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.     

精神分裂症患者康复期心理状态与耻感、应对方式及社会支持的关系

目的 探讨精神分裂症患者康复期心理状态与耻感、应对方式及社会支持之间的关系,为康复干预方案的制定提供参考.方法 选择2015年1～12月在精神病医院住院治疗的178例恢复期精神分裂症患者作为研究对象,根据卡尔加里精神分裂症抑郁量表(CDSS)评分将其分为抑郁组(54例)和非抑郁组(124例),采用精神病患者病耻感评估量表、应对方式量表和社会支持量表分别对两组患者进行调查,分析其各量表得分差异,以及抑郁评分和各量表得分之间的相关性.结果 抑郁组和非抑郁组患者在年龄、性别比例、病程等一般资料方面比较差异无统计学意义(P＞0.05);抑郁组患者病耻感中社交因子、能力因子评分以总评分均明显高于非抑郁组;积极应对评分明显低于非抑郁组,而消极应对评分明显高于非抑郁组;抑郁组患者社会支持各方面评分以及总分均明显低于非抑郁组患者.相关性分析表明抑郁心理与患者病耻感评分呈正相关(P＜0.05);消极应对与抑郁呈正相关(P＜0.05),积极应对与抑郁呈负相关(P＜0.05);社会支持各方面评分均与抑郁呈负相关(P＜0.05).结论 精神分裂症患者康复期抑郁心理状态与耻感呈正相关,与消极应对方式呈正相关,与社会支持呈负相关.     

A new rating scale for adult resilience: what are the central protective resources behind healthy adjustment?

Resources that protect against the development of psychiatric disturbances are reported to be a significant force behind healthy adjustment to life stresses, rather than the absence of risk factors. In this paper a new scale for measuring the presence of protective resources that promote adult resilience is validated. The preliminary version of the scale consisted of 45 items covering five dimensions: personal competence, social competence, family coherence, social support and personal structure. The Resilience Scale for Adults (RSA), the Sense of Coherence scale (SOC) and the Hopkins Symptom Checklist (HSCL) were given to 59 patients once, and to 276 normal controls twice, separated by four months. The factor structure was replicated. The respective dimensions had Cronbach's alphas of 0.90, 0.83, 0.87, 0.83 and 0.67, and four-month test-retest correlations of 0.79, 0.84, 0.77, 0.69 and 0.74. Construct validity was supported by positive correlations with SOC and negative correlations with HSCL. The RSA differentiated between patients and healthy control subjects. Discriminant validity was indicated by differential positive correlations between RSA subscales and SOC. The RSA-scale might be used as a valid and reliable measurement in health and clinical psychology to assess the presence of protective factors important to regain and maintain mental health.     

Cognitive predictors of psychosocial functioning outcome in schizophrenia: a follow-up study of subjects participating in a rehabilitation program

The aims of this prospective study were to explore in subjects with psychosis participating in a rehabilitation program whether cognitive performances at baseline predicted (i) psychosocial functioning over a 15-16 month follow-up; (ii) improvement in psychosocial functioning over the rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performance in 55 subjects with schizophrenia spectrum disorders who completed a rehabilitation program. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. One subscale of the Client's Assessment of Strengths, Interests, and Goals (CASIG) provided a measure of subjective quality of life (QoL). Improvement was defined as a 15% or more increase in psychosocial scores between baseline and follow-up. Worse baseline sustained attention predicted better self-rated quality of life, and better baseline visual memory predicted better community functioning over the rehabilitation follow-up period, in particular, higher autonomy in activities of daily living, and less physical and psychiatric symptoms that could interfere with rehabilitation. Baseline cognitive performances predicted community functioning improvement during the follow-up period: visual memory predicted improvement in daily living autonomy and in social competence; sustained attention predicted improvement in behavioral problems (such as medication compliance, collaboration with treatment providers or impulse control) and social competence; planning performances predicted improvement in social competence. These cognitive functions could be specifically targeted in a rehabilitation program aimed at enhancing functioning in those particular dimensions.     

Social network among young adults with first-episode schizophrenia spectrum disorders

Background Social network has considerable impact on physical and mental health. Patients experiencing first-episode psychosis early in adult life may experience severe problems concerning development and maintenance of their social network. Methods A total of 547 first-episode psychotic patients (18–45) were randomised to standard or integrated treatment, (ACT, social skills training and family intervention), and followed up at 2 years. Results Service use or psychotic symptom score did not influence the social network size, measured after the first 2 years of treatment. Small network size was associated with long duration of untreated psychosis (DUP), poor premorbid adjustment, male gender and severe negative symptoms. The number of friends at 2-year follow-up was predicted by age, A-level status, negative symptoms and number of friends at entry, while the determinants for number of family contacts were age, gender, disorganised dimension and family contacts at entry. Conclusions Premorbid functioning, network size at entry and DUP is closely related to small social network size. The integrated psychosocial treatment programme was not sufficient to address this problem.     

Sense of coherence among cognitively intact nursing home residents – a five-year longitudinal study

Aim and objectives: To examine how stable the sense of coherence (SOC) is over a five-year period among residents of nursing homes (NH) who are not cognitively impaired and whether components of social support influence SOC.Background: Many studies have investigated the stability of SOC, and the findings have been inconsistent. Social support is a crucial resource in developing SOC. Few researchers have studied the stability of SOC and how various social support dimensions influence changes in SOC among older NH residents who are cognitively intact.Design: The study was prospective and included baseline assessment and five-year follow-up.Methods: The sample comprised 52 cognitively intact NH residents (Clinical Dementia Rating score ≤0.5). We obtained data through direct interviews using the Social Provisions Scale and Sense of Coherence Scale.Results: SOC increased statistically significantly from baseline to follow-up. The social support subdimension reassurance of worth predicted change in SOC after adjustment for sociodemographic factors. When controlled for baseline SOC, attachment was associated with change in SOC, but reassurance of worth was not.Conclusions: The study indicates that the change in SOC over time during the 5 years of follow-up and the social support dimension attachment appear to be important components of change in SOC. Nursing personnel should be aware of the residents’ individual needs for attachment and the importance of emotional support for personal strength and ability to cope.     

Sharing secrets: oxytocin and trust in schizophrenia

Previous studies indicated that oxytocin plays an important role in human trust, which is impaired in patients with severe mental disorders. In this study, we measured plasma oxytocin levels in patients with schizophrenia (n=50) and in healthy controls (n=50) after neutral and trust-related interpersonal interactions. Trust-related interactions were associated with increased oxytocin levels in controls. This effect was absent in patients with schizophrenia. Low oxytocin levels measured after trust-related interactions significantly predicted the negative symptoms of schizophrenia but were not related to positive symptoms, depression, anxiety, and neuropsychological functions. These results suggest that decreased trust-related oxytocin release is related to the negative symptoms and may be associated with social withdrawal, isolation, and flattened affect in schizophrenia.     

Intersubject agreement concerning relationships between the positive and negative poles of constructs in repertory grid tests.

Previous research indicate that there is more intersubject agreement concerning patterns of correlations between constructs than concerning how specific elements are rated on each construct. In this study, Canadian undergraduates (15 women, 15 men) rank-ordered eight photographs of strangers separately on the basis of the positive and negative poles of six constructs. The results indicated that there is more consensus concerning specific patterns of relationships between the positive poles of constructs than concerning those between their negative poles. Some implications of this finding for repertory grid assessment and research were discussed.     

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.     

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.     

Structure analysis of Antonovsky's sense of coherence from an epidemiological mental health survey with a brief nine-item sense of coherence scale

Antonovsky has proposed the sense of coherence (SOC) as a crucial factor that protects against symptoms of mental disease. A central issue in research on the SOC construct is whether this is most appropriately considered as one-dimensional or three-dimensional with comprehensibility (C), manageability (Ma) and meaningfulness (Me) as separate dimensions. In this paper we address this issue by means of confirmatory factor analysis of a shortened nine-item version of Antonovsky's original 29- and 13-items Sense of Coherence Scale (SOCS-29), using epidemiological data from a mental health survey of adults in local communities (N = 1,062). In addition to analysing the internal structure of the SOC items, we examine the association between estimated factor scores and variables expected to be statistically related to SOC. Goodness-of-fit indices were very good for the three-factor model but acceptable even for the one-factor model. In the three-factor model, however, the factors were found to be very highly or, with regard to Ma and C, even perfectly correlated. Moreover, the factor scores had very similar correlations with measures of psychological wellbeing, depression and anxiety and they are also very similarly related to age (and none of them are related to gender). We therefore conclude in favour of a one-factor model.     

手外伤患者的社会支持及其影响因素调查

目的探讨手外伤患者的社会支持情况及其影响因素。方法采用特质应对方式量表(TCSQ)、90项症状清单(SCL-90)、社会支持量表(SSRS),艾森克人格问卷(EPQ),对2006年8月至11月住杭州整形医院手外科急诊手部外伤患者进行问卷调查,有效问卷200份,采用SPSS软件进行频数分析、u检验和多元逐步回归分析。结果手外伤患者社会支持中主观支持、客观支持和社会支持总分高于手部残缺患者,差异均有统计学意义(P<0.01)。影响主观支持的因素为年龄、人际敏感、婚姻、焦虑;影响客观支持的因素为性别、积极应对、消极应对;影响支持利用度的因素为婚姻、消极应对、敌对、积极应对;影响社会支持总分的因素为年龄、积极应对、消极应对、人际敏感。结论给予合理、有效的心理干预,调整应对方式及进行自我效能技术训练和个性化的社会支持,可以提高社会支持水平,有利于其早日康复。     

Sense of coherence among the elderly in relation to their perceived life history in an Eriksonian perspective

The concept of 'sense of coherence' has been shown to be an important factor influencing wellbeing and health. In addition, remembrance of the past affects the wellbeing of the elderly. The present study investigated the relationship between sense of coherence and the perceived life history of elderly persons. We hypothesized that the manner in which the past is recalled and evaluated is influenced by, and in turn influences, the sense of coherence. Fifty-eight elderly individuals reported and evaluated their personal life stories, according to Erik H. Erikson's psychosocial stages of development. The sense of coherence was assessed using a Swedish translation of Antonovsky's original scale. Results indicated that the more positive the evaluation of the life history, the stronger the sense of coherence. Four of the Eriksonian developmental stages were found to be significantly correlated with sense of coherence: the conflicts about trust/mistrust, autonomy/shame, identity/identity diffusion, and intimacy/isolation. The sense of coherence factors for meaningfulness, manageability and comprehensibility were related to specific stages in the life history. Using a process perspective, three life span profiles were distinguished. One showed a generally low life-stage evaluation, and had significantly lower scores on the sense of manageability. This indicates that there are specific associations between the remembered past and sense of coherence.     

Social Support and Well-being at Mid-Life Among Mothers of Adolescents and Adults with Autism Spectrum Disorders

The present study investigated the impact of social support on the psychological well-being of mothers of adolescents and adults with ASD (n?=?269). Quantity of support (number of social network members) as well as valence of support (positive support and negative support) were assessed using a modified version of the "convoy model" developed by Antonucci and Akiyama (1987). Having a larger social network was associated with improvements in maternal well-being over an 18-month period. Higher levels of negative support as well as increases in negative support over the study period were associated with increases in depressive symptoms and negative affect and decreases in positive affect. Social support predicted changes in well-being above and beyond the impact of child behavior problems. Implications for clinical practice are discussed.     

Relationship between tobacco smoking and positive and negative symptoms in schizophrenia

In an attempt to understand the reasons behind the high prevalence of tobacco smoking in patients with schizophrenia, the study examined whether specific symptoms of schizophrenia were associated with smoking. Standardized assessments of nicotine dependence (Fagerstrom Test for Nicotine Dependence) and psychopathology (Positive and Negative Syndrome Scale) were performed on 87 inpatients with schizophrenia. Nearly 76% of patients were nicotine dependent. Significant positive correlations were found between Fagerstrom scores and the total negative symptom score and scores on the negative symptom subscales of blunted affect, social withdrawal, difficulty in abstract thinking, and stereotyped thinking. Fagerstrom scores were also significantly associated with impairment in attention, orientation, thinking, and impulse control. Positive symptoms were not significantly associated with smoking. A combination of negative symptoms, duration of illness, and alcohol use optimally predicted smoking in the sample. Neurobiological mechanisms could possibly underlie some of our findings and require further investigation.     

Information Sampling,Judgment, and the Environment: Application to the Effect of Popularity on Evaluations

If people avoid alternatives they dislike, a negative evaluative bias emerges because errors of under‐evaluation are unlikely to be corrected. Prior work that analyzed this mechanism has shown that when the social environment exposes people to avoided alternatives (i.e., it makes them resample them), then evaluations can become systematically more positive. In this paper, we clarify the conditions under which this happens. By analyzing a simple learning model, we show that whether additional exposures induced by the social environment lead to more positive or more negative evaluations depends on how prior evaluations and the social environment interact in driving resampling. We apply these insights to the study of the effect of popularity on evaluations. We show theoretically that increased popularity leads to more positive evaluations when popularity mainly increases the chances of resampling for individuals with low current evaluations. Data on repeat stays at hotels are consistent with this condition: The popularity of a hotel mainly impacts the chances of a repeat stay for individuals with low satisfaction scores. Our results illustrate how a sampling approach can help to explain when and why people tend to like popular alternatives. They also shed new light on the polarization of attitudes across social groups.     

Salutogenic factors for mental health promotion in work settings and organizations

Accompanied by an increasing awareness of companies and organizations for mental health conditions in work settings and organizations, the salutogenic perspective provides a promising approach to identify supportive factors and resources of organizations to promote mental health. Based on the sense of coherence (SOC) - usually treated as an individual and personality trait concept - an organization-based SOC scale was developed to identify potential salutogenic factors of a university as an organization and work place. Based on results of two samples of employees (n = 362, n = 204), factors associated with the organization-based SOC were evaluated. Statistical analysis yielded significant correlations between mental health and the setting-based SOC as well as the three factors of the SOC yielded by factor analysis yielded three factors comprehensibility, manageability and meaningfulness. Significant statistic results of bivariate and multivariate analyses emphasize the significance of aspects such as participation and comprehensibility referring to the organization, social cohesion and social climate on the social level, and recognition on the individual level for an organization-based SOC. Potential approaches for the further development of interventions for work-place health promotion based on salutogenic factors and resources on the individual, social and organization level are elaborated and the transcultural dimensions of these factors discussed.     

Salutogenic factors for mental health promotion in work settings and organizations

Abstract

Accompanied by an increasing awareness of companies and organizations for mental health conditions in work settings and organizations, the salutogenic perspective provides a promising approach to identify supportive factors and resources of organizations to promote mental health. Based on the sense of coherence (SOC) – usually treated as an individual and personality trait concept – an organization-based SOC scale was developed to identify potential salutogenic factors of a university as an organization and work place. Based on results of two samples of employees (n = 362, n = 204), factors associated with the organization-based SOC were evaluated. Statistical analysis yielded significant correlations between mental health and the setting-based SOC as well as the three factors of the SOC yielded by factor analysis yielded three factors comprehensibility, manageability and meaningfulness. Significant statistic results of bivariate and multivariate analyses emphasize the significance of aspects such as participation and comprehensibility referring to the organization, social cohesion and social climate on the social level, and recognition on the individual level for an organization-based SOC. Potential approaches for the further development of interventions for work-place health promotion based on salutogenic factors and resources on the individual, social and organization level are elaborated and the transcultural dimensions of these factors discussed.