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Psychosocial wellbeing in the Central and EasternEuropean
transition: An overview and systematicbibliographic reviewFrancisco
Jos Eiro Orosa aa Department of Psychiatry and Legal Medicine,
Universitat Autnoma deBarcelona, Barcelona, Department of
Psychiatry , University Hospital Vall dHebron,Barcelona, and
Community Action Group , Madrid , SpainPublished online: 23 Apr
2012.
To cite this article: Francisco Jos Eiro Orosa (2013)
Psychosocial wellbeing in the Central and Eastern
Europeantransition: An overview and systematic bibliographic
review, International Journal of Psychology, 48:4, 481-491,
DOI:10.1080/00207594.2012.669481
To link to this article:
http://dx.doi.org/10.1080/00207594.2012.669481
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Psychosocial wellbeing in the Central and EasternEuropean
transition: An overview and systematic
bibliographic review
Francisco Jose Eiroa Orosa
Department of Psychiatry and Legal Medicine, Universitat
Autonoma de Barcelona,Barcelona, Department of Psychiatry,
University Hospital Vall dHebron, Barcelona, andCommunity Action
Group, Madrid, Spain
T his paper presents the results of a systematic review of
literature on the psychosocial wellbeing ofpopulations in Central
and Eastern Europe during the transition period subsequent to the
fall of the SovietBloc. A revision of research addressing emotional
wellbeing trends in this period and theoretical models wascarried
in order to verify their validity in the analysis of empirical
studies. Hence, a systematic bibliographic
review was conducted, aiming to find possible subjective
mediators between social variables derived from changesand
emotional wellbeing. The results of the review show that subjective
mediators such as locus of control,perceived control, self-efficacy
beliefs, perceived familial support, and the subjective evaluation
of social change
explain part of the relationship between macrosocial changes and
emotional wellbeing. Results appear coherentwith proposed
multidimensional models of social change and mental health,
although further research should beconducted to determine the
specific weight of these phenomena in individual emotional
wellbeing.
C et article presente les resultats dune revue systematique de
la litterature concernant le bien-etre despopulations de lEurope
centrale et de lEurope de lEst durant la periode de transition
suivantleffondrement du bloc sovietique. Un examen de la recherche
portant sur les modeles theoriques et les tendances
du bien-etre emotionnel durant cette periode est fait pour
verifier leur validite a travers lanalyse detudesempiriques. Donc,
une revue bibliographique systematique est menee pour trouver de
possibles mediateurssubjectifs entre des variables sociales venant
des changements et le bien-etre emotionnel. Les resultats de
cette
revue montrent que les mediateurs subjectifs comme le locus de
controle, le controle percu, les croyances dauto-efficacite, le
support social percu, la perception du soutien familial et
levaluation subjective du changement socialexpliquent en partie la
relation entre les changements macrosociaux et le bien-etre
emotionnel. Les resultats
semblent coherents avec les modeles multidimensionnels du
changement social et de la sante mentale, bien quedautres
recherches devraient etre menees pour determiner le poids
specifique de ces phenomenes dans le bien-etreemotionnel
individuel.
E ste trabajo presenta los resultados de una revision
sistematica de la literatura sobre el bienestarpsicosocial de las
poblaciones de Europa Central y del Este durante el perodo de
transicion posterior a lacada del Bloque Sovietico. Se llevo a cabo
una revision de investigaciones sobre las tendencias de
bienestar
emocional durante ese perodo, as como de modelos teoricos con el
fin de verificar su validez en el analisis deestudios empricos.
Para ello se realizo una revision bibliografica sistematica con el
proposito de encontrarposibles mediadores subjetivos entre las
variables sociales derivadas de los cambios y el bienestar
emocional.
Los resultados de la revision muestran que mediadores subjetivos
tales como locus de control, controlpercibido, creencias de
autoeficacia, el apoyo famliar percibido, y la evaluacion subjetiva
de los cambios
Correspondence should be addressed to Francisco Jose Eiroa
Orosa, Department of Psychiatry, University Hospital Vall
dHebron,
Passeig Vall debron, 119-129, 08035 Barcelona, Spain. (E-mail:
[email protected]).
A previous version of this study was presented at the first
conference of the Central and Eastern European Society ofBehavioral
Medicine. I would like to acknowledge the support of the staff of
the Autonomous University of Madrid, theWarsaw School of Social
Psychology, and the Semmelweis University in Budapest.
International Journal of Psychology, 2013Vol. 48, No. 4, 481491,
http://dx.doi.org/10.1080/00207594.2012.669481
2013 International Union of Psychological Science
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sociales explican parte de la relacion entre los cambios
macrosociales y el bienestar emocional. Los resultadosparecen
coherentes con los modelos multidimensionales de cambios sociales y
salud mental ya propuestos, sinembargo nuevas investigaciones
deberan llevarse a cabo para determinar el peso especfico de estos
fenomenos
en el bienestar emocional individual.
According to George Rosen (1968), the first workaddressing
social change and mental health wasperformed by Benjamin Rush in
1774. ThisAmerican physician, and signer of theDeclaration of
Independence, researched fertilityin American women during the
revolutionaryperiod. Since then, hundreds of studies havesought to
address if and how social changesinfluence the psychosocial
wellbeing of individuals,although under very heterogeneous
methodologi-cal approaches and ideologies.More than 200 years after
this pioneer work,
as a result of the fall of the Iron Curtain,massive political,
economic, and social changesdrove Central and Eastern Europe to a
pre-viously unknown situation of transformation.Six months after
the fall of the Berlin Wall, aneditorial of the American Journal
ofPsychotherapy, written by Stanley Lesse (1990),announced that the
situation offered as neverbefore, magnificent opportunities to
observe theinterrelationships between these transitions andtheir
macro-psychosocial effects. Neumann(1991) goes further, stating
that Communismin Eastern Europe has failed mainly because
thedeteriorating psychosocial conditions pushed themajority of the
population into a state of social,psychological, and, in many
cases, somaticdisorder approaching disease.Twenty years after these
statements, the real
impact of the rapid changes in collective psycho-social
wellbeing remains unclear. Although manyresearch projects attempted
to address this topic,they did so under a heterogeneous set of
dis-ciplines, methodologies and ideologies. Whatseems clear is that
the transition brought aboutfactors of collective wellbeing such as
democraticchanges, more respect to human rights, and
adeinstitutionalization process of mental healthfacilities, but
focused attention away from therole of society as a provider of
care, promotingindividualism (Lewis et al., 2001). Hence,
manyindividuals adjustment to the process, especiallythat of the
most vulnerable such as children or theunemployed, was very poor
(World HealthOrganization (WHO) Regional Office forEurope,
2003).WHO established a network of mental
health professionals in the member states,
who provided specific information for everycountry. According to
the report of itscommittees 53rd session (WHO RegionalOffice for
Europe, 2003), the reasons for theincreasing prevalence of mental
disorders espe-cially in these societies and populations
under-going stressful change are connected withdifferences in life
expectancy related to societalstress and risky lifestyles. The
cluster of stress-related factors includes depression and
suicide,addiction, violence, risk-taking behaviors andlifestyles,
and cardiovascular and cerebrovascu-lar morbidity and
mortality.Overhospitalization and problems with theprocess of
deinstitutionalization are majorproblems in these countries as well
(Jenkins,1991; Jenkins, Klein, & Parker, 2005). Theslow
improvement of community-based servicesand prevention programs is
another factor totake into account.
Our objective within this work is to review andorganize the
existing evidence, giving readers abroader point of view when
analyzing thisphenomenon. Specifically, we try to address
twoquestions: (1) Was there a generalized reduction inemotional
wellbeing during the transition period?(2) What matters when
analyzing this? (Or, intechnical terms: Which subjective
mediators/con-founders can explain the poor adjustment ofcertain
individuals in this period?
DEFINITION OF TERMS
We use two principal concepts in this paper: (1)Emotional
wellbeing in this study is defined interms not only of mental
health (incidence andprevalence of psychiatric comorbidity,
depression,anxiety, mental hospital admission rates, andsuicide)
but also of subjective measures of well-being such as self-rated
physical health, enjoymentand interest in life, positive attitudes,
and self-esteem (Grob, Wearing, Little, & Wanner, 1996;Pinquart
& Silbereisen, 2004) in contrast with ill-being (Smith, 1996).
(2) Psychosocial wellbeingrefers to an outcome within mediating
factors andcontexts which includes social and emotionalwellbeing
(Larson, 1996; Martikainen, Bartley, &Lahelma, 2002).
482 EIRO OROSA
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WAS THERE A GENERALIZEDDECREASE IN EMOTIONAL
WELLBEING? EPIDEMIOLOGICALSTUDIES
Assessing the real variation in psychosocial well-being in the
ex-communist Central and EasternEuropean area during this special
period is not aneasy task. Psychiatric comorbidity could be used
asa proxy for emotional wellbeing. However, thefirst problem arises
when one tries to establish abaseline of psychiatric comorbidity
before thechanges. Institutional data in the ex-communistcountries
seems unreliable according to the evi-dence of the use of
psychiatry by the state as a toolfor repression (Bonnie, 2002).
Furthermore, fewauthors faced the task of comparing in
observa-tional studies Western and Eastern psychiatriccomorbidity
before the Iron Curtain collapsed.Temkov, Jablensky, and Boyadjieva
(1975) esti-mated the incidence and prevalence of
psychiatricdisorders in formerly socialist economies and
inestablished market economies in the 1970s.Slightly lower but
comparable rates can beobserved in the formerly socialist
countriesduring that period. Another study carried out byRathner el
al. (1995), before the political changes,shows a very similar
picture for Western andEastern societies regarding eating
disorders,although Hungarians had more minor psychiatricmorbidity
than East Germans and Austrians did.The authors discuss these
results in light of theprocess of Westernization that had begun in
thelate 1980s. Regarding suicide, research carried byMakinen (2006)
concluded that suicide changed itssocial nature during the
Communist period,becoming more normal, and more equally
dis-tributed among social classes and geographicallocations in the
whole Warsaw Pact area.
Data extracted from the European Health forAll Database (WHO
Regional Office for Europe,2011) gives official epidemiological
figures for thewhole process in the region. We can see
higherfigures for both prevalence of mental disorders andmental
hospital discharges in the group ofcountries that joined the
European Union (EU)in 2004 and 2007 (Poland, Estonia,
Latvia,Lithuania, Czech Republic, Slovakia, Hungary,and Slovenia in
2004; Bulgaria and Romania in2007) and in the Commonwealth of
IndependentStates (CIS) than in the European Region as awhole, as
shown in Figures 1 and 2. Figures ofincidence of mental disorders
and suicide followdifferent patterns. While incidence (Figure
3)seems much higher and increasing in the new EUmembers than in the
European Region and the
Figure 2. Hospital discharges, mental behavioral disorders
(per 100,000).
Figure 1. Prevalence of mental disorders (%).
Figure 3. Incidence of mental disorders per 100,000
population.
PSYCHOSOCIAL WELLBEING 483
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CIS, suicide (Figure 4) increased dramatically inthe 1990s among
CIS members (although itdecreased at the beginning of the third
millen-nium), while patterns in the new members of theEU are
similar to those of the whole EuropeanRegion.Although World Health
organization data come
from heterogeneous sources in each country,research carried out
employing observationalmethodology show similar results. A
decreasingpattern in psychological wellbeing was found inBulgaria
(Beshkov & Gerdgikov, 1999; cited inTomov, Mladenova, Lazarova,
Sotirov, &Okoliyski, 2004), Czech Republic (Bobak,Pikhart,
Rose, Hertzman, & Marmot, 2005),Estonia (Reinap, Lai, Janno,
Tamme, & Tamm,2005), Hungary (Kopp, Csoboth, &
Rethelyi,2004), Lithuania (WHO Regional Office forEurope, 2001),
Poland (Czapinski, 1999; WarsawInstitute of Psychiatry and
Neurology, 2004; WHORegional Office for Europe, 2001),
Ukraine(Bromet et al., 2005), and Russia (Bobak et al.,2005;
Charman & Pervova, 1996). An internationalpoll reports
unhappiness and dissatisfaction withhealth, and decrease of
satisfaction with life andhealth with aging in the whole of Eastern
Europeand the former Soviet Union area compared withWestern
countries (Deaton & National Bureau ofEconomic Research, 2007).
To our knowledge, noempirical study claims a reduction in
psychologicaldistress or psychiatric comorbidity in the areastudied
during the political transition.Makinen (2000) studied suicide
patterns in all
the countries of the former Soviet Bloc. No generalpattern was
found, but the author divided thecountries regarding the basis of
their suicide
mortality profiles (the level of suicide and itsage/sex
distribution). No possible universal deter-minants of suicide were
included among theindependent variables studied. He was,
however,able to construct a model in which the changes inlife
expectancy, alcohol consumption, democrati-zation, and homicide
explained more than 92% ofthe variation in the changes in suicide
rates in morethan half of the countries during two
periodssubsequent to democratization, retaining its poweracross
time.
Taken together, all this information seems topoint to a
reduction of collective emotional well-being in the area.
Identifying the profiles ofindividuals experiencing this reduction
constitutesthe next objective of this work.
WHAT MATTERS WHEN ASSESSINGTHE IMPACT OF SOCIAL CHANGE IN
EMOTIONAL WELLBEING: SYSTEMATICBIBLIOGRAPHIC REVIEW OFSUBJECTIVE
MEDIATORS
Different theories can be applied to the study ofhuman
development in times of social change, asPinquart and Silbereisen
(2004) reviewed, with afocus on the effects of the breakdown of
thecommunist system. Using as frameworkBronfenbrenners (1979)
ecological paradigm, thetransactional stress theory (Lazarus,
1966), andrecent developments of lifespan theories of controland
coping, they introduce a behavioral model ofdevelopmental outcomes
concerning abrupt socialchange, in which social support and
individualresources such as internal locus of control,self-efficacy
beliefs, problem-solving abilities, orsecure attachment buffer the
effect of negativeconsequences of social change on
psychologicaldistress.
In addition to these cognitive mediators, the wayin which the
subjective perception of social changeinfluences individuals
psychological wellbeing wasexamined in South Korea during the
economiccrisis experienced as a result of the collapse of
thefinancial market between 1997 and 2000 (Kim,2008). In this study
the subjective perception ofsocial change was shown to mediate
between theperceived scope and pace of social change,
copingresources, and individuals psychologicalwellbeing.
METHODS
Following these models, a systematic bibliographicreview was
conducted with the objective of testing
Figure 4. SDR, suicide, and self-inflicted injury (all ages,
per 100,000).
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whether Pinquart and Silbereisen (2004) and Kims(2001)
hypothesis about social change and psy-chosocial wellbeing are
applicable to the Centraland Eastern European transition. Inclusion
cri-teria were as follows: English-language empiricalstudies
concerning the Central and EasternEuropean transition or carried
out between 1989and 2010, which included subjective
mediatorsbetween any social outcome of sociopoliticalchange and
emotional wellbeing.
We used a syntax that selected the names of atleast one
ex-communist country of Central andEastern Europe (Russia, Ukraine,
Moldova,Belarus, Estonia, Latvia, Lithuania, Poland,Czech Republic,
Slovakia, Hungary, Slovenia,Bulgaria, Romania) or any of these
terms: post-communist, Iron Curtain, political transition,Eastern
Europe, Central Europe, Soviet Union;accompanied by at least one
term referring toemotional wellbeing (psychiatric morbidity,mental
health, psychological wellbeing, psycholo-gical distress,
psychopathology, depression, anxi-ety, stress, affective,
subjective health, self-ratedhealth, suicide, or emotional
wellbeing itself).Databases explored included
PsycINFO,PsycARTICLES, Medline, ERIC, Social CitationIndex and
Sociological Abstracts. Titles were readfrom an initial pool of
over 8000 articles; about500 were chosen for abstract review.
Articlescentered in clinical facilities, addressing
economicwellbeing, not including socioeconomic variablesderived
from changes, or not including anysubjective mediator were excluded
(some of thelast category are included in the introduction
asepidemiological studies). A total of 14 studies metinclusion
criteria.
RESULTS
A comprehensive description of the bibliographicreview is given
in Table 1. Subjective mediatorscould be classified into three
specific clusters:(1) perceived locus of control and
self-efficacy,(2) subjective evaluation of social conditions
andchanges, (3) familial social support.
Self-evaluation: Perceived locus ofcontrol and self-efficacy
Locus of control is a concept first developed byRotter (1954) in
the framework of his sociallearning theory of personality. It is
defined bythe extent to which individuals believe that theycan
control events that affect them. Self-efficacy aconcept first
developed by Bandura (1977) as part
of the social cognitive theory; it has been claimed
to be strongly related to, or even to be a part of,
the construct of perceived control (Ajzen, 2002).
Furthermore, the learned helplessness paradigm
(Seligman, 1975; Seligman & Maier, 1967) explains
how the perceived absence of control over the
outcome of a situation can result in depression and
related mental illnesses. These concepts appear to
be largely used and successfully tested as subjective
mediators between consequences of abrupt social
change and physical and emotional wellbeing.Poor control over
life was associated with
chronic illnesses in an urban population in
Poland (Stelmach, Kaczmarczyk-Chalas, Bielecki,
& Dryga, 2004). Perceived control was strongly
associated with self-rated health, and appeared to
mediate the effects of deprivation and inequality in
several countries of the area (Bobak, Pikhart,
Rose, Hertzman, & Marmot, 2000). This construct
was also found to be correlated with depression,
mediating socioeconomic circumstances along
with social support (Aluoja, Leinsalu, Shlik,
Vasar, & Luuk, 2004). External locus of control
and emotional distress seem to mediate between
sociodemographic variables (structural dimensions
according to the authors) and poor self-rated
health (Leinsalu, 2002).The comparison of control over life
between
Eastern and Western cultures gives interesting
results. Carlson (1998) found higher rates in
Western countries among adults; Grob et al.
(1996) found higher rates in Eastern countries
among adolescents and Wardle et al. (2004) lower
scores among Eastern university students.Regarding microsystems
as workplaces, low
control at work and depression was found to be
a mediator between general morbidity and mor-
tality and the majority of risk consequences of a
low socioeconomic situation among men in two
national representative surveys of the Hungarian
population conducted in 1988 and 1995 (Kopp
et al., 2004). Nevertheless, the imbalance of
effortreward at work (which could be considered
an objective measure of working conditions) but
not job control (which could be considered a
measure of subjective control) was associated with
depressive symptoms and increased alcohol intake
and problem drinking in a transnational study in
three Eastern European urban populations
(Bobak et al., 2005).Self-efficacy beliefs were found to
mediate
between commitment to the old political system
and distress over time in a study of Eastern
German adolescents (Pinquart, Silbereisen, &
Juang, 2004)
PSYCHOSOCIAL WELLBEING 485
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TABLE
1Systematicbiblio
graphic
review
(mediatorvariables)
Reference
Participantcountries
Socialvariables
Mentalandperceived
physicalhealth
variables
Subjectivemediators
Resultsandconclusions
Aluoja
etal.(2004)
Estonia
Sociodem
ographic
data
(income,
occupational
status).
Depressiveness(sad-
ness,loss
of
interest,worth-
lessness,hopeless-
ness,self-
accusations,
thoughts
ofsui-
cide,
feelingsof
lonelinessand
impossibilityof
enjoyment).
Indices
ofsocial
adjustment(sense
ofcontrol,self-
ratedhealth,per-
ceptionofthe
future,perceived
socialsupport
andsatisfactionin
nineareas).
Strongrelationship
betweendepressivesymptomsand
sociodem
ographic
factors.
Depressiverespondents
hadconsiderably
poorersubjective
socialadjustmentthanrespondents
withanorm
almood
state.They
reported
lower
self-ratedhealthandexperienced
less
satisfactionin
most
importantareasoftheirlives.
Lesssatisfied,depressivesubjectsalsoexhibited
less
perceived
control.Thisisin
linewithstudiesstressingthe
role
oflow
perceived
controlin
depressionaseither
an
independentfactororamediatorofsocioeconomic
circumstancesandsocialsupport.
Bobaket
al.(2000)
Russia,Estonia,
Lithuania,Latvia,
Czech
Republic,
Hungary
and
Poland
Socioeconomic
fac-
tors
(education,
maritalstatus,
material
deprivation).
National
mortality
rates
Self-rated
health.
Perceived
control.
Consistentlywithmortality
rates,theprevalence
ofpoor
self-ratedhealthishigh,particularlyin
theform
erSoviet
UnionandHungary.
Educationandmaterialdeprivationare
importantpredic-
tors
ofself-ratedhealth,andthesocioeconomic
gradients
are
large.
Ecologicalmeasuresofinequalities
werenotsignificantly
relatedto
self-ratedhealth,andanypotentialeffectswere
removed
bycontrollingforindividualsmaterialdepriva-
tion.
Perceived
controlwasstrongly
associatedwithself-rated
health,andappearedto
mediate
theeffectsofdeprivation
andinequality.
Bobaket
al.(2005)
Russia,Poland,and
Czech
Republic
Deprivation,effort
reward
atwork.
Alcoholism
,
depressive
symptoms.
Jobcontrol.
Theim
balance
ofeffortreward
atwork
isassociatedwith
increasedalcoholintakeandproblem
drinking.Jobcontrol
waspositivelyassociatedwithallproblem
drinkingindices,
butnoneoftheassociationsreached
statisticalsignificance.
Theassociationappears
tobepartly
mediatedbydepressive
symptoms,whichmightbeeither
anantecedentora
consequence
ofmensdrinkingbehavior.
Carlson(1998)
10ex-communist
countriesand15
Western
countries
Country,age,
sex,
level
ofeducation
(ageatcomple-
tion)andoccupa-
tionalgroup,
mem
bership
of
nonpolitical
association.
Self-perceived
health
Lifecontrol,job
satisfaction,and
freedom
tomake
decisions,satis-
factionwitheco-
nomic
situation,
politicalinterest,
importance
of
familyand
friends.
Theaveragelevel
ofself-perceived
healthisgenerallyworsein
form
ercommunistcountriesthanin
Western
Europe,
for
both
men
andwomen.Theresultsindicate
thatpeoples
participationin
civic
activitieshasapositiveeffect
ontheir
health.Peopleslife
controlwasim
portantfortheirself-
perceived
healthin
alm
ost
everyEuropeancountry,both
in
theWestandtheEast.In
theform
ercommunistcountries,
however,people
did
notfeel
thatthey
hadthesamecontrol
over
theirlives
asdid
peoplein
theWest.Peopleseconomic
satisfactionwasthemost
powerfulpredictorof
self-perceived
health,in
both
theEasternandWestern
parts
ofEurope.
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Carlson(2000)
Russia
Objectivematerial
prosperity,
education.
Self-ratedhealth.
Familialsocialsup-
port,subjective
view
ofmaterial
prosperity.
Lesseducatedsubjectsreported
poorhealthtw
iceasoften
asa
higher-educatedgroup.Subjectivematerialprosperityand
relationswithin
thefamilywereim
portantforself-rated
healthandpartiallyexplained
theeducationalhealth
differences.
Forkel
&Silbereisen(2001)
East
andWest
Germany
Socioeconomic
con-
ditions(w
ork
sta-
bility,income,
incomechange,
materialneeds
...).
Depressed
mood.
Familialsocial
support
Familialsocialsupport
tested
inamediationmodel
predicted
interindividualdifferencesin
adolescentsdepressed
moodin
WestGermanybutnotin
East
Germany.Thisresultis
interpretedin
lightofdifferentattributionsandpublic
attitudes
tothecause
ofhardship.
Grobet
al.(1996)
8ex-communist
countriesand6
Western
countries
Gender,age,
region,
comparative
socialstatus.
Wellbeing.
Perceived
control
(controlexpec-
tancy,control
appraisal),sub-
jectivewellbeing
(positiveatti-
tudes,
self-esteem).
Themeanlevelsofwellbeingandperceived
controlvaried
along
stable
Western
vs.unstable
Easternsociohistoricalcontexts:
Easternadolescents
showed
(a)lower
levelsofwellbeing
(perhapsrelatedto
economic
aspects
ofchange)
and(b)
higher
levelsofperceived
control(perhapsrelatedto
perceived
freedomsim
plied
inthedirectionofchange).
Notably,however,theindividual-difference
relationsamong
theconstructswereveryuniform
across
the14settings,
suggestingthattheadaptivepsychologicalinterface
between
wellbeingandpersonalcontrolisrelativelyrobust
against
sociopoliticalinfluences.
Koppet
al.(2004)
Hungary
Gender,personal
andfamily
income,
education.
Severityofdepres-
sivesymptoma-
tology,anxiety,
BMI,tabaquism,
consumptionof
alcoholandself--
reported
morbidity.
Hostility,socialsup-
port
andcontrol
inwork.
Within
asocietyin
transition,theabsolute
economicindicators
are
inclose
relationship
withmorbidityand,withcertain
limitations,withmortality,mainly
amongmen.Theresults
alsoindicate
thattheseverityofdepressivesymptomscanbe
regarded
asaseriousrisk
factorofgeneralmorbidityand
mortality
andthatthemajority
ofrisk
consequencesofalow
socioeconomicsituationare
mediatedbydepressionandlow
controlatwork
amongmen,andbydepressionandanxiety
amongwomen.
Leinsalu
(2002)
Estonia
Maritalstatus,edu-
cation,economic
activity,occupa-
tionalstatus,per-
sonalincome.
Self-ratedhealth,
physicalhealth
status,em
otional
distress.Health
selection.
Locusofcontrol.
Thestudyrevealedsubstantialdifferencesin
self-ratedhealth
bydim
ensionsofsocialstructure
thatwerethoughtto
be
importantin
presentdayEstoniansociety.A
low
level
of
education,Russianethnicity,lowincome,and,formen
only,
ruralresidence
werethemost
influentialdim
ensionsin
predictingpoorhealth.Thisstudyshowed
thatpoor
self-ratedhealthwasstrongly
associatedwiththreecorre-
latesofem
otionaldistress,locusofcontrol,and,in
particular,self-reported
physicalhealthstatus.However,
thesecorrelatescould
notexplain
theethnic
oreducational
differencesin
self-ratedhealth.
Pikhart
etal.(2004)
Russia,Poland,
Czech
Republic
Socialcharacteristics
(education,mate-
rialdeprivation,
Depressive
symptoms.
Effortreward
imbalance
model,
jobcontrol.
Strongassociationsbetweendepressivesymptomsandeffort
reward
imbalance
atwork,materialdeprivation,andmarital
statuswerefound.Therewereweakassociationsbetween
depressionscore,education,andhistory
ofunem
ployment
(continued
)
PSYCHOSOCIAL WELLBEING 487
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Table
1.Continued.
Reference
Participantcountries
Socialvariables
Mentalandperceived
physicalhealth
variables
Subjectivemediators
Resultsandconclusions
experience
of
unem
ployment).
butdepressionwasnotassociatedwithjobcontrolafter
controllingforsocioeconomic
factors.TheRussiandata
did
notshowsuch
arelationship.Itispossiblethatmeasurement
ofjobcontrolwithin
therapidly
changingem
ployment
practices
inRussia
isproblematic.
Piko&
Fitzpatrick(2001,2007)
Hungary
Socioeconomic
status:Objective
socialclass
(status
oroccupation,
andeducationof
thestudents
mother
and
father),typeof
school.
Psychosocialhealth
(self-perceived
health,psychoso-
cialwellbeing,
andfrequency
of
psychosomatic
symptoms).
Subjectiveevalua-
tionofsocioeco-
nomic
status.
Classicalorobjectivesocialclass
indicators
werenotlikelyto
playaveryim
portantrole
inpredictingadolescents
psychosocialhealth,even
inapostcommunistcountrysuch
asHungary.Onthecontrary,SESself-assessm
ent,a
subjectiveevaluationofonesownsocioeconomiccondition,
showed
asignificantassociationwithpsychosocialhealth,
even
after
controllingforother
variables.
Pinquart
etal.(2004)
East
Germany
Commitmentto
the
old
political
system
.
Psychological
distress.
Self-efficacy
beliefs.
Adolescents
whowerehighly
committedto
theold
East
Germanpoliticalsystem
showed
astronger
increase
in
distressafter
unification,butonly
ifthey
hadlow
preunificationself-efficacy
beliefs.In
adolescents
with
averageandhighlevelsofpreunificationself-efficacy,
previousidentificationwiththeEastGermansystem
wasnot
relatedto
changein
psychologicaldistress.In
addition,
higher
self-efficacy
predictedadecrease
inpsychological
distressover
time.
Stelm
ach
etal.(2004)
Poland
Personaldata,
familystatus,
education,
income,
employment.
Frequency
ofdoc-
torsvisits,medi-
calhistory,
chronic
diseases
diagnosedbya
specialistin
the12
monthspriorto
thesurvey.
Controlover
life
Poorcontrolover
life
wasassociatedwithchronicillnesses.The
studysuggests
thathigher
educationandhigher
incomein
theperiodofsocioeconomic
changes
are
theexplanatory
variablesforgoodhealth.Theincidence
ofcoronary
heart
disease
andback
illnesseswasverystrongly
relatedwithlow
education;low
incomewasrelatedless
strongly
with
hypertension,back
illnesses,andcoronary
heart
disease.
Wardle
etal.(2004)
5ex-communist
countriesand5
Western
countries
Sex,age,
region
(East
vs.West).
Depressive
symptoms.
Lifesatisfaction,
perceptionsof
controlandmas-
tery
over
life,
healthlocusof
control.
Depressionscoreswerehigher
inCentralEasternthanWestern
Europeansamples.Theprevalence
oflow
life
satisfaction
wasalsogreaterin
CentralEasternEuropeans,butratings
ofself-ratedhealthdid
notdiffer.Ratingsofperceived
controlweredim
inished,butsense
ofmasteryandinternal
healthlocusofcontrolwerehigher
inCentralEastern
Europe.Depressionandlowlife
satisfactionwereassociated
withlow
perceived
controlandmasteryandwithstrong
beliefsin
theinfluence
ofchance
onhealth.However,taking
thesefactors
into
accountdid
notexplain
theEastWest
difference
indepressivesymptomsandlow
life
satisfaction.
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Subjective evaluation of socialconditions and changes
Pinquart et al. (2004) found that adolescentshighly committed to
the old East German politicalsystem had a stronger increase in
distress afterunification, but only if they had had low
pre-unification self-efficacy beliefs. Furthermore, Pikoand
Fitzpatrick (2007) showed that subjectiveevaluation of ones own
socioeconomic conditionshows a higher association with
psychosocialhealth than objective social class indicatorsamong
students enrolled in secondary schools ofthe Southern Plain Region
of Hungary. Likewise,subjective material prosperity and familial
socialsupport explained self-rated health and educa-tional health
differences in a study carried out inRussia (Carlson, 2000).
Familial social support
Two studies tested the mediating role of familialsocial support.
As cited in the previous section(Carlson, 2000), familial social
support mediatesthe relation between education, material
prosper-ity, and self-rated health. By contrast, Forkel
andSilbereisen (2001), using a meditational analysis,show how
familial social support influencesdifferences in adolescents
depressed mood inWest but not in East Germany according tomaterial
conditions.
DISCUSSION
On one hand it seems clear that the sociopoliticalchanges in
Central and Eastern Europe had astrong impact on emotional
wellbeing.International reports, official figures, and
observa-tional studies agree on the reduction of emotionalwellbeing
in large portions of society. According tothe reports reviewed, it
seems that vulnerableindividuals such as children with low
socialsupport or adults affected by the labour marketreform, may
represent specific affected groups.
Cognitive and subjective mediators appear askey factors to
understand how changing macro-systems affect emotional wellbeing.
The concept ofperceived control has received extensive
attentionalong with other possible explanators such asself-efficacy
or the subjective evaluation of thepolitical process. As addressed
in the Korean study(Kim, 2001) and the model proposed by
Pinquartand Silbereisen (2004), these factors could help to
explain how these relations are mediated in
individuals.Comparisons of perceived control over life
between Eastern and Western cultures are in line
with Pinquart and Silbereisens (2004) model,
which expects age variation in the impact of
social change because of age-associated change in
individual resources and different views of the
direction of change. The few studies addressing
subjective evaluation of changes are line with Kim
(2001).The role of social support seems more con-
troversial. While the results of Carlson (2000)
clearly support the role of familial social support,
the study of Forkel and Silbereisen (2001) failed to
do this among East German adolescents. These
results could be interpreted in the frame of a
collective process in which economic hardships, at
least in the first steps of transition, did not give rise
to stigmatization and thus did not influence
adolescents emotional wellbeing.From a social constructionist
point of view,
assessing changes in collective narratives could
explain how this process is developed. Some
previous work has been done in this direction.
The concept of collective identity has been used as
an analysis instrument on the East Germany
revolutionary mobilization (Pfaff, 1996).
Furthermore, under a social constructionist orien-
tation, Sztompka (2004) outlines an ideal-typical
sequence through which individual traumas
unfold, and applies it to the period of economic
and social collapse in Eastern and Central Europe.Study
limitations should be addressed, especially
regarding the heterogeneity of the concept of social
change and how social outcomes of sociopolitical
change were defined. Future research should focus
on objective and subjective measures of social
change, which could be applied to different
contexts in order to allow comparisons among
studies.Although in this study we did an overview of the
individual factors that mediate the influence of
macrosocial changes in Central and Eastern
Europe on mental health, further research is
needed. Despite the fact that the research on the
subjective vision of changes has been carried out
from a sociopolitical perspective (Orkeny &
Szekelyi, 2000), psychosocial studies should inves-
tigate in depth the possible implications for
emotional wellbeing of the evaluation of social
environment in times of social change. These
studies, using larger and stratified samples,
should address short-term as well as long-term
developmental outcomes, taking account of both
PSYCHOSOCIAL WELLBEING 489
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individual and social resources (Pinquart &Silbereisen,
2004).
Manuscript received June 2011
Revised manuscript accepted January 2012
First published online April 2012
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