The adolescent, at the very best, can only have gained a tentative strong SOC, which may be useful for a short-range prediction about coping with stressors and health status (Antonovsky, 1987, p. 107).

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, a number of physiological and cognitive changes occur while individuals are confronted with developmental tasks and challenges. During the last decade, there has been a marked increase in neurobiological research on the cognitive, emotional, and behavioral changes as well as development that occur during adolescence. These studies have found that cognitively, the adolescents as the adults are capable to suppress responses when no emotional information is provided (Tottenham, Hare, & Casey, 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, Hare, & Casey, 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 by this 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 the attempts to navigate the increasingly complex relationships (Blakemore & Mills, 2014). Indeed, it is during these years that abstract thinking and cognitive processing develops 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 grow older, their coping repertoire expands and shifts from primarily external, behavior-oriented to more internal, cognitively based strategies (Aldwin, 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 own cognitive activity during the process of thinking enable adolescents to see from the perspective of other persons, to plan ahead, 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 have also the potential to influence the emotional–motivational and behavioral components of SOC. It is during these years that as young people move from one experience of using certain coping resources to another, different resources can be reviewed and crystallized.

In the following section, we present special adjustments that have been done for the SOC questionnaire along with multitudes studies that focused on this development period and took different directions in the study of salutogenesis during adolescence.

SOC Studies During Adolescence

Since there are hundreds of papers and studies regarding adolescents and SOC, for the purpose of this chapter we decided to narrow down our search and thus the amount of papers included in this review. Our search included sites such as—Ebsco, PsycInfo, PubMed, SocioFile, and GoogleScholar, and in addition we searched the sites of Sage, Springer, and Wiley. We looked at the last decade from 2003 to 2013 and included the search words: adolecs*, youth, sense of coherence, and salutogenesis. We came up with more than 60 articles and research from 18 countries including Scandinavian countries, South Africa, Europe, Middle East, Australia, and the United States. Table 14.1 summarizes these studies.

Table 14.1 SOC Studies during adolescence

The following themes emerged from the identified studies:

Adaptations of the Sense of Coherence Questionnaires

Based on the original SOC questionnaire (Antonovsky, 1983), several researchers have examined the adaptability of the questionnaire to adolescent population. For example, the adolescent sense of coherence scale 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. Thus, several items were removed from the original 29 items scale and other were rephrased to make sure that the adolescents understand the items (Antonovsky & Sagy, 1986), ending up with the final version of 13 items which has been considered a single factor and not the three separate components—meaningfulness, comprehensibility, and manageability (Hagquist & Andrich, 2004). Since the original use of the updated scale many studies used this version and reliability proved to be very good (α ≈ .80). Another approach to the adaptation of the scale to the adolescence age stage was based on the use of the children version (CSOC ) without the examples and distractors that were requested for the younger children. The description of the CSOC can be found in the chapter on children. 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 .78 was obtained (Levi, Einav, Ziv, Raskind, & Margalit, 2014).

Sense of Coherence 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 which addressed the issue of age and the stability of SOC revealed inconsistencies (Apres et al., 2013; Ayo‐Yusuf, Reddy, & Van Den Borne, 2008; García-Moya et al., 2013; Kristnsson & Ohlund, 2005; Moksnes, Espnes, & Lillefjell, 2012). Indeed, Eriksson (2007) have 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 (Kroninger-Jungaberle, 2013), others focused on the variability between groups of adolescents between younger and older adolescents (García-Moya et al., 2013) as well as between groups with high vs. low scores of SOC. The group with lower SOC reported more variability in its SOC scores (Buddeberg-Fischer, Klaghofer, & Schnyder, 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, Sagy, Sabato, & Galili, 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).

Box 1: Coping Strategies as Mediators of the Relationship Between Sense of Coherence and Stress Reactions : Israeli Adolescents Under Missile Attacks

Orna Braun-Lewensohn, Shifra Sagy, Guy Roth—Anxiety, Stress & Coping, 24(3), 327–341: 2011.

Studies on adolescents have indicated that during adolescence SOC may play a protective role similar to that of the mature adult SOC (e.g., Braun‐Lewensohn & Sagy, 2010). However, in several studies conducted during acute stress situations (such as wars, terror, and evacuations), SOC was found weaker effect of explanation of the variance of stress reactions than in chronic stress situations (e.g., Sagy & Braun-Lewensohn, 2009). Thus, the present study sought to explore the contribution of SOC in an acute stress situation by trying to find other mediating factors which could explain the outcomes of stress reactions. Employing the interactionist cognitive approach (Lazarus & Folkman, 1984), we considered two variables that could be significant in mediating the relationship between the personal SOC and stress reactions: cognitive appraisal and coping strategies. The importance of this study is in its being a field research carried out in the midst of the stressful situation of war and severe missile attacks. Although previous studies indicated SOC as a weak factor in explaining stress reactions during acute stressful situations, the present study highlights the possibility that, through the mediating process of coping strategies, SOC could still have high explanatory effect on stress reactions not only in chronic states. The results of this study have drawn attention to the importance of SOC as a resilience factor during an acute stressful situation.

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 (Apres et al., 2013; Dorri, Sheiham, Hardy, & Watt, 2010; Evans, Marsh, & Weigel, 2010; Kristensson & Öhlund, 2005; Moksnes, Rannestad, Byrne, & Espnes, 2011; Moksnes et al., 2012; Nio, 2010). In addition, socioeconomic status plays an important role in the SOC prediction. Thus, higher levels of parents’ education (Feldt, Kokko, Kinnunen, & Pulkkinen, 2005; Geckova, Tavel, van Dijk, Abel, & Reijneveld, 2010; Ristkari et al., 2009), higher economic status (Geckova et al., 2010), and living with two parents (Ayo‐Yusuf, Reddy, & Van Den Borne, 2009) have been important indicators of stronger SOC. Lastly, membership in a minority group in different cultures around the world predicted lower SOC than the majority counter-parts members (Braun-Lewensohn, 2014; Braun-Lewensohn & Sagy, 2011a, 2011b; Glanz, Gertraud, & Carlin, 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. They reported that higher SOC has been related to a better perceived health while lower SOC was related to greater amounts of medication usage. Moreover, SOC was negatively related to reported health problems (Blom, Serlachius, Larsson, Theorell, & Ingvar, 2010; García-Moya et al., 2013; Geckova et al., 2010; Honkinen, Suominen, Välimaa, Helenius, & Rautava, 2005; Koushede & Holstein, 2009; Mattila et al., 2011; Modin, Östberg, Toivanen, & Sundell, 2011; Myrin & Lagerström, 2006; Moksnes et al., 2011).

Other examinations related to health focused on groups with specific health problems. For example, surprisingly, adolescents with heart problems were found to have higher 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 high existential implications that increases their meaningfulness. Moreover, a supportive home environment experienced by these adolescents emphasize specific life events as being more comprehensible, manageable, and meaningful hence, nurtured feelings of SOC (Luyckx, Missotten, Goossens, & Moons, 2012). More expected results were found for adolescents with epilepsy where decreased 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 higher SOC (Gauffin, Landtblom, & Räty, 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, 2011a, 2011b, 2010; Braun‐Lewensohn & Sagy, 2010; 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; Moksnes, Espnes, & Haugan, 2013; Nielsen & Hansson, 2007; Ristkari et al., 2009; Simonsson, Nilsson, Leppert, & Diwan, 2008). All these studies confirm that the SOC can be considered a resilient 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 higher SOC reported a more healthy life style, a better quality of life, and well-being (Honkinen et al., 2009; Neuner et al., 2011). The healthy lifestyle related on one hand to physical activities and exercises (Bronikowski, 2010) and on the other hand to smoking habits, alcohol abuse (García-Moya et al., 2013, 2013a; Myrin & Lagerström, 2006; Nielsen & Hansson, 2007), and eating habits (Myrin & Lagerström, 2006). Similarly, the relations between SOC and oral behavior were reported. Higher SOC was linked to lower gingivitis, more willingness to change tooth brush habits, and especially increased tooth brushing (e.g., Ayo‐Yusuf, Reddy, & Van Den Borne, 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 personal levels 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 SOC. For example, open family communication (García-Moya et al., 2013; Marsh et al., 2007) focused parenting style (García-Moya et al., 2013) and parents’ knowledge regarding their children activities (García-Moya et al., 2013) 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 the 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, enhanced academic motivation, and success. A 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 special populations with regard to SOC. Adolescents with learning disabilities are an additional example to 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 chronic impact are expressed in lower 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 which explored these factors as predictors to SOC development. An additional group of studies explored SOC as a collective construct contributing to the mental health of adolescents. Exploring SOC as dependent variable, it seems that social support (Marsh et al., 2007) neighborhood or community cohesion (García-Moya et al., 2013; Marsh et al., 2007; Peled, Sagy, & Braun-Lewensohn, 2013) and success in school (García-Moya et al., 2013) are all constructive in the development of strong SOC.

In a different vein, and as an experience to expand SOC from personal to collective level an adjusted instrument, sense of community coherence, that includes Antonovsky’s components of personal SOC—comprehensibility, manageability, and meaningfulness (Braun-Lewensohn, 2014; Braun-Lewensohn & Sagy, 2011b; Peled et al., 2013) was developed. 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 more able they are to express themselves and the greater the likelihood that they will feel satisfied with and challenged and interested by what the community has to offer them (Braun-Lewensohn & Sagy, 2011b; Sagy & Dotan, 2001). Recent studies showed that indeed sense of community coherence is another source of support to effective coping during adolescence when facing acute or chronic types of stress especially among collectivist cultures (Braun-Lewensohn, 2014; Braun-Lewensohn & Sagy, 2011a, 2011b; Peled et al., 2013).

Conclusions, Implications, and Future Research Directions

This chapter focused on sense of coherence and salutogenesis during the developmental period of adolescence. As noted earlier in this chapter, the uniqueness of this developmental stage is the many challenges and changes which individuals are going through during these years. While in many ways the adolescents appear to function similar to adults, there are numerous cognitive, biological, and behavioral processes which are being formed and shaped during these years in the paths 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 the way in which 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 behavior in different ecological contexts. We 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 meaningful resources for effective 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, calls 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 sense of coherence during adolescence. In spite of the many studies that have been conducted and published in the last decades and the important developments in this field, there are still some venues that have been neglected. First, the role of family coherence as a protective factor for health and mental health as well as relationships with success in school and other psychosocial behaviors should be further explored. 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, 2011b). Thus, it seems important to further examine this issue. 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.

Box 2: Coping Resources and Stress Reactions Among Three Cultural Groups One Year After a Natural Disaster

Orna Braun-Lewensohn Clinical Social Work, DOI:10.1007/s10615-013-0463-0: 2014

A year after a huge bush fire, adolescents from three cultures—Jews, Muslims, and Druze—located in the Carmel district (the area of the fire) were asked to report their personal and community sense of coherence (SOC) as well as their stress reactions of anxiety, anger, and psychological distress. We wanted to examine Antonovsky’s conviction (1987) that sense of coherence (SOC) is a cross-cultural concept by comparing adolescents belonging to the majority group, an individualistic culture (Jews), to members of two minority groups which are collectivistic cultures (Muslim and Druze), in terms of personal and community SOC as well as on stress reactions. We also wanted to determine whether the coping resources explained similarly or differently the stress reactions which were examined. Results show that although levels of personal SOC varied significantly across the groups, with the majority group having the strongest sense of coherence, personal SOC had a strong protective effect against stress reactions in all groups. Community SOC, in turn, had a protective effect only for members of collectivist culture. We can cautiously conclude, therefore, that it may be possible for different cultures to have their own, culturally relevant translations for SOC so that it becomes a meaningful protective factor when confronting stressful situations.