Psychological wellbeing of Turkish university students with physical impairments: An evaluation within the stress-vulnerability paradigm

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Psychological wellbeing of Turkish university

students with physical impairments: An

evaluation within the stress-vulnerability

paradigm

Mujde Koca-Atabey a b , A. Nuray Karanci

a , Gulay Dirik

c & Deniz Aydemir

d

a Department of Psychology, Middle East Technical University, Ankara, Turkey

b TUBITAK, Ankara, Turkey

c Department of Psychology, Uludag University, Bursa, Turkey

d Department of Psychological Counselling and Guidance, Middle East Technical

University, Ankara, Turkey

Available online: 24 Nov 2010

To cite this article: Mujde Koca-Atabey, A. Nuray Karanci, Gulay Dirik & Deniz Aydemir (2011): Psychological

wellbeing of Turkish university students with physical impairments: An evaluation within the stress-vulnerability

paradigm, International Journal of Psychology, 46:2, 106-118

To link to this article: http://dx.doi.org/10.1080/00207594.2010.513413

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INTERNATIONAL JOURNAL OF PSYCHOLOGY, 2011, 46 (2), 106–118

Psychological wellbeing of Turkish universitystudents with physical impairments: An evaluation

within the stress-vulnerability paradigm

Mujde Koca-Atabey1,2, A. Nuray Karanci1, Gulay Dirik3, and Deniz Aydemir4

1Department of Psychology, Middle East Technical University, Ankara, Turkey2TUBITAK, Ankara, Turkey3Department of Psychology, Uludag University, Bursa, Turkey4Department of Psychological Counselling and Guidance, Middle East Technical University,Ankara, Turkey

G enerally, universities in developing countries offer little in the way of provisions and support (material,emotional, etc.) for disabled students. Therefore, disabled students experience considerable burdens and

barriers in their educational life. This study investigated the psychological wellbeing of disabled Turkishuniversity students by examining influences on stress-related growth and psychological distress. Disability isdefined within the framework of a social model. According to this view, impairment refers to the functionallimitation(s) that affect(s) a person’s body, whereas disability refers to the loss or limitation of opportunitiesowing to social, physical or psychological obstacles. Seventy disabled university students with physicalimpairments were administered a questionnaire package, including a sociodemographic information sheet, Waysof Coping Questionnaire, Stress-Related Growth Scale, Multidimensional Scale of Social Support, Life EventsInventory, and Brief Symptom Inventory. Snowball sampling was used and voluntary participation was essential.The results showed that disability burden, daily hassles, and helplessness coping were significant predictors ofpsychological symptoms. For stress-related growth the only variable that appeared significant was problem-solving coping. The results pointed out that there may be different pathways to distress and growth. In order todecrease psychological distress and enhance growth in disabled university students, disability awarenessprograms, changes in the barriers in the academic and physical environments of the university campuses, andcoping skills training to increase problem-focused coping and to combat helplessness may prove to be effective.Reducing daily hassles for the disabled students is likely to contribute to their wellbeing by decreasing theirburdens. Also, a more disability-friendly environment is likely to be empowering for disabled university students.

Keywords: Disabled university students; Psychological distress; Stress-related growth; Stress-vulnerability model;Social model of disability.

E n general, les universites des pays en voie de developpement offrent peu de prestations et d’aide (materielles,emotionnelles etc.) aux etudiants handicapes. Par consequent, ces etudiants experimentent un fardeau et des

obstacles considerables durant leur education. Cette etude evalue le bien etre psychologique d’etudiantsuniversitaires turques handicapes en examinant les facteurs relies au developpement du stress et a la detressepsychologique. Le handicap est defini a l’interieur de la structure d’un modele social. Selon ce point de vue,l’infirmite refere a(aux) la limitation(s) fonctionnelle(s) qui affecte(nt) le corps de la personne, tandis que lehandicap refere a la perte ou a la limitation des opportunites en raison d’obstacles sociaux, physiques oupsychologiques. Soixante dix etudiants avec handicaps physiques ont repondu a un ensemble de questionnairesincluant une feuille d’informations socio-demographiques, ‘‘Ways of Coping Questionnaire’’, ‘‘Stress-RelatedGrowth Scale’’, ‘‘Multidimensional Scale of Social Support’’, ‘‘Life Events Inventory’’ and ‘‘Brief SymptomInventory’’. La methode d’echantillonnage ‘‘snowball’’ a ete utilisee et la participation volontaire etait essentielle.Les resultats montrent que le fardeau du handicap, les complications journalieres, l’adaptation a la resignationetaient des predicteurs significatifs de symptomes psychologiques. Pour le developpement du stress la seule

Correspondence should be addressed to Mujde Koca-Atabey, Tubitak-Sobag, Tunus Caddesi No:80 Kavaklidere/Ankara, Turkey.E-mail: [email protected] or [email protected]

! 2010 International Union of Psychological Science

http://www.psypress.com/ijp DOI: 10.1080/00207594.2010.513413

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variable significative est l’adaptation a la resolution de problemes. Les resultats indiquent qu’il y a peut etredifferents chemins vers la detresse et la croissance. De maniere a decroıtre la detresse psychologique et augmenterle developpement chez ces etudiants, des programmes de prise de conscience des handicaps, des changements auxobstacles academiques et environnementaux au sein du campus universitaire ainsi que des formations permettantd’augmenter l’adaptation visant les problemes et de combattre la resignation peuvent s’averer efficaces. Reduireles complications journalieres contribuera fortement a leur bien etre en les soulageant de leurs fardeaux. Aussi, unenvironnement plus convivial pour les handicapes devrait probablement permettre l’autonomisation de cesetudiants.

E n general, las universidades de los paıses en vıas de desarrollo ofrecen pocas provisiones y apoyo (material,emocional, etc.) a los estudiantes discapacitados. Por lo tanto, los estudiantes con discapacidades

experimentan una considerable carga y barreras en su vida educativa. Este estudio investigo el bienestarpsicologico de los estudiantes universitarios turcos con discapacidad a traves de la evaluacion de los factoresrelacionados con el crecimiento del estres y las dificultades psicologicas. La discapacidad se define en el marco deun modelo social. De acuerdo a esta perspectiva, el impedimento se refiere a la/s limitacion/es funcional/es queafectan el cuerpo de una persona, mientras que la discapacidad se refiere a la perdida o limitacion deoportunidades debido a obstaculos sociales, fısicos o psicologicos. Se les administro una baterıa de cuestionariosa setenta estudiantes universitarios discapacitados con impedimentos fısicos, incluyendo una hoja de informacionsocio-demografica, el Ways of Coping Questionnaire [Cuestionario de Estilos de Afrontamiento], la Stress-Related Growth Scale [Escala de Crecimiento Relacionado al Estres], la Multidimensional Scale of SocialSupport [Escala Multidimensional de Apoyo Social], el Life Events Inventory [Inventario de Acontecimientos deVida] y el Brief Symptom Inventory [Breve Inventario de Sıntomas]. Para el muestreo se utilizo el metodo de bolade nieve y la participacion voluntaria fue esencial. Los resultados mostraron que la carga de discapacidad, losproblemas cotidianos y la indefension en el afrontamiento fueron predictores significativos de sıntomaspsicologicos. Para el crecimiento relacionado al estres la unica variable que se mostro significativa fue elafrontamiento a traves de la resolucion de problemas. Los resultados indicaron que parecen existir recorridosdiferentes conducentes al estres y al crecimiento. Con el fin de disminuir el sufrimiento psicologico y estimular elcrecimiento en los estudiantes universitarios con discapacidad, los programas de concientizacion acerca de ladiscapacidad, el cambio en las barreras del entorno fısico y academico de las instituciones universitarias y elentrenamiento en las habilidades de afrontamiento para incrementar el afrontamiento centrado en el problema ypara luchar contra la indefension pueden mostrar ser efectivas. Es probable que la reduccion de los problemascotidianos de los estudiantes con discapacidad contribuya a su bienestar disminuyendo sus cargas. Ademas, esprobable que un entorno mas apto para personas minusvalidas le otorgue mas poder a los estudiantesuniversitarios con discapacidad.

According to the social model, disability refers tothe loss or limitation of opportunities due tophysical, social and psychological barriers (Morris,1993). In line with this view, the society plays acritical role in determining a person’s disability.Although the social model of disability is criticizedfor creating a dichotomy in relation to disabilityand impairment it is also important and useful inwinning the battle about barrier removal(Sheakespeare & Watson, 2002). Therefore, inthis paper we use the term ‘‘disability’’ to stress theimportance of barriers that may hinder studentswith physical impairments in reaching their goalsand adjusting to university life. Kang (2009) notedthe importance of language that is used indisability studies and emphasized that it mayplay a constructive or deconstructive role.

The present study aims to examine the wellbeingof disabled university students in Turkey:a developing, secular, and predominantly Muslimcountry that has an impairment-unfriendly envir-onment in general. For example, universities lack

lifts in major buildings, hindering access to crucialresources. Due to the high demand for universityeducation and the relative scarcity of universitiesthere is tough competition for a university place-ment in Turkey. Placements are made on the basisof performance in the central university entranceexamination. Only 11.5% of high-school studentstaking this examination get the opportunity to beplaced in a bachelor’s degree program. Thisproportion drops to 9% for the disabled applicants(Student Selection and Placement Center, 2006).In order to understand the situation for disabled

students, a clear definition of disability is required.It can be argued that no two people are identical intheir type of disability, since disability is deter-mined not solely by impairments but is also bysocietal provisions and barriers (Barnes & Mercer,2003; Morris, 1991). Thus, an inability to speak isan impairment but an inability to communicate dueto the lack of appropriate technical aids is adisability. Similarly, an inability to walk is animpairment but an inability to access a building

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because of the stairs and lack of elevators is adisability. Thus, physical, social, or attitudinalbarriers are more important then the limitations ofan individual (Morris, 1993). Pollard and Kennedy(2007) stated that the anxiety and depression levelsof people who are disabled (due to a spinal cordinjury) are related with their coping strategiesrather than the level of injury or functionalindependence. In contrast to the social model ofdisability, the medical model argues that disabilityis a type of illness. According to this view, disabilityshould be conceptualized within clinical terms andmedical professionals are given the role of expertsin this area (Oliver, 1996; Ong-Dean, 2005).Due to the lack of facilities (lifts in buildings,

sound alert systems in crossings, wheelchair access,etc.) to ease the burdens of impairment inuniversity campuses in Turkey and the lack ofeducational facilitators, it can be expected thatdisabled Turkish university students may experi-ence considerably more burden than disabledstudents in more developed countries. Tufan(2007) stated that in Turkey, disabled people areexcluded from almost every area of society. Theirneeds are neglected in designing physical environ-ments and their rights are disregarded in the legalarena. It is obvious that the general disabilityframework in our country is based on the medicalmodel of disability, perceiving the disabled personas a remediable person who is ill (cited in Tufan,2008). However, disability should be interpreted asa conception, which rests on social conditions(Tufan, 2007). One of the rare studies in Turkey ondisabled university students found that the pro-blems regarding exams, library, and refectory aremuch more severe for disabled students ascompared to nondisabled counterparts (Dokmen& Tutarel-Kislak, 2004).Holloway (2001) stated that disability in the

educational setting should be perceived as result-ing from the limitations of the systems availablefor accessing the course information.The university experience of disabled studentsmay depend on their perceptions and attitudestoward their disabilities (Fuller, Healey, Bradley,& Hall, 2004), but it also may depend on the levelof support available for each student. Even thoughrecruiting disabled students might be an opportu-nity to enrich the academic environment for bothdisabled and nondisabled students (Ash, Bellew,Davies, Newman, & Richardson, 1997), disabledstudents generally have a longer and more difficultjourney to higher education than their nondisabledcounterparts (Koca, 2005). University entrance ofdisabled students may be hindered either implicitlyor explicitly by the effects of ‘‘ableism’’ (Paterson,

Hogan, & Wills, 2008). Collinson and Penketh(2010) explored personal narratives of learninghistories of six postgraduates and academics withdyslexia. They reported that most of the dyslexicpeople were excluded from formal education andthey could not reach higher education. Althoughthey are generally excluded from formal education,some dyslexic people show resistance and partici-pate in formal learning in later life.

On the other hand, access to university hasmany different aspects, such as physical access(i.e., being able to access the buildings), academicaccess (i.e., accessing the course information andthe instructors), or social access (i.e., participatingin social club activities). Therefore, disabledstudents can experience considerable stress andbarriers that may show variations dependent onthe opportunities given to them in pursuing theirgoals towards a university degree. Anderson,Madill, Warren, and Vargo (1996) stated thatdisabled students expressed concerns related tophysical barriers in the university buildings, theneed for emotional support and ongoing adjust-ment to disability, which are not identified bynondisabled students. Similarly, university staffmay not be sensitive to the emotional needs ofdisabled students. The attention of students maybe drawn to disabled students by insensitive andunwelcoming staff. Goode (2007) provides anexample of a deaf student who was publiclyidentified as such by a lecturer in the context ofa class discussion about euthanasia.

According to the diathesis-stress model, eachindividual is endowed with a degree of diathesisthat interacts with stressful circumstances to lead todistress or psychological problems (Zubin &Spring, 1977). Personality characteristics, such asoptimism, neuroticism, and introversion(e.g., Brisetta, Scheier, & Carver, 2002; Chemers,Hu, & Garcia, 2001; Chung, Berger, & Rudd,2007), ways of coping, such as active problem-focused coping and emotion-focused coping(e.g., Leong, Bonz, & Zachar, 1997; Zea, Jarama,& Bianchi, 1995), and lack of social support(e.g., Tao, Dong, Pratt, Hunsberger, & Pancer,2000) are among these vulnerability factors. On thestress side, major negative life events and dailyhassles are important sources of stress(e.g., Dunkel-Schetter & Lobel, 1990; Pancer,Hunsberger, Pratt, & Alisat, 2000). Disability canbe viewed as a condition creating stress especially innonsustainable physical (Casas, 2007) and preju-diced social environments (Hahn, 1988).Furthermore, the daily hassles created by lack ofallowances for students with special needs mayconstitute stress that may lead to psychological

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distress, especially when they occur together withineffective coping strategies.

Although the negative effects of exposure tostress and traumatic life events have been exten-sively studies, more recently studies also demon-strated that people experience positive changes as aconsequence of coping with traumatic or highlystressful life events (Morris, Shakespeare-Finch,Rieck, & Newbery, 2005; Taku, Lawrence,Calhoun & Tedeschi, 2008; Tedeschi, Park, &Calhoun, 1999). Positive change following traumaand adversity has been labeled as posttraumaticgrowth (PTG), stress-related growth, positiveadjustment, positive adaptation, thriving, positiveby-products, blessings, and adversarial growth(Linley & Josepph, 2004). Posttraumatic growthis conceptualized by Keechi and colleagues(Tedeschi, Park, & Calhoun, 1999) as significantchanges in emotions and cognitions, which mayalso lead to changes in behaviors.

Studies have shown that individuals may experi-ence posttraumatic growth after exposure to avariety of traumas, such as bereavement amongHIV/AIDS caregivers (Cadell, 2007; Cadell &Marshall, 2007) breast cancer survivors and theirhusbands (Weiss, 2004), patients with breast cancer(Karanci & Erkam, 2007), and patients with heartdisease (Sheikh, 2004). Although research on PTGis flourishing, some researchers question thevalidity of the concept and propose that withoutaction, and especially when reported close to theevent, PTG may be a self-defensive strategy, andthus can be taken as a coping strategy rather than atrue transformation (Zoellner & Maercker, 2006).Furthermore, the type of event that has thepotential of leading to PTG is also debated andgenerally the model posits that only stronglydistressing events can pave the way to PTG(Tedeschi & Calhoun, 1996). Being disabled canalso be taken as a severe adverse or traumaticevent, which may lead to both distress and growth.

The relationship between disability and stress-related growth is a complex one. Turner and Cox(2004) reported that people who experiencea traumatic event (motor vehicle accident or fall)and become disabled could develop new perspec-tives on life and living. They may believe that theyhave grown and have become stronger. Theseindividuals may report that their level of under-standing is enhanced, they may appreciate the timethey spent with friends and family, and they mayclaim that they had no real goals for big things.In another study, it was found that patients withpsoriasis may experience greater psychologicalmindedness and awareness of the reality of diseasecourse. They acknowledged their vulnerability and

stressed the need to find other goals, perspectives,and identities. The patients may also rebuild anassumptive world that has meaning (Fortune,Richards, Griffiths, & Main, 2005). Gains ininterpersonal relationships are the most citedbenefits for rheumatoid arthritis patients(Danoff-Burg & Revenson, 2005). Dirik andKaranci (2008), in Turkish patients with rheuma-toid arthritis, found considerable growth related totheir condition; perceived social support andproblem-focused coping were significant predic-tors for experiencing growth.Individuals who became disabled after a trau-

matic injury or chronic illness may find an innerstrength to rebuild a life and experience anexpanded self (Salick & Auerbach, 2006). A studyconducted among women living with HIV/AIDSshowed that stress-related growth mainly dependedon the social support level of the patients and it ismore than a positive reappraisal or the absence of anegative affect (Siegel, Raveis, & Karus, 1997).Higher levels of social support are associated withlower levels of depression among disabled indivi-duals (Eliot, Herrick, & Witty, 1992). The impor-tance of social resources in developing post-traumatic growth is also emphasized by otherresearchers (Calhoun & Tedeschi, 2004; Dirik &Karanci, 2008; Kleiber, Hutchinson, & Williams,2002; Pals &McAdams, 2004). Several studies havereported relationships between PTG and copingstrategies (Aldwin, Sutton, & Lachman, 1996;Dirik & Karanci, 2008; Kesimci, Goral, &Gencoz, 2005). Problem focused coping strategieswere found to be associated with increased PTG(Dirik & Karanci, 2008; Bellizzi & Blank, 2006;Kesimci, Goral, & Gencoz, 2005; Widows,Jacobsen, Booth-Jones, & Fields, 2005). Widowsand colleagues (2005) examined PTG levels ofcancer patients undergoing bone marrow trans-plantation. They found that greater PTG wasrelated to problem-solving coping. Thus, it seemsthat taking an active stance towards problems andengaging in active coping is a facilitator of PTG.The present study aimed to examine the vari-

ables related to psychological wellbeing in terms ofpsychological distress and stress-related growthamong disabled university students with physicalimpairments in Ankara, the capital city of Turkey.Specifically, the relationship of sociodemographicvariables, perceived severity of disability, origin ofdisability (congenital vs. acquired), daily hassles,perceived social support, and coping strategieswith distress and post-traumatic growth wasexamined. Understanding factors related to dis-tress and growth may offer valuable data for

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developing programs of support for disabledstudents by the university counseling services.

METHOD

Participants

The participants consisted of 70 disabled univer-sity students with physical impairments fromAnkara, the capital city of Turkey. The selectioncriteria were identifying himself/herself as dis-abled, being enrolled in a university, and living inAnkara. The students were from six differentuniversities in Ankara. Four of these universitiesare public and two of them are foundationuniversities. The mean age of the participantswas 23.93 years (SD 4.05, range 18–42). Therewere a total of 36 males and 33 females (one of theparticipants did not mention gender). Most of the

participants had a visual disability and were livingwith their families.

The sociodemographic and disability-relatedcharacteristics of the participants are shown inTable 1.

Procedure

The disabled university students in Ankara wereapproached mainly through a snowball samplingmethod. Snowball sampling is the recruitment offriends and associates via word of mouth (Fry &Dwyer, 2001). Snowball sampling might be usedwhen researching a target population that isliving in geographically dispersed regions (e.g.,Mohammadi, Jones, & Evans, 2008); when thepotential participants are scarce in number, suchas drug users (Heimer et al., 2002) or when thetopic of the research is sensitive (e.g., medicationadministration errors) (Sheu, Wei, Chen, Yu, &

TABLE 1Demographic characteristics of the sample

Variable N (%) Mean Standard deviation Range

Age (years) 67 23.93 4.05 18–42Gender 69

Male 36 (52.2)Female 33 (47.8)

Level of income 66Low 15 (2.7)Middle 49 (74.2)High 2 (3.0)

Residence type 70Dorm 18 (25.7)w/family 40 (57.1)w/friends 10 (14.3)w/relatives 1 (1.4)Other 1 (1.4)

Scholarship 68Yes 32 (47.1)No 36 (52.9)

Disability type 68Orthopedic 23 (33.8)Visual 33 (48.5)Hearing 10 (4.7)Multiple 2 (2.9)

Origin of disability 68Congenital 34 (50)Acquired 34 (50)

Duration of disability foracquired disabilities (years)

25 (73.5) 14.38 7.32 0.58–29Perceived burden of disability 4.08 1.77 1–7Perceived visibility of disability 4.80 2.16 1–7Having a disabled family member 70

Yes 18 (25.7)No 52 (74.3)

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Tang, 2008). The main reason for this samplingprocedure was that there are almost no formalrecords regarding Turkish disabled students in theuniversities. The inclusion criteria for participa-tion in the study were being a university student,living in Ankara, and giving voluntary consentfor participation. First, ethical approval wasreceived from the university, then the participantswere approached and given an explanation of thepurpose of the study, and informed consent formswere obtained. The research instrument wasdistributed to the students at regular class hoursor before/after special meetings in the universitiesfor disabled students. The completion of thequestionnaire set took approximately 20min. Oncompletion students were provided a briefingabout the study. For the visually impairedstudents the questions were read and responsesrecorded by the researchers.

Instruments

The first part of the research questionnairecontained questions on sociodemographic vari-ables and disability, e.g., age, gender, income level,perceived burden of disability rated on a sevenpoint scale (1!no burden at all, 7! a totalburden), perceived severity (1! not severe at all,7! very much severe) and perceived visibility ofdisability (1! not visible at all, 7! very muchvisible). The disability burden index used in theanalysis was the arithmetic mean of severity ofdisability and burden of disability. The perceivedvisibility of disability was not included since itreduced the alpha level. The Cronbach alpha of thedisability burden index was .70.

The second part was the Ways of CopingQuestionnaire (WCQ). WCQ was developed byFolkman and Lazarus (1985) in order to examinethe coping process in diverse stressful contexts.The WCQ was adapted into Turkish by Siva, whoadded eight new items relevant to Turkish culture(cited in Ucman, 1990). Karanci, Alkan, Aksit,Sucuoglu, and Balta (1999) shortened the WCQinto 42 items using a three-point response scale(1!never, 2! sometimes, 3! always) in order toinvestigate the relationship between psychologicaldistress and coping strategies of earthquakesurvivors in Turkey. Gunes (2001) used this42-item WCQ with earthquake survivors and thefactor analysis revealed four subscales. Subscalesand the internal consistencies were as follows:problem-solving/optimistic coping (r! .83), fatal-istic coping (r! .77), helplessness coping (r! .73),and escape coping (r! .55).

The present study also used the 42-itemsolution of the WCQ with the same factorstructure as Gunes (2001), excluding one itemfrom the helplessness coping subscale (‘‘I expectedunderstanding from people’’) due to its lowcorrelation with the factor score. The internalconsistencies of subscales were at the acceptablelevels, problem-solving/optimistic (r! .81), fatal-istic (r! .77), helplessness (r! .72), and escape(r! .60) for the present study.The third part was the Stress Related Growth

Scale (SRGS). The SRGS is a 50-item scaledeveloped by Park, Cohen, and Murch (1996). Itis rated on a three-point Likert-type scale. It wasfound that most items loaded the highest on onegeneral factor. The SRGS was translated andadapted into Turkish by Gunes (2001). The internalconsistency of the scale was .94. For the presentsample Cronbach alpha was found to be .91.The fourth part was the Multidimensional Scale

of Perceived Social Support (MSPSS). The MSPSSaimed to measure support from family, significantothers, and friends. It has 12 items rated on seven-point scales (1! agree very strongly; 7! disagreevery strongly). It has been previously adopted andused with Turkish samples (Eker & Akar, 1995).The internal consistency for the present samplewas .82.The fifth part of the questionnaire package was

the Brief Symptom Inventory (BSI), rated on afive-point Likert scale. BSI was developed byDerogatis (1992) and adopted into Turkish bySahin and Durak (1995), with a Cronbach alphacoefficient of .96. The Cronbach alpha for thepresent sample was .94.The sixth scale used in the present study was

the Life Events Inventory, a 49-item scale ratedon five points (1!never, 5! always) (Oral,1999). It was developed in order to measurethe frequency of specific daily hassles and lifeevents (such as problems relating to transporta-tion or monetary issues) experienced by univer-sity students in Turkey. The Cronbach alpha was.90 in the original study and .89 for the presentsample.

Statistical analysis

Data analysis was conducted using SPSS(Version 15). After a correlation analysis, twoseparate stepwise regression analyses were con-ducted in order to examine the predictors ofpsychological symptoms (i.e., BSI) and growth(i.e., SRGS). All significance testing took place atthe .05 level (two-sided).

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RESULTS

In order to examine variables related to psycho-logical distress and stress-related growth, initially acorrelation analysis was conducted to see thecorrelations of the potential independent variableswith the two dependent variables, namely BSI andSRGS scores. The means and standard deviationsof the study variables not included in Table 1 aregiven in Table 2.

Correlations among the variables ofthe study

A correlation analysis was conducted in order tosee the correlations between the dependent vari-ables and the independent variables in the study.Table 3 presents the Pearson correlations.As can be seen from the table, BSI scores were

negatively related to perceived social support

(r!"0.30), whereas they were positively relatedwith disability burden index (r! 0.47), life events(r! .60), and helplessness coping (r! .53). On theother hand, stress-related growth was negativelyrelated with helplessness coping (r!".35) whereasit was positively related to having a disabled familymember (r! .29) and problem-solving coping(r! .45).

After examining the variables significantlyrelating with the dependent variables (psycho-logical symptoms and stress-related growth), theindependent variables that had significant zero-order correlations with either of the dependentvariables were chosen to be used in the twoseparate regression analysis. This reduction wasdone to reduce the number of independentvariables to accommodate the small samplesize.

Regression analyses

In order to examine the variables that are relatedto psychological symptoms and stress-relatedgrowth, two separate stepwise regression analyseswere conducted. In both of these analyses, thesame sets of variables were used as predictorvariables. Independent variables were entered inthree blocks. In the first block, in order to controlfor their effects, sociodemographic variables,namely gender (1!male, 2! female) and age,were entered. In the second block disabilityburden index and having a disabled familymember were entered. In the last block lifeevents, perceived social support, and two factorsof the ways of coping inventory had significant

TABLE 3Correlations among the study variables

Variable 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1. Age "0.04 0.07 "0.28* 0.22 "0.11 "0.01 "0.12 0.34* 0.21 0.12 0.05 0.00 0.08 0.212. Gender 0.07 "0.00 0.05 0.24 0.04 0.19 0.01 "0.01 0.02 0.17 0.10 0.27 0.123. Income 0.27* 0.12 0.12 "0.11 0.06 0.10 0.20 0.13 0.04 "0.01 "0.18 0.104. Type of disability "0.32* 0.14 "0.01 "0.14 "0.05 0.06 0.03 "0.37* "0.24 "0.06 "0.045. Origin of disability "0.13 "0.07 "0.10 0.23 0.11 0.24 0.11 0.15 0.24 0.116. Burden index "0.12 "0.02 0.12 0.30* 0.01 "0.05 "0.14 "0.07 0.47*7. Disability in family 0.27* "0.07 "0.17 "0.05 0.01 0.18 0.29* "0.148. Perceived social support "0.26 "0.25* "0.06 0.14 0.31* 0.16 "0.30*9. Life events 0.45* "0.04 0.09 "0.04 "0.07 0.60*10. Helplessness coping 0.17 "0.35* "0.47* "0.35* 0.53*11. Fatalistic coping 0.04 "0.06 0.20 "0.1012. Escape coping 0.29* 0.27 "0.1413. Problem-solving coping 0.45* "0.0914. Stress-related growth "0.2415. Psychological symptoms

*p5 .05.

TABLE 2Means, standard deviations, ranges and possible ranges of

the variables

Variable MeanStandarddeviation Range

Possiblerange

Stress-related growth 119.12 15.64 77–150 50–150Psychological symptoms 44.15 29.86 3–99 0–212Coping total 91.48 6.88 76–111 42–126Helplessness 14.37 3.07Problem-solving 36.82 4.46Fatalistic 12.52 2.70Escape 6.61 1.40

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zero-order correlations with the dependent vari-ables (helplessness coping and problem-solvingcoping) were entered.

Predictors of psychologicalsymptoms (BSI)

The results of the regression analysis (see Table 4)showed that the first step (control variables)explained 3% of the variance, which was notsignificant, F(2, 67)! 1.13. The second stepexplained 16% of the variance, F(1, 66)! 12.47,and disability burden index appeared as a sig-nificant predictor in this step. In the third step lifeevents accounted for another 10% of the variance,F(1, 65)! 9.40. Helplessness coping accounted foradditional 5% of the variance in the last step,F(1, 64)! 4.96. In total, all variables explained34% of the variance in psychological symptoms,F(5, 69)! 6.60.

According to the results, in the final model,disability burden index (t! 2.57), life events(t! 2.32), and helplessness coping (t! 2.23)appeared to be positively related to psychologicalsymptoms.

Predictors of stress-relatedgrowth (SRGS)

The results of regression analysis (see Table 4)showed that the variance explained by the first stepwas not significant, F(2, 67)! 2.06; R2! .06. Whendisability burden index and having a disabledfamily member were entered into the regressionequation (Step 2), they explained a further 6% ofthe variance, which was significant, F(1, 66)! 4.32.Having a disabled family member (t! 2.08) wassignificant in this step. The third step (helplessnesscoping, problem-solving coping, perceived socialsupport, and life events) accounted for an

TABLE 4Variables associated with psychological symptoms

Variables associated with psychological symptoms

Step variables ß t R2 (df) F change

I. Control variables 0.03 (2, 67) 1.13Gender (1!male, 2! female) 0.11 0.87Age 0.15 1.25

II. Disability-related variables 0.16 (1, 66) 12.47Disability burden index 0.40 3.53*

III. Life events, coping and support 0.10 (1, 65) 9.40Life events 0.33 3.07*

IV. Life events, coping and support 0.5 (1, 64) 4,96Helplessness 0.26 2.23*

Total R2 34

*p5 .05.

TABLE 5Variables associated with stress-related growth

Variables associated with stress-related growth

Step variables ß t R2 (df) F change

I. Control variables 0.06 (2, 67) 2.06Gender (1!male, 2! female) 0.23 1.96Age 0.07 0.62

II. Disability-related variablesDisability in family 0.24 2.08* 0.06 (1, 66) 4.32

III. Life events, coping and support 0.11 (1, 65) 9.39Problem-solving coping 0.34 3.06*

Total R2 23

*p5 .05.

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additional 11% of the variance, F(1, 65)! 9.39.Problem-solving coping (t! 3.06) was significantin this step. As shown in Table 5, in the final modelonly problem-solving coping appeared as a sig-nificant predictor. In total, all the variablesexplained 23% of the variance in stress-relatedgrowth, F(4, 69)! 4.79. Thus, problem-solvingcoping (t! 3.06) appeared to be positively relatedto the stress-related growth.

DISCUSSION

To our knowledge this is the first study thatincludes the positive as well as the negativeconsequences of coping in disabled universitystudents, from a developing country, Turkey.Although Sunderland, Catalano, and Kendall(2009) showed that disabled people mention bothpositive (joy and happiness) and negative experi-ences, official professional and public discourseson disability focus predominantly on negativediscursive patterns. Disability is also conceptua-lized as a fact of life, a different life experience thatmight be interesting and affirmative (Morris, 1991;Oliver, 1996; French, 2004). Sunderland (2008)also argues that university experience might be anexperience for freedom. This study has specialsignificance due to the inclusion of positivefeatures of coping with disability as well asadversarial effects.Disabled students all around the globe

experience approximately similar problems.Disabled students not only concentrate theirenergies to master academic studies, but alsoshould exert effort to combat the barriers relatedto lack of adequate facilities for their special needsand the attitudes of academic staff and otherstudents. In our developing country, Turkey,disabled university students experience more pro-blems then disabled students in developed coun-tries. For example, there is no disabilitydepartment in our universities to help them inaccessing learning and teaching needs. The presentstudy aimed to examine variables related to stress-related growth and psychological symptoms in theTurkish university students.The results of the study indicated that disabled

university students report considerable levels ofgrowth, as indicated by the mean growth scoresobtained. When compared to other studies thatexamined stress-related growth among Turkishuniversity students following major traumaticevents—such as loss of a loved one, serious illnessin the family, or accidents (Goral, Kesimci, &Gencoz, 2006; Kesimci et al., 2005)—the scores of

the present sample were higher. This may showthat although being a student with physicalimpairment may be quite difficult in a developingcountry with very restricted provisions for specialneeds, being able to survive the hassles and copewith them may foster positive changes.

Among the study variables, the correlationanalysis showed that only having a disabledmember in the family, helplessness coping, andproblem-solving coping were significantly relatedto growth. Thus, the origin of the disability, i.e.,having congenital or acquired disability, was notfound to be related to growth. It might be arguedthat since the mean duration of disability foracquired disabilities is a relatively long period forthe current sample (see Table 1), the students withacquired disabilities might have had time to adjustto their conditions and thus may not differ fromthe students with congenital disabilities. Futurestudies are needed in order to clarify the relation-ship between more recent onset of disability andthe study variables. The regression analysisshowed that only problem-solving coping is asignificant predictor of growth. This finding is inaccordance with the literature (Karanci & Erkam,2007; Dirik & Karanci, 2008; Goral et al., 2006;Gunthert, Cohen, & Armeli, 1999). Goral andcolleagues (2006) found that problem-focusedcoping is associated with stress-related growthamong Turkish undergraduate students. It wasalso found to be one of the predictors of stress-related growth among breast cancer patients(Karanci & Erkam, 2007). Similarly, Dirik andKaranci (2008) found that problem-focused copingis related to PTG levels in rheumatoid arthritispatients. Problem-solving coping may providedisabled students with a sense of control andself-efficacy that may facilitate their efforts tocope with the demands of university life andactually help them in reaching their goals. Thissuccessful coping may enhance their perceptionsof growth.

In future studies it will be fruitful to examine theacademic standing of students and to evaluate itsrelationship with coping and growth. Consideringthe lack of social and physical facilities for Turkishdisabled university students, it seems plausible thatthose who adopt a problem-solving approach havean important personal resource enabling them totackle life problems and thus experience positivetransformations in themselves. This needs to befurther examined in future studies using largersamples. This result seems to point out that ratherthan disability burden, the hardships and socialsupport levels growth is related to anactive, problem-focused coping with difficulties.

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In light of this finding it seems important tofacilitate problem-solving skills through counsel-ing programs for this group of students.

For psychological symptoms, the zero-ordercorrelations showed that disability burden andperceived social support helplessness coping weresignificantly related to symptoms. It is againinteresting to note that origin of disability andtype of disability were not related to symptoms.The regression results also showed that disabilityburden, daily hassles, and helplessness coping weresignificant predictors. Perceiving the disability assevere and experiencing burden seems to putconsiderable stress on students and lead topsychological symptoms. Daily hassles that stu-dents experience were also related to their psycho-logical distress. These findings support the socialmodel of disability, by showing that the moresevere and burdensome they experience theircondition to be, and the more daily hassles theyface, the more distressed they are. It is difficult tochange the medical condition of students, but withadequate sensitivity, advocacy, and a change ofpolicy related to disabled students all these factorscould be lessened to benefit the disabled studentsand allow them to reach their potentials, like allthe other students.

In future studies it will be important to examinethe types of daily hassles most reported by thedisabled students and to examine in more detailwhat they find supportive and what they regard asburdensome, so that these conditions can beimproved. Furthermore, combating helplessnessseems to be an important target for counselingprograms.

Helplessness coping was a significant variablefor increasing psychological distress. Not beingable to cope directly with problems of life—adopting an avoidance stance—has been repeat-edly shown to increase distress (Kim, Duhamel,Valdimarsdottir, & Bovbiaerg, 2005). For thissample, it makes sense to find that adopting ahelpless approach, together with the lack ofappropriate facilities to eradicate disability, leadsto psychological distress. It is interesting to notethat problem-solving coping did not appear to be apredictor of distress. Thus, there seem to bedifferent pathways to distress and growth. Forpsychological symptoms it seems that the stress-vulnerability paradigm is in action. Both thevulnerability factor (helplessness coping) and thestress factor (disability burden and daily hassles)seem to operate in determining distress symptoms.Thus, although counseling programs may behelpful in facilitating problem-solving and com-bating helplessness, the university administration

needs to foster a more disabled-friendly environ-ment. This effort should include physical environ-mental changes but also advocacy to change theattitudes of the university staff and nondisabledstudents.

Implications

Disabled people are experiencing socially imposedharm (Anstey, 2002). Disability in the educationalsetting should be perceived as resulting from thelimitations of the systems available for accessingcourse information (Holloway, 2001). It is arguedthat each disabled student has to overcome twohurdles in order to be successful in the university:the academic hurdle and the student’s disabilities(Borland & James, 1999). The present results pointout that it is not only the hurdles, but alsopsychological vulnerabilities (i.e., coping) thatdetermine distress. Increasing the personalresources of the individual is a solution for bothdisability-related (e.g., Anderson et al., 1996) anddisability-unrelated (e.g., Sumer, Karanci, Kazak-Berument, & Gunes, 2005) circumstances. Copingtraining programs that emphasize problem-solvingcoping strategies teach that combating helplessnesscoping might be helpful in order to enhancegrowth. Another type of program that can beimplemented in order to empower disabled uni-versity students is a disability awareness programfor universities, targeting instructors, administra-tors, and students. A more disability-friendlyenvironment is likely to be empowering fordisabled university students.

CONCLUSION

Although this study has a small sample size, theresults showed that the burden of disability anddaily hassles faced, and also personal character-istics as coping, are involved in adjustment. Due tothe small sample size and the fact that onlyphysically impaired students were involved, thestudy needs to be replicated with larger samples ofdisabled students. The results of the present studycan be a small step forward for the empowermentof disabled university students. Disability is acomplex issue (Dalal & Pande, 1988). The presentresearch acknowledges this and proposes thatthere are different pathways for psychologicalsymptoms and growth. So, rather than beingmerely a cause of symptoms, disability mightalso be a chance for growth. For a change inphysical and social conditions, disabled peoplethemselves should first identify the situation.

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A second phase could be taking an active part intackling daily problems rather than adopting ahelpless approach. Future studies could furtherinvestigate the psychological wellbeing of disabledpeople of different ages and educational back-grounds, and the attitudes and awareness ofuniversity staff and nondisabled students towardsdisability and how they contribute to wellbeing.

Manuscript received October 2009Revised manuscript accepted June 2010First published online November 2010

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