Disentangling Sense of Coherence and Resilience in case of multiple traumas

The protective role of sense of coherence in resident physicians facing secondary trauma due to patient death in intensive care-A qualitative inquiry

The salutogenic paradigm is increasingly used in research and practice but remains to be investigated in secondary trauma of health professionals. This qualitative study explored the main anchor of salutogenics, the sense-of-coherence, as a coping mechanism among resident physicians facing secondary trauma due to continuous exposure to patient suffering and deaths. Participants were sixteen resident physicians from intensive care units at emergency departments of two Israeli public tertiary hospitals. Data analysis employed reflexive thematic analysis. Findings suggest that while all residents described having comprehensibility, manageability and meaningfulness differed among residents. Some residents thrived, coped well with secondary trauma, centered on patient emotional needs, and drew meaningfulness from the challenges. Other residents suffered while providing care, reported poor well-being, were too overwhelmed to center patients, and doubted their career choices. Salutogenic-based interventions to cultivate the resilience of resident physicians experiencing secondary trauma are proposed.

The relationship between childhood gender nonconformity, aversive childhood experiences, and mental health in heterosexual and non-heterosexual cisgender men: The buffering effect of sense of coherence

Childhood gender nonconformity (CGNC) seems to be associated with more mental health problems in adulthood. Previous research has suggested that this link might be mediated via the increased risk for aversive childhood experiences (ACEs) as a negative social reaction to CGNC. However, no study yet examined the role of resilience factors in this relationship. The present study aims to address this gap by examining the potential buffering effect of sense of coherence (SOC). In a German sample of 371 cisgender men, we used mediation models to investigate the relationship between CGNC, ACEs, and mental health problems in adulthood, that is, depressive symptoms, loneliness, and suicidal behavior. We then employed moderated mediation models to examine the buffering effect of SOC on the association ACEs and mental health problems. The results showed that higher levels of CGNC were associated with more severe adult mental health problems, with this link being partially mediated by higher levels of ACEs. For depressive symptoms and suicidal behavior in the last 12 months, we found evidence of a buffering effect of SOC. Higher levels of SOC were associated with a weaker association between ACEs and mental health problems. In contrast, this effect was absent for loneliness and lifetime suicidal behavior. Our study provides evidence that ACEs partly account for the relationship between CGNC and mental health in adulthood. Moreover, we found support for SOC having a buffering effect on this link. Future studies need to examine whether SOC might be an important target for resilience training in those experiencing CGNC. However, sustainable interventions may rather address the negative social reactions to CGNC.

Definitions of resilience and resilience resource use as described by adults with congenital heart disease

Background

Adult congenital heart disease (ACHD) is a lifelong illness that presents ongoing challenges to quality of life. Fostering personal resilience resources to sustain well-being can enhance patients' psychosocial health.

Objective

We aimed to describe patients' resilience experiences: how they understand, develop, and utilize resilience resources in managing ACHD.

Methods

We conducted a qualitative study of patients with ACHD. Participants were recruited using maximum variation sampling. Individual, semi-structured interviews were conducted June 2020 to August 2021. We queried approaches to managing ACHD-related stress and experiences with resilience and analyzed responses with thematic analysis.

Results

Participant (N = 25) median age was 32 years (range 22-44); 52% identified as female and 72% non-Hispanic white. Participants' anatomic ACHD was moderate (56%) or complex (44%); physiologically, 76% were functional class C or D. Participants described various resilience resources, which map to an established resilience framework: 1) internal resources: maintaining positivity, self-directed activity, and setting goals; 2) external resources: social support; 3) existential resources: purpose, gratitude, and cultivating health. Even among participants who reported feeling unfamiliar (8/25) with the term "resilience," all participants shared experiences reflecting resilience developed while living with ACHD.

Conclusion

ACHD-relevant resilience resources may help patients and clinicians navigate ACHD-related stress and promote psychosocial well-being.

The long-term buffering effect of sense of coherence on psychopathological symptoms during the first year of the COVID-19 pandemic: A prospective observational study

The COVID-19 pandemic is a major chronic stressor affecting all societies and almost all individuals. Consequently, research demonstrated a negative impact of COVID-19 on mental health in parts of the general population. However, not all people are affected equally thus making the identification of resilience factors modulating the pandemic's impact on mental health an important research agenda. One of these factors is sense of coherence (SOC), the key component of the salutogenesis framework. The current study aimed at investigating the long-term relationship between SOC and psychopathological symptoms, and the impact of COVID-19-related rumination as its moderator. The prospective observational study assessed psychopathological symptoms and SOC before the COVID-19 outbreak in Germany (February 2020) and at six critical time points during the pandemic in an online panel (n = 1,479). Bivariate latent change score models and latent growth mixture modeling were used to analyze changes in psychopathological symptoms and SOC along with their interaction and to differentiate trajectories of COVID-19-related rumination. A model allowing for unidirectional coupling from SOC to psychopathological symptoms demonstrated best fit. In the total sample, psychopathological symptoms increased significantly over time. Previous SOC predicted later changes in psychopathological symptoms, whereby a stronger SOC was associated with a decrease in symptoms over time. The same pattern of results was evident in the high-rumination (17.2%) but not in the low-rumination group (82.8%). Our findings demonstrate that SOC is an important predictor and modulator of psychopathological symptoms during the COVID-19 pandemic, particularly in those respondents that ruminate about the pandemic.

Childhood maltreatment, late-life depression, and sense of coherence: a structural equation modeling

OBJECTIVES

Late-life depression is a severe problem leading to adverse consequences in the lives of seniors. Pervasive evidence emphasizes that childhood maltreatment is one of determining factors in late-life depression. The literature suggests a complicated mechanism underlying this relationship. This study aimed to examine whether the sense of coherence (SOC) mediated and moderated the relationship between childhood maltreatment and late-life depression.

METHOD

This study sample included 237 community-dwelling older adults (aged 60-97) with a mean of 69.23 years and standard deviation = 6.87, from November to December 2019 in Tehran. A face-to-face interview was done, and the data was collected based on a multistage sampling approach and analyzed with the structural equation modeling.

RESULTS

Childhood maltreatment was positively associated with depression while negatively correlated with the SOC in older adults. A low level of SOC was also correlated with symptoms of depression. In addition, the SOC partly mediated the association between childhood maltreatment and late-life depression. However, no moderation effect of SOC was found.

CONCLUSIONS

Childhood maltreatment may be linked with late-life depression. Part of this relationship is highly likely indirect, through the effect of SOC, which could inform intervention efforts to promote the level of SOC to alleviate symptoms of depression in seniors.

Being Hopeful and Mindful During Adversity: A Longitudinal Study on College Students’ Adjustment During COVID-19

Objectives

The current study examined whether hope and mindfulness were associated with changes in two maladjustment measures, internalizing and externalizing behaviors, during the COVID-19 pandemic and tested sense of coherence as a mediator. The salutogenic theory of health, which posits that sense of coherence is central to individuals’ well-being in stressful situations and that individuals derive their sense of coherence from their generalized resistance resources (GRRs), was used to guide the analyses.

Methods

On two occasions separated by about 6 months, 253 Hong Kong college students (mean age = 21.0 years at time 1; 86% of them were women) filled in online questionnaires during the COVID-19 outbreaks. Path analysis was conducted to examine the interrelationships among hope and mindfulness, sense of coherence, and internalizing and externalizing behaviors.

Results

Results indicated that hope and mindfulness at time 1 were associated with internalizing and externalizing behaviors at time 2, even after controlling for confounding variables and prior levels of internalizing and externalizing behaviors. Moreover, sense of coherence at time 1 significantly mediated these associations.

Conclusions

Findings pointed to the potential roles of hope, mindfulness, and sense of coherence in understanding Chinese college students’ adjustment during the COVID-19 pandemic. Future research is needed to test whether sense of coherence and behavioral adjustment can be promoted through hope- and mindfulness-based intervention programs. Future research is also needed to examine the interrelationships among health-promoting assets, sense of coherence, and individual adjustment in samples of diverse cultural backgrounds.

Resilience in the Perinatal Period and Early Motherhood: A Principle-Based Concept Analysis

A context-specific delineation of research approaches to resilience in the perinatal and early motherhood literature is currently lacking. A principle-based concept analysis was used to establish a description of how women's resilience is currently conceptualised and operationalised within empirical research in the perinatal period and early motherhood (defined as up to five-years postpartum). CINAHL, Medline, PsychInfo, EMBASE, ASSIA, Web of Science, Scielo, Maternity and Infant Care, the Cochrane Library, and the World Health Organization were systematically searched (January/February 2020 and March 2022). Fifty-six studies met the inclusion criteria. Analysis demonstrated interchangeable use of associated concepts such as 'coping', 'coping strategies', and 'adaptation'. Resilience was frequently operationalised as the absence of illness symptomatology, rather than the presence of mental well-being. Investigations of positive areas of functioning were predominately related to the mother's family role. There was limited qualitative exploration of women's perspectives. Recommendations for the pragmatic application of resilience research were not well developed. The narrow operationalisation of resilience by mental ill-health and parental role, and the distinct absence of women's perspectives, restricts the logical maturity and pragmatic application of the concept. Future research may benefit from exploration of women's insights on indicators that might best reflect positive functioning and resilience in this period.

Resilience Predicts Lower Anxiety and Depression and Greater Recovery after a Vicarious Trauma

This study validated the French version of the Brief Resilience Scale (BRS-F) and tested the protective role of resilience in the context of vicarious trauma (22 March 2016 terrorist attacks in Brussels) regarding anxiety and depression symptoms. Confirmatory factor analyses indicated a single-factor structure of the BRS-F. Investigation of convergent validity showed that the BRS-F was positively correlated with usual outcomes such as subjective happiness, acceptance, and sense of coherence, and negatively correlated with anxiety and depression symptoms. Lastly, the results of the study showed that resilience protected against the effect of vicarious trauma in two ways. First, at the time of exposure, the more resilient individuals reported lower levels of anxiety and depression symptoms. Second, after three months, the more resilient individuals recovered from these symptoms, whereas no significant effect was found for less resilient individuals. Theoretical and clinical implications of the findings are discussed.

The Transcultural Community Resilience Scale: Psychometric Properties and Multinational Validity in the Context of the COVID-19 Pandemic

Few instruments assess community resilience. In the midst of the COVID-19 pandemic, the capacity of communities to support resilience of members deserves to be assessed to develop programs for improving mental health of affected populations. This article presents the development of the Ottawa-Community Resilience Scale (O-CRS), its underlying factorial structure and transcultural validity with a multilingual (English, French, Creole, Kinyarwanda), multinational (DR Congo, Haiti, Rwanda, Togo) and multicultural sample affected by this pandemic. A sample of 1,267 participants (40.9% women) were recruited in the four countries: DRC (n = 626, 43.4% women), Haiti (n = 225, 42.0% women), Rwanda (n = 174, 40.5% women), and Togo (n = 242, 33.2% women), with a mean age of 32 (SD = 10.1). They completed measures assessing individual resilience, depression and the O-CRS. Exploratory and confirmatory Factor Analyses, Cronbach alpha, coefficient H and the McDonald's Omega, and bivariate regression were used to estimate the underlying components of the O-CRS, its internal consistency and concurrent validity. Parallel factorial analysis and confirmatory factor analysis results revealed an excellent fit 3-factor structure. Internal consistency coefficients varied between 0.82 and 0.95. The O-CRS showed a good construct validity with a positive association with individual resilience and negative association with depression score. Developed with a collaborative approach involving researchers, practitioners, and clients/patients, the O-CRS and its three factors (community strengths and support, community trust and faith, and community values) demonstrated excellent psychometric properties for assessing community resilience among adults during the COVID-19 pandemic.

Resilience and associated psychological, social/cultural, behavioural, and biological factors in patients with cardiovascular disease: a systematic review

AIMS

The aim of this systematic review of the literature is to synthesize the evidence regarding the associations between individual-level psychological, social/cultural, behavioral, and biological variables with resilience in patients with CVD.

METHODS AND RESULTS

A systematic search of PubMed, PsycINFO and CINAHL was conducted from database inception through March 2020. Studies with a quantitative research design were eligible for inclusion if published in English and focused on resilience among adults with CVD. Of the 788 articles retrieved, 34 studies (35 articles) were included in the review. Twenty-three studies focused on psychological factors, with findings of inverse relationships between resilience and depression, anxiety, and stress. Evidence regarding associations between resilience and social/cultural or behavioral variables was scarce. Four of the 6 studies regarding biological factors found low stress resilience in young adulthood was associated with early diagnoses of stroke, heart failure, and coronary heart disease.

CONCLUSION

Enhancing resilience may improve quality of life for CVD patients, but research is needed to further explore the complex relationships between resilience and associated variables. This research should prioritize under-represented groups (i.e. women and minority racial/ethnic groups), with the eventual goal of developing interventions to support resilience in CVD patients.

Buffering PTSD in Canine Search and Rescue Teams? Associations with Resilience, Sense of Coherence, and Societal Acknowledgment

Rescue workers present an elevated risk for posttraumatic stress disorder (PTSD) and recently, research has begun to focus on coping styles and social support as protective factors in this population. Associations in the particular group of search and rescue dog handlers still lack evidence. The aim of the study is to investigate if functional cognitions and social support also decrease the risk for PTSD. Active voluntary rescue dog handlers (n = 116) rated levels of resilience, sense of coherence, and social acknowledgment (SAQ; subscales general disapproval, familial disapproval, recognition), in addition to a trauma checklist and PTSD symptoms. Linear regression analyses and two different graph models were calculated to explore associations, as well as potential pathways. Controlling for trauma exposure, the SAQ general disapproval emerged as the only significant predictor in the regression model. In the graph models, SAQ familial disapproval was linked to SAQ recognition and SAQ general disapproval. The latter, together with a sense of coherence manageability, affected PTSD re-experiencing symptoms through resilience. The findings are in line with earlier work. The study underlines the importance of targeting resilience and manageability, as well as enhancing social support in prevention programs for PTSD in canine search and rescue teams. Future research is warranted to further investigate model stability and replicate findings.

Validation of the Polish version of the Brief Resilience Scale (BRS)

Background

We conducted three studies to validate the Polish version of the BRS. Our objectives are as follows: first, to explore the dimensional structure of the scale and to determine the internal consistency (study 1: n = 1022); second, to determine the congruent and divergent validity of the BRS (study 2: n = 242); and third, to examine sensitivity of the BRS scale to detect high-risk population (study 3: n = 602).

Methods

To explore the dimensional structure of the scale, we tested a two-factor model with one factor for positively worded items and one factor for negatively worded items. To determine the congruent and divergent validity of the BRS, we analysed correlations among BRS and resilience, positive mental health, and with positive and negative religious coping. We used Student’s t-test to examine sensitivity of the BRS scale to detect a high-risk population.

Results

Based on the CFA, a bivariate model was confirmed for items positively and negatively formulated with a higher order factor, which indicates the homogeneity of the scale, similar to the analyses carried out for their language versions confirming this type of homogeneity of the scale. The internal compatibility assessment based on Cronbach’s Alpha and McDonald’s Omega is good (0.88). Our analyses intended to test convergent and divergent validity, and showed that the BRS results are significantly related to a questionnaire measuring similar constructions. Our validation studies also provided important diagnoses regarding BRS "sensitivity", indicating that groups with higher stress levels achieved lower BRS resilience results.

Conclusion

The results of our research indicate that the Polish version of the BRS should be considered to be a reliable and valid research tool. The Polish version of BRS is a reliable and accurate way of measuring resilience as the ability to bounce back from adversity and overcome various challenges or stressors. This scale may be used for both research and intervention purposes.

Associations of sense of coherence and self-efficacy with health status and disease severity in COPD

Sense of coherence and self-efficacy has been found to affect health-related quality of life in chronic diseases. However, research on respiratory diseases is limited. Here we report findings on quality of life (QoL) of COPD patients and the associations with coherence and self-efficacy. This study consists of the Greek national branch of the UNLOCK study, with a sample of 257 COPD patients. Coherence and self-efficacy are positively inter-correlated (Pearson rho = 0.590, p < 0.001). They are negatively correlated with the quality of life (CAT) [Pearson rho: coherence = −0.29, p < 0.001; self-efficacy = −0.29, p < 0.001) and mMRC (coherence = −0.37, p < 0.001; self-efficacy rho = −0.32, p < 0.001)]. Coherence is inversely associated with (Global Initiative for Chronic Obstructive Lung Disease) GOLD 2018—CAT and GOLD 2018—mMRC classification and “having at least one exacerbation in the past year”. Findings are stressing the need for their incorporation in primary health care and COPD guidance as it maybe that enhancing coherence and self-efficacy will improve QoL.

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.

Psychometric properties of the Dutch revised sense of coherence scale in a firefighter sample

BACKGROUND

Sense of coherence (SOC) has been associated with resilience to posttraumatic stress disorder (PTSD) and seems to be a promising factor in primary prevention of PTSD in high risk populations.

OBJECTIVE

The present study evaluated the psychometric properties of the Dutch revised Sense of Coherence Scale (SOC-R) in a sample of N = 527 firefighters.

METHOD

To investigate the internal structure of this 13-item scale, a Mokken scale analysis and an exploratory factor analysis were conducted (i.e. parallel analysis based on MRFA).

RESULTS

The combined results of these analyses suggested that a one-factor solution with 10 out of 13 items was most compelling for our firefighter sample. Reliability estimates for the 10-item version increased compared to the 13-item version (13-item: α = .82, λ₂ = .83; 10-item: α = λ₂ = .85). As expected, the Dutch version showed positive associations with resilience (convergent validity), and low correlations with neuroticism and extraversion (discriminant validity).

CONCLUSIONS

The one-factor solution of the Dutch SOC-R with 10 items (excluding item 2, item 3, and item 6) is most convincing. The use of this scale might be specifically interesting regarding its potential to primary prevention of trauma-related psychopathology in high-risk samples.

The relationship between cumulative traumatic experiences and ICD-11 post-traumatic symptoms in children and adolescents in foster care: The mediating effect of sense of coherence

BACKGROUND

Children and adolescents in foster care show a high prevalence of cumulative traumatic experiences (CTE), symptoms of posttraumatic stress disorder (PTSD) and symptoms related to disturbances in self-organization (DSO). PTSD and DSO constitute the ICD-11 diagnosis Complex PTSD (CPTSD). Sense of coherence (SOC) has been shown to alleviate the impact of CTE.

OBJECTIVE

This study aimed to investigate the mediating role of SOC in the relationship between CTE, PTSD, and DSO.

PARTICIPANTS AND SETTING

Trauma history (CTE), PTSD, DSO and SOC were assessed in a sample of 140 children and adolescents in foster care aged 10-18 using self-report questionnaires.

METHOD

Mediation analysis determined the direct, indirect and total effect of the mediation of SOC in the relationship between CTE, PTSD and DSO.

RESULTS

The results showed no mediation of SOC in the relationship between CTE and PTSD symptoms (indirect effect of b = -.001, 95 %CI: -.088-.086). However, SOC mediated the relationship between CTE and DSO symptoms (indirect effect b = .128, 95 %CI: 0.045-.211).

CONCLUSIONS

Those results may point to a promotive function of SOC for the overall development and different areas of self-organization, but not for PTSD symptoms. It is possible that the influence of the trauma on symptoms of PTSD is too pervasive for the promotive function of SOC. The present findings strengthen the assumption that PTSD and DSO are separate second-order factors, which characterize different groups of trauma survivors. The present findings are vital to inform tailored prevention and intervention strategies for survivors of early CTE.

Construct validity and factor structure of sense of coherence (SoC-13) scale as a measure of resilience in Eritrean refugees living in Ethiopia

Background

There is a scarcity of adapted measures to study resilience and mental health of people in humanitarian settings in Africa. The aim of this study was to identify the factor structure and other psychometric properties of the Sense of Coherence (SoC-13) scale in Eritrean refugees living in Ethiopia.

Methods

In a cross-sectional survey, 562 adults were selected randomly from Eritrean refugees living in Mai Aini camp, Ethiopia. The SoC-13, the Center for Epidemiologic Studies Depression scale (CES-D), the Pre and Post-Migration Living Difficulties checklist, the Primary Care Post-Traumatic Stress Disorder screener (PC-PTSD), the Oslo Social Support Scale (OSS-3), the Coping Style scale and the Fast Alcohol Screening Test (FAST) were administered concurrently. Confirmatory Factor Analysis (CFA) was used to investigate the factor structure of the SoC-13 using IBM SPSS Amos, version 21.

Result

A one factor model of the SoC with twelve items had the best fit to the current data (CFA = 0.982, RMSEA = 0.035 [90%CI = 0.018, 0.050]), with good internal consistency (Cronbach’s Alpha = 0.75). When all 13 items of the Tigrigna version were considered, there was an inverse association of SoC-13 with PC-PTSD(r = − 0.433, p < 0.001), CES-D (r = − 0.597, p < 0.001), Pre and post-migration living difficulties checklist (r = − 0.265, p < .001and r = − 0.249, p < 0.001 respectively), and FAST (r = − 0.105, p < 0.001), providing support for the divergent validity of the scale. The SoC-13 was associated positively with the Oslo Social Support scale (OSS-3)(r = 0.363 p < 0.001) and task-oriented coping (r = 0.089, p < 0.001), demonstrating convergent validity. The four items, specifically item-1, item-2, item-3 and item-12 have shown relatively weaker item loadings (β<0.40); but item-2 demonstrated non-significant loading (β = 0.06, p>0.05) in a one factor model of SoC-13.

Conclusions

Although the 13-items of the Tigrigna version of the SoC scale loaded significantly onto their respective factors in the three factor model, only 12 items loaded significantly onto the one factor model, which demonstrated superior fit to the current data. Keeping in mind that future research should examine the conceptualizations of the four items demonstrating poor convergent validity in this Eritrean sample, the reduced Tigrigna version of SoC-12 is a reasonable measure of sense of coherence in this community.

Electronic supplementary material

The online version of this article (10.1186/s13031-019-0185-1) contains supplementary material, which is available to authorized users.

Evaluation of the revised Sense of Coherence scale in a sample of older adults: A means to assess resilience aspects

OBJECTIVES

The present study evaluated the revised Sense of Coherence (SOC-R) scale in a sample of older adults, using an extended range of psychological concepts. It further examined the psychometric properties of the revised scale and tested the theoretical assumptions underpinning the SOC-R concept.

METHOD

The SOC-R scale was evaluated in 268 Swiss older adults (mean age = 66.9 years), including n = 15 heavily traumatized former indentured child labourers. Standardised questionnaires collected information on positive and negative life experiences, resources, current health, and well-being.  Results: Confirmatory Factor Analysis indicated good model fit for a second-order three-factor model of SOC-R with the factors manageability, balance, and reflection. Satisfactory convergent and discriminant correlations were shown with related psychological concepts, including neuroticism (r = -.32, p < .01), optimism (r = .31, p < .01), and general self-efficacy (r = .49, p < .01). SOC-R was not observed to differ by age group. Moderation analyses indicated that SOC-R moderated the relationship between certain early-life adversities and mental health.

CONCLUSION

The study provides support for the psychometric properties and theoretical assumptions of SOC-R and suggests that SOC-R is a valid and reliable measure suitable for use with older adults. Future studies should employ longitudinal designs to examine the stability of SOC-R.

Sense of Coherence and Stress-Related Resilience: Investigating the Mediating and Moderating Mechanisms in the Development of Resilience Following Stress or Adversity

Background: Trauma, stress, and adversity are well-known for having lasting negative effects on health. Yet, not all individuals go on to develop psychopathology or impaired health. However, little is known about the underlying mechanisms which influence the development of stress-related resilience. Sense of coherence-revised (SOC-R) may play a role in this process, as it is formed through overcoming stress or adversity. It may also influence the steeling effect, which suggests that previous exposure to moderate adversity increases resilience to later adversities. Objectives: This study aimed to examine the mediating and moderating roles of SOC-R in the relationship between stress or adversity, and psychological health and well-being. It further aimed to investigate the role of SOC-R in steeling processes. Methods: The study used a longitudinal design, with data collection at baseline and one-year follow-up. Participants included (N = 238) Swiss older adults (Mage = 68.3 years). Standardized questionnaires assessed early-life adversity, recent chronic stress, SOC-R, and current health and well-being. Mediation and moderation analyses examined the mechanisms underpinning stress-related resilience and curvilinear associations assessed steeling. Results: Results showed that the Manageability subscale of SOC-R significantly moderated the relationship between chronic stress and general mental health (b = 0.04, 95% CI [0.007, 0.082], t = 2.32, p < 0.05). Furthermore, SOC-R significantly mediated the relationship for general mental health (GMH) and satisfaction with life (SWL) with childhood emotional neglect (GMH: b = -0.056, 95% BCa CI [-0.126, -0.002]; SWL: b = -0.043, 95% BCa CI [-0.088, -0.004]), childhood physical neglect (GMH: b = -0.100, 95% BCa CI [-0.232, -0.002]; SWL: b = -0.081, 95% BCa CI [-0.181, -0.002]), and chronic stress (GMH: b = -0.052, 95% BCa CI [-0.100, -0.001]; SWL: b = -0.055, 95% BCa CI [-0.097, -0.020]). No curvilinear associations were observed between stress or adversity and SOC-R. Conclusions: This study expands on the limited research on stress-related resilience by examining the role of SOC-R in the interactions between adversity, stress, and health. Future research should examine SOC-R in samples with a greater range and different types of adversity. Overall, findings suggest that SOC-R is an important mechanism underpinning the development of stress-related resilience.

Multiple traumas and resilience among street children in Haiti: Psychopathology of survival

In Haiti, as in several developing countries, the phenomenon of street children has become a major public health issue. These children are often victims of traumas and adverse life events. This article aimed to investigate traumas experienced by street children and their coping and resilience strategies used to deal with adversities in a logic of survival, relying on a mixed method approach. A group of 176 street children, aged 7-18 (n = 21 girls), recruited in Port-au-Prince, completed measures assessing PTSD, social support and resilience. Semi-structured interviews were conducted to document traumatic experiences, factors related to resilience and coping strategies. After performing statistical analyses to evaluate prevalence and predictors associated with PTSD, and level of social support satisfaction and resilience, qualitative analysis using a grounded theory approach was conducted. Results showed that street children experienced multiple traumas such as neglect, maltreatment, psychological, physical and sexual abuse. However, they also showed self-efficacy to face their traumatic experiences and few of them (less than 15%) obtained scores reaching clinical rates of PTSD, while a large majority presented a level of resilience between moderate to very high. A socio-ecological model of multiple traumas and a model of coping, survival and resilience strategies are conceptualized. Data provide a better understanding of the traumas experienced by street children, their coping and resilience strategies. Results underscore ways to develop practices to offer psychological support, social and vocational integration based on the real needs of these children, in a perspective of social justice.

Mental Health in Anesthesiology and ICU Staff: Sense of Coherence Matters

Background: Hospitals, and particularly intensive care units (ICUs), are demanding and stressful workplaces. Physicians and nurse staff are exposed to various stressors: emergency situations, patients' deaths, and team conflicts. Correspondingly, several studies describe increased rates of PTSD symptoms and other mental health problems in hospital staff. Therefore, it is important to identify factors that lower the risk of psychopathological symptoms. High levels of sense of coherence (SOC) and general resilience as well as an internal locus of control (LOC) have already been identified as important health-benefitting factors in medical staff. The current study aimed to evaluate their unique impact in an ICU and an anesthesiology unit. Method: The cross-sectional online survey investigated SOC, LOC, general resilience, general mental health problems as well as PTSD symptoms in nurses and physicians within an ICU and an anesthesiology unit (N = 52, 65.4% female). General mental health problems were assessed using the ICD-10-Symptom-Rating (ISR) and PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5). The Sense of Coherence Scale (SOC-L9) assessed SOC, the Resilience Scale (RS-11) measured general resilience, and LOC was determined using a 4-item scale for the assessment of control beliefs (IE-4). Results: As expected, SOC, r = -0.72, p < 0.001, general resilience, r = -0.46, p < 0.001, and internal LOC, r = -0.51, p < 0.001, were negatively correlated with general mental health problems while an external LOC showed a positive association, r = 0.35, p = 0.010. However, in a multiple regression model, R ² = 53.9%, F _{(4, 47)} = 13.73, p < 0.001, only SOC significantly predicted general mental health problems by uniquely accounting for 13% of the variance. For PTSD symptoms, which were highly correlated with general mental health problems, a similar pattern of results was found. Conclusion: SOC was found to be the most important correlate of both general mental health problems and PTSD symptoms in an ICU and an anesthesiology unit. Thus, if further evidenced by longitudinal studies, implementing interventions focusing on an enhancement of SOC in training programs for ICU and anesthesiology unit staff might be a promising approach to prevent or reduce psychopathological symptoms.

An Examination of Differences in Psychological Resilience between Social Anxiety Disorder and Posttraumatic Stress Disorder in the Context of Early Childhood Trauma

Background: Much of the research on anxiety disorders has focused on associated risk factors with less attention paid to factors such as resilience that may mitigate risk or offer protection in the face of psychopathology.

Objective: This study sought to compare resilience in individuals with posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) relative to age-, gender- and education- matched individuals with no psychiatric disorder. We further assessed the correlation of resilience scores with childhood trauma severity and type.

Method: The sample comprised of 93 participants, 40 with SAD with childhood trauma), 22 with PTSD with childhood trauma, and 31 with no psychiatric disorder (i.e., healthy matched controls). Participants were administered the Mini-International Neuropsychiatric Interview (MINI), Liebowitz Social Anxiety Scale (LSAS), Clinician-Administered PTSD Scale (CAPS), Childhood Trauma Questionnaire—Short Form (CTQ-SF), and the Connor-Davidson Resilience Scale (CD-RISC). The mean age of participants was 34 years (SD = 11). 52 Participants were female (55.9%) and 54 Caucasian (58.1%). Analysis of variance was used to assess for significant group differences in resilience scores. Non-parametric correlation analyses were conducted for resilience and different types of childhood trauma.

Results: There were significant differences in resilience between the SAD and PTSD groups with childhood trauma, and controls. Both disorder groups had significantly lower levels of resilience than healthy controls. No significant correlation was found between total resilience scores and childhood trauma scores in the childhood trauma (SAD and PTSD) groups. However, in the combined dataset (SAD, PTSD, healthy controls), significant negative correlations were found between resilience scores and emotional abuse, emotional neglect, and total childhood trauma scores.

Conclusions: Patients who have PTSD and SAD with childhood trauma appear to be significantly less resilient than those with no disorder. Assessing and addressing resilience in these disorders, particularly when childhood trauma is present, may facilitate long-term recovery and warrants further investigation.

With the strength to carry on

People with chronic obstructive pulmonary disease (COPD) are affected by somatic as well as psychological symptoms such as anxiety and depression and reduced quality of life. Protective psychological factors exist which enable people to adapt successfully to disease, but research about these factors in COPD is sparse. The aim of this study was to investigate whether sense of coherence (SOC), resilience and social support are potential protective factors and thus associated with reduced levels of symptoms of anxiety and depression and lower perceived disability in people with COPD. An online study was conducted in which n = 531 participants with COPD completed questionnaires assessing protective psychological factors, anxiety and depressive symptoms (Hospital Anxiety and Depression Scale) and disease-specific disability (COPD Disability Index). Regression analyses were conducted. SOC and resilience contributed significantly to reduced levels of symptoms of anxiety and depression and to lower disease-specific disability after controlling for confounding variables and disease severity. Symptoms of anxiety and depression were most strongly predicted by SOC. This study's results indicated that SOC and resilience could represent helpful individual resources due to their protective potential helping people adjust to COPD. Limitations and implications of this study are discussed.

Erste Analyse der psychometrischen Eigenschaften und Struktur der deutschsprachigen 10- und 25-Item Version der Connor-Davidson Resilience Scale (CD-RISC)

Zusammenfassung. Die Connor-Davidson Resilience Scale (CD-RISC) wurde 2003 konzipiert, um das Konstrukt der Resilienz zu messen. In dieser Studie wurden die ersten deutschsprachigen Übersetzungen der 10- und 25 Item-Version der CD-RISC untersucht. Der Frage nach der faktoriellen Struktur des Selbstratingfragebogens im Original und in Übersetzungen wurde bereits in internationalen Studien nachgegangen, wobei unterschiedliche Faktorenstrukturen gefunden wurden. Fragestellung: Was sind die faktoriellen und psychometrischen Eigenschaften der deutschsprachigen CD-RISC Fassung? Methoden: An einer Stichprobe von 201 gesunden Probanden wurde mit einer Hauptkomponentenanalyse untersucht, welche Komponenten die Datenstruktur am besten beschreiben. Konvergente Validität wurde mit der deutschen Version der Resilienzskala (RS-25) von Wagnild und Young (1993) , Test-Retest-Reliabilität wurde mit erneuter Messung der CD-RISC nach sechs Monaten überprüft. Zusätzlich wurden Korrelationen zu Persönlichkeitsfacetten mittels dem NEO-Fünf-Faktoren Inventar (NEO-FFI: Borkenau & Ostendorf, 1993 ) zur Überprüfung der diskriminanten Validität berechnet. Ergebnisse: Die Exploration der Komponentenstruktur ergab eine eindimensionale Struktur für beide Versionen der deutschensprachigen CD-RISC. Test-Retest-Reliabilität, konvergente und diskriminante Validität waren zufriedenstellend. Die CD-RSIC kann als valides and reliables Messinstrument zur Erfassung des Konstrukts der Resilienz betrachtet werden.

Sense of coherence in young people with congenital heart disease

OBJECTIVE

Patient-reported outcomes (PROs) have been found to play a role in the development of clinical complications. Hence, it is crucial to understand why some patients do well in terms of PROs and others do not and to identify these groups of patients. Sense of coherence (SOC), capturing a person's outlook on life, is associated with PROs in adolescents with congenital heart disease (CHD). Therefore, we (1) examine how SOC develops in young people with CHD, (2) identify subgroups of SOC development, and (3) characterize subgroups in terms of demographic and clinical variables and PROs.

METHOD

In this 4-wave longitudinal study, 429 adolescents with CHD (53.4% boys; median age = 16.3 years) completed assessments of SOC (SOC-13). PROs included quality of life (linear analog scale), loneliness (UCLA-8), depression (CES-D), and perceived health (PedsQL). Latent class growth analysis was used to identify clinically meaningful subgroups of SOC development.

RESULTS

Patients with CHD had a moderate SOC that slightly decreased over the first 18 months. Four subgroups of SOC development emerged: Consistently High (27%), Intermediate Stable (41%), Intermediate Decreasing (25%), and Chronically Low (7%). Subgroups differed in terms of sex and PROs, but not in terms of age, disease complexity, primary diagnosis, or surgical history.

CONCLUSION

Patients with a strong and stable SOC over time showed a better adaptation than patients with a lower and/or decreasing SOC. Our results can guide the identification of patients at risk for adverse health outcomes and the development of interventions to enhance optimal living in patients with CHD.

Transgenerational transmission of trauma in families of Holocaust survivors: the consequences of extreme family functioning on resilience, sense of coherence, anxiety and depression

BACKGROUND

The psychological transmission of the noxious effects of a major trauma from one generation to the next remains unclear. The present study aims to identify possible mechanisms explaining this transmission among families of Holocaust Survivors (HS). We hypothesized that the high level of depressive and anxiety disorders (DAD) among HS impairs family systems, which results in damaging coping strategies of their children (CHS) yielding a higher level of DAD.

METHODS

49 CHS completed the Resilience Scale for Adults, the Hopkins Symptom Check List-25, the 13-Item Sense of Coherence (SOC) scale, and the Family Adaptability and Cohesion Scale. We test a mediation model with Family types as the predictor; coping strategies (i.e. Resilience or SOC) as the mediator; and DAD as the outcome variable.

RESULTS

Results confirm that the CHS׳ family types are more often damaged than in general population. Moreover, growing in a damaged family seems to impede development of coping strategies and, therefore, enhances the occurrence of DAD.

LIMITATIONS

The present investigation is correlational and should be confirmed by other prospective investigations.

CONCLUSIONS

At a theoretical level we propose a mechanism of transmission of the noxious effects of a major trauma from one generation to the next through family structure and coping strategies. At a clinical level, our results suggest to investigate the occurrence of trauma among parents of patients consulting for DAD and to reinforce their coping strategies.