Studies meeting inclusion criteria
Our initial search revealed a total of 286 titles. After screening, 94 duplicate titles were removed. Of the remaining 192 titles, 137 papers were excluded based on the inclusion and exclusion criteria. A detailed examination of the full manuscripts (n = 55) eliminated 6 papers due to measurements of SOC in the post-partum period (n = 5) [25–29] and one paper involved fathers/partners only as responders [30]. Forty-nine papers remained for analysis [31–79].
General characteristics of included studies
The data extracted are summarized in Tables 1 and 2. The majority of the studies recruited subjects from free standing clinics (n = 21; 42.9%) of various types (i.e., antenatal, fertility, ultrasound imaging, midwifery), hospital maternity wards (n = 20; 40.8%); combination of clinics or social media (n = 2; 4.1%), pregnancy and parenting online platforms (n = 4; 8.2%) and newsletter support group and magazines (n = 2; 4.1%). The PROs and their relationship with SOC are provided in Tables 3 and 4, based on study design. Of the 49 manuscripts reviewed, the majority (n = 31; 63.3%) of the studies were prospective cohort in design while the remainder (n = 18; 36.7%) were cross sectional cohorts. A combined total of 28,990 subjects (i.e., pregnant responders and their partners or controls) were counted with 93.8% (n = 27,186) involving pregnant women completing a SOC questionnaire.
Table 1
Study aims, country of origin, research design, SOC instrument and sample size of manuscripts reviewed.
References
|
Study Aim
|
Country of Origin
|
SOC Instrument
|
Study Design
|
Total Responders
|
Pregnant Responders
|
Yu et al. (2022) [31]
|
To estimate differences in levels of health-promoting behavior during the trimesters, identify distinct patterns of health-promoting behavior trajectories and evaluate predictors of these trajectory group memberships.
|
China
|
SOC-13
|
Prospective Cohort
|
158
|
158
|
Pasricha et al. (2021) [32]
|
To investigate the associations of expecting mothers’ SOC, perceived social support, and maternal-fetal attachment with mental health outcomes
|
India
|
SOC-13
|
Cross-sectional cohort
|
122
|
122
|
Muggleton et al. (2021) [33]
|
To compare outcomes for women/people attending a conventional childbirth education program with those attending a salutogenic childbirth education program.
|
Australia
|
SOC-13
|
Prospective Cohort
|
206
|
153
|
Hildingsson et al. (2021) [34]
|
To evaluate women’s experiences of pregnancy and antenatal care, gauge their emotional well-being and satisfaction in a continuity of midwifery care project.
|
Sweden
|
SOC-29
|
Prospective Cohort
|
226
|
226
|
Hildingsson et al. (2021) [35]
|
To assess the relationship between birth outcome and birth experience with a woman’s emotional health, continuity with a known midwife, and their birth experience.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
243
|
243
|
Einav et al. (2020) [36]
|
To examine whether the marital experience of individuals change and develop according to various phases in their family unit, particularly those related to their personal, parental, and marital practice.
|
Israel
|
SOC-13
|
Cross-sectional Cohort
|
137
|
38
|
Finnbogadottir et al. (2020) [37]
|
To explore childbirth outcomes in women with a history of violence including domestic violence during pregnancy.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
1694
|
1694
|
Voogand et al. (2020) [38]
|
To assess the relationship between FOC and SOC, and their components in women expecting their first child.
|
Sweden
|
SOC-13
|
Cross-sectional cohort
|
414
|
414
|
Asif et al. (2020) [39]
|
To assess the association between severe obstetric perineal lacerations and PPD symptoms and among women with low resilience
|
Sweden
|
SOC-29
|
Cross-sectional cohort
|
2026
|
2026
|
Neerland et al (2020) [40]
|
To develop and assess the reliability and validity of the P-LAB instrument during the third trimester of pregnancy.
|
USA
|
SOC-13
|
Prospective Cohort
|
206
|
206
|
Bratt et al. (2019) [41]
|
To evaluate the influence of time of diagnosis of fetal congestive heart failure on parental distress.
|
Sweden
|
SOC-13
|
Prospective cohort
|
232
|
232
|
Mohamamdirizi et al. (2018) [42]
|
To determine the SOC and fear of childbirth in high and low risk pregnancies.
|
Iran
|
SOC-29
|
Cross-sectional cohort
|
440
|
440
|
Bäckström et al. (2018) [43]
|
To evaluate the factors associated with quality of couple relationship among first-time mothers and partners during pregnancy and the first six months of parenthood.
|
Sweden
|
SOC-13
|
Prospective cohort
|
207
|
207
|
Przestrzelska et al. (2018) [44]
|
To evaluate the factors affecting SOC among women during pregnancy.
|
Poland
|
SOC-29
|
Cross-sectional cohort
|
400
|
400
|
Staneva et al. (2018) [45]
|
To examine the relationship of psychosocial factors during pregnancy to adverse birth outcomes.
|
Australia & New Zealand
|
SOC-13
|
Prospective Cohort
|
285
|
285
|
Hildingsson (2017) [46]
|
To investigate changes in SOC from early pregnancy to one year after birth and the role of background characteristics, birth outcome and parental stress.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
3058
|
3058
|
Linden et al. (2016) [47]
|
To explore well-being and diabetes management in women with type 1 diabetes mellitus in early pregnancy.
|
Norway
|
SOC-13
|
Cross-sectional Cohort
|
168
|
168
|
Ngai and Ngu (2016) [48]
|
To examine the relationship of family and marital functioning and family SOC among Chinese couples during pregnancy, at 6 weeks and 6 months postpartum.
|
China
|
Family SOC-12
|
Prospective Cohort
|
404
|
202
|
Ferguson et al. (2016) [49]
|
To explore associations between pregnant women's SOC and their birthing outcomes and identify factors that influence a change in women's SOC scores from the antenatal to the postnatal period
|
Australia
|
SOC-13
|
Prospective Cohort
|
753
|
753
|
Staneva et al. (2016) [50]
|
To explore various factors that contribute to increased distress for women during pregnancy and the role of SOC and maternal orientations.
|
Australia & New Zealand
|
SOC-13
|
Cross-sectional Cohort
|
293
|
293
|
Ferguson et al. (2015) [51]
|
To investigate the relationship between SOC and women's pregnancy and anticipated labor choices.
|
Australia
|
SOC-13 & SOC 9
|
Cross-sectional Cohort
|
1074
|
1074
|
Carlsson et al. (2015) [52]
|
To examine the relationship between women's childbirth self-efficacy beliefs to aspects of well-being in the third trimester of pregnancy and associations between childbirth self-efficacy and obstetric factors.
|
Sweden
|
SOC-13
|
Cross-sectional Cohort
|
406
|
406
|
Ferguson et al. (2015) [53]
|
To examine the validity and reliability of the SOC-13 among pregnant Australian women and the relationship between SOC and a woman’s childbirth choices and outcomes.
|
Australia
|
SOC-13 & SOC 9
|
Cross Sectional Cohort
|
718
|
718
|
Sekizuka-Kagami et al. (2015) [54]
|
To examine the association of pregnant women’s SOC scores with threatened premature birth.
|
Japan
|
SOC-13
|
Cross Sectional Cohort
|
43
|
43
|
Ngai and Ngu (2014) [55]
|
To investigate the risk factors associated with postnatal depression in mothers and fathers, the predictive role of family SOC, stress, social support, and family and marital functioning during pregnancy and the effect of changes in these factors during the perinatal period.
|
China
|
Family SOC-12
|
Prospective Cohort
|
400
|
200
|
Finnbogadóttir et al. (2014) [56]
|
To explore the prevalence of domestic violence among pregnant women in southern Sweden and its association with background factors
|
Sweden
|
SOC-13
|
Cross Sectional Cohort
|
1939
|
1939
|
Ngai and Ngu (2014) [57]
|
To investigate the predictive role of family SOC, social support and stress during pregnancy among Chinese parents and the effect that any changes in these factors may have on family and marital functioning at 6 weeks postpartum.
|
China
|
Family SOC-12
|
Prospective Cohort
|
404
|
202
|
Takegata et al. (2014) [58]
|
To determine the relationship between antenatal FOC and SOC among healthy Japanese pregnant women.
|
Japan
|
SOC-13
|
Cross Sectional Cohort
|
240
|
240
|
Ngai and Ngu (2014) [59]
|
To examine the relationship between family SOC, stress, family and marital functioning, and depressive symptoms among Chinese childbearing couples.
|
China
|
Family SOC-12
|
Cross sectional cohort
|
448
|
224
|
Swartz et al. (2013) [60]
|
To investigate if SOC varies between groups of parents with three different lifestyles (i.e., anthroposophic, partly anthroposophic and non- anthroposophic) and assess if parental SOC related to the diurnal cortisol levels and to the levels of their infants at the age of 6, 12 and 24 months.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
556
|
284
|
Ngai and Ngu (2013) [61]
|
To investigate the relationship between family SOC, social support, stress, QoL and depressive symptoms in first-time Chinese childbearing women and the mediating role of family SOC on stress, QoL and depressive symptoms.
|
China
|
Family SOC-12
|
Cross sectional cohort
|
267
|
267
|
Jeschke et al. (2012) [62]
|
To determine whether the previous use of EA or a low SOC are independent predictors of a delivery with EA.
|
Germany
|
SOC-29
|
Cross sectional cohort
|
193
|
193
|
Larsson et al. (2009) [63]
|
To evaluate parents’ worry and SOC before and after a routine second-trimester ultrasound examination and to compare groups with normal and abnormal findings.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
2049
|
1197
|
Ekelin et al. (2009) [64]
|
To investigate parents’ expectations, experiences and reactions, SOC and degree of anxiety before and after a second-trimester routine ultrasound examination with normal findings.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
SOC-13
|
1258
|
Sekizuka et al. (2009) [65]
|
To assess the validity of s-IgA and SOC as predictors of threatened premature birth.
|
Japan
|
SOC-13
|
Prospective Cohort
|
72
|
72
|
Larsson et al. (2009) [66]
|
To compare parents’ experience of a routine ultrasound examination in the second trimester of pregnancy when CPC was found and evaluate how the SOC, STAI and PEER-U differed before and after the ultrasound examination within and between the study and control groups.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
88
|
52
|
Oz et al. (2009) [67]
|
To explore the relationship between SOC and perceived stress and uncomplicated labor.
|
Israel
|
SOC-13
|
Prospective Cohort
|
145
|
145
|
Hibino et al. (2009) [68]
|
To assess the health impact of stress on women who were pregnant during, or immediately after, a major earthquake and were living in the disaster area.
|
Japan
|
SOC-13
|
Prospective Cohort
|
99
|
99
|
Ekelin et al. (2008) [69]
|
To develop and test a specific questionnaire to measure parents’ expectations, experiences and reactions to routine ultrasound examinations during pregnancy.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
126
|
63
|
Hellmers et al. (2008) [70]
|
To evaluate the preferred mode of birth among first-time mothers in Germany and USA and its relationship to maternal wellbeing and SOC.
|
USA and Germany
|
SOC-L9
|
Prospective Cohort
|
374
|
374
|
Hildingsson et al. (2008) [71]
|
To investigate the proportion of women dissatisfied with partner support in early pregnancy, identify the characteristics of women dissatisfied with partner support and to follow up these women’s situation 2 months and 1 year after childbirth.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
2430
|
2430
|
Habroe et al. (2007) [72]
|
To assess if childbirth after ART results in high SOC and does baseline SOC influence the association between childbirth after ART and SOC at 1-year follow-up.
|
Denmark
|
SOC-9
|
Prospective Cohort
|
1934
|
1025
|
Rudman et al. (2007) [73]
|
To investigate women’s satisfaction with intrapartum care along three distinct dimensions (i.e., interpersonal care, information and involvement in decision-making and physical birth environment) and describe the characteristics of women with different patterns of satisfaction.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
2605
|
2605
|
Sekizuka et al. (2006) [74]
|
To evaluate postpartum stress reactions using a postpartum depression scale and by measuring the level of a stress-related substance.
|
Japan
|
SOC-29
|
Prospective Cohort
|
50
|
50
|
Almedom et al. (2005) [75]
|
To examine SOC and salivary cortisol levels at immediate prenatal and postnatal periods.
|
Eritrea
|
SOC-13
|
Prospective Cohort
|
SOC-13
|
50
|
Sjöström et al. (2004) [76]
|
To describe pregnant women’s perception of wellbeing during pregnancy and after delivery and to explore a possible relationship with their SOC.
|
Sweden
|
SOC-13
|
Prospective Cohort
|
120
|
120
|
Engelhard et al. (2003) [77]
|
To explore the relationship between SOC in early pregnancy and PTSD after pregnancy loss, the relationship between SOC and post-loss depressive symptoms and the role of crisis support as a mediator between SOC and PTSD
|
Holland
|
SOC-13
|
Prospective Cohort
|
117
|
117
|
Abrahamsson and Ejlertsson (2002) [78]
|
To examine the relationship between SOC, smoking and health variables
|
Sweden
|
SOC-13
|
Prospective Cohort
|
337
|
337
|
Uren and Wastell (2002) [79]
|
To assess the degree to which the phenomenological experience of perinatal bereavement is consistent with both attachment theory and the theoretical account in trauma research of coping as meaning-making, the extent to which current grief acuity is related to attachment security and the search for meaning and the predictive power of SOC to current grief acuity.
|
Australia
|
SOC-29
|
Cross -sectional
|
84
|
84
|
ART = assisted reproductive technology; CPC = choroid plexus cyst/cysts; EA = epidural anesthesia; FOC = fear of childbirth; PEER-U = Parent’s Expectations, Experiences and Reactions to routine Ultrasound examination; P-LAB = Preparation for Labor and Birth; PPD = postpartum depressive; PTSD = posttraumatic stress disorder SOC = sense of coherence; QoL = quality of life; s-IgA = secretory immunoglobulin A; STAI = State-Trait Anxiety Inventory; USA = United States of America
|
Table 2
Patient outcomes, weeks of gestation/trimester of pregnancy and summary findings of SOC and patient outcomes in the reviewed manuscripts.
References
|
Validated PRO and/or Outcome Measures
|
Weeks of Gestation
|
Trimester
|
Summary of Findings of SOC with respect to PROs
|
Yu et al. (2022) [31]
|
• Family Adaptability, Partnership, Growth, Affection, Resolution (APGAR) Index
• Chinese version of General self-efficacy scale (GSES)
• Health-Promoting Lifestyle Profile
|
12, 24 and 36
|
1-2-3
|
Low-increase health promoting behavior trajectory was associated with low maternal SOC
|
Pasricha et al. (2021) [32]
|
• Edinburg Postnatal Depression scale (EPDS)
• Multidimensional Scale of Perceived Social Support
• Short Warwick Edinburgh Mental Well-Being Scale
• Maternal Fetal Attachment Scale
|
NR
|
2 and 3
|
SOC and perceived social support were found to uniquely contribute to the variance in antenatal depressive symptoms while SOC and maternal-fetal attachment uniquely contributed to the variance in antenatal well-being
|
Muggleton et al. (2021) [33]
|
• SOC-13
|
NR
|
NR
|
The new program demonstrated statistically significant increases in each component of the SOC.
|
Hildingsson (2021) [34]
|
• Edinburg Postnatal Depression scale (EPDS)
• Fear of Childbirth
• Cambridge Worry Scale
|
Mid-pregnancy (i.e., 39th week of gestation) and 2 months after birth
|
--------
|
Cluster 1 (women who did not have a known midwife during labor and birth (reference group) were women with low levels of depressive symptoms, fear of birth, with major worries and high levels of SOC. Cluster 2 (women who did not have a known midwife during labor and birth showed the opposite pattern, with higher levels of depressive symptoms, fear, and worries, and lower SOC.
|
Hildingsson et al. (2021) [35]
|
• Cambridge Worry Scale (CWS)
• Edinburg Postnatal Depression scale (EPDS)
• Fear of Childbirth (FOC)
• Childbirth Experience Questionnaire (CEQ)
|
Mid-pregnancy (i.e., 39th week of gestation) and 2 months after birth
|
|
Women in the “emotionally unhealthy” cluster (i.e., those afraid of birth, having depressive symptoms, low SOC, and major worries, who did not have a known midwife during birth scored lowest in all domains of the CEQ.
|
Einav et al. (2020) [36]
|
• Parental Self-Efficacy Scale
• Future Parental Self-Efficacy Scale
• Parental Satisfaction Questionnaire
• Relationship Assessment Scale
|
NR
|
NR
|
As the level of SOC increased, the levels of maternal and relationship satisfaction also increased, and vice versa. There was no link found between maternal efficacy and SOC and no differences between the
groups in their SOC (F(2,107) = 0.77; p = 0.46; partial g92 = 0.01).
|
Finnbogadottir et al. (2020) [37]
|
• NorVold Abuse Questionnaire (NorAQ)
• Edinburgh Postnatal Depression Scale (EPDS)
• The Alcohol Use Disorders Identification Test (AUDIT)
|
Q1 at second trimester and Q2 in late pregnancy (mean week of gestation =
33.9; SD 2.20)
|
|
Women reporting a history of violence also reported a significantly lower SOC score and higher EDS scores than women who did not.
|
Voogand et al. (2020) [38]
|
• Wijma Delivery Expectancy Questionnaire Version A (WDEQ-A)
|
NR
|
NR
|
The analysis of FOC and SOC showed a significant negative correlation (n = 414, p < 0.001). In the analysis of the three components of SOC, only comprehensibility showed a significant correlation with FOC (n = 414; p < 0.001). Pearson’s r= -0.376; p < 0.001
|
Asif et al. (2020) [39]
|
• Depression Self-Reporting Scale (DSRS)
• Swedish version of Edinburgh Postnatal Depression scale (EPDS)
|
32
|
|
A strong association was detected with depression among women with low resilience. The study also showed that resilience (as measured by SOC-29) was involved in moderating the risk for postpartum depression after an obstetric adverse outcome.
|
Bratt et al. (2019) [41]
|
• Hospital Anxiety and Depression Scale (HAD) (Swedish version)
• Life Satisfaction Scale
• Dyadic Adjustment Scale (DAS)
|
22+ (T1); 2–6 months postnatally (T3)
|
2
|
Parents with a fetus prenatally diagnosed with congenital heart disease scored lower life satisfaction and SOC than parents with a postnatal diagnosis.
|
Mohamamdirizi et al. (2018) [42]
|
• Fear of Childbirth Questionnaire (FOC)
|
28.5 (SD = 1.33)
|
3
|
High SOC scores found in high-risk pregnancies compared to low risk pregnancies but no differences in FOC between the two groups. No significant correlation between SOC and FOC in the two groups.
|
Bäckström et al. (2018) [43]
|
• Quality of Dyadic Relationship-36 (QDR-36)
• Multidimensional Scale of Perceived Social Support (MSPSS)
|
25
|
2
|
Among first-time mothers, better perceived couple relationship quality six months after childbirth was statistically significantly associated higher SOC at gestational week 25 and more positive change in SOC between gestational week 25 and 6 months postpartum.
|
Przestrzelska et al. (2018) [44]
|
• Edinburgh Postnatal Depression Scale (EPDS)
|
≧ 30
|
3
|
The deficit of social support, especially the lack of support from the husband/partner and risk of depression was noticeably correlated with a low SOC
|
Staneva et al. (2018) [45]
|
• Pregnancy Risk Assessment Monitoring System (PRAMS).
• Revised Prenatal Distress Questionnaire (NuPDQ)
• Edinburgh Postnatal Depression Scale (EPDS)
• Multidimensional Scale of Perceived Social Support (MSPSS)
• Antenatal Maternal Orientation Measure-Revised
|
12–26 (T1), > 26 (T2), 3– 6 months postpartum (T3)
|
Not Specified
|
SOC was not associated with birth outcome. Negative relationships between higher depressive and anxiety symptoms and a Regulator orientation were correlated with lower SOC while having a strong social support was correlated with a higher SOC.
|
Hildingsson (2017) [46]
|
• Edinburgh Postnatal Depression Scale (EPDS)
• Cambridge Worry Scale
• Swedish Parenting Stress Questionnaire (SPSQ)
|
10–13
|
1
|
Low SOC was associated with women who were single, not born in Sweden, younger than 25 years, low level of education, tobacco users, had unplanned pregnancies, less positive attitudes towards being pregnant, towards the birth and the newborn baby and those who lacked support from their partner. Women with depressive symptoms, those who preferred a Caesarean section, and women with major worries about giving birth, the baby’s health and going to hospital also reported lower scores on SOC compared to women without these characteristics.
|
Linden et al. (2016) [47]
|
• Well-Being Questionnaire (WBQ-12)
• Swedish Diabetes Empowerment Scale (SWE-DES-10)
• Swedish-Problem Areas in Diabetes Scale (SWE-PAID-20)
• Swedish Hypoglycemia Fear Survey (SWE-HFS)
• Hemoglobin A1c (HbA1c)
|
11.2 (SD = 4.8)
|
1
|
High SOC was associated with high/positive scores for self-efficacy in diabetes management, a high total score for well-being, and self-rated overall health and low total scoring for diabetes distress and hypoglycemia fear. Correlation of HbA1c in early pregnancy with SOC-13 (r = − 0.23 (p < 0.01) was statistically significant.
|
Ngai and Ngu (2016) [48]
|
• The Medical Outcomes Study Family and Marital Functioning Measures (MOS-FMFM)
|
NR
|
NR
|
High correlation of prenatal SOC and prenatal family and marital functioning. Strong family sense of coherence correlated significantly with better functioning during pregnancy and at 6 weeks and 6 months postpartum in both sub-groups.
|
Ferguson et al. (2016) [49]
|
• Support Behaviour Inventory (SBI) Scale
• Edinburgh Postnatal Depression Scale (EPDS)
|
18.6 (SD = 7.4)
|
2
|
Women with high SOC were less likely to experience Caesarean sections and more likely to experience assisted vaginal birth, more likely to be older, to have higher SBI scores and lower EPDS scores. Antenatal SOC scores were not associated with induction of labor, epidural use, spontaneous vaginal birth or birth satisfaction.
|
Staneva et al. (2016) [50]
|
• Prenatal Distress Questionnaire
• Edinburgh Postnatal Depression Scale (EPDS)
• Antenatal Maternal Orientation Measure-Revised
|
18.6 (SD = 0.21)
|
2 and 3
|
Lower SOC was highly and significantly associated with pregnancy-specific distress, depressive symptoms, impaired interpersonal relationships with both partners and a woman’s own mother, and with maternal orientations (i.e., negatively correlated with a Regulator mothering style and positively correlated with the Facilitator mothering).
|
Ferguson et al. (2015) [51]
|
• Support Behaviour Inventory (SBI) Scale
• Edinburgh Postnatal Depression Scale (EPDS)
|
18.6 (SD = 7.4)
|
2
|
SOC scores were not associated with the pregnancy or anticipated labor choices of women. As age and SBI scores increased, the likelihood of a high SOC score increased. As EPDS scores increased the likelihood of high SOC decreased.
|
Carlsson et al. (2015) [52]
|
• Swedish Childbirth Self-Efficacy Inventory (Swe-CBSEI)
• Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ)
• Maternity Social Support Scale (MSSS)
• Profile of Mood States (POMS)
|
35–42
|
3
|
Those with high childbirth self-efficacy also had higher SOC scores. SOC was positively correlated with: MSSS; Swe-CBSEI; and POMS Vigour. SOC was negatively correlated with: JW-WEDQ; POMS fatigue; POMS confusion; POMS tension and POMS depression.
|
Ferguson et al. (2015) [53]
|
• Edinburgh Postnatal Depression Scale (EPDS)
|
< 30
|
NR
|
There was a significant negative relationship between SOC-13 scores and EPDS scores and between SOC-9 scores and EPDS scores.
|
Sekizuka-Kagami et al. (2015) [44]
|
• Stress Perception Scale
|
18.1 (SD = 3.1)
|
2
|
A low SOC-13 scale score was associated with threatened premature birth.
|
Ngai and Ngu (2014) [55]
|
• General Health Questionnaire (GHQ)
• Social Readjustment Rating Scale (SRRS)
• Medical Outcomes Study Social Support Survey (MOS-SSS)
• Medical Outcomes Study Family and Marital Functioning Measures (MOS-FMFM)
|
NR
|
NR
|
A low score on the family SOC, poor social support and depressive symptoms during pregnancy correlated significantly with high depressive symptoms at six months postpartum in both mothers and fathers. Prenatal family and marital functioning had a high correlation with prenatal Family SOC
|
Finnbogadóttir et al. (2014) [56]
|
• Abuse Assessment Screen: “Have you been exposed to abuse during current pregnancy?”
• NorVold Abuse Questionnaire
• Edinburgh Postnatal Depression Scale (EPDS)
• Alcohol Use Disorders Identification Test (AUDIT
|
13
|
2
|
Women having a low SOC score indicated an inability to use their own resources to maintain and improve their health in stressful situations and were 9.1 times more likely to be exposed to domestic violence during pregnancy.
|
Ngai and Ngu (2014) [57]
|
• Medical Outcomes Study Family and Marital Functioning Measures (MOS-FMFM)
• Medical Outcomes Study Social Support Survey (MOS-SSS)
• Social Readjustment Rating Scale (SRRS)
|
NR
|
NR
|
Prenatal Family and Marital Functioning and prenatal Family SOC were strongly correlated. Among mothers, significant factors associated with better family and marital functioning at six weeks postpartum was greater family SOC, higher social support and less stress during pregnancy and less changes in family SOC and stress from pregnancy to six weeks postpartum.
|
Takegata et al. (2014) [58]
|
• Wijma Delivery Expectancy/Experience Questionnaire
|
37
|
3
|
Higher SOC was correlated with lower fear of childbirth (FOC) in women in the third trimester.
|
Ngai and Ngu (2014) [59]
|
• Medical Outcomes Study Family and Marital Functioning Measures (MOS-FMFM)
• Social Readjustment Rating Scale (SRRS)
• General Health Questionnaire (GHQ)
|
NR
|
NR
|
Stronger family SOC correlated significantly with better family and marital functioning, less stress, and fewer depressive symptoms among couples.
|
Swartz et al. (2013) [60]
|
• Salivary cortisol
|
NR
|
3
|
SOC scores did not differ between the three lifestyle groups (i.e., anthroposophic, partly anthroposophic and non- anthroposophic), and there were no correlations between SOC scores and salivary cortisol concentrations in separate analyses of mothers, fathers and children at any sampling age or at any sampling time during the day (i.e., morning, afternoon, bedtime).
|
Ngai and Ngu (2013) [61]
|
• Medical Outcomes Study Social Support Survey (MOS-SSS)
• Social Readjustment Rating Scale (SRRS)
• Medical Outcomes Study Short Form 12-Item Health Survey (SF-12)
• General Health Questionnaire (GHQ)
|
NR
|
NR
|
Family SOC and social support had a direct effect on the mental health component of QoL and depressive symptoms, but not on the physical component of QoL.
|
Jeschke et al. (2012) [62]
|
• Havelhoehe Questionnaire on Delivery
• Visual Analog Scale for Pain
|
34–40
|
3
|
SOC was not recognized as an independent predictor for epidural anesthesia (EA) use. However, women with high SOC scores more often had the desire to deliver without EA
|
Larsson et al. (2009) [63]
|
• Parent’s expectations, experiences and reactions to routine ultrasound examination (PEER-U) questionnaire
|
NR
|
2
|
No significant differences between those with normal findings and abnormal findings groups regarding SOC scores or their status before and after their ultrasound examinations.
|
Ekelin et al. (2009) [64]
|
• Parent’s expectations, experiences and reactions to routine ultrasound examination (PEER-U) questionnaire
• State-Trait Anxiety Inventory (STAI) scale (6-item version)
|
NR
|
2
|
PEER-U values were significantly higher in the group with low SOC scores indicating that parents with low SOC scores had a higher level of worried state of mind, which confirmed that vulnerable parents reacted to routine ultrasound examinations with more worry than others.
|
Sekizuka et al. (2009) [65]
|
• Stress Perception Scale (SPS)
|
12.0 ± 0.6 and 30.0 ± 0.2
|
1 and 3
|
The percentage of women with threatened premature birth was significantly higher women with low SOC scores. Low SOC scores and low s-IgA levels were associated with threatened premature birth.
|
Larsson et al. (2009) [66]
|
• Parent’s expectations, experiences and reactions to routine ultrasound examination (PEER-U) questionnaire
• State-Trait Anxiety Inventory (STAI) scale (6-item version)
|
NR
|
2
|
No significant difference between parents with choroid plexus cyst/cysts identified during routine ultrasound and matched controls. No difference was found when comparing before and after routine ultrasound within each group with respect to SOC scores.
|
Oz et al. (2009) [67]
|
• Perceived Stress Scale (PSS)
|
37–41
|
3
|
A statistically significantly higher score in the SOC-13 was found in the uncomplicated delivery group compared with the complicated delivery group. No statistically significant difference was found between groups for the PSS score. Maternal labor complications were significantly associated with lower SOC-13 scores
|
Hibino et al. (2009) [68]
|
• Edinburgh Postnatal Depression Scale (EPDS)
|
13.1±6.7
|
2
|
The SOC during pregnancy moderated between depression after delivery and “existing anxiety about an earthquake” and tended to moderate between “physical abnormality during pregnancy or childbirth” and “evacuation.” All other earthquake-related factors were not moderated by the SOC during pregnancy.
|
Ekelin et al. (2008) [69]
|
• Parent’s expectations, experiences and reactions to routine ultrasound examination (PEER-U) questionnaire
• State-Trait Anxiety Inventory (STAI) scale (6-item version)
|
NR
|
2
|
The SOC and STAI instruments correlated with each other in the “before ultrasound” and in the “after ultrasound” group.
|
Hellmers et al. (2008) [70]
|
• WHO-5 Well-Being Index
• Edinburgh Postnatal Depression Scale (EPDS)
|
28–35
|
3
|
Women with a higher SOC tended more strongly towards spontaneous birth while the women with a lower SOC tended more strongly toward a caesarean. A correlation between the choice of mode of birth in pregnancy (at T1) and SOC was not found.
|
Hildingsson et al. (2008) [71]
|
• Edinburgh Postnatal Depression Scale (EPDS)
• Cambridge Worry Scale (Swedish version)
• Physical Wellbeing Scale
|
16
|
2
|
Women dissatisfied with partner support were more likely to have a lower SOC. Women dissatisfied with partner support were more likely to be multiparas, not living with their partner in early pregnancy and more likely to report unfavorable timing of pregnancy. In addition, these women experienced more physical symptoms, and less emotional wellbeing in terms of more depressive symptoms, more major worries and a lower SOC. One year after childbirth, women dissatisfied in early pregnancy had higher rate of divorce and disappointment with their partner’s participation in childcare and household chores and understanding from partner.
|
Habroe et al. (2007) [72]
|
• Achieved childbirth following successful assisted reproductive technology (ART).
|
NR
|
NR
|
Achieving childbirth after ART was associated with a significant increase in SOC at 1-year follow- up. This change happened more frequently among those who had a low SOC at baseline.
|
Rudman et al. (2007) [73]
|
• Edinburgh Postnatal Depression Scale (EPDS)
|
16
|
2
|
Depressive symptoms and low SOC were associated with the dissatisfied clusters of women that had dissatisfied and very dissatisfied interpersonal personal care, dissatisfied in information and decision-making and very dissatisfied in their intrapartum care.
|
Sekizuka et al. (2006) [74]
|
• Secretory Immunoglobulin A (s-IgA)
• Self-assessed depression scale
• Satisfaction with intrapartum care
|
36
|
3
|
The depression score was higher, and the s-IgA level was lower in the low-SOC scoring group indicating that stress reactions were more intense in the low SOC score group.
|
Almedom et al. (2005) [75]
|
• Salivary Cortisol
|
NR
|
3
|
Mothers who delivered in hospital had significantly higher SOC scores compared to those who opted for home birth. There were no significant associations between pre- or postnatal salivary cortisol concentrations and total SOC score. However, postnatal cortisol levels were lower in mothers with higher SOC scores, and significantly lower in those with higher ‘‘comprehensibility.’’
|
Sjöström et al. (2004) [76]
|
• Health Index
• Hospital Anxiety and Depression (HAD) scale
|
10–12; 34–36
|
1 and 3
|
The strongest predictor of the women’s ratings on the HI and HAD scales was an individual’s SOC. Thus, the stronger their SOC, the better the individual’s well-being and less anxiety and depression.
|
Engelhard et al. (2003) [73]
|
• Posttraumatic stress disorder (PTSD) symptom scale
• Beck Depression Inventory
• Crisis Support Scale
|
≤ 12
|
1
|
A strong SOC predicted fewer depressive symptoms and less PTSD symptoms after pregnancy loss. The SOC was related positively to crisis support, particularly to confiding in others and emotional support.
|
Abrahamsson and Ejlertsson (2002) [78]
|
• Smoking status (i.e., non-smokers, quitters, decreasers, continuers, relapsers)
|
NR
|
NR
|
The smoking relapsers had the lowest SOC level. Low SOC level was also associated with women who did not have good subjective health, smokers, had two or more symptoms of depression, of tension or of musculoskeletal symptoms, or who have a history of visiting a medical general practitioner.
|
Uren and Wastell (2002) [79]
|
• Attachment in Perinatal Bereavement Scale
• Perinatal Bereavement as Trauma
• Spiritual Orientation Scale (SOS)
• Perinatal Grief Scale (PGS)
• Global Severity Index (GSI)
• Impact of Event Scale Revised (IES-R)
• Adult Attachment Scale (AAS)
|
20–25, 26–30, 31–35, 36–39, 40
|
2 and 3
|
SOC remained the most significant predictor of perinatal grief.
|
SOC = sense of coherence; NR = not reported; PRO = patient reported outcome; QoL = quality of life
|
Table 3
The relationship of SOC and PROs in the cross-sectional study designs
PRO
|
Reference
|
PRO Mean (SD)
|
SOC Instrument
|
SOC Mean (SD)
|
Relationship of SOC to PRO
|
Abuse Assessment Screen: “Have you been exposed to abuse during current pregnancy
|
56
|
NR
|
SOC-13
|
NR
|
Multiple logistic regression found marginal association between domestic violence during pregnancy and low SOC-score (p = 0.075)
|
Adult Attachment Scale
|
79
|
NR
|
SOC-29
|
NR
|
SOC reported as correlated” with both closeness (r = 0.49; ns) and anxiety (r = – 0.44; ns).
|
Alcohol Use Disorders Identification Test (AUDIT)
|
56
|
NR
|
SOC-13
|
NR
|
NR
|
Antenatal Maternal Orientation Measure-Revised
|
50
|
• Regulator = 2.49 (0.70)
• Facilitator = 4.59 (0.66)
|
SOC-13
|
NR
|
SOC significantly correlated (p < 0.001) with a Regulator (r=-0.20) and Facilitator (r = 0.22) Mothering Style
|
Attachment in Perinatal Bereavement Scale
|
79
|
• Numbness = 3:99 (0.90)
• Disorientation = 3:51(1.14)
• Yearning = 4:25 (0.74)
• Despair = 4:14 (0.86)
|
SOC-29
|
NR
|
NR
|
Global Severity Index (GSI)
|
79
|
0.81 (0.66)
|
SOC-29
|
NR
|
SOC was negatively correlated with GSI (r=-0.69; ns)
|
Swedish Childbirth Self-Efficacy Inventory (Swedish (CBSEI)
|
52
|
NR
|
SOC-13
|
NR
|
SOC and CBSEI are correlated with r = 0.306 (p < 0.01)
|
Swedish Diabetes Empowerment Scale (SWE-DES-10)
|
47
|
3.9 (0.5)
|
SOC-13
|
68.9 (9.7); Range = 13–91
|
SOC and SWE-DES-10 have r = 0.33; P < 0.001)
|
Depression Self-Reporting Scale
|
39
|
NR
|
SOC-29
|
NR
|
NR
|
Edinburgh Postnatal Depression Scale (EPDS)
|
32
|
1.152 (0.56)
|
SOC-13
|
4.335 (1.06)
|
SOC and EPDS were correlated with r = − 0.62 (p < 0.001)
|
44
|
6.5 (2.1)
|
SOC-29
|
NR
|
EPDS was a significant predictor for SOC. Pregnant women with a low SOC score achieved higher EPDS scores.
|
50
|
6.41 (4.80)
|
SOC-13
|
48.48 (8.20)
|
SOC and EPDS were correlated r= -0.64 (p < 0.01)
|
51
|
6.46 (4.4)
|
SOC-13 & SOC 9
|
SOC-9: 47.4(8.0); SOC-13 = 67.0(11.1)
|
As EPDS scores increased, the likelihood of high SOC decreased.
|
53
|
NR
|
SOC-13 & SOC-9
|
67.5 (10.9)
|
Correlation between SOC-13 and the EPDS were r=-0.659 (p < .001) and between SOC-9 and EPDS (r=-0.666 (p < .001).
|
56
|
NR
|
SOC-13
|
NR
|
NR
|
Fear of Childbirth (FOC)
|
42
|
• High risk Pregnancy: 42.2 (6.0)
• Low Risk Pregnancy: 41.7 (6.0)
|
SOC-29
|
High risk pregnancy: 119 (16.8); Low risk pregnancy: 108.2 (6.0)
|
No significant correlation between FOC and the SOC in the low- and high-risk
pregnant women.
|
General Health Questionnaire (GHQ)
|
59
|
2.2 (4.5)
|
Family SOC-12
|
65.0 (9.2)
|
GHQ and SOC have r = − 0.37 (p < 0.006)
|
61
|
24.1 (4.8)
|
Family SOC-12
|
64.6 (9.4)
|
GHQ and SOC have r=-0.38 (p < 0.01)
|
Havelhoehe Questionnaire on Delivery
|
62
|
NR
|
SOC-29
|
151.2 (17.2)
|
SOC was significantly positively related to more confidence in delivery (r = 0.349; p < 0.001).
|
Hemoglobin A1c
|
47
|
NR
|
SOC-13
|
68.9 (9.7)
|
Negative correlation with early pregnancy HbA1c (r=-0.23; p < 0.01)
|
Swedish Hypoglycemia Fear Survey (SWE-HFS)
|
47
|
26.6 (11.8)
|
SOC-13
|
68.9 (9.7)
|
NR
|
Impact of Event Scale -Revised (IES-R)
|
79
|
• Intrusion, 1.64 (1.02)
• Avoidance, 0.66 (0.70)
• Hyperarousal, 0.95 (1.03)
|
SOC-29
|
NR
|
SOC was correlated with subscale of IES-R: Intrusion (r=-0.42; ns); Avoidance (r = − 0.52; ns); Arousal (r= − 0.53; ns)
|
Maternal Fetal Attachment Scale (MFAS)
|
32
|
3.960 (0.45)
|
SOC-13
|
4.335 (1.06)
|
SOC and MFAS were correlated with r = 0.10 (p > 0.05)
|
Maternity Social Support Scale (MSSS)
|
52
|
NR
|
SOC-13
|
NR
|
MSSS and SOC were statistically significant correlated (r = 0.436; p < 0.01)
|
Medical Outcomes Study Family and Marital Functioning Measures (MOS-FMFM)
|
59
|
40.2 (4.8)
|
Family SOC-12
|
65.0 (9.2)
|
Statistically significant correlation between SOC and MOS-FMFM (r = 0.73)
|
Medical Outcomes Study Short Form 12-Item Health Survey (MOS- SF12)
|
61
|
• Physical Component Scale (PCS) 43.3 (7.9)
• Mental Component Scale (MCS) 48.2 (8.7)
|
Family SOC-12
|
64.6 (9.4)
|
SOC correlated with PCS (r = .04; ns) and MCS (r = .26; p < 0.01)
|
Medical Outcomes Study Social Support Survey (MOS-SSS)
|
61
|
74.4 (14.6)
|
Family SOC-12
|
64.6 (9.4)
|
MOS-SSS and SOC were correlated r = 0.38 (p < 0.01)
|
NorVold Abuse Questionnaire (NorAQ)
|
56
|
NR
|
SOC-13
|
NR
|
Women with low SOC score were 9.1 more likely to be exposed to domestic violence during pregnancy (p < 0.001)
|
Parental Self-Efficacy Scale
|
36
|
• Overall: 4.14 ± 1.33
• Among pregnant women: 2.30 ± 0.72
|
SOC-13
|
Among pregnant women: 4.37±0.75
|
SOC and Parental Self-Efficacy had a correlation of r = 0.08 (p = ns)
|
Parental Satisfaction Questionnaire
|
36
|
• Overall: 6.14 ± 0.76
• Among pregnant women: NR
|
SOC-13
|
Among pregnant women: 4.37 ± 0.75
|
Parent Satisfaction and SOC had a correlation of r = .29 (p < .001)
|
Perinatal Bereavement as Trauma
|
79
|
• Meaning = 2.53 (1.39)
• Search = 2.50 (1.07)
• Coping = 2.57 (1.21).
|
SOC-29
|
NR
|
Weak correlation for Search (r= -0.37; p = ns), Meaning (r = 0.27; p = ns) and Coping (r = 0.07; p = ns)
|
Multidimensional Scale of Perceived Social Support (MSPSS)
|
32
|
5.719 (0.93)
|
SOC-13
|
4.335 (1.06)
|
SOC and MSPSS are correlated with r = 0.51 (p < 0.001)
|
Perinatal Grief Scale (PGS)
|
79
|
3.37 (.72)
|
SOC-29
|
NR
|
PGS and SOC were significantly correlated (r =-0.71; p < 0.001)
|
Prenatal Distress Questionnaire (NuPDQ)
|
50
|
9.16 (5.15)
|
SOC-13
|
48.48 (8.20)
|
NuPDQ and SOC are significantly correlated (r=-0.51; p < 0.001)
|
Swedish Problem Areas in Diabetes- 20 (SWE-PAID-20) Scale
|
47
|
27.1 (15.9)
|
SOC-13
|
68.9 (9.7)
|
NR
|
Profile of Mood States (POMS)
|
52
|
NR
|
SOC-13
|
NR
|
SOC and subscales of POMS were significantly correlated (p < 0.01): Vigour (r = 0.238); Fatigue (r=-0.469); Confusion (r=-0.454); Tension (r=-0.472); Depression (r=-0.517); Anger (r=-0.519)
|
Relationship Assessment Scale
|
36
|
• Overall: 5.65±1.29
• Among pregnant women: 6.04± 1.23
|
SOC-13
|
Among pregnant women: 4.37 ± 0.75
|
r = .36 (p < .001)
|
Social Readjustment Rating Scale (SRRS)
|
59
|
232.7 (149.1)
|
Family SOC-12
|
65.0 (9.2)
|
SOC and SRRS were not statistically correlated (r = − 0.15; p = ns)
|
61
|
231.7 (146.5)
|
64.6 (9.4)
|
SOC and SRRS were statistically significant correlated (r= -0.19; p < 0.01)
|
Spiritual Orientation Scale (SOS)
|
79
|
Beliefs = 3.52 (.98)
|
SOC-29
|
NR
|
SOC and SOS Beliefs correlated at r= -0.01; p = ns
|
Stress Perception Scale (SPS)
|
54
|
NR
|
SOC-13
|
NR
|
SOC and SPS were significantly correlated (r = -0.351; p < 0.01).
|
Support Behaviour Inventory (SBI) scale
|
51
|
NR
|
SOC-13 & SOC 9
|
• SOC-9: 47.4(8.0)
• SOC 13 = 67.0(11.1)
|
Adjusted odds ratio for SBI Scare and SOC = 1.056 (95% CI = 1.033–1.078; p < 0.000)
|
Visual Analog Scale (VAS) for pain
|
62
|
NR
|
SOC-29
|
151.2 (17.2)
|
NR
|
Warwick Edinburgh Mental Well-Being Scale (short form) (WEMWS)
|
32
|
3.375 (0.63)
|
SOC-13
|
4.335 (1.06)
|
SOC and WEMWS are correlated with r = 0.39 (p < 0.001)
|
Well-Being Questionnaire- 12 (WBQ-12)
|
47
|
22.6 (5.7)
|
SOC-13
|
68.9 (9.7)
|
SOC and WBQ-12 were significantly correlated (r = 0.59; p < 0.001)
|
Wijma Delivery Expectancy Questionnaire Version A
|
38
|
• Mild fear of childbirth (FOC) = 0–84
• Severe FOC = 85–165
|
SOC-13
|
• Low SOC = 13–60
• High SOC = 61–91
|
FOC and SOC had a significant negative correlation (n = 414, p < 0.001).
|
Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ)
|
39
|
Mild fear of childbirth (FOC): 60.5 (± 14.4)
Severe FOC: 102 (± 14.6)
|
SOC-13
|
• SOC = 69.3 ± 11.8
• Mild FOC: Comprehensibility (26.30 ±5.00); Manageability (21.69 ±3.97); Meaningfulness (22.94±3.59)
• Severe FOC:
Comprehensibility (22.71±6.08); Manageability (19.02±5.03); Meaningfulness (21.29±4.21)
|
Pearson’s r between DEQ-A and SOC-13 was − 0.376 < 0.001
|
52
|
NR
|
SOC-13
|
NR
|
SOC and JW-DEQ were significantly correlated (r=-0.468; p < 0.01)
|
58
|
NR
|
SOC-13
|
62.52 (10.62)
|
SOC and total score of JW-DEQ were significantly correlated (r = − 0.44; p < 0.01)
|
AUDIT = Alcohol Use Disorders Identification Test; CBSEI = Childbirth Self-Efficacy Inventory; DES-10 = Diabetes Empowerment Scale-10; EPDS = Edinburgh Postnatal Depression Scale; FOC = Fear of Childbirth; GHQ = General Health Questionnaire; GSI = Global Severity Index; HbA1c = Hemoglobin A1c; IES-R = Impact of Event Scale -Revised; MCS = Mental Component Scale; MFAS = Maternal Fetal Attachment Scale; MOS-FMFM = Medical Outcomes Study Family and Marital Functioning Measures; MOS- SF12 = Medical Outcomes Study Short Form 12-Item Health Survey; MOS-SSS = Medical Outcomes Study Social Support Survey; MSPSS = Multidimensional Scale of Perceived Social Support; MSSS = Maternity Social Support Scale; NR = not reported; ns = non-significant; NorAQ = NorVold Abuse Questionnaire; NuPDQ = Prenatal Distress Questionnaire; PCS = Physical Component Scale; PGS = Perinatal Grief Scale; POMS = Profile of Mood States; SBI = Support Behaviour Inventory; SOC = Sense Of Coherence; SOS = Spiritual Orientation Scale; SPS = Stress Perception Scale; VAS = Visual Analog Scale; WBQ-12 = Well-Being Questionnaire- 12; W-DEQ = Wijma Delivery Expectancy/Experience Questionnaire; WEMWS = Warwick Edinburgh Mental Well-Being Scale; SRRS = Social Readjustment Rating Scale; SWE-HFS = Swedish Hypoglycemia Fear Survey; SWE-PAID-20 = Swedish Problem Areas in Diabetes-20
|
Table 4
The relationship between SOC and patient reported outcomes in prospective studies.
PRO
|
Reference
|
PRO Mean (SD)
|
SOC Instrument
|
SOC Mean (SD)
|
Relationship of SOC to PRO
|
Antenatal Maternal Orientation Measure-Revised
|
45
|
• Regulator orientation: 2.52 (0.70)
• Facilitator orientation: 4.56 (4.56)
|
SOC-13
|
30 (-)
|
• SOC and Regular Orientation: r = − 0.19; (p < 0.001)
• SOC and Facilitator Orientation: r = 0.21; (p < 0.001)
|
Alcohol Use Disorders Identification Test (AUDIT)
|
37
|
• NR
|
SOC-13
|
NR
|
NR
|
Beck Depression Index (BDI)
|
77
|
• Early Pregnancy: 7.9(5.4)
• After Pregnancy Loss: 6.6 (6.3);
|
SOC-13
|
Early Pregnancy only: 65.1 (9.6)
|
Early pregnancy SOC and BDI after pregnancy loss r=–.37 (p < 0.01)
|
Cambridge Worry Scale
|
34
|
NR
|
SOC-29
|
NR
|
NR
|
35
|
NR
|
SOC-13
|
NR
|
NR
|
46
|
NR
|
SOC-13
|
• Early pregnancy: 69.41 (11.29)
• 2 months after birth: 70.01(11.29)
• 1 year after birth: 67.29 (12.75)
|
Women with major worries about giving birth, the baby’s health and going to the hospital had lower scores on SOC
|
Childbirth Experience Questionnaire (CEQ)
|
35
|
Emotionally healthy cluster
Own Capacity 2.80 (0.67)
Professional support 3.60 (0.63)
Perceived safety 3.24 (0.66)
Participation 3.26 (0.89)
Total CEQ 3.14 (0.63)
Emotionally Unhealthy cluster
Own Capacity 2.60 (0.71) 0.048
Professional support 3.44 (0.67) 0.082
Perceived safety 2.87 (0.70) 0.000
Participation 2.98 (0.89) 0.033
Total CEQ 2.89 (0.64) 0.006
|
NR
|
NR
|
NR
|
Crisis Support Scale (CSS)
|
77
|
One month After Pregnancy Loss:
• Partner = 29.8 (4.8)
• Family/friends = 27.0 (5.2)
• Health care workers = 24.6 (7.6)
• Overall = 27.2 (4.0)
|
SOC-13
|
In early pregnancy: 65.1 (9.6)
|
Prenatal SOC and overall CSS score after pregnancy loss were correlated (r = .22; p < 0.01)
|
Dyadic Adjustment Scale (DAS)
|
41
|
• Prenatal DAS = 116.6 (9.9)
• Postnatal DAS = 115.3 (14.8);
|
SOC-13
|
• Prenatal SOC: 66.6 (9.6)
• Postnatal SOC: 59.6 (12.6)
|
Decrease in SOC from prenatal to postnatal was statistically significant for SOC (p < 0.001) but not for DAS (p = ns)
|
Edinburgh Postnatal Depression Scale (EPDS)
|
34
|
NR
|
SOC-29
|
NR
|
NR
|
35
|
NR
|
SOC-13
|
NR
|
NR
|
37
|
NR
|
SOC-13
|
NR
|
NR
|
45
|
At T1 only: 6.23 (4.65)
|
SOC-13
|
At 12–26 weeks of gestation: SOC = 48.46 (7.86)
|
Significant correlation (p < 0.001) between EPDS and SOC at T1 (r = − 0.64) and T2 (r = − 0.52)
|
46
|
Low EPDS = 0–12
High EPDS = 13–30
|
SOC-13
|
• Early Pregnancy (Low versus High EPDS): 70.76 (10.20) versus 54.92 (12.09)
• 2 months after birth (Low versus High EPDS): 71.18 (11.12) versus 58.50 (13.38)
• One Year After Birth (Low versus High EPDS): 68.77 (11.88) versus 55.54 (13.46)
|
Women with EPDS scores 13–30 reported lower SOC scores compared to women with EPDS scores 0–12 at all time points.
|
49
|
• 30th week of pregnancy EPDS = 6.46 (4.4)
• Week 8 postpartum EPDS = 5.74 (4.2)
|
SOC-13
|
• 30th week of pregnancy: SOC = 48.05 (7.582)
• Week 8 postpartum: SOC = 49.85 (7.861)
|
Women with high antenatal SOC scores were more likely to have lower EPDS scores (Adjusted OR = .572 (95% CI:.508–.644; p < 0.001)
|
68
|
• Before childbirth: 3.9 (4.1)
• After childbirth: 3.8 (4.1).
|
SOC-13
|
• Before childbirth: SOC = 59.2 (10.3)
After childbirth: SOC = 60.5 (9.5)
|
SOC and EPDS before delivery: r=-0.21 (p < 0.05); SOC before delivery and EPDS after delivery: r=-0.09 (p < 0.05)
|
70
|
During Pregnancy:
• American Responders = 7.54 (5.57);
• German data not provided
Postpartum:
• American women = vs 6.88 (5.74);
• German women: 4.80 (4.07)
|
SOC-L9
|
• NR
|
NR
|
71
|
• Satisfied with partner
support - EPSD = 7.4
Not satisfied with partner
• support - EPSD = 11.8
|
SOC-13
|
• Satisfied with Partner Support: SOC = 69.7
Not Satisfied with Partner Support: SOC = 58.1
|
NR
|
73
|
NR
|
SOC-13
|
NR
|
NR
|
Family Adaptability, Partnership, Growth, Affection, Resolution (APGAR) Index
|
31
|
NR
|
SOC-13
|
NR
|
NR
|
Fear of Childbirth
|
34
|
NR
|
SOC-29
|
NR
|
NR
|
35
|
NR
|
SOC-13
|
NR
|
NR
|
General Health Questionnaire (GHQ)
|
55
|
• During pregnancy: 2.2 (2.4)
• 6 months postpartum :1.6 (2.2)
|
Family SOC-12
|
• During pregnancy: 65.7 (8.1)
• 6 months postpartum: 65.9 (9.1)
|
Prenatal GHQ and prenatal SOC (r = − .25); GHQ at 6 months postpartum and prenatal SOC (r = − .21). All correlations were statistically significant at p < 0.01
|
General Self-Efficacy Scale (GSES) (Chinese version)
|
31
|
NR
|
SOC-13
|
NR
|
NR
|
Health Index (HI)
|
76
|
• Gestation 34–36 weeks: 26.8 (3.9)
• 8 weeks postpartum: 28.8 (2.7)
• 10–12 weeks postpartum 28.5 (_3.2)
|
SOC-13
|
• Gestation 34–36 weeks: 67 (12)
• 8 weeks postpartum: 68 (11)
• 10–12 weeks postpartum: 67 (10)
|
The strongest predictor of the women’s ratings
on the HI at 12 weeks gestation was SOC (Beta coefficient = 0.28; p < 0.01) and at 34–36 weeks gestation (Beta coefficient = 0.26; p < 0.01) and at 8 weeks postpartum (Beta coefficient = 0.39; p < 0.001)
|
Health-Promoting Lifestyle Profile
|
31
|
NR
|
SOC-13
|
NR
|
NR
|
Hospital Anxiety and Depression (HAD) Scale
|
76
|
• Gestation 34–36 weeks: HAD-Anxiety = 4.9 : HAD-Depression = 4.4
• 8 weeks postpartum: HAD-Anxiety = 5.2 : HAD-Depression = 3.9
• 10–12 weeks postpartum: HAD-Anxiety = 5.4; HAD-Depression = 4.3
|
SOC-13
|
• Gestation 34–36 weeks: SOC = 67 (12)
• 8 weeks postpartum: SOC = 68 (11)
• 10–12 weeks postpartum: SOC = 67 (10)
|
NR
|
41
|
• Prenatal Anxiety = 6.11 (3.9)
• Prenatal Depression = 3.96 (2.85)
• Postnatal Anxiety = 7.60 (4.69)
• Postnatal Depression = 5.73 (4.18)
|
SOC-13
|
• Prenatal SOC = 66.6 (9.6)
• Postnatal SOC = 59.6 (12.6)
|
NR
|
Secretory Immunoglobulin A (sIgA)
|
65
|
First Half of Pregnancy
• < 24 years: 13.9 (4.1)
• ≥ 25 years: 15.6 (4.8)
• ≥ 35 years: 16.2 (6.3)
Second Half of Pregnancy:
• < 24 years: 21.0 (5.5)
• ≥ 25 years: 22.5 (8.7)
• ≥ 35 years: 21.6 (5.7)
|
SOC-13
|
• First Half of Pregnancy: SOC = 60.7 (11.8)
• Second Half of Pregnancy: SOC = 59.5 (10.9
|
The s-IgA level
determined in the first half of pregnancy was lower in the low SOC group (14.4 ± 4.7 lg/ml) than in the high SOC group (16.3 ± 5.1 lg/ml), but the difference was not significant
(p = 0.080).
|
Life Satisfaction Scale
|
41
|
• Prenatal Group at T2 = 44.9 (9.9)
• Postnatal Group at T2 = 56.5 (5.0)
|
SOC-13
|
• Prenatal Group at T2: SOC = 59.6 (12.6)
• Postnatal Group at T2: SOC = 72.5 (7.5)
|
NR
|
Medical Outcomes Study Family and Marital Functioning Measures (MOS-FMFM) Scale
|
48
|
• Pregnancy MOS-FMFM = 40.3 (4.6)
• 6 weeks postpartum MOS-FMFM = 37.2 (4.3)
• 6 months postpartum MOS-FMFM = 37.0 (4.9)
|
Family SOC-12
|
• Pregnancy SOC = 65.8 (8.1)
• 6 weeks postpartum SOC = 65.9 (9.1)
• 6 months postpartum SOC = 65.7 (9.2)
|
Prenatal SOC correlated with prenatal MOS-FMFM (r = .70; p < 0.01); MOS-FMFM at 6 weeks postpartum (r = 0.40; p < 0.01); MOS-FMFM at 6 months postpartum (r = 0.27; p < 0.01); SOC at 6 weeks postpartum correlated with MOS-FMFM 6 weeks postpartum (r = 0.60; p < 0.01) and SOC at 6 months postpartum correlated with MOS-FMFM at 6 months postpartum r = 0.62; p < 0.01)
|
55
|
• During pregnancy: 40.3 (4.6)
• 6 months postpartum: 36.9 (4.9)
|
Family SOC-12
|
• During pregnancy: 65.7 (8.1)
• 6 months postpartum: 65.9 (9.1)
|
Prenatal MOS-FMFM and prenatal SOC (r = .70; p < 0.01)
|
57
|
• Pregnancy: 40.3 (4.6)
• Postpartum: 38.0 (4.2)
|
Family SOC-12
|
• Pregnancy = 65.8 (8.1)
• Postpartum = 65.9 (9.1);
|
Prenatal SOC correlated significantly with prenatal MOS-FMFM (r = 0.70; p < 0.01) and MOS-FMFM at 6 weeks postpartum (r = 036; p < 0.01)
|
Medical Outcomes Study Social Support Survey (MOS-SSS)
|
55
|
• During pregnancy: 74.8 (13.3
• 6 months postpartum: 73.9 (19.50
|
Family SOC-12
|
• During pregnancy: 65.7 (8.1)
• 6 months postpartum: 65.9 (9.1)
|
Prenatal MOS-SSS and Prenatal SOC (r = .33; p < 0.01); Prenatal MOS-SSS and Change in SOC (r = − .09; p = ns); Change in MOS-SSS and Change in SOC (r = .21; p < 0.01).
|
57
|
• Pregnancy = 750 (13.3)
• 6 weeks postpartum = 728 (20.5)
|
Family SOC-12
|
• Pregnancy = 658 (8.1)
• 6 weeks postpartum = 659 (9.1)
|
Prenatal MOS-SSS and Prenatal SOC (r = 0.33; p < 0.01);
|
Multidimensional Scale of Perceived Social Support (MSPSS)
|
43
|
• Q1 MSPSS: Family = 24.2 (5.0); Friends = 23.5 (4.6); Significant others = 26.5 (3.0)
• Q2 MSPSS: Family = 26.3 (3.2); Friends = 25.6 (3.5); Significant others = 27.6 (1.4)
• Q3 MSPSS: Family = 24.3 (4.5); Friends = 23.6 (4.6); Significant others = 26.6 (2.5)
|
SOC-13
|
• Q1 SOC = 66.0 (12.3)
• Q2 SOC = 71.7 (11.5)
• Q3 SOC = 70.7 (12.2)
|
NR
|
45
|
MSPSS = 70.66 (12.89)
|
SOC-13
|
At T1: SOC = 48.46 (7.86)
|
MSPSS and SOC was significantly correlated (r = 0.48; p < 0.001)
|
NorVold Abuse Questionnaire (NorAQ)
|
37
|
NR
|
SOC-13
|
NR
|
NR
|
Preparation for Labor and Birth (P-LAB) instrument
|
40
|
NR
|
SOC-13
|
NR
|
Correlation between P-LAB and SOC was r = .22
(p < .05).
|
Pregnancy Risk Assessment
Monitoring System (PRAMS)
|
45
|
NR
|
SOC-13
|
At T1: SOC = 48.46 (7.86)
|
NR
|
PEER-U Questionnaire
|
63
|
Before Ultrasound
• AF Group(n = 66): Median PEER-U = 22.9 (Interquartile range = 15.1) ;
• NF Group (n = 1983): Median PEER-U = 20.8 (Interquartile range = 16.7)
After Ultrasound
• AF Group(n = 66): Median PEER-U = 20.5 (Interquartile range = 19.5) ;
• NF Group (n = 1983): Median PEER-U = 10.3 (Interquartile range = 12.8)
|
SOC-13
|
Before Ultrasound
• AF Group(n = 66) Median SOC = 72 (Interquartile range = 12)
• NF Group (n = 1983) Median SOC = 72 (Interquartile range = 14)
After Ultrasound
• AF Group(n = 66): Median SOC = 72.5(Interquartile range = 10.2)
• NF Group (n = 1983): Median SOC = 73.0 (Interquartile range = 13.0)
|
NR
|
64
|
• Before Ultrasound: Primivara PEER-U = 25.0 (18.8); Multivara PEER-U = 20.8 (18.8)
• After Ultrasound: Primivara PEER-U = 10.3 (11.5); Multivara PEER-U = 7.7 (10.3)
|
SOC-13
|
• Before Ultrasound: SOC = 70.2 (10.6)
• After Ultrasound: SOC = 70.3 (10.7)
|
NR
|
66
|
• Before Ultrasound: 18.8 (12.5)
• After Ultrasound: 25.6 (20.5)
|
SOC-13
|
• Before Ultrasound: 73.5 (12.0)
• After Ultrasound: 74.0 (13.8)
|
NR
|
69
|
NR
|
SOC-13
|
NR
|
NR
|
Perceived Stress Scale (PSS)
|
67
|
• Complicated delivery: 18.8 (0.59)
• Uncomplicated delivery 17.98 (0.62)
|
SOC-13
|
• Complicated delivery: 67.74 (1.19)
• Uncomplicated delivery 72.18 (1.32)
|
A negative correlation was found between SOC and PSS (r=-0.627; p < 0.01).
|
Post-traumatic Stress Disorder (PTSD) Symptom Scale
|
77
|
After Pregnancy Loss Only: Mean (SD) = 18.3 (9.0)
|
SOC-13
|
• Early pregnancy only: 65.1 9.6
|
SOC in early pregnancy was related negatively to PTSD symptoms one month after pregnancy
loss. More specifically, the SOC was related significantly to PTSD avoidance (r = -0.24; p = 0.008) and arousal symptoms ( r = -0.27, p = 0.004) but not to re-experiencing symptoms (r = -0.10; p = ns)
|
Quality of Dyadic Relationship-36 (QDR-36)
|
43
|
• Q1 QDR-36: Consensus = 5.2 (0.5); Cohesion = 4.8 (0.7); Satisfaction = 5.1 (0.5); Sensuality = 5.5 (0.6); Sexuality = 4.1 (0.7)
• Q2 QDR-36: Consensus 5.4 (0.5); Cohesion = 5.2 (0.7); Satisfaction = 5.3 (0.4); Sensuality = 5.5 (0.6); Sexuality = 4.0 (0.7)
• Q3 QDR-36: Consensus 5.2 (0.5); Cohesion = 4.8 (0.9); Satisfaction = 5.0 (0.6); Sensuality = 5.1 (0.8); Sexuality = 3.9 (0.7)
|
SOC-13
|
• Q1: SOC = 66.0 (1.3)
• Q2: SOC = 71.7 (11.5)
• Q3: SOC = 70.7 (12.2)
|
Perceived quality of couple relationship (QDR-36) six
months after childbirth was associated with higher scores at gestational week 25 (p = 0.013) and more positive change in SOC between gestational week 25 and six months after childbirth (p = 0.002).
|
Reproductive outcome of Assisted Reproductive Technology (ART) at 1-year follow-up (Yes or No)
|
72
|
62.6% (n642) of the 1,025 women reported a treatment-related pregnancy during the follow-up period
|
SOC-9
|
High SOC score = ≥850 points
LOW SOC score = ≤850 points
|
Among the women, an Odds ratio of 1.81 (CI: 1.202.74) for those with high SOC at follow-up and having delivered after ART.
|
Revised Prenatal Distress Questionnaire (NuPDQ)
|
45
|
• T1 NuPDQ: 9.04 (4.88)
• T2 NuPDQ: 6.00 (4.46)
|
SOC-13
|
• At T1 only: SOC = 48.46 (7.86)
|
SOC was negatively correlated with NuPDQ at T1 (r = − 0.54; p < 0.001) and T2 (r = − 0.50; p < 0.001)
|
Salivary cortisol
|
60
|
NR
|
SOC-13
|
• Anthroposophic (n = 75): Mean = 67.2; SE = 1.1
• Partly anthroposophic (n = 113): SOC = 67.0; SE = 0.9
• Nonanthroposophic (n = 96); SOC = 67.5; SE = 1.0
|
NR
|
75
|
• Prenatal cortisol = 1.337 µg/day
• Postnatal cortisol = 1.068 µg/day
|
SOC-13
|
NR
|
No significant associations between prenatal or postnatal salivary cortisol concentrations and total SOC score. However, postnatal cortisol levels were lower in mothers with higher SOC scores (p < 0.0171).
|
Secretory Immunoglobulin A (sIgA)
|
74
|
Prepartum:
• Primipara (n = 24): sIgA = 23.84 µg/ml (11.40)
• Para (n = 30): sIgA = 20.30 µg/ml (12.89)
Postpartum:
• Primipara (n = 24): sIgA = 26.20 µg/ml (11.90)
• Para (n = 30): sIgA = 26.90 µg/ml (13.90)
|
SOC-29
|
Prepartum period based on birth history
• Primipara (n = 24): SOC = 139.3 (22.5)
• Para (n = 30): SOC = 139.5 (24.6)
|
s-IgA level was significantly lower (i.e., 15.84 µg/ml (8.98) versus 27.74 µg/ml (12.95)) in the low-SOC scoring
group (i.e., ≤139) than in the high-SOC score group (i.e., ≥140)
|
Self-Assessment Depression Scale
|
74
|
Prepartum Only
• Primipara (n = 24): 28.7 (7.6);
• Para (n = 30): 29.0 (6.6)
|
SOC-29
|
Prepartum period based on birth history:
• Primipara (n = 24): SOC = 139.3 (22.5)
• Para (n = 30): SOC = 139.5 (24.6)
|
The Mann-Whitney U test showed no significant difference in the SOC score between those with high depression (i.e., score ≥ 40) and low depression scores (i.e., score < 40 scores)
|
Smoking status (i.e., non-smokers, quitters, decreasers, continuers, relapsers)
|
78
|
Smoking status (i.e., non-smokers, quitters, decreasers, continuers, relapsers) assessed before and after birth
|
SOC-13
|
SOC measured early pregnancy only:
• non-smokers (SOC = 72.8 (11.2)
• quitters (SOC = 71.9 (11.2)
• decreasers (SOC = 70.8 (11.9) )
• continuers (SOC = 69.3 (12.1)
• relapsers (SOC = 64.2 (12.0));
• Differences are statistically significant
|
Relapsers had the lowest SOC scores
|
Social Readjustment Rating Scale (SRRS)
|
55
|
• During pregnancy: 221.6 (135.8)
• 6 months postpartum: 226.8 (165.0)
|
Family SOC-12
|
• During pregnancy: SOC = 65.7 (8.1)
• 6 months postpartum: SOC = 65.9 (9.1)
|
Prenatal SRRS and Prenatal SOC was negatively correlated with r=-0.10 (p = ns)
|
57
|
• During Pregnancy: 75.0 (13.3)
• 6-weeks postpartum: 72.8 (20.5)
|
Family SOC-12
|
• During Pregnancy: SOC = 65.8 (8.1)
• 6-weeks postpartum: SOC 65.9 (9.1)
|
Correlation between prenatal SOC and prenatal stress was not significant (r=-0.11; p = ns)
|
State and Trait Anxiety Inventory (STAI) Scale (6-item version)
|
64
|
• Before Ultrasound: STAI-S = 33.1 (10.9); STAI-I = 34.0 (8.7)
• After Ultrasound: STAI-S = 31.2 (9.8); STAI-I = 33.5 (8.7)
|
SOC-13
|
• Before Ultrasound: SOC = 70.2 (10.6)
• After Ultrasound: SOC = = 70.3 (10.7)
|
NR
|
66
|
Before Ultrasound
• STAI-S = 30.0 (16.7);
• STAI-T = 30.0 (13.8)
After Ultrasound:
• STAI-S = 36.7 (18.3)
• STAI-T = 33.0 (12.2)
|
SOC-13
|
• Before Ultrasound: SOC = 73.5 (12.0)
• After Ultrasound: SOC = 74.0 (13.8)
|
NR
|
69
|
NR
|
SOC-13
|
NR
|
The SOC and STAI
Instruments correlated with each other “before ultrasound” (r= -0.606 (p< 0.001) and “after ultrasound” (r=-0.627 (p < 0.001).
|
Stress Perception Scale (SPS)
|
65
|
• First Half of Pregnancy = 21.1 (10.4)
• Second Half of Pregnancy = 21.6 (11.6)
|
SOC-13
|
• First half of Pregnancy: SOC = 60.7 (11.8)
• Second half of Pregnancy: SOC = 59.5 (10.9)
|
NR
|
Support Behaviour Inventory (SBI) Scale
|
49
|
NR
|
SOC-13
|
• 30th week of pregnancy: (SOC) = 48.05 (7.582)
• Week 8 postpartum: (SOC) = 49.85 (7.861)
|
The odds ratio between SBI and high SOC was 1.074 (95% CI:1.044–1.105; p < 0.001)
|
Swedish Parenting Stress Questionnaire (SPSQ)
|
46
|
SPSQ
• Incompetence (2.2 (0.66)
• Role restriction (3.5 (0.77)
• Social isolation (2.0 (0.69)
• Spouse relation problem (2.4 (0.88)
• Health problem (2.5 (0.75)
• Total stress (2.5 (0.54))
|
SOC-13
|
• Early pregnancy: SOC = 69.41 (11.29)
• 2 months after birth: SOC = 70.01(11.29)
• 1 year after birth: SOC = 67.29 (12.75)
|
The total SPSQ and the three SOC measures were significantly
negatively correlated: Low SOC (r=-.40), Moderate SOC (r=-.49) and High SOC (r =-0.64).
|
Cambridge Worry Scale (Swedish version)
|
71
|
• Satisfied with Partner Support - CWS = 15.3
• Not Satisfied with Partner Support - CWS = 23.4
|
SOC-13
|
• Satisfied with Partner Support: SOC = 69.7
• Not Satisfied with Partner Support: SOC = 58.1
|
NR
|
World Health Organization Well-Being Index (WHO-5)
|
70
|
During pregnancy:
• German women = 16.04 (3.85)
• American women = 16.44 (3.98)
Postpartun:
• German women = 15.37 (4.20)
• American women = 14.56 (5.58)
|
SOC-L9
|
NR
|
NR
|
Women’s satisfaction
with intrapartum care along three distinct dimensions (interpersonal
care, information and involvement in decision-making
and physical birth environment
|
73
|
Nine clusters of women with different profiles of satisfaction
with intrapartum care were identified:
A. Very satisfied
B. Satisfied Inf/
C. Satisfied Env
D. Average
E. Dissatisfied Env
F. Dissatisfied Int pers
G. Very dissatisfied Int pers
H. Dissatisfied Inf/ Dec
• I. Very dissatisfied
|
SOC-13
|
NR
|
Depressive symptoms and low SOC in early pregnancy were associated with the dissatisfied
clusters F (Dissatisfied Interpersonal care) G (Very dissatisfied Interpersonal care), H (Dissatisfied Information/
decision-making) and I (Very dissatisfied)
|
APGAR = Adaptability, Partnership, Growth, Affection, Resolution; ART = Assisted Reproductive Technology; BDI = Beck Depression Index; CEQ = Childbirth Experience Questionnaire; CSS = Crisis Support Scale; DAS = Dyadic Adjustment Scale; EPDS = Edinburgh Postnatal Depression Scale; GSES = General Self-Efficacy Scale; GHQ = General Health Questionnaire; HAD = Hospital Anxiety and Depression; HI = Health Index; MOS-FMFM = Medical Outcomes Study Family and Marital Functioning Measures; MOS-SSS = Medical Outcomes Study Social Support Survey; MSPSS = Multidimensional Scale of Perceived Social Support; NorAQ = NorVold Abuse Questionnaire; NuPDQ = Revised Prenatal Distress Questionnaire; NR = Not Reported; ns = not significant; P-LAB = Preparation for Labor and Birth; PEER-U = Parent’s Expectations, Experiences and Reactions to routine Ultrasound examination; PRAMS = Pregnancy Risk Assessment Monitoring System; PRO = Patient Reported Outcome; PSS = Perceived Stress Scale; PTSD = Post-traumatic Stress Disorder; QDR-36 = Quality of Dyadic Relationship-36; SBI = Support Behaviour Inventory; sIgA = Secretory Immunoglobulin A; SOC = Sense of Coherence; SPS = Stress Perception Scale; SPSQ = Swedish Parenting Stress Questionnaire ; SRRS = Social Readjustment Rating Scale; STAI = State and Trait Anxiety Inventory; WHO-5 = World Health Organization Well-Being Index
|
Research locations
The majority of the studies reviewed were from Sweden (n = 19; 38.9%) [34, 35, 37–39, 41, 43, 46, 52, 56, 60, 63–64, 66, 69, 71, 73, 76, 78] followed by Australia (n = 7; 14.2%) [33, 45, 49, 50, 51, 53, 79], Hong Kong/China (n = 6; 12.2%) [31, 48, 55, 57, 59, 61], and Japan (n = 5; 10.2%) [54, 58, 65, 68, 74]. There were two studies each (4.1%) from Israel [36, 67] and Germany [62, 70]. The countries of Denmark [72], Eritrea [75], Holland [77], Iran [42], India [32], Norway [47], Poland [44] and USA [40] were represented with one (2.0%) study.
Cross-sectional studies
Among the cross-sectional studies (see Table 3), six studies [36, 39, 40, 44, 50, 52, 54, 56, 79] provided no explicit measures of SOC while three studies reported multiple SOC scores. Mohamamdirizi et al. [42] reported significantly different SOC measures in high risk versus low-risk pregnancies and Przestrzelska et al. [44] reported that SOC scores did not significantly differ in women with physiological versus complicated pregnancies. Fergusson et al. [51] reported different SOC scores as measured by the SOC-9 and the SOC-13.
Pasricha et al [32] found positive correlations (p < 0.05) with measures of wellbeing and social support and negative correlation (p < 0.05) with depression. Einav et al. [36] reported correlations between Relationship Satisfaction and Maternal Satisfaction that were statistically significant (i.e., p < .001).
Prospective studies
While 9 studies [31, 34, 35, 37, 40, 69, 70, 73, 75] provided no explicit measures of SOC, the majority of the prospective studies (n = 19; 38.8%) (see Table 4) provided multiple measures of SOC [33, 41, 43, 46, 48, 49, 55, 57, 60, 63, 64, 65, 66, 67, 68, 71, 74, 76, 78]. The study by Muggleton et al. [33] provided measures of SOC-13 only without validated PRO measures. Two of the prospective studies [45, 77] provided measures of SOC at only one time point with single measures of SOC. Four prospective studies measured SOC at three different time points [43, 46, 48, 76]. Six studies [33, 41, 49, 55, 57, 68] measured SOC in the prenatal and postnatal period while 4 studies [63, 64, 65, 66] measured SOC twice in the prenatal period. SOC scores at multiple time points were significantly different in three studies [41, 43, 46] but not in 8 studies [33, 48, 57, 63, 64, 65, 66, 76]. The study by Ngai and Ngu [48] and Hibino et al. [68] did not report the significance of the measured SOC at different time points.
Weeks of gestation at completion of SOC instrument.
Eighteen studies did not specify the week(s) of gestation of pregnancy when the pregnant subjects completed the questionnaires. Of these 18 studies, four studies [63, 64, 66, 69] indicated SOC measures in the 2nd trimester and two studies [60, 75] specified SOC measures in the 3rd trimester. One study [31] completed questionnaires at 12, 24 and 36 weeks of gestation while one study [34] had responders completing the questionnaire at 39th week of gestation and 2 months postpartum. One study specified the 2nd and 3rd trimester as when the questionnaires were completed. The remaining studies (n = 11; 22%) [32, 36, 38, 48, 53, 54, 57, 59, 61, 72, 78] were non-specific about the weeks of gestation or trimester when SOC was measured. Thirteen of the 18 studies were prospective cohorts [31, 34, 48, 55, 57, 60, 63, 64, 66, 69, 72, 75, 78] while the remaining five [36, 38, 53, 59, 61] were cross-sectional in study design. Of the studies specifying a trimester of pregnancy when SOC was measured, four studies [32, 37, 50, 79] involved subjects in their second and third trimesters while two studies [65, 76] involved pregnant responders at the first and third trimester. Three studies [46, 47, 77] involved pregnant subjects in the first trimester, 13 studies [41, 43, 49, 51, 54, 56, 63, 64, 66, 68, 69, 71, 73] in the second trimester and 13 studies [35, 39, 40, 41, 44, 52, 58, 60, 62, 67, 70, 74, 75] in the third trimester. One study [53] characterized the responders as < 30 weeks pregnant and categorized the study as not specifying the weeks of gestation when SOC was completed. The study by Uren and Wastel [79] involved responders in the second and third trimester with stillbirths but nonetheless were chosen to be include in our analysis (see Table 2).
Types of SOC questionnaires
The type of SOC questionnaire used differed between studies. The most utilized SOC instrument was the SOC-13, having been used in 35 studies (i.e., 71%) with two of these studies utilizing SOC-13 concurrent with SOC-9 [47, 49]. This was followed with studies using the Family SOC Short Form (FSOC-S) (n = 5; 10%), the SOC-29 (n = 7; 14%), the SOC-9 (n = 1, 2%) and SOC-L9 (n = 1, 2%).
Relationship of PRO with SOC
In addition to the use of various SOC instruments, an additional 67 PROs were reported in the reviewed studies. The majority of these (n = 61; 91%) utilized a validated instrument while six measures (8.9%) did not. Three studies utilized laboratory measures as outcomes [60, 74, 75]. A number of the validated PROs were utilized in multiple studies. For example, the Medical Outcomes Study Family and Marital Functioning Measures was applied in 4 different studies [48, 55, 57, 61] as was the PEER-U questionnaire [63–64, 66, 69].
17 (25%) of the 67 PROs were specific to pregnancy. Those PROs specific to pregnancy included the Maternal Fetal Attachment Scale (MFAS) [32], the Antenatal Maternal Orientation Measure (Revised) [50], the Maternity Social Support Scale (MSSS) [52], Fear of Childbirth Questionnaire [34, 42], the Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) [38, 52, 58], Attachment in Perinatal Bereavement Scale (APBS) [79], Perinatal Bereavement as Trauma [79], Perinatal Grief Scale (PGS) [79], the Swedish Childbirth Self-Efficacy Inventory (Swe-CBSEI) [52], the Havelhoehe questionnaire on delivery (HQD) [60], the Pregnancy Risk Assessment Monitoring System (PRAMS) [45], the Prenatal Distress Questionnaire [45, 50], the Childbirth experience Questionnaire [35] and the Preparation for Labor and Birth (P-LAB) instrument [40]. The PEER-U questionnaire [63, 64, 66, 69] is not unique to the pregnant women per se but rather developed to measure parents’ expectations, experiences and reactions in connection with routine ultrasound examinations during pregnancy. For the purpose of this review, it was included. The Edinburg Postnatal Depression Scale (EPDS) [32, 34, 35, 37, 39, 44–45, 49–51, 53, 56, 68, 70, 71, 73] was commonly used in the postnatal period but can be applied throughout the perinatal period but included here as pregnancy-specific in addition to the non-validated PRO measuring women’s satisfaction with intrapartum care [73].
Eight of these pregnancy-specific measures (i.e., EPDS [34, 45, 46, 49, 68, 70, 71, 73], PEER-U [63, 64, 66, 69], the NuPDQ [45], PRAMS [45], the Preparation for Labor and Birth (P-LAB) instrument [40], the Childbirth Experience Questionnaire [35] and Women’s Satisfaction with Intrapartum Care [73]) were used in the prospective cohort studies while the remainder were utilized in cross-sectional study designs. In these pregnancy-specific PROs, their correlation with SOC were as expected. For example, measures of compromised health or functioning were negatively correlated with SOC so that depression as measured by the EPDS, difficult life events as measured by the PEER-U questionnaire, prenatal distress as measured by NuPDQ, fear of childbirth (FOC), perinatal grief and distress, and delivery expectancy/experience as measured by the JW-DEQ were negatively correlated. Conversely, measures of optimum health or increasing functioning were positively correlated with SOC so that childbirth self-efficacy (i.e., using the CBSEI), delivery as measured by the Havelhoehe questionnaire, maternal social support were positively correlated. With other measures, such as the Perinatal Bereavement as Trauma [79], Antenatal Maternal Orientation Measure-Revised [45], Satisfaction with Intrapartum Care [73] along with other multiple domain measures, SOC was negatively or positively correlated (see Tables 3 and 4).
PROs specific to pregnancy also examined a number of birth-related variables and birth outcomes in relation to SOC. Some studies found no relationship with SOC while others document a relationship with low, high and changing (i.e., decreasing or increasing measures of SOC (see Table 5). Interestingly, these studies document varied relationships indicating birth outcomes are related to both low and high SOC scores or decreasing and increasing SOC scores within the same studies. The study by Asif et al. [39] examined birth outcomes such as the use of the epidural analgesia or vacuum extraction but did not relate their findings to SOC measures. Similarly, Hildingsson et al. [35] described birth outcomes of women in two clusters (i.e., “emotionally healthy” versus “emotionally unhealthy”) and found that overall, women in the “emotionally unhealthy” cluster had a less positive birth experience. Spontaneous labor (as opposed to induction and a vaginal birth) was less prevalent in the “emotionally unhealthy” group while there was a higher prevalence in the “emotionally unhealthy” group in the use of epidural analgesia or augmentation of labor and babies born to have a severe neonatal diagnosis.
Table 5
Summary of findings of studies examining birth-related variables and birth outcomes with respect to SOC.
Reference
|
Study Design
|
No. of pregnant responders
|
Statistical Analysis
|
Summary Findings
|
Study strength and limitations
|
Studies with no relationship of SOC scores to birth-related variables and outcomes
|
Neerland et al (2020) [40]
|
Prospective cohort
|
206
|
Descriptive statistics, Cronbach’s alpha, ICC and exploratory factor analysis
|
No convergent validity between P-LAB an SOC-13.
|
A convenience sample of participants characterized as lacking heterogeneity and therefore challenged the generalizability of the results
|
Staneva et al. (2018) [45]
|
Prospective Cohort
|
285
|
Descriptive statistics, ANOVA, hierarchical multiple regression analysis with variance inflation factor statistic, Pearson’s correlation
|
Poor correlation between SOC and adverse birth outcomes index. Therefore, SOC was not included in the final regression analyses.
|
Women experiencing PTB was 5% of total sample thus d may have
inadequate statistical power to detect significant associations with
adverse birth outcomes. Sampling bias resulting in poor generalizability.
|
Hildingsson (2017) [46]
|
Prospective Cohort
|
3058
|
Descriptive statistics, ANOVA and t-test (paired and independent
|
Onset of labour, oxytocin augmentation, use of EA and mode of birth were not associated with SOC scores at any time point.
|
Study design with a large sample size and high response rates (i.e., range: 85%-88%). Limited generalizability due to observational nature of study without accounting for confounding factors in the analysis.
|
Fergusson et al. (2016) [49]
|
Prospective cohort
|
753
|
Descriptive statistics, odds ratio, Pearson’s r, paired t-test and logistic regression analysis
|
Experiencing an induction of labour, caesarean section or spontaneous vaginal birth was not associated with SOC score changes from the antenatal to postnatal period.
|
Sampling bias resulting in questionable generalizability. Regression analysis performed to infer causal relationship between SOC and variables of interest.
|
Ferguson et al. (2015) [51]
|
Cross-sectional cohort
|
1075
|
Descriptive statistics, odds ratio, logistic regression analysis
|
Logistic regression found SOC scores were not associated with pregnancy or anticipated labour choices such as planned birth type and anticipated epidural use in labour.
|
Study strengths include a large sample size with use of regression analysis. Limitations include use convenience and snowball sampling resulting in selection bias.
|
Carlsson et al. (2015) [52]
|
Cross-sectional cohort
|
406
|
Descriptive statistics, χ2 test or Fisher's exact test, logistic regression analysis
|
No differences in women with low or high SOC score with respect to cervix dilatation at admission, mode of delivery and birth outcomes such as duration of labour, hemorrhage, infant Apgar score and length of hospital stay.
|
Cross-sectional study design cannot make cause and effect inferences. Also, the sample was collected from one part of Sweden and from more prosperous responders. Therefore, generalizability is hampered.
|
Jeschke et al. (2012) [62]
|
Cross-sectional cohort
|
193
|
Student’s t -test, chi-square test, odds ratio, Pearson’s r, multiple logistic regression analysis
|
Multiple logistic regression found SOC was not an independent predictor for epidural analgesia.
|
Lacks genralisability as subjects from a single hospital. Regression analysis performed but the authors cautioned that
some residual confounding factors may be unmeasured
|
Hellmers and Schuecking (2008 )[70]
|
Prospective cohort
|
374
|
Descriptive statistics, Student’s t-test, ANOVA, Pearson’s r, and chi-square test, paired t-test
|
Among German women, correlation between the choice of mode of birth in pregnancy and SOC was not found.
|
A convenience sample was utilized with a small sample size of USA responders. What about the German women?
|
Studies with low SOC scores in relation to birth-related variables and outcomes
|
Hildingsson (2017) [46]
|
Prospective Cohort
|
3058
|
Descriptive statistics, ANOVA and t-test (paired and independent
|
A less positive birth experience was associated with lower levels of SOC.
|
Study design with a large sample size and high response rates (i.e., range: 85%-88%). Limited generalizability due to observational nature of study without accounting for confounding factors in the analysis.
|
Carlsson et al. (2015) [52]
|
Cross-sectional cohort
|
406
|
Descriptive statistics, χ2 test or Fisher's exact test, logistic regression analysis
|
Significant group differences found in epidural analgesia as pain relief in women with low childbirth self-efficacy if considered as proxy measure for SOC
|
Cross-sectional study design cannot make cause and effect inferences. Also, the sample was collected from one part of Sweden and from more prosperous responders. Therefore, generalizability is hampered.
|
Sekizuka-Kagami et al. (2015) [54]
|
Cross-sectional cohort
|
43
|
Descriptive statistics Pearson’s or Spearman’s correlation coefficient, chi-square test, t-test, ANOVA, receiver operating characteristic (ROC) analysis and logistic regression analysis
|
Logistic regression showed SOC-13 scale score affected threatened premature birth (p < 0.001) and that a low SOC-13 scale score was associated with threatened premature birth.
|
Limitation of small sample size and factors for causal relationship between
SOC and threatened premature birth may be questionable. Regression analysis performed to make the association.
|
Sekikuza et al. (2009) [65]
|
Prospective cohort
|
72
|
Descriptive statistics, paired t test and Pearson’s r, chi-square test, ANOVA, Student’s t test, Kruskal–Wallis H test, Mann-Whitney U test and logistic regression analysis
|
Logistic regression analysis demonstrated that low SOC scores and low s-IgA levels were associated with threatened premature birth.
|
Small sample size and selection bias compromise causal inference between SOC and s-IgA to threatened premature birth. Cause and effect inferences made from regression analysis.
|
Hellmers and Schuecking (2008) [70]
|
Prospective cohort
|
374
|
Descriptive statistics, Student’s t-test, ANOVA, Pearson’s r, and chi-square test, paired t-test
|
Among German women, those with lower SOC tended more strongly toward a Caesarean birth.
|
A convenience sample was utilized with a small sample size of USA responders. What about the German women?
|
Studies with high SOC scores in relation to birth-related variables and outcomes
|
Fergusson et al. (2016) [49]
|
Prospective cohort
|
753
|
Descriptive statistics, odds ratio, Pearson’s r, paired t-test and logistic regression analysis
|
High SOC scores were associated with age, higher Support Behaviour Index scores and lower EPDS scores, less likely to experience Caesarean sections and more likely to experience assisted vaginal birth
|
Sampling bias resulting in questionable generalizability. Regression analysis performed to infer causal relationship between SOC and variables of interest.
|
Carlsson et al. (2015) [52]
|
Cross-sectional cohort
|
406
|
Descriptive statistics, χ2 test or Fisher's exact test, logistic regression analysis
|
High SOC scores associated with less epidural anesthesia and high childbirth self-efficacy.
|
Cross-sectional study design cannot make cause and effect inferences. Also, the sample was collected from one part of Sweden and from more prosperous responders. Therefore, generalizability is hampered.
|
Oz et al. (2009) [67]
|
Prospective cohort
|
145
|
Descriptive statistics, chi-square test, Student t-test, multiple logistic regression analysis
|
Using multiple logistic regression modelling with uncomplicated delivery as the outcome variable, SOC-13 was found to be an independent factor predicting uncomplicated delivery. A high SOC score was correlated with uncomplicated delivery
|
Generalisability compromised by small sample size and selction bias. Regression analysis performed to decrease effects of cofounding variables.
|
Hellmers and Schuecking (2008) [70]
|
Prospective cohort
|
374
|
Descriptive statistics, Student’s t-test, ANOVA, Pearson’s r, and chi-square test, paired t-test
|
Among USA women, those with higher SOC did not tend more strongly towards spontaneous birth than women with lower SOC.
|
A convenience sample was utilized with a small sample size of USA responders. What about the German women?
|
Engelhard et al. (2003) [77]
|
Prospective cohort
|
117
|
Descriptive statistics Pearson’s r, Cronbach’s alpha, multiple logistic regression analysis
|
Stronger SOC in early pregnancy
predicted less PTSD symptoms after pregnancy loss. However, correlations were modest and weaker relative to earlier retrospective studies, particularly with SOC.
|
Limitations included use of self-report, recall bias, simultaneous assessment of crisis support, and PTSD symptoms. Strengths included prospective design, adequate sample size and relatively homogeneous traumatic events.
|
Studies with decreasing SOC in relation to birth-related variables and outcomes
|
Fergusson et al. (2016) [49]
|
Prospective cohort
|
753
|
Descriptive statistics, odds ratio, Pearson’s r, paired t-test and logistic regression analysis
|
Logistic regression found change in women's SOC scores were associated with assisted vaginal birth, use of EA, and birth satisfaction. Decrease in women's SOC scores resulted in use of EA and dissatisfaction with their birth experience.
|
Sampling bias resulting in questionable generalizability. Regression analysis performed to infer causal relationship between SOC and variables of interest.
|
Studies with increasing SOC in relation to birth-related variables and outcomes
|
Mugggleton et al. [33]
|
Prospective cohort
|
153
|
|
The present study did not identify any statistically significant differences between groups in mode of birth, though this was not the focus of the study.
|
|
Fergusson et al. (2016) [49]
|
Prospective cohort
|
753
|
Descriptive statistics, odds ratio, Pearson’s r, paired t-test and logistic regression analysis
|
An increase in postnatal SOC was associated with birth satisfaction.
|
Sampling bias resulting in questionable generalizability. Regression analysis performed to infer causal relationship between SOC and variables of interest.
|
ANOVA = analysis of variance; EA = epidural anaesthesia; EPDS = Edinburg postnatal depression score; ICC = Intraclass Correlation; P-LAB = Preparation for Labor and Birth; PTB = pre-term birth; PTSD = posttraumatic stress disorder; ROC = receiver operating characteristic; s-IgA = secretory Immunoglobulin A; SOC = sense of coherence; USA = United States of America
|
The most utilized PRO was the Edinburgh Postnatal Depression Scale (EPDS) [80] to assess depression in approximately one-third (n = 15; 31%) of the 49 manuscripts reviewed involving both cross-sectional [39, 44, 50, 51, 53, 56] and prospective studies [35, 37, 45, 46, 49, 68, 70, 71, 73]. Although designed originally to assess postnatal depression, it has been commonly used in the prenatal period and is well validated to do so [81]. Of the 17 studies measuring EPDS, eight studies [34, 35, 37, 39, 46, 53, 56, 73] did not report EPDS scores while seven studies [35, 37, 39, 44, 56, 70, 73] did not provide measures of SOC. Not surprisingly, none of the seven studies [35, 37, 39, 44, 56, 70, 73] reported relationship between EPDS and SOC measures. The study by Przestrzelska et al. [44] only commented on the inverse relationship between EPDS and SOC scores (i.e., high EPDS in pregnant women with low SOC scores). Three studies [44, 49, 56] reported significant odd ratio values with an inverse relationship between EPDS and SOC. Nine studies indicated a significant negative correlation between SOC and EPDS [32, 34, 45, 50, 53] or made inferences on their inverse relationship [46, 51, 68, 73]. This association of low SOC score with higher depression (EPDS) scores in pregnancy have also been confirmed with the subscale of depression of the Profile Mood States (POMS) questionnaire [52], General Health Questionnaire [55, 59, 61], the Hospital Anxiety and Depression (HAD) scale [41, 76] and the Beck Depression Index (BDI) [77] and the Depression Self-Reporting Scale (DSRS) [39].
In a series of papers, Ngai and Ngu [48, 55, 57, 59, 61] utilized PROs developed from the Medical Outcomes Study (MOS). The MOS was a 2-year observational study of patients with chronic conditions involving 22,462 patients in a cross-sectional phase and 2,349 patients in a longitudinal phase. The purpose of the study was to determine causes of variations in patient outcomes by differences in systems of care, clinician specialty, and clinicians' technical and interpersonal styles. The MOS was also implemented to develop more practical tools for routine monitoring of physical, social, and role functioning in everyday living based on patients' perceptions of their general health and well-being and satisfaction with care [78].
Ngai and Ngu [48, 55, 57, 59] found that a strong family SOC (i.e., as measured by the Family SOC-12) correlated significantly with better prenatal family and marital functioning, social support, and the mental health component of QoL among pregnant women as measured by the MOS Family and Marital Functioning Measures (MOS–FMFM). The MOS Social Support Survey (MOS-SSS) [55, 57, 61] to assess a pregnant woman’s support network and the availability of social support involving the emotional, tangible, affectionate, and positive social interaction domains significantly positively correlated with Family SOC-12 [61]. A low score on the family sense of coherence, poor social support and depressive symptoms during pregnancy correlated significantly with high depressive symptoms and decline in family and marital functioning at 6 weeks postpartum [55, 57]. Ngai and Ngu [61] also found greater correlation between SOC and the mental health component (versus physical health) of the SF-12. The relationship between a high SOC and better social support were also demonstrated with the use of the Support Behaviour Inventory (SBI) scale [49, 51], the Multidimensional Scale of Perceived Social Support (MSPSS) [43, 45], the Maternity Social Support Scale (MSSS) [52] and the Crisis Support Scale (CSS) [77]. Pregnant women with high antenatal SOC scores were more likely to have higher SBI scores [49, 51]. First-time mothers who stated a higher SOC during pregnancy and at six months postpartum reported higher perceived quality of couple relationship which in turn was significantly associated with higher perceived social support at gestational week 25 (p = 0.037) [43]. Using multivariate analysis of variance (MOANCOVA), Einav et al. [36] reported a significant difference among the pregnant women, primiparous mothers and multiparous mothers with respect to their SOC, maternal efficacy, and marital satisfaction. However, univariate analysis revealed significant differences in maternal efficacy, partial and marginally significant differences in relationship satisfaction.
Staneva et al. [45] reported that having a strong social support as measured by the MSPSS was correlated with a higher SOC. Carlsson et al. [52] found a significant correlation between SOC and MSSS, acknowledging that SOC and social support are known factors to buffer stress when dealing with stressful situations during pregnancy. Engelhard et al. [77] found that SOC was related positively to crisis support (particularly to confiding in others and emotional support (r = 0 .23, p = 0 .017). Similar to the findings by Przestrzelska et al. [44], Rudman et al. [73] found that low SOC was associated with lack of social support using a non-validated self-report questionnaire inquiring about type and extent of social support received by a pregnant woman.
Other components of mental health and its relationship with SOC in pregnancy were also investigated. Women having low SOC were reported with the highest levels of parental stress [46]. A significant negative correlation was reported between SOC and stress as measured by the Stress Perception Scale [54], the Perceived Stress Scale (PSS) [67], and the Social Readjustment Rating Scale (SRRS) [61]. SOC and SRSS were not significantly correlated in three studies [56, 57, 59] while Sekizuka et al. [65] did not report the relationship between SOC and the Stress Perception Scale.
The revised version of the Prenatal Distress Questionnaire that measures anxiety and distress were also negatively correlated with SOC [47, 50]. The State-Trait Anxiety Inventory Mood Scale to assess state anxiety (i.e., anxiety about an event) and trait anxiety (i.e., anxiety level as a personal characteristic) were applied in three studies involving the development and use of the PEER-U instrument [64, 66, 69].
Concurrent validity was established by correlating the state of mind index component of the PEER-U instrument to two established PROs – the State and Trait Anxiety Inventory Scale or STAI Scale and SOC. A statistically significant negative correlation was reported between STAI and SOC by Ekelin et al. [69] before and after ultrasound imaging. Ekelin et al. [69] and Larsson et al. [66] provided no report on the relationship between STAI and SOC. Anxiety was also measured by the Hospital Anxiety and Depression (HAD) scale [41, 76] and the Prenatal Distress Questionnaire [45, 50]. Bratt et al. [41] and Sjostrom et al. [76] found that HAD did not change significantly from the prenatal to the postnatal period. Unfortunately, the authors did not report the relationship between SOC and HAD scores. Anxiety as measured by the NuPDQ was significantly negatively correlated with SOC scores [45, 50]. Despite no report on the relationship (i.e., correlation) between SOC and the Cambridge worry Scale [46, 71], pregnant women with major worries reported lower SOC. Other studies have found that SOC in early pregnancy was found to be significantly negatively correlated to post-traumatic stress disorder (PTSD) symptoms one month after pregnancy loss as measured by the PTSD Symptom Scale (PSS-SR) [77] and mood as measured by the Profile of Mood States (POMS) instrument [52].
To assess parents’ expectations, experiences and reactions to an ultrasound examination, the Parents’ Expectations, Experiences and Reactions to an Ultrasound or PEER-U instrument was used in 4 studies [63–64, 66, 69]. Unfortunately, all 4 studies provided no analysis with respect to PEER-U scores’ relationship to SOC.
Mohamamdirizi et al. [42] found no significant correlation between SOC and Fear of Childbirth while Asif et al. [39], Carlsson et al. [42] and Takegata et al. [58] found a significant negative correlation between fear of childbirth and delivery and SOC as measured by Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). The use of the NorVold Abuse Questionnaire (NorAQ) questionnaire found that women with low SOC scores were more likely to be exposed to domestic violence during pregnancy compared to those indicating no history of violence [37, 56]. A positive correlation between SOC-13 and wellbeing has been found using the Well-Being Questionnaire (WBQ12) [47] and the Health Index [76]. However, Hellmers and Schuecking [70] provided no analysis on the relationship between SOC and wellbeing as measured by the WHO-5 Well-Being Index. In terms of diabetes management during pregnancy, SOC scores were found to be positively correlated with self-efficacy in diabetes management as measured with the Swedish Diabetes Empowerment Scale (SWE-DES-10) [47]. However, no analysis was provided on the relationship between SOC and the Swedish Hypoglycemia Fear Survey (SWE-HFS) [39] and Swedish Problem Areas in Diabetes Scale (SWE-PAID-20) [47].
In a study on perinatal bereavement for women, Uren and Wastell [79] found that SOC was significantly correlated with the Perinatal Grief Scale (PGS) and strongly negatively correlated with the Global Severity Index (i.e., a global health measure so that a higher score indicates poorer global health that is a summation of all the Brief Symptom Index (BSI) items but not significantly negatively correlated with the Impact of Event Scale Revised (IES-R) [79] and the Adult Attachment Scale (AAS) [79]. An increase in SOC from the prenatal to the postpartum period paralleled an increased in life satisfaction (as measured by Life Satisfaction) [41]. No measures of childbirth self-efficacy as measured by the Swedish Childbirth Self-Efficacy Inventory (Swe-CBSEI) [52] and SOC were reported by Carlsson et al. [52] but reported a significant correlation between the two variables. In terms of attitudes towards the use of Epidural Anesthesia during labor, SOC was found to positively correlate significantly with the statement ‘feeling well prepared for delivery’ and ‘joyful expectation of delivery’ as measured by the Havelhoehe Questionnaire on Delivery (HQD) [62].
The Antenatal Maternal Orientation Measure-Revised differentiates between two distinct styles of mothering (i.e., Facilitator or Regulator). Lower SOC was highly and significantly associated with styles of mothering – negatively with a Regulator and positively with a Facilitator maternal orientation [45, 50]. No direct correlation or association with SOC was reported with the variables of the Pregnancy Risk Assessment Monitoring System (PRAMS) [45], the Visual Analog Scale (VAS) for pain [62], the Hospital Anxiety and Depression (HAD) Scale [41, 76], Multidimensional Scale of Perceived Social Support (MSPSS) [43], State and Trait Anxiety Inventory Scale or STAI Scale (6-item version) [64, 66], Stress Perception Scale (SPS) [65], the Edinburgh Postnatal Depression Scale (EPDS) [35, 37, 39, 56, 70, 71, 73], Attachment in Perinatal Bereavement Scale [75], the Cambridge Worry Scale (Swedish version) [46, 71], the WHO-5 Well-Being Index [66] and the Alcohol Use Disorders Identification Test (AUDIT) [37, 56].
Relationship of SOC with other outcomes or laboratory measures.
A handful of the reviewed manuscripts did not utilize a validated PRO instrument. Przestrzelska et al. [44] utilized a non-validated self-report questionnaire to examine the type and extent of social support received by the pregnant women. Staneva et al. [45] applied the Pregnancy Risk Assessment Monitoring System (PRAMS) to collect information on previous pregnancies, mode of conception, previous and current pregnancy complications, current gestation type (one or more), history of medical or psychological and psychiatric problems, current psychiatric diagnoses (bipolar, generalized anxiety, and major depressive disorders), and whether the current pregnancy was planned and/or wanted. The validity of PRAMS in terms of sensitivity, specificity and positive predictive value for maternal and infant health indicators remains to be fully defined [83]. Hildingsson et al. [71] measured physical wellbeing by asking responders to rate on a Likert scale (0 = no problem; 5 = serious problem) seven common symptoms in early pregnancy (i.e., headache, neck and shoulder pain, low back pain, stomachache, dysuria, sleeping problems and fatigue) with the sum of scores as the index of physical wellbeing. Habroe et al. [72] examined achieved childbirth as an outcome measure following ART and found that achieving childbirth after ART and high SOC at 1-year follow-up was significant among women who had low baseline SOC (OR = 1.81; 95% CI: 1.20–2.74). Rudman et al. [73] examined women’s satisfaction with intrapartum care using the three dimensions of interpersonal care, information and involvement in decision-making and physical birth environment. The investigators found 9 clusters of women with different profiles of satisfaction with intrapartum care. Rudman et al. [73] found that depressive symptoms and low SOC in early pregnancy were associated with the dissatisfied clusters F (Dissatisfied Interpersonal care) G (Very dissatisfied Interpersonal care), H (Dissatisfied Information/decision-making) and I (Very dissatisfied). Zekizuka et al. [74] utilized a self-assessment depression scale in the prepartum and postpartum period and women’s satisfaction with intrapartum care. The authors found no significant difference (i.e., p < 0.664) in the SOC scores in the postpartum period between the groups with high depression (i.e., ≥ 40 score; n = 5; SOC = 133.2±23.0) and low depression scores (< 40 scores; n = 49; SOC = 140.1±23.7). Assessing the smoking status of pregnant women (i.e., non-smokers, quitters, decreasers, continuers, relapsers), Abrahamsson and Ejlertsson [78] found that the level of SOC may have a mediating effect in relation to smoking behaviour such that the level of SOC might influence the strength required for smoking cessation.
In total, we found 5 studies correlating SOC measures with laboratory analysis. Linden et al. [47] found that SOC scores were significantly negatively correlated with high hemoglobin (Hb) A1c levels (i.e., ≥ 49 mmL/mol). In the third trimester, Swartz et al. [60] found no correlation between the women’s SOC scores with salivary cortisol samples collected from the whole family (mother, father, children) when their child was 6 months, 12 months and 24 months of age, regardless of sampling time (i.e., morning, afternoon, bedtime). Furthermore, Swartz et al. [48] found that SOC scores did not differ between the three different lifestyle groups (i.e., anthroposophic, partly anthroposophic and nonanthroposophic) of the pregnant women. Sekizuka et al. [65] found no association secretory between s-IgA and SOC but found that low SOC scores in the first half of pregnancy was associated with threatened premature birth. Sekizuka et al. [65] found that lower SOC scores were associated with higher depression scores and lower s-IgA levels. Almedon et al. [75] examined maternal SOC scores and salivary cortisol levels in Eritrean mothers during the immediate prenatal and postnatal period. Mothers who delivered in a hospital had significantly higher SOC scores and lower postnatal cortisol levels compared to those with home births. This difference was more pronounced in the comprehensibility subscale of the SOC scores.
Studies without observed changes or significant differences in SOC scores
Przestrzelska et al. [44] found no difference in SOC measures in women experiencing “physiological” or complicated courses of pregnancy. Ngai and Ngu [48, 57] reported the non-significant changes in family SOC from pregnancy to the postpartum period(s). Larsson et al. [63] reported no significant differences in SOC scores before and after ultrasound examination in those subjects with normal or abnormal findings. Sense of coherence scores were stable prior to and following ultrasound examination regardless of no abnormalities detected [64] or when choroid plexus cyst/cysts were detected [66]. Sekizuka et al. [65] found that the differences between SOC scores in the first half of pregnancy and those in the latter half of pregnancy were not significant. Sekizuka et al. [74] found no statistically significant difference in SOC scores based on postpartum depression scores. Finally, Sjöström et al. [76] found no significant differences in SOC scores at gestation weeks 10–12, gestation weeks 34–36 and 8 weeks postpartum.
Quality Assessment
The quality assessment tools for observational cohort and cross-sectional studies were utilized for this purpose (see Table 6). Overall, the majority of the studies were of good methodological quality. All the reviewed manuscripts clearly stated the research question or objective of the study, the population of subjects were clearly defined and recruited from the same or similar populations. The inclusion/exclusion criteria for study participation were clearly specified and it was determined that there was sufficient timeframe to reasonably expect to observe an association between exposure and outcome. In all of the manuscripts reviewed, the exposure of interest (i.e., pregnancy) was clearly defined and valid and measured prior to the outcomes being measured. In the prospective studies, the exposure was measured more than once except in three studies [64, 67, 69]. In these studies, ultrasound examination was performed in pregnant women during the second trimester. A number of the cross-sectional studies examined different exposures of pregnancy in terms of pregnant or non-pregnant [36, 53], low-risk versus high-risk pregnancy [42], pregnancy complications [44], presence or absence of pregnancy complication [51, 54, 58] and trimester of pregnancy [59, 61, 79]. In a majority of the reviewed manuscripts (n = 34; 76%), the participation rate of eligible persons at least 50%. However, only 7 (15%) manuscripts [40, 42, 49, 51, 53, 56, 67] provided a sample size justification. Of the prospective studies (n = 28; 62%), five studies had greater than 20% lost to follow-up. Only half (n = 24; 53%) of the reviewed manuscripts addressed confounding by statistical adjustments for their impact on the relationship between exposure(s) and outcome(s).
Table 6
Summary findings of quality assessment of reviewed manuscripts
|
Response to Quality Assessment Criteria
|
Reference
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
Yu et al. (2022) [31]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Pasricha et al. (2021) [32]
|
Y
|
Y
|
O-NA
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
O-NA
|
N
|
Muggleton et al. (2021) [33]
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
Y
|
O-NR
|
Y
|
O-NR
|
Y
|
N
|
N
|
Y
|
Hildingsson et al. (2021) [34]
|
Y
|
Y
|
O-NA
|
Y
|
N
|
Y
|
Y
|
O-NR
|
Y
|
O-NR
|
Y
|
N
|
Y
|
N
|
Hildingsson et al. (2021) [35]
|
Y
|
Y
|
O-NR
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Einav et al. (2020) [36]
|
Y
|
Y
|
O-NR
|
N
|
N
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Finnbogadottir et al. (2020) [37]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Voogand et al. (2020) [38]
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
Asif et al. (2020) [39]
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
N
|
0-NA
|
Y
|
Neerland et al (2020) [40]
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Bratt et al. (2019) [41]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
N
|
N
|
Mohamamdirizi et al. (2018) [42]
|
Y
|
Y
|
O-NR
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
O-NA
|
N
|
Bäckström et al. (2018) [43]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Przestrzelska et al. (2018) [44]
|
Y
|
Y
|
O-NR
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Staneva et al. (2018) [45]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Hildingsson (2017) [46]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Linden et al. (2016) [47]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Ngai and Ngu (2016) [48]
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
N
|
N
|
Ferguson et al. [49]
|
Y
|
Y
|
O-NA
|
Y
|
N
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Staneva et al. (2016) [50]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
N
|
N
|
Ferguson et al. (2015) [51]
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Carlsson et al. (2015) [52]
|
Y
|
Y
|
O-NA
|
Y
|
N
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Ferguson et al. (2015) [53]
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
O-NA
|
N
|
Sekizuka-Kagami et al. (2015) [54]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Ngai and Ngu (2014) [55]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Finnbogadóttir et al. (2014) [56]
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Ngai and Ngu (2014) [57]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Takegata et al. (2014) [58]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Ngai and Ngu (2014) [59]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Swartz et al. (2013) [60]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Ngai and Ngu (2013) [61]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Jeschke et al. (2012) [62]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
O-NA
|
Y
|
Larsson et al. (2009) [63]
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
N
|
N
|
Ekelin et al. (2009) [64]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
N
|
N
|
Sekizuka et al. (2009) [65]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Larsson et al. (2009) [66]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
Oz et al. (2009) [67]
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Hibino et al. (2009) [68]
|
Y
|
Y
|
N
|
N
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Ekelin et al. (2008) [69]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
Y
|
N
|
Hellmers et al. (2008) [70]
|
Y
|
Y
|
N
|
N
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Hildingsson et al. (2008) [71]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Habroe et al. (2007) [72]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Rudman et al. (2007) [73]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Sekizuka et al. (2006) [74]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Almedom et al. (2005) [75]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Sjöström et al. (2004) [76]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
N
|
Engelhard et al. (2003) [77]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Abrahamsson and Ejlertsson (2002) [78]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Uren and Wastell (2002) [79]
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
O-NA
|
N
|
O-NA
|
Y
|
Y=Yes; N=No; O-NA =Other-Not Applicable; O-NR = Other – Not Reported
1 = Research question or objective clearly stated?
2 = Study Population clearly specified and defined?
3 = Participation rate of eligible persons at least 50%?
4 = Subjects recruited from same population with prespecified inclusion/exclusion criteria?
5 = Was sample size justification, power description, or variance and effect estimates provided?
6 = Were the exposure(s) of interest measured prior to the outcome(s) being measured?
7 = Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed?
8 = For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as continuous variable)?
9 = Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
10 = Was the exposure(s) assessed more than once over time?
11 = Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
12 = Were the outcome assessors blinded to the exposure status of participants?
13 = Was loss to follow-up after baseline 20% or less?
14 = Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)?