Sense of coherence and physical health-related quality of life in Italian chronic patients: the mediating role of the mental component

Maura Galletta; Manuela Cherchi; Alice Cocco; Giacomo Lai; Valentina Manca; Martina Pau; Federica Tatti; Giorgia Zambon; Simona Deidda; Pierangelo Origa; Elena Massa; Efisio Cossu; Francesco Boi; Paolo Contu

doi:10.1136/bmjopen-2019-030001

Sense of coherence and physical health-related quality of life in Italian chronic patients: the mediating role of the mental component

BMJ Open. 2019 Sep 17;9(9):e030001. doi: 10.1136/bmjopen-2019-030001.

Authors

Affiliations

¹ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy maura.galletta@gmail.com.
² Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
³ Department of Surgical Sciences, Colorectal Surgery Unit, University of Cagliari, Cagliari, Italy.
⁴ Department of Medical Sciences and Public Health, Medical Oncology Unit, University of Cagliari, Cagliari, Italy.
⁵ Department of Medical Sciences and Public Health, Endocrinology and Diabetes Unit, University of Cagliari, Cagliari, Italy.
⁶ Department of Medical Sciences and Public Health, Endocrinology Unit, University of Cagliari, Cagliari, Italy.

Abstract

Objective: To examine the relationship between sense of coherence (SOC) and physical health-related quality of life in patients with chronic illnesses by focusing on the mediating role of the mental component of quality of life.

Design: Cross-sectional survey design.

Setting: Secondary care; three departments of an Italian university hospital.

Methods: The participants (n=209) in the study were adult (≥18 years) outpatients with a chronic pathology (eg, diabetes, thyroid disorders or cancer) at any phase in the care trajectory (eg, pre-treatment, undergoing treatment, follow-up care). They agreed to participate in the study after providing their informed consent. Data were collected using a structured self-reporting questionnaire. Data analysis was carried out using SPSS, and mediation analysis was performed via PROCESS macro.

Results: The SOC score of the study sample was equivalent to that of the general population (mean difference=-2.50, 95% CI -4.57 to 0.00). Correlation analysis showed that SOC was mainly correlated to the mental component (MCS) (r=0.51, p<0.01) of quality of life and then to the physical component (PCS) (r=0.35, p<0.01). Mediation analysis showed that SOC was directly related to MCS (p<0.001, 95% CI 0.62 to 0.99) but not to PCS (p=0.42, 95% CI -0.27 to 0.12). In turn, MCS was directly related to PCS (p<0.001, 95% CI 0.76 to 1.01). The indirect effect of SOC on PCS through MCS was significant (0.71, p<0.001, bootstrap 95% CI 0.54 to 0.91), thus supporting the mediating role of the mental component of quality of life.

Conclusion: The indirect effect suggests that SOC is a marker of quality of life, especially of the mental component. The findings show that SOC is a psychological process that impacts patients' mental health status, which in turn affects physical health. Better knowledge of a person's SOC and how it affects his/her quality of life may help to plan tailoring interventions to strengthen SOC and improve health-related quality of life.

Keywords: Chronic patient; Health; Mediating role; Quality of life; Sense of Coherence.

MeSH terms

Adaptation, Psychological
Adolescent
Adult
Aged
Aged, 80 and over
Chronic Disease / psychology*
Cross-Sectional Studies
Female
Humans
Italy
Male
Middle Aged
Outpatients
Quality of Life*
Self Report
Sense of Coherence*
Young Adult