Original articles
The concept of “sense of coherence” and the development of posttraumatic stress disorder in traffic accident victims

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Abstract

According to the “sense of coherence” concept, those subjects who can give meaning to a traumatic event can comprehend what has happened and have a sense of manageability of the sequelae, are able to cope better with the traumatic event itself. In the present study, this concept was applied to traffic accident victims. Severely injured traffic accident victims were assessed a few days after the accident and at 6-month follow-up. At follow-up, patients filled in the 29-item version of the Sense of Coherence (SOC) self-rating scale. The results show that the SOC total score correlated negatively with the development of: (i) posttraumatic psychopathology; (ii) psychological disorders (i.e., posttraumatic stress disorder after the accident); and (iii) anxious cognitions. The personality trait of neuroticism correlated negatively and extraversion and frustration tolerance correlated positively with SOC total score. Previous hypotheses are supported by our findings.

Introduction

A considerable number of victims develop symptoms of posttraumatic stress disorder (PTSD) after confrontation with adverse and traumatic life events. But, until now, PTSD after “civilian traumas” has been neglected [1].

Therefore, central issues (e.g., the kind of person who develops PTSD after an accident) have not yet been addressed sufficiently. Studies on traffic accident victims reveal that previous psychological disorder is correlated with PTSD after trauma 2, 3. Other factors, such as stressful life events before trauma, have been shown to enhance vulnerability 4, 5. This view on pathogenetic factors was extended by Antonovsky’s view on salutogenetic, protective factors and “sense of coherence” [6]. These factors are thought to activate and strengthen individual resources in the successful prevention of physical or psychological disorders. The “sense of coherence” was conceptualized as “a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that a) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable; b) the resources are available to one to meet the demands posed by these stimuli; and c) these demands are challenges, worthy of investment and engagement” [7]. According to this concept, the psychometric instrument Sense of Coherence (SOC) rating scale was developed with the subscales of “comprehensibility,” “manageability,” and “meaningfulness.” The instrument has been applied to healthy persons and physically or psychologically ill patients and has shown the highest scores for healthy subjects.

It is therefore not surprising that the SOC concept correlated positively with other concepts dealing with resources like self-esteem, mastery, optimism, or locus of control [8]. In our prospective studies on prevalence and prediction of psychological sequelae after road traffic accidents we found prevalence rates for PTSD within 6-month follow-up of nearly every fifth victim who was severely injured [9]. In this study we provide answers to the questions of whether sense of coherence is related to: (i) the development or the lack of PTSD after traffic accidents; (ii) cognitions and emotions; (iii) physical or psychopathological symptoms; or (iv) premorbid personality, coping styles, or attributional styles.

Section snippets

Method

Severely injured road traffic accident victims were included on a consecutive basis. They were car or motorcycles drivers, bicyclists, or pedestrians. They suffered from bone fractures, experienced <15 minutes without consciousness, and had to be hospitalized in the Department of Trauma Surgery. The Department of Trauma Surgery treats all of the severely injured patients of the region around Freiburg, which means there is no bias selection of patients.

A few days after their accident (mean 8

Sociodemographic data

The sample of 51 patients consisted of 34 male and 17 female victims of injury. Mean age was 33.6±14.3 years.

Diagnoses

Fifty-one patients were divided into four groups according to their psychiatric diagnoses, and SOC total scores of these groups were calculated, including: group A, patients who did not fulfill the criteria for any psychiatric disorder at either first or second assessment (n=15, SOC total score 161.9±20.7); group B, patients who fulfilled the diagnostic criteria for PTSD during time of

Discussion

As far as we know, this is the first study of “sense of coherence” and PTSD in traffic accident victims. Our results show that cognitive and affective reactions to the accident correlate with the sense of coherence (SOC). The reactions are independent of the severity of injury. Pessimistic cognitions are related to low SOC.

In contrast, an optimistic view is related to higher SOC. Compared with traffic accident victims with high SOC, patients with low SOC stay longer in rehabilitation clinics,

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