Sense of coherence was found to be an important predictor and modulator of psychopathologic symptoms associated with the COVID-19 pandemic. These findings were published in the Journal of Psychiatric Research.
This cross-sectional online study was conducted in February 2020. After the outbreak of the COVID-19 pandemic, the study authors decided to expand the study and allow for pre- and postpandemic comparisons. German speakers (N=1479) who lived in Germany and neighboring countries were invited to respond to surveys about sense of coherence, psychopathologic symptoms, sleep quality, and COVID-19-related rumination.
At baseline, participants were a mean age of 55.3 (range, 20-95) years, 52.8% were women, and most lived in Germany (96.3%).
Only a model allowing for unidirectional coupling from sense of coherence to psychopathologic symptoms significantly improved model (χ2, 78.70; P <.001). Models without coupling effects between sense of coherence and psychologic symptoms or models allowing for bidirectional coupling did not improve model fit.
Constant increases to sense of coherence (α, 15.05; P <.001) and psychopathologic symptoms (α, 36.01; P <.001) were observed, in which increased sense of coherence or psychopathologic symptoms associated with greater changes in sense of coherence or psychopathologic symptoms but were not interrelated. However, previous sense of coherence predicted changes in psychopathologic symptoms (z, -1.99; P =.048).
These relationships indicated that individuals with low sense of coherence and average psychopathologic symptoms at baseline would be expected to have a 3.04-point increase in psychopathologic symptom scores during the pandemic compared with a 2.93-point decrease in symptoms among those with strong sense of coherence.
The trajectories of sense of coherence and psychopathologic symptoms had 6 patterns. Patients in the group with high COVID-19 associated rumination had increased psychopathologic symptoms (F[1,647], 275.43; P <.001), poorer sleep quality (F[1,654], 17.91; P <.001), and weaker sense of coherence (F[1,656], 66.48; P <.001) compared with patients in the low COVID-19-related rumination group.
A model using COVID-19-related rumination as a moderator improved the model fit (χ2, 194.54; P <.001).
Sense of coherence changed among both the low- (α, 16.75; P <.001) and high- (α, -21.28; P <.001) rumination groups. In both groups, changes in sense of coherence did not relate with psychopathologic symptoms.
These relationships indicated that in the high-rumination group, individuals with lower sense of coherence and average psychopathologic symptoms at baseline would be expected to have a 10.51-point increase in psychopathologic symptom scores during the pandemic compared with a 9.78-point decrease in symptoms for those with a strong sense of coherence.
The limitations of this study included the reliance on self-reported data and the fact that the study population did not represent the general population of Germany with regard to age and education.
The study authors concluded, “The current study improves our understanding of the interaction between the resilience factor sense of coherence and mental health during the COVID-19 pandemic. We found a small, yet significant increase of psychopathological symptoms in the total sample and identified a subgroup of respondents (17.2%) characterized by high COVID-19-related rumination, high levels of psychopathological symptoms and weaker sense of coherence that was particularly burdened by the pandemic. In this subgroup, and in the total sample, previous levels of sense of coherence were predictive of later changes in psychopathological symptoms. A stronger sense of coherence was associated with smaller changes and a greater chance to experience symptom decreases over time.”
Schäfer SK, Sopp MR, Koch M, Göritz AS, Michael T. The long-term buffering effect of sense of coherence on psychopathological symptoms during the first year of the COVID-19 pandemic: a prospective observational study. J Psychiatr Res. 2022;153:236-244. doi:10.1016/j.jpsychires.2022.07.004