TIME Perspective and Psychological Problems Among Adolescents Affected by Violent Conflict in Indonesia

Conflicts and wars in several areas in Indonesia have caused a large number of Internally Displaced Persons (IDPs). IDPs adolescents are a vulnerable group for developing psychological problems. There was a concern about the form of time perspective that these adolescents have and its relationship with the occurrence of psychological problems in thefuture. However, there is a lack of studies of internally displaced persons that assess the relationship between psychological distress and time perspective in low income countries. The study aim was to assess psychological status and time perspective of adolescents who were affected by violent conflict in Indonesia. Cross sectional community based study. Questionnaires were used to obtain data from 129 adolescents whose lives were affected by violent conflict, both displaced and non-displaced. Subjects were selected by simple random sampling. Displaced adolescentswere present-past oriented, while non-displaced adolescents were future oriented. Displaced adolescents had more difficulties compared to non-displaced adolescents, especially in emotional symptoms. Factors like migration status, gender and religion have partial significance toward time dominance and psychological problems. There is a significant association between time perspective and psychological problems in which present-past oriented adolescents had greater difficulties than future oriented adolescents. The most common problem was emotional symptoms, especially anxiety problems.


Introduction
The number of internally displaced persons (IDPs) worldwide was more than 20 million in 2005, and has increased during the last 20 years (Internal Displacement Monitoring Center, 2006). Even so, the mental health of IDPs is still not well addressed. Most mental health studies of displaced persons have been done with refugees, and only a few studies have assessed the mental health of IDPs (Porter & Haslam, 2005). Refugees and IDPs live in different settings, so separate studies are needed to assess mental health problems in IDPs (Westermeyer, 1985). Furthermore, IDPs were more likely to experience reduced mental health compared with other kinds of displaced persons (Porter & Haslam, 2005).
In lieu of the fact that mental health services are in high demand, especially among displaced persons, children and adolescents have less priority than adults. Ninety percent of countries have no mental health policy that includes children and adolescents (WHO report, 2001), regardless of the known importance of early treatment in order to prevent more complex mental problems in adult life (Santrock, 1996;Bloch and Singh, 1997). In "normal" populations the number of children and adolescents with psychological problems is one in ten (Bloch & Singh, 1997), while among IDPs and refugees the number is higher (Lopes-Cordozo et al. 2000;Goldstein et al. 1997).
Besides studies which emphasized adversity and risks of forced migration on psychological problems, Beiser (1987) and also Beiser and Hyman (1997) investigated personal resources effective in repairing lives shredded by catastrophe. They have found a relationship between time perspective and mental health, specifically that certain kinds of time perspective can be protective factors in the mental health of refugees. Under conditions of extreme adversity, certain time perspectives may become adaptive strategies, mitigating the risk of depression. They found that there is a significantly different time perspective between Southeast Asian refugees and the Canadian Non-displaced.
Time perspective among adolescents is influenced by age, sex and social class (Cottle, 1969). Cottle also found that the development of time perspective depends on individual values. Moreover, Eisler (1993) found that there are influences of age, gender and culture in time perception. However, time has different meanings in different cultures. Therefore time perspective among adolescents might be different across ethnic groups or religions, and Indonesia is a very heterogeneous country in these respects.
As far as we know, there has never been a study in Indonesia to investigate time perspective and its relationship to psychological problems among adolescents who were affected by violent conflict. It is important to explore protective factors to avoid the development of psychological problems during adolescence, strengthen the ability to fulfill developmental tasks properly, and continue to live without psychological problems in the future. The hypotheses of this study were that IDP adolescents have different time perspective compared to non-displaced adolescents after a long period of conflict and war, and that IDP adolescents have more psychological problems compared to non-displaced adolescents.

Setting
The setting of this study was Ambon city, the most populated city in Moluccas province, Indonesia. In 2002, the IDPs population in Ambon city, the capital of the Moluccas province, was 170,590 persons (Badan Pusat Statistik Kota Ambon, 2003), more than 40% of the city's population. The IDPs live in camps and relocation areas all over the Ambon city and its surroundings, while a small number have already returned to their villages (Kompas cyber media, 1999(Kompas cyber media, -2004. The island has been the scene of Moslem-Christian violence in recent years. The conflict, which began in January 1999, has spread from its origin in Ambon city. The internal violence and war has lasted for more than four years when the study was conducted, and is believed to be mainly a religious war between Christians and Moslems (Kompas cyber media, 1999(Kompas cyber media, -2004. The latest large-scale incident occurred in April 2004, but smaller incidents still occurred sporadically throughout the island until recently. The damage has been very severe, making Ambon one of the least developed provinces in Indonesia, especially in economic terms, during recent years (Badan Pusat Statistik Kota Ambon, 2003). The tragedy has also produced hundreds of thousands of IDPs. People in Ambon have lived in sections divided by religion since the conflict began. There were borders between the Moslem and Christian majority sections guarded by the Indonesian military, and this was the main cause of displacement in the city.

Participants
The study was conducted on a total of 129 participants, 67 of them were IDPs and 62 were non-displaced. All participants (IDPs and non-displaced) were chosen by using probability sampling. A cross-sectional study was carried out in Ambon Island in Indonesia from July to September 2003. Four camps were selected from approximately 85 camps in Ambon city, these were THR, Belkot, Gonzalo, Halong, Waiheru and Wisma atlet. We also selected 2 neighborhood areas in Ambon city which population were not displaced and therefore called as Non-displaced population, as they received IDPs who moved into their neighborhood. These IDPs live in IDPs camps at all three sub-districts in Ambon city: Nusaniwe, Sirimau and Teluk Ambon Baguala. Camps in Ambon city are divided into Moslem and Christian camps because of the religious conflict.

Procedures
Since there is no institution of authority directly in charge of coordinating all camps, we (the main researcher and research assistants) went directly to camp leaders/ coordinators who are the only administrative level among the IDPs population. The next step was sending letters to each camp leader asking them to give us permission and assistance in conducting the study in their camps. Camp leaders had the authority concerning all the administrative and practical matters in the camp. We then arranged meetings with all camp leaders (one by one), explained the objectives of the study, and requested samples from the camp. All of the camp leaders agreed to participate and provided a name list of all IDPs living in the camp. The procedure started by collecting the names of all those between 12 and 18 years at the time of the study, assigning a number to each name, then withdrawing 10 to 12 numbers randomly at each camp. After a number was drawn, we did not put it back to the bucket for the next drawing (Kerlinger et al. 2000). After that we paired the numbers taken to the name list and give the names to camp leaders. The technique we used at camps and neighborhoods level was simple random sampling by using lottery to pick up names from a hat. The number of dropped potential participants because of the age was three (two respondents were too old and one too young), and one participant was dropped from the participant's list because he was just coming to Ambon from Southeast Sulawesi province to continue his education. Camp leaders then contacted the parents/caretakers of each child and together with the investigators explained about the study. We also used that opportunity to ask for informed consent from parents/caretakers, as it is important for each participant to know what he/she will undergo and give to the researchers (Kerlinger et al. 2000). Since all the participants were below 17 years, they are considered minors and therefore need to have permission from their parents, as well as their own willingness and consent.
After consent from parents/caretakers was granted, we meet the children (some in individual meetings and others in small groups) to explain again about the study and ask their consent to participate. Both parents and children had to give consent to be included in the field work. Only one prospective participant refused to take part because he had to actively participate in the preparation of Indonesia's Independence Day.
The data collection was conducted in the meeting halls of camps, churches, mosques, a camp leader's house or in just a cozy corner at the camp compound. We let camp leaders and participants negotiate the place they felt was most convenient. We also asked participants to choose a time when they could spend around one hour and not interrupt their schooling or house chores time.
We interviewed each participant on one occasion which lasted approximately 30 minutes per participant. We administered the Strength and Difficulties Questionnaire and Cottle Circle Test in a row, in the form of structured interviews.

Measurements of independent variables
Time perspective. The Circle Test developed by Thomas J. Cottle is an instrument to measure perceptions of the relationship of past, present and future, and the significance of any of the zones. Respondents are asked to draw three zones as circles of vary sizes (Cottle, 1967). Later Morton Beiser (1987) conducted case studies of refugees making up part of a sample of 1348 persons relocated from Southeast Asia to Vancouver, Canada. He used the Circle Test in a different kind of administration. He made three circles (past, present and future), each in three different sizes (small, medium and large). Then he asked respondents to pick and arrange three circles, one from each time sphere so the sizes and arrangement would reflect their opinions about time (Beiser, 1987).
The Circle Test is a projective technique, used to provide information about one's subjective experience of time (Cottle, 1967), which can be scored by assigning each result to one category of time dominance and one category of time relatedness. In this study we used the drawing administration method based on the result of the pilot study. Subjects were given a pencil and a blank piece of paper and asked to draw three circles as the representative of the past, present and future according to his/her perception. The result then was scored according to Cottle's manual and it will give two (nominal) scores for time perspective, one is the category of time relatedness and the other is category of time dominance (Cottle, 1967;Cottle, 1976;Beiser, 1987). This test can be done in a group or on an individual basis (Cottle, 1967). In this study, we administered it individually.
This instrument was chosen for several reasons. The Circle Test can give two dimensions of subjective time perspective, which is time relatedness and time dominance (Cottle, 1967) in a single instrument. The measurement of time dominance and relatedness are wide in possibility (at least five types of time dominance and three types of time relatedness). This instrument also has been used among refugees, who have many similarities with participants in this study (IDPs), and to Southeast Asian communities (Beiser, 1987). The Circle Test also can be administered with good response among adolescents (Cottle, 1967). Content validity of the instrument has been assessed by asking respondents why they chose a particular size of circle and pattern of relationship (Beiser, 1987). The answer confirmed both the respondents' understanding of the task and the meaningfulness of the symbols. Another study that investigated the Circle Test's validity for identifying adolescent time perspective, confirmed that adolescents who had a future time perspective were more likely to have a sense of continuity, optimism and certainty about career decisions. They were also more likely to have higher grade point averages and a greater sense of hopefulness than were those adolescents with a past, present or undifferentiated time perspective (Haldeman, 1992).
Since this instrument has never been used in Indonesia, we conducted a pilot study for instrument adaptation. In the original version of Circle Test, Cottle (1967) used a paper and pencil test and later Beiser (1987) used another method. He provided the participants with circles marked with past, present and future, and each set of time spheres consisted of three circles in small, medium and large size. Thus the instructions for both methods are slightly different in the way respondents have to respond the test. We tried both methods and did the linguistic equivalent for each of the instructions with the same procedure as we translated the SDQ. In addition, we used Beiser's way of checking the content validity of the test (Beiser, 1987) by asking respondents their reason for drawing/choosing a particular size of circle and pattern of relationships. We found that the drawing test was easier to understand by the respondents. From short interviews after the test, respondents also mentioned that they liked the drawing test better because they could choose any sizes they wanted to draw the circles and any kind of lines they wanted to draw. Sometimes respondents expressed their feeling toward time through not a fine line of circles.
Respondents also confirmed the content validity by giving the reason of the circle sizes being drawn and the relationship between them.

Measurement of outcome
To measure psychological adjustment of the participants we used the Strengths and Difficulties Questionnaire (SDQ). SDQ is a schedule with fixed alternative items, in which respondents are forced to choose one of the options provided by the questionnaire (Kerlinger et al. 2000). Although fixed alternative items have the decided advantages of achieving greater uniformity of measurement and thus reliability -by forcing the respondents to answer in a way that fits the response categories previously set up, and thus being easily coded-they have certain disadvantages. The major disadvantage is their superficiality: without probes they do not ordinarily get beneath the response surface. They may also irritate a respondent who finds none of the alternatives suitable, and he/she may just give an answer to conceal ignorance, or that does not really represent his/her real response.
SDQ measures two aspects in one's psychological condition, namely the strength and the difficulties, as represented in its name. There are four sub-scales measuring difficulties and they are added up into total difficulties to achieve a score. Strength is only measured by one sub-scale, and the score is treated as an independent score. It is not affecting the total difficulties score and vice versa. Respondents used a three-point Likert scale to indicate how far each attribute applies to the target child and youth (Goodman, 1997). The selection of SDQ items and their grouping into scales was based on current nosological concepts as well as on previous factor analysis (Goodman, 2001).
The SDQ is a brief behavioral screening questionnaire for 3-16 year olds (www.sdqinfo.com). It exists in several versions: parents report version, teachers report version and self report version to meet the needs of researchers, clinicians and educationalists. All versions of the SDQ ask about 25 attributes, five positive and 20 negative. These 25 items are divided into five scales: 1. Emotional symptoms (5 items), 2. Conduct problem (5 items), 3. Hyperactivity problem (5 items), 4. Peer relationship problem (5 item) and 5. Prosocial behavior (5 items). Total difficulties was calculated by summing up from the aforementioned four difficulties scales (based on 20 items). Questionnaires for self-completion by adolescents ask about the same 25 traits, though the wording was slightly different (Goodman et al.1998).
This self report version is suitable for young people aged around 11 to 16, depending on their level of understanding and literacy.
We used only the self report version in this study even though some of the participants were above 16 years, because the age limit is not a strict boundary (Goodman, 1997). The participants were given a score according to the manual. In this study. the administration of SDQ was transformed into an individual structured interview. The scoring was done according to the same norms used by the English version self report questionnaire (available at www.sdq-info.com). We analyzed the SDQ's score both in continuous score and in categorical form. We found it important to use both methods of scoring because they each can serve different purposes. Treated as continuous score, SDQ's score can be assigned more flexibly toward numerous statistical analyses (of course the categorical score can be used to attain some statistical parameter, too). This is an important benefit in order to understand the psychological situation and its concomitances. In categorical form, SDQ result can serve as a sorting tool to see comorbidity of psychological problems in the population. Therefore we can make better suggestions regarding the psychological intervention.
Since the SDQ translation in Indonesian is not available on the website (www.sdqinfo.com) we translated the English self report version into Indonesian. The procedure is in accordance to generally accepted guidelines for cross cultural instrument development (Westermeyer, 1985). First, the SDQ self report version was translated into Indonesian by a trained translator with a psychology education background, then back translation was done by other comparable translator. The result was then reviewed for differences and revised as needed by the main researcher.

Time dominance differences between displaced and non-displaced adolescents
There is no significant difference of time dominance between internally displaced persons (IDPs) and Nondisplaced when all five categories were included in the analysis (χ2 = 4.503; p = .342). IDPs and non-displaced persons have the same probability of having any of time dominance categories.
Due to some very small numbers of participants in each category of time dominance as presented in Figure 1 The result shows that there is a significant difference of time dominance between adolescent IDPs and nondisplaced (Figure 2). Significantly a greater number of IDPs have present and past oriented time dominance while non-displaced have future oriented time dominance.

Differences of psychological difficulties and strength between IDPs and Non-displaced
There are significant differences between IDPs and nondisplaced in total difficulties and emotional symptoms ( Figure 3). IDPs have a greater total difficulties and emotional symptoms score than Non-displaced. In other sub-scales, IDPs also have higher difficulties scores (in hyperactivity, conduct problems, peer problems) and higher scores in prosocial behavior compared to nondisplaced, although the differences between the two groups are not significant.
There is a significant difference in time dominance between IDPs and non-displaced only when the time dominance were clustered into two main categories which were future oriented (FO) and present-past oriented (PO) time dominance. The reason that most probably caused this result is the limited number of the sample. As Kerlinger et al. (2000)

Figure 3. t-test Score of Psychological Difficulties and Strengths among IDP (♦) and Non-displaced ( ) Adolescent in Indonesia (N = 129)
becomes narrower and the standard error becomes smaller. As a result, a large sample increases the likelihood of detecting a difference. Since the result is nearly significant, it is possible that increasing the sample size would increase the chances of identifying differences in the samples. The result in examining time dominance is that IPD adolescents have present-past oriented time dominance while non-displaced adolescents have future oriented. This finding is expected but also contrary to Beiser's (1987) findings which revealed that the Canadian non-displaced was more past oriented than the Indochinese refugees. Beiser (1987Beiser ( , 1999 interviewed refugees who have been living in Canada over a period of ten years. Maybe the fact that the refugees have left the insecure place and now stay in a more stable place encourages them to focus more on the future and pay less attention to the past. While on the other hand native Canadians who have been living in Canada all their lives have equally good and bad memories about the past, as well as hope for the future. Therefore the non-displaced seems to be more occupied with remembering the past than preparing for the future. From the informal interviews, respondents expressed their concern about their future. They seem to be considering more about what might come in the future, because of the situation and difficulties in life they experience in the present, like no house and lack of insecurity. IDPs adolescents think that the future is the most important time sphere. They put high hope on it, but on the other hand the future is still in the form of anticipation (Cottle, 1976). Everything is uncertain and adolescents tend to protect themselves from becoming disappointed if the future is not as good as they hope. Since they believe that they have no or little control over the future, they still have hope that the future will be better. Therefore, they seem not to be very concerned about the future, but they still prepare for it in the present. Most of them then take the present as the best period because of the reality in it. Present is the moment that they live in and they know exactly the things that they have and do not have. St. Augustine mentions that the present is the only real thing, and that is how these adolescents feel. In the present adolescents can be sure about their safe place; they have their families (and extended families) and they are together. That gives them emotional security which they need (Miller, 1993).
The past is considered as the glorious moment, when everything was in order, and they did not have fear at all. The bad things such as violent, conflicts and wars that happened in the past are things that they choose to forget. Instead the good relationships and life conditions are things that they want to remember. Therefore IDPs adolescents, who in their past have their own homes and security, feel that the past is very good and hope that in the future things will be like in the past.In the Beiser's study, the refugees were leaving their country, a place where they felt insecure, and moved to a more stable and secure country. Even though they were uncertain about how life would be in the new place, at least they knew that they would be secure there. For young people, this condition makes them focus on the future t-test Score

SDQ domains
since they are the group who are most adaptive to cultural uprooting (Beiser, 1999;Beiser & Hyman, 1997). The IDPs in Ambon never left the place of conflict. They keep on living there despite insecurity and fear toward the future (anxiety). This condition might have affects on the adolescents in the way they perceive time, so that they choose to focus on remembering the good things from the past as well as the reality in the present, instead of anticipating too many uncertainties in the future. The association between time dominance and psychological problems is expected. Participants with present-past oriented time dominance have higher total difficulties than those with future oriented time dominance. The significant difference among them is in emotional symptoms. As we discussed before the nature of the items in emotional symptoms sub scales are more related to anxiety than to depression. Since anxiety is essentially future oriented fear (Castillo, 1997) then it can explained the result of the study. McClelland (1976) suggested that anxiety discourages people from thinking about the future and encourages them to think that personal success is unlikely. Adolescents who chose to pay more attention to the present or the past and avoid thinking about the future have higher emotional symptoms because they were also more anxious about the future. They perceive the future as something uncertain and prefer to focus on the reality of the present and memory of the past. This is the first study in Indonesia to investigate time perspective and IDPs adolescent psychological problems. Regarding time perspective, future research can be applied to different populations and different age groups; for example, those who live in the slum areas of urban cities. These communities have different kinds of adversity, but can be as serious as that of a community that has experienced structured violence. Poverty makes communities vulnerable to violence such as abuse of women and children, rape, drug abuse, etc. (report from One Stop Trauma Center Jakarta, [2001][2002]. Thus their ways of viewing time might be different from others who live modestly in rural areas, or people who live without significant adversity in general; and the way people handle time greatly influences their attitudes and psychological problems (Beiser, 1987;.
Research related to psychological problems can be done in a larger community base. Since SDQ can provide a quick and comprehensive description of the psychological situation for young people, more studies on instrument adaptation should be conducted. The use of SDQ can also be combined with the parents and teachers version, or with other instruments to make it more comprehensive. The data can then be used as a basis for any future research which might be done in Indonesia, or to prepare a more suitable intervention plan related to psychological problems. Since the year 2002 Indonesia's ministry of health has had a special sub directorate to deal with community mental health.
In accordance with an increase of awareness in the importance of mental health in the community, further research should be carried out in order to provide actual information from the community. With relevant and reliable research, the program for promoting mental health can be designed more accurately. The design used in this study, cross sectional, has several limitations which might influence the result and dissemination of the findings. Since it is difficult to establish a cause-effect relationship, it will be very interesting if further research in the same topic can be done to explore causal effect. Longitudinal study is probably the most suitable design to investigate how far time perspective can change due to the change of situation. It can also check whether time perspective can really be protective factor or not, and when is the best time for time relatedness to emerge in order to avoid psychological distress.
With some integrated intervention toward adolescent IDPs and non-displaced, hopefully they can process their traumatic experience as they can give meaning to dangerous past experiences (Sugar, 1999). They can avoid the "time bomb", the existence of intangible disturbances at the present time, which can become a danger to the next generation, when these adolescents become parents (Danieli, 1988). Besides that they can have a psychologically healthier life in the present as they are able and more confidence in making up plan for the bright future.

Conclusion
This study's main findings confirmed the hypotheses that internally displaced adolescents have different time perspective compared to non-displaced adolescents, and that IDP adolescents have more psychological problems compared to non-displaced adolescents. The displaced adolescents have present and past oriented time dominance while non-displaced have future oriented time dominance. IDPs also have greater total difficulties and emotional symptoms scores than non-displaced.