Navigating cross-national adjustment: the protective role of sense of coherence in international students’ psychological distress

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.

Sense of Coherence (SOC) is conceptualized as a disposition to experience life as meaningful and manageable. Research suggests a protective effect of SOC on psychological health in stressful circumstances. This study assessed the capacity of SOC to buffer the effect of illness symptoms on psychological distress among patients with fibromyalgia. Self-reported changes in SOC after participation in a Mindfulness-Based Stress Reduction (MBSR) program were also examined. Ninety-one women with fibromyalgia provided baseline data pertaining to illness symptoms, perceived stress, and depression prior to participation in a randomized trial of MBSR. SOC and fibromyalgia symptoms were independently related to perceived stress and depression at baseline. SOC was not a statistically significant moderator of symptom effects on psychological distress. In comparison with wait-listed controls, program participants reported a significant increase in SOC after MBSR participation. These results provide the first demonstration from a randomized trial that SOC may be enhanced via intervention.

BackgroundThere is a need for further investigation of sense of coherence (SOC), the central concept of salutogenesis, and its relationship with long-term illnesses such as psoriasis. The aim of this study is to investigate the development of SOC during patient education in the context of climate therapy and to explore factors that may predict changes in SOC among people with psoriasis.MethodsA prospective design included a baseline assessment and two follow-ups after a 3-week patient education and climate therapy programme (follow-up 1) and again 3 months later (follow-up 2). A total of 254 adults (aged 20–80) with psoriasis participated. SOC was measured by the SOC Questionnaire, illness perception was measured by the Revised Illness Perception Questionnaire, and positive and active engagement in life was measured by the positive and active engagement subscale of the Health Education Impact Questionnaire. Paired-sample t tests were used to evaluate changes in SOC from the baseline to follow-up. Multiple linear regression was used to analyse the ability of socio-demographic and clinical variables, illness perception and positive and active engagement in life to predict the changes in SOC.ResultsThe SOC score changed significantly by 2.65 points, (95% CI = 0.621, 3.685) from the baseline to follow-up 1. SOC score was still improved by 1.15 points (95% CI = 0.073, 0.223) at follow-up 2.Baseline and change in positive and active engagement in life were linked to change in SOC with standardized beta 0.170 (95% CI = 0.024, 0.319) and 0.259 (95% CI = 0.092, 0.428), respectively. In addition illness coherence perception at baseline and change in emotional representations were significantly associated with the change in SOC with standardized beta 0.212 (95% CI = 0.073, 0.361) and –0.270 (95% CI = –0.481, –0,077), respectively.ConclusionsSOC improved significantly from before to after patient education in the context of climate therapy. The results indicate that improving positive and active engagement in life, coping with emotional distress and a coherent understanding of the illness might provide important opportunities to improve SOC among people with psoriasis.

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. 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. 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. 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.

Gay men face a greater risk of psychological distress than heterosexual men, yet research on protective factors among gay men has been limited. This prospective cohort study investigated whether a sense of coherence (SOC), as a form of coping, helps to protect against psychological distress among middle-aged and older gay men. A nationwide online survey was conducted among a baseline sample of 1135 Australian gay-identified men aged 40 years and older, with a follow-up survey 12 months later. SOC was measured using the 13-item SOC Scale. Psychological distress was measured using the K10 Psychological Distress Scale. Hierarchical regressions were conducted, with analyses controlling for several potential risk factors for distress. Over half of participants had moderate or high psychological distress. However, baseline distress was significantly lower among those with stronger baseline SOC. In addition, baseline SOC significantly predicted distress 12 months later. This predictive effect of SOC was independent of baseline distress levels and occurred despite a strong correlation between baseline and follow-up distress. With SOC appearing to be a protective factor, strategies among middle-aged and older gay men that strengthen SOC may assist in the prevention and treatment of anxiety and other psychological distress in this vulnerable population.

Despite ongoing physical and psychological distress, little is known about sense of coherence (SOC) and holistic quality of life (QOL) in women with irritable bowel syndrome (IBS). The purposes of this study were to (a) describe and compare SOC and holistic QOL of women with and without IBS, and (b) examine the relationships among SOC, holistic QOL, and gastrointestinal (GI) and psychological distress symptoms. A two-group comparison design was used to test the study hypotheses that women with IBS would have lower SOC and holistic QOL than control women without IBS, and that SOC and holistic QOL would be inversely related to GI and psychological distress. A total of 324 women were studied (n= 235 with IBS, n= 89 controls). Measures included the 13-item SOC Questionnaire, Modified Flanagan QOL Scale, Bowel Disease Questionnaire, and Symptom-Checklist-90-R. Both SOC and holistic QOL were lower in women with IBS (p <.001). Correlations between SOC and global distress, depression, anxiety, and somatization without GI symptoms were moderately and inversely related (r= -.64, -.64, -.53, and -.31, respectively; p <.001) in the total sample. Relationships between holistic QOL and psychological distress indicators were universally of lower magnitude (r= -.56 to -.27, p <.001). The only GI symptom indicator significantly related to SOC and holistic QOL was alternating constipation and diarrhea (tau= -.21 and -.17, respectively; p <.001). Women with IBS have a reduced SOC and holistic QOL when compared to women without IBS. It remains to be determined whether interventions targeted at enhancing SOC and holistic QOL can impact the psychological distress associated with IBS.

Mental disorders constitute an increasingly important public health problem in the general population. Therefore, investigation of the determinants and state of mental health of those who will be treating patients, that is, future medical doctors, is justified. The paper gives an account of a mental health survey of medical students at a university in Hungary. A representative sample of year I-V students (N = 100) filled an anonymous standardized self-administered questionnaire that included demographic and socioeconomic items, mental well-being characterized by a sense of coherence (SOC) and psychological distress, as well as health behaviour. SOC was measured by the 13-item Antonovsky questionnaire and psychological distress was measured by the 12-item general health questionnaire (GHQ). Models for estimating mental well-being in relation to various determinants were built by backward stepwise regression. Almost one-fifth of the students scored above the strict threshold on the GHQ indicating notable psychological distress. SOC showed significant positive correlation with perceived health and significant negative correlation with psychological distress. SOC and psychological distress were determined by different sets of explanatory variables in the regression models. Psychological distress and the use of sedative without medical prescription are inversely related to SOC; whereas social support and female gender show positive correlation to SOC according to our estimation. SOC, as expected, was a strong explanatory variable for psychological distress, forecasting an improvement in the GHQ score. Psychological distress was significantly greater in our sample of Hungarian medical students than in the same age group of the general population. Psychological distress is strongly related to SOC and can be estimated by our proposed models. Both SOC and psychological distress can be used to characterize the mental health of future medical doctors, the improvement of which needs attention even during their training.

Sense of National Coherence and Willingness to Reconcile

Previous research has found that work ability (as measured with the Work Ability Index) is related to mental health in employee samples and in the general population. This study extends this research to unemployed people. In addition, it tests whether the effect of impaired work ability on mental health can be explained by changes in sense of coherence. A longitudinal design with two measurement points was used with a sample (N = 98) of jobless individuals in Finland participating in labor market interventions. Consistent with expectations, impaired work ability predicted lower sense of coherence and more psychological distress, and the association between impaired work ability and distress was mediated by sense of coherence. The important role of impaired work ability for jobless individuals' sense of coherence and, consequently, mental health during unemployment is discussed.

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). 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. 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. 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.

BackgroundOur study aimed (1) to describe the proportion of psychological distress among Chinese outpatients at general hospitals, (2) to compare cognitive and behavioral characteristics of patients with different distress patterns, and (3) to investigate the discriminant function of the analyzed variables in indicating the affinity towards the different distress patterns.MethodsThis multicenter cross-sectional study was conducted at ten outpatient departments at Chinese general hospitals. The somatic symptom severity scale (PHQ-15), the nine-item depression scale (PHQ-9), and the seven-item anxiety scale (GAD-7) were employed to classify patients in terms of four distress patterns.ResultsA total of 491 patients were enrolled. Among them, the proportion of patients with high psychological distress was significantly higher within those with high somatic distress (74.5% vs. 25.5%, p < .001). Patients with psychological distress alone and mixed distress were significantly younger and with lower monthly family income, while the proportion of female patients (80.9%) was highest in the somatic distress group. Patients with mixed distress had the most negative cognitive and behavioral characteristics [highest health anxiety (5.0 ± 1.9), lowest sense of coherence (35.5 ± 10.0), the worst doctor–patient relationship from both patients’ (36.0 ± 7.3) and doctors’ perspectives (23.3 ± 7.0)], as well as most impaired quality of life (41.6 ± 7.4 and 31.9 ± 10.3). In addition, compared with patients with somatic distress alone, those with psychological distress alone had lower sense of coherence, worse doctor–patient relationship, and more impaired mental quality of life, but less doctor visits. Discriminant analysis showed that gender, mental quality of life, health anxiety, sense of coherence, and frequent doctor visits were significant indicators in identifying patients with different distress patterns.ConclusionsOur study found that (1) psychological distress was not rare in the Chinese general hospital outpatients, especially in those with high somatic distress; (2) patients with psychological distress alone sought less help from doctors, despite their severe psychosocial impairment; and (3) gender, health anxiety, sense of coherence, mental quality of life, and frequent doctor visits could help to identify different distress patterns.

Sense of coherence (SOC), a concept that refers to individuals’ abilities to manage, comprehend, and find meaning in their lives and the world around them, has been shown to be an important predictor of health outcomes. While SOC was initially hypothesized to be static after early-adulthood, there is growing evidence that health interventions can strengthen SOC. In this study, we accordingly examined whether SOC could be strengthened among adults in the context of a physical activity intervention.This intervention, Communities on the Move, was conducted in the Netherlands, and was primarily targeted at older adults from socially vulnerable backgrounds. Four cohorts were followed for 18 months each, between 2012 and 2016. The SOC-3 questionnaire was used to collect data on SOC at baseline (T0) and after eighteen months (T3), with information on 117 participants in both of these waves. To assess the change in SOC between T0 and T3, ordered logistic regressions were performed, as well as mixed ordered logistic regressions with random intercepts for group and program location.This study found evidence that SOC significantly changed from T0 to T3. Participants with weak SOC at baseline reported a median one-point stronger SOC at T3 (on a 6-point scale), while those with moderate or strong SOC at baseline reported a median change of zero points between T0 and T3. Further, based on the results of the regression analyses, those with weaker SOC scores were most likely to have stronger SOC at T3: having a weak SOC at baseline was associated with a 76% probability of stronger SOC, and a 4% probability of weaker SOC at T3. These results indicated that SOC may be strengthened in vulnerable older adults, particularly when their SOC is initially low.

Models of university outcomes have shown that the quality of the student experience has consequences for outcomes, such as academic achievement; however, such models have not included measures of students’ sense of coherence (SOC). In general, individuals with a high SOC are more likely than others to be able to deal with various stressors. This article focuses on the SOC of Canadian first year male and female domestic and international university students of European and Chinese origin and on the relationships among SOC, problem freedom, and academic achievement. The sample was drawn from first year students at the University of British Columbia, York University, McGill University, and Dalhousie University. It was found that, independent of place of birth, the SOC of students of Chinese origin was lower than that of domestic students of European origin. There were no differences in the SOC of male and female students. Despite differences in SOC related to ethno‐racial origin, it was not possible to conclude that within the university context the factors responsible for the SOC of European origin students were different from those supporting the SOC of Chinese origin students. By comparison, path analyses revealed that while high SOC contributed to problem freedom of both males and females, within the university context, relational factors contributed more to the SOC of females than males. Importantly, professors’ support was one of these factors. In turn, high SOC students were more able than others to deal with problems associated with university life, and students’ who were able to deal with their problems successfully were more likely than others to have high levels of achievement. Findings such as these indicate that by providing support to students professors may contribute to their academic achievement by increasing their SOC and ability to deal with various problems. University policies designed to ameliorate students’ difficulties would have the same effect.

Sense of coherence is a theoretical construct which is used to measure the degree to which a person finds the world comprehensible, manageable and meaningful. The main aim of the present study was to assess the hypothesis of Antonovsky that meaningfulness is the most crucial component in sense of coherence. The second aim was to explore the importance of its components and factors at baseline on sense of coherence changes and if the findings can be used in cardiac rehabilitation. One hundred patients, who suffered a primary myocardial infarction were followed during two years. The instruments used were; sense of coherence questionnaire-13, 12-item short-form health survey questionnaire, the Seattle angina questionnaire and health curve. Thirty-nine percent of the participants fulfilled Antonovsky's hypothesis. Comprehensibility and the baseline factors of smoking, alcohol use, marital status and disease perception proved to be of importance for sense of coherence changes over time. The hypothesis that meaningfulness is the most crucial component in sense of coherence is rejected for patients with primary myocardial infarction. Comprehensibility is more important than meaningfulness for changes in sense of coherence. Nurses therefore have an important task to increase comprehensibility and sense of coherence by providing information and knowledge about myocardial infarction and lifestyle changes at an early stage. The information should be given in an individualized and easily understandable way from a salutogenic perspective, which means to identify and work with factors that can contribute to preserving and promoting health.

Sense of coherence and substance use: Examining mutual influences