Does sense of coherence affect the relationship between self-rated health and health status in a sample of community-dwelling frail elderly people?

BACKGROUND: The objective of this study was to examine the association between self-rated health (SRH) and physical, functional, social and mental health measures in community dwelling elderly people needing nursing care. Of special interest was how coping resources (SOC) influenced this relationship. Self-rated health is a good predictor of future health status as measured by mortality and morbidity, decline of functional abilities, use of healthcare, and nursing home placement. The high mean age and the relatively high level of care-dependency in this sample, make this investigation important. METHODS: A hierarchical regression analysis was applied in a cross sectional sample of 242 elderly (mean age 84.6 years). RESULTS: Subjective health complaints (SHC) in both sexes, and psychological distress (only in men), was associated directly with SRH. Coping resources associated with SRH directly, and indirectly through subjective perceived health (SHC and GHQ) but only in men. The influence of registered illness was mediated through the effects of subjectively perceived health in both women and men. Sex differences moderated the effects of SOC on SRH. CONCLUSION: Subjectively perceived health was more important in the perception of SRH than objective health measures. Men, in contrast to women, tend to convert physical illness into emotional distress.     

Predictors of subjective age in people aged 40–79 years: a five-year follow-up study. The impact of mastery,mental and physical health

Objectives: Assessing subjective age perception (SAP) and changes in SAP as well as exploring which variables of socio-demographic, health and personal mastery independently predicted SAP.Methods: The panel data are from two waves of the Norwegian Study on the Life Course, Ageing and Generations (NorLAG). Our sample consists of 2471 people aged 40–79 years at baseline who were surveyed in 2002/2003 (T1) and 2007/2008 (T2). Univariate and multiple regressions were performed; multivariate analyses assessing the relative importance of the independent variables (at T1) for the SAP at T2.Results: Older chronological age, good physical health, good mental health, a high level of personal mastery and having lower education significantly predicted a youthful SAP. For the whole sample, older age and a high level of personal mastery were the most important predictors. For those aged 40–49 being a man, having lower education, good physical health and high personal mastery predicted a younger SAP, whereas in the group aged 50–59 years being married/cohabiting and having a high level of education were predictors of an older SAP. For those aged 60–69, high personal mastery was the only independent predictor of a younger SAP. For those aged 70–79 years, only health – good mental and physical health – independently predicted a younger SAP.Conclusions: Most respondents feel younger than their chronological age, the more the older they are. Self-rated physical and mental health and personal mastery are associated with SAP and vary in different age groups.     

Questioning the stability of sense of coherence

Background: Much debate exists about the stability of the sense of coherence measure. This study examined changes in sense of coherence (SOC), and the variables associated with these changes, over a 4-year period, in a representative sample of the Canadian labour force (n=6,790).Methods: Two methods were used to assess change in SOC: (1) Change outside of that which could be considered as indistinguishable from measurement error, and (2) Change of more than 10%, which was originally proposed by Antonovksy, the scales designer.Results: Over the study period, 35.4% of the population reported changes in SOC outside the range we consider possible due to measurement error, with 58% reporting change greater than 10%. Unskilled occupations were associated with declines in SOC, with household income demonstrating a curvilinear relationship with decline in SOC in the female population only. None of the variables used predicted increases in SOC.Conclusions: Given the degree of change in SOC, and the representativeness of the study sample, we suggest that SOC has a large state component. Given this lack of stability, we recommend caution if using the SOC to represent a stable global orientation within a causal context.Abbreviations SOC Sense of Coherence - T-RT Test-Retest - SEM Standard Error of Measurement - MDC Minimum Detectable Change     

What makes old people perceive symptoms of illness? The impact of psychological and social factors

Feeling ill is by definition a subjective experience. Independent of biological background, people differ in their inclination to perceive and report feelings of illness. Three factors were assumed to affect the way symptoms of illness are perceived and reported: the sense of coherence (SOC), the social network and the degree of depression. Fifty-eight elderly individuals reported symptoms according to a symptom checklist. They also reported social network structures/functions and degrees of depression according to standardized questionnaires. SOC showed to be strongest bivariately correlated to the number of reported symptoms, followed by the degree of depression and social network. Multiple regression analyses showed that SOC alone was related to symptoms of depression and tension. In addition, SOC in combination with social network was related to the total symptom report, and depressive mood in combination with social network was related to symptoms from muscles and skeleton. The main finding of this study is the strong connection between SOC and the perception and reporting of symptoms of illness.The results support the idea that SOC serves as a buffer against the experience of stress, but also that SOC interacts with social context variables to define the sickness behavior.     

Gender specific associations between social network and health behavior in old age

Social networks may affect old people's health behaviors, such as their subjective health evaluations, health care utilization and symptom reporting. In this study, the relationships between social network characteristics and health behaviors were investigated for each gender separately. It was assumed that the relationships differ between the genders and that female health behavior would be more strongly related to the social network. Social network characteristics, reported symptoms, subjective health and health care utilization were assessed for 107 men and 77 women that were 71 years of age.The results showed that, for women, a general satisfaction with the social network was associated with good subjective health. In addition, satisfaction with social participation and social anchorage were associated with a high frequency of health care utilization. For men, none of these health-related behaviors were bivariately associated with the social network. Furthermore, for women, the frequency of reported symptoms were more often associated with social network characteristics. Multivariate analyses showed that for women, dissatisfaction with social participation and support from the neighborhood predicted stomach symptoms. For men, dissatisfaction with instrumental support and contact with children predicted tension symptoms. This study suggests that health behaviour relates both to social network and gender.     

Hostility, anger, and sense of coherence as predictors of health-related quality of life. Results of an ASCOT substudy

OBJECTIVE: The aim of this study was to investigate the relationship of hostility and anger expression to sense of coherence (SOC) and their role as predictors of health-related quality of life (HQL). It was hypothesised that SOC would mediate the impact of hostility and anger on HQL. METHODS: This is a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial, which evaluates different treatment strategies to prevent cardiovascular disease in hypertensive patients. At baseline, SOC was assessed with a short form measure, and hostility-anger with the Cynical Distrust scale and with the Anger Expression scales. HQL was assessed at 6 months with the RAND-36. The sample comprised of 774 subjects (77.5% men). RESULTS: Results showed that strong SOC associates with ability to control expression of anger and with low levels of suppressed or openly expressed anger. Anger control and SOC were related to good HQL; cynicism, anger-out, and anger-in correlated negatively with HQL. Path models revealed that SOC was the strongest predictor of HQL while hostility and anger lost their direct impact on HQL. CONCLUSIONS: Given the significant associations of hostility and anger with SOC, it is concluded that the salutogenic theory of Antonovsky (A. Antonovsky, Health, Stress, and Coping: New Perspectives on Mental Health and Physical Well-Being, Jossey-Bass Inc, San Francisco, 1979) should be extended to include hostility-related constructs. The impact of hostility and anger on HQL is, to a great extent, mediated through SOC, which implies that in future studies, the role of hostility as a risk factor of ill health should be reconsidered from the SOC theory perspective.     

The relationships of health to affect assessed in both state and trait form: How does age impact the relationships?

The purpose of this study was to compare the relationships of health to both state and trait affects. A secondary goal was to determine if these relationships are affected by age. Using structural equation modeling, the latent variable health (pain, self-rated health and a count of health conditions) was regressed on the latent variables state and trait positive affects, and state and trait negative affects. Age and sex were treated as covariates. Results indicated that trait negative affect and state positive affect are associated with health, suggesting that multiple processes may account for the affect/health relationship. Furthermore, when age was entered into the model, it was found that age is related to presence of disease, but unrelated to subjective ratings of health.     

Sense of coherence as a mediator between hostility and health: seven-year prospective study on female employees

OBJECTIVE: We proposed and tested a model in which low sense of coherence (SOC) was hypothesized to underlie the association between hostility and health problems. METHODS: Structural equation modeling was based on cross-lagged 7-year follow-up data, relating to five measurement points in 433 female municipal employees. RESULTS: The mediated model fitted well with the data. After adjustment for baseline characteristics, hostility was associated with increased risk of health problems, as indicated by records of sickness absences and poor self-rated health. Incorporating SOC into the model attenuated this association by 33-50%, depending on the indicator of health. The mediated effect of SOC was stronger than that of an alternative mediator, depressive symptoms. CONCLUSION: Low SOC may be a psychological background factor partially underlying the adverse effect of hostility on ill health.     

Old and Ill and Still Feeling Well? Determinants of Subjective Well-Being in ≥60 Year Olds: The Role of the Sense of Coherence

OBJECTIVE: The authors investigated the determinants of subjective well-being in a sample of elderly by applying a salutogenetic model of subjective well-being in which sense of coherence (SOC) plays a central role. The hypothesis was that subjective evaluation and SOC as a personality resource explain more variance of subjective well-being than the objective changes resulting from the aging process. METHODS: A sample of >or=60-year-old patients of an internal hospital, previously examined between 1994 and 1997, were once more contacted between 2000 and 2002. Fifty-six patients were investigated by means of psychometric scales and biographic interviews. Compared with the sample of the first investigation, a positive selection effect could be found for the sample of the present investigation with regard to age- and health-related variables, however, not with regard to subjective well-being. A path model formulated in advance was tested. RESULTS: Despite an increase in physical disability, subjective well-being remained constant for both points in time. The path model supported the hypothesis that subjective well-being at the second measurement point was hardly influenced by "objective" conditions of aging and functional impairment but was significantly influenced by the individual's subjective evaluation of the present situation as well as the sense of coherence. CONCLUSIONS: Our results support a salutogenetic model of subjective well-being in our sample; these findings should, however, be replicated in other samples.     

The Antonovsky Sense of Coherence Scale. Test statistical evaluation of a representative population sample and construction of a brief scale

In this article we will describe the evaluation of Antonovsky's 29-items Sense of Coherence Scale (SOC-29) in a large community sample (n = 2.005) of the German population and the development of the Leipzig Short Scale (SOC-L9), which consists of only 9 items. The SOC-29 has a high internal consistency (alpha = 0.92), however, the SOC-subscales (comprehensibility, manageability, meaningfulness) were correlated with each other. A principal component factor analysis did not identify the 3-factor structure of the SOC-Scale. It appears that the best solution consists of one global factor. The newly developed SOC-L9, conceptualized as an unidimensional scale, is a reliable and valid instrument, which allows to assess the SOC economically. In our study the Sense of Coherence depended on age and gender. Women and older people reported a lower SOC. Furthermore we found significant associations between SOC and different subjective health measures. A high SOC was associated with both a lower extent of subjective body complaints and somatoform symptoms and with minor health-related problems in daily living.     

Successful aging

OBJECTIVE: Until now, prospective studies of aging have begun with 50-60-year-olds, not adolescents. Premature death, childhood variables, and alcohol abuse have been often ignored, as has successful aging. METHOD: The authors reviewed the existing literature on health in late life in order to highlight that, increasingly, successful aging is not an oxymoron. The present study followed two cohorts of adolescent boys (237 college students and 332 core-city youth) for 60 years or until death. Complete physical examinations were obtained every 5 years and psychosocial data every 2 years. Predictor variables assessed before age 50 included six variables reflecting uncontrollable factors: parental social class, family cohesion, major depression, ancestral longevity, childhood temperament, and physical health at age 50 and seven variables reflecting (at least some) personal control: alcohol abuse, smoking, marital stability, exercise, body mass index, coping mechanisms, and education. The six outcome variables chosen to assess successful aging at age 70-80 included four objectively assessed variables (physical health, death and disability before age 80, social supports, and mental health) and two self-rated variables (instrumental activities of daily living and life enjoyment). RESULTS: Multivariate analysis suggested that "good" and "bad" aging from age 70-80 could be predicted by variables assessed before age 50. More hopeful still, if the seven variables under some personal control were controlled, depression was the only uncontrollable predictor variable that affected the quality of subjective and objective aging. CONCLUSIONS: One may have greater personal control over one's biopsychosocial health after retirement than previously recognized.     

Burnout among relatives of psychiatric patients attending psychoeducational support groups

OBJECTIVE: The effectiveness of family interventions may be improved by concentrating on elements of objective burden that best predict subjective burden. The relationship between subjective burden and objective burden was investigated among caregivers of patients with serious mental illness in the Netherlands who were attending psychoeducational support groups. METHODS: The study used pretest data from an intervention study in which psychoeducational family support groups in the Netherlands were evaluated. A total of 164 participants from 19 psychoeducational groups organized by nine community mental health centers completed the Dutch translation of the Maslach Burnout Inventory and the Involvement Evaluation Questionnaire. Regression analyses were conducted, with elements of subjective burden as dependent variables and elements of objective burden, demographic characteristics, and characteristics of the patient's disorder as predictors. RESULTS: Burden in general and emotional exhaustion were the aspects of subjective burden best predicted by objective burden. In two regression models, objective burden together with the other predictors explained 57 percent and 54 percent of the variance in subjective burden. Two aspects of objective burden-strain on the relationship with the patient and ability to cope with the patient's behavior-were related to almost all the investigated aspects of subjective burden. CONCLUSIONS: Strong evidence was found for the relationship between objective and subjective burden and for the hypothesis that particular elements of objective burden contribute more to subjective burden than others. The findings suggest that psychoeducation should concentrate on helping relatives cope with the strain on the relationship with the patient and on improving their ability to cope with the patient's behavior.     

Sense of coherence and emotional health in adolescents

The present paper investigates possible gender and age differences on emotional states (state depression and state anxiety) and sense of coherence (SOC) as well as the association between SOC and emotional states. The cross-sectional sectional sample consists of 1209 adolescents 13-18 years from public elementary and secondary schools in Mid-Norway. The results showed that girls reported higher scores on state anxiety and state depression, whereas boys consistently scored higher on SOC in all age groups. SOC was inversely associated with both state depression and state anxiety. An interaction effect of gender by SOC was found on both state depression and state anxiety, where the association was stronger for girls than for boys. Conclusions: The associations found give support for the implications of salutogenic factors in relation to emotional health in adolescents.     

Assessing the construct validity of three indicators of psychological distress in relation to perceived health and physical illness

Objetives The aim of this study is to compare three indicators of psychological distress (PD) on the strength of their association with subjective (or perceived) health and to analyse to what extent these associations will change after adjusting for physical illness measures and other possible confounding variables. Methods Data were used from a community-based sample of adults (N=9,428). Psychological distress was measured using three different instruments: the Negative Affect Scale of Bradburn, a nervousness scale, and a self-reported depressive complaints. Physical illness was measured by seven specific chronic conditions, a co-morbidity index of 17 conditions and two disability measures. Subjective health was assessed by a single question. Ordinary least square and logistic regression as well as structural equation modelling were used to analyse the data. Results The relation between subjective health and PD is strongest in case nervousness and this, or negative affect, are used as indicators of PD. The measure of depressive complaints is less strongly, but still substantially, related to subjective health. After correction for physical illness variables, the change in strength of the association is slightest for depressive complaints and highest for nervousness. Only small differences between negative affect and nervousness were established. These measures, which were more contaminated by physical ill health than depressive complaints, have the strongest association with subjective health both before as well as after correction for physical illness components. Conclusion Negative affect and nervousness are reliable and valid indicators of PD, which can be used to predict subjective health. However, for this purpose, a correction for the confounding effects of physical illness variables will be necessary. The depressive complaints measure is not only less predictive of subjective health but also less contaminated by physical illness variables, making it a better indicator of PD if correction for physical illness variables is not possible.     

A prospective study of childhood psychopathology: independent predictors of change over three years

BACKGROUND: Whilst the correlates of child mental health problems are well understood, less is known about factors that operate to maintain healthy or unhealthy functioning, or that contribute to change in functioning. A range of factors may be of interest here, including relatively stable characteristics of children or their environment, that may have long-lasting and enduring consequences for their mental health, along with events that prompt changes in a child's mental state. METHODS: Children were followed up 3 years after the original survey for a sub-sample of the 1999 British Child and Adolescent Mental Health Survey (N = 2,587 children). Latent mental health ratings drew on data provided by parent, teacher, and youth versions of the Strengths and Difficulties Questionnaire at baseline, and at follow-up. A residual scores method was used to assess change in functioning over time. RESULTS AND CONCLUSIONS: Latent mental health scores showed strong stability over time (r = 0.71) indicating the need for effective intervention with children who have impairing psychopathology, since they are unlikely to get better spontaneously. A poorer outcome was associated with: externalizing as opposed to emotional symptoms, reading difficulties; living in a single-parent or reconstituted family at baseline; and after exposure between Time 1 and Time 2 to parental separation, parental mental illness, child illness, and loss of a close friendship. All these factors could be targeted in public health or clinical interventions, particularly as predictors of change in child mental health were closely comparable across the range of initial SDQ scores, suggesting that they operated in a similar manner regardless of the initial level of (mal)adjustment.     

Factors associated with high use of public mental health services by persons with borderline personality disorder

OBJECTIVE: The research presented here was a pilot study to identify clinical factors associated with high use (as opposed to lower use) of inpatient psychiatric services by persons with borderline personality disorder. METHODS: The initial sample was a random sample of English- and Spanish-speaking persons aged 18 to 60 years who had received at least one outpatient mental health service in the previous 90-day period and were enrolled in one of the participating mental health centers in King County, Washington. A random sample of persons who met selection criteria was randomly drawn; persons with high levels of use were oversampled to ensure adequate representation. Twenty-nine participants met full criteria for borderline personality disorder on the Personality Disorders Examination structured interview and completed all measures. Fifteen (52 percent) of these had a high level of use of inpatient services, and 14 did not. RESULTS: High use of inpatient psychiatric services was predicted by a history of parasuicide in the previous two years but not by the number or severity of parasuicides; by the presence and number of anxiety disorders but not by depression or psychotic or substance use disorders; and by poorer cognitive functioning. Life stressors, global functioning, and health service variables did not differentiate patients with high levels of service use from other patients with borderline personality disorder. CONCLUSIONS: Further research should explore these predictors of service use to determine whether they are replicated in larger samples, and treatments that target these variables should be evaluated.     

The important role of sense of coherence in relation to depressive symptoms for Taiwanese family caregivers of cancer patients at the end of life

OBJECTIVE: To determine whether the strength of personal coping capability, the sense of coherence (SOC), makes a unique contribution in explaining the extent of depressive symptoms experienced by family caregivers of terminally ill cancer patients. METHODS: A total of 253 Taiwanese family caregivers of terminally ill cancer patients participated in this survey. Caregiver depressive symptoms were assessed using the CES-D. Potential correlates of depressive symptoms were categorized as: (1) characteristics of the caregivers; (2) demographics and disease-related characteristics of the patients; (3) objective caregiving loads; (4) confidence in end-of-life caregiving; (5) subjective caregiving burden; and (6) SOC. RESULTS: Family caregivers scored high on the CES-D [mean (S.D.)=22.24 (11.36)]. Results from the R(2) change in the hierarchical multiple regression model indicated that the incremental variance explained by each block of variables for (1) the characteristics of family caregivers, (2) the characteristics of cancer patients, (3) objective caregiving loads, (4) confidence in caregiving, and (5) subjective caregiving burden was 20.5%, 6.8%, 1.5%, 3.7%, and 11.9%, respectively. In the final step of regression, SOC of caregivers increases the explained variation in depressive symptoms by 21.5%. CONCLUSIONS: This study confirms that, among the independent variables examined in this study, variations in SOC are comparatively important in explaining the variation of depressive symptoms experienced by Taiwanese family caregivers. Developments and evaluations of the effectiveness of clinical interventions aimed at augmenting caregivers' coping capability (such as SOC) to facilitate positive appraisal and finding meaning, to improve understanding of the demands and challenges of caregiving, and to mobilize resources available to manage caregiving tasks are highly recommended.     

Factors associated with hopelessness: a population study

BACKGROUND: Hopelessness is associated with depression and suicidality in clinical as well as in non-clinical populations. However, data on the prevalence of hopelessness and the associated factors in general population are exiguous. AIMS: To assess the prevalence and the associated factors of hopelessness in a general population sample. METHODS: The random population sample consisted of 1722 subjects. The study questionnaires included the Beck Hopelessness Scale (HS), Beck Depression Inventory (BDI), Toronto Alexithymia Scale (TAS-20) and Life Satisfaction Scale (LS). RESULTS: Eleven percent of the subjects reported at least moderate hopelessness. A poor financial situation (OR 3.64), poor subjective health (OR 2.87) and reduced working ability (OR 2.67) independently associated with hopelessness. Moreover, the likelihood of moderate or severe hopelessness was significantly increased in subjects dissatisfied with life (OR 5.99), with depression (OR 4.86), with alexithymia (OR 2.37) and with suicidal ideation (OR 1.85). CONCLUSIONS: This study demonstrated a moderately high prevalence of hopelessness at the population level. Hopelessness appears to be an important indicator of low subjective well-being in the general population that health care personnel should pay attention to.     

The genetic background of the associations between sense of coherence and mental health,self-esteem and personality

Purpose

Sense of coherence (SOC) represents coping and can be considered an essential component of mental health. SOC correlates with mental health and personality, but the background of these associations is poorly understood. We analyzed the role of genetic factors behind the associations of SOC with mental health, self-esteem and personality using genetic twin modeling and polygenic scores (PGS).

Methods

Information on SOC (13-item Orientation of Life Questionnaire), four mental health indicators, self-esteem and personality (NEO Five Factor Inventory Questionnaire) was collected from 1295 Finnish twins at 20–27 years of age.

Results

In men and women, SOC correlated negatively with depression, alexithymia, schizotypal personality and overall mental health problems and positively with self-esteem. For personality factors, neuroticism was associated with weaker SOC and extraversion, agreeableness and conscientiousness with stronger SOC. All these psychological traits were influenced by genetic factors with heritability estimates ranging from 19 to 66%. Genetic and environmental factors explained these associations, but the genetic correlations were generally stronger. The PGS of major depressive disorder was associated with weaker, and the PGS of general risk tolerance with stronger SOC in men, whereas in women the PGS of subjective well-being was associated with stronger SOC and the PGSs of depression and neuroticism with weaker SOC.

Conclusion

Our results indicate that a substantial proportion of genetic variation in SOC is shared with mental health, self-esteem and personality indicators. This suggests that the correlations between these traits reflect a common neurobiological background rather than merely the influence of external stressors.