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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

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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: franciscojose.eiroa@uab.cat).

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).

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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

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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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