Koherenssin tunteen taustatekijät ja seuraukset

ABSTRACT Sense of coherence (SOC) is a core concept within Antonovsky s salutogenic theory and is argued to be a psychological determinant of health. The present social-epidemiological study explores the associations between a wide range of generalized resistance resources of SOC among Finnish- and Swedish-speaking women and men with a view to gaining deeper insight into its developmental circumstances and determinants. Secondly, a five-year follow-up study was conducted in order to assess the stability of SOC in difficult life events. Finally the role and effect of SOC in the intentions to retire early was investigated in a prospective study. The above studies were based on two data sets: the Finnish 'Survey on Living Conditions' (ELO-94) conducted in 1994 by means of personal face-to-face interviews (N=6506), and a prospective postal survey of the 15-year Health and Social Support (HeSSup) study for which the baseline data was collected in 1998 (N=25 898) and the follow-up in 2003. The present study reveals that the level of SOC in adulthood is strongly dependent on close and successful social relationships during both childhood and adulthood, and that there is a strong association with qualitative work features. Not having a partner as well as being unable to use one s skills at work proved to threaten men s SOC in particular, whereas a lack of social support did the same for women. Otherwise, the association with generalized resistance resources turned out to be quite similar in both genders. Swedish-speaking Finns appear to have a slightly stronger SOC due to the better psycho-emotional circumstances in the childhood home and work circumstances in adulthood, in other words higher levels of generalized resistance resources compared to Finnish speakers. These language group differences did not concern any social-life factors included in the present study. The results of the five-year follow-up study suggest that SOC is not stable, and that the level clearly decreases after a negative life event. Even a strong SOC decreased during the follow-up period and, furthermore, was no more stable than a mediocre or weak SOC. There seems to be a clear and independent association with the intentions to retire early among both men and women following full adjustment. Swedish speakers appear to be less inclined to retire early than Finnish speakers. In the light of the present study, it seems that SOC is determined not only by socio-economic factors but also by close and successful social relationships during both childhood and adulthood. This applied to both genders and language groups. Interventions aimed at promoting the health of the disadvantaged should therefore focus on families with children, and extend later also to other than socio-economic spheres of life. SOC theory could also be applied in efforts to inhibit early retirement: management practices aimed at providing employees with a work environment and tasks that are comprehensible, manageable and meaningful could potentially decrease the intentions to retire early.TIIVISTELMÄ Sosiologi Aaron Antonovskyn teoria koherenssin tunteesta kuvaa ihmisen yleistä asennoitumista maailmaa ja siinä tapahtuvia asioita kohtaan. Toisin sanoen koherenssin tunne kuvaa ihmisen kykyä ymmärtää ja hallita elämän haasteita sekä löytää niistä mielekkyys- eli kykyä selviytyä. Tämän selviytymiskyvyn katsotaan ehkäisevän terveyttä kuormittavan pitkäkestoisen stressitilan syntyä ja koherenssin tunnetta pidetään psykologisena terveyden selittäjänä. Tämän tutkimuksen tarkoituksena on aiempia tutkimuksia systemaattisemmin selvittää koherenssin tunteen taustatekijöitä, eli olosuhteita joissa koherenssin tunne kehittyy, sekä seurauksia suomalaisessa suomen- ja ruotsinkielisessä väestössä. Koherenssin tunteen mahdollisia taustatekijöitä kartoitettiin tässä tutkimuksessa useiden lapsuuden kodin olosuhteita sekä sosioekonomisten ja psykososiaalisten työ- ja yksityiselämää kuvaavien tekijöiden avulla molempien sukupuolten ja kieliryhmien keskuudessa. Viiden vuoden seurantatutkimuksessa kartoitettiin koherenssin tunteen tason pysyvyyttä negatiivisten elämäntapahtumien yhteydessä. Lopuksi tutkittiin koherenssin tunteen seurauksia eli yhteyttä varhaisiin eläkeaikomuksiin niin ikään viiden vuoden seurannassa. Tutkimuksessa on käytetty kahta aineistoa: Tilastokeskuksen vuonna 1994 keräämää Elinolotutkimusta (ELO-94, N=6506) sekä 15 vuoden Health and Social Support-seurantatutkimusaineistoa (HeSSup, N=25 898), jossa perusaineisto kerättiin vuonna 1998 ja ensimmäinen seuranta vuonna 2003. Tutkimuksessa korostui lapsuuden olosuhteiden, parisuhteen hyvän laadun ja sosiaalisten suhteiden merkittävä rooli koherenssin tunteen tason selittäjinä. Myös työn laadulliset piirteet, kuten työn kokeminen antoisaksi, olivat vahvasti yhteydessä koherenssin tunteen tasoon. Sukupuolieroja havaittiin vain muutama: yksin eläminen sekä kyvyttömyys käyttää tietojaan/taitojaan työssään uhkasivat erityisesti miesten koherenssin tunteen tasoa, kun taas sosiaalisen tuen puute teki saman naisille. Siitä huolimatta voimavarojen yhteys koherenssin tunteeseen oli sukupuolten välillä pääsääntöisesti samankaltaista. Ruotsinkielisten suomalaisten koherenssin tunteen taso oli vahvempi suomenkielisiin suomalaisiin verrattuna. Tätä eroa selittivät ruotsinkielisten paremmat lapsuudenkodin elinolosuhteet sekä työolosuhteet aikuisuudessa. Sen sijaan useat tutkimuksessa käytetyt sosiaalista elämää kuvaavat tekijät, kuten ystävien määrä, ihmissuhteiden laatu, sosiaalinen tuki ja sen vastavuoroisuus, jakaantuivat lähes identtisesti kieliryhmien kesken. Koherenssin tunteen taso ei tässä tutkimuksessa osoittautunut pysyväksi, vaan laski negatiivisten elämäntapahtumien kohdalla. Myöskään vahva koherenssin tunteen taso ei osoittautunut pysyvämmäksi kuin keskitasoinen tai heikko koherenssin tunteen taso. Koherenssin tunteella oli selkeä ja itsenäinen yhteys varhaisiin eläkeaikomuksiin sekä miesten että naisten keskuudessa. Tämä tutkimus korosti läheisten ja hyvien ihmissuhteiden laatua sekä lapsuudessa että aikuisuudessa koherenssin tunteen tason selittäjinä. Tulos koski miehiä ja naisia sekä molempia tutkittuja kieliryhmiä. Lapsuuden olosuhteiden merkittävä rooli koherenssin tunteen tason selittäjänä kertoo siitä että toimenpiteet heikommassa asemassa olevien terveyden edistämiseksi tulisi kohdistaa lapsiperheisiin. Lasten hyvinvoinnista ja oikeuksista puhuttaessa tulisi korostaa niiden yhteyttä aikuisuuden terveydentilaan. Samaten sosioekonomisten tekijöiden ohella tulisi huomioida sosiaalisten suhteiden ja tuen merkitys ihmisten hyvinvoinnin kannalta. Koherenssin tunteen itsenäinen ja selkeä yhteys varhaisiin eläkeaikomuksiin viittaa mahdollisuuteen käyttää kyseistä teoriaa hyväksi työurien pidentämistavoitteissa. Merkityksellinen sekä ymmärrettävissä ja hallittavissa oleva työ saattaisi ehkäistä varhaista eläkkeelle siirtymistä ja tulisi turvata jokaiselle työntekijälle työnantajien taholta

Koherenssin tunteeseen yhteydessä olevat voimavarat miehillä ja naisilla

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Tutkimuksen tavoitteena oli selvittää israelilaisen sosiaalipsykologi Aaron Antonovskyn koherenssin tunne teorian taustalla olevia voimavaroja suomalaisten miesten ja naisten keskuudessa eli selittää koherenssin tunnetta. Useimmissa terveystutkimuksissa koherenssin tunnetta on käsitelty psykososiaalisena terveyttä edistävänä voimavarana eli terveyden selittäjänä. Tutkimuksessa kartoitettiin voimavaroista lähinnä lapsuuden olojen, työelämän, perhe-elämän sekä sosiaalisten suhteiden yhteyttä koherenssin tunteeseen. Lisäksi selvitettiin iän ja koulutuksen yhteyttä koherenssin tunteeseen. Tutkimuksen erityisenä tavoitteena oli tutkia, eroavatko miesten ja naisten koherenssin tunteen kannalta tärkeät voimavarat toisistaan. Mahdollisten erojen oletettiin perustuvan työnjakoon ja sukupuolirooleihin liittyvien odotusten ja paineiden vaikutukseen. Tutkimuksen aineisto oli Tilastokeskuksen vuonna 1994 keräämä Elinolotutkimus, ELO94 (N=8650). Tämän tutkimuksen kohteena olivat työikäiset 25-64 -vuotiaat miehet ja naiset (N=6506). Aineistoa tarkasteltiin aluksi koherenssin tunteen keskiarvoja selittävien voimavaramuuttujien luokissa. Varsinaiseksi analyysimenetelmäksi valittiin ”tavallinen” regressionalyysi, josta selviää selittävien muuttujien ja selitettävän muuttujan eli voimavarojen ja koherenssin tunteen keskinäinen riippuvuus. Lopuksi malliin lisättiin interaktiotermit sen selvittämiseksi, eroavatko voimavarojen yhteydet koherenssin tunteeseen miesten ja naisten välillä tilastollisesti merkitsevästi. Tutkimustulokset osoittivat lähes kaikkien tutkimukseen valittujen muuttujien olevan yhteydessä koherenssin tunteeseen. Siten mm. koulutuksella, työllisyystilanteella ja ammattiasemalla on merkitystä koherenssin tunteen tason kannalta. Merkittävimmiksi koheressin tunteen tasoa sekä miehillä että naisilla selittäviksi voimavaroiksi kohosivat kuitenkin parisuhteen laatu, sosiaalisen tuen saanti ja siihen tyytyväisyys, työn sisällölliset tekijät sekä lapsuuden oloista erityisesti pelko perheenjäsentä kohtaan. Siten koherenssin tunne teorian kuvaama huono-/hyväosaisuus liittyy ennen kaikkea lähisuhteisiin eli niiden laatuun ja niistä saatuun sosiaaliseen tukeen, työn sisällöllisiin tekijöihin sekä lapsuusajan ongelmiin. Ainoaksi selkeäksi sukupuolieroksi muodostui se, että ilman parisuhdetta elävien miesten koherenssin tunteen taso oli vastaavassa tilanteessa eläviin naisiin verrattuna huomattavan heikko. Selvää näyttöä siitä, että esim. työ merkitsisi enemmän miesten ja/tai perhe ja lapset tai sosiaalinen tuki enemmän naisten koherenssin tunteen kannalta, ei löytynyt. Mittarina koherenssin tunne on Suomen oloissa siis sukupuolineutraali. Lisäksi miesten ja naisten koherenssin tunne oli samalla tasolla, mikä osoittaa, että viime kädessä voimavarat jakaantuvat tasaisesti miesten ja naisten välillä

Uptake of and Motivational Responses to Mental Health-Promoting Practices: Comparing Relaxation and Mindfulness Interventions

BackgroundComparative analyses of alternative interventions within the same trial enable acceptability and fidelity of each to be investigated more critically. In addition, whereas so far studies have focused on efficacy evaluations, more understanding is needed on motivational factors influencing the uptake of mental health-promoting practices rather than solely their effects. PurposeThis study investigates whether the motivational responses to a mindfulness intervention are different from a relaxation intervention. We compare social cognitions outlined by the reasoned action approach and their roles in practice uptake, self-reported reasons for non-practice, and experienced benefits. MethodsIn a cluster-randomized trial (ISRCTN18642659; N = 3134), 12-15-year-old participants were given a 9-week intervention and followed up to 52 weeks. Main statistical analyses included t-tests, mixed ANOVAs, path models, and chi-square tests. ResultsSocial cognitions in the mindfulness arm were slightly more positive immediately post-intervention, but recipients mostly responded similarly to the two interventions in the longer term. While attitudes, norms, intention, and self-efficacy were relatively high post-intervention, most of them slightly decreased by 26 weeks. Main reasons for non-practice in both arms included not finding the exercises helpful, no felt need, boringness of exercises and forgetting. The most common benefits experienced by practicing respondents were stress management and concentration ability. Better sleep was a more frequently reported benefit in the relaxation arm, but no other major differences emerged. ConclusionThis study offers an example of comparing motivational responses to experimental and active control arm interventions, a potentially helpful approach in improving intervention adherence.Peer reviewe

Effects of school-based mindfulness intervention on health-related quality of life : moderating effect of gender, grade, and independent practice in cluster randomized controlled trial

Object We investigated the impact of a school-based 9-week mindfulness program vs. active control program (relaxation) and inactive control group on children's self-reported Health-Related Quality of Life (HRQoL) moderated by gender, grade, and independent practice. Method In total 3519 (50/50% boys/girls) Finnish students aged 12-15 years from 56 schools were randomized into mindfulness intervention, active, and inactive control groups. HRQoL was measured at baseline, at 9 weeks, and at 26 weeks and analyzed with multilevel linear modeling. Results Significant improvement on HRQoL was found (beta = mean difference) (beta = 1.587, 95% CI 0.672-2.502, p < 0.001) after 9 weeks and at 26 weeks of follow-up among students in the mindfulness group as compared to the active control group. Moderating effects on HRQoL were found for gender, grade, and independent practice: girls, 7th and 8th grade students, and students with regular independent mindfulness practice benefited most. Conclusions Gender and developmental stage may moderate the effects of mindfulness interventions on HRQoL and offer guidance in designing effective promotive interventions for children and adolescents.Peer reviewe

Healthy Learning Mind (HLM) : Cluster Randomized Controlled Trial on A Mindfulness Intervention, Moderators and Association with Perceived Socioeconomic Status, and Comparison to Other National Data

Background This paper presents the baseline characteristics and their moderators in the Healthy Learning Mind (HLM)- school-based cluster-randomized controlled trial. Objectives The paper evaluates the state of various measures of well-being, their moderators and how these results compare to national and global norms/population studies. Methods Data were collected from all participants prior to the intervention and further analyzed by gender, grade and perceived socioeconomic status, including standardized measures for resilience, depressive symptoms and socioemotional functioning; health-related quality of life, dispositional mindfulness, satisfaction with life, compassion/self-kindness, self-rated health and morning tiredness. Results Participating 2793 students (1425 girls, 1368 boys), ages 12 to 15 years, filled in the questionnaires. The outcomes were in line with previous research, demonstrating gender differentiation and lower wellbeing among older children and adolescents. Conclusions All outcomes were associated with perceived socioeconomic status, suggesting that perceived low socioeconomic status should be addressed as a serious risk factor and included as a moderator in similar trials.Peer reviewe

Applying behavioral theory to increase mindfulness practice among adolescents : An exploratory intervention study using a within-trial RCT design

For mindfulness programs to have sustained benefits, participants should continue to practice mindfulness independently. Behavioral theories have been used to predict and change other health behaviors, but have rarely been applied to mindfulness practice. This research aimed to identify predictors/determinants of sustained mindfulness practice after a school-based mindfulness program (Study 1) and to develop and test a booster intervention to increase mindfulness practice (Study 2). These studies were embedded in a larger trial evaluating a school-based mindfulness program involving 12-15year-olds (Healthy Learning Mind, HLM). Study 1 examined theory-based predictors of mindfulness practice among participants in Batch 1 of the HLM trial (n=310). These findings were used to develop a brief motivational booster intervention, which Study 2 evaluated in a within-trial cluster-randomized controlled trial in Batch 3 of the HLM trial (HLM Only arm n=177; HLM+booster arm n=152). In Study 1, 40% of youths reported having practiced mindfulness ata 6-month follow-up. The perception that peers were practicing mindfulness exercises predicted mindfulness practice (=.497, p=.002), and a key self-reported reason for non-practice was that they did not find mindfulness useful. The booster intervention (designed to specifically target these descriptive norms and outcome expectations) demonstrated some positive trends in the determinants of mindfulness practice, but did not increase mindfulness practice. The limited effectiveness of the booster intervention might be explained by the minimal contact time of the booster intervention or its delivery in the later lessons of HLM. This study demonstrates how behavior change theories can be applied to help promote independent mindfulness practice outside of intervention settings.Peer reviewe

The Effects of School-based Mindfulness Intervention on Executive Functioning in a Cluster Randomized Controlled Trial

Executive functions (EFs) are essential for student's learning and classroom functioning. The current cluster randomized controlled trial examines the effects of mindfulness intervention vs. active control program (i.e., relaxation) focusing on the main EFs (i.e., working memory, response inhibition, cognitive processing, cognitive flexibility and verbal fluency). A total of 131 students from 6th grade and 8th grade (median age 12 and 15) from four comprehensive schools participated. The schools were to equal shares randomized to intervention and active control groups, i.e., groups who underwent a 9-week mindfulness practice or relaxation program, respectively. Participants completed a cognitive test-package at baseline/pre-intervention, post-intervention at 9 weeks and follow-up at 6 months. Both intervention and active relaxation-based control groups improved on a majority of EF measures at both 9 weeks and 6 months. There was no significant difference between the mindfulness intervention group and the active control program in EFs. The current study suggests that mindfulness intervention and active control program do not differ in their effects to EFs, although both may have positive outcomes. Further research with both active and inactive control groups is needed to map the potential benefits of similar programs for cognitive functioning.Peer reviewe

School-based mindfulness intervention for depressive symptoms in adolescence : For whom is it most effective?

Introduction: There is accumulating evidence for the effectiveness of mindfulness-based interventions in alleviating depressive symptoms. A crucial question is, however, whether mindfulness interventions are more effective for some individuals than others, depending on individual characteristics before a mindfulness intervention. We exploratorily investigated whether the effectiveness of school-based mindfulness intervention against depressive symptoms is modified by executive functions, rumination, and emotion regulation among adolescents. Methods: The longitudinal data included adolescents with at least mild depressive symptoms at the baseline (n = 369, at the 6th-8th grade, 68.4% female) who were randomized into a 9-week school-based mindfulness intervention group, into an active control group receiving relaxation program, or into an inactive control group. Adolescents' executive functions, rumination, and emotion regulation (i.e., acceptance, catastrophizing, and positive reappraisal) were assessed at the baseline; and depressive symptoms at three time points (at the baseline and at 9-week and 6-month follow-ups). Results and Conclusions: In adolescents with at least mild depressive symptoms at the baseline, high catastrophizing, high acceptance, and low executive functions were found to increase the effectiveness of mindfulness-based intervention against depressive symptoms. There seemed to be some sex differences. Thus, when aiming to alleviate depressive symptoms, mindfulness-based intervention may possibly be more effective for adolescents with high catastrophizing, high acceptance, and low executive functioning (than for adolescents with the opposite dispositions). However, as this study was exploratory by nature and corrections for multiple testing were not used, the findings must be regarded as preliminary and need confirmation in further studies.Peer reviewe

Latent profile analysis as a method for process evaluations : Discovering response subgroups in a mindfulness intervention

Rationale. Clustering techniques have been used within intervention studies to locate any distinct subgroups among intervention participants. One way in which they have not yet been utilized, but for which there is potential benefit, is in finding different motivational and behavioral response types to a newly introduced behavior. Objective This study aimed to use latent profile analyses (the same as latent class analyses except with continuous indicator variables) to identify 1) types, or classes, in terms of social cognitive responses to a mindfulness intervention, using The Reasoned Action Approach constructs, and 2) longitudinal/change trajectory classes of the target behavior (i.e., mindfulness practice). Methods The data derived from a school-based mindfulness intervention (N = 1646) among 12-15 year-olds, conducted in southern Finland from 2014 to 2016. We explored associations between the identified classes and with gender, linguocultural group, and mental health and practice outcomes. Results Analyses indicated a solution of five latent classes for both social cognition post-intervention—Uncertain but Positive (40.2%), Acceptable but No (18.8%), Indifferent (16.8), Inclined (15.5%), Disinclined (8.6%)—and practice trajectories—Stable Low (52.1%), Decreased from Seldom (25.8%), Decreased from Sometimes (10.7%), Increased from Zero (6.8%), Increased from Seldom (4.6%). The strongest differentiating theoretical construct among the social cognitive classes was a descriptive norm. The classes were characterized by some associations between each other (e.g., “Acceptable but No” and “Stable Low”) and with linguocultural groups (e.g., “Inclined” and small language minorities) and mental health (e.g., “Disinclined” and externalization and depressive symptoms), but no specific associations were found by gender. Conclusions This study shows how more person-centered analyses can be utilized in process evaluations, which predominantly only make use of variable-centered analyses. This knowledge could suggest ways to tailor universal interventions for subgroups with different receipt profiles and thereby improve intervention acceptability and engagement.Peer reviewe