Sense of coherence - A mediator between disability and handicap?

Background: The aim of this study was first to analyze the associations bet ween disability and handicap and Antonovsky's concept of sense of coherence (SOC); secondly, to find out how the SOC concept could be integrated in th e WHO model of impairments, disabilities, and handicaps (ICIDH). Methods: D ata from two studies were used: one on patients with rheumatoid arthritis, one on severely injured accident victims. Objective measures of the illness or the injury were conceptualized as indicator variables for disability, w hereas variables related to the patients' subjective judgement were concept ualized as indicator variables for handicap. Correlations were calculated b etween both sets of variables and the SOC scale total score. Results: SOC s howed no significant correlation with 'disability variables' (rheumatoid ar thritis: HAQ, SF36 physical functioning; accidental injuries: ISS, GCS). Ho wever, significant correlations were found between SOC and all 'handicap va riables' (rheumatoid arthritis: HAD, SF36 social functioning; accidental in juries: CAPS-2, IES, SCL-90-R depression subscale). Conclusions: SOC is rel ated to the psychosocial effects of health problems. It may be understood a s a mediator between disability and handicap. Prospective studies are neede d to clarify whether the SOC scale can be used as an outcome predictor with regard to psychosocial adaptation, in acute as well as in chronic health p roblems.