Sense of coherence in different stages of health and disease in northern Sweden--gender and psychosocial differences

Development of Sense of Coherence Stability in the AGORA Healthy Ageing Study

Sense of coherence (SOC) is a psycho-social trait formed in childhood or adolescence, allowing individuals to be more resilient to daily life stressors, stay well, and improve their personal health. Although SOC remains stable after the age of thirty, only a few studies investigated its stability in adulthood. The aim was to investigate the development of SOC over time in 489 participants and its association with age, gender, educational level, or negative life events. The study was performed as part of the Healthy Ageing project of the Academic Collaborative Centre AGORA, a longitudinal study involving four municipalities of Eastern Netherlands. A self-administrated questionnaire was used to monitor the SOC of the elderly in 2008, 2010, and 2013, using the Orientation to Life Questionnaire (SOC-13). The analysis included repeated-measures ANOVA analysis and bivariate analysis using Pearson's chi square test. We found no statistically significant variation in SOC over time (F (2, 282) = 2.99, p = 0.052) and no significant association with age (F (2, 282) = 2.851, p = 0.06), gender (F (2, 282) = 0.845, p = 0.43), or educational level (F (2, 282) = 0.708, p = 0.49). SOC remained stable in the elderly population, even if they experienced negative events over their lifespan.

Sense of Coherence and Health-Related Quality of Life in Patients with Multiple Sclerosis: The Role of Physical and Neurological Disability

Multiple sclerosis is a progressive demyelinating disease of the central nervous system that can lead to permanent disability and significantly impact the quality of life. The present study explores the relationship between neurological disability and disease symptoms, quality of life, and the level of sense of coherence, which is an important resource for coping with the disease. EDSS, GNDS, SOC-29, and MSIS-29 were used in the presented study. The study group consisted of 137 people diagnosed with multiple sclerosis. The study showed the correlation between most of the analyzed variables. Mood disability and fatigue were significant predictors of the sense of coherence and explained 34% of its variance. Physical disability and fatigue served as significant predictors of the physical aspect of quality of life, explaining 49% of its variance. Fatigue and sense of coherence were significant predictors of the psychological aspect of quality of life, explaining 47% of the variance. In studies on a group of people with multiple sclerosis, it is worth considering, in addition to the level of disability, also invisible symptoms, such as fatigue or mood disability, which are important for the quality of life and the level of resources. As this study suggests, a sense of coherence is a resource essential for the quality of life of people with disabilities.

Sense of coherence and coping behaviours in persons with late effects of polio

BACKGROUND

Sense of coherence (SOC), comprising "comprehensibility", "manageability" and "meaningfulness", is important for successful adaptation in persons with late effects of polio (LEoP) and can be used as an estimate of the ability to cope with stressors. Coping behaviours are the actions a person performs to reduce stress and can be divided into problem-focused coping, emotion-focused coping and less useful coping. Our knowledge is very limited of what coping behaviours persons with LEoP use to manage their life situation as well as the association between SOC and coping behaviours.

OBJECTIVE

The aims of this cross-sectional study were to assess coping behaviours and to explore the association between SOC and coping behaviours in persons with LEoP.

METHODS

In total, 93 ambulant persons (52% women, mean [SD] age 74 [8] years) with clinically and electromyographically verified LEoP responded to a postal survey with the Sense of Coherence Scale 13 items (SOC-13) and the Brief Cope Scale. Three linear regression analyses were used to explore the association between SOC and problem-focused coping, emotion-focused coping and less useful coping, controlling for age and sex.

RESULTS

The most-used coping behaviours belonged to the categories problem-focused and emotion-focused coping. We found a significant negative association between SOC and less useful coping; less useful coping explained 34% of the variance of SOC (adj R2 = 0.34, p < 0.001), whereas age and sex were not significant in the analyses.

CONCLUSIONS

Persons with LEoP primarily use problem-focused and emotion-focused coping behaviours, which suggests that generally they have adapted well to their disability. Regardless of age and sex, persons with lower SOC scores use less useful coping behaviours, which suggests that they are not as well adapted. These results can facilitate the development of rehabilitation interventions that help persons with LEoP adapt to their situation with a life-long disability.

Previous life experiences and social relations affecting individuals wish for support when establishing healthy habits - a qualitative study of Norwegian Healthy Life Centre participants

BACKGROUND

Interventions to reduce and prevent overweight, obesity and T2D has been advocated worldwide. In Norway, Healthy Life Centres have been established to help individuals to reduce and prevent diseases, offering physical activity and dietary advice to establish healthy habits. Previous life experiences, social support and help from health personnel could play a role in the process of establishing healthy habits. The aim of this study was to explore how two groups of Healthy Life Centre participants described their previous life experiences, social relations and wish for support from Healthy Life Centre personnel.

METHODS

A qualitative design was used, including 49 individual semi-structured interviews. The interviews for this study were performed in two different samples, one sample of participants applying for HLC participation in 2013 (n = 23) and one sample of participants invited to HLC participation in 2015 (n = 26). The data was analyzed using systematic text condensation.

RESULTS

Three main themes in a chronological (past, present and future) order were identified: 1. Previous life experiences stamping life situation (past time). 2. Social relations being a support or a burden in everyday life (present time) and 3. Expressing wishes for HLC support (future).

CONCLUSIONS

In the process of establishing healthy habits, the need for help from personnel may be differentiated based on previous life experiences and present social relations.

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

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

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

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

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

Sense of coherence and impact of oral health on quality of life in adults and elderly in Southern Brazil

This cross-sectional study aimed to investigate the association between the Sense of Coherence and impact of oral health on the quality of life. Was conducted with a sample of 720 individuals of both sexes, between the ages of 50 and 74 years, selected through multistage proportional random sampling. The data collection instruments used were: short version of the Sense of Coherence Scale (SOC-13), Oral Impacts on Daily Performances (OIDP) questionnaire, oral clinical examination and questionnaire containing socio demographic and use of dental services information. Bivariate and multivariate analyses were performed through Poisson regression adjusted for robust variance, with level of significance p < 0.05. Oral impacts were reported by 416 participants (57.8%). In the adjusted model, those with strong SOC were more likely of not having any impact when compared with individuals with weak SOC (PR=1.30). Need for dental prosthesis was also associated with the outcome, individuals who did not require prosthesis had less impact (PR=1.50). The findings showed that SOC is associated with OIDP, supporting the hypothesis that individuals with strong SOC present a lower impact of oral health on the quality of life, suggesting that SOC is a determinant that can provide protection against that impact.

Temperament and Sense of Coherence: Emotional Intelligence as a Mediator

Sense of coherence (SOC) reflects an individual’s capacity and available resources to deal with stressful situations. For some time now studies have revealed that people differ in their experience of SOC; yet, very little is known about how and through which mechanisms a high level of SOC is formed. In order to increase our understanding about the paths to a high SOC in the stage of adulthood, we focused on exploring the role both of temperament, as it has been confirmed as a potential component in the development of more complex traits that emerge later in life, and of emotional intelligence (EI) as it has been found to increase SOC. The sample consisted of 173 participants between 18 and 49. We used the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A), Orientation to Life Questionnaire (OLQ), and Emotional Intelligence Questionnaire (INTE). Results showed a negative correlation between the depressive, cyclothymic, irritable, and anxious dimensions of temperament and SOC, and EI. There was also a positive correlation between hyperthymic temperament and SOC, and EI. EI correlated positively with a general sense of coherence and its three dimensions. The PROCESS macro for SPSS showed that emotional intelligence mediates the relationship between depressive, cyclothymic, hyperthymic, irritable and anxious temperament, comprehensibility, manageability, meaningfulness, and global orientation to life. On the basis of the obtained outcomes, it can be stated that emotional intelligence mediates the relationship between dimensions of temperament and dimensions of SOC.

Social factors relating to depression among older people in Japan: analysis of longitudinal panel data from the AGES project

Objectives: Preventing the onset of depression among older people in Japan requires clarifying the social determinants of depression by using longitudinal data, while also taking biological and psychological factors into account. Identification of such determinants may enable more active intervention through social policy. We aimed to reveal the social factors related to depression in Japan's older people and consider associated policy implications. Method: Panel data obtained from a longitudinal survey (Wave 1 to Wave 2) of 3464 elderly subjects, aged 65 years or more, as part of the Aichi Gerontological Evaluation Study (AGES) project was employed. The outcome variable was depression, as evaluated by the Geriatric Depression Scale. Frequency of meeting with friends, social support, hobbies, participation in organizations, life events, illness, self-rated health, instrumental activities of daily living, and sense of coherence were entered as explanatory variables within a logit model for each gender. Results: Of the subjects without mental illness or depression at Wave 1, 14% had become depressed by Wave 2. In both men and women, life events predicted increased odds of depression, while sense of coherence predicted reduced odds. The frequency of meeting with friends, hobbies, and self-rated health predicted reduced odds of depression in men, while age predicted increased odds in women. Conclusion: Overall, social interaction is important for preventing depression in Japan, and that the establishment of a system capable of promoting social interaction and providing care to the elderly during life events may be a useful social policy approach to preventing depression.

Sense of Coherence and the Association with Sociodemographics and Disability Related Factors in Persons with Late Effects of Polio

BACKGROUND

Sense of Coherence (SOC) is important for successful adaptation in persons with life-long disabilities. A previous study has shown that persons with Late Effects of Polio (LEoP) have a level of SOC indicating that they generally have the ability to understand, handle, and have the motivation to deal with stressful events and problems arising in their lives. However, no study has explored the associations between SOC, sociodemographics, and disability-related factors in persons with LEoP.

OBJECTIVE

To explore the associations between SOC, sociodemographics, and disability-related factors in persons with LEoP.

DESIGN

A cross-sectional design.

SETTING

University hospital outpatient clinic.

STUDY PARTICIPANTS

Ninety-three persons (mean age 74 years, 52% women) with LEoP.

MAIN OUTCOME MEASUREMENTS

Swedish versions of the Sense of Coherence scale (SOC-13), Self-reported Impairments in Persons with Late Effects of Polio (SIPP) scale, Reintegration to Normal Living Index (RNL-I) (subscales "Daily Functioning" and "Perceptions of Self"), and Satisfaction With Life Scale (SWLS).

METHODS

The participants responded to a postal survey with background information and the four rating scales. To determine factors associated with SOC, a hierarchical regression analysis was performed with SOC as the dependent variable.

RESULTS

Higher age, less bothered by symptoms of LEoP, better perceptions of self, and higher life satisfaction were significantly associated with a greater SOC score. The final model explained 60% of the variance in the SOC (R² Adj = 0.60, P < .001).

CONCLUSIONS

The strong association between SOC, higher age, and disability-related factors is important to consider in the rehabilitation of persons with LEoP. This knowledge can assist rehabilitation professionals to plan interventions that enable people with LEoP to develop strategies to better manage their daily life.

LEVEL OF EVIDENCE

III.

Sense of Coherence in persons with late effects of polio

BACKGROUND

Sense of Coherence (SOC) is important for successful adaptation and mental well-being in people with life-long medical conditions. Late effects of polio (LEoP) often lead to a life-long disability, but no study has assessed SOC in this population.

OBJECTIVE

To assess SOC in persons with LEoP and to explore the association between SOC, demographics (age, gender, marital status and level of education) and variables related to LEoP (age at polio onset, number of years from polio until onset of LEoP and self-rated disability).

METHOD

Ninety-three community-dwelling persons with clinically verified LEoP responded to a postal survey with the Sense of Coherence Scale (SOC-13). A hierarchical multiple regression analysis was performed to explore the associations with SOC.

RESULTS

SOC varied considerably among the participants. The mean and median SOC-13 total sum score was 71.8 and 76 points, which is similar to age-matched non-disabled people. The number of years before onset of LEoP and self-rated disability together with the participants' marital status and level of education explained 37% (p < 0.001) of the variance in SOC.

CONCLUSION

Persons with LEoP have a level of SOC indicating that they generally have the ability to understand, handle and being motivated when dealing with stressful events and problems arising in their lives as a result of their disability. Being married and having a higher education, living many years before onset of LEoP and perceiving a mild to moderate disability contributed to a strong SOC.

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

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

Salutogenesis: A New Approach toward Oral Health Promotion

Introduction:

Sense of coherence (SOC) is hypothesized to be an important psychological factor that enables people to cope with stressors and successfully maintain and improve health. Very few publications report on the relationship between “salutogenesis,” as measured by the concept of SOC and oral health status. However, little is known about the relationship between the mother's SOC and dental caries of their children.

Aims and Objectives:

The aim of the present study was to explore the impact of mother's SOC level on dental caries status of their children.

Materials and Methods:

A school-based cross-sectional study was conducted with the children aged 4–8 years attending public school (n = 200). Questionnaires were applied to mothers to obtain level of SOC. Dental caries status in children was assessed using decayed, missing, filled tooth surfaces (DMFS) and/or dmfs index. One-way analysis of variance F-test and post hoc Tukey test were used to assess the effect of mother's SOC level on their children's caries dmfs index.

Results:

Mean of dmfs and/or DMFS in children showed statistically significant relation with their mother's SOC level (P < 0.01). On intergroup comparison, significant (P < 0.01) difference was found when mean of dmfs and/or DMFS with mothers having low SOC and high SOC was compared. However, there was no significant relation when mean was compared to mothers with medium and low SOC.

Conclusion:

Dental caries of children gets influenced by mother's SOC level. There was an inverse relationship between mother's SOC level and their children dental caries status.

Social work interventions in Sweden for patients newly diagnosed with type 1 or type 2 diabetes

We evaluated psychosocial work with patients in ordinary clinical practice who were newly diagnosed with type 1 or type 2 diabetes and experienced psychosocial problems at disease onset. We examined types of psychosocial problems, causes of these problems, psychosocial interventions, extent of achievement of psychosocial treatment goals, and whether the patients felt they benefited from the treatment. Eighty-nine working-age (18-65-year-old) Swedish adults newly diagnosed with diabetes were included. Each was interviewed and responded to questionnaires at the beginning and end of the study period. Thirty-four (38%) received psychosocial treatment as needed over 2 years. A psychosocial treatment plan with a defined goal was developed for each. Interventions included counseling, problem-focused support, social information, and advice. The treatment process was documented. Eighteen patients had type 1, and 16 had type 2 diabetes. One-third had emotional problems directly caused by receiving a diagnosis. Several of them had crisis reactions. The rest had problems primarily caused by their life situations. Those with psychosocial problems caused by receiving a diagnosis achieved treatment goals more frequently than the others. Distinguishing the cause of the psychosocial problems of newly diagnosed patients may help ensure that social work resources in health care are used as effectively as possible.

Sense of coherence and associated factors among university students in China: cross-sectional evidence

Background

Sense of Coherence (SOC) is considered as a health-promoting resource; it is mainly developed before the age of 30. The multiple demands university students face, such as study-related stress and financial difficulty, could challenge their SOC development. This study aimed to: 1) investigate the association between SOC, socio-demographic and lifestyle-related characteristics; 2) assess the effect of perceived stress on SOC controlling for other variables among the Chinese university students. Analyses were done to derive a better view on possible strategies to strengthen students’ SOC and with that to promote their health.

Methods

The data used were from a Chinese university student health survey (N = 1,853). Logistic regression analyses were used to explore the effects of varied socio-demographic, lifestyle-related variables on students’ level of SOC, as well as the association between perceived stress and SOC controlling for other variables in the analysis.

Results

Both social support (OR = 2.56 [1.87–3.50]) and better performance compared with peers (OR = 1.64 [1.15–2.34]) were associated with a stronger SOC. Not feeling isolated at university (OR = 1.60 [1.04–2.47]) and satisfaction with the political situation (OR = 2.05 [1.57–2.67]) were also associated with a stronger SOC. This counts also for high health awareness (OR = 1.40 [1.05–1.87]) and nutrition importance (OR = 1.67 [1.04–2.69]). Perceived stress (OR = 0.81 [0.79–0.83]) was negatively associated with a strong SOC when controlling for socio-demographic and lifestyle-related variables.

Conclusion

We suggest integrating stress coping, emotion management training programmes as well as measures promoting social integration for students and teachers at campus, promoting healthy behaviours, and creating a supportive learning environment as strategies for enhancing the SOC level of university students in China.

Sense of Coherence among Older Adult Residents of Long-Term Care Facilities in Taiwan: A Cross-Sectional Analysis

Background

Growing evidence shows that sense of coherence (SOC) is related to health promotion. Knowledge of SOC among older adults in Taiwan is limited. The present study aimed to investigate SOC status and its relationship to personal and environmental factors among older adult residents of long-term care facilities (LTCFs) in northeastern Taiwan.

Methods

This cross-sectional study was performed in Yilan, Taiwan. With face-to-face interviews, we obtained data from 104 LTCF residents (aged 65 years and older) using the Chinese version of Antonovsky's short 13-item SOC scale. We also collected the information on personal characteristics, physical and social environmental resources. Multiple linear regression was used to analyze factors potentially influencing SOC.

Results

Of the participants, the mean score (±standard deviation) of SOC was 58.3 (±8.8), while scores on SOC subscales (comprehensibility, manageability, and meaningfulness) were 23.4 ±4.5, 17.9 ±3.8, and 17.0 ±3.2, respectively. Education level, activities of daily living and number of LTCF staff were found to be independently associated with SOC status after adjusting for demographic characteristics, health status, and environmental resources. In addition, interactions between personal and environmental factors had a crucial influence on SOC status.

Conclusions

Participants in this study had relatively low SOC scores compared to their counterparts in Western countries. In addition to personal factors, environmental factors can play a significant role in SOC status among older adult LTCF residents. Comprehensive evaluation of SOC status should consider person-environment interaction effects.

Sense of coherence and depressive symptoms among low-income Bedouin women in the Negev Israel

BACKGROUND

Higher sense of coherence (SOC) has been associated with lower depression in Western societies; however, it is not clear whether this association manifests similarly in non-Western cultural contexts.

AIMS

To examine the associations between different levels of SOC and depressive symptoms (DS) among indigenous-minority Arab Bedouin women in Israel and explore possible explanatory variables for this association.

METHODS

We conducted face-to-face interviews with 464 women (aged 18-49 years). DS was measured based on the Center for Epidemiologic Studies Depression Scale. We used the SOC-13 questionnaire and conducted path analysis using Structural Equation Modeling to examine the contribution of two levels of SOC (low/high) to predict DS beyond psychological resources and socioeconomic position.

RESULTS

The mean score of SOC was 3.42, standard deviation (SD) = 1.15. While high SOC (mean = 4.38, SD = 0.66, range = 3.5-6.38) was positively and significantly associated with DS (r = 0.46), SOC was not associated (r = 0.02) with DS in the low SOC group (mean = 2.4, SD = 0.56, range = 1-3.42).

CONCLUSIONS

Relationships between high versus low SOC and DS among Bedouin women differ from those found in Western societies. This raises questions about the use of SOC as a universal tool in different cultural contexts.

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.

Assessments of coping after acquired brain injury: a systematic review of instrument conceptualization, feasibility, and psychometric properties

OBJECTIVE

To identify measures of coping styles used by patients with acquired brain injury; to evaluate the conceptualization, feasibility, and psychometric properties of the instruments; and to provide guidance for researchers and clinicians in the choice of a suitable instrument.

DESIGN

Systematic review.

RESULTS

The search identified 47 instruments, of which 14 were selected. The instruments focused on dispositional coping, situation-specific coping, or domain-specific coping. Psychometric properties were scarcely investigated. The COPE stood out in terms of psychometric properties but had low feasibility. The brief COPE, Coping Scale for Adults-short form, and Utrecht Coping List stood out in terms of feasibility, and the available psychometric properties of these instruments were good. Only the Coping With Health Injuries and Problems was used as other report.

CONCLUSION

Information on psychometric properties of coping instruments in acquired brain injury is scarcely available and limits the strength of our recommendations. For patients with mild injuries, we cautiously recommend the COPE and for patients with more severe injuries the brief COPE, Coping Scale for Adults-short form, Utrecht Coping List, and Coping With Health Injuries and Problems-other-report. Other instruments may be used to address particular issues such as coping with a specific stressful situation or illness.

Sense of coherence in first-time parents: a longitudinal study

Background: Antonovsky’s idea of sense of coherence (SOC) is related to wellbeing and is of importance for individuals in public health care. SOC in parents with healthy children has not previously been studied. The objectives of this study were (1) to describe the SOC of first-time parents during the first 8 years of their child’s life, (2) to describe gender differences in regards to SOC, and (3) to describe covariates with SOC in the parents’ life situations. Methods: The study was longitudinal comprising three cross-sectional studies conducted when the first child was 6 months (T1), 4 years (T2), and 8 years (T3) of age. A sample of 258 mothers and fathers answered a questionnaire on the experienced quality of their partner relationship (QDR36) on all three occasions. SOC was measured using the SOC-13, and psychosocial variables were included at T2 and T3. Descriptive, comparative statistics and multiple regression analyses were performed. Results: SOC decreased for both genders at T2 and increased again at T3. At T1 and T2 the fathers’ SOC was statistically higher than that of the mothers, but at T3 this difference could no longer be statistically secured. Covariates at T2 were QDR index, social support, experience of parenthood, strained economy, and health. Covariates at T3 were experience of parenthood and social support, QDR index, and strained economy. Conclusions: SOC in first-time parents decreased at 4 years, especially in mothers, and social support can be of significance for parents of young children to be able to experience health.

Daily life and life quality 3 years following prostate cancer treatment

Background

Knowledge of experiences from prostate cancer is sparse in a longitudinal perspective. From a nursing perspective, results from combined qualitative and quantitative studies are lacking however would present the broadest knowledge base for best practice. Present descriptions of medical-physical symptoms such as urinary, bowel and sexual dysfunction from quantitative inquiries need be complemented with qualitative results. Such knowledge is essential in relation to treatment and communication with patients over the years and not only shortly after surgery.

Methods

A longitudinal study was formatted to investigate general and specific health quality and sense of coherence quantitative alterations over three years. A general health quality module (EORTC QLC-C30) and a disease-specific module (EORTC PR-25) were applied for the longitudinal study together with the Orientation to life questionnaire (SOC), measuring a persons’ sense of coherence. In order to strengthen reliability and compensate for low participation we used the Directed content analysis for interviewing and analysis. The method allows using findings from earlier research when interviewing along with detecting new areas. Twenty-one men were followed over three years and six of them, in the third year, accepted to be interviewed.

Results

We found high quality of life ratings and extended the study with follow-up interviews in year three, to investigate whether questionnaire results were in line with interview findings. We found high life quality and functioning ratings that were in line with qualitative descriptions. Interview analysis showed retrieval of life as lived before, yet in a different way, the men never forgot the diagnosis event, had a unique illness history worth hearing, and had come to terms with most treatment-related shortcomings. Sense of coherence ratings were medium to high and confirmed stability over time in comprehensibility, manageability and meaningfulness after prostate cancer treatment.

Conclusions

Over the years, the men’s negative experiences from shifted into ‘a good life’ though in a different way than before. The interpretation is supported in the study by quantitative results showing a high degree of functioning. The men’s sense of coherence seamed to support their handling of life three years after prostate cancer treatment.

Effectiveness of a cognitive-behavioral group intervention for knee osteoarthritis pain: protocol of a randomized controlled trial

Background

Knee osteoarthritis is the most common type of arthritis, with pain being its most common symptom. Little is known about the psychological aspects of knee osteoarthritis pain. There is an emerging consensus among osteoarthritis specialists about the importance of addressing not only biological but also psychosocial factors in the assessment and treatment of osteoarthritis. As few studies have evaluated the effect of psychological interventions on knee osteoarthritis pain, good quality randomized controlled trials are needed to determine their effectiveness.

Methods/Design

We intend to conduct a 6-week single-blinded randomized controlled trial with a 12-month follow-up. Altogether, 108 patients aged from 35 to 75 years with clinical symptoms and radiographic grading (KL 2–4) of knee osteoarthritis will be included. The clinical inclusion criteria are pain within the last year in or around the knee occurring on most days for at least one month, and knee pain of ≥40 mm on a 100-mm visual analogue scale in the WOMAC pain subscale for one week prior to study entry. Patients with any severe psychiatric disorder, other back or lower limb pain symptoms more aggravating than knee pain, or previous or planned lower extremity joint surgery will be excluded. The patients will be randomly assigned to a combined GP care and cognitive-behavioral intervention group (n = 54) or to a GP care control group (n = 54). The cognitive-behavioral intervention will consist of 6 weekly group sessions supervised by a psychologist and a physiotherapist experienced in the treatment of pain. The main goals of the intervention are to reduce maladaptive pain coping and to increase the self-management of pain and disability. The follow-up-points will be arranged at 3 and 12 months. The primary outcome measure will be the WOMAC pain subscale. Secondary outcome measures will include self-reports of pain and physical function, a health related quality of life questionnaire, and various psychological questionnaires. Personnel responsible of the data analysis will be blinded.

Discussion

This study addresses the current topic of non-pharmacological conservative treatment of knee OA-related pain. We anticipate that these results will provide important new insights to the current care recommendations.

Trial registration

Current Controlled Trials ISRCTN64794760

Relationships among sense of coherence, resources, and mental health in urban and rural residents in Japan

Background

The salutogenic model states that coping resources are defined within sociocultural and historical contexts and that various social and historical factors influence the availability of such resources. Though previous studies have suggested the need for an interregional comparison of psychological and social resources, few studies have undertaken such an investigation. The aim of this study is to investigate the associations among coping resources, sense of coherence (SOC), and health status in a comparison of urban and rural residents.

Methods

General residents (aged 30–69 years) in two areas were targeted for the current study. Through a random sampling selection, 1,000 residents from each area were picked, and an anonymous questionnaire was mailed to each resident. Ultimately, 269 and 363 valid responses from the urban and rural areas, respectively, were analyzed. SOC, both social and psychological resources, and mental health were assessed. To examine relationships between SOC and resources associated with mental health, mental health was defined as a dependent variable. Hierarchical multiple regression was conducted with variables entered from sociodemographic characteristics, social and psychological resources, and SOC.

Results

Regarding regional characteristics, social capital and participation in community activities were significantly greater in the rural area than in the urban area. Urban residents reported significantly higher self-esteem and optimism than rural residents. SOC showed the most significant association with mental health in both areas. Mental health was significantly associated with physical activity limitations and life stressors in both areas. However, the associations were weakened when social and psychological resources and SOC were added, which demonstrated their buffering effect on the negative influence of life stressors on health. When SOC was added, the association of self-esteem with mental health disappeared in both areas, but optimism in the urban area and humor in the rural area were directly and independently associated with mental health.

Conclusions

Our findings indicate that resources available to urban and rural residents are characteristic of the area where they live, and that social and psychological resources as well as SOC are associated with better mental health. Possible directions for health support strategies, reflecting regional characteristics, are suggested.

Sense of coherence and need for support among long-term survivors of childhood cancer

BACKGROUND

The concept of sense of coherence (SOC) may be applied to explain individuals' resources for dealing with the stressors confronted in daily life. Little is known about what impact cancer in childhood may have on the development of SOC.

OBJECTIVE

The objectives of this study were to compare SOC between long-term survivors of childhood cancer and a comparison group and to explore the need for current support among the survivors and the association between need for support and SOC.

METHODS

Data were collected from 224 long-term survivors aged 18 to 37 years using the 13-item SOC scale and interviews. A matched comparison group (n = 283) randomly selected from the general population was included.

RESULTS

There was no significant difference in the mean SOC score between the survivors and the comparison group. Twenty percent of the survivors reported a need for support, a need significantly predicted by a low SOC, as well as surgery and/or radiation treatment often in combination with chemotherapy.

CONCLUSIONS

Long-term survivors of childhood cancer seem to have resources to cope with stressful situations in life to the same degree as people in general. Survivors with fewer resources to cope and those having received a more intense treatment were more likely to be in need of support.

IMPLICATIONS FOR PRACTICE

The concept of SOC in nursing practice may be helpful to identify and discuss an individual's resources and impediments to health to better understand the need for support among survivors of childhood cancer.

Self-rated Health in Middle-aged Women: Associations with Sense of Coherence and Socioeconomic and Health-related Factors

This study aimed to describe and analyse self-rated health in relation to sense of coherence and socioeconomic and health-related factors and to explore the associations between self-rated health and these factors in order to identify health resources and health limitations in a group of healthy middle-aged women. Healthy middle-aged women from a defined geographical area in Southern Sweden ( n =577) answered a postal survey with the sense of coherence scale and questions about socioeconomic and health-related conditions. The results showed that very good/rather good self-rated health was associated with high sense of coherence and good economic situation, and these factors can be seen as a health resource. Poor self-rated health was most strongly associated with perceived symptoms of tension, weak sense of coherence, treatment for depression, treatment for chronic disease, and difficult economic situation, and these factors can be seen as health limitations. In conclusion, only 29% of the women rated their health as very good and 41% of the women had symptoms of tension but they were not sick-listed. It is of major public health interest to improve the understanding of self-rated health and to develop health promotion for women and methods to prevent symptoms of tension and sick-listing.

Sense of coherence over time for parents with a child diagnosed with cancer

BACKGROUND

When a child is diagnosed with childhood cancer this creates severe stress in the parents. The aim of the study was to describe the sense of coherence and its change over time in a sample of parents of children diagnosed with cancer.

METHODS

The Swedish version of SOC (29 items) was used to measure the parents' (n = 29) sense of coherence. Data were collected at four time-points: Time-point 1 at the time of diagnosis; time-point 2 during the treatment; time-point 3 after the child had completed their treatment and time-point 4 when the child had been off treatment for some years or had died.

RESULTS

The results showed that SOC in the investigated population is not stable over time. The parents decreased in total SOC between time-points 1, 2 and 3. Mothers had significantly weaker total SOC score including the components Manageability and Meaningfulness at time-points 1 as well time-point 2 compared to the fathers. However, for the component Comprehensibility no significant differences were shown between mothers and fathers. This study indicates that mothers' and fathers' SOC scores change over time during the child's cancer trajectory. However, the pattern in these changes varies between mothers and fathers.

CONCLUSIONS

This study indicates that mothers and fathers may have different support needs during their child's cancer trajectory.

Relação entre senso de coerência materno, condições socioeconômicas e percepção da saúde bucal

O objetivo desta pesquisa foi verificar a relação entre o senso de coerência materno das mães de pré-escolares e as variáveis idade, renda, escolaridade, trabalho, moradia e percepção da saúde bucal. Seiscentas e quarenta mães de pré-escolares do nível III (4 e 5 anos de idade) do município de Campo Grande (Mato Grosso do Sul) responderam a dois questionários, um para a caracterização socioeconômica e percepção da saúde bucal materna e outro para mensurar o senso de coerência materno. Os dados obtidos foram submetidos a análise estatística por meio do programa Bio Estat, versão 5.0. Para a comparação dos escores do senso de coerência materno foi utilizado o Teste Mann Whitney, ao nível de significância de 5%. Houve associação entre menores valores do senso de coerência materno e condições socioeconômicas desfavoráveis, assim como, em situação de stress, as mães apresentaram uma visão pessimista em relação à própria saúde bucal. Portanto, o senso de coerência materno tem fortes características psicológicas e pode ser um determinante de saúde bucal.

Psychosocial problems in patients with newly diagnosed diabetes: number and characteristics

Early in the course of diabetes, it is important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care. We aimed to identify (a) the number and characteristics of patients, 18-65 years, newly diagnosed with diabetes, who needed psychosocial interventions and (b) the type of psychosocial problems they had. A total of 106 patients (72 men) were included in the study. Interviews showed that 41.5% had psychosocial problems. Fifteen dropped out early in the study; 38% of those remaining had psychosocial problems (PSP). More than half had problems with their life situation; most commonly in relationships. About a third had problems related to diabetes, most commonly, work-related. Compared to other participants, PSP patients lived in more strained social situations, especially regarding personal finances and social support. More of the PSP patients were anxious and depressed. They used negative coping strategies more often and more frequently expected that diabetes would negatively affect their future. In conclusion, early in the course of diabetes, screening instruments should be used to identify PSP patients. Treatment by medical social workers skilled in diabetes care should be offered.

Low sense of coherence interferes with lumbar spinal stenosis patients' postoperative recovery: a prospective one-year follow-up study

In a prospective observational study (N = 97) we examined the changes in the SOC score after a surgical intervention for lumbar spinal stenosis (LSS) and the factors associated with low and high SOC scores. Logistic regression analyses were used to investigate the predictors for the lowest SOC tertile. The post-surgical recovery among the low SOC group halted on three-month follow-up, whereas in the high SOC group a steady improvement was detected up to one year postoperatively. Preoperative and postoperative depressive symptoms were highly pertinent to the SOC of LSS patients, both as an indicator and a predictor of a low one-year SOC.

Sense of coherence and health-related behaviour among university students--a questionnaire survey

The aim of this study is to evaluate the relation between a sense of coherence and intensity of health-related behaviour among 521 Polish university students. The study was conducted using validated instruments with two questionnaires: Antonovsky's SOC-29 and the Inventory of Health-Related Behaviour. The mean value of SOC amounted to 125.2. More than half of the studied group were characterized by the average level of SOC. No statistical differences were found between the faculty of study and SOC (p = 0.107). A low intensity of health-related behaviour characterized a large group of students. Students of particular faculties differ among themselves in a statistically significant way in the level of health-related behaviour (p = 0.015). SOC is related to healthy behaviour (p < 0.001). University students are often characterized by an average level of SOC and a low intensity of health-related behaviour. Medical students are characterized by higher level of health-related behaviour in comparison with humanistic and science students. SOC correlates positively with a tendency to health-related behaviour. The higher the level of coherence, the higher is the tendency towards pro-health behaviour.

Return or no return--psychosocial factors related to sick leave in persons with musculoskeletal disorders: a prospective cohort study

PURPOSE

The aim of this study was to compare psychosocial factors between healthy persons and sick-listed persons with musculoskeletal disorders (MSD); both groups with MSD 10 years ago.

METHODS

This cohort study was prospective and 385 persons participated in a rehabilitation program 10 years ago, and 354 persons took part in the follow-up. Of these, 243 persons completed a questionnaire. Two groups were included in the study: a healthy group (not sick-listed) (n = 112) and a sick-listed group (n = 74). Psychosocial factors related to sick leave were compared between the groups.

RESULTS

In the 10-year follow-up, the healthy group showed a significantly higher quality of life, more control over the working situation, better sense of coherence and unexpectedly more life events. There was no significant difference in social integration and emotional support between the groups.

CONCLUSIONS

Using the knowledge about the characteristics of the healthy group, adequate rehabilitation for every sick-listed person with a musculoskeletal disorder can be given and therefore facilitate the returning to work process. A multidimensional approach taking into account a person's physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society.

Do psychological factors and general health influence the short-term efficacy of resilient appliance therapy in patients with temporomandibular disorder pain?

OBJECTIVES

To study how sense of coherence (SOC), grade of depression and non-specific physical symptoms and general health influence the efficacy of intraoral appliance therapy in patients with temporomandibular disorder (TMD) pain. A second objective was to study the association between SOC, grade of depression, grade of non-specific physical symptoms and general health.

MATERIAL AND METHODS

A total of 73 TMD pain patients participated; 36 were treated with a resilient appliance and 37 with a non-occluding control appliance in a randomized controlled trial for a period of 10 weeks. All patients had at least one pain diagnosis according to the research diagnostic criteria for TMD, including both the Symptom Checklist-90-Revised (Axis II) measuring grade of depression and non-specific physical symptoms, and general health (physical characteristics). Patients also filled in the 29-item SOC questionnaire.

RESULTS

A low grade of SOC was found in eight of the patients in the treatment group and in 17 of the control group at baseline, with a statistically significant difference between the groups. Logistic regression analyses revealed that, after correcting for the background variables, the resilient appliance did not differ from the non-occluding control appliance in terms of treatment outcome. No statistically significant differences were found when correlating mean SOC with grade of depression, grade of non-specific physical symptoms and general health.

CONCLUSIONS

These findings indicate that none of the studied background variables (age, gender, SOC, depression, non-specific physical symptoms or general health) seemed to influence the short-term efficacy of intraoral appliances. No association was found between SOC and depression, non-specific physical symptoms or general health in TMD pain patients.

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.

Sense of coherence and mental health rehabilitation

OBJECTIVE

To provide an understanding of Antonovsky's sense of coherence theory in relation to rehabilitation and to explain how applying his theory in rehabilitation practice can be beneficial. The focus of this paper will be on the rehabilitation and recovery of those with mental health issues.

FINDINGS

Sense of coherence theory helps explain the process of recovery for those with mental health issues. There is substantial evidence that sense of coherence plays a central role in coping with stressors in the rehabilitation/recovery process and that it contributes to mental health and psychosocial functioning. If rehabilitation services adopt a salutogenic approach and seek to enhance a client's sense of coherence then this can be beneficial in terms of the client's rehabilitation and recovery.

CONCLUSION

Rehabilitation services should ensure that they have rehabilitation goals that strengthen individuals' sense of coherence. Further investigation is required into the development of rehabilitation programmes with sense of coherence theory as part of their foundation.

The impact of social support on mental health service users' sense of coherence: a longitudinal panel survey

BACKGROUND

Social support is a crucial coping resource in the development of a strong sense of coherence. However, little is known about which components of social support are most important for the positive development of sense of coherence.

OBJECTIVES

The aim of this study is to investigate the ability of the six social provisions in Weiss's theory of social support to predict the positive development of sense of coherence among people with mental health problems.

DESIGN

The study has a prospective design including a baseline assessment and one-year follow-up.

SETTINGS

The community mental health care system in a large city in Norway.

PARTICIPANTS

The sample comprised 107 people with mental health problems. The inclusion criteria were: 18-80 years of age, living at home, mental health problems considered relatively stable, able to engage in dialogue, reliant on the mental health services and/or an activity centre, good orientation, mastery of the Norwegian language and no alcohol and/or drug problems. A total of 92 completed both measures.

METHODS

Sense of coherence was measured by the Sense of Coherence questionnaire, mental symptoms by the revised Symptom Checklist-90-R and social support by The Social Provision Scale (all Norwegian versions).

RESULTS

The results show that while social support predicted change in sense of coherence (standardized beta coefficient for social support was 0.32, P=0.016), mental symptoms did not (standardized beta coefficient -0.07, P=0.621). The social provision of opportunity for nurturance contributed most to the prediction (standardized beta coefficient 0.24, P=0.019).

CONCLUSIONS

The results indicate that improving social support with special emphasis on opportunity for nurturance might provide important opportunities for increasing sense of coherence among people with mental health problems.

Sense of coherence as a resource in relation to health-related quality of life among mentally intact nursing home residents - a questionnaire study

BACKGROUND

Sense of coherence (SOC) is a strong determinant of positive health and successful coping. For older people living in the community or staying in a hospital, SOC has been shown to be associated with health-related quality of life (HRQOL). Studies focusing on this aspect among nursing home (NH) residents have been limited. This study investigated the relationship between SOC and HRQOL among older people living in NHs in Bergen, Norway.

METHODS

Based on the salutogenic theoretical framework, we used a descriptive correlation design using personal interviews. We collected data from 227 mentally intact NH residents for 14 months in 2004-2005. The residents' HRQOL and coping ability were measured using the SF-36 Health Survey and the Sense of Coherence Scale (SOC-13), respectively. We analyzed possible relationships between the SOC-13 variables and SF-36 subdimensions, controlling for age, sex, marital status, education and comorbidity, and investigated interactions between the SOC and demographic variables by using multiple regression.

RESULTS

SOC scores were significantly correlated with all SF-36 subscales: the strongest with mental health (r = 0.61) and the weakest with bodily pain (r = 0.28). These did not change substantially after adjusting for the associations with demographic variables and comorbidity. SOC-13 did not interact significantly with the other covariates.

CONCLUSION

These findings suggest that more coping resources improve HRQOL. This may indicate the importance of strengthening the residents' SOC to improve the perceived HRQOL. Such knowledge may help the international community in developing nursing regimens to improve HRQOL for older people living in NHs.

Acute coronary syndrome: social support and coping ability on admittance

AIM

To compare social support and coping ability in acute coronary syndrome patients at the time of the cardiac event with a healthy community-based sample, with regard to age, sex, education and marital status.

METHOD

The study comprised 241 patients and 316 healthy controls. The participants answered a self-administered questionnaire that included three well-established scales. Multiple logistic regression was used in the analysis to compare the health situation between the patients and controls.

RESULTS

Persons suffering from acute coronary syndrome rated emotional support significantly lower than the healthy controls. However, there were no differences between the two groups in terms of socio-demographic variables.

CONCLUSION

This study indicates that social support may be a predictor of acute coronary syndrome.

The sense of coherence in hospitalized cardiac and cancer patients

The sense of coherence (SOC) is a measure of one's global orientation toward the world; it is the extent to which one perceives life as comprehensible, manageable, and meaningful. The study assesses the SOC of cardiac and cancer inpatients, and examines whether age, gender, race, education, and length of illness predict SOC. Participants comprise 172 patients (84 women, 88 men) at an urban hospital in the Northeastern United States, 122 with cardiac conditions and 50 with cancer. The mean age is 59.8. Results show that the SOC of cardiac and cancer patients is slightly lower than the general population. There are no differences in SOC between cardiac and cancer patients. Multiple regression shows that age and length of illness predict SOC (R=.26, R2=.07, p=.002); however because of the small effect size and collinearity, their exact contributions need further study. SOC does not vary according to gender, race, or education.

Healthy lifestyle choices: could sense of coherence aid health promotion?

BACKGROUND

A research framework based on the personal characteristic defined by a sense of coherence (SOC) focuses on the effective use of resources to maintain good health.

OBJECTIVES

To test the hypothesis that individual differences in SOC are associated with healthier lifestyle choices independently of social class and education.

DESIGN AND SETTING

Cross sectional. Population based cohort study recruited through 35 general practice registers. Reported dietary intakes of alcohol, fruit and vegetables, fibre, saturated fat, non-discretionary salt (sodium), and total sugars were assessed by food frequency questionnaire. Current cigarette smoking, physical inactivity, and SOC were assessed through questionnaires.

PARTICIPANTS

7,863 men and 10,424 women. Residents of Norfolk (UK).

RESULTS

Compared with participants with the weakest SOC, those with the strongest were 28% less likely to be current smokers (odds ratio 0.72 (95% confidence interval (CI), 0.58 to 0.89)), 36% less likely to be physically inactive (0.64 (0.55 to 0.75)), and reportedly consumed on average 63 g/day more fruit and vegetables (95% CI, 46 to 80), and 1.2 g/day more fibre (0.8 to 1.6). These associations were independent of age, sex, social class, and education. For physical inactivity and consumption of fruit, vegetables, and fibre, these differences exceeded those observed between the extremes of social class and education.

CONCLUSIONS

Individual differences in SOC are associated with healthy lifestyle choices independently of social class and education, and may therefore aid the design of future health promotion interventions.