Developmental contexts and sense of coherence in adolescence: A systematic review

This is the accepted manuscript of the following article: Rivera, F., García-Moya, I., Moreno, C., & Ramos, P. (2012). Developmental contexts and sense of coherence in adolescence: A systematic review. Journal of Health Psychology, 18(6), 800–812. ©2012 The Author(s) https://doi.org/10.1177/1359105312455077 Developmental contexts and sense of coherence in adolescence: a systematic review Authors: Francisco Rivera Department of Behavioral Sciences, University of Huelva. Spain. Irene García-Moya Department of Developmental and Educational Psychology, University of Seville. Spain. Carmen Moreno Department of Developmental and Educational Psychology, University of Seville. Spain. Pilar Ramos Department of Developmental and Educational Psychology, University of Seville. Spain. Corresponding author: Francisco Rivera Mailing address: Department of Behavioral Sciences. University of Huelva. Campus de El Carmen. Avenida de las Fuerzas Armadas, s/n. C. P. 21071. Huelva (Spain) Telephone number: +34 954554331 E-mail: francisco.river[email protected] Funding acknowledgements The work by Irene García-Moya is supported by the Spanish Ministry of Education (National Program FPU: ref. 2009-0978). Abstract The salutogenic model has led to revolutionary changes in the study of health. In recent years, a large amount of research has been carried out on the relationship between SOC and health, but relatively little is known about SOC in adolescence. This work is a systematic review of the studies that looked at SOC in adolescent samples. Valuable information is provided regarding the characteristics of the samples, the reliability of the SOC scale versions, the influence of demographic variables, and how family, school, peers, and neighbourhood impact SOC development. Furthermore, future directions for the study of SOC in adolescence are provided. Developed by Aaron Antonovsky in the late 70s, the salutogenic model was a response to the pathogenic model (focused on identifying risk factors for distress and illness) that was dominating public health research at the time. The salutogenic model represented a revolutionary change in perspective due to its interest in health-promoting factors and increasing the quality of life in the whole population. More recently, the salutogenic model has become a model of reference for the development of healthpromoting interventions and an integrative theoretical framework that brings together several concepts from different disciplines (Eriksson and Lindström, 2006, 2008). Furthermore, the salutogenic model is the first to examine the sense of coherence (SOC)— a new construct that is strongly related to health and quality of life. As a consequence, SOC has drawn attention from a growing number of researchers representing a wide range of disciplines, such as Medicine, Psychology, Public Health, and Sociology. SOC is a global disposition, present in everyday life, that conditions the way in which an individual reacts to life demands and the extent to which the individual is affected by those demands. SOC is composed of three highly interrelated dimensions that, together, play a fundamental role in successful coping (Antonovsky, 1987). The three dimensions include comprehensibility (the capacity to perceive the world and life events as understandable, ordered and, to some extent, predictable), manageability (the confidence that one has the necessary resources to deal with environmental demands successfully), and meaningfulness (the belief that life is worthwhile and that the challenges in life deserve the investment of effort and resources). After formulating the concept of SOC, Antonovsky (1987) developed an instrument— the Orientation to Life Questionnaire (also known as the SOC Scale)— to measure it. The original instrument (SOC-29), consisting of 29 items, has been reviewed and shortened into versions such as the SOC-13 and SOC-9. Domain-specific versions have also been developed, including the FSOC for the family context and the CSOC for children. The availability of a measurement instrument developed specifically for assessing SOC may have encouraged more research on this construct than on similar concepts such as hardiness (Kobasa, 1979). Thus, numerous studies have been conducted to examine the relationship between SOC and health in adults. The large body of work motivated two seminal reviews that integrated the collective findings of more than 500 papers published on this topic between 1992 and 2003 (Eriksson and Lindström, 2006, 2007). In contrast, little is known about SOC during childhood and adolescence, despite the fact that these developmental stages, especially adolescence, are considered by some researchers as being fundamental to the shaping of SOC (Cederblad et al., 1994; Lundberg, 1997). Furthermore, there has been empirical evidence supporting a relationship between SOC, health-related behaviour, and well-being during adolescence (Honkinen et al., 2005; Nielsen and Hansson, 2007). At the same time, Antonovsky (1996) believed that upon confirming the relevance of SOC as an explanatory factor for health, research should be devoted to identifying the factors that facilitate the development of a strong SOC. According to the author, experiences that promote SOC should involve a consistency in life circumstances, a balance between life demands and available resources, and participation, that is, the possibility of playing an active role in life. However, despite Antonovsky’s emphasis on the need to identify SOC-promoting factors, surprisingly little is known about the process of SOC development and the factors that influence that process. Some authors point to adolescence as a crucial stage for exploring both the origins and the development of SOC (Evans et al., 2010; Marsh et al., 2007). In particular, the past few years have seen more research devoted to the study of SOC in adolescence. Although a valuable body of results is beginning to form, the lack of systematisation make it difficult to achieve a full understanding of the phenomenon. In response, this work provides a systematic review of the research on SOC in adolescence conducted between 1986 and 2011. Specifically, we took into account multiple aspects of the research, including the types of samples, the reliability of the different versions of the SOC scale, the influence of gender and age on the development of SOC, and the impact of the different developmental contexts (family, school, peers, and neighbourhood) on SOC development. By presenting accurate and systematic information on the above issues, we hope our review can serve as a starting point for future investigations into adolescent SOC. Method Search strategy This work involved the review of a total of 1458 studies on SOC that were reported in English and published between 1979 and 2011. Studies were identified by means of a systematic search process in a variety of databases including Proquest, PubMed, Ovid SP, Wiley Online Library, and ISI Web of Knowledge. Sense of coherence, salutogenesis, salutogenic, Antonovsky, and Orientation to Life Questionnaire were used as keywords in our search. From the 1458 studies, scientific research articles were selected and further narrowed down into a final set that included only the studies focusing on SOC in adolescence. The final selection employed as a criterion the appearance of the words adolesc*, children, youth, students or school-age in the title, abstract or keywords. Inclusion and exclusion criteria For the purpose of our analysis, adolescent samples included samples with participants between 11 and 18 years of age. When the age range of the participants was broader, the mean age was used as the criterion of reference. In other words, if a study sample had a mean age between 11 and 18 years, the study was included in the review. Conversely, if the mean age of a study sample was below 11 or above 18 years, the study was excluded. For studies that were based on a general population that included adolescents, we excluded the studies in which participants were not differentiated by age. However, when participants were differentiated by age, only the data from the adolescent subset were included in the review. Finally, studies that looked at SOC in undergraduate students were excluded. Final material and procedure The implementation of the search strategy and inclusion and exclusion criteria described above resulted in a final set of 68 research papers (see Appendix 1). The papers were examined using a standardised protocol that looked at a wide variety of indicators (see supplementary material). In the following section, we present data on the size and characteristics of the samples, the different versions of the SOC scale and their reliability, the influence of demographic variables (gender and age), and the relationships between SOC and variables related to the main contexts (i.e., family, school, peer group, and neighbourhood) of adolescent development . Results Sample size and characteristics Together, the 68 studies examining SOC in adolescence provided data on a total of 84,771 adolescents. The large number resulted from the fact that more than half of the reviewed studies (57.35%) involved samples of over 500 participants and that 38.23% of the studies involved over 1,000 participants. All these studies were quantitative and the vast majority of them employed a cross-sectional design (only 7 studies were longitudinal). In addition, most studies had been carried out with adolescents from Scandinavian countries (44%) and Israel (21%), whereas the rest of the studies employed samples from diverse countries in America, Europe Africa and Asia. Regarding the characteristics of the samples, 44 out of 68 studies employed normative samples. Thus, 70,818 adolescents (or, 83.54% of the total number) represented the normative population. The remaining studies involved a wide variety of samples that included clinical samples and adolescents with special characteristics or who lived in high-risk environments (e.g., Gustafsson, Nelson and Gustafsson, 2010; Edbom et al., 2010). Versions of the questionnaire and reliability Comparing across different versions of the questionnaire used in the study of SOC in adolescence (see Table 1), we found that the SOC-13 was the most frequently used version, being used in 54% of the reviewed studies. This shortened version of the SOC Scale had good reliability (with an average Cronbach’s alpha of 0.82). The next most widely used version was the original SOC-29, which was employed in 15% of the studies and also had good reliability (average Cronbach’s alpha of 0.88). Other versions of the SOC scale (CSOC, FSOC, SOSC, and ad hoc selections of items for specific studies) were used less frequently and their reliability tended to be more modest or even questionable. - INSERT Table 1 HEREDemographic variables and SOC In terms of the impact of gender and age on SOC during adolescence, the research conducted to date appears to be producing contradictory results. Only 28 out of 68 studies on SOC in adolescence examined the influence of gender on SOC. Of the 28 studies, 32.14% concluded that no significant differences existed between boys and girls, whereas 67.86% reported higher levels of SOC in adolescent boys. In a first attempt to clarify these contradictory results, we conducted an in-depth examination of the 18 studies that provided enough information for the calculation of effect size based on Cohen’s d. Effect size values suggested that boys had higher levels of SOC in 12 of the 18 studies, but no differences were found in the remaining six studies. Nonetheless, whenever differences were found, the effect size was low, ranging from 0.2 to 0.4 (Axelsson et al., 2005; Buddeberg-Fischer, Kalghofer and Schnyder, 2001; Dorri, Sheiham and Watt, 2010; Hansson, Olsson and Cederblad, 2004; Honkinen et al., 2009; Kristensson & Öhlund, 2005; Margalit & Eysenck, 1990; Marsh et al., 2007; Moksnes et al., 2010; Natvig, Hannestad and Samdal, 2006; Nielsen and Hansson, 2007; Nilsson et al., 2007; Simonsson et al., 2008; Sollerhed, Ejlertsson and Apitzsch, 2005), with the exception of one study that reported a medium effect size (d = 0.64) (Myrin and Lagerström, 2008). The influence of age was examined in 16 out of the 68 studies. The one longitudinal study in our sample (Honkinen et al., 2008) showed negligible differences (d = 0.02) in SOC levels as participant age increased from 15 to 18 years. Cross-sectional studies reported dissimilar results. However, given that nine of the cross-sectional studies found no significant differences based on adolescent age (Jellesma et al., 2006; Koushede and Holstein, 2009; Kristensson and Öhlund, 2005; Margalit and Eysenck, 1990; Moksnes et al., 2010; Nash, 2002; Nilsson et al., 2007; Räty, Larsson and Söderfeldt, 2003; Simonsson et al., 2008), there seemed to be stronger support for the stability in SOC during adolescence. Significant differences were found in the remaining six studies, but the direction of the influence was not clear and effect size values tended to be low. Taking into account the frequent reports made in developmental psychology research of gender differences in psychological and social development, we conducted a combined analysis of gender and age to more closely examine the influence of gender in the adolescent SOC. The mean age was used as a reference and effect size values were calculated using Cohen’s d. This adolescent SOC is relatively new, research on the psychometric properties of the SOC scales is still lacking. Therefore, further work is needed to validate different versions of the SOC scale in adolescent samples. With respect to the influence of gender and age in SOC development in adolescence, we sought to clarify the contradictory findings on the influence of gender by estimating effect size and combining the analyses of gender and age. Both strategies proved to be helpful. Whereas no gender differences were found in adolescents younger than 15 years of age, most of the studies involving older adolescents reported higher levels of SOC in boys. As for the influence of age, only one longitudinal study was available, and the findings from cross-sectional work were contradictory, which was likely due to the differences in the age ranges studied. Thus, it is important to conduct longitudinal studies that examine the influence of age on SOC throughout the entire period of adolescence, which may shed light on the developmental process of SOC during adolescence. Finally, our effort to identify contextual factors that facilitate or inhibit the development of a strong SOC is in line with the idea that health is nurtured in daily life experiences and in the contexts in which everyday life takes place (WHO, 1986). Despite the strong agreement on the need to consider socialisation contexts when studying adolescent development (Steinberg, 2002), this review revealed that there has been little research attention on developmental contexts as potential sources of relevant experiences for SOC development. In addition, not only does the relationship between developmental contexts and SOC remain relatively unexplored, but different contexts have received unequal attention with regard to their roles. Specifically, family and school have been the most frequently studied contexts, whereas the peer group and the neighbourhood have typically been neglected. Nevertheless, the reviewed studies support the importance of experiences within the family, the school, the peer group and the neighbourhood in shaping adolescent SOC. Therefore, studies looking at key development contexts in adolescence are needed to identify influential variables in the development of SOC. Finally, results from this review highlight the need for a more detailed understanding of the influence of different developmental contexts on SOC development in adolescence. In the case of family and school, given that the influence of specific dimensions has already been established, the next steps should involve more ambitious studies that adopt a wider focus and analyse a greater number of relevant dimensions. As for the peer group and the neighbourhood, more research is needed given the scarcity of studies to date. Furthermore, given that adolescence is a developmental stage in which everyday life contexts expand and diversify, future research should include integrative analysis that considers more than one context and explores the interactions between contexts. An integrative approach is needed to accomplish a deeper, more comprehensive and more realistic understanding of adolescent development. This work represents the first effort to date to conduct a systematic review of the research on SOC in adolescence. This is a necessary undertaking in terms of organising and integrating the body of knowledge on this topic, and of directing research to areas that have not been explored as extensively. In conclusion, this review contributes not only through providing answers to important questions but also through generating a wide range of new research questions. Thus, our review is both a straightforward and revealing summary of the current state of the research on SOC in adolescence and a guide that points to possible directions for future research. References Antonovsky A (1987) Unraveling the mystery of health. How people manage stress and stay well. San Francisco: Jossey-Bass. Antonovsky A (1996) The salutogenic model as a theory to guide health promotion. Health Promotion International 11(1): 11-18. Antonovsky H and Sagy S (1986) The development of a Sense of Coherence and its impact on responses to stress situations. Journal of Social Psychology 126: 213-227. Axelsson L, Andersson I, Hakansson A and Ejlertsson G (2005) Work ethics and general work attitudes in adolescents are related to quality of life, sense of coherence and subjective health - a Swedish questionnaire study. BMC Public Health 5: 103. Blom EH, Larsson JO, Serlachius E and Ingvar M (2010). 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Child Abuse & Neglect 25(11): 1463-1480. Simonsson B, Nilsson K, Leppert J and Diwan V (2008) Psychosomatic complaints and sense of coherence among adolescents in a county in Sweden: a cross-sectional school survey. BioPsychoSocial Medicine 2(1): 4. Sollerhed AC, Ejlertsson G and Apitzsch E (2005) Predictors of strong sense of coherence and positive attitudes to physical education in adolescents. Scandinavian Journal of Public Health 33(5): 334-342. Steinberg LD (2002) Adolescence. Boston: Mc Graw-Hill. Torsheim T, Aaroe LE and Wold B (2001) Sense of coherence and school-related stress as predictors of subjective health complaints in early adolescence: interactive, indirect or direct relationships? Social Science & Medicine 53(5): 603-614. World Health Organization (1986) Ottawa Charter. Canada: World Health Organization. Appendix 1. References included in the systematic review Antonovsky H and Sagy S (1986) The development of a sense of coherence and its impact on responses to stress situations. Journal of Social Psychology 126(2): 213-225. Anttila T, Poikolainen K, Uutela A and Lonnqvist J (2000) Structure and determinants of worrying among adolescent girls. Journal of Youth Studies 3(1): 49 - 60. Axelsson L, Andersson I, Hakansson A and Ejlertsson G (2005) Work ethics and general work attitudes in adolescents are related to quality of life, sense of coherence and subjective health - a Swedish questionnaire study. BMC Public Health 5: 103. Ayo-Yusuf OA, Reddy PS and Van Den Borne BW (2008) Adolescents' sense of coherence and smoking as longitudinal predictors of self-reported gingivitis. Journal of Clinical Periodontology 35(11): 931-937. Ayo-Yusuf OA, Reddy PS and Van Den Borne BW (2009) Longitudinal association of adolescents’ sense of coherence with tooth-brushing using an integrated behaviour change model. Community Dentistry and Oral Epidemiology 37(1): 68-77. Baker SR, Mat A and Robinson PG (2010) What psychosocial factors influence adolescents' oral health? Journal of Dental Research 89(11): 1230-1235. Blom EH, Larsson JO, Serlachius E and Ingvar M (2010) The differentiation between depressive and anxious adolescent females and controls by behavioural self-rating scales. Journal of Affective Disorders 122(3): 232-240. Räty LKA, Larsson BMW and Söderfeldt BA (2003) Health-related quality of life in youth: a comparison between adolescents and young adults with uncomplicated epilepsy and healthy controls. Journal of Adolescent Health 33(4): 252-258. Raty LKA, Soderfeldt BA, Larsson G and Larsson BMW (2004) The relationship between illness severity, sociodemographic factors, general self-concept, and illness-specific attitude in Swedish adolescents with epilepsy. Seizure-European Journal of Epilepsy 13(6): 375-382. Ristkari T, Sourander A, Helenius H, Nikolakaros G, Salantera S, Multimaki P, et al. (2005) Sense of coherence among Finnish young men--a cross-sectional study at military call-up. Nordic Journal of Psychiatry 59(6): 473-480. Ristkari T, Sourander A, Ronning J and Helenius H (2006) Self-reported psychopathology, adaptive functioning and sense of coherence, and psychiatric diagnosis among young men--a populationbased study. Social Psychiatry & Psychiatric Epidemiology 41(7): 523-531. Ristkari T, Sourander A, Ronning JA, Nikolakaros G and Helenius H (2008) Life events, self-reported psychopathology and sense of coherence among young men--a population-based study. Nordic Journal of Psychiatry 62(6): 464-471. Ristkari T, Sourander A, Ronning JA, Piha J, Kumpulainen K, Tamminen T, et al. (2009) Childhood psychopathology and sense of coherence at age 18: findings from the Finnish from a boy to a man study. Social Psychiatry & Psychiatric Epidemiology 44(12): 1097-1105. Ruiselová Z (2000) Salutogenetic approach in the context of the Big Five Factors. Studia Psychologica 42(3): 157-161. Sagy S (1998) Effects of personal, family, and community characteristics on emotional reactions in a stress situation. Youth & Society 29(3): 311-329. Sagy S (2002) Moderating factors explaining stress reactions: comparing chronic-without-acute-stress and chronic-with-acute-stress situations. Journal of Psychology 136(4): 407419. Sagy S and Dotan N (2001) Coping resources of maltreated children in the family: a salutogenic approach. Child Abuse & Neglect 25(11): 1463-1480. Sagy S, Shani E and Leibovich E (2009) Factors related to attitudes towards drug use and alcohol drinking: Comparing immigrants from the former Soviet Union and Israeli-born adolescents. Journal of Substance Use 14(1): 10-18. Shani E, Ayalon A, Hammad IA and Sikron F (2003) What picture is worth a thousand words? A comparative evaluation of a burn prevention programme by type of medium in Israel. Health Promotion International 18(4): 361-371. Simonsson, B, Nilsson K, Leppert J and Diwan V (2008) Psychosomatic complaints and sense of coherence among adolescents in a county in Sweden: a cross-sectional school survey. BioPsychoSocial Medicine 2(1): 4. Sollerhed AC, Ejlertsson G and Apitzsch E (2005) Predictors of strong sense of coherence and positive attitudes to physical education in adolescents. Scandinavian Journal of Public Health 33(5): 334-342. Torsheim T, Aaroe LE and Wold B (2001) Sense of coherence and school-related stress as predictors of subjective health complaints in early adolescence: interactive, indirect or direct relationships? Social Science & Medicine 53(5): 603-614. Verkooijen KT, Nielsen GA and Kremers SPJ (2008) The association between leisure time physical activity and smoking in adolescence: An examination of potential mediating and moderating factors. International Journal of Behavioral Medicine 15(2): 157-163. Zimprich D, Allemand M and Hornung R (2006) Measurement Invariance of the Abridged Sense of Coherence Scale in Adolescents. European Journal of Psychological Assessment 22(4): 280287. Table 1. Versions of the SOC Scale and reliability in adolescent samples Reliability (Cronbach’s alpha values) f Mean Range Level SOC-29 11 .87 .81-.94 Good SOC-13 37 .82 .55-.87 Good SOC-13 HBSC 3 .81 .72-.85 Good CSOC 3 .72 .71-.72 Acceptable FSOC 4 .79 .76-.81 Acceptable SCHOOL SOC 3 .65 .64-.66 Questionable OTHERS 9 .70 .61-.80 Questionable Note: More than one version of the SOC scale were used in some of the studies. The version of the questionnaire was not reported in one of the studies, and not all studies reported Cronbach’s alpha. Consequently, the mean reliability values were calculated based on a reduced number of studies. 0 2 4 6 8 10 12 14 16 18 20 Family School Peers Neighbourhood Figure 1. Developmental contexts analysed in studies on SOC in adolescence