Structural validity and temporal stability of the 13-item sense of coherence scale: prospective evidence from the population-based HeSSup study

Enhancing Oral Health via the Sense of Coherence Approach Among Adult Patients at University Dental Hospital

Purpose

The purpose of the study was to assess the sense of coherence and its relationship with oral health and other study variables among adult patients at university dental hospital.

Patients and Methods

This cross-sectional study included adult patients visiting the Dental Hospital of the College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam. Sense of coherence was determined by Antonovsky's Sense of Coherence scale (SOC-13), which consists of 13 items on a 7-point Likert. DMFT index, plaque index, gingival index, and simplified oral hygiene index were used to evaluate the oral health of study participants. Bivariate and multivariable analyses were performed, and 0.05 level of significance was used in the study.

Results

The study included the data of 558 participants with a mean age of 32.19±10.11 years. The mean score of SOC was 52.77±13.11, which was significantly higher in high-income participants (P <0.001), participants without a medical condition (P=0.021), non-smokers (P <0.001), and those who visited the dentist in less than one year (P=0.028). Bivariate analysis showed statistically significant negative correlations between SOC and DMFT index (P=0.002), SOC and plaque index (P <0.001), SOC and gingival index (P=0.002), and SOC and simplified oral hygiene index (P=0.001). Multivariable analysis also showed that SOC was significantly correlated with DMFT index (P=0.001), plaque index (P <0.001), gingival index (P <0.001), and oral hygiene index (P=0.004) after controlling for age, gender, education, and monthly income.

Conclusion

This study found that high-income and healthy participants, non-smokers, and those who visited the dental office during the last one year demonstrated significantly higher SOC. In addition, there was a statistically significant correlation between SOC and oral health. These study findings highlight the importance of raising awareness about SOC to improve oral health outcomes in adult patients.

Sense of coherence, its components and depressive and anxiety symptoms in expecting women and their partners - A FinnBrain Birth Cohort Study

OBJECTIVE

Expecting mothers with high sense of coherence (SOC) exhibit improved physical, emotional, and childbearing health. However, the dimensions of SOC and the factor structure of the SOC-13 scale during prenatal period is slightly known. Especially the differences in experiencing SOC and its components (comprehensibility, manageability, meaningfulness) among both expecting parents (mothers and fathers) is poorly understood. The association between SOC and mood disorder symptoms (depression and anxiety) during pregnancy is scarcely studied.

METHODS

The structure of the SOC-13 scale, differences in SOC experiences, and the associations between SOC and depressive and anxiety symptoms were studied in a sample of 2784 pregnant women (mothers) and 1661 men/partners (fathers) belonging to the FinnBrain Birth Cohort Study. Self-reports (SOC-13, EPDS, SCL-90: ANX) from gestational week 24 were used. Confirmatory factor analysis (CFA) and invariance testing was carried out to investigate the factorial structure of SOC-13 among both groups (mothers and fathers). Group comparisons were used to study differences in the level of SOC among mothers vs. fathers, low vs. high depression and anxiety subgroups, and multiparous vs. nulliparous mothers.

RESULTS

A two-factor model for SOC-13 consisting of comprehensibility-manageability and meaningfulness fitted the data best. Mothers reported higher levels of meaningfulness, whereas fathers reported higher levels of comprehensibility-manageability. SOC was significantly higher among fathers vs. mothers, but mothers with depressive symptoms reported higher SOC than fathers with depressive symptoms.

CONCLUSIONS

During pregnancy, SOC can be viewed as a two-dimensional (vs. one- or three-dimensional) concept, and mothers and fathers have differences in the components of SOC. Importantly, mothers vs. fathers with depressive symptoms express higher overall SOC indicating that pregnancy may relate to higher than usual SOC especially among women with psychological distress. Understanding how expecting mothers and fathers experience SOC during pregnancy, particularly in relation to depressive symptoms, helps midwives and maternity care providers to focus health promoting support more precisely.

Positive mental health and sense of coherence among emergency medical service professionals

Background

Positive mental health (PMH) is a construct used to define and evaluate health from a positive perspective. Healthcare professionals in the emergency ambulance service are more likely to experience mental health disorders than the overall population. The demographic and occupational variables and Sense of Coherence (SOC) can act as predictors of PMH and can serve as protective elements against stress and demanding situations in the work environment.

Objective

This study aimed to evaluate PMH and its relationship with demographic and occupational variables and determine if SOC is a predictive variable for PMH in health professionals working in the emergency ambulance service.

Methods

A descriptive, cross-sectional, and correlational study was conducted with a sample of 406 healthcare professionals from the emergency ambulance service in eight health regions of Catalonia, Spain. The following variables were analyzed: Age, biological sex, household members, dependents family members, professional category, type of contract, job satisfaction and sense of collaboration with other institutions. The following assessment instruments were used: Positive Mental Health Questionnaire and Sense of Coherence scale.

Results

High scores were obtained in Positive Mental Health (PMH). Study participants who reported feeling completely satisfied in their work also showed a significant relationship with all PMH factors: greater satisfaction with their personal life, in their helpful prosocial attitude toward others, in their capability to deal effectively with stress and navigate conflict scenarios, in their ability to solve problems and self-realization, greater empathy and ability to understand the feelings of others, greater ability to establish interpersonal relationships. Comprehensibility, as a dimension of SOC, was identified as a predictor for some factors of PMH: a greater personal satisfaction, self-control, autonomy, interpersonal skills and total PMHQ. More than 43% of positive mental health in health professionals is explained by higher Meaningfulness and Comprehensibility values of the SOC, the absence of dependent family members and having a non-graduate background.

Conclusion

Healthcare workers in the emergency ambulance service had high PMH. Meaningfulness (ME) and Comprehensibility (C), dimensions of SOC, were identified as model predictors of greater PMH, showing higher scores in most of PMH factors. To enhance SOC as a mental health promotion measure, resilience programs should be implemented to help professionals develop skills to face and overcome adverse situations. Educating in stress management thought networks are key elements to strengthen SOC. Managers in emergency medical services play a key role in transforming healthcare work environments to promote positive outcomes in the mental health of their healthcare workers.

Meaningfulness and mortality: exploring the sense of coherence in Eastern Finnish men

AIMS

The sense of coherence scale has been shown to have an epidemiological relationship with mortality. This study aimed to investigate how the three components of sense of coherence (meaningfulness, comprehensibility and manageability) and the individual items of these components relate to mortality.

METHODS

Eastern Finnish men (n=2315) aged 42-60 years at baseline in the 1980s completed a 12-item sense of coherence scale and were followed for 25 years, on average, until death or until the end of 2019. Hazard ratios for mortality were calculated using two models: one adjusted for age and the second for an additional 12 mortality risk factors.

RESULTS

Of the three sense of coherence components, only meaningfulness was associated with all-cause mortality, and in the fully adjusted model, those in the weakest tertile had a 1.14 (95% confidence interval 1.01-1.29, P=0.042) times higher hazard ratio for mortality than those in the strongest tertile. Of the individual sense of coherence items, only the first question, 'How often do you have the feeling that you really don't care about what is going on around you?', was associated with all-cause mortality, and in the fully adjusted Cox model, the hazard ratio of weak versus strong was 1.18 (95% confidence interval 1.03-1.36, P=0.020).

CONCLUSIONS

The sense of coherence component related to meaningfulness, including its first item, 'Caring about what goes on around you', plays a significant role in the association with mortality among middle-aged men in Eastern Finland. This item should be considered a noteworthy patient-reported variable when predicting mortality in public health settings.

Evidence of internal construct validity of SOC-13 total score, for use in hand therapy

PURPOSE

The objective was to examine whether the 13-item Sense of coherence scale (SOC-13) can be reported as a unidimensional interval-scale metric, when new approaches based on the Rasch model to address local item dependency are applied, and to determine whether an interval-scale scoring can be made available.

METHODS

Data were derived from two samples of patients with hand-related disorders (merged n = 915). Rasch analyses of the SOC data were conducted using item-level analysis and a testlet approach.

RESULTS

Initial item-level analysis of the SOC-13 confirmed previous findings of misfit to the Rasch model. In resolving local dependency by constructing three testlets, which corresponded to the three components of the SOC construct, fit to the Rasch model (χ2(df) = 43.11 (27), p = 0.163) and unidimensionality of the SOC-13 could be established. A transformation table was successfully created to convert the SOC-13 raw ordinal score to corresponding Rasch interval-scaled values.

CONCLUSIONS

The results of this study indicate that data obtained by the SOC-13 can be regarded as essentially unidimensional, and an interval-scale transformation table of the SOC-13 total scores was developed, for use in clinical practice and research on coping resources in patients with hand-related disorders.

Sense of coherence in a general adult population in Northern Norway and its associations with oral health

BACKGROUND

Sense of coherence (SOC) is a global orientation to life that may affect a person's way of acting and living within his or her life context, which can have an impact on general and oral health. The aims of this study were (i) to describe the distribution of SOC in a general adult population; (ii) to explore whether sociodemographic characteristics, oral health-related behaviours, self-reported oral health, and clinical oral status were associated with SOC; and (iii) to explore whether SOC was associated with self-reported oral health, controlling for sociodemographic characteristics, oral health-related behaviours, and oral clinical status.

METHODS

This study was based on data from the cross-sectional population-based study Oral Health in Northern Norway (N = 1819 individuals, 923 women, mean age 47.1 ± 15.2 years). Data were collected between October 2013 and November 2014 in Troms County. Participants answered a questionnaire that included items on SOC, sociodemographic characteristics, oral health-related behaviours, and self-reported oral health. Clinical oral status (number of teeth, dental caries, and periodontal status) was determined through oral and radiographic examination. Linear regression analysis was used to examine factors associated with SOC. Logistic regression analysis was used to examine SOC and its association with self-reported oral health adjusted for sociodemographic characteristics, behaviours, and clinical oral status.

RESULTS

The mean SOC score was 68.5 (standard deviation 10.5). The younger age groups (20-29 and 30-39 years) had mean SOC scores of 64.0 (95% CI: 62.7,65.3) and 67.2 (95% CI: 66.0,68.5), respectively, and the older age groups (40-79 years) had mean SOC scores between 69.8 and 70.1 (95% CI: 68.2,71.3). A higher mean SOC score was associated with older age, higher education level, higher income (all p < 0.001), being married/cohabiting (p = 0.005), and toothbrushing ≥ 2 times/day (p = 0.008). Approximately 49% of participants reported good oral health. SOC was positively associated with self-reported good oral health in the adjusted model (odds ratio:1.03 [95% CI: 1.02,1.05] p < 0.001).

CONCLUSIONS

SOC was associated with sociodemographic characteristics and toothbrushing habits. There was no significant association between SOC and clinical oral status; however, SOC was positively associated with self-reported good oral health. This indicates that a person's SOC might have an impact on how an individual perceives their oral health, independent of sociodemographic characteristics and the presence of oral diseases.

Change in sense of coherence mediates the association between economic recession and mortality among middle-aged men: A population-based cohort study from Eastern Finland

A financial recession has been associated with a decrease in all-cause mortality, but little is known about how psychosocial fluctuations in stress tolerance or orientation to life affect this association. Sense of Coherence (SOC) is a core construct in the Salutogenic Model of Health and is determined by generalized resistance resources and measures one's orientation to life by comprehensibility, manageability, and meaningfulness. We followed the mortality of a cohort of middle-aged Finnish men (n = 854) from the 1980s to the end of 2019. The cohort baseline was stratified into four age groups at baseline: 42, 48, 54, and 60. SOC was measured twice, at the baseline and at the 11-year follow-up visit. Between these SOC measurements, Finland confronted a deep financial recession, the effects of which were examined at the follow-up visit by questionnaires related to economic hardship (sum of nine items) and experience of the recession (one item). Using age group, marital status, employment status, and education as covariates, the change in SOC mediated both the economic hardship and the experience of recession relations to mortality: the indirect effects -19.57 (95% CI -43.23 to -0.92), and -26.82 (95% CI -59.52 to -0.61), respectively. Every one-point increase in economic hardship predicted about 2 and a half weeks shorter life expectancy, and those who experienced very strong disadvantages of economic recession had about 3 and a half months lower life expectancy by the end of 2019 than those who fully avoided the disadvantages. Furthermore, the younger age groups, 42 and 48, experienced the recession more severely than the older groups, 54 and 60. We conclude that following how orientation to life changes among middle-aged might be an informative approach after a recession.

Sense of coherence and religion/spirituality: A systematic review and meta-analysis based on a methodical classification of instruments measuring religion/spirituality

The coherence hypothesis assumes that sense of coherence (SOC) explains the positive link between religion/spirituality (R/S) and mental health. The aim of our meta-analysis is to evaluate the evidence for the association between SOC (sensu Antonovsky) and different aspects of R/S and thus to contribute to the verification of the coherence hypothesis. Eighty-nine English- and German-language primarily cross-sectional studies with 67,913 participants met the inclusion criteria. The R/S scales of all included studies were subjected to item-by-item qualitative content analysis in order to determine whether scales do actually measure religion or spirituality and which R/S aspects dominated the instrument. Based on this classification, overall and subgroup meta-analyses were conducted using a random effects model. The adjusted effect size between SOC and all positive R/S measures was r+ = .120, 95% CI [.092, .149]. Particularly significant (r+ < -.180 or > .180) were correlations with negative R/S scales (r+ = -.405, 95% CI [-.476, -.333]), R/S instruments measuring primarily positive emotions (r+ = .212, 95% CI [.170, .253]) or meaning-making (r+ = .196, 95% CI [.126, .265]). Both sample characteristics (age, culture, gender, health status, religious affiliation) and study characteristics (e.g., publication year) had a moderating effect on the R/S-SOC connection. The correlation was particularly high in studies from Southern Asia (r+ = .226, 95% CI [.156, .297]), the African Islamic cultural value zone (r+ = .196, 95% CI [.106, .285]), and in a small subgroup of Iranian studies (r+ = .194, 95% CI [.117, .271]). The results confirm that R/S and SOC are clearly associated and suggest that there are different religious/spiritual pathways to a strong SOC. The strength of the associations presumably depends not only on individual differences, but also on cultural embeddedness and social plausibility of R/S. Trial registration. PROSPERO registration number: CRD42021240380. https://www.crd.york.ac.uk/prospero/display_record.php?ID = CRD42021240380.

A high sense of coherence can mitigate suicidal ideation associated with insomnia

BACKGROUND

The present study aimed to investigate whether insomnia is associated with suicidal ideation (SI) among Japanese workers by conducting a multi-level analysis with sense of coherence (SOC) as a random effect.

PARTICIPANTS AND PROCEDURE

A cross-sectional survey was conducted among 19,481 workers in Tsukuba, Japan. Data from 7,175 participants aged 20-65 years were included in the analysis. The Athens Insomnia Scale (AIS) was used as the independent variable, and SI over the past year was used as the dependent variable. SOC was measured using the five-point SOC-13 scale, and socioeconomic and health factors were investigated as covariates. Participants were divided into three groups (low, medium, and high) based on their SOC scores. Multilevel logistic regression analysis was performed to calculate odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

In the high-SOC group, only one person had SI. In a multi-level logistic analysis that excluded the high SOC group, insomnia was found to be associated with SI (OR = 2.26, 95% CI [1.75, 2.93]). Furthermore, the AIS sub-items "Final awakening earlier than desired" (OR = 1.26, 95% CI [1.05, 1.50]) and "Sense of well-being during the day" (OR = 1.63, 95% CI [1.34, 1.99]) were associated with SI. 8.95% or 11% of the variation in the presence or absence of SI was found to be explained by differences between SOC groups.

CONCLUSIONS

The study highlights that insomnia is associated with SI, and that high SOC may reduce SI even under insomnia. Future longitudinal studies are needed to confirm whether high SOC reduces SI due to insomnia.

Sense of coherence mediates perceived social support and depressive and anxiety symptoms in cervical cancer patients: a cross-sectional study

BACKGROUND

Depression and anxiety symptoms are two common psychological disturbances in cervical cancer patients. We tested whether sense of coherence (SOC) mediates the association of perceived social support (PSS) with depression and anxiety symptoms among cervical cancer patients in China.

METHODS

We conducted a survey involving 294 cervical cancer patients aged ≥ 18 years from July to December 2020 at three hospitals in Liaoning Province, China; 269 patients completed the survey. We included a demographic questionnaire, the Multidimensional Scale of Perceived Social Support (MSPSS), Antonovsky's Sense of Coherence Scale, the Hamilton Depression Rating Scale, and the Zung Self-Rating Anxiety Scale (SAS) in this study. We used hierarchical regression analysis to examine the relationship among PSS, SOC, and symptoms of depression and anxiety. We used asymptotic and resampling strategies to explore the mediating effect of SOC.

RESULTS

PSS was negatively associated with depressive symptoms (r = - 0.439, P < 0.01) and anxiety symptoms (r = - 0.325, P < 0.01). SOC was negatively related to depressive symptoms (r = - 0.627, P < 0.01) and anxiety symptoms (r = - 0.411, P < 0.01). SOC partially mediated the association between PSS and depressive symptoms (a*b = - 0.23, BCa95% CI: [- 0.31, - 0.14]) and anxiety symptoms (a*b = - 0.15, BCa95% CI: [- 0.23, - 0.08]). The proportions of the mediating effect accounting for SOC were 49.78% and 41.73% for depressive symptoms and anxiety symptoms, respectively.

CONCLUSION

The study showed that SOC could mediate the association between PSS and symptoms of depression and anxiety. This suggests that SOC might serve as a potential target for intervention in symptoms of depression and anxiety that accompany cervical cancer.

The relationship between sense of coherence and mental health problems from childhood to young adulthood: A meta-analysis

BACKGROUND

Sense of coherence (SOC) as the key component of the salutogenesis framework is negatively correlated with mental health problems in adults but also in children and adolescents. Since SOC is conceptualized to develop and stabilize from childhood to young adulthood, these life phases are of critical importance for the salutogenesis concept. Individual studies examining SOC's link with mental health at younger ages yielded heterogeneous effect size estimates. Thus, the present meta-analysis is the first to quantify the current state of evidence on the association between SOC and mental health problems.

METHODS

The random-effects multi-level meta-analysis followed PRISMA guidelines and was based on 57 studies (70 samples) comprising 41,013 participants. Weighted mean age of participants was 15.46 years and 50.4 % were female.

RESULTS

The mean correlation (r) between SOC and overall mental health problems was M(r) = -0.46, 95 % CI [-0.53, -0.39]. However, there was substantial heterogeneity between studies, while differences between symptom types were smaller. Subsequent moderator analyses showed that higher sample age was associated with more negative relationships and higher internal consistencies of SOC measures. Moreover, internalizing symptoms, depressive symptoms, and feelings of loneliness showed a stronger negative association with SOC than psychosomatic symptoms.

LIMITATIONS

Our findings on age-related differences were based on (repeated) cross-sectional data and require replication in longitudinal studies.

CONCLUSIONS

Results yielded a negative association between SOC and mental health problems with increasing magnitude from childhood to young adulthood. Thus, SOC-fostering interventions may help to buffer negative effects of stress and improve resilience starting from early ages.

Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms- a longitudinal cohort study in Nepal

BACKGROUND

The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal.

METHODS

A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression.

RESULT

In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45^th postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant.

CONCLUSION

Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.

Calling as a resource for health and occupational wellbeing among the care sector workers in Finland

BACKGROUND

The salutogenic approach in workplace health promotion emphasizes resources to gain and maintain good health and wellbeing. One of these resources could be calling, but its relation to the salutogenic approach is unknown.

OBJECTIVE

To explore the associations between salutogenic measures of health and occupational wellbeing and calling among workers from the care and educational sectors.

METHODS

A cross-sectional survey was conducted in Autumn 2020 among Finnish public and private sector care workers. A total of 7925 workers responded. Descriptive analyses and analysis of variance were used for the data analysis.

RESULTS

Salutogenic measures of health and occupational wellbeing correlated strongly mutually, and both correlated moderately with calling. Workers aged over 55 years, workers acting in the education sector, workers with superior positions and temporary workers had the highest scores on health, occupational wellbeing and calling. When comparing occupational wellbeing dimensions by profession, managers had the highest scores and nurses the lowest.

CONCLUSIONS

This study provides knowledge of promotive factors and health and occupational wellbeing resources for workplace health promotion in the care sector. Perceived calling in work can be considered a salutogenic resource for overall health and wellbeing; however, these connections should be further studied.

Association between Physical Fitness, Physical Activity Level and Sense of Coherence in Swedish Adolescents; An Analysis of Age and Sex Differences

INTRODUCTION

The aim of this study was to investigate the association between physical fitness, physical activity, and sense of coherence (SOC) in Swedish adolescents (n = 2028 males, n = 1287 females) aged 14 to 18 using a cross-sectional design.

METHODS

Using the Swedish Physical power Mental harmony and Social capacity (FMS) student profile, participants performed physical tests measuring their cardiovascular ability (CV) and muscular strength. Questionnaires were used to measure physical activity levels (PA), the participation in organized physical training, sedentary behavior (SB), screen time, and SOC value. Multiple linear regression analyses were used to analyze the association between SOC and independent variables.

RESULTS

The regression analyses explained a small, shared variance between SOC and the independent variables in boys (4.3%) and girls (3.3%). SB showed a positive association with SOC both in girls (β = 0.114, p = 0.002) and boys (β = 0.109, p = 0.013). Abdominal strength was positively associated, while VO₂max was inversely associated, with SOC (β = 0.113, p = 0.022; β = -0.109, p = 0.026, respectively) in boys. Girls had poorer fitness than boys did across all age groups except at age 18. PA levels decreased from age 14 to 18 in girls and boys, but without differences between sexes. Abdominal strength decreased from age 14 to 18 in girls and boys. In general, girls had lower SOC than boys across all age groups.

CONCLUSIONS

Poor sedentary behavior was significantly associated with weaker SOC for both genders, indicating overall physical activity as the most important factor for stronger SOC. However, emotional support in vulnerable environments may have a bigger impact than physical activity or sedentary behavior on the SOC value for adolescents.

Long-term changes in sense of coherence and mortality among middle-aged men: A population -based follow-up study

Sense of coherence (SOC) scale measures one's orientation to life. SOC is the core construct in Antonovsky's salutogenic model of health. It has been shown that weak SOC correlates with poor perceived health, low quality of life, and increased mortality. Some studies have indicated that SOC is not stable across life, but there are no previous studies on how a change of SOC is reflected in mortality. However, there is some evidence that a change in perceived quality of life is associated with mortality. The study explores the association between the change in SOC and mortality using longitudinal data from a cohort of middle-aged Finnish men recruited between 1986 and 1989. Approximately 11 years after the baseline examinations, between 1998 and 2001, 854 men returned the SOC questionnaire a second time. The baseline SOC was adjusted for the regression to the mean phenomenon between the two measurements. The hazard ratios of the SOC difference scores were adjusted for initial SOC age and 12 somatic risk factors of mortality (alcohol consumption, blood pressure, body mass index, cholesterol concentration, physical activity, education, smoking, marital status, employment status, history of cancer, history of cardiovascular disease and diabetes). SOC was not stable among middle-aged Finnish men and a decline in SOC was associated with an increased hazard of all-cause mortality. In the fully adjusted model, a decrease of one standard deviation (SD) of the SOC mean difference increased the mortality hazard by about 35 %, two SDs decrease about 70 %, and 2.5 SDs about 100 %. Strengthening SOC showed a limited association with decreasing mortality hazards in the age-adjusted model. Policies, strategies, or plans, supporting SOC in the middle-age may help to decrease mortality and increase quality of life in later years.

Sense of Coherence as a Mediator in the Association Between Empathy and Moods in Healthcare Professionals: The Moderating Effect of Age

While empathy is considered a critical determinant of the quality of medical care, growing evidence suggests it may be associated with both one’s own positive and negative moods among healthcare professionals. Meanwhile, sense of coherence (SOC) plays an essential role in the improvement of both psychological and physical health. Reportedly, individual SOC reaches full stability after around age 30. The aim of this study was first to evaluate the mediatory role of SOC on the association between empathy and individual moods among 114 healthcare professionals in a general hospital, and then to examine the moderating effect of age on this association. Participants completed a range of self-report demographic questionnaires, Empathy Process Scale (EPS), the 13-item Antonovsky’s SOC, and Profile of Mood States (POMS). Findings showed that SOC mediated the relations between empathy (EPS) and both POMS-Vigor (POMS-V: self-vigor mood) and POMS-Depression (POMS-D: self-depression mood). Notably, moderated mediation analysis revealed that there was a significant interaction (age × SOC) on self-vigor mood (POMS-V) in healthcare professionals. The indirect effect of empathy (EPS) on self-vigor mood (POMS-V) through SOC was significant at over mean age “32.83.” Although there was no significant interaction with age regarding the indirect effect of empathy (EPS) on self-depression mood (POMS-D), in the sub-category level analysis of empathy (EPS), we found a significant interaction item [age × empathy for other’s negative affect (EPS-N)] on SOC. This indirect effect was also significant at over mean age “32.83.” Taken, together, the current study highlighted the significant mediator of SOC on that empathy amplifies self-vigor mood and attenuates self-depression mood as a protective factor among the Japanese healthcare professionals. Some components of these processes may depend on the moderating role of age, indicating that we may need to consider the SOC development with age for more effective empathy performance interventions among healthcare professionals.

Analysis of the psychometric properties of the Sense of Coherence scale (SOC-13) in patients with cardiovascular risk factors: a study of the method effects associated with negatively worded items

Purpose

The objectives of this study were to analyze the psychometric properties of the Sense of Coherence scale (SOC-13), determine the role of the method effect in the performance of the instrument, and identify the relationship with health perception, quality of life, and sleep quality in patients at cardiovascular risk.

Methods

The final sample consisted of 293 patients at cardiovascular risk, with a mean age of 61.9 years (SD = 8.8), 49.8% of whom were women. The SOC-13, the Patient Health Questionnaire (PHQ-9), and the Medical Outcomes Study-Sleep Scale (MOS-Sleep) were administered. In addition, the participant's self-perceived health and quality of life were also evaluated. All analyses were carried out with SPSS 26.0 and EQS 6.1 statistical software.

Results

The results showed adequate reliability for the SOC-13, with a Cronbach's alpha of .789. The fit of the structures was not adequate in any of the cases (.26 to .62 for one factor, .26 to.73 for three factors, .20 to .54 for one second-order factor, and .25, .42, and .54 for three first-order factors). The three structure models showed an improved fit when adding a latent factor resulting from the method effect (.6 to .85 for one factor, .11 to.90 for three factors, and .11 to .96 for one second-order factor). Moreover, positive correlations were found with health perception, perceived quality of life, and perceived sleep quality.

Conclusion

The SOC-13 is a suitable instrument for patients with cardiovascular risk in Spain, and it is also an indicator of health perception, quality of life, and perceived quality of sleep. Control of the method effect improves the fit of the instrument’s structure. As a future direction, it is recommended to conduct new studies in this and other samples and using different versions of the SOC.

Trial registration

International Standard Randomized Controlled Trial Number: ISRCTN76069254, 08/04/2015 retrospectively registered.

Measurement Invariance of the SOC-13 Sense of Coherence Scale Across Gender and Age Groups

Abstract. Sense of coherence (SOC) describes an individual’s ability to deal with life challenges (manageability), comprehend the environment (comprehensibility), and perceive life and its challenges as meaningful (meaningfulness). We examine measurement invariance (MI) of the SOC-13 scale across gender and age groups in a matched sample of N = 1,816 (50% females; age range 16–83 years). A two-factor model, with a common factor for manageability/comprehensibility items and a second factor for meaningfulness items, best represented the SOC-13 in all groups. Full metric, partial scalar, and full strict invariance held across gender groups. Across age groups, full metric, partial scalar, and partial strict invariance could be established. We conclude that SOC-13 is a reliable and valid measure. Measurement is comparable across gender and age.

Association Between Sense of Coherence and Health Outcomes at 10 and 20 Years Follow-Up: A Population-Based Longitudinal Study in Germany

Background: The sense of coherence (SOC) is reported to influence health, but health may also have an impact on SOC. The objective of this study was to examine the longitudinal associations between SOC and selected self-reported and physician-assessed health outcomes over a period of 10 and 20 years and to determine the predominant direction of the associations.

Methods: We conducted a population-based, longitudinal study, involving 392 participants (188 females and 204 males; mean age 43.01 years) who were followed for a median of 10 and 18 years. Analyses of variance were carried out to examine the longitudinal associations between SOC at baseline and health outcomes (i.e., self-rated health status, SHS; physical health status assessed by a physician, PHS; self-reported satisfaction with life, SWL) at follow-ups. The direction of associations was examined using a cross-lagged model on correlation coefficients.

Results: There were significant group effects for SOC at baseline on SHS at 20-year follow-up (F = 4.09, p = 0.018, ηp² = 0.041), as well as on SWL at 10-year (F = 12.67, p < 0.01, ηp² = 0.072) and at 20-year follow-up (F = 8.09, p < 0.1, ηp² = 0.069). SHS (r = 0.238, p < 0.01), PHS (r = −0.140, p < 0.05) and SWL (r = 0.400, p < 0.01) predicted SOC at 10-year follow-up stronger than vice versa. The direction of associations between SOC and health parameters at 20-year follow-up was less consistent.

Conclusions: The long-term associations between SOC and self-reported and physician-assessed health may be reciprocal in community-dwelling adults. More research is needed to examine the predictive power of health on SOC and whether interventions targeted at improving health parameters, may impact SOC.

The Persian irrational performance beliefs inventory (iPBI-Persian): Translation, confirmatory factor analysis, and test–retest reliability, in Iranian athletes

This paper reports the development and initial validation of the Persian language Irrational Performance Beliefs Inventory (iPBI-Persian). The original iPBI was developed to provide a validated measure of the four core irrational beliefs of rational emotive behavior therapy (REBT) within performance-based samples, such as athletes. Data retrieved from 334 athletes (169 men, 165 women, Mage = 21.52 ± 4.00 years) were analyses using SPSS and LISREL software packages. After the linguistic and cross-cultural adaptation processes, confirmatory factor analysis (CFA) results showed that six items did not have acceptable factor loadings. After removal of problem items, a 22-item version was developed (CFI = 0.96). The iPBI-Persian demonstrated excellent levels of reliability, with internal consistency and test–retest reliability, as well as construct validity. This paper indicates that the 22-item iPBI-Persian can be used as a self-assessment instrument to evaluate irrational performance beliefs in Iranian athlete samples.

Sense of coherence and coping strategies: How they influence quality of life in Iranian women with breast cancer

Aim

To investigate the mediation/moderation effect between Coping Behaviors (CBs) and Sense of Coherence (SOC) in the prediction of health‐related quality of life (HRQoL) in breast cancer patients.

Design

Cross‐sectional.

Methods

A total of 221 patients were included in this study. The 13‐item Orientation to Life Questionnaire, Brief COPE and Functional Assessment of Cancer Therapy—Breast were investigated. Pearson's correlation coefficient and mediation/moderation analysis were performed.

Results

Significant correlations were observed for SOC, active coping, acceptance, positive reframing (PR), planning, use of emotional support (UES), use of instrumental support, behaviour disengagement and self‐blame with HRQoL. Except for planning and acceptance, SOC partially mediated the CBs' effect on HRQoL. The UES and PR's effects on HRQoL were significant at lower SOC levels and diminished at higher SOC levels.

Conclusion

Practitioners can incorporate SOC and adaptive CBs, including PR and UES, into the rehabilitation programmes to improve HRQoL in patients.

Sense of Coherence and Coping Strategies in Patients With Dysphonia

AIM

To analyze sense of coherence (SOC) of dysphonic individuals considering the type and degree of dysphonia, coping strategies, and sociodemographic variables.

METHODS

This cross-sectional study was performed with 50 dysphonic individuals under follow-up at a Brazilian Speech-Language Pathology Clinic. They answered a questionnaire with sociodemographic information, the PEED-10 (Brazilian Voice Disability Coping Questionnaire) and the Brazilian version of Sense of Coherence scale. The SOC was categorized as high or low using Cluster analysis. After descriptive analysis, data were analyzed through both the bivariate and multivariate logistic regression model method and the Spearman's correlation test (P< 0.05).

RESULTS

Most individuals presented a high SOC (60%). Individuals with mild dysphonia were 7.00 times more likely to present high SOC (95% CI = 1.24-39.38).  Individuals between 45 and 70 years old were 5.03 times more likely to present high SOC (95% CI = 1.25-20.28). In addition, the higher SOC, as well as the scores of manageability domain, the lower the use of strategies focused on emotion.

CONCLUSION

Patients with mild dysphonia are more likely to have a high SOC. The same goes for individuals over the fourth decade of life. Also, the greater the SOC, the fewer emotional strategies are used to cope with dysphonia.

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.

Parent Management Training Oregon Model and Family-Based Services as Usual for Behavioral Problems in Youth: A National Randomized Controlled Trial in Denmark

This randomized control trial used intent-to-treat analyses to compare parent management training-Oregon model (PMTO) (N = 64) to family-based services as usual (SAU) (N = 62) in 3.5-13-year-old children and their families in Denmark. Outcomes were parent report of child internalizing and externalizing problems, parenting efficacy, parenting stress, parent sense of coherence, parent-report of life satisfaction, and parental depressive symptoms. Outcomes were measured at pretreatment, post-treatment, and 18-20 months post-treatment. Results demonstrated that both PMTO and family-based SAU resulted in significant improvements in child externalizing and internalizing problems, parenting efficacy, as well as parent-reported stress and depressive symptoms, life satisfaction, and aspects of sense of cohesion. Effect sizes at post-treatment and follow-up were in the small to moderate range, consistent with prior PMTO evaluations. However, there were no significant differences between PMTO and family-based SAU. Further research on the process and content of family-based SAU is needed to determine how this approach overlaps with and is distinct from PMTO.

Leisure behavior and sense of coherence in the context of depression

AIMS

Improved sense of coherence (SOC) can protect health among individuals with depression. Literature suggests that leisure behavior can improve SOC, yet empirical studies are lacking. The current study aimed to examine whether leisure behavior was associated with SOC and depression.

METHODS

A cross-sectional online survey method was used with a sample of community-living adults (62% female, age 18-75 years) with a self-reported current or historical diagnosis of depression recruited from four different depression-related populations.

RESULTS

The results of structural equation modeling found that leisure behavior predicted greater SOC as well as lower depressive symptoms. Greater SOC was associated with lower perceived stress and lower depressive symptoms. The total effect size, including both direct and indirect association between leisure behavior and depressive symptoms was 0.452.

CONCLUSION

The findings suggested the potential benefits of leisure behavior on SOC and depressive symptoms.

Relationship between sense of coherence, health and work engagement among nurses

AIM

To examine the sense of coherence among registered nurses and its relationship with health and work engagement.

BACKGROUND

Sense of coherence is a global orientation to view life as structured, manageable and meaningful and have the capacity to cope with stressful situations. A high sense of coherence score indicates that an individual can understand, manage and attribute meaning to events in his or her life as well as in the work environment. Registered nurses face many workplace stressors that may be easier to manage with a strong sense of coherence; however, the effect of this score on their self-reported health status and work engagement remains unknown.

METHODS

In a cross-sectional study, 109 registered nurses working in a long-term care setting responded to a self-administered questionnaire. Social support, work-related family conflicts, sense of coherence, self-reported health status and work engagement variables were analysed using multiple linear regression models.

RESULTS

Nurses with a high sense of coherence score reported no work-related family conflicts (mean difference -6.91; 95% CI -10.65 to -3.18; p = .000), better health (r = .408) and greater work engagement (r = .223), compared to their peers with lower sense of coherence. The association between sense of coherence and self-reported health was confirmed by linear regression modelling (β = .276, p = .003).

CONCLUSIONS

Nurses with a higher sense of coherence had better health and greater work engagement. The work engagement variable showing the highest association with sense of coherence was dedication.

IMPLICATIONS FOR NURSING MANAGEMENT

Implementing interventions that increase sense of coherence among nurses can increase commitment to their work, to the institution and to building more engaged teams.

Can We Rely on Self-Assessments of Sense of Coherence? The Effects of Socially Desirable Responding on the Orientation to Life Questionnaire (OLQ) Responses

A large number of studies in health psychology have shown that sense of coherence (SOC) is an essential factor in wellbeing and health. SOC is most commonly measured with the Antonovsky’s Orientation to Life Questionnaire (OLQ), which has been so far translated into at least 48 languages. Despite the vast popularity of the OLQ, the relationships between OLQ and socially desirable responding (impression management and self-deception) have not been studied. The purpose of the present study was to investigate the correlations between social desirability and Antonovsky’s OLQ. Method: The first sample consisted of 423 students who completed the 13-item OLQ and the Eysenck Personality Questionnaire (EPQ), including the Lie scale. Also, the Balanced Inventory for Desirable Responding by Paulhus was administered together with the OLQ to 202 students. Results: SOC correlated positively with measures of social desirability among men but not among women. Hence, sex moderated the relationship between socially desirable responding and sense of coherence. Conclusions: Socially desirable responding and, especially, self-deception are positively related to high scores in SOC among men but not among women. The OLQ as a measure of sense of coherence can be used among women without worrying about the bias caused by socially desirable responding. When using the OLQ among men, the strong relationship between self-deception and sense of coherence should be taken into account.

Association between adverse childhood experiences and adult diseases in older adults: a comparative cross-sectional study in Japan and Finland

OBJECTIVE

We aimed to examine the association between adverse childhood experiences (ACEs) and diseases in older adults in Japan and Finland.

DESIGN

Cross-sectional comparative study.

SETTING

Data from a gerontological study in Japan and two public health studies in Finland were evaluated.

PARTICIPANTS

A total of 13 123 adults (mean age, 69.5 years) from Japan and 10 353 adults (mean age, 64.4 years) from Finland were included in this study. Logistic regression was used to examine the association of each of, any of and the cumulative number of ACEs (parental divorce, fear of a family member and poverty in childhood; treated as ordered categorical variables) with poor self-rated health (SRH), cancer, heart disease or stroke, diabetes mellitus, smoking and body mass index. Models were adjusted for sex, age, education, marital status and working status.

RESULTS

Of the respondents, 50% of those in Japan and 37% of those in Finland reported having experienced at least one of the measured ACEs. Number of ACEs was associated with poor SRH in both countries, and the point estimates were similar (OR: 1.35, 95% CI: 1.25 to 1.46 in Japan; OR: 1.34, 95% CI: 1.27 to 1.41 in Finland). Number of ACEs was associated with the prevalence of cancer, heart disease or stroke, diabetes mellitus, current smoking and an increase in body mass index in both countries.

CONCLUSIONS

The association between ACEs and poor SRH, adult diseases and health behaviours was similar among older adults in both Japan and Finland. This international comparative study suggests that the impact of ACEs on health is noteworthy and consistent across cultural and social environments.

Cross-Cultural Evaluation of Antonovsky’s Orientation to Life Questionnaire: Comparison Between Australian, Finnish, and Turkish Young Adults

Antonovsky’s concept “sense of coherence” (SOC) and the related measurement instrument “The Orientation to Life Questionnaire” (OLQ) has been widely applied in studies on health and well-being. The purpose of the present study is to investigate the cultural differences in factor structures and psychometric properties as well as mean scores of the 13-item form of Antonovsky’s OLQ among Australian (n = 201), Finnish (n = 203), and Turkish (n = 152) students. Three models of factor structure were studied by using confirmatory factor analysis: single-factor model, first-order correlated-three-factor model, and the second-order three-factor model. Results obtained in all three countries suggest that the first- and second-order three-factor models fitted the data better that the single-factor model. Hence, the OLQ scoring based on comprehensibility, manageability, and meaningfulness scales was supported. Scale reliabilities and inter-correlations were in line with those reported in earlier studies. Two-way analyses of variance (gender × nationality) with age as a covariate showed no cultural differences in SOC scale scores. Women got higher scores on the meaningfulness scale than men, and age was positively related to all SOC scale scores indicating that SOC increases in early adulthood. The results support the three-factor model of OLQ which thus should be used in Australia, Finland, and Turkey instead of a single-factor model. Need for cross-cultural studies taking into account cultural correlates of SOC and its relation to health and well-being indicators as well as studies on gender differences in the OLQ are emphasized.

Evaluation of the revised sense of coherence scale in a representative German sample

Background and objectives

To evaluate the Revised Sense of Coherence (SOC-R) scale in a large representative German sample.

Design

A nationwide household survey involving a total of 2510 face-to-face interviews.

Methods

In addition to the SOC-R, childhood trauma and maltreatment (CTM), lifetime traumatic events (Childhood Trauma Questionnaire, CTQ, and the Life Events Checklist for DSM-5, LEC-5), and mental health (Patient Health Questionnaire, PHQ-4) were assessed.

Results

The final sample consisted of N = 2373 participants (52.3% females; M = 48.24 years). Confirmatory factor analyses confirmed a three-factor structure for the SOC-R (‘manageability’, ‘balance’, ‘reflection’) with acceptable indices (RMSEA .066; 90% CI [.062, .071]). Reliability analyses revealed good internal consistency (α = .87). Construct validity was supported by significant but low correlations with psychopathology. Gender marginally influenced SOC-R (t = 1.99, p = .05). Moderation analyses revealed that SOC-R exerted a protective impact on depression in the context of CTQ (t = 2.29, p < .05) and lifetime traumatic events (t = –2.37, p < .05).

Conclusions

This study supports the psychometric properties of the SOC-R and emphasizes the importance of considering salutogenic effects to better understand interindividual differences in the effect of adversity.

Effects of a COPD self-management support intervention: a randomized controlled trial

BACKGROUND

This study examines the effects of the COPD-specific health promoting self-management intervention "Better living with COPD" on different self-management-related domains, self-efficacy, and sense of coherence (SOC).

METHODS

In a randomized controlled design, 182 people with COPD were allocated to either an intervention group (offered Better living with COPD in addition to usual care) or a control group (usual care). Self-management-related domains were measured by the Health Education Impact Questionnaire (heiQ) before and after intervention. Self-efficacy was measured by the General Self-Efficacy Scale (GSE) and SOC was measured by the 13-item Sense of Coherence Scale (SOC-13). Effects were assessed by ANCOVA, using intention-to-treat (ITT) analysis and per-protocol analysis (PPA).

RESULTS

The PPA and the ITT analysis showed significant positive changes on Constructive attitudes and approaches (heiQ) (ITT: P=0.0069; PPA: P=0.0021) and Skill and technique acquisition (heiQ) (ITT: P=0.0405; PPA: P=0.0356). Self-monitoring and insight (heiQ) showed significant positive change in the PPA (P=0.0494). No significant changes were found on the other self-management domains (heiQ), self-efficacy (GSE), or SOC (SOC-13).

CONCLUSION

Better living with COPD had a significant positive short-term effect on some self-management-related domains, and could be an intervention contributing to the support of self-management in people with COPD. However, further work is needed to establish the clinical relevance of the findings and to evaluate the long-term effects.

Social cognitive intervention reduces stress in Hungarian university students

Summary

A social cognitive intervention was developed and delivered as a credit course to improve mental distress of university students, based on findings in a previous health survey showing notable mental distress among future teachers in Hungary in 2007. The intervention included increasing information on psychoactive substances used for stress reduction; skills development in stress reduction methods; improving skills in communication and problem-solving. All students who participated in the previous health survey were targeted. Mental status of the participants was assessed by a questionnaire before (n: 128, 22% male, mean age 23.21 years) and after (n: 148, 30% male, mean age 23.54 years) the intervention. Specifically, self-efficacy as outcome was approximated by a trait measure (sense of coherence); psychological distress was measured by the 12-item General Health Questionnaire (Goldberg et al., 1997. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191–197) after the intervention compared with that before. After the intervention, psychological distress was reduced among the participants (p: 0.013). Non-significant improvement occurred in the mean score for sense of coherence (from a mean 60.8 points before to 61.4 points after, p: 0.688). The intervention produced a modest but significant decrease in psychological distress in students at a cost of 54 US$ per 1 point improvement in mental distress. The intervention, a first example of the translation of the social cognitive theory into practice among students in higher education can be integrated into the curriculum as a standardized optional course.

Development and Psychometric Evaluation of a Revised Sense of Coherence Scale

Abstract. The present study introduces a revised Sense of Coherence (SOC) scale, a new conceptualization and operationalization of the resilience indicator SOC. It outlines the scale development and aims for testing its reliability, factor structure, and validity. Literature on Antonovsky’s SOC (SOC-A) was critically reviewed to identify needs for improving the scale. The scale was investigated in two samples. Sample 1 consisted of 334 bereaved participants, Sample 2 of 157 healthy controls. The revised SOC Scale, SOC-A, and theoretically relevant questionnaires were applied. Explorative and confirmatory factor analyses established a three-factor structure in both samples. The revised SOC Scale showed significant but discriminative associations with related constructs, including self-efficacy, posttraumatic growth, and neuroticism. The revised measure was significantly associated with psychological health indicators, including persistent grief, depression, and anxiety, but not to the extent as the previous SOC-A. Stability over time was sufficient. The study provides psychometric support for the revised SOC conceptualization and scale. It has several advantages over the previous SOC-A scale (unique variance, distinct factor structure, stability). The scale could be used for clinical and health psychological testing or research into the growing field of studies on resilience over the life span.

Factors related to sense of coherence in adult patients with Type 2 diabetes

The influence of a diabetic person's sense of burden and blood sugar control through sense of coherence (SOC) on self-management has yet to be sufficiently clarified. The purpose of this study was to examine the utility of salutogenesis, which has sense of coherence at its core, for the self-management of patients with type 2 diabetes. A total of 258 questionnaires were distributed to patients who were seen at one of three hospitals in an urban area in Japan, after obtaining consent from the patient. They were between 20 and 75 years old and regularly received care. Of the 185 responses, 177 were valid. The responses were analyzed by referring to the framework of salutogenesis, and the relationship between patient characteristics, SOC, the Problem Areas In Diabetes survey (PAID), and glycosylated hemoglobin (HbA1c) were studied with structural equation modeling (SEM). SOC had a main effect on PAID scores and an indirect effect on HbA1c. Moreover, age influenced SOC positively. The SOC of patients with type 2 diabetes in the present study was comparatively high. These observations suggest a direct effect of SOC on reducing the sense of burden from having diabetes and an indirect effect on decreasing HbA1c. This research suggested the possibility that diabetes can be controlled by improving SOC.

Sense of Coherence and Gambling: Exploring the Relationship Between Sense of Coherence, Gambling Behaviour and Gambling-Related Harm

Understanding why some people experience problems with gambling whilst others are able to restrict gambling to recreational levels is still largely unexplained. One potential explanation is through salutogenesis, which is a health promotion approach of understanding factors which move people towards health rather than disease. An important aspect of salutogenesis is sense of coherence. Individuals with stronger sense of coherence perceive their environment as comprehensible, manageable and meaningful. The present study examined the relationship of individuals' sense of coherence on their gambling behaviour and experience of gambling related harm. This exploratory study utilised an archival dataset (n = 1236) from an online, cross sectional survey of people who had experienced negative consequences from gambling. In general, a stronger sense of coherence was related to lower problem gambling severity. When gambling behaviour was controlled for, sense of coherence was significantly related to the experience of individual gambling harms. A strong sense of coherence can be seen as a protective factor against problematic gambling behaviour, and subsequent gambling related harms. These findings support the value of both primary and tertiary prevention strategies that strengthen sense of coherence as a harm minimisation strategy. The present study demonstrates the potential value of, and provides clear direction for, considering sense of coherence in order to understand gambling-related issues.

Effects of a 9-month resistance training intervention on quality of life, sense of coherence, and depressive symptoms in older adults: randomized controlled trial

Purpose

(1) To determine the effects of a 9-month resistance training intervention on quality of life, sense of coherence, and depressive symptoms in older adults, and (2) to compare effects between different training frequencies.

Methods

Men and women aged 65–75 (N = 106) were randomized to four groups according to training frequency: training groups RT1 (n = 26), RT2 (n = 27), and RT3 (n = 28) and non-training control group (n = 25). All training groups attended supervised resistance training twice a week for 3 months. For the following 6 months, they continued training with different frequencies (1, 2 or 3 times per week). Psychological functioning was measured by quality of life (WHOQOL-Bref), sense of coherence (Antonovsky’s SOC-13), and depressive symptoms (Beck’s Depression Inventory II). Measurements were conducted at baseline and 3 and 9 months after baseline. The effects of the intervention were analyzed using generalized estimating equations (GEE).

Results

After 3 months, there was an intervention effect on environmental quality of life (group × time p = .048). Between 3 and 9 months, environmental quality of life decreased among RT1 compared to RT2 and RT3 (group × time p = .025). Between baseline and 9 months, environmental quality of life increased in RT2 compared to all other groups (group × time p = .011). Sense of coherence increased in RT2 compared to the control group and RT3 (group × time p = .032).

Conclusion

Resistance training is beneficial for environmental quality of life and sense of coherence. Attending resistance training twice a week seems to be the most advantageous for these aspects of psychological functioning.

Longitudinal Factor Analysis and Measurement Invariance of Sense of Coherence and General Self-Efficacy in Adolescence

Abstract. Sense of coherence (SOC) and General Self-efficacy (GSE) are trait-like self-regulatory attributes, supposedly benefitting health. Previous data on their factorial validity and longitudinal stability in adolescent samples have been inconclusive. The present study examined the factor structure, measurement invariance (MI), and stability coefficients of SOC and GSE among German adolescents in a longitudinal design over the course of nine years from age 15 to age 24. Results supported the factorial validity of both scales. GSE parameters were invariant up to the level of strict invariance, whereas for SOC partial scalar and strict invariance were attainable after modifications. Here we document reliability, validity, and factor mean changes of the SOC and GSE scales from adolescence to young adulthood. Interindividual differences in SOC were moderately stable. Though this implies limited sensitivity to intraindividual developmental changes, it qualifies SOC for long-term predictions. GSE was conspicuously less stable, raising questions about its long-term criterion validity.

Family relations, sense of coherence, happiness and perceived health in retired Taiwanese: Analysis of a conceptual model

AIM

A growing awareness of the rapidly increasing aged population in the world has led to growing attention to mental health in late life. Happiness has been emphasized as an important indicator of physical health and is predicted by a sense of coherence. However, the mechanism of influence of family relations on sense of coherence, happiness and perceived health is unknown. The present study aimed to analyze a conceptual model of the relationships among family relations, sense of coherence, happiness and perceived health in retired persons.

METHODS

A total of 142 retired participants were recruited from social service centers in Taipei, Taiwan. A structured questionnaire measuring the relationships among family relations, sense of coherence, happiness and perceived health was filled in by each respondent. Data were analyzed using structural equation modeling.

RESULTS

The results showed that family relations is positively correlated with happiness, sense of coherence and perceived health. The results also showed that good family relations and a sense of coherence predict greater happiness. The results from structure equation modeling showed that the relationship between family relations and perceived health is completely mediated by happiness and a sense of coherence, but only the indirect effect of happiness is significant. The results also showed that family relations is partially mediated by the sense of coherence to happiness.

CONCLUSIONS

In caring for retired older people, medical professionals need to increase their family relations and sense of coherence simultaneously, and then promote happiness in their interventions. Geriatr Gerontol Int 2018; 18: 154-160.

Preliminary Validation of a Short-Form Version of the Attachment Style Questionnaire for Use in Clinical Rehabilitation Counseling Research and Practice

The purpose of this study was to develop and validate a short-form version of the Attachment Style Questionnaire (ASQ) in people with disabilities. The construction sample consisted of 108 participants recruited from spinal cord injury (SCI) advocacy organizations. The cross-validation sample comprised 140 individuals with traumatic injuries recruited from a rehabilitation hospital. Measures administered were the ASQ, Trait Hope Scale, Sense of Coherence Scale, and Satisfaction With Life Scale. Results showed that the three subscales of secure, anxious, and avoidant attachment from the short-form ASQ had high correlations with the three subscales from the long-form ASQ. The reliability of the subscales for the short-form ASQ was adequate and similar to the long-form ASQ. Both the short- and long-form ASQ subscales were found to correlate with hope, sense of coherence, and subjective well-being in the expected theoretical directions. Confirmatory factor analysis also supported the three-factor measurement structure of the short-form ASQ. This study provides evidence to support the psychometric properties of the abbreviated ASQ in people with disabilities. The short-form version of the ASQ is a brief, reliable, and psychometrically sound measure of attachment that can be used in clinical rehabilitation counseling research and practice.

Norwegian and Swedish nursing students’ concerns about dying

Providing care for dying patients is demanding for nurses. The aim of this study was to investigate Norwegian and Swedish nursing students’ concerns about dying and sense of coherence in their first and third year. Further, to describe the students’ experiences of caring for dying patients during their education. Nursing students in their first and third year in Norway ( n = 64) and Sweden ( n = 79) responded to the questionnaire Concerns about Dying and Sense of Coherence Scale. Interviews were conducted with 11 students. In their third year, both groups reported reduced concerns with regard to their own death. Norwegian students with no experience in healthcare before education reported more concerns about dying patients. Caring for a dying patient was experienced as a challenge to endure, perform and learn. There is a need to develop teaching methods and to give individualized support to nursing students during their education.

A systematic review of adolescents' sense of coherence and health

The aim of this systematic review was to describe the association between adolescent sense of coherence (SOC) and health and identify the future direction for research in this area. Systematic searches were conducted (2007-2014) in the PubMed, CINAHL, PsycINFO and Cochrane electronic databases and carried out manual searches in three scientific journals. A total of 827 original papers were found and 23 were selected. Based on the results, adolescents' sense of coherence (SOC) was related to health in terms of the adolescents' quality of life, health behaviour, mental health and family relationships by using 31 different health-related instruments. In conclusion, the use of the SOC approach for adolescents can provide a useful view of their health during this transition phase to adulthood. Due to the large variation in the additional instruments used, combining and comparing the results proved challenging. More comparative and longitudinal research is needed to increase understanding of adolescents' health in relation to SOC and develop services that support both elements.

Test-retest reliability of Antonovsky's 13-item sense of coherence scale in patients with hand-related disorders

PURPOSE

To report on the distribution and test-retest reliability of Antonovsky's 13-item Sense of Coherence (SOC-13) Scale in patients with hand-related disorders (HRD). Links between the SOC-13 score and factors such as age, number of days between date of injury and start of rehabilitation, gender and educational level were explored.

METHOD

Survey with test-retest, using self-administered questionnaire. SOC-13 was completed before starting rehabilitation at an outpatient clinic after 14 days and three months. Adult patients with HRD were included.

RESULTS

A total of 170 participants completed the SOC-13 at baseline (median SOC 71, range 30-91). The Intra-class Correlation Coefficient between baseline and 14 days was 0.84 (n = 151), and baseline and three months was 0.79 (n = 113). Weak correlations were found between SOC and age rs = 0.17, p < 0.03. No correlation was found between SOC and number of days since injury rs = 0.01, p > 0.92. No difference was found in SOC score related to gender or educational level.

CONCLUSIONS

The SOC-13 scale showed reliability for patients with HRD. There was a weak connection between age and SOC without clinical relevance. SOC-13 has the potential to be a powerful tool to measure the ICF component personal factors, which could have an impact on patients' rehabilitation outcomes. Implications for rehabilitation Antonovsky's SOC-13 scale showed test-retest reliability for patients with hand-related disorders. The SOC-13 scale could be a suitable tool to help measure personal factors.

The validity and reliability of the Sense of Coherence scale among Indian university students

Background:

The importance of salutogenesis, with the focus of what creates health rather than what causes diseases, has been highlighted for a long time. This has been operationalized by Aaron Antonovsky as the Sense of Coherence (SOC-13) scale. The aim of this study was to further examine the psychometric properties of the SOC-13 in India.

Methods:

The present study was carried out among second-year degree students at three randomly chosen institutions at Mangalore University. Investigators assessed the appropriateness, relevance, comprehensiveness and understandability of the scale. Further, the scale was assessed by five subject experts. The SOC-13 was then pretested by administering it to peers, individuals and a few of the study subjects. Internal consistency was assessed by Cronbach’s alpha and split-half reliability. Test-retest reliability was assessed by administering the instrument to the same study participants after two weeks. Confirmatory factor analysis employing varimax rotation was employed.

Results:

The SOC-13 revealed a Cronbach’s alpha value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.71 and 0.70, respectively. Test-retest reliability was found to be 0.71 ( p < 0.01). Factor analysis revealed a three-factor solution explaining 40.53% of the variation in SOC.

Conclusions:

SOC-13 was found to be a reliable and valid instrument for measuring SOC in an Indian context. The present study contributes to health promotion in an Indian context, and could be useful even in other developing countries and for further research in India.