Resilience, misfortune, and mortality: evidence that sense of coherence is a marker of social stress adaptive capacity

Sense of Coherence and Incident Dementia in Older Japanese Adults: The Japan Gerontological Evaluation Study

OBJECTIVES

The sense of coherence refers to effectively using available resources to manage stress and promote overall health. Previous studies have linked it to various health outcomes; however, evidence regarding its association with the risk of incident dementia is limited. Hence, this study aimed to fill this research gap using data from a large-scale population survey.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

This study included 31,556 participants aged 65 years and older who were free from dementia and disabilities. The participants were enrolled in the 2010 baseline survey of the Japan Gerontological Evaluation Study, and were followed up until the end of 2019.

METHODS

The sense of coherence was assessed using a 6-item short-version questionnaire. Incident dementia cases were ascertained through the public long-term care insurance database in Japan.

RESULTS

During a median follow-up of 8.3 years, 4326 incident dementia cases were identified. After adjusting for conventional risk factors, the hazard ratios (95% CIs) for each quintile compared to the lowest quintile of the sense of coherence were 0.82 (0.75-0.90), 0.75 (0.68-0.83), 0.76 (0.68-0.84), and 0.78 (0.70-0.87), respectively. The multivariable hazard ratio (95% CI) per 1-SD increment was 0.91 (0.88-0.95). These inverse associations did not exhibit any gender differences (P for gender interaction = .11) and were further confirmed after excluding early incident cases. Similar associations were found for its components; the corresponding multivariable hazard ratios (95% CIs) per 1-SD increment were 0.94 (0.91-0.97) for comprehensibility, 0.92 (0.89-0.95) for manageability, and 0.93 (0.90-0.97) for meaningfulness.

CONCLUSIONS AND IMPLICATIONS

Moderate and above sense of coherence was associated with the lower risk of dementia among the older population, suggesting a beneficial role of stress management in maintaining the cognitive health of older adults.

University students' experience of the Beirut port explosion: associations with subjective well-being and subjective symptoms of mental strain

BACKGROUND

On 4 August 2020, an explosion shook Beirut, killing more than 200 people and leaving thousands injured or homeless.

AIMS

This study examined mental health of university students through a cross-sectional online survey between December 2020 and January 2021.

METHODS

The questionnaire consisted of the WHO-5, sense of coherence (SoC), future anxiety, self-developed subjective symptoms of mental strain (SSMS), and items assessing proximity to explosion, extent of injury and house damage. Gender, study level and social status were used as sociodemographic characteristics.

RESULTS

Of 1042 participants, 30.8% were at 0-7 km from explosion; 38.1% reported physical injuries; and 12.4% saw their home damaged. Two third (60.3%) reported ≥3 SSMS, and 73.4% reported low well-being. Students with low well-being were more often female and master students (p < 0.001). Females were more often affected by ≥3 SSMS (p < 0.001). Regression analysis with low well-being as dependent variable revealed significant associations with study level (OR: 2.30-2.94), future anxiety (OR: 2.72-4.34) and SoC (OR: 1.81-5.61). For ≥3 SSMS, females (OR: 3.09), moderate/very close distance (OR: 2.13-4.98), injury/death of family member or friend (OR: 2.07-2.06), house damage (OR: 1.72) future anxiety (OR: 1.97-3.11) and SoC (1.79-2.88) were significant predictors.

DISCUSSION

Preventive mental health strategies that strengthen SoC and outlook on future could protect against SSMS and low well-being following major trauma.

How Patients Who Are Transported by Ambulance Experience Dyspnea and the Use of a Dyspnea Scale: A Qualitative Study

Approximately 7% of all dispatched ambulances in Denmark are for patients for whom breathing difficulties are the main cause for using ambulance services. Objective measurements are routinely carried out in the ambulances, but little is known of the patients’ subjective experience of dyspnea. The purpose of this study was to investigate how patients with acute dyspnea, transported to hospital by ambulance, experience their situation, along with their experience of the use of a dyspnea scale. The study was carried out in the North Denmark Region. Transcribed patient interviews and field notes were analyzed and interpreted with inspiration from Paul Ricoeur. For interviews, we included 12 patients with dyspnea who were transported to the hospital by ambulance: six women and six men all aged 60 years or above. Observations were made over six ambulance transports related to dyspnea. Three themes emerged: “anxiety”, “reassurance in the ambulance” and “acceptance of the dyspnea measurements in the ambulance”. Several patients expressed anxiety due to their dyspnea, which was substantiated by observations in the ambulance. The patients expressed different perspectives on what improved the situation (treatment, reassurance by ambulance professionals). The patients and the ambulance personnel were, in general, in favor of the dyspnea scale.

Association of Psychological Resilience with All-Cause and Cardiovascular Mortality in a General Population in Italy: Prospective Findings from the Moli-Sani Study

Psychological resilience (PR) is the capacity to adapt positively in face of adversity. Its role as an independent protective factor has been acknowledged in recent years. We aimed to test the association of PR with all-cause and cardiovascular disease (CVD) mortality in a general adult population. We performed longitudinal analyses on 10,406 CVD-free individuals from the Moli-Sani cohort (follow up = 11.2 year). PR was assessed by the 25-item Connor and Davidson resilience scale. PR factors were identified through polychoric factor analysis. Associations with mortality were tested using multivariable Cox regressions. Higher levels of PR were associated with reduced all-cause mortality in a model including sex and age (HR = 0.78; 95%CI 0.62-1.00). The association decreased after inclusion of socioeconomic, clinical, and behavioral factors into the model (HR = 0.80; 95%CI 0.62-1.03). No relation was observed with cardiovascular mortality in the fully adjusted model (HR = 0.89; 95%CI 0.56-1.39). An inverse association of Factor 1 (reflecting positive acceptance of change) with all-cause mortality (HR = 0.89; 95%CI 0.82-0.98; p value = 0.01) was found. However, at a borderline non-significant way, PR predicts all-cause mortality in a general population of Italian adults. This is supported by the findings demonstrating a significant association between the PR's domain reflecting a positive acceptance of change and all-cause mortality.

Sense of coherence and dental fear/dental anxiety: A systematic review and meta-analysis

AIM

The aim of this systematic review and meta-analysis was to evaluate the association between sense of coherence (SOC) and dental fear/dental anxiety.

METHODS

Computerized searches were performed in six databases. Gray literature and manual searches were also conducted. Study selection, risk of bias assessment, and meta-analyses were performed. The results of meta-analyses were reported in odds ratio (OR), mean difference (MD), and confidence interval (CI).

RESULTS

After removing duplicates, 131 references were retrieved and the full texts of 12 were evaluated. Nine references met the eligibility criteria and were included. The results of meta-analyses demonstrated that individuals with a weaker SOC had a score in the dental anxiety/dental fear scale 6.04 times higher than individuals with a stronger SOC (OR = 6.04, CI = 2.62-13.91). Individuals with no dental anxiety/dental fear had a mean score of the SOC scale higher than individuals with dental anxiety/dental fear (MD = 5.39, CI = 2.21-8.56). Sensitivity analysis demonstrated that the result of a higher mean score of the SOC scale among individuals with no dental anxiety/dental fear remained (MD = 7.38, CI = 3.79-10.98). Risk of bias ranged from low to high. The certainty of evidence was very low.

CONCLUSION

Individuals with stronger SOC have lower levels of dental fear/dental anxiety.

A Modified Version of the Transactional Stress Concept According to Lazarus and Folkman Was Confirmed in a Psychosomatic Inpatient Sample

BACKGROUND

Stress is a major risk factor for the impairment of psychological well-being. The present study aimed to evaluate the empirical evidence of the Transactional Stress Model proposed by Lazarus and Folkman in patients with psychosomatic health conditions.

METHODS

A structural equation model was applied in two separate subsamples of inpatients from the Department of Psychosomatic Medicine (total n = 2,216) for consecutive model building (sample 1, n = 1,129) and confirmatory analyses (sample 2, n = 1,087) using self-reported health status information about perceived stress, personal resources, coping mechanisms, stress response, and psychological well-being.

RESULTS

The initial model was created to reflect the theoretical assumptions by Lazarus and Folkman about their transactional stress concept. This model was modified until a sufficient model fit was reached (sample 1: CFI = 0.904, TLI = 0.898, RMSEA = 0.072 [0.071-0.074], SRMR = 0.061). The modified model was confirmed in a second sample (sample 2: CFI = 0.932, TLI = 0.928, RMSEA = 0.066 [0.065-0.068], SRMR = 0.052). Perceived external stressors and personal resources explained 91% of the variance of the stress response, which was closely related to symptoms of depression (63% variance explained). The attenuating effect of resources on stress response was higher (standardized β = -0.73, p < 0.001) than the impact of perceived stressors on stress response (standardized β = 0.34, p < 0.001).

CONCLUSION

The empirical data largely confirmed the theoretical assumption of the Transactional Stress Model, which was first presented by Lazarus and Folkman, in patients with a wide range of psychosomatic conditions. However, data analyses were solely based on self-reported health status. Thus, proposed inner psychological mechanisms such as the appraisal process could not be included in this empirical validation. The operationalization and understanding of coping processes should be further improved.

Insights Gained in the Aftermath of the COVID-19 Pandemic: A Follow-Up Survey of a Recreational Training Program, Focusing on Sense of Coherence and Sleep Quality

The original aim of this study was a follow-up assessment of a recreational program running for six months (September 2019-February 2020) within controlled conditions. Following the arrival of the COVID-19 pandemic, the survey acquired a new goal: how do the subjects of the follow-up sampling experience this severe stress situation, and in this experience, what role does physical activity and a salutogenetic sense of coherence play. Austrian women (N = 53) took part in the training program, whose physical condition was assessed before the start of the program, then reassessed after three months and after six months; the organizers also had them fill out the sense of coherence questionnaire (SOC) as well as the Regensburger insomnia scale. After the lifting of the lockdown introduced due to the pandemic, participants completed an online survey relating to their changed life conditions, physical activities, sense of coherence and sleep quality. Results: After the first three months of the training, no significant changes were detected. After six months, the participants SOC and sleep quality improved (Friedman test: p = 0.005 and p < 0.001). During the lockdown, sleep quality generally deteriorated (W-rank test: p = 0.001), while SOC did not change. The women in possession of a relatively stronger SOC continued the training (OR = 3.6, CI 95% = 1.2-12.2), and their sleep quality deteriorated to a lesser degree. (OR = 1.7, CI 95% = 1.1-2.8). Conclusion: The data reinforce the interdependency between physical exercise (PE) and SOC; furthermore, the personal training that the authors formulated for middle-aged women proved to be successful in strengthening their sense of coherence, and it also reduced the deterioration in sleep quality due to stress.

Vitamin D levels are associated with trait resilience but not depression in a general population sample

INTRODUCTION

Insufficient vitamin D levels were found to be related to various psychiatric disorders and particularly depression. The functional polymorphisms rs4588 and rs7041 of the vitamin D-binding protein (also group-specific component or Gc) influence vitamin D level and activity. Resilience is considered the individual predisposition to maintain psychological functioning in the face of adversities. We sought to investigate whether associations of vitamin D levels and genotypes of rs4588 and rs7041 were associated with trait resilience and symptoms of depression.

METHODS

Serum levels of total 25(OH)D were measured in a general population sample (n = 1,908) of the Study of Health in Pomerania (SHIP-1). The Resilience Scale-25 (RS-25) was applied to assess trait resilience. Lifetime depressive symptoms were assessed using the CID-S, while current depressive symptoms were measured using the Beck Depression Inventory II (BDI-II). Study participants were genotyped for rs4588 and rs7041.

RESULTS

Participants with vitamin D insufficiency had lower adjusted mean RS-25 scores as compared to vitamin D replete subjects (p = .002). Linear regression analyses revealed a positive association between 25(OH)D and RS-25 scores (ß = 2.782, p = .002). Additional adjustment for BDI-II scores slightly attenuated this result (ß = 1.830 and p = .026). Symptoms of depression and the lifetime diagnosis of MDD were not significantly associated with vitamin D concentrations. rs4588 and rs7041 showed strong associations with vitamin D concentrations (both p < .001), but not RS-25 scores.

CONCLUSIONS

In contrast with previous studies, our findings do not provide evidence for a strong role of vitamin D in the psychopathology of depression. However, considering the role of trait resilience as a common protective factor to different psychiatric disorders, our results support the concept of low vitamin D as a general risk factor to stress-related psychopathologies.

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

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

The relationship between 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.

Autonomous orientation predicts longevity: New findings from the Nun Study

OBJECTIVE

Work on longevity has found protective social, cognitive, and emotional factors, but to date we have little understanding of the impact of motivational dynamics. Autonomy orientation, or stable patterns of self-regulation, is theorized to be a protective factor for long-term mental and physical health (Ryan & Deci, 2017), and it is therefore a prime candidate for examining how stable psychosocial factors are linked to longevity, or life expectancy.

METHOD

Essays written in the 1930s by participants in the Nun Study were coded for indicators of an autonomy orientation. These were selected in line with an extensive theoretical literature based in self-determination theory (Deci & Ryan, 1985). Essays were coded for the propensity for choice in action, susceptibility to pressure, self-reflection, integration of experiences, and parental support for autonomy. These coded variables were used to predict age of death.

RESULTS

Using 176 codable essays provided by now-deceased participants, linear regression analyses revealed that choiceful behavior, self-reflection, and parent autonomy support predicted age of death. Participants who demonstrated these stable and beneficial motivational characteristics lived longer.

CONCLUSIONS

Personality constructs reflecting a healthy form of self-regulation are associated with long-term health. Implications for health interventions are discussed.

Polish Version of the Resilience Scale (RS-14): A Validity and Reliability Study in Three Samples

There has been a need for an instrument which not only can adequately evaluate trait-like resilience, but also can be applied to Polish adolescents and young adults. The purpose of this study was to validate the Resilience Scale RS-14 (Wagnild, 2009a,b). We aimed to examine and assess the psychometric properties of the Polish version in three different samples. The first sample was made up of adolescents aged 13–17 (N = 400).The second sample was made up of a problem group aged 13–18 (N = 656) who had special needs and attended either Probation Centers, Youth Sociotherapy Centers, or Youth Educational Centers. The third sample was made up of students in early adulthood aged 19–27 (N = 1,659). Exploratory and confirmatory factor-analytic methods were employed. CFA demonstrated a good fit of the factor structure in all three samples. The original one-dimensional structure of the RS short form was confirmed. All items loaded (>0.40) onto 1 factor, indicating cohesive structure for a 1-factor model explaining 35.02% of the variance in the whole sample, 34.62% in the young adolescent sample, 31.11% in the problem sample, and 38.51% in the early adulthood sample. Descriptive statistics, reliability (young adolescence α = 0.85, problem sampleα = 0.82 early adulthood α = 0.87) and validity data were calculated; test-retest showed good stability [r₍₄₀₎ = 0.88; p < 0.001]. The validity of the scale RS-14 was applied in two groups (the N = 382 early adulthood aged 19–27, and the N = 120 problem group aged 13–18) and was subsequently evaluated. The RS-14 correlated significantly, as expected, with measures of positive concepts (satisfaction with life). Results showed that resilience was negatively related with indexes of perceived stress and the dimension-of-depression. Findings support the RS-14 to be a valid and useful instrument for assessing resilience in diverse Polish adolescent groups, including those with special needs and those in early adulthood.

The relation between sense of coherence and daily hassles among university students

Based on Antonovsky’s salutogenic model, it was hypothesized that persons with a high sense of coherence (SOC), compared to persons with a low SOC, (1) experience fewer hassles and (2) experience hassles as less stressful. In addition to each of the two main hypotheses, gender differences and interaction between SOC and gender were also explored. Two hundred and fifty-eight female students (M_age = 23.77 years) and 136 male students (M_age = 24.02 years) participated in a survey where they responded to a questionnaire that was designed to measure some demographic variables, SOC and daily hassles. The data were analysed by two 3 (SOC-groups) × 2 (Gender) ANOVAs for independent measures, with frequency and intensity as dependent variables, followed up with Tukey’s HSD post-hoc tests. The results confirmed both main hypotheses. In addition, the results showed no interaction between SOC and gender, no differences between female and male students with regard to the number of experienced hassles but that female students experienced the hassles more intensively. These findings further corroborated the two fundamental parts of Antonovsky’s salutogenic model concerned with avoidance and appraisal of stressors.

Stress Resilience in Late Adolescence and Survival among Cancer Patients: A Swedish Register-Based Cohort Study

BACKGROUND

Chronic stress has been suggested to play a role in cancer progression, but few studies have so far examined the potential influence of stress susceptibility. This national register-based cohort study utilizes a unique data source to investigate whether a stress resilience measure is associated with survival in cancer patients.

METHODS

The cohort includes 9,318 Swedish male cancer patients born during 1952 to 1956 who had their stress resilience evaluated at a semistructured interview with a psychologist during mandatory conscription examination in late adolescence.

RESULTS

Over a median of 3 years of follow-up from cancer diagnosis, a total of 2,541 patients died (2,322 from cancer). Overall, low (23%) compared with high (25%) stress resilience was associated with increased mortality (adjusted hazard ratio estimated by Cox regression 1.45; 95% confidence interval 1.28-1.65), particularly among men with carcinomas of the oropharynx (2.62, 1.24-5.56), upper respiratory tract (4.64, 1.05-20.41), and prostate (2.20, 1.04-4.62), as well as with Hodgkin lymphoma (3.52, 1.40-8.86). An association was evident for both cancer types associated with smoking (1.35, 1.10-1.66) and malignancies without an established smoking etiology (1.32, 1.12-1.56). The association between low stress resilience and mortality could partly be explained by tumor stage, marital status, and psychiatric comorbidity at cancer diagnosis.

CONCLUSIONS

We observed an association between low stress resilience and mortality among men diagnosed with cancer, particularly oropharyngeal cancer, upper respiratory tract cancers, prostate cancer, and Hodgkin lymphoma.

IMPACT

These results suggest that individual variation in stress resilience may influence survival among men with some cancer types.

Sociodemographic, clinical, and psychological characteristics identify groups of Italian cancer patients with high rates of unmet needs

PURPOSE

Although an optimal goal remains the routine assessment of unmet needs of all patients with cancer, particular attention should be paid to those groups of patients with characteristics known to be more frequently associated with unmet needs in general or with specific areas of need. This report aims to describe the sociodemographic, clinical, and psychological characteristics associated with higher unmet needs in Italian cancer patients.

METHODS

A total of 835 cancer patients from different care settings (ward, day hospital, follow-up ambulatory, rehabilitation unit, and palliative care) filled out the Needs Evaluation Questionnaire (NEQ), the Psychological Distress Inventory, and the Sense of Coherence Scale. Association of NEQ scores with the clinical and demographic variables were tested using analysis of variance.

RESULTS

Higher NEQ total score was associated with lower educational level, inpatient care setting, radiotherapy treatment, psychological distress, and lower resilience trait sense of coherence. Different predictors were identified for different areas of unmet needs. Care setting, psychological distress, and resilience trait were the strongest indicators of unmet needs in every area: information/communication, assistance/care, material needs, relational needs, and psychoemotional support.

CONCLUSIONS

Clinicians should consider that inpatients with a high distress and a low resilience trait sense of coherence represent a group of cancer patients to be investigated with particular attention regarding unmet needs.

Are Three Items Sufficient to Measure Sense of Coherence?

Abstract. The present study aimed at evaluating if the three-item sense of coherence (SOC) scale developed by Lundberg and Nystrom Peck (1995) can be effectively used for research purpose in both nonclinical and clinical samples. To provide evidence that it represents adequately the measured construct we tested its validity in a nonclinical (N = 658) and clinical sample (N = 764 patients with cancer). Results obtained in the nonclinical sample attested a positive relation of SOC – as measured by the three-item SOC scale – with Antonovsky’s 13-item and 29-item SOC scales (convergent validity), and with dispositional optimism, sense of mastery, anxiety, and depression symptoms (concurrent validity). Results obtained in the clinical sample confirmed the criterion validity of the scale attesting the positive role of SOC – as measured by the three-item SOC scale – on the person’s capacity to respond to illness and treatment. The current study provides evidence that the three-item SOC scale is a valid, low-loading, and time-saving instrument for research purposes on large sample.

A strong sense of coherence associated with reduced risk of anxiety disorder among women in disadvantaged circumstances: British population study

OBJECTIVE

Many patients receiving medical treatment for anxiety relapse or do not improve. Research has therefore been turning to coping mechanisms as a way to decrease anxiety rates. Previously, we showed that living in a deprived area significantly increases the risk of anxiety in women, but not in men. The objective of this study is to assess whether sense of coherence (coping mechanism) buffers the influence of area deprivation on women's risk of generalised anxiety disorder using data from the European Prospective Investigation of Cancer-Norfolk.

DESIGN

Large, population study.

SETTING

UK population-based cohort.

PARTICIPANTS

30 445 people over the age of 40 years were recruited through general practice registers in England. Of these, 20 919 completed a structured health and lifestyle questionnaire used to assess generalised anxiety disorder and sense of coherence. Area deprivation was measured using 1991 Census data, and sense of coherence and anxiety were examined in 1996-2000. 10 183 women had data on all variables.

MAIN OUTCOME MEASURE

Past-year generalised anxiety disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

RESULTS

In this study, 2.6% (260/10 183) of women had generalised anxiety disorder. In those with a strong sense of coherence, area deprivation was not significantly associated with anxiety (OR 1.29, 95% CI 0.77 to 2.17). However, among women with a weak sense of coherence, those living in deprived areas were almost twice as likely to have generalised anxiety disorder compared with those living in more affluent areas (OR 1.99, 95% CI 1.37 to 2.91).

CONCLUSION

The number of women living in deprived conditions is large worldwide, and significant numbers are affected by generalised anxiety disorder. Sense of coherence moderates the association between area deprivation and anxiety in women; therefore, interventions targeting coping mechanisms may need to be considered for people with anxiety.

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.

Job displacement and social safety net on depressive symptoms in individuals aged 45 years or above: findings from the Korean Longitudinal Study of Aging

This study aimed to investigate the relationship between the unemployment experience and depressive symptoms among mid-aged (ages 45–59) and elderly (ages 60 or above) persons and to examine further the effects of unemployment insurance, industrial accident compensation insurance (IACI) and national pension on the stated relationship. Data were used from the Korean Longitudinal Study of Aging (KLoSA) between 2006 and 2012. A total of 1,536 individuals employed at the 2006 baseline were followed. The association between employment status change during 2006 to 2008, 2008 to 2010 or 2010 to 2012 and depressive symptoms in years 2008, 2010 or 2012 were analysed using a generalised estimating equation model. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale (CES-D 10) scale. The results showed that the ‘employed to unemployed’ group had statistically significant increases in depression scores in the mid-aged (β = 0.4884,p= 0.0038) and elderly (β = 0.8275,p⩽ 0.0001) categories, compared to the ‘employed to employed’ group. Findings were maintained in groups without a social safety net. Contrastingly, the ‘employed to unemployed’ groups with unemployment insurance and IACI did not show statistically significant increases in depression scores. The ‘employed to unemployed’ category of individuals enrolled in the national pension system exhibited a lower increase of depression. Therefore, an enhanced focus on the mental health of unemployed individuals is required, in addition to the provision of a reliable social safety net.

Concordance Between Life Satisfaction and Six Elements of Well-Being Among Respondents to a Health Assessment Survey, HealthPartners Employees, Minnesota, 2011

INTRODUCTION

We assessed and tracked perceptions of well-being among employees of member companies of HealthPartners, a nonprofit health care provider and health insurance company in Bloomington, Minnesota. The objective of our study was to determine the concordance between self-reported life satisfaction and a construct of subjective well-being that comprised 6 elements of well-being: emotional and mental health, social and interpersonal status, financial status, career status, physical health, and community support.

METHODS

We analyzed responses of 23,268 employees (of 37,982 invitees) from 6 HealthPartners companies who completed a health assessment in 2011. We compared respondents' answers to the question, "How satisfied are you with your life?" with their indicators of well-being where "high life satisfaction" was defined as a rating of 9 or 10 on a scale of 0 (lowest) to 10 (highest) and "high level of well-being" was defined as a rating of 9 or 10 for 5 or 6 of the 6 indicators of well-being.

RESULT

We found a correlation between self-reported life satisfaction and the number of well-being elements scored as high (9 or 10) (r = 0.62, P < .001); 73.6% of the respondents were concordant (high on both or high on neither). Although 82.9% of respondents with high overall well-being indicated high life satisfaction, only 34.7% of those indicating high life satisfaction reported high overall well-being.

CONCLUSION

The correlation between self-reported life satisfaction and our well-being measure was strong, and members who met our criterion of high overall well-being were likely to report high life satisfaction. However, many respondents who reported high life satisfaction did not meet our criterion for high overall well-being, which suggests that either they adapted to negative life circumstances or that our well-being measure did not identify their sources of life satisfaction.

Sense of coherence and gender as a predictor of the effect of laboratory induced stress on cognitive performance

The current experimental study examined sense of coherence (SOC) as a predictor of the effect of induced stress (time limit and posing a threat) on the level of overall cognitive performance (based on three subscales: mathematics, shapes, and analogies). Results indicated the following: (a) induced stress (experimental group, n = 80) scored lower on the overall cognitive score, compared to the no-stress (control group, n = 81); (b) subjects in the stress group with higher SOC performed better on the overall cognitive score, compared to subjects with lower SOC; however, in the no-stress group there was no significant effect of SOC on cognitive performance;

Test of Antonovsky's Postulate: High Sense of Coherence Helps People Avoid Negative Life Events

This study tested Antonovsky's postulate that a high sense of coherence (SOC) helps people avoid negative life events. It was assumed that negative life events that were uncontrollable would not show this effect, while those events that potentially could be controlled would show a significant relationship with SOC. 1,012 female nurses ( M age = 46.9 yr.; SD = 8.9) participated in this longitudinal study and were divided into groups with low, moderate, and high SOC. Sixteen negative life events were categorized into uncontrollable and controllable events, with the controllable events divided into three sub-categories. Five one-way analyses of variance (ANOVAs) for independent measures followed up with post hoc tests were performed, with the number of experienced events in a given category by each participant (at Time 2) as the dependent variable and the three SOC groups (formed at Time 1) as the independent variable. The results indicated that the high SOC group reported fewer controllable negative life events, while there was no significant relationship between the SOC level and uncontrollable negative life events. The findings support the postulate in Antonovsky's model, with the distinction between controllable and uncontrollable negative life events.

Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age

Objective

Psychosocial stress is a suggested risk for coronary heart disease (CHD). The relationship of stress resilience in adolescence with subsequent CHD risk is underinvestigated, so our objective was to assess this and investigate the possible mediating role of physical fitness.

Methods

In this register-based study, 237 980 men born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semistructured interview with a psychologist. Some 10 581 diagnoses of CHD were identified. Cox regression estimated the association of stress resilience with CHD, with adjustment for established cardiovascular risk factors.

Results

Low-stress resilience was associated with increased CHD risk. The association remained after adjustment for physical fitness and other potential confounding and mediating factors, with adjusted HRs (and 95% CIs) of 1.17 (1.10 to 1.25), with some evidence of mediation by physical fitness. CHD incidence rates per 1000 person-years (and 95% CIs) for low-stress, medium-stress and high-stress resilience were 2.61 (2.52 to 2.70), 1.97 (1.92 to 2.03) and 1.59 (1.53 to 1.67) respectively. Higher physical fitness was inversely associated with CHD risk; however, this was attenuated by low-stress resilience, shown by interaction testing (p<0.001).

Conclusions

Low-stress resilience in adolescence was associated with increased risk of CHD in middle age and may diminish the benefit of physical fitness. This represents new evidence of the role of stress resilience in determining risk of CHD and its interrelationship with physical fitness.

Sense of coherence changes with aging over the second half of life

Sense of coherence (SOC), a concept reflecting meaningfulness, comprehensibility, and manageability of life, has been demonstrated to have strong connections to positive outcomes such as good health. However, less is known about how SOC changes over the second half of life as age-related deficits accumulate. We used longitudinal samples of mature adults that included the oldest-old to track change in SOC from age 55 to 101. Growth curves using an accelerated longitudinal design were estimated for 1809 individuals who contributed 4072 observations from five national Swedish surveys between 1991 and 2010/11. Results indicated that deficits in health and social resources were largely responsible for the precipitous decline in SOC after age 70. When controlling for these deficits, SOC increased continuously into advanced old age. We conclude that the capacity to comprehend, manage, and find meaning in life--the component elements of SOC--strengthens over the last years of life, suggesting a positive ontogenic development that runs parallel but opposite to the negative impact of health and social decline.

The sense of coherence and styles of success in the medical career: a longitudinal study

BACKGROUND

Sense of coherence is related to well-being, stress and life satisfaction among medical students and physicians. The purpose of the study was to investigate relation between sense of coherence during medical education and styles of success in the medical career.

METHODS

The participants were first examined when they applied to medical school in 1999. Questionnaires were given to these students each academic year from 2000 to 2005. Also, 54 medical doctors who had participated in the first phase of the study completed a questionnaire in 2009, four years after graduation. The baseline questionnaire measured the sense of coherence. The follow-up questionnaire included measures of quality of life, work stress and burnout, satisfaction with medicine as a career, and professional competency.

RESULTS

Medical students with the highest sense of coherence later have the highest quality of life and income, and are the least overwhelmed by work stress, but they also show the least satisfaction with medicine as a career and a low level of professional competence.

CONCLUSIONS

Antonovsky's SOC-29 questionnaire can be used to identify specific tendencies in the development of the medical career. Our results may be useful to medical school admissions officers and resident selection committees, in order to identify candidates at risk for failure.

Posttraumatic recovery to distress symptoms ratio: a mediator of the links between gender, exposure to fire, economic condition, and three indices of resilience to fire disaster

This study investigated the direct and indirect effects of demographic predictors on level of resilience following a potentially traumatic event. We hypothesized that the direct effects of three variables (exposure to fire hazards, gender, and economic condition) on resilience following a fire disaster would be mediated by the proportion of posttraumatic recovery to post-fire distress symptoms. The sample consisted of 234 Israeli Druze youth whose hometown was endangered and damaged by the Mount Carmel fire disaster in December 2010. Results partially supported the research hypotheses.

Adverse childhood experiences and psychosocial well-being of women who were in foster care as children

BACKGROUND AND OBJECTIVE

Research has shown that many children in foster care later have psychosocial problems as adults; this is often attributed to cumulative adversities and a lack of supportive caregivers. The risk factors associated with foster care, such as maternal separation and multiple placements, often counteract many protective factors that can ameliorate the effects of childhood adversities. This study assessed the relationship between adverse childhood experiences (ACEs) and psychosocial well-being in women who were in foster care as children.

METHODS

A total of 101 women aged 18-71 years (mean, 36.83 [12.95] years) completed an anonymous online survey based on the 10-item ACE Questionnaire, the Sense of Coherence questionnaire, and the General Health Questionnaire.

RESULTS

More than 56% of respondents were identified as experiencing current psychological distress. Sense of coherence scores (mean, 54.26 [15.35]) showed a significant inverse association with both General Health Questionnaire (mean, 14.83 [5.88]) and ACE (mean, 5.68 [2.90]) scores (r = -0.64 and -0.31, respectively) and 97% reported at least 1 ACE, 70% reported ≥ 5 and 33% reported ≥ 8. Linear regressions indicated that ACEs reported to occur before foster care were associated with lower levels of sense of coherence (8%) and higher levels of psychological distress (6%). Physical neglect and living in a dysfunctional household (parental loss, maternal abuse, or household member associated with substance abuse or prison) significantly decreased during foster care by 16 and 19 percentage points, respectively. Rates of emotional and physical abuse did not change.

CONCLUSION

The number of ACEs was associated with the level of psychological distress. Our findings suggest that children entering the foster care system are already vulnerable and at risk of experiencing ACEs during foster care and psychological distress during adulthood. Measures implemented to protect children must not cause more harm than good. Social services that preserve and strengthen the family unit and reduce the number of ACEs both before and during foster care are recommended. Social workers and clinicians who are trained to address and manage the unique developmental needs of children in foster care may help reduce the effects of ACEs and optimize developmental health.

Emotional risks to respondents in survey research

Some survey research has documented distress in respondents with pre-existing emotional vulnerabilities, suggesting the possibility of harm. In this study, respondents were interviewed about a personally distressing event; mood, stress, and emotional reactions were assessed. Two days later, respondents participated in interventions to either enhance or alleviate the effects of the initial interview. Results indicated that distressing interviews increased stress and negative mood, although no adverse events occurred. Between the interviews, moods returned to baseline. Respondents who again discussed a distressing event reported moods more negative than those who discussed a neutral or a positive event. This study provides evidence that, among nonvulnerable survey respondents, interviews on distressing topics can result in negative moods and stress, but they do not harm respondents.

Use and perceived benefits of complementary therapies by cancer patients receiving conventional treatment in Italy

CONTEXT

In Italy, data regarding the use of complementary therapies (CTs) among patients with cancer are sparse and discordant.

OBJECTIVES

The present study aimed to investigate the demographic and psychological characteristics of Italian cancer patients who use CTs and the perceived benefit of users.

METHODS

Eight hundred three patients from six Italian oncology departments were interviewed about CT use and completed two questionnaires to explore psychological distress and the resilience trait called sense of coherence (SOC). Patients included in the study had different primary tumor sites and were in different phases of the disease and care process.

RESULTS

At the time of measurement, 37.9% of patients were using one or more types of CTs. The most commonly used CTs were diets and dietary supplements (27.5%), herbs (10.8%), homeopathy (6.4%), and mind-body therapies (5.5%). The Italian context is characterized by a high percentage of patients who informed their physicians about CT use (66.3%) and who experienced benefits (89.6%); 75.2% of the patients had used CTs in the past. Multivariate analysis revealed that young, female patients, who previously used complementary and alternative medicine in the past, appear more likely to use at least one type of CT in the present. Predictors of the use of CTs varied according to the type of CT. Among psychological factors, SOC was positively associated with both past and present CT use.

CONCLUSION

Overall prevalence of CTs among Italian cancer patients is high and is in accordance with the European average. In addition to clinical and sociodemographic factors, the resilience trait SOC also was associated with CT use.

The association between adverse life events and body weight change: results of a prospective cohort study

BACKGROUND

Stress has been shown to be a determinant of weight change and risk for obesity. To date, there is scarce evidence that stressful life events and their severity contribute to changes in body weight. We studied the association between the occurrence, impact of and adaptation to adverse life events and weight change and the role of initial weight status.

METHODS

Analyses were based on data from a population-based cohort of 2789 adults. Adverse life events, their impact and adaptation were measured retrospectively after baseline and follow-up weight and height measurements.

RESULTS

Over six years, participants gained an average of 2.8 kg. There were no differences in weight change between those who had experienced an adverse life event versus those who had not. However, the impact of life events had a significant interaction with initial weight status. Adults with a healthy weight showed an average weight reduction of 0.2 kg (95% CIs: -0.7 - 0.2), and overweight adults showed an average weight gain of 0.4 kg (95% CIs: -0.3 - 1.1) for each point increase in impact after experiencing an adverse life event. Further, a slower adaptation to events was significantly associated with greater weight loss among those who lost weight.

CONCLUSIONS

We found no proof for an association between life events and weight change in the entire study sample, but we found that adults at a healthy weight responded differently to adverse life events than those who were overweight.

PTSD in paramedics: resilience and sense of coherence

BACKGROUND

Paramedics are frequently subjected to traumatic experiences and have higher PTSD prevalence rates than people in the general population. However, the vast majority of paramedics do not develop PTSD. While several risk factors for PTSD have been established, little is known about protective factors. It has been suggested that a good sense of coherence (SOC) and high resilience lower the risk for developing PTSD.

AIMS

To examine whether SOC and resilience are associated with PTSD severity in paramedics.

METHOD

A cross-sectional study investigated SOC, resilience and PTSD in paramedics (N = 668). PTSD was assessed with the Posttraumatic Stress Diagnostic Scale (PDS); resilience and SOC were measured with the Resilience Scale (RS-11) and the Sense of Coherence Scale (SOC-L9). Further measures included preparation of dealing with traumatic events and availability of psychological help.

RESULTS

As expected, both resilience and SOC were negatively correlated with PTSD symptoms. The regression analysis showed that 19.2% of the total variance in symptom severity was explained by these variables. However, SOC was a better predictor than resilience for PTSD severity, as it accounted for more unique variance. Paramedics who were prepared for dealing with work-related traumatic events and who received psychological help had less severe PTSD symptoms and higher SOC scores than paramedics for whom these services were not available.

CONCLUSIONS

Enhancing resilience, and especially SOC, seems a promising approach to reduce PTSD symptom severity in high risk groups like paramedics.

Social adversity experience and blood pressure control following antihypertensive medication use in a community sample of older adults

BACKGROUND

Psychosocial stress is a risk factor for hypertension and has been shown to affect response to treatment for psychiatric illnesses.

PURPOSE

We investigate the relationship between a history of social adversity experience and blood pressure control following antihypertensive medication use.

METHODS

A total of 1,186 participants selected from the European Prospective Investigation into Cancer-Norfolk study (531 men and 655 women, aged 42 to 80 years) had attended two health checks at which blood pressure measurements were taken; were taking antihypertensive medication at the second, but not the first health check; and had completed a questionnaire assessment of their social and psychological circumstances which included details of traumatic experiences in childhood and of adverse life events, long-term difficulties, and perceived stress in adulthood.

RESULTS

Experience of recent loss events in adulthood was associated with a smaller reduction in systolic blood pressure after starting hypertension treatment (β = 1.78, 95 % confidence interval 0.15-3.40, per life event), independently of age, sex, preexisting health conditions, cigarette smoking history, alcohol consumption, physical activity, and obesity.

CONCLUSION

Results from this study suggest that stress caused by recent losses may be associated with reduced effectiveness of treatment for hypertension. Subject to replication, these findings may help determine the specific physiological mechanisms by which medication treatment effectiveness is affected by stress.

Mortality following unemployment during an economic downturn: Swedish register-based cohort study

OBJECTIVE

To investigate if unemployment during an economic downturn is associated with mortality, even among men with markers of better health (higher cognitive function scores and qualifications), and to assess whether the associations vary by age at unemployment.

DESIGN

Longitudinal register-based cohort study.

SETTING

Study entry was in 1990 and 2001 when Sweden was entering periods of significant economic contraction.

PARTICIPANTS

A representative sample of men from the general population (n=234 782) born between 1952 and 1956 who participated in military conscription examinations. Men in receipt of disability or sickness benefit at study entry were excluded.

MAIN OUTCOME MEASURE

All-cause mortality.

RESULTS

Unemployment compared with employment in 1991 (ages 34-38 years) produced adjusted HRs (with 95% CIs) for all-cause mortality (3651 deaths) during follow-up to 2001 and after stratification by education of 2.35 (1.99 to 2.76) for compulsory education, 2.25 (1.97 to 2.58) for up to 3 years postcompulsory education and 1.90 (1.40 to 2.57) for more than 3 years postcompulsory education. When unemployment was compared with employment in 2001 (ages 45-49 years) with follow-up to 2010, the pattern of mortality risk (4271 deaths) stratified by education was reversed, producing adjusted HRs of 2.81 (2.47 to 3.21) for compulsory education, 2.87 (2.58 to 3.19) for up to 3 years postcompulsory education and 3.44 (2.78 to 4.25) for more than 3 years postcompulsory education. Interaction testing confirmed effect modification by age/period (p=0.003). The degree of gradient reversal was slightly less pronounced after stratification by cognitive function but produced a similar pattern of results (p=0.004).

CONCLUSIONS

Unemployment at older ages is associated with greater mortality risk than at younger ages, with the greatest relative increase in risk among men with markers of better health, suggesting the greater vulnerability of all older workers to unemployment-associated exposures.

Validierung der türkischen Version des Screenings für Somatoforme Störungen (SOMS) 1Wir danken Frau Z. Subasi für ihre Hilfe in der Begleitung der Patienten in der ersten Einsatzphase des türkischen SOMS

Bei türkischstämmigen Migranten ist die Inanspruchnahme psychotherapeutischer Behandlung häufig mit somatoformen Beschwerden verknüpft. Zur besseren Objektivierung dieser Beschwerden wurde das Screening für Somatoforme Störungen (SOMS), das körperliche Beschwerden nicht organischer Genese erfasst, in die türkische Sprache übersetzt und anhand einer Stichprobe von 114 türkischsprachigen Patienten einer muttersprachlichen psychosomatischen Ambulanz sowie einer Gruppe von 105 psychisch unauffälligen türkischen Migranten validiert. Die türkische Version des SOMS wies eine hohe interne Konsistenz (von α = 0.78 bis α = 0.93), eine hohe konkurrente und divergente Validität (von r = .37 bis r = –.48) anhand von Depressivitätsscores nach dem Beck-Depressions-Inventar und dem Gesamtscore des Kohärenzgefühls nach der Sense of Coherence Scale sowie eine hohe diskriminante Validität auf. Mit der türkischen Version des SOMS wird ein verständliches, reliables und valides Instrument zur Erfassung somatoformer Symptome bei türkischen Migranten vorgelegt.

Older adults' spirituality and life satisfaction: a longitudinal test of social support and sense of coherence as mediating mechanisms

Spirituality is proposed to be a component of successful ageing and has been shown to predict wellbeing in old age. There has been conceptual discussion of possible mechanisms that link spirituality with positive psychological functioning in older adults, but few empirical examinations of these linking mechanisms over time. The current study examined the role of Antonovsky's Sense of Coherence (SOC) and social support in mediating the effects of spirituality on life satisfaction in older participants over a four-year period. The study used a cross-lagged panel analysis to evaluate longitudinal mediation within a path analysis framework. Results showed that the meaningfulness dimension of SOC mediated the influence of spirituality on life satisfaction over time, suggesting that spirituality may influence older adults' experience and perception of life events, leading to a more positive appraisal of these events as meaningful. Social support was not found to mediate the pathway between spirituality and life satisfaction. This study may be the first to examine the link between spirituality, sense of coherence, social support and wellbeing, as measured by life satisfaction, using longitudinal data from a community sample of older adults. The study provides evidence for the positive role of spirituality in the lives of older people. This is an area that requires further examination in models of successful ageing.

Sense of coherence and depression in the framework of immigration: Turkish patients in Germany and in Turkey

The present study explores sense of coherence (SOC) levels in two clinical samples (outpatients with neurotic disorders) with the same Turkish cultural background in comparison to the German reference values as well as the association between SOC and depression and the protective role of SOC. A total of 96 Turkish patients in Germany (36.67 ± 9.52 years) as well as 60 local Turkish patients (38.57 ± 10.15 years) have been examined for SOC measured with the Sense of Coherence scale (SOC-29) and depression with the Beck Depression Inventory (BDI). Both samples scored significantly lower for SOC compared to the normal Turkish and German population and to German subjects with psychiatric symptoms (p < 0.001) but did not differ significantly from each other. Negative significant correlations were found between SOC and the degree of depressiveness in both groups (immigrants: r = -0.59, p < 0.001; Turks: r = -0.51, p < 0.001). Multiple regression analyses including SOC, age, gender, education, marital and employment status have demonstrated SOC to be the strongest predictor for depressiveness. SOC can be regarded as a protective factor for depression in patients with Turkish migration background in Germany and in local Turkish patients. However, further studies are needed to clarify if the concept SOC can be used adequately in collectivistic cultures as, for example, the Turkish one.

Search for a curvilinear relationship between the sense of coherence and the intensity of PTSD in MVA survivors

The relationship between the sense of coherence (SOC) and the intensity of posttraumatic stress disorder (PTSD) was examined in order to determine its nature and to resolve the inconsistencies between (1) a growing body of empirical research that indicates a linear relationship between these variables, and (2) the schema-based theories of PTSD that suggest a curvilinear relationship between cognitions and the intensity of PTSD. In this cross-sectional study an attempt was also made to identify some psychological factors that moderate this relationship. Participants were a sample of 1132 motor vehicle accident (MVA) survivors. The results showed that gender and temperamental predisposition to PTSD constituted moderator variables of the relationship between SOC and the intensity of PTSD. This supported both the empirical evidence on the linear and negative relationship between SOC and the intensity of PTSD and the theories that postulated the curvilinear relationship.

Sense of coherence predicts post-myocardial infarction trajectory of leisure time physical activity: a prospective cohort study

Background

Physical activity confers a survival advantage after myocardial infarction (MI), yet the majority of post-MI patients are not regularly active. Since sense of coherence (SOC) has been associated with health outcomes and some health behaviours, we investigated whether it plays a role in post-MI physical activity.

We examined the predictive role of SOC in the long-term trajectory of leisure time physical activity (LTPA) after MI using a prospective cohort design.

Methods

A cohort of 643 patients aged ≤ 65 years admitted to hospital in central Israel with incident MI between February 1992 and February 1993 were followed up for 13 years. Socioeconomic, clinical and psychological factors, including SOC, were assessed at baseline, and LTPA was self-reported on 5 separate occasions during follow-up. The predictive role of SOC in long-term trajectory of LTPA was assessed using generalized estimating equations.

Results

SOC was consistently associated with engagement in LTPA throughout follow-up. Patients in the lowest SOC tertile had almost twice the odds (odds ratio,1.99; 95% confidence interval,1.52-2.60) of decreasing their engagement in LTPA as those in the highest tertile. A strong association remained after controlling for disease severity, depression, sociodemographic and clinical factors.

Conclusion

Our evidence suggests that SOC predicts LTPA trajectory post-MI. Assessment of SOC can help identify high-risk MI survivors, who may require additional help in following secondary prevention recommendations which can dramatically improve prognosis.

Psychological resilience and long-term distress in Swedish and Icelandic parents' adjustment to childhood cancer

AIM

Studies of parental reactions to a child's cancer have traditionally been carried out within the framework of psychiatry and psychopathology. We studied the significance of individual resource factors strengthening parents' resilience to long-term cancer-related distress, a focus that has rarely been used.

PARTICIPANTS AND METHODS

The two-nation Nordic sample included 398 parents; 190 of whom had experienced a child's cancer, and 208 reference parents. We studied the sense of coherence (SOC) using the SOC-13 questionnaire. For assessing distress reactions we used a primarily illness-specific 11-dimensional Parental Psychosocial Distress in Cancer (PPD-C) self-report questionnaire developed for use with parents of childhood cancer patients, and the General Health Questionnaire (GHQ). Resilience was defined as absence of/less severe distress.

RESULTS

Low SOC was significantly associated with more severe distress in all dimensions of the PPD-C and GHQ. The protective effect of SOC was indicated by it being most negatively related to general psychiatric symptoms, physical and psychological stress symptoms, anxiety and depression. The influence of SOC varied with parents' gender, showing a stronger modifying influence among mothers. Mothers and fathers also differed in their utilisation of professional psychosocial support when confronted with the child's cancer.

CONCLUSION

Parental resilience to cancer-related distress varies with identifiable strength factors. A strengths-oriented approach helps in understanding parental adjustment to childhood cancer. In order to counteract psychological vulnerability, addressing resilience instead of pathology helps to identify parents at risk and in need of professional support when faced with a child's cancer.

A Salutogenic Analysis of Healthy Aging in Active Elderly Persons

The authors systematically explore relationships between generalized resistance resources (GRRs), the sense of coherence (SOC), and the healthease/dis-ease (HE-DE) continuum. A sample of 170 active older adults at the mean age of 67 years filled out a comprehensive questionnaire. The results indicate that 11 GRRs significantly predicted SOC (56% of variance accounted for) and that GRRs significantly predicted the HE-DE continuum (38%). Holding GRRs constant, SOC significantly accounted for 3% additional variance in health. Finally, SOC mediated GRRs’ effects on health. SOC proved to be a complete mediator for autonomy/identity resource gains, social external health locus of control, self-efficacy, and self-esteem, and a partial mediator for activity level and social support. The findings suggest that SOC plays a central role for health maintenance and health promotion in the third age because it pools resource influences on health. The authors recommend the application of salutogenic theory to intervention.