Paper
Friday, July 13, 2007
Sense of Coherence and Recovery from Depression
Ingela Skärsäter, PhD1, Mary Kay Rayens, PhD2, Ann R. Peden, ARNP-CS, DSN2, Lynne A. Hall, RN, DrPH2, and Mei Zhang, MSN, MPH, RN2. (1) Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg University, SE 405 30 Göteborg, Sweden, Sweden, (2) College of Nursing, University of Kentucky, Lexington, KY, USA
| Learning Objective #1: define the construct of sense of coherence. |
| Learning Objective #2: discuss the implications of improvement of sense of coherence in patients with a first-time diagnosis of depression. |
Background: Sense of coherence (SOC) is associated with resilience and positive perception of physical and mental health.
Aim: A 4-year follow-up of adults receiving treatment for a first episode of major depression (DSM-IV) was conducted to determine whether sense of coherence changes over time and if this construct is associated with depressive symptoms, aggression, and functional status.
Methods: Patients (N = 33) receiving usual care (medication and/or psychotherapy/counseling) completed semi-structured interviews every six months starting at diagnosis. Data were collected between 1998-2004 using: the Montgomery-Asberg Depression Rating Scale; the Aggression Questionnaire; the Global Assessment of Functioning; and the Medical Outcomes Study Short Form-36.
Results: At baseline, SOC was negatively correlated with total aggression (r=-.45. p=.009) and AQ hostility (r=-.73, p<.0001); SOC was unrelated to depressive symptoms or functional status. SOC increased over time (F=6.3, p<.0001). At the 4-year follow-up, SOC was inversely related to depressive symptoms (r=-.60, p=.006), total aggression (r=-.65, p=.002), and AQ anger (r=-.52, p=.02) and hostility (r=-.77, p<.0001). It was positively associated with the GAF (r=.64, p=.002) and SF-36 physical and mental health components (r=.74, p=.0004 and r=.72, p=.0007, respectively).
Discussion: Improvement in SOC occurs in response to treatment of depression. The finding that depressive symptoms and functional status were not correlated with SOC at baseline but were significantly associated following treatment demonstrates that SOC is related to outcomes that are changing as a result of the therapy, regardless of the patient’s SOC level upon diagnosis. Treating depressive symptoms may have the added benefit of bolstering sense of coherence and may enhance the individual’s ability to manage stressful situations or change their response to stressors.