences on physical and mental health across the lifespan (WHO, 2007). Despite
the difficulty of the study of pure typologies, neglect has been associated with
negative social, behavioral, and cognitive consequences (Spratt et al., 2012;
Schumaker, 2012) in the short, medium and long term, especially with a trajectory
of worsening problem behavior (Woodruff & Lee, 2011).
During childhood, slow development problems have been especially pointed
out, and most behavioral areas are affected (e.g. Pino, Herruzo & Moya, 2000)
with attention deficit and cognitive problems, communicative and expressive
skills difficulties, lower academic achievement, altered emotional behavior, less
social skills such as empathy and interpersonal relationships, and more difficulties
in social interaction with distorted patterns of interaction with careers and with
peers (Nikulina, et al., 2011; Wright, Masten & Narayan, 2013) and also, poten-
tially causes child neurobiological deficits, impairment of executive functions, as
well as elevation of the stress hormone cortisol (De Bellis, 2005).
According to numerous reports, children who grow up in neglectful or abusive
homes suffer from impairments in their basic trust, self-esteem, and ability to
form and maintain relationships, in the development of the attachment, and are
prone to serious personality disorders and other psychopathology as adults. Their
school achievement tends to be poor and their cognitive development delayed.
They are at heightened risk for severe behavior problems, from non-compliance
and temper tantrums through delinquency, violence, and other forms of anti-
social behavior (LaPota, Donohue, Warren & Allen, 2011; Manly, Lynch, Oshri,
Herzog & Wortel, 2013; Stith, et al., 2009; Wright, et al., 2013). In contrast to
6
REALITIES IN A KALEIDOSCOPE
physically abused children, neglected children have more serious cognitive deficits,
socialization problems, and appear to exhibit more internalizing behaviors instead
of externalizing behaviors (Chen, Propp, DeLara & Corvo, 2011; Dubowitz &
Bennet, 2007; Hildyard & Wolfe, 2002).
Neglected children were found by both parents and teachers to display more
internalizing behavior problems than comparison children (Fantuzzo, Weiss, At-
kins, Meyers & Noone, 1998). Kotch et al (2008) found that children who have
been abused or neglected are at high risk for exhibiting externalizing behavior
problems, and can continue to aggressive and criminal behaviors (Gilbert et al.,
2009) especially if it occur prior to age of 5 (Kosch et al., 2008). Woodruff & Lee
(2012) found that children who had internalizing behavior problems and neglect,
showed a worsening trajectory of behavior problems.
Mc Cord (1983) in a retrospective study established that 20% of neglected or
abused children committed crimes when they became teenagers. Once they commit
crimes in their adolescence, this conduct usually stayed until they became adults.
Regarding the antisocial conduct, those who had been physically abused were
involved in more crimes with aggression and assaults (Woodruff & Lee, 2012).
A factor highly related with neglect is poverty or low income. It has been
widely acknowledged that poverty has a harmful impact on children’s deve-
lopment (Rijlaarsdam et al., 2013). It has been identified as a high risk factor in
many literature reviews (Guterman, 1997; Jonson-Reid, Drake & Zhou, 2013;
Lee & George, 1999; Sedlack, et al. 2011; Woodruff & Lee, 2011). Children
residing in economically deprived families more often manifest behavioral and
emotional problems (Bradley & Corwyn, 2002). In addition, there is evidence
that the harmful effects of poverty are already observable early in a child’s life.
There is ample evidence that the home environment and parental emotional well-
being mediate the association between low family income and child emotional
and behavioral problems (Bor, et al., 1997; Hearn, 2011; Kiernan & Huerta 2008;
Lieberman, Chu, Van Horn & Harris, 2011; Linver, Brooks-Gunn & Kohen, 2002;
McLeod & Shanahan 1993; NICHD 2005). As Sedlack et al. (2011) concluded,
despite differences in study designs and samples, economic and parenting factors
consistently predict neglect, from a global prospective study, although these
aspects have been pointed out many times for decades. Thus, Wolock & Horowitz
(1984) reported that neglectful families have below levels of socio-economic
factors those abusive families. Polansky (1985) reported that neglectful mothers
living in the same environments those non neglectful mothers had low levels of
psychological interaction, and experience feelings of isolation and a lack of social
support. Low socio-economic status has also been associated with higher ex-
ternalizing behavior problems over time from kindergarten to adolescence (Lan-
dsford, et al., 2011). Thus, it has been found the relationship between poverty and
neglect as an important risk factor for externalizing behavior problems in a long-
7
term. On the other hand, neglect has been associated with internalizing problems
in a short-term and later with externalizing problems.
As neglect occurs in people of low social classes, Schumaker (2012) suggests
that one must discriminate between poverty and neglect, because poverty alone
cannot explain the study results. Chapple & Vasque (2010) assert that the ill
effects of poverty on child and adolescent development clearly are confounded
with child neglect. Therefore it is interesting to conduct a study to discriminate
between the effects of poverty themselves and those linked to neglect. Thus,
methodological aspects will be implemented in order to control and discriminate
both variables.
The aim of this paper consists of evaluating behavior problems in a sample of
physically neglected Spanish (Andalusian) children between 1-5 years old, com-
paring them with children from their same environment who do not suffer from
neglect, as well as with a control group of children from the same city who live in
non-socially deprived environments, in order to isolate the effect of poverty from
neglect, controlling sex, age, number of brother and sisters, mother age, cultural
level, and single-parent families. It is expected that the findings will show more
behavioral problems among neglected children than in the low income non-
neglected and the control.
Methodology
Participants
Seventy two children from a city of Andalucía (Spain), divided in three different
groups, have participated in this study: Group1 (G1) physically neglected children
who live in a socially deprived area (n=24), Group 2 (G2) non-physically ne-
glected children who live in the same deprived area (n=24) and Group 3 (G3),
non-physically neglected children from other non-socially deprived areas of the
city (n=24). Members in G1 were chosen at random, among the 476 families with
children between 0-6 years old in a high-risk situation detected by the Community
Social Services in the three areas of the city, where most of the socially deprived
population live. In these three areas the population is close to 30,000 inhabitants,
characterized by a wide base pyramid of population, with an average of 4-5
people per family, 8% of those being gypsies. 80% of the houses are council
houses, being an area of expansion of a city that is continually growing, with a
high rate of movement from one house to the next, which produces a severe
deterioration of the houses. This population comes mainly from villages and
socially deprived areas, as well as from old areas of the city, forming a social
blend, which does not have an associative character (information obtained from
Community Social Services). The sample of 24 school aged children between 1-
8
5 years old was composed of 6 children between 1-2 years, 6 between 2-3 years,
6 between 3-4 years, and 6 between 4-5 years (average= 2y 10m). The teachers of
the 24 chosen children, as well as the social workers from the area where they
lived, were interviewed in a way that they provided information to complete an
abuse rate questionnaire made by Arrubarrena, De Paúl and Torres (1994), to
check that the children were neglected rather than any other kind of maltreatment.
In particular, this scale established 8 criteria or definitions, which the state of
neglect was determined. These criteria were named as presence/absence (food,
clothes, hygiene, health care, supervision, education, hygienic and security con-
ditions at home). The average number of criteria among children of G1 was 4.7.
The choice of the subjects in group 2 was randomly selected among children of
the same area of the city, being matched up one by one in age and sex with
children in G1. They were evaluated in the same way as G1, and showed an
average number of neglect criteria of 0.2.
Both groups had the same cultural level (low), level of income (low and
irregular), social status and age of the mother and number of brothers and sisters.
It was verified with their social workers and teachers that there was not neglect or
any other form of maltreatment, in the same way as we proceeded with G1. The
24 children in the third group (non-neglected, non- socially deprived sociocultural
environment), were chosen at random among students from several municipal
nursery schools, matching them up in age and sex (one by one) with G1. This
group was matched up with the two previous ones in age and social status of the
mother and in the number of brothers/sisters. However, regarding income level
(medium) and cultural level (medium) G3 was not matched up with the other two,
considering the objectives of this study. It was also verified that they did not
suffer from physical neglect or any other form of maltreatment, using the same
procedure as in the other two groups. Average number of neglect criteria was
0.16. Demographic characteristics for neglected and comparison groups are pre-
sent in Table 1.
Table 1. Demographic scores

Parametre Grup 1 Grup 2 Grup 3 Statistical analysis
Brother and sisters number 3.7 2.7 2.4 F=1.2 P>0.05
Number of subject with 3 4 22 Chi2=0.167(1,N=48)
stabilized incomes P>0.05 ** (G1-G2)
Incomes per subject 60$ 72$ 390$ F<1 **(G1-G2)
Monoparental families 4 2 2 Chi2=1.125(2,N=72)P>
number 0.05
Mothers age 27.3 28.9 30.9 F=2.01 P>0.05
Cultural level low=100% low=96% low=0% Chi2=2.087(1,N=48)
middle=4% middle or up = 100% P>0.05 **(G1-G2)
Sex 50%/50% 50%/50% 50%/50%
Children age 2y.10m. 2y. 10m 2 y. 10m.
Note: The analysis marked with ** is only between G1 and G2, because the other
group was not matched to them.
9
There is not statistical analysis for sex and age because the children were
matched one to one across the three groups.
Instruments
Behavior problems have been evaluated using ICAP: Inventory for the Plann-
ing of Services and Individual Programming of Bruinninks, Hill, Weatherman &
Woodcock (1990), a structured instrument that allows normative scores to be
obtained (adapted to the Spanish population by Montero, 1993) in adaptive
behavior and behavior problems, offering other scores of a descriptive type.
Behavior problems are evaluated in 8 areas individually evaluated, and are su-
mmarized in a general rating encompassing both the severity and frequency of
problematic behaviors that can be further classified as internalized (self-injury,
stereotyped behaviors and withdrawn or lack of attention), externalized (offensive
and uncooperative behaviors) or antisocial (hetero-aggression, object destruction
and disruptive conduct). This scale has shown an Inter-rater reliability of 0.83 and
test-retest of 0.86. The criterion validity is 0.58 (correlation with another scales as
Scales of Independent Behavior – Revised (SIB-R) (Bruininks, Woodcock, Wea-
therman & Hill, 1996).
Design
The aim of this research has been evaluated through an ex post facto prospective
design with two independent variables:
IV1: Neglect (with two levels: Yes/No)
IV2: Sociocultural environment (with two levels: Deprived/ Non-deprived).
We made three groups:
G1: Neglected children who live in a socially deprived sociocultural envi-
ronment.
G2: Non-neglected children who live in a socially deprived sociocultural
environment.
G3: Non-neglected children who do not live in a socially deprived so-
ciocultural context.
With these variables, we aim to discriminate neglect from the poverty/social
class effects. The dependent variable was constituted by scores in the ICAP
Behavior Problems Scale, although for the disclosure of the final results we will
also use the percentage of subjects with behavior problems, classified by the
ICAP.
10
Procedure
This study started with a selection of subjects who have been described in the
participants section. The ICAP must be completed by a person who had had daily
contact, or nearly daily contact, with the evaluated person, at least for three
months. The evaluation was carried out by a trained psychologist, through inter-
views with the main teacher and the support teacher, with the aim of obtaining
reliable data completed by parent’s reports if it is necessary. The agreement index
was over 85% in each group (G1= 86%; G2 = 95%; G3 = 97.3%). The interviewer
and the educators did not know the objectives of the investigation nor had they
any information about the children being allocated in different groups for research.
Results
Figure 1 shows percentages of students with behavior problems in each group,

measured by ICAP Behavior Problems Scale (We can see direct average scores in
the ICAP Behavior Problems Scale in table 2).
Table 2. Direct scores obtained in groups with behavior problems (ICAP) and ANOVA
Indices G1 G2 G3 ANOVA(1)
Internalized -10.6 1.7 0.9 F(2,60)=23.6 P=0.0000
Antisocial -6.2 -1.1 0.3 F(2,60)=9.3 P=0.0003
Externalized -8.9 -3.4 -0.8 F(2,60)=5.7 P=0.0054

Note (1) Analysis of variance of the general comparison between groups. All of them
are significant. Non-planned comparisons confirmed in all cases that significant diffe-
rences existed between G1 and the other two groups (P=0´000 and P=0´000 respectively),
which didn’t show significant differences between them (P>0´1 in all cases).
11
Figure 1. Percentage of subjects with behavior problems assessing with de ICAP.

Group 1 was formed by neglected children, Group 2 by non-neglected children living in
the same slums and Group 3 was formed by non-neglected children from other parts of the
city.
As far as the internalized problems are concerned (that is, atypical and re-
petitive habits, withdrawn and lack of attention), 50% of physically neglected
children have shown slight behavior problems. Nevertheless, it has to be high-
lighted that most of these children only presented problems of withdrawal and
lack of attention. On the contrary, subjects in G2 and G3 do not show these
behavior problems. Among those in G1, children between 4-5 years old were the
ones with a higher internalized score of behavior problems. In the antisocial
index, offensive social conduct and non-collaborative conducts are included. 30%
of the children in G1 showed these kind of problems (in particular, non-colla-
borative conducts). Again, these scores contrast with the other two groups, which
do not show signs of these problems. Finally, the externalized index includes
aggressive conducts (hetero-aggressive), object destruction and disruptive ones,
and in a smaller proportion, the hetero-aggressive ones, not showing any des-
tructive conducts. 46% of children in G1 showed these problems. Among G1, the
subgroup of children who are from 4 to 5 years old, are the ones with a higher
externalized score of behavior problems.
These results were analyzed by ANOVA (direct scores). The general com-
parison between groups were significant (F[2,60]= 16.3; p= .0000) and non-
planned comparisons confirmed in all cases that differences existed between G1
and the other two groups (P= .000 and P= .000 respectively), which did not show
differences between them (P> 0.1 in all cases).
12
Discussion
The aim of this paper was to assess behavior problems in a sample of neglected
children between 1-5 years old, comparing them with non-neglected children
from their same deprived environment, as well as with control children from the
same city who live in non-socially deprived environments, in order to isolate the
effect of poverty from neglect, when sex, age, number of brother and sisters,
mother age, cultural level, and single-parent families were controlled. As ex-
pected, there were more behavioral problems among neglected children than in
the low income non-neglected and the control groups while both the non-neglected
children did not show significant differences.
In general, the results of this study confirm (first time in Spain) those obtained
in others (Leventhal, 2003; Sedlack et al. 2011; Spratt et al., 2012; Woodruff &
Lee, 2011) showing that neglected children presented more behavior problems
than the control. In particular, in this sample of Spanish children between 1-5
years old, internalizing behavior problems are the most frequent problems follo-
wed by externalizing problems. Therefore, in a population that has previously
been scarcely studied, there is a strong relationship between physical neglect and
the appearance of behavior problems, withdrawal and lack of attention. In fact,
these results confirm the general hypothesis (Erickson, Egeland & Pianta, 1989)
that relates physical neglect with isolation and inadequate social interaction.
Also, the most interesting aspect of the present study is the comparison made
between neglected children and other children of the same social status and
sociocultural environment, as well as with other children from different envi-
ronments and social status. The presence of behavioral problems among the G1,
and the absence of those problems among the two other groups of population,
answers the questions asked by, among others, Sedlack et al. (2011) or Azar
(2002) that pointed out the necessity to dissociate effects resulting from mal-
treatment and those from the own characteristics of the population. The results of
the present study show that the effects are related to abuse and neither to social
status nor sociocultural environment.
The relevant fact of this data, from our point of view, is that it confirms the
hypothesis supported by, among others, Azar (2002) which would explain that the
behavior problems like developmental retardation and lack of attention are not
caused by social status, but by the interactions within the family. Children in G2
lacked sufficient economic means as well as those in G1, and were surrounded by
the same socially deprived environment. However, they did not show behavioral
problems, probably because their families look after them, have the minimum
resources to keep hygienic habits and sufficient child care; they have their emo-
tional necessities cared for and the necessary attentions, etc., which makes them
13
equal to the rest of the children in the city as far as protection from the development
of behavioral problems.
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16
Working together
www.rcis.ro
The Relation between Personality Traits,

Social Support and Traumatic Stress
Marius Ciprian CEOBANU1, Cornelia MAIREAN2
Abstract
This study examines the relationship between the Big Five personality traits,
social support and traumatic stress symptoms in the context of secondary exposure
to traumatic life events. Moreover, we examine if emotional and informational
social support moderate the relation between personality traits and all the three
dimensions of traumatic stress – intrusions, avoidance, and arousal. A sample of
162 nurses and physicians participated in this study and completed self-reports
measuring neuroticism, extraversion, agreeability, openness, conscientiousness,
social support, and symptoms of secondary traumatic stress. The results revealed
positive associations between neuroticism and all the symptoms of traumatic
stress, while extraversion, agreeability, openness, and conscientiousness nega-
tively correlated with intrusions, avoidance, and arousal. Moreover, emotional
and informational social support moderates the relation between extraversion,
openness and traumatic stress symptoms. These findings are discussed from the
perspective of the resilient value of personality traits and the importance of
perceiving support in promoting emotional adjustment, for persons indirectly
exposed to traumatic events.
Keywords: traumatic stress, resilience, medical staff, social support, coping.
Introduction
The development of posttraumatic stress disorder is a common risk for persons

exposed to different stressful or traumatic life events (Morina, Wicherts, Lobbr-
echt, & Priebe, 2014). Repeated professional exposure to traumatic events, such
as confrontation with severe injuries, death, violence, pain and suffering, was also
related to the development of posttraumatic stress symptoms and burnout (Adri-
1
Alexandru Ioan Cuza University, Faculty of Psychology and Education Sciences, Ia[i,
ROMANIA. E-mail: ciprian@uaic.ro
2
Alexandru Ioan Cuza University, Faculty of Psychology and Education Sciences, Ia[i,
ROMANIA. E-mail: cornelia.mairean@psih.uaic.ro
17
aenssens, De Gucht, & Maes, 2015; Bernaldo-De-Quiros, Piccini, Gomez, &

Cerdeira, 2015). Although the research about the effects of stressful events mainly
concentrates on primary victims, posttraumatic responses of intrusions, avoidance
and arousal that might follow indirect traumatic exposure are also documented in
various professional groups like: fire-fighters, mental health professionals, medical
personnel, or social workers (Duffy, Avalos, & Dowling, 2014; Mealer & Jones,
2013). To describe these responses, researchers have used the term secondary
traumatic stress (Figley, 1995). However, there is evidence that not everyone
copes with potential traumatic experiences in the same way and not all individuals
exposed to serious events, develop stress related symptoms (Shoji, Bock, Cieslak,
Zukowska, Luszczynska, & Benight, 2014). Because some individuals seem to be
less likely to develop stress, resilient promoting factors should be considered in
order to better understand the variety of individual responses to stressful life
situations. There is evidence that personality factors and the availability of social
support influence how well a person copes with different types of stressors (Clark
& Owens, 2012; de Boer, van Rikxoort, Bakker, & Smit, 2014). However, much
research on the associations between personality, social support and stress usually
concentrate on primary victims. In the context of secondary trauma, there are few
studies on the variables associated with a “cost of caring” for health care providers
of traumatized persons. Given the high likelihood that medical personnel from
hospitals will be exposed to potentially traumatic events during their daily duty of
taking care of victims and sick people, this study aims to identify underlying
resilience factors that impact traumatic stress in a sample of medical staff.
Personality and traumatic stress
In the context of exposure to stressful life events, studies have found that some
personality traits are positively associated with resilience, favourable trajectory
of mental health, and low levels of burnout (Adriaenssens et al., 2015; Lockenhoff,
Duberstein, Friedman, & Costa, 2011; Swider & Zimmerman, 2010). The Big
Five Factor Model is the best-known model that describes personality in terms of
five factors: neuroticism, extraversion, agreeableness, openness to experience,
and conscientiousness.
Neuroticism is defined as the tendency to respond to stressful events with a
high level of negative affectivity and emotional distress. In the personality and
stress literature, probably one of the most consistent and generally recognized
finding is the link between neuroticism and traumatic stress (Boals, Southard-
Dobbs, & Blumenthal, 2014; Borja, Callahan, & Rambo, 2009; Caska & Renshaw,
2013). Findings on the relation between extraversion and traumatic stress are
more diverse. Defined by the tendency to experience positive emotions, activity,
and sociability, extraversion is associated with a low level of traumatic stress
(Clark & Owens 2012). However, other studies reported no association between
18
posttraumatic stress and extraversion or a negative association between these

variables (Caska & Renshaw, 2013). Openness, defined as an orientation toward
new situations, creativity, and intellectual interest, is associated with the ability to
manage the uncertainty of life effectively and to deal better with traumatic events
and trauma-induced life changes (Tedeschi & Calhoun, 1996). However, some
recent studies report no significant associations between openness and posttra-
umatic stress symptoms (Caska & Renshaw, 2013; Clark & Owens, 2012). Further
on, agreeableness is defined through flexibility, tolerance, interpersonal trust and
consideration of others (McCrae & Costa, 1997; Watson & Clark, 1997). There is
some evidence that lower levels of agreeableness are associated with posttraumatic
stress (Caska & Renshaw, 2013). Finally, conscientiousness is conceptualized as
the tendency toward persistence, organization, and conformity to rules (e.g. Costa
& McCrae, 1992). Studies report that lower levels of conscientiousness correlates
with greater posttraumatic stress symptom severity (Caska & Renshaw, 2013).
Because the literature on the role of personality in the development of posttra-
umatic stress symptoms is inconsistent, other factors may be responsible for the
association between personality traits and stress related symptoms. We hypo-
thesize that one of these factors may be social support that play a moderating role
in the relationship between personality factors and stress.
The role of social support
Social support is a complex construct that originates from a variety of sources

(e.g., family, friends, community) and refers to the provision of emotional support
(e.g. reassuring companionship), informational support (i.e. providing advice
about daily care), and instrumental help to individuals (Schulz & Schwarzer,
2004). All these forms of social support have been shown to provide many benefits
to the overall health, well-being, and life satisfaction (Escriba-Aguir & Perez-
Hoyos, 2007; Moser, Stuck, Silliman, Ganz, & Clough-Gorr, 2012; Runcan &
Iovu, 2013). Several studies also found that social support is an important pro-
tective buffer against posttraumatic stress development (de Boer et al., 2014).
These results were also confirmed in studies that analyzed these relations in
persons indirectly exposed to trauma life events, including medical personnel
(Androniceanu, 2014; Duffy et al., 2014). The presence of a supportive social
network was found to have a strong preventive effect on the development of
posttraumatic stress in the context of occupational stress (Adriaenssens, de Gucht,
& Maes, 2012). Lack of social support, on the contrary, has been found to be
related to higher levels of fatigue, burnout, difficulties in managing work-related
stress and even posttraumatic stress responses (Duffy et al., 2014). However,
there are also studies that failed to find protective effects of social support on
posttraumatic stress symptoms (Laffaye, Cavella, Drescher, & Rosen, 2008) while
other research suggests that only some forms of social support, like emotional
support, predicted traumatic stress (Clark & Owens, 2012). Moreover,
19
unexpectedly, other study showed that seeking social support was associated with
an increased chance of developing traumatic stress (Buurman, Mank, Beijer, &
Olff, 2011). Thus, the role of social support in originating traumatic stress requires
further research.
The present study
The aim of the present study is to assess the relation between personality traits,
social support and secondary traumatic stress, in a sample of Romanian medical
staff. Because of the inconsistency between these variables, we consider that
more research is needed in order to clarify these associations. Moreover, little
research has been done in order to understand how personality traits and social
support work together in predicting traumatic stress.
Although few studies have examined the moderating role of social support on
the relation between personality traits and traumatic stress, there is some support
for this premise. First, there is empirical support for the fact that perceived social
support has an important stress-buffering role when people confront with stressful
situations (Hamaideh, 2012; Hayes Bach, & Boyd, 2010). Individuals, who per-
ceive a high level of social support in stressful situations, seem to deal better with
these situations than individuals without significant social support. Second, there
is evidence that social support interacts with intrapersonal variables, like self
esteem or mastery, in order to confer resilience (Bovier, Chamot, & Perneger,
2004). Third, higher levels of extraversion, agreeability, openness, and con-
sciousness have been found to be most strongly related to social support (DeLon-
gis & Holtzman, 2005; Leskela et al., 2009; Swickert, 2009), while high levels of
neuroticism are often associated with a tendency to utilize less social support
(Swickert, Hittner, & Foste, 2010). In sum, there is empirical evidence indicating
that personality factors confer resilience due to their association with social
support. To the best of our knowledge, there are not any studies that have examined
social support as moderator of the relationship between big five personality traits
and traumatic stress in a sample of Romanian medical staff. Most of the previous
studies on this theme focused on primary victims of trauma life events. Since
professional exposure to these events is not without consequences, further work is
needed in order to expand our knowledge about factors that promote resilience
despite adversity. This study was designed to address this issue.
Based on theoretical and empirical evidence presented above, we hypothesized
that: (1) neuroticism will positively correlate with secondary traumatic stress
symptoms, while extraversion, agreeability, openness, and conscientiousness will
negatively correlate with secondary traumatic stress symptoms; (2) social support
will negatively correlate with secondary traumatic stress; (3) emotional/ infor-
mational support will moderate the relation between personality factors on secon-
dary traumatic stress symptoms.
20
Methodology
Participants
Physicians and nurses from four hospitals from Romania participated in this
study. The final sample consisted of 162 participants (66.9% nurses and 33.1%
physicians) from several hospital units: Intensive Care, Emergency, Neurosurgery,
Cardiology, and Oncology units. From the total sample, 87% were female and
13% were male (Mage=32.02; S=10.69). The inclusion criterion was working for
at least one year in healthcare setting. The experience in the healthcare field
ranges from 1 to 40 years (M=7.46 years, SD=6.22) and they work with the
patients between 15 and 50 hours per week (M=33.36, SD=7.85).
Measures
The Secondary Traumatic Stress Scale (STSS; Bride, Robinson, Yegidis, &
Figley, 2004) was used to measure three dimensions of secondary traumatic stress:
intrusion, avoidance and arousal. The 17 items were evaluated on a 5-point Likert
scale, ranging from 1 (never) to 5 (very often). Cronbach’s Alphas for this current
sample were 0.70 for intrusion, 0.80 for avoidance, and 0.78 for arousal subscale.
Five Factor Model Rating Form (FFMRF; Mullins-Sweatt, Jamerson, Samuel,
Olson, & Widiger, 2006) is a 30-item scale measuring five major areas of per-
sonality: Neuroticism, Extraversion, Openness, Agreeableness, and Conscien-
tiousness. Each item is assessed by a single item that is anchored at both the low
and high ends by a set of 2-3 adjectives. Cronbach alphas for the current sample
ranging between 0.71 and 0.78, for the five scales.
The Medical Outcomes Study Social Support Survey (MOS; Sherbourne &
Stewart, 1991), a 19-item scale, was used to assess two dimensions of perceived
social support: emotional/ informational support and positive social interaction
(the availability of other persons to talk and do fun things with you). The items
were rated from 1 (never) to 5 (always). Cronbach’s Alphas for this current
sample were 0.92 for emotional informational support subscale and 0.90 for
positive social interaction subscale.
Demographic variables were collected via a questionnaire that covered age,
gender, occupation, hospital unit, number of hours of work with patients per week
and work experience.
Procedure
A researcher presented the research as an exploration study of the employers’

responses related to their daily professional activities. The participants were
informed that their participation was voluntary and would not become part of
21
their evaluation. The participants completed all measures anonymously to protect

their confidentiality, after signing an informed consent. Because the workload in
the workplace is very high, the participants had one week to complete the survey.
Of the 223 surveys distributed, 170 (76.23%) were returned. We removed 8
participants from the analysis because they provided incomplete data. No in-
centives were offered to the participants in this study.
Results
Preliminary analysis
In order to test for a possible bias, we conducted an analysis of variance (One-

way ANOVA) comparing professionals’ from different hospital units (Intensive
Care, Emergency, Neurosurgery, Cardiology, and Oncology) means on intrusions,
avoidance, and arousal. The results showed no significant differences on any of
the aforementioned study variables. Moreover, independent samples t-tests indi-
cated no significant differences between physicians and nurses on intrusions,
avoidance, and arousal.
The association between personality traits, social support and traumatic

stress symptoms
Neuroticism positively correlated with intrusion, avoidance, arousal, the re-

lations being moderate to strong. The other personality traits correlated negatively
with all the dimension of secondary traumatic stress, therefore high levels of
extraversion, agreeableness, openness and conscientiousness are associated with
lower levels of intrusions, avoidance, and arousal. A single exception was noted,
the association between openness and intrusion being non-significant. The results
also showed that emotional support did not correlate with the three dimensions of
secondary traumatic stress. There were also no significant associations between
the hours of work with patients per week, the professional experience and all the
studied variables. Means, standard deviations and correlation coefficients for all
scales are reported in Table 1.
22
Table 1. Means, standard deviations, and bivariate correlations for all manifest
variables and indicators
1 2 3 4 5 6 7 8 9 10 11
1. N 1
2. E -.27** 1
3. A -.32** .28** 1
4. O -.19* .22** .31** 1
5. C -.54** .44** .46** .35** 1
6. EIS -.14 .25** .29** .24** .24** 1
7. I .45** -.21** -.19* -.19 -.34** -.09 1
8. Av .53** -.26** -.40** -.13* -.47** -.15 .64** 1
9. Ar .52** -.19* -.33** -.22** -.41** -.11 .65** .84** 1
10. Exp -.03 .09 .01 .03 .07 .06 -.26** -.10 -.14 1
11. HW -.03 .04 .10 .05 .18* .05 .03 -.12 -.12 .18* 1
12. M 22.26 23.61 34.12 25.20 48.33 32.12 9.60 14.81 10.48 7.34 33.31
13. SD 5.56 3.51 4.33 3.92 6.26 6.49 3.17 5.15 4.13 7.91 8.90

Note: N – neuroticism, E – extraversion, A – agreeableness, O –openness, C -

consciousness; EIS – Emotional/ Informational Support; I – intrusion; Av – avoidance;
Ar – arousal; Exp – professional experience; HW - hours per week; N=162; * p <.05; **
p <.01; *** p <.001
Testing for moderation
For the SEM model of direct and moderation effects, estimates were derived
using maximum likelihood estimations and an overall model fit was assessed with
the normative fit index (NFI), goodness of fit (GFI), the comparative fit index
(CFI) and the root mean square residual (RMSEA). Acceptable model fit indices
are indicated by an λ2/df <3, an GFI, NFI and CFI>.90 (Hu & Bentler, 1999). The
fit for our overall model was good (Figure 1): λ2(20)=59.78, p=.059; λ2/df=1.80;
NFI=.96; CFI=.97; GFI=.92.
The demographic control for professional experience and hours per week was
not significant. The results revealed a significant positive link between neuro-
ticism and the three dimensions of secondary traumatic stress: intrusion (b = .24,
p < .001), avoidance (b = .41, p < .001), and arousal (b = .34, p < .001). Extra-
version, and conscientiousness are negatively related with intrusions (bs = -.20, -
.17, respectively, p = .005, < .001), avoidance (bs = -.34, -.38, respectively, p =
.004, < .001), and arousal (bs = -.20, -.27, respectively, p = .050, < .001).
Agreeability and openness are negatively associated only with avoidance (bs = -
.45, -.16, respectively, p < .001, p = .015) and arousal (bs = -.30, -.22, res-
pectively, p < .001, p = .007).
23
HW
Neuroticism
.24*** -.04
-.06 -.02
.34*** .41***
Intrusions
Extraversion -.20**
-0.20* -.34** -.10
-.03*
Avoidance
-0.45***
Agreeability
-.30***
-.05
-.17
-.04*
-0.16*
Openness Arousal
-.22**
-.06
-.17*** -.38***
-.02*
Consciousness -.27*** Professional
experience
Emotional/
informational support
Figure 1. Structural equation model and path analysis of the risk factors for and
moderation of secondary traumatic stress (N=162). Standardized path coefficients re-
ported. Correlations between exogenous constructs and error variances were omitted
from the model for readability. HW – hours of work with patients per week; * p <.05; **
p <.01; *** p <.001. Model fit: λ2(20)=59.78, p=.059; λ2/df=1.80; NFI=.96; CFI=.97;
GFI=.92.
There was mixed support for the predictions based on the second aim regarding
the interaction between personality traits and social support. The results showed
that emotional support moderated the effect of extraversion on intrusion (see
Figure 2), as well as the effect of openness on avoidance (see Figure 3), and
arousal (see Figure 4). We explored these moderating effects of perceived social
support by calculating mean intrusions, avoidance, and arousal values for low,
medium and high levels of social support. Medium values are based on the mean;
low and high levels of the variable are one standard deviation below and above
the mean, respectively (Aiken & West, 1991).
24
11,5
11
10,5 Emotional/ informational
10 support (Low)
9 support (Med)
8 support (High)
7,5
7
Extraversion Extraversion Extraversion
(Low) (Med) (High)
Figure 2. Presence of intrusions as a function of extraversion and emotional/

informational support.
17
16,5
16 Emotional/ informational
15,5 support (Low)
15
Emotional/ informational
14,5
support (Med)
14
13,5
13 support (High)
12,5
12
Openness (Low) Openness (Med) Openness (High)
Figure 3. Presence of avoidance as a function of openness and emotional/

informational support.
25
12
11,5
11 Emotional/ informational
10,5 support (Low)
10
support (Med)
9,5
9 support (High)
8,5
8
Openness (Low) Openness (Med) Openness (High)
Figure 4. Presence of arousal as a function of openness and emotional/ informational

support.
Discussion
The first aim of this study was to explore the relation between personality
traits and traumatic stress symptoms in the context of secondary exposure to
traumatic life events. Our results confirm the fact that people with a high level of
neuroticism present a higher level of all the dimensions of traumatic stress. On the
other hand, high levels of extraversion, agreeability, openness, and conscien-
tiousness are associated with low levels of secondary traumatic stress symptoms.
These findings are in line with previous studies concerning the relationship
between these traits and traumatic stress in primary victims (Clark & Owens,
2012). Therefore, extraversion, agreeableness, openness, and conscientiousness
seem to be protective factors, in the context of exposure to stressful events,
directly or indirectly, while neuroticism may be considered a risk factor for
developing traumatic stress after exposure to critical situations. In the present
study, the stronger relations were identified between traumatic stress and two
personality traits: neuroticism and conscientiousness. Therefore, these results
confirm the fact that one of the most consistent finding in the stress and personality
literature is the link between neuroticism and traumatic stress (Borja et al., 2009).
The strong relation between conscientiousness and traumatic stress can be ex-
plained by the fact that persons high in conscientiousness are mostly focused on
the fulfilment of their professional goals. When confronted with stressful si-
tuations, these persons may be more able to use efficient coping strategies in
order to decrease the stress and to accomplish their goals (Caska & Renshaw,
2013).
26
Our second aim was to analyze the relation between social support and traumatic
stress. Quite unexpectedly, our results revealed that social support was not signi-
ficantly associated with any of the three symptoms of traumatic stress analyzed in
this study. However, this is not the first study that did not find significant asso-
ciations between social support and traumatic stress. These findings add to the
limited literature suggesting that perceived social support is not related to trau-
matic stress symptoms (Laffaye et al., 2008). However, we only measured emo-
tional and informational support. It is possible that other forms of social support,
like positive social relationships, are more important in reducing traumatic stress.
Moreover, we did not measure the source of perceived social support. One pre-
vious study showed that supervisor social support predicts positive outcomes in
the context of occupational stress, while co-worker social support had no effect
(Escriba-Aguir & Perez-Hoyos, 2007). Another explanation for these non-signi-
ficant results lies in the fact that the relation between support and traumatic stress
is moderated by other variables like personality traits, as our results confirmed.
The third aim of the current research was to explore whether the association
between personality traits and secondary traumatic stress dimensions was mo-
derated by perceived emotional and informational social support. The results
showed that social support moderated the effects of two personality traits, extra-
version and openness, on the three traumatic stress symptoms. Specifically, our
results show that people with a high level of extraversion who perceive a high
level of social support have the lowest level of intrusion. Moreover, for people
with a high level of openness, the lowest level of stress is reported by those who
also report a high level of emotional and informational support. The relation
between openness and arousal is similar to the one identified between extraversion
and intrusions. Specifically, people with a high level of openness have a lower
level of arousal compared to persons with a low level of openness. This difference
is more evident for those persons who also report a high level of social support.
All these findings support the assumption that for persons with high levels of
extraversion and openness, emotional and informational support is a key factor in
order to decrease traumatic stress symptoms. Previous studies showed that extra-
verts have larger social support networks and manifest a greater need for emotional
disclosure and sharing experiences (Swickert, 2009). Openness, defined as a
receptive orientation toward novel experiences and ideas, is a protective factor
agains traumatic stress development. However, only a high level of openness is
not sufficient to reduce stress, but perceived emotional and informational support
can promote resilience in these persons.
27
Limitation and future research directions
Several limitations should be mentioned. Firstly, because the study is cross-

sectional, we must interpret the cause–effect conclusions cautiously. Secondly,
the nature of exposure to different traumatic life events may differ across different
hospital units. However, our results did not reveal significant differences in the
level of traumatic stress symptoms between participants from different units.
Moreover, we controlled the influence of hours of work with patients per week
when we analysed the moderation effects and the result was negligible. Third, the
majority of the participants are female and nurses. Therefore, the results can be
generalized mainly to these categories. Further studies are needed to replicate
these findings in larger samples, consisting of both women and men. Additional
research should also be done to explore the moderating role of other forms of
social support, from different sources, on the relation between personality traits
and traumatic stress symptoms.
Despite the above mentioned limitation, the present study expands the em-
pirical evidence confirming the moderating role of social support in the relation
between extraversion, openness and traumatic stress, in a less studied sample –
the Romanian medical staff. These results could inform prevention and early
intervention efforts that attempt to integrate individual differences in order to
reduce traumatic stress caused by professional activities. The management of the
medical institutions has to identify those who suffer from traumatic stress and
take protective measures, including access to counselling. It is important that
workers exposed to different stressful situations that involve others people’s lives
should have the opportunity and time to share their feelings, especially individuals
high in extraversion and openness. Therefore, it is important to provide a network
of support, including formal groups which can provide both emotional and infor-
mational assistance. Psychological debriefing could be a solution for providing
emotional and informational support in order to manage negative emotions.
As a conclusion, these results highlight the importance of understanding that
intrapersonal resources, like personality traits, and interpersonal resources, like
social support, are not manifested in isolation of one another. The complex
interrelations between intrapersonal and interpersonal factors should be con-
sidered when designing intervention programs in order to ensure resilience among
persons indirectly exposed to stressful life events. Future research in this field
should replicate and then extend these findings.
28
Acknowledgements
This paper is supported by the Sectoral Operational Programme Human Re-

sources Development (SOP HRD), financed from the European Social Fund and
by the Romanian Government under the contract number POSDRU/159/1.5/S/
133675.
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31
Working together
www.rcis.ro
Resources of Resilience amongst

the Urban Population
Cristina OTOVESCU 1, Adrian OTOVESCU2,
Gabriela MOTOI3, Dumitru OTOVESCU4
Abstract
The issue of resilience is analysed both theoretically and according to the data
obtained after a field research on a population of 600 people from Drobeta Turnu
Severin. The information attests that the main factors, for the destabilisation of
the urban population, are related to the affective, social and biological dimension
of it. The research unravelled the personal and collective effects of sufferance,
along with the strategies adopted for resolving the traumatising conditions. The
overwhelming majority of the population are optimistic people, confident in their
own forces, who appreciate that their life has been so far, generally, very succes-
sful.
Keywords: resilience, perturbing factors, sufferance/pain, individual/collective

resilience, strategies of resilience.
Introduction
Resilience constitutes a researching specific issue that has emerged in the last
half of the century, thanks to the contribution brought by different specialists in
psychology. This can also be found in other fields, such sociology, socio-biology,
biology, social assistance, law, history etc., even if the specialists from those areas
have not used specifically the concept of resilience. Although each science has its
1
University of Craiova, Faculty of Law and Social Sciences, Craiova, ROMANIA. E-mail:
otocris@yahoo.com
2
University of Craiova, Faculty of Letters, Craiova, ROMANIA. E-mail: adiotovescu@yahoo.com
3
gabrielamotoi@yahoo.com
4
dumitruotovescu@yahoo.com
32
own perspective for analysis, nevertheless, the purpose of the already mentioned
sciences is a common one: to investigate the adapting capacity of the people to the
natural and social environment, by revealing their resources and the ways of using
them for the positive adaptation
The premise we start from is that the human being has a bio-psycho-social
structure, which the differentiation of his preoccupations derive from too: (1) the
biologists and the physicians examine, mostly, the biological resources of the man
and his resilience in relation with the destabilising factors of the physical and
natural environment;(2) the psychical resources represent the studying subject of
the psychologists and psychiatrists, who are interested in the individual’s re-
silience, according to the action of the traumatising factors from the natural and
social environment; (3) for the sociologists, the knowledge of resilience in a
group and human collectivity is primordial, by identifying the socio-cultural
resources;(4) the people who work in the field of law wish to discover to what
extent the laws and the normative documents from a certain society (the observing
of the human rights) help the individual to manage the destructive actions that he
faces at some point;(5) the social assistant examines the personal resilience
resources and proposes intervention therapies for positive adaptation, based on
specific social investigations (Ionescu, 2013).
The term of resilience was initially usedonce with the preoccupations from the
mechanical physics, being defined as “a property of a metal or alloy to resist to
shocks” (according to online DEX). Later, it was also borrowed in certain psycho-
logical studies, his reputation being known about the contributions of the psycho-
logists Gamezy (1974, 1985) Rutter 1987, 1995, 1999, 2006, 2008, 2012), Masten
(1994, 2001, 2003) and Cyruhnik (2006). Being possibly adopted further, in the
future, by other sciences too, which used other concepts for the explanation of the
relations among people and environment, and their potential to resist to extreme
shocks.
Theoretical premises
In the psychological language, resilience is frequently named “personal re-

silience” or “individual resilience”(Tugade &Fredrickson,2004; 86: 320–333.).
This situation is explainable through the fact that, as regarding the psychological
preoccupations, the man is usually analysed as an individual who has a certain
psychical life, being endowed with the capacity to reason, will, temperament,
character, aptitudes, memory, affectivity, motivations etc. For the psychologists,
“resilience represents the individual’s competence to recover after an illness, a
change or a calamity” (Neagu, 2010). Generally, resilience is being defined in the
researching area of psychology as “the positive adapting” that appears after a
stressful or adverse event (Hopf, 2010). The process is one of positive adapting,
33
of active resilience and functional recovery that allows the individual to mobilize
his inner resources and to effectively counteract the action of the upsetting or
destructive forces, in order to succeed. Therefore, the solutions offered by the
psychological research on resilience concern the individual and the personal life.
The interest for the deeper research of resilience, from the psychological point of
view, was generated by the notice that certain children, who had to live in a hostile
environment, characterized by poverty, war, epidemic diseases etc., succeeded in
transcending those situations by developing surviving skills that later helped
them to have a normal development. It is very interesting to study the life ex-
perience of Boris Cyruhnik who lived the deportation ordeal of his family and
Nazi persecution. The problem of resilience was internationally studied by no-
torious psychologists (Rutter, 1987, 1995, 1999, 2006, 2008, 2012; Garmezy,
1974, 1985; Bronfenbrenner, 1979; Anthony, 1987) and, more recently (Ungar,
2004, 2008; Masten, 1994, 2001, 2003). Further on, we are going to insist more
on the specificity of the sociological interpretation of resilience.
The sociological perspective. From the sociological outlook, the man is ana-
lysed as a social being, as a member of a certain group, collectivity or society.
Such a cognitive measure leads us to the use of „group resilience”, „collective
resilience” or community/social/society resilience concepts. For the sociologists,
collective resilience regards the capacity of resisting and recovery, revitalisation,
rebirth of some groups/communities/societies, after the destabilizing or trauma-
tizing action of certain natural and social factors, radical and explosive changes
that concern the life of a human collectivity on the whole. In consequence, when
sociology deals with the problems of the collective resilience, the solutions are
appropriate at collective level. The fact that resilience is a concept which has not
been used in the tradition of the sociological thinking, this does not mean that the
real problem that it involves was ignored by certain specialists form this area. For
instance, let’s recollect that in the psycho-sociological theory about the social
nature of the self, William James (1890) draws the attention on the “aggressing”
or “damaging” phenomenon regarding the image of certain groups of individuals
from a society, which produces “sufferance” to them, signifying the lowering of
the “self-esteem”, in relation to the others. The thinker proposed a theory of the
social self, through the self-esteem recovery, mentioning two ways: by operating
with the knowledge that explains scientifically the relations between the individual
and his environment and by stimulating the society to preserve the individual’s
and groups’ self-esteem to high standards. The variation of the self-esteem is
admirably presented by the American author, who mentioned that: “A person with
low aspirations and great success shows a high level self-esteem”. On the contrary
“a person with high expectations, but with reduced results will have a limited self-
esteem”. Such logical reports, discovered by W. James, between the rate of success
of an individual and his expectations and aspirations, can be rendered valuable in
the psycho-sociological concept about resilience, by the thoroughly study of the
34
self-esteem, as source of resilience. This can mean that if an individual does not
ask anything from life is passive and inert, fatalist and cannot succeed in. Con-
sequently, we often hear that the future is for the brave. Furthermore, the American
sociologist William Thomas elaborated the theory of “social labelling” and “the
theory of individual/social life organisation/disorganisation” in The Polish Pea-
sant in Europe and America (written together with Florian Znaniecki, and publi-
shed between 1918 and 1920). In the sociological conception about the orga-
nization/disorganization of the individual and collective life, the author demon-
strates how a society can be disorganized when its culture is in decline and does
not offer solutions or resources of resilience. The thesis they reach to is that the
period of reorganization is inevitably wider than that of disorganization, as in the
case of the Romanian society (which is in an almost endless process of transition
from communism to capitalism). According to the author, between the two stages,
all the forms of disorder and social pathology, human degradation and malfunction
of institutions, which means that the old social system was not accepted, and the
population was “morally disarmed”. Therefore, a defending deficit appears, which
affects, in our opinion, the humans and individuals’ resources of resilience. In his
work called Sociological imagination, Charles Wright Mills evidences the drama
of the contemporary man, incapable to adjust to the rhythm of the social changes,
which leads to the collapse of his fundamental values, fact that creates panic and
depression, alienation, impeding his capacity of resilience and transformation, in
a world that he defines as one of “anxiety and indifference” (Mills, 1975: 86).
Therefore, the sociological approach considers resilience a group or collectivity
studying issue. To this respect, the French sociologist Emile Durkheim and other
promoters of the etatist or collectivist conception from sociology considered that
the social environment owns a primordial role in relation with the individual,
meaning that he is in a permanent state of dependency and can be anytime
suffocated by the environment in which he lives. Nevertheless, according to the
psychologists and the psychological orientation from sociology, some people find
plenty of resources in their own strength for succeeding. Similarly, we can also
talk about certain peoples and territorial communities that, despite some tragic
situations they faced (natural calamities, loss of their freedom after prolonged
conquests, internal wars, hunger, poverty, bloody reprisals, genocide acts etc.),
ultimately, they managed to go beyond these dramatic periods and to revive,
surviving and reinventing themselves in the history. For example, these are the
cases of the Armenian people (1914) and the Jewish one (1940-1944) – which
experienced the holocaust, losing millions of citizens, the cities of Hiroshima and
Nagasaki, completely destroyed after the atomic bombing from the end of World
War II. All these demonstrate that not only people, but also societies are subjected
to major jeopardy and risk involving their physical disappearance, emerged both
from the internal and external sides. Currently, the problems that the entire
humanity is facing are numerous, and some of them have already become chronic
world-wide (wars, under-development, devaluation of human life, diseases,
35
poverty, terrorism, natural and nuclear disasters, economic crises etc.) (Otovescu
et.al, 2011:38-88; Otovescu et.al, 2012). Although the consequences are painful,
and some of them are even frightful (for example, over 60 million people lost
their lives, along the 20th century, because of the two world wars), yet, the mankind
managed to resist biologically, psychically and morally, to discover proper re-
sources for continuing life on earth.
The biological perspective. In order to understand the man as a biological
being, when examining the issue of resilience, we can resort to Charles Darwin’s
“natural selection” theory. It has as main grounds the idea of the fight for existence
of all the living beings, therefore of the humans too, explaining this way his
biological condition, his natural evolution as natural being, through his adapting
to the environment and the surviving of those apt to assure the hereditary tran-
smission of the character. The mechanical applicability of the Darwinist theory to
the social life, by thinkers as Gumplowitz (1893), Gobineau (1853; 1855; 2002)
or Nietzsche (1901; 1999), led to erroneous interpretations; such are the classi-
fication of the human races in superior and inferior, the eulogy of the most
powerful individual etc. A certain animal remaining in the human behaviour
cannot be ignored, according to a thesis sustained by Wilson too (1975). The
author evidenced some previously programmed aspects of the human and animal
behaviour (such communication, hierarchy, solidarity, altruism, aggressiveness
etc.), fructified the discoveries from genetics and analysed the issue of the natural
selection in terms of costs and benefits, on social and institutional level (tran-
scending the impasse of the classical evolutionism that reduced selection to
individuals).
Interdisciplinary confluences. The fact that the man is, simultaneously, a bio-
psycho-social being, determines not only the possibility but also the necessity of
the interdisciplinary researching of resilience. The connections between indi-
viduals and groups or collectivities are indissoluble because there are neither
individuals living outside a society, nor societies without individuals (Otovescu,
2009: 73-74). Meanwhile, we underline that the individuals play a well-established
role in the social evolution (that unfolds according to norms, laws, values created
by humans and not by a simple process of adapting, which justifies the natural
evolution).The capacity to adapt is a natural endowment of the humans, which the
living inside a society can protect easily or can suppress, depending on the nature
of the society and its institutions. The more developed and better organised a
society is, the greater its surviving possibilities are. Resilience is a biological and
cultural potential that the individuals and the communities they belong to can
equally benefit from. Essentially, resilience is the consequence of individuals and
human collectivities selection, process after which the powerful, the flexible, the
adaptable, the confident and the optimistic triumph. From here emerges the
necessity to also discover the factors, the individual or collective resources that
36
lead the individuals and the communities to success, when confronting adverse
conditions.
Methodological approaches
The objective of this paper is to unravel the resources of resilience of the urban
population, when disruptive factors manifest inside a community. The premise we
started from is that the city from the Romanian society constitutes a specific
system, characterized by definite institutional structures and activities, that satis-
fies the basic needs of its dwellers: for working and obtaining an income able to
assure them a decent living, for communication, solidarity, education, security,
spare time activities etc. It is well-known that any territorial collectivity, therefore
the city too, has to own a functional order, to correspond the expectations of the
citizens: an economic order, an administrative order, a moral order, an institutional
order, a behavioural pattern and people’s interaction order etc. All these lead to
the accomplishment of the individual and collective needs, to the solving of
problems and conflicts that may appear in the cohabitation process. The lack of
order from certain departments of the city produces instability and blockings,
dissatisfaction, disorganization in the individual and collective life, personal and
family failure.
For that reason, the deciphering of collective resilience resources implies,
altogether, the discovery of the factors or conditions, the situations that direct to
instability, traumas for individuals. The results of psychological researches show
that, given the same circumstances of hostility, adversity or risk, people react
differently: some of them are psychically and behaviourally disorganised, while
others struggle and succeed to surpass the difficulties. How does this beneficial
effect for the individual life take place? What do people who surpass the diffi-
culties resort to? Do they use only their inner strength or the help of the close
people (family, relatives, friends, colleagues, and neighbours), the support of
official/unofficial institutions? It is known that family, profession/occupation and
job, social group (friends, colleagues, relatives, and neighbours) represent that
main factors on which the man rely on, as a social being.
The investigation of the collective resilience in the urban environment was
realised through two sociological methods: a quantitative one – the poll based on
a questionnaire, and a qualitative one – the structured interview (that we are going
to detail in the present article). The researching area was represented by the
population from Drobeta Turnu Severin (County residence of Mehedin]i). The
volume of the sample was of 600 people, of 18 years old and over, both genders,
randomly chosen, with a sampling interval of 3 and a margin of  2.4%, assuring
the degree of representativeness according to the share of the population on
streets and neighbourhoods from the city. Both the questionnaires and the
37
interviews were applied at the domicile of the respondents, through direct contact
(face to face). Most of the questions from the questionnaire had pre-formulated
answers and, generally, they were grouped thematically, according to the in-
dicators considered in the process of gathering field information.
The projection of the sociological research was made taking into account
several hypotheses, among which, in the present context, we mention the follow-
ing: (1) If people have an optimistic nature and show trust in themselves and
succeed in life in a greater extent than the pessimistic or the sceptical and dis-
trustful; (2) The harsher sufferance of people is related to their affective nature
(the loss of a dear person), social nature (the loss of a job, marriage) and biological
nature (the confrontation with a serious illness); (3) The older the people are, the
more resistant to the traumatising factors they become.
Results of the field research
Perturbing factors and destabilising causes
In the last 25 years, the Romanian society has been marked by an ample
process of radical social changes, due to the transition from the communist to
capitalist regime. This process has been encompassing not only the entire society,
but its territorial component communities, especially the cities, the Municipality
of Drobeta Turnu-Severin being among them. The basic reconstruction of Ro-
mania, starting with 1989, and of other eight European societies (that broke from
their communist past), produced a series of anomic phenomena and human de-
gradation situations, as W. Thomas also noticed, when referring to his times
society. These pathological behaviour manifestations, at individual and group
level, and the institutional malfunctions – unknown to the societies with a long
capitalist evolution – challenged the adaptation capacity of the urban population
to the rhythm and the negative consequences of the social changes, and we can
call it urban resilience. In such a climate, of confusion and disorientation, of
values collapsing and weakening of public institutions authority etc., a multitude
of perturbing and traumatising factors manifested, towards which there were
registered ambivalent reactions: of resignation and failure or of individual and
collective resilience.
Next, we are trying to sketch a typology of the destabilising factors/causes,
along with the forms of resilience, mentioning that most of them have been
registered in our society during the interval 1990-2014. The most general classi-
fication has in its foundation their origin and, this way, we can encounter factors/
causes that belong to the natural conditions (earthquakes, floods, landslides,
draught etc.) and those specific for the human background. Altogether, some
factors are specific for the rural environment, while others regard only the urban
38
environment and the society in its whole. There are factors that are related to the
individual (e.g.: a serious illness), while others produce the destabilising effects
inside a group or collectivity (an earthquake, for instance), to the society (for
example, a war). According to their nature and the field of manifestation, we met
the next categories of traumatising factors: (1) personal or individual factors:
illness, sufferance or pain caused by the death of a dear person, solitude, stress,
failure, pessimism; (2) family factors: conjugal violence, adultery, divorce, aggre-
ssiveness against children etc.; (3) social factors: unemployment, lack of a dw-
elling, poverty, hunger, devaluation of human life, low living standard, degra-
dation of communication relations between people, lack of medication and inno-
vatory treatments, alert rhythm of changes, lack of physical protection and per-
sonal priorities, corruption, aggressiveness and abuses of certain public insti-
tutions etc; (4) political factors: deficit of laws for regulating the situation in
certain fields, inter-institutional conflicts, political crisis, inefficiency of the state’s
fundamental institutions, collective interests ignoring, lack of objective and na-
tional development projects etc.; (5) economic factors: lack of jobs and major
investments for the development of national infrastructure, lack of income, low
level of wages/pensions, financial crisis, dissolving of factories and instability of
jobs etc.; (6) juridical factors: bad management of justice, exaggerated prolonging
of law suits, abusive investigations and the harassment; (7) moral factors: mali-
ciousness, envy, treason, revenge, public contempt, discrediting, mass-media
defamatory actions, lack of respect and solidarity, ignoring the sufferance of the
people near us etc.
Some factors are generally human; others are specific for a certain society and
historic period. Some act on long term, others on medium and short term. In any
society, social order and disorder coexist, in variable proportions, from one
country to another. This means that the destabilising, unhealthy factorsare inherent
to the human condition and, in the same time, they produce an immunity deficit,
through the supplying of the social pathology phenomena. This is the reason for
the necessity to be counteracted by the healthy and positive forces of the society,
through actions of individual, collective and institutional resilience, official or
unofficial, that fortify the general immunity inheritance. The combined action of
some perturbing or destructive factors (such the finding of a serious illness),
breaking of a marriage and loss of job can have devastating effects of a person, on
short or long term, blocking his resources of resilience.
Along our research, we wished to unravel the main perturbing factors that
acted among the population from Drobeta Turnu-Severin and, implicitly, to find
out the share of the people who resisted the effects on them, and the means or the
strategy they adopted to move on with their lives. The concrete information was
gathered with the help of a question: Which is the greatest pain or sufferance have
you had so far?
39
Table 1. Hierarchy of pain or sufferance categories (according to self perception)
No. Which is the greatest pain or sufferance have you had so far? %
1 Passing away of a dear person 45.1
2 Loss of the job 6.7
3 Argument with the family/relatives 3.9
4 Suffering from a serious illness 2.5
5 Divorce 2.3
6 Other 2.4
7 DK/DA 37.1
TOTAL 100
It can be noticed that there were four categories of causes or traumatising

factors, at the level of the researched collectivity. Among these, on the first place
there was the loss of a dear person, which has the highest share, affecting almost
half of the total investigated population (45.1%), being followed by the loss of the
job (approximately 7%), which proves the second hypothesis of our research. The
first is a general-human factor that cannot be avoided and that every person who
was born inside a family has to face in the community. This has an unlimited
duration of manifestation. Moreover, unemployment is a direct and inevitable
consequence of the market economy that generates affective vulnerabilities (indi-
vidual and familial), on variable intervals of time. If death is an implacable
natural phenomenon, unemployment is a social one whose solution belongs espe-
cially to the political and economic institutions from the local community (C.W.
Mills), and also to each individual. In the first case, people are powerless, and
their spiritual recovery depends on the time passing, their own education and
relation with the social environment; in the second case, positive adapting and the
seeking for working opportunities depend mainly on the subjective, personal
factor.
The sufferance induced by the death of parents (31.8%) and of husband/wife
(19.9%) was invoked by over a half of the questioned subjects. Other dear people
were a brother/sister (6%), friends (6%), children (5.7%), grandparents (5%), and
cousins (2%). Other traumatising factors for the urban population from Drobeta
Turnu Severin were the family conflicts (3.9%), suffering from a serious illness
(2.5%), and divorce (2.3%).
Types and forms of resilience
Generally, for each of the types of factors mentioned above, there are corres-
ponding response reactions. If we consider the interferential criterion, then we
can distinguish the next types of resilience: individual, group, collective and
national. In exceptional situations, such is the rapid and mortal spreading of some
incurable viruses (as in the recent case of the Ebola virus epidemic, from three
states of the Western Africa), the entire global community mobilise themselves to
40
resist in front of such dangers that menace the entire human species. According to
the duration of manifestation, resilience can manifest on short, medium and long
term. According to the sphere of action, it can be extended or restrained inside a
human collectivity. According to the way of manifestation, it can be general or
selective (for example, an individual is capable to rebuild his life after a divorce,
but is not able to apply for a new job, after unemployment). According to the
structure of the human being, we can talk about hostile situations, not only through
the discovery of personal solutions, but also through the resort to the help of
official institutions, as citizens (the observing of right to life implies the granting
of medical assistance, unemployment payment etc.). According to the degree of
intensity, we can talk about a minimal and maximal resilience. Moreover, we can
meet a latent, potential resilience and a manifesting, potential one; a powerful and
weak resilience etc.
The research made amongst the urban population from Drobeta Turnu Severin
evidenced that the overwhelming majority of them have generous resources of
individual and collective resilience, especially with relation to the activities they
have performed, during their life, from which have not missed the moments of
pain or sufferance. The affirmation is made after the answers to the question: Has
your life so far been mostly full of...?
Table 2. General evaluation of personal life (according to success and failures)
No. Categories de options %

1 Triumphs, accomplishments, success 82.7
2 Failure, dissatisfaction, disappointment 16.6
3 DK/ DA 0.7
Total 100.0
The high share of the people who generally evaluated their own life, by then,
in positive terms can be firstly explained through the psychical factors related to
the human nature – the type characteristic to each person. The poll showed that
79% of the inquired subjects confessed they have an optimistic nature, they
manifest trust and hope that they can achieve their goals, which conforms the first
hypothesis of our study. At the opposed pole there were situated the pessimistic
people, who trust nobody, not even themselves, and who lack the hope of fulfilling
their dreams (21%).
The individual psychical pattern, from which the personal resilience derives,
has a major part when comes to fighting against obstacles in life, but does not
totally justify the conclusion above. For this reason, we consider that it is ne-
cessary to take into account other factors too, related to social life, affiliation,
collective mentality and cultural identity, national belonging. Different previous
sociological researches attest the fact that the Romanians are generally optimistic
people, full of energy and eager to succeed personally and at the family level, to
41
have a prosperous life, which their successors will enjoy too. Nonetheless, the
investigation made in Drobeta Turnu-Severin showed that 51% of the dwellers
are content and very content, a percent that coincide with the share of those who
evaluated their lives through failure and dissatisfaction. The main sources of
satisfaction, as the questioned people appreciated, are, first of all “a fulfilling
family life” (43.3%), “professional success” (24.3%) and “good health” (11.3%),
followed by “safety of the neighbourhood” they live in (5.3%), “the achievements
of their children” (2.4%) etc. such sources of satisfaction also indicates the system
of values that they people from Severin rely on their own lives. On the other hand,
“reduced income” (48%), “lack of jobs” (3.8%), “stress/fatigue” (3.1%), “chil-
dren’s behaviour” (2.5%) and illnesses were considered the most important causes
for discontent or dissatisfaction, and discomfort.
Certainly, people’s life is not just triumph, but it also involves failure, disa-
ppointment, resignation. In other words, success and disappointment coexist, but
what matters is the share of the people who see their own life devalued, mea-
ningless, rejected by the local community. Therefore, the category of the unful-
filled, in proportion of almost 17%, draws the attention on the necessity of some
individual and group therapies, of local social assistance intervention, for helping
them in order to recover their own determination, to gain resources of resilience,
to not be vulnerable anymore.
Capacity of resilience against pain/sufferance
Duration. According to this indicator, it was noticed that over a half of the
people affectively unbalanced by the loss of a dear person and by a persistent
serious illness, continue to be even presently distressed, at almost 10 years after
the event took place. The traumatised are the people who lost a family member:
children (declared 95% of the total number of those affected by these tragic
situations), husband/wife (68.3%), brother/sister (59.8%), and parents (49.7%).
Table 3. Types of pain/sufferance (by time of manifestation)
The greatest Time of manifestation Total

pain/ sufferance under 3 4-6 7-9 10-12 1-3 4-6 7-9 still in
months months months months months months months present
disappearance of 2.6% 4.9% 1.1% 4.5% 9.7% 5.2% 6.4% 65.6% 100.0%
some dear
people
contacting a 0.0% 9.1% 0.0% 9.1% 18.2% 0.0% 9.2% 54.5% 100.0%
serious illness
loss of the job 12.9% 12.9% 6.5% 6.5% 9.7% 3.2% 22.3% 26.1% 100.0%
argument with 28.6% 7.1% 4.3% 5.0% 0.0% 14.3% 5.0% 35.7% 100.0%
the
family/relatives
divorce 4.8% 0.0% 4.8% 0.0% 19.0% 4.8% 38.1% 28.6% 100.0%
42
The effects of pain/sufferance. The research evidenced six important consequences,

which are different according to the factors or the perturbing causes. For example,
depression is characteristic for the people who contacted a serious illness (50%)
and for those who lost a dear person (37%); the lack of will for living and
concentration, or depressionate extremely important for those who lost their jobs;
the increase of irascibility is higher among those who argued with their family or
relatives; solitude and depression are more frequent among those who experienced
a divorce.
Table 4. Types of pain/sufferance (by effects on the personal and social life)
The greatest Effects on the personal and social life Total
pain/ sufferance Increase of Lack lack of Solitude Lack of Depression Others
irascibility of will concentration support
for
living
disappearance 4.5% 8.6% 5.2% 19.2% 12.3% 37.0% 13.2% 100.0%
of some dear
people
contacting a 0.0% 10.0% 15.0% 0.0% 12.5% 50.0% 12.5% 100.0%
serious illness
loss of the job 4.5% 20.8% 20.8% 4.5% 18.5% 19.1% 11.8% 100.0%
argument with 43.0% 10.0% 20.0% 0.0% 13.7% 13.3% 0.0% 100.0%
the
family/relatives
divorce 15.4% 7.9% 0.0% 37.7% 0.0% 23.6% 15.4% 100.0%
The possibility to transcend the sufferance. From the entire population who
mentioned the sufferance, 23% succeeded in transcending it up to present, almost
20% are still facing it, and 57% did not know what to answer. Those who
experienced family arguments and lost their jobs proved to be in a greater extent
(65% and 52%) to surpass the sufferance provoked by these situations, while
more than half of the divorced (60%), from those with a serious illness or who
dealt the loss of a dear person confessed that they did not manage to surpass the
personal problems. The resilience of these categories is relevant for 46% of those
who lost someone, for 44.4% of those who got sick and for 40% of the divorced.
Table 5. Capacity of resilience (by types of pain/sufferance)
The greatest pain/ sufferance Did you succeed to transcend this Total
problem?
Yes No
disappearance of some dear 46.4% 53.6% 100.0%
people
contacting a serious illness 44.4% 55.6% 100.0%
loss of the job 51.7% 48.3% 100.0%
argument with the family/relatives 65.0% 35.0% 100.0%
Divorce 40.0% 60.0% 100.0%
43
Strategies of resilience
On individual level, the strategy involves the establishing of the objective and
necessary means to accomplish it, ascertaining of operational solutions, choosing
of approaching methods. The research evidenced seven solutions or recipes that
the questioned subjects resorted to in order to transcend the traumatising situations
they faced. Among these, two are common for all the categories of sufferance:
those who aim the friendship connections and those who are related to the qua-
lified services of some specialists (physicians, psychologists, psychiatrists). From
the table bellow, we can notice that in all the cases it was resorted to combined
solutions, methods or modalities, but some of them have a greater frequency,
being specific for the attenuation or the healing of certain causes of the sufferance.
For example, the remedy for unemployment implies the initiation of their own
business, finding of another job, in locality or in another country, as 62% of the
people who lost their jobs declared. The data of the research show that the
emigration for working abroad was the solution that 36% of the redundant people
from Drobeta Turnu Severin resorted to, most of them leaving in Italy, England,
Germany and Spain. According to the official statistic data, Mehedin]i County has
over 12,713 unemployed people (of which 27% live in cities), unemployment
being one of the most important social problem the population has been dealing
with in the last two decades. The rate of unemployment in January 2014 was of
10.50% (AJOFM Mehedin]i, February 2014), being one of the highest, as com-
pared to the other Counties from the country (on the national level, the rate of
unemployment was of 7.3%).
Medical treatment and friendship proved to be useful to defeat the serious
illness. In case of losing a dear person, people resorted to the help of friends and
specialists in psychology/psychiatry. The consequences of a divorce were healed
by remarrying, requirement of affective support and travelling long journeys.
Table 6. Ways and solutions to transcend the sufferance
The greatest pain/ Ways to transcend the sufferance Total

sufferance I I found I got I went to see I I I
resorted another divorced a physician, bought travelled remarried
to job psychologist, a pet a lot
friends psychiatrist
disappearance of 42.9% 0.0% 0.0% 21.8% 12.1% 12.1% 12.1% 100.0%

some dear people
contacting a 36.2% 0.0% 0.0% 58.5% 2.1% 3.2% 0.0% 100.0%
serious illness
loss of the job 35.3 % 61.7% 0.0% 3.0% 0.0% 0.0% 0.0% 100.0%
argument with the 30.9% 20.8% 9.8% 4.5% 18.5% 4.5% 11.0% 100.0%
family/relatives
divorce 28.6% 0.0% 0.0% 9.4% 4.2% 22.0% 35.8% 100.0%
44
The correlation of the answers to the question Up until now, have you managed
to transcend the issue of the experienced sufferance? with gender, age and legal
status of the questioned people, reveals conclusive information about the capacity
of resilience of the urban population, according to these demographic variables.
Thus, it came that the men transcend the sufferance in a greater extent (55.3%)
than the women (44.7%), the last ones being, most of them (66.2%), still do-
minated by the registered affective anxieties.
Table 7. Capacity of resilience (by gender)
Up until now, have you managed to Gender Total

transcend the issue of the experienced Male Female
sufferance?
Yes 55.3% 44.7% 100.0%
No 33.8% 66.2% 100.0%
Furthermore, the middle aged people have a higher existence potential than the
older groups of age, which, apparently should be immunized after accumulating
knowledge and multiple life experiences. The collected data prove the contrary:
as the age increases, the share of the people who said they transcend the ex-
perienced sufferance (from 14.9%, between “56 to 65 years old”, to 11%, between
“66 years old and over”), fact that invalidates the third hypothesis of our study.
Table 8. Capacity of resilience (by age)
Up until now, have you Age Total

managed to transcend the issue 18-25 26-35 36-45 46-55 56-65 66 years
of the experienced sufferance? years years years years years old and
old old old old old over
Yes 11.6% 19.9% 21.3% 21.3% 14.9% 11.0% 100.0%
No 6.2% 16.2% 17.5% 8.8% 10.0% 41.3% 100.0%
From the correlation with the legal status, it resulted that the married people,
with a normal family life, have positive readapting resources in a higher share
(58.5% of the total number), than those who live alone, who proved to be more
vulnerable. The proof is that 47.5% of the unmarried people and 33.8% of the
widowers and widows appreciated that they did not surpass the previous suffe-
rance, as it can be noticed in the data of the table below.
Table 9. Capacity of resilience (by legal status)
Up until now, have you Legal status Total

managed to transcend the DK/DA married Unmarried divorced widower/ concubine
issue of the experienced widow
sufferance?
Yes 1.0% 58.5% 16.0% 7.4% 16.0% 1.1% 100.0%
No 0.0% 16.2% 47.5% 2.5% 33.8% 0.0% 100.0%
45
Conclusions
The first researches on personal resilience belong to some specialists in

psychology, but the complexity of the human being (determined by his bio-
psycho-social structure) claims the necessity of some inter-disciplinary analyses,
based on the theoretical acquisitions from biology, psycho-sociology, social assis-
tance, law sciences etc. In the present article we insisted on the specificity of the
sociological approach that treats resilience as a social phenomenon, evaluating its
manifestations on the collectivity level, according to the information gathered
inductively (from individual to general). Thus, the sociological perspective was
combined with the psychological one, for realising the research and for investi-
gating the concrete data, considering that each individual lives in tight connection
with the destiny of the collectivity he belongs to (from here resulting the heuristic
importance of the psycho-sociological studies).
Due to the fact that resilience is a consequence after the action of some
perturbing factors, it is necessary to know the relation between cause and effect.
In this context, it has to be underlined that resilience is different according to a
certain system of reference and it has to be examined individually, in group, in
collectivity and in the national society. The diversity of the environments a person
lives in and the fields of activity from a society cause a multitude of traumatising
actions, classified in several types (personal, familial, social, politic, economic,
judicial, moral) etc. The typology procedure regarded resilience too, studied in
accordance with certain criteria. If we take into account the structure of the
human being, we notice three distinct types of resilience: biological, psychical
and social/societal. Equally important is also the distinction drawn between the
personal resilience and collective resilience, between the general and the selective
one (a man benefits by a positive adaptation only in relation to definite trauma-
tising causes). The typology is a necessary condition for the methodical research
and for obtaining scientifically relevant knowledge.
Human life is not perfect and, therefore, any person can face pain or sufferance.
The research showed that, amongst the analysed collectivity, there are predo-
minant the dissatisfactions related to the human’s affective nature (disappearance
of a dear person, mentioned by 45.1% of the dwellers), of social life (loss of the
job and, implicitly, the source of income, the arguments between family members
and divorce, mentioned by 12.9%) and the precarious health condition of the
individual (the menacing of the physical existence by a serious illness – 2.5%).
The effects of the sufferance on the personal and social life are different according
to the generating cause. From the entire population, who indicated a pain/suffe-
rance, the most widely spread effect of it refers to depression (19.4%), followed,
from the highest to the lowest share, by solitude (6.2%), lack of will for living
(5.2%), lack of support (3.5%), concentration (3.1%) etc. Over 41% of the ques-
tioned people expressed the opinion that the sufferance they experienced affected
46
their personal life, working efficiency and their behaviour in relation to the other
people (becoming, especially, more irascible – over 3.5%). The capacity of resi-
lience is more reduced when considering the loss of a dear person, contacting of
a serious illness (that do not depend directly on the individual) and the conse-
quences of a divorce, but stronger as confronted to unemployment and family
arguments.
Resilience is a natural heritage of the man, which can be amplified through
systematic education, through the efficient involving of some specialised insti-
tutions and the nurturing of certain values (friendship, solidarity, observing of
right to work etc.), meant to support the individual efforts for positive adaptation
and human development. The personal strategies of resilience are based on con-
crete solutions (differentiated according to the traumatising factors), such is the
resorting to friends (almost 43%), finding a new job (21.3%) etc. On the investi-
gated collectivity level, 23% of the people who experienced a sufferance succe-
eded in transcending it, almost 20% are still experiencing it and 57% did not
answer.
The data contrast, to a great extent, with the appreciation for their own life
(which approximately 83% of them mentioned as successful) and their own nature
(evaluated as optimistic by 79%). This discrepancy might be explained though the
fact that the sufferance was regarded as a passing event, while the opinion about
the fulfilled personal life considers it in general and, the efforts made for the
familial and professional achievements, in particular. On the other side, the
optimistic people are not expelled from suffering and the trust and the courage
that drives them, certainly help them to transcend easily the temporary moments
of internal unbalance, as compared to the pessimistic ones.
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Working together
www.rcis.ro
Relationships between Fashion Enterprises

Resilience under Market Disruption
and Employees’ Creative Involvement
and Wellbeing Degree
Carmen Luiza COSTULEANU1, Diana DUMITRESCU2,
Stejarel BREZULEANU3, Nicolae BOBITAN4
Abstract
Resilience became an important term in the language of many disciplines,

although there is no commonly accepted definition that is used across all dis-
ciplines. There exist a lot of factors studied for their involvement in the economic
resilience of companies under market disruption (in crisis). But the employees’
creative involvement and wellbeing degree were paid less attention. Our study
targeted the relationships between such social dimensions and firm resilience for
18 clothing-related small and medium-sized enterprises (SMEs) from Romania
(Moldova region). Case selection was via theoretical sampling. To be specific to
our choice of the variable to denote ‘health’ of business systems the Altman’s Z-
score was taken into consideration. We aimed to find the eventual correlations
between the Z-score transition profiles and employees’ creative involvement and
wellbeing score for selected firms, having a predominantly or final ‘health’ status,
during 2009-2013. The most important finding of our study is represented by the
strong correlation between the ‘healthy’ Z-score transition profiles of the com-
panies and the real employees’ creative involvement in company’s production
management and their wellbeing degree. The employees’ involvement in com-
panies’ governance might represent the basis for building up the organizational
resilience.
1
Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine, Department
of Agroeconomics. Iasi, ROMANIA. E-mail: ccostuleanu@yahoo.com
2
West University of Timi[oara, Faculty of Economic and Business Administration, Department of
Accounting. Timi[oara, ROMANIA. E-mail: dianadumi@gmail.com
3
Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine, Department
of Agroeconomics, Iasi, ROMANIA. E-mail: stejarel@uaiasi.ro
4
West University of Timi[oara, Faculty of Economic and Business Administration, Department of
Accounting. Timisoara, ROMANIA. E-mail: nicu.bobitan@yahoo.com
50
Keywords: resilience, employees, creative involvement, wellbeing degree,

governance.
Introduction
Resilience (derived from the Latin resalire, to spring back) has become an
important term in the language of many disciplines ranging from psychology to
ecology. Unfortunately, there is no commonly accepted definition of resilience
that is used across all disciplines. The concept of resilience is widely used in
many fields as a frame of reference. It is generally understood to be a capacity
which a person, group, subject or system can develop when facing a situation
affecting integrity, enabling them to hold up, recover and come out of it stronger.
Resilience is considered as a cross-sectional study in which more and more areas
of knowledge find a positive way to address and raise new studies (Vaquero,
Urrea & Mundet, 2014).
The rapid expansion of the use of the resilience concept is not without ge-
nerating many questions. Is this extension risky? Does it contribute to the trivi-
alization, to the dilution of the concept of resilience? Or does it testify of its
development, its richness, and heuristic value? What are the consequences on the
theory of resilience? What are the implications for practice? Though initial studies
focused on individual resilience and on facilitating personal characteristics, it
very quickly became clear that many factors pertaining to the family and to the
general environment are involved in the process underlying the development of
resilience. Thus have been established the fields of family, community and, more
recently, societal (Ionescu, 2014), organizational, institutional and economic
resilience. Resilience factors are those that lead to the diminishing of the potential
of individuals to become involved in certain behaviors, those that create a buffer
against risk factors (Tomita, 2014).
Organizations are a fundamental part of societies and economic systems whe-
ther they are private, public or not for profits. There are very few aspects of the
societies and economies that don’t rely wholly or in part on the performance of
organizations. They can range in size from several people through to thousands.
An organization is any entity with objectives. The dictionary definitions include
“a body of persons organized for some end or work.” The challenge is how do
entities continue to meet their objectives when they are under acute stress or
shock? The societies and economies are almost completely dependent on in-
credibly complex networks or webs of organizations. These networks and webs
are both physical and relational and are continually evolving and are increasingly
interdependent. How shocks play out in these systems is not well understood and
traditional analytical approaches seem to have limited value. Successful outcomes
will depend on interplay between organizations from the private, public and not
51
for profit sectors. How then can the effectiveness and efficiency with which
organizations deal with the risk of a severe shock be developed and enhanced?
(Tarrant, 2010). Resilience - a firm’s ability to adapt, endure, quickly bounce
back, and then thrive despite a catastrophic event - addresses diverse managerial
constructs including performance (Carmeli & Markman, 2011).
Role of employee accountability and sense of ownership, along with con-
tinuous improvement through knowledge sharing, learning and right mind-set
might be essential for organizations to build resilience and, hence, long-term
performance (Keller & Price, 2011; Pal, Torstensson & Mattila, 2014). Working
together effectively across the company leads to a sense of cognitive wellbeing
through alignment of the organizational values, corporate culture, shared vision
and responsibilities (ideational foundation) for promoting adaptive learning capa-
bilities (Boisot & Child, 1999; Pal et al., 2014). Sustainability and resilience in
SMEs will be enhanced by (1) ability to embrace organizational and people
dimensions as well as operational aspects of change management, and (2) paying
attention to long-term planning and external communication to drive change
proactively (Ates and Bititci, 2011). Despite the above mentioned findings, the
employee creative involvement and wellbeing degree were paid less attention.
Our study targeted the relationships between such social dimensions and firm
resilience for a number of clothing-related small and medium-sized enterprises
(SMEs) from Romania (Moldova region).
Methodology
Case selection was via theoretical sampling (Flick, 2009; Pal, Torstensson &
Mattila, 2011). Data collection, in this study, was done in two phases. Initially, the
annual reports (mainly income statements and balance sheets) of 30 Romanian
(Moldavian) clothing firms (convenience-based non-probabilistic sampling tech-
nique) were studied for the last nine years (2005-2013) to make their Z-score
profiles and characterize economic resilience in terms of business ‘health’ (Pal et
al., 2011; Pal et al., 2014). Such initial data and contacts were obtained from
Romanian Chamber of Commerce (CCR), National Agency for Fiscal Admi-
nistration (ANAF) and by searching through Romanian firm directories.
Among the 30 selected entities, 18 accepted to enter the next phase of interview
to get more in-depth knowledge on the issue. All the firms were Romanian
(Moldova region) clothing-relating SMEs and family-owned through most of the
time in their history. They accepted to deliver the following information from
2005 to 2013: current assets, total assets, current liabilities, total liabilities, re-
tained earnings, earnings before interest and tax, net worth (total share holder’s
equity), sales and number of employees. All the companies were private limited
ones, registered before 2005, non-listed (meaning that they are not listed in the
52
share market and do not have a public undertaking). The 18 included firms in our
study were named in alphabetical order as A to R.
The Z-score (Altman, 1968; Altman, 2000; Pal et al., 2011) discriminant
functions are as follows:
Z’ = 0.717T1+0.847T2+3.107T3+0.420T4+0.998T5 (for private manufacturing
firms) and
T1= (Current assets-Current liabilities)/Total assets,
T2= Retained earnings/Total assets,
T3= Earnings before interest and tax (EBIT)/Total assets,
T4= Net worth (Total share holder’s equity)/Total liabilities,
T5 = Sales/Total assets.
The zones of discrimination:
Z’ > 2.9 (for private firms) – “healthy=H” zone,
1.23 (for private firms) < Z’ <2.9 (for private firms) – “unhealthy=U” zone,
Z’ < 1.23 (for private firms) – “catastrophic=C” zone.
The second step, the stable employees for the last 5 years were asked to
complete a survey questionnaire concerning their perception on “creative in-
volvement” and “wellbeing degree” related to their jobs. The closed nature of the
survey allowed the respondents to answer either ‘poor’, ‘fair’, ‘good’, ‘very
good’ and ‘excellent’ to each question. The answers were further coded as follows:
‘poor’=1, ‘fair’=2, ‘good’=3, ‘very good’=4 and ‘excellent’=5, being established
a deductive methodology for data analysis.
Thus, the survey results were firstly analyzed using descriptive statistical
techniques appropriate to the subject research. After that, we used Spearman
Rank Order Correlation test to find the eventual correlations between the Z-score
transition profiles and employees creative involvement and wellbeing score for
selected firms, having a predominantly or final ‘health’ status, during 2009-2013.
The p value below 0.050 was considered absolutely necessary for significant
results.
53
Results
Might be evident that achievement of organizational business goals contribute

to better business system ‘health’ and a transition to an ‘unhealthy’ or ‘catas-
trophic’ state is associated with the lack of achieving these goals. But now exists
a definite index for measuring business ‘health’ and studied over a time-period is
highlighting the transitions (Pal et al., 2011).
To be specific to our choice of the variable to denote ‘health’ of business
systems the Altman’s Z-score was taken into consideration. This multivariate
discriminant model has been a popular method to predict corporate bankruptcy
since the end of 1960s. and has been modified for utilization in case of private as
well as non-manufacturing firms and in a broader sense being used to analyze
business ‘health’ in terms of five standard ratio categories viz. profitability,
liquidity, leverage, solvency and activity for indicating both long-term and short-
term financial performances (Altman, 1968; Altman, 2000; Pal et al., 2011).
Figure 1 shows the “Z-score transition profiles” of all the 18 companies over the
studied period (2005-2013). The Z-score transition profile of each company is
obtained by plotting its Z-score values over the years 2005 to 2013, and classifying
them as either ‘healthy’, ‘unhealthy’ or ‘catastrophic’. Figure 2 presents the
number of employees for the studied period (2005-2013) for the 18 companies.
Table 1 includes the employees’ creative involvement and wellbeing score for
selected firms, having a predominantly or final ‘health’ status, during 2009-2013.
7
A
B
6 C
D
5 E
F
G
4 H
I
3 J
HEALTHY
K
L
Z-score
2 M
N
UNHEALTHY
O
1
P
Q
0 R
CATASTROPHIC
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Year
Figure 1: Z-score transition profiles for the 18 clothing companies (2005-2013).
54
As already known, for Spearman Rank Order Correlation test, the pairs of
variables with positive correlation coefficients and p values below 0.050 tend to
increase together (Q, O, R, K and C companies). For the pairs with negative
correlation coefficients and p values below 0.050, one variable tends to decrease
while the other increases (H and G companies). For pairs with p values greater
than 0.050, there is no significant relationship between the two variables.
170
160 A
150 B
C
140
D
130 E
120 F
110 G
100 H
I
90
J
80 K
70 L
60 M
50 N
E
O
40
P
l
30 Q
20 R
10
0
b
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Year
Figure 2: Number of employees for the 18 clothing companies (2005-2013).
Table 1: Employees’ creative involvement and wellbeing score for selected firms
Company Economic status Employees creative involvement

2009 2010 2011 2012 2013 and wellbeing degree
Q H H H H H 4.462±0.582
O H H H H H 4.265±0.605
H U H H H H 4.050±0.803
R H H C H H 3.962±0.942
G H H H H C 3.235±0.981
K C U U C H 4.256±0.938
C C U C U H 4.105±1.100

H=healthy; U=unhealthy; C=catastrophic;  = High; = Moderate;  =Low

Spearman Rank Order Correlation: Correlation coefficient for Q=0.671 and p=
0.0428; Correlation coefficient for O=0.323 and p=0.0381; Correlation coefficient for
H=-0.207 and p=0.0480; Correlation coefficient for R=0.414 and p=0.0243; Correlation
coefficient for G=0.365 and p=0.0308; Correlation coefficient for K=0.548 and p=
0.0111; Correlation coefficient for C=0.146 and p=0.0476.
55
The most important finding of our study is represented by the strong correlation
between the ‘healthy’ transition profiles of the companies and the real employees’
creative involvement in company’s production management and their wellbeing
degree. This case is exemplified by Q, O, H and R companies with almost entirely
‘healthy’ status between 2009 and 2013.
In the case of the company G, 2013 brought a change of the CEO and, thus, a
reduced creative involvement of the employees. Their wellbeing degree, also
reduced, is mirrored in the ‘catastrophic’ transition profile of the company for
2013.
The reverse situation is found in the case of K and C companies, the increased
employees’ creative involvement and wellbeing degree for 2012 and 2013 were
reflected in the transition profile from ‘catastrophic’ (2012) to ‘healthy’ (2013)
for company K and, respectively, from ‘unhealthy’ (2012) to ‘healthy’ (2013) for
company C.
Discussions
Sustainability (resilience) is becoming more and more the key challenge for
organizations. Sustainability depends on internal and external characteristics of
the organization that should or must be preserved within the time and depends on
the definition of what is a suitable state of the system (organization and its
environment) within medium and long terms as safety can be seen as feature of
sustainability. Although there are some elements of unpredictability in complex
systems, sustainability for an organization is based at least on its ability to learn
and adapt (Merad, Dechy & Marcel, 2014).
Although the importance of positive feelings has been recognized through the
years in the academic organizational behavior and popular literature, both ma-
nagement scholars and practitioners have arguably too often taken a negative
perspective-trying to fix what is wrong with managers and employees and con-
centrating on weaknesses. Positive organizational behavior follows the lead of
recently emerging positive psychology, which is driven by theory and research
focusing on people’s strengths and psychological capabilities. Instead of just
retreading and putting a positive spin on traditional organizational behavior
concepts, this unveiling of positive organizational behavior sets forth specific
criteria for inclusion. Not only does positivity have to be associated with the
concept, but it must also be relatively unique to the organizational behavior field,
have valid measures, be adaptable to leader/management and human resource
training and development, and, most important, capable of contributing to per-
formance improvement in today’s workplace. The criteria-meeting concepts of
confidence/self-efficacy, hope, optimism, subjective well-being/happiness, and
56
emotional intelligence (or the acronym CHOSE) are identified and analyzed as
most representative of the proposed positive organizational behavior approach.
The implications of these positive organizational behavior concepts for the work-
place are given more and more particular attention (Luthans, 2002).
A positive psychology intervention might be characterized as any intentional
activity or method that is based on (a) the cultivation of positive subjective
experiences, (b) the building of positive individual traits, or (c) the building of
civic virtue and positive institutions. Positive psychology interventions seem to
be a promising tool for enhancing employee well-being and performance. As a
side-effect, positive psychology interventions also tend to diminish stress and
burnout and to a lesser extent depression and anxiety (Meyers, van Woerkom &
Bakker, 2013).
The construct of Psychological Capital (PsyCap) focuses on the positive psy-
chological capacities of self-efficacy, hope, optimism and resilience and their
relationship with a range of desirable work attitudes, behaviors and organizational
outcomes. There is now almost a decade of accumulated PsyCap research. Ho-
wever, a critical and synthesized analysis of the construct in terms of its theoretical
conceptualization and psychometric properties is yet to appear in the literature
(Dawkins, Martin, Scott & Sanderson, 2013).
Given turbulent economic times, the concept of employee resilience is re-
ceiving increasing attention in many organizations. A first key finding is that the
concept of resilience can be developed from strong theoretical foundations. Se-
cond, a coherent set of resilience-enhancing human resources practices have the
potential to contribute to employees’ psychological capital, attitudes and behavior
and to organizational performance not only in turbulent circumstances but also
during periods of relative calm. Given the theoretical framing, formal resilience
training should be viewed as a single component of a broader, coherent set of
resilience-enhancing human resources practices (Bardoel, Pettit, De Cieri & Mc-
Millan, 2014).
Recent economic crisis has highlighted the importance of an organization’s
ability to withstand economic shocks. This has rekindled interest in organization
resilience on the one hand, and the relationship between alternative governance
forms such as employee owned businesses (EOBs) on the other. This relationship
was explored using performance data on 204 publicly traded non-employee owned
businesses and 49 EOBs prior to the economic downturn (2004-2008), and during
the economic downturn (2008-2009). This data was complemented with a survey
of resilience related governance and organizational practices in 41 EOBs and 22
non-EOBs. The results show that: (a) employee ownership that is combined with
employee involvement in firm governance is associated with greater stability in
business performance over a business cycle; (b) EOBs have longer investment
payback horizon when compared to non-EOBs across a number of activities; (c)
57
top management in EOBs are more likely to seek employee input in strategic
decision making; (d) EOBs are more likely to use employee involvement to
achieve tighter coupling between feedback from operations and the setting of
strategic direction for the firm. These results suggest that employee stock owner-
ship programs alone are not sufficient to develop higher levels of organizational
resilience. Managers must combine employee stock ownership with employee
involvement in governance if they wish to build up resilience in advance of
adverse economic conditions (Lampel, Bhalla and Jha, 2014).
Conclusions
Resilience for an organization is based at least on its ability to learn and adapt.
The most important finding of our study is represented by the strong correlation
between the “healthy” Z-score transition profiles of the companies and the real
employees’ creative involvement in company’s production management and their
wellbeing degree. The employees’ involvement in companies’ governance might
represent the basis for building up the organizational resilience.
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59
Working together
www.rcis.ro
Suddenly – War. Intervention Program

for Enhancing Teachers and Children’s
Resilience Following War
Miri SHACHAM1
Abstract
The Israeli population has been coping with terror acts and war, where residents
- adults and children, are under missile attacks and terror which endanger their
lives. In order to enhance coping resources in this harsh reality, the “Mashabim”
Community Stress Prevention Center in Israel devised special programs for te-
achers and children at schools. The programs are based upon the “Basic Ph”
Model of Coping and Resiliency developed in Israel (Lahad, 1997; Lahad, Sha-
cham and Ayalon, 2013). This article describes a case study of one elementary
school whose teachers and pupils were under massive fire during the Second
Lebanon War. Immediately upon cease-fire, an intervention program was im-
plemented within the school. The program included special workshops for teachers
for enhancing resilience following war. The program also offered verbal and non-
verbal activities for pupils, to enable them to express their experiences, emotions
and thoughts through painting, sculpting, movement, physical activity, talking
and storytelling. The article discusses the program’s theoretical basis and its
implementation in school. Furthermore, the findings emerging from in-depth
interviews with the teachers are presented, indicating the contribution of the
intervention program to teachers with reference to four aspects: enhancing the
teachers’ coping resources, effective preparation for activities with the pupils in
class, development of the team as a significant support group and the need for in-
depth trauma and resilience related training.
Keywords: the “Basic Ph” model, coping, resilience, intervention, teachers,

children’s resilience.
1
Ort Braude College, Karmiel, ISRAEL. E-mail: mshacham2@gmail.com
60
Introduction
In the aftermath of the Second Lebanon War, which lasted 33 days and ended
two weeks before the beginning of the school year, the Community Stress Pre-
vention Center (hereinafter CSPC) team devised special programs for enhancing
coping resources and resilience of teachers and children (Shacham & Cohen,
2007). These programs were based on previous programs developed by the CSPC
following past events of bombardments, evacuation, terrorism, traffic accidents
and interpersonal violence. The programs suggest activities based upon the “Basic
Ph” Model of Coping and Resiliency (Ayalon, 2013).
The “Basic Ph” Model of Coping and Resiliency
The Integrative Model of Coping and Resiliency, known as the “BASIC Ph”
Model was developed in Israel by Lahad (1997). The “BASIC PH” model is based
on the Applied Psychology Approach, developed over 25 years of studies, ob-
servations and interviews with different populations worldwide who have lived
under the shadow of constant threat to their lives. This approach maintains that
each person possesses internal strengths – coping resources – to be engaged in
times of stress. Each person develops his/her unique coping pattern in a lifelong
process which begins in infancy.
This comprehensive model relates to six major coping modalities at the core of
an individual’s coping style, mobilized mainly in times of stress, uncertainty and
crisis: Beliefs and Values, Affect, Social, Imagination, Cognition and Physiology.
Beliefs and values resource - rooted mainly in beliefs, attitudes, values, hope,
clarification and meaning.
Affect resource - utilizes personal and interpersonal, verbal and non-verbal
emotional resources. Verbal and vocal expressions can include crying, laughter or
talking to someone, whilst non-verbal methods include drawing, writing and
reading.
Social resource – based on coping through social support, assuming a role,
sense of belonging to community and society, seeking support and communicating
with family, friends and peers.
Imagination and creativity resource – based on coping through use of ima-
gination, daydreaming, creativity (painting, music, sculpting and writing), humor,
relaxation and guided imagery.
Cognition resource – involves coping through information gathering and pro-
cessing, thinking up alternatives and priorities, problem solving, cognitive orga-
nization of reality, rational thought, seeking logical information and data co-
llecting.
61
Physiology resource – pertains to coping by physical means and sensory

reactions, physical activity, games, meditation, eating, sleeping and also me-
dication.
This model formed a basis for psychosocial interventions and research follo-
wing disasters and catastrophes around the world (Ayalon, 2013; Lahad, Shacham
& Niv, 2000; Shacham and Lahad, 2004; Shacham, 2013).
Programs for Developing Resiliency and Coping Resources in Children
Proper intervention enhancing resiliency in children following crisis or con-

tinuous threat, are imperative to an apt psychological development and adap-
tability (Hobfoll et al, 2007). Many researches have dealt with the effect of
intervention programs on reducing children trauma symptoms. Berger, Pat-Ho-
renczyk & Gelkopf (2007) reviewed several intervention programs designed for
children exposed to war and terrorism. These interventions are usually carried out
inside the classrooms by members of the school staff with whom the children are
familiar. These programs sometimes address parents as an additional coping
resource. They presented an intervention program applied in a Haifa school
following a series of five terror attacks during a period of two years. The program’s
goal was to enhance pupils’ personal resiliency in the face of continuous terrorism.
The program was guided by the school teachers and included lectures on typical
stress-related symptoms (psycho-education), self-relaxation exercises, narrative
techniques and art therapy to process children’s traumatic experiences. The re-
search found that at the end of the program the children exhibited a reduction in
trauma symptoms, somatic complaints, functioning deficiencies and anxiety re-
lated to their exposure to the harsh events.
Wolmer, Hamiel, Barchas, Slone and Laor (2011), used a teacher-delivered
protocol focusing on enhancing resilience. The participants, ages 8-12, were
exposed to daily rocket attacks in the north of Israel, during the Second Lebanon
war. This program was implemented 5 months after the war. The protocol, which
was delivered weekly, tackled topics such as stress management, awareness of
bodily tensions, attention regulations, identification and correction of negative
thoughts. The findings indicated that participating children showed significantly
less trauma symptoms, stress, fear and negative mood reactions over 3 months’
time than the control group.
Teachers were at the center of a national intervention program in Jerusalem
following a series of terrorist attacks. This was due to the teachers’ daily contact
with children, their ability to provide children with direct, unremitting support
and their knowledge of child development (Baum, 2005). Teachers were given
62
skills and knowledge in the subjects of resiliency, stressful situations and trauma
exposure to form a better dialogue with children on the complex issues of fear,
loss and coping with trauma. Cohen, Ankor & Lahad (2002) focused on training
teachers and school counselors to intervene and instruct teenagers to become
sources of support in times of crisis. The interventions included use of art-related
expressive and creative techniques, simulation games and problem solving. The
program’s goals were strengthening resilience, presenting tools for coping with
stress, disputing rumors and coping with “the day after” the traumatic event.
Following the end of the 2008 conflict in Northern Uganda, the education
system sought to enhance the children’s resilience. A psychosocial structured
activities (PSSA) program was implemented in 21 schools in northern Uganda
(Ager et al., 2011). The PSSA intervention is a school-based, multi-phased me-
thod, which focuses on children’s natural resiliency to help them recover from
trauma. It consists of 15 sessions that incorporate themes of safety and control,
awareness and self-esteem, coping skills and future planning. Findings showed
that over a 12 month period the well-being of children in the PSSA intervention
increased significantly more than for children in the comparison group.
Baum et al., (2013) underlined the importance of training teachers to help
build resilience in children in the aftermath of war. In their study, they utilized a
brief (12 h) teacher training to provide them with resilience-building tools for the
pupils. The workshop also gave them an opportunity to process their feelings and
thoughts in reaction to their exposure to trauma. Findings showed that training
teachers helped build resilience in children; this was reflected by lower post-
traumatic stress and anxiety symptoms in their pupils. Most researches in this
field address the issue of children’s resilience and reduction in trauma symptoms.
There is a gap in knowledge with regard to the contribution of such an intervention
program to enhancing resilience among teaching staff at school.
Methodology
The research approach chosen for this research was case study (Yin, 2012).
The desired research design’s main considerations stemmed from the need to
conduct a special intervention program adapted to school needs in the end of the
war and the opportunity to obtain data in real time with regard to the contribution
of this program to school teachers. The research tools were focus group of 6
teachers following the workshops for the teachers and an individual structured
interview with open-ended questions to 14 teachers in the end of the intervention
program delivered to the pupils. The objective was to encourage the teachers to
raise associative reactions, feelings, thoughts and perceptions.
63
Case study: “Suddenly – War”. A Program for Enhancing Teachers and

Children Resilience Following War
The following case study pertains to the application of a special program for
enhancing teachers and children’s resiliency after the Second Lebanon War in an
Israeli elementary school. The war lasted 33 days during which pupils and teachers
experienced rocket attacks on their homes. Some of the residents chose to evacuate
and moved to live in safer places. Nevertheless, they still had worries about their
beloved ones who had remained in the shelled area. Upon cease fire, an inter-
vention program was implemented in the school, with the following goals: (1)
Enhancing the resilience of teachers who had to absorb the pupils in their classes
after the war; (2) Provide teachers with tools for working with pupils to enhance
their coping resources; (3) Strengthen the pupils’ sense of confidence, belonging
and availability to learning. An additional goal was to identify pupils who needed
personal support from the interdisciplinary team – school counselor, psychologist,
nurse and social worker.
Enhancing the Teachers’ Coping Resources

In the first stage, workshops for teachers were provided before the children’s
return to school. The workshops were conducted by the researcher and a team of
CSPC experts. The goals were to allow teachers to express feelings, personal
stories and experiences during the war, reflect on what had helped them cope and
receive support from their colleagues at school. The workshops included ex-
periencing the “Basic Ph” Model – identifying personal profile and expanding
repertoire of coping resources, understanding “trauma’ and “post-trauma” sym-
ptoms. Through their experiences in the workshops, teachers became acquainted
with creative verbal and non-verbal tools to use with their pupils. Homeroom
teachers, together with the school counselor and the physical education, music
and art teachers developed activities for the children for the first month after
returning to school. Teachers were guided by the school counselor and the CSPC
team throughout the time of implementing the program in the classes.
Enhancing the Pupils’ Coping Resources
Pupils’ activities in the program included writing personal stories, painting,

sculpting, relaxation and guided imagery, movement activities, music and dis-
cussions with their homeroom teacher. The pupils used the various activities to
express feelings of anxiety, pain and concern in the familiar class environment, in
a safe, enabling atmosphere. Even when harsh and painful things were expressed,
the teachers made sure that the pupils were creating a link to their coping re-
sources, “What helped me cope…what else can help me cope?”
64
Parental Involvement in the Program
Parents’ involvement was greatly emphasized in the program. Parents and

pupils stayed in telephonic contact with homeroom teachers during the war and
continued to do so following the war and before the opening of the school year.
The parents were offered a special workshop by CSPC team focused on coping
with trauma, children’s “normal” reactions to an “a-normal” situations and the
need to address the school therapeutic team for individual support when they
noticed signs of distress with their children.
The Intervention Program’s Contribution to the Teachers
In the current research, a focus group and in-depth interviews were conducted
with 14 teachers in one of the schools that participated in the intervention program,
so as to examine their perceptions of the intervention program contribution to
their well-being, coping resources and resilience. Four main themes had emerged
from content analysis of the interviews: (1) The contribution of the intervention
program to enhancing teachers’ coping resources; (2) Effective preparation for
activities with the pupils in class; (3) Development of the teaching staff as a
significant support group; (4) Need for in-depth trauma and resilience related
training.
Most teachers believed the program had contributed to them by allowing them
to express what they experienced during the war, and examine what helped them
cope with the difficulties and what else could help them. Teachers noted that
following the workshops, they were more emotionally available to contain pupils’
experiences: “Now, after the workshops I feel more open and willing to listen to
the children experiences and feelings”.
In the workshop, the teachers experienced the activities based upon the “Basic
Ph” model, which enabled in-classroom processing of the war’s events as depicted
by the pupils – bombings, evacuation, parents being injured, and homes destroyed.
According to the teachers, these daily activities have allowed teachers and the
therapeutic staff to identify and assist pupils who struggled with adjusting to the
school year’s routine, after the war. The teachers reported that most of the pupils
in their classes attributed great importance to these activities and were eager to
share experiences, emotions and thoughts with classmates in verbal and non
verbal activities. The pupils could choose their course of expression, and the
variety of ways of coping enriched their personal repertoire and allowed them to
take part in activities that suited them.
A significant finding that emerged from the interviews regarding the con-
tribution of the program to the teachers was that the school staff, whose members
had been through similar experiences during the war, has become a significant
support group for them during the program:
65
“I can get help from my colleagues when I need it, and I had learned a lot from
their experiences and ways of coping.”
“I feel that I am not alone. It was hard for me with a baby and a husband fighting
in the army. I had to evacuate to a safer place. I was away from home and from my
friends. I received a lot of support from the staff at school, and this support helped me
get myself together and return to teaching.”
Another issue raised by teachers was lack of knowledge in the domain of

trauma and resilience. Half of the interviewees claimed they had not acquired
knowledge and insights pertaining to trauma and resilience in their teacher training
program. The intervention program made them realize the need for in-depth
learning in this field. “I meet students in other stressful situations such as acci-
dents, illness or death in the family, and the tools I have acquired in the workshop
are vital to my role as a teacher and an educator. I would like to learn more about
this highly significant field.”
Discussion
Congruent with Baum’s research (2005, 2013), the research findings reinforce
the need for the first stage of the intervention program which included workshops
for teachers who implement the program in their classes. Teachers living in the
shelled area, had also been through the harsh experiences of war and evacuation
and needed the workshops in order to be available to the students who returned to
school, listen to them and support them. The research findings reveal that the
workshops enabled teachers to share their experiences and feelings with their
colleagues and constitute a support group which had a significant contribution to
their ability to open the school year and facilitate the intervention program for the
students. The research revealed the teacher’s intensive need for additional com-
prehensive training with regard to trauma and resilience, which would equip them
with the necessary tools for helping their students in times of stress and crisis.
Although the research was conducted in one school only, it can shed light on the
theoretical basis of the intervention program , on its implementation and on the
needs of teachers who are the ones chosen to guide the intervention program, as
they are significant figures who are familiar with the pupils and know how to
support them.
Conclusions
As an educational counselor and a psycho-trauma researcher, I believe that

creative resiliency programs are important as models for enhancing teachers’ and
pupils’ resilience in the face of stressful and uncertain situations which sadly
66
characterize Israeli reality. Coping resources can be developed and enriched by

early on preparation for stressful situations, increasing the ability to cope and
developing personal and community resilience over time. These programs for
enhancing children resilience based upon The Basic Ph Model suit, by the nature
of activities they offer, every child in the world, regardless of location, language
or culture, and can enhance resilience following natural disasters, accidents and
traumatic family events. It is recommended that schools acquaint teachers with,
produce and apply programs in times of peace and routine to enhance pupils’
resilience for times of stress and crisis. These conclusions ought to have an
impact, in my opinion, on the teacher training process. I believe that teachers
should study the subject of trauma, stress reactions and resiliency and practice
developing their personal coping resources as well as their pupils’.
References
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(2011). The impact of the school based psychosocial structured activities (PSSA)
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68
Working together
www.rcis.ro
Impact of Divorce and Mother’s Psychological

Well-Being on Children’s Emotional,
Behavioral, and Social Competences
Anda Maria JURMA1
Abstract
Parental divorce was known for over 40 years as being the cause of some
serious, long lasting behavioural, emotional, social and academic problems in
children. The aim of this study was to identify the consequences of divorce upon
children, mothers’ wellbeing and the parenting styles. We have studied a group of
79 children and adolescents selected from one school in Timisoara (Romania),
aged between 7-15 years, and their mothers. The children were divided into two
groups: 41 children and adolescents from divorced families and a control group of
38 children and adolescents from two parents (“normal”) families. The following
instruments were used: Strength and Difficulties Questionnaire (SDQ) to measure
the children’s emotions, behaviour and social competencies; Symptom Checklist
(SCL-90-R) to measure the mother’s psychological wellbeing; The Parenting
Scale to identify the parenting style used by mothers in the educational process.
The results showed that children from divorced families have more emotional
problems compared with children coming from two parents families; the divorced
mothers have higher scores at all psychological problems compared with married
mother and are more likely to be over reactive or have more hostility in their
parenting style, while the married mothers are more lax in their parenting style.
Emotional and behavioural problems of children from divorced families were
strongly correlated with their mother’s problems. In conclusion, the psychological
wellbeing of divorced mothers have a certain influence on the child’s adjustment,
and thus, on the ability of the children to cope with the divorce situation.
Keywords: divorce, children, resilience, parenting, mother wellbeing.
1
Victor Babes University of Medicine and Pharmacy Timisoara, Romania. E-mail:
andamaria.jurma@gmail.com
69
Introduction
Parental divorce was known for over 40 years as being the cause of some
serious, long lasting behavioural and emotional issues in children (Kelly & Emery,
2003; Amato, 2000; Kelly, 2000). The children whose parents had divorced may
have several behavioural problems, internalizing symptoms, social and academic
problems when they are compared to those from functional families (Lansford,
Malone, Castellino, Dodge, Petit, & Bates, 2006; O’Connor, Caspi, DeFries, &
Plomin, 2000; O’Connor, Dunn, Jenkins, Pickering, Rasbash, 2001). Children
from divorced families may have lower academic performances, a higher risk of
school dropout, difficulties establishing intimate relationships as a young adult;
they can get married late and can have marital dissatisfaction and may often
divorce (Amato, 2010; Hango & Houseknecht, 2005; Sun & Li, 2002). The
adolescences and young adults originating from divorced families in which the
conflict between the two parents was not open can have higher peer problems,
problems establishing intimate relationships and emotional adaptability problems
compared to those from divorced families in which the conflict was open (Lan-
sford et al., 2006; O’Connor et al., 2000; O’Connor et al., 2001).
Parent-child relationship plays an important role in child adjustment after
divorce. A warm and positive parental environment brings support, ensures good
communication, responds to the child needs, and provides a strong parental control
and a good discipline (Jourdan-Ionescu et al., 2013). Rushena, Prior, Sanson and
Smart (2005) mentions that features of children have a strong influence on parent
- child relationship, which in turn affect the child’s adaptation. Children’s indi-
vidual characteristics such as personal strengths and relationships with others are
protective factors of resilience.
An important aspect for a child, connected to the divorce is represented by the
improper parenting impact and parental psychopathology during and after the
divorce. As a rule, parenting is represented in literature (Cojocaru & Cojocaru,
2011: 215) as taking place on two fundamental axes: parental control and emo-
tional support, any parenting style being a version of a combination between the
two dimensions, in varying proportions. From vary motives the parents may have
difficulties responding to child needs and may resent varying degrees of stress in
their role as a parent that may have implications in child functioning, parent or
family functioning (Cojocaru, Cojocaru, 2011: 213). Parental stress occurs when
the requirements of parenting exceeds the capacity and resources of the parents to
coop. The stress can diminish the warmth and implication of the mothers in the
relationship, along with socio-economic problems, social position ones and phy-
sical and mental health issues (Cooper, McLanahan, Meadows, & Brooks-Gunn,
2009).
70
The aim of the study is to identify the consequences of the divorce on children,
mothers’ wellbeing and parenting styles. The study had the following objectives:
identifying emotional and behavioural problems of children from divorced fa-
milies and also the divorced mothers’ symptoms; analysing the parental styles of
the divorced mothers; exploring the relationship between mothers’ symptoms,
their parenting styles and the emotional and behavioural problems of the children.
The study is based on the assumption that there is a strong relation between the
presence of psychological symptoms of divorced mothers and the behaviour
problems of their children, probably through the parenting styles. By comparison
with other studies in the field of divorce’s consequences to the children adjust-
ment, this study takes into consideration the relation between mother’s mental
health and the parenting styles that influences the behaviour of the children and
the level of their emotional, conduct and peer problems.
Methodology
Participants
In the study have been included 79 children and adolescents (along with their
mothers). The age of the children varied between 7 and 15 years old. The subjects
were selected from a single school in the Timisoara city (Romanian) that has
allowed access to the researcher. The study was approved by the school board and
all the mothers signed the informed consent for participating in the study. The
participation was voluntary and no subject was paid for participating.
The subjects were divided into two groups: the study group included 41
children and adolescents from divorced families, of which 26 (63.4%) were boys
and 15(36.6%) girls (age range between 7 to 15 years; M= 10.85 years, SD =
2.56). Their mothers age ranged from 29 to 45 years (M = 36.2 years, SD = 2.78).
Inclusion criteria for the study group were that all children from divorced families
are living only with their natural mother since the divorce, for at least 1 year. We
excluded from the study the children with step mothers and the adopted children.
In the control group, out of 38 children and adolescents, 22 (57.9%) were boys
and 16 (42.1%) girls (age range 7 to 15 years; M = 10.18 years, SD = 2.99). Their
mother age ranged from 31 to 47 (M = 37.8, SD = 2.04). Inclusion criteria for the
control group were that all children are living with both parents. We excluded
from the study the children with step parents, foster parents and the adopted
children.
71
Measures
All mothers completed the following instruments at home and brought it back
to school:
- Strength and Difficulties Questionnaire (SDQ), a behavioural screening
questionnaire measuring parents’ perceptions of prosocial and difficult behaviours
in their children aged 3 to 16 years. It includes 25 items relating to the frequency
of positive (prosocial behaviour) and negative behaviours (emotional symptoms,
conduct problems, hyperactivity and peer problems), in normal, borderline and
abnormal range (Goodmann, 1997). The Total Difficulties score (Turner, Markie-
Dadds, Sanders, 1998) was adequate, internal reliability (α =.76) and test-retest
reliability (r =.85). The questionnaire has a Romanian version and is largely used
in the field of child psychiatry.
- Symptom Checklist (SCL-90-R), is a self-report system inventory designed
to reflect the physical and the psychological symptoms of a person in the last 7
days, often used in screening for psychopathology. The internal consistency of the
scale in clinical situations is between r = .79 and r =. 89 and test-retest reliability
is between .73 and .92, and considered very good by the authors (Derogatis,
1983). The list contains 90 complains and problems that people could have. 83 of
them are grouped in 9 scales: Somatization; Obsessive-Compulsive; Interpersonal
Sensitivity; Depression; Anxiety; Hostility; Phobic Anxiety; Paranoid Ideation;
Psychoticism. The Romanian version of SCL-90 was completed by the mothers to
identify the presence of psychological symptoms.
- The Parenting Scale (Arnold, O’Leary, Wolff, Acker, 1983) is a 30-item
questionnaire which measures dysfunctional disciplines styles in parents by asking
about the probability that parents use particular discipline strategies; it yields a
total score and three factors related to these strategies: Laxness (permissive,
inconsistent discipline), Over-reactivity (harsh, emotional, authoritarian discipline
and irritability), and Hostility (use of verbal or physical force). The scale has
adequate internal consistency (Turner, Markie-Dadds, Sanders, 1998) for Total
score (α = .84), Laxeness (α = .83), Over-reactivity (α = .82) and Hostility (α =
.63) scales and has good test-retest reliability (r =.84, .83, .82 and .79 respectively)
(manual triple P) and has also Romanian version utilised in therapeutic programs
for parents.
Analysis plan
Data was collected using the above mentioned instruments that were completed
by the children’ mothers, without the assistance of an evaluator, at home. In order
to protect the identity of the participants, all names were replaced with iden-
tification numbers. Subjects were given assurance that their identity will be kept
confidential.
72
Total scores were calculated according to the specific instructions of each

instrument. Means and standard deviations were calculated; the statistical tests
applied were the T-test (for comparison between the two groups) and the Pearson
correlation test (for correlations between variables). Results were considered
statistically significant at p < 0.05, for a confidence interval of 95%. The statistical
analysis was performed using SPSS for Windows 17.0
Results
The scores of the SDQ questionnaires were analysed in order to determine the
differences between the behaviours of children from divorces and non-divorced
(“normal”) families. It must be noted, however, that the behaviours of children
were rated (assessed) by their mothers. Considering the number of subjects in the
groups, the Student (T-test) test for independent groups was used for comparison.
The average scores are presented in Table 1, together with t-values, and the
statistical significance of the differences. The results show that children from
divorced families present significantly more emotional problems those children
from normal families.
It must be observed that all children have been rated as having high scores for
“hyperactivity”; this could be a bias induced by the mothers’ perception regarding
the level of activity “normal” for children at this age. Also, all children have high
scores at the “prosocial” behaviour item, which, again, could be due to the
mothers’ perception regarding the level of social interaction “normal” for children.
Table 1. Results and comparison of SDQ scores for children from divorced and normal
families
SDQ behaviour Divorced Normal T-value Statistical Observations

scores Families Families significance (difference
Mean Mean
Emotional 5.61 3.39 4.04 p=0.00 Statistically
problems significant
Conduct Not statistically
4.10 3.08 1.94 p=0.06
problems significant
Hyperactivity Not statistically
5.71 5.47 0.39 p=0.70
significant
Peer problems Not statistically
3.90 3.42 0.88 p=0.38
significant
Prosocial Not statistically
6.97 6.34 0.96 p=0.34
behaviour significant
73
The results show that children from divorced families have significantly more
emotional problems than children from normal families.
In order to assess the psychological state of the mothers, the SCL-90 scale was
used. The SCL-90 scale has 9 subscales; each subscale rates symptoms on a
Likert ascending scale from 0 to 5.
In order to compare the intensity of mothers’ psychological symptoms, the T-
test was used, comparing the scores at the various SCL-90 subscales. Differences
were considered statistically significant at p < 0.05 (Table 2).
Table 2. Results and comparison of SDQ scores for children from divorced and normal
families
SCL -90 Divorced Normal T-value Statistical Observations

subscales Families Families significance (difference
(psychological Mean Mean
areas)
Somatization Statistically
1.43 0.84 -3.74 p=0.00
significant
Obsessive- Not statistically
1.17 0.96 -1.43 p=0.15
Compulsive significant
Interpersonal Not statistically
0.99 0.79 -1.66 p=0.10
Sensitivity significant
Depression Statistically
1.36 0.96 -2.56 p=0.01
significant
Anxiety Not statistically
1.04 0.78 -1.63 p=0.11
significant
Hostility Statistically
0.94 0.48 -3.58 p=0.00
significant
Phobic Anxiety Statistically
0.73 0.41 -2.27 p=0.03
significant
Paranoid Not statistically
0.93 0.71 -1.49 p=0.14
Ideation significant
Psychoticism Not statistically
0.63 0.58 -0.35 p=0.72
significant
Mothers that have experienced a divorce present significantly higher intensity

symptoms in the areas of somatization, depression, hostility and phobic anxiety
than mothers that have not experienced a divorce.
74
Table 3. Results and comparison of The Parenting Scale scores for divorced and
normal families
Parenting style Divorced Normal T-value Statistical Observations
scale score Families Families significance (difference
Mean Mean
Lax style Not statistically
1.46 1.63 1.50 p=0.14
significant
Over-reactive Not statistically
1.51 1.34 -1.52 p=0.13
style significant
Hostile style Not statistically
1.66 1.58 -0.72 p=0.47
significant
The results show that there is no statistically significant difference between the
intensity of the various parenting styles of mothers from divorced or normal
families, though it would seem that mothers that have experience a divorce tend
to adopt a more hostile parenting style, while mothers that have not experience a
divorce tend to adopt a more lax parenting style. The lack of statistical significance
could be due to the low number of case investigated. In order to investigate the
relationship between the mothers’ psychological well-being and the children’
behavioural problems, the Pearson Correlation test was used (Table 4).
Table 4. The relationship between the mothers’ psychological well-being (as measured
by the SCL-90 subscales scores) and the children’ behavioural problems (measured by
the SDQ questionnaire)
SDQ items Emotional problems Conduct problems Hyperactivity Peer problems Prosocial behaviour
(children)
Normal Normal Normal Normal Normal
SCL-90 Divorced Divorced Divorced Divorced Divorced
subscales
(mothers)
Somatization
0.56* 0.38* 0.30 -0.05 0.13 0.13 0.18 -0.12 0.39* -0.01
Obsessive-
Compulsive 0.36* 0.60* 0.24 0.24 0.25 0.45* 0.38* -0.01 0.05 -0.08
Interpersonal
Sensitivity 0.27 0.63* 0.35* 0.27 0.29 0.40* 0.15 0.01 -0.01 -0.19
Depression
0.50* 0.66* 0.40* 0.31 0.32* 0.41* 0.48* -0.02 0.08 -0.08
Anxiety
0.41* 0.60* 0.32* 0.15 0.22 0.23 0.34* -0.17 0.08 0.21
Hostility
0.42* 0.45* 0.37* 0.18 0.26 0.18 0.38* -0.21 0.14 0.10
Phobic
Anxiety 0.20 0.46* -0.07 0.04 -0.00 0.04 -0.20 -0.25 0.42* 0.22
Paranoid
Ideation 0.23 0.66* 0.26 0.20 0.18 0.34* 0.13 -0.04 0.25 0.01
Psychoticism
0.19 0.60* 0.24 0.20 0.15 0.26 0.21 -0.11 0.12 0.12
*Correlation is significant at p<0.05
75
In children from divorced families, the level of the child’s emotional problems
seems to be directly related to the mother’s level of somatization, obsessive-
compulsive symptoms, depression, anxiety and hostility. The correlation is es-
pecially high for somatization and depression, showing that for a child from a
divorced family, the intensity of his/her mother’s somatization and/or depression
problems (symptoms) influences the intensity of the child’s emotional problems.
The level of mother’s depression symptoms seems to be highly influential on the
child’s behaviour in multiple forms, inducing emotional and conduct problems,
hyperactivity and peer problems. Mother’s anxiety and hostility levels also in-
fluence, though to a lesser degree, the level of children’ emotional, conduct and
peer problems. For children in normal families, the intensity of their mothers’
psychological symptoms in all areas has an important impact on their emotional
well-being and can induce emotional problems, but do not seem to have an
influence on their conduct or peer problems, or their prosocial behaviour.
Table 5. The relationship between the mothers’ psychological well-being (as measured
by the SCL-90 subscales scores) and the parenting style (as measured by the Parentig
scale)
Parenting style Laxness Over-reactivity Hostility

Divorced Divorced
SCL-90 subscales Divorced Normal Normal Normal
(mothers)
Somatization -0.26 0.05 0.26 0.52* 0.71* 0.19
Obsessive-Compulsive -0.44* 0.09 0.13 0.20 0.77* 0.10
Interpersonal Sensitivity -0.16 0.23 0.21 0.25 0.41* 0.23
Depression -0.34* 0.18 0.43* 0.29 0.80* 0.27
Anxiety -0.25 0.09 0.33* 0.32* 0.82* 0.30
Hostility -0.25 0.05 0.14 0.37* 0.87* 0.13
Phobic Anxiety -0.33* 0.23 -0.24 0.50* 0.22 0.53*
Paranoid Ideation -0.25 0.17 -0.19 0.30 0.67* 0.26
Psychoticism -0.27 0.06 -0.18 0.18 0.60* 0.25
*Correlation is significant at p<0.05
As we see in Table 5, in divorced families, the higher the level of mothers’

obsessive-compulsive symptoms, depression and phobic anxiety symptoms is,
the less lax the parenting style. A higher level of depression in mothers in divorced
families translates into a more over-reactive and especially hostile parenting style
in divorced families. High levels of anxiety also induce a more hostile parenting
style, but hostility in the parenting style is also strongly influenced by the levels
of all psychological symptoms of mothers, with the exception of phobic anxiety.
In normal (two-parent) families, an over-reactive parenting style is correlated
directly with a higher level of somatization, anxiety, hostility symptoms in
76
mothers, while a hostile parenting style is strongly correlated with the level of
mothers’ phobic anxiety.
On the other hand, in normal families the Pearson correlation test shows that
there are only two statistically significant relationships between the problems of
the children and the parenting style; namely, that peer problems are less intense in
children from normal families whose parents have a more lax (P = -0.36) or more
hostile (P = -0.34) parenting style.
In children from divorced families, emotional problems increase with a more
over-reactive (P = 0.27) or hostile (P = 0.34) parenting style, while conduct
problems increase with a more lax parenting style (P = 0.24). Peer problems on
the other hand decrease with a more lax parenting style (P = -0.36).
Comparing, we can say that a more lax parenting style tends to decrease the
children’ peer problems, but tends to increase conduct problems in children from
divorced families.
Discussions
The results of the study show that mothers that have experienced a divorce
present significantly higher intensity symptoms in the areas of somatization,
depression, hostility and phobic anxiety than mothers that have not experienced a
divorce. These symptoms have a strong influence on the children; especially the
symptoms of depression and somatization seem to strongly affect children from
divorced families, increasing their level of emotional problems. The depression
symptoms of the mother influences the behaviour of children from divorced
families in multiple forms, inducing emotional and conduct problems, hyper-
activity and peer problems.
The results also show that high levels of psychological symptoms (especially
depression and anxiety) in mothers in divorced families tend to induce a more
hostile parenting behaviour, while mothers in normal families tend to a more
over-reactive parenting style when their level of psychological symptoms (espe-
cially somatization, anxiety, hostility and phobic anxiety) increases.
On the other hand, the parenting style in itself does seem to influence only
some areas of child behaviour (peer problems and conduct problems in children
from divorced families), and no statistically significant differences could be
identified in regard of the parenting style of mothers from divorced and normal
families.
Children and adolescences coming from one parent families have a high rate
of behavioural and emotional disorders and substances abuse, low self-esteem
levels, low social competences and low academic performances compared to
77
children from families without any divorce history, with both parents present
(O’Connor et al., 2000; O’Connor, et al., 2001, Lansford et al, 2006; Sroufe,
Duggal, Weinfield, & Carlson, 2000). It can be said, on one hand, that there is a
strong connexion between child psychopathology and marital conflicts, low pa-
rental competences, divorce or separation and, on the other hand, there is a strong
connexion between the parents’ psychopathology and child adaptation (O’Connor
et al., 2000; O’Connor et al., 2001). Our study found emotional and behavioural
problems in children from divorced families and also a strong correlation between
these problems and psychological problems of mothers. There are numerous
researches which show that parental depression and parental dysfunctions raise
the risk of occurrence of some psychopathological disorders in children (Nomura,
Wickramaratne, Warner, Mufson, & Weissman, 2002; Linville, Chronister, Dis-
hion, Todahl, Miller, Shaw et al., 2010). Children that are raised by depressive
mothers may have symptoms of depression, anxiety, alcohol problems or social
relationship (Linville et al., 2010). Nomura’s study (2002) tried to determine to
what extends the divorce and the depression of the parents is associated with the
depression of the child. The conclusion of his study show that the existence of
parental depression has an even bigger impact on child than the marital conflicts,
being associated with the apparition of depression, anxiety or other psychiatric
diagnosis, while depression and marital conflicts are associated with the risk of
conduct disorders and antisocial behaviour appearance in children. In our study
there are similarities, meaning that the presence of psychopathological symptoms
in mothers, both divorced and married, correlate both with emotional disorders
and with hyperactivity and peer problems in children. Also, the results show that
mothers that have experienced a divorce present significantly higher intensity
symptoms in the areas of somatization, depression, hostility and phobic anxiety
than mothers that have not experienced a divorce; these psychological problems
have an important impact on the child, especially in regard of his/her emotional
problems. Especially the level of mother’s depression symptoms seems to be
highly influential on the child’s behaviour in multiple forms, inducing emotional
and conduct problems, hyperactivity and peer problems. Mother’s anxiety and
hostility levels also influence, though to a lesser degree, the level of children’
emotional, conduct and peer problems.
Kushner (2009) describes five protective factors that can intervene in the
process of resilience in children whose parents are divorced: the involvement of
parent which not remained with the child; reduction of post-divorce parental
conflict; the fact of living the most psychologically competent parent; the quality
of parenting practices (existence of emotional warmth, support, adequate moni-
toring and discipline of the child); supervision division between the two parents,
with the lack of conflict between them.
78
Mother-child relationships that are characterized by warmth, supportiveness,

effective problem-solving skills, positive communication, and low levels of con-
flict and negativity are consistently associated with lower mental health problems
and positive social adaptation outcomes following divorce (Simons, Lin, Gordon,
Conger & Lorenz, 1999; Wolchik, Wilcox, Tein, & Sandler, 2000; Wolchik,
Schenck, & Sandler, 2009; Velez, Wolchik, Tein, & Sandler 2011). Maternal
discipline that is consistent and appropriate, rather than punitive, also facilitates
children’s post-divorce adjustment (Wolchik et al., 2000). Although most of the
research on this resilience resource has examined direct relations between ma-
ternal parenting and children’s post-divorce adjustment, a few studies have shown
that high quality parenting mitigates the negative effect of divorce-related stressors
on mental health problems (Wolchik et al., 2009). Wolchik, Wilcox et al. (2000)
showed that relations between divorce stressors and internalizing problems and
externalizing problems were stronger for children who reported both low accep-
tance and low consistency of discipline than for those who reported either high
consistency of discipline and low acceptance or high acceptance and low con-
sistency of discipline. Children with high levels of both acceptance and consistent
discipline had the lowest levels of adjustment problems.
In our study were also identified emotional and behavioural problems in
children from divorced families and also a more hostile parenting style of their
mothers, related especially with the presence of anxiety and depression to the
mothers. The psychopathological symptoms of the divorced mothers together
with their hostile parenting style could have an influence on mother – child
relationship.
Linville’s (2010) study show that parental depression and parental strategies
are significantly associated with the behavioural disorders of children. Similar
results have been obtained by our study, showing that to divorced families there
is a strong correlation between parental strategies, the symptoms of the mothers
and behavioural and emotional problems of children, in families with both parents
present not all of this correlations being present.
Limits of the research
The main limitation of the present study is the fact that is a cross-sectional not
a longitudinal study; therefore no relation with the future success and abilities to
cope with problems of the children later in life could be investigated. Also, the
study was limited to children from a single setting and the sample was not
statistically significant.
79
Conclusions
This paper highlighted some aspects related to the consequences of divorce on

children, mothers and parenting strategies, knowing these aspects could be a basis
for some strategies that can assist the children in the adjustment process after the
parent’s divorce, to prevent the long time consequences of divorce or parental
separation over the mental health of the child and further on in his adult life.
According with Tomita (2014: 69), adolescents are faced with challenges and
difficult development tasks, also being exposed to extremely varied risk factors
which, if protective factors are not sufficiently powerful, can lead to emotional
and behavioural disorders, going as far as criminal behaviours. The presence of
emotional and behavioural problems in children and adolescents from divorced
families, allows us to consider sometimes the divorce a period of crisis in their
life. In these situations we can include the children and especially adolescents in
the therapeutic program named Life Space Crisis Intervention (LSCI) that uses
children’ reactions to stressful events related to: behaviour change, enhance of
self-esteem, reduction of anxiety, and expanding understanding and insight into
their own (and others’) behaviour and feelings (Tomita, 2014: 75).
On the other hand, in order to improve the parent - child relationship, con-
sidered a protective factor related with resilience process of children after divorce,
it is also necessary to include the both parents in parent education programs aimed
on the one hand to develop new, positive, behaviours and to eliminate the be-
haviours that affect the child’s development (Cojocaru & Cojocaru 2011: 213).
Even the child remains to live with only one parent the resilience process needs
both parents to involve in the parenting process. Participating in education pro-
grams, the parent understands that it is up to him/her how a conflict situation is
handled, and this empowerment of the parent, achieved during the programme
(both by developing his/her reflexive skills, as well as by enriching the range of
responses to critical situations) makes the parent more responsible (Cojocaru,
Cojocaru, 2011: 217). Beyond the practical aspects, the present study focused on
the divorced mothers’ symptoms that can be related with the behaviour of children,
the relation being mediated or not by the parenting style. Our clinical experience
show that, when we examine a child form a divorced family, always we also need
to look closely to the mother psychological well-being and to intervene when is
necessary.
80
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82
Working together
www.rcis.ro
Application of Data Envelopment Analysis

to Evaluating Elderly Social Welfare
Performance
Suh Chen HSIAO1, Luke HSIAO2
Abstract
The constant development of economic societies allows the elderly enjoying

certain social security and increasing the demands for the social welfare of health,
medical treatment, public health, and society management; and, the government
therefore has declared for reinforcing the social welfare as the key administration.
With the increasing expenses but decreasing incomes, the social welfare budget is
still increasing. Under the restricted resources, allocation becomes a major cha-
llenge for the governmental administration. Modified Delphi Method is utilized
in this study for screening the input/output factors. Total 30 copies of ques-
tionnaires are distributed, and 22 are effectively responded, with the response rate
73%. Data Envelopment Analysis (DEA) is applied to evaluating the efficiency.
The variable data used in this study are open statistical data from Ministry of
Interior. The research results show 3 DMUs with strong-form efficiency in the
practice of elderly social welfare (efficiency=1), about 15% of all DMUs, re-
vealing the favorable elderly social welfare efficiency; another 3 DMUs present
marginal inefficient in the practice of elderly social welfare (0.9<efficiency<1),
about 15% of all DMUs, revealing the elderly social welfare efficiency being
more easily enhanced than other counties and cities; and, 14 DMUs appear
distinctly inefficient in the local sustainability efficiency (efficiency<0.9), about
70% of all DMUs.
Keywords: social welfare, elderly society, organizational performance, effi-

ciency evaluation, capacity
1
University of Southern California, School of Social Work, USA. E- mail:shuhsiao@usc.edu
2
I-Shou University, Department of public Policy and Management, Taiwan ROC (corresponding
author). E-mail: ychsiao@isu.edu.tw
83
Research background
To cope with the changes in population, family structure and function, labor
market, and value, the social environments are continuously changing. The pro-
motion of social welfare aims to solve the problems induced by the changes in
social environments. The largely increasing national income and the changes in
social, political, and economic structures have enhanced the public demands for
social welfare; and, the government has declared for reinforcing the social welfare
as the key administration. With the constant development of economic societies,
the elderly enjoy certain social security so that the demands for the social welfare
of health, medical treatment, public health, and society management are en-
hancing. How to secure the elderly enjoying the social welfare correspondent to
the development of economic societies, to enhance the standard of various public
management services for the elderly, and to implement the dignified survival and
living of the elderly is related to social justice, social harmony and stability as
well as an important issue of communications between generations for every
citizen propagating the tradition of respecting and loving the elderly.
Elderly social welfare is closely related to civil rights. The practice of social
welfare emphasizes the active movements of the government and requires the
formulation of scientific and democratic policies, the participation of independent
and mature organizations, and the rights of just and authoritative judgment. The
trend of expanding social protection to secure social rights of every person with
national promotion is a typical characteristic of social policy development in a
welfare country. Improving elderly social welfare is an active movement of a
responsible government as well as the respect and protection for the pioneers of
social development and advance. Consequently, the research results are expected
to be the reference of the government planning budgets so that the budget plan is
reasonably allocated, rather than the public sectors following old systems and
council divisions bidding for the budgets.
Literature review
Social welfare
Amado et al. (2012) mentioned that the essence of social welfare was still
based on living guarantee, in spite of the system being constantly expanded. The
increase of national income might be able to reduce absolute poverty but could
not prevent from relative poverty. The economic essence of social welfare was to
prevent the citizens from such poverty for the national minimum security. Bain &
Company (2013) indicated that the economic essence of social welfare was not to
secure national living with a standard but to protect the citizens in different levels,
84
and even to provide the minimum security of relative poverty for the ones with
high income. Unless the national income reached the high level, the governmental
finance was rich, and the absolute poverty was extinct, social welfare could hardly
protect the national high-quality life. Black (2011) mentioned that social welfare
should present the minimum security under the economic and social conditions of
general countries. An individual pursuing more comfortable life relied on personal
efforts; the government did not necessarily and was impossible to offer the
security. Morikawa (2014) simply defined social welfare as the minimum security
directly or indirectly provided by the government. Nevertheless, some countries
included corporate welfare and governmental welfare into the social welfare
system to inflate the budget but not to present actual meanings (Schulz, 2010).
Chao et al. (2011) proposed following welfare resources allocation principles. (1)
Attributed Need. The existing systems not satisfying the normative criteria of
such demands might be related to the citizens, such as national health insurance in
Britain, or to certain groups, like day care for employed mothers. (2) Com-
pensation. The beneficiaries had contribution to the country, such as retired
soldiers and social insurance personnel, or the victims suffered from ill social
structure, like the ones suffering from ethnic prejudice. (3) Diagnostic Diffe-
rentiation. The ones were judged by experts for specific demands, like the ones
with physical disabilities or emotional disorder. (4) Means-Test. The ones could
not purchase the required goods and services because of economic conditions,
such as low-income households. Hieda (2012) proposed fiscal welfare and occu-
pation welfare, beyond social welfare. Social welfare contained social welfare,
social aids, subsidies for specific groups, and general welfare services. Fiscal
welfare indicated the government utilizing the fiscal policies for the income
distribution, e.g. an individual could itemize deduction (like donation, medical
expenses, loss from natural disasters) when declaring personal income tax. Fur-
thermore, occupation welfare was related to work and was provided by the
employers, covering day care and medical services, which are regarded as em-
ployee welfare nowadays (Zuidgeest et al., 2011).
Meaning and measurement of performance
Ansah et al. (2013) defined organizational performance as the achievement of

a “desired end”. In other words, performance referred to the consistency between
real output and expected output of an organization; however, how to set “desired
end” became an argument among researchers over organization theories.
The theoretical model of performance is generally divided into three models
(Bélanger, 2011): (1) Goal Model. An organization was assumed a rational system
in this model, would formulate feasible approaches according to objective envi-
ronments and real demands and referring to the capability, and integrated the
organizational resources to effectively complete various organizational goals. (2)
85
System Model. Breland (2010) considered that an organization in the model was
regarded as a system, which received resources from external environments,
treated and transformed such resources, and output such transformed resources to
external environments. Through the “input, transform, and output” process, the
organization was capable of acquiring resources and outputting feedback to the
environment. In this case, organizational performance depended on the balance
between resource input and output in an organization; (3) Participation-Satis-
faction Model. The satisfaction of the organizational members was emphasized. It
considered the success of an organization not relying on the achievement of
organizational goals, but the individual performance in the organization. In this
model, the survival of an organization depended on individual contribution to the
organization that performance was individual satisfaction with the organization
and the subjective perception.
Chen et al. (2011) pointed out effectiveness as pursuing the achievement of
organizational goals, while efficiency focusing on the relationship between input
and output and seeking for minimum resource costs. Since organizational re-
sources were restricted, efficiency was emphasized by management levels. Effi-
ciency was regarded as a manager applying certain input to generating more
output or using less input to generate certain output. Effectiveness, on the other
hand, referred to a manager achieving the organizational goal. The pursuit of
efficiency therefore stressed on the use of means, while the pursuit of effectiveness
was to measure the ends. As a result, a manager should consider achieving the
organizational goals as well as pay attention to the outcomes. Falasca (2011)
argued to establish the performance evaluation system, which emphasized that
simply presenting the outcomes, without any rewards, would change the entire
organization. They indicated that measuring one thing, it would be well done; the
success or failure would not be known without measurement; rewards would not
be given without knowing what was successful; not rewarding success was like
rewarding failure; experiences could not be acquired without knowing what
success was; failure could be an example for future; and, the proof of performance
could win supports from the public.
Measurement of organizational performance on elderly social welfare
Claes & Loo (2011) stressed on the importance of individual performance in a

social welfare organization and measured the performance with long-term and
short-term indicators to give considerations to both long-term and short-term
objectives. Ippoliti & Falavigna (2012) observed the conflict of performance
measurement between internal members of an organization and external people; a
Balanced Way was therefore proposed to provide information for managers re-
alizing the performance of an organization on various dimensions. In other words,
the performance measurement of a non-profit organization should satisfy the
demands of internal and external people.
86
Efthymios et al. (2010) pointed out five primary factors in the operation of
social welfare organizations, namely service subject (C), business operation to
create value (O), financial and object resources (R), participants (P), and created
and provided services (S). The operation and coordination among the five factors
presented the good performance of a social welfare organization. It was considered
that a social welfare organization should design the strategic performance in-
dicators from the aspects of mission achievement, social acceptance, efficiency,
degree of input, satisfaction, balance, and conversion degree.
Referring to the performance measurement system in National Conservancy,
Hsieh et al. (2012) divided the performance measurement system into Impact,
Activity, and Capacity, and designed the questionnaire to interview 30 managers
of non-profit organizations; and, the interview results were analyzed for the
conclusion and suggestions. It was considered that the performance measurement
of some non-profit organizations was not connected with the aims, and other non-
profit organizations merely focused on some of the three domains that the per-
formance measurement was biased. Johansson (2010) pointed out the problems
derived from ageing population, including more complete planning and security
against economic security, more long-term care for prolonging life expectancy
and weakening family functions, and group assistance in emotional support. An
ounce of prevention is worth of a pound of cure. Merely the provision of diver-
sified welfare services could satisfy distinct demands of the elderly and allow
them happily participating in and possess quality and dignified life. Ageing is a
part of life; being elder could be a golden or a dark period in the life. It is expected
that all seniors could enjoy the results striven in the youth and have a happy
elderly life (Willans & Seary, 2011).
Research design
Screening of input and output
To combine the selection of input/output factors with expert opinions, reduce

input costs, and avoid fuzziness in the interview process, Modified Delphi Method
is utilized for screening the input/output factors. For the special consideration,
brainstorming open-ended questionnaire is omitted; and, the structural ques-
tionnaire is directly developed, after referring to large amount of literatures, for
the first run of questionnaire survey. With Modified Delphi Method, the structural
questionnaire is directly used for the first run survey in order to reduce time and
have the experts focus on the research subject, without guessing open-end ques-
tions. Total 30 copies of questionnaires are distributed, and 22 copies are effec-
tively responded, with the response rate 73%. The variable data used in this study
are the open statistical data from Ministry of Interior.
87
The variables are defined as below:

- Input variable: (1) Multi-service center for the elderly. The number of
welfare centers for senior citizens set up by departments of social welfare;
(2) Number of social welfare personnel, including administrators, social
workers, and professionals; (3) Budget for elderly social welfare. invested
budget for practicing elderly social welfare.
- Output variable: (1) Budget implementation efficiency. Efficiency in the
practice with invested budget; (2) Person-time of social welfare activities.
Planning to give senior subsidies and the number of beneficiaries of elderly
honored activities.
Efficiency evaluation and analysis
From the view of economics, the less input but the more output of a unit
presents the better Performance. To measure such performance, Efficiency could
be used as the evaluation standard. From the comparison between input and
output, efficiency could be defined as efficiency = sum of weighted output/sum of
weighted input. The maximum output function received with different input mix
is called Product Function. When the maximum output received from general
input is less that the production of product function, the product function is the
maximal frontier of production, also called Production Frontier. Geometrically,
the principle of envelope is utilized for reflecting inputs and outputs of all eva-
luated DMUs to a space so as to evaluate the relative efficiency of an organization
and search for the efficiency envelope which could envelope all observation data
to form the efficiency frontier. The distance between the observation value of an
individual DMU and the efficiency envelope could be used for calculating the
relative efficiency.
Data Envelopment Analysis (DEA) is utilized for evaluating efficiency in this
study. Different from traditional regression analysis, which seeks for an average
path from a series of data, various samples are enveloped to find out the rela-
tionship that it presents advantages of a favorable efficiency evaluation model.
Such a method applies linear planning, considers the factors in performance
measurement among various DMUs, and compares the performance of DMUs
with similar characteristics.
Farrell first replaced the common Default Function with Non-default Pro-
duction Function to estimate the efficiency in 1957 and applied mathematical
planning to calculate the production efficiency frontier, i.e. efficiency production
function. Two elements of efficiency were proposed: (1) Technical efficiency
(TE) responded the maximum output with fixed input.; (2) Allocative efficiency
(AE) or price efficiency (PE) responded the optimal proportion of input under the
concerned input. In this case, Farrell first divided overall efficiency into technical
88
efficiency related to real input/output and allocative efficiency related to the

optimal elements, under the assumption of constant return to scale and constant
input price; and, the product of the two was the total economic efficiency. The
following assumptions were used by Farrell: (1). The production frontier consisted
of the most efficient DMUs, and insufficient DMUs appeared under the frontier
(i.e. right back of the frontier); (2) The production frontier was a convex point and
the slope was negative. 3. Constant return to scale appeared between outputs and
inputs.
Empirical analysis of elderly social welfare performance
Analysis of elderly social welfare performance
According to the input/output indicators in this study, the total production

efficiency and the pure technical efficiency of elderly social welfare practiced in
various counties and cities were calculated with CCR and BCC models; and, the
return to scale was acquired by dividing the two. Total production efficiency, pure
technical efficiency, scale efficiency, and return to scale are organized in Table 1.
Table 1. Relative efficiency of elderly social welfare
Total Technical Scale

Country/city public sector
efficiency efficiency efficiency
Taipei City 0.83 0.87 0.80
New Taipei City 1.00 1.00 1.00
Taichung City 0.98 0.97 0.95
Tainan City 1.00 1.00 1.00
Kaohsiung City 1.00 1.00 1.00
Keelung City 0.86 0.86 0.86
Hsinchu City 0.70 0.72 0.70
Jiayi City 0.88 0.89 0.86
Taoyuan City 0.94 0.95 0.93
Hsinchu County 0.74 0.73 0.74
Miaoli County 0.62 0.64 0.60
Changhua County 0.90 0.91 0.90
Nantou County 0.77 0.78 0.76
Yunlin County 0.72 0.71 0.73
Jiayi County 0.69 0.67 0.70
Pingtung County 0.85 0.86 0.83
Yilan County 0.83 0.85 0.80
Hualien County 0.76 0.77 0.75
Taitung County 0.80 0.82 0.79
Penghu County 0.67 0.68 0.66

89
From Table 1, New Taipei City, Tainan City, and Kaohsiung City were re-
latively efficient with the total efficiency=1, while the rest counties and cities
presented low total production efficiency; especially, Miaoli County, with the
lowest total efficiency, was relatively the most insufficient county. In other words,
17 DMUs were relatively inefficient, except the ones with the total production
efficiency=1. The factor in inefficiency might be not effectively applying inputs
or not achieving the optimal scale of production. It required further analyses.
Sensitivity Analysis
The risk evaluation in this study aimed to analyze and find out the key factors
in the practice of elderly social welfare with Sensitivity Analysis. The input and
output variables were removed one by one for DEA in order to understand the
efficiency sensitivity. The research results revealed the change of sensitivity as
the evaluation criteria, including susceptibility factor multi-service center for the
elderly, number of social welfare personnel, budget for elderly social welfare,
budget implementation efficiency, and person-time of social welfare activities.
From Table 2,
(1) The efficiency of all DMUs, except Taipei City, Miaoli County, and
Penghu County, decreased after removing Multi-service Center for the
Elderly. In other words, multi-service centers for the elderly presented
higher importance for all DMUs, while the efficiency of Taipei City, Miaoli
County, and Penghu County increased after the removal because of worse
efficiency of elderly service centers.
(2) The efficiency of all DMUs, except Taipei City, decreased after re-
moving Number of Social Welfare Personnel. In other words, social welfare
appeared higher importance for all DMUs, while the efficiency of Taipei
City increased after the removal because of insufficient social welfare
workers.
(3) The efficiency of all DMUs decreased after removing Budget for Elderly
Social Welfare, presenting the higher importance of education sectors for
all DMUs.
(4) The efficiency of all DMUs decreased after removing Budget Imple-
mentation Efficiency, revealing the higher importance of environmental
load for all DMUs.
(5) The efficiency of all DMUs decreased after removing Person-time of
Social Welfare Activities, showing the higher importance of economic
efficiency for all DMUs.
90
Table 2. Sensitivity Analysis of single input and output being removed one by one
Remove Remove
Remove Remove Remove
budget person-
Original multi- number of budget for
implementation time of
DMU relative service social elderly
efficiency social
efficiency center for welfare social
welfare
the elderly personnel welfare
activities
Taipei City 0.83 0.96 0.92 0.81 0.80 0.81
New Taipei 0.93 0.97
1.00 0.91 0.97 0.92
City
Taichung 0.91 0.96
0.98 0.93 0.90 0.95
City
Tainan City 1.00 0.93 1.00 0.93 0.94 0.98
Kaohsiung 0.95 0.92
1.00 1.00 1.00 0.90
City
Keelung 0.80 0.81
0.86 0.83 0.81 0.84
City
Hsinchu 0.67 0.62
0.70 0.65 0.63 0.61
City
Jiayi City 0.88 0.82 0.84 0.80 0.83 0.81
Taoyuan 0.90 0.92
0.94 0.91 0.88 0.89
City
Hsinchu 0.68 0.71
0.74 0.70 0.68 0.65
County
Miaoli 0.51 0.53
0.62 0.65 0.60 0.58
County
Changhua 0.87 0.88
0.90 0.81 0.83 0.85
County
Nantou 0.70 0.74
0.77 0.73 0.71 0.75
County
Yunlin 0.68 0.66
0.72 0.64 0.70 0.63
County
Jiayi County 0.69 0.62 0.61 0.67 0.65 0.60
Pingtung 0.79 0.80
0.85 0.83 0.80 0.76
County
Yilan 0.76 0.72
0.83 0.81 0.79 0.71
County
Hualien 0.64 0.62
0.76 0.73 0.69 0.72
County
Taitung 0.70 0.77
0.80 0.76 0.74 0.71
County
Penghu 0.61 0.60
0.67 0.69 0.61 0.62
County
Number of 0 0
efficient 3 1 2 0
DMU
Data source: Self-organized in this study
91
Conclusion
According to the efficiency and variable information acquired from DEA, 3

DMUs present strong-form efficiency in the practice of elderly social welfare
(efficiency=1), about 15% of all DMUs, revealing the favorable efficiency; ano-
ther 3 DMUs show marginal inefficiency in the practice of elderly social welfare
(0.9<efficiency<1), about 15% of all DMUs, presenting that the efficiency can be
more easily enhanced; and, 14 DMUs appear distinctly inefficient on the local
sustainability efficiency (<0.9), about 70% of all DMUs, in which Miaoli County
presented the lowest local sustainability efficiency. Based on the DEA results, the
service contents and amount offered by departments of social welfare show the
highest budget scale allocation on elderly social welfare, while the total budget
scale is not reduced with decreasing budget in the inflation. In this case, the
budget scale for other policies would be reduced because of increasing social
welfare budget. The ageing problem is getting serious in Taiwan that the total
budget would appear negative growth, i.e. the total budget would not be able to
increase the quota for social welfare. As a result, the overall social welfare budget
policy should be re-evaluated.
Suggestions
By introducing clusters in this study, the following suggestions are proposed.

(1) Performance as the consideration of resource allocation. The gover-
nmental administration should base on the maximum welfare of the citizens.
Under resource restrictions, allocation becomes a primary problem. The
financial conditions in Taiwan are worse than it in the past that every penny
needs to be carefully considered to make the maximum benefit. Based on
the research results, it is suggested that the practice efficiency is regarded
as the reference of resource allocation. New Taipei City, Tainan City, and
Kaohsiung City, with favorable practice efficiency, are offered more bud-
gets to create higher efficiency. The ones with worse efficiency, like Miaoli
County, are reduced the budget allocation to cut down insufficient expenses.
The budget allocation quota should be adjusted annually till the efficiency
standards of various counties and cities are about the same. Budget allo-
cation could be the optimal allocation for maximizing the practice effi-
ciency.
(2) Establishment of database with various complete social welfare results
for evaluation. Register statistics aims to collect administrative data. It is
suggested that departments of social welfare should divide the register
statistics in detail, according to the demands, for convenient comparison
and reference of appropriate and real-time information for decision-makers.
92
(3) The idea of group living of the elder is different from it in the previous
generation. They reveal stronger demands for welfare projects of culture,
sports, and health and spiritual and cultural products. Such changes in
social consumption structure facilitate the adjustment of markets and pro-
duct structure and the development of relevant industries. The government
simply improves the management contents and method in some traditional
field, but not taking certain common preference for policy supply into
account that the social welfare output would be largely reduced. Based on
understanding the current situations of social welfare, elderly rights, and
elderly social welfare, the improvement path to develop regular social
welfare needs to be selected and the social welfare improvement measure
needs to be implemented so that the elderly could acquire better security in
the social welfare and harmonious development.
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94
Working together
www.rcis.ro
Stress, Resilience and Life Satisfaction

in College Students
Ana-Maria CAZAN1, Camelia TRU}A2
Abstract
The current study aims to assess the construct validity of the Adolescent
Resilience Scale and its psychometric properties in order to determine its re-
levance when used within the Romanian context. The second aim of the study is
to investigate the associations between resilience, perceived stress and life sa-
tisfaction. A number of 341 Romanian students from several faculties were re-
cruited. The results suggest that the Adolescent Resilience Scale has good psycho-
metric properties after its translation into Romanian, which is an argument for its
future use in Romanian settings. The confirmatory factor analysis supports the
construct of adolescent resilience even after the Romanian translation. Consistent
with previous studies, the path analyses shows that stressors function as a mediator
between resilience, reactions to stress and life satisfaction.
Keywords: life satisfaction, perceived stress, reaction to stress, resilience,

stressors.
Introduction
The term resilience has gained great popularity during last decade as the
necessity for predicting the ability to tolerate stress and negative events has
increased not only in clinical settings but also in organizational and educational
ones (Hjemdal, Friborg, Stiles, & Martinuss, 2006). The ability to recover from
negative emotional experiences and to flexibly adapt to stressful events is essential
to individual’s well-being and life satisfaction (Tugade & Fredrickson, 2004).
1
Transilvania University of Braov, Psychology and Training in Education, Braov, România,
ana.cazan@unitbv.ro
2
Transilvania University of Braov, Psychology and Training in Education, Braov, România,
camitruta@unitbv.ro
95
Yet, the dynamic interplay between stressful experiences, well-being and succes-
sful adaptation is still under debate. It is known that those low in psychological
resilience exhibit higher reactivity to daily stressful events, while those who score
high in psychological resilience rebound more easily from adversity (Ong, Ber-
geman, Bisconti, & Wallace, 2006) and are more satisfied with their life (Tugade
& Fredrickson, 2004), but the underlying mechanisms are not very clear.
Psychological resilience has been approached from three different perspectives,
as an outcome of effective coping to stress, as the process of successful adaptation
despite adversity, or as a psychological ability to successful recover from negative
emotional experiences.
Conceptualized as an outcome, resilience implies a pattern of effective be-
haviours in individuals exposed to risk (Olsson, Bond, Burns, Vella-Brodick, &
Sawyer, 2003). In this perspective, resilience is defined in terms of competencies
under stress, several studies showing that young people functioning efficiently
despite stressful events demonstrate a high form of resilience (Ong et al., 2006).
In particular, resilience has been studied in relation with academic stress, viewed
as a risk factor. If the academic related demands exceed an individual’s adaptive
resources, then several health symptoms may appear (Wilks, 2008). For example,
Zalenski, Levey-Thors and Schiaffino (1998) found a strong association between
the number of stressful life events and physical symptoms in college students.
Resilience is also seen as a dynamic process that modifies the impact of
significant negative events and leads to successful adaptation to adversity (Olsson
et al., 2003). Process- focused research assesses both risk factors and protective
mechanisms (resources on the individual, social or family level). Competencies,
skills, peer-support or family support are considered to be protective factors as
they moderate risk and reduce the negative impact of risk on resilience (Wilks,
2008). The process-focused perspective aims at developing interventions to im-
prove psychological and physical health by enhancing resilience and decreasing
high-risk behaviours (Ahern, Kiehl, Sole, & Byers, 2006).
The third research approach implies that resilience is a personality trait. Re-
silience has been repeatedly associated with the Big Five personality factors, all
studies showing evidence that a high resilient personality is characterized by high
score on all factors (emotional stability, extraversion, openness, agreeableness
and consciousness) (Hjemdal et al., 2006). Defining features of highly resilient
individuals are positive social orientation towards other, the achievement orien-
tation (Werner & Smith, 1992), optimistic and energetic approach to life and the
positive emotionality (Cohn, Fredrickson, Brown, Mikels, & Conway, 2009;
Tugade & Fredrickson, 2004). In a longitudinal study, Asendorpf and van Aken
(1999) associated resilience with the three personality types derived from J.H.
Block and J. Block theory on ego-control and ego-resilience. Their findings show
96
that resilience is best conceptualized as a continuous trait that reflects an individual’s

ability to adapt to changing environments.
Successful adaptation is the core element of each conceptualization of re-
silience. Highly resilient people have adaptive coping skills and perform better in
specific task, such as academic ones (Wilks, 2008). Resilience does not imply a
low vulnerability to stress, but rather the ability to effectively recover from
negative events (Garmezy, 1981). Most often, trait resilience is considered a
personality characteristic that moderates the relation between stress and adaptation
or health outcome (Ahern et al., 2006).
Previous studies on the relationships between resilience and life satisfaction
show that change in resilience over time predicted change in life satisfaction
(Cohn et al., 2009). Resilience acts not only as a predictor, but also mediates the
relationship between positive emotions and life satisfaction. Also, in a longitudinal
study on Norwegian medical students, (Kjeldstadli et al., 2006) was found that
not only resilience but also perceived stress differentiate those with high levels of
life satisfaction from students with low or fluctuating levels of life satisfaction.
Most of the previous research approached resilience and perceived stress as
predictors of life satisfaction, as already shown (Abolghasemi & Varaniyab, 2010;
Kjeldstadli et al., 2006).
Even though much research on resilience used samples of students due to
convenience, Oshio, Kaneko, Nagamine, and Nakaya (2003) argue that the mea-
surement of resilience during adolescence is justified by the significant psycho-
logical and social changes an individual must face during this stage. Resilience is
conceptualized as a key factor in coping with these changes and the associated
difficulties. Another argument is the high prevalence of risk behaviours in ado-
lescence, such as alcohol or drug use, sexual behaviours, eating behaviours,
behaviours leading to injury (Ahern et al., 2006). All these behaviours may have
a high impact on adolescents’ mental health, functional capacity or social com-
petence (Olsson et al., 2003).
Method
The current study aims to assess the construct validity of the Adolescent
Resilience Scale (Oshio et al., 2003) and its psychometric properties in order to
determine its relevance when used within the Romanian context. Thus, one pur-
pose of this paper is to propose an instrument to measure resilience, for the use of
educators and researchers, which is valid and easy to administer. Another aim is
to investigate the associations between resilience, perceived stress and life sa-
tisfaction.
97
Participants
A convenience sampling procedure was used. A number of 341 Romanian

students from several faculties were recruited, 260 female, 81 male, with a mean
age of 20.65.
Measures
The Adolescent Resilience Scale (Oshio et al., 2002) consists of 21 items

covering three factors: Novelty Seeking, Emotional Regulation, and Positive
Future Orientation. Novelty seeking refers to the ability to show interest in and
concern about a wide variety of events. Emotional regulation is a trait of indi-
viduals who exhibit composure and control their internal emotions. Positive future
orientation concerns the approach to goals in the future (Nakaya, Oshio, &
Kaneko, 2006). The scale was translated and adapted for the Romanian population
and the psychometric analysis revealed high reliability coefficients for all the
dimensions: .76 for Novelty Seeking, .70 for Emotional Regulation, .82 for
Positive Future Orientation and .81 for the entire scale.
The Student-life Stress Inventory (SSI) (Gadzella, 1994) measures academic
stressors and reactions to stressors. The academic stressors subscale assesses five
stressor categories: frustrations, conflicts, pressures, changes, and self-imposed.
Reactions to stressors refer to four categories describing reactions to physio-
logical, emotional, behavioural, and cognitive stressors. The 51 items require a 5-
point Likert-type response format. The Alfa Cronbach coefficient shows good
psychometric properties, ranging between .70 and .84.
The Satisfaction with Life Scale (Diener, Emmons, Larsen, & Griffin, 1985) is
one of the most widely used scales for the measurement of subjective well –
being. The scale includes five items rated on a seven - point Likert scale (1 =
Strongly disagree, 7 = Strongly agree). The Satisfaction with Life Scale was
developed to assess satisfaction with the respondents’ life as a whole. According
to the SWLS, higher scores indicate greater life satisfaction. Previous studies
using the Romanian version of SWLS reported good psychometric properties, the
Alfa Cronbach coefficient obtained for the entire scale being .82 (Cazan, 2014).
Procedure
The participants were informed about the study aims and its confidentiality.
Participants responded to the questionnaires in large-group settings, after com-
pleting the informed consent forms. Participants were compensated with extra
credits.
98
Results
Reliability and construct validity of the Adolescent Resilience Scale – the

Romanian Version
The first phase of the study aimed to assess the construct validity of the
Adolescent Resilience Scale (Oshio et al., 2003) and its psychometric properties.
The Alfa Cronbach coefficient for the entire scale was .81, highlighting a high
internal consistency of the scale, although inferior to the original version with an
Alfa Cronbach of .85, reported by Oshio and his colleagues (2003). For the three
subscales, the Alfa Cronbach coefficients were similar to those reported in pre-
vious research for the Romanian version: .76 for Novelty Seeking, .70 for Emo-
tional Regulation, .82 for Positive Future Orientation. Similar to the findings of
Oshio and his colleagues (2003), significant positive inter correlations among all
factors of the Adolescent Resilience Scale were found.
Table 1. Person correlation coefficients among the resilience subscales

1 2 3 4 M SD
1. Total resilience 1 78.27 8.88
2. Novelty seeking .756** 1 28.88 3.88
3. Emotion regulation .767** .311** 1 28.93 4.82
4. Positive orientation .675** .401** .233** 1 20.45 3.31
Note. **. Correlation is significant at the 0.01 level (2-tailed). N = 341
Assessment of normality and outliers suggests that there were no multivariate

outliers, Mahalanobis distance showing minimal evidence of multivariate outliers.
The authors of the instrument suggested that a total score of the scale can be
computed and given the significant correlations between the subscales and the
total score, we tested two second order models, the first model without correlated
errors and the second one, with correlated errors. The last model seemed to be the
most efficient (Table 2).
99
Figure 1. Confirmatory Factor Model of the Adolescent Resilience Scale
100
Table 2. Goodness-of-fit measures for the tested models – First order and second
order CFA for the Adolescent Resilience Scale
Model Correlated χ2(df) GFI CFI AIC RMSEA (90%

errors CI)
1. Second - 633.228 .825 .776 732.228 .084
order - (186) (.077-.091)
uncorrelated p < .001
errors
2. Second err6  err7 541.336 .876 .866 547.336 .066
order - err8  err9 (183) (.058-.073)
correlated err20  err21 p < .001
errors
Note. GFI: Goodness-of-Fit Index, CFI: Comparative Fit Index, AIC: Akaike
Information Criterion, RMSEA: Root Mean Square Error of Approximation, 90% CI:
90% confidence interval for RMSEA.
Based on the initially hypothesized model (Model 1), the modification indexes
related to the covariances showed evidence of misspecification associated with
the pairing of error terms of the items 6 and 7 (err6↔err7; MI = 57.80), the items
8 and 9 (err8↔err9; MI = 71.47) and with items 20 and 21 (err20↔err21; MI =
32.27). Thus, the second model included the correlated errors. As the model fit
was better than for the first model, we considered model 2 to represent the final
best-fitting and most parsimonious model to represent the data (Figure 1).
The results suggest that the Adolescent Resilience Scale has good psychometric
properties after its translation into Romanian, which is an argument for its future
use in Romanian settings. Although previous studies argued that very little the-
oretical rationale is presented for the scale, and that the manner in which the
psychological characteristics were chosen to represent resilience is unclear (Win-
dle, Bennett, & Noyes, 2011), the present study demonstrated acceptable reli-
ability and validity.
Resilience, stress, and life satisfaction
The second objective of the study was to investigate the associations between
resilience, perceived stress and life satisfaction. Our hypothesis was that stressors
mediate the relationship between resilience, reactions to stress and life satis-
faction. Results showed moderate but significant correlation coefficients between
resilient personality, academic stress dimensions and life satisfaction (Table 3).
101
Table 3. Means, standard deviations (SD), and zero-order correlations for all study variables
M SD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1. Novelty
28.87 3.89 1
seeking
2.Emotion
28.92 4.83 .31** 1
regulation
3.Positive future
20.46 3.31 .40**.23** 1
orientation
4.Resilience
78.27 8.89 .75**.76** .67** 1
overall score
5.Satisfaction
25 5.51 .27**.25** .34** .38** 1
with life
- - -
6. Frustrations 13.82 4.36 -.22** -.36** 1
.19** .35** .49**
- -
7. Conflicts 6.45 2.59 .01 -.12* -.19** .44** 1
.28** .22**
- -
8. Pressure 12.72 3.38 -.03 -.10 -.24** .51** .35** 1
.34** .27**
102
- -
9. Change 7.75 2.93 -.12* -.12* -.29** .57** .33**.51** 1
.36** .33**
10. Self - -
21.24 3.64 .08 .03 -.11* -.02 .23** .13* .42**.22** 1
imposed .29**
- -
11. Stressors 61.9912.06 -.08 -.15** -.34** .81** .59**.79**.73**.58** 1
.46** .37**
12.Physiological - -
28.07 8.17 -.09 -.17** -.28** .48** .28**.50**.49**.33**.60** 1
reactions .32** .24**
13. Emotional - - -
10.88 3.67 -.18** -.34** .54** .30**.57**.47**.40**.65**.63** 1
reactions .16** .37** .33**
14. Behavioural - - -
13.87 4.23 -.12* -.37** .48** .35**.41**.42**.31**.56**.49**.58** 1
reactions .19** .44** .34**
15. Cognitive
6.77 1.93 .15** -.05 .10 .07 -.02 .30** .18**.34**.26**.29**.39**.33**.34**.26** 1
reactions
- - - -
16. Reactions 58.9114.57 -.12* .59** .36**.59**.55**.42**.72**.90**.82**.74**.48** 1
.41** .169** ,346** .32**
Note. **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). N = 340.
Given the significant correlations between the stressors and between the reactions
to stress, we used in the structural model the overall scores to avoid the over-
lapping. In order to test the mediation hypothesis we tested two alternative
structural models: a full versus a partial mediation model. The models included as
endogenous variable the overall score for the stressors scale, the score for the life
satisfaction scale and the overall score for the reactions to stress scale (Figure 1).
Figure 2. The structural equation model regarding the mediating effect of stressors on
the association between resilient personality, academic stress reactions and satisfaction
with life
103
Compared to the partial mediation model, the full mediating model was tested
with the direct paths from the three dimensions of the resilient personality to the
satisfaction with life and to the reactions to stressors dimension. The differences
between the two models regarding the fit indices led to the conclusion that the full
mediation model was the best model (Table 3). According to Hu & Bentler (1999)
and Kline (2011), the goodness-of-fit criteria were used in the current study
acknowledged the potential for acceptable (λ2/df ratio <3, CFI and TLI >.90,
SRMR <.10, RMSEA <.08) and excellent fit (λ2/df ratio <2, CFI and TLI >.95,
SRMR <.08, RMSEA <.06).
Table 3. Goodness-of-fit measures for the tested models – First order and second
order CFA for the Adolescent Resilience Scale
Model χ2(df) CFI TLI AIC RMSEA (90% CI)
1. Partial 51.14 (7) .916 .820 91.141 .136
mediation model p < .001 (.103-.173)
2. Full mediation .838 (1) 1.000 1.000 40.838 < .001
model p = .360 (.000-.139)
Note. GFI: Goodness-of-Fit Index, CFI: Comparative Fit Index, AIC: Akaike In-
formation Criterion, RMSEA: Root Mean Square Error of Approximation, 90% CI: 90%
confidence interval for RMSEA.
The significance of the mediating effect of stressors was tested using the
Bootstrap estimation procedure in AMOS. The standardized path coefficients and
standardized indirect effect of stressors and its associated 95% confidence inter-
vals are displayed in Table 4.
Table 4. Direct, indirect and total effects (Standardized estimates) for the structural
model
Variables Stressors Satisfaction with life Reactions to stressors
EFFECTS Direct/Total Direct Indirect Total Direct Indirect Total
Novelty seeking .10 .16* -.03 .13* -.04 .07 .03
Emotion regulation -.48** -.01 .16* .15* -.08 -.32** -.40**
Positive future orientation -.08 .23** .03 .26** -.03 -.06 -.09
Stressors - -.33** - -.33** .67** - .67**
Note. * p<.05, ** p<.01.
According to the results, Novelty seeking has a positive direct effect on Satis-
faction with life, Emotion regulation has a negative direct effect on Perceived
stressors, an indirect positive effect on Satisfaction with life, and an indirect
negative effect on Reactions to stress, Positive future orientation has only a
positive direct effect on Satisfaction with life. As expected, Perceived stressors
104
have negative indirect effects on Satisfaction with life and positive direct effects
on Reactions to stress. Thus, the hypothesis concerning the mediating effect of
stressors is confirmed.
Discussion
The primary aim of our study was to examine the factor structure of the
Adolescent Resilience Scale and to analyse the mediating effect of stressors on
the associations between resilient trait, satisfaction with life and reactions to
stress. The present study confirmed acceptable reliability and validity for the
Romanian version of the scale. The results support the construct of adolescent
resilience even after the translation, which lead to the idea that the findings
obtained through the Adolescent Resilience Scale could be generalized to other
populations than Japanese, contrary to other results reported in the literature
(Ahern et al., 2006). As previous studies highlighted, adolescent resilience mea-
sures are reliable and valid across diverse youth populations (Connor & Davidson,
2003; Smith-Osborne & Bolton, 2013).
The associations between resilience and other psychological aspects were also
investigated: negative life events and resilience have significant influences on
mental health problems (Peng et al., 2012); resilience predicts successful adap-
tation (Ahem et al., 2006); positive emotions play a mediating role between
psychological resilience and stress recovery (Tugade & Fredrickson, 2004); re-
silience is positively related to life satisfaction (Abolghasemi & Varaniyab, 2010;
Cohn et al., 2009). In the current study, as expected and consistent with previous
results, the path analyses showed that stressors functioned as a mediator between
resilience and reactions to stress and life satisfaction.
An important implication of the study concerns the possibility to design inter-
ventions aiming to help resilient individuals to recover from stressful situations
and to increase their life satisfaction, contributing to a successful adaptation. The
main conclusion of the study is that individuals with high resilience are expected
to cope well with adverse events and to adapt more successfully. Another contri-
bution of the study regards the use on a Romanian sample of a relatively short and
easy to administer instrument but with good psychometric properties assessing
resilience, given the lack of measurement tools in resilience research for ado-
lescents. However, some limitations of the present study should be noted. The
convenience sample used in this research imposes the need to replicate and to
verify the psychometric properties of the Adolescent Resilience Scale in other
populations. There are also many variables related to the resilience which were
not included in the research, the study being limited to the academic environment
and to the academic stressors and reactions to stressors. Lately, the study of
resilience in adolescence focused on topics such as teenagers’ pregnancy (Black
105
& Ford-Gilboe, 2004), prediction of psychiatric symptoms (Hjemdal et al., 2006),

health problems (PrinceEmbury, 2008; Tian & Hong, 2013), adjustment diffi-
culties (Ungar & Liebenberg, 2009), suicide risk among depressed adolescents
(Nrugham, Holen, & Sund, 2010). A longitudinal design would also demonstrate
the stability or the changes regarding the level of resilience during attending
university.
Conclusions
The results showed that the Adolescent Resilience Scale is a valid measure for
the assessment of resilience in Romanian college students. The reliability and the
construct validity of the scale proved that it is an efficient instrument, the results
being important for the Romanian context given the fact that there are no other
similar scales used in the recent research in the field. Although several scales
reported in the international literature are in the early stages of development, the
validation studies are very important, given the increasing interest in resilience.
In order to extend the validation work, further research will intend to identify if
the measurement parameters are invariant across gender, age and cultural origin
groups. Studies with different subjects as discussed in the previous section are
also necessary to better understand these results and to understand the factor
structure of the scale.
The appropriate values of the fit indices and the high reliability of the scales
included in the study represented the starting point for demonstrating that stressors
mediate the relationship between resilience, reactions to stress and life satis-
faction. The results showed that emotion regulation has the most significant
mediated effects on reactions to stress, highlighting the fact that the stressors
could activate the emotional resources necessary to a successful adjustment. On
the other hand, positive future orientation had the most significant mediated
effects on satisfaction with life, showing that stressors could set the subjective
perception of individuals regarding their own life.
The results sustain, therefore, further investigation of resilience as a personality
trait and that individual differences in psychological resilience may constitute the
key towards a better understanding of adolescents’ and students’ reactions to
stress within Romanian academic context. Highly resilient students are more
likely to perceive stressors as less demanding and, therefore, to better cope with
them and to adapt more efficiently to academic requirements. In addition to
evidencing greater emotional regulation skills, highly resilient students seem to
master their competencies and internal and external resources to face challenging
circumstances, which, in turn, leads to higher levels of satisfaction with life.
106
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108
Working together
www.rcis.ro
Impact of Residence on Dental Fear

and Anxiety in Romanian Children
Réka GYERGYAY 1 , Irina ZETU2, Melinda SZÉKELY3, Mariana P|CURAR4,
Cristina BIC|5, Krisztina MÁRTHA6
Abstract
Child dental fear and anxiety (DFA) is a worldwide problem with extremely
diversified influencing factors and various prevalence. The aim of the present
study was to evaluate dental fear and anxiety in Romanian children living in
Romania and as a minority in Hungary in order to appreciate the importance of
domicile on DFA. 713 schoolchildren between ages of 11-18-years, 406 from
Romania and 306 from Hungary, were evaluated using Klineknecht‘s Dental Fear
Scale (DFS), Getz‘s Dental Belief Scale (DBS) and Background Scale, res-
pectively. The mean age of the surveyed sample was 14.8 ±2.32 years. The mean
scores DFS: 37.81 ±14.24, DBS: 37.37 ±11.38, Background Scale: 2.21 ±2.63
indicate the presence of a moderate dental fear, with no statistically significant
differences between the two samples. From the viewpoint of gender, males from
Romania showed statistically significant differences in case of DBS compared to
their fellows in Hungary. Considering age, the youngest children evaluated, the
11-year-olds were the least fearful, with the peak of DFA situated around age 12-
1
University of Medicine and Pharmacy Tg-Mure[, Department of Pedodontics, Faculty of Dentistry,
Tg-Mure[, ROMANIA. E-mail: gyereka@yahoo.com
2
University of Medicine and Pharmacy Grigore T. Popa, Department of Orthodontics, Faculty of
Dentistry, Ia[i, ROMANIA. E-mail: nicoleta.zetu@gmail.com (corresponding author)
3
University of Medicine and Pharmacy, Tîrgu-Mure[, Department of Morphology of Teeth and
Dental Arches; Technology of Dental Prothesis and Dental Materials, Faculty of Dentistry,
ROMANIA. E-mail: mszekely_2000@yahoo.com
4
University of Medicine and Pharmacy Tg-Mure[, Department of Orthodontics, Faculty of
Dentistry, Tg-Mure[, ROMANIA. E-mail: marianapac@yahoo.com
5
Dentistry, Tg-Mure[, ROMANIA. E-mail: cristina.ioana.bica@gmail.com
6
Dentistry, ROMANIA. E-mail: marthakriszti@yahoo.com
109
14 years. We state that domicile did not have an effect on the level of dental fear
in this case. A decrease in the severity of dental fear and anxiety was also observed.
Significant distinctions between the two samples are present only in particular
aspects of the questionnaires used.
Keywords: children, dental fear and anxiety, Romania, Hungary, commu-

nication, teenagers.
Introduction
Child dental fear and anxiety (DFA) is a behavioural problem that staff of
dental offices has to face globally. Moreover, it is also accompanied with con-
sequences, as it is directly linked with poor dental health both on the short and
long term (Rotaru et al., 2001; R\ducanu et al., 2009; M\rginean & Filimon,
2011; Milsom et al., 2003).
The phenomenon of dental fear and anxiety is defined as a feeling of appre-
hension about dental treatment that is not necessarily connected to a specific
stimulus. It appears in early childhood and its presence has been recorded in
different countries and various ethnic groups (Folayan et al. 2004; Chapman &
Kirby, 1999). The prevalence of dental fear and anxiety among children oscillates
on a wide range worldwide. This could be on the one hand due to the different
methodologies used. On the other hand, it reflects the interplay of factors and
variables related to anxiety, which can be influenced also by the environment and
culture. Culture is a shared system of attitudes and feelings, which may be defined
as a system of common beliefs, values, customs, behaviours and artifacts that
members of society use to cope with their surroundings. With its wide-ranging
impacts, it is likely that the modulating effect of culture, in synergy with other
variables contributes to the variation seen in reports of dental fear and anxiety
between regions (Folayan et al. 2004; Chapman & Kirby, 1999). Romanian
children have been assessed in different circumstances and with variable methods
in the past years (R\ducanu et al., 2009; M\rginean & Filimon, 2011; M\rginean
& Filimon, 2012; Lazar et al. 2012; Vaida et al., 2007). The aim of the present
study was to investigate dental fear and anxiety in Romanian children who live in
Romania and as a minority outside the borders of the country, in Hungary. This
may reflect the impact of living in a foreign country on the perception of dental
fear and anxiety. Respectively, it could reveal the differences between dental care
in the two neighboring countries.
110
Materials and methods
To achieve our objectives, we conducted a cross-sectional questionnaire-based

study in two different locations. One of them took place in the central part of
Romania and the other one, in the south-eastern part of Hungary, close to the
Romanian border. The subjects of our survey were 713 schoolchildren of Ro-
manian nationality between the ages 11-18 years. In total 320 males and 393
females were analyzed, from whom 406 subjects lived in Romania and 307 in
Hungary.
Participation in the survey was voluntary with respect to anonymity. This was
done after appropriate information about the study had been provided to the
participants and also to their parents, who gave their written consent. The study
was approved by the Research Ethics Committee of the University of Medicine
and Pharmacy Tîrgu Mure[ (42/14.03.2013) and by the Ethical Commitee of
Semmelweis University from Budapest (TUKEB 8.9/2008), respectively.
For the assessment of dental fear and anxiety, we applied for Kleinknecht’s
Dental Fear Survey (DFS) (Kleinknecht et al., 1973; Kleinknecht et al., 1984),
which has been validated in a previous survey (M\rginean & Filimon, 2011;
Lazar et al., 2012). The subjects’ opinion about dentists was measured with Getz’s
Dental Belief Scale (DBS), already validated in Hungary (Gáspár et al., 2003;
Markovics et al., 2005), but used for the first time in Romanian children. The
Background Scale measured the dental fear of the child‘s environment (parents,
siblings and friends).
The questionnaires were self-applied and on one occasion were completed in
groups at school, after lessons. For statistical analysis t-test, one-way ANOVA
and chi square test were used by the SPSS/PC Statistics 17.0 software (SPSS, Inc.
Chicago, IL) with the level of significance set at p  0.05.
Results
The mean age (±S.D) of the surveyed subjects was 14,8 ±2,32 years, 15,7
±2,06 years for the sample living in Romania and 13,61 ±2,1 for the one living is
Hungary, respectively. The mean scores of the surveyed subjects from the view-
point of residence are presented in Table 1. The sample from Hungary showed
slightly higher scores in case of DBS and lower scores in case of DFS and
Background Scale, respectively, but the differences were not statistically signi-
ficant (p  0.05, independent t test).
111
Table 1. Dental fear and anxiety scores of Romanian children from Romania and
Hungary aged 11-18 years
Whole sample Romania Hungary p
(n=713) (n=406) (n=307) ( 0.05)
DFS 37.81 ±14.24 38.38 ±14.58 37.06 ±13.77 0.2207
DBS 37.37 ±11.38 37.03 ±11.1 37.82 ±11.74 0.3614
Backgound scale 2.21 ±2.63 2.28 ±2.55 2.13 ±2.73 0.4602
Regarding the severity of dental fear, there was no statistically significant

difference between the two countries (p  0.05, chi square test). 189 subjects
(46.66%) from the sample from Romania presented low dental fear (DFS score
 33), 173 subjects (42.61%) had moderate dental fear (DFS=34-58), while 44
subjects (10.84%) were prone to dental phobia (DFS 59). In case of the sample
from Hungary, 156 subjects (50.81%) presented low, 130 subjects (42.35%),
moderate and only 21 subjects (6.84%) severe dental fear levels.
Moreover, analyzing from the perspective of gender, females from the two
samples did not show any mathematically significant difference in none of the
questionnaires. Males from the Hungary presented statistically significantly higher
scores only in case of DBS (p  0.05, independent t test) (Table 2).
Table 2. Dental fear and anxiety scores of Romanian children from Romania and
Hungary aged 11-18 years from the viewpoint of gender
FEMALES Whole Sample Romanian Hungarian p

(n=393) (n=236) (n=157) ( 0.05)
Age 15.03 ±2.32 15.88 ±2.07 13.76 ±2.09
DFS 40.11 ±14.07 40.28 ±13.66 39.85 ±14.71 0.7635
DBS 36.41 ±11.16 36.9 ±11.02 35.66 ±11.36 0.2813
Background 2.28 ±2.55 2.4 ±3.22 2.09 ±0.8 0.2366
scale
MALES Whole Sample Romanian Hungarian p
(n=320) (n=170) (n=150) ( 0.05)
Age 14.51 ±2.3 15.44 ±2.04 13.45 ±2.12
DFS 34.99 ±13.97 35.74 ±15.43 34.15 ±12.09 0.3088
DBS 38.56 ±11.56 37.22 ±11.25 40.08 ±11.75 0.0268
Background 2.13 ±2.73 1.96 ±0.8 2.33 ±3.9 0.2224
scale
Table 3 presents the scores given to each question of the DFS from the view-
point of domicile. The Cronbach alpha value for DFS was 0.935, which is a case
in point to the subjects‘ good collaboration. It was observed, that the questions
referring to the injection were scored the highest and those about the drill were
somewhat lower but still high. Besides these, the judgment of dentistry as a whole
(20th question) was still high, but it did not reach the level of the most fearful part
112
of the treatment, which was related to receiving an injection. We observed

statistically significant differences from the viewpoint of residence between
questions no. 2, 3, 4, 6, 9-13 and 20, respectively (independent t-test, p<0.05).
Table 3. DFS question scores

Whole
Romania Hungary p
DFS sample
(n=406) (n=307) (0.05)
(n=713)
Avoiding dental care
1. unable to get an appointment 1.61 ±1.02 1.67 ±1.12 1.54 ±0.86 0.0912
2. unable to go to the appointment 1.25 ±0.73 1.33 ±0.82 1.15 ±0.59 0.0015
Autonomic nervous system activity
during treatment
3. muscle tension 2.1 ±1.04 2.41 ±1.11 1.69 ±0.77 <0.0001
4. quick respiration 1.78 ±1.05 1.96 ±1.13 1.55 ±0.88 <0.0001
5. sweating 1.67 ±0.95 1.64 ±0.95 1.72 ±0.96 0.2755
6. nausea 1.32 ±0.74 1.29 ±0.74 1.36 ±0.75 0.2288
7.quick pulse 2.06 ±1.14 2.27 ±1.22 1.78 ±0.96 <0.0001
Fears caused by situations and
stimulus
8. asking for an appointment 1.63 ±0.97 1.61 ±0.93 1.66 ±1.03 0.4452
9. approaching the dental office 1.77 ±1.05 1.77 ±1.04 1.76 ±1.06 0.8235
10. sitting in the waiting room 1.78 ±1 1.71 ±0.98 1.87 ±1.03 0.0371
11. sitting in the dental unit 2.01 ±1.1 1.92 ±1.07 2.11 ±1.14 0.0224
12. smells of the dental office 1.68 ±1.03 1.62 ±1.04 1.77 ±1 0.0522
13. seeing the dentist 1.71 ±0.96 1.61 ±0.92 1.85 ±1 0.0008
14. seeing the injection 2.65 ±1.3 2.71 ±1.32 2.58 ±1.26 0.1946
15. feeling the injection 2.59 ±1.26 2.64 ±1.27 2.52 ±1.25 0.1788
16. seeing the drill 2.3 ±1.26 2.22 ±1.23 2.41 ±1.28 0.0466
17. hearing the drill 2.07 ±1.17 2.05 ±1.14 2.1 ±1.2 0.5643
18. feeling the vibration caused by the
2.18 ±1.23 2.26 ±1.24 2.09 ±1.21 0.0644
drill
19. scaling 1.51 ±0.95 1.47 ±0.81 1.55 ±1.11 0.3034
20. general fear towardsdentistry 2.15 ±1.12 2.24 ±1.1 2.03 ±1.15 0.0161
Cronbach alpha was 0.848 for DBS. In Table 4, scores given to each question
of the DBS dissociated by domicile can be seen. From the viewpoint of domicile,
questions number 2, 7 and 14 showed mathematically significant differences
(independent t-test, p<0.05). On the one hand subjects from Romania objected
mostly towards the lack of time dentists deal with when treating patients. On the
other hand, subject from Hungary reported fear of posing questions and sentiment
of guilt caused by dentists.
113
Table 4. DBS question scores
DBS Whole sample Romania Hungary p

(n=713) (n=406) (n=307) ( 0.05)
1. I believe dentists do not like it
2.68 ±1.14 2.62 ±1.15 2.75 ±1.13 0.1432
when patients ask questions.
2. Dentists help but they always seem
3.09 ±1.27 3.26 ±1.24 2.87 ±1.28 <0.0001
busy, which makes me feel guilty.
3. Dentists do not give sufficient
explanation about what they are 2.47 ±1.31 2.46 ±1.25 2.49 ±1.4 0.759
doing when working on my teeth.
4. I feel that dentists do not listen to
2.02 ±1.17 1.99 ±1.12 2.06 ±1.23 0.4274
what I am saying.
5. I am concerned that the dentist will
do what he wants and not really listen 2.13 ±1.31 2.16 ±1.32 2.09 ±1.3 0.5195
to me.
6. I am concerned that the dentist will
do what he wants and not really listen 2.62 ±1.39 2.54 ±1.4 2.73 ±1.37 0.0654
to me.
7. Dental professionals say things to
make me feel guilty about the way I 2.22 ±1.22 2.03 ±1.13 2.47 ±1.29 <0.0001
care for my teeth.
8. Dentists often say things that make
2.3 ±1.34 2.31 ±1.34 2.27 ±1.33 0.6981
me feel ridiculous.
9. I feel I cannot trust dentists’ words
2.49 ±1.39 2.49 ±1.41 2.49 ±1.36 0.9883
about my anxiety.
10. I feel concerned that dentists will
not take my worries (fears) about 1.95 ±1.25 2.01 ±1.27 1.87 ±1.22 0.1372
dentistry seriously.
11. I am concerned that dentists
might not be skilled enough to deal 2.85 ±1.43 2.87 ±1.46 2.84 ±1.39 0.7995
with my fears or dental problems.
12. If I were to indicate that it hurts, I
think that the dentist would be
2.45 ±1.42 2.39 ±1.41 2.54 ±1.44 0.1685
reluctant to strop and try to correct
the problem.
13. When I am in the chair I do not
feel like I can stop the appointment 3.06 ±1.53 3.1 ±1.51 3.01 ±1.55 0.4013
for a rest if I feel the need.
14. I feel uncomfortable asking
2.86 ±1.54 2.65 ±1.53 3.14 ±1.53 <0.0001
questions.
15. Being overwhelmed by the
amount of work needed (all the bad
news) could be enough to keep me 2.2 ±1.36 2.18 ±1.39 2.22 ±1.33 0.751
from beginning or completing
treatment.
The scores of the Background Scale were very similar in the two samples (see
Table 1). A score of 2.28 was attained for the sample from Romania and 2.13 for
the one from Hungary. They indicate a low level of dental fear originating from
the subjects‘ childhood environment.
114
Figures 1, 2 and 3 present the mean scores of the three questionnaires in

different age groups in the two countries. From the viewpoint of age, in the
sample from Romania, the 11-year-old group presented the lowest scores for
every questionnaire. The DFS and Background Scale were topped by the 14-year-
old group, while the 16-year-olds showed the highest scores for DBS. In the same
time, in the subjects from Hungary, the 11-year-olds were once again the least
fearful. The climax of dental fear emerged in the 12-year-old group, from where
the scores gradually decreased. In addition to this, DBS scores showed that the
12-year-olds had the most problems with dentists, while the 14-year-olds appre-
ciated their environment to be the most afraid of dental treatments. Age is a
significant factor from a mathematical point of view in case DFS and DBS in both
of the samples (one-way ANOVA, p<0.05).
45
40
35
30
25
20
15
10
5
0
11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years
Romania Hungary
Figure 1. DFS scores for different age groups
50
40
30
20
10
0
Romania Hungary
Figure 2. DBS scores for different age groups
115
3
2,5
2
1,5
1
0,5
0
Romania Hungary
Figure 3. Background Scale scores for different age groups
Discussions
The prevalence of DFA in children varies globally. Worldwide studies have

shown that between 3% and 43% of children exhibit dental anxiety (Folayan et
al., 2004). In northern Europe it has been reported between 3% and 21%. The
maximum frequency was reported to be around 11 years of age, with a decline
towards adolescence (R\ducanu et al., 2009; Chapman & Kirby, 1999), as children
may develop methods to control their anxiety as they grow older (Udoye et al.,
2005; Klinberg & Broberg, 1998). In terms of gender, females present in most of
the cases, higher levels of anxiety (Chellappah et al., 2006).
The mean score of DFS indicates the presence of a slightly moderate dental
fear in this sample. Only 10.84% of the children from Romania and 6.84% of the
children from Hungary suffered from phobia, while the rest of the subjects
presented low or moderate levels of fear in 50–50 percent. Moreover, this DFS
score (37.81) is lower than the ones found in other evaluations of children from
Romania and Hungary. Markovics et al. measured 50.6 DFS score on a sample
with the same age (15.2±2.0 years) (Markovics et al., 2005), while M\rginean and
Filimon found 40.57 for DFS in a young adult population (M\rginean & Filimon,
2011). In the same time, Hungarian children‘s scores were very similar to ours
(aged 8–15 years DFS:40.4 (Fábián et al., 2003), aged 14–18 years DFS:40.6
(Fejérdy et al., 2003).
Gótai et al. (Gótai et al., 2012) have evaluated the dental fear and anxiety of
Hungarian population living in Hungary and Slovakia using similar methods to
ours. They found lower scores in Hungarians living in Slovakia when compared
116
in Hungary, but the results were statistically significant only in the case of DFS
(DFS: 42,04 for Hungary and 36,17 for Slovakia, DBS: 33 for Hungary and
32,58, Backgound Scale: 3,03 for Hungary and 2,46 for Slovakia). There is no
mathematically significant difference between these results and ours.
Another similar study was performed by Markovics et al. (2005). It was with
regard to Hungarian children residing in Romania, close to the Hungarian border.
This study is very similar to ours by means of methodology and sample. Never-
theless, their findings indicate a much more severe dental fear than the one found
in our samples (DFS: 50,6 and DBS: 44,9). The detailed analysis of the questions
of DFS and DBS highlights aspects of dental treatment, which cause the most
problems to patients. Consistent with the literature, questions referring to injection
and drilling scored the highest in this case as well (Gótai et al., 2012; Cerghizan,
2009). The subjects from Romania presented more autonomic nervous system
activity than their fellows from Hungary, whereas the latter ones claimed higher
levels of fears by situations and stimuli. Similarly to Markovics et al.‘s results,
our subjects from Romania also claimed lack of time (Markovics et al., 2005).
The biggest problem for our subjects from Hungary were, difficulties in commu-
nication, especially with regards to the fear of posing questions to their dentists.
This observation resembles the one made by Gótai et al. (Gótai et al., 2012).
Conclusions
The findings of the present study suggest that dental fear and anxiety in
Romanian children living as a minority in Hungary is similar to the results of their
Romanian fellow counterpart‘s residing in Romania. Besides, the scores measured
indicate the presence of a moderate dental fear which is consistent with inter-
national findings. Moreover, an improvement can be observed, as the scores of
dental fear show a decreasing tendency in comparison with other regional surveys.
Childhood enviroment did not have any influence on the child‘s dental fear in
neither of the countries. The differences found between the two samples were
spread among the details of the procedures. On the one hand, autonomic nervos
system activity was more frequent in the sample from Romania, and, on the other
hand, children from Hungary were more afraid of situations and stimuli. In
addition to this, dental treatment performed in Romania under time pressure was
felt to be the major problem, while in Hungary, behavioural aspects of the patient-
practitioner relationship were objected. Therefore, it is shown in this case, that
residing in a foreign country does not affect dental fear and anxiety in a significant
way.
117
Acknowledgements
The co-operation of the schools and children who participated in this study is
gratefully acknowledged. This paper was supported by the Sectoral Operational
Programme Human Resources Development 2007-2013 (SOP HRD), financed
from the European Social Fund and by the Romanian Government under the
contract number POSDRU/159/1.5/S/133377.
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Working together
www.rcis.ro
The Mediation Role of Resilience on the

Relationship between Workplace Bullying
and Romanian Employees’ Strain
Teodora MAIDANIUC-CHIRILA1
Abstract
The concept of resilience is understood as a person’s capacity to hold up,

recover, and come out stronger after facing a situation affecting integrity. The
present article aims to verify the mediation role of resilience on the relationship
between workplace bullying and strain. A total of 88 Romanian employees parti-
cipated in the present study by completing online questionnaires referring to
workplace bullying, resilience, and strain. The results showed the mediation role
of resilience on the relationship between workplace bullying and physical strain
in that the direct relationship between workplace bullying and physical strain
decreases when resilience is introduced as a mediator. These results showed that
those employees who have higher levels of resilience have lower levels of physical
strain when they are confronted with workplace bullying behaviours. The findings
of the present study can help human resources practitioners improve their anti-
bullying programs by developing not only resilient individuals in their workplaces,
but also by helping the organization to develop as a resilient company.
Keywords: workplace bullying, resilience, physical strain, mental strain,

mediation model
Introduction
Progression of resilience as a concept extends from the 1800s and continues to

the present time. During its conceptual development, resilience has been con-
structed as a trajectory, a continuum, a system, a trait, a process, a cycle, and a
qualitative category (Flach, 1980; Rutter, 1985; Jacelon, 1997; Tusaie & Dyer,
2004; Bonanno, 2004 & 2005). The influence of resilience is evident by its reach
1
Romanian Academy, Iai Branch, ROMANIA. E-mail: chirila.teodora@yahoo.com
120
across diverse disciplines. In the area of business, resilience is measured by an

organization’s ability to withstand the impact of any interruption and recuperate
while resuming its operations to provide basic services. As evident in most fields,
and seen in most typologies, the essence of resilience is described as the ability to
bounce back from some form of disruption, stress, or change (Santos, 2013) and
applied to the workplace bullying phenomenon, resilience can be understood as
being the organization’s ability to bounce back from the stress produced by
negative bullying acts and to protect the targeted employees by employing useful
internal policies. At an individual level, the concept of resilience refers to the
capacity composed of the set of personal characteristics and the contexts of
development of an individual and the set of internal and external mechanisms
when facing adversity (Masten & Obradovic, 2006; Ungar, 2011). Some authors
refer to resilience as the ability to respond positively, despite living in challenging
or threatening circumstances. This means holding out, facing, and reacting better
than expected in a situation of risk, a traumatic event, or adversity affecting the
psycho-social integrity of an individual (Brooks, 2006; Masten, Best, & Garmezy,
1990; Masten, 2001; Rutter, 1993 & 1995). Applied to workplace bullying phe-
nomenon, resilience can be seen as the victim’s ability to hold up, to face, and
react better than expected to workplace bullying negative behaviors.
Resilience is a reference framework to describe the positive aspects and mecha-
nisms in an individual, group, material, or system which, when facing a desta-
bilizing and disruptive situation affecting their integrity and stability, enables
them to hold up, cope, recover, and come out strengthened by it (Vaquero, Urrea,
& Mundet, 2014). From an ecological point of view (Ungar, 2011), the concept of
resilience can be used to refer to individual and context characteristics. Also,
resilience refers to all the mechanisms used by the internal and external assets
when facing adversity. Resilience is a concept related to numerous individual
characteristics (abilities, skills, and personal qualities) and multi-systemic (cha-
racteristics and qualities of the family, social and cultural environment, where an
individual develops, as well as the relationships formed within this context and
the individual) (Navarro, 2011). In the present study, resilience is approached on
an individual level, being described as the employee’s ability to recognize, under-
stand, and better react to workplace bullying acts in order to maintain his mo-
tivation and enthusiasm for his work without any major health costs.
The workplace bullying phenomenon
Workplace bullying phenomena has become a real issue in Europe and it is

considered to be more prevalent than sexual harassment or racial discrimination
(Rayner, 1997). According to an anti-bullying campaign, one in five employees is
being verbal aggressed in a repeated and deliberate manner (Namie, 2000). Over
the years various definitions have been given to workplace bullying in order to
121
differentiate it from other types of conflict. According to these definitions work-

place bullying is defined as being that situation in which a person perceives
herself being intentionally exposed during a longer period of time to repetitive
negative acts (Chirila & Constantin, 2013). The aggressed person finds herself in
an inferior position from which she can’t defend herself anymore (Leymann,
1992; Salin, 2003; Vartia, 2003).
From the perspective of stress theories, bullying is understood as being a
social stress factor (Zapf, Knorz, & Kulla, 1996), which can cause problems not
only for employees but also to the entire organization. These employees ex-
perience mental and physical decline and a decrease in their job performance, and
the organization will be confronted with legal and financial problems (Rayner &
Cooper, 1997). Across time, the workplace bullying literature promoted a series
of explanatory theories among which can be mentioned the escalated conflict
theory (Glasl, 1982); frustration-aggression theory (Berkowitz, 1989; Fox &
Spector, 1999); social interaction theory (Felson & Tedeschi, 1993); the nervous
breakdown theory (Wilkie, 1996); stress and emotion theory (Fox, Spector, &
Miles, 2001); and the cognitive model explaining workplace aggression (Beugre,
2005). So far, Beugre’s (2005) cognitive theory is the most detailed explanatory
model of workplace aggression. According to this model, the workplace bullying
behaviors appear as a consequence of a cognitive process of potential benefits and
consequences. Between the trigger moment and the displayed behaviors there is a
cognitive process step on the facilitating factors existing in the organization. If
there are some facilitator factors the cognitive process focus on the costs and
benefits of displayed bullying behaviors. If the costs and benefits are rewarding
then the workplace bullying behaviors appear.
The role of resilience in case of workplace bullying experiences
Resilience is an adapting dynamic process to the permanent changes existing

in the environment in order to maintain a balance between stressors and personal
goals achievement (Herman, Steward, Diaz-Granados, Berger, Jackson, & Yuen,
2011; Pipe, Buchda, Launder, Hulvey, Karus, & Pendergast, 2012). The way in
which a person responds to environmental stress is unique and requires personal
resources, and resilience can be one of these personal resources (Jackson, Firtko,
& Edenborough, 2007; Sauer, 2013). Resilience literature evidences five features
of resilience, including: having a meaningful life (i.e., having a purpose), per-
severance, equanimity, self-reliance, and existential loneliness (i.e., coming home
to yourself) (Wagnild, 2009).
According to Wagnild’s (2009) five-feature model, a person is resilient when
she has a personal goal in life, when she is determined to fight adversity in order
to achieve her goal, when she maintains a balanced perspective on life, and when
she uses humor to face life stressors. Moreover, self-reliance refers to the person’s
122
ability to rely on herself in order to achieve her goals. A person with high levels
of self-reliance often knows her strengths and weaknesses and efficiently uses
these strengths in order to make successful decisions (Wagnild, 2011). Existential
loneliness refers to the person’s ability to feel good with her own person without
having the need to conform to a majority (Wagnild, 2011).
So far the relationship between workplace bullying and resilience has been
investigated among nurses, and studies have shown that those nurses who had
high levels of resilience also had high levels of profesional satisfaction (Larrabee,
Persily, Simoni, Johnson, Maricshak, & Gladden, 2010) and higher levels of
mental and physical health (Sauer, 2013). Furthermore, studies evidenced that
those nurses who had higher levels of resilience also had lower levels of anxiety,
depression, and stress symptoms (Mealer, Jones, Newman, McFann, Rothbaum,
& Moss, 2012). Often the reaction to workplace bullying varies from one person
to another, suggesting that there are personal resources which help them overcome
workplace bullying (Sauer, 2013). Among factors such as personality traits and
emotional traits, resilience has been suggested to be a useful resource to overcome
workplace bullying. So far there are few studies (Jackson et al., 2007; Mealer et
al., 2012; Sauer, 2013) interested in the resilience role in a bullying framework
and these studies often are made on a particular sector (i.e., the health sector). The
present study tries to fullfil this gap by investigating the resilience role in a
bullying framework on employees no matter what their activity sector is.
Methodology
The aim of the present study
The aim of the present study is to investigate the mediation role of resilience
on the relationship between workplace bullying and employees’ strain as it was
suggested by Sauer (2013), who tested the mediation role of resilience on the
relationship between workplace bullying and physical health and didn’t obtain a
significant mediation model.
Hypothesis: Psychological resilience mediates the relationship between bully-
ing and strain.
Participants
A total of 88 Romanian employees participated by completing online questio-

nnaires. Their age ranged from 22 and 53 years old (M = 28.57; SD = 4.86), and
there were 68 female employees (77.3%) and 19 male employees (21.6%). Only
three employees had a high-school diploma (3.4%), 34 employees had a bachelor’s
degree (38.6%), 38 had a master’s degree (43.2%), 11 employees had a Ph.D.
123
degree (12.5%), and only one employee had a postdoctoral degree. From 88
employees, 28 (31.8%) work in public institutions, 23 work in private institutions,
27 of employees work in private firms, and seven employees work in non-
governmental organizations. All the employees completed online the questionna-
ires referring to workplace bullying, resilience, and strain. The present study was
presented as being one interested in the dynamics of interpersonal relationships at
work and employees having lower scores on resilience, higher scores on wor-
kplace bullying, and higher levels of mental and physical strain were considered
for the present study.
Measurements
Workplace bullying
The workplace bullying phenomenon was assessed with the aid of the Romanian
version of NAQR (Chiril\ & Constantin, 2014). The original form was obtained
from Einarsen, Hoel, and Notelaers (2009). The NAQR is the most commonly
used tool in research studies that explore bullying in workplace settings. The
NAQR is a standardized instrument with 22 items that measure perceived ex-
posure to bullying at work in the past six months. All items were written in
behavioral terms, and the word bullying was not used until the last question. The
response for the first 22 items was a five point ordinal scale designed to measure
the frequency of exposure: never = 1, now and again = 2, monthly = 3, weekly =
4, and daily = 5 (Einarsen et al., 2009). The last item on the questionnaires was a
self-label identification of exposure to bullying which includes the definition for
bullying with six options “no,” “yes, very rarely,” “yes, now and then,” “yes,
several times per month,” and “yes, almost daily” (Einarsen et al., 2009). The
questionnaire included three sub-sets: work-related bullying, person-related bully-
ing, and physically intimidating bullying. The NAQR provided two summary
scores, frequency of bullying behaviors, and intensity of bullying. Any item
behavior that was reported weekly (4) or daily (5) indicates an exposure to
negative behavior. Intensity of negative behavior was measured by the sum total
score (range 22-110). A higher score indicated a higher intensity of bullying
behaviors. Notelaers and Einarsen (2009) (as cited in Einarsen, Hoel, Zapf &
Cooper, 2011) found that an NAQR score between 33-44 indicates the respondent
is “sometimes” bullied, ad a score greater than or equal to 45 indicates the
respondent is a victim of workplace bullying (Einarsen et al., 2011). The internal
consistency for the entire scale is .94, meaning that all the items are measuring the
same psychological construct which is workplace bullying.
124
Psychological resilience
Psychological resilience was assessed with the aid of the Resilience scale (RS-
14; Wagnild, 2011). This scale was obtained from Wagnild and it was translated
into Romanian using the back-method translation. The Resilience Scale (RS-14)
is a 14 item self-reported inventory designed to measure resilience (Wagnild,
2009). Resilience is a dynamic process of adaptation in response to ever-changing
demands, stressors, and adversity with the goal of maintaining equilibrium (Herr-
man et al., 2011; Pipe et al., 2012). There are five characteristics of resilience: (a)
a purposeful life, (b) perseverance, (c) equanimity, (d) self-reliance, and (e)
existential aloneness (Wagnild, 2009). Responses are scored on a seven-point
Likert scale (strongly disagree to strongly agree). The RS-14 has been used to
measure resilience in a variety of populations including adolescents, young, and
middle-aged adults 53 and senior adults. Wagnild (2009) conducted a review of
research which used the resiliency scale (RS-14 and RS-25) to measure resilience
and found higher resilience scores correlated with psychological well-being,
health promoting activities, purpose in life, and sense of coherence, morale, and
forgiveness. Theoretically, resilience would be positively related to life satis-
faction and morale, and inversely related to depression (Wagnild, 2011). The
resilience score from the RS-14 was obtained by summing all items; possible
scores range from 14-98. Scores of 14-56 indicate very low levels of resilience;
57-64 is low, 65-73 moderately low, 74-81 moderately high, 82-90 high, and 91-
98 very high levels of resilience (Wagnild, 2011). The internal consistency for the
entire scale is .86.
Mental and physical strain
Mental strain was assessed with seven items from the Occupational Stress
Inventory (Evers, Frese, & Cooper, 2000). These items were translated into
Romanian using the back-method translation. The internal consistency for all the
seven items is .63. Physical strain was assessed with five items from the Occu-
pational Stress Inventory (Evers et al., 2002). All the five items were translated
into Romanian using the back-method translation and the internal consistency is
also .63.
Results
Mediation was used to model the relationship between variables because there
is a hypothetical casual sequence between variables (Tabachnick & Fidell, 2007).
In this example, bullying is the independent variable of interest. Physical strain
was the dependent variable. Resilience is a mediator if (a) there is a significant
125
relationship between bullying and physical strain, (b) there is a significant

relationship between bullying and between resilience, (c) resilience still predicted
strain after controlling for bullying, and (4) the relationship between bullying and
physical strain decreased with resilience in the equation (Baron & Kenny, 1986).
Correlations
Table 1. Mean, standard deviation and correlations between workplace bullying,

resilience, and strain
Variables M SD 1 2 3 4
1. workplace 1.72 .64 1
bullying
2. resilience 5.79 .70 -.242* 1
3. mental strain 2.12 .43 .112 -.359** 1
4. physical strain 1.80 .49 .269 -.228** .452** 1
*, p < .05; **, p < .01
The correlation analyses revealed significant correlations between workplace

bullying, resilience, and physical strain. There are also significant correlations
between resilience, mental strain, and physical strain. As presented above, there is
a significant, medium, and negative correlation between workplace bullying and
resilience, meaning that high scores of workplace bullying correlate with low
scores of resilience and low scores of workplace bullying correlate with high
scores of resilience. Furthermore, workplace bullying significantly and positively
correlates with physical strain meaning that high scores of workplace bullying
correlates with high scores of physical strain and low scores of workplace bullying
correlates with low scores of physical strain. Moreover, resilience negatively and
significantly correlates not only with physical strain but also with mental strain.
These correlations indicate that high scores of resilience correlate with low scores
of mental and physical strain and low scores of resilience correlate with high
scores of mental and physical strain.
126
Regressions
Table 2. Multiple regression analysis for workplace bullying and resilience as

predictors of physical strain
Models B SE β t p R2 F(dt) R2
Model 1
Workplace .207*** .080 .269*** 9.880 .000 .073 6.731 .062
bullying
Model 2
Resilience -.160* .074 .228* - .033 .052 4.714 .041
2.171
Model 3
Workplace -.177* .077 -1.302* - .024 .154 5.106 .124
bullying * 2.305
resilience
*, p < .05, **, p < .01, ***, < .001
All the regression models presented in the Table 2 show significant models,
meaning that workplace and resilience taken as separate predictors (i.e., Model 1
and Model 2) are significant predictors of physical strain. The workplace bullying
regression model explains 6.2% of physical strain variance and the resilience
regression model explains 4.1% of physical strain variance.
The third model contains as a predictor the interaction between workplace
bullying and resilience. This model is also statistically significant and explains
12.4% of the physical strain variance. This third model explains best the appe-
arance of physical strain among Romanian employees.
Table 3. Linear regression analysis for workplace bullying as predictor for resilience
Models B SE β t p R2 F(dt) R2

Workplace
-.264* .115 -.242* -2.309 .023 .058 5.330 .047
bullying
*, p < .05;
The third table present the regression results of workplace bullying as a

predictor of resilience. This regression is also statistically significant and explains
4.7% of resilience variance.
127
The mediation model
Figure 1. The mediation model proposed
The mediation model presented above shows the mediation role of resilience
on the relationship between workplace bullying and physical strain. In Figure 1
there are presented not only the un-standardized coefficients but also the stan-
dardized ones. As can be seen in Figure 1, the direct relationship (i.e., the re-
lationship between workplace bullying and physical strain) is statistically signi-
ficant (B = .207%; β = .269%). This direct relationship indicates that high levels
of workplace bullying lead to high levels of physical strain and low levels of
workplace bullying lead to low levels of physical strain.
The indirect relationship (i.e., workplace-bullying -> resilience -> physical
strain) is also significant. The relationship between workplace bullying and resi-
lience is statistically significant (B = -.264*/-.242*), meaning that high levels of
workplace bullying lead to low levels of resilience or low levels of workplace
bullying lead to high levels of resilience. Furthermore, the relationship between
resilience and physical strain is also statistically significant, meaning that low
levels of resilience lead to high levels of physical strain or that high level of
resilience lead to low levels of physical strain. Moreover, the Sobel test showed a
value of 1.573 for a significance level of p = .057. The mediation model is signi-
ficant and the results show that resilience acts like a mediator of the relationship
between workplace bullying and physical strain, meaning that resilience mitigates
the effects of workplace bullying on employee’s physical strain.
The mediation model proposed shows that the indirect relationship is smaller
than the direct relationship, meaning that the resilience mediates the relationship
between workplace bullying and physical strain. This mediation relationship
shows that resilience mitigates the effects of the direct relationship. In other
words, the fact of being resilient leads to employees with lower levels of physical
strain. The results of the present study evidenced the important role of resilience
in experiencing workplace bullying. The fact of being resilient leads to healthier
employees.
128
Discussions
The present study aimed to investigate the mediation role of resilience in the
relationship between workplace bullying and physical strain. This relationship
was previous tested by Sauer (2013), who didn’t obtain a significant mediation
model. This study revealed significant correlations among workplace bullying,
resilience, and physical strain. There wasn’t obtained a significant correlation
between workplace bullying and mental strain, but the correlation between work-
place bullying and physical strain was statistically significant, meaning that the
more employees experience workplace bullying acts the more they will feel
physical strain.
Furthermore, resilience was statistically significant correlated not only with
physical strain, but also with mental strain. The correlation was negative, meaning
that the more the employee has higher levels of resilience the less he will feel
mental and physical strain. According to Baron and Kenny (1986), there is a
mediation role of resilience if (a) there is a significant relationship between
bullying and physical strain, (b) there is a significant relationship between bullying
and between resilience, (c) resilience still predicted physical strain after con-
trolling for bullying, and (d) the relationship between bullying and physical strain
decreased with resilience in the equation. All four conditions were confirmed
only for workplace bullying, resilience, and physical strain. As could be seen in
the section result, the correlations among workplace bullying and physical strain
was significant, the correlation between workplace bullying and resilience was
also significant, resilience still predicted physical strain when controlled for
workplace bullying, and the relationship between workplace bullying and physical
strain decreased with resilience in equation.
The hypothesis that resilience can mitigate the effect of workplace bullying on
strain was assessed only for physical strain. The results of the present study are
convergent with those existing in the literature (Mealer et al., 2012), showing that
resilience can mediate the relationship between bullying and outcomes, meaning
that resilience can act as a personal resource to overcome adversity produced by
the workplace bullying phenomenon. Through the present study, Sauer’s (2013)
suggestion that resilience would act like a mediator between workplace bullying
and resilience was confirmed. The results of the present study showed that re-
silience acts like a personal resource of the targeted employee, a resource which
helps him hold up, resist workplace bullying acts, and bounce back with new
personal strengths.
The results of the present study have practical implications because they can
be the basis for training programs meant to develop personal resilience among
workplace bullying employees. Also, the findings of the present study can help
human resources practitioners improve their anti-bullying programs by developing
129
not only resilient individuals at work, but by helping to the development of a

highly resilient company or organization.
Study limits
The present study has also a series of limits such as: (1) the results rely on self-
report questionnaires triggering subjective responses and personal reinterpretation
of the social climate at work and potential overestimates of personal resilience.
Further research should take into account a more objective methodology in order
to assess these variables; (2) the cross-section study design allows data collection
at one point in time. A limitation of this study design is that findings are descriptive
and prediction and causation cannot be determined; (3) outcomes such as de-
pression, anxiety, self trust and self esteem should be investigated in relationship
with workplace bullying and resilience.
Acknowledgements
This paper is supported by the Sectoral Operational Programme Human

Resources Development (SOP HRD), financed from the European Social Fund
and by the Romanian Government under the construct number POSDRU/159/1.5/
S/133675.
Maidaniuc-Chiril\ Teodora, Postdoctoral Fellow, SOP/HRD/159/1.5/S/133675
Project, Romanian Academy Iasi Branch.
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Working together
www.rcis.ro
Exploration of the Critical Success Factors

in Online Evidence-Based Public Policy
Learning Behaviors
I-Jan YEH1
Abstract
Nowadays, learners of public policy could rapidly search for the desired data
and information anytime and readily obtain the needed knowledge via internet or
web-based learning. Yet the emergent trend of learning public policy online
collides with the evidenced-based approach to policy making embraced by policy-
makers seeking the most effective ways to tackle policy problems. Namely,
whether or not online policy learning meets the requirements of evidenced-based
plaque many researchers of policy learning and policy transfer. The main themes
of this study are to tap into the critical factors affecting web-based policy learning
and examine whether or not such learning behavior meet the tenet of evidenced-
based. Drawn from college students in the department of public policy, public
administration, and public management, both the under and graduate students
with experiences in online search for learning public policy are selected for the
research. In this study, total 600 copies of questionnaires are distributed, and 423
effective copies are retrieved, with the effective rate 71– ate et. The research
findings show that Web Searching Behaviors, weighted 0.438 about 43.8% of
global weight, is mostly emphasized in Hierarchy 2, followed by Information
Commitment (weighted 0.327) and Internet Self-efficacy (weighted 0.235). From
the global weight of the Critical Success Factors in online evidence-based public
policy learning behaviors, the top five indicators, among 12 evaluation indicators,
are Information Resources, Communicative Efficacy, Search Task, User Cha-
racteristics, and Standards for Accuracy.
Keywords: online evidence-based public policy learning, information

commitment, internet self-efficacy,
1
Shih Hsin University, Department of Public Policy and Management, Taiwan ROC. E-mail:
ijyeh@cc.shu.edu.tw
134
Research background and motivation
The true test of public policy hinges largely on whether or not policy making
could be informed by a new kind of interaction between knowledge producers and
users (Torgerson, 1985), and in turn conducive to solve the socially concerned
issues, i.e. the policy being effective. With the impact of rapid development of
network communications and the diversity of information and knowledge con-
tents, the interaction between knowledge producers and users becomes intensive
and spontaneously, therefore learners of public policy could rapidly search for the
desired data and information anytime and obtain the needed knowledge with their
mobile device. Yet the emergent trend of learning public policy online collides
with the evidenced-based approach to policy making embraced by policymakers
seeking the most effective ways to tackle policy problems. Namely, whether or
not online policy learning meets the requirements of evidenced-based plaque
many researchers of policy learning and policy transfer. This study maintains that
policy information or knowledge acquired through online learning being evidence-
based is closely related to the learners’ web searching behaviors, information
commitment, and internet self-efficacy. As such, the major theme of this study is
to tap into the critical factors affecting web-based policy learning and examine
whether or not such learning behavior meet the tenet of evidenced-based.
Researches on web-based learning have been, until lately, mainly focus on
education, particularly the online learning of teachers or students. For instance,
Wang (2010) indicated that the judgment of a teacher on online information could
affect the frequency of using web-based integrated instruction. A teacher applying
web searching to acquiring instructional data and the use of information techno-
logy are associated with the designed instructional activities or assignments for
the students. A teacher with higher frequency of using information technology,
multimedia, or network for the designed instructional activities or assignments
presents the higher probability to facilitate the students learning with network
resources (Hsu, 2011). Lately, as the utilization of online financial information
and learning finance online are gradually becoming the daily life of most investors
and students, Chow, Chien, and Yeh (2015) examine the critical factors affecting
the financial information seeking behavior of students, and suggest that finance
students applied an assortment of standards to seek information via the Internet,
among them are learning motivation, financial information commitments, and
internet self-efficacy. Yet, there is no research exploring what are the critical
factors affecting learning public policy online, and under what circumstance can
such learning be called evidence-based.
New knowledge is constantly developing in the changing era with advancing
technologies so that learning new knowledge and technologies become the essen-
tial lessons for every employee. Even the civil servants in governmental sectors
can inevitably face such a trend. According to Taiwan e-Learning and Digital
135
Program in e-Taiwan Construction Plan of Executive Yuan, Lee et al. (2013)

pointed out the ubiquitous learning environments in digital learning and em-
phasized that learner motivation, acceptance, and learning efficacy should be
taken into account when constructing digital learning environments. E-learning
for Civil Servants has also proceeded in Directorate-General of Personnel Admi-
nistration since 2008. According to Executive Yuan and the national programs,
the government expected to improve the shortcomings of time and space in
traditional learning through the Internet and to create an online learning envi-
ronment which was not restricted to time and space and presented instantaneity,
interaction, and personalization so that the civil servants could acquire personal
desired knowledge through online learning to enhance the competitiveness.
In comparison with the development of domestic information and commu-
nication technologies and the achievement of e-government, Chang (2012) men-
tioned that the digital learning market was not as the anticipation because of
insufficient teaching contents and short of interaction making the learners not
perceive the learning presence, and possibly because the learners, based on the
online course regulations, generating passive learning by interacting for the
interaction. Furthermore, the past research on digital learning was discussed with
the evolution of science and technology. From the aspects of innovation and
application of technologies, the learning advantages and drawbacks resulted from
digital technologies were likely to be focused on. A lot of research therefore
discussed how public sectors introduced and applied digital technologies to the
learning and how the government introduce and promote online learning schemes
in public sectors (You, 2002; Wang, 2007; Shang, Liu & Lin, 2008), but little
applied experiments from the aspect of public managers to clarify the correlations
between the dimensions and key factors in the web searching learning of civil
servants. For this reason, the online evidence-based public policy learning is
constructed in this study in order to assess the accuracy and usefulness of Web-
based policy materials and assist learners in acquiring high-quality policy in-
formation.
Literature review
Evidence-based public policy learning
A lot of countries have been enthusiastic about evidence-based path in past

years; Adeleh et al. (2014) disagreed that it revealed the past policy making not
presenting empirical evidence. Baglione (2013) proposed that the policy making
process presented the preference of policy makers or the practice of political
views of chief executives and academic institutes or professional researchers
would be entrusted to proceed systematic research in order to find out the
136
empirical evidence to support the specific policies. The problem was that such
research, with specific purposes, was likely to rationalize the existing policies and
reduce the assistance of social science research in the policy making. Blattner &
Lomicka (2012) indicated that research responding to the existing policies might
conform to the evidence-based requirements for scientific strictness, academic
carefulness, and rational appeal, but such evidence was not evidence-based for
the supporters of evidence-based path.
According to Danli (2011), evidence-based supporters considered that the limit
of contemporary scientific research and the development of web database actually
could find out the relationship among policy-related variables and the situational
background of policies by exploring, making a painstaking investigation, and
meta-analyzing the existing researches to make the policy suggestions for policy
makers determining the weight of the evidence-based evidence in the policy-
making process. This study follows the perspective of Danli by examining the
existing researches aimed at exploring web/internet searching behavior to find
out the extent to which the knowledge acquiring behaviors of public policy
learners conform to the epistemological tenets developed for web users, and the
extent to which learners of public policy are capable of using internet to obtain the
expected results.
Ertmer et al. (2011) indicated that the supporters of evidence-based path also
realized the political consideration in the policy-making process and maintained
that the policy rationality should not be overwhelmed by political rationality in
the process. Viewing policy rationality and political rationality as the ends of a
spectrum, Fahim & Sa’eepour (2011) posited that the evidence-based approach
should be utilized both at the policy formulation/planning stage and the policy/
project evaluation stage in order to prevent the mess of political consideration
from being focal point in the entire policy-making process. In addition, the
prerequisite of policy-making process being conformed to evidence-based is
whether or not the learning behavior/strategy exhibited by learners of public
policy follows the dictate of evidence-based approach. Namely, learners of public
policy are required to possess certain level of policy literacy in order for policy to
meet the tenet
Internet/Web Searching Behaviors
Assadi et al. (2013) pointed out data searching as a complex cognition process
that everyone would apply distinct searching methods and sequence, even when
the same topic was selected (Rouet, 2003). From the literature, a learner’s sear-
ching process could contain trial and error, problem solving, purposeful thinking,
and selecting main idea (Liu, 2003); besides, a learner, aiming at the availability
of evaluation information, the conformity of searching data to the objective, the
reliability of data sources, and the accuracy of evaluation data, would evaluate
137
whether the searched data were necessary and be triggered new concepts from the
searching data for new searching strategies (Tsai & Tsai, 2003). Bray & Iswanti
(2013) mentioned that a learner was likely to proceed purposive data searching
behaviors in web environment and search for usable data through multiple data
sources to solve the encountered problems (McKinley, 2013).
When a learner preceded web data searching, the searching behaviors in
network situations could be measured from three dimensions (Debowski, 2002):
(1) Task-focused effort, including searching time and number of input times; (2)
Wasted effort, containing repeated and redundant search and error inputs; (3)
Search quality, to compare the searching quality with the searching width, depth,
and order.
The past research has discussed learners’ learning behaviors in network en-
vironments from various dimensions, covering the factors of network information
searching strategies, information judgment, concept, and strategies (Ellis, Good-
year, Prosser & O’Hara, 2006; Navarro-Prieto, Scaife & Rogers, 1999; Tsai &
Tsai, 2003; Hsieh, 2008). In terms of web searching strategies, the cognition
strategy of network users, particularly the information processing skills, was the
Critical Success Factor in web searching (Hess, 1999). Sockett & Toffoli (2012)
stated that the webpage browsing experiences would affect the user’s searching
behaviors; Song & Salvendy (2003) stressed on the importance of individual
webpage browsing experiences; and, Graff (2005) indicated that the differences
in network browsing strategies existing between seniors and juniors as well as
between webpage users with linguistic statement and image recognition.
Savolainen (2008) divided the factors in an individual selecting information
into (1)Availability and Accessibility of Information, referring to the data being
able to easily used and rapidly accessed, (2)Content of Information, referring to
the information provided in Information Resources being experience-based infor-
mation, facts, broad information, specific information, or comments, (3)Usability
of Information Resources, referring to the information being easily organized and
comprehended, and (4)User Characteristics, such as user habits.
Information Commitments
Bean (2011) explained that network technology provided abundant information

resources and a lot of network learning courses could use web searching and
network information for enriching the instruction and learning (Tsai, 2004).
Network learning facilitated the users becoming active learners in the learning
process (Tsai, 2001). Grosseck et al. (2011) mentioned in the research that a lot of
information was covered in network environments and some of such information
was consistent with the user’s concept cognition, while the others might conflict
with the user’s concept cognition; the users would evaluate such network infor-
mation with a series of judging model (Tsai, 2004), called Information
138
Commitments. It is therefore worth studying the accuracy and usability of the

data searched and evaluated by the users on the Internet.
Chesniak (2013) mentioned epistemological view commitments as individual
opinions about effective knowledge and information which would guide to the
construction of personal knowledge (Tsai, 2004). Referring to the idea of episte-
mological view commitments, Tsai (2004) proposed Information Commitments
as the criteria to evaluate network users judging the accuracy and usability of
network information, where three dimensions were covered.
Standards for Accuracy. Wang (2012) indicated that network users used Stan-
dards for Accuracy for evaluating the accuracy of network information, Standards
for Accuracy contained two dimensions of Multiple Sources and Authority, and
some network users utilized multiple information, such as other web sites or other
information resources, for testing the information accuracy; besides, Authority
was the standard to test information accuracy, as network users generally con-
sidered the information provided by larger scale or more professional web sites
being accurate.
Standards for Usefulness. Network users applied Standards for Usefulness to
evaluating the practicality of network information. Standards for Usefulness
contained two dimensions of Content and Function. The former referred to net-
work users judging the usability of a web site by the provided contents, while the
latter indicated that the functions provided by a web site were the major consi-
deration, such as the arrangement of information, presentation of contents, degree
of aesthetics, and browsing speed.
Searching Strategy. Searching Strategy was the strategy used by network users
for searching information on the Internet. It also contained two dimensions of
Elaboration & Explore and Match. The former referred to the purposeful thinking
of network users who could organize and integrate the data from various web sites
to find out the optimal information conforming to the purpose. The latter, on the
other hand, referred to network users merely searching few web sites for the
information and intending to find out a web site which could best conform to the
searching target (Wu et al., 2013).
Internet Self-efficacy
For individuals, Bicen & Cavus (2011) regarded self-efficacy as a belief of an

individual presenting certain capability and understanding how to effectively
complete certain affairs. When the space of learning environments transforming
to the Internet because of the advance of computer network technology, an indi-
vidual would appear Internet Self-efficacy (ISE) because of the demands for
special learning environments and the external human factors (Tsai & Tsai, 2003).
Davidson & Delbridge (2011) defined Internet Self-efficacy as an individual self-
139
evaluating the confidence in the ability of using network in personal operating

and using network environments. Wu and Tsai (2007) also pointed out Internet
Self-efficacy as the expected confidence of network users when using the Internet.
Summarizing other researchers’ definitions of Internet Self-efficacy as Efficacy
Expectation and Result Expectation extending from Bandura self-efficacy, Has-
hemi & Zabihi (2012) regarded Internet Self-efficacy as the expected confidence
of achieving the network use tasks when corresponding the subject to personal
network use (Commander et al., 2012).
Tsai (2007) considered self-efficacy as the belief and expectation of an indi-
vidual learner to the work performance that it could affect the action choice of a
person, who would expect the period in handling emergent conditions according
to the efforts. Hiew (2012) explained Tsai’s definition of Internet Self-efficacy as
network users being aware of the confidence and expectation of network use. In
this case, a learner with higher efficacy expectation would appear larger chance of
success on computer or network related work. Based on Tsai’s opinions, Deardorff
(2011) pointed out the difference between Internet Self-efficacy and Computer
Self-efficacy. Tsai considered that Computer Self-efficacy was studied for years,
while Internet Self-efficacy was an emerging concept; however, learners with
higher Computer Self-efficacy could reveal more positive attitudes towards net-
work and further correlated with Internet Self-efficacy. After understanding the
meaning of Internet Self-efficacy, Delden (2012) simply defined Internet Self-
efficacy as the self-judgment of a learner using the Internet and the confidence
and expectation from the Internet. Krabs (2013) mentioned about the critical role
of Internet Self-efficacy in the motivation of network users associating with
network technology. Tsai (2004) indicated that network users with higher Internet
Self-efficacy would reveal higher motivation on dealing with tasks through net-
work. In the research on Internet Self-efficacy, Tsai and Tsai (2003) discovered
that network users with higher Internet Self-efficacy could apply more efficient
methods to solve network use problems and present higher use motivation and
learning achievement on network learning. Accordingly, a network user’s Internet
Self-efficacy not only could affect the network use motivation, but was also a
critical factor in network learning (Kramsch, 2013). In the research in 2007, Tsai
classified Internet Self-efficacy Survey (ISS) into: (1) General Self-efficacy Scale,
to measure learner confidence in using network in general situations (e.g. I am
good at searching data through the Internet); (2) Communicative Self-efficacy
Scale, to measure learner confidence and expectation of the basic communication
on the network or the network-based interactive relationship (e.g. I think I could
communicate with others in the online classroom).
140
Research design and method
Delphi Method
Delphi Method, as an emerging research method by combining the advantages

of meeting and questionnaire survey, gradually achieves the consensus through
anonymous written questionnaires to be the important reference of research re-
sults. Delphi Method is utilized in this study for confirming the questionnaire
contents of the online public policy learning behavior model. After three runs of
questionnaire survey, the consensus and points of view of the experts are cohered
to enhance the effectiveness and adaptability of the questionnaire content so that
the questionnaire survey becomes more feasible. Based on Delphi Method, the
factors in the web searching behavior model for policy learners are constructed,
and “questionnaire survey on the factors in online evidence-based public policy
learning behaviors” is compiled as the research instrument. Questionnaire survey
is applied to discussing the correlations among factors in web searching learning
behaviors and further exploring the relations between the factors and the evidence-
based performance.
Analytic Hierarchy Process (AHP)
Since the proposal of Saaty, AHP has been developed for more than 3 decades
and is broadly applied. The applicability of AHP, the applied fields, and the
applied processes for complex problems are discussed in this section. AHP is
mainly applied to decision-making problems. Saaty (1980) and Vargas (1991)
indicated that it could be applied to the following types of problems when analy-
zing problems, including (1) Setting Priorities, (2) Generating a Set of Alter-
natives, (3) Choosing a Best Alternatives, (4) Determining Requirements, (5)
Allocating Resources, (6) Predicting Outcomes, (7) Measuring Performance, (8)
Designing Systems, (9) Insuring the Stability of a System, (10) Optimization,
(11) Planning, (12) Resolving Conflict, and (13) Risk Assessment.
With classification, the Critical Success Factors in online evidence-based
public policy learning behaviors are set, and such key factors are regarded as the
AHP dimensions. Figure 1 shows the revised research framework for this study.
141
Search Task
Search Process
Search Result
Critical success factors in evidence-based public policy learning behaviors
Web Searching Usability of Information

Behaviors
Content of Information
Information Resources
User Characteristics
Standards for Accuracy
Information Standards for Usefulness

Commitments
Searching Strategy
General
Internet Self-
efficacy Communicative
Figure 1. Research framework
142
Research subject
Aiming at colleges with the department of public policy, the junior, senior, and
graduate students (including general and on-job students) are selected the ones
with experiences in web searching learning public policy for this study. The
relevant departments in northern, central, southern, and eastern areas are pur-
posively sampled, and the students are randomly selected according to the scale
of the departments. Total 600 copies of questionnaires are distributed, and 423
effective copies are retrieved, with the effective rate 71%.
Data analysis and result
Having completed all hierarchical weights, the relative importance of the

evaluation indicators in different hierarchies were allocated to show the im-
portance of the indicators in the entire evaluation system and to generate the
global weight of the Critical Success Factors in the online evidence-based public
policy learning behaviors, Table 1.
Table 1: Global weight of online evidence-based public policy learning behaviors
Hierarchy Hierarchy Global

Dimension Indicator Global ranking
2 weight 2 ranking weight
Search Task 0.118 3
Search Process 0.032 11
Search Result 0.030 12
Information
0.053 8
Availability
Web Searching
0.438 1 Content of
Behaviors 0.084 6
Information
Information
0.131 1
Resources
User
0.106 4
Characteristics
Standards for
0.093 5
Accuracy
Information
0.327 2 Standards for
Commitment 0.072 7
Usefulness
Searching Strategy 0.047 9
General 0.043 10
Internet Self-
0.235 3
efficacy Communicative 0.124 2
143
Conclusion
According to the empirical analyses, the following conclusions are expected to

provide definite guidance and directions for online evidence-based public policy
learning behaviors. From the questionnaire analyses, the global weight of the
evaluated online evidence-based public policy learning behaviors is organized in
Table 1, and the conclusions are summarized as follows. In Hierarchy 2, Web
Searching Behaviors, weighted 0.438 with 43.8% global weight, is mostly em-
phasized, followed by Information Commitment (weighted 0.327) and Internet
Self-efficacy (weighted 0.235). Accordingly, Web Searching Behaviors is the
most emphasis in online evidence-based public policy learning behaviors.
In Hierarchy 3, the hierarchical weights of the evaluation indicators are ranked
as below: (1) The evaluation indicators in Web Searching Behaviors are ranked
Information Resources, Search Task, User Characteristics, Content of Information,
Information Availability, Search Process, and Search Result; (2) The evaluation
indicators in Information Commitment are ranked Standards for Accuracy, Stan-
dards for Usefulness, and Searching Strategy; (3) The evaluation indicators in
Internet Self-efficacy are ranked Communicative Efficacy and General Efficacy.
By organizing the global weight of the Critical Success Factors in online
evidence-based public policy learning behaviors, the top five emphasized indi-
cators, among 12 evaluation indicators, are ranked Information Resources, Com-
municative Efficacy, Search Task, User Characteristics, and Standards for Accu-
racy.
Suggestion
In light of the above research results, the following suggestions are proposed
in this study.
Learning system supporting user characteristics. It is suggested to construct a
real learning support system, which thoroughly utilizes the advantages of network
for developing effective public policy learning, as it is the research issue to which
public sectors should pay attention. Consequently, it is suggested that with the
premise of User Characteristics existing in social background, wisdom back-
ground, attitude value, emotion, and psychology, civil servants should make
efforts to balance the personality characteristics and the learning environments so
as to overall enhance the attainments. Learning support systems should be establi-
shed for evaluating civil servants in the beginning of web searching learning and
distinct counseling and training should be practiced, aiming at civil servants with
different User Characteristics, in order to ensure the learning information re-
sources for civil servants in the initial learning, remove various obstacles in the
network learning, and promote the learner confidence.
144
Strengthening the Communicative Efficacy among organizational public policy

learning teams. To enhance the exchange among civil servants, public sectors
need to offer online communication and interaction trainings, e.g. civil servants
studying the public policy learning points and difficulties together for the con-
clusion and testing. Civil servants exchange the learning methods & thoughts and
the online learning experiences with self-learning notes and the texts of statement.
Moreover, the roles of civil servants could be exchanged at different learning
periods that everyone has to actively speak, discuss, communicate, and interact to
enhance civil servants grasping the public policy learning knowledge.
Cultivating an individual actively responding to online public policy learning
skills and abilities. Civil servants could form active responding strategies in the
social cognition process of living, working, and learning and develop extremely
active functions in the online public policy learning process. In this case, civil
servants would actively make efforts to enhance the self-efficacy, develop the
subjective initiative, and be confident with the network learning in the learning
process to promote the online public policy learning standard.
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Working together
www.rcis.ro
Willingness to Seek Psychological Help

among Turkish Adults
Nursel TOPKAYA1
Abstract
The aim of the current study was to examine the relationships between loss of
face, public stigma, social network stigma, attitudes towards seeking psycho-
logical help, and willingness to seek psychological help among Turkish adults.
The results of structural equation modeling of data from 202 Turkish adults
demonstrated that loss of face was significantly and directly related to willingness
to seek psychological help. The results also revealed that the relationship between
public stigma and willingness to seek psychological help was mediated by attitu-
des toward seeking psychological help. Furthermore, 10% of the variance in
attitudes toward seeking psychological help and 48% of the variance in willin-
gness to seek psychological help were explained by the final model. The results
are discussed in the current socio-cultural context and previous research findings.
Keywords: loss of face, public stigma, social network stigma, attitudes, help
seeking, Turkey.
Introduction
As in many other countries, researchers noted high prevalence of mental health

problems among Turkish people and unwillingness to seek psychological help for
those problems (Erol, Kiliç, Ulusoy, Keçeci, & {im[ek, 1998; Topkaya & Meydan,
2013). This makes it important for researchers and practitioners to understand the
factors that may impact one’s willingness to seek psychological help in Turkey.
Loss of face, public stigma, and social network stigma have all been showed to
correlate with both attitudes and willingness to seek psychological help (Gong,
Gage, & Tacata, 2003; David, 2010; Leong, Kim, & Gupta, 2011; Ludwikowski,
Vogel & Armstrong, 2009; Yakunina & Weigold, 2011). Gong et al., (2003) state
1
Ondokuz Mayis University, TURKEY. E-mail: nursel.topkaya@omu.edu.tr
149
that concerns for loss of face are not solely an “Asian American” or “Asian”
concern, but also affect individuals from all societies and ethnic groups (p. 471).
Yet, the relationships between loss of face, attitudes and willingness to seek
psychological help have remained largely as unexplored in Turkey. Moreover,
there are gaps in the literature related to loss of face, public stigma, and social
network stigma and how these factors impede on Turkish adults. Therefore, the
purpose of this study was to examine the implications of loss of face, public
stigma, social network stigma, and attitudes on willingness to seek psychological
help.
Help-Seeking In Turkey
Culture not only influences the perceptions but also the explanations and
behavioral choices regarding the health and illness concerns (Arnault, 2009).
Turkish culture is generally considered to value collectivist norms of the im-
portance of family and close relationships (Imamoglu, 1987). In collectivist
cultures, the self is defined by important relationships, group memberships, and
social roles, while in individualistic cultures the self is defined by consistent
expression of unique personal characteristics independent from social relation-
ships (Cross, Gore, & Morris, 2003; Markus & Kitayama, 1991; Triandis, 1989).
In Turkish culture, the family is considered central and family members are often
close (Aytaç, 1998; Imamoglu, 1987; 2003). Family is also one of the main
sources of support in addressing problems (Imamoglu, 2003). Turkish people
usually obtain psychological help from their families or other informal social
support networks rather than from formal professional sources (Mocan-Aydýn,
2000). Traditionally, it is more suitable not to self-close private experiences to the
people outside the family. Moreover, the fear of public stigmatization in relation
to willingness to seek psychological help is common pattern among Turkish
people (Kocaba o lu & Aliustao lu, 2003; Topkaya, 2011a). Therefore, Turkish
people may experience increased public-stigma, social network stigma, and loss
of face due to the desire to protect not only their own reputation but also that of
their family.
Study Variables in relation to Willingness to Seek Psychological Help
Reviews of research have shown that some cultural factors are not examined
as the other factors in the help-seeking literature. Loss of face is such factor. Face
is one’s situations defined by specific roles that one carries out as a member and
representative of a group concerning his/her social character and social integrity
(Zane & Yeh, 2002). Loss of face can be defined as deterioration in one’s social
image (Kam & Bond, 2008). In recent years, a number of research studies have
been conducted to examine the loss of face or the negative experiences associated
150
with loss of face and how these factors affect the individuals (Zane & Yeh, 2002;
Mak, Chen, Lam, & Yiu, 2009; Lin & Yamaguchi, 2011).
To date, some of the empirical studies included the loss of face as a variable in
help-seeking literature and the results of empirical investigations have produced
inconsistent results. Some studies demonstrated that higher loss of face concerns
lead to negative attitudes towards seeking psychological help or less willingness
to seek help. For example, Zayco (2008) found that lower loss of face concerns
were significant predictors of positive help-seeking attitudes of Asian Americans.
Leong et al., (2011) found that higher loss of face was associated with negative
attitudes toward seeking psychological help among Asian American college stu-
dents. On the other hand, the results of some studies demonstrated that there was
a significant positive relationship between loss of face and intentions to seek
counseling or no relationship. For instance, a study with Asian international
students (Yakunina & Weigold, 2011) showed that greater loss of face concern
was related to greater intention to seek help. Leong, Wagner, and Kim (1995)
found that loss of face was not a significant predictor of positive attitudes toward
group counseling.
Another variable that is related to willingness to seek psychological help is
public stigma. Public stigma refers to the perception endorsed by a group or
society that an individual is socially unacceptable if the person seeks psycho-
logical help (Corrigan, 2004). Certainly, research studies indicate that public
stigma associated with seeking mental health services keep the people from
seeking psychological help. One study conducted in Turkey revealed that public
stigma was negatively and directly related with the help seeking intentions of
Turkish adults (Topkaya, 2011a). Iwasaki (2005) reported that higher levels of
stigma concerning depression were negatively related to continuing treatment
among Japanese participants.
In addition to public stigma, one of the several distinct forms of stigma may be
perceptions of stigmatization by one’s social network for seeking psychological
help. Social network stigma can be defined as negative stereotypes and prejudice
about seeking psychological help held collectively by people in a person’s direct
social group (Vogel, Wade, & Ascheman, 2009). The influence of an individual’s
social network seems to play a crucial role in the decision whether to seek
psychological help similar to public stigma (Vogel, Wade, Wester, Larson, &
Hackler, 2007). Accordingly, it might be expected that help-seeking will be
inhibited if an individual’s social network holds negative attitudes concerning
help-seeking.
Individuals’ attitude toward seeking psychological help is one factor that has
been investigated frequently in help seeking literature. Attitudes toward seeking
psychological help have been linked with various demographic and psychological
factors (e.g., gender, gender roles, emotional openness, self-disclosure, and self-
151
concealment) (Nam et al., 2013) in the studies. Moreover, positive or negative

attitudes toward seeking psychological help were one of the main factors and
accounted for the explained variation in the willingness to seek psychological
help (Bayer & Peay, 1997; Cepeda-Benito & Short, 1998; Kelly & Achter, 1995;
Vogel, Wade, & Hackler, 2007; Vogel & Wester, 2003).
Current Study
The influence of loss of face, public stigma, and an individual’s social network
stigma should play a crucial role in the decision whether to seek psychological
help. However, no study has examined all three and how they are linked to
Turkish individual’s decisions to use mental health services through attitudes
toward psychological help. Based on above mentioned studies, it was hypo-
thesized that the relations of loss of face, public stigma, and social network
stigma to willingness to seek psychological help would be mediated by attitudes
toward seeking psychological help. Therefore, individuals with higher loss of
face, perceived public stigma and social network stigma would experience less
positive attitudes toward psychological help, and then decreased likelihood of
seeking professional help (see Figure 1).
Figure 1. Hypothesized Mediated Model. A plus sign indicates a positive correlation

between the latent variables, while a minus sign indicates a negative correlation between
the variables.
152
Method
Participants
Two hundred two Turkish adults participated in this study. The mean age of the
participants was 34.12 (SD = 8.84). 50.5% (102) of them was female, and 47.5%
(96) of them was male, and 2.0% (4) of them did not report. Twenty eight
participants (13.9%) reported that they had received psychological help before,
and 163 (80.7%) participants reported never having received psychological help.
Measures
Loss of Face was measured with the Loss of Face Scale (LOF; Zane & Yeh,
2002). The 21-item LOF is designed to assess concerns with losing the person’s
social integrity. Participants answered items on a 7-point Likert scale ranging
from 1 (strongly disagree) to 7 (strongly agree). Higher scores indicate greater
concerns for losing face. Example item includes “Before I do anything in public,
I prepare myself for any possible consequence. For the present study, the estimated
internal consistency reliability of the scale scores was .82.
Public stigma was measured with the Stigma Scale for Receiving Psycho-
logical Help Scale (SSRPH; Komiya, Good, & Sherrod, 2000). The 5-item SSRPH
is designed to assess perceptions of the public stigma associated with seeking
professional help. Participants answered items on a 4-point Likert scale ranging
from 1 (strongly disagree) to 4 (strongly agree). Higher scores indicate greater
perception of public stigma. Example item includes “It is advisable for a person
to hide from people that he/she has seen a psychologist.” For the present study,
the estimated internal consistency reliability of the scale scores was .81.
Social network stigma was measured with the Perceptions of Stigmatization
by Others for Seeking Help (PSOSH; Vogel et al., 2009) scale. The 5-item
PSOSH is designed to assess the extent that people agree or disagree with items
predicting how those they interact with would respond to their own potential
help-seeking behaviors. Participants answered items on a 5-point Likert scale
ranging from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicate
greater perceived stigmatization by one’s social network. Example item includes
“React negatively to you”. For the present study, the estimated internal con-
sistency reliability of the scale scores was .92.
Attitudes were measured with the Attitudes toward Seeking Professional Psy-
chological Help Scale (ATSPPH-SF; Fischer & Farina, 1995). The 10-item
ATSPPHS is designed to assess attitudes toward seeking psychological help.
153
Participants answered items on a 4-point Likert scale ranging from 1 (strongly

disagree) to 4 (strongly agree). Higher scores indicate positive attitudes towards
seeking psychological help. Example item includes “A person should work out
his or her own problems; getting psychological counseling would be a last resort.”
For the present study, the estimated internal consistency reliability of the scale
scores was .70.
Willingness was measured with the Help-Seeking Intentions Inventory for
Adults (HSIIA; Topkaya, 2011a). HSII is designed to measure how likely people
would be to seek counseling if they were experiencing the problem listed. Parti-
cipants answered items a 4-point Likert scale ranging from 1 (very unlikely) to 4
(very likely). Higher scores indicate greater likelihood of seeking psychological
help. Example item includes “relationship difficulties”. For the present study,
estimates of internal consistency were α = .77 for relational concerns, α = .70 for
traumatic concerns, and α = .71 for emotional and behavioral concerns subscales.
Procedure
After completing an informed consent, participants received a packet con-

taining the above measures and demographic questions. The participants com-
pleted Turkish translated versions of the scales. After finishing the questionnaire,
the purpose of the study was explained to all participants. Participants were
recruited on a volunteer basis.
Results
Descriptive Statistics
Table 1 lists the zero-order correlations, means, and standard deviations for the
overall scale scores.
Table 1. Means, Standard Deviations, and Zero-Order Correlations (N = 202)
Mean S 2 3 4 5
1. Willingness 32.60 6.07 .43 -.25 -.15 .19
2. Attitude 22.57 3.87 -.13 -.20 -.11
3. Public stigma 12.62 3.90 .22 .10
4. Social network stigma 9.91 5.36 .06
5. Loss of Face 83.38 21.06 -
154
Testing Mediated Effects
Two-step procedure recommended by Anderson and Gerbing (1988) was

followed with regard to testing mediation using SEM: (a) conducting a confir-
matory factor analysis to develop a measurement model with an acceptable fit to
the data, and then (b) conducting a structural model to test the hypothesized
relationships. The recommendation of Holmbeck (1997) was also followed and
compared the hypothesized, partially mediated structural model with a modified
structural model to select the best fitting model. The maximum likelihood method
in the LISREL 8.54 program was used to examine the measurement and structural
models. Four indexes were used to assess the goodness of fit of the models: the
comparative fit index (CFI; .95 or greater), the incremental fit index (IFI; .95 or
greater), the standardized root-mean-square residual (SRMR; .08 or less), and the
root-mean-square error of approximation (RMSEA; .06 or less; see Hu & Bentler,
1999; Martens, 2005).
Item Parcels. Following the recommendation of Russell, Kahn, Spoth, and
Altmaier (1998), observed indicators (or parcels) for each of the latent variables
was created except for willingness to seek counseling, which was estimated from
the three HSII subscales. Two indicators for public stigma, social network stigma,
and attitudes towards seeking psychological help and three indicators for loss of
face were created (see Table 2 for parcel correlations).
Table 2. Zero-Order Correlations among the 12 Observed Variables (N = 202)
Measured variable 2 3 4 5 6 7 8 9 10 11 12
Public stigma 1 .60 .20 .24 .08 .10 .07 -.15 -.21 -.14 -.23 -.26
Public stigma 2 .15 .17 .12 .08 .08 -.06 -.10 -.05 -.16 -.18
Social network stigma 1
.87 -.03 .09 .10 -.13 -.21 -.14 .00 -.14
Social network stigma 2
-.02 .10 .10 -.16 -.19 -.15 -.10 -.18
Loss of face1 .56 .69 -.03 -.09 .13 .16 .06
Loss of face 2 .61 -.08 -.16 .09 .13 .10
Loss of face 3 .00 -.06 .23 .19 .09
Attitude 1 .56 .50 .06 .34
Attitude 2 .28 .14 .32
Willingness 1
.42 .54
Willingness 2 .38
Willingness 3 -
155
Normality. The maximum likelihood procedure used to test the hypothesized

model assumes normality therefore; the multivariate normality of the observed
variables was checked (see Bollen, 1989). The result indicated that the multi-
variate data were not normal, χ2 (2, N = 202) = 3230.111, p < .001. Therefore,
Satorra–Bentler scaled chi-square (see Satorra & Bentler, 1988) was reported in
following analyses.
Measurement Model. A test of the measurement model provided a good fit for
the data: χ2 (44, N = 202) = 92.67, p = .000 (CFI = .94; IFI = .94, RMSEA = .074;
90% CI [.053, .095]; SRMR = .058). The means, standard deviations, and zero-
order correlations for the 12 observed variables (i.e., parcels) are shown in Table
2. Table 3 shows the unstandardized and standardized factor loadings, standard
error, and Z statistic for each of the 12 observed variables on their latent variables.
The measured variables’ loadings on the latent variables were all statistically
significant, p < .001.
Table 3. Factor Loadings for the Measurement Model (N = 202)
Measured Unstandardized Standardized

SE Z
Variable factor loading factor loading
Public stigma
Public stigma parcel 1
1.55 .42 8.64 .76***
Public stigma parcel 2
1.73 .45 8.17 .76***
Social network stigma
parcel 1 1.96 .06 9.20 .97***
parcel 2 1.58 .37 8.05 .79***
Loss of Face
Loss of face parcel 1 5.94 .45 11.37 .74***
Attitude
Attitude parcel 1 1.81 .33 8.83 .82***
Attitude parcel 2 1.45 .50 8.29 .71***
Intent
Intent parcel 1 1.62 .52 9.12 .69***
Intent parcel 2 1.07 .68 6.86 .57***
Intent parcel 3 1.87 .50 8.83 .71***
***p < .001.
156
Structural Model. First, the hypothesized partially mediated structural model

(see Figure 1) was tested with the maximum likelihood method in LISREL Version
8.54 with the same fit indices used above. The structural model provided a good
fit to the data: χ2 (43, N = 202) = 70.91, p = .000 (CFI = .97; IFI = .97, RMSEA
= .057; CI [.032, .080]; SRMR = .052). But, the indirect paths from social
network stigma and loss of face to attitudes, and direct path from social network
stigma to willingness to seek counseling paths were not significant. Next, follo-
wing the recommendation to examine other comparative models (see Martens,
2005), the hypothesized partially mediated structural model was compared against
a modified model using the Satorra–Bentler scaled chi-square differences test. In
the modified model, indirect paths from social network stigma and loss of face to
attitudes, and direct path from social network stigma to willingness to seek
counseling paths were constrained to zero. Results of the modified model also
provided a good fit to the data: χ2 (47, N = 202) = 70.75, p = .010 (CFI = .97; IFI
= .97, RMSEA = .052; CI [.025, .075]; SRMR = .054). However, a scaled chi-
square differences test comparing the models showed statistically not significant
difference between compared two models: χ2 (3, N = 202) = .20, p < .001. In
addition to parsimony principle, the modified model with the inclusion of the
direct path from loss of face to willingness to seek help had slightly better fit
indexes for the data. As such, the modified model was selected as the best fit to
the data and was subsequently used in the bootstrap procedure. The parameter
estimates for the alternative model are shown in Figure 2.
Figure 2. Final Mediated Model. Dashed line indicates non-significant relation.
157
Table 4. Correlations among Latent Variables for the Measurement Model (N = 202)
1 2 3 4 5
1. Public stigma - .30 .30 - .29 -.34
2. Social network stigma - .19 -.18 -.14
3. Loss of Face - -.05 .21
4. Attitude - .60
5. Willingness -
Significance levels of indirect effects. Shrout and Bolger’s (2002) bootstrap

procedure was used to examine the significance levels of the indirect effect. The
first step was to compose 10000 bootstrap samples (N = 202) from the original
data set using random sampling with replacement. The modified model was then
run once with each bootstrap sample to yield 10000 estimations of each path
coefficient. LISREL’s output of the 10000 estimations of each path coefficient
was used to calculate an estimate for indirect effect. The indirect effect of public
stigma on willingness was calculated through the attitudes mediators by multi-
plying 10000 pairs of two path coefficients: (a) from public stigma to attitudes,
and (c) from attitudes to willingness to seek psychological help. The final step
was to see whether the 95% CI for the estimate of a given indirect effect included
zero. If it does not, one can conclude that the indirect effect is statistically
significant at the .05 level (Shrout & Bolger, 2002). As can be seen in Table 5, the
indirect effect was significant (i.e., the 95% CI values did not include zero). It is
also important to note that 10% of the variance in attitudes was explained by
public stigma; and 48% of the variance in willingness to seek psychological help
was explained by loss of face, public stigma, and attitudes.
Table 5. Bootstrap Analyses of the Magnitude and Statistical Significance of the

Indirect Effect
95% CIa
Mean
 Mean
Independent Mediator Dependent  Standardized SE of indirect
indirect
variable variables variable indirect effect Mean effect
effect
(Lower &
upper)
Public (-.36)x(.44) = - .3.882,
Attitude Willingness 4.1378 .13034
stigma .1584 4.393
a
These values based on unstandardized path coefficient. CI = confidence interval.
158
Discussion
The aim of the current study was to examine the relationships between loss of
face, public stigma, social network stigma, attitudes towards seeking psycho-
logical help, and willingness to seek psychological help among Turkish adults.
Specifically, it was hypothesized that Turkish adults who were less concerned
about loss of face, public stigma, and social network stigma would report more
positive attitude, leading to greater willingness to seek psychological help. The
findings partially supported the hypotheses. Public stigma was found to be related
to willingness to seek psychological help both directly and through the attitudes
toward psychological help. Counter to expectations, loss of face was positively
and directly, rather than negative and indirect, associated with willingness to seek
psychological help. On the other hand, social network stigma was not found to be
significantly related to both attitudes and willingness to seek psychological help.
The results of the current study demonstrated that loss of face was associated
positively to willingness to seek psychological help among Turkish adults. This
result indicated that people who had more loss of face concerns were more likely
to have willingness to seek psychological help. This result was inconsistent with
the previous research findings. For instance, one of the earliest study conducted
by Gong et al., (2003) demonstrated that high level of face concerns lead to
decreased utilization of mental health services among Filipino Americans. In
another study, Zayco (2008) found that loss of face is negatively related to
attitudes toward seeking psychological help. Likewise, David (2010) reported
that people with less loss of face concerns had more positive attitudes toward
seeking psychological help yet; loss of face was not a significant predictor of
positive attitudes toward seeking psychological help. The results of the current
study indicate that loss of face, one of the socio-cultural variables related with the
willingness to seek psychological help operates differently than the way from the
other cultures. The findings also revealed that loss of face was not associated with
attitudes toward psychological help. These findings suggest that Turkish adults
might be willing to seek psychological help in order to save their face even they
do not have positive inclination to use mental health services. In the same vein,
although Zayco (2008) found that loss of face is negatively related to attitudes
toward seeking psychological help, she also found that higher concern for loss of
face predicted higher confidence in mental health professionals. Therefore, mental
health professionals should plan some interventions to reach people caring about
loss of face to increase willingness to seek psychological help.
159
Limitations and Future Directions
Although, this is the first study that addresses loss of face in the help-seeking
literature with Turkish adults, it has a number of limitations. This study provides
an empirical link between loss of face and willingness to seek psychological help
however, additional research is needed to confirm the external validity of this
result. Moreover, more research is needed to understand the role of one’s social
network stigma in help-seeking literature. Using more representative sample
might increase the generalizability of the findings to other Turkish populations
from different regions. Future researchers could also incorporate other psycho-
logical variables in the extant literature (e.g., psychological distress) in exploring
some potential mediation effects in the relationships between loss of face, public
stigma, social network stigma and willingness to seek psychological help. Despite
the above mentioned limitations, the present study especially contributes signi-
ficantly to our understanding of how loss of face relates to willingness to seek
psychological help among Turkish adults. It is hoped that such findings will spark
future research to understand help-seeking behavior in specific cultural contexts.
Conclusion
The results of the study showed that public stigma was related to willingness
to seek psychological help directly. Moreover, it was found that public stigma
influence attitudes which, in turn, willingness to seek psychological help. These
results indicate that participants with higher public stigma concerns were less
likely to seek help and participants who held more positive attitudes were more
likely to seek help. This finding was in the same line with the findings of previous
studies (Topkaya, 2011a; Vogel, Wade, & Hackler, 2007; Vogel, Wester, Wei, &
Boysen, 2005).
One of the interesting findings of the study was not observing significant
relationship between social network stigma and either, attitudes towards seeking
psychological help or willingness to seek psychological help. These findings
suggest that Turkish people do not care much about the stigmatization one’s he or
she interacts with or think that they might tolerate the consequences of the social
network stigma.
It is noteworthy that attitudes toward seeking psychological help remained a
significant predictor of willingness to seek psychological help among Turkish
adults in this study. This finding was also consistent with previous research
findings (Topkaya, 2011a; Vogel & Wester, 2003; Vogel et al., 2005). Goh and his
colleagues (2007) emphasize the role of culture in shaping people’ attitudes toward
psychological help. Likewise, Chen and Mak (2008) state that the attitudes toward
seeking psychological help are formed through the influence of culture. Therefore,
160
some culture-specific interventions might be designed to reach people with less

positive attitudes to eliminate the effects of public stigma and to increase willin-
gness to seek psychological help.
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Working together
www.rcis.ro
The Investigation of Primary School Students’

Perception of Quality of School Life and Sense
of Belonging by Different Variables
Ramin ALIYEV1, Erhan TUNC2
Abstract
The purpose of this study is to assess whether the perception of quality of

school life and sense of school belonging to differs in public and private primary
school students by school type, gender, grade level, family socio-economic status
and parental education level. The participants of the study are composed of sixth,
seventh, and eight grade students in public and private primary schools in the
Province of Gaziantep during the 2011-2012 academic years. The participant
sample included 650 students from nine school districts in the city of Sahinbey
and Sehitkamil. The data was collected through the use of a personal information
form prepared by the researcher, Quality of School Life Scale (QSLS), and School
Sense of Belonging Scale (SSBS). The data analysis was done through descriptive
statistics, t-test, and analysis of variance (ANOVA). According to the data analysis,
while QSLS average sub-scale ranged from 3.13 to 3.91, the average total scores
were 3.52. In terms of school type variable; QSLS subscale scores of the student-
to-student communication and feelings of rejection in students who attended
public school were significant; while teacher-to-student, feelings for school and
sense of school belonging mean scores significantly differed in students who
attended private schools. In terms of gender differences, the sense of school
belonging and SSBS total scores significantly differed in favor of female students
and feelings toward school significantly differed in favor of male students. As a
result of the research, we can state that because there were significant differences
between the different variables of school type, gender, and parents’ educational
levels; the quality of school life and sense of school belonging can be affected by
these variables.
1
Zirve University, Faculty of Education, Department of Education Sciences, Division of Psycho-
logical Counseling and Guidance, TURKEY. E-mail: aliyevus@gmail.com
2
Gaziantep University, Faculty of Education, Department of Education Sciences, Division of
Psychological Counseling and Guidance, TURKEY. E-mail: erhantunc25@gmail.com
164
Keywords: quality of school life, sense of school belonging, perception,

emotional connections
Introduction
Sense of belonging of primary school students to their group mainly depends

on being approved and accepted by the group and the feeling of being a precious
member of the group. Need for belonging which is regarded to be one of the
fundamental needs of human being since the early years of life corresponds to the
need of love. Need for belonging has a significant place among identity seek and
identity needs which emerge in adolescence period and identity needs. Adaptation
of an individual to the society is based on the satisfaction level of the need for
belonging.
The arrangement of education environment to meet need for belonging of the
adolescent defines the quality of school life. Leonard (2002) defines quality of
school life as the synthesis between positive and negative experiences in certain
fields of school life and other feelings and reports that fundamental indicators of
quality of school life refer to stress and satisfaction of teachers and students in
these certain fields. Quality of school life refers to the quality experienced by
students in education places where they feel safe, good and motivated. According
to Karatzias, Papadioti Athanasiou, Power and Swanson (2001), quality of school
life is one of the general well-being indicators of children and can be considered
as a general well being which is a result of adaptation of students to school life
and their integration with this environment. Integration of people with the envi-
ronment which they take place in is associated with the level of sense of belonging
to this environment. According to Alantar and Maner (2008), the attachment
theory explains the tendency for establishing more solid emotional connections
with others and emotional problems such as anxiety, nerve, depression which
develop during undesirable separations and losses. In addition, this theory gives
clues about how to cope with individual differences and problematic life expe-
riences on the basis of person’s interaction with connection objects. Balkis, Duru
and Bulus (2005), used the words of “attachment to school” instead of the concept
of “sense of belonging” to define student’s sense of school belonging. A student
who accepts himself/herself as a part of the school has positive feelings about the
school. Activities to be conducted to improve quality of school life will help to
meet needs of students related to the adolescence period and improve their sense
of belonging. Quality of school life has impact not only on sense of belonging but
also on students’ academic success and other education outputs; thus this field has
attracted the attention of pedagogues and many research have been conducted on
students’ well being in school (Mok & Flynn, 1997; Sinclair & Fraser, 2002).
According to the findings of Mok and Flynn (1997), school satisfaction has
165
positive effects on adoptation of educational values and school and children’s

motivation.
Hunt-Sartori (2007), it was found that students’ perceptions towards quality of
school life have significant relationships with less discipline problems and higher
academic success. Tangen (2009) states that quality of school life is under-
estimated despite its importance. However, Johnson and Johnson (1993) report
that the quality of experiences obtained in school affects attitudes and behaviors
of students and students’ positive opinions about school, intraclass activities and
teachers are important for general mental health of students and improve the
targeted acquisitions of school. Negative opinions, feelings and attitudes of stu-
dents towards their school make daily life in school unsatisfactory for students
and pose an obstacle for learning. For example, in a study conducted by Leonard
(2002), it was found that students who perceive their schools as unhappy places
have negative perceptions towards every aspect of school life while those who
perceive quality of school life to be high, have lower absence rates. Moreover, if
quality of school life decreases students can be affected by more serious negative
factors. For example Curelaru, Iacob and Abalasei (2009) found that students who
experienced violence in school was suffered from own self-esteem, loneliness,
depression, anxiety, absenteeism etc.
In a research conducted by Bourke and Smith (1989), the effects school
environment on students’ well being and success were investigated. In this re-
search, it was found that students having a better school life have higher academic
success. Perception of quality of school life not only affects academic success but
also has a significant role on sense of belonging. It was found that the number of
studies conducted to investigate the perception of quality of school life is limited
in Turkey (Doganay & Sari, 2006; Sari, 2007; Sari, Otunc & Erceylan, 2007; Sari
& Cenkseven, 2008; Durmaz, 2008; Korkmaz, 2009; Inal 2009; Alaca, 2011).
Furthermore, it can be said that this study is important as it brings suggestions to
determine and improve primary school students’ perceptions towards life quality
in their schools.
It is believed that this research will contribute to fill a significant gap in the
literature as it determines students’ sense of school belonging and investigates the
relationship between results related to the sense of belonging and perceptions
towards quality of school life on primary school students. The actuality of this
issue can be understood considering the fact that this is the first research, which
has compared public school with private school. In literature, we can find various
researches, which investigated quality of school life and sense of school belonging
however, there is no research which was conducted on these two factors comparing
public and private schools. Therefore, the research conducted on primary school
students sought answer to the question of” Do students’ perceptions towards
quality of school life and sense of school belonging differ by school type (public
school, private school) and some other variables?” The research aims to determine
166
whether the perception of quality of school life and sense of school belonging
differ by some variables for primary school students in Sahinbey and Sehitkamil
districts of the Province of Gaziantep. In line with this general objective, it was
investigated whether students’ perception of school life and sense of school
belonging significantly differ by the school type, gender, grade level, income
levels of parents, education levels of parents.
Methodology
This research is a descriptive study in screening model, which was planned to

investigate primary school students’ perception of quality of school life and sense
of school belonging. Screening model is a research approach, which aims to
describe an ongoing or past situation as it is. The researched event, person or
object is defined within its own conditions and with bare facts (Karasar, 2005).
Sample
The research sample consists of 650 6th, 7th and 8th grade students in 6 public
and 3 private primary schools in 2011–2012 academic years in Sahinbey and
Sehitkamil districts of the Province of Gaziantep. Of the all participants, 264 are
male and 386 are female.
Data Collection Tools
Quality of School Life Scale (Sari, 2007), Psychological Sense of School

Membership Scale (Goodenow, 1993) and Personal Information form, which was
developed by the researcher, were used to collect student information such as
school type, gender, grade, socio-economic level of family and education level of
parents. Detailed information about these data collection tool is presented be-
low.Quality of School Life Scale Sari (2007) is a Likert-type assessment in-
strument, which was developed to determine 4th to 8th grade primary school
students’ perception of the quality of school life. Factor structure and reliability of
the scale was reconstructed by Sari in 2011 and a new structure which is similar
to the previous one was obtained. The scale consists of 35 items within sub-
dimensions of “Teacher-to-Student Communication” (9 items), “Student-to-Stu-
dent Communication” (9 items), “Feelings for School” (8 items), “School Ma-
nagement” (6 items) and “Status” (3 items). Cronbach internal consistency coeffi-
cients of these five dimension which explain 46.92% of total variance are .83, .80,
.82, .77 and .69, respectively. QSLS is answered with a five-point grading system
(1. Strongly Disagree – 5. Strongly Agree) 15 negative statement in the scale (3.,
4., 7., 8., 10., 14., 16., 18., 22., 23., 25., 27., 29., 32. and 35. items) are scored in
167
reverse. A total score can be obtained from QSLS and also sub-dimensions can be
used to measure total scores.
The Psychological Sense of School Membership Scale developed by Goode-
now (1993a) and adopted by Sari in Turkey is a Likert-type instrument consisting
of 18 items which were developed in order to assess students’ levels of sense of
feeling an important part of school, feelings for being valued and integrated with
group, connections with school, teacher and peers. The answers are collected
through a five-point scale (1.Completely false 5.Completely true). Items in the
scale developed for primary school students consist of statements, which define
personal, subjective perspectives of students towards school rather than an objec-
tive assessment. The scale includes items such as “Here, teachers are interested in
people like me”, “Teachers in this school treat me as a friend”, “Being in this
school makes me angry”. Five items in the scale (3, 6, 9, 12 and 16. items) are
negative statements. When these negative items are scored in reverse, average
value of all items is measured for each student or students’ scores can be measured
on the basis of sub-scales as well. High scores to be obtained from the scales
indicate high sense of school belonging. Results of factor analyses conducted by
Sari (2011) indicate that items gather under two components and these two factors
explain 28.90% and 9.59% of the total variance. The first factor (Sense of School
belonging) comprises 13 positive statements of the scale while the other factor
(Sense of Rejection) comprises 5 negative statements of the scale. Factor loads of
the items differ between 0.44 and .66 in first factor; between 0.46 and 0.75 in
second factor. Cronbach alpha internal consistency coefficients of sub-scales were
found to be .84 and .78, respectively. Cronbach alpha internal consistency coeffi-
cient of scale scores was found to be .84 when negative items were scored in
reverse. Item-total score correlations of items differ between .31-.61. The results
of t-test conducted on 27% sub and top groups show that all items can recognize
groups significantly (p<.001). After the research sample was determined, data
collection tools (Personal Information Form, Quality of School Life Scale, (Sari,
2007), Psychological Sense of School Membership Scale (Goodenow, 1993) used
in the research were applied on 3 private and 6 public school students. Students
were informed about the objective of the research and explanations were made
about giving more objective answers to data collection tools in schools where the
scales would be applied. Data of 650 candidates who completed the practice
without error were considered to be valid.
Analysis of Data
Descriptive statistics, t-test and one-way variance analysis (ANOVA) were

used to analyze the data. SPSS 17 statistic package program was used for analyses.
T-tests were conducted to investigate students’ perceptions of quality of school
life and sense of school belonging by variables of school type and gender. In
addition, one-way variance analyses were conducted to investigate whether
168
students’ perceptions of quality of school life and sense of school belonging

differs by grade, education and income levels of parents and income level of
families. Significance level was considered as .05 to interpret the differentiation
of findings is significant or not.
Findings
Findings of Public and Private Primary School Students’ Perceptions of

Quality of School Life
The first question of the research was “Is there any significant difference
between students’ perceptions of quality of school life and sense of school belon-
ging by school type (private school, public school)?”. Independent-group t-test
analyses were conducted for school type variables to answer this question and the
related findings are presented in following table.
Table 1. Arithmetic Mean, Standard Deviation, t and p Values on Students’ Perceptions

of Quality of School Life and Sense of School Belonging by School Type
Public School Private School

(N=420) (N=230) t p
Sub-scales X Ss X Ss
Teacher-to-Student Communication 3.13 .82 3.91 .91 3.182 .000*
Student- to-Student Communication 3.55 .87 3.21 .73 1.613 .004*
Feelings for School 3.41 .71 3.66 .77 2.610 .008*
School Management 3.17 .65 3.11 .88 2.160 1.631
Status 3.38 .75 3.42 1.54 1.560 .092
QSLS Total 3.57 .85 3.51 .93 3.73 1.331
Sense of School Belonging 3.23 .77 3.42 .59 .827 .007*
Sense of Reject 3.66 .53 3.35 .88 1.912 .004*
SSBS Total 3.45 .66 3.44 .81 2.098 1.112

*p<.05
According to Table 1, mean values calculated for students in public schools
were found to be 3.13 in teacher-to-student communication dimension, 3.55 in
student-to-student communication dimension, 3.41 in feelings for school di-
mension, 3.17 in school management dimension, 3.38 in status dimension and
3.57 in total scores of QSLS. Arithmetic mean values calculated for students in
private school were found to be 3.91 in teacher-to-student communication di-
mension, 3.21 in student-to-student communication dimension, 3.66 in feelings
for school dimension, 3.11 in school management dimension, 3.42 in status
dimension and 3.51 in total scores of QSLS. Mean values calculated for students
in public schools were found to be 3.23 in sense of school belonging dimension,
3.66 in sense of reject dimension and 3.45 in total scores of SSBS. Mean values
calculated for students in private schools were found to be 3.42 in sense of school
169
belonging dimension, 3.35 in sense of reject dimension and 3.44 in total scores of
SSBS.
It was found that public school students’ mean scores in Student-to-student
Communication, School Management, Total QSLS Scores, Sense of Reject and
Total SSBS Scores were higher compared to those in private schools. According
to the data obtained from other sub-scale scores, it was found that private school
students have higher scores compared to those in public schools. T-test was used
to investigate the significance of the difference between score means. It was
found that mean values in Student-Student Contact and Sense of Reject differ in
favor of public school students while mean values in Student-Teacher Commu-
nication, Feelings for School and Sense of School Belonging differ in favor of
private school students (p<.05). Differences between score means of School
Management, SSBS and QSLS were not found to be statistically significant
(p>.05).
Findings of Students’ Perceptions of Quality of School Life and Sense of

School Belonging by Gender
The second question of the research was “Is there any significant difference
ging by gender?”. Independent-group t-test analyses were conducted for the
gender variable to answer this question and the related findings are presented in
following table.
Table 2. Arithmetic Mean, Standard Deviation, t and p Values on Students’ Perceptions

of Quality of School Life and Sense of School Belonging by Gender
Female Male
(N=264) (N=386) t p
Sub-scales X Ss X Ss
Teacher-to-student Communication 2.99 .65 2.87 .96 2.710 .060
Student-to-student Communication 3.44 .77 3.09 1.06 1.503 .000*
Feelings for School 3.23 .91 3.41 .91 3.432 .009*
School Management 3.11 .81 3.23 .99 2.324 .166
Status 3.68 .83 3.71 .81 2.139 .556
QSLS Total 3.29 .81 3.44 .72 3.786 .053
Sense of School Belonging 3.53 .66 3.31 .71 3.184 .007*
Sense of Reject 3.62 .91 3.71 .68 .804 .079
SSBS Total 3.60 .76 3.39 .61 3.098 .002*

*p<.05
According to Table 2, mean values of scores were found to be 2.99 for female
and 2.87 for male students in teacher-to-student communication dimension; 3.44
for female and 3.09 for male students in student-to-student communication
170
dimension; 3.23 for female and 3.41 for male students in feelings for school
dimension; 3.11 for female and 3.23 for male students in school management
dimension; 3.68 for female and 3.71 for male students in status dimension; 3.29
for female and 3.44 for male students in total scores of QSLS; 3.53 for female and
3.31 for male students in sense of school belonging dimension; 3.62 for female
and 3.71 for male students in sense of reject and 3.60 for female and 3.39 for male
students in total scores of SSBS.
It was found that female students have higher scores in “student-to-student”,
“feelings for school”, “sense of school is belonging” and “total SSBS scores” than
male students do while male students have higher mean values in other sub-scale
scores compared to girls. T-test was used to investigate the significance of the
difference and significant differentiations were found in “student-to-student”,
“feelings for school”, “sense of school belonging”, and “total SSBS scores” in
favor of female students and in “feelings for school” dimension in favor of male
students (p<.05). Differences between score means of other sub-scales were not
found to be statistically significant (p> .05).

School Belonging by Grade Level
The third question of the research was “Is there any significant difference
ging by grade level?”. One-way variance analyses were conducted for the grade
variable to answer this question and the related findings are presented in following
table.
Table 3. Findings of Students’ Perceptions of Quality of School Life and Sense of

School Belonging by Grade Level
Variable Grade N X Ss df F p
Level
6 192 3.42 .66
Perception of quality of school life 7 215 3.51 .59 2 .178 .694
8 243 3.48 .22
6 192 3.35 .71
Sense of School Belonging 7 215 3.44 .77 2 .592 .454
8 243 3.29 .81
p<.05

According to Table 3, mean values of scores obtained in Quality of School

Life Scale were found to be 3.42 for sixth grade students; 3.51 for seventh grade
students and 3.48 for eighth grade students while mean values of scores obtained
from Sense of School Belonging Scale are 3.35 for sixth grade students, 3.44 for
seventh grade students and 3.29 for eighth grade students. No significant
171
difference was found between mean values of scores obtained from both
assessment instruments by students’ grade (p>.05).

School Belonging by Income Level of Parents
The fourth question of the research was “Is there any significant difference
ging by income level of parents?”. One-way variance analyses were conducted on
the variable of income level of parents and the related findings are presented in
Table 4.

School Belonging by Income Level of Parents
Variable Income N X Ss df F p Significant Difference
(LSD)
Alt 140 3.11 .37
Perception of quality
Medium 329 3.92 .69 2 2.24 .003* Medium>High, Low
of school life
High 190 3.07 .71
Low 140 3.79 .63
Sense of School
Medium 329 3.43 .58 2 7.56 .002* Low>High, Medium
Belonging
High 190 3.52 .68

*p<.05
According to Table 4, mean values of QSLS scores of students by income level

of family were found to be 3.11 for students whose families are in low income
group; 3.92 for those whose families are in medium income group and 3.07 for
those whose families are in high income group. Mean values of SSBS were found
to be 3.79 for students whose families are in low income group; 3.43 for those
whose families are in medium income group and 3.52 for those whose families
are in high income group. ANOVA was used to find out the significance of the
difference between these mean values and it was found that there is a significant
difference between both QSLS and SSBS scores of students with different income
groups (p<.05). According to the results of LSD test which was conducted to
investigate the main reason of this difference, it was found that QSLS score
means differ in favor of students whose families are in medium income group
compared to those in high and low income groups while SSBS score means differ
in favor of students whose families are in low income group compared to those in
medium and high income groups.
172

School Belonging by Education Level of Mother
The fifth question of the research was “Is there any significant difference
ging by income level of parents?”. One-way variance analyses were conducted on
the variable of income level of mother and the related findings are presented in
Table 5.

School Belonging by Education Level of Mother
Perception of Quality of School Life
Mother Education N X Ss df F p Significant Difference
(LSD)
Secondary school graduate >
Illiterate 19 3.48 .53
Illiterate
Only literate 38 3.51 .67
Only literate,
Graduate (primary school) 79 3.58 .61 High school graduate,
5 6.161 .004* Secondary school graduate >
Graduate (secondary school) 173 3.72 .61 University graduate,
Graduate (High school) 195 3.36 .60 High school graduate,
Graduate (University) 146 3.39 .58 University graduate,
Sense of School Belonging
N X Ss df F p Significant Difference
Mother Education
(LSD)
3.91 .66 Illiterate>Only literate
Illiterate 19 Illiterate > Primary school
graduate
3.68 .59
Only literate 38 Illiterate > Secondary school
graduate
3.72 .57 Illiterate > High school
Graduate (primary school) 79 graduate
5 8.090 .002* Illiterate > University
3.71 .59
Graduate (secondary school) 173 graduate
High school graduate >
4.03 .60 Primary school graduate
Graduate (High school) 195 High school graduate >
Secondary school graduate
3.66 .55 High school graduate >
Graduate (University) 146
University graduate

*p<.05
According to Table 5, mean values of QSLS scores were found to be 3.48 for
students whose mothers are illiterate, 3.51 for those whose mothers are only
literate, 3.58 for those whose mothers are primary school graduate, 3.72 for those
whose mothers are secondary school graduate, 3.36 for those whose mothers are
173
high school graduate and 3.39 for those whose mothers are university graduate.
Mean values of SSBS scores were found to be 3.91 for students whose mothers
are illiterate, 3.68 for those whose mothers are only literate, 3.72 for those whose
mothers are primary school graduate, 3.71 for those whose mothers are secondary
school graduate, 4.03 for those whose mothers are high school graduate and 3.39
for those whose mothers are university graduate. The differences between scores
obtained from QSLS and SSBS sub-scales of student groups were found to be
statistically significant (p<.05).
According to the results of LSD test which was conducted to investigate the
main reason of the significant differences between group means, it was found that
QSLS score means differ in favor of students whose mothers are secondary school
graduate compared to those whose mothers are illiterate, only literate, primary
school graduate, high school graduate and university graduate while SSBS score
means differ in favor of students whose mothers are in university graduate com-
pared to those whose mothers are illiterate, only literate, primary school graduate,
secondary school graduate and high school graduate.

School Belonging by Education Level of Father
The fifth question of the research was “Is there any significant difference
ging by income level of parents?” One-way variance analyses were conducted on
the variable of income level of father and the related findings are presented in
Table 6.

School Belonging by Education Level of Father
Perception of Quality of School Life
Father Education N X Ss df F p
Graduate (primary school) .73 3.30 .66
5 2.917 .061
Graduate (secondary school) 215 3.37 .63
Graduate (High school) 195 3.41 .71
Graduate (University) 160 3.31 .53
Sense of School Belonging
Father Education N X Ss df F p
Graduate (primary school) .73 3.83 .67
5 7.021 .079
Graduate (secondary school) 215 3.72 .60
Graduate (High school) 195 3.84 .72
Graduate (University) 160 3.83 .58
p<.05
174
According to Table 6, mean values of QSLS scores were found to be 3.42 for
students whose fathers are illiterate, 3.29 for those whose fathers are only literate,
3.30 for those whose fathers are primary school graduate, 3.37 for those whose
fathers are secondary school graduate, 3.41 for those whose fathers are high
school graduate and 3.39 for those whose fathers are university graduate. Mean
values of QSLS scores were found to be 3.81 for students whose fathers are
illiterate, 3.78 for those whose fathers are only literate, 3.83 for those whose
fathers are primary school graduate, 3.72 for those whose fathers are secondary
school graduate, 3.84 for those whose fathers are high school graduate and 3.83
for those whose fathers are university graduate. The differences between group
means were found to be significant in terms of QSLS and SSBS scores (p>.05).
Discussion
In this research, according to the investigation by school type (public school,

private school) of students, it was found that mean scores of students in public
school are 3.13 in dimension of teacher-to-student communication; 3.55 in di-
mension of student-to-student communication; 3.41 in dimension of feelings for
school; 3.17 in dimension of school management; 3.38 in dimension of status and
3.57 in total QSLS scores. Arithmetic mean values calculated for students in
private school were found to be 3.91 in teacher-to-student communication dimen-
sion, 3.21 in student-to-student communication dimension, 3.66 in feelings for
school dimension, 3.11 in school management dimension, 3.42 in status dimension
and 3.51 in total scores of QSLS. Mean values calculated for students in public
schools were found to be 3.23 in sense of school belonging dimension, 3.66 in
sense of reject dimension and 3.45 in total scores of SSBS. Mean values calculated
for students in private schools were found to be 3.42 in sense of school belonging
dimension, 3.35 in sense of reject dimension and 3.44 in total scores of SSBS.
Significant differences were found in “Student-to-student Communication” and
“Sense of Reject” scores in favor of public school students and in “Teacher-to-
student Contac”, “Feelings for School” and “Sense of School Belonging” scores
in favor of private school students (p<.05). Differences between score means of
School Management, Status SSBS and QSLS were not found to be statistically
significant (p>.05).
Taking stand from these results, we can say that people’s perception of quality
of school is closely associated with their communication types with others in the
school (teacher and other students). For example Booker (2004) reports that
students start to have higher level of attachment to the school community when
they have positive and supportive interactions with their friends and teachers.
According to Perdue, Manzeske and Estell (2009), the quality in friendships,
support taken from peers and aggressive behaviors against students are closely
175
associated with students’ attachment to school. As the positive qualities of school

climate improve, students’ aggressive behavior rates decrease (Birnbaum et al.,
2003). On the other hand, McNeely, Nonnemaker and Blum (2002) report that
students have less tendency towards substance abuse in early ages, get involved in
violence or sexuality when they feel that they are cared by others in their school
and they consider themselves as part of the school. Karatzias, Power and Swanson
(2002) who found that the perception of quality of school life is the most important
predictor of getting involved in bullying, found that those getting involved in
bullying have more negative perception of quality of school life and these students
have higher level of school-related stress and they emphasize that these findings
indicate the relationships between school satisfaction and bullying.
According to investigation of research results by gender, it was found that
mean values of scores were found to be 2.99 for female and 2.87 for male students
in teacher-to-student communication dimension; 3.44 for female and 3.09 for
male students in student-to-student communication dimension; 3.23 for female
and 3.41 for male students in feelings for school dimension; 3.11 for female and
3.23 for male students in school management dimension; 3.68 for female and 3.71
for male students in status dimension; 3.29 for female and 3.44 for male students
in total scores of QSLS; 3.53 for female and 3.31 for male students in sense of
school belonging dimension; 3.62 for female and 3.71 for male students in sense
of reject and 3.60 for female and 3.39 for male students in total scores of SSBS.
It was found that scores of female students in “student-to-student”, “feelings
for school”, “sense of school belonging” and “total SSBL scores” were higher
than scores of male students and mean values of male students in other sub-scale
scores were found to be higher than those of female students. T-test was used to
investigate the significance of the difference and significant differences were
found in “student-to-student”, “feelings for school”, “sense of school belonging”
and “total SSBL scores” in favor of female students. p<.05 Differences between
score means of other sub-scales were not found to be statistically significant (p>
.05).
Comparing students’ perception of quality of school life by gender, it was
found that female students’ scores obtained from all dimensions of SSBS and
total scale scores were higher than male students and the differences between
groups are generally significant. These findings are in conformity with the re-
search findings in the literature. For example Alaca (2011), Bourke and Smith
(1989), Doganay and Sari (2006), Hunt-Sartori (2007), Inal (2009), Marks (1998)
and Mok and Flynn (2002) found that female students have more positive per-
ception of quality of school life compared to male students. Based on this research
and the findings of other research in the literature, we can say that female students
have higher satisfaction in school than male students do. This satisfaction is more
apparent in female students than it is in male students in terms of the teacher-to-
student relationships dimension (for female students =3.97; for male students
176
=3.56); feelings for school dimension (for female students=4.06, for male students=
3.61); status dimension which refers to feel valuable in school (or female students
=4.05; for male students =3.85) through which quality of school life differs
significantly by gender, feelings for school. Considering these three dimensions
which can be clearly seen that they develop in parallel with each other, we can say
that female students have sufficient satisfaction from their communication ways
with their teachers and they feel as a valuable member of their school community
and in this scope, their feelings for school develop in a more positive way. Various
research reports that female students perceive their teachers’ behaviors in the
class more positive (Cemalcilar, 2010; Un-Acikgoz, Ozkal and Gungor-Kilic,
2003), they have higher scores and they like academic activities than male students
do. Haapasalo, Valimaa and Kannas (2010) found that female students feel more
safe in school, they like being in school and school activities, they find school
rules more fair, they can perceive their teachers more friendly than male students
do and in this direction, they have more positive perception of school in general
sense compared to male students.
According to the research results, mean values of scores obtained from Quality
of School Life Scale were found to be 2.94 for sixth grade students; 3.51 for
seventh grade students and 3.48 for eighth grade students while mean values of
scores obtained from Sense of School Belonging Scale are 3.35 for sixth grade
students, 3.84 for seventh grade students and 3.41for eighth grade students. No
significant difference was found between mean values of scores obtained from
both assessment instruments by students’ grade (p>.05). Primary school years are
the most important years for both academic self-confidence development of
students and psychological and social development. School is one of the most
important lie areas in adolescence period and students spend approximately 30-35
hours/week in this area within close relationship with their teachers and friends.
Capps (2003) emphasizes the importance of psychological acceptance and social
support to be granted by teachers and other friends in adolescence period in which
motional fluctuations are especially common.
According to the research results, mean values of QSLS scores of students by
income level of family were found to be 3.11 for students whose families are in
low income group; 3.92 for those whose families are in medium income group
and 3.07 for those whose families are in high income group. Mean values of SSBS
were found to be 3.79 for students whose families are in low-income group; 3.43
for those whose families are in medium income group and 3.52 for those whose
families are in high income group. It was found that there are significant difference
between both QSLS and SSBS scores of students with different income groups
(p<.05). According to the results of LSD test which was conducted to investigate
the main reason of this difference, it was found that QSLS score means differ
significantly in favor of students whose families are in medium income group
compared to those in high and low income groups while SSBS score means differ
177
significantly in favor of students whose families are in low income group compared
to those in medium and high income groups.
We can say that low level of perception of quality of school life in children of
families with high income level is the result of the fact that schools do not meet
the high expectations of the family and low level of perception of quality of
school life in children of families with low income level is the result of conditions
offered by schools. It can be said that school environment and sense of self of
students with low income level determine the perception way of quality of school
life. The significantly high score means obtained from the sense of school belon-
ging scale by students with low income can be resulted from the fact that need for
love cannot be satisfied sufficiently due to poor socio-economic conditions.
Families in low-income level may have many different priorities other than
education, which is a very long-term investment and yet could not guarantee a
good income and social status despite to this long term. As stated by Hoover-
Dempsey and Sandler (1995), the neglect of low-income families for school can
be related to their poverty and these families give priority to meet their fun-
damental living needs. On the other hand, it was observed that children of high-
income families obtained low scores from the scale as they assess their good
living conditions and school environment through high life quality expectations.
It can be said that low SSBS scores of children of low-income families are related
to the fact that self-design of children growing up in low-income family envi-
ronment affects their assessment on school environment. Ozkan (1994) found that
self-respect is related to the income level of family. Self-respect is highly asso-
ciated with the interest of the family. Self-respect of young people whose families
are interested in them is at high rates. As the interest decreases, this rate decreases
as well.
Conclusions
According to the investigation on research results by education level of mother,

mean values of QSLS scores were found to be 3.48 for students whose mothers
are illiterate, 3.51 for those whose mothers are only literate, 3.58 for those whose
mothers are primary school graduate, 3.72 for those whose mothers are secondary
school graduate, 3.36 for those whose mothers are high school graduate and 3.39
for those whose mothers are university graduate. Mean values of SSBS scores
were found to be 3.91 for students whose mothers are illiterate, 3.68 for those
whose mothers are only literate, 3.72 for those whose mothers are primary school
graduate, 3.71 for those whose mothers are secondary school graduate, 4.03 for
those whose mothers are high school graduate and 3.66 for those whose mothers
are university graduate. Differences between QSLS and SSBS scores of students
groups were found to be statistically significant (p<.05).
178
According to the results of LSD test which was conducted to investigate the
main reason of the significant differences between group means, it was found that
QSLS score means differ significantly in favor of students whose mothers are
secondary school graduate compared to those whose mothers are illiterate, only
literate, primary school graduate, high school graduate and university graduate
while SSBS score means differ significantly in favor of students whose mothers
are university graduate compared to those whose mothers are illiterate, only
literate, primary school graduate, secondary school graduate and high school
graduate. Differences between QSLS scores were found to be significant in favor
of students whose mothers are high school graduate compared to those whose
mothers are illiterate, only literate, primary school graduate, secondary school
graduate and university graduate.
According to the investigation on research results by education level of father,
mean values of QSLS scores were found to be 3.42 for students whose fathers are
illiterate, 3.29 for those whose fathers are only literate, 3.30 for those whose
fathers are primary school graduate, 3.37 for those whose fathers are secondary
school graduate, 3.41 for those whose fathers are high school graduate and 3.31
for those whose fathers are university graduate. Mean values of SSBS scores were
found to be 3.81 for students whose fathers are illiterate, 3.78 for those whose
fathers are only literate, 3.83 for those whose fathers are primary school graduate,
3.72 for those whose fathers are secondary school graduate, 3.84 for those whose
fathers are high school graduate and 3.83 for those whose fathers are university
graduate. The differences between group means were found to be significant in
terms of QSLS and SSBS scores (p>.05).
In line with these discussed results; education institutions can define the
factors, which determine students’ perception levels of quality of school life and
sense of school belonging and conduct studies to improve school environment.
Studies to attract attention to the importance of quality of school life and sense of
school belonging for school managers and other educationalists can be planned
and some criteria can be determined to develop quality of school life and sense of
school belonging as a target in strategic plans of schools. Further research can be
conducted on this matter in different school types (science, Anatolian, social
sciences, religious, vocational high school etc.) and the relationship between
perception of quality off school life and sense of school belonging and also
whether these two factors are predictors for each other can be investigated. Studies
can be conducted to find out whether families’ attitudes towards school affect
students’ perception of quality of school life and sense of school belonging.
Higher scores of female students in teacher-to-students, student-to-student com-
munication sub-scales and sense of school belonging scale than the scores of male
students may require developing different criteria for gender in assessment.
179
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182
Working together
www.rcis.ro
Perverse Effects of Change in the Romanian

Academic Field
Dumitru STAN1
Abstract
According to the conclusions of a sociological research carried out almost two

decades ago, for a person to become part of the Romanian society’s elite, one had
to be a university graduate. Anyone who succeeded in getting remarkable results
in economy, sports, music, politics, etc., was recognized as a rightful member of
the elite only if she/he was also a university graduate. At that time, the higher
education system in Romania was functioning, to a large extent, on the orga-
nizational and scientific bases established before 1990. Since then, all levels of
the national educational system were reformed, including the university, based on
the idea that the country’s social improvement depends primarily on the quality of
education received by young generations. In order to assess the value of higher
education reforms and to establish whether the university continues to be viewed
as a generator of Romanian elites, we revised several aspects of the aforemen-
tioned research in a new investigation. The results reflect again the positive image
that university students and teaching staff have about themselves and about the
socio-cultural responsibilities of higher education institutions. Unlike the previous
research, ours found out two very frequent criticisms in the subjects’ answers: a.
the crisis within the university is about to become as severe as the other types of
crisis in the social system; b. as the social recognition of the university graduate
diminishes, so do the elite status and the people’s trust in the potential of the
university, while the university’s crisis deepens.
Keywords: university crisis, cultural capital, transition, the university’s

fundamental mission, academic excellence, anti-crisis reactions, perverse effect
1
Alexandru Ioan Cuza University of Ia[i, Department of Sociology and Social Work, Iasi,
ROMANIA. E-mail: dtrustan@yahoo.com
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Introduction
It has been said, perhaps in the most extolling manner possible, that the
university is the institution which holds a strong monopoly over the universal
(Bourdieu, 1984: 311). This statement is justified in as much as a large part of the
advancements in knowledge obtained by humankind over time and in all fields
are connected to the university’s existence. Moreover, the gallery of great creators
of culture has been largely constituted from university students and professors, as
a lot of the personalities who have had a great impact on social and political
evolution also came from the university medium.
Many commentators on pedagogy and education pinpoint the beginnings of
higher-education in antiquity. Nevertheless, it is more reasonable not to equate
the university with the Academy founded by Plato, nor with the Lykeion organized
by Aristotle; not even the later Roman school curricula of the trivium and qva-
drivium types, or the French Palatine School can be defined as forms of higher-
education, unless, perhaps, they are compared to what the other kinds of con-
temporary schools offered. “The university as a learning and research centre
developed around the year 1200” (Cairns, 1992: 234), more precisely, when
teaching no longer took place mainly in monastic schools or cathedrals, but rather
in amphitheatres. It is self-understood that in the beginnings of higher-education
the theological formative elements dominated, while arts, medicine and law were
gradually added later.
In the medieval times, “the responsibility to study universality” (Nicolescu,
2007: 115) meant to create and broadcast knowledge of the highest order, yet
without making a radical distinction between exact and speculative knowledge or
between culture and science. The Renaissance and modernity imposed, however,
a categorical split between the knowledge made use of in the academic medium
and that of the facile education or common accessibility. At the same time it
required special, ‘superior’ abilities on the part of both students and their teachers.
Thus, the university became a higher-education institution, and its superior po-
sition needed to be justified by the optimal attainment of several missions, which
are called fundamental or founding.
One of the first such missions is the universalistic or encyclopedic modelling
of the participants in the academic field. This aim explains why, for example, the
student N. Copernicus read astronomy, medicine, law and theology; why professor
I. Newton from Cambridge University was a physicist, mathematician, alchemist,
theologist and philosopher; why P. Andrei’s name is linked to such fields as
sociology, philosophy, logics and political science; why professor S. Mehedin]i is
considered a geographer, ethnologist, anthropologist and theologist as well. Even
today, the socio-cultural expectations towards those who work in the university
are somewhat broader than those towards one working in a narrow, over
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specialized field. In the present context of sciences and professional skills, it

would be unthinkable for a doctor not to know some chemistry, physics, biology
and anthropology, for an economist not to know elements of mathematics, so-
ciology, history and political science, for an agronomist not to make use of
connected and complementary information from geography, ethnology, econo-
mics, etc. The encyclopedic demands of university development were charac-
teristic of the medieval period especially; later, they became less pressing but did
not disappear altogether, although the education programmes were considerably
restructured and reduced. In effect, the universalist and encyclopedic requirements
became implicit or subordinate, as if academics should fulfill them automatically
just by being part of the academia and by being infected with the many higher
education offers. The cultural assets requested of the members of the university
have always been far larger than what the institution passed on to them; thus, both
academic staff and students were demanded to reach performance levels beyond
what they themselves had received from the university, whereas aspirants to the
higher education system had to comply with draconian selection criteria. The
(almost) forbidding admission criteria limited the number of graduates to such an
extent that those who succeeded were believed to have exceptional qualities and
to be entitled to key positions in the social system.
The second fundamental mission of the university is to perform scientific
creation and assure the continuation of generations of creators. Thus, the higher-
education institution is understood as “a genuine workshop for scientific work
and creativity, in which the professor discovers the objective truth or pure science
and engages young students on the path of discovery.” As sociologist P. Andrei
puts it, “if the professor limits his activity to... the stiff expounding of acquired
knowledge, s/he does not fulfill his mission, as s/he is supposed to set new powers
in motion by making their scholarship come to life, penetrate the students’ spirit
and unfold their whole being, open new horizons for them and show them higher,
more splendid, more noble goals. The university does not aim to turn young
students into scholars..., but it must teach them... the scientific method and awaken
the passion for science and thinking in their souls.” (Andrei, 2010: 39-40). In the
same note, professor D. Gusti, who was called spiritus rector of Romanian
sociology, stated that the university is “a social community of life and concepts,
which comes to life due to the close collaboration between professors and students
working on a common masterpiece – the unfinished monument which is being
built for centuries – science... Equal in their aims dedicated to the same Truth cult,
professors and students differ only in their experience; a professor is an eternal
student, while a student is by definition... a novice professor” (Gusti, 1996: 22).
The most representative result of the master - disciple partnership has to be
knowledge, as a reliable gauge of the intellectual strength of the university
medium. As knowledge tends to be objectively capitalized on in time, and the
young generation has access to the scientific results of its predecessors, one may
185
conjecture that the university not only prepares a new generation of creators to
replace the former, but it also creates the basis for scientific performances that
exceed those of the previous generations. In other words, thanks to the university,
today’s generation surpasses the older generations’ scientific capital, while in
their turn accepting the possibility that it may experience the same from future
generations. Even when scientific progress is achieved in specialized research
institutions which are administratively autonomous, one must not forget that its
authors obtained these results due to the abilities and skills they assimilated in the
university. Therefore, the university is the origin of most growth in modern and
post-modern societies, which is why it can be dubbed the “engine” or the “brain”
or the most authorized source of progress in evolved social systems.
The third fundamental mission of the university is to prepare students for the
profession and to assess their status as specialists. In pre-modern times, going to
university had a very small pragmatic motivation and lacked mercantilism com-
pletely; those who had student-status, in the very few universities across Europe,
aimed at amassing more or less scientific cultural capital taken from the greatest
scholars of the time, in order to be recognized as intellectual authorities in their
turn. After going through ritualized procedures and exams, the stages of “learning”
were confirmed by diplomas, titles or ranks. The ‘scholar’ status was equivalent
to that of wise man, and in special contexts, he who had such a status could enjoy
a higher reputation than political or military leaders. However, rarely did uni-
versity graduates obtain public functions as a consequence of their studies. As a
rule, the completion of higher education marked symbolic or cultural borders
between individuals and the existing social barriers were consolidated; a high-
ranking nobleman had every chance to increase the advantages of his social
position if he also obtained a diploma upon graduation. Modernity attached two
new functional orientations to the university: (1) the reduction of the studies to the
level of specialization or hyperspecialisation; (2) the employment of the studies in
professions needed on the job market. The higher-education graduate has thus
become a specialist in a field or a sub-field of knowledge, and the acquired
abilities and skills are certified only for one or a small number of professions.
While preparing for a profession, a student assimilates elements of a rather
abstract, basic knowledge which is nevertheless applicable to numerous particular
cases (Abbot, 1988: 318) which are encountered once entering a profession. The
very fact of having been confirmed as a specialist should represent the guarantee
of being able to optimally function in the profession and of triggering desirable
changes in society.
The university’s fourth fundamental mission is the facilitation of trans-national
communication and mobility. Most cultural goods and values which were created
in the academia, especially the scientific ones, are the result of dialogues, con-
sultations, arguments, confirmations done by experts and specialists from various
higher-education centres. Sometimes they come from the same country, other
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times from different countries, but in both cases they are motivated by the perspective
of scientific innovation. Collaboration among academics is not a simple whim or
bout of curiosity, but an absolutely vital activity because “there are too few
experts in each discipline on a university campus…, one or two on small campuses
and rarely more than half a dozen on large ones. These specialists must commu-
nicate not only outside the boundaries of their disciplines, but also between
campuses” (Dogan & Pahre, 1993: 235). Inside their own department, academics
have rather few intellectual exchanges, due to a rather large number of causes
which separate them: ideological differences, incompatible preferences for the-
ories and methodologies, vanity, in-field professional rivalry, lack of tolerance
caused by character traits, divergent purposes for the use of research results, etc.
From the less transparent layers of these causes one may deduce why “university
departments are not intersections, but empty halls” (Dogan & Pahre, 1993: 236)
and why scholars tend to keep the secret of their investigations at least until they
are published or patented. The previously listed causes also help one understand
why members of the academia prefer international mobilities between universities
to national ones, why longitudinal communication between higher-education
institutions preceded and stimulated various forms of super-national political
integration, and why academics around the world are stubbornly looking for an
easy common language which would allow them to feel they belong to a trans-
cultural corporation. The greater the density of cultural contacts, transfers and
borrowings between universities, the more rapidly will the gaps between civi-
lizations be closed, and societies’ hopes for anti-crisis actions to succeed will
increase. Because it produces, imports and exports science, the university asserts
itself as an authority in the hierarchy of institutions which want to ensure the
health of the social system. In order to fulfill this aim, it offers expertise and
capitalizes on cognitive forces. The latter become truly operational especially
when they answer to social commands, and the university is responsive to soli-
citations and stimulative for communication and mobility.
One final mission, perhaps the most representative for the university’s exis-
tence, is building social excellence. Due to the intellectual qualities of the people
who make it up, the kinds of abilities and competences that it forms, the commu-
nication and assessment methods it uses, the worth of the purposes it serves, the
applied strategies, the relations established with other institutions, the openness to
everyday life’s problems, and so on, the university is the obvious source of
obtaining society’s superlatives: (1) it sifts through longitudinal knowledge and
decides on what needs to be kept and communicated to the future generations of
students by permanently correcting curricula, syllabi, teaching-learning styles,
etc.; (2) it guarantees that higher education proceeds at the most up-to-date level
of knowledge; (3) it establishes axiological boundaries to differentiate between
science and non-science, truth and falsehood, moral and immoral, specialist and
non-specialist, genuine elite and speculative or situational elite, etc.; by doing so
187
it answers to society’s demands for certainty, precision and security; (4) it annihilates
or at least it diminishes the importance of exotic criteria for defining the people’s
merits (physical strength, kinship, fortune size, belonging similarities, etc.) and in
return, it promotes the criterion of intellectual-spiritual force (graduation of
education levels, attested number of study years, prizes and commendations
received as a result of authoritative assessments, number of texts read or written.
etc.); (5) it places its own graduates in socially prestigious positions and implicitly
favors their entry to the elite segment. Every time these aspects are found in the
common functioning of the social system, it can be stated that the university
accomplishes its mission of generating excellence; if this does not happen, then
there is concrete proof to confirm the manifestation of both a university crisis and
a social body crisis. In other words, the university is by nature an institution of
excellence which has two possible states: optimal functioning, when it produces
all the situations connected to excellence, and crisis, when it does not accomplish
all its specific missions and it cannot help society fight against dysfunctions. The
first of these states is very difficult to reach, even for countries which are known
to have good quality higher education. For instance, the USA holds top positions
in almost all international university classifications, yet too many American
students “know nothing about nothing, are abysmally ignorant… 85% wonder
what the Magna Carta might be. The Nazis? One in three has no idea. When was
Jesus born? Four out of ten students do not figure out that the answer is provided
by the calendar they are using…” (Sartori, 2005: 147). If one were to add to this
example the sociological research results according to which a quarter of the
pupils in high school education in the USA do not meet the requirements of
elementary education, 106 million Americans cannot read, meaning that they can
barely spell, and that in the well-educated Italian context, inheritor of the Re-
naissance – the greatest of all cultural revolutions ever experienced by humankind
–, 65% of the individuals state that they have never read a book, and 62% say that
they do not read even a magazine or a sports newspaper (Sartori, 2005: 146) –
then the picture of the educational system crisis becomes clearer. Moreover, the
aspects regarding the responsibilities that the university has to meet become more
important: correcting the deficiencies inherited by students from the pre-university
level, adapting the academic objectives to the intellectual level of the students,
joining the group endeavour of solving social crises and rethinking periodically
what university excellence is.
The academic missions which we briefly presented above are principles, tenets
or ideal standards for guiding the functioning of higher-education institutions of
all kinds and everywhere. I called them “fundamental missions” because they
have provided the university with its individuality since its inception and because
they look like almost apostolical and perpetual commandments or spiritual debts
to which the ones involved need to commit, whatever the costs. The extent to
which these missions are accomplished has not and will never be complete, which
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allows us to conclude that the state of crisis is part of the normal existence of the
university and that it is a constant ingredient in its entire history. Nevertheless, the
magnitude of the crisis differs from one university to the next, from one country
to the other and even from one stage in the evolution of the same university to
another. On the whole, such differences as seen from the perspective of the
university’s mission can be grouped in a simple, yet operational typology in anti-
crisis projects: (1) if there is a small difference between the contents anticipated
or planned by any one of the mentioned academic missions and the actual level
achieved by them, one may say that the dysfunctions’ impact is easy to deal with
and the university crisis is superficial; (2) if the gap we are referring to is large
and affects several missions for a long period of time, it can be said that the
university is up against a profound crisis.
Superficial crises are not simply unimportant, meaning easy to overcome, but
also necessary because they rejuvenate the university’s activities and motivate its
heuristic or innovative spirit. In contrast, profound crises are pathological, epi-
demic and extremely dangerous: they create panic and discrimination, they lead
to chaotic and inefficient consumption, they encourage mutinous individual and
group behaviour, they change the course of the systems away from their essential
purposes: the educational system skids towards economy and business, the eco-
nomic system tends to replace the one focused on social benefits, the judiciary
system bends under political pressures, the ethical and deontological system
becomes indulgent towards various survival commercial objectives, etc. Para-
doxically, once such a crisis is in place, it generates such deep social distrust as to
the possibility to overcome this state, that even the intensive actions taken to
bring the crisis to a halt are assimilated to the context of rising dysfunction.
Finally, any profound crisis necessitates the reform of the system where it mani-
fests itself, it alerts the social medium as to which of its aims or missions have
been perturbed and encourages society to identify action strategies ample enough
to avoid the traps of reproducing similar critical effects in the future (Krugman,
2009: 188).
Periodically, the educational system, including the university system, has to be
reformed or at least reorganised, even if it is affected or threatened by superficial
crises only. However, the envisaged changes take place far more slowly in com-
parison to other areas of the social space because many distorting elements
intervene in the perception and assessment of the dysfunctions. Here are some of
the confusing situations which delay the end of the Romanian higher-education
crisis: (1) denying that the crisis is present and minimising its intensity to the
extent that the verdict according to which the solution to the crises is easy and
natural is accepted; (2) associating reform interventions from outside education
institutions with explanatory variables, as academics accuse that they have been
involved in a risky social experiment without their consent; (3) the fear of chan-
ging the present university algorithm and of the augmentation of the noxious
189
changes it may suffer by replacing some less functional aspects with even less
appropriate, uncertain or simply pathological ones; (4) the shameful involvement
of the political system in the university’s functioning and the latter’s massive
dependence on the external financial system, given that for Romanians such
experiences are not only numerous, but also quite recent.
Methodological options. Argumentation
The events of December 1989 were triggered by a national explosion of

opposition to the profound crises present at all levels of the Romanian society.
That sick reality had to be revigorated and repositioned in a rational sociocultural
model, free of ideology, abuse and conventional lies. A quarter of a century after
that irrational and anomic reality, we have the tendency to show too much cle-
mency for the failures of the socialist system. This attitude is encouraged on the
one hand by the considerable temporal distance which separates us from the time
of the respective system’s shocks and which stops us from evaluating it in the
light of the true magnitude of that criminal period. On the other hand, the same
permissive attitude appears as many Romanians are disappointed by the con-
sequences of the fall of socialism: they participated in radical social movements,
but the high costs they had to pay did not return solutions that would get them out
of the crises which accompanied that time. Furthermore, in other respects re-
cognized everywhere as crucial to sustaining the quality of life (being able to find
a job easily, state-provided housing, immediate integration of university graduates
in the labour market, general application of social benefits, practice of social
economy for the benefit of vulnerable populations, etc.), it is obvious that the
post-revolution Romanian society has not progressed, but on the contrary, it has
regressed alarmingly. The regresses registered in these aspects explain why some
people have nostalgic feelings towards the socialist system’s offers, especially
towards their humanistic dimension.
The common university model of the totalitarian period, for instance, is the
object of the nostalgists’ indulgence (most of whom were educated at that time),
as well as of today’s young generation’s sympathy, impressed by the advantages
it used to offer: a large number of academic and welfare scholarships, campus
accommodation for almost all students, compulsory governmental allocation of a
work place after graduation, the absence of tuition fees, etc. Due to such popular
student perks, many of the downsides of the old university (ideologisation, fa-
vouring members of the ruling party, almost complete international isolation,
total subordination to state and party, etc.) are forgiven, overlooked or defined as
secondary negative aspects. Thus, the university crisis in the years before 1990 is
thought of as having lacked in gravity. However, what has been happening in the
Romanian university education system since then is recognized by most analysts
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as a profound type of crisis or a form of “structural-functional blockage of higher-

education”, caused by (Vl\sceanu, Zamfir & Mih\ilescu, 1993): (1) a centralised,
deeply bureaucratic system of government, coordination and control; (2) the
failure of the mechanisms to match higher-education with societal demands; c.
the lack of levels of differentiation in the organisation of higher education; (3) the
existence of an excessive and chaotic separation between programmes of study
and specialisations, which leads to early and inefficient professional training; (4)
a severe lack of teaching staff and the existence of an imbalance between ge-
nerations in the number of experienced and inexperienced academics; (5) a blowup
of the number of higher-education institutions after 1990, especially in the private
sector, although society did not really need such an enlargement; (6) the under-
financing of universities; (7) the dramatic insufficiency of facilities; (8) the
inappropriate quality and insufficient number of social services for students.
The impact of these undesirable situations was felt by the entire social spec-
trum, but most of all by the main people in the university – academics and
students. Secondly, it triggered concern in the hearts of highschoolers who were
about to finish school and were interested in enrolling for university very soon. In
this socio-cultural context, during 1993-1996, as part of a research supported by
the Institute for Educational Sciences, we investigated three samples of subjects
representing three population categories (390 students from three academic cen-
tres: Ia[i, Bac\u and Suceava, 64 teaching staff involved in training specialists in
humanistic and technical courses of study; 1221 final year highschoolers from
counties where there is no university, as well as from counties where universities
are near and generate deep-rooted anticipatory socialisation in pupils). The sam-
ples made up of university students and pupils were investigated only with the
help of a sociological survey, while the teaching staff subjects were asked for
information by using both the survey and a semi-structured interview. All ca-
tegories of subjects were sources for obtaining diagnoses of the intensity of the
university crisis, appeal of specialisations, sources of dissatisfaction, students’
expectations about the academic medium, indentifying possible solutions for the
crisis’ many aspects, the immediate and long-term consequences of not having
solved the university’s critical situations in time, mutual influences of university
and society crises, social selection of society’s members as an effect of university
preparation, rise in the number of diplomas and the deterioration of higher-
education institutions’ image, today’s university action priorities, etc. The results
of the quantitative analysis of the data together with the qualitative analysis of the
interpretations given by the subjects to some experiences they had in their daily
lives (Flick, 1998), led us to several conclusions relevant for the topic. These
confirm the profound state of crisis in the Romanian university after the escape
from the totalitarian era, as well as the need for urgent reforms in the education
system at this level. Similar conclusions have been restated in a recent qualitative
sociological study: in the 2013-2014 academic year, 28 academics and 76 MA
191
students from Ia[i, Bac\u and Suceava answered semi-controlled interview

questions, which focused on issues similar to those encompassed by the research
done two decades earlier. An utterly new conclusion can be drawn from the
examination of the later research data and it should be applied by all the people
involved with the university, especially by those who are responsible for im-
plementing anti-crisis measures: the deeper and longer the higher education crisis,
the greater the probability of the delayed reforming interventions to be unable to
solve the crisis, but to trigger new perverse predicaments.
The facets of the university crisis during the transition
“The transition can be defined as a middle stage between two limits: a starting
point…, which is more or less known, and an end point…, that can only be
predicted, and is therefore a direction rather than an actual state” (St\nciulescu,
2002: 29). Essentially, the transition is a change in society as a whole or of only
a part of it, from an initial state which is found to be poor or deficient, to a state
which is supposed to be better, if not ideal. The more complicated the socio-
cultural medium where the transition takes place is, the more difficult, risky and
controversial any process of changes may become. Therefore, the transformations
accompanying the transition do not signify that certain, triumphant, precisely
configured and anticipated stages have been covered, they rather reflect the lack
or incoherence of the strategic criteria for anti-crisis action. From a psycho-
sociological perspective, the transition represents a strange blend of fears and
hopes, hesitant initiatives and risky outbursts, mostly positive expectancies from
the members of society but not having clear or coherent support, embodiments of
individual and collective involvement in the context of tense social situations,
rather spontaneous and contextual uses of brainpower in identifying and legi-
timising comfortable urgent solutions to the numerous dysfunctional situations.
If solutions of this kind that appear in one of the structures of the social body,
such as the university, are recognized by most of the beneficiaries and generate
social stability in the long term, then that structure can be said to have overcome
the transition period and that it is fully making use of the advantages that resulted
from the pursuits of that period. As for the Romanian higher-education, its crisis
started precisely when the post-totalitarian political regime came to power, when
the bureaucratic and almost military order in the university was perturbed, even
destructured, marking the beginning of the transitional drudgery towards a new
education system and a new society. “When we think about a new society, a
serious danger we may be faced with is to imagine it as something completely
new, where novelty is equal to that which is different, and the future is equal to
effacing the past” (Giussani, 2005: 61). In fact, many elements from the old
structure are naturally reproduced because they have auxiliary purposes or
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decisive roles in the development of the transition process and in curing or

revealing the crisis.
Depending on the number of elements (scientific, cultural, organizational,
ethical, professional, etc.) contributing to the university’s visible identity and
their duration from one stage to the next in the evolution of the university, we
may identify a series of hypothetical typological alternatives as to the depth of the
crisis and the particularities of the transition in higher-education: (1) the large
number of such elements, almost identically reproduced over a relatively long
period of time, counted in decades, but at a liminal, survival level, reveal the
presence of a chronic university crisis, as well as its inability to procure and
manage the resources and means necessary to implement the changes demanded
by transition; (2) the large number of elements preserved in almost identical
forms, over long and very long periods of time, from several decades to centuries,
when the identity elements are legitimate, socially accepted and functional, in-
dicate either the complete absence of a university crisis, or its lack of seriousness,
as well as the time mismatch of launching transformations characteristic of the
university transition to a different state; (3) the small number and insufficient
continuity elements for a period of time longer than a year suggests the imperative
need for a transition towards a new institutional model, in the context of an
extended and profound university crisis; (4) the small number of recurring ele-
ments in a period of time smaller than a year, while the higher education institution
behaves optimally, prefers and puts forward models of excellence (Savater, 1997:
14-15), represents a dynamic, modern university, oriented towards very short-
term transition missions in the guise of organizational development, prevention
and prompt interventions in relation to any kind of internal crisis or vile external
influence.
These hypothetical alternative crises and transitions in higher-education insti-
tutions can be said to correspond to actual academic organisations: in the first type
may be included all universities which, since their founding or shortly after, chose
to function by imitating foreign academic models or lack autonomy completely,
being forced to follow the prescriptions of outside reasoning exclusively; in the
second type we find highly prestigious universities, such as Oxford, Cambridge,
Harvard, the Sorbonne, and others, which have been implementing the recipe for
functional success for a long time, where an efficient combination of tradition and
modernity opens their way to leadership positions, transforms them into authority
brands and protects them from the crises’ dissolving aggression; the Romanian
universities from 1990 to 1995 are of the third type; at that time crisis had become
distressing because many of the socialist regime’s directives regarding higher
education were cancelled and the transition needed to be carried through at any
cost in order to replace the invalidated norms with a new legislation, which
matched the new socio-cultural and political realities; today’s western universities
can be found in the last of the four defined types, as they have been significantly
193
successful (scientific achievements, landmark publications, satisfactory funding,

students interested in the quality of teaching, etc.) and adapted quickly to the
pressures posed by the manifest crises, anticipating possible crises and over-
coming transition periods in such a short time that they seem to have not faced
crises; the changes they made were not great and needed not lead to the mo-
dification of the education by-laws.
The selection in terms of what is worth keeping and what needs to be eliminated
from the contents of a modern institution, especially when it is experiencing a
crisis, must be made by referral to the legislation. To take any other path would be
the expression of a partial, subjective position or proof of bureaucratic violence
which, normally, the social system must refuse to legitimize. For a system forma-
lized by education, the rational way to choose between worthy, desirable or
enduring aspects and perishable, undesirable or critical ones is the law of edu-
cation. It is instrumental in enforcing a logical, stable and unified course of
education at all levels, and the sweeping change of such an itinerary involves
changing the law in force with a new one. The time gap between two successive
education laws, and the initiatives for organisational renewal and legislative
additions which are made in-between can be said to form the transition period in
the field of education.
Each law which is generically entitled “of instruction”, “of education”, “of
public schooling”, “of instruction and education” is meant to be an optimal
formula for the functional education of a schooling model, valid for as long a
period of time as possible, where all the successful increments from the previous
transition period are to be found and which is to postpone as much as possible the
system’s going through a new transition process. The Romanian higher-education,
as the embodiment of the most elevated education, has experienced after the
political change of 1989 a course which is significantly different from the above-
mentioned formula: (1) it immediately entered (1990) a first transition phase, or
a legislative purging phase, when the university should have been urgently freed
of the guidance of the socialist ideology; (2) it brought together the transition
changes and the main anti-totalitarian orientations of education in a university
model found in the Law of Instruction (1995); (3) it continued the legislative
improvement of the education system during a second transition phase which
took place from 1995 to 2011, when a generous plan for ‘reviving’ Romania
through education was intended; (4) it collated the changes made in this new
transition stage and the need for change stated by those involved in the university
in a new document – the National Education Law (2011) – which was thought to
have put an end to the transitional quests and in which the university should have
found a feasible, stable functioning model; e. the latest law has already been
modified many times, and there are still proposals to change it; this allows us to
state that we are experiencing a third transitional phase and that when it is over
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the education system and, implicitly, the university will have a new organisational
and operational law.
By correlating these time limits and the nature of the actual changes that have
happened in the Romanian education system from 1990 to date, some obvious
conclusions become apparent: (1) the transition was difficult in the academic
medium until the Law of Instruction of 1995 and the Programme for Reviving
Romania through Education of 1997 were passed, but it became easier after the
National Education Law of 2011 came into force; (2) the modifications performed
on the education system due to legislative sources such as ordinances, decisions
and by-laws have not brought the anticipated stability and for this reason the three
transition phases seem to constitute a continuous process or a single long period
of time (1990-2014); (3) the two education laws summarised the changes that had
been adopted during the previous transition stages and they were by no means
documents that would mark the system’s exit from the crisis; (4) the phases of the
transition period, as they have been delineated, have more methodological worth
in distributing the analyses on the university crisis, because they define, on the
one hand, the contexts of the situation, and on the other hand, they offer clues as
to the footing of the forces that society can muster to return to a normal state.
In line with these conclusions, the series of changes that have taken place in
the academic field over the three transitional phases (1990-1995, 1995-2011,
2011-2014) under the government of the two education laws (1995, 2011) were
attempts at identifying a functional university model which would be able to
initiate powerful anti-crisis action at any time. If we take into account the large
number of alterations in higher-education, the long period over which they were
made and especially the instability of their application, then we may conclude that
the Romanian university has not yet found a comfortable recipe for functioning
and is still experiencing transition and extended crisis. Surprisingly, not even
after the application of two laws meant to handle the education system problems,
subsequent to the first two transition phases, were the university crises signi-
ficantly alleviated. In terms of the first transition stage, here are some relevant
examples from the research about the positioning and amplitude of the signs of
the university crisis (Stan & Stan, 1997: 76-91).
Signs of university crisis as defined by the student sample
Directly affected by the dysfunctions of higher education, and, particularly,

threatened by the possibility of suffering on long term the crises thereof, students
have nominated, probably, the most acute phenomena which cause the univer-
sities’ lack of attractiveness.
(1) Unattractive outcomes of attending university. Three arguments help stu-
dents in choosing their programme of study or specialisation: the certainty of
finding a job upon graduation, the prospect of making a lot of money and the high
195
social prestige connected to the specialisation. The society crisis leads to the
social annulment of some programmes and therefore to the ‘uselessness’ of certain
departments. Dissatisfied with the chances they have to get a job given the studies
they are pursuing, the subjects listed the programmes of studies they would find
tempting if they were to apply for university again: law (29%), economics (16%)
and medicine (12%). Only these fields of study offer guarantees in terms of the
three professional orientation criteria; the others offer the privilege of being a
student, but also socially useless diplomas.
(2) The costs of higher education are too high in comparison with the benefits
students have from it. According to the subjects, the university should give up on
programmes of study with a very narrow specialisation and offer students the
possibility to have ‘double’ or even ‘triple’ specialisation. Only in this situation
would the university become ‘truly viable’ and spare the students from having to
turn to attending a second faculty to consummate their studies. No less than 35%
of the subjects stated that they would like for university training to be extended,
saying that the additional schooling would make them more competitive and
useful on the labour market. However, the same subjects point out that the slow
return of the investments from the schooling period explains why few realise their
wish.
(3) The inadequate relationship between students and academic staff. The
crisis becomes manifest from the very start of this relationship as the tutors are
not interested in assessing the initial real level of the first-year students’ know-
ledge. In the absence of a diagnosis at the starting point, the teachers’ curricular
offer is unrealistic, and their professional dialogue with the students becomes
tense, 58% of the subjects state. Almost as many subjects, 56%, confirm that the
tutors are not interested at all in having harmonious relationships with their
students, do not think of them as partners in an educational relation, do not adapt
the scientific contents of the courses they teach to the intellectual particularities of
the students or to the courses of studies they attend.
(4) The position of the university in a duplicitous register. The rigidity of
formal academic behaviour, the overloaded education programmes, the tutors’
apathy, the students’ overwork and boredom, the focus on the quantity rather than
the quality of the information taught, financial costs which are difficult to meet,
lack of certainty as to the worth of the diploma after graduation, the small
probability that the investment made during the studies will be returned, etc. are
aspects which place the university in a socially undesirable region. All these
elements prove the instability of the higher-education institution, its critical
situation which may cause students to opt for a break in their studies or even
abandon them. Nevertheless, only 7.37% of the interviewed students would
choose these solutions, while the others are ready to accept the difficulties of the
specialisation period as being natural. Therefore, regardless of how small the
guarantees offered by higher-education to students are, their highest hopes for
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THEORIES ABOUT...
social success are still linked to the university. In the years 1993-1996, the
undesirable part was strongly minimised by the fact that the university graduate
was attested as a member of the society elite. Even when the labour market did
not validate the social usefulness of a specialisation, that is, the graduates did not
get a job in the field they had studied, chances were that they could be socially
successful simply because they possessed a higher education certificate.
Signs of a university crisis indicated by the academic staff subjects
Unlike students, members of the teaching staff have indicated the critical
aspects of higher education in a much more technical manner, without speculative
aspects, fact which evidences the existence of justified doubts regarding the
immediate possibility of countering such issues.
(1) Overworking young academics. The most frequent difficulties encoun-
tered by young academics, according to the investigated subjects, are: the number
of the teaching hours (75%), the insufficient time allotted to preparing the tutoring
activities (64%), deficiencies in communicating with students (28%), lack of
credibility and prestige resulted from age rather than expertise (25%). The over-
work mentioned by the respondents is not caused by the legal teaching load, but
by the endeavour to have a large number of classes (cumulative salary, pay by
hour, both in state and private education, etc.) to cover the material needs. More-
over, most of these academic staff were doing their PhDs, which lead to a dimi-
nishing of the time spent on preparing for the professional tasks, and of the time
needed to replenish one’s ability for work.
(2) Students’ superficiality in attending courses and seminars. From the point
of view of nearly three quarters of the questioned academic staff (76%), the
students are not sufficiently motivated to have professional achievements: exams
are passed by making minimal efforts to learn, scholarships are very low, and
finding a job seems not to depend on the university at all. Moreover, student
folklore contributes to discourage students from learning by spreading stories
about mediocre graduates who had extraordinary social success. Thus, student
attendance rates have been approximated by the academic staff to range between
35% and 75%. If to this insufficiency in terms of students not participating in
teaching activities we add the fact that 82% of the students prepare for the exams
only during the examinations period and only by reading the lecture notes, and
that even those students who get the highest grades read no more than five books
as additional readings for a discipline, then it may be stated that the essence of the
university crisis is mirrored in the students’ level of professional development.
(3) The accumulation of an impressive number of factors which generate
dissatisfaction. The higher-education teaching staff subjects indicated these fac-
tors in the following order: lack of free time (86%), neglect of home chores
(84%), insufficient salaries (73%), inadequate preparation of teaching activities
197
(64%), students’ lack of interest in what academics do (45%), tensed relations

between young and old academics (25%), job insecurity (25%), psychological
discomfort caused by the possibility that some courses of study and faculties may
be dissolved (25%). As may be observed, the impact of these factors generated by
the university medium on the teaching staff is greater outside the institution than
inside it, which is why the members of the teaching body have the feeling that
their social position is deteriorating if the university crisis is not stopped in time.
(4) Alarming skepticism as to the university crisis being solved. Academics
over the age of 45 are pessimistic about ending the adversity found in higher
education, while younger academics are a little more confident. The former argued
that “at least a century’s” worth of interventions from outside the institution is
needed, while the latter perceive “changes in education programmes”, “impro-
vement of teaching style” and “professional development” as immediate and
internal sources for easing the higher education crisis. Furthermore, because of
the Romanian industry regression after 1990, technical education has declined to
such an extent that the representative subjects in the sample said they would be
happy to abandon their teaching careers (64%) and turn to fields which may offer
them material-financial satisfaction (50%).
Signs of university crisis resulted from investigating potential higher-

education students
The deficient social representations regarding universities are also confirmed

by the persons who are just envisaging registering for courses of higher education,
even though their age and educational background have not offered sufficient
information to this end.
(1) Student useless specialisation. For 25% of the final-year highschoolers,
the university does selfish or useless activities, as long as it does not guarantee
graduates a place where they may practice the profession they train for. In contrast,
for nearly 73% of the subjects, the university is ‘a necessary evil’, as it is the only
body which mediates obtaining a higher-education diploma and a place in the
society elite.
(2) The doubtful quality of the formative act. Although university education
is in high demand, its image among candidates is rather compromised by how
easy new students are selected and by the low expectations towards them during
their studies. 11% of the subjects forcefully stated that, basically, the university
“is interested in producing as large a number of higher education graduates as
possible and does not care about their quality.”
(3) Generating unattractive and minor social expectations. Either due to
ignorance or to a nihilistic attitude characteristic to adolescents, 14% of the
subjects said that they do not expect any spectacular changes in their lives once
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THEORIES ABOUT...
they become students, 13% opinionated that the university is incapable of offering
them anything in addition to what they got during the previous schooling stages,
and 18% said they were content with the university only because it “delays the
moment when they have to enter the responsibility-laden life”.
(4) The disadvantages are more numerous than the advantages students get.
Subjects have pointed out “the delay in doing the military service” and “the
diminishing of the military service period” (in the meantime, it is no longer
obligatory for men to do military service), apart from getting a higher education
diploma and “entering the society cultural elite” as certain advantages which the
university provides. In terms of ‘disadvantages’, they identified many other
aspects whose impact is obvious: “losing years in life”, having “expenses which
are difficult to return”, “experiences of dreadful anxiety due to exams”, facing “a
low quality of life”, depending greatly on other people, etc. Nevertheless, re-
gardless of how large in number the disadvantages are, they are taken as granted
in going through the rite of passage to social maturity by those who are about to
obtain the student status.
All these indexed categories reflect the state of the university crisis in the first
phase of the transition period, as well as the climate in which the first education
law appeared after the demise of the totalitarian political regime. At first sight, the
myriad of dysfunctions manifest in the Romanian higher-education at that time
leads us to believe that the university institution was excessively compromised
and that it had a significant contribution to the overall society crisis. In fact, even
though it was experiencing a deep crisis, the university, alongside the church and
the army, was among the institutions which were able to initiate anti-crisis action
and fulfill specific missions to a satisfactory degree. In other words, despite its
being affected by crisis, the university kept its imposing status: it offered the most
prestigious qualifications and diplomas, it brought together the best teaching staff
and the most famous researchers, it proposed solutions to exit the crisis at the
level of the entire social body, it stratified the population based on the level of
schooling, etc. Finally, one may argue not only that the university remained one
of society’s elite institutions, but also that many structures depended on the way
it functioned.
Present signs of the university crisis
As it was directly faced with the state of crisis or asked to offer remedial
services to other social sectors experiencing adversity, the university had to
continually perfect its ability to put anti-crisis action into practice. Identifying the
procedures applied in such actions and establishing the quality of the effects
obtained by the university in fighting against the crisis in its own terrain were the
objectives of the qualitative sociological study done in the 2013-2014 academic
year. On this occasion, almost two decades after the research summarised above,
199
we identified present-day signs of the university crisis. It must be noted that,

although present during the third phase of the transition period (2011-2014), most
of them are inherited from previous stages:
(1) Delusive functional autonomy. The issue of academic liberties in the guise
of university autonomy has been trumpeted since 1990, long defined, invoked and
explained, but it still remains to be solved. Members of the university are aware
that such autonomy involves both independence from the political power and
being “shielded from pressures, influence or financial fluctuations” (V\ideanu,
1996: 96). Unfortunately, “when university managers do politics, the students are
manipulated by parties and political figures, while academics’ salaries can be
paid only if the money comes from a political government, it is clear that the
university’s autonomy is an inapplicable principle, a way to gracefully deceive”
– said an academic who has over forty years of experience in higher-education.
(2) Pseudo-democratization of education by eliminating admission exams or
reducing the requirements in the student selection tests. The fact that all highschool
graduates can apply for higher education studies would represent proof that
education is democratic. However, the fact that many highschool graduates do not
become students because they do not have the financial means to sustain them-
selves shows that admission is not only an occasion for defining social differences,
but also a process of curtailment of equality of chances in relation to the education
system. “By giving up the strict selection of applicants, poor candidates have
been robbed of the possibility to escape poverty. It is as if society is excluding
those who need help the most and favours the already favoured,” said a young
academic with five year’s experience in state higher-education.
(3) Inexplicable rise in the number of students. In an official UNESCO report
from 1996, it is claimed that “everywhere around the world higher education
institutions are being pressured to raise the number of admitted students. At the
level of the entire planet, their numbers have risen from 20 million in 1970 to over
60 million today” (Delors, 2000: 108). Recently, in Romania, the number of
university graduates has risen to approximately 10% of the population, but this is
a modest level in comparison to some EU countries where around 50% of their
citizens are university graduates (Marga, 2009: 118). The interviewed subjects
agree that going through the superior stages of schooling equals to the growth of
the cultural capital, but at the same time they think that “the studies have no
purpose; it is unclear whether the university actually produces specialists, but it
is certain that the number of unemployed holding a higher education diploma is
increasing from one year to the next” (MA student, 2nd year).
(4) Study fees’ valence of corruption. The admission criteria’s relaxation
triggered a high demand in higher education. The natural outcome of this demand
was the rise in the number of tuition paid places in both state and private education.
The money resulted from tuition fees should ultimately represent the worth of the
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THEORIES ABOUT...
educational services provided. Often, however, the students that pay tuition, as
well as those who get the money from the state budget have an erroneous and
perverse image about the fees’ role: “by paying the fee I ensured my graduation.
I knew that I would seldom attend courses, but also that the faculty would not
expel me because it would lose my money” (MA student, 2nd year); “in my view, a
student is a piece of my salary. If I fail him in an exam and he gives up school, I
am more affected than he is. This is why I prefer to lower my demands, close my
eyes, appear to be deaf…” (Member of the teaching staff, sixteen years of ex-
perience in private higher-education).
(5) Too large a number of universities. According to a well-versed conno-
isseur of the Romanian university medium, “neither Romania, nor any other
similar country, can support over ninety accredited universities corruption-free.
Moreover, in our case, the universities are misplaced from the very beginning in
the legislation and surreptitiously put on a par with businesses or civil associations.
No one knows what it actually means to do scientific research or to be a university
professor anymore” (Marga, 2009: 113-114). The answers given by the study
subjects are equally reproachful: “although lacking in basic facilities, experience
in the field, their own teaching staff, any serious arguments, commercial uni-
versities have been founded and accredited and they discredit the very idea of
university” (member of the teaching staff, eighteen years of experience in state
higher-education); “the new universities were helped to appear not because the
education system or society needed them, but because they offered the possibility
to do business in a new field: education” (member of the teaching staff, thirty
years of experience in state higher-education).
(6) Abnormal conversion of higher education into mass education. If the
university were allowed to function by adapting unconstrained to the demands of
the labour market, there would surely not exist so many universities, so many
students or so many dysfunctions in the academic medium. In reality, it is not the
free market that is responsible for the crisis, but the authorities’ interventions
(Braun, 2011), who administer possibilities rather than realities and take into
account principles rather than needs. “Because we wanted to transform the uni-
versity into a western institution, we decided immediately, from behind some
ministry desks, on taking the easiest measure: accepting all candidates. This
decision should have been taken at the end, after we had modified the basic
facilities and had clarified all the rules of the game. We did not do what we should
have done and we ended up having a diploma inflation, and the statuses of being
a student or a university professor have become trivial”, says one of the subjects,
member of the teaching staff with eighteen years of experience in state higher-
education. Another revealing answer was given by a second year MA student:
“that which everyone has can no longer be thought of as superior, it is something
common or normal; the bachelor diploma impresses no one now… and even the
PhD one has lost its worth.”
201
(7) Anti-crisis action is taken too late and does not succeed in significantly
reviving the university medium. Without resources, methods and long and me-
dium-term strategic vision, reactions against crises are last-moment counter-
attacks or stances which have small chances to produce enduring changes. Because
they happen too late, their only effect is to maintain the university at a survival
level. Even this level is compromised if, according to the subjects’ opinions,
“stopping academics from migrating abroad or to financially more rewarding
professional fields and discouraging young people from going to western uni-
versities” will not be successful (member of the teaching staff, thirteen years of
experience in state higher-education). The students’ distrust of the Romanian
university’s potential to exit the crisis deepens as their expectations become
disappointments: “at the start of each academic year I used to hope that something
will come up, something that would motivate me, make me feel that attending the
courses is worth it. But for nothing! There are the same teachers who make me fall
asleep, the same unattractive teaching methods, the same mates who feign interest,
although they feel the same way I do… No matter how much changed now, for me
the university remains a false, failed world” (MA student, 2nd year).
The list of indicators of the university crisis today is, according to the research
results, far longer. In addition, the seriousness of their impact is not lower than the
described indices, especially when the dysfunctional realities are related. We
hereby list some of the signs indicated by the subjects, keeping their often me-
taphorical means of expression: (1) lack of intentness in teaching activities; (2)
lack of earnestness in both teaching staff and students; c. useless students’ asses-
sment of the teaching body because of lack of consequences; (3) moral degradation
of the diplomas and the downgrading of professional specialisation brought about
by the rapid progress of scientific knowledge; (4) widening of the gaps between
the professors’ demands and the students’ abilities; (5) learning contents brought
to a theoretical and abstract level which makes higher education seem to have no
connection to reality; (6) selection of young teaching staff and PhD students
according to more or less subjective and unethical criteria; (7) subservient struc-
turing of teaching groups and maintaining quiet rivalries in their midst; i. lack of
organisation and cohesion in terms of trade in large student bodies; (8) university
members pursuing large economic profits to the detriment of specific cultural
profits; (9) counterfeit achievements presented by academics and students alike
with a view to “embellish their CVs”; (10) neglecting the students’ development
during their undergraduate years and presenting the PhD as the ‘true’ consumma-
tion of professional achievement, although few students have access to this level
of education.
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THEORIES ABOUT...
Conclusion
The two sociological studies have pointed to the same diagnosis: the Romanian
university following the totalitarian political regime is in a profound state of
crisis. The reforming endeavours have not suppressed the crisis, they only led to
the proliferation of its aspects. Moreover, because the university is not fulfilling
its traditional missions any longer, it is receiving an increasing number of accusa-
tions, as if it were guilty of the entire society’s decline. Its image as a powerful
institution has been gradually deteriorating and the falling trend is becoming
more and more obvious as it is continually losing its historically gained right-
fulness. Surprisingly, the efforts meant to produce desirable changes in the uni-
versity functioning have contributed considerably to this loss due to associate
perverse effects.
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203
Working together
www.rcis.ro
Psycho-Social Aspects in Children

with Cystic Fibrosis
Dana Teodora ANTON-PADURARU1, Anamaria CIUBARA2, Egidia MIFTODE3
Abstract
Cystic fibrosis (CF) is a multisystemic genetic disorder affecting 1:2500

newborns. Its prognosis has changed in the last two decades with increasing life
expectancy. Nevertheless, this disease can impact the psychosocial development.
Children with CF and their caregivers may experience different significant stre-
ssors that can lead to poor adaptation, increase depressive and anxious symptoms
and decreased quality of life. Psycho-social interventions are concerned with
adherence to treatment, emotional and social adaptation and health-related quality
of life. Although the life expectancy increased, it is important to assure a better
quality of life. The authors present the psychiatric and the psychosocial aspects of
CF found at children with cystic fibrosis and their caregivers. They conclude that
precocious identification and effective treatment of depressive and anxious sym-
ptoms could improve the patient’s daily functioning and the disease management.
Keywords: children; cystic fibrosis, psycho-social aspects, resilience, genetic

disease, social interventions, stigma.
1
University of Medicine and Pharmacy “Grigore T. Popa”, Faculty of Medicine, Discipline of
Pediatrics, Iasi, ROMANIA. E-mail: antondana66@yahoo.com
2
Psychiatry, 16 Universitatii Street, 700115, Iasi, ROMANIA. E-mail: anamburlea@yahoo.com
(corresponding author)
3
Infectious Diseases, Infectious Diseases Hospital,Iasi, ROMANIA. E-mail: emiftode@ya-
hoo.co.uk
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THEORIES ABOUT...
Introduction
Cystic fibrosis (CF) – an autosomal recessive disorder, is the most common

life-shortening genetic disease of Caucasian population. The disease affects mos-
tly the lungs, but also the pancreas, liver, kidneys and intestine. The feature of the
disorder and their severity varies among affected individuals. The management of
CF requires a daily, time-consuming treatment regimen that includes antibiotics,
nebulizers, chest physiotherapy, pancreatic enzyme replacement therapy, nutri-
tional therapy and the therapy of complications. Therefore, cystic fibrosis can
interfere or impair daily life activities and social interactions. Advances in medical
treatment have prolonged the life of patients with CF. Dealing with chronic illness
and societal pressure can lead to stress, anxiety and depression that have direct
and indirect consequences for health outcomes. Barbero remembers that “people
with CF are people first and not a disease” (Barbero, 1994). The disease affects
personal relationships, health status, body image, self-esteem and vocational
certainty.
Although actual treatment has considerably improved the survival of patients
with CF, the relevant psycho-social aspects have still been insufficiently con-
sidered. Due to the importance of identifying and treating the psychological and
psychiatric symptoms and of the consequences for long-term health outcomes, we
propose to present the impact of these psychological symptoms on health out-
comes, such as pulmonary exacerbations, nutritional status and on the quality of
life.
Impact of CF on the patient
Chronic illness, in particular CF, influences the children in all stages of de-
velopment. In the first 2 years of life the parent-child relationship is very important
for the developing of the infant and the quality of attachment predicts child
psychosocial factors like behavioral and emotional regulations, social skills and
the ability to cope with stress management. Children between 3-5 years of age
continue their psychosocial development, the understanding of the disease is
improved, but don’t understand the idea of death. Children between 5-9 years of
age recognize death, but regard it as a person (Teicher, 1969). They don’t under-
stand why they must take tablets and nebulized drugs and make physiotherapy
and their siblings or friends not. For patients between 9-12 years of age peer
acceptance is an important problem, the flatulence, tiredness and complex treat-
ment being obstacles to conformance to the peer group (De Wet & Cywes, 1984).
Young peoples can experience difficulties with learning due to school absenteeism
and extended periods of hospitalization.
205
Adolescence is a critical and tumultuous period enough without having a

serious disease. Adolescents experience many physical, cognitive, mental, emo-
tional and psychosocial changes. The health issues experienced by adolescents
with chronic diseases are linked to the illness they suffer from, to adolescence in
general and to psycho-social problems generated by the interaction between the
disease, the adolescent and his immediate environment (Sawyer S., 2012; Co-
jocaru & Popa, 2013). Adolescents with CF not only have to deal with the normal
changes expected, but also have to deal with the transition of assuming res-
ponsibility for their care from the parents and transitioning their care from a
pediatric to an adult care team. Moreover, many of these young adults have to
deal with the impact of the progressive deterioration of their disease. During
consultations, adolescents frequently ask “why do I have CF and not my sister or
my brother?” The presence of a complex chronic disease can complicate ado-
lescence by affecting pubertal status and stature. In adolescence, majority of
patients with CF report a dissatisfaction with their body due to the excessive
thinness, slightly protruding abdomen, mild clubbing of the fingertips and to the
delayed secondary sexual characteristics (De Wet & Cywes, 1984; Teicher, 1969,
Whiters, 2012) and the interface between bio-psychological development and
disease make this period challenging for the adolescent with CF. Visible signs of
illness and of treatment such as scars, physical “bumps” from indwelling intra-
venous access and take of the medication in front of peers can create significant
physical differences for children with CF. During adolescence, relationships
between both same and opposite sex peers come closer. Adolescents with CF
report that they have fewer friends and develop fewer relationships with persons
of the opposite sex. Related to this, most patients feel isolation and non-acceptance
by the peer group that could determine depression, anxiety and additional distress.
Different symptoms like flatulence, steatorrhoea and coughing are very distressing
and isolate adolescents (Whiters, 2012).
Presence of pulmonary exacerbations and of diabetes can adversely affect
quality of life of patients with CF. Respiratory infections are a danger, making
school a hazard. Pulmonary disease remains the most common cause of morbidity
and mortality in CF. The thick and viscous secretions provide an opportunistic
environment for the colonization of bacterial infections. Patients with CF are
susceptible to lower respiratory infections with very aggressive germs like P.aeru-
ginosa, H. Influenzae, S.aureus, Str. pyogenes. Once infection is established,
eradication is in many cases impossible and progressive lung disease often aggra-
vates morbidity and mortality risk (West, 2002). Pathogens the most frequently
involved in community acquired pneumonia are resistant to many antibiotics
(almost 20 % of cases), and by consequence, the treatment need to be done with
at least two antibiotics (in up to 80% of cases) or it could be initially inadequate
(Torres et al., 2014).
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THEORIES ABOUT...
In recent studies, CF is considered as a risk factor for multidrug resistant

strains. Frequent cures of antibiotics for pulmonary infections are followed by
adverse effects such as digestive troubles which impact the quality of life. Chronic
infection with transmissible P. aeruginosa strains confers a worse quality of life
in CF patients. Compared to patients with chronic infection, acquisition of spo-
radic P. aeruginosa may not significantly impact on the psychological wellbeing
of the patient (Ashish et al., 2012). Prevention of cross-infection with tran-
smissible strains is essential to ensure better physical and psychological outcomes
for patients with CF. For this reason and due to the bacterial resistance of the
organisms it is not recommended that patients with CF to come into contact with
other individuals with CF. Both patients and caregivers report a negative emotional
impact of not socializing with other patients and feelings of alienation created by
segregation. The isolation leads to a lack of peer support and potential social
isolation (Goldbeck, Fidika, Herle, & Quittner, 2014). Britto et al. (2002) observed
that the increasing number of pulmonary exacerbations in the previous 6 months
and the decreasing time since the last exacerbations have a detrimental effect on
QOL. Infections increase health care costs which include laboratory exams for the
detection of microbial pathogens, broad spectrum antibiotics and frequent hospi-
talizations. An effective way to prevent pulmonary infections is the vaccination of
children with CF. A recent study demonstrated the sustained declines in hospi-
talizations for childhood pneumonia during the decade after the introduction of
pneumococcal vaccine. Furthermore, substantial reductions in hospitalizations
for pneumonia among adults were observed. Vaccination of children has a great
impact on unvaccinated persons regarding the frequency of hospitalizations, the
decline in the length of stay, the stability of in-hospital rates of death from
pneumonia and antibiotic consumption (Griffin, Zhu, Moore, Whitney & Grijalva,
2014).
Cystic fibrosis related diabetes (CFRD) is distinct from type 1 and type 2
diabetes, but has features of both. CFRD occurs in approximately 20% of ado-
lescents with CF and the additional diagnosis of CFRD has a negative impact on
pulmonary function and survival in CF. CFRD can also have psychological impact
on children and their caregivers. The need for more demanding treatment and
different restrictions may have a heavy blow and an additional burden to the
patient with CF (Tolbert, 2003). Many patients with CFRD feel over-burdened by
the extra-health responsibilities. Successful management requires support from a
multi-disciplinary team with the necessary specialist knowledge and skills. Close
liaison between the CF team and the diabetes team is essential. Good commu-
nication between diabetes and CF care providers is essential because poor team
communication and inadequate information from health care providers have been
identified as significant sources of stress for patients with CFRD. The treatment
team should address psychosocial issues and recognize the risk of depression
(Moran et al., 2010). The CF treatment is complex and includes use of antibiotics
207
and nebulizers, enzyme replacement therapy, physiotherapy and nutritional therapy.

Many children with CF, especially adolescents refuse to take enzymes while
eating with friends. Frequently, the conflict between child and parent regarding
adherence to treatment can have negative impact on the emotional health of both
(Kamper, 2012). The adolescents and their parents considere that the three most
common barriers to treatment adherence are lack of time, forgetfulness and
unwillingness to take medication in public (Cohen-Cymberknoh, Shoseyov, &
Kerem, 2011). Poor adherence is also associated with higher heathcare costs and
wasted resources.
Adolescence is in the same time a period of experimentation and this may
include: new hair colors, body piercing, styles of dress, drug use, alcohol use
(13% drink more than recommended amounts), smoking (46% had tried smoking,
3% smoke regularly) and sexual activity (40% engaged in unprotected sex)
(Bryon, Havermans, & Noordhoek, 2012). Many teens with CF have said they use
alcohol or drugs to self medicate due to depression and anxiety and to seek a
temporary relief from the challenges of the disease (Sandu et al., 2013). De-
pression also contributes to self-harm, namely “cutting,” as well as eating disor-
ders. In teenage girls the desire to be thin can lead to non-adherence with pan-
creatic enzyme therapy and ignoring of dietary advice. The physical and emotional
impact of this experimentation can sometimes be much harder for teens with CF.
Adolescents present an increased awareness of the future and of death. The
morbidity and mortality factors pose cognitive, emotional, and behavioral challen-
ges for many children with CF and their families (Ernst, Johnson, & Stark, 2011).
Barbero (1994) has identified different obstacles that make difficult for the indi-
vidual with CF to adapt and accept the illness. One of them is vocational planning.
Though some chronic illness is associated with an increased risk of suicide, the
studies of teenagers with CF reported that the prevalence of suicide is not common
(Whiters, 2012). In the opinion of Pakhale S. et al. (2014) stigma has been
demonstrated to have a significant impact on health outcomes and quality of life
and could be associated with lower adherence to the treatment (Hutuleac, 2013).
Transition of the patients from a pediatric CF centre to an adult CF centre is
accompanied by physical, mental and social changes temporarily disrupting the
normal life and requiring a period of adjustment (De Vries, 2012). The transition
of the CF patients from adolescence to adulthood is more difficult because they
have to gain medical independence and to face the reality that there is no radical
medical treatment. The transfer of the patients can also generate anxiety and
many of them refuse to move from the pediatric centre (Pfeffer, Pfeffer, & Hodson,
2003, Whiters, 2012). With advancing life the patients’ self-esteem declines, the
frustration and emotional disturbance increased and the compliance decreased.
Drust et al. (2001) studied the psychosocial impact of lung transplantation and
they observed that the common emotional responses included manageable fear/
anxiety of lung rejection and uncertainty of the future, impatience with disruptions
208
THEORIES ABOUT...
of daily routines caused by post-transplant medical management and its effect on

the attainment of set goals, and frustration with parental over-protectiveness. In
patients with chronic diseases, inclusively in CF, anxiety and depression have
been shown to have direct and indirect consequences for health outcomes: less
compliance with medical and dietary regimens, frequent cancel or miss clinic
appointments, increased health care utilization, higher health care costs, worse
quality of life (QOL) (DiMatteo, Lepper, & Croghan, 2000; Katon & Chiek-
anowski, 2002; Whiters, 2012). Patients who are depressed are three times more
likely to be nonadherent than those who are not depressed. They are less likely to
follow dietary regimens and are also more likely to engage in risky behaviors
(smoking, drinking). Furthermore, children whose mothers exhibited depressive
symptoms are more likely to use the emergency department. (Cruz, Marciel,
Quittner, & Schechter, 2009). The barriers to treatment adherence include ina-
dequate knowledge, forgetting, rebellion, less parental supervision or forcing to
comply with treatment by the parents, a wish to conform to peers, difficulties with
time management and disagreeing with the physician (Pfeffer, et al., 2003; Whi-
ters, 2012).
Several mechanisms have been suggested for the link between depression and
poor adherence: (1) depressive symptoms may have an effect on self-care be-
haviors, such as diet, exercise, and disease management, because it is associated
with decreased energy and motivation to perform complex tasks; (2) depression is
associated with cognitive distortions including worse perceptions of self-efficacy,
which reflect one’s ability to initiate and accomplish complex tasks (Quittner et
al., 2008). Although actual treatment has considerably improved the survival of
patients with CF, the relevant psychological aspects have still been insufficiently
considered. This paucity of high quality research has led to an under-appreciation
of the prevalence of depression and anxiety in clinical practice in pediatric CF
population. Of the few studies of school-age children and adolescents with CF,
some reported a rate of depression ranging from 11% to 14.5% in contrast to a rate
of 2-6% in the general pediatric population (www.tides-cf.org). Published rates of
anxiety have ranged from 5% to 9% (Demyttenaere et al., 2004). Analyses of
comorbid symptoms indicated that adolescents reporting depression were 14.97
times more likely to report anxiety (Driscoll, et al, 2009). Burke cited by Cruz et
al. (2009) observed a high lifetime prevalence rate of specific anxiety disorders
(4% panic disorder, 11.5% phobias, 11.5% separation anxiety and 10% over-
anxious disorder. Quality of life (QOL) is a measure of the impact of the disease
on psychological, psychosocial and physical functioning. CF has a negative
impact especially on physical functioning aspects of QOL. Change of disease
severity may well be more likely to correlate to level of psychological and
psychosocial functioning (Pfeffer et al., 2003).
209
Impact of CF on the caregivers of children with CF
The newborn screening for CF has many benefits, but also presents some
hazards: false-positive values that may cause parental anxiety, false-negative
values that may lead to a delay in diagnosis and reporting of carriers may be
unwanted information and may cause discrimination. The diagnosis of CF causes
a number of emotions and for many the first reaction is “I can’ believe this”. The
communication of diagnosis of CF is followed by sorrow, depression, loss and
disempowerment for the parents. After communicating the diagnosis of CF, the
first consultation with parents should focus on the relationship between parents
and the team that monitors the child. Then, caregivers of children with CF may
experience a variety of significant stressors such as guilt for having passed a
genetic disease to one’s child, quarterly appointments with CF healthcare team,
hospitalizations due to pulmonary infections, time-consuming and complex treat-
ment regimens (minimum 45 minutes for nebulized antibiotics and chest physio-
therapy), decreased amount of time spent with other family members and shor-
tened life expectancy of the child (Driscoll, Montag-Leifling, Acton, & Modi,
2009). Parents of CF children are at risk of overprotecting their child. Fear of
infection determines the parents to restrict the physical movements, toys and
social contacts. All daily activities are affected indirectly by the diagnosis. For
example, mealtime is the area of most reported difficulty. The parents are con-
cerned to achieve a high daily caloric intake for their child, but they encounter
problems as food refusals, non-compliance to eat and leaving the table (Bryon,
2006).
In some cases, we can found negative psycho-social aspects related to the
evolution of the disease: (1) some parents think that if their child will go to
school, he will be overloaded and the disease will worsen; (2) other parents think
that frequenting the community, the chances of child to contact serious infections
are higher; (3) there are parents who worry about the incorrect administration of
treatment when the child will no longer be under their constant supervision (Pop
& Popa, 2006). For parents of children with CF the transition from child care to
adult care is an emotional step. If before the transfer the parents are responsible
for the child’s care, after the transfer they must gradually transfer it to the child
and adult healthcare professionals. The responsibility they feel towards com-
pliance of care of their child and the fear of decline are discouraging factors in
their role in the transition process (De Vries, 2012).
Little is known about depressive and anxious symptoms and QOL in caregivers
of children with CF. There are few studies that consider that the rate of depression
in parent caregivers is also high compared to parents of healthy children. In a trial
of 88 parents of young children with CF, ages 1 to 11 years, 29% of parents scored
in the clinical range on a depression screening tool. This is similar to a study of
role strain in parents of young children with CF, in which 36.4% of the mothers’
210
THEORIES ABOUT...
depressive symptoms fell within the clinical range (Quittner & Slater, 2005).
Furthermore, even higher rates of depression were reported in a study of parents
soon after the diagnosis, with 64% of mothers and 43% of fathers scoring in the
clinical range (Quittner, DiGirolamo, Michel & Eigen, 1992; Pfeffer et al., 2003).
So, family problems can affect the patients themselves. Many factors are asso-
ciated with psychological and psychiatric problems and poor Health Related
Quality of life (HRQOL): (1) inadequate knowledge and incorrect beliefs about
CF may be associated with the psychological distress; (2) the interaction between
nutrition, pulmonary inflammation response and lung health remains complexe
and incompletely understood, although there is a growing consensus that nutri-
tional interventions lead to the delay of the progression of pulmonary disease
(Milla, 2007). There is evidence that acute changes in health do have an effect on
QOL: (3) hospitalizations for pulmonary exacerbations have a significant and
negative impact on patient’s QOL (Bodnar, et al, 2014); (3) P. aeruginosa is the
most common pathogen in lung infections in patients with CF. The importance of
its early detection is due to its correlation with a more pronounced reduction in
pulmonary function, which results in impaired quality of life and poorer prognosis
of patients chronically colonized with the bacterium (WHO Technical Report,
1998); (4) comparatively with other European countries where neonatal screening
for CF is performed, in Romania the diagnosis of CF is usually delayed because
neonatal screening is not available. Therefore, it is difficult to prevent the develop-
ment of early lung disease. These negative differences compared to other countries
may decrease the life expectancy and the HRQOL; (5) nutritional status is corre-
lated with progression of lung disease, recovery from sickness and life expectancy;
(6) non-compliance to treatment: the reasons of accidental or intentional non-
compliance are inadequate knowledge, rejection or denying of diagnosis, psycho-
social resistance, educated non-adherence, forget-fullness, underestimating of the
severity of their disease, particular treatments; (7) from ages 12-18, adolescents
experience many physical, cognitive, emotional and psychosocial changes. The
interface between biopsychological development and disease make this period
challenging for the adolescent with CF.
Impact of CF on relationships in families of children

with this disease
Between mother of the child with CF and his child there is an intense reci-
procally interpersonal relationship. Mother try to be with her child as much as
possible and she want to try anything that might offer hope for cure. In the same
time, for the child hospitalized his mother’s absence is a cause of distress (Teicher,
1969). The long time spent and the increased cost for the caring of children with
CF determine social and financial deprivation of the other members of the family.
211
The life of the parents is centered on the child with CF and they consider
themselves as a major factor determining the child’s behaviour. In the same time,
the lack of communication between family members impairs family functioning,
causing separation and divorce. Other reasons that could explain the divorce is the
great genetic risk attached to further pregnancies in the families with a child with
CF, limited time due to the implementation of lengthy treatment regimens and
curbed holiday possibilities (De Wet & Cywes, 1984). The absence of divorce not
always means marital stability, the parents remaining together for the sake of the
child. Oppenheimer and Rucker (1980) observed that home treatment was more
efficient when children lived at home with both their parents then when family
was breakdown. On the other hand, Allan quoted by De Wet (1984) observed that
in an Australian study 25% of the marriages became more closely especially when
fathers are actively involved in the care of the child with CF and support the
mother in the periods of stress.
The disease also has impact on siblings of patients with CF: (1) the younger
siblings present somatic complaints, consider the treatment of their brother as
favoritism and sometimes simulate CF; (2) the older siblings are concerned and
have a protective attitude against the brothers with CF. The teenage girls expressed
some concern about the risk of being CF carrier; (3) the siblings closest in age to
the patient consider that they lacked the mother’s attention (De Wet & Cywes,
1984). The strong emotional reactions of having a child with a chronic illness
may promote more negative parenting relationships with well children. This
differential treatment may have effects on the siblings, the quality of the sibling
relationship being negatively affected with long-term social implications for both
children (Ernst, Johnson & Stark (2011).
Conclusions
Inadequate knowledge about CF may be associated with psychological distress.

Prevention of cross-infection with transmissible strains is important for a better
physical and psychological outcome. Precocious identification and effective treat-
ment of depressive and anxious symptoms could improve the patient’s daily
functioning and the disease management. For the early detection and effective
management of depression and anxiety in patients with CF it is necessary: (1) to
screen for these conditions annually together with primary care physicians; (2) to
develop decision rules about when to treat these symptoms in clinic versus referral
to outside specialists; (3) to establish a referral network of specialists in the
community who have experience treating depression in patients with chronic
illnesses; (4) to increase training for members of the CF multidisciplinary team
regarding depression and anxiety. A better psychological support means a better
212
THEORIES ABOUT...
psychological functioning. Good friends are a necessary source of support for

children with CF and could lead to minimizing the visible differences from others.
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Working together
www.rcis.ro
Ethical Implications of Bio-Psycho-Social

Transformations Entailed by the Aging Process
Ilinca UNTU1, Roxana CHIRITA2, Diana BULGARU-ILIESCU3,
Bogdan DANIEL CHIRILA4, Anamaria CIUBARA5, Stefan Lucian BURLEA6
Abstract
This paper aims at making a review of the latest works concerning the topic of
aging, particularizing the specificities of the aging process of the neuropsy-
chological functions and their causes, with a view on the social and ethical
implications of the psycho-cognitive deterioration entailed by aging and the
possible means of intervention for primary, secondary and tertiary prevention of
pathological mental aging. Our goal is to lay the groundwork for future studies
that are to elaborate well-defined guides of the aging phenomenon under all its
forms and at all levels it affects.
Keywords: pathological aging, theories of aging, dementia, cognitive reserve,

capacity, cognitive training
1
University of Medicine and Pharmacy „Grigore T. Popa”, Department of Psychiatry, Iasi,
ROMANIA. E-mail: ilinca_tzutzu@yahoo.com
2
University of Medicine and Pharmacy „Grigore T. Popa”, Department of Psychiatry Iasi,
ROMANIA. E-mail: d.stigma@gmail.com
3
University of Medicine and Pharmacy „Grigore T. Popa”, Department of Forensic Medicine,
Iasi, ROMANIA. E-mail: bulgarudiana@yahoo.com
4
ROMANIA. E-mail: c_bogdan_d@yahoo.com
5
ROMANIA. E-mail: anamburlea@yahoo.com. (corresponding author)
6
University of Medicine and Pharmacy „Grigore T. Popa”, Department of Anesthesilogy, Iasi,
ROMANIA. E-mail: lucianburlea@yahoo.com
216
THEORIES ABOUT...
Introduction
Considering that population aging is an ever more stringent phenomenon, at

both global and strictly national level, entailing a series of multidimensional
issues, this paper aims at making a review of the field literature on the causes of
the aging process, the potential means of preventing or slowing down the neuro-
psycho-degenerative processes that could be implemented as intervention means,
as well as on the ethical implications of the approach to elderly concerning their
self-care, self-conducting, self-management and decision-making capacities when
making legal decisions or choose various therapeutic interventions necessary to
them.
Epidemiologic elements of normal and pathological aging
At world level, the population aging process began in mid-20th century, having
a deep economic, political and social impact. The first aspect to discuss is how to
prioritize and promote the well-being of the elderly. Population aging process is
based on the rapid growth of the elderly percentage, caused on the one hand by
the high birth rates recorded at the beginning and the middle of the 20th century
and on the other hand by the increased life expectancy, which favours survival at
old ages. The elderly counted 841 million people in 2013, four times more than in
1950. This number is expected to triple by 2050. Hence, the percentage of people
aged over 60 was 12% in the 50s, 23% in 2013 and it is expected to reach 32% by
2050, with more or less significant variations depending on the standard of living
in various regions of the world. A functional definition states that a young old
person is aged 60/65-75, a middle old person 75-85 and a very old person over 85
(Atti et al., 2010).
Physiological/ normal aging represents the result of a natural maturing process,
while pathological aging is caused by factors such as brain disease or cerebral
trauma. Hence, if a deteriorating aspect is not ascribed to a well-defined pathology,
then aging ranges within normal parameters, while the existence of a triggering
element makes aging pathological. Though gerontology uses the concept of patho-
logical or abnormal aging when there are variations from normality, a clear
differentiation between normal and pathological aging remains a challenge. One
of the best-known and severe forms of pathological aging is dementia, mate-
rialized by global psycho-cognitive deterioration and a significant and rapid
alteration of the patient’s general functionality. The world economic impact of
dementia is overwhelming, being estimated to 604 billion dollars in 2010. In the
absence of effective primary and secondary prevention means, costs are expected
to double by 2030. At the same time, both physiological and pathological aging
entail a series of mental transformations, which often raise ethical issues regarding
217
the multidisciplinary approach to this population group (World Population Aging,

2013).
Theories on aging process
Aging is a dynamic process to which the central nervous system subjected,

based on the axonal reconnection neuroplasticity and on a limited regeneration
and repair capacity of the central nervous system. Although lost cells are not
replaced, they are taken over by reserve neurons, through a mechanism of bio-
chemical compensation on pre-synaptic and post-synaptic level. In aging-related
neurodegenerative diseases, the dopaminergic neuron mass decreases considera-
bly, dependent on trophic support (brain derived neurotrophic factor and glial cell
derived neurotrophic factor) (Del Arco, 2011).
Contemporary biological theories on the aging process are grouped into two
main categories: programmed theories and error theories. The first posits that
aging follows a biological course that continues the process of growth, deve-
lopment and maturing. This process depends on alterations in the expression of
genes responsible for maintenance, repair and defence systems. Hence, it features
three fundamental components: programmed longevity, endocrine theory and
immunological theory (Whitney, 2009). The first launches the concept of aging,
as a result of the sequential switch of activating and inactivating certain genes,
until age-related deficits become manifest. On the other hand, endocrine theory
posits that biological clocks are hormonally modulated concerning the tempori-
zation of the aging process, while immunological theory states that the immune
system has a programmed decline over time, with increasing vulnerability towards
infectious agents (Song, 2009). A well-documented element is that the immune
system reaches its efficacy peak in puberty, and that it decreases gradually. Hence,
the aging process is associated with marked decrease of antibody efficiency, the
pathogenic agents being harder to combat, which leads to cell stress and even
death. Disorders related to immune response are correlated with cardiovascular
conditions, with inflammatory processes, with oncogenesis and, not least, with
Alzheimer’s disease (Jin, 2010).
Error theories underline the fundamental role of the exogenous attack upon
human body, which leads to the creation of cumulative prejudices on various
levels, thus causing aging. They include wear and tear theory, rate of living
theory, cross-linking theory, free radicals theory and somatic DNA damage theory
(Miron et al., 2014). The first refers to the fact that cells and tissues have vital
parts that wear and tear, thus leading to aging. The second theory is based on the
idea that the rate of basal oxygen metabolism is inversely proportional with the
duration of life and with the aging process. Cross- linking theory posits that the
accumulation of certain proteins alters cells and tissues, which results in aging.
218
THEORIES ABOUT...
Free radicals theory underscores that superoxide and the other reactive species of
oxygen determine damage on the level of cell macromolecular components, which
gradually leads to organic dysfunctions and to its shutdown; eventually, to the
shutdown of the entire body (Reichman, Fiocco & Rose, 2010). Macromolecules
such as nucleic acids, lipids, carbohydrates and proteins are prone to the attack of
free radicals. Somatic DNA damage theory refers to the fact that DNA alteration
is continual in every cell of our body. While some of the alterations are repaired,
others accumulate gradually because repairing factors do not act as rapidly as
damaging factors. Gene mutations have a cumulative character because of aging,
leading to cell deterioration and dysfunction. Hence, the aging process can be
caused by the alteration of gene integrity of the body cells (Jin, 2010).
Deterioration and its relationship with the notion of cognitive reserve
A series of neuropsychiatric conditions affect mainly the elderly; one of the

most common ones is Alzheimer’s disease, usually diagnosed after the age of 65.
Dementia is an acquired and persistent syndrome that impairs the mnesic function
and the global cognitive capacities, which leads to decrease or even loss of
functions (Atti, 2010). The most frequent cause of dementia is Alzheimer’s
disease: 50-75% of all cases. However, a series of studies conducted post-mortem
have demonstrated that many of these cases actually represent dementias of mixed
aetiology, being usually a mixture of elements specific to Alzheimer’s disease and
of vascular elements. In early stages, its most common symptom is a significant
decrease in the capacity to acquire new information, based on the impairment of
mnesic function. Recent studies have reported that neuronal stem cells within
adult brain hippocampus are involved in memory functioning. Their number drops
considerably with age, but the underlying mechanism is still a topic to debate. The
theory of telomeres has proved that they shorten by each successive cell division.
When telomeres drop to a critical length, cells do not replicate significantly; this
leads to cell death, organic dysfunction and the exitus of the entire body. The
concept of cognitive reserve refers to the maintaining of the operative capacity of
the brain, despite the alteration of global functionality related to aging. Human
cognitive reserve varies by genetic factors, education level, lifestyle and envi-
ronmental factors. Cognitive reserve also represents the capacity of increasing the
efficiency and capacity of existing neuronal pathways and of recruiting new
pathways that are not specifically assigned a certain task. Individuals with higher
cognitive reserve will feature cognitive processes that are more flexible, involving
longer asymptomatic periods, despite potential neurovascular injury. Hence, the
term cognitive reserve is essentially different from brain reserve, which refers
strictly to neuronal and synaptic density. In this context, it has been proven that
individuals with similar brain reserve show different manifestations following
brain injury, depending on the complexity and flexibility of their cognitive
219
processes (that is, the cognitive reserve potential) (Sperling, Mormino & Johnson,
2014).
Cognitive deterioration and cognitive training means
In time, all individuals become subjected to a certain degree of cognitive

decline; it has been proven that the deterioration of the biological background of
the cognitive functions has its earliest onset in the mid-thirties. This onset includes
regional reduction in brain volume, alteration of myelin integrity, cortex thinning,
alteration of dopamine, serotonin and acetylcholine receptors functionality, accu-
mulation of neurofibrillary deposits and changes in brain metabolites concen-
tration. These misbalances determine cumulatively a series of signs and symptoms
associated to aging, having in the foreground the psycho-cognitive deterioration
accompanied by subsequent decrease in global functionality (Reichman, Fiocco
& Rose, 2010). The cognitive decline does not affect the elderly to the same
extent; its severity depends on a series of factors, such as oxidative stress, chronic
inflammation, endocrine issues, endothelial function, excess weight, poor nutri-
tion (leading to numerous deficits), lifestyle, social activity, the presence of other
somatic conditions. Considering the nature of most of these elements, a series of
transformations are modifiable; the proactive change of lifestyle, the positive
modification of diet and cognitive training proved effective in slowing down
intellectual decline and in the long-term maintaining of good overall functioning
(Sperling, Mormino & Johnson, 2014).
There are two categories of approaching methods concerning cognitive trai-
ning: compensating and restorative. Compensating training concerns acquiring
new ways of accomplishing diverse cognitive tasks, practically, it refers to cate-
gorising and visualizing information to be stored, as well as to using external
helpful elements, such as notes or calendars. Restorative methods concern the
consolidation of specific cognitive fields, with the purpose of improving fun-
ctional performance. A series of more recent studies have demonstrated the
importance and benefit of non-traditional pro-cognitive activities, such as social
networks, recreational activities, exercising, and other integrated activities. The
benefit of conducting multidimensional activities involving creativity and skill
development is obvious (Stine-Morrow, 2008).
220
THEORIES ABOUT...
Impact of aging-related psycho-cognitive deterioration on global

functioning
Cognitive decline – just like depressive symptomatology – plays a fundamental

role in the functional disability of the elderly; a major issue related to functional
aging is the relationship between active life and the period spent in debilitating,
pathological conditions. In this sense, the concepts of active life expectancy and
non-debilitating life expectancy are to be underscored (Bulgaru- Iliescu et al.,
2013).
Specialists within the field of geriatric psychiatry are forced to deal with
numerous and significant ethical and medical challenges while treating old pa-
tients with psychiatric conditions (with or without dementia).
Normal aging is accompanied by the onset of numerous somatic pathologies.
Mental diseases are common at this age, diagnosing them being often a challenge.
Dementia involves intellectual impairment, the decline being progressive. Old
people – especially those with many associated pathologies – are considered to be
non-contributors; they depend on the socio-familial support systems and they are
prone to social marginalization. Multiple losses inherent to the life of the elderly
– such as the death of family members and friends, health decline, loss of status
and roles or a change in roles, loss of independence, of home safety, lower standard
of living – lead to lower quality of life and to the accentuation of psychiatric
disturbances among the elderly (Fjell, 2010). Loss is a predominant theme and
reactive depression represents a frequent response to it, manifested by lack of
appetite, sleep disturbances, decreased interest for usually pleasant activities,
anhedonia, flat affect, sense of uselessness, memory and cognition deterioration.
Actually, cognition deterioration requires a rigorous assessment and a clear diffe-
rential diagnostic, compared to dementia (Cohen, 2006).
Society is interested in maintaining optimal autonomy and quality of life
among the elderly, and in preventing any kind of abuse toward these persons
(possible because of cognitive decline). Discernment is assessed through an
expertise conducted by a medical and legal psychiatric committee, following a
clinical psychiatric and psychological examination. In the end, the committee
decides whether the person in question is or not competent or benefits from
discernment (a psychiatric or neurological condition leads to lack of discernment).
Such an incompetent person is unable to understand, appraise or decide on daily
matters (Sprehe, 2003).
221
Ethical implications of normal/pathological aging process
Discernment, responsibility and competence become fundamental in the

management of old persons with mental conditions; their consent has to be valid,
informed and non-coercive when concerning issues such as accepting medication,
determining the tutorship, guardianship, determining the reliability of the will,
suspending driver’s license, or other situations pertaining to family civil code or
even to criminal code. Things become complicated when these patients have
nobody to look after them or when there are conflicts of interests with the
caregivers (Rosner, 2003).
Older patients – with or without dementia – may or may not be able to represent
their own interests or to manage their own lives. Competence represents the
capacity of performing tasks specific to the management of daily activities and of
money, of understanding the nature and consequences of their acts, of decision-
making. Competence is a juridical term which means to have enough resources
(capacity, ability and authority), while discernment represents a functional term
related to the individual’s capacity of making decisions and of performing certain
acts, of understanding the nature and consequences of their acts (Stoppe, 2008).
Medical and legal psychiatric expertise determines whether the patient is com-
petent or non-competent. Standards regarding the general competence of the
elderly promote, as defining elements of discernment, awareness of their own life
situations, space and time orientation and self-orientation, capacity of under-
standing the consequences of their acts, memory, judgment capacity, intellectual
function decline, potential emotional disturbances accompanying the aging pro-
cess and overall functionality (Georges, 2005).
When the discernment and competence of psychiatric patients are abolished or
reduced in the context of psychiatric pathology, the elderly usually suffering from
psycho-cognitive deterioration, tutorship or guardianship is required to ensure the
individual rights of these patients. A third person, acting as a tutor, makes im-
portant decisions on behalf or in the interest of the patient. When applicable, the
instructions given by the patient before symptomatic cognitive deterioration and
before becoming non-competent will be observed (concerning their treatment and
care in terminal stages) (Oprea et al., 2013). Through such a document, patients
with dementia can exercise their right to self-determination (Cohen, 2004).
Medical and legal psycho-geriatric examination involves a routine clinical,
psychological and paraclinical evaluation, in cases where cognitive deterioration
is suspected (mostly dementias, pseudo-dementias, delirium, sudden onset di-
seases and progressive deterioration diseases, fluctuating states of confusions,
focal deficiencies) (Bulgaru-Iliescu, Costea, Enache, Oprea, Gheorghiu, Ast\-
r\stoae, 2013). Old age and eccentric or violent behaviour does not automatically
mean lack of discernment. Mental aspects specific to the elderly include reticence
222
THEORIES ABOUT...
toward financial issues and family relationships, strong religious or political

beliefs, denial of death, fear of abandonment, hypochondriac ideas (that worsen
pre-existing somatic symptoms) and the desire to be approved. The medical and
legal psycho-geriatric examination must comprise a rigorous evaluation of cog-
nitive function and of global orientation and functionality using specific scales
(Georges, 2005).
The main ethical dilemmas in dementia refer to the decision of reducing the
therapeutic program with expensive drugs, the decision of transferring the patient
to a specialized facility, confidentiality clauses, psychiatric treatment and social
control rules (from patients’ rights to social needs versus human rights, to legal
and ethical regulations in medicine, palliative treatments and care) (Bulgaru-
Iliescu et al., 2013).
Geriatric judicial psychiatry does not exist as independent specialization any-
where in the world yet, because it is considered that only a few old persons
commit criminal acts; the only attitude requested is to pay more attention to the
elderly, mostly to their needs in terms of mental health. Healthcare standards need
improving, especially those regarding basic needs and the quality of life. Low
socio-economic level and the social awareness of aging (especially pathological
aging) influence the quality of life and the rehabilitation of older patients, as well
as the prevalence of mental diseases at this age (Gestenbrand, Struhal, Baum-
gartner, Raynoschek, 2005). The psychiatric examiner often oscillates between
legal and ethical accuracy: absence of disease does not mean good health. Family
code defines total guardianship and its conditions following an evaluation by a
medical and legal psychiatric committee that sets the diagnosis of a mental
condition or of a disability and that determines whether the person is incapacitated
or not (Rosner, 2003).
The application of criminal code in the elderly who committed a criminal
offence refers to their competence when the act was committed, to the competence
of procedure and power of understanding and to the competence of standing as a
witness. The implication of the geriatric psychiatrist in the treatment, care and
evaluation of felons with mental illnesses and the implication of psychiatrists in
the ethical issues raised represent fundamental dilemmas of psychiatrists and
geriatric psychiatrists (Rosner, 2003).
Conclusions
It is anticipated that the world population will continue to grow older at an

even faster rate, cognitive disorders in general and Alzheimer’s disease in parti-
cular becoming nosological phenomena of paramount socio-economic impor-
tance. This means that more attention should be paid to prevention methods for
aging-related cognitive decline and to the prevention of psycho-cognitive
223
deteriorating processes related to dementia with various aetiologies (especially in

Alzheimer’s disease and vascular causes which are most common and often
interconnected). At the same time, the aging processes entailing various degrees
of cognitive deterioration and decrease in mental functions involve various ethical
specificities. These specificities concern the protection of the elderly from their
own physical self-care incapacity, their financial interests or their decisions con-
cerning necessary therapeutic elements. This set of complex issues raised by the
aging process, especially in its pathological aspects (often dementia), underline,
once more, the need to find concrete means of approaching aging as a phenomenon
and each old person from a multidisciplinary perspective, in order to increase
their quality of life. This paper, elaborated as a synthesis concerning the general
aspects of the aging process, its ethical implications and the methods to prevent
and mitigate mental deterioration, aims to represent a theoretical starting point for
future research and for the creation of optimal intervention means to overcome
the problems related to old age.
Aknowledgements
This papers was funded by Project “Moral and Professional Profile Study of
the Expert from the Forensic Psychiatric Committees in Romania”, financed by
University of Medicine and Pharmacy „Grigore T. Popa”, Iasi.
References
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Distinguishing between Consequences of Neglect and Poverty on Problem

Impact of Residence on Dental Fear and Anxiety in Romanian Children

Perverse Effects of Change in the Romanian Academic Field

Distinguishing between Consequences

The aim of this study is to distinguish between consequences of neglect and

Keywords: neglect, poverty, externalizing behavior problems, internalizing.

Table 1. Demographic scores

Figure 1 shows percentages of students with behavior problems in each group,

Figure 1. Percentage of subjects with behavior problems assessing with de ICAP.

Arruabarrena, M.I., De Paúl, J. & Torres, B. (1994). El maltrato infantil. Detección,

The Relation between Personality Traits,

The development of posttraumatic stress disorder is a common risk for persons

aenssens, De Gucht, & Maes, 2015; Bernaldo-De-Quiros, Piccini, Gomez, &

Personality and traumatic stress

posttraumatic stress and extraversion or a negative association between these

The role of social support

Social support is a complex construct that originates from a variety of sources

The present study

A researcher presented the research as an exploration study of the employers’

their evaluation. The participants completed all measures anonymously to protect

In order to test for a possible bias, we conducted an analysis of variance (One-

The association between personality traits, social support and traumatic

Neuroticism positively correlated with intrusion, avoidance, arousal, the re-

Note: N – neuroticism, E – extraversion, A – agreeableness, O –openness, C -

Testing for moderation

-0.20* -.34** -.10

Figure 2. Presence of intrusions as a function of extraversion and emotional/

Figure 3. Presence of avoidance as a function of openness and emotional/

Figure 4. Presence of arousal as a function of openness and emotional/ informational

Limitation and future research directions

Several limitations should be mentioned. Firstly, because the study is cross-

This paper is supported by the Sectoral Operational Programme Human Re-

Resources of Resilience amongst

Keywords: resilience, perturbing factors, sufferance/pain, individual/collective

In the psychological language, resilience is frequently named “personal re-

Results of the field research

Perturbing factors and destabilising causes

Table 1. Hierarchy of pain or sufferance categories (according to self perception)

It can be noticed that there were four categories of causes or traumatising

Types and forms of resilience

Table 2. General evaluation of personal life (according to success and failures)

No. Categories de options %

Capacity of resilience against pain/sufferance

Table 3. Types of pain/sufferance (by time of manifestation)

The greatest Time of manifestation Total

The effects of pain/sufferance. The research evidenced six important consequences,

Table 5. Capacity of resilience (by types of pain/sufferance)

Table 6. Ways and solutions to transcend the sufferance

The greatest pain/ Ways to transcend the sufferance Total

disappearance of 42.9% 0.0% 0.0% 21.8% 12.1% 12.1% 12.1% 100.0%

Table 7. Capacity of resilience (by gender)

Up until now, have you managed to Gender Total

Table 8. Capacity of resilience (by age)

Up until now, have you Age Total

Table 9. Capacity of resilience (by legal status)

Up until now, have you Legal status Total

The first researches on personal resilience belong to some specialists in