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Thesis (PhD(Psychology))--University of South Australia, 2004. This study sought to describe selected elements of mental health in two culturally distinct communities before and shortly after the 1987 military coups in Fuji, and then address an intriguing question: “Did the 1987 military coups result in a substantial decline in the mental health of indigenous Fijians and Indo-Fijians?” Defined in biopsychosocial terms, community mental health was approached from a transactional stress and coping perspective (Lazarus & Folkman, 1984) that incorporated a vitamin model (Warr, 1987) set within a human ecological framework (Bronfenbrenner, 1979; Hawley, 1986). Three components (stressor exposure; preferred coping; and selected clinical and non-clinical indicators) were examined with methodology influenced by cross-cultural psychology, medical anthropology, trans-cultural psychiatry and an action research orientation. A pre-coup community mental health baseline was reconstructed from archival material using a forensic-style audit technique and community coping ratios (CCR) devised for the study. Post-coup data were collected by structured interviews in English, Fijian and Hindi from two cross-sectional community samples (Fijian: n = 250; Indo-Fijian: n = 250). Between-group analyses (reconstructed data) and within- and limited between-group comparisons (post-coup survey) were conducted. Archival audits indicated important pre-coup Fijian/Indo-Fijian differences with respect to perceptions of modernization and social-change; and economic development and technological change. CCRs indicated Indo-Fijians coped above the community norm with stressors from both areas; Fijians coped below the community norm with the first and around the norm with the second. Fijians were overrepresented on three non-clinical indicators (alcoholism; domestic violence; selected crime statistics), while Indo-Fijians accounted for around 90% of reported suicides. Overall, pre-coup community mental health appeared relatively “positive” for Indo-Fijians, but “negative” for Fijians consistent with a social change adaptive failure hypothesis. Post-coup, Fijians identified “the family” as a preeminent stressor distantly followed by “the workplace” and “financial management” consistent with a social change adaptive failure hypothesis. Indo-Fijians cited three co-equal stressors: “the military coups”, “the family” and “financial poverty” contrary to a victimization hypothesis. Self-identified (“real”) stressors elicited predominantly emotion-focused (e-f) coping by both communities; however, Fijians showed a substantial difference between “real” and hypothetical coping. Factor analysis of GHQ-28 (Goldberg & Hillier, 1979) data indicated a different factor structure for each community, while a separate somatic symptom inventory (Miller & Smith, 1982) showed high levels of somatization among Indo-Fijian men (between ten to thirty-times more symptoms than their Fijian counterparts). Overall, clinical data indicated older Indo-Fijian men at greatest mental health risk followed by younger Indo-Fijian men, with older and younger Fijian men at least risk; Fijian and Indo-Fijian women occupied the mid-ground. Contrary to most studies, Indo-Fijian women reported significantly lower scores (better mental health) than Indo-Fijian men. Post-coup societal indicators were similar to pre-coup patterns with the exception of suicide which declined substantially in both communities. Pre-coup/post-coup comparisons (within-group) of clinical indicators showed a post-coup shift in community mental health in a “positive” direction for Fijians, although not “sufficient” to overturn a social change adaptive failure hypothesis. Similar Indo-Fijian comparisons revealed an apparent diminution of post-coup mental health although these data failed to support a victimization hypothesis. However, methodological considerations restricted this analysis. Overall, the study demonstrated the importance of psychological contextualism and relevance of community mental health in socio-political analyses; a need for culturally-sensitive research procedures and use of non-clinical concepts and indicators; and the feasibility of audit techniques and a CCR statistic. Implications for health service providers, educators and human resource managers were also outlined, study limitations noted, and targets for further research were identified. |
