Sense of Coherenece _and School Stress

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Social Science & Medicine 53 (2001) 603614

Sense of coherence and school-related stress as predictors of

subjective health complaints in early adolescence: interactive,

indirect or direct relationships?

Torbjorn Torsheima,*, Leif Edvard Aaroeb, Bente Wolda

aResearch Centre for Health Promotion, University of Bergen, Christiesgt.13, N-5015 Bergen, Norwayb Department of Psychosocial Sciences, University of Bergen, Christiesgt.12, N-5015, Bergen, Norway

Abstract

The role of sense of coherence (SOC) on the relationship between adolescent school-related stress and subjective

health complaints was tested with structural equation modelling. As part of the crossnational WHO-survey Health

behaviour in school-aged children 1997/98 Norwegian representative samples of 1592 grade 6, 1534 grade 8, and 1605

grade 10 students completed measures on SOC, school-related stress and subjective health complaints. A test of nested

structural models revealed that both stress-preventive (D w2 814. 86,p50:001), stress-moderating (D w2 11.74, p50:02)

and main health-enhancing (D w2 1289.1,p50:001) effects of SOC were consistent with the data. A model including all

these relationships fitted the data well (CFI=0.91, RMSEA=0.04). Age-group comparisons revealed that the

association between SOC and stress grew weaker with age (p50:05), whereas the direct association between SOC and

health complaints grew stronger (p50:001). The main effect of SOC accounted for between 39% (11 year olds) and

54% (15 year olds) of the variance in subjective health complaints. Findings indicate that SOC may potentially be a

salutogenic factor in adolescents adaptation to school-related stress, and that relationships between SOC and healthy

adaptation, may be evident in younger age-groups than previously anticipated. # 2001 Elsevier Science Ltd. All

rights reserved.

Keywords: Sense-of-coherence; Moderator; Stress; Adolescence; Health-complaints; Resilience

Introduction

Subjective health complaints like headache, backache,

and abdominal pains, are common in early adolescence

(Aro, Paronen, & Aro, 1987; Garralda, 1996; Goodman

& McGrath, 1991; King, Wold, Tudor-Smith, & Harel,1996; Mikkelsson, Salminen, & Kautiainen, 1997). A

series of studies have implicated school-related stress in

the development and maintenance of such health

complaints (Aro et al., 1987; Garralda, 1996; Hurrel-

mann, Engel, Holler, & Nordlohne, 1988; Ystgaard

1997). However, the finding that not all students develop

complaints from school-related demands has directed

the attention to factors that moderate the perception of

stress, and the adverse health impact of stress (e.g.

Wagner & Compas, 1990; Ystgaard, 1997). In adults,

one of the stress moderators that has generated

considerable interest is the sense of coherence (SOC), a

global orientation to view life situations as comprehen-sible, manageable and meaningful (Antonovsky, 1987).

In the original theoretical formulation Antonovsky

(1987) proposed that SOC may influence stress and

health in three ways: (1) SOC influences whether a

stimuli is appraised as stressor or not; (2) SOC influences

the extent to which a stressor leads to tension or not;

and (3) SOC influences the extent to which tension leads

to adverse health consequences. While research on

adults in part support these assumptions (for a review,

see Antonovsky, 1993), the role of SOC in child and

adolescent health is largely unexplored. With the view

that school adaptation has an essential impact on a wide

*Corresponding author. Tel.: +47 55 58 33 01; fax: +47 55

58 98 87.

E-mail address:[email protected]

(T. Torsheim).

0277-9536/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved.

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range of social, psychological, and behavioural out-

comes, empirical evidence on the stress moderating role

of SOC during adolescence may offer particularly scope

for development of prevention policies. The aim of the

present paper is to examine the ways SOC and school-

related stress interact in relation to subjective health

complaints during early adolescence.

SOC and stress appraisal

In the processes linking life situations to health, stress

appraisal is the first process that SOC may influence.

Stress research indicates that level of ambiguity and

uncertainty are important dimensions in appraisals of

life situations. Unpredictable or incomprehensible life

situations are potent sources of stress (Lazarus &

Folkman, 1984). As a global orientation to life, the

sense of coherence (SOC), will influence the degree to

which people view life demands as chaotic andincomprehensible, or coherent and comprehensible.

Through the confidence that . . .the stimuli deriving

from ones internal and external environments are

structured, predictable and explicable. . . (Antonovsky,

1987, p. 19), individuals with a strong SOC will be less

likely to perceive ambiguity in encounters with life

demands.

In keeping with the hypothesis that a high SOC may

help to appraise demands as non-stressful, studies on

adult populations have reported moderate inverse

associations between measures of SOC and measures

of perceived stress. A review of these studies (Anto-

novsky, 1993) showed that that the associations are

generally stronger for perceived measures of stress than

for measures of stressful life events, suggesting a role in

appraisal processes, and not in the actual exposure to

stressful events.

SOC and stress moderation

As a next step in the stress process, SOC has been

suggested to influence coping expectancies in encounters

with stress (Antonovsky, 1987, p.19). According to the

transactional model of stress (Lazarus & Folkman,

1984), coping expectancies develop from secondaryappraisal processes, where people assess the means that

are available to deal with the stressful condition. As a

global orientation to life, individuals with a strong SOC

will have a general confidence that resources are

available to meet the demands posed by stressful

situations (Antonovsky, 1987, p.19). This confidence

increases the likelihood of positive coping expectancies.

In related conceptual formulations (e.g. Bandura, 1986;

Kobasa, 1979; Ursin, 1988) coping expectancies are

assumed to moderate reactions to stress. In line with

these models, Antonovsky (1987) proposes that a strong

SOC may help to prevent stress from turning into

potentially harmful tension. From this perspective SOC

acts as a classic moderator of life stress.

Empirical studies on the stress-moderating role of

SOC show mixed findings. In a study of Finnish adult

workers, Feldt (1997) found that the relationship

between work demands and health complaints was

stronger for workers with a low SOC, but in statisticalterms the interaction was weak. In a similar vein,

Vahtera and colleagues (1996) found that job demands

from active jobs lead to sickness spells in workers with

low SOC, but not in workers with a high SOC. In

contrast, a number of other studies have failed to detect

stress-distress moderation (e.g. Anson, Carmel, Leven-

son, Bonneh, & Maoz, 1993; Flannery & Flannery,

1990), leaving the issue of SOC as a moderator

unresolved.

SOC and stress-termination

As a third mechanism, Antonovsky suggested that a

high SOC may prevent stress-associated tension from

developing into health problems. Stressing the point that

SOC is not a particular coping style, Antonovsky (1987)

proposed that individuals with a high SOC are more

likely to select the coping strategy that is efficient for

dealing with the stressor. High SOC individuals tend to

use problem-focused strategies, they are flexible in their

choices of strategies, and they are skilled in using

feedback to redirect coping attempts. As a consequence,

individuals with a high SOC are, in general, more likely

to remove the source of stress, and to terminate the

associated tension. Over time, individuals with a strong

SOC will experience shorter periods of harmful tension

than individuals with a weak SOC, suggesting a main

effect between level of SOC and health.

In line with the tension-termination hypothesis, a high

SOC has been strongly associated with measures of self-

reported health and well-being, as well as low scores on

markers of disease (for a review see Antonovsky, 1993).

While these findings are in line with the tension-

termination hypothesis, authors have suggested that

the strong associations to some extent may reflect

methodological confounding between measures of SOC

and measures of self-reported health (Geyer, 1997;Korotkov, 1993).

SOC and the mechanisms of health complaints

Through the influence on stress appraisals, coping

expectancies and coping behaviour, SOC may affect

processes that are essential in the development and

maintenance of subjective health complaints. Uncer-

tainty is a potent stimuli for the stress response. Once

initiated, the profile of the stress response is moderated

by response-outcome expectancies and control beliefs

(Ursin & Hytten, 1992). Low perceived control over

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stressful conditions have been associated with a general

tonic activation involving all biological response sys-

tems, including changes in neuro-endocrine, vegetative,

neuro-muscular, central-nervous and immune system

functioning (Ursin, 1997). Activation is sustained when

coping efforts to remove the stressor are unsuccessful, or

when no attempts are made to remove the stressor (i.e.helplessness). Sustained activation causes long term

sensitisation of neural transmission (Antelman, Soares,

& Gershon, 1997; Dubner & Ruda, 1992; Woolf &

Thompson, 1991). Recent contributions view long-term

sensitisation as a candidate mechanism for chronically

elevated levels of health complaints (Ursin, 1997). In

sum, these finding suggest that stressful appraisals,

negative coping expectancies and unsuccessful coping

behaviour are associated with physiological processes

that may permanently lower the threshold for experien-

cing subjective health complaints.

SOC in adolescence

In view of the pervasive impact that is claimed for the

adult SOC, surprisingly little is known about the role of

SOC in the normal adaptation of general adolescent

populations. In the original theoretical formulation,

Antonovsky (1987) emphasises that SOC is a develop-

mental construct that becomes crystallised at the age of

30, suggesting a more fluctuating and less essential role

for SOC in earlier age-groups: The adolescent, at the

very best can only have gained a tentative strong SOC,

which may be useful for short-range prediction about

coping with stressors and health status. (Antonovsky,

1987, p. 107).

The hypothesised limited role for SOC in adolescent

health, has been paralleled by a limited research focus

on these groups. Some authors view adolescent experi-

ences as important for the development of SOC in

adulthood (e.g. Lundberg, 1997; Cederblad, Dahlin,

Hagnell, & Hansson, 1994) but few contributions have

addressed the potential health impact SOC may have

during adolescence. The few studies on child and

adolescent SOC, have to a large degree focused on

particular risk groups, such as adolescents experiencing

evacuation stress (Antonovsky & Sagy, 1986), learningdisabled children (Margalit & Efrati, 1996), and

adolescents with chronic disease (Baker, 1998). Contrary

to the idea of a fluid and weak adolescent SOC, these

studies indicate that a young SOC may contribute to

stress and coping in much the same way as does the

mature adult SOC.

While the above studies offer preliminary evidence

that SOC may help adolescent risk groups to cope with

particular difficult life conditions, the health impact of

SOC may be even more far-reaching for normative

demands that every adolescents encounter during the

course of normal development. School-related demands

are potent sources of stress in adolescent normal

populations (Eme, Maisak, & Goodale, 1979; Greene,

1988; Henker, Whalen, & ONeil, 1995). Elevated levels

of such stress is associated with psychological distress

(Wagner & Compas, 1990; Ystgaard, 1997) and somatic

complaints (Aro et al., 1987; Garralda, 1996; Hurrel-

mann et al., 1988). As schooling is mandatory in mostcountries, exposure to school demands is beyond the

control of adolescents. Identification of resources that

may help to prevent stressful appraisals, or moderate the

adverse health impact of stress, may serve as an

important first step in developing preventive strategies.

The present study

Antonovskys (1987) original contribution suggests

that the adolescent SOC may affect level of health

complaints indirectly by preventing school-related stressappraisals, interactively by moderating the impact of

stress, and directly by reducing the likelihood of

sustained activation. A potential shortcoming in pre-

vious research, is the failure to compare the relative

importance of these mechanisms at given developmental

stages in life. To gain more knowledge on the role of

SOC in early adolescents adaptation to school-related

stress, the present paper investigates each of these

assumed relationships:

1. SOC is inversely related to appraisals of school-

related stress.

2. SOC moderates the relationship between school-

related stress on subjective health complaints.

3. SOC is inversely related to health complaints.

Method

Sample and sampling procedure

As part of the WHO survey Health behaviour in

school-aged children 1997/98 a representative sample of5026 Norwegian 11, 13 and 15 year olds took part in the

study, representing a response rate of 78%. 1733 was

from grade 6 (mean age 11.46), 1623 was from grade 8

(mean age 13.46), and 1670 was from grade 10 (mean

age 15.48). The sample was obtained using a clustered

sampling procedure with school-class as the sampling

unit (Currie, 1998). Clustered samples may potentially

underestimate measurement error due to non-indepen-

dent observations. However, previous documenta-

tion (King et al., 1996, P. 215) suggests there to be

essentially no such design effect for self-reported health

measures.

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Instruments

The HBSC symptom checklist

This is an 8-item scale on reported symptoms

(headache, abdominal pain, backache, depressed

mood, irritability, nervousness, sleeping difficulties,

dizziness). In the last 6 months: how often haveyou had the following? Symptoms are rated on a five-

point frequency scale: about every day; more than

once a week; about every week; about every month;

rarely or never. (Cronbachs alpha : .76; test-retest:

0.80)

Perceived school-related stress

The HBSC school-related stress subscale measured

this (Samdal, Wold, & Torsheim, 1998b). The subscale

comprises three items, see Appendix B (Cronbachs

alpha: 0.75; test-retest 0.80).

Sense of coherence

Antonovskys (1987) Orientation to Life Question-

naire, short form (SOC-13), was adapted to fit early

adolescents (see Appendix A). A description of the

adaptations are made in Torsheim and Wold (1998). The

13-items tap into three components of comprehensibil-

ity, manageability and meaningfulness (Cronbachs

alpha: 0.85, test-retest: 0.78).

Procedure

The survey was carried out according to a standar-

dised protocol (Currie, 1998). Prior to the distribution of

material, teachers received instructions how to admin-

ister the survey. Questionnaires were distributed and

filled out during a regular school-hour. Students were

informed that participation was voluntary, and that

their responses were anonymous.

Statistical analysis

The fit of the models were assessed with Structural

equation modeling (SEM) procedures using EQS for

windows ver. 5.4 (Bentler, 1995). When a theoretically

founded causal model exists, SEM offers severaladvantages compared to linear regression analysis.

SEM offers more sophistication in detecting violation

of the model assumptions, and in comparison of

alternative causal models. SEM may be particularly

advantageous for the kind of interaction that the

moderator model implies. In multiple regression, mea-

surement errors tend to be high in interaction terms

(Busemeyer & Jones, 1983), thus increasing the prob-

ability of type II errors in the tests of interaction. In

SEM the latent variables are measured without mea-

surement error, which reduces the problem of type II

error in tests of interaction. Several procedures for latent

variable modeling of interaction (i.e. moderation) effects

have been developed during the last decade (e.g. Jaccard

& Wan, 1995; Kenny & Judd, 1984; Ping, 1996). The

present study implemented the two-step procedure

developed by Ping (1996). Prior to model estimation,

the observed variables were centered to ensure uncorre-

lated main and interaction terms. A product termbetween the average of the indicators of the school-

related stress factor and the average of the indicators of

the latent sense of coherence factor was computed.

Estimation of the latent school-related stress *SOC

interaction factor was done in two steps. Firstly, the

errors and the loadings for the latent stress and the

latent SOC factor was estimated. In the second step, the

estimated errors and loadings were used to compute

fixed error and loading for the measurement equation of

the latent interaction factor, leaving only the structural

model to be estimated. Under the assumptions of

normality and unidimensional measures, the methodprovides estimated solutions that are essentially identical

to more elaborate methods (for a practical example see

Ping, 1998).

Goodness-of-fit criteria

Several indices of goodness of fit exist. In the

present study, the comparative fit index (CFI) and

the root mean square error of approximation (RMSEA)

were used as the goodness-of-fit-criteria. By convention,

a CFI above 0.90 and a RMSEA lower than 0.05 is

taken to reflect adequate model fit. Comparisons of

nested models were made by testing the significanceof the difference in w2. According to Baron and

Kenny (1986), a moderator effect would be indicated

by a significant improvement in model fit when

adding the effect of interaction factor to the main effects

model.

Measurement models

The latent factors of the structural models were based

on the following congeneric measurement models: For

the latent school-related stress factor, the three items of

the school-related stress subscale were used as three

observed indicators of school-related stress. For theadapted SOC-13 scale, the summed scores for each of

the three subcomponents meaningfulness, manageability

and comprehensibility were used as indicators of the

latent SOC factor. Feldt and Rasku (1998) showed that

the three subfactors may reflect one underlying factor.

For the latent SOC*stress interaction factor, the product

of the average of the three stress indicators and the

average of the three SOC indicators were used as the

observed indicator, with fixed loadings and error

variances. For the subjective health complaints latent

variable, the eight observed complaint variables were

used as indicators.



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Missing values

Cases with more than 30% missing values were

excluded from the analysis. For the rest, missing values

were replaced with variable means. The final sample thus

consisted of 1592 11 year olds, 1534 13 year olds, and

1605 15 year olds.

Results

Table 1 shows the correlation matrix and the means

and standard deviations that was used for the estimation

of the structural equations.

Preliminary analysis of measurement model

Unidimensional measurement models is a prerequisite

for obtaining unbiased results. The fit of the measure-

ment model for SOC, school-related stress and sub-jective health complaints was tested simultaneously by

allowing the three latent factors to correlate. Unidimen-

sionality for each of the latent factors would be

indicated by a high overall goodness of fit. The

correlated factors model obtained a CFI of 0.96 and a

RMSEA=0.03, suggesting a satisfactory, yet not perfect

degree of unidimensionality. Close scrutiny of the

measurement model suggested a minor departure from

perfect unidimensionality in the observed indicators of

the latent health complaints factor. Modelling the

symptoms as two correlated latent factors, rather than

the proposed one-factor model, provided a small

improvement in the overall measurement model

(CFI=0.98, RMSEA=0.02) but did not alter the error

terms and factor loadings for the observed indicators of

SOC and stress. To check for potential bias in the

proposed one-factor model of health complaints the

structural models to be presented in the next sections

were estimated for both the one-factor solution and the

two-factor measurement model. The substantive find-

ings did not differ for these solutions, suggesting no

essential bias for the one-factor model. For parsimony,

the results to be presented in the next sections is for the

proposed one-factor measurement model of health

complaints only.

Model selection

Structural models were tested as a series of nested

models, moving from the most restricted model to

models with less restricted assumptions.

The most restricted model in the present study, was a

model were school-related stress predicts health com-

plaints but where SOC has no effects. This model served

as a null model to compare the fit of the three stress-

health mechanisms that SOC was assumed to influence.

As shown in Table 2, the null model showed a poor fit

to the data, indicated by a CFI of 0.79. In this model,

school-related stress was moderately associated with

health complaints (Standardised path coefficients, 11

year olds 0.35; 13 year olds 0.38; 15 year olds 0.32; p5

0:001 for all paths).

To assess the fit of the three mechanism, each of the

proposed relationships were added in a stepwise manner.Model 1 included indirect effects only, model 2 included

indirect and direct effects, and model 3 included indirect,

direct, and interactive effects on health complaints.

Model 1 (M1) tested the assumption that SOC

influences level of stress, but SOC was assumed to have

no interaction with stress and no main effects on health

complaints. M1 produced a relatively poor fit to the data

(CFI=0.84), but the fit was better than the null model

(Ddf 3, Dw2 814:86, p50:001), suggesting that the

modelled relationship between SOC and perceived

school-related stress was consistent with the data.

Model 2 added the assumption that SOC has a directeffect on health, but SOC was not assumed to interact

with stress. This model fitted the data well, indicated by

a CFI of 0.91, and a RMSEA of 0.04. Model 2 fitted the

data better than model 1 (Ddf 3, Dw2 1289:1,

p50:001), suggesting that the assumption of a main

effect of SOC on health complaints was consistent with

the data.

Model 3 tested the additional assumption that SOC

and school-related stress interact in predicting health

complaints. A significance test of the difference in w2,

revealed a marginally better fit for model 3 (df 3,

Dw2 11:74,p50:02), suggesting that also the modelled

interaction effects fitted the data.

Invariance across age

The best-fitting model, model 3, incorporating both

indirect, direct, and interactive effects of SOC on health

complaints, was chosen as baseline model for testing

invariance of structural coefficients across age groups.

To test if the path coefficients were invariant across age

groups, constraints of equality were imposed on the

structural equations.

Four equality constraints were entered simultaneously:

Equality across groups for (1) the path coefficientbetween SOC and school-related stress; (2) the path

coefficient between SOC and subjective health com-

plaints; (3) the path coefficient between school-related

stress and subjective health complaints; and (4) the

path coefficient between the SOC*stress interaction

factor and subjective health complaints.

The constrained baseline model had a poorer fit to the

data than the unconstrained model (Dw2, 31.40, df 8,

p50:001), suggesting that the assumption of invariant

path coefficients did not fit the data. To detect which of

the path coefficients that varied across age groups,

constraints were released in a sequential manner. The



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school-related stress was different across age. For the

remaining two path coefficients, release of constraints

did not improve model fit (models 3d and 3e), which is

consistent with the assumption of invariance across age

groups.

Path coefficients and effect decomposition

Fig. 1 shows the path coefficients of model 3c.

Sense of coherence (SOC) was moderately associated

with school-related stress, with the strongest inverse

Table 2

Model summary for the tested models, multisample analysis

Model df w2 CFI RMSEA Comparison Ddf Dw2 P

(M0) Null model 273 3985.40 0.79 0.05

(M1) Stress appraisal 270 3170.54 0.84 0.05 M1 vs M0 3 814.86 50.001

(M2) Health resistance 267 1881.44 0.91 0.04 M2 vs M1 3 1289.1 50.001(M3) Stress moderation 264 1869.70 0.91 0.04 M3 vs M2 3 11.74 50.02

Table 3

Testing constraints of equal path coefficients across groupsa

Hypothesis df w2 CFI RMSEA Comparison df Dw2 p

(M3a) Path coefficients equal across groups 272 1901.10 0.91 0.04

(M3b) SOC!Health complaints6across groups 270 1885.14 0.91 0.04 M3b vs M3a 2 15.96 50.001

(M3c) SOC! stress6across groups 268 1877.78 0.91 0.04 M3c vs M3b 2 7.36 50.05

(M3d) Stress moderation6across groups 266 1874.13 0.91 0.04 M3d vs M3c 2 3.65 ns

(M3e) Stress!Health Complaints6across groups 266 1873.40 0.91 0.04 M3e vs M3c 2 4.38 nsaNote. ns nonsignificant at the 0.05 level.

Fig. 1. Structural path model for direct, indirect and interactive relationships for SOC and stress on health complaints, multisample

analysis on 11 year olds, 13 year olds and 15 year olds. aPath coefficient: upper number 11 year olds; middle number 13 year olds; lower

number 15 year olds. bPath coefficients when no effects of SOC is included (null model).



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association among 11 year olds (standardised path

coefficients: 11 year olds 0.47; 13 year olds 0.41; 15

year olds 0.40). SOC was inversely related to health

complaints, with stronger relationship with increasing

age (standardised path coefficients: 11 year olds 0.59;

13 year olds 0.67; 15 year olds 0.71; p50:001 for all

age groups).When controlling for the effects of SOC, the relation-

ship between school-related stress and health complaints

was very weak (standardised path coefficients: 11 year

olds 0.08; 13 year olds 0.07; 15 year olds 0.07; p50:05

for all age groups).

An effect decomposition was done to assess the

relative contribution for the different relationships

regressed on subjective health complaints. Across age,

as shown in Table 4, the main effect of SOC accounted

for an increasing share of variance in health complaints,

from 39% in the group of 11 year olds up to 54% in the

group of 15 year olds. The interactive effects of SOC andschool-related stress accounted for between 0.5 and 1%

of the variance in health complaints.

Discussion

In brief, we found that both stress-mediated effects,

stress-interactive effects, and direct effect of SOC on

health complaints were consistent with the data.

SOC and school-related stress

The reason for investigating the role of SOC was

twofold. Firstly, a large literature indicate that many

students perceive school-demands to be stressful. Sec-

ondly, the variance in these perceptions predicts

variance in psychological and physical distress. Factors

that prevent stressful appraisals, or that moderate the

impact of stressful appraisals may be potential targets

for preventive action.

One of the assumptions made by Antonovsky (1987),

is that individuals with a high SOC will tend to appraise

demands as predictable and comprehensible. Based on

Antonovsky, we expected SOC to be inversely related to

perceived school-related stress. Students with a high

SOC would be more inclined to view school demands as

comprehensible and predictable, and less threatening to

well-being. In line with these expectations moderate-to-

strong inverse relationships were found in all three age

groups. The subcomponent of comprehensibility has

been suggested to be an important factor in stress

appraisal of recurring demands (Antonovsky, 1987).

The role of comprehensibility may be particularly

relevant in relation to school related demands, as theambiguities posed by schoolwork is closely related to a

lack of comprehension. The expectations of comprehen-

sible demands may provide a cognitive set that organises

the appraisal of such demands as they occur.

The relationship between SOC and school-related

stress grew weaker with age. With the notion of an

emerging, and more and more crystallised SOC, this

pattern was somewhat surprising. One possible explana-

tion is that academic demands increase over age, and

become less susceptible to benign appraisals. In the

context of qualification to higher education, the

potential threatening aspects of school-demands maybecome more salient. Such contextual factors may

influence stress appraisals more strongly than the level

of SOC. As such, the relative contribution of SOC in

appraisals of school-related stress may become lower

when contextual factors dominate.

Several authors have argued that school may be

regarded as a work setting for adolescents (Rudd &

Walsh, 1993; Samdal, Nutbeam, Wold, Kannas, 1998a).

The size of the path coefficients between SOC and

school-related stress, was strikingly similar to what has

been found in adult studies for work-related demands

(Larsson & Setterlind, 1990; Ryland & Greenfeld, 1991).

If we assume that schoolwork and paid work share

essential features, such as performance demands and

time pressure, our findings may reflect that that the

adolescent SOC operates in much the same way as does

the adult SOC. While several authors have stressed the

labile character of the adolescent SOC (e.g. Antonovsky,

1987; Lundberg, 1997), the parallel findings in this study

do not support a strong distinction between the function

of the adolescent and the adult SOC in appraisals of

work demands.

Does SOC moderate the impact of school-related stress?

In the original theoretical formulation SOC is

assumed to moderate the impact of stress. Individuals

Table 4

Effect decomposition of associations with subjective health complaints, best-fitting model (standardised solution)

Direct effects of SOC Interaction Direct effects of stress Disturbance Total variance

11 year olds 0.3944 0.0119 0.0060 0.5883 1.001a

13 year olds 0.4886 0.0079 0.0046 0.4998 1.001

15 year olds 0.5388 0.0055 0.0042 0.4529 1.001

a

Total variance exceeds 1.0 due to rounding errors.



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high on SOC would expect stressors to be manageable.

According to cognitive activation theory (Ursin &

Hytten, 1992) such expectations may prevent the

initiation of harmful activation during stress.

The model that included interaction effects fitted the

data better than the model including main effects only.

For students with a high SOC, school-related stress wasless strongly associated with health complaints. It is

tempting to interpret this in support for a stress-

moderating role for SOC, but several methodological

factors speaks against such an interpretation. When

judging the present interaction-effects one has to

consider that the study employed a method that

minimises measurement error in the interaction term.

The interactive effects were still only marginal, account-

ing for between 0.5 and 1% of the true variance in health

complaints. Notably, the main effect of SOC on health

complaints was strong. As suggested in the seminal

paper by Baron and Kenny (1986), interaction effectsmay be difficult to interpret when the assumed

moderator has a strong main effect on the outcome.

From this point of view, it seems inappropriate to

interpret the interaction effect as moderation. In any

case, taking into account that other studies have shown

mixed findings of moderation effects, it seems reasonable

not to overstate the substantive significance of the

present interaction effects.

The weak interaction effects found in our study are in

line with the bulk of studies reporting weak or non-

significant interaction effects between SOC, stress and

health outcomes (Anson et al., 1990; Feldt, 1997;

Vahtera et al., 1996). For studies of stress-moderation

in general, weak or absent interaction effects, has been

explained with reference to lack of statistical power, and

amplification of measurement error (Busemeyer &

Jones, 1983). However, in the case of SOC, the weak

interaction may also reside in the generality of the SOC

construct. In social support research, a key issue has

been that global support may not be able to match

specific stressors (Gore & Aseltine, 1995). Thus, global

resources should not produce strong moderation of

domain-specific stress. The stressor-resource matching

argument could also apply to SOC. The point that sense

of coherence is not a particular coping style, orbehavioural trait (Antonovsky, 1987), suggests that

SOC may moderate stress through domain-specific

response outcome beliefs, but these response outcome

beliefs may be affected by a host of other situational

factors. The moderating effect of SOC on stress, may

thus be levelled out in specific situations. While global

expectancies of being able to manage stress, may be

relevant in encounters with school-related stressors,

school-specific efficacy and skills may be even more

instrumental in shaping coping expectancies. In future

studies, instead of trying to establish moderation effects

of SOC on domain-specific stressors, it may well prove

to be more fruitful to establish main effects between

SOC and domain-specific self-efficacy and outcome

beliefs.

SOC and subjective health complaints

The effect decomposition revealed that most of thevariance accounted for by SOC could be attributed to

the direct relationship between SOC and health com-

plaints. In fact, the direct effects of SOC accounted for

almost half of the variance in health complaints. The

indirect and interactive relationships only accounted for

a marginal proportion of variance.

The strong main effect of SOC is open to several

interpretations. According to Antonovsky, people with a

high SOC use more effective coping strategies, and will

always be moving from a state of tension to non-tension.

In a more speculative vein, Antonovsky (1987) proposes

that SOC affects the tendency for the physiologicalsystem to enter disequilibrium. Interestingly, this hy-

pothesis converge with recent contributions that

view subjective health complaints as a physiological

sensitisation phenomenon (Ursin, 1997). The strong

association between SOC and health complaints,

controlling for level of stress, could reflect that

individuals with a high SOC show a resistance to such

sensitisation.

The strong associations do however bring forward the

issue of a conceptual or methodological confound

between SOC and subjective health complaints. Several

authors have argued that measures of SOC in part

reflect negative affectivity or negative mood dispositions

(Geyer, 1997; Korotkov, 1993). According to symptom

perception theory, negative affectivity is associated with

high introspection and low threshold for symptom

perception (Watson & Pennebaker, 1989). Conse-

quently, associations between SOC and health com-

plaints could reflect common influence of negative

affectivity. However, as argued by Stru mpfer and

colleagues (1998), the association between SOC and

negative affectivity may not primarily be an issue

of methodological confounding. If low negative affec-

tivity is viewed as emotional stability, the strong

associations may well been seen as a validation of thestress-resistance component in SOC (Stru mpfer et al.,

1998).

While a high SOC may be a part of a larger

adaptation pattern that includes low negative affectivity,

SOC is not necessarily the same as negative affectivity

(Stru mpfer et al., 1998). One possible interpretation is

that SOC represents the cognitive-motivational mani-

festation of depression, and not the affective component

per se. Cognitive models on depression (e.g. Beck, 1974)

indicate that depressive beliefs causes affective states.

The strong association with health complaints could

mean that a low SOC reflects the depressed belief-system



10/12

that sustain a high arousal, which must be clearly

distinguished from theeffects of such arousal.

Alternative models

The present paper investigates causal models for the

relationship between stress, SOC and subjective healthcomplaints, but the crossectional design does not allow

for any firm conclusions regarding causality. This

limitation needs to be particularly addressed when using

structural equation modelling. While the results are

consistent with the general mechanisms proposed by

Antonovsky, several alternative models could fit the

data equally well.

As a model worth considering, developmental per-

spectives suggest that SOC may mediate school-related

stress. Load experiences from social role performance,

have been assumed to have a strong impact on the

development of SOC (Cederblad et al., 1994; Antonovs-ky, 1991). According to this view, experiences of

persistent overload or underload, is associated with the

development of a low SOC, whereas experiences of

balanced load, promote a strong SOC. Following this

argument, the adolescent SOC could be seen as

influenced by school-related stress, rather than as

predicting school-related stress.

Though conceptually very different, the SOC-as-

outcome model would fit the present data equally well

as the models that were tested in our study. The problem

of interpretation this leaves us with does not change the

fact that there is a robust covariance structure between

SOC, school-related stress and subjective health com-

plaints. Future prospective studies could benefit from

adopting a transactional perspective on the relationship

between SOC and stress, where reciprocal effects can be

modelled.

Conclusion

The aim of the present paper was to assess the role of

SOC in adolescents health adaptation to school-related

stress. The results provide some support for the general

stress-health mechanisms that Antonovsky formulated.While the present study did not address stability of SOC,

the strong cross-sectional consistency across samples,

indirectly point to a degree of stability in SOC also in

adolescence. As such the present study underscores the

need to adopt a life-span perspective when examining

the role of sense of coherence in health.

Importantly, the present findings were established in

relation to a kind of stress and health complaints that

the general population of adolescents are exposed to

during socialisation into adulthood. The cross-sectional

design does not permit us to draw strong practical

implications from the study, but the study does take a

first step in providing a conceptual framework for how

salutogenic factors may intervene on adolescent adapta-

tion to school-related demands.

Acknowledgements

The authors would like to thank Candace Currie for

preparation of the research protocol of the Health

Behaviour in School-Aged Children 1997/98 survey.

The writing of the manuscript was made possible

through a doctoral grant from the Norwegian Research

Council, division of medicine and health.

Appendix A. The age-adapted SOC-13

Here is a series of questions relating to various aspects

of our lives. Each question has five possible answers. For

each question, please mark the answer which bestexpresses your feelings about your life.

1. (Me) How often do you have the feeling that you

dont really care about what goes on around you?1

2. (C )How often has it happened in the past that you

were surprised by the behavior of people who you

thought you knew well?

3. (Ma) How often has it happened that people whom

you counted on disappointed you?

4. (Me) How do you think you are going to feel about

the things you will do in the future?

5. (Ma)How often do you have the feeling that you arebeing treated unfairly?

6. (C) How often do you have the feeling that you are

in a unfamiliar situation and dont know what to

do?

7. (Me) How do you feel about the things you do

every day?

8. (C) How often does it happen that you dont quite

understand your own feelings and ideas?

9. (C) How often does it happen that you have feelings

inside that you would rather not feel?

10. (Ma) Many people-even those with a strong

character- sometimes feel like losers in certain

situations. How often have you felt this way inthe past?

11. (C) How often does it happen that you have the

feeling that you dont know exactly whats about to

happen?

12. (Me) How often do you have the feeling that there

is little meaning in the things you do in your daily

life?

1Response keys for all questions except no.4 and no. 7 were:

Very often } Often } Sometimes } Seldom } Never. For

no.4 and no.7 response keys were : Like it a lot } Like it } Its

OK}

Dont like it}

Dont like it all.



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13. (Ma)How often do you have feelings that youre

not sure you can keep under control.

Appendix B. The HBSC school-related stress subscale

Do you agree or disagree with the following

statements? (strongly agree } agree } neither nor }

disagree } strongly disagree)

V1. I have too much schoolwork.

V2. I find schoolwork difficult.

V3. I find schoolwork tiring.

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