The Developmental Stage of Adolescence

Adolescence is a period of growth and development between childhood and adulthood. This developmental period involves new demands on the individual. A major task of this period is moving toward independence from dependency on the family; therefore, peers become a crucial socialization circle for the adolescent (Romeo, 2013; Spear, 2013). During this period, several physiological and cognitive changes occur as young people confront developmental tasks and challenges. During the last decade, there has been a marked increase in neurobiological research on cognitive, emotional, and behavioral changes, and development during adolescence. These studies have found that cognitively, adolescents, as well as adults, can suppress responses when no emotional information is provided (Tottenham et al., 2011). However, it is the avoidance of social cues during challenging situations in which adolescents have a difficulty to make a proper and rational response (Casey & Caudle, 2013). Thus, it seems that tension between regulation of behavior and sensitivity to positive environmental cues makes the response of the individual during the period of adolescence more complex (Somerville et al., 2011).

In line with the positive youth development perspectives (Damon, 2004), there is a growing recognition of the individuals who are eager to explore the world, to acquire competence, and to struggle with challenges and difficulties. This approach focuses on productive activities rather than on trying to cure and treat maladaptive tendencies. The agenda is to maximize the potential of the individual and to reduce the potential of hazardous, destructive, and antisocial behaviors (Lerner & Benson, 2003). The period of adolescence is a particularly important developmental stage since social, emotional, and cognitive processes are involved in attempts to navigate increasingly complex relationships (Blakemore & Mills, 2014). Indeed, it is during these years that abstract thinking and cognitive processing develop along with enhanced moral reasoning and judgment. These positive processes enable the adolescent to explore the world, gain competences, and contribute to the world surrounding him/her (Damon, 2004). As children age, their coping repertoire expands and shifts from primarily external, behavior-oriented to more internal, cognitively based strategies (Aldwin et al., 1994).

The advanced forms of reflection, such as the ability to consider things in hypothetical and abstract terms, and the ability to monitor one’s cognitive activity during the process of thinking, enable adolescents to see from the perspective of other persons, to plan, to anticipate the future consequences of an action, and to offer alternative explanations of events. Cognitive mastery is, therefore, an important contribution to young people’s ability to manage or regulate their feelings and to control their emotions and/or avoid being overwhelmed by them (Garnefski et al., 2001). These abilities also have the potential to influence the emotional–motivational and behavioral components of sense of coherence (SOC). It is during these years, as young people move from one experience of using specific coping resources to another, that different resources can be reviewed and crystalized.

In the following section, we present adjustments to the SOC questionnaire and discuss a variety of ways that researchers have approached the study of salutogenesis and adolescence.

Studies of SOC During Adolescence

Our literature search used Ebsco, PsycInfo, PubMed, SocioFile, and GoogleScholar, and we searched the sites of the publishers Sage, Springer, and Wiley. We looked at the last decade from 2014 to 2019 and included the search words: adolecs*, youth, sense of coherence, and salutogenesis. We came up with more than 30 articles and research from 16 countries in Europe, the Middle East, Australia, and the United States. Table 16.1 summarizes these studies.

Table 16.1 Studies of SOC during adolescence

The following themes emerged from the identified studies.

Adaptations of the SOC Questionnaires

Based on the original SOC questionnaire (Antonovsky, 1983), several researchers have examined the adaptability of the questionnaire to adolescent populations. For example, the adolescent sense of coherence scale (Antonovsky & Sagy, 1986) was adjusted to fit adolescents’ characteristics, that is, development of self-identity, orientation to one’s self society, confusion, unpredictable changes, close emotional ties with parents for the development of open communication, stability of the community, etc. Several items were removed from the original 29-item scale, and others were rephrased to make sure that adolescents understand the items (Antonovsky & Sagy, 1986), ending up with the final version of 13 items which is considered as a single factor and not the three separate components—meaningfulness, comprehensibility, and manageability (Hagquist & Andrich, 2004). Many studies have used this scale, and reliability proved to be very good (α ≈ 0.80). Another approach to the adaptation of the scale to the adolescence developmental stage was based on the use of the child version (CSOC) without the examples and distractors for younger children. The description of the CSOC can be found in the chapter on children (Margalit & Efrati, 1996). The adolescence adaptation from the CSOC consisted of 16 items (e.g., “When I want something I’m sure I’ll get it”; “When I need help there is someone around to help me”), on a five-point Likert-type scale ranging from 1 (never) to 5 (always). A Cronbach’s alpha of 0.78 was obtained (Levi et al., 2014).

The SOC Construct During Adolescence

The stability question regarding SOC accompanied this construct since the beginning of research about it. Antonovsky and Sagy (1986) argued that SOC should be strengthening during adolescence and stabilized toward the end of this developmental period. However, studies that addressed the issue of age and the stability of SOC revealed inconsistencies (Apers et al., 2013; Ayo-Yusuf et al., 2008; Garcia-Moya et al., 2013a, b, c, d; Kristensson & Öhlund, 2005; Moksnes et al., 2012). Indeed, Eriksson and Lindström (2007) stated that SOC is likely to vary during adolescence due to developmental changes, transitions, and challenges. While some researchers did not find differences among various age groups (Honkinen et al., 2008) and claimed the existence of SOC stability during adolescence (Kröninger-Jungaberle & Grevenstein, 2013), others focused on the variability between groups of adolescents between younger and older adolescents (Garcia-Moya et al., 2013a, b, c, d) as well as between groups with strong versus weak scores of SOC. The group with a weaker SOC reported more variability in its SOC scores (Buddeberg-Fischer et al., 2001).

Moreover, during periods of political violence , studies have shed light on the impacts of fragile periods and documented a drop in SOC levels during acute stress situations. However, once the acuteness is over, the SOC gains back its strengths (Braun-Lewensohn et al., 2013). Nevertheless, when adolescents face chronic states of stress, such as longitudinal missile attacks, the deterioration of the SOC remained stable over time (Braun-Lewensohn & Sagy, 2010).

Other demographic characteristics , apart from age, have significant roles in the determination of the SOC levels. Gender differences were examined, and many studies showed that the SOC scores of boys were higher than the scores of girls (Apers et al., 2013; Dorri et al., 2010; Evans et al., 2010; Kristensson & Öhlund, 2005; Moksnes et al., 2011, 2012; Nio, 2010). Also, socioeconomic status plays an important role in the SOC prediction. Thus, higher levels of parents’ education (Feldt et al., 2005; Geckova et al., 2010; Ristkari et al., 2009), higher economic status (Geckova et al., 2010), and living with two parents (Ayo-Yusuf et al., 2009) have been important indicators of stronger SOC. Lastly, membership in a minority group in different cultures around the world predicted weaker SOC scores than those of majority groups (Braun-Lewensohn, 2014; Braun-Lewensohn & Sagy, 2011a, b; Glanz et al., 2005).

SOC, Health, Mental Health, and Psychosocial Behavior

Examining the various studies , we found that the relations of health, mental health, and psychosocial behaviors with SOC were explored. More specifically, researchers investigated the SOC as a predictor of health outcomes, mental health, and diverse health-promoting behaviors during adolescence.

Several studies examined the relations between the SOC and general health (Eriksson & Lindström, 2006; Nilsson et al., 2003). Stronger SOC was related to better-perceived health, while weaker SOC was related to medication use. Moreover, SOC was negatively related to reported health problems (Blom et al., 2010; Garcia-Moya et al., 2013a, b, c, d; Geckova et al., 2010; Honkinen et al., 2005; Koushede & Holstein, 2009; Mattila et al., 2011; Modin et al., 2011; Moksnes et al., 2011; Myrin & Lagerström, 2006).

Other examinations related to health focused on groups with specific health problems. For example, surprisingly, adolescents with heart problems were found to have a stronger SOC compared to healthy adolescents. These results were explained by the fact that youngsters with such chronic disease have learned to cope with their problem, which increased their manageability, besides having existential implications that increased their meaningfulness. Moreover, a supportive home environment experienced by these adolescents emphasizes specific life events as being more comprehensible, manageable, and meaningful; hence, nurtured feelings of SOC (Luyckx et al., 2012). More expected results were found for adolescents with epilepsy where a weaker SOC was found in the long run, reflecting the experience of losing control during seizures and difficulty in assessing when to expect the next seizure. Following this line, those adolescents with no seizures had a stronger SOC (Gauffin et al., 2010).

Mental health has been the focus of numerous studies that examined diverse outcomes. Stress-related outcomes such as anxiety, anger, depression, psychological distress, and other emotional and internalizing or externalizing problems were examined in the context of political violence (Braun-Lewensohn & Sagy, 2010, 2011a, b; Sagy & Braun-Lewensohn, 2009) and with regard to challenging and extreme life events such as child abuse (Gustafsson et al., 2010) or juvenile delinquency (Koposov et al., 2003). However, adolescents were also examined during regular daily life with “normal” life stressors, such as academic, school, or peer pressure as well as family conflicts (Moksnes et al., 2012, 2013; Nielsen & Hansson, 2007; Ristkari et al., 2009; Simonsson et al., 2008). All these studies confirm that the SOC can be considered a resilience factor. It can be concluded that a strong SOC predicts reduced stress and decreased internalizing or/and externalizing problems.

Moreover, examining the relationships of SOC with psychosocial behaviors even strengthens the consideration of SOC as a resilient factor. Accordingly, results of various studies showed that adolescents with stronger SOC reported a healthier lifestyle, a better quality of life, and well-being (Honkinen et al., 2009; Neuner et al., 2011). The healthy lifestyle is related, on the one hand, to physical activities and exercises (Bronikowski, 2010) and, on the other hand, to smoking habits, alcohol abuse (Garcia-Moya et al., 2013a, b, c, d, 2013a; Myrin & Lagerström, 2006; Nielsen & Hansson, 2007), and eating habits (Myrin & Lagerström, 2006). Similarly, the relations between SOC and oral behavior (e.g., toothbrush habits) were reported. Stronger SOC was linked to lower gingivitis, more willingness to change toothbrush habits, and especially increased tooth brushing (e.g., Ayo-Yusuf et al., 2008, 2009; Dorri et al., 2010).

Ecological Contexts: Family, School, Peers, and Community

Ecological contexts (Bronfenbrenner, 1977, 1979; Bronfenbrenner & Morris, 2006) extend the consideration from a focus on the personal level to awareness and sensitization to contextual characteristics and systemic consideration such as the families, schools, and communities. Several family-related factors were examined in relation to the SOC. For example, open family communication (Garcia-Moya et al., 2013a, b, c, d; Marsh et al., 2007), focused parenting style (Garcia-Moya et al., 2013a, b, c, d), and parents’ knowledge regarding their children activities (Garcia-Moya et al., 2013a, b, c, d) were considered positive contributors to the development of a strong SOC. In addition, child-centered parenting during adolescence (examined within a longitudinal paradigm) predicted a stronger SOC at adulthood (Feldt et al., 2005).

In addition to examining family contexts and factors which could enhance or reduce personal SOC, few studies also related to family sense of coherence as another source to rely on when facing difficulties and/or stressful situations. Likewise the personal SOC, it was found that also family SOC is a resilient factor, and adolescents with stronger family SOC reported reduced stress (Sagy & Braun-Lewensohn, 2009; Sagy & Dotan, 2001).

Another important ecological system is school. While the family dimension produced mainly studies that pinpointed attention at the contribution of family characteristics to the development of SOC, studies of schools focused attention on outcomes, examining the adolescents’ achievement and adjustment, and their relationship to SOC as a mediation factor. Within the educational systems , a stronger SOC predicted high grades and enhanced academic motivation and success. Lower stress levels were also reported as related to stronger SOC (Honkinen et al., 2005; Kristensson & Öhlund, 2005; Lackaye & Margalit, 2006). Moreover, stronger SOC was linked to social competence (Mattila et al., 2011; Moksnes et al., 2011).

The school system provides a unique opportunity to look at particular populations with regard to SOC. Adolescents with learning disabilities are an additional example of the importance of the SOC (Idan & Margalit, 2014; Lackaye & Margalit, 2006). These youngsters are identified by their chronic academic challenges emerging from neurodevelopmental difficulties. Their difficulties at school systems remain a continuous source for increased stress, endless day-to-day struggling with age-appropriate academic roles, and with social and emotional consequences. Indeed their sources of stress are not dramatic, but their lasting impact is expressed in weaker SOC. Studies placed the SOC as a mediator of hopeful thinking, predicting adjustment and effort investment in school. The adolescents’ systems, such as families, schools, and communities, may further clarify the important role of the SOC and the factors that predict its development.

The focus on peer relations and community atmosphere produced studies that explored these factors as predictors of SOC development. An additional group of studies explored SOC as a collective construct contributing to the mental health of adolescents. Exploring SOC as a dependent variable, it seems that social support (Marsh et al., 2007), neighborhood or community cohesion (Garcia-Moya et al., 2013a, b, c, d; Marsh et al., 2007; Peled et al., 2013), and success in school (Garcia-Moya et al., 2013a, b, c, d) are all constructive in the development of strong SOC.

To expand the measurement of the SOC from the personal to the collective level, the sense of community coherence instrument was developed, which includes the components of comprehensibility, manageability, and meaningfulness (Braun-Lewensohn, 2014; Braun-Lewensohn & Sagy, 2011b; Peled et al., 2013). Comprehensibility refers to the sense of predictability, safety, and security felt by members of the community and the extent to which that community is understandable. A community’s manageability expresses its ability to assist its members, via treatment providers and group programs, among others, in times of crisis and distress. Lastly, the higher the level of meaningfulness among the members of a community, the abler they are to express themselves, and the higher the likelihood that they will feel satisfied with and challenged and interested by what the community has to offer them (Braun-Lewensohn & Sagy, 2011b). Recent studies showed that indeed the sense of community coherence is another source of support for coping during adolescence when facing acute or chronic types of stress, especially among collectivist cultures (Braun-Lewensohn, 2014; Braun-Lewensohn & Sagy, 2011b; Peled et al., 2013).

Conclusions, Implications, and Directions for Future Research

This chapter focused on the sense of coherence and salutogenesis during the developmental period of adolescence. While in many ways, adolescents appear to function similarly to adults, numerous cognitive, biological, and behavioral processes are formed and shaped on the path to maturity and normative adulthood.

A recent review on salutogenesis and the concept of SOC examined the influence of different factors such as gender and age as well as different developmental contexts (family, school, peers, and neighborhood) on the development of SOC (Rivera et al., 2013). In our current review, we extended conceptualization and research results regarding SOC during this important developmental period of adolescence within a different orientation. Mainly, we addressed how the SOC questionnaire was adopted to fit adolescent populations, as well as the clarifying ways how SOC is linked to different health, mental health, and psychosocial behaviors in different ecological contexts. We can conclude that the review of studies from around the world in the last decade demonstrated that personal and systemic (i.e., family and community) SOC are important resources for coping with a wide variety of stressful situations. The survey of the studies shows that the SOC may be considered as a protective factor for adolescents in different cultures. During adolescence, the SOC may contribute to moderating and mediating stress experiences and may also play a protective role, similar to that of the mature adult SOC.

The educational and community implications of the current consideration of the SOC as a critical resource call for the sensitizing educators and community workers to the importance of the salutogenic construct. Future empowering programs should be guided by this construct, leading to the development of prevention/inoculation to stress planning as well as programs promoting positive psychosocial and healthy behaviors and academic success.

Our review raises several directions for future research in the field of salutogenesis and the sense of coherence during adolescence. Despite developments, there are still some issues that require attention. This includes the role of family coherence as a protective factor for health and mental health, for success in school, and psychosocial behaviors that determine their relationships and their attitudes toward each other. Moreover, non-western cultural groups were less studied in this context. When studied, some questions regarding the universality of the concept of SOC were raised (Braun-Lewensohn & Sagy, 2011a). Thus, it seems important to examine this issue further. We should focus on the meanings of sense of coherence in such cultures as well as the understanding of the questionnaire and the implication of SOC in such societies.