Sense of coherence in Palestinian helpers operating in emergency settings: a mediation study

Background Palestinian helpers—such as medics, paramedics, and mental health personnel—operating in emergency settings are commonly recognised as being at risk of developing trauma symptoms. Research has assessed the role of sense of coherence (SOC) as a key determinant of reactions to psychological distress in these emergency workers. SOC is a global tendency to view one's environment as comprehensible, manageable, and meaningful. In this study, we aimed to assess the functioning of SOC as a determinant of the interaction between individual helper's primary responses to traumatic events (assessed via intrusion and avoidance measures) and the secondary effects in terms of general psychological distress (as shown in levels of anxiety, social dysfunction, and loss of self-confidence). Three hypotheses were tested: first, that SOC would mediate the association between effects of traumatic events with anxiety, social dysfunction, and loss of confidence. Methods The research project included physicians, psychiatrists, social workers, and volunteers at public hospitals in three different areas of the occupied Palestinian territory. We administered the General Health Questionnaire, SOC scale, and Impact of Event Scale. We did multivariate regression and mediation analysis to assess whether and to what extent SOC affected the effects of trauma on helpers. All analyses were done with SPSS 22. The participants gave written informed consent. The research was approved by the ethics committee of Milano-Bicocca University. Findings We recruited 218 people to our study. Of those recruited, 122 were men (56%) and 96 were women (44%). Mean age of participants was 30·4 years (SD 8·68, range 18–59). SOC was found to be a determinant of the association between effects of traumatic events and anxiety (F=5·44, p=0·03) and loss of confidence (F=15·67, p=0·0028). Analysis suggested that SOC partly mediated the effects of trauma on both anxiety (β=0·287, p=0·0018) and social dysfunction (β=0·282, p=0·0022), whereas it fully mediated the relationship between trauma and loss of confidence (β=0·055, p=0·627). Interpretation Our findings suggest that SOC helps individuals to manage and overcome traumatic experiences, reduce anxiety and sense of bereavement, and maintain a functioning system of relationships in the wake of trauma. Thus, SOC displays protective abilities that might be assessed and targeted for training or clinical treatment in this specific group of professionals