Urban Hassles as Chronic Stressors and Adolescent Mental Health: The Urban Hassles Index

Transcription

1 Urban Hassles as Chronic Stressors and Adolescent Mental Health: The Urban Hassles Index David B. Miller, PhD, MSW, MPH Aloen Townsend, PhD This paper discusses the continued development, theoretical framework, and utility of the Urban Hassles Index (UHI), which was designed to measure stressors affecting adolescents in the urban environment. These stressors are chronic and differ in context and content from the more acute life events that are usually measured in adolescent stressor indices. This paper highlights factor analysis results of the UHI and the conceptualization of the dimensions of the index. The UHI s utility as a rapid assessment tool for practitioners and others working with adolescents is discussed. Directions for future research are also highlighted. [Brief Treatment and Crisis Intervention 5:85 94 (2005)] KEY WORDS: adolescence, mental health, urban hassles, major life events, chronic stressors, scales, indices. The urban environment presents both advantages and challenges for adolescents. The study of those challenges remains important to the field of social welfare and social work. Many urban adolescents face a myriad of stressors, including poverty and exposure to violence (Paxton, Robinson, Shah, & Schoeny, 2004; Safyer, 1994). In order to help these adolescents achieve their potential and to lessen the effects From the Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio. Contact author: David B. Miller, Mandel School of Applied Social Sciences, Case Western Reserve University, Euclid Avenue, Cleveland, Ohio dbm5@po.cwru.edu. doi: /brief-treatment/mhi004 of stress-related outcomes for them, it is critical for those providing services and developing programs for this population to understand the daily stressors they encounter, their reaction to these stressors, and the consequences of the stressors. Additional knowledge and understanding of the influence of day-to-day stressors or daily hassles can enhance the assessment of the contributing factors of psychosocial distress among urban adolescents. This paper describes the further design and application of a new tool, the Urban Hassles Index (UHI) (Miller, Webster, & MacIntosh, 2002), which seeks to identify those stressors experienced by adolescents in the urban environment. It also identifies the effects these hassles have on the mental health status of Brief Treatment and Crisis Intervention Vol. 5 No. 1, ª Oxford University Press 2005; all rights reserved. 85

2 MILLER AND TOWNSEND a sample of adolescents, while providing practitioners and researchers with a different perspective of the contextual circumstances surrounding adolescent development within the urban environment. Major Life Events or Daily Hassles? Here we might ask, Is it the heaviest straw or the last straw that breaks the camel s back? It is posited that daily hassles may be a better indicator than major life events in the study of causal relationships between stress and adjustment (Luthar & Zigler, 1991), because indices of life events tell us very little about the day-today events that lead to stress in the lives of people (Kanner, Coyne, Schaefer, & Lazarus, 1981). Definition of Hassles Lazarus (1984) defines daily hassles as experiences and conditions of daily living that have been appraised as salient and harmful or threatening to the endorser s well-being (p. 376). Hassles have also been defined in the literature as irritating, frustrating everyday experiences arising from the transactions between the individual and the environment (Kanner et al., 1981). In the current study, daily hassles are seen as events that occur on a continuum, from minor, irritating events (e.g., noisy neighbors) to more serious events/ transactions (e.g., pressure to join a gang). This definition attempts to overcome some of the conceptual issues identified by Hahn and Smith (1999). The study of daily hassles, individual perceptions, and reactions to the hassle(s) may provide a clearer understanding of coping behaviors as well as the etiology of psychological and physiological distress (Compas, Davis, Forsythe, & Wagner, 1987; Kanner et al., 1981; Lazarus, 1984) than the study of major life events alone. For instance, results from Rowlison and Felner (1988) indicate that the assessment of daily hassles in adolescents lives appears to offer a much-needed supplement to standard life-events methodology, which by itself is insufficient for fully understanding the relationship between life stress and adjustment. Research on Stressors Experienced by Adolescents The empirical literature on the measurement of stressors experienced by adolescents reflects the experiences predominantly of white, middle-class youth living outside of urban environments. Additionally, the scales measure primarily life events rather than daily hassles. For example, in the development of the Adolescent Perceived Events Scale, Compas et al. (1987) selected 658 adolescents to identify scale items. Less than 1% of their sample selfidentified with an ethnic minority, and most of the sample were from rural or suburban middleclass backgrounds. Following the identification of significant events, both daily and major, experienced by these adolescents, Compas and colleagues established the reliability of the measure on another homogeneous sample of adolescents in Vermont, also predominantly rural and white middle-class. Similarly, Mullis, Youngs, Mullis, and Rathge (1993) utilized the Life Experiences Survey to measure the number of positive and negative life events experienced in a sample of 1,740 high school students. These researchers indicated that 88% of their sample was white. No information was provided regarding the ethnic composition of the remaining 12% of the sample. These two studies reflect the reliance of researchers primarily on middle-class, white samples in stress-related studies and those life events that occur episodically within those 86 Brief Treatment and Crisis Intervention / 5:1 February 2005

3 The Urban Hassles Index groups. Investigation of chronic stress among urban disadvantaged adolescents, however, is an important area deserving of further study. Swearingen and Cohen (1985) developed the Junior High Life Experiences Survey (JHLES) in order to address some of the limitations of previous measures of adolescent stress in that the JHLES asks respondents to rate the severity of experiences they have found to be stressful. This study included two separate groups of middle school (i.e., 7th and 8th grade) boys and girls, with sample sizes of 48 and 233, respectively. African American adolescents composed 25% and 21% of the samples, respectively. However, the events included on the scale did not address the daily experiences of adolescents in an urban environment. For instance, typical experiences related to daily safety in the community were not included in the JHLES, such as concern over taking different ways home each day to avoid drug dealers and users or concern about the appropriate color of clothing to wear to prevent being victimized. Omizo, Omizo, and Suzuki (1988) found that school-age children report experiencing multiple stressors; however, as conceptualized in that study, environmental factors contributed relatively little to the children s levels of stress. Notwithstanding the study s lack of attention to environmental factors, the researchers suggested that stress does manifest in negative outcomes in developmental trajectories. In a study of chronic stressors in southwestern Ontario, Avison and Turner (1988) found that chronic strains significantly contributed to psychological distress (i.e., depression). The authors suggested that chronic strains may have a greater effect on mental health status in that they are unresolved, continuing difficulties for the individual (p. 261). These researchers also posited that life-event measures of stress often include items that are actually chronic and continuous stressors. This work lends support to the need to further study chronic stressors. Although the respondents were adults, it is conceivable that adolescents who do not have the benefit of resources available to adults would experience equal if not greater negative effects of chronic stress. Given that the study was conducted in southwestern Ontario, Canada, and the researchers did not indicate that race or ethnic background were variables under study, it is presumed that members of minority groups were not included in this study. While there are similar chronic stressors across groups, members of racial and ethnic groups may experience stressors that are qualitatively different. Lu (1991), in a prospective longitudinal study of 50 respondents, found that daily hassles significantly contributed to mental health status. Lu found that respondents reporting high levels of daily hassles had poorer mental health outcomes at Time 1. When the sample was measured again, daily hassles were found to be a significant predictor of respondent mental health status. Again, the evidence points to the fact that chronic, daily stressors can and do affect mental health status as much as, if not more than, major life events. The sample, unfortunately, did not include members of racial minority groups, and the mean age of respondents was 39.1 (SD ¼ 9.9). In one of the few studies in which a large number of adolescents of color were included, Reynolds, O Koon, Papademetriou, Szczygiel, and Grant (2001) found that high levels of stressful life experiences contributed to increased reports of somatic complaints. Using a sample of 1,037 adolescents between the ages of 11 and 15, Reynolds et al. suggested that somatic complaints were associated with chronic exposure to environmental stress. These researchers sought to address only effects that were internalized by the adolescents, and pointed out that much of the extant literature on stress and adolescents did not include members Brief Treatment and Crisis Intervention / 5:1 February

4 MILLER AND TOWNSEND of minority groups, whose contextual environments were not taken into account by the measures heavily relied on in the studies. Measuring Daily Stressors of Urban Adolescents A literature search reveals few instruments (see Reynolds et al., 2001) relevant to the daily experiences of disadvantaged urban adolescents. Yet, the development of such instruments is critical to understanding the source of chronic stressors, the resulting psychological distress experienced, and their effect on coping behaviors (Kanner et al., 1981; Marsella, 1998). The urban environment presents its own unique set of circumstances, particularly in disadvantaged communities. Luthar and Zigler (1991) suggested that urban adolescents, in general, and minority-group adolescents, in particular, experienced daily hassles that were quite different from and, in some instances, more stress producing than those of majoritygroup or white middle-class adolescents. Researchers (Deardorff, Gonzales, & Sandler, 2003; Safyer, 1994) have posited that life in the inner city is characterized by numerous factors (e.g., violence, poor housing, drug use) that can affect the development of the adolescents who are exposed to those factors on a daily basis. For example, the stressors experienced by adolescents, particularly of the nature and type within the urban environs, would logically affect a student s performance in the classroom. In summary, notwithstanding these few studies, the effects of chronic stressors (i.e., daily hassles) on urban adolescents is an area in which additional empirical research is necessary but largely lacking. Additionally, there is the need to measure those stressors that are germane to specific contextual circumstances. The study whose findings are reported here attempts to integrate these two important areas. Method Sample A purposive sample of 254 adolescents was drawn from two public schools: one a middle school and the other a high school. Within these two schools, students in a required health class participated in the survey. Their parents had to provide written consent, while the students provided written assent. Measures Urban Hassles. The UHI (Miller et al., 2002) was expanded to 32 items, based on a literature review of the stressors germane to the urban environment as well as discussions with professionals working with adolescents in urban settings. Items were developed to counter the bias present in life-events measures developed and standardized primarily with middle-class white adolescents. Thinking back over the last 2 weeks, participants were directed, please indicate how often these events have happened to you. Responses were coded 0 ¼ never, 1 ¼ sometimes, 2 ¼ often, and 3 ¼ very often (see the Appendix for entire 32-item scale). Principal-components analysis and orthogonal (varimax) rotation were used to select items for the UHI. For the 32 items, six principal components emerged with eigenvalues greater than 1.00, accounting for 63% cumulative variance. Inspection of the scree plot and the factor loadings suggested retaining the initial four components (21 items). Items loading solely on the other two factors and items with substantial cross-loadings among the initial four factors were omitted. A principal-components analysis of the 21 retained items (specifying orthogonal rotation and four components) indicated that all four components had eigenvalues greater than 1.00, accounting for 51% cumulative variance. 88 Brief Treatment and Crisis Intervention / 5:1 February 2005

5 The Urban Hassles Index TABLE 1. Factor Analysis of Urban Hassles Scale Rotation Sums of Squared Loadings Component Description of Factor Total Variance, % Cumulative % 1 Environmental conditions Interpersonal interactions/surveillance Safety concerns Anticipatory victimization Cronbach s alpha for the entire UHI was.85. Unweighted additive subscale scores were created from the items loading on each of the four components (see Table I). The first subscale consisted of seven items reflecting hassles related to external (environmental) conditions (e.g., loud cars and loud neighbors at night; item loadings ¼.53 to.76; possible range of scores ¼ 0 21; a ¼.77). The second subscale consisted of six items reflecting hassles related to interpersonal interactions/surveillance (e.g., asked to sell drugs; item loadings ¼.46 to.80; possible range of scores ¼ 0 18; a ¼.75). The third subscale consisted of five items reflecting hassles related to safety concerns (e.g., worrying about safety of family members; item loadings ¼.42to.83;possiblerangeofscores¼ 0 15; a ¼.75). The fourth subscale consisted of three items reflecting hassles related to anticipatory victimization (e.g., having to take a longer way to school or work to avoid trouble; item loadings ¼.63 to.75; possible range of scores ¼ 0 9; a ¼.69). Correlations between subscales ranged from.28 to.50, all p.01. Scores on the total UHI could range from 0 to 63 (a ¼.85). Higher scores represented greater hassles. The mean UHI score was (SD ¼ 10.01, observed range ¼ 0 44). Mental Health. Two widely used standardized measures were included to assess adolescents mental health. One was the Hopkins Symptom Checklist (HSCL) (Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974). The 58-item HSCL assesses common symptoms on five dimensions (somatization, obsessive-compulsive, interpersonal sensitivity, anxiety, and depression). For the present study, only the anxiety and depression items were included. The anxiety subscale consists of 6 items assessing symptoms and behaviors associated clinically with high manifest anxiety (e.g., nervous or shakiness inside, trembling). The depression subscale consists of 10 items assessing a broad range of symptoms and behaviors associated clinically with depressive syndrome (e.g., crying easily, feeling blue or sad). For each anxiety and depression item, participants were asked how much that problem has bothered them during the past 7 days (coded 1 ¼ not at all to 4 ¼ extremely bothered). Higher scores represented greater anxiety or depressive symptomatology. Both subscales of the HSCL and the total scale showed adequate internal consistency in the present study (a ¼.80 for anxiety,.83 for depression, and.87 for the total). The mean anxiety score was 8.15 (SD ¼ 2.81, observed range ¼ 6 22), the mean depressive symptoms score was (SD ¼ 5.21, observed range ¼ 8 34), and the mean total score was (SD ¼ 7.26, observed range ¼ 14 49). The second measure of mental health was the Adolescent Symptom Inventory (ASI), which consists of questions from the subscales of conduct disorder and posttraumatic stress disorder (PTSD). The mean score was 5.62 (SD ¼ 6.73, observed range ¼ 0 39). The ASI showed adequate internal consistency in the present study (a ¼.88). Brief Treatment and Crisis Intervention / 5:1 February

6 MILLER AND TOWNSEND Analysis Plan Pearson correlations were used to assess the bivariate relationships between urban hassles and mental health. An independent-group t test was used to evaluate differences in mean hassles by gender. To further investigate the relationship between hassles and mental health, scores on the UHI were divided into three groups (low, moderate, and high). Low scores (n ¼ 86), ranging from 0 to 9, represented the bottom third of the distribution; moderate scores (n ¼ 79), ranging from 10 to 17, represented the middle third of the distribution; and high scores (n ¼ 73), ranging from 18 to 44, represented the top third of the distribution. The three UHI groups were then used as the sole predictor in one-way analyses of variance (ANOVAs), with mental health (anxiety, depression, antisocial behavior, or PTSD) as the outcome. Levene s F was used to evaluate the ANOVA assumption of homogeneity of variances. Dunnett s C was then used to test for post-hoc differences between the three groups, because their variances were not homogeneous. Participants with missing information were excluded from analyses. Thus, the number of valid cases varied by analysis (N ¼ 175 to 238). Results Background Characteristics of Sample The sample was evenly divided by gender. Of the 254 participants, 248 reported their gender. The study had 122 males (49%) and 126 females (51%). The average age of the participants was (SD ¼ 2.05), with a range of years. Racial classification was reported for 245 of the participants. African Americans were the majority (n ¼ 156, 64%), while whites were the next largest group (n ¼ 55, 22%). Native Americans, Asian/Pacific Islanders, and Latinos/ Hispanics made up the remainder (n ¼ 34, 14%). Gender Differences in Total Hassles There was a significant gender difference on hassles, t(230) ¼ 1.98, p ¼.05. The magnitude of the difference was small, eta 2 ¼.02. Males reported higher hassles than females (M ¼ 15.67, SD ¼ 10.71, vs. M ¼ 13.12, SD ¼ 8.73, respectively). Correlations Between Hassles and Mental Health Measures As shown in Table II, a higher total score on the UHI was significantly and moderately correlated with a higher total score on the HSCL and a higher total score on the ASI. Greater hassles on each of the four UHI subscales also were consistently related to poorer mental health. The magnitude of the correlations varied, however, depending on which subscale of hassles and which measure of mental health was considered. For example, scores on interpersonal interactions/surveillance hassles were more strongly correlated with scores on the total ASI than with scores on the total HSCL or its anxiety and depression subscales. Hassles from external environmental conditions, however, were nearly equally strongly correlated with all mental health measures. ANOVA Results The level of hassles reported on the total UHI (low, moderate, or high) was significantly related to all three mental health measures, as shown in Table III. The higher the level of hassles, the more anxiety and depression and the higher the ASI score the adolescents reported. On every outcome, adolescents experiencing a low level of hassles reported significantly better mental health than adolescents experiencing either a moderate or a high level of hassles. Similarly, adolescents experiencing a moderate level of hassles reported significantly better mental health than those 90 Brief Treatment and Crisis Intervention / 5:1 February 2005

7 The Urban Hassles Index TABLE 2. Bivariate Correlations Between the Urban Hassles Index and Measures of Adolescents Mental Health (N ¼ 254) Total Score Environmental Conditions Subscale Interpersonal interactions/surveillance Subscale Safety Concerns Subscale Anticipatory Victimization Subscale Mental Health Measures Urban Hassles Index Hopkins Symptom Checklist Total score.48** Anxiety subscale.42**.38**.14*.36**.37** Depression subscale.47**.44**.20**.41**.31** Adolescent Symptom Inventory Total score.48**. Antisocial behavioral.50**.44**.45**.28**.26** subscale Posttraumatic stress disorder subscale.48**.45**.198*.428*.35** *p.05, **p.01. experiencing a high level of hassles. The relationship (eta 2 ) between level of hassles and mental health was consistently strong. Discussion Findings of this study suggest that practitioners must take into account the myriad of daily stressors that youths in urban settings must confront and the manner in which these youths adapt to and cope with them. By understanding these stressors, practitioners and advocates can articulate to policymakers the need to reverse the community and environmental degradation experienced by many youths and their families within the urban milieu. The stressors identified by the UHI may provide practitioners with a tool that can serve as a rapid assessment of events affecting adolescents social functioning. From a research perspective, these findings provide an alternative TABLE 3. Mean (SD) Mental Health Scores by Level of Hassles Mental Health Measure Hopkins Symptom Checklist Level of Hassles 1 Low 2 Moderate 3 High F(df) eta 2 Contrasts a Significant Anxiety subscale 7.07 (1.82) 7.84 (2.15) 9.82 (3.61) F(2, 225) = < 2 < 3 Depression subscale (2.79) (4.46) (6.25) F(2, 235) = < 2 < 3 Adolescent Symptom Inventory Antisocial behavior subscale 2.20 (2.17) 4.98 (6.14) (8.13) F(2, 172) = < 2 < 3 Posttraumatic stress disorder subscale (4.12) (5.98) (8.62) F(2, 235) = < 2 < 3 a Using Dunnett s C. p.001. Brief Treatment and Crisis Intervention / 5:1 February

8 MILLER AND TOWNSEND framework for investigating the nature and effects of cumulative stress as well as another area to investigate regarding the possible etiology of maladaptive coping skills. Future research must seek further validation of the UHI across different samples. Additionally, the age range to which the UHI may be applied could be expanded to include young adults. Some hassles (e.g., being pressured to carry weapons) have a consistently negative impact across all mental health domains, while others have a selective impact (e.g., working to help with finances of home). The magnitude and circumstances of the differing effects is an area needing further investigation. The limitations of this study were its crosssectional design, along with the purposive sampling strategy. The findings, while interesting, cannot be generalized beyond the sample from which these data were collected. The effects of long-term exposure to chronic stressors could not be established, nor could we control for events that may have interacted with the stressors that contributed to poor mental health outcomes. Future research would be well served to employ a prospective longitudinal approach so that the effects of and reaction to chronic stressors can be examined across developmental milestones. As this study and other research studies may suggest, chronic stressors or what this study s authors describe as daily hassles can negatively affect mental health status. Although the evidence is limited at this time, understanding these chronic and ubiquitous stressors is essential for social work practitioners, social science researchers, and public policymakers. Interventions that do not consider the environmental context in the day-to-day lives of urban adolescents and young adults are doomed at best to offer a temporary respite; at worst, to fail. APPENDIX. The Urban Hassles Scale Directions: How often do the following happen to you? Thinking back over the last 2 weeks, please indicate how often these events have happened to you. Please circle the number that best describes how often an event happened to you. 0 = Never 1 = Sometimes 2 = Often 3 = Very Often 1. Asked for money by drug addicts Taken a longer way to school or work to avoid trouble 3. Pressured to join a gang Made fun of because of good grades Worried that someone will try to take your clothes, shoes, or money 6. Pressured for sex by boyfriend/girlfriend Working to help pay bills at home Nervous about gunshots at night Nervous about sirens at night Worrying about safety of friends Worrying about safety of family members Brief Treatment and Crisis Intervention / 5:1 February 2005

9 The Urban Hassles Index APPENDIX continued. The Urban Hassles Scale 0 = Never 1 = Sometimes 2 = Often 3 = Very Often 12. Worrying about your own safety Keeping your worries about safety secret from friends 14. Being stopped and questioned by police Asked to sell drugs Asked to hide or carry drugs Being followed in department stores by salespeople 18. Not being able to go into convenience stores...with friends because of rule against more than 2 students/teens at a time in the store 19. Being unable to go to parties or games with friends because of transportation problems 20. Teased about the clothes you wear Walking past abandoned buildings and lots Pressured by friends to fight Made fun of because of bad grades Pressured to carry a weapon for protection Having something stolen or having your house or car broken into 26. Being concerned about living in an unsafe area Fear of confrontation with strangers Loud, noisy cars and neighbors at night People hanging around on street corners or in front of stores 30. Waiting for bus near dirty, smelly bus stops Having problems or conflicts with teachers Parent(s) being nosey about what you do ª2001 by David B. Miller. Reproduction prohibited without permission of author. References Avison, W. R., & Turner, R. J. (1988). Stressful life events and depressive symptoms: Disaggregating the effects of acute stressors and chronic strains. Journal of Health and Social Behavior, 29, Compas, B. E., Davis, G. E., Forsythe, C. J., & Wagner, B. M. (1987). Assessment of major and daily stressful events during adolescence: The Adolescent Perceived Events Scale. Journal of Consulting and Clinical Psychology, 55, Deardorff, J., Gonzales, N. A., & Sandler, I. N. (2003). Control beliefs as a mediator of the relation between stress and depressive symptoms among inner-city adolescents. Journal of Abnormal Child Psychology, 31, Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The Hopkins Symptom Checklist (HSCL): A selfreport symptom inventory. Behavioral Science, 19, Hahn, S. E., & Smith, C. (1999). Daily hassles and chronic stressors: Conceptual and measurement issues. Stress Medicine, 15, Kanner, A. D., Coyne, J. C., Schaefer, C., & Lazarus, R. S. (1981). Comparison of two modes of stress management: Daily hassles and uplifts Brief Treatment and Crisis Intervention / 5:1 February

10 MILLER AND TOWNSEND versus major life events. Journal of Behavioral Medicine, 4, Lazarus, R. S. (1984). Puzzles in the study of daily hassles. Journal of Behavioral Medicine, 7, Lu, L. (1991). Daily hassles and mental health: A longitudinal study. British Journal of Psychology, 82, Luthar, S. S., & Zigler, E. (1991). Vulnerability and competence: A review of research on resilience in childhood. American Journal of Orthopsychiatry, 61, Marsella, A. J. (1998). Urbanization, mental health, and social deviancy: A review of issues and research. American Psychologist, 53, Miller, D. B., Webster, S. E., & MacIntosh, R. (2002). What s there and what s not: Measuring daily hassles in urban African American adolescents. Research on Social Work Practice, 12, Mullis, R. L., Youngs, G. A., Mullis, A. K., & Rathge, R. W. (1993). Adolescent stress: Issues of measurement. Adolescence, 28, Paxton, K. C., Robinson, W. L., Shah, S., & Schoeny, M. E. (2004). Psychological distress for African-American adolescent males: Exposure to community violence and social support as factors. Child Psychiatry and Human Development, 32, Omizo, M. M., Omizo, S. A., & Suzuki, L. A. (1988). Children and stress: An exploratory study of stressors and symptoms. School Counselor, 35, Reynolds, L. K., O Koon, J. H., Papademetriou, E., Szczygiel, S., & Grant, K. (2001). Stress and somatic complaints in low-income urban adolescents. Journal of Youth and Adolescence, 30, Rowlison, R. T., & Felner, R. D. (1988). Major life events, hassles, and adaptation in adolescence: Confounding in the conceptualization and measurement of life stress and adjustment revisited. Journal of Personality and Social Psychology, 55, Safyer, A. W. (1994). The impact of inner-city life on adolescent development: Implications for social work. Smith College Studies in Social Work, 64, Swearingen, E. M., & Cohen, L. H. (1985). Measurement of adolescents life events: The Junior High Life Experiences Survey. American Journal of Community Psychology, 13, Brief Treatment and Crisis Intervention / 5:1 February 2005