Social Support as a Moderator between Health Status and Self-Esteem, Psychosocial Stress, and

96 Pages·2015·1.18 MB·English

Philadelphia College of Osteopathic Medicine
DigitalCommons@PCOM
PCOM Psychology Dissertations Student Dissertations, Theses and Papers
2009
Social Support as a Moderator between Health
Status and Self-Esteem, Psychosocial Stress, and
Mood in Old Order Amish Women
Christina L. Abbott
Philadelphia College of Osteopathic Medicine, [email protected]
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Abbott, Christina L., "Social Support as a Moderator between Health Status and Self-Esteem, Psychosocial Stress, and Mood in Old
Order Amish Women" (2009).PCOM Psychology Dissertations.Paper 1.
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Philadelphia College of Osteopathic Medicine

Department of Psychology

SOCIAL SUPPORT AS A MODERATOR BETWEEN

HEALTH STATUS AND SELF-ESTEEM, PSYCHOSOCIAL STRESS, AND MOOD

IN OLD ORDER AMISH WOMEN

By Christina L. Abbott

Submitted in Partial Fulfillment of the Requirements of the Degree of

Doctor of Psychology

September 2009
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
DEP ARTMENT OF PSYCHOLOGY
Dissertation Approval
This is to certify that the thesis presented to us by ( I., [~_(in,,,.c L. ,Ii hJ~ #-
L
, 20 DS , in partial fulfillment of the
-,
requirements for the degree of Doctor of Psychology, has been examined and is
acceptable in both scholarship and literary
Committee Members' Signatures:

Donald Masey, Psy.D., Chairperson

Virginia Salzer, Ph.D.

Karen Lindgren, Ph.D.

Robert A. DiTomasso, Ph.D., ABPP, Chair, Department of Psychology
iii

Acknowledgements

I want to thank my loving husband Berwood for his unfailing support, insight and
guidance, my stepchildren Hannah and Spenser for their patience and understanding, and
my mother Loretta Rogers, for her unwavering love and support. This accomplishment is
as much theirs as it is mine, and I will be forever grateful.
iv

Abstract

The Amish population is growing in Lancaster County, Pennsylvania (Kraybill, 2008)
and Amish use of medical and psychological services provided by the outside world is
increasingly common (Cates & Graham, 2002; Weyer et al., 2003). Yet, little is known
about how Amish women perceive their health status or how these variables interact in
this population. This study revealed an identifiable relationship between health status and
psychological functioning in 288 Amish women, ages 18 to 45. As health improves, self-
esteem and mood also improve. Of greater importance is the fact that when good social
support is available, even Amish women in poor health report high self-esteem.
v

Table of Contents
Acknowledgements.………………………………………………………………… iii

Abstract……………………………………………………………………………... iv

List of Tables……………………………………………………………………….. viii

Chapter One: Introduction….…………………………………………………........ 1

Statement of Problem……………………………………………………. 1

Purpose of the Study…………………………………………………….. 3

Relevance to Better Understanding the Amish………………………….. 4

Chapter Two: Literature Review…………………………………………………… 5

Relevant Constructs ……………………………………………………... 5

Health Status……………………………………………………. 5

Social Support………………………………………………...… 6

Self-Esteem……………………………………………………... 8

Relationship Between Health Status and Psychological Functioning…… 8

Health Status and Depression…………………………………... 8

Health Status and Self-Esteem………………………………….. 10

Health Status and Psychosocial Stress………………………….. 13

Role of Social Support in Moderating Psychological Functioning……… 17

Physical and Mental Health Functioning in the Amish………………….. 18

Amish and Physical Health……………………………………. 19

Amish and Mental Health……………………………………... 21

Social Support Among the Amish……………………………………….. 25

Chapter Three: Hypotheses………………………………………………………… 28

Hypotheses/Research Questions………………………………………… 28

Statement of the Hypotheses…………………………………………….. 28

Hypothesis 1………….…………………………………….….. 28

Hypothesis 2………….…………………………………….….. 29

Hypothesis 3………….…………………………………….….. 29

Hypothesis 4………….…………………………………….….. 29

Hypothesis 5………….………………………………….…... 30
vi

Hypothesis 6……….…………………………………….…... 31
Hypothesis 7………….………………………………….…... 31
Chapter Four: Methods…………………………………………………………….. 32
Overview……………………………………………………………….... 32
Design……………………………………………………………………. 31
Participants………………………………………………………………. 33
Sampling Method………………………………………………………... 33
Sample Selection………………………………………………………… 34
Recruitment……………………………………………………………… 34
Response Rate…………………………………………………………… 35
Measures…………………………………………………………………. 35
Functional Health Status………………………………………... 35
Objective Health Status………………………...………………. 36
Social Support………………………………..….……………… 36
Depression……………………………………...………………. 38
Psychosocial Stress…………………………………...………… 38
Self-Esteem……...……………………………………………… 39
Procedures……………………………………………...………………... 39
Analysis of Risk/Benefit Ratio…………………………………...……… 40
Procedures for Maintaining Confidentiality……………………………... 40
Chapter Five: Results………….…………………………………….……………... 41
Internal Reliability………….…………………………………….……… 41
Scale Development………….…………………………………….……... 42
Hypotheses Testing………….…………………………………….…….. 44
Hypothesis 1………….…………………………………….…... 44
Hypothesis 2………….…………………………………….…... 44
Hypothesis 3………….…………………………………….…... 44
Hypothesis 4………….…………………………………….…... 44
Hypothesis 5………….…………………………………….…... 45
Hypothesis 6………….…………………………………….…... 46
Hypothesis 7………….…………………………………….…... 47
vii

Chapter Six: Discussion..……………………………………………………….….. 49

Summary and Significance of Findings…………………………………. 49

Contributions of the Study………………………………………………. 53

How Can We Better Serve the Amish?..………………………………… 55

Limitations of the Study…………………………………………………. 57

Directions for Future Research………………………………………….. 58

References…………………………………………………………………………... 60

Appendices………………………………………………………………………….. 72

A. Short Form-12 Survey (SF-12v2™)………………………………….. 73

B. Chronic Health Conditions………………………………...…………. 74

C. MOS Social Support Survey………………………………………….. 75

D. Center for Epidemiologic Studies Depression Scale…………………. 76

E. Psychosocial Profile Hassles Scale…………………………………… 77

F. Rosenberg Self-Esteem Scale………………………………………... 78
viii

List of Tables

Table 1 Comparison of Internal Consistency Estimates Between the Current Study

and the Original Studies…………………………………………………………….. 41

Table 2 Means and Standard Deviations for Key Measures………………………... 42

Table 3 Moderated Multiple Regression Results for Self-Esteem…………...……... 45

Table 4 Moderated Multiple Regression Results for Depression.…………...……... 46

Table 5 Moderated Multiple Regression Results for Stress……..…………...……... 47

Table 6 Frequency of Responses to the Psychosocial Profile Hassles Scale………. 49
Social Support as a Moderator Between Health Status and Self-Esteem, Psychosocial

Stress, and Mood in Old Order Amish
Statement of Problem
There are approximately 220,000 Amish people living in twenty-seven states
across America and Ontario, Canada (Kraybill, 2008). The largest Amish settlement is
located in Holmes County, Ohio. The second largest settlement is located in Lancaster
County, Pennsylvania. Lancaster’s settlement is the oldest and most densely populated.
An estimated 27,000 Amish reside in Lancaster County, half of whom are under the age
of 18. Although many non-Amish believe that the Amish population is slowly dying out,
this is not the case. In fact, during the past century the Amish population has doubled in
size approximately every twenty years. The rapid growth in the Amish population is
attributed to their robust birth and retention rates (Kraybill, 2008). The average Amish
family has seven children. The number of adults who leave the Amish community or
youth who choose not to be baptized is less than 10 percent (Kraybill, 2008). The life
expectancy for the Amish is 70.7 (± 15.6) years (Mitchell et al., 2001); unlike men and
women in the general population, Amish men live as long as Amish women (Miller,
1980).
Amish population growth is also attributed to the community’s ability to resist the
forces of modernization that threatened their cultural beliefs, yet simultaneously
accepting select technology that perpetuates their society. Like many other Amish
communities, the Lancaster County Amish shun most modern day conveniences. They
use the horse and buggy for transport, do not own televisions, prohibit higher education,
and do not use electricity in the home (Ediger, 2005; Hostetler, 1993; Kraybill, 2008).