The adult sense of coherence scale is applicable to 12-year-old schoolchildren--an additional tool in health promotion

Incremental validity of sense of coherence, neuroticism, extraversion, and general self-efficacy: longitudinal prediction of substance use frequency and mental health

BACKGROUND

Several studies have demonstrated the importance of sense of coherence (SOC), neuroticism (N), extraversion (E), and general self-efficacy (GSE) for health, yet the unique utility of these overlapping constructs remains uncertain. The present research aims at exploring incremental validity when predicting (1) substance use specifically and (2) mental health generally among adolescents.

METHODS

A prospective and longitudinal design was used to predict (1) initial substance use nine years into the future and (2) mental health one year and four years into the future. Participants were 318 adolescents (age 14 to 15 at the beginning of the study).

RESULTS

Structural equation modeling revealed (1) that SOC had long-term incremental validity over N, E, and GSE for tobacco use and alcohol use, whereas cannabis use was predicted by E and GSE; and (2) that long-term mental health after four years was only predicted by SOC.

CONCLUSIONS

Two studies provide further evidence for the importance of considering salutogenic factors when forecasting mental health and health-related behavior beyond classical constructs such as N, E, and GSE. Differences in criterion validity reveal that SOC cannot be equated with reversed neuroticism.

Preliminary Finnish measures of eating competence suggest association with health-promoting eating patterns and related psychobehavioral factors in 10-17 year old adolescents

Eating competence is an attitudinal and behavioral concept, based on The Satter Eating Competence Model. In adults, it has been shown to be associated with a higher quality of diet. Eating competence or its association with the quality of diet has not been studied in adolescents. The aim of the current study was to explore the utility of using a preliminary Finnish translation of the ecSI 2.0 for evaluating presumed eating competence and its association with food selection, meal patterns and related psychobehavioral factors in 10–17 year old adolescents. Altogether 976 10–17 years old Finnish adolescents filled in the study questionnaire. When exploring the construct validity of ecSI 2.0, the confirmatory factor analysis (CFA) indicated acceptable model fit and all four components of the ecSI 2.0 (eating attitudes, food acceptance, internal regulation of food intake, management of eating context) correlated with each other and were internally consistent. Over half (58%) of the adolescents scored 32 or higher and were thus classified as presumably eating competent (pEC). Eating competence was associated with greater meal frequency, more frequent consumption of vegetables and fruits, and more health-promoting family eating patterns. In addition the pEC, adolescents more often perceived their body size as appropriate, had less often tried to lose weight and had a higher self-esteem and a stronger sense of coherence than the not pEC ones. Family eating patterns and self-esteem were the main underlying factors of eating competence. In conclusion, this preliminary study suggests eating competence could be a useful concept to characterize eating patterns and related behaviors and attitudes in adolescents. However, these preliminary findings need to be confirmed in further studies with an instrument fully validated for this age group.

Association between sense of coherence in adolescence and social benefits later in life: a 12-year follow-up study

OBJECTIVES

Local government concerns over expenditure on social and healthcare are growing. The aim of the present study was to explore the association between a weak 'sense of coherence' (SOC) in teens and their subsequent risk of receiving social and healthcare benefits during young adulthood, and to monitor how SOC developed during this period.

DESIGN

Prospective cohort study.

SETTING

North Denmark Region.

PARTICIPANTS

773 Pupils from seventh and eighth forms who answered a questionnaire in 1998.

OUTCOME MEASURES

Different social benefits (from the Danish DREAM database embracing disbursed public social benefits). Change in SOC score from 1998 to 2010.

RESULTS

722 had answered seven items of the original SOC-13 questionnaire (denoted by SOC-7). Girls with a weak SOC-7 (the lowest 1st quartile) in 1998 had a significantly increased risk of receiving unemployment benefits (RR 1.3 (1.1 to 1.6)), social assistance (RR 1.8 (1.3 to 2.5)) and sickness benefits (RR 1.5 (1.2 to 2.0)) compared with girls with a strong SOC-7. For boys, only minor protective and non-significant differences were found. The SOC answers from 1998 and 2010 were compared (n=394). SOC increased significantly and mostly in girls.

CONCLUSIONS

SOC-7 may serve as a predictor for social life event outcomes and hence facilitate an early identification and a selective approach to support teenage girls with a weak SOC. From adolescence to young adulthood, SOC-7 was of a relatively unstable nature.

A supportive family environment in childhood enhances the level and heritability of sense of coherence in early adulthood

PURPOSE

To analyze the effects of genetic and environmental factors on sense of coherence (SOC) in young adulthood and whether family environment measured in childhood modifies these effects.

METHODS

SOC was measured at 20-27 years of age in 3,193 Finnish twins using the Antonovsky's 13-item short scale. The twins and their parents had rated their emotional family environment independently when the twins were 12 years of age. The data were analyzed using applications of structural linear equation modeling to twin data.

RESULTS

Females rated SOC 2.42 points lower than males. Additive genetic factors explained 39% of the variation of SOC in males and 49% in females, whereas the rest of the variation was explained by environmental factors unique to each twin individual. For the dimensions of SOC, the highest genetic correlation was found between comprehensibility and manageability (0.90 in males and 0.97 in females). SOC was strongest in the participants who had reported supportive family atmosphere and low relational tensions to parents in childhood. These participants also had higher genetic variance and lower unique environmental variance of SOC when compared to those who reported emotionally more stressful family environment. The results were similar when we used parental rating of family environment.

CONCLUSION

Genetic factors are important for SOC, but genetic influences are much greater in supportive family environments. This emphasizes the importance of childhood home for the development of strong SOC.

Unhealthy food in relation to posttraumatic stress symptoms among adolescents

The linkage between mood states and unhealthy food consumption has been under investigation in the recent years. This study aimed to evaluate the associations between posttraumatic stress (PTS) symptoms after lifetime traumatic experiences and daily unhealthy food consumption among adolescents, taking into account the possible effects of physical inactivity, smoking, and a sense of coherence. A self-administered questionnaire measured symptoms of PTS, lifetime traumatic experiences, food frequency scale, sense of coherence scale in a representative sample of eighth grade pupils of the Kaunas, Lithuania, secondary schools (N=1747; 49.3% girls and 50.7% boys). In the logistic regression models, all lifetime traumatic events were associated with PTS symptoms, as well as were unhealthy foods, (including light alcoholic drinks, spirits, soft and energy drinks, flavored milk, coffee, fast food, chips and salty snacks, frozen processed foods; excluding sweet snacks, biscuits and pastries) and sense of coherence weakened the strength of the associations. However, physical inactivity and smoking showed no mediating effect for the majority of unhealthy foods. In conclusion, we found that intervention and preventive programs on PTS symptoms may be beneficial while dealing with behavioral problems (unhealthy diet, smoking, alcohol, physical inactivity) among adolescents.

Do movement deviations influence self-esteem and sense of coherence in mild unilateral cerebral palsy?

BACKGROUND

Individuals with unilateral cerebral palsy (CP) are often physically high functioning. Despite the mildness of the impairment, the movement deviations during walking are often noticeably deviant. In the arm, increased muscle tone causes posturing and decreased motion. In the lower extremity, gait deviations mainly involve the foot and ankle. The deviations often become more apparent with transitions between movements and during rapid movement but also when the person is emotionally affected. Arm posturing and gait deviations may be perceived as cosmetic and social impediments when the individual enters adolescence and becomes more self-conscious. The aim was to study the influence of movement deviations in the upper and lower extremity during walking, on self-esteem, and sense of coherence (SOC) in teenagers and young adults with mild unilateral CP.

METHODS

Three-dimensional gait analysis was performed with an 8-camera system. Movement deviations of the lower extremity, the Gait Profile Score (GPS) and of the upper extremity, and the Arm Posturing Score (APS) were calculated. Self-reported questionnaires "I think I am" measuring self-esteem and SOC were used.

RESULTS

Forty-four patients with a mean age of 17.6 years (range, 13.0 to 24.0 y), 22 females and 22 males, and 15 sex-matched and age-matched controls participated in the study. Forty-two patients were classified as Gross motor function classification scale (GMFCS) I and 2 as GMFCS II. Patients were rated with lower self-esteem than controls (mean, 63.4 vs. 84.7; P=0.025). The SOC assessments revealed no difference. The GPS and APS was higher in patients (6.9 vs. 4.1; P<0.001) and (mean, 10.5 vs. 5.7; P<0.001), respectively. The APS correlated with both self-esteem (coefficient -0.397; P=0.001) and SOC (coefficient -0.375; P=0.05). No correlations were found with the GPS.

CONCLUSIONS

Although physically high functioning, movement deviations in teenagers and young adults with mild unilateral CP are correlated with lower self-esteem. This is more pronounced with increased arm movement deviation and should be considered when evaluating these individuals.

LEVEL OF EVIDENCE

Prospective cross-sectional study. Level III.

Dental fear and sense of coherence among 18-yr-old adolescents in Finland

The aim was to investigate whether dental fear was associated with the sense of coherence (SOC) among 18-yr-old adolescents (n = 777). Cross-sectional data from a prospective cohort of a random sample of families from Finland and their first-born children were used. Dental fear was measured using the Modified Dental Anxiety Scale and categorized as high dental fear for scores of 19-25 and as no to moderate dental fear for scores of 5-18. Sense of coherence was measured using a 13-item version of Antonovsky's Sense of Coherence Questionnaire, dichotomized as scores 13-63 for weak SOC and as scores of 64-91 for strong SOC. Gender and education were included as background factors in the logistic regression analyses. The prevalence of high dental fear was 8%. Those reporting high dental fear reported more often a weaker SOC than did those with no to moderate dental fear (69% vs. 31%, OR = 2.5, 95% CI = 1.4-4.4), also when adjusted for gender and education (OR = 2.2, 95% CI = 1.2-3.9). According to the theory of salutogenesis, as proposed by Antonovsky, SOC is a resource instrument especially in situations of tension or strain and hence a strong SOC might protect against high dental fear.

Sense of coherence and health behaviour in adolescence

AIM

To explore associations of Sense of coherence (SOC) with health behaviour and social competence among 15-year-old adolescents.

METHODS

Study population is a prospective cohort of a randomized cluster sample of families and their first-born children from south-western Finland in 1986-1987. In this study, cross-sectional data of the 15-year-olds were used. The present data were based on mailed, pretested questionnaires. The outcome variable, SOC, was based on the 13-item scale of Antonovsky's Orientation to Life Questionnaire (OLQ). The principal explanatory variables were health behaviour, including experienced oral health, and social competence. The statistical analysis was performed using linear regression modelling.

RESULTS

Strong SOC of adolescents associated significantly with lighter use of alcohol, being a non-smoker, better care of oral health and better social competence compared with the others.

CONCLUSION

Sense of coherence is a useful tool for identifying adolescents in need of extra support and motivation for their health behaviour.

Parental psychological well-being and cognitive development of very low birth weight infants at 2 years

AIM

To assess the associations between cognitive development of very low birth weight (VLBW) infants and measures of parental psychological well-being.

METHODS

In this prospective cohort study, 182 VLBW infants born 1/2001-12/2006 at the Turku University Hospital, Finland, were followed up. At 2 years corrected age, cognitive development of the child was assessed using the Mental Development Index of Bayley Scales, and both parents filled in validated questionnaires defining parental psychological well-being (Beck Depression Inventory, Parenting Stress Index and Sense of Coherence Scale).

RESULTS

The cognitive delay of the infant was associated with paternal symptoms of depression (p = 0.007) and parenting stress (p = 0.03). Mothers of the infants with cognitive delay reported increased parenting stress related to the difficulty to accept the child (p = 0.001). Weak sense of coherence predicted depressive symptoms in both parents (p < 0.0001).

CONCLUSION

Even if the fathers of VLBW infants experienced depressive symptoms less often than the mothers, the ability of the fathers to cope was significantly associated with the cognitive development of the infant. In addition, the fathers reported more parenting stress if the infant had a cognitive delay. The mothers reported more parenting stress related to accepting the VLBW infant with cognitive delay.

Sense of coherence as a predictor of quality of life in adolescents with congenital heart defects: a register-based 1-year follow-up study

OBJECTIVE

Sense of coherence (SOC) is a resource for health and quality of life (QoL) in adults. The aim of this investigation was to prospectively evaluate the association between SOC and QoL in adolescents with congenital heart defects (CHDs).

METHODS

This is an observational study among 770 adolescents aged 14 to 17 years from a national CHD register. SOC was measured at baseline with the SOC-L9 questionnaire. QoL was measured at baseline and at a follow-up 12 months later. For this, we used the KINDL-R (revidierter KINDer Lebensqualitätsfragebogen) questionnaire to evaluate overall well-being and 6 subscales (physical well-being, psychological well-being, self-esteem, family-related well-being, friend-related well-being, and school-related well-being). The association between SOC and QoL both in terms of overall well-being and the KINDL-R subscales was evaluated in multilevel linear models. Fully adjusted models accounted for age, gender, behavioral factors, and medical and socioeconomic status.

RESULTS

Overall well-being, self-esteem, and school-related well-being were significantly higher at follow-up than at baseline. SOC (median: 50 [range: 16-63] points) was positively associated with overall well-being and all KINDL-R subscales at baseline. In overall well-being and the KINDL-R subscales (except in psychological well-being), significant negative interaction terms were observed for SOC at baseline and time to follow-up. However, the associations between SOC at baseline and overall well-being and all KINDL-R subscales at follow-up remained significant even in fully adjusted models.

CONCLUSION

SOC is an independent predictor of QoL in adolescents with CHD. In psychological well-being, this prediction remains stable, whereas in total well-being and all other QoL subdimensions, its strength as such wanes over the course of a year but does not entirely dissipate. Further studies should evaluate whether interventions designed to increase SOC in children with CHD would also improve their QoL.

Childhood psychopathology and sense of coherence at age 18: findings from the Finnish from a boy to a man study

OBJECTIVE

To examine associations between childhood psychopathology and family factors at age 8, and sense of coherence (SOC) at age 18.

METHODS

The sample includes 2,314 Finnish boys born 1981 with information about psychopathology from parents and teachers using Rutter scales, and self-reports of depressive symptoms using Child Depression Inventory (CDI), and self-reports of SOC at age 18.

RESULTS

Low parental education level and living in other than two biological parent family at age 8 were associated with low SOC 10 years later. Boys with internalizing symptoms based on parent/teacher reports, and depressive symptoms based on self-reports at age 8 were at risk for lower SOC at follow-up. Comorbidity of internalizing and conduct problems had the strongest association with low SOC.

CONCLUSION

The study shows that internalizing symptoms, comorbid conduct and emotional problems, low parental education level and nonintact family at age 8 predict low SOC at age 18. Future research whether universal, selective or indicated early interventions targeted on risk factors of childhood mental health problems may result in promotion of well-being (including good SOC) in early adulthood is warranted.

Sense of coherence and psychosocial factors among adolescents

AIM

The overall aim of the present study was to investigate whether there was a relationship between sense of coherence and psychosocial factors among adolescents.

METHODS

A cross-sectional study was conducted in a sample of pupils in year eight from comprehensive schools in Stockholm city, selected with regard to socioeconomic area. In the final sample of the study there were 383 pupils: 196 girls and 187 boys. Two questionnaires, the Sense of Coherence Scale and the Health Profile Scale measuring health behaviour, were used to collect data.

RESULTS

Girls showed a significantly more negative outcome compared with boys, in eight psychosocial factors. The most pronounced difference between boys and girls was seen in feeling depressed: 17% and 54% respectively. Five factors proved to be associated with low SOC in the multivariate analysis: life dissatisfaction, feeling depressed, worries about family members, poor psychosomatic health and being a girl.

CONCLUSION

The findings reveal domains where adolescents, especially girls, seem to be more vulnerable. Psychosomatic health and mental health are related to low sense of coherence.

Health behaviours, risk-taking and conceptual changes among schoolchildren aged 7 to 19 years in semi-rural Sweden

BACKGROUND

This study covers a broad age group (7-19 years) and includes a wide range of themes. The aim is to describe how various behaviours, complaints and conceptual changes come into play and to discuss the factors that might support or hamper the happiness and well-being of growing children and adolescents. We also discuss the implications of our findings for future prevention programmes.

METHODS

This cross-sectional study included all schoolchildren in a semi-rural district in Sweden (2181 pupils). A structured classroom questionnaire was used but the children were also given the opportunity to describe in their own words what was important for their happiness and well-being.

RESULTS

Mean response rate was 85%. Most changes in behaviour occurred between 11 and 14 years of age. Girls had a more rapid process of change than boys. Both girls and boys experienced stress in their relations with peers, parents and teachers. Gender differences in emotional support were prominent. Regardless of age and sex, all schoolchildren asked for a richer choice of leisure time activities, a place where they could meet with friends and caring teachers, parents and adults in the surrounding community.

CONCLUSIONS

Adolescence was perceived as a risky and problematic period not only by adults but also by the adolescents themselves. However, the perceived risks and the worries differed. While the adults mainly worried about the early onset of smoking and drug use, the schoolchildren worried about their social situation and their personal relationships. After decades of preventive programmes in Swedish schools, only modest results are seen. To be effective, future preventive programmes probably have to focus more on the conceptual world of the growing child.

Stability of the sense of coherence in adolescence

The aim of this prospective study was to explore the stability of sense of coherence (SOC) in adolescents from the age of 15 to 18 years.

METHODS

A prospective population-based follow-up study of 1294 first-born children was started in 1986. When the children were 15 (N = 846) and 18 (N = 792) years old, SOC was measured using questionnaires filled out at home.

RESULTS

The mean change in SOC scores (0.10, SD 10.2; in percentages 1.98%, SD 18.4) in the whole sample between the ages of 15 and 18 years was negligible and non-significant (p = .788). At the individual level, some changes were seen in the scores. The SOC scores of boys at the ages of 15 and 18 years were significantly higher than those of girls (mean 65.4 vs. 60.8 and 65.4 vs. 61.7, respectively). The SOC scores of adolescents living with both parents were higher than those with one parent or other guardian (mean 64.5 vs. 59.9), and the difference was significant in both age groups (p < .001).

CONCLUSION

Contrary to assumptions made in Antonovsky's theory, we found no significant change in SOC between the ages of 15 to 18 years, and coherence stability did not depend on the initial SOC. Some fluctuation in SOC scores was seen at the individual level. For planning of interventions, it is important to know that SOC seems to be reasonably stabilized before the age of 15 years.