Popular revolutions overthrew authoritarian governments beginning in Tunisia, then Egypt and then came the revolutions in other Arab countries like Libya, Yemen, Syria and Bahrain. These revolutions may explain the way in which the citizens in the Arab world changed to the contrary from political apathy to political violence 1.
A revolution in Egypt was expected as a reaction to corruption, tyranny, unemployment, frustrations people face in society, violations and harsh conditions for years under the state of emergency in force continuously for 30 years. The success of revolution in Tunisia made people believe that the successful experience can be replicated in Egypt 2.
Anger is one of basic feelings mostly experienced in daily life. It is a strong feeling of distress in response to a specific provocation, mostly by perceived misdeeds 3,4. People become angry when others attack their personality, treat them unfairly, blame someone's unjustified action, keep them from getting what they want or violate cultural norms 5–7.
This study was designed to assess the impact of January 25 Egyptian Revolution on the behavior and different psychological domains in Assiut University students (immediately and 2 years after the revolution).
Participants and methods
This study was carried out through two phases:
Phase 1: immediately after the revolution
Phase 1 study was conducted on 3193 students from Assiut University [36.8% (n=1174) males vs. 63.2% (n=2019) females]; 33.8% (n=1078) students were from practical and 66.2% (n=2115) were from academic faculties.
Phase 2: 2 years after the revolution
Phase 2 study was conducted on 2914 students from Assiut University [38.8% (n=1133) males vs. 61.1% (n=1781) females); 42.8% (n=1248) students were from practical and 57.2% (n=1666) students were from academic faculties.
Type of the study
This was a cross-sectional study conducted on a selected random sample representing Assiut University students.
Procedural concepts of the research
Phase 1: immediately after the revolution (from 1 March 2011 to 30 April 2011)
Phase 1 study was carried out through three stages:
- First stage (preparation stage) (4 weeks):
- In this stage, the team defined the size of the sample, faculties and their types as well as the parameters of the study, including social, economic, political, psychological, and future vision of young people toward the Egyptian society after revolution.
- The social, economic, and political parameters were evaluated through standardized questionnaire prepared specifically by the research team for this study.
- The psychological parameters was evaluated using Symptom Checklist-90-R (SCL-90-R) 8,9 and Scale of Personal Experiences Associated with Emotion of Anger 10.
- Second stage (screening stage) (6 weeks):
- All these parameters were applied in one sitting as follows:
- The idea and aim of this study were explained.
- Written consents with agreement to complete the questionnaires and tests included in this study anonymously were obtained.
- Social, economic, and political questionnaires were applied to assess the possible predisposing factors and to actively relive the students in the circumstances just before, during, and immediately after the 25th of January revolution.
- Finally, SCL-90-R and Scale of Personal Experiences Associated with Emotion of Anger were applied to better evaluate the impact of the revolution and its reflections on the psychological domains in the studied students.
- Third stage (data entry, statistics, and tabulation of the results) (12 weeks).
Phase 2: 2 years after the revolution (from 1 March 2013 to 30 April 2013)
Phase 2 was carried out through the same three stages as in phase 1.
Tools used in the study
Two questionnaires were used in this study to evaluate the impact of January 25 Egyptian Revolution on the psychological domains of students in Assiut University: (a) SCL-90-R 8,9 and (b) Scale of Personal Experiences Associated with Emotion of Anger 10. Social, economic, and political questionnaires were prepared specifically for this study to assess the possible predisposing factors and to actively relive the students in the circumstances just before, during, and immediately after the January 25 Egyptian Revolution.
This study was approved by the Ethics Committee of Assiut University, and all questionnaires were filled anonymously.
Tables 1 and 2 illustrate the prevalence of psychiatric symptoms using SCL-90-R among students of both sexes immediately and 2 years after the revolution. The prevalence of all psychiatric symptoms decreased 2 years after the revolution in comparison with their corresponding values immediately after revolution except phobia (doubled) and hostility, which increased.
Tables 3 and 4 illustrate the prevalence of personal experiences associated with emotion of anger among students of both sexes on the Scale of Personal Experiences Associated with Emotion of Anger immediately and 2 years after the revolution. Although the prevalence of anger as a whole and anger severity (moderate and severe anger) diminished 2 years after revolution, anger triggers, emotional feelings, and behavioral patterns associated with anger increased compared with their corresponding values immediately after revolution. Prevalence of anger was significantly higher among men than women immediately after revolution, but the revers was observed 2 years later.
Table 5 illustrates the mean scores of different psychiatric symptoms among students using SCL-90-R (immediately and 2 years after the revolution). All psychiatric symptoms were recorded with higher mean scores among students 2 years after revolution than immediately after revolution, except for obsession. The difference was statistically significant, except for sensitivity and depression.
Table 6 shows the mean scores of personal experiences associated with emotion of anger among students on the Scale of Personal Experiences Associated with Emotion of Anger immediately and 2 years after revolution. The total score of anger and all variables decreased significantly 2 years after revolution except for the emotional feelings associated with anger, which increased significantly 2 years later.
Tables 7 and 8 illustrate correlation between different psychiatric symptoms on SCL-90-R and Scale of Personal Experiences Associated with Emotion of Anger among students immediately and 2 years after revolution.
In 2009 the World Bank reported that Egypt has high levels of corruption, little voices attributable to some citizens in the country’s affairs and perceived government ineffectiveness 11. The Egyptian revolution gained momentum as a result of several political and social factors. High-level of corruption, bureaucratic lawlessness, high rates of unemployment, and violations of human rights are the likely precedents.
This study was carried out on two phases. Phase 1, which was 3 weeks after Mubarak stepped down from the presidency and the Egyptian Army Supreme Council took over. In this phase a specifically prepared social questionnaire was used that could relive the studied students in the events just preceding, during, and immediately after the revolution, and thus could truly express the impact of revolution on different psychological aspects of the studied students. Phase 2, 2 years after revolution: the long-lasting impact of revolution on different psychological aspects of the studied students was re-evaluated by application of SCL-90-R and the Scale of Personal Experiences Associated with Emotion of Anger.
Immediately after the revolution, paranoia, anxiety, sensitivity, depression, somatization, obsession, hostility, psychosis, and phobia were the most commonly encountered psychiatric symptoms in order of frequency among the studied students. Two years after the revolution, prevalence of all psychiatric symptoms decreased; except phobia and hostility, which increased. Prevalence of all psychiatric symptoms was significantly higher among women than men, on both phases of the study, except hostility (Tables 1 and 2). Although hostility was insignificantly higher among men immediately after revolution, it increased significantly among women 2 years later. Despite decreased prevalence of most studied psychiatric symptoms 2 years after revolution, the mean scores of all these symptoms increased significantly; except for obsession, which decreased significantly (Table 5). Khamis 12 in his study on the occurrence of post-traumatic stress disorder (PTSD) and psychiatric disorders (i.e. anxiety and depression) in Palestinian adolescents following Intifada-related injuries found that ∼76.5% of the injured victims had PTSD with excess risk for chronic symptoms and comorbidity along with other psychiatric disorders such as anxiety and depression.
Longitudinal and cross-sectional studies comparably demonstrated that negative social events – particularly in childhood – can result in a variety of internalizing and externalizing problems such as social anxiety disorder (SAD), fear of negative evaluation, depressed mood, loneliness, body dissatisfaction, eating disturbances, somatic complaints, and poor self-esteem 13,14.
Moreover, recent evidence support the notion that relatively common social events, such as public humiliation, teasing, and bullying, may be extremely upsetting and distressing and contribute to the development of SAD symptoms 15,16. In addition, individuals with SAD often report event-specific hallmark symptoms of post-traumatic stress (e.g. intrusive memories, avoidance, hyperarousal) following significant negative social event.
Similarly, Dedert et al.17 examined the association of lifetime traumatic stress with psychiatric diagnostic status and symptom severity in veterans serving in the US military after 9/11. Ninety-four percent of the respondents reported having at least one traumatic stressor meeting DSM-IV criterion A for PTSD (i.e. life threatening event to which the person responded with fear, helplessness, or horror). The rate of psychiatric disorders in this sample was as follows: 30% PTSD, 20% major depressive disorder, 6% substance abuse or dependence, and 10% for the presence of other Axis I psychiatric disorders.
The recorded high prevalence rate of paranoia immediately after revolution could be explained using vulnerability–stress models, which propose that social stress triggers psychotic episodes in high-risk individuals. Previous studies have found not only stress but also a decrease in self-esteem to precede the formation of delusions. Kesting et al.18 assessed the direct impact of social stress on paranoid beliefs using an experimental design and considered a decrease in self-esteem as a mediator and the proneness to psychosis and paranoia as moderators of the effect. They found a direct effect of social stress on paranoid ideation. The impact of social stress on paranoid ideation was mediated by a decrease in self-esteem and moderated by proneness to paranoia. In their heuristic model, Preti and Cella 19 proposed both ostracism and public discredit to be stressors that elicit negative emotions and precede the formation of delusions.
The increase in the prevalence of phobia and hostility among students, especially women, 2 years rather than immediately after revolution (Tables 1 and 2), reflects their frustration for not achieving the objectives of revolution (living, freedom, and social justice), putting the law of demonstrations and the use of excessive force to break up demonstrations, killing many of the demonstrators, arresting many numbers and throwing them in prisons, prevention of young people from expressing their opinions, withholding youths from the active participation in the activities of the revolution in addition to the marked deterioration in the security and economic aspects of Egyptian society.
Anger is both the subjective experience and the drive behind many forms of aggression 20. On evaluating the anger-provoking reasons among high school and university students, Kisaç 21 found that most of the students’ behaviors and behavioral patterns associated with anger occur when they are being treated with injustice, perceived personal threat, being criticized unfairly, or prevented from their desires or aims. Similarly, in the current study, failure to achieve the goals of revolution (living, liberty, and social justice) even after 2 years was the main cause of increased anger (16–19%), which consequently resulted in increased emotional feelings (15.3–20.9%) and behavioral patterns associated with anger (13.6–17.7%) (Tables 3 and 4).
However, the types of anger expression have to be taken into account because women and men may express their anger differently 22,23. Studies have revealed that verbal and facial expressions are rather used by girls, whereas physiological means and behavioral acting out such as hitting, kicking, or punching are more commonly attempted by boys to express their anger 23,24. In the present study, immediately after revolution, the prevalence of anger was significantly more among men than women. This was expressed in the form of more prevalent anger severity among men (severe and moderate anger), and despite they were significantly more reasonable for evaluating the sources of anger than women, men expressed significantly more emotional feelings and behavioral patterns associated with anger (Table 3). On the contrary, the reverse was observed 2 years after revolution where female students showed significantly more anger severity, more anger triggers, and became more reasonable in evaluating the sources of anger than males students (Table 4). These findings are consistent with the results of Averill 3, which pointed out that female students are more hot-tempered than male students. They could be very rigid and strict about others’ misbehaviors. He found that female students became more angry on ‘being in trouble because of other’s mistake’, ‘when people behaved self-centered’, ‘when jobs don’t go as they wish’, ‘hearing that someone gossips on them’, ‘when some people behaved silly’, and ‘when they are sleepless’ than male students. Only in the situation of ‘being criticized whatever the reason’ male students are angrier than female students. Similarly, in other studies women were found to express more intense anger for longer period of time and use passive strategies, such as avoidance, interpersonal reconciliation, turning against the self, and nonaggressive strategies. However, to express their anger, men use more direct, physical act or retaliating strategies such as hitting 25–27.
Lastly, significant positive correlations were found between all psychiatric symptoms and nearly all subscales of anger immediately and 2 years after revolution. Meanwhile, behavioral patterns associated with anger showed the least correlation with psychiatric symptoms (Tables 7 and 8). These findings could be explained by the fact that both anger experience or expression and psychiatric symptoms affect each other in a bidirectional manner. More broadly, individuals with depression encounter difficulty with modulation and management of anger. Thus, the lack of correlation between behavioral patterns associated with anger and other psychiatric symptoms on both situations (Tables 7 and 8) might reflect the overexpression of behavioral patterns associated with anger due to difficulty in modulation and management of anger expression in depressed students. Moreover, hostility, a negative evaluation of others often accompanied by a wish that they be harmed, can create guilty feelings. Hostility can be related to devaluation of others, a defense employed by patients with depression to increase their self-esteem. In contrast, rage, or explosive and uncontrolled anger, can be followed by intense bouts of self-criticism and depression.
High prevalence psychiatric symptoms particularly paranoia, anxiety, sensitivity, and depression were recorded among university students immediately after revolution. The prevalence of all psychiatric symptoms decreased slightly 2 years after revolution; except phobia and hostility, which increased. The prevalence of anger triggers, emotional feelings, and behavioral patterns associated with anger increased 2 years after revolution. All studied psychiatric symptoms correlated significantly with all subitems of anger scale; except for the behavioral patterns associated with anger, which showed the least correlation.
Conflicts of interest
There are no conflicts of interest.
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