Psychological, social and emotional well-being of adults with a history of institutionalization: the pilot study findings

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PSYCHOLOGICAL, SOCIAL AND EMOTIONAL WELL-BEING OF ADULTS WITH A HISTORY OF INSTITUTIONALIZATION: THE PILOT STUDY FINDINGS

M.A. Chumakova^a, M.A. Zhukova^be, S.A. KORNILOV,

I.V Golovanova^b, A.O. Davydova^b, T.I. Logvinenko^b,

I.V Ovchinnikova^b, M.V. Petrov^d, A.V. Antonova^a,

O.YU. Naumovaf E.L. Grigorenko^be

^a National Research University Higher School of Economics, Moscow, Russian Federation

^b Saint Petersburg State University,Saint Petersburg, Russian Federation

^c Institute for Systems Biology, Seattle, USA

^d Kashchenko Psychiatric Hospital, Nikolskoye Village, Gatchinsky District, Leningrad Region, Russian Federation

^e University of Houston, Houston, USA

^f Vavilov Institute of General Genetics, Moscow, Russian Federation

Abstract

The paper presents pilot research data that is part of the research project “The Impact of Early Deprivation on the Bio-Behavioral Indicators of Child Development” from the Government's megagrant programs No. 14.Z50.31.0027. The purpose of the paper is the study of mental, social and emotional well-being indicators of adults raised in orphanages in comparison with a control group of adults who grew up in biological families. The comparison was carried out using scales of the WHO Questionnaire for assessing quality of life and Adult Self-Report (ASR) from The Achenbach System of Empirically Based Assessment (ASEBA) for assessing psychological and emotional well-being. Results revealed no significant differences between the groups studied. However, using the classification procedures, we found that an important feature is the living conditions that enable classification of membership in a group of graduates of an orphanage or in a group of adults from biological families: a separate apartment or a “public” space (a communal apartment or a dorm). A hypothesis has been put forward about the impact of the current living environment on the diagnosed indicators of the mental, social and emotional well-being of orphanage graduates.

Keywords: orphans, orphanage, mental, social and emotional well-being.

Резюме

В статье представлены пилотные данные исследования, являющегося частью исследовательского проекта «Влияние ранней депривации на биоповеденческие показатели развития ребенка», осуществляемого в рамках программы мегагрантов Правительства РФ № 14.Z50.31.0027. Цель статьи -- изучение показателей психического, социального и эмоционального благополучия взрослых с опытом институционализации в сравнении с контрольной группой взрослых, выросших в биологических семьях. Сравнение проводилось по шкалам Опросного листа Ахенбаха и краткого опросника ВОЗ для оценки качества жизни. Значимых различий по шкалам опросников между группой выпускников детских домов и контрольной группой обнаружено не было. Однако при использовании процедур классификации было установлено, что важным признаком, позволяющим классифицировать принадлежность к группе выпускников детского дома или к группе взрослых из биологических семей, являются условия проживания: отдельная квартира или «общественное» пространство -- коммунальная квартира или общежитие. Выдвинута гипотеза о влиянии актуальной жизненной среды на диагностируемые показатели психического, социального и эмоционального благополучия выпускников интернатных учреждений.

Ключевые слова: сироты, детский дом, психическое, социальное и эмоциональное благополучие.

Introduction

biological familie orphanages mental indicators

According to survey data collected in the Russian Federation, many children with a history of institutional placement (in orphanages or baby homes) experience problems with social adaptation, due to a lack of social skills and emotion regulation (Bobyleva, 2007). It has been shown that children currently residing in orphanages (Pastukhova, 2011), as well as children who have graduated from and left orphanages (Prisyazhnaya, 2007), experience problems with social adaptation. Children in this group show an increased prevalence of internalizing problems (e.g., aloofness, fear of being alone) and attachment disturbances. Adults with a history of institutionalization often experience problems with employment because of low working motivation; they also demonstrate high rates of substance abuse (Sem'ya, 2007).

The detrimental psychological effects of being raised in institutions without parental care have been vastly discussed and investigated world-wide (e.g., Bos et al., 2011; Erol, Oztop, & Ozcan, 2008; Groze & Ileana, 1996; Merz & McCall, 2010). It has been shown that children and adolescents raised in institutions exhibit marked deficits across a number of developmental domains compared to age- matched children raised in family settings. These include cognitive, affective, and behavioral difficulties and higher rates of such disorders as anxiety, depression, ADHD and conduct disorder (Bos et al., 2011; Erol et al., 2008; Merz & McCall, 2010).

Factors that may influence or contribute to these social maladaptations may include strict routines within the institution, lack of interaction with caregivers, and restricted social activities (Shulga, 2011). These factors contribute to dependent behavior and insecurities about the future, resulting in difficulty in forming and maintaining social connections for adults with a history of institutionalization.

Despite the importance of social adaptation for children and adolescents raised in institutional care, there is currently a dearth of research on the long-lasting residual effects of institutional placement on the life course of orphanage graduates who are actively engaged in social life. This lack of empirical data may be partially explained by the difficulty of organizing such studies: the recruitment of participants is challenging due to the stigma surrounding orphanage graduates; this label holds negative connotations that lead to many concealing their life stories. In addition, information is legally restricted in the Russian Federation concerning adoption and institutional placement.

The long-term impact of institutionalization is a serious concern as people with a history of institutional care (IC) face possible exclusion from social life (Bakhmatova & Chusova, 2013). As a group, adults with a history of institutionalization are characterized by higher, compared to baseline, unemployment rates and criminal records (Sem'ya, 2007). Focus groups have identified the following factors that potential employers reported about adults with an IC history: lack of social skills (passive or aggressive attitudes towards peers; abuse of welfare benefits; avoiding responsibility or shifting responsibility; and substance abuse). In turn, according to surveys conducted with adults with an IC history, these adults perceive employers to have unrealistic expectations, believe they are being treated unequally as a socially disadvantaged group, and report that they are negatively labeled as poor or thieves or delinquents (Ibid.). Thus, employers avoid employing individuals who have an IC history, and people with an IC history are not looking for full-time jobs; this makes social adaptation for adults with an IC challenging (Bakhmatova & Chusova, 2013).

To address this problem a number of policies have been introduced in Russia aimed at increasing the social adaptation of people with an IC history (Sem'ya, 2007). Yet, these policies are not evidence-based, as this group of adults is poorly represented in the research literature (Shulga, 2011). The lack of empirical data on adults with an IC history is evident not only in Russia, but also elsewhere in the world. Institutional care is a common solution for abandoned children in Eastern Europe, the Middle East, as well as from African and Asian countries. Although IC is rarely observed in North America and Western Europe, that is where the overwhelming majority of scientific research on the role of IC in human well-being is taking place. Therefore, most of the data regarding children growing up without their biological parents is derived from studies investigating the effects of foster/adoption family transition - the most common solution for orphans or abandoned children in North American and Western European countries - on children's developmental outcomes (e.g., Dubois-Comtois et al., 2015; Ferrari, Vezzali, & Rosnati, 2017; Piermattei, Pace, Tambelli, D'Onofrio, & Di Folco, 2017).

A Canadian study investigated adults with a history of IC placement, i.e., the physical and mental health of adults in psychiatric institutions who were raised in orphanages (Sigal, Perry, Rossignol, & Ouimet, 2003). The study included men and women ranging from 43 to 73 years of age, who were placed in an institution at an early age (mean age at institutional placement was 5 years, however the majority of respondents were institutionalized right after birth). The indicators of their physical and mental health were compared to a randomly selected representative sample of Quebec residents. The results showed that adults with an IC history had lower educational attainment and marriage rate than their community peers and, in general, lived more isolated lives. These adults, in comparison to the general population, reported chronic stress-related diseases more often (e.g., depression, allergies), however, there were no actual differences in the rates of chronic illness. Yet, although psychological distress and suicidal thoughts (and attempts) were more frequently observed in adults with an IC history, no statistical differences in self-perceived quality of life were identified.

Another study, conducted in Germany, aimed at understanding the relationship between the conditions of adolescence (foster care vs institutional placement) and attachment patterns in adulthood (Nowacki & Schoelmerich, 2010). Results showed that adults raised in foster families demonstrated more secure attachment patterns than adults raised in institutions. In addition, the study illustrated that adults with an IC history had elevated and close to clinical threshold indicators of psychological stress.

There is also some data on the long-term effects of institutionalization. Specifically, data was collected from 100 girls who were internationally adopted from institutions in Hong Kong to Great Britain in the 1960s (Rushton, Grant, Feast, & Simmonds, 2013). All of the girls were institutionalized prior to adoption for an average of 3 months. Data was collected when the women were 42-53 (M = 48) years of age. Comparison groups from the community as well as women who were born and adopted within Great Britain were studied. No statistical differences were found between the groups in their rates of mental health difficulties, marriage and divorce rates, and emotional support from others. The authors of the study speculated that if the institutional experience is long-term, but interrupted by adequate care, the IC experience per se does not elevate the risk for mental and physical health issues in adulthood. These findings have been interpreted as evidence of the potential longitudinal remediation of IC effects during the course of life.

In the English Romanian Adoptee Study (ERA), where the residual effects of IC history in internationally adopted Romanian orphans were investigated, the higher prevalence of attention deficits and hyperactivity in adolescence with an IC history was identified (Kennedy et al., 2016; Rutter et al., 2010). Participants were divided into two groups: individuals who had experienced short-term institutionalization, and those who had experienced long-term deprivation (children adopted by British families right after birth or who had lived in Romanian orphanages less than 6 months, and children who had been residing in Romanian institutions from 6 to 43 months). Data was collected from the participants at two age points: at 15, then 22-25 years of age. Results showed that the institutionalization effect was more pronounced for hyperactivity and attention deficits during adolescence (i.e., at the age of 15), however, in individuals who had experienced long-term institutionalization, these indicators were critical at both time points. In sum, it has been shown that institutional care has detrimental long-lasting effects on specific aspects of cognitive and social-emotional development lasting into adulthood.

In 2017, a large Australian study was published (Fernandez et al., 2017) that included 669 adults ranging from 27 to 100 years who had experienced IC. Most of the participants (~ 60%) had accommodation problems in adulthood (were homeless or resided in shelters), and more than 1/3 reported having criminal records. More than 50% of participants had problems coping with stress, or reported having mental health problems and relationship issues.

Based on the empirical data reported above, it can be concluded that a history of IC may have long-lasting effects, contributing to higher stress levels and somatic problems, as well as difficulty with attention and hyperactivity. Yet, other data suggests that an IC history can be remediated over the course of life and does not have to leave a traumatic footprint on development. Given such mixed results, it is evident that further empirical data is required in order to learn more about the residual effects of institutionalization.

It is also noteworthy that apart from the social adaptation issues present in adults with an IC history, there is a societal bias in attitudes toward adults with an IC history. According to sociological surveys, the mass media in Russia has created two positive and two negative images of people with IC histories that are very simplified and stereotypical (Abramov & Antonova, 2017): “the positive independent type” (the self-made character); “positive passive” (lacking a sense of agency), “negative independent” (a deviant trouble maker) and “negative passive” (socially stigmatized) (Ibid., p. 421). This study shows that the “passive” stereotypes are mostly spread and perpetuated by the mass media, whereas the “independent” types are rarely discussed. This tendency can have negative effects on potential employers, teachers, and romantic partners, who as a result develop a bias towards people with an IC history.

In sum, the literature on the long-term impact of IC is both limited in size and inconsistent in findings; clearly, more research is needed to increase its volume and resolve its inconsistencies. This article presents pilot data from a study aimed at assessing the psychological, social and emotional well-being of people with a history of institutionalization compared to a group of peers raised in biological families.

Sample. The sample consisted of 58 participants ranging from 16 to 37 years of age (Med = 20, M = 21.81, SD = 5.77):