Parental Verbal Abuse: Culture-Specic Coping Behavior of College Students in the Philippines Esther J.

Esteban, PhD University of Asia & the Pacic, Manila, Philippines J. ABSTRACT: In a larger research study that investigated the conceptualizations, experiences, and coping behaviors of 294 male and female college students exposed to parental verbal abuse, this paper identies and measures seven culture-specic coping behaviors in the Philippine setting, as experienced by 143 highly abused students identied in the study. Results indicated that both males and females coped essentially through silence. Neither used humor to relieve anxiety nor an intermediary to facilitate communication with the abusive parent. Multivariate analysis of variance suggested that while both experienced anger, females were more inclined than males to accept and tolerate verbal abuse, suppress feelings, and attempt to please the abusive parent. Female victims were disadvantaged due to: differentiated child-rearing expectations and practices; birth order; and the female victims attitudes, affective reactions, and failure at meaningful communication with the abusive parent. 294 7 143

Introduction In one of the earliest denitions of verbal abuse, Garbarino et al. described it as emotional abuse, an attack on a childs development of self and social competence, a pattern of psychically destructive behavior. Other denitions identied verbal abuse as a distinct form of emotional abuse 2 and placed it at the core of emotionally abusive behavior.3The American Professional Society on the Abuse of Children 4 referred to emotional abuse as psychological maltreatment, a repeated pattern of caregiver behavior that conveys to children that they are worthless, awed, unloved, unwanted, endangered, or only of value in meeting anothers needs. 2 behavior.3The Address correspondence to Esther J. Esteban, School of Education, University of Asia & the Pacic, Pearl Drive, Ortigas Center, P.O. Box 13673 Ortigas Post Center,Pasig City 1605, Philippines; e-mail: jestherph@yahoo.com J.Ortigas PO 13673 1605 jestherph@yahoo.com Child Psychiatry and Human Development, Vol. 36(3), Spring 2006 2005 Springer Science+Business Media, Inc.DOI: 10.1007/s10578-005-0001-6 243 +Inc.DOI10.1007/s10578-005 3632006 2005 0001-6243 P244 Child Psychiatry and Human Development A denition by OHagan 5 concluded that emotional and psychological abuse share characteristics in common: both are sustained, repetitive, and inappropriate responses to the child. They differ in their effects on the child: emotional abuse inhibits the childs capacity for spontaneous, positive, and appropriate emotional expression, whereas psychological abuse undermines a childs capacity to understand and manage his or her environment by creating confusion and fear, thereby rendering the child more vulnerable and less condent. The creative and developmental potential of the child, i.e., mental faculties and mental processes, are reduced.

 5 Although difcult to dene and lacking in standardized measures,610 verbal abuse is offensive parental communication that undermines the emotional and psychological well being of the child. Classications of verbal abuse, such as rejection, degradation, threats,denial of affection have been developed by several researchers.1113 Specic examples are words that spurn, belittle/devalue, terrorize/threaten, deny emotional responsiveness/ignore, shame/ridicule, criticize, humiliate, contradict, block, divert, and manipulate. ,6-10 researchers.1113 /// / In a diverse and increasingly globalized world, Matsumoto,14 a strong advocate of cross-cultural research, maintains that researchers will have to include culture as a major determinant in theories of human behavior and as a variable in their studies and denitions.A denition by McGee and Wolfe,15 that described psychological maltreatment as the interaction between maltreating parental behaviors and the special vulnerabilities of a given child particularly at his or her developmental level, has been criticized for omitting a cultural context; 16 lacking a distinction between what is psychologically harmful or potentially benecial behavior in different cultures; 17 and not including societal standards for assessing the construct. 18 Korbin 19 has claried that every culture denes some behavioral acts that are abusive or deviant from acceptable standards; they vary in form and rate. It is not always clear, however, whether the child perceives parental abusive language as normal in his or her own culture. 14 McGee 15 ;16 ;17 18Korbin19 While numerous studies in the Philippines 2024 have explored parental physical and sexual abuse especially among the urban poor,Marcelino et al.25concluded that no signicant study on parental verbal abuse has been undertaken in any socio-economic incomelevel. They encouraged research that involved the childrens participation and advocated culturally appropriate and child-specic indicators to measure the phenomenon. 20-24 al.25concluded - This paper presents partial ndings from a larger research study that measured the conceptualizations, experiences, and coping behaviors of Filipino college students who experienced parental verbal abuse.26 Highlighted are the seven culture-specic coping behaviors identied as prevalent and socially acceptable in Philippine culture. Included also are the students affective reactions to the experience of abusive language. abuse.26

Frydenberg 27 explains that coping consists of productive and nonproductive strategies, functional or dysfunctional, depending on contextual factors, i.e., on coping strategies peculiar to a given social and cultural milieu. In a model for adolescent coping, Frydenberg and Lewis 27 list the following strategies: physical recreation, ignoring the problem, tension reduction, keeping to self, focus on problem-solving, wishful thinking, self-blame, worry, hard work and achievement, relaxation diversions, giving up, spiritual support, positive focus, social support, professional help, belongingness, social action, and close friendships. Frydenberg27 Frydenberg 27 Theorists Lazarus and Folkman28focus on three basic coping models relevant to adolescence that they have incorporated into their Ways of Coping Scale: problem-focused coping, appraisal-focused coping and emotion-focused coping. In the absence of a coping model for Filipino college students exposed to parental verbal abuse, and in the interest of including culture-context in the project, a panel of ve Filipino experts social anthropologist, social psychologists, and child psychiatristswas convened to identify prevalent, culture-specic, coping behaviors in the Philippine setting. Given the urgent need for more validated measurements designed for Philippine culture, researchers have been encouraged to develop instruments. The method of consulting a panel of experts who are knowledgeable (and sensitive to cultural practices) is used to harness expertise in areas not widely studied. The seven culture-specic behaviors identied by the expert panel for this study were: acceptance of offensive words; tolerance out of respect for parent; suppression of feelings; silence; attempts to please offensive parent; humor; and use of an intermediary to communicate with the abusive parent. Traditionally, Filipino children have been encouraged to be dependent, respectful, obedient, shy, non-aggressive, and submissive; they are prohibited from talking back or rebelling from their parents and elders. 29 These non-confrontational behaviors and parental expectations may result in the child experiencing feelings of low selfesteem, 30,31 shame and guilt. 32 Whether these same behaviors are present in other cultures is not the subject of this paper; however, they may warrant further investigation. Two culture-specic research variables that also were taken into consideration in the study were gender-specic child-rearing practices and birth order. In a research project commissioned by the UNICEF which surveyed 131 studies undertaken between 1970 and 1997 on child rearing of male and female children (018 years) in the Philippines to better understand gender socialization, the following conclusions were reported by Liwag et al. 33 : the girl- and boy-child are raised and treated differently within the family; the girl-child is disadvantaged because of restrictions she has to contend with being compared with the boy-child; the girl-child has more responsibilities inside the house as training for the role she is expected to perform in the future. Folkman28focus ; ;; 29 30,31 32 131 1970 1997 0-18 Liwag 33 Carandang

34 further explains that in the Philippines, the eldest girl and boy are both expected to have the authority and responsibility in the household next to the parents. The task of being the substitute caregiver often places excessive pressure and may induce compulsive disorders especially as the eldest girl struggles to please and obey parents and be accountable for younger siblings The two variables: gender-specic child rearing practices and birth order were incorporated in this study because of their implications for differences in malefemale coping behavior. The study aimed to ll a research gap, generate awareness, and motivate the delivery of prevention and intervention programs. The study did not explore the motivations of the parentabuser or therapeutic practices. Carandang 34 Methods In the larger project that examined the conceptualizations, experiences, and coping behavior of college students, 26294 students completed a researcherdesigned self-report survey.Stratied random cluster sampling was used with the permission and coordination of university administration and staff, professors, and psychologists/counselors on site. From a master schedule of classes for the rst three levels of college students across all core subjects, classes were randomly selected based on the targeted number of respondents, stratied according to year level and gender. This ensured that the participants represented a diversity of academic interests. All students were from families of middle and higher income levels at a small, private non-sectarian university in Metro Manila with a total enrollment of 1448. Results Among the 294 survey respondents, 48% were highly abused (daily or 3 times a week); 34% were moderately abused (once a week) and 18% were non-abused (once a month or almost never). The 48% that were highly abused (N = 143) had a mean age of 18.4 years. There were more females (61%); freshmen and sophomores (82%); rstborns (44%); and students from families with three children (58%). The majority lived in Manila with their biological parents (98%); in bi-lingual homes, Tagalog and English (74%); with their college-educated parents (75%) who were engaged in business occupations and a wide range of other professions. Of the 143 highly abused respondents, the frequency of abuse by fathers and mothers was essentially the same; 54% were abused by both parents. Of the highly abused, 30% were highly abused in 515 categories by the father and 30% were highly abused in 516 categories by the mother. Specic to this study on culturespecic coping behavior of the highly abused students, Tables 1 and 2 present the mean ratings and multivariate analysis of the seven culture specic coping behaviors. In Table 1, silence or keeping quiet was an important coping mechanism across gender; males and females had the same mean for the use of humor, although it was seldom applied. Across gender, least used of all the coping strategies was the use of an intermediary to communicate with the offensive parent. The females mean scores were signicantly higher than the corresponding mean ratings for the males in the following coping strategies: acceptance of offensive words; tolerance out of respect; suppression of feelings; and attempts to please parent. 26294 researcherdesigned survey.Stratified / 1448 294 48 3 34 18 48N = 143 18.4 618244 5898

74;75 143 54 30 5-15 30 5-16 1 2 1 The results of the multivariate analysis (Table 2) suggested thatfemales were more inclined than males to quietly endure the abuseand maintain smooth interpersonal relationships.Related to the data that indicated quiet acceptance and tolerance among the abused females (Tables 1 and 2), were the females affectivereactions that indicated the suffering underlying their silence and suppression. The affective responses that were analyzed were:fear; depression, e.g., sadness, crying, hopelessness, discouragement;post traumatic stress disorder (PTSD)-like responses, e.g., anger, being out-of-control, feeling of being emotionally drained and stressed,annoyance, frustration; rejection, e.g., feelings of loneliness and being ignored; and hurt. 2 thatfemales abuseand relationships.Related 1 2 affectivereactions PTSD Supportive of the quantitative data were supplemental insights gained from condential one-on-one interviews with 15 highly abused females and 9 highly abused males who had volunteered from the survey pool. Indicative of their tolerance and acceptance of the offensive communication, were their remarks when asked to react to the offensive parental communication that had been presented to them in three scenarios. Without exception, they responded that such communication was normal, natural, common, expected, typical, usual, or a parental prerogative as a disciplinary practice. 15 Despite their acceptance of parental verbal abuse as normal,expected, and common as a disciplinary practice, thematic analyses of the students perceptions of the effects revealed that parental verbalabuse saddens, hurts, frightens, frustrates, and undermines theself-esteem of its victim. verbalabuse In comparison with the males who did not rationalize abusive parental behavior, two thirds of the highly abused females made excuses for the offensive parent. Further, the females pointed out theprobable faults of the child and the childs obligations to be an obedient offspring. Several recurring themes were articulated by all interviewees based on personal experiences: the injustice of the parental manner of communication; the degradation and offense to personal dignity; the hurt that they felt; the insensitivity of the parent; and the parents unwillingness to apologize for the offensive communication. theprobable ; Unsolicited commentaries by the mostly rst-born (70%) highly abused female interviewees cited frustration and resentment in response to the heavy burdens and duties of the victimized rst-born daughter. As the eldest of four children, one interviewee described the essence of her role and its corresponding effects. The eldest is expected to take

the responsibilities of the parents, to know more, to be the role model. My parents expect me to be the teacher and guide. My brothers tease and provoke trouble and I get blamed. The youngest is the favorite and gets more attention. This can lead to jealousy. The eldest is under pressure, always in fear because you have to be the best. This can affect self-esteem. Youre afraid that your siblings will do better in their studies. 70 As the interviewees further related the abusive scenarios to their own personal experience, both male and female participants afrmed the following coping mechanisms of suppression, silence, and avoidance.Each explained that he or she would keep quiet, cool down,say nothing, murmur to myself, keep to myself, avoid my parents,not listen, go someplace alone, drive around alone, be alone with nature. Seven females retaliated by giving the silent treatment or cold shoulder. The majority escaped through multimedia usage. A few engaged in more creative activities to escape or gain relief from the abuse, e.g., hobbies, dance, sports, music. No mention was made by either males or females of the use of an intermediary or intercessor to help bridge communication with the verbally abusive parent. Of the 9 females and 3 males who attempted to confront the abusive parent, all met with failure and felt frustration at the inability to engage in meaningful communication. No interviewee used humor to rationalize or lighten the burden of parental verbal abuse. avoidance.Each 9 3 In comparison with the male interviewees who said they shared their frustrations and experiences with friends, the majority of the female interviewees explained that they kept the abuse to themselves and preferred to go it alone, explaining that they did not want to air dirty linen in public, or burden friends, or face potential gossip. Among the male and female interviewees, 67% described their abusive parents as authoritarian, controlling, and power-tripping. Signicantly, only the females (13 out of 15 or 86%) described their abusive parents as being simultaneously permissive, i.e., of not setting rules or structure, not implementing sanctions. They found these parents to be unpredictable and the contradictory parental styles were viewed as confusing. 67 13 15 86 Discussion Considering that almost half of the survey respondents were highly abused (experienced verbal abuse daily or 3 times per week), it appears that verbal abuse is still a pervasive manner of communication even among middle and high income, well-educated parents.The harsh disciplinary practice could explain the fear and feelings of rejection (Tables 3 and 4) that the victims feel. 3

 3 4 The affective reactions among the males and females (Tables 3 and 4) betray their underlying emotional suffering. There is little distinction between males and females in their levels of anger and feelings of out-of-control. Hoglund & Nicholas 32 found that greater exposure to emotional abusiveness related to overt/covert hostility and expressed/unexpressed anger. The silent treatment of the females towards their abusers, which the interviewees admitted they had learned from their mothers, suggested unexpressed anger and covert hostility. Rubin 38 indicated that the silent treatment can be cruel and inicts pain and damage on its victim, i.e., it is a form of abuse. 3 4 / / 32 38 Survey results clearly indicted that verbally abused daughters were signicantly more prone to depression than sons. Peterson et al 39 reported that depression increases substantially during the adolescent years with dramatic divergence in rates for females and males. Several studies 4042 concluded that adolescent girls are twice as likely to report signicant depressed affect as boys. Frydenberg 27 explained that adolescent girls use emotion-focused ways of dealing with a problem, rather than problem-solving, if they perceive that the situation will not change. The interviewees unanimous inability and failure to engage in meaningful communication with the abusive parent appears to reect several of the avoidant-coping strategies found in Frydenberg and Lewis 27 model. Their tendency towards affective responses coincides with the emotion-focused coping model of Lazarus and Folkman. 28 39 40-42 Frydenberg27 Frydenberg 27 Lazarus 28 In the interview scenarios, the females commiserated with the victim but also acknowledged the childs faults and disobedience. Similarly,they empathized with the abusive parents but also pointed out the devastating hurt and humiliation that the abusers inicted. This dual perspective of empathy alongside accusations of both the parentabuser and childvictim likely reects the daughters growing internalization of parental attitudes juxtaposed with their sensitivity and suffering as victims. It may also explain the females anger and frustration, as they struggled to reconcile respect for their parents, compliance with high parental expectations, and fulllment of the responsibilities imposed on daughters, especially the rst-born Survey ndings suggest passivity, tolerance, avoidant and emotionfocused coping (Tables 1 and 2), particularly among the highly abused females. The thematic analyses of the interviewees perceptions of the effects of verbal abuse, e.g., it frightens, saddens, and hurts, indicate that although students consider the abusive language as normal in their culture, they report the effects of the language as detrimental. Filipino cultural anthropologists 43,44 acknowledge that the use of humor is a prevalent coping response to adversity and an indicator of resiliency. Laughing off a problem, making jokes and being playful serve to relieve anxiety and diffuse tension. Although the victims may joke about other matters, both the survey and interview ndings suggested that this generation does not nd parental verbal abuse a matter of little consequence or to be taken lightly. Their sensitivity to verbal abuse and perhaps heightened awareness of its negative effects, overshadowed by their stress and suffering, may have led the victims to take the offensive communication seriously and not nd it an issue to push aside in a lighter vain.

 emotionfocused 1 2 43,44 The common Filipino practice of using an intercessor or go between 43,44 to help mediate a discussion or conict and maintain a smooth interpersonal relationship appears not to be a coping option. Instead of asking another member of the extended family or friend to intercede and facilitate communication and resolution, the college students choose to go it alone. 43,44 Interestingly, ndings for the two aforementioned culture-specic coping behaviors: use of an intercessor and humor, which the students appear not to have used, did not match the panels expectations. The discrepancy could be partially explained by the students high exposure to multi-media, which may have accelerated crosscultural exchanges and exposure to the issue of parental verbal abuse approached from different viewpoints. Such exposure could foster a generation gap in the use of coping mechanisms.

There are several problems with generalizing the results of this study. The study was voluntary. As verbal abuse is such a sensitive topic, only those willing to speak out may have participated, resulting in potential selection bias. Furthermore, the study was conducted among college students from families in middle to higher socioeconomic income levels, which may not generalize to adolescents who do not go to college. Although preliminary ndings from Cervantes45study suggest that prevalence of verbal abuse among adolescents from families of low socioeconomic levels may be as high as 88%, further research is needed to replicate and expand the current study to lower income levels. Further research is recommended, e.g., the association between parental verbal abuse and depression in the child victim is noteworthy and merits more serious exploration. Studies across cultures would be of special interest to determine striking similarities and differences. Cervantes'45study 88 Ney 46 concluded that victims may someday abuse their own children in much the same way as they were abused by their parents, suggesting the urgent need to heal and process the experiences and emotions attached to victimization. His research further indicates the necessity of human resource development to help parents retool their communication skills in the exercise of parental discipline. 46 Summary The study presents evidence of parental verbal abuse among college students of well-educated, middle to high income parents in the Philippines. In a cultural setting that shies away from direct confrontation with an authority gure and that values smooth interpersonal relationships, the highly verbally abused students

demonstrated avoidant and emotion-focused coping. Although the students perceived the injustice of the abuse, acknowledged its affront to their dignity,and experienced anger, they tolerated and rationalized its practice.Of the seven culture-specic coping variables that were tested, both males and females coped through silence. They seldom used an intermediary to communicate with the abusive parent or laughed off the abusive words through humor. Females appeared to be disadvantaged and more vulnerable than males in the following coping behaviors: acceptance of the offensive words, tolerance out of respect, suppression of feelings, and attempts to please the offensive parent. Factors that accounted, in part, for the differences between male and female coping behavior were: differentiated parental child rearing practices of sons and daughters; high parental expectations of daughters, especially the rst-born, to assume parental roles and responsibilities; the females likely internalization of parental values and demands for obedience and submission; the females rationalizations of verbal abuse as a parental prerogative; the females signicantly higher levels of affective reactions of depression, rejection, hurt, and fear; and the females failure at meaningful communication with the abusive parent. The study gained insights into coping behavior in the cultural context of the Philippines, in particular, the intra-psychic conict of the female victim as she tries to understand, rationalize, and tolerate parental verbal abuse and still please, obey, and respect her offensive parent. practice.Of ; ;; Because verbal abuse is the least studied of all forms of abuse,7 ndings in this pioneering project indicate the need for further studies in determination of reliability and validity of the study questionnaire; further correlation of parental verbal abuse and depression, especially among adolescents; and design of culturallyspecic prevention and intervention programs among child psychiatrists and psychologists; family therapists; social workers; and educators, parents, and students in school-based programs. 7 culturallyspecific Esther J. Esteban References 1. Garbarino J, Guttman E, Seeley JW: The Psychologically Battered Child: Strategies for Identication, Assessment, and Intervention. San Francisco: Jossey Bass, 1986 2. Navarre EL: Psychological maltreatment: the core component of child abuse. Psychological Maltreatment of Children and Youth. eds. Brassard MR, Germain R, Hart SN. New York: Pergamon Press, 1987. 3. Tomison AM, Tucci J: Emotional abuse: the hidden form of maltreatment. Spring, 1997. [Online] URL. http.//www.aifs.org./au/nch/issues8.html. 4. The American Professional Society on the Abuse of Children. In: Handbook Child Protection. eds. Dubowitz H, DePanlis D. Thousand Oaks, CA: Sage,2000. 5. OHagan, KP: Emotional and psychological abuse: problems of denition. Child Abuse Negl 19: 440461, 1995. 6. Black DA, Schumacher JA, SmithSlep AM, Heyman RE: Risk factors child emotional abuse. 1999. [Online] URL. http://www.NNH.ORG/RISK/NEW CHAP13-RISKFACTORSFORCHILD. 7. National Research Council: Understanding Child Abuse and

Neglect. Washington, D.C.: National Academy Press, 1993. 8. Claussen AH, Crittenden PM: Physical and psychological maltreatment: relations among types of maltreatment. Child Abuse Negl 15: 518, 1991. 9. Giovannoni J: Denitional issues in child maltreatment. In: Child Maltreatment: Theory and Research on the Causes and Consequences of Child Abuse and Neglect. eds. Cicchetti D, Carlson V. Cambridge: Cambridge University Press, 1989. 10. Nesbit WC, Karagianis LD: Psychological abuse in the home and in the school. Can J Educ 12: 177183, 1987 11. International Conference on Psychological Abuse of Children and Youth. Child Abuse Trauma, ed. Briere JN. Newbury Park, CA: Sage, 1992. 12. Ofce for the Study of the Psychological Rights of the Child. In: Handbook Child Protection. eds. Dubowitz H, DePanlis D. Thousand Oaks, CA: Sage, 2000. 13. Evans P: The Verbally Abusive Relationship. Holbrook, MA: Adams Media Corporation, 1996. 14. Matsumoto D: Culture and Psychology. Pacic Grove, CA: Brooks/Cole Publishing Co., 1996. 15. McGee RA, Wolfe DA: Psychological maltreatment: toward an operational denition. Dev Psychopathol 3: 1318, 1991. 16. Sternberg KJ, Lamb ME: Can we ignore context in the denition of child maltreatment? Dev Psychopathol 3: 8792, 1991. 17. Belsky J: Denitional limitations and unstated assumptions. Dev Psychopathol 3: 3136, 1991. 18. Barnett D, Manly MT, Cicchetti D: Continuing toward an operational denition of psychological maltreatment. Dev Psychopathol 3: 1929, 1991. 19. Korbin J: Cross-cultural perspectives and research directions for the 21st century. Child Abuse Negl 15: 6777, 1991. 20. Buzon P, Hernani E, Lumapas T, Mordeno I: A study of the self-esteem of the physically and sexually abused children of childrens help and assistance foundation inc. (CHAFI) and an analysis of their roles in the group. Manila: CHAFI, 1997. 21. Center for Womens Studies (University of the Philippines): Breaking the Silence: the Realities of Family Violence in the Philippines and Recommendations for Change. Quezon City: Center for Womens Studies and UNICEF, 1996. 22. Choudhury PA: Four cases of child abuse in the Philippines. Presented to the National Conference on Child Abuse, Manila, Philippines, April 1997. 23. Department of Social Welfare and Development: Statistical report on child abuse. Philippines Bureau of Child and Youth Welfare, 1994. 24. Institute of Womens Studies/Inter-Institutional Consortium: Brave Little Women: a Study on Incest. Manila: Institute of Womens Studies, St. Scholasticas College, 1995. 25. Marcelino E, dela Cruz M, Balanon F, Camacho A, Yacat J: Child Abuse in the Philippines. Quezon City: PLAN International Philippines and University of the Philippines CIDS, 2000. 26. Esteban E: Parental Verbal Abuse: Filipino College Students Conceptualizations, Experiences and Coping Responses. Unpublished dissertation. Manila: Miriam College Foundation Graduate School. 2002. 27. Frydenberg E: Adolescent Coping. New York: Routledge, 1997. 28. Lazarus RS, Folkman S: Stress, Appraisal and Coping. New York: Springer, 1984. 29. Medina BT: The Filipino Family. Quezon City: University of the Philippines Press, 2001. 30. Gross A, Keller H: Long-term consequences of childhood physical and psychological maltreatment. Aggressive Behav 18: 171185. 1992. 31. Briere JN: Child Abuse Trauma. Newbury Park, CA: Sage, 1992. 32. Hoglund C, Nicholas K: Shame, guilt, and anger in college students exposed to an abusive family. J Fam Violence 10: 141157, 1995. 33. Liwag M, dela Cruz A, Macapagal M: How we raise our daughters and sons: child-rearing and gender socialization in the Philippines. Monograph. Manila: UNICEF and Ateneo Wellness Center, 1999. 34. Carandang ML: Filipino Children under Stress. Manila: Ateneo de Manila University

Press, 1987. 35. Zimmerman M, Chelminski I, Posternak M: A review of studies of the Hamilton depression rating scale in healthy controls: implications for the denition of remission in treatment studies of depression. Nerv Ment Dis 192(9): 595601, 2004. 36. Rantz MJ, Petroski GF, Madsen RW, Mehr DR, Popejoy L, Hicks LL, Porter R, Zwygart-Stauffacher M, Grando V: Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports: an update. Jt Comm J Qual Improv 26(2): 101110, 2000. 37. Sajonas RD: The Relationship of Paternal Alcoholism to the Childs Self-Concept. Unpublished masteral thesis. Manila: Miriam College Foundation Graduate School. 1996. 38. Rubin TI: Child Potential. New York: The Continuum Publishing Co., 1991. 39. Peterson AC, Compas BE, Brooks-Bunn J, Stemmler M, Ey S, Grant KE: Depression in adolescence. Amer Psychol 48: 155168, 1993. 40. Earls F: Epidemiology of psychiatric disorders in children and adolescents. In: Psychiatry: Social, Epidemiological, and Legal Psychiatry. eds. Klerman GL, Weissman MM, Applebaum PS, Roth LH. New York: Basic Books, pp. 125152, 1986. 41. Peterson AC, Craighead WE: Emotional and personality development in normal adolescents and young adults. In: Suicide and Depression among Adolescents and Young Adults, ed. Klerman GL. Washington, D.C.: American Psychiatric Press, pp. 1952, 1987. 42. Nolen-Hoeksema S: Sex differences in unipolar depression: evidence and theory. Psychol Bull 101: 259282, 1987. 43. Jocano F: Filipino Value System: A Cultural Denition. Manila: PUNLAD Research House, Inc., 1997. 44. Philippine Philosophical Studies: Values in Philippine Culture and Education. ed. Dy MB, Washington, D.C.: The Council for Research in Values and Philosophy, Series III. Asia 7, 1994. 45. Cervantes, LH: Verbal Abuse by Parents and Teachers. Unpublished masteral thesis. Miriam College Foundation Graduate School, 2002. 46. Ney PG: Transgenerational child abuse. Child Psychiat Hum Dev 18: 151168, 1988.