Social Support and Sense of Coherence: Independent, Shared and Interaction Relationships with Life Stress and Mental Health

Association between coping resources and mental health during the COVID-19 pandemic: a cross-sectional study in the Czech Republic

The COVID-19 pandemic has caused detrimental global consequences for public health, health-care systems, economies, and society in general. The Czech Republic was one of the most affected countries in the world regarding daily cases increases during the first waves of the pandemic. The present study investigates the association between coping resources, mental health and anxiety. We collected data (N = 476) via an online survey. A multiple regression analysis was performed to investigate the predictors of mental health and anxiety. Mental health was significantly predicted by SOC, SONC, social support and trust in institutions. Anxiety was significantly predicted only by SOC and SONC. The study provides support for the salutogenic model of health and adds to the evidence that sense of coherence, that is, one's ability to view life as comprehensible, manageable, and meaningful, is the most important coping resource in light of a major event, such as the COVID-19 pandemic.

Sense of coherence and social support as predictors of mental health during COVID-19 pandemic

OBJECTIVES

to verify the role of sense of coherence, sense of national coherence, social support and trust in institutions to predict mental health in Brazilians during the COVID-19 pandemic.

METHODS

a cross-sectional study, carried out from November, 2020 to January, 2021 via an online survey. Standardized instruments were used. The sample consisted of 1,630 Brazilians. Pearson's correlation and linear regression were performed in data analysis.

RESULTS

sense of coherence was the only predictor of anxiety [β= -0.61; p<0.001], explaining 38% of the variance in its scores, while sense of coherence [β= 0.52; p<0.001], sense of national coherence [β= 0.16; p<0.001], and social support [β= 0.15; p<0.001] predicted positive mental health and together explained 51% of its variance.

CONCLUSIONS

the findings suggest that sense of coherence, sense of national coherence and social support represent important predictors for mental health and that strengthening these resources, could potentially promote Brazilians' mental health.

Developing an Intervention and Evaluation Model of Outdoor Therapy for Employee Burnout: Unraveling the Interplay Between Context, Processes, and Outcomes

Background

Burnout is a major societal issue adversely affecting employees’ health and performance, which over time results in high sick leave costs for organizations. Traditional rehabilitation therapies show suboptimal effects on reducing burnout and the return-to-work process. Based on the health-promoting effects of nature, taking clients outdoors into nature is increasingly being used as a complementary approach to traditional therapies, and evidence of their effectiveness is growing. Theories explaining how the combination of general psychological support and outdoor-specific elements can trigger the rehabilitation process in outdoor therapy are often lacking, however, impeding its systematic research.

Aim

The study aims to develop an intervention and evaluation model for outdoor therapy to understand and empirically evaluate whether and how such an outdoor intervention may work for rehabilitation after burnout.

Methodological Approach

We build on the exemplary case of an outdoor intervention for rehabilitation after burnout, developed by outdoor clinical psychologists in Netherlands. We combined the generic context, process, and outcome evaluation model and the burnout recovery model as an overarching deductive frame. We then inductively specified the intervention and evaluation model of outdoor therapy, building on the following qualitative data: semi-structured interviews with outdoor clinical psychologists and former clients; a content analysis of the intervention protocol; and reflective meetings with the intervention developers and health promotion experts.

Results

We identified six key outdoor intervention elements: (1) physical activity; (2) reconnecting body and mind; (3) nature metaphors; (4) creating relationships; (5) observing natural interactions; and (6) experiential learning. The results further showed that the implementation of these elements may facilitate the rehabilitation process after burnout in which proximal, intermediate, and distal outcomes emerge. Finally, the results suggested that this implementation process depends on the context of the therapist (e.g., number of clients per day), therapy (e.g., privacy issues), and of the clients (e.g., affinity to nature).

Conclusion

The intervention and evaluation model for outdoor therapy shows how key outdoor intervention elements may contribute to the rehabilitation process after burnout. However, our model needs to be further tested among a larger group of clients to empirically evaluate whether and how outdoor therapy can support rehabilitation.

Order out of chaos: Sense of coherence and the mediating role of coping resources in explaining mental health during COVID-19 in 7 countries

In the midst of the COVID-19 pandemic and the universal chaos created by it, this study explores the role of sense of coherence (Soc, Antonovsky, 1979) and how it enables coping with a stressful situation and staying well. SOC is a generalized orientation which allows one to perceive the world as comprehensible, manageable, and meaningful. In an attempt to understand ‘how does the SOC work’ we employed the salutogenic assumption that a strong SOC allows one to reach out in any given situation and find those resources appropriate to the specific stressor. Thus, we hypothesized that the positive impact of SOC on mental health outcomes would be mediated through coping resources that are particularly salient in times of crisis. One resource is related to the micro level (perceived family support) and the other concerns the macro level (trust in leaders and social-political institutions). Data collection was conducted in different countries during May–June 2020 via online platforms. The data included 7 samples of adult participants (age 18–90) from Israel (n ​= ​669), Italy (n ​= ​899), Spain (n ​= ​476), Germany (n ​= ​708), Austria (n ​= ​1026), Switzerland (n ​= ​147), and the U.S. (n ​= ​506). The questionnaires included standard tools (MHC-SF, SOC-13) as well as questionnaires of perceived family support and trust that were adapted to the pandemic context. As expected, SOC was associated with mental health in all the samples. Perceived family support and trust in leaders and social-political institutions mediated the relationships between SOC and mental health, controlling for age, gender, and level of financial risk. It appears that SOC has a universal meaning, not limited by cultural and situational characteristics. The discussion focuses on the theoretical, social, and political applications of the salutogenic model – and its core concept of SOC – in the context of coping with a global pandemic across different cultural contexts and countries.

Sense of Coherence, Social Support, Maternal-Fetal Attachment, and Antenatal Mental Health: A Survey of Expecting Mothers in Urban India

Introduction: Pregnancy is associated with psychological, physiological and social shifts, and can be a vulnerable time in a woman's life. Despite a growing understanding of the importance of antenatal mental health, there is a paucity of research on psychosocial factors relevant to this phase, especially in developing countries. The aim of the present study was to investigate the associations of expecting mothers' sense of coherence, perceived social support, and maternal-fetal attachment with mental health outcomes. Method: Participants (N = 122) were nulliparous expectant mothers residing in urban India. Cross-sectional data was collected using an online questionnaire. Results: Participant reports of perceived social support and sense of coherence were negatively correlated with symptoms of antenatal depression, while reports of maternal-fetal attachment, sense of coherence, and social support were positively associated with antenatal well-being. In a multilinear regression model, perceived social support and sense of coherence uniquely contributed to symptoms of antenatal depression, while maternal-fetal attachment and sense of coherence uniquely contributed to antenatal well-being. Discussion: The findings of this study highlight the role of perceived social support, sense of coherence and maternal-fetal attachment in contributing to expecting mothers' mental health and well-being in urban India. These findings have implications for clinical practice and research, intending to the subjective experiences of pregnant women to improve antenatal mental health. Future research investigating these psychosocial factors using longitudinal designs is warranted and would help clinicians and practitioners identify women at risk for perinatal mental health concerns.

Living in opposition: How women in the United States cope in spite of mistrust of federal leadership during the pandemic of Covid-19

International research collaborators conducted research investigating sociocultural responses to the Covid-19 pandemic. Our mixed methods research design includes surveys and interviews conducted between March and September of 2020 including 249 of 506 survey responses and 18 of 50 in-depth, exploratory, semi-structured interviews with self-defined politically left-leaning women in the United States. We employ a sequential design to analyze statistical and qualitative data. Despite international data suggesting that trust in federal governments reduces anxiety, women who did not trust and actively opposed the Trump administration reported lower levels of anxiety than expected. Results indicate reliance on and development of new forms of connection that seem to mitigate symptomatic anxieties when living in opposition. Women living in opposition to the leadership of the federal government use and develop resources to help them cope. Research on coping strategies and mental health and anxiety during crisis can inform recommendations for ways to support and strengthen sense of coherence during tumultuous times.

Seizing and realizing the opportunity: A salutogenic perspective on rehabilitation after burnout

BACKGROUND:

Most research on burnout has focused on its antecedents, correlates, and consequences. However, little empirical attention has been paid to what constitutes successful rehabilitation after burnout, especially among young employees.

OBJECTIVE:

The present study empirically examined resources supporting successful rehabilitation after burnout among young employees (between 18 and 35 years of age) from a salutogenic perspective.

METHODS:

Interpretative phenomenological analysis was used as a methodological framework to explain the experiences of young employees underlying their rehabilitation after burnout.

RESULTS:

The analysis showed that the rehabilitation process comprises four phases: 1) facing the crisis; 2) addressing the root causes; 3) seizing and achieving the opportunity; and 4) staying at work. Essential overarching resources facilitating successful recovery after burnout included receiving social support from family, friends, and colleagues, as well as having a feeling of control over the rehabilitation process. Participants learned to be aware of potential pitfalls that could trigger burnout symptoms, while having confidence in their ability to prevent burnout from reoccurring. These continuous learning processes were experienced as a prerequisite to remain at work.

CONCLUSIONS:

Receiving social support and experiencing a feeling of control over the rehabilitation process appear to be key resources in facilitating a stable, meaningful return to work after burnout.

Individual, social and national coping resources and their relationships with mental health and anxiety: A comparative study in Israel, Italy, Spain, and the Netherlands during the Coronavirus pandemic

Employing the salutogenic model, we asked how individuals in different countries cope with the COVID-19 crisis and stay healthy. We were interested in exploring the individual (i.e. sense of coherence) as well as the social and national resources (i.e. social support, sense of national coherence, and trust in governmental institutions) that could explain levels of mental health and anxiety during the outbreak of the pandemic. Data collection was conducted via convenience sampling on online platforms, during the end of March and the beginning of April 2020. The data included four samples: 640 Israeli participants (319 males), 622 Dutch participants (177 males), 924 Italian participants (338 males) and 489 Spanish participants (117 males); age range of 18–88 years. The questionnaires included standard tools (MHC-SF, GAD-7, SOC, SONC). Several questions were adapted to the context of coronavirus and measured levels of exposure to COVID-19, trust in governmental institutions, and social support. The results significantly confirmed the suggested salutogenic model regarding the contribution to individual and national coping resources to anxiety levels and mental health. The patterns of the coping resources in explaining anxiety and mental health were similar in the four samples, and SOC was the main predictor these outcomes. Despite these similarities, a different pattern and also different magnitudes of the predictive value of the coping resources were found for the two different reactions: anxiety vs. mental health. While SOC and situational factors (like financial threat) were significant in explaining anxiety levels, the SOC and national resources were found as significant in explaining mental health levels. The findings support the salutogenic approach in studying reactions during pandemic time. They also shed some light on the difference between pathogenic and salutogenic measures in studying psychological reactions to stressful situations.

Use of Salutogenic Approach Among Children and Adolescents with Chronic Illnesses: A Scoping Review

PROBLEM

A pathogenic medical orientation focusing on disease management relies heavily on the skills of healthcare professionals. In contrast, a salutogenic approach focuses on health promotion by encouraging resource strengthening among patients to maintain and support recovery, which could help alleviate healthcare burden and enhance healthcare quality. Considering the increased life expectancies of chronically ill children, this review aimed to consolidate evidence on the use of salutogenesis among children and adolescents with chronic illnesses.

ELIGIBILITY CRITERIA

A scoping review guided by Arksey and O'Malley's five-stage framework was conducted. Studies with samples of children or adolescents aged 19 years and below with chronic disease were included in the review.

SAMPLE

A library search was performed across six electronic databases (PubMed, Embase, CINAHL, PsycInfo, and Web of Science) from each database's inception to March 2020. Twelve studies were included.

RESULTS

Current evidence only highlighted the trend and advantages of high sense of coherence and identify factors that enhance sense of coherence. Boys, younger age, higher cognitive functioning, non-migrants, non-smokers, and available peer and family support contribute to higher levels of sense of coherence, which lead to better perceived health, quality of life, and more positive coping strategies.

CONCLUSIONS

Healthcare professionals should adopt a salutogenic approach to encourage patient involvement, independence, and responsibility in maintaining their own health.

IMPLICATIONS

Further research is needed to provide a holistic view of the sense of coherence and application of salutogenesis (especially other salutogenic concepts) among this sample group, which can also inform future salutogenic intervention studies.

The Relationship Between Individual, Social And National Coping Resources And Mental Health During The Covid-19 Pandemic In The Netherlands

BACKGROUND

The COVID-19 pandemic has a potential negative impact on mental health. Adopting the salutogenic model of health, this study examined the predictive value of personal (sense of coherence), social (social support, trust in institutions), and national (sense of national coherence) resources for mental health in the Netherlands during the COVID-19 pandemic.

PARTICIPANTS AND PROCEDURE

An online survey was administered in the Netherlands (N = 622) in April 2020. A multiple regression analysis was performed to test the predictive value of the resources for mental health.

RESULTS

Mental health was significantly predicted by the sense of coherence, social support and sense of national coherence, but not by trust in institutions. The results showed that personal and social resources were most strongly related to mental health.

CONCLUSIONS

The results suggest that mental health is predicted by various resources. Hence, strengthening resources seems vital in promoting mental health in times of crisis.

College Students' Sense of Coherence and Connectedness as Predictors of Suicidal Thoughts and Behaviors

This study aimed to explore the relationship between college students' sense of coherence and connectedness and their development of suicidal thoughts and behaviors. Using archival data from a larger survey with responses from 26,742 undergraduate and graduate students at 74 colleges and universities, we applied Exploratory Factor Analysis to derive these protective factors (coherence and connectedness) as well as hypothesized distal and proximal risk factors (pre-existing vulnerabilities and distress). Structural Equation Modeling was used to explore latent variable interactions among these factors with regards to outcomes on a continuum of suicidal thinking and behavior. Sense of coherence mitigated the impact of pre-existing vulnerabilities on movement along the continuum, while connectedness mitigated the impact of distress. Findings suggest that including both connectedness and coherence in suicide prevention frameworks will increase the impact of suicide prevention programming.

Objectively recorded physical activity in pregnancy and postpartum in a multi-ethnic cohort: association with access to recreational areas in the neighbourhood

Background

Physical activity may reduce the risk of adverse pregnancy outcomes; however, compared to non-pregnant women, a lower proportion of pregnant women meet the physical activity guidelines. Our objectives were to explore overall changes and ethnic differences in objectively recorded moderate-to-vigorous intensity physical activity (MVPA) during pregnancy and postpartum and to investigate the associations with objective and perceived access to recreational areas.

Methods

We analysed 1,467 person-observations from 709 women in a multi-ethnic population-based cohort, with MVPA data recorded with the SenseWear™ Pro³ Armband in early pregnancy (mean gestational week (GW) 15), mid-pregnancy (mean GW 28) and postpartum (mean postpartum week 14). MVPA was limited to bouts ≥10 min. Women were nested within 56 neighbourhoods defined by postal code area. We derived neighbourhood-level objective access to recreational areas (good vs limited) by geographic information systems. We collected information about perceived access (high vs low perception) to recreational areas in early pregnancy. We treated ethnicity, objective and perceived access as explanatory variables in separate models based on linear mixed effects regression analyses.

Results

Overall, MVPA dropped between early and mid-pregnancy, followed by an increase postpartum. Western women performed more MVPA than women in other ethnic groups across time points, but the differences increased postpartum. Women residing in neighbourhoods with good objective access to recreational areas accumulated on average nine additional MVPA minutes/day (p < 0.01) compared with women in neighbourhoods with limited access. Women with perceptions of high access to recreational areas accumulated on average five additional MVPA minutes/day (p < 0.01) compared with women with perceptions of low access. After mutual adjustments, perceived and objective access to recreational areas remained significantly associated with MVPA. The association between MVPA and access to recreational areas did not differ by time point, ethnic group or socio-economic position.

Conclusions

In all ethnic groups, we observed a decline in MVPA between early and mid-pregnancy. However, at both time points during pregnancy, and especially three months postpartum, Western women were more physically active than ethnic minority women. In all ethnic groups, and at all three time points, both objective and perceived access to recreational areas were positively associated with MVPA levels.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0401-y) contains supplementary material, which is available to authorized users.

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.

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.

From sociocultural disintegration to community connectedness dimensions of local community concepts and their effects on psychological health of its residents

In a series of community mental health promotion studies in Lofoten, Norway, the concept of sociocultural integration is used to describe properties of a local community that are related to people's psychological health. Starting with Durkheim's description of a cohesive society, we compare different concepts that are related to sociocultural integration, for example, sense of community, social capital, and social cohesion. We then examine the relationship of various individual oriented social psychological concepts to sociocultural integration. These concepts often share theoretical and operational definitions. The concept of sociocultural integration in the Lofoten studies was proved to be very valuable in understanding how the properties of a community can affect people's mental health and their social psychological properties. It has also shown its value in the planning of mental health services and demonstrating its success in concrete community-based mental health promotion projects. Thus they could make important contributions to further studies and actions in local communities where the intersection between the individual, their social network, and their local community occurs.

Dimensions of Attitudes towards the Mentally Ill in the General Population Stability and Change over Time at Urban and Rural Sites

Items measuring attitudes toward the mentally ill can be limited in relevance to a particular period or place. The main objective of the study was to provide evidence toward a questionnaire that was short and psychometrically stable over time and geography, and that could be used within comprehensive mental health surveys of general populations. Four rural samples, Lofoten 1983 (n = 470), 1990 (n = 947), 2000 (n = 864), and Valdres 2010 (n = 772), and two urban samples, Oslo 1990 (n = 948) and 2000 (n = 467), were used to test this. The questionnaire was self-administered with fixed questions and response alternatives. Using the three Lofoten and the two Oslo samples, the stability of the factor analytic structure of 19 attitude items was established. In all analyses, there was a clear leveling off after three factors. The 13 highest loading items on these three factors were used in a new rural region, Valdres, in 2010. The three established factors/dimensions, named Distance, Demands, and Positive, seemed to be reasonably stable within a variety of Norwegian samples. On the other hand, the analyses were different enough to recommend researchers and politicians to be careful when comparing absolute levels of the suggested indexes across different locations and at different points in time.