The relationship between sense of coherence and post-traumatic stress: a meta-analysis

Salutogenesis and COVID-19 pandemic impacting nursing education across SEANERN affiliated universities: A multi-national study

BACKGROUND

The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected.

DESIGN

The descriptive cross-sectional quantitative design was used.

SETTINGS

Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021.

PARTICIPANTS

A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study.

METHODS

Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic.

RESULTS

Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels.

CONCLUSIONS

While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better.

Entrepreneurial Resilience: A Case Study on University Students

Entrepreneurial resilience refers to the capacity to face, overcome and project oneself after suffering life events with a negative impact. Emerging adulthood and the characteristics of university life facilitate the occurrence of stressful situations that can affect well-being. The aim of this phenomenological research is to explore the strategic components of entrepreneurial resilience and how young university students have shaped their entrepreneurial resilience after experiencing negative life events. The present research is a multiple case study that was developed through a mixed methodology. The methodological sequence was quantitative and qualitative, with priority given to the qualitative phase of the research. Ten university students with high levels of resilience were interviewed. The data were analysed using thematic analysis. The results indicate that resilience is built through intrapersonal and exopersonal processes. These processes make up a set of strategic dimensions related to entrepreneurial behaviour that are used for the construction of personal projects.

The BLOSSoM study: Burnout after perinatal LOSS in Midwifery. Results of a nation-wide investigation in Italy

BACKGROUND

Respectful care of bereaved parents after stillbirth plays a pivotal role in enabling the grieving process and reducing the traumatic impact of this life-changing event. Unfortunately, professionals and midwives, in particular, are often emotionally unprepared and frequently left alone when dealing with these stressful events.

AIM

The BLOSSoM (Burnout after perinatal LOSS in Midwifery) study aims to address the levels of professional burnout in Italian midwives and evaluate the psychological impact of bereavement care on professionals.

METHODS

Web-based cross-sectional study, including socio-demographic questionnaire, survey on the knowledge of guidelines for stillbirth management and two psychometric tests: Maslach Burnout Inventory (MBI) and Impact of Event Scale - Revised (IES-R).

FINDINGS

Of 445 female midwives, mean age 35.1 (SD 9.9), working years 11.2 (SD 10.2), 149 (33.4%) reported specific training on stillbirth and 420 (94.6%) highlighted the need for further training and support. Medium to high levels of burnout (Emotional Exhaustion) were present in 65 midwives (15.9%) with a high prevalence of Reduced Personal Accomplishment (292, 64.2%). 'Communicating the diagnosis of death' was considered the hardest task, followed by 'assisting the meeting with the baby'; 109 midwives (24.5%) reported high IES-R scores (>30), suggesting symptoms of PTSD related to stillbirth events; a good level of knowledge of guidelines favoured Personal Accomplishment (OR 0.3 [0.1 - 0.6]). The number of stillbirths assisted by midwives was not associated with burnout levels.

CONCLUSION

Midwives are particularly at risk of developing professional burnout, as early as after five years of work, with a significant association with the psychological impact exerted by stressful events (stillbirth).

Association Between Sense of Coherence and Frailty: A Cross-Sectional Study in China

PURPOSE

Frailty is an emerging global public health burden. Most existing studies have focused on risk factors for frailty, focusing less on protective factors against frailty. This study aims to examine the association between the sense of coherence (SOC), the most common construct of salutogenesis and frailty status among community-dwelling old adults.

METHOD

A cross-sectional study was conducted among 7,970 old adults aged ≥65 years in three cities in China from June 2019 to October 2020. Frailty was operationalised as the sum of self-reported fatigue, resistance, ambulation, illness, and loss of weight (FRAIL scale). The χ² test was used to analyse the distribution difference of frailty in demographic, behavioural, and SOC levels. Confounder-adjusted multinomial logistic regression was used to examine the association between SOC and frailty.

RESULTS

The prevalence of pre-frailty and frailty was 43.1 and 8.0%, respectively. The results of the confounder-adjusted regression showed that older adults with moderate-level SOC (odds ratio, OR: 0.61, 95% CI: 0.54-0.69) and strong-level SOC (OR: 0.55, 0.48-0.64) had lower odds of being pre-frail compared to those with weak SOC. It also showed that older adults with moderate-level SOC (OR: 0.32, 95% CI: 0.27-0.40) and strong-level SOC (OR: 0.22, 95% CI: 0.16-0.29) had lower odds of being frail compared to those with weak SOC.

CONCLUSION

SOC may be a protective factor against frailty. Improving SOC may be a strategy to prevent frailty among Chinese community-dwelling older adults.

Is a sense of coherence associated with prolonged grief, depression, and satisfaction with life after bereavement? A longitudinal study

There is growing interest in psychological factors maintaining healthy functioning following adverse events. One such variable is a sense of coherence (SOC), an orientation to life comprising manageability, comprehensibility, and meaningfulness. Little research has examined the role of SOC in adjustment to bereavement. The present longitudinal study examined the role of SOC in recovery from loss, in a Danish sample (N = 221) of elderly spousally bereaved people. The aim was twofold. First, we aimed to establish the optimal measurement model of SOC, evaluating the fit of different factor solutions for the 29-item SOC-29 scale and 13-item SOC-13 scale, using confirmatory factor analysis. Second, we sought to examine associations of emerging SOC factors with symptoms levels of prolonged grief disorder (PGD) and depression, and with satisfaction with life, assessed concurrently (at 6 months post-loss) and at two consecutive time points, 13 and 18 months post-loss. Results showed that the three-factor model of the SOC-13 (with distinct manageability, comprehensibility, and meaningfulness factors) provided a good fit to our data. With respect to our second aim, analyses showed that the three SOC factors were associated with concurrently assessed PGD, depression, and satisfaction with life. In the analyses predicting outcomes at Wave 2 and Wave 3, meaningfulness (but not manageability and comprehensibility) predicted some of the outcomes, above and beyond baseline scores of the outcomes. Findings suggest that meaningfulness may increase healthy and attenuate unhealthy responses to loss. Helping bereaved people to experience life's demands as worthy of investment and engagement is likely an important target for bereavement care.

Resilience and Post-traumatic Stress Disorder in the Swiss Alpine Rescue Association

OBJECTIVE

The present study aimed to assess the frequency of trauma exposure, the prevalence of possible post-traumatic stress disorder (PTSD), the extent of resilience, and sense of coherence among personnel of the Swiss alpine rescue association (ARS).

METHODS

Using a trilingual online survey approach, 465 mountain rescuers of the ARS were surveyed using the Posttraumatic Diagnostic Scale (PDS), the PTSD Checklist 5 (PCL-5), the Resilience Scale 13 and 14 (RS-13/-14), the Perceived Stress Scale 10 (PSS-10), the General Health Questionnaire 12 (GHQ-12), the Pittsburg Sleep Quality Index (PSQI), the Sense of Coherence Scale 13 (SOC-13), and the Berlin Social Support Scales (BSSS).

RESULTS

Although the rate of mountain rescuers having witnessed or experienced a traumatic event was high (71%), the prevalence of possible PTSD was low (0.9%). The sample showed high resilience and high sense of coherence. Resilience was positively correlated with work experience. Low perceived stress and high sense of coherence predicted resilience. The severity of PTSD symptoms was mainly predicted by low sense of coherence. Sense of coherence mediated the interaction between resilience and severity of PTSD symptoms.

CONCLUSION

The findings suggest that resilience and sense of coherence are indicative for the low prevalence of possible PTSD among mountain rescuers, and may therefore represent valuable screening and training parameters for mountain rescue personnel.

Predictive Model of Preventive Behaviors against COVID-19 in the Older Adult: The PREASOC-COVID-19 Study

Background: The purpose of this study was to analyze the relationship between COVID-19 preventive behaviors, as the dependent variable, with risk perception, coping style and sense of coherence, as independent variables, in older people living in the community. Methods: An observational design for predictive model development. This study was reported following the STROBE statement. The subjects were people over 65 years of age living in the community. Data collection included sociodemographic variables related to COVID-19, risk perception and types, coping styles in the face of contagion, sense of coherence, and preventive behaviors in the face of COVID-19. The data collection period was from November 2020 to January 2021. Results: A total of 305 people participated in this study (71.5% women, mean age 71.34 years; 6.9% suffered from COVID-19 and 44.3% knew someone close to them who suffered from the virus). The coping style variables problem-focused, emotion-focused, and sense of coherence subscales Significance and manageability explained 17% of the variable preventive behaviors against COVID-19. There were statistically significant differences by gender in all subscales, with women scoring higher in all of them; Conclusions: Men with low risk perception, extrinsic risk perception, and low sense of coherence presented worse COVID-19 preventive behaviors. It would be interesting to develop specific prevention and health education campaigns for this population.

Late Adulthood, COVID-19-Related Stress Perceptions, Meaning in Life, and Forgiveness as Predictors of Mental Health During the COVID-19 Pandemic

The purpose of this study was to examine multiple direct and indirect pathways of the association between older age and mental health through COVID-19-related stress perceptions, meaning in life, and forgiveness of situations. Participants were 1,382 U.S. adults who were part of the Harvard Digital Lab for the Social Sciences panel who volunteered to complete a 12 min survey in the spring of 2020. The sample had an average age of 56 years, was slightly more male (55%) than female (44%) or other (2%), mostly White (88%), well-educated (70% bachelors degree or more), and middle-income ($60,000–$75,000 annually). Measures included: COVID-19-related stress perceptions (e.g., concerns about infection, job, lack of necessities), presence of and search for meaning in life, forgiveness of situations, psychological distress, hopelessness, and optimism. A latent mental health variable was created that was comprised of psychological distress, hopelessness, and optimism. All hypothesized direct effects were in evidence, and all but one indirect effect were observed. Specifically, older age was related to better mental health through higher presence of meaning and lower search for meaning. Older age was also related to better mental health through a serial indirect pathway from lower COVID-19-related stress perceptions to higher presence of and lower search for meaning and higher forgiveness of situations to mental health. The proposed model was largely supported and confirms existing theory and research on aging, positive psychological processes, and mental health. Findings also offer new insights on the unique potential role of forgiveness of situations and its theoretical relevance to offending situations such as the COVID-19 pandemic. The present study offers a beginning for theorists, researchers, and practitioners to consider the connections between aging and mental health and the intricate interconnections between stress appraisal and positive coping resources that may serve to support it.

Starting ambulance care professionals and critical incidents: a qualitative study on experiences, consequences and coping strategies

BACKGROUND

Ambulance care professionals are regularly confronted with critical incidents that increase risks for mental health disorders. To minimize these risks, it is important that ambulance care professionals adequately cope with critical incidents. Especially from the perspective of starting ambulance care professionals it is unknown which coping styles they use when experiencing a critical incident and how they are trained to cope with critical incidents. The aim of this study was to gain insight in (a) what starting ambulance care professionals describe as critical incidents, (b) how they experience these critical incidents and their consequences, (c) how they cope with these incidents, and (d) how they are trained and guided to cope with these incidents.

METHODS

A qualitative design with individual, semi-structured interviews was used. The data was analyzed by using inductive thematic analysis.

RESULTS

Twenty-two starting ambulance care professionals were interviewed of which, 11 were male. The age ranged from 23 to 31 years, with 11 participants being 27 years or younger. Three key-themes emerged that make an incident critical: (1) emotional connection versus emotional detachment, (2) feeling loss of control, and (3) incomprehension. All participants experienced several short to middle term physical, psychological and social consequences after encountering a critical incident. Starting ambulance care professionals applied different coping strategies during different phases of the ambulance care process: a mix of depersonification, focus on the medical task, support from colleagues and their own network, seeking confirmation, and distraction. Most starting ambulance care professionals don't actively remember they received education about coping with critical incidents during their initial educational program. During and after traineeships, the workplace preceptor has a crucial role for starting ambulance care professionals to learn them how to cope with critical incidents.

CONCLUSIONS

Three key-themes interact to make an incident more critical for starting ambulance care professionals. To cope with these critical incidents, starting ambulance care professionals use a variety of coping strategies. These results can be used to develop training and coaching for starting ambulance care professionals so they can adequately cope with critical incidents.

Post-traumatic Growth in the First COVID Outbreak in Hong Kong

Post-traumatic growth (PTG) emerges from highly stressful situations. The coronavirus (COVID) pandemic may qualify as one. This study investigated the PTG among Hong Kong citizens during the first outbreak in spring 2020, shortly after a large-scale social movement subsided. A longitudinal online survey was launched during the peak (Time 1) and the palliation (Time 2) of the outbreak. Among the 327 participants who completed both waves, 28.4% exhibited probable post-traumatic stress disorder (PTSD) in Time 1, while 18.0% reported significant PTG in at least one domain in Time 2. The interaction between the sense of coherence (SOC) and post-traumatic stress mediated the relationship between Time 1 perceived outbreak severity and Time 2 PTG, such that PTG was more likely among participants with higher post-traumatic stress and SOC. PTG was also associated with a weaker contingency between Time 1 and Time 2 perceived outbreak severity. Echoing the transformational model, our findings show that both experienced stress and coping resources are essential for PTG to emerge. We also demonstrated how PTG might lead to more flexible risk perceptions according to the development of the outbreak.

Sense of Coherence and Burnout in Healthcare Professionals in the COVID-19 Era

Emotional exhaustion in the context of vulnerability to burnout is a part of the universal narrative of high stress and systematically reported in healthcare professionals. The sense of coherence (SOC) is a salutogenic construct, operationalized by A. Antonovsky as a generalized resistance resource (GRR) to stress in three dimensions: meaningfulness (Me), the desire of a person to be motivated to cope; comprehensibility (C), the belief that the challenge is understood; and manageability (Ma), the belief that coping resources are available. The relation between SOC and the dimensions of burnout-Emotional Exhaustion (EE), Depersonalization (D), and Personal Accomplishment (PA)-is a part of salutogenic functioning, which reveals the inner motivation and self-organization of the psycho-emotional energetic resource. This study traces the salutogenic functioning of Bulgarian healthcare professionals during the pandemic. A general psychological background of coherence and exhaustion has been identified. All components of the SOC were positively correlated to Personal Accomplishment. Emotional Exhaustion and Depersonalization correlated negatively with coherence. SOC was validated as a possible determinant to predict the reduction of exhaustion and depersonalization as well as high levels of professional performance. The dimension of Meaningfulness in the coherence phenomenon was demonstrated to have the highest predictive value for professional burnout.

Shame, guilt, and posttraumatic stress symptoms: A three-level meta-analysis

Existing empirical findings are inconsistent on the correlations of shame and guilt with posttraumatic stress symptoms (PTSS). This study aimed to quantitatively summarize the strength of the associations of shame and guilt with PTSS and explore potential moderators. Based on a three-level meta-analytic method, shame was positively correlated with PTSS, no matter whether the effects of guilt were controlled; guilt also had a positive correlation with PTSS, regardless of whether the effects of shame were partialling out. Moderator analyses showed that type of shame measure (generalized vs. contextual vs. trauma-specific shame) moderated the relation between shame and PTSS, and type of guilt measure (generalized vs. contextual vs. trauma-specific guilt) moderated the relation between guilt and PTSS. In addition, culture had a marginally significant moderating effect on the relation between guilt and PTSS, with a stronger association of guilt with PTSS in Western culture than in Eastern culture. These results supported the links of shame and guilt to PTSS and implied that we should focus on the conceptual underpinnings of the manifest psychometric issue and maintain cultural sensitivity in future research. The implications for posttraumatic stress disorder treatment were also discussed.

Effect of Nurse-Led Consultations on Post-Traumatic Stress and Sense of Coherence in Discharged ICU Patients With Clinically Relevant Post-Traumatic Stress Symptoms-A Randomized Controlled Trial

OBJECTIVES

To investigate the effect of nurse-led consultations on reducing post-traumatic stress symptoms and increasing sense of coherence in discharged ICU patients with clinically relevant post-traumatic stress symptoms and to identify variables associated with symptoms 12 months later.

DESIGN

A pragmatic nonblinded randomized controlled trial.

SETTINGS

Five surgical and medical ICUs at Oslo University Hospital.

PATIENTS

Adult patients treated in the ICU greater than or equal to 24 hours were screened with Post-Traumatic Stress Scale 10 intensive part B after ICU discharge. Those scoring greater than or equal to 25 were included in the study.

INTERVENTION

Patients randomized to intervention group were offered three nurse-led consultations within 2 months, and patients in the control group received standard care.

MEASUREMENTS AND MAIN RESULTS

Sense of Coherence Scale 13 and Post-Traumatic Stress Scale 10 intensive part B were completed after inclusion, and reevaluated after 3, 6, and 12 months. Linear mixed model for repeated measures and linear regression analyses were performed. Among 523 screened patients, 111 and 113 were randomized to intervention group and control group, respectively. Mean Post-Traumatic Stress Scale 10 intensive part B score was 37 (±10) before randomization. No differences in post-traumatic stress symptoms or sense of coherence were found between intervention group versus control group, with a mean Post-Traumatic Stress Scale 10 intensive part B score 39 (95% CI, 37-41) versus 37 (95% CI, 35-39), 32 (95% CI, 28-35) versus 32 (95% CI, 29-35), 31 (95% CI, 28-34) versus 30 (95% CI, 27-33), and 31 (95% CI, 28-34) versus 29 (95% CI, 26-33) at baseline, 3, 6, and 12 months, respectively. There was a significantly reduced Post-Traumatic Stress Scale 10 intensive part B score for both groups during the year (p = 0.001). Low sense of coherence, pain, and previous psychiatric problems were associated with increased level of post-traumatic stress symptoms at 12 months.

CONCLUSIONS

Nurse-led consultations did not reveal any significant effect on post-traumatic stress symptoms or sense of coherence after ICU discharge in patients with clinically relevant symptoms.

Zusammenhänge zwischen selbstberichteter Resilienz, wahrgenommener sozialer Unterstützung und Wohlbefinden bei Mitgliedern der Freiwilligen Feuerwehr

Zusammenfassung. Soziale Unterstützung und eine ausgeprägte Resilienz werden in der Forschungsliteratur als protektiv für das psychische Wohlbefinden von Einsatzkräften diskutiert. Die hier dargestellte Untersuchung verfolgt das Ziel, Resilienz und ihren Zusammenhang mit psychischem Wohlbefinden bei der speziellen Gruppe der Freiwilligen Feuerwehr (FF) zu untersuchen. In einer Untersuchung mit mehreren Messzeitpunkten (November 2016-Mai 2018, T1: N = 475, T2: N = 117, T3: N = 58) wurden FF gebeten, Selbstbeurteilungsfragebögen auszufüllen. Es fanden sich geringe bis mittlere Zusammenhänge von Resilienz mit dem psychischen Wohlbefinden ( r = .20-.65). Soziale Unterstützung zeigte kleine Zusammenhänge mit Wohlbefinden ( r = .14, r = .23). Ein indirekter Zusammenhang bestand zwischen wahrgenommener sozialer Unterstützung mit dem psychischen Wohlbefinden, mediiert durch Resilienz. Weiterführende Forschung sollte klären, ob, und ggf. wie Resilienz für diese Berufsgruppe trainierbar ist und ob Verbesserungen im Wohlbefinden damit einhergehen.

Lifetime prevalence of polyvictimization among older adults in Sweden, associations with ill-heath, and the mediating effect of sense of coherence

Background

Experiences of violence and abuse is a prominent part of the life history of many older adults and is known to have negative health effects. However, the importance of multiple victimization over the life course, e.g., lifetime polyvictimization, is not well investigated in this age group. The objective of this study was to investigate the prevalence of lifetime physical, emotional, and sexual victimization as well as polyvictimization among older adults in Sweden. We explored background characteristics associated with polyvictimization and hypothesized that violence victimization and especially polyvictimization would be associated with lower health status. To better understand factors that promote health in the aftermath of victimization, we also explored the effect of two resilience factors, sense of coherence (SOC) and social support, on the association between victimization and ill-health.

Method

Cross-sectional data from a random population sample in Sweden (women n = 270, men n = 337) aged 60–85 was used. Respondents answered questions about exposure to violence, health status, social support, and SOC. Conditional process analysis was used to test if SOC mediates the association between victimization and health outcome, and if social support moderates the association.

Results

Overall, 24.8% of the women and 27.6% of the men reported some form of lifetime victimization and 82.1% of the female and 62.4% of the male victims were classified as polyvictims, i.e., reported experiences of more than one episode of violence. As hypothesized, we found a negative association between victimization and health status and the association was most prominent for polyvictims. We found moderated mediation for the association between polyvictimization and health status, i.e., polyvictimization was associated with lower SOC and SOC had a positive correlation with health status. Social support moderated the association, i.e., victims without social support had lower health scores.

Conclusions

Lifetime polyvictimization was common among older adults and associated with lower health status. To help victims of violence recover, or preferably never develop ill-health, a better understanding of what fosters resilience is warranted. This study implies that social support, and especially SOC may be factors to consider in future interventions concerning older adults subjected to violence.

Sense of coherence, engagement, and work environment as precursors of psychological distress among non-health workers during the COVID-19 pandemic in Spain

BACKGROUND

The interrelationship between the sense of coherence, work environment, work engagement, and psychological distress have particular interest in non-health workers who carried out essential activities during the COVID-19 pandemic.

OBJECTIVE

To assess the effects of the COVID-19 on the physical and mental health of non-health workers.

DESIGN

Observational descriptive cross-sectional study.

DATA SOURCES

1089 questionnaires have been analysed. Engagement (UWES-9), sense of coherence (SOC-13), mental health (Goldberg GHQ-12), demographic data, perception of health and stress and work environment were assessed.

RESULTS

At low levels of engagement, the percentage of distress is higher (77.9%). Low levels of sense of coherence correspond to the highest percentages of distress (86.3%). The 94.1% believe it necessary for professionals and volunteers involved in COVID-19 to receive psychological support. Low comprehensibility is mediated by the perception of stress; if the perception is low, comprehensibility is modulated by the level of significance; if it is low, it generates 95.9% of distress.

CONCLUSION

The interrelationship between the sense of coherence, work environment, work engagement, and psychological distress have particular interest in non-health workers who carried out essential activities during the COVID-19 pandemic. Almost all respondents believed that professionals and volunteers involved in COVID-19 should receive psychological support. This may be an indicator of the effect of the COVID-19 pandemic on workers' mental health.

Use of Diaries in Intensive Care Unit Delirium Patients: German Nursing Perspectives

Diaries are written for patients in intensive care units by staff and relatives, especially when patients experience a disorder of their consciousness, such as delirium. Diary entries are written in common language, describing the situation of the patient. The diary can be read by the patient and the family and support the coping and understanding of what happened. It can function as a tool for supporting communication about different experiences and views of critical illness.

Facing the COVID-19 Pandemic: The Role of Sense of Coherence

The worldwide outbreak of COVID-19, the ensuing pandemic, and the related containment measures pose considerable challenges to psychological resilience and well-being. Researchers are now forced to look for resources to cope with negative experiences linked to this health emergency. According to the salutogenic approach proposed by Antonovsky, the sense of coherence (SOC) is a major source of resilience. Thus, this study aimed at assessing the role of SOC in moderating the link between illness experiences (in terms of knowing persons diagnosed with COVID-19 and fear of contracting COVID-19) and psychological well-being. 2,784 participants, taken from a large sample of the Italian population (65.4% females) and aged between 18 and 85 years, filled in an anonymous online survey during the 3rd week of the lockdown. Findings supported the moderating role of SOC in shaping the link between illness experiences and psychological well-being. Specifically, participants who knew at least one person diagnosed with COVID-19 showed lower levels of psychological well-being at low levels of SOC. The negative relation between participants' fear of contracting COVID-19 and psychological well-being was stronger for those who showed higher levels of SOC. This study discusses the implications of these results for interventions aimed at reducing the pandemic's detrimental effects and promoting resilience.

Pre-rehabilitation sense of coherence as a predictor of symptom change after rehabilitation

Sense of coherence (SOC) constitutes the key component of salutogenesis theory. It reflects individuals' confidence that their environment is comprehensible and manageable and that their lives are meaningful. Research demonstrates a strong cross-sectional relationship between SOC and mental health. However, little is known about SOC's temporal stability and its potential to predict changes in psychopathological symptom severity in different settings. The goal of the current study was to address this gap. The sample of the two-wave longitudinal study consists of 294 patients receiving inpatient psychotherapeutic (and psychopharmacological) treatment for various psychological disorders at a German psychosomatic rehabilitation clinic. SOC (Antonovsky, Social Science & Medicine, 1993, 36, 725-733) and outcome measures (i.e., general mental health problems, depression and anxiety symptoms) were assessed within two days of arrival and at the end of rehabilitation (week 5/6). SOC was significantly enhanced after treatment whereas psychopathological symptoms were significantly reduced. Regression analyses revealed that pre-treatment SOC was a significant negative predictor of post-treatment symptom severity for all outcome measures even after controlling for pre-treatment symptoms. The current findings provide first evidence that SOC is a significant unique predictor of symptom change. Future studies need to further investigate longitudinal associations between SOC and mental health outcomes in different settings.

Impact of COVID-19 on Public Mental Health and the Buffering Effect of a Sense of Coherence

INTRODUCTION

It is claimed that the coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on mental health. However, to date, prospective studies are lacking. Moreover, it is important to identify which factors modulate the stress response to the pandemic. Previously, sense of coherence (SOC) has emerged as a particularly important resistance factor.

OBJECTIVE

This prospective study aimed to assess the impact of the COVID-19 outbreak on mental health and to investigate the ability of pre-outbreak SOC levels to predict changes in psychopathological symptoms.

METHODS

This study assessed psychopathological symptoms and SOC before and after the COVID-19 outbreak as well as post-outbreak COVID-19-related traumatic distress in a German-speaking sample (n =1,591). Bivariate latent change score (BLCS) modeling was used to analyze pre- to post-outbreak changes in psychopathological symptoms and the ability of SOC to predict symptom changes.

RESULTS

Overall, there was no change in psychopathological symptoms. However, on an individual-respondent level, 10% experienced a clinically significant increase in psychopathological symptoms and 15% met cut-off criteria for COVID-19-related traumatic distress. Using BLCS modeling, we identified a high-stress group experiencing an increase in psychopathological symptoms and a decrease in SOC and a low-stress group showing the reversed pattern. Changes in SOC and psychopathological symptoms were predicted by pre-outbreak SOC and psychopathological symptom levels.

CONCLUSIONS

Although mental health was stable in most respondents, a small group of respondents characterized by low levels of SOC experienced increased psychopathological symptoms from pre- to post-outbreak. Thus, SOC training might be a promising approach to enhance the resistance to stressors.

Predictors of posttraumatic stress following transient ischemic attack: An observational cohort study

OBJECTIVE

Transient ischemic attack (TIA) has been reported to be frequently followed by symptoms of post-TIA posttraumatic stress disorder (post-TIA PTSD). Risk factors for post-TIA PTSD remain largely unknown. We aimed to identify predictors of post-TIA PTSD development to enable post-TIA PTSD risk assessment and inform future development of treatment and prevention interventions.

METHOD

TIA patients were examined twice for this observational cohort study. Symptoms of post-TIA PTSD, depression and anxiety were assessed shortly after TIA during in-hospital stay (T1) and three months after TIA (T2). The impact of known general PTSD risk factors (psychiatric history, peritraumatic dissociation, social support), psychological resilience factors (sense of coherence, mindfulness, attachment style) and TIA characteristics (affected circulatory territory, symptom type and duration) at T1 on post-TIA PTSD symptom severity at T2 was tested using hierarchical multiple linear regression.

RESULTS

Sixty-one patients (83.6%) completed the study at T2. Fifteen patients (24.6%) were classified as post-TIA PTSD⊕ at T2. In multiple linear regression analysis, age, sex, psychiatric history, peritraumatic dissociation and social support together explained 39.9% of variance of post-TIA posttraumatic stress symptom severity. Sense of coherence and mindfulness explained further 17.8% of variance. Clinical TIA characteristics were not associated with post-TIA PTSD.

CONCLUSIONS

Post-TIA PTSD is a common phenomenon. General PTSD risk factors can be applied for post-TIA PTSD risk assessment. Sense of coherence and mindfulness are promising target variables for post-TIA PTSD treatment and prevention interventions.

The supervisory relationship from an attachment perspective: Connections to burnout and sense of coherence in health professionals

Supervision is an essential part of the training and work environment of health professionals, especially of psychotherapists and clinical/health psychologists. However, although the supervisory process is always a relational one and may therefore be influenced by attachment dynamics, the importance of the supervisory relationship for the professional's performance and the well‐being of the supervisee has yet to be fully examined.

In this cross‐sectional observational study, the Experiences in Close Relationships‐Revised (ECR‐RD; avoidant and anxious attachment), the Supervisory Relationship Questionnaire (SRQ), the Maslach Burnout Inventory (MBI) and the Sense of Coherence Scale (SOC‐13) were analysed for 346 (81.8% female) health professionals.

Considering professional experience and number of supervision sessions as control variables, a better supervisory relationship negatively predicted burnout symptoms (β = −.31) but positively predicted sense of coherence (β = .31, both p < .01). The final model, including avoidant and anxious attachment as additional predictors, explained 30% of the variance in burnout symptoms and 41% of the variance in sense of coherence.

The results underline the importance of the supervisory relationship for the well‐being and the professional performance of health professionals. Interactions between the supervisory relationship and underlying attachment parameters should be further explored in future studies.

Correlates of mental health in occupations at risk for traumatization: a cross-sectional study

BACKGROUND

Hospitals, police stations, and fire departments are highly demanding workplaces. Staff members are regularly exposed to various stressors including traumatic events. Correspondingly, several studies report high rates of mental health issues among these occupations. Nevertheless, despite these challenging circumstances, some staff members manage to sustain their mental health. The current study is the first to investigate three health-promoting factors simultaneously among three different, highly demanding occupations.

METHODS

The present cross-sectional survey investigated health-promoting factors (sense of coherence - SOC, trait-resilience, locus of control - LOC) and mental health outcomes (general psychopathological symptom burden, posttraumatic stress, burnout) in medical staff (n = 223), police officers (n = 257), and firefighters (n = 100).

RESULTS

Among all occupations, SOC, trait-resilience, and an internal LOC were negatively associated with general psychopathological symptoms, posttraumatic stress, and burnout symptoms. By contrast, all these outcome measures were positively correlated with an external LOC. Multiple regression models including all health-promoting factors explained 56% of the variance in general psychopathological symptoms and 27% in posttraumatic stress symptoms. Among all occupations, SOC was the strongest predictor of both general psychopathological symptom burden and posttraumatic stress symptoms. Multigroup path analyses revealed minor differences across occupations, mainly driven by a stronger influence of LOC in police officers.

CONCLUSION

Across all occupations, SOC was identified as the most important health-promoting factor. Future longitudinal studies should further examine the causal link between health-promoting factors and mental distress in different workplaces. Such studies will also allow for further development and evaluation of resilience promoting programs.

Post-traumatic stress disorder in volunteer firefighters: influence of specific risk and protective factors

BACKGROUND

Volunteer firefighters belong to a risk population regarding the development of posttraumatic stress disorder (PTSD). However, given the frequency of work-related trauma, PTSD prevalences seem relatively low. Protective factors appear to be effective and are the focus of this study.

OBJECTIVE

We investigated the PTSD-prevalence as well as the influence of trauma exposure and the impact of protective factors resilience and Sense of Coherence (SoC) on symptoms of PTSD in volunteer firefighters.

METHOD

Data from 232 participants of an online questionnaire study were analysed using a path model approach.

RESULTS

'The results suggest a possible prevalence of PTSD of 12.5% and 2.2% for partial PTSD based on self-report measures. SoC and trauma event load proved to be independent of each other, as no intercorrelations were found. But both directly predicted PTSD severity. Higher resilience scores predicted the participants' Sense of Coherence, but PTSD severity was only indirectly affected by resilience, which was entirely mediated by SoC. Further, although SoC and trauma load increase with age and years of job experience, it is only SoC that affects PTSD severity, not age or years of experience.

CONCLUSIONS

The results emphasize that not only exposure to potentially traumatic events predicts the later probability of developing symptoms of PTSD, but that the integration of stressful experiences into the self-concept (associated with SoC) is essential for the development of PTSD. Future research should address the question of causality between SoC and PTSD, and consider which factors moderate the SoC.

What's Love Got to do with it: Role of oxytocin in trauma, attachment and resilience

Oxytocin (OT) is a neurohypophysial hormone and neuropeptide produced by the hypothalamus and released by the pituitary gland. It has multiple physiological roles including stimulation of parturition and lactation, and promotion of pro-adaptive social behaviors necessary for mammalian survival. OT interacts with one receptor subtype: the OT receptor (OTR) which, upon stimulation, triggers different intracellular signal transduction cascades to mediate its physiological actions. Preclinical studies show that OT regulates social behaviors such as pair bonding, recognition and social interaction. It also coordinates the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the release of corticotrophin-releasing hormone. Further evidence suggests that OT plays an important role in regulating caloric intake and metabolism, and in maintaining electrolyte and cardiovascular homeostasis. OT is also involved in attenuating the neurophysiological and neurochemical effects of trauma on the brain and body by facilitating both physical attachment such as wound healing, and psychological/social attachment, thereby increasing resilience to subsequent traumatic events. Clinical trials have reported that intranasal administration of OT provides therapeutic benefits for patients diagnosed with traumatic stress-related diseases such as major depressive disorders and post-traumatic stress disorder. OT's therapeutic benefits may result from context-dependent interactions with key neural pathways (social, cognitive, and reward), neurotransmitters (dopamine, norepinephrine, serotonin, and endogenous opioids), and biomarkers (adrenocorticotropic hormone, cortisol, and dehydroepiandrosterone sulfate), that lead to a decrease in stress -associated behaviors, and facilitate post-traumatic growth, ultimately leading to increased resilience, through improved social cohesion and attachment. OT induced-augmentation of physical and cognitive resilience may play a significant role in both the prevention of, and improved clinical outcomes for, traumatic stress-related disorders following either acute or enduring traumatic experiences.

The Relationship between Dog Ownership, Psychopathological Symptoms and Health-Benefitting Factors in Occupations at Risk for Traumatization

Individuals working in high-risk occupations (e.g., emergency staff) are exposed to high levels of occupational stress including traumatic events. Correspondingly, several studies report high rates of mental health problems among these occupations. Pet ownership has been associated with better mental health. However, to date a study on the association between pet ownership and indicators of mental health in these occupations is missing. The present cross-sectional survey (N = 580) investigated pet ownership, attachment to pets, health-benefitting factors (i.e., sense of coherence, trait-resilience, locus of control) and psychopathological symptoms (i.e., general mental health problems, posttraumatic stress, burnout) in medical staff, police officers, and firefighters. Dog owners and non-dog owners showed comparable levels of psychopathological distress and health-benefitting factors. Compared to cat owners, dog owners demonstrated stronger emotional attachment to their pet. Moreover, a stronger attachment was also linked to higher levels of psychopathological symptoms and lower levels of health-benefitting factors. However, the relationship between attachment to pets and health-benefitting factors could be explained by their overlap with psychopathological symptom levels. Overall, our findings are not in line with the notion that pet ownership generally has a health-benefitting effect. Future studies need to investigate circumstances that modulate positive effects of pet ownership.

Psychological Distress Among Healthcare Professionals Involved in the Covid-19 Emergency: Vulnerability and Resilience Factors

The aim of this paper is to outline some considerations about the psychological distress in healthcare professional during the COVID-19 pandemic. We summarize available literature both on ‘protective’ and ‘predisposing’ factors potentially involved in the occurrence of psychological distress, including PTSD, in frontline healthcare operators. Valid social support, self-efficacy, internal locus of control (LOC) and sense of coherence (SOC) have been considered as resilience factors, in previous studies. Likewise, several observations pointed on the relevance of individual and environmental vulnerabilities. No real evidence is available about strategies to face the emotional burden for healthcare operators due to present COVID-19 scenario. However, we strongly believe that the containment of isolation anxiety with an appropriate emotional support should be the first instrument to minimise the psychological effect of pandemic on the more exposed healthcare professionals.

Resilience as a mediator in the relationship between posttraumatic stress and posttraumatic growth among adult accident or crime victims: the moderated mediating effect of childhood trauma

Background: Results on the association between posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) are inconsistent, and there may be unknown factors mediating or moderating this relationship. Identifying these factors could help in developing an intervention strategy for promoting PTG. However, few studies have examined relationships among PTSS, resilience, and PTG concurrently, and no study has investigated the effect of childhood trauma on these relationships in adulthood. Objective: The aim of this study was to examine the moderated mediating effect of childhood trauma on resilience and its associations with PTSS and PTG in adult victims of traumatic accidents or crimes. We hypothesized that resilience would mediate relationships between PTSS and PTG and that its mediating effects would differ depending on childhood trauma. Methods: We included adult victims of accidents or crimes referred to a university hospital or specialized support centre (n = 143). PTSS, resilience, childhood trauma, and PTG were measured with the following questionnaires: PTSD Checklist for DSM-5, Connor-Davidson Resilience Scale, Adverse Childhood Experiences Questionnaire, and the Short Form of the Posttraumatic Growth Inventory, respectively. Results: The effect of PTSS on PTG was found to be fully mediated by resilience, and this mediating effect was moderated according to childhood trauma: the more childhood traumatic experiences, the greater the mediating effect of resilience was between PTSS and PTG. The effect of resilience on PTG was highest in the high childhood trauma group. Conclusion: Therapists treating individuals with psychological trauma should attempt to identify a history of childhood trauma and to evaluate resilience. Therapeutic approaches tailored according thereto may improve PTG among individuals with PTSS symptoms, especially those with high levels of childhood trauma.

A decennial review of psychotraumatology: what did we learn and where are we going?

On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where we will acknowledge some of our most impactful articles of the past decade (also discussed below and marked with * in the reference list). In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.