3. Family Attitudes and Perfectionism as Related to Depression in Latter-day Saint and Protestant Women

By Marleen Williams

Marleen Williams, “Family Attitudes and Perfectionism as Related to Depression in Latter-day Saint and Protestant Women,” in Religion, Mental Health, and the Latter-day Saints, ed. Daniel K. Judd (Provo, UT: Religious Studies Center, Brigham Young University, 1999), 47–66.

Family Attitudes and Perfectionism as Related to Depression in Latter-day Saint and Protestant Women

Marleen Williams

Marleen Williams was assistant clinical professor at the counseling center at Brigham Young University when this was published.


Abstract

Some writers have identified more traditional women, such as those who are conservatively religious, as being at higher risk for depression. Since Latter-day Saint women have been included among those thought to be vulnerable to depression, this study investigated the role of religious orientation, traditional family orientation, and perfectionism in relation to depression for both LDS and a group of mainline Protestant women who were included for comparison. No significant difference was found in prevalence of depressive symptoms between Latter-day Saint and Protestant women. Perfectionism correlated significantly with depression for both groups. Personal interview data suggested that LDS women in this study who were mildly depressed exhibit characteristics consistent with depression theories in general. Awareness that elevated depression scores are not more frequent among Latter-day Saint women can assist therapists in avoiding a cultural stereotype when planning appropriate treatment.

The rate of depressive disorders has consistently been shown to be higher for women than for men (Frerichs, Anshensel, & Clark, 1981; Levitt & Lubin, 1975; Nolen-Hoeksema, 1990; Radloff & Rae, 1979). Several studies have linked female depression with the traditional female role (Elpern & Karp, 1984; Pidano & Tennen, 1985; Re petti & Crosby, 1984; Rosenfield, 1980; Stoppard & Paisley, 1987; Tinsley, Sullivan-Guest, & McGuire, 1984; Whisman & Jacobson, 1989). Other studies show no relation (Glazebrook & Munjas, 1986; Krueger & Bornstein, 1987; Steinberg, Leichner, & Harper, 1987). The issue concerning whether gender roles influence depression appears to be complex and dependant on how the research is structured and what methodology is used (Denmark, Russo, Frieze, & Sechzer, 1988; Tavris, 1991; Whitley, 1984).

Religion has also been explored as a possible factor influencing mental health in general and depression in particular. Empirical studies show mixed outcomes (Judd, 1985) with positive and negative results balancing out each other and equaled by neutral outcomes, suggesting that religion by itself cannot predict mental health. In a review of the literature on religion and mental health, Judd concluded that internalized or intrinsic religion is solidly associated with mental health while extrinsic religiosity is not.

Perfectionism has also been shown to be a predisposing factor in depression (Barrow & Moore, 1983; Beck & Burns, 1979; Burns, 1980a, 1980b; Hewitt & Flett, 1991; Pirot, 1986). Perfectionism is described as rigidly striving for goals and basing self-worth on productivity and accomplishment (Hewitt, 1986).

It has been suggested that more conservative, traditional religious women are at greater risk for depression. Mormon women (members of The Church of Jesus Christ of Latter-day Saints) have been targeted as likely to be experiencing vulnerability to depression because of traditional roles and pressures toward extrinsic religiosity and perfectionism (R. H. Burgoyne & R. W. Burgoyne, 1977, 1978; Degn, 1979; Ericksen, 1979; Exponent II, 1979; Payne, 1980; Warenski, 1978). Johnson (1979), in an address before the American Psychological Association, claimed that the traditional patriarchal system of Mormonism oppresses women by rigidly restricting roles and emotional expression. Payne saw church-fostered traits of industry and activity, wise use of time, restraint of aggression, and compulsive performance of duty as being “similar to hallmarks of obsessive-compulsive personality.”

These assertions linking Mormon women with vulnerability to depression are based on case studies and anecdotal reports. It is not clear whether these cases were typical depressions and coincidently Mormon or whether religion was specifically implicated in the depression.

Empirical studies show Mormon women as being similar to other groups in measures of depression (Bergin, Masters, & Richards, 1987; Cornwall, personal communication, 1991; Masters, Bergin, Reynolds, & Sullivan, 1991; Spendlove, West, & Stanish, 1984). Spendlove (1982) speculated that the stability of the traditional Mormon female role may lower the risk for depression. These studies have been done on Mormon women living in Utah. Of more than ten million Mormons, only slightly over one and a half million live in Utah. Utah is the headquarters of the Mormon faith, and the local culture is strongly influenced by religious values. This study was done in the state of New Mexico which has a Mormon population of 3.3 percent. Mormons outside of Utah are minority groups and are exposed to a more diverse culture. Therefore, they have neither the cultural supports nor the cultural pressures of those living in Utah.

This study explored whether differences exist between Mormon and Protestant women on levels of depression and on measures of intrinsic versus extrinsic religiosity, perfectionism, and traditional family role values. It also examined whether relations exist between depression and the other three variables. Some qualitative data were also gathered to examine other possible religious influences on depression.

Subjects and Procedures

Subjects were eighty-four Mormon women and one hundred and fourteen Protestant women. Membership roles were obtained from Mormon, Presbyterian, Methodist, and Lutheran ecclesiastical leaders in Farmington, New Mexico. The Protestant congregations were selected because they were similar to Mormons in percentages of population in New Mexico. Trained female interviewers who were unaware of the purpose of the study, were instructed to contact all names on the list and to follow-up with those not at home at other times in order not to bias respondents in favor of working or nonworking women. Only subjects who were married or living with a male companion were interviewed in order to control for differences in marital status. The interviews used a standardized interview which in corporated standardized measuring instruments. Women were told that this was a study on attitudes and beliefs related to health and mental well-being.

Of the 360 Mormon women contacted, 23 percent completed the telephone interview. Twenty percent of the 555 Protestant women agreed to a telephone interview. Farmington is a somewhat isolated community with a rural orientation. Unfamiliarity with research procedures may have reduced the response rate.

Mormon and Protestant subject groups were compared demographically. Chi-squared analyses indicated demographic similarity between groups in age, income, health, work status, and race. The groups differed with Protestant women being more likely to have a postcollege-graduate education, and Mormon women were more likely to have three or more children.

At the close of the fifteen minute interview, each respondent was asked if she would participate in a more in-depth personal interview. Thirty-two percent of the Protestant respondents (thirty-one nondepressed and five depressed) agreed. Thirty-eight percent of the Mormon respondents (twenty-one nondepressed and twelve depressed) gave consent. From these, ten women from each category were randomly selected. Because only five Protestant depressed women consented, all were interviewed. A score of ten or higher on the Beck Depression Inventory (BDI) was used as the criteria for depression. Mean scores taken from a random sample of the depressed groups were both in the range of mildly depressed (Beck & Steer, 1987).

Measurement Instruments

The measuring devices used to assess the variables included the Beck Depression Inventory (BDI), the Religious Orientation Scale (ROS), the Burn Perfectionism Scale (BPS), and the Traditional Family Inventory (TFI).

The BDI was used to measure symptoms of depression (A. T. Beck, 1967; A. T. Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). Validity and reliability data are more thoroughly reported for this depression scale than any other (A. T. Beck & R. W. Beck, 1972; Beck et al.; Becker, 1974; Burns, 1980a; Hammen, 1980).

The ROS was developed jointly by members of a seminar at Harvard under the direction of Gordon Allport. Recent studies using factor analyses reveal three separate factors. Several independent studies show two extrinsic factors as well as an intrinsic factor (Gorsuch & McPherson, 1989;Kirkpatrick, 1989; Kirkpatrick& Hood, 1990; Leong & Zachar, 1990). The social-extrinsic factor measures the use of religion for social rewards, whereas the personal-extrinsic factor measures religion as a mean of gaining personal relief, protection, and comfort.

The BPS was created from a modified portion of the Dysfunctional Attitude Scale (DAS) (Burns, 1980b). Research substantiates convergent, discriminant, and predictive validity of the perfectionism scales (Hewitt, Mittelstaedt, & Wollert, 1989).

The TFI is a Likert-type questionnaire developed to examine traditional values and styles of relationships within families. The theoretical aim of the scale to assess an individual’s position on a democratic-autocratic continuum. The TFI was chosen for this study because, of all available scales, it most represents the concept of the male-dominated authoritarian family with a wife filling a submissive role.

Several other questions were added to the telephone interview. These were independent of established measurement instruments but were added to provide additional information on marital satisfaction and gender roles. Questions related to marital satisfaction include: I am satisfied with the quality of my marriage; My husband contributes his fair share to child care and family activities; My husband provides emotional support to me; and My husband helps with household chores. Questions related to gender roles were: It is better for everyone if the man earns the main living and the woman takes care of the home and family; Parents should encourage just as much independence in their daughter as in their son; In a successful marriage the partners must have freedom to do what they want individually; and If a husband or wife works full time, they should share household tasks equally.

Those women who were given a more in-depth personal interview were visited in their homes by appointment with the researcher. They were assured that interviews were confidential and that no name would be attached to the interview or to details from the interview. Permission was received to tape record each interview for convenience in analyzing information. They were told that the purpose of the study was to understand how women really felt and to give them an opportunity to speak anonymously.

Although the personal interview was loosely structured to allow for individual responses, some specific questions were used to guide the interview. Each interview began with the question “How do you feel your religion affects your happiness and mental well-being?” Subjects were allowed to respond in any way or at any length they chose. Interviews were kept open, rather than structured, to allow for individual issues and emotions to surface and be explored.

Data Analysis

Empirical Data

Group Differences

The first question asked was whether significant differences exist between groups on measures of depression and the eight other variables measured: extrinsic-personal religiosity, extrinsic-social religiosity, extrinsic total, intrinsic religiosity, perfectionism, marital satisfaction (questions 11, 12, 13, 14), traditional family orientation, and gender roles (questions 27,28,29,30). Means and standard deviations on these measures are provided for each group.

An ANOVA was done to determine whether significant differences existed. Wilks Lambda showed significant differences existed between groups (p < .05). Univariate tests showed no significant differences on scores for depression, extrinsic orientation, intrinsic orientation, perfectionism, marital satisfaction (all four questions), and three of the gender role questions. Depression means for both groups were similar to other nonclinical samples. Significant differences did exist, however, on three of the measures. Protestants scored higher on extrinsic-social (p < .05). Mormon women had more traditional family orientations as measured by the Traditional Family Inventory (p < .05). Mormon women expressed more agreement with the question “It is better for everyone if the man earns the main living and the woman takes care of the home and family.” This difference was significant at a level of p < .0001.


Table 3.1:Means and Standard Deviations on All Measured Variables

Variable

Mormon Mean

Standard Deviation (N=84)

Protestant Mean

Standard Deviation (N=84)

Depression

6.69

5.24

5.45

4.02

Extrinsic-personal

21.13

3.63

21.63

3.76

Extrinsic-social

9.0

3.36

10.01

3.63

Extrinsic total

30.13

5.53

31.64

5.95

Intrinsic

16.37

6.33

17.54

5.53

Perfectionism

41.27

10.86

41.18

10.93

Marital satisfaction

8.93

6.16

8.42

5.30

Traditional family orientation

39.83

10.01

42.43

7.81

Gender roles

6.89

2.39

8.33

2.38


Correlation-Analysis

The data was analyzed to determine whether relations exist between depression scores and the eight other measures used. Correlation analysis was done to determine this. The Bonferroni approach was used by dividing the nominal alpha level by the number of tests involved (.05/8 = .006). The data were then interpreted in terms of these two extremes which consist of a more lenient standard (alpha level) and a very conservative standard (alpha level divided by the number of tests). The correlation results and corresponding p-values are reported in Table 3.2.


Table 3.2: Correlation between Scaled Scores on Beliefs, Attitudes, and Depression

 

Mormon & Protestant Group Combined (N=198)

Mormon Women

(N=84)

Protestant Women

(N=114)

 

Pearson r

p-value

Pearson r

p-value

Pearson r

p-value

Extrinsic-personal

-.011

.881

-.05

.681

.039

.684

Extrinsic-social

.054

.447

.184

.093

-.020

.83

Extrinsic-total

.026

.712

.082

.458

.012

.899

Intrinsic

.040

.572

.159

.15

-.06

.528

Perfectionism

-.348

.0001

-.354

.001

-.356

.0001

Marital satisfaction

.141

.05

.069

.530

.12

.03

Traditional family orientation

-.104

.143

-.007

.953

-.185

.05

Gender roles

-.142

.05

-.165

.135

-.068

.469


Depression and Perfectionism

The relationship between perfectionism and depression was significant for Mormons (r = -35,p < .001), Protestants (r = -.36, p < .0001), and the combined groups (r = -.35, p < .0001). Correlations were in the negative direction because lower numbers indicated higher agreement with perfectionistic ideas. Higher numbers on the depression scale indicated more endorsement of depressive symptoms. Perfectionism appears to be related to depression for all of the women studied. Religious denomination does not make a significant difference. Interestingly, the correlations between this sample on the BPS and the BDI are remarkably similar to those found by Hewitt, Mittelstaedt, and Wollert (1989) on a sample of male and female college students (r= .36 p < .01). Burns (n.d.) also reports a correlation of .34 (p < .0001) between these two measures on a sample of 498 outpatients. This suggests that the significant link between depression and perfectionism found in this study is not peculiar to this group of women but represents a similar connection that exists across a broader population.

Depression and Marital Satisfaction

The four questions on marital satisfaction were analyzed to see if intercorrelations existed. All four questions showed significant intercorrelations. Correlations ranged from .75 to .37 (p < .0001 in all cases). These were analyzed as a scale.

A significant relation between “My husband helps with household chores” and depression existed for Protestant women (r = .29,p < .002) but not for Mormon women. Protestant women who did not feel that their husbands helped with household chores were more depressed. Results of this analysis are found in Table 3.3.


Table 3.3: Correlation between Marital Satisfaction Scores and Depression

 

Mormon Women (N=84)

Protestant Women (N=114)

 

Pearson r

p-value

Pearson r

p-value

I am satisfied with the quality of my marriage.

.133

.227

.136

.15

My husband contributes his fair share to child care and family activities.

-.044

.69

.076

.424

My husband provides emotional support to me.

.104

.347

.130

.169

My husband helps with household duties.

.046

.678

.285

.002


Depression and Gender Roles

The four questions related to gender roles were also analyzed. These included: It is much better for everyone if the man earns the main living and the woman takes care of home and family; Parents should encourage just as much independence in their daughter as in their son; In a successful marriage, the partners must have freedom to do what they want individually; and If a husband or wife works full time they should share household tasks equally. The last three questions showed significant intercorrelations with each other (ranges r = .16–27,p < .03,p < .0001). The first question, “It is much better for everyone if the man earns the main living and the woman takes care of home and family,” did not correlate significantly with the others.

A significant relationship was found between this question and depression for Mormon women only (r = -.35, p < .001). Mormons who endorsed the statement were more depressed.

Results of the analysis are found in Table 3.4.


Table 3.4: Correlation Between Gender Role and Depression

 

Mormon Women (N=84)

Protestant Women (N=114)

 

Pearson r

p-value

Pearson r

p-value

It is much better for everyone if the man earns the main living and the woman takes care of home and family

-.345

.001

-.128

.187

Parents should encourage just as much independence in their daughters as in their sons

-.008

.943

-.037

.692

In a successful marriage the partners must have freedom to do what they want individually.

.043

.699

.117

.214

If husband or wife works full time they should share household tasks equally.

-.033

.77

-.129

.173


This raised questions as to whether these depressed women were working or homemakers and whether a relationship existed between work status, endorsement of this statement, and depression. Further analysis was done to see if relationships existed between the number of hours worked outside the home and whether a woman agreed or disagreed with the idea that women should care for home and family and men earn the living. There was no significant relationship found between depression and the number of hours worked for either those who agreed or those who disagreed with the item. There was also no significant difference between Mormon and Protestant women in the number of hours worked. Although endorsement of this statement is associated with depression for Mormon women, this does not appear to be related to whether or not they actually work outside the home.

Depression and Religious Orientation

Contrary to expected findings, neither intrinsic nor extrinsic religiosity had any significant relationship with depression for either group. Although other research shows intrinsic religiosity as being more associated with good mental health, no relationship between depression and either orientation was found for these women. This was true even though the two groups differed significantly on the extrinsic-social scale with Protestants scoring higher.

Depression and Traditional Family Inventory

Significant differences existed between the two groups on this scale, but the less traditional Protestant group showed a higher correlation with depression. With a correlation of only -.185 (p < .05), it may or may not be considered significant depending on whether a standard alpha or the Bonferroni approach is used for interpretation. The Mormon group had a correlation of -.007 (p < .95). The correlations are negative because lower scores on the TFI imply more agreement with traditional orientation. As Protestant women’s scores become more traditional, depression scores are more likely to go up. This is not true for Mormon women who are significantly more traditional as a group.

Personal Interviews

All thirty-five interviews were read by the researcher to determine what themes, issues, and emotions occurred as well as to enrich understanding of empirical data. Reading was done by the researcher in order to protect the privacy of the subject and the confidential nature of the interview. Lack of a reliability check may have influenced interpretation.

Data from the personal interviews were interpreted cautiously because of the small numbers of the sample and inability to determine how representative the sample was of the larger Mormon and Protestant populations. Interviews did, however, offer some understanding of the internal dynamics of this sample and are useful in generating hypotheses for further testing.

Although no significant differences existed in prevalence of depression, religious issues appeared to play a more prominent role for Mormon women than for Protestants who are mildly depressed. This was particularly true in areas of support and judgement from others, ability to set priorities and make decisions when value conflicts exist, need for approval and to “look good,” self-blame, and in taking responsibility for other’s behavior.

Personal interview data also provided some possible explanations for the significant correlation between depression in Mormon women and agreement with the question “It is better for everyone if the man earns the main living and the woman takes care of home and family.” Possible explanations are that depressed Mormon women endorse this statement because they perceive it as being in agreement with statements by church authorities, they have a desire to respond in a socially approved way, they express a lack of confidence in their abilities to explore activities outside of the home, or they have a combination of these elements.

These reasons provide more plausible explanations when it is taken into consideration that no significant correlation was found between depression scores and whether or not the woman worked or the number of hours worked. This was true for both Mormon women who endorsed this question as well as those who expressed disagreement. This may also provide an explanation for low intercorrelations between this question and the other three questions which all related to equality in gender roles and did not correlate significantly with depression. Mildly depressed Mormon women may have endorsed “It is better for everyone if the man earns the main living and the woman takes care of home and family” for reasons not as related to gender role attitudes as related to other issues such as agreement with authority or self-esteem.

Discussion

There was no significant difference in depression scores between Mormon and Protestant women. This finding is consistent with other empirical research on depression and Mormon women (Bergin et al., 1987; Cornwall, personal communication, 1991; Masters et al., 1991; Spendlove, 1982). It does not lend support to theories based on anecdotal and case reports which present Mormon women as more vulnerable to depression because of cultural values. Evidence contradicts Johnson’s theory of Mormon women being more depressed due to subjugation under a patriarchal system or because of tradition roles (Johnson, 1979). Anecdotal and case reports provide only a partial and distorted picture of a larger culture. Generalizing from a small number of clinical cases to a larger population of a specific cultural group creates inaccurate stereotypes. Research showing Mormons as not having higher rates of mental illness further illustrates the fallacy of stereotyping a cultural group based on isolated clinical cases (Bergin et al.; Cornwall; Masters et al.; Spendlove et al, 1984).

Awareness that depression is not a cultural phenomenon for Mormon women may assist therapists in treatment-planning for these women. Psychotherapy can be not only ineffective but also harmful if conducted in an inappropriate manner (Bergin & Lambert, 1978; Lambert, Bergin, & Collins, 1977).

Therapists need to be aware of both the cultural background and the individual differences within that culture. Psychotherapy cannot divorce itself from the social, cultural, and religious background of the client (Sue & Zane, 1987; Varma, 1988). Bishop (1992) contends that counseling has virtually ignored differences in religious values in cross-cultural counseling.

Stereotypical assumptions about Mormon family and gender values leading to depression in women may lead to therapeutic errors resulting in more distress for the client. Wohl (1989) proposed that all psychotherapy is inescapably bound to a particular cultural framework and that all psychotherapy has cross-cultural components in that no two people have internalized identical constructs of their cultural worlds.

A danger in cross-cultural psychotherapy is that the therapist may respond inappropriately to the patient due to a lack of understanding and empathy for the patient’s culture (Gorkin, 1986). The therapist’s own stereotypes and prejudices, if not acknowledged, can create powerful countertransference distortions. Failure of therapists to understand their own stereotypes and prejudices concerning cultural values and ideals can create countertransference issues which interfere with the therapeutic process (Ticho, 1971).

Failing to conceptualize the client’s problem in a manner that is congruent with the client’s belief system, requiring culturally incompatible responses, and creating culturally discrepant goals for the client all reduce the credibility and effectiveness of the therapist (Sue & Zane, 1987). Failure to understand cultural belief systems and to establish the credibility of the therapist with members of cultural groups is a major factor in those cultural groups under-utilizing mental health services (Marsella & Pederson, 1981; Sue & Zane). Identifying and treating dysfunctional habits and attitudes that are idiosyncratic to that individual would be more effective than looking to Mormon cultural values as the cause of depression.

In conjunction with this, although results showed Mormon women to be more traditional, the traditional orientation is not as strongly associated with depression as it was for Protestant women. This provides some evidence for the hypothesis generated by other research that the importance and stability of the role of wife and mother in the Mormon culture lowers her risk for depression (Spend love, 1982; Wilkinson & Tanner, 1980). Awareness of cultural values concerning traditional roles can assist therapists in making culturally sensitive interventions with Mormon clients.

Of all the factors measured, perfectionism showed the highest correlation with depression scores. This was only a modest correlation, however. There were no significant differences between Mormon and Protestant women in degree of perfectionism suggesting that perfectionism is more related to individual personality style or other factors than to religious denomination. No studies have been done comparing religious with nonreligious subjects on perfectionism, but correlations from other studies between the BPS and the BDI suggest that there may be no differences (Burns, 1980; Hewitt, Middelstaedt, & Wollert, 1989). Data from this study do not support anecdotal and hypothetical beliefs that Mormon culture and values create a predisposition to perfectionism (R. H. Burgoyne & R. W. Burgoyne, 1977; Degn, 1979; Exponent II, 1979; Payne, 1980). Empirical data show no significant differences between Mormons and other groups in measures of perfectionism. Interviews suggest that perfectionistic women may employ that same style in interpreting and utilizing religious concepts.

Personal interview data suggested that mildly depressed Mormon women in this study exhibit characteristics that are consistent with research relating to depression-prone personalities in other groups (Ariete & Bemporad, 1980). Elements of depression in the Mormon women who were interviewed fit models of depression related to vulnerability to evaluative feedback particularly from authority figures (Roberts, 1991; Roberts & Nolen-Hoeksema, 1989), lack of self-differentiation (Kaplan, 1986), learned helplessness (Abramson, Seligman, & Teasdale, 1978; Peterson & Seligman, 1984; Seligman, Abramson, Semmel, & Baeyer, 1979), difficulty setting priorities based on internalized values rather than external expectations and rule-bound conventions (Bloom, 1986; Gilligan, 1982, 1984; Kohlberg & Kramer, 1969), and perfectionism (Barrow & Moore, 1983; Burns, 1980; Hewit & Flett, 1991; J. B. Miller, 1986). Although themes and issues were often specifically related to cultural norms and values, the dynamics of the depression were similar to the dynamics of depression in other groups. Nondepressed Mormon women reported general satisfaction and agreement with gender roles and ability to set priorities and make choices based on internalized values when conflicts arose.

Some limitations exist in interpreting this study. The somewhat skewed sample taken from a small rural community may not represent Mormons and Protestants in other areas, particularly large cities. In addition, research comparing Mormon women with Protestant women may not generalize to comparing Mormon women to the population in general. This research does suggest some avenues for further study, however. Cultural-sensitive therapy may be more effective with Mormon women than interventions based on inaccurate stereotypes. Nondirective therapy may provide a nonjudgmental environment and allow the client to sort out her own values, define herself, and trust her ability to make decisions.

Most importantly, research should be aimed at acquiring a more accurate understanding of women’s psychology as it arises out of their own experience (J. B. Miller, 1986; Stiver, 1986). We cannot assume a “single society” wherein research done on one group can be generalized to all. Understanding women and minority groups in the context of their own cultural experience and values can reduce biases and stereotypes that limit treatment effectiveness. Qualitative research takes into account the subject’s perspective and allows her to express her own reality. In understanding diverse gender and cultural groups, science needs to first “look and describe before it constructs and explains” (Tavris, 1991). This approach can provide a more accurate view for understanding specific groups such as Mormon women and other subgroups whose cultures may differ from mainstream values and attitudes.

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