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Geographical Transitions: Context-Dependent Effects and the Concept of Congruence
The purpose of this chapter is to consider some of the background research literature on the effects of relocation and migration on mental and physical health. The chapter provides the background for understanding the importance of relocation in the lives of individuals. On first considerati on, the evidence supports an association between relocations and vulnerability to ill health. However, there are a number of methodological difficulties with the interpretation of the evidence. In most cases where a positive association is reported, there is the confounding effect of downward mobility or the difficulty of self-selection factors. Taken collectively, however, there is a strong case for arguing that there is an apparent associative link between mobility and mental health or physical disorder. The relationship needs unpacking with the help of studies focused on specific psychological effects.
The History of Research into Geographical Moves
The history of research into the effects of geographical transitions suggests that they are stressful and likely to increase the risk of mental or physical disorder. The scale designed by Holmes and Rahe (1965), which provides an order of magnitude of the stressful qualities of life events, indicates that geographical moves ('major change in residence') are listed 24th on the rank order list of stressful life events as assessed from the ratings of healthy Americans. The finding that clinically depressed patients rate moving as the third of the most important factors in their recent life history, prior to the onset of depression (Leff, Roatch, & Bunney, 1970), might imply that moves feature more prominently as major life events. But it might also be argued that since only clinical populations were involved in the study, the importance of moves might only be high for those already vulnerable in some way.
The above analysis hints at the importance of contexts and personal meanings as determinants of the weighting a person gives to a particular life event. Geographical moves may be of more significance to some individuals because of personal life history or because of personality dispositions. Fisher (1988a) argues that in order to understand the relationship between life events and disorder, it is necessary to take account of mediating variables such as control, self-esteem, and attributional style, as well as mood state at the time the assessment is made. These variables or their absence may constitute vulnerability or fortitude factors respectively. Clearly, what is needed is some attempt to weigh up contextual and personality factors in determining the impact of geographical transitions. Exactly the same argument is true for analysis of the impact of all forms of life events on health and welfare. However, attempts to provide weighting of contexts in assessing the relationship between life events and disorder, although desirable, produce difficulties because of the need for semi-structured interviews which may constrain the reports given by subjects and because of the subjectivity involved when contextual detail is judged (see Brown, 1974).
Migration and Health
The research literature on relocation and migration has, over the years, provided a very strong indication of a relationship with poor mental and physical health. However, there are a number of difficulties with the interpretation of the research findings. Correlations do not imply causation; more car drivers who wear seat-belts are involved in car accidents but this should not be taken to imply that wearing a seat-belt causes a car accident. Equally, even when the causal link can be established, the direction of causation remains unknown; A may cause B, B may cause A, or there may be some third factor which influences both A and B. These considerations are important because although there is a tendency to attribute the causes of ill health to the geographical transition, self-selection factors may be operative (those who move away may be those who are poor or discontented with a previous environment).
A number of early studies focused on the health of migrant communities as compared with that of the indigenous population. For example, Odegaard (1932) reported greater rates of hospital admissions for mental disorder amongst Norwegian immigrants to Minnesota than for either the native-born of Minnesota or Norway. Malzberg and Lee (1940) reported a similar result for populations in New York when age, colour, and sex were taken into account. These studies, although not devoid of the above-stated methodological difficulties, point to the vulnerability of the migrant group. The reasons for the effect remain unclear; there may have been exposure to adverse environments, mediating behaviours may increase the risk of ill health, general poverty factors may weaken resources through poor nutrition, etc.
However there is also evidence against the hypothesis of vulnerability of the migrant with regards to mental disorder. Thus, Kleiner and Parker (1963) demonstrated the greater prevalence of psychoneurotic and psycho somatic symptoms in native-born individuals migrating within the U.S. A. There was some evidence of greater discrepancy between educational aspiration and achievement for the native-born group. There were no differences between the migrant or native-born groups in terms of status inconsistency. These studies also underlined the possible importance of circumstantial factors in that the discrepancy between education and achievement was greater for the native-born migrant groups.
Perhaps the most quoted work which also underlines the confounding of circumstantial factors with the effects of mobility, is that of Faris and Dunham (1939) who, using home ownership as an index of stability and rental status as an index of mobility in the city of Chicago, found a negative association with mobility and mental health. The mobile areas of cities were also, however, most socially disorganised and most likely to be associated with poverty. The conclusion that social location may be the cause of psychopathology epitomises the main difficulties of interpretation. As is now well understood, those with poor mental health may become incompetent and drift down to ghetto areas of cities; equally the stress of these areas may create the nurturent conditions for psychopathology. With regard to the issue of whether or not moving and migration are stressful perse, the study merely underlines the close association with poverty, social class, lack of educational and social mobility in such cases. Thus, moves may reflect or create underlying conditions associated with psychopathology. Moves and contexts seem inextricably linked.
The picture is much the same with physical health. Research evidence across the last 60 years has demonstrated the vulnerability of migrant populations to physical ill health. In particular, cardiovascular disease, gastric disorders, and infectious illnesses such as tuberculosis have been found to be more prevalent in migrant populations than in the 'initial' or 'receiving' communities (see Medalie & Kahn, 1973; Cruze-Coke, Etch-everry & Nagel, 1964; Wolff, 1953; Christenson & Hinkle, 1961). In most of these studies the problem of the confounding of the stressful effects of moving with both the circumstances which engender it and the situations which result, remains a problem. Migration may also create intermediate conditions of crowding, poor sanitation, and so on, or may create fatigue and lowered resistance. A further difficulty is that moving may provide a focus for the reporting of existing symptoms.
In general, the migration studies hint at the possibility of the existence of stress-related factors creating poor mental and physical health, but do not provide sufficient detail concerning the immediate responses resulting from migration and moving.
Specific Effects of Relocation
In order to identify the effects of transition on mental and physical health, examination of psychological changes following the move is an advantage. Unfortunately, there have not been many studies of this nature, but one useful study was carried out by Fried (1962) who examined the reaction of slum dwellers to enforced moves into better housing within a city, as part of a slum clearance scheme. If anything, the circumstances surrounding the move should have been perceived as positive. There was the possibility of upward social mobility to better housing in a better district. However, pre-and post-relocation interviews showed that psychological reactions were intense, overwhelming, prolonged, and characterised by grief for home: 'I felt as if the heart was taken out of me' (p. 347). Depressive mood and a sense of helplessness were major features of the observed reaction following the move.
Fried's study also emphasised the central importance of objects and places as critical factors; those who moved to new housing reported missing loved home fixtures and reported returning to look at the house because of all the happy memories. Perhaps objects symbolically represent memories or perhaps they become coveted and loved possessions in their own right because of their familiar presence in the home. The role of situational and personal factors was evident. Status, defined by occupational, educational, and income factors was positively associated with successful adjustment, 72% of the higher-income group adjusted successfully to the move as compared with 22% of their lower-income counterparts.
Planning for the move appears to be a critical factor although it may reflect underlying factors associated with willingness to adjust; 52% who reported planning for the move were subsequently found to have adjusted well, as compared with 24% of those who, if anything, reported resisting the move. Fried developed the idea of 'preparedness for transition' as a critical determinant of the success of adaptation. 'Mastery' defined in terms of the determination to struggle and persist against all envisaged problems was seen as a sign of 'inner preparedness' for the impending move.
More recent studies of relocation tend to have been concerned not with enforced conditions (as in slum clearance) but with the naturally occurring voluntary moves undertaken by individuals during their lives. Two points of view exist. The first is that moving is stressful, unpleasant and has to be coped with because of the necessities of upward mobility. The other is that moving is a positive process resulting in new experiences and encounters. Demographic trends in the U.S.A. indicate that about 20% of the population are mobile and that many people do accomplish moves voluntarily and without becoming ill. Fischer and Stueve (1977) conclude that only those individuals affected by poverty, racial discrimination, or physical infirmity are likely to be vulnerable to adverse effects.
Perhaps contextual and personal tactors operate to influence outcome and, thus, both positions could be valid. What may be important is willingness to change cultural and social outlook and to become committed to a new place. Syme (1967) describes the process of going through these changes as 'cultural mobility' and envisages the changes as influencing the disease risk. An interesting outcome of a longitudinal study on the effects of relocation by Stokols, Schumaker, and Martinez (1983) was an indication that even though mobility might be the fashion for a vigorous, modern economic nation, moving may have negative implications. The study involved 242 adult employees, 121 of whom completed a follow-up study of emotional and physical well being three months after a move to a new job in a new location. The authors obtained self-report data on mobility history and reported that frequent relocation was associated with a greater number of illness-related symptoms and reduced satisfaction. The study indicated the adverse effect of moves on those with 'low exploratory tendency'; this was described in terms of lack of exploration of various aspects of the psychosocial environment. This is an interesting finding because, as will be argued later in the book, commitment to new sources of information may be a very important prerequisite of adjustment.
The study also showed that raised illness symptoms were present in those who had low mobility history but who perceived low choice of residence and low congruence with expectations. This suggests that explanation of mobility history and its relationship with success and happiness post relocation is complex. Both low mobility and high mobility groups may be more at risk for adverse experience than moderate mobility groups.
Fisher, Frazer, and Murray (1986), and Fisher and Hood (1988) have produced evidence to show that some aspects of previous mobility experience may protect against adverse reaction to the move away from home in both university students and boarding school populations. In particular, previous experience away from home at an institution reduces the risk of homesickness reporting. Again the issue of interest is whether we are dealing with a self-selection factor (perhaps those who have good experiences on leaving home are more willing to move to a new environment), or whether benefits occur because resources are acquired and a person learns how to deal with a new environment when separated from the security and support from home. These issues will be dealt with in later chapters.
Contextual Factors and Personal Decision
Since human responses in relation to anticipated events may involve planning and exploration in advance (see Fisher 1986, Chapter 7), contextual factors might operate on the decision to move, as well as on decisions as to whether or not the move is perceived as resulting in satisfactory and positive experiences. The irreversible nature of some moves may give the early decision making particular potency and create a period of stress in advance.
At this early stage in decision making, variables such as economic and social advantage may be weighed against the advantages of remaining in the current place. The 'push' and 'pull' of the situation may need to be assessed over a period of time. The individual may thus be information-seeking and might be expected to be preoccupied.
The Congruence Model of Relocation
Stokols (1979) developed a congruence analysis of human stress in which the important factor is 'environment-behaviour' congruence, or the extent to which a particular environment meets the needs of a particular person. It is defined in terms of two measurable elements; the first is controllability and the second is salience. A further useful distinction made by Stokols is between experiential congruence (or the degree to which the environment objectively meets a person's needs), and mental congruence or how well the environment actually accommodates the characteristics and be-haviour of the person (Michelson, 1976).
Stokols notes the importance of hierarchically ordered concerns. For example, physical safety and emotional security are foremost followed by environmental constraints and supports etc. It is assumed that when higher order concerns are not threatened or relevant, lower order concerns become more salient.
With regard to the effects of contexts on the response to moves, the important point is that contextual factors may provide: (a) the basis of the decision to move; and (b) the context in which the impact of the move is evaluated. A person may base the decision to move on anticipated benefits and weight these against the costs. If after the transition these conditions are not what was expected, a situation of incongruence is created. Also the objective and subjectively perceived aspect of the situation may be discrepant; a person may perceive a pleasant environment in negative terms because he or she did not want to move or feels depressed. All these factors are likely to affect commitment.
The congruence model provides some reconciliation of the view that moves have both positive and negative features and that personal factors may selectively highlight various aspects of moving.
Person-environment Fit in Work Environments
In the context of examining stress in working environments, French, Caplan, and Van Harrison (1982) formulated the concept of person-environment congruence. The characteristics of the person and the environment as objectively defined, constitute objective congruence. The subjectively perceived properties of the environment and the objective environment, constitute level of perceived congruence. French et al. reported that perceived congruence is related to mental and physical health in occupational settings in the form of a 'U' relationship.
These issues are returned to later in the book but in the context of the issue of the effects of relocation, these models allow scope for differences in individual reaction as well as providing a basis for understanding environ mental influences. Each move may result in beneficial or adverse effects as a function of circumstances, personal preferences, and meanings attributed by individuals.
Figure 1.1, on page 8, illustrates the possible ways in which relocations as life events may link with physical health. First, there may be the creation of adverse environmental conditions. Secondly, there may be behavioural links which increase the risk of encounters with disease agents or which involve abuse of bodily systems. Thirdly, there may be stress effects because of the instability of moving. These stress effects may create a hormone climate in which the immune system is suppressed or in which chronic disease is more likely because of functional abuse of bodily systems.
Summary and Conclusions
The investigations of migration and mobility have indicated that there appears to be a strong relationship between relocations and ill health. However there are many confounding variables which make interpretation of the evidence difficult. What is needed are studies which unpack some of the issues by focusing on the psychological effects of major moves in individuals. Models which emphasise the importance of congruence or fit betwe...
