ADDIS ABABA UNIVERSITY SCHOOL OF PSYCHOLOGY CLINICAL, HEALTH, AND COUNSELING PSYCHOLOGY PROGRAMS UNIT

ADDIS ABABA UNIVERSITY SCHOOL OF PSYCHOLOGY CLINICAL, HEALTH, AND COUNSELING PSYCHOLOGY PROGRAMS UNIT A Comparative Study of Psychological Wellbeing between Orphan and Non-orphan Children in Addis Ababa: The Case of Three Selected Schools in Yeka Sub-city Afework Tsegaye June 2013 Addis Ababa 1

ADDIS ABABA UNIVERSITY SCHOOL OF PSYCHOLOGY CLINICAL, HEALTH, AND COUNSELING PSYCHOLOGY PROGRAMS UNIT A Comparative Study of Psychological Wellbeing between Orphan and Non-orphan Children in Addis Ababa: The Case of Three Selected Schools in Yeka Sub-city. A THESIS SUBMITTED TO THE SCHOOL OF PSYCHOLOGY ADDIS ABABA UNIVERSITY IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN COUNSELING PSYCHOLOGY By Afework Tsegaye June, 2013 Addis Ababa 2

ADDIS ABABA UNIVERSITY SCHOOL OF PSYCHOLOGY CLINICAL, HEALTH, AND COUNSELING PSYCHOLOGY PROGRAMS UNIT A Comparative Study of Psychological Wellbeing between Orphan and Non-orphan Children in Addis Ababa: The Case of Three Selected Schools in Yeka Sub-city By Afework Tsegaye APPROVED BY: Chair person, Department of Signature Date Graduate Committee Advisor Signature Date Examiner, Internal Signature Date Examiner, External Signature Date 3

Acknowledgement I would like to express my gratitude of all who generously gave their time, energy and knowledge in helping me while understanding this research. Without the contribution of these people the study could not have come to completion. First and foremost, I would like to express my deepest gratitude to Ato Daniel Tefera and Ato Teshwal Ashagrie my thesis advisors, for their efforts in providing me with relevant advice, critical comments and constructive suggestion throughout the course of my thesis work. Further, this study could not have been concluded without the deep love and the real commitment of my best friends Engida Sisay, Eyosiyas Yilma, Henok Senay, Natnael Terefe. Furthermore, I want to express my deepest love, acknowledgment, and appreciation to my beloved family: for their love, support and wisdom; without them I never could have made it this far. It also want to extend my deepest gratified to the study participants for providing me with invaluable information without any kind of inhabitations. i

Table of Contents Acknowledgement.....i Table of contents..ii Appendices..iv Acronyms.......v List of tables....vi Abstract...........vii CHAPTER ONE: INTRODUCTION 1.1. Background........ 1 1.2. Problem Statement.................6 1.3. Objective................8 1.3.1. General objective...8 1.3.2. Specific objective 9 1.4. Significance of the study.9 1.5. Limitation of the study..10 1.6. Definition of important terms.10 CHAPTER TWO: REVIEW OF RELATED LITERATURE 2.1. Conception of psychological wellbeing.12 2.1.1. Meaning of psychological wellbeing 14 2.1.2. Component of psychological wellbeing...15 2.1.3. Measuring of psychological wellbeing.18 2.1.4. Demographic variable and psychological wellbeing.21 2.2. Problem and challenges of orphans...23 2.3. Major psychological problems and manifestations of orphans.26 2.4. Empirical Quantitative studies on orphans and vulnerable children in different countries of the world.28 2.5. Summary of review literature 34 ii

CHAPTER THREE: METHODS 3.1 Research design..36 3.2. Study Area and Target Population.37 3.3. Sampling.37 3.4. Inclusion and exclusion criteria for the Children Sample..39 3.5. Research variable...39 3.5.1. Independent variable 39 3.5.2. Dependent variable...39 3.6. Data collecting instrument...39 3.6.1 Demographic Questionnaire.39 3.6.2. Psychological wellbeing scale.39 3.6.3. Semi-structured interview guide..41 3.7. Pilot testing 42 3.8. Data collection procedure..42 3.9. Ethical Considerations 43 3.10. Data analysis 43 CHAPTER FOUR: RESULTS 4.1. Background Information of Study Subjects...45 4.2. Descriptive Summary of Psychological Wellbeing among Orphan and Non-orphan Children..48 4.3 Status of psychological wellbeing of orphan and non-orphan children..49 4.4. Difference in psychological well-being between orphan and non-orphan children..52 4.5. Psychological well-being and demographic factors..55 CHAPTER FIVE: DISCUSSIOND CHAPTER SIX: SUMMARY, CONCLUSION AND RECOMMENDATIONS 6.1 Summary.61 6.2 Conclusion..62 6.3 Recommendations...62 References. 64 iii

APPENDICES Appendix-A Demographic data questioner and Ryff s psychological wellbeing scale (Amharic version) Appendix-B Demographic data questioner and Ryff s psychological wellbeing scale (English version) Appendix- C Interview guide line (English version) Appendix-D Interview guide line (Amharic version) iv

ACRONYMS AIDS: Acquired immunodeficiency syndromes AU: Autonomy CSA: Central Statistics Authority DHS: Demographic and Health Survey EM: Environmental mastery EMOH: Ethiopian ministry of health HIV: Acquired immunodeficiency virus MOLSA: Ministry of Labour and Social Affairs NGO: Non-governmental organisation OVC: Orphans and vulnerable children PG: Personal growth PL: Purpose in life PR: Positive relations with others SA: Self-acceptance PWB: Psychological Well-Being UN: United Nations USAID: United Nations Program for HIV and AIDS UNAIDS: United Nations Agency for International Development UNICEF: United Nations Children Education Fund WHO: World Health Organisation v

LIST OF TABLES Table 1: Demographic characteristics of study subject...46 Table 2: Respondent characteristics on parental status...47 Table 3: Summary statistics of the total and sub-scales of psychological well-being for orphan and non-orphan children...48 Table 4: Summary result of the status of psychological well-being of orphan children...50 Table 5:- Summary result of the status of psychological well-being of nonorphan 51 Table 6: Independent sample t-test for difference in psychological wellbeing between orphan and non-orphan children 53 Table 7: Correlation between psychological well-being and demographic measures.56 vi

Abstract The general objective of this study was to compare the psychological well-being of orphan and non-orphan children in Addis Ababa and to explore the conditions or situation that could promote the psychological wellbeing for the orphan. Both quantitative and qualitative methods were employed to achieve the research objectives. Three groups of respondents, recruited from three randomly selected schools in Yeka Sub-city of Addis Ababa, participated in the study. The participants were: 120 orphan children, 120 non-orphan children, and 3 representatives of charity clubs in the selected schools. The orphan and non-orphan children were selected using systematic random sampling technique while the three representatives were purposively taken as a sample. A demographic questionnaire, a psychological wellbeing scale and interviews instruments was administered. Data from the quantitative survey were analysed using percentages, t-test, and Pearson correlation. The qualitative data were analysed using inductive thematic analysis. Using mean split technique on the psychological wellbeing scores of orphan and non-orphan children, orphan had low psychological wellbeing whereas the non-orphan had high psychological wellbeing. T-test for group mean difference on psychological wellbeing revealed that orphans were found to have a significantly lower psychological wellbeing as compared to the non-orphan children. Results from Pearson correlation analysis revealed that grade level was significantly and positively correlated with psychological wellbeing whereas parental status was significantly and negatively correlated with psychological wellbeing. Gender and age were not significantly related with psychological wellbeing. From the analysis of the qualitative data, encouraging the orphan s individuality and autonomy and enhancing their self-esteem, and respect and care by adults were identified as the major themes that could promote orphan children s sense of well-being. vii

CHAPTER ONE INTRODUCTION 1.1. Background Orphans frequently lack sufficient food, shelter, schooling and medical care and are at risk of abuse and economic exploitation (Berry and Guthrie, 2003). Most research work on orphan concentrates on basic need. There is little available research, but increasing concern, regarding the psychological well-being of orphans in Africa (Cluver and Gardner, 2006). HIV AIDS have been one of the severest clinical and public health problems ever faced by human being. The epidemic has caused a substantial increase with mortality among adults during reproductive ages (Porter and Zaba, 1986; Blacker, 2004) and as a consequence, rising numbers of children are orphaned by AIDS (Monasch and Boerma, 2004). Despite AIDS being a major reason for stigmatization and discrimination, orphan children are being discriminated based solely on their status as orphans (Subbarao, Mattimore, and Plangemann, 2001). Globally, an orphan is defined by international organizations based on age and parental status. According to (UNAIDS, USAID AND UNICEF, 2002) an orphan is defined as a child less than 15 years of age who has lost its mother. Recently, however, it changed its definition to cover the loss of both parents and to include children below 18 years of age (UNAIDS, 2004). In Ethiopia, most Governmental and non-governmental organization are using this definition the concept. The Amharic words equivalent to the word orphan are Yemut Lij or Wola aj Alba From 2001 to 2003, the global number of AIDS orphans has increased from 11.5 to 15 million. Although Africa is proportionally the region hardest hit by HIV AIDS, the 1

number of orphans is largest in Asia due to much larger populations (UNAIDS, UNICEF and USAID, 2004). The recent report on orphans and vulnerable children (OVC) by the United States of Government (USG) and partners estimated that, in 2008, 163 million children (age 0 17 years) across the globe were orphans (referring to loss of one or both parents to all causes) and that 17.5 million of these children lost one or both parents to AIDS (USG, 2009). The global figure of 17.5 million orphans as a consequence of AIDS represents an increase from the 2007 estimate of 15 million AIDS-related orphans (UNAIDS, 2010). Almost 14.94 million children orphaned by AIDS live in sub-saharan Africa (UNAIDS, 2010). Ethiopia has OVC burden, with almost 5.4 million orphans, with around 15% of these believed to have been orphaned as a result of HIV/AIDS (EMOH, 2007). The majority of children orphaned as a result of HIV/AIDS are in Amhara (39%), Oromia (22.4%) and SNNPR (14.1%) and the remaining causes of orphan hood and vulnerability are due to food insecurity, poverty, conflict, natural disasters, malaria, and other infectious diseases (PEPFAR, 2012). According to the 2011 Ethiopian Demographic and Health Survey, Seventy-two per cent of children under the age of 18 live with both parents; 14 per cent live with their mothers but not their fathers; 3 per cent live with their fathers alone; and 11 per cent live with neither of their natural parents and also 18 per cent of households are cared by an orphan (EDHS, 2012). The impacts of parental death on children are complex and affect the child s psychological and social development. Fredriksan and Kandous (2004) state that, orphaned children might have stunted development of emotional intelligence, and life skills such as communications, decision making, negotiation skills etc.. Moreover, they often show lack of hope for future and have low self-esteem (Kedija, 2006). 2

Evidence on the health status of OVC is less clear, however; a cross-sectional study in urban Uganda found no differences between orphans and non-orphans in reported treatment-seeking behavior and in anthropometric measures (Sarker, Neckermann and Mu ller, 2005). Comparing orphans and non-orphans living in the same households in a rural area of South Africa, Parikh, Desilva, Cakwe, Quinlan, et al. (2007) found no significant health disadvantage for orphans on a series of wellbeing indicators. A study in rural western Kenya similarly compared several health and nutritional indicators (including fever, malaria, history of illness, anemia, and stunting) for orphaned and non-orphaned children under age 6 and concluded that orphaned children are at no greater risk of poor health than non-orphaned children (Lindblade, Odhiambo, Rosen, and DeCock, 2003) although orphans were somewhat more likely to be wasted than non-orphans (USAID, 2008). The losses of the parents continue to affect the children s developmental stages. For example, a study conducted in Zambia by Family Health International (2003) on 788 orphans concerning their emotional well-being revealed that orphans often had scary dreams or nightmares while other were sometimes unhappy. In addition, the study find out that some were sometimes, or often, fighting with other children, desired to be alone and often were worried. A study conducted in Ethiopia by Ministry of Labour and Social Affairs (2003) revealed that the score for emotional adjustment level of AIDS orphans was lower than that of the non-aids orphans. According to MOLSA, this low level of emotional adjustment among AIDS orphans was reflected in the degree of unhappiness, worry, low level of patience, fatigue, depression and feeling of hopelessness and pessimism among AIDS orphans. Another study which dealt with the psychological distress of non-adis and ADIS orphan adolescent in Addis Ababa concluded that large proportion of orphan adolescents 3

are having psychological problems that can affect their present and future life ( Hiwot, Fentie, Lakew and Wondoesn, 2011). Children whose parents are ill because of HIV/AIDS or those who have been orphan by the disease face stigma and discrimination; they may be rejected by their friends and school mates, as well as at health centre. Studies of HIV-infected mothers have shown high levels of depression linked to their diagnosis and AIDS-related illness, which may impact on children s mental health both directly and via reduced parenting capacity (Cluver, Orkin, Boyes and Gardner, 2012) In general, the long term effects of orphan-hood to be negative. These children are at an increased risk for suffering from malnutrition, poor physical and mental health, as well as being at risk for stigmatization and exploitation and also orphans are at a high risk for contracting HIV themselves as a result of maternal transmission, prostitution, and sexual exploitation, many orphans are forced to drop out of school for financial reasons this would hinders their future opportunities for jobs and economic growth (Brown and Sittitrai, 2005; UNICEF, 2006). The effects of malnutrition and poor health are far reaching. In addition to potentially causing early death, they can also lead to low educational achievement and productivity because malnutrition can lead to delayed intellectual development (Brown and Sittitrai, 2005; UNICEF, 2006). In Africa most of researcher focusing orphaned children health and nutritional issues only few studies mention psychological aspects of orphan child for example in Dar-es- Salaam, Tanzania, Makame, Ani and Grantham-McGregor (2002) found adverse psychological consequences of orphan hood, such as anxiety, sense of failure, pessimism, and suicidal tendency, in Uganda Atwine, Cantor-Graae and Bajunirwe (2005) found much higher levels of anxiety, depression and anger among orphans than among nonorphans, in Rwanda Thurman, Brown, Richter, Maharaj and Magnani (2006) found that 4

orphans living in youth-headed households were significantly more likely than those in adult-headed households to report emotional distress, depressive symptoms and social isolation and in rural Zimbabwe, Nyamukapa, Gregson, Lopman, Saito, Watts, Monasch, & Jukes (2007) found that orphans had significantly higher psychosocial distress than nonorphans (USAID, 2008) Most of studies revealed that orphans suffer higher level of psychosocial problems than their non-orphan peers. In particular, maternal and double orphans are more likely to experience behavioural and emotional difficulties, suffer abuse and low rate of trusting relationships (Baaroy and Webb, 2008; Mikang, 2008; Qunzhao, 2010). It has also been reported that orphans are more likely to suffer from behavioural or conduct problems and report suicidal thoughts than non-orphans (Cluver, Gardner & Operario, 2007; Cluver & Gardner, 2006). In general, Orphan children seem socially deprived and they tend to encounter higher emotional distress, hopelessness, and frustration than non-orphans (Mbozi, Debit, and Munyati, 2006). Most orphans may be distressed by their new circumstance that may require them to cater for themselves and/or assume care-giving responsibility for their younger ones Sexual abuse (Pridmore and Yates, 2005) and social discrimination (Cluver, Gardner, and Operario, 2008; Nyambedha, Wandibba and Aagaard-Hansen, 2003) against orphan haven reported. To date, research on orphan is focused on the health and nutritional status (e.g. Panpanich, 1999), treatment-seeking behavior and in anthropometric measures (Sarker et al., 2005), socio-economic problems (Case, Paxson and Ableidinger, 2002), psychological wellbeing of institutionalized orphan children (Laurg, 2008), mental health problems (Cluver and Gardner, 2006), the psychological effect of orphan-hood ( Sengendo and Nambi, 1997), psychosocial and developmental status (Nagy and Amira, 2010), 5

psychosocial wellbeing of OVC (Grace, 2012), psychological well-being and socioeconomic hardship among AIDS orphans and other vulnerable children (Delva, Vercoutere, Loua, Lamah et al., 2009), and the psychosocial well-being of teenaged orphans (Gumed, 2009). In Ethiopia emotional adjustment among AIDS orphans and the psychological distress of non-adis and ADIS orphan adolescent had been studied (MOLSA, 2003; Hiwot, Fentie, Lakew and Wondoesn, 2011). The status of the psychological well-being of Ethiopian orphan is not explored. Therefore, the focus of the present study is to fill this gap in research. 1.2. Statement of the problem In Ethiopia, the lives of orphans and working children (Tatek, 2008) and the psychological distress and its predictors in AIDS orphan adolescents (Hiwot, et al., 2011) were studied. Overall, in most studies little attention has been given to the psychological wellbeing of orphan in Ethiopia. Orphans and vulnerable children (OVC) continue to maintain a spot at the forefront of the international agenda with millions of children worldwide being orphaned or made vulnerable by HIV/AIDS and with the numbers of projected to increase in the next decade (UNAIDS, 2004). Large and growing numbers of OVC children are a worldwide concern; Whereas sub-saharan Africa has the highest proportion of children who are orphaned, where more than one in seven children are orphaned (UNAIDS, UNICEF, & USAID, 2004). Orphan children may face many hardships during childhood including a decline in health, nutrition, and psychological well-being (Laura, 2008). Orphan-hood is frequently accompanied with multidimensional problems including prejudice, school services, inadequate food, sexual abuse and others that can further expose children s prospects of completing school. Moreover, the death of one or both parents has a profound and lifelong impact on the psychological wellbeing of children. Children and 6

adolescents in particular are at increased risk for unresolved or complicated bereavement because of their developmental vulnerability and emotional dependency. Being an AIDS orphan may further place them at heightened risk of prolonged mental problems (Hiwot et al., 2011). Quite recently there has been a growing international interest in research on orphans (Pivnick and Villegas, 2000; Forehand, Steele, Armistead et al., 1998; Gardner and Operario, 2006; Cluver Gardner, and Operario, 2007; Atwine, Cantor-Graae, and Bajunirwe, 2005; Andrews, Skinner and Zuma, 2006; Doku, 2009; Earls, Raviola and Carlson, 2008; Wild, Flisher, Laas, and Robertson, 2006) because of the realization that parental death is a risk factor for psychological distress (Bauman and German, 2005). The number of children experiencing orphan-hood is increasing at an alarming rate. Although specific data on the number of orphans are highly inconsistent, most of this increase is explained by HIV/AIDS-induced adult mortality. The impact of the HIV/AIDS epidemic in creating a burden of care of orphans for the traditional family structure is well documented in a handful of culture-specific studies (e.g. Foster, 2000; Hunter, 1990; Oleke, Blystad, Moland, Rekdal and Heggenhougen, 2006). The consequences of the HIV epidemic in Ethiopia are seen in the eyes of children who have lost one or both of their parents, traumatized by events beyond their control and understanding. These children are often stigmatized by relatives and rejected by communities which tend to think that caring for a child orphaned by AIDS is a lost investment. Millions of children have lost their childhood. They live on the streets and are forced to endure countless humiliations in order to meet their basic needs like clothing and food. Other children are forced to become heads of households; yet without the necessary resources, they abandon school and the opportunities that come with it. 7

The Ethiopian literature on psychological wellbeing orphan children is very small. The limited research that has been carried out focused on HIV orphans who suffer from particular social and economic disadvantages and mental health problems. Although orphaned children seem to attract the attention of researchers GOs and NGOs in Ethiopia, much of the attempt are on the economic needs of children not on the psychosocial problems affecting their wholesome development. Few exceptions, of course, could be cited which have recently conducted local surveys in Addis Ababa and elsewhere. Among these, Belay and Belay (cited in Desalegn, 2006) conducted a psychosocial survey of orphaned and vulnerable children, their family and communities in both rural and urban settings. It explicitly found out the psychosocial situations of orphaned children before, during and after parental death and the support and care they get from all levels on the other hand, Tedla (2005) witnessed the prevalence of stigma and discrimination against AIDS orphans. Study on the psychological wellbeing of orphan children in Ethiopia is lacking. Thus, this study explores the psychological well-being of the orphan and compares their psychological well-being with that of non-orphans, and examines if socio demographic backgrounds associate with the psychological well-being of the orphan children. 1.3. Objective of the study 1.3.1 General objective This study explores the psychological wellbeing orphan to compares the status of their psychological well-being with non-orphan children in Addis Ababa Yeka sub-city. 8

1.3.2 Specific objective The study more specifically addresses the following specific objectives: 1. Explore the status of the psychological well-being of orphan and non-orphan children. 2. Compares the status of psychological wellbeing of orphan and non-orphan children. 3. Examines the association between socio demographic variables (age difference, gender difference, educational level and having or loss of parent) and psychological well-being of orphan children. 4. Explores the psychological and social conditions or situation that could promote the psychological wellbeing of orphan children. 1.4. Significance of the study The results of the study are believed to be helpful in the following ways: The study assesses the status and comparing the psychological well-being of orphan and non-orphan children. As a result, the concerned bodies, policy makers, schools, family, governmental and non-governmental organization will work together on orphans or strengthen the existing programs in order to increase the psychological well-being of orphan children. This research is important for those involved in therapy and in counselling to identify children who are at low level of psychological wellbeing and to develop and improve prevention and intervention methods for orphans. The finding of this study will also provide important direction for conducting further research in the areas of psychological wellbeing and mental health of orphans. 9

1.5. Limitations of the study The data collected for this study was based on self-reported scale that was provided by children targeted by the study. Therefore, there is some potential reporting bias which may have occurred because of respondents interpretation of the questions or desire to report their emotions in a certain way or simply because of inaccuracies of responses. 1.6. Definition of important terms Psychological well-being:- individual meaningful engagement in life, selfsatisfaction, optimal psychological functioning and development at one s true highest potential. It has six dimensions that are autonomy, environmental mastery, personal growth, positive relationship with other, purpose in life and self-acceptance of individuals (Ryff, 1989). Autonomy: the extent to which children s view themselves as being independent and able to resist social pressures Environmental mastery: the extent to which children s feel in control of and able to act in the environment Personal growth: the extent to which children s have a sense of continued development and self-improvement. Positive relations with others: the extent to which children s have satisfying, trusting relationships with other people. Purpose in life: the extent to which children s hold beliefs that give life meaning Self-acceptance: the extent to which children s have a positive attitude about themselves. 10

Orphan children:-a child under 18 years of age whose mother, father or both parents have died from any cause (UNICEF, 2006). Orphans from all causes can be more specifically described as follows: Single orphan: - A child who has lost one parents. Double orphan: - A child who has lost both parents Maternal orphan: - A child whose mother has died (including double orphans) Paternal orphan: - A child whose father has died (including double orphans 11

CHAPTER TWO REVIEW OF RELATED LITERATURE 2.1. Conception of psychological well-being Throughout human history, normative understandings of well-being have defined particular human characteristics and qualities as desirable and worthy of pursuit or emulation (Taylor, 1989). Such normative understandings are represented by traditional philosophies and religions that often stress the cultivation of certain virtues (Diener, 1984). In contemporary Western society, these norms are largely provided by philosophies of psychological well-being. Psychological well-being is among the most central ideas in counseling. It plays a crucial role in theories of personality and development in both pure and applied forms; it provides a baseline from which we assess psychopathology; it serves as a guide for clinical work by helping the counselor determine the direction clients might move to alleviate distress and find fulfillment, purpose, and meaning; and it informs goals and objectives for counseling-related interventions (Christopher, 1999). Psychologists and health professionals (Campbell, 1981; Deci and Ryan, 2008) have studied well-being extensively. While the distinct dimensions of well-being have been debated, the general quality of well-being refers to optimal psychological functioning and experience. Two broad psychological traditions have historically been employed to explore well-being. The Eudaimanic is deriving from ancient Greek philosophy notably the work of Aristotle and were later championed by mills among other. Eudaimanic measures emphasis human flourishing literally eu (wellbeing or good) and Daimonia (demon or sprit) and virtuous action, which is argued to be not always congruent with happiness or 12

satisfaction, but to reflect a broader and multi-factored set of need. Hedonic measures follow the criteria of maximizing pleasure and avoiding pain an approach dating back to ancient Greek philosophy that found later expression in the work of Bentham and his followers (OPHI, 2007). Ryff and Singer (1998) define eudaimonia as the idea of striving towards excellence based on one s own unique potential. The hedonic view equates well-being with happiness and is often operationalized as the balance between positive and negative affect (Ryan and Deci, 2001). The eudaimonic perspective, on the other hand, assesses how well people are living in relation to their true selves (Waterman, Schwartz, and Conti, 2008; Ryff, 1989). There is not a standard or widely accepted measure of either hedonic or eudaimonic well-being, although commonly used instruments include Bradburn s Affect Balance, Neugarten s Life Satisfaction Index, Ryff psychological wellbeing scale, Rosenberg s self-esteem scale, and a variety of depression instruments (Ryan and Deci, 2001). Recent years have witnessed an exhilarating shift in the research literature from an emphasis on disorder and dysfunction to a focus on well-being and positive mental health. This paradigm shift has been especially prominent in current psychological research but it has also captured the attention of epidemiologists, social scientists, economists, and policy makers (Huppert, 2005). This positive perspective is also enshrined in the constitution of the World Health Organization, where health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1948). More recently, the WHO has defined positive mental health as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (Huppert, 2009). 13

2.1.1. Meaning of psychological wellbeing Psychological well-being is perhaps the most widely used construct among psychologists and mental health professionals. However, there is still no consensus regarding the operational definition of this construct (Khan and Juster, 2002). Yet, many theories of well-being have been proposed and an extensive body of empirical research using different indices of this construct has been conducted. However, theorists have found that the concept of psychological wellbeing (PWB) is much more complex and controversial. Practically speaking, psychological wellbeing serves as an umbrella term for many constructs that assess psychological functioning (Girum, 2012). Psychological well-being is about lives going well. It is the combination of feeling good and functioning effectively. Sustainable well-being does not require individuals to feel good all the time; the experience of painful emotions (e.g. disappointment, failure, grief) is a normal part of life, and being able to manage these negative or painful emotions is essential for long-term well-being. Psychological well-being is, however, compromised when negative emotions are extreme or very long lasting and interfere with a person s ability to function in his or her daily life (Huppert, 2009). Ryff s (1989) defined well-being is the optimal psychological functioning and experience. Shek (1992) defines psychological well-being as that state of a mentally healthy person who possesses a number of positive mental health qualities such as active adjustment to the environment and unity of personality Dzuka and Dalbert (2000) defined psychological well-being is the overall satisfaction and happiness or the subjective report of one s mental state of being healthy, satisfied or prosperous and broadly to reflect quality of life and mood states. 14