Sense of coherence and health: evidence from two cross-lagged longitudinal samples

Self-rated health among university students in relation to sense of coherence and other personality traits

The aim of the study was to determine students' self-rated health in relation to sense of coherence and other personality traits. A cross-sectional descriptive design was used with questionnaires as the means of data collection. The study population comprised a randomized stratified sample of students from a small university in southern Sweden. Ethical approval was obtained from the vice chancellor, and the issues of informed consent, confidentiality, privacy and self-determination were respected. Two instruments were used for data collection; the 29-item Sense of Coherence (SOC) scale, and an instrument created for this study, named Personality and Health Instrument, containing 52 questions. Self-rated health was estimated by inverse number of health complaints. A factor analysis identified seven factors related to personality traits; the three most important were hardiness, positive affect/optimism and Type A personality. The personality trait variables were tested for correlation with each other as well as with self-rated health. The mean score for SOC was similar for female and male students, but a positive association between SOC and self-rated health was found only among women. Optimism was associated with less health complaints among female students. Type A personality was associated with poorer health both among women and men. The personality traits SOC, positive affect/optimism, hardiness and alienation showed high internal correlations. The SOC scale is discussed in relation to gender specificity and in relation to methodological and conceptual confounding. Further research is needed to explore the relation between SOC, optimism, hardiness, hostility and health. The significance of the study is that it raises questions about the validity and specificity of the SOC instrument and provides ideas for future research to develop the sense of coherence concept and instrument.

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.

Socioeconomic status, sense of coherence and health in Canadian women

OBJECTIVE

The purpose of this study was to explore the role of sense of coherence (SOC) in the relationship between household income and self-rated health among Canadian women. SOC is a global orientation that enables one to perceive events of the world as comprehensible, manageable, and meaningful.

METHODS

A secondary data analysis was conducted using the National Population Health Survey 1994-95. Only women between the ages of 20 and 64 (n = 6748) were selected for this study. Data were analysed using multivariate path analyses.

RESULTS

SOC is a psychosocial factor that intervenes in the income and health relationship. It did not function, however, as an interaction buffer to ameliorate the adverse effects of low income on health.

CONCLUSION

This study lends support for public health interventions that target the socioeconomic conditions that influence health, and for strategies that foster the development of a strong SOC.

Gender, kinship and caregiver burden: the case of community-dwelling memory impaired seniors

BACKGROUND

This study examined whether there were gender and kinship (spouse, child, more distant relative) differences in caregiver burden. It further examined the constellation of gender and kinship by examining whether adult daughter caregivers experienced greater burden compared to wives, husbands, sons, and other more distant relatives.

METHODS

The sample consisted of 305 family caregivers of memory-impaired individuals who were age 70 years or older and resided in non-institutional settings in Arkansas. A cross-sectional design was employed using validated measures to assess both the memory-impaired elders' and family caregivers' self-reported physical and memory status.

RESULTS

After controlling for the age and health status characteristics of the memory-impaired elder, sociodemographic and health status characteristics of the family caregiver, and the caregiver coping response (measured by the sense of coherence), multiple regression analyses found kinship, but not gender differences in caregiver burden. Adult children experienced more caregiver burden than more distant relatives. There were no significant differences in caregiver burden between adult children and spouses. Adult daughters had greater caregiver burden scores compared to more distant relatives, but had comparable scores to wives, sons, and husbands. Other significant correlates of burden included caregiver personal characteristics (age and ethnicity) and the sense of coherence.

CONCLUSIONS

The study discusses the practice implications of adult children and adult daughters' propensity to suffer burden when caring for their memory-impaired parents living in the community. It also discusses the relevance of caregiver personal characteristics and the sense of coherence as correlates of burden.

Social and Psychological Resources and Adaptation

Psychology has increasingly turned to the study of psychosocial resources in the examination of well-being. How resources are being studied and resource models that have been proffered are considered, and an attempt is made to examine elements that bridge across models. As resource models span health, community, cognitive, and clinical psychology, the question is raised of whether there is overuse of the resource metaphor or whether there exists some underlying principles that can be gleaned and incorporated to advance research. The contribution of resources for understanding multicultural and pan-historical adaptation in the face of challenge is considered.

Primary care patients with musculoskeletal pain. Value of health-status and sense-of-coherence measures in predicting long-term work disability

OBJECTIVE

To investigate long-term sick leave among primary care patients with musculoskeletal disorders and the predictive value of health-status and sense-of-coherence measures.

METHODS

Patients aged 17 to 64 years who, during seven weeks, attended one of six primary care centers because of non-traumatic musculoskeletal pain and who completed the SF-36 health questionnaire and the sense of coherence (SOC) scale at baseline and after one year.

RESULTS

Of 189 patients, 36 (19%) were sicklisted for at least three months before and/or after their visit; the most common diagnoses were non-specific soft-tissue or multiple joint, low back, and shoulder pain. The long-term sicklisted patients had significantly worse baseline SF-36 and SOC scores than the non-sicklisted patients; moderate improvement in the SF-36 bodily pain but no improvement in the physical functioning scores occurred. The duration of sick leave at baseline and the SF-36 bodily pain score were significant predictors of continuos one-year work disability.

CONCLUSION

Long-term sick leave was common among primary care patients with musculoskeletal pain. The physical functioning and return-to-work outcomes after one year were poor. The SF-36 bodily pain scale might be helpful in identifying at risk patients.

Sense of coherence as a mediator between hostility and health: seven-year prospective study on female employees

OBJECTIVE

We proposed and tested a model in which low sense of coherence (SOC) was hypothesized to underlie the association between hostility and health problems.

METHODS

Structural equation modeling was based on cross-lagged 7-year follow-up data, relating to five measurement points in 433 female municipal employees.

RESULTS

The mediated model fitted well with the data. After adjustment for baseline characteristics, hostility was associated with increased risk of health problems, as indicated by records of sickness absences and poor self-rated health. Incorporating SOC into the model attenuated this association by 33-50%, depending on the indicator of health. The mediated effect of SOC was stronger than that of an alternative mediator, depressive symptoms.

CONCLUSION

Low SOC may be a psychological background factor partially underlying the adverse effect of hostility on ill health.

Attachment and psychosomatic medicine: developmental contributions to stress and disease

OBJECTIVE

The object of this study was to evaluate the evidence linking attachment insecurity to illness. Attachment theory describes lifelong patterns of response to threat that are learned in the interaction between an infant and his or her primary caregiver. Despite its biopsychosocial domain, attachment theory has only recently been applied to psychosomatic medicine.

METHOD

MEDLINE and PsychInfo databases were searched from 1966 to 2000 for English language papers with key words "attachment" and "object relations." Papers and their cited references were reviewed if they were directly related to physical illness, symptoms, or physiology. A hypothetical causal model was developed.

RESULTS

Direct and indirect evidence from survey studies supports an association between attachment insecurity and disease. Animal studies and human experiments suggest that attachment contributes to individual differences in physiological stress response. There is also less robust support for insecure attachment leading to symptom reporting and to more frequent health risk behaviors, especially substance use and treatment nonadherence. Evidence supports the prediction from attachment theory that the benefits of social support derive more from attachment relationships than nonattachment relationships.

CONCLUSIONS

Although the available data are suggestive rather than conclusive, the data can be organized into a model that describe attachment insecurity leading to disease risk through three mechanisms. These are increased susceptibility to stress, increased use of external regulators of affect, and altered help-seeking behavior. This model warrants further prospective investigation.

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education.

OBJECTIVE

The aim of the study reported here was to determine whether SOC predicted subjective state of health.

METHODS

The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables.

RESULTS

A strong SOC predicted good health in women and men.

CONCLUSIONS

SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.