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Journal ArticleDOI

Perceived stress and depression amongst older stroke patients: Sense of coherence as a mediator?

TL;DR: SOC is the mediating variable between perceived stress and depression, and can reduce the influence of perceived stress on depression.
About: This article is published in Archives of Gerontology and Geriatrics.The article was published on 2018-11-01 and is currently open access. It has received 25 citations till now. The article focuses on the topics: Perceived Stress Scale & Center for Epidemiologic Studies Depression Scale.

Summary (2 min read)

1. Introduction

  • According to a report by the Chinese National Stroke Registry (Wang et al., 2011), strokes occurred in more than 7 million Chinese people in 2011, and more than 65% of them were old people.
  • In addition, whether or not SOC mediates the association between perceived stress and depression and depressive symptoms among Chinese older stroke patients has not been confirmed.

2.1. Design and participants

  • The study was conducted using a cross-sectional survey among older stroke patients.
  • The PSS is a five-point Likert scale, on which every item is scored from 1 (strongly disagree) to 5 (strongly agree), the total score ranges from 14 to 70, and the higher scores indicate a higher level of stress.
  • First, one city was randomly selected in each region (eastern, western, southern, northern and central) of Henan, one hospital was randomly selected from several hospitals where the beds are greater than 500 in each city.
  • Descriptive statistics for demographic variables, perceived stress, sense of coherence, and depression scores were presented using frequencies, percentages, means, and standard deviations.

3.1. The sample

  • In addition, the minimum, maximum and mean score of each scale and their subscales are shown in Table 2. 3.3.
  • This indicated that these demographic variables could explain 7.7% of the variation in depression, and age, gender and spouse states were significant predictors.
  • To confirm the significance of the direct, indirect, and total effects in a mediation model, the standardized structural equation modeling including three latent variables is shown in Fig. 2, and the modified goodness-of-fit indexes showed the mediation model fitted the data well in Table 5.
  • The standardized direct, indirect, and total effect of perceived stress and sense of coherence on depression is presented in Table 6.

4. Discussion

  • The frequency of older stroke patients with risk of depression was 30.2% in the present study, which was similar to previous research showing the prevalence of post-stroke depression varying from 5% to 54% (Kouwenhoven, et al., 2011; Shi et al., 2017; Xu et al., 2011).
  • This indicated that these variables may exert effect on depression via perceived stress or sense of coherence among older stroke patients.
  • All dimensions of sense of coherence were verified to be negatively and significantly associated with depression; and all dimensions of perceived stress were significantly and positively associated with depression.
  • Previous two studies on older adults conducted by Tsai et al (Tsai et al., 2015 ) Liu et al (2017) have also shown that perceived stress may bring forth even higher risk for depression by eroding their sense of personal control and self-worth, which is similar to the present study.
  • Therefore, relevant interventions should be implemented to enhance the sense of coherence and withstand the occurrence and destroy perceived stress.

5. Conclusion

  • Sense of Coherence is the mediating variable between perceived stress and depression.
  • Sense of Coherence may cause the negative influence that perceived stress has on depression.
  • Actively exploring interventions to improve sense of coherence and promote the construction and development of the intervention index system will not only help healthcare staff to offer health education to old stroke patients, but also help old stroke patients themselves to maintain physical and mental health, thereby help to reduce the occurrence of the depression of old stroke patients.

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Citations
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Journal ArticleDOI
TL;DR: In this paper, the authors analyzed the association between depression, health-related lifestyles, sleep quality, and sense of coherence (SOC) in a population with cardiovascular risk.
Abstract: People with cardiovascular risk have more depression than the general population. Depression and cardiovascular risk have been commonly linked to lower sense of coherence (SOC) values, unhealthy lifestyles, and poor sleep quality. The aim of this study was to analyze the association between depression, health-related lifestyles, sleep quality, and SOC in a population with cardiovascular risk. A cross-sectional study was conducted in 310 participants (aged 35–75 years) with cardiovascular risk. Sociodemographic and anthropometric characteristics, cardiovascular risk, SOC score, depression levels, sleep quality, and lifestyles (physical activity, diet quality (measured as the adherence to the Mediterranean diet), and tobacco and alcohol consumption) were determined. The regression analysis showed significant associations between depression levels and sex (odds ratio (OR): 2.29; 95% CI: 1.29, 4.07), diet (OR: 0.85; 95% CI: 0.73, 0.99), body mass index (BMI) (OR: 1.06; 95% CI: 1.01, 1.12), cardiovascular disease (CVD) (OR: 2.55; 95% CI: 1.18, 5.48), sleep quality (OR: 0.26; 95% CI: 0.15, 0.46), and SOC (OR: 0.96; 95% CI: 0.94, 0.98). Protective effects of male sex, a lower BMI, no CVD, a higher adherence to the Mediterranean diet, a high sleep quality, and a higher SOC were found. In conclusion, among lifestyles determined, only diet was associated with depression levels. SOC and sleep quality were also found as significant predictors for depression levels.

15 citations

Journal ArticleDOI
TL;DR: From the U3A research group, better educated elderly people have a higher sense of coherence and show a more positive self-perception of aging, and these people are less likely to show signs of senile depression.
Abstract: Purpose The aim of the study was to assess the relationship between the sense of coherence and self-perception of aging and the risk of depression among attendees of the University of the Third Age (U3A). The influence of socio-demographic factors was studied. Participants and Methods The study involved 315 attendees of the U3A aged on average 68.4 years, age range 60-82 years old. The overwhelming majority were women (91.7%). Cross-sectional research was conducted using standardized questionnaires - the SOC-29 scale, the Geriatric Depression Scale (GDS - brief version) and the author's own questionnaire regarding self-perception of aging. Results The study participants showed an average level of sense of coherence (130.7± 23.2). The highest number of people obtained average results of sense of coherence, both in terms of global SOC (75.2%) and its components. The highest scores on the SOC-29 scale were found for the sense of comprehensibility (41.3%). The mean value of the self-perception of aging was 69.0±16.0 and indicates the lower range of results for positive attitude. Nearly ¾ (72.1%) of the respondents had a positive self-perception of aging. The values of the scale of self-perception of aging showed a statistically significant relation to the global level of sense of coherence and its components (p<0.001). In people without depression, positive self-perception of aging was significantly more frequent than among participants with depression of increasing intensity. Education was significantly correlated with the results of the SOC-29 scale, the self-perception of aging scale and the GDS scale. Conclusion From the U3A research group, better educated elderly people have a higher sense of coherence and show a more positive self-perception of aging. Moreover, these people are less likely to show signs of senile depression.

15 citations


Cites background from "Perceived stress and depression amo..."

  • ...Guo also proved that a sense of coherence was linked to depression in the group of 3000 elderly patients with stroke.(39) According to Antonowsky’s theory of salutogenesis, people with a higher sense of coherence have a lower propensity for depression....

    [...]

Journal ArticleDOI
TL;DR: The SNSI-CHI is both reliable and valid and culturally appropriate for use in China and its structure enables cross-cultural comparison.

14 citations

Journal ArticleDOI
TL;DR: Findings confirmed the direct association among SOC, PHQ and SWB, but verified two underlying mechanisms regarding the mediating effect of SOC by using SEM: GRRs are positively associated with a higher SOC, which further contributes to favorable SWB; and PHQ is negatively associated with poor SWB indirectly via SOC.
Abstract: Objective: The aim of this study was to identify the potential psychological mechanism of well-being in migrants in Shanghai, China. Methods: A cross-sectional study was conducted in 2018. First, a literature review was conducted to understand the salutogenesis of migrants in China. Then, 2573 random participants were recruited from six workplaces and public places in six districts of Shanghai. The Chinese versions of the Patient Health Questionnaire-9 (PHQ-9), the Personal Wellbeing Index (PWI), and the Sense of Coherence (SOC) Scale were used to evaluate the depression, subjective well-being (SWB), and SOC of migrants. The t-test, ANOVA, and multiple linear regression and structural equation models (SEM) were used to analyze the correlations and paths among generalized resistant resources (GRRs), SOC, PHQ, and SWB. Results: The subjects were aged between 18 and 58 (mean, 28.17; SD, 6.99). SOC showed a positive correlation with SWB (r = 0.46, p < 0.001) and a negative correlation to PHQ (r = −0.53, p < 0.001). After controlling for the demographic characteristics, we found that PHQ, SOC (comprehensibility, manageability, meaningfulness), and GRRs (income ratio, marital status) contributed 33.3% of the variance in SWB, and their linear regression coefficients were: −0.32 (p < 0.001), 0.09 (p < 0.001), 0.09 (p < 0.001), 0.15 (p < 0.001), 0.06 (p < 0.05), and 0.16 (p < 0.05), respectively. These findings not only confirmed the direct association among SOC, PHQ and SWB, but also verified two underlying mechanisms regarding the mediating effect of SOC by using SEM: (1) GRRs (income ratio, marital status) are positively associated with a higher SOC, which further contributes to favorable SWB; and (2) PHQ is negatively associated with poor SWB indirectly via SOC. Conclusion: Migrant workers with low SOC and high PHQ are vulnerable to poor well-being levels. Meanwhile, GRRs (income ratio, marital status) may strengthen the SOC level, and can be regarded as the basis of intervention. Further investigation may be needed to focus on external psychological support factors.

10 citations


Cites result from "Perceived stress and depression amo..."

  • ...This structural path from depression to well-being was consistent with recent findings [57,58], which means that appropriate intervention strategies to strengthen SOC may help protect against depression and weaken the negative effect on well-being through this path....

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Abstract: Published research in English-language journals are increasingly required to carry a statement that the study has been approved and monitored by an Institutional Review Board in conformance with 45 CFR 46 standards if the study was conducted in the United States. Alternative language attesting conformity with the Helsinki Declaration is often included when the research was conducted in Europe or elsewhere. The Helsinki Declaration was created by the World Medical Association in 1964 (ten years before the Belmont Report) and has been amended several times. The Helsinki Declaration differs from its American version in several respects, the most significant of which is that it was developed by and for physicians. The term "patient" appears in many places where we would expect to see "subject." It is stated in several places that physicians must either conduct or have supervisory control of the research. The dual role of the physician-researcher is acknowledged, but it is made clear that the role of healer takes precedence over that of scientist. In the United States, the federal government developed and enforces regulations on researcher; in the rest of the world, the profession, or a significant part of it, took the initiative in defining and promoting good research practice, and governments in many countries have worked to harmonize their standards along these lines. The Helsinki Declaration is based less on key philosophical principles and more on prescriptive statements. Although there is significant overlap between the Belmont and the Helsinki guidelines, the latter extends much further into research design and publication. Elements in a research protocol, use of placebos, and obligation to enroll trials in public registries (to ensure that negative findings are not buried), and requirements to share findings with the research and professional communities are included in the Helsinki Declaration. As a practical matter, these are often part of the work of American IRBs, but not always as a formal requirement. Reflecting the socialist nature of many European counties, there is a requirement that provision be made for patients to be made whole regardless of the outcomes of the trial or if they happened to have been randomized to a control group that did not enjoy the benefits of a successful experimental intervention.

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TL;DR: In this paper, the authors focus on communication processes and understand how messages have an effect on some outcome of focus in a focus-based focus-oriented focus-set problem, which is the goal of most communication researchers.
Abstract: Understanding communication processes is the goal of most communication researchers. Rarely are we satisfied merely ascertaining whether messages have an effect on some outcome of focus in a specif...

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"Perceived stress and depression amo..." refers methods in this paper

  • ...Then, we employed a structural equation modeling approach (using AMOS version 22.0) with the widely used bootstrap method (Kenneth and Robert, 1990; Hayes 2009), to confirm the hypothetical relationship among perceived stress, sense of coherence, and depression....

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  • ...0) with the widely used bootstrap method (Kenneth and Robert, 1990; Hayes 2009), to confirm the hypothetical relationship among perceived stress, sense of coherence, and depression....

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Abstract: WORLD MEDICAL ASSOCIATION DECLARATION OF HELSINKI Ethical Principles for Medical Research Involving Human Subjects 世界医師会ヘルシンキ宣言 ヒトを対象とした医学研究の倫理原則 ---------------------------------------------------------------------------Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended by the: 29th WMA General Assembly, Tokyo, Japan, October 1975 35th WMA General Assembly, Venice, Italy, October 1983 41st WMA General Assembly, Hong Kong, September 1989 48th WMA General Assembly, Somerset West, Republic of South Africa, October 1996 52nd WMA General Assembly, Edinburgh, Scotland, October 2000 53rd WMA General Assembly, Washington 2002 (Note of Clarification on paragraph 29 added) 55th WMA General Assembly, Tokyo 2004 (Note of Clarification on Paragraph 30 added) 59th WMA General Assembly, Seoul, October 2008 64th WMA General Assembly, Fortaleza, Brazil, October 2013

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"Perceived stress and depression amo..." refers background in this paper

  • ...…at their disposal and are adequate to meet the demands posed by the stimuli; (3) Meaningfulness refers to the extent to which a person feels that these demands are challenges that are worthy of investment and engagement (Antonovsky, 1987; Antonovsky, 1993; Pretty et al., 2014; Würtz et al., 2015)....

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  • ...manageability, and meaningfulness (Antonovsky, 1987)....

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  • ...Sense of Coherence Scale The Sense of Coherence (SOC) scale was developed from interviews with people who had recovered from adverse experiences, consisting of comprehensibility, manageability, and meaningfulness (Antonovsky, 1987)....

    [...]

  • ...It is a personal way of thinking, being, and acting, with an inner trust, which leads people to identify, benefit, use, and reuse the resources at their disposal (Antonovsky, 1987)....

    [...]

  • ...Antonovsky (1987) hypothetically claimed that SOC is a rather stable quality of an individual after 30 years of age, however, some new researchers (Sagy and Antonovsky, 2000; Vastamäki et al., 2009; Yamazaki et al., 2011; Kähönen et al., 2012) present interesting results indicating that SOC is more…...

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Frequently Asked Questions (2)
Q1. What are the contributions mentioned in the paper "Perceived stress and depression amongst older stroke patients: sense of coherence" ?

Zhou et al. this paper found that perceived stress not only exerts a direct effect but also has an indirect effect on depression and depressive symptoms through triggering specific psychological responses. 

This study has some limitations: ( 1 ) the participants were limited to Henan province, although there is a good representation, however it still does not represent the situation in other regions, therefore a larger and more diverse sample is required for further study ; ( 2 ) the study only carried out the exploration of the preliminary theory about the mediating effect of sense of coherence, but did not put forward more specific interventions for older stroke patients on strengthening the sense of coherence, hence, future studies should develop a more thorough and particular intervention index system on strengthening the sense of coherence ; ( 3 ) this study found that sense of coherence only partially mediates the association between perceived stress and depression, concluding that other factors can be acted as mediators. Therefore, future studies should examine additional mediators to provide a wide perspective on the complex relationship between perceived stress and depression among the older stroke patients.