Sense of coherence in different stages of health and disease in northern Sweden--gender and psychosocial differences

A salutogenic approach to oral health promotion

Theoretical frameworks on health promotion focusing on social determinants of oral health have highlighted promising approaches for improving the oral health of populations and reducing inequities in oral health. In the last two decades the salutogenic theory has gained ground in the field of health promotion, but not in oral health promotion. Instead of focusing on risk factors and behavior change, the theory highlights the importance of resources and the ability to use them. The model's central construct, sense of coherence (SOC), suggests explanations of the relationship between life stressors and health status. The stronger the SOC, the more successfully people will cope with stressors and thus maintain their health. This paper discusses the potential of the salutogenic theory to guide the development of actions in the five fields of oral health promotion: creating supportive environments; promoting health through public policy; strengthening community action; developing personal skills; and reorienting health services. The theory can serve as a framework for oral health promotion measures that strengthen the available resources, create better ones, and enable people to identify and benefit from them.

Does sense of coherence affect the relationship between self-rated health and health status in a sample of community-dwelling frail elderly people?

BACKGROUND

The objective of this study was to examine the association between self-rated health (SRH) and physical, functional, social and mental health measures in community dwelling elderly people needing nursing care. Of special interest was how coping resources (SOC) influenced this relationship. Self-rated health is a good predictor of future health status as measured by mortality and morbidity, decline of functional abilities, use of healthcare, and nursing home placement. The high mean age and the relatively high level of care-dependency in this sample, make this investigation important.

METHODS

A hierarchical regression analysis was applied in a cross sectional sample of 242 elderly (mean age 84.6 years).

RESULTS

Subjective health complaints (SHC) in both sexes, and psychological distress (only in men), was associated directly with SRH. Coping resources associated with SRH directly, and indirectly through subjective perceived health (SHC and GHQ) but only in men. The influence of registered illness was mediated through the effects of subjectively perceived health in both women and men. Sex differences moderated the effects of SOC on SRH.

CONCLUSION

Subjectively perceived health was more important in the perception of SRH than objective health measures. Men, in contrast to women, tend to convert physical illness into emotional distress.

A sense of coherence and health. Salutogenesis in a societal context: Aland, a special case?

BACKGROUND

Antonovsky's salutogenic concept of a sense of coherence (SOC) has proved most influential in the way that health is now perceived.

AIM

To (1) describe the distribution of SOC among 40-70-year-old Alanders; (2) examine the distribution of depression in Aland, Finland, and its relationship with SOC; and (3) discuss the findings within a salutogenic framework in a societal context.

DESIGN

A cross-sectional study design was adopted. Antonovsky's SOC Questionnaire (13 items) and the Beck Depression Inventory (13 items) were used. In addition, in a separate questionnaire, sociodemographic information about each participant was sought, together with a question specific to this study and designed to measure self-rated health.

SETTING

Aland, an autonomous island province of Finland.

RESULTS

The proportion of respondents reporting good health was high (64%). The overall mean (SD) SOC was 70.7 (11.7) points, whereas for farmers and fishermen it was 73.88 (8.8) and 74.33 (9.2) points, respectively. SOC was significantly and strongly related to the self-rated health score. The higher the SOC, the better was the health of the respondents. Furthermore, the study provided clear evidence of the potential of the SOC concept as a positive mental health indicator.

CONCLUSION

The SOC seems to be a health-promoting resource that supports the development of a positive subjective state of health.

Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynaecological cancer

BACKGROUND

Demoralisation is a dysphoric mood state commonly seen in the medically ill. Its core features comprise hopelessness, helplessness, loss of purpose and meaning, despair, and existential distress. Sense of Coherence (SOC) is a quantifiable dispositional orientation that captures the character traits likely to protect against demoralisation. In this study, we hypothesised on theoretical grounds that a strong SOC would be associated with lower levels of demoralisation in the context of gynaecological cancer (GC).

METHOD

One hundred and twenty women with a recent (<12 months) diagnosis of GC were recruited from outpatient clinics. Participants were interviewed and completed questionnaire measures of demoralisation and SOC. A multiple regression analysis was performed using the five subscales of the Demoralisation Scale as predictor variables and SOC as the dependent variable.

RESULTS

Together, the five subscales of the Demoralisation Scale accounted for 60% of the variance in SOC.

CONCLUSIONS

The results supported the hypothesis, suggesting that SOC may be protective against demoralisation in the context of serious illness. Larger, multivariate studies that examine additional variables (such as coping) would be required to further clarify the relationship between SOC and demoralisation. In the meantime, clinicians may want to consider efforts to enhance SOC in patients.

Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years

OBJECTIVES

To find predictive factors for long-term sick leave (SL) and disability pension (DP) among frequent attenders (FAs) and normal attenders (NAs) in primary health care.

STUDY DESIGN

A cohort study with follow-up over 5 years.

METHODS

Groups of FAs and NAs were followed over 5 years. Information about background, situation, sociodemography, life events, social support and sense of coherence were gathered at baseline. Multiple logistic regression analysis was used to determine the influence of each variable on long-term SL and receipt of a DP.

RESULTS

During the study period, 18.9% of FAs received long-term SL/DP compared with 6% of NAs. Chronic disease was a predictive factor for long-term SL/DP among FAs [odds ratio (OR) 7.0] and NAs (OR 3.4). Among FAs, a life event was also a predictive factor (OR 2.1). Each additional life event increased the ratio of FAs with long-term SL/DP by 110%. Conflicts and losses had the greatest negative effects on FAs.

CONCLUSIONS

FAs are a high-risk group for long-term SL/DP. Besides chronic disease, a life event was the only predictive factor for long-term SL/DP among FAs. These findings indicate that FAs are a vulnerable group for stressful events. Consequently, healthcare personnel should take more notice of life events among FAs.

Depression and associated factors in patients with lumbar spinal stenosis

PURPOSE

To investigate the prevalence of depression and associated factors in patients (n = 100) with lumbar spinal stenosis selected for surgical treatment.

METHOD

Depression was assessed with the 21-item Beck Depression Inventory. Psychological well-being was assessed with Life Satisfaction Scale, Toronto Alexithymia Scale and Sense of Coherence Scale. Physical functioning and pain were assessed with the Oswestry disability index, the questionnaire devised by Stucki and the Visual Analogue Scale. All questionnaires were administered before surgical treatment of lumbar spinal stenosis.

RESULTS

Twenty percent of the patients with LSS were found to have clinically important depression. In univariate analyses, subjective disability measured with the Oswestry disability index, low sense of coherence and poor life satisfaction were common in depressed patients. In the multiple logistic regression analyses, being dissatisfied with life was associated with depression. When sense of coherence score was included in the model, then only low sense of coherence was independently associated with depression. Neither socio-demographic nor pain-related factors associated with depression.

CONCLUSIONS

Clinically important depression is rather common among preoperative patients with lumbar spinal stenosis. The factors associated with depression are subjective disability of everyday living and decreased life satisfaction. A low sense of coherence is an important correlate of depression. The results underline the importance of assessing depression in clinical practice dealing with these patients.

Antonovsky's sense of coherence scale and the relation with health: a systematic review

STUDY OBJECTIVE

The aim of this paper is to synthesise empirical findings on the salutogenic concept sense of coherence (SOC) and examine its capacity to explain health and its dimensions.

DESIGN

The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992-2003. The review includes 458 scientific publications and 13 doctoral theses.

SETTING

Worldwide, based on postgraduate scientific publications in eight authorised databases, doctoral theses, and available books.

MAIN RESULTS

SOC is strongly related to perceived health, especially mental health. The stronger the SOC the better the perceived health in general, at least for those with an initial high SOC. This relation is manifested in study populations regardless of age, sex, ethnicity, nationality, and study design. SOC seems to have a main, moderating or mediating role in the explanation of health. Furthermore, the SOC seems to be able to predict health. SOC is an important contributor for the development and maintenance of people's health but does not alone explain the overall health.

CONCLUSION

SOC seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Salutogenesis is a valuable approach for health promotion and would be worth to implement in practice much more than to date.

Somatic comorbidity and younger age are associated with life dissatisfaction among patients with lumbar spinal stenosis before surgical treatment

The objective of the study was to examine self-reported life satisfaction and associated factors in patients (n=100) with lumbar spinal stenosis (LSS) in secondary care level, selected for surgical treatment. Life satisfaction was assessed with the four-item Life Satisfaction scale. Depression was assessed with a 21-item Beck Depression Inventory (BDI). Psychological well-being was assessed with Toronto Alexithymia Scale and Sense of Coherence Scale. LSS related physical functioning and pain were assessed with Oswestry disability index, Stucki questionnaire, Visual Analogue Scale and pain drawings. All questionnaires were administered before surgical treatment of LSS. Results showed that 25% of the patients with LSS were found to be dissatisfied with life. In a univariate analysis, smoking, elevated subjective disability scores and extensive markings in the pain drawings were more common in the dissatisfied patients. The dissatisfied patients also showed lower coping resources, elevated alexithymia and depression scores, and were more often depressed. In multiple logistic regression analyses, only younger age and somatic comorbidity were associated with life dissatisfaction. This association remained significant even when the BDI score was added into the model. No other significant associations emerged. In conclusion, life dissatisfaction was rather common among preoperative LSS patients. Pain and constraints on everyday functioning were important correlates of life dissatisfaction. However, only younger age and somatic comorbidity were independently associated with life dissatisfaction. These results emphasize the importance of recognizing and assessing the effect of coexisting medical conditions and they need to be addressed in any treatment program.

Life events, social support and sense of coherence among frequent attenders in primary health care

OBJECTIVES

The aim of this survey was to compare stressful life events, social support and sense of coherence (SOC) between frequent attenders (FAs) and normal attenders (controls) in primary health care.

STUDY DESIGN

A cross-sectional study was conducted in a primary healthcare centre in the south-west of Sweden.

METHODS

A postal questionnaire was sent to 263 frequent attenders and 703 normal attenders. The questionnaire comprised sociodemographic variables and scales of stressful life events, social support and SOC. The results from the questionnaire were compared between the groups, and the significance of the variables in terms of attendance was tested in a multiple regression analysis.

RESULTS

More of the FAs were secondarily single, they had more chronic diseases and were more often living on a sickness/disablement pension than the controls. FAs did not report more stressful life events than the controls nor was their experience of events more negative. Social support was as strong among FAs as among controls, and it had no significant effect on their frequent attendance. FAs had a significantly weaker SOC compared with controls. The variables that significantly influenced frequent attendance were high age [odds ratio (OR) = 1.02], chronic disease (OR = 3.08), sickness/disablement pension (OR = 2.46) and SOC (OR = 0.97).

CONCLUSIONS

SOC had a significant influence on frequent attendance in primary health care, but stressful life events and social support did not. FAs did not report more stressful life events. However, due to an inadequate coping strategy, indicated by a weak SOC, the life events probably caused them more symptoms and diseases, and thereby a higher consulting frequency.

The Role of Family Background, School Success, and Career Orientation in the Development of Sense of Coherence

Abstract. This study investigates family background (child-centered parenting, parental socioeconomic status), school success in adolescence, and career orientation (education, stability of career line) in adulthood as antecedents of adult sense of coherence (SOC; Antonovsky, 1987a ), which has been posited to be a disposition crucial to understanding individual differences in successful coping with stress. Participants (104 men and 98 women) were drawn from the ongoing Jyväskylä Longitudinal Study of Personality and Social Development (JYLS), which was started when the participants were 8- or 9-year-old children (in 1968). Data gathered at ages 14, 27, 36, and 42 were used in this study. The results of structural equation modeling (SEM) indicated that child-centered parenting in adolescence and a stable career line in adulthood were directly associated with a high SOC at age 42. In addition, child-centered parenting, high parental socioeconomic status, and school success at age 14 were indirectly associated with adult SOC via education and stability of career line. The SEM multigroup comparison showed that the obtained associations were similar for men and women.

Sense of coherence is a sensitive measure for changes in subjects with Parkinson's disease during 1 year

To investigate subjective and objective changes in function in subjects with Parkinson's disease (PD) home visits with interviews were performed with a 1-year interval. Depressive symptoms were rated with the Geriatric Depression Scale, subjective health with the generic SF-36 scale and the disease-specific PDQ-8 scale; objective changes were assessed according to the Hoehn and Yahr scale; insomnia was rated with an eight-item questionnaire and the sense of coherence (SOC) was determined with the short version of that scale. A total of 91 subjects (39 women and 52 men with a mean age of 70 years) living at home, most of them moderately to severely disabled, were interviewed. Time since diagnosis was <2 years for 13%, 2-10 years for 55%, and >10 years for 32%. During the studied year the subjects' status declined significantly as shown by changes in both the PDQ-8 and the Hoehn and Yahr scales. The most striking finding was a pronounced decrease in the SOC scale (p < 0.0001). This indicates that the subjects' ability to handle stress-related problems secondary to the progress of disease might have decreased. In order to optimize nursing care for subjects with PD, in addition to medical treatment, an assessment of the SOC could aid nursing staff in evaluating subjects' ability to handle their life situation.

Sense of coherence--stability over time and relation to health, disease, and psychosocial changes in a general population: a longitudinal study

AIMS

To explore the stability of sense of coherence (SOC) over time in a normal population and to examine its relation to gender and psychosocial factors.

METHODS

The Northern Sweden MONICA Project population surveys were performed in 1994 and 1999. A cohort of 1,254 subjects participating in both surveys answered questions about experiences of disease, perceived health, marital status, psychosocial factors, and Antonovsky's SOC scale with 13 items.

RESULTS

The mean SOC score showed a decrease in the five-year follow-up and those with identified disease and the oldest age group (45-74 years) had the largest decrease of the SOC score. People with the lowest SOC scores in 1994 had the largest decrease during the period. Men and women shared a similar pattern regarding the decrease in SOC over time. The impact of individual social changes during the study period showed that both men and women who had experienced loss of perceived good health and high social support had the largest decrease. Furthermore, women seemed to be more affected by changes than men.

CONCLUSIONS

We found that SOC was only stable for those with initially high levels of SOC. For other people, individual conditions and societal changes influenced their SOC. Further longitudinal studies in normal populations are needed to investigate the stability of SOC scores.

Does it make sense in a coherent way? determinants of sense of coherence in swedish women 40 to 50 years of age

The aim of this study was to explore how socioeconomic and psychosocial life experiences in childhood and at adult age influence the level of sense of coherence (SOC) in women. The idea was to seek empirical support for establishing whether SOC is an individual construct being developed in early life and basically resistant toward adverse environmental factors or rather an entity influenced by adult psychosocial factors and as such, sensitive to health promotion activities; that is, if evidence could be found for a causal direction from classic factors involved in health promotion, such as social network and support, to SOC. A questionnaire (Krantz & Ostergren, 1999) was mailed to a random sample of 486 women, equivalent to 50% of the women between the ages of 40 and 50 in a medium-sized municipality (population 13,200) in Sweden. The response rate was 81.7% (397 women). Odds ratios (OR) were used to estimate bivariate associations between socioeconomic and psychosocial variables and low SOC. Logistic regression analysis was used to test for confounding and as a method of analyzing the structure of tentative causal chains. It was found that adult factors such as job strain (OR = 3.42, 95% confidence interval [CI] = 2.11-5.54), low social support (OR = 4.00, CI = 2.48-6.46), and low social anchorage (OR = 4.14, CI = 2.57-6.67) were independent predictors for low SOC in adult women. Childhood conditions such as family disruption and child abuse proved not to influence SOC to a statistically significant degree. Our study suggests that SOC is an entity partly associated with an individual's position in the social structure and partly by work conditions and social network and support rather than by childhood conditions. We could not claim this study to be a critical test of Antonovsky's (1979) theories in the full refutationistic sense. To approach this goal, it would take a carefully designed prospective study assessing the effect of different factors on SOC in a true life course perspective.

Relationship of Sense of Coherence to Other Psychosocial Indices

Summary: The concept of “sense of coherence” (SOC) has been widely recognized since it was first introduced by Antonovsky. The originality and usefulness of the SOC scale and its relation to other psychosocial measures has been the subject of lively debate. The aim of this paper was to test for associations between SOC and work-related psychosocial factors (mainly the Job Demand-Control model), general living conditions, education, and social network factors. Cross-sectional data from a population-based sample of 1782 rural males from nine counties in Sweden were analyzed with a multiple regression technique. The subjects were occupationally active at inclusion and the mean age was 50 years (range 40-60). SOC was assessed with the original 29-item questionnaire. Psychosocial variables and lifestyle factors were assessed using questionnaires and structured interviews. The mean SOC among the subjects was 152.3 (standard deviation, 19.4). A strong negative correlation was found between SOC and job demand, whereas a positive correlation with job control was demonstrated. A positive correlation with general living conditions and with social support was also found. However, there was no correlation to education and occupation. Thus, SOC was shown to be strongly correlated to work-related psychosocial factors and social support, but independent of sociodemographic factors.

Acceptance of disability and sense of coherence in individuals with Ehlers-Danlos syndrome

Ehlers-Danlos syndrome (EDS) is a relatively rare, inherited connective tissue disorder and skin hyperextensibility, joint hypermobility, chronic joint and limb pain, blood vessel and tissue fragility are frequent symptoms. The aims of this study were to describe the degree to which individuals with EDS accept and cope with perceived limitations related to the syndrome, and to determine the relationships between acceptance of disability (AD), sense of coherence (SOC), functional health status and background data. Four questionnaires were mailed: the AD scale Modified (ADM), the SOC Scale, the Sickness Impact Profile (SIP) and a background form. The respondents with EDS were recruited through the EDS National Association in Sweden and the response rate was 74% (69 females and eight males). The Ethical Committee at Huddinge University Hospital (ref. no. 152/95) approved the study. This study has shown that the level of AD and SOC in individuals with EDS is similar to other patient groups, e.g. individuals with ostomy and with diabetes. Further, the SOC was in concordance with that of the general population. Those working full-time accepted their disability to a greater degree than those on sick leave or disability pension. A multiple regression analysis showed that a greater AD was associated with a higher level of SOC and a better functional health status. The SOC and SIP together accounted for 50% of the variance in the ADM. For health promotion in nursing practice it is important to have insight into the problem areas which may influence the overall life situation for an individual with EDS. A key issue for nurses is to identify individuals with low acceptance of their disease and/or low SOC in order to support these persons' adaptation process. Future research on EDS may be directed towards projects focusing on the development and implementation of models to strengthen the level of AD and SOC in this group.