A critical analysis of Antonovsky’s sense of coherence theory in relation to mental health and mental disorder and the effect of a lifelong learning intervention on the sense of coherence of mental health service users.

The theoretical focus of this thesis is Antonovsky’s sense of coherence theory, the research paradigm is humanistic existential and the main area of investigation is mental health. The context of this thesis is the EU’s Empowerment of Mental Illness Service Users: Lifelong Learning and Action (EMILIA) project which sought to increase the social inclusion and empowerment of mental health service users through providing formal learning and employment opportunities.
Literature reviews were conducted on sense of coherence theory and on learning interventions for mental health service users. The sense of coherence literature review revealed a substantial level of research into the theory and its application. The investigation into learning interventions for mental health service users found that they can bring significant benefits.
The thesis considered how Antonovsky’s sense of coherence theory related to mental health and disorder and it found that the underlying theory has relevance in understanding coping with and the existence, development and treatment of mental disorder. The analysis indicated the possible mental health benefits of seeking to strengthen sense of coherence. The implications of the findings are discussed in relation to topics such as health care and recovery.
A combined research methods approach was taken to the assessment of the EMILIA project. A quantitative study was conducted using the SOC-13 (Antonovsky, 1987) measure to assess whether participation in the EMILIA project strengthened sense of coherence. The results showed that involvement in EMILIA significantly increased sense of coherence. This result supports efforts to increase the social inclusion and empowerment of mental health service users through providing learning and employment opportunities. The results also revealed that there was a strong positive correlation between SF-36-v2 mental health related quality of life and SOC-13 at baseline, follow-up and change over time. These results are in line with the majority of previous studies conducted in this area. Qualitative thematic analysis was used to assess the mechanisms and processes that led to this result. This analysis helped demonstrate that the EMILIA project strengthened participants’ ability to effectively respond to the needs and demands of their lives and it revealed insights into the mechanisms and application of SOC theory.
In response to Antonovsky’s call to study the sense of coherence concept using methods other than his orientation to life questionnaire, qualitative research methods were employed. This thesis investigated how sense of coherence theory applied when mapped onto descriptions by mental health service users of how they deal with problems that they face in their lives. The thematic analysis revealed that sense of coherence theory mapped effectively onto the interview transcripts. The analysis identified various factors that can be considered to be general resistance resources in the sense of coherence model. It also revealed distinctions between concrete and relationship orientated problem solving that led to an enhanced model of sense of coherence theory.
This thesis proposes that SOC theory can be regarded as a theoretical framework for designing interventions for mental health service users that seek to enhance coping, adaptability, recovery, social inclusion, and empowerment. The results suggest that programmes similar to EMILIA style opportunities should be an integrated part of recovery focused provision.
Overall commonalities in the findings of the two thesis studies provided new insights into the factors, mechanisms and processes involved in coping and adaption that are essential to and intertwined with SOC strength, mental health and recovery. Social capital was indentified as a key general resistance resource and the combined findings provide support for projects and interventions for mental health service users that seek to facilitate increased social capital.

A thesis submitted to Middlesex University in partial fulfilment of the requirements for the degree of Doctor of Philosophy (PhD).