Most staff stay healthy during humanitarian work, although some worsen. Mean scores on health indicators may be masking individual participants struggling with health issues.

To investigate different field assignment-related health trajectories among international humanitarian aid workers (iHAWs) and explore the mechanisms used to stay healthy.

Growth mixture modelling analyses for five health indicators using pre-/post-assignment and follow-up data.

Among 609 iHAWs three trajectories (profiles) were found for emotional exhaustion, work engagement, anxiety and depression. For post-traumatic stress disorder (PTSD) symptoms, four trajectories were identified. The ‘healthy/normative’ trajectory had the largest sample size for all health indicators (73–86%). A stable (moderate) ‘ill health’ trajectory was identified for all health indicators (7–17%), except anxiety. An ‘improving’ trajectory was found for PTSD and anxiety symptoms (5–14%). A minority of staff (4–15%) worsened on all health indicators. Deterioration continued for PTSD, depressive symptoms and work engagement 2 months post-assignment. A strong sense of coherence was associated with higher odds of belonging to the ‘healthy’ trajectory. Female biological sex was associated with higher odds of belonging to the ‘worsening’ depression and anxiety trajectories. Extended duration of field assignment was related to higher odds of belonging to the ‘worsening’ depressive symptoms trajectory.

Most iHAWs stayed healthy during their assignment; a stable ‘ill health’ trajectory was identified for most health indicators. Sense of coherence is an important mechanism for understanding the health of all iHAWs in the different health trajectories, including the ‘healthy’ profile. These findings give new possibilities to develop activities to prevent worsening health and help strengthen iHAWs’ ability to remain healthy under stress.

Grief and bereavement are commonplace in clinical practice but have become a more pervasive issue because of the coronavirus 2019 pandemic. Consequently, the need for investigations, learning, and education about complicated grief and prolonged grief have been highlighted. Meanwhile, film-based teaching resources concerning grief care have been employed to complement curricula in medical education.

To explore how the grieving experience can be better communicated and mitigated, and explain how a film-based resource can be applied to improve the understanding of this issue.

We reviewed and analyzed the meaning and cause of complicated, prolonged, disenfranchised grief, as well as related experiences (e.g., survivor guilt) featured in selected films. We discussed the interpretation of these films with medical students and faculty, based on a previously described approach [1].

We recaptured the roles of empathic communications and resilience skills in grief care. They bring a sense of coherence (SOC) or meaning to life by prompting the sharing of grief experiences, helping to reconstruct and contextualize a person’s loss, and assuaging feelings of worthlessness and hopelessness. Incidentally, recent studies have suggested that complicated and prolonged grief involves alterations in brain functioning of the reward system.

This film-based approach utilizes vicarious experiences to better understand grief management. It allows the learner to more easily recognize that SOC, flexible situation-adjusted empathy, and the sharing of resources for improved communication to promote self-care are essential for patients, their families, as well as psychiatrists themselves. [1] Sondheimer, A. The life stories of children and adolescents. Acad Psychiatry. 2000:24(4):214–24.

No significant relationships.

To assess the relationship between the sense of coherence (SOC), eating behaviour and nutritional status.

It is a systematic review.

The following databases were searched: MEDLINE/PubMed, Science Direct/Elsevier, LILACS/Bireme, SciELO and Google Scholar, using the indexed terms ‘salutogenesis’, ‘sense of coherence’, ‘nutritional status’, ‘nutrition’, ‘eating behavior’ and ‘healthy eating’. The indexed terms were used in Portuguese and English according to the database searched. The data were extracted in a standardised way and the quality of the studies was assessed using the Newcastle–Ottawa Scale.

Observational studies were included, with no limitations on the date of publication or language.

After reading the titles and abstracts of 1855 articles, 107 full texts were retrieved, of which 27 were included. Of these, twenty-five were cross-sectional and two were longitudinal. The average score for Newcastle–Ottawa studies was 6 and most studies were rated as moderate and low quality. The cumulative sample size of all included studies was 28 981 adults and the elderly, aged between 18 and 81 years. The studies were carried out in fifteen different countries. Fifteen articles assessed eating behaviour/habit and twelve assessed nutritional status. Studies have shown that SOC has a positive relationship with an appropriate eating behaviour/habit. On the other hand, the relationship between SOC and nutritional status was controversial among studies. The heterogeneity of the data resulting from the use of different methods of evaluation of the outcomes of interest (nutritional status and eating behaviour) made it impossible to perform a meta-analysis.

SOC was positively associated with adequate eating behaviour. However, it was not possible to establish a relationship between SOC and nutritional status.

Burnout has become a critical issue in health care systems during the COVID-19 pandemic. Several studies report on the importance of peoples’ sense of coherence (SOC) or control over work for dealing with burnout. SOC implicates a stress-coping capacity involving comprehensibility, manageability, and meaningfulness. However, little is known on how SOC cognitively modulates burnout experiences.

To investigate neurocognitive mechanisms of SOC and burnout in medical professionals.

Forty-one registered nurses were enrolled. We used functional magnetic resonance imaging and measured resting-state brain activity. We identified brain regions associated with SOC and burnout levels by correlating these trait scores to regional fractional amplitude of low frequency fluctuations (fALFF). Subsequently, we investigated whether participants’ levels of SOC impacted their fALFF-burnout association by mediation analysis.

SOC and depersonalization dimension of burnout were negatively correlated (p < 0.01). The fALFF in the mid-dorsolateral prefrontal cortex (DLPFC) correlated positively with SOC scores, and negatively with depersonalization dimension of burnout (p < 0.05). Furthermore, SOC mediated the negative relationship between DLPFC activity and burnout severity (p < 0.05).

Our data suggested that SOC alleviates burnout experience and supports prefrontal activity to prompt cognitive control; they may facilitate flexible shifting of perspective and optimistic reappraisal of work-stress. In effect, workplace-stressors may be acknowledged as being more meaningful than distressing. Without sufficient SOC, frequent exposures to stressors can lead to maladaptive coping to exhibit emotional numbing or depersonalization.

No significant relationships.

Total hip replacement is one of the most successful orthopaedic interventions in improving considerably the patients' performance, nevertheless some patients demonstrate declined functional ability following an operation. Such condition is not a consequence of medical illness or the surgery itself but might rather be associated with mental status. The authors conduct an investigation concerning the relation between some psychological and psychiatric factors and their influence on health-related quality of life in patients after total hip replacement.

Into the study group we included 102 subjects undergoing total hip replacement (59 female, 43 male). In all subjects we measured depression (Beck Depression Inventory – BDI), anxiety (State and Trait Anxiety Inventory – STAI), sense of coherence (SOC-29), personality traits (Eysenck Personality Inventory – EPI) and health related quality of life (SF-36).

The postoperative values of the PCS and the MCS for the whole group of patients correlated negatively with the SOC values (p = 0.04 and p = 0.03 respectively). Neuroticism (EPI) and anxiety as a trait (STAI) were also associated with postoperative performance, both in mental (p = 0.03 and p = 0.008 respectively) and physical (p = 0.005 and p = 0.04 respectively terms).

Total hip replacement improves significantly the patient’s health-related quality of life at 6 months after surgery, what is influenced by sense of coherence, neuroticism and anxiety as a trait. Above mentioned factors should be taken into account when rehabilitation and social readaptation processes are planned.

This study aims at exploring a structural model of satisfaction with life's (SWL) predictors in a cross-national sample of older adults.

A community-dwelling sample of 1,234 older adults was assessed regarding SWL, sense of coherence (SOC) and socio-demographic, lifestyle and health-related characteristics. Structural equation modeling was used to investigate a structural model of the self-reported SWL, comprising SOC, socio-demographic characteristics (age, sex, education, marital and professional status, household, adult children, income, living setting and religion), lifestyle and health-related characteristics (physical activity, recent disease and medication).

Significant predictors are SOC (β = .733; p < .001), religion (β = .725; p < .001), income (β = .551; p < .001), adult children (β = .546; p < .001), education (β = −.403; p < .001), living setting (β = −.292; p < .001) and medication (β = −. 197; p < .001). The variables accounted for 24.8% of the variability of SWL. Moreover, differences between the four nationality groups (F(3, 671) = 3.671, p = .066) were not found concerning SWL.

Sense of coherence is the strongest predictor of self-reported SWL. Other predictors are religion, income, adult children, education, living setting and medication. The four nationalities did not present significant differences, concerning SWL. This study highlights the factors that influence older adults’ SWL, namely, SOC, religion and income, as promoters of aging well, within a salutogenic model of health for older populations.

The aim of this study was to build a structural model to explore the predictors of adjustment to aging (AtA) in a community-dwelling older population.

A community-dwelling sample of 1270 older adults aged between 75 and 102 years answered a questionnaire to determine socio-demographic (sex, age, professional and marital status, education, household, adult children, family‘s annual income, living setting and self-reported spirituality), lifestyle and health-related characteristics (perceived health, recent disease, medication and leisure). Several instruments were used to assert psychological variables, namely AtA, sense of coherence and subjective well-being. Structural equation modeling was used to explore a structural model of the self-reported AtA, encompassing all variables.

Significant predictors are self-reported spirituality (β = .816; p < .001), perceived health (β = .455; p < .001), leisure (β = .322; p < .001), professional status (β = .283; p < .001), income (β = .230; p = .035), household (β = −.208; p = .007), sense of coherence (β = −.202; p = .004) and adult children (β = .164; p = .011). The variables explain respectively 60.6% of the variability of AtA.

Self-reported spirituality is the strongest predictor of AtA. This study emphasizes the need for deepening the variables that influence older adults’ AtA, in particular perceived health and further lifestyle-related characteristics, as being relevant for promoting aging well in later life, within a salutogenic context for health care.

Growing literature suggests that the sense of coherence (SOC) positively influences well-being in later life.

This study reports the assessment the following psychometric properties: distributional properties, construct, criterion and external-related validities, and reliability, of the Orientation to Life Questionnaire (OtLQ) in an cross-national population of older adults.

We recruited 1291 community-dwelling older adults aged between 75-102 years (M=83.9; SD=6.68). Convenience sampling was used to gather questionnaire data. The construct validity was asserted by confirmatory factor analysis, convergent and discriminant validity. Moreover, criterion and external-related validities, as well as distributional properties and reliability were also tested.

Data gathered with the 29-items OtLQ scale showed overall good psychometric properties, in terms of distributional properties, construct, criterion and external-related validities, as well as reliability. Three factors were validated for the OtLQ scale: (a) comprehensibility; (b) manageability; and (c) meaningfulness.

We validated the 3-factor OtLQ scale, which produced valid and reliable data for a cross-national sample with older adults. Hence, it is an adequate instrument for assessing sense of coherence among older people in health care practice and program development contexts.

This research aims to explore a structural model of sense of coherence’ predictors in a cross-cultural older population.

Measures were completed using a variety of culturally appropriate methods, including mail-outs, self-administration and interviews. For the purposes of this study, the Sense of Coherence Scale, the Adjustment to Aging Scale, one measure of cognitive functioning - the Mini-Mental State Examination (MMSE) and demographics, were included. All variables prompted fewer than 1% missing values and complete data were available for 709 older adults (M = 82.4, SD = 6.45, (range 74–102)) from eight different nationalities. Structural equation modeling was used. Controlling for age, gender and country of origin, we assessed the level of sense of coherence of elderly people, and its predictors.

Sense of coherence is predicted, not only by self-reported spirituality, but also by adjustment to aging, among other variables. Sense of coherence was significantly associated with age progression (β = .426; p = .001) and perception of health (β =− .381; p = .001). All estimates were statistically significant (p<.01).

Specifically in late adulthood, changes may affect older adults’ worldview and thus their SOC. The older individual with a strong SOC has a greater ability to mobilize and exploit potential resources. In brief, this study stresses the predictors of sense of coherence in older age. Recommendations for future research on older adults’ sense of coherence and clinical practice are also presented.

Goal concordant or congruent care involves having expressed wishes upheld. Yet, the preferred location for end-of-life care may be unaddressed. Caregiver–patient congruence between preferred and actual locations of care may influence the quality of life in bereavement. The study aimed to explore how the congruence between caregiver–patient preferred and actual locations of death influenced well-being in bereavement.

Mixed methods were employed. In-depth in-person interviews were conducted with 108 bereaved caregivers of a hospice patient about 4 months after the death. An interview guide was used to collect quantitative and qualitative data: demographics, decision-making, Core Bereavement Items (CBI), Health Related Quality of Life, and perspectives on the end-of-life experiences. Data were analyzed with a convergent mixed methods one-phase process.

Patient preference–actual location congruence occurred for 53%; caregiver preference–actual location congruence occurred for 74%; caregiver–patient preference and location of death occurred for 48%. Participants who reported some type of incongruence demonstrated higher levels of distress, including more days of being physically and emotionally unwell and more intense bereavement symptoms. The Acute Separation subscale and CBI total scores demonstrated significant differences for participants who experienced incongruence compared with those who did not. Preference location congruence themes emerged: (1) caregiver–patient location congruence, (2) caregiver–patient location incongruence, and (3) location informed bereavement.

Congruence between a dying person's preferred and actual locations at death has been considered good care. There has been little focus on the reciprocity between caregiver–patient wishes. Discussing preferences about the place of end-stage care may not make location congruence possible, but it can foster shared understanding and support for caregivers’ sense of coherence and well-being in bereavement.

A diagnosis of congenital heart disease (CHD) in offspring triggers psychological distress in parents. Results of previous studies have been inconsistent regarding the psychological impact of a prenatal versus a postnatal diagnosis. The aim of this study was to evaluate the influence of the time of diagnosis on levels of parental distress.

Pregnant women and their partners with a fetus diagnosed with complex CHD, parents of children with postnatally diagnosed CHD, and pregnant women and their partners with uncomplicated pregnancies were invited to participate. Data were collected during pregnancy and 2–6 months after delivery using the Hospital Anxiety and Depression Scale, sense of coherence, life satisfaction, and Dyadic Adjustment Scale.

During pregnancy, the prenatal group scored lower sense of coherence compared to controls (p=0.044). Postnatally the prenatal group scored lower on sense of coherence compared to the postnatal group and controls (p=0.001; p=0.001). Postnatally, the prenatal and postnatal groups had higher levels of anxiety compared to controls (p=0.025; p=0.0003). Life satisfaction was lower in the prenatal group compared to that in the postnatal group and in controls (p=0.000; p=0.0004).

Parents with a prenatal diagnosis of CHD in offspring report a low sense of coherence already during pregnancy which decreased further at follow-up. The same group reported a lower satisfaction with life compared to parents of a child with postnatal diagnosis of CHD and parents of a healthy child. This motivates further efforts to improve counselling and support during pregnancy and for parents after a prenatal diagnosis.

For patients’ entire families, it can be challenging to live with cancer during the palliative stage. However, a sense of coherence buffers stress and could help health professionals identify families that require support. Therefore, the short version of the Family Sense of Coherence Scale (FSOC-S) was translated, culturally adapted, and validated in a Swedish sample.

Translation and cross-cultural adaptation of the FSOC-S into Swedish was conducted in accordance with the World Health Organization's Process for Translation and Adaptation of Research Instruments guidelines. Participants were recruited from two oncology clinics and two palliative centers in Sweden.

Content validity was supported by experts (n = 7), persons with cancer (n = 179), and family members (n = 165). Homogeneity among items was satisfactory for persons with cancer and family members (item-total correlations were 0.45‒0.70 and 0.55‒0.72, respectively) as well as internal consistency (ordinal alpha = 0.91 and 0.91, respectively). Factor analyses supported unidimensionality. FSOC-S correlated (rs > 0.3) with hope, anxiety, and symptoms of depression, which supported convergent validity. The test-retest reliability for items ranged between fair and good (kw = 0.37‒0.61).

The FSOC-S has satisfactory measurement properties to assess family sense of coherence in persons with cancer and their family members. FSOC-S could be used to identify family members who experience low levels of perceived family sense of coherence which provides health care professionals with insight into families’ needs and ability to live with cancer in the palliative stage.

We examined the prevalence of self-perceived respiratory symptoms (SRS) in the absence of any objective findings of respiratory pathology, and the association of such prevalence with psychological factors and healthcare use in the general population.

The study was conducted among a nationally representative sample of Finnish adults (BRIF8901). Respiratory functioning was measured by a spirometry test. Structured questionnaires were used to measure SRS, physician visits and psychological factors of alexithymia, sense of coherence, illness worry and common mental disorders. Individuals with a diagnosed respiratory disease or a severe psychiatric disorder, determined in a diagnostic interview, were excluded, giving a sample comprising 4544 participants.

Twenty-six per cent of the general population and 36% of those with no diagnosed severe psychiatric disorder or respiratory disease experienced SRS despite a normal spirometry result. Psychological factors were associated with SRS (0.0001 < p < 0.032), and on the number of physician visit explaining 42.7% of the difference in visits between individuals with and without SRS, respectively. Illness worry was associated most strongly with SRS [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.19–1.41, p < 0.0001] and higher numbers of physician visits (OR 1.35, CI 1.32–1.38, p < 0.00001), even after several adjustments.

Respiratory symptoms without objective findings are common in the general population. The study results underline the role of psychological factors in the reporting of respiratory symptoms and the associated medical burden, thereby indicating the functional nature of the symptomatology.

In light of the demographic aging trend in Europe, investigation into successful aging is a public health priority. This paper describes the sense of coherence (SOC) of a sample of community-dwelling older adults in Spain and analyzes the relationship between SOC and both health and sociodemographic variables. SOC measures the extent to which an individual conceptualizes the world as comprehensible, manageable, and meaningful. Strong SOC may promote good health.

The study followed a cross-sectional design involving a nationally representative sample of 1,106 community-dwelling adults aged 60 years and older in Spain. The sample was collected by geographically based proportional stratified sampling. Results are based on responses to a questionnaire requesting sociodemographic information and including the following validated scales: SOC, Barthel index (BI), functional independence scale (FIS), personal wellbeing index (PWI), EQ-5D dimensions (mobility, personal care, daily activities, pain/discomfort, anxiety/depression), and the depression subscale of the hospital anxiety and depression scale (HADS-D). A multivariate linear regression model analyzed determinants of SOC.

Personal wellbeing (b = −0.32), depression (b = 0.26), and educational level (b = −0.06) were significant determinants of SOC. Lower SOC was associated with problems in all EQ-5D dimensions and moderate/severe disability as measured by the BI.

SOC in older adults is related to functional status, mental health status, personal wellbeing, and educational level. Public health initiatives should work to reduce the psychological and physiological impact of aging by focusing on the conditions that facilitate the coping of older adults.

The aim of this study was to illuminate experiences of finding meaning in life among spouses of people with amyotrophic lateral sclerosis.

Thirteen interviews were analyzed with qualitative content analysis.

The spouses were struggling for meaning at the end of a dark tunnel. They felt limited and isolated in their proximity to death. They lived imprisoned lives, felt lonely, considered life to be unfair and incomplete, and mourned the loss of their future. However, they found meaning despite the proximity of death through cherishing their own lives, fellowship, accepting the present, and believing in meaning after the partner's death.

Meaning in life strengthened spouses' well-being and ability to find pleasure in a difficult situation. It also strengthened their will to live after the partner's death. Limitations and isolations were strong predictors of what could impair their well-being and the possibility of finding meaning after the partner's death. Spouses need individual support throughout the disease process and after the partner's death, to give them the strength to find meaning in life and prioritize what is important for them. Paying attention to what might prevent them from finding meaning could make it easier to help them in their situation. Providing joint support to the patient and spouse might also help them to see each other's situation, come together, and help each other.

Sense of coherence (SOC) is associated with the capability to cope with caregiving. Our aims were (1) to describe the trajectory of SOC in aged spousal caregivers of persons with mild Alzheimer's disease (AD) in 3-year follow-up and (2) to identify baseline determinants influencing SOC change.

Both AD (n = 170) (CDR-SOB, MMSE, NPI, ADCS-ADL) and caregiver- (n = 170) (BDI, SOC) related efficacy parameters were evaluated annually. Follow-up time was 3 years. The relationship of potential baseline factors with longitudinal SOC was analyzed using linear mixed models.

The mean drop-out-adjusted SOC score (148.5 at baseline) was decreased by 4.56 points (p = 0.002) during the follow-up. Caregivers’ depression at baseline predicted the significant decrease of SOC (every + 1 BDI point decreases 2.181 points in SOC, p = 0.0001). When caregiver's depression was not taken into account in the analysis, female gender, and higher age and AD patient's lower baseline MMSE were associated significantly (p < 0.05) with decreasing SOC score in the follow-up. Other studied covariates were not associated with SOC change.

SOC is not as stable as expected, but decreases during long-lasting caregiving. Caregiver's depression at baseline predicts SOC decrease over time. In the future, caregiver dependent factors should be evaluated at the beginning of caregiving to target individualized support programmes to the vulnerable caregivers.