Sense of coherence and mental health rehabilitation

Salutogenesis: A sense of coherence and health among British military veterans exposed to impactful life challenges - the emergence of post-traumatic growth and positive deviance within a life-story approach

Background

This study sought to capture the perspectives and experiences of two sub-groups of military veterans, namely those who had previously been identified as offenders and those employed as practitioners within the criminal justice system in the United Kingdom.

Methods

The lead author undertook narrative inquiry in the form of life story research. The life stories of 17 in-depth interviews were conducted across England and Wales, allowing for insight into the lived experiences of two life story trajectories of the health of military veterans. Existing literature on salutogenesis, health, post-traumatic growth, and positive deviance has also been investigated.

Results

Life story interviews were transcribed verbatim and analyzed concurrently using thematic analysis to identify emergent themes. The researchers used thematic analysis as an analytical framework to allow descriptive themes from the literature on salutogenesis, health, post-traumatic, and positive deviance to be compared with those of life-story interviews.

Conclusion

The study adopts a salutogenic approach, which suggests that an important indicator for a sense of coherence is enabled through the positive utilization of resilience through the reconstruction of military identity and experience. Notably, the concept of salutogenesis demonstrates the ability to draw from internal and external resources as circumstances require, to survive, and because of this, the participants' health is maintained or improved. Hence, adaptation was notable through the coherence identified by the identity of being a veteran noted between the two subgroups and represents a continuous and dynamic process. The study suggests that the development of a sense of coherence is not restricted to the early decades of life but is a continuous process as contexts, personal circumstances, and opportunities arise. This later point is realized through the presence of post-traumatic growth and positive deviance, as they aid in the nurturing and development of a renewed sense of coherence via the known identity of military service and life.

The Sense of Coherence and Health Behavior of Men with Alcohol Addiction

INTRODUCTION

Alcohol dependence is one of the world's major health challenges. The salutogenic concept of health developed by Antonovsky focuses on the search for resources and factors supporting health. Its basic concept of the sense of coherence (SOC) focuses on strengthening the global orientation of the patient, and creating permanent internal resources that translate into the improvement of pro-health behavior, including the fight against alcoholism.

OBJECTIVE

The objective of this study was to determine the correlation between individual factors and the SOC as well as the influence of the SOC concept on pro-health behavior of people addicted to alcohol.

MATERIALS AND METHODS

The study group consisted of 110 men undergoing treatment in an addiction treatment ward. To check the level of the SOC, two standardized questionnaires, Antonovsky's "SOC-29 Life Orientation Questionnaire" and Juczyński's "Health Behaviour Inventory", were used. The correlation coefficient between the sociodemographic variables was checked using the Pearson's r test.

RESULTS

A positive correlation was found with the intensity of pro-health behaviors for three sociodemographic variables. In people aged 43-65 (r = 0.299; p = 0.030), people with primary/vocational education (r = 0.276; p = 0.015), and respondents living in rural areas (r = 0.303; p = 0.028) a greater SOC was associated with pro-health behaviors.

CONCLUSIONS

Individuals addicted to alcohol are characterized by a low SOC and a low level of pro-health behaviors. Strengthening the internal level of the SOC can constitute an element of addiction therapy when introducing health education to prepare the patient for independent life in sobriety.

The Effects of Horticultural Therapy on Sense of Coherence among Residents of Long-Term Care Facilities: A Quasi Experimental Design

Promoting positive mental health is crucial for the elderly living in long-term care facilities (LTCFs). This study aims to examine the effectiveness of horticultural therapy on the level of sense of coherence (SOC) among older LTCF residents with relatively normal mental function. With convenient sampling, a total of 86 participants were recruited from 12 LTCFs in northeastern Taiwan. In the experimental group (n = 49), the mean (±standard deviation) score of SOC was 50.45 ± 6.07 at baseline and increased to 56.37 ± 7.20 (p < 0.001) after 12-week horticultural intervention. In contrast, the mean SOC score did not change significantly in the control group (n = 37) during the study period. Generalized estimating equation analysis showed that a significant interaction effect between group and time on the SOC score (p < 0.001). Our findings indicate that horticultural therapy is effective to strengthen the SOC level of older LTCF residents without dementia.

Sense of Coherence and COVID-19: A Longitudinal Study

The strong restrictive measures adopted in 2020 against the spread of the COVID-19 pandemic in Italy have deeply affected the general population's mental health. In the current longitudinal study, we specifically focus on sense of coherence (SOC), both in terms of comprehensibility/manageability and meaningfulness, among a large sample of Italian adults; SOC is a potential resource likely to foster the ability to cope with stressors. A total of 2,191 Italian participants (65.8% female) aged 18-82 completed an anonymous online self-report questionnaire at Time 1 (during the lockdown, March 2020) and at Time 2 (at the resumption of most activities, July 2020). The Repeated Measures Latent Profile Analysis (RMLPA) allowed us to identify seven different SOC profiles based on the change in both SOC dimensions, ranging from a strong "crisis" in terms of this resource in the face of the pandemic to a solid possibility to count on it. Interestingly, female and younger respondents were more likely to belong to those profiles characterized by lower levels of SOC, and these profiles have specific relations with fear and wellbeing. The implications of these results and the further expansion of the study are discussed.Supplemental data for this article is available online at https://doi.org/10.1080/00223980.2021.1952151 .

Association between mental health, caries experience and gingival health of adolescents in sub-urban Nigeria

Background

This study assessed the association of mental health problems and risk indicators of mental health problems with caries experience and moderate/severe gingivitis in adolescents.

Methods

A cross-sectional household survey was conducted in Osun State, Nigeria. Data collected from 10 to 19-years-old adolescents between December 2018 and January 2019 were sociodemographic variables (age, sex, socioeconomic status); oral health indicators (tooth brushing, use of fluoridated toothpaste, consumption of refined carbohydrates in-between-meals, dental services utilization, dental anxiety and plaque); mental health indicators (smoking habits, intake of alcohol and use of psychoactive drugs) and mental health problems (low and high). Gingival health (healthy gingiva/mild gingivitis versus moderate/severe gingivitis) and caries experience (present or absent) were also assessed. A series of five logistic regression models were constructed to determine the association between presence of caries experience and presence of moderate/severe gingivitis) with blocks of independent variables. The blocks were: model 1—sociodemographic factors; model 2—oral health indicators; model 3—mental health indicators and model 4—mental health problems. Model 5 included all factors from models 1 to 4.

Results

There were 1234 adolescents with a mean (SD) age of 14.6 (2.7) years. Also, 21.1% of participants had high risk of mental health problems, 3.7% had caries experience, and 8.1% had moderate/severe gingivitis. Model 5 had the best fit for the two dependent variables. The use of psychoactive substances (AOR 2.67; 95% CI 1.14, 6.26) was associated with significantly higher odds of caries experience. The frequent consumption of refined carbohydrates in-between-meals (AOR: 0.41; 95% CI 0.25, 0.66) and severe dental anxiety (AOR0.48; 95% CI 0.23, 0.99) were associated with significantly lower odds of moderate/severe gingivitis. Plaque was associated with significant higher odds of moderate/severe gingivitis (AOR 13.50; 95% CI 8.66, 21.04). High risk of mental health problems was not significantly associated with caries experience (AOR 1.84; 95% CI 0.97, 3.49) or moderate/severe gingivitis (AOR 0.80; 95% CI 0.45, 1.44).

Conclusion

The association between mental problems and risk indicators with oral diseases in Nigerian adolescents indicates a need for integrated mental and oral health care to improve the wellbeing of adolescents.

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.

"Finally, I belong somewhere I can be proud of" - Experiences of being a Clubhouse member in Norway

Purpose: The number of psychosocial Clubhouses is growing rapidly in Norway. However, more knowledge is needed about the subjective experience of Clubhouse members in terms of their recuperation processes and experiences in the Clubhouse context. Therefore, this qualitative study explored what it is like to be a Clubhouse member in Norway, and further discuss it in light of the theory of Salutogenesis on successful pathways to coping and well-being.Methods: Using a hermeneutic-phenomenological approach, the present study included in-depth, semi-structured individual interviews with 18 Clubhouse members from three accredited Norwegian Clubhouses. Analysis was conducted using systematic text condensation.Results: Three main themes emerged from the analysis: "Finally, I belong somewhere I can be proud of," "I feel more like an ordinary citizen, just different," and "I feel somewhat equal to others." Overall, the participants experienced improved mental and social well-being owing to their membership of a Clubhouse.Conclusions: Our findings correspond with previous international research. Owing to the positive effect participation in the Clubhouse seem to have on members' motivation, Salutogenesis might help explain helpful processes within the model. Moreover, the model might be a relevant example for policy and service development in mental health care and the labour market.

Salutogenesis as a theoretical framework for psychosocial rehabilitation: the case of the Clubhouse model

Purpose: This study explored whether the holistic theory of salutogenesis may be a suitable theoretical framework for the Clubhouse model of psychosocial rehabilitation, a pioneer among psychosocial rehabilitation programmes.

Methods: A systematic examination of elements of the Clubhouse model, as prescribed by the Clubhouse standards, was performed within the context of the theory of salutogenesis including its basic salutogenic orientation and the main concepts of sense of coherence and resistance resources.

Results: We found that several standards and practices within the Clubhouse model can be understood as applications of salutogenesis. We have hypothesized that the Clubhouse model promotes peoples’ sense of coherence and mental health. However, our investigation also showed that, to enhance the recovery of Clubhouse members, more explicitly incorporating some salutogenic principles, such as “appropriate challenges” and “active adaptation as the ideal in treatment”, may benefit Clubhouse practice.

Conclusions: The Clubhouse model of psychosocial rehabilitation is very consistent with the salutogenic orientation and main salutogenic concepts. The present study suggests that salutogenesis may be a suitable theoretical framework for the Clubhouse model and possibly in the psychosocial rehabilitation field in general.

Association between sense of coherence and dental caries: systematic review and meta-analysis

Sense of coherence (SOC) is regarded as the individuals' capacity for managing the stressors over their lifespan. The aim of this systematic review and meta-analysis was to evaluate the association between SOC and dental caries. Electronic searchers were conducted in six databases: PubMed, Medline, Scopus, Web of Science, Lilacs and Proquest from their date of inception until November/2017. An update took place in August/2018. A hand search in the reference list of the included articles and gray literature search were also carried out. Retrieved titles/abstracts were screened by two review authors. Data of the included articles were extracted and quality assessment was also conducted. The first search retrieved 346 titles/abstracts. The update retrieved 33 records. Following the removal of 70 duplicates, 309 references were screened and 17 were included. The quality assessment ranged from low quality articles to high quality articles. High quality study showed that adult individuals with lower SOC were more likely to have dental caries. Meta-analysis showed that adolescents with low SOC were 5.41 times more likely to present dental caries than adolescents with high SOC (CI = 2.15–13.59). Mothers with low SOC were 5.55 times more likely to have children/adolescents with dental caries than mothers with high SOC (CI = 2.92–10.57). The subgroup analysis exploring continuous data showed that the SOC of mothers of children/adolescents without dental caries was significantly higher than the SOC of mothers of children/adolescents with dental caries (CI = 0.10–0.51). Higher levels of SOC seem to be associated with lower levels of dental caries.

The relationship between internalized stigma and quality of life among people with mental illness: are self-esteem and sense of coherence sequential mediators?

PURPOSE

To elucidate the mechanism through which internalized stigma reduces the quality of life (QoL) of people with mental illness by exploring the mediating roles of self-esteem and sense of coherence (SOC).

METHODS

A cross-sectional analysis of 229 patients diagnosed with schizophrenia or affective disorders was undertaken to test a sequential mediation model assuming that more severe internalized stigma is related to lower self-esteem, which is associated with weaker SOC, which in turn relates to worse QoL.

RESULTS

The proposed model was supported by the data. A sequential indirect effect from internalized stigma to QoL via self-esteem and SOC turned out to be significant [beta = -0.06, SE = 0.02; 95% CI (-0.11, -0.03)]. Support was also found for simple mediation models with either self-esteem or SOC as single mediators between internalized stigma and QoL.

CONCLUSIONS

Self-esteem and SOC are personal resources that should be considered as potential targets of interventions aiming to prevent the harmful consequences of internalized stigma for the QoL of people receiving psychiatric treatment.

A protective personal factor against disability and dependence in the elderly: an ordinal regression analysis with nine geographically-defined samples from Spain

BACKGROUND

Sense of Coherence (SOC) is defined as a tendency to perceive life experiences as comprehensible, manageable and meaningful. The construct is split in three major domains: Comprehensibility, Manageability, and Meaningfulness. SOC has been associated with successful coping strategies in the face of illness and traumatic events and is a predictor of self-reported and objective health in a variety of contexts. In the present study we aim to evaluate the association of SOC with disability and dependence in Spanish elders.

METHODS

A total of 377 participants aged 75 years or over from nine locations across Spain participated in the study (Mean age: 80.9 years; 65.3% women). SOC levels were considered independent variables in two ordinal logistic models on disability and dependence, respectively. Disability was established with the World health Organization-Disability Assessment Schedule 2.0 (36-item version), while dependence was measured with the Extended Katz Index on personal and instrumental activities of daily living. The models included personal (sex, age, social contacts, availability of an intimate confidant), environmental (municipality size, access to social resources) and health-related covariates (morbidity).

RESULTS

High Meaningfulness was a strong protective factor against both disability (Odds Ratio [OR] = 0.50; 95% Confidence Interval [CI] = 0.29-0.87) and dependence (OR = 0.33; 95% CI = 0.19-0.58) while moderate and high Comprehensibility was protective for disability (OR = 0.40; 95% CI = 0.22-0.70 and OR = 0.39; 95%CI = 0.21-0.74), but not for dependence. Easy access to social and health resources was also highly protective against both disability and dependence.

CONCLUSIONS

Our results are consistent with the view that high levels of SOC are protective against disability and dependence in the elderly. Elderly individuals with limited access to social and health resources and with low SOC may be a group at risk for dependence and disability in Spain.

Follow-up two years after diagnosis of diabetes in patients with psychosocial problems receiving an intervention by a medical social worker

We followed up the psychosocial situation two years after diabetes diagnosis in patients (n = 82) aged 18-65 years, with psychosocial problems (PSP; n = 27) or not (NPSP; n = 55). We used a social questionnaire, the Hospital Anxiety and Depression scale (HAD), the Sense of Coherence scale (SOC), and the General Coping Questionnaire (GCQ). The PSP group had a more difficult situation with more strained economy, lower social support, more anxiety and depression, and lower SOC on both occasions. Being in the PSP group predicted experiencing a strong negative influence of the disease at follow-up. Regarding coping strategies, "problem focusing" decreased in both PSP and NPSP over time. "Social trust" and "intrusion" decreased only in NPSP. Otherwise the coping pattern was unchanged, with PSP showing lower scores on "self-trust" and "minimization" and higher scores on "protest," "isolation," and "intrusion." The most influenced areas at follow-up in the PSP group were work, relationship to partner and economy, and in the NPSP leisure-time activities, sexual life and work. Our findings underline the need to identify patients with psychosocial problems early.

The sense of coherence as a predictor of the scope and impact of stigma experiences among people with mental illness

This study explored the role of the sense of coherence (SOC) in predicting the scope and impact of stigma experiences in 229 patients with schizophrenia or affective disorders. Findings revealed that SOC significantly predicted lower levels of stigma, accounting for 13% of the variance in stigma experiences and 4% of the variance in stigma impact, over and above that explained by background characteristics, diagnosis and the psychiatric symptoms of the participants.

Nurses' roles in systematic patient education sessions in psychiatric nursing

The purpose of this study is to gain understanding of nurses' expectations of their roles in systematic patient education in psychiatric inpatient care. Qualitative design was used in the study. The data were collected through interviews with nurses participating in the implementation of systematic patient education (information technology (IT) based patient education n= 14, or conventional patient education n= 16). The data were analysed using inductive content analysis. The analysis showed that nurses had different roles in both IT-based and conventional patient education. Nurses acted as learners, advisors, collaborators, teachers or limiters. The nurses tailored the role in each session according to the patients' interest and mental status. We can conclude that nurses working in psychiatric hospitals have different roles in systematic patient education and they are ready and willing to tailor their roles according to patients' individual needs. Information technology should be adopted without delay as a new treatment method in daily practice in psychiatric services. It has potential to support equality between patient and nurse in secluded environments.

Factors associated with good self-management in older adults with a schizophrenic disorder compared with older adults with physical illnesses

The number of older people living with a schizophrenic disorder (SD) is increasing yet little attention paid has been paid to the needs of this population relative to people with other chronic illnesses. In order to achieve optimal functioning people with a SD need to manage their illness and its impact; therefore, this study set out to determine the factors associated with self-management in this population. The illness management of people over 50 years of age and living with schizophrenia (n= 84) was compared with their peers who were diagnosed with a chronic physical illness (n= 216). Participants completed a survey that included an illness management inventory, self-rated health and sense of coherence. The results demonstrated that participants with a SD had lower illness management levels, particularly for understanding their symptoms and taking appropriate actions in relation to health care. Poor self-rated health and the presence of comorbid conditions had a pervasive negative effect on self-management factors in the SD group, whereas being married, having a greater sense of coherence and being voluntary to treatment had a positive effect. Nurses need to develop strategies to address general health and self-management in older adults living with a SD.