PRELIM INARY EMPIRICAIi U W B R
8
TANDINGThis chapter summarizes some preliminary evidence on how the work- trauma process may be working in different cultural settings. The purpose is to link the subject matter of Chapter Two with conclusions and suggestions for further research, detailed in the following chapter. Given the importance of focusing on the key variables outlined by Chapter Two, we summarise only key findings here. Full data is in Appendix VI following.
Note that in all of the analysis presented here pair-wise deletion is used. Thus, if one item is not completed, scores for that respondent are not shown. Mean substitution was not used. Where tables are introduced in this chapter, they are preceded in small case by a brief explanation of the tables contents and structure. This is not intended as an interpretation of the data in the tables but rather designed to facilitate general ease when consulting tables independently of the text.
Cultural differences in symptomatology
Full results of traumatic reactions and general pathology symptoms are recorded in Table XII, below. This table shows that, contrary to expectations, there were not comparable responses across emergency services in different cultural settings. In fact, there were large differences in symptomatology.
The stressors endemic to Japanese society detailed in Chapter Two and that suggested comparatively high general pathology symptoms (extensive work hours, economic strain, pressure to perform in hierarchical organizations etc.) were only partially supported by the data. Partial in the sense that only compared to the UK, incidence of depression was particularly high (5.61 versus 2.32). All symptoms of general pathology and traumatic reactions were higher in Japan than the UK.
However, an unexpected finding was to see such consistently high profiles in Hong Kong. In all seven symptoms, both general pathology and traumatic reactions, mean scores in Hong Kong were higher than mean level of corresponding symptoms in Japan. Differences were particularly pronounced in the IES-15 scale. Intrusion symptoms in Hong Kong were 11.70 versus 2.67 in Japan and 2.31 in the UK. Avoidance symptoms were 10.90 versus 2.43 (Japan) and 1.73 (UK) . This data was unexpected.*"
TABLE XII: CULTURAL DIFFERENCES IN GENERAL PATHOLOGY & TRAUMA REACTIONS
EXPLANATION OF TABLE: This table indicates mean level of the 7 measured symptoms in each cultural setting. For ease of reference, symptoms are grouped by the instrument of which they are a sub-set, and the scale maximum is provided to facilitate understanding the mean score in perspective. Standard deviation is indicated in parenthesis beneath each mean and significant differences are indicated by '#' symbols in the table, with t-values at the bottom of the table. (The explanation for calculating a test of significant differences is in end-note . The bottom of the table also covers details on the symptoms.
SYMPTOMS UK JAPAN HONG KONG
IES-15
Intrusion symptoms
(Impact of Event Scale; scale maximum 35) Avoidance symptoms
(Impact of Event Scale; scale maximum 40)
a# 2.31 (3.75) b# 1.73 (3.39) a# 2.67 (5.02) b# 2.43 (4.69) a# 11.70 (8.35) b# 10.90 (8.56) HAD-14 Anxiety symptoms
(Hospital Anxiety and Depression; 21) Depression symptoms
(Hospital Anxiety and Depression; 21)
c# 5.13 (4.14) d# 2.32 (2.60) c# 6.30 (3.61) d# 5.61 (3 .69) c# 8.20 (4.16) d# 7.52 (3.15) HSCL-21
Performance difficulties symptoms (HSCL-21; scale maximum 28)
General feelings of distress symptoms (HSCL-21; scale maximum 28}
Somatic distress symptoms (HSCL-21; scale maximum 28) e# 10.28 (2.93) f# 9.7 (3.15) g# 9.33 (3.35) e# 12.27 (3.74} f# 10.68 (4.30) g# 11.76 (3.56) e# 15.46 (4.54) f# 14.48 (4.84) g# 17.96 (5.92)
Key; Impact of Event Scale, Intrusion and Avoidance factors; Hospital Anxiety and Depression Scale, Anxiety and Depression factors; Hopkins Symptom Check List, Performance Difficulties, Somatic Distress and General Feelings of Distress.
Tests of significant difference; At a#, b#, c#, d#, e#, f#, g#, there are significant difference between Hong Kong and Japan, Hong Kong and UK, Japan and UK ® p<0.0005
(t=3.4602), using a one-tailed test with degrees of freedom (' V ) = 60.
Note : The methodology for calculating significant difference with an example from this table is in the endnotes to this chapter but is based on the simple one-tailed t- distribution (Sprent, 1977).
Marital status# parenting status and age
Full details on the relationship of marital status with symptoms are ;S contained in Appendices VIV (part B) and X (part B) . Appendix XI >
(parts A-G) details the relationship of all symptoms with all sources of social support, including partners. Appendices XIII and XIV list
the correlation of all symptoms with social support. This section > summarizes key findings.
In all samples approximately 80% of respondents were married. A ^
cross-tabulation of symptoms by marital status, summarised in Table XIII below, shows clear differences in general pathology and specific traumatic reaction symptoms between single and married subjects.
Traumatic symptomatology was uniformly higher in single Japanese im
personnel versus married personnel. Symptoms of general pathology were higher in married Japanese. Anxiety and depression symptoms were higher in single UK and Hong Kong personnel.
«
TABLE XIII: CULTURAL DIFFERENCES IN SYMPTOMATOLOGY BY MARITAL STATUSt
EXPLANATION OF TABLE: This table shows how mean level of the 7 measured symptoms in each cultural setting varies according to subjects who are single and married. The table, and all subsequent tables, follows the order UK, Japan, Hong Kong. To ensure that sample differences are understood the table discloses both n. (number) and % (percent) demographics. Significant differences are indicated by ’#' symbols in the table. The bottom of the table covers details on the symptoms and types of significant differences.
CÜLTURE..MARITAL STATUS SYMPTOM
n. % IBS-1 lES-A HAD-A HAD-D HSCL-PD HSCL-SD HSCL-GFD
UK Single 6 8.57 1.33 3.17 5.33 2.67 10.27 8.78 9.83 (1.97) (7.76) (3.27) (3.20) (3.17) (2.65) (3.07) a#,b#,c# a#,b# c# c# c# C# Married § 57 81.43 2.2 1.30 4 .88 2.14 10.25 9.42 9.75 (3.67 (2.09) (4.02) (2.59) (3.43) (3.02) (3.63) a#,b#,e a#,b#,d#,e# d#,e# d#,e# d#,e# d#,e# d#, e# JAPAN
Single 125 18 .77 3 .48 3.26 5.67 5.03 11.77 10.02 11.41 (6.41) (5.93) (3.40) (3.80) (3.29) (3.28) (4.20) a#,b# a#,b# a#,b# a#,b#,c# a#,b#,c# a#,b#,c# a#,b#,c#
Married 537 80.63 2 .53 2.29 6.43 5.73 12.40 10.87 11.83 (4.68) (4.41) (3.64) (3.63) (3.85) (3.64) (4.32) a#,b#,d# a#, b#,d# a#,b#,d#,e# a#,b#,d#,e# a#,b#,d#,e# a#,b#,d#,e# a#, b#, d#, e# HONG KONG
Single 10 15 .67 11.50 11.20 9.70 8.70 14.50 19.44 15.50 (7.79) (6.76) (3.09) (3.02) (2.55) (5.94) (4.14) b# b# a#,b# a#,b# a#,b# a#,b# a#,b#
Married 49 81.67 11. 94 10.96 7.90 7.27 15.64 17.83 14.27 (8.50) (8.99) (4.35) (3.18) (4.83) (5.92) (5.04) d# d# a#,d# a#,d# a#,d# a#,d# a#,d#
Note :
t See Appendix VIV (part B) for full data on respondents designated 'other' § Note that n=5 (7.35%) of UK sample have 'other' marital status.
Key; IBS - Impact of Event Scale, Intrusion and Avoidance factors; HAD - Hospital Anxiety and Depression Scale, Anxiety and Depression factors; HSCL - Hopkins Symptom Check List, Performance Difficulties, Somatic Distress and General Feelings of Distress.
Tests of significant- difference; All instances in this table marked # are significant ®p<0.001, using a one-tailed test with degrees of freedom ('v') = 60; and v=3 00 for the
intra-Japan testing.
Instances denoted a# are significant differences between single and married respondents within each cultural setting;
Instances denoted b# are significant differences between single respondents in Hong Kong and Japan and Hong Kong and UK;
Instances denoted c# are significant differences between single respondents in Japan and UK;
Instances denoted d# are significant differences between married respondents in Hong Kong and Japan and Hong Kong and UK;
Instances denoted e# are significant differences between married respondents in Japan and UK.
Full data on the level of symptoms in those with or without children is in Table XIV, below. The table shows that all indices of general pathology were lower in UK and Hong Kong non-parents; that is those without children exhibited higher general pathology symptomatology than those with children. The opposite was observed in Japan where, by contrast, all symptoms of general pathology in Japanese were observed to be higher than non-parents.
Intrusion symptoms in Japanese non-parents were however higher than parents : 3.01 versus 2.53. High symptoms in Japanese non-parents were also seen in avoidance symptoms. This tendency was also seen in Hong Kong and the UK, where non-parents also exhibited higher levels of intrusion and avoidance symptomatology compared to parents. The cultural differences in symptomatology amongst parents is illustrated below: