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Safadel L, Jomehry F, Emamipoor S, Rezaei O. Development of Structural Model of Salutogenic Health Indicators Based on Coping Resources and Stress Management Mediated by Health Promoting Lifestyle in Police Patients with Irritable Bowel Syndrome. JPMed 2022; 11 (1) : e15
URL: http://jpmed.ir/article-1-1024-en.html
1- Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran , lil.sd1397@gmail.com
2- Department of Psychology, Faculty of Psychology & Educational Sciences, Alameh Tabatabaee University, Tehran, Iran
3- Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran
4- Department Of Psychiatry, University Of Social Welfare & Rehabilitation Sciences, Tehran, Iran
English Extended Abstract:   (1656 Views)
... [1]. Two approaches, pathogenic (pathological) and salutogenic (origin of health), mention factors such as risk factors and disease resistance [2]. Irritable bowel syndrome is a chronic and widespread psychosomatic disease in which psychological factors are involved [3]. ... [4-7]. More than one-third of military women have irritable bowel syndrome [8]. ... [9, 10]. The pathophysiology of this disease is not fully understood [11, 12]. ... [13]. However, as the police officers are exposed to chemical, physical, and other environmental and psychological stressors, they are prone to gastrointestinal infections, which increases the risk of irritable bowel syndrome. [14, 15]. Studies have noted the relationship between stress management variables and coping resources in adaptation to chronic diseases such as irritable bowel syndrome [16-20], but previous studies have not emphasized the salutogenic perspective on variables related to adaptation to this disease.
Aim (s)
Variables emphasized by salutogenic were used in this study to develop a structural model for health indicators based on coping resources and stress management, mediated by a health-promoting lifestyle in police patients with irritable bowel syndrome (IBS).
Research Society, Place, and Time
Police patients with IBS who were referred to the gastrointestinal and psychiatric clinic of one of the police hospitals in 2020 and 2021 were introduced as the statistical population of the study.
Sampling Method and Number
250 samples were selected through convenience sampling method from patients who were diagnosed with IBS by a psychiatrist based on ROME-IV criteria.
Used Devices & Materials
Research tools included the Bringsen Health Salotogenic Indices Scale (Cronbach's alpha 0.81), Epstein Stress Management Questionnaire (Cronbach's original version 0.80 and translated version 0.94), Walker Health Promotion Lifestyle Profile Questionnaire (Cronbach's alpha 0.82) And the Matheny Stress Resources Questionnaire (Cronbach's alpha of the original version 0.84 to 0.97 and the translated version 0.94).
Ethical Permissions
This paper is taken from the Ph.D. dissertation on health psychology of the Islamic Azad University, Central Tehran Branch, code 10120709981008, and all ethical principles were observed.
Finding by Text
229 participants (130 (56.8%) female and 99 people (43.2%) male) with an age range of 18-49 years with a mean of 30.27 and a standard deviation of 4.18 completely answered the questionnaires of this study. 81 people (35.4%) were single, 110 (48%) were married and 32 (14%) were divorced. Mean research variables were as follows: salutogenic health indices 33.34±9.39, health-promoting lifestyle 142.90±35.90, stress management 78.19±19.18 and sources of coping with stress 82.38 19±19.07 (Table 1). To comply with the assumptions, the assumptions of structural equation modeling including the data level, which was spaced for all variables, the normality of the data, the absence of skewed data, and linearity were examined. In this study, the hypothesized model of the relationship between stress management and coping resources as an input or independent variable mediated by a health-promoting lifestyle on salutogenic indices as a dependent or output variable in SmartPLS-3 software was investigated. Confirmatory factor analysis was used to evaluate the fit, validity, and reliability of the model for measuring the relationship between coping resources and stress management on the salutogenic index of health through lifestyle mediation. The indicators of the goodness of fit of the measured model on the salutogenic index of health that is mediated by lifestyle had suitable values (Table 2). Therefore, the data were statistically consistent with the factor structure and theoretical basis of the four latent variables of the research. The standardized factor load (λ) of all selected markers for the structures in question (higher than 0.70) were all statistically significant at the 5% error level (Table 3). These results provided sufficient evidence to confirm the one-dimensionality of the selected markers in each of the relevant structures. Therefore, it can be said that the selected markers for each of the relevant structures were selected correctly. According to the results presented in Table 3, the combined reliability (CR) of all research structures was more than 0.70 and their Cronbach's alpha coefficient was higher than 0.70. Therefore, all latent variables (constructs) of the research measurement model had good reliability. The results presented in Table 3 showed that the average variance extracted (AVE) of all research constructs was more than 0.50. Therefore, all constructs of the research measurement model had good convergent validity. Also, in general, the root means of the extracted variance for each of the structures (0.43

Main Comparison to the Similar Studies
Consistent with other findings of this study, sources of coping with stress, including social support, trust, religion and spirituality, stress monitoring, the ability to reduce tension, a sense of dominance, physical health, ability to engage in problem-solving and organizing [27], have a direct effect on salutogenic indicators of health, including levels of mood, tension, sleep, concentration, creativity, accuracy, expression of emotions, illness, energy level, social ability, and physical function [23]. This result is also consistent with the study of Fouché et al. [3] who showed that there is a correlation between coping resources and indicators of health and adaptation to the disease in people with IBS. The Wilpart study, which showed that [16] low levels of physical coping resources (such as exercise or health-promoting activities) were associated with high levels of anxiety in people with irritable bowel syndrome, is also consistent with this study. On the other hand, the findings of this study showed that stress management [24] had a direct effect on salutogenic indicators of health which is consistent with the studies of Kamkar et al. [17] and the study of Soleimani et al. [29] which have shown that stress management is effective in reducing the severity of symptoms in patients with IBS. On the other hand, the results showed that the sources of coping with stress and stress management indirectly influenced salutogenic health indicators by mediating a health-promotion lifestyle. A health-promoting lifestyle is defined as a multidimensional model involving a person's perceptions and actions that begins with motivating oneself and contributes to a stronger level of health and self-fulfillment [30]. This finding is in line with the studies of Guo [18], Haji Shafiei [19], Maghtaei, Vakhshuury, and Khoshdel [14], the research of Papaefthymiou et al [31], and the study of Kang [20]. ... [32]. Several studies have shown an association between post-traumatic stress disorder (PTSD) and IBS in members of the police forces [6], which may indicate the role of stress in the military for IBS; Therefore, considering that stress is inherent in military jobs and also considering the role of acute and chronic stress in the development of IBS, the importance of training military personnel in stress management strategies and sources of coping with stress and lifestyle modification is highlighted.
Due to errors in measuring self-reports, the use of self-report tools may affect the results. Another limitation of this study was convenience sampling method.
This research was a cross-sectional correlation design based on which no causal results can be obtained, so experimental designs can be used in future research. It is suggested that in future studies, the random sampling method be applied in the selection of samples.
The present study showed that a health-promoting lifestyle including spiritual growth, stress management, nutrition, physical activity, health responsibility, and interpersonal support, can positively and significantly mediate the relationship between coping resources and stress management with salutogenic indicators of health in a sample of police personnel.
Clinical & Practical Tips in Police Medicine
Due to the nature of the job, police personnel is highly exposed to acute and chronic stressors, to manage and adapt to IBS, training personnel in stress management techniques such as managing or reducing the source of stress, thought management, prevention and planning and practicing relaxation techniques, providing solutions to increase sources of coping with stress through spiritual exercise, social support, active coping, as well as holding courses to promote a healthy lifestyle (exercise, proper nutrition, feeling responsible for your health) along with maintaining their physical, mental and social health can be effective in optimal police personnel’s performance.
We thank all the people who helped us in this research.
Conflict of Interest
The authors state that there is no conflict of interest in the present study.
Funding Sources
This research had no financial support.

Table 1) Minimum, maximum and the average of research variables
Research variables Minimum Maximum Mean The standard deviation Qualitative index
Salutogenic indicators of health 14 61 33.34 9.39 medium
Health-promoting lifestyle 54 206 142.90 35.90 High
stress management 29 123 78.19 19.18 medium
Resources for coping with stress 31 124 82.38 19.07 High

Table 2) Fit indicators of the model for measuring the impact of coping resources and stress management on salutogenic health index mediated by lifestyle
Fit index SRMR NFI RMS_Theta
Suggested value <0.10 >0.70 <0.12
Estimated value 0.072 0.751 0.017

Table 3) Summary of Evaluation Results of a Model for Measuring the Relationship between Coping Resources and Stress Management on Health Salutogenic Index with Lifestyle Mediation
Latent variables Marker Standardized factor load λ t p Combined validity (CR) Cronbach's alpha AVE
Coping Resources AC 0.922 2.53 0.01 0.945 0.930 0.740
SC 0.860 3.27 0.01
ST 0.807 3.56 0.01
TC 0.891 2.46 0.01
TR 0.832 2.68 0.01
WC 0.892 3.58 0.01
stress management
RLX 0.935 2.63 0.01 0.843 0.763 0.592
MA 0.848 2.05 0.01
MNG 0.942 3.15 0.01
TT 0.920 4.61 0.01
life style
HR 0.751 4.62 0.02 0.722 0.712 0.501
IPR 0.802 4.48 0.01
N 0.844 1.96 0.01
SA 0.709 2.68 0.05
SAC 0.780 2.94 0.02
SM 0.722 2.30 0.02
Salutogenic index of health
IAF 0.898 2.29 0.01 0.896 0.768 0.812
IPC 0.904 2.98 0.01

Figure 1) Model for measuring resource coping and stress management on salutogenic health index mediated by lifestyle

Table 4) Summary of evaluation results of structural model of coping resources and stress management on salutogenic health index mediated by lifestyle
Latent variable Direct effect Indirect effect Total effect f² R² Q²
Endogenous Exogenous λ p λ P λ p
Salutogenic index of health Coping Resources 0.37 0.01 0.11 0.05 0.48 0.01 0.23 0.20 0.36
stress management 0.11 0.05 0.13 0.01 0.24 0.01 0.08
life style 0.20 0.01 - - - -
life style Coping Resources 0.15 0.01 - - - - 0.24 0.35 0.31
stress management 0.18 0.01 - - - - 0.15

Article number: e15
Full-Text [PDF 666 kb]   (1449 Downloads) |   |   English Extended Abstract (HTML)  (243 Views)  
Article Type: Original Research | Subject: Police Related Psychology
Received: 2021/05/22 | Accepted: 2022/04/4 | Published: 2022/04/16

1. Larsen PD. Lubkin's chronic illness: impact and intervention. 9th ed Burlington: Jones and Bartlett; 2021. 636 p. https://www.amazon.com/Lubkins-Chronic-Illness-Impact-Intervention/dp/1284049000
2. Garmy P, Clausson EK, Hagell P, Jakobsson U, Berg A. Psychometric analysis of the salutogenic health indicator scale (SHIS) in adolescence. Scand Public Health. 2016;45(3):253-9. https://doi.org/10.1177/1403494816680801 [DOI:10.1177%2F1403494816680801] [PMID]
3. Fouché P, Gouws C, Cloete P, Naidoo SH. Biopsychosocial coping and adjustment of adult female irritable bowel syndrome patients. South Afr J Psychol. 2006;36(4):780-94. https://doi.org/10.1177/008124630603600408 [DOI:10.1177%2F008124630603600408]
4. Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence- based medicine. World J Gastroenterol. 2014;20(22):6759-73. doi: 10.3748/wjg.v20.i22.6759 [DOI:10.3748/wjg.v20.i22.6759] [PMID] [PMCID]
5. Pourmohseni- Koluri F, Eslami F. The effectiveness of group cognitive therapy based on mindfulness on mental health and quality of life of patients with irritable bowel syndrome. J Health Psychol. 2017;5(20):48- 67. [Persian]. https://hpj.journals.pnu.ac.ir/article_3319.html?lang=en
6. Wang WF, Guo X, Yang YS. Gastrointestinal problems in modern wars: clinical features and possible mechanisms. Mil Med Res. 2015;2(15):1-8. [DOI:10.1186/s40779-015-0042-5] [PMID] [PMCID]
7. Keshteli AH, Dehestani B, Daghaghzadeh H, Adibi P. Epidemiological features of irritable bowel syndrome and its subtypes among Iranian adults. Ann Gastroenterol. 2015;28(2):253-8. [Persian]. https://europepmc.org/article/med/25831414
8. White DL, Savas LS, Daci K, Elserag R, Graham DP, Fitzgerald SJ et al. Trauma history and risk of the irritable bowel syndrome in women veterans. Aliment Pharmacol Ther. 2010;32(4):551-61. [DOI:10.1111/j.1365-2036.2010.04387.x] [PMID] [PMCID]
9. Graham DP, Savas L, White D, El- Serag R, Laday- Smith S, Tan G et al. Irritable bowel syndrome symptoms and health related quality of life in female veterans. Aliment Pharmacol Ther. 2010;31(2):261-73. [DOI:10.1111/j.1365-2036.2009.04159.x] [PMID] [PMCID]
10. Wu W, Guo X, Yang Y, Peng L, Mao G, Qurratulain H et al. The prevalence of functional gastrointestinal disorders in the Chinese air force population. Gastroenterol Res Pract. 2013:6. [DOI:10.1155/2013/497585] [PMID] [PMCID]
11. Wendy G. 50 Thing You Can Do Today To Manage IBS. Kindle ed. Summersdale Publishers Ltd; 2011. 161p. https://www.amazon.com/Things-Manage-Personal-Health-Guides-ebook/dp/B005KB9WUS
12. Sayuk GS, Gyawali CP. Irritable bowel syndrome: modern concepts and management options. Am J Med. 2015;128(8):817-27. [DOI:10.1016/j.amjmed.2015.01.036] [PMID]
13. Muscatello MR, Bruno A, Mento C, Pandolfo G, Zoccali RA. Personality traits and emotional patterns in irritable bowel syndrome. World Gastroenterol. 2016;22(28):6402-15. https://dx.doi.org/10.3748%2Fwjg.v22.i28.6402 [DOI:10.3748/wjg.v22.i28.6402] [PMID] [PMCID]
14. Vakhshuury M, Khoshdel A. The relation between dietary patterns and functional gastrointestinal disorders among Iranian Military men. Adv biomed res. 2019;1-9. [DOI:10.4103/abr.abr_180_18] [PMID] [PMCID]
15. Bennett EJ, Tennant CC, Piesse C, Badcock CA, Kellow JE. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut. 1998;43(2):256- 61. [DOI:10.1136/gut.43.2.256] [PMID] [PMCID]
16. Wilpart K, Törnblom H, Svedlund J, Tack JF, Simrén M, Van Oudenhove L. Coping skills are associated with gastrointestinal symptom severity and somatization in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2017;15(10):1565-71. [DOI:10.1016/j.cgh.2017.02.032] [PMID]
17. Kamkar A, Golzary M, Farrokhi NA, Aghaee SH. The effectiveness of cognitive-behavioral stress management on symptoms of patients with irritable bowel syndrome. Armaghane danesh. 2011;16(4):300-10. [Persian]. DOI: 10.1016/j.cgh.2017.02.032/
18. Guo YB, Zhuang KM, Kuang L, Zhan Q, Wang XF, Liu SD. Association between diet and lifestyle habits and irritable Bowel syndrome: A Case- Control Study. Gut Liver. 2015;9(5):649-56. [DOI:10.5009/gnl13437] [PMCID]
19. Hajishafiee M, Keshteli AH, Saneei P, Feinle‐Bisset C, Esmaillzadeh A, Adibi P. Healthy lifestyle score and irritable bowel syndrome: A cross‐sectional study in adults. Neurogastroenterol Motil. 2020;32(5):e13793. [Persian]. [DOI:10.1111/nmo.13793] [PMID]
20. Kang S.H, Choi SW, Lee SJ, Chung WS, Lee HR, Chung KY, et al. The effects of lifestyle modification on symptoms and quality of life in patients with irritable bowel syndrome: a prospective observational study. Gut Liver. 2011;5(4):472-7. doi: 10.5009/gnl.2011.5.4.472 [DOI:10.5009/gnl.2011.5.4.472] [PMID] [PMCID]
21. Kline RB. Principles and practice of structural equation modeling:. 4th ed. Guilford publications; 2015. 534p. https://www.guilford.com/books/Principles-and-Practice-of-Structural-Equation-Modeling/Rex-Kline/9781462523344
22. Afrasiabi A, Yaghmaie F, Abdoli S, Abed Saiedy Zh, Research tool and cross- cultural adaptation. Adv Nurs Midwifery. 2006;16(54):58-67. [Persian]. https://www.sid.ir/en/journal/ViewPaper.aspx?id=109687
23. Bringsen A, Andersson HI, Ejlertsson G, Development and quality analysis of the salutogenic health indicator scale (SHIS) 2009.Scand J Publ Health;37:13-9. DOI: 10.1177/1403494808098919 [DOI:10.1177/1403494808098919] [PMID]
24. Epstein, R. (1999). Stress-management and relaxation activities for trainers. New York: McGrawHill. https://www.amazon.com/dp/0070217629
25. Mohammadi Zeidi I, Pakpour Hajiagha A, Mohammadi Zeidi B. Reliability and validity of persian version of the health- promoting lifestyle profile. J Mazandaran Univ Med Sci. 2012;21 (1):102-13. [Persian] http://jmums.mazums.ac.ir/article-1-955-en.html
26. Tanjani PT, Azadbakht M, Garmaroudi G, Sahaf R, Fekrizadeh Z. Validity and reliability of health promoting lifestyle profile II in the Iranian elderly. Int J prev med. 2016;7(74). https://pubmed.ncbi.nlm.nih.gov/27280010/ [DOI:10.4103/2008-7802.182731] [PMID] [PMCID]
27. Matheny KB, Aycock DW, Curlette WL, Junker GN. The coping resources inventory for stress: A measure of perceived resourcefulness. J clin psychol. 1993;49(6):815-30. https://pubmed.ncbi.nlm.nih.gov/8300870/ https://doi.org/10.1002/1097-4679(199311)49:6<815::AID-JCLP2270490609>3.0.CO;2-# [DOI:10.1002/1097-4679(199311)49:63.0.CO;2-#]
28. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav res methods. 2008;40(3):879-91. 10.3758/brm.40.3.879 29- Soleymani P, Abolghasemi A, vakiliabasalilu S, Rahimi A, 29- Bayramzade N. Efficacy of cognitive- behavioral stress management training on symptoms severity and emotional well- being of patients with irritable bowel syndrome. Horizon Med Sci. 2016;22(4):313-9. [Persian]. http://dx.doi.org/10.18869/acadpub.hms.22.4.313 10.18869/acadpub.hms.22.4.313 []
29. Hulme PA, Walker SN, Effle KJ, Jorgensen L, McGowan MG, Nelson JD et al. Health-promoting lifestyle behaviors of Spanish-speaking Hispanic adults. J Transcult Nurs. 2003;14(3):244-54 https://doi.org/10.1177/1043659603014003011 [DOI:10.1177/1043659603014003011 .] [PMID]
30. Papaefthymiou A, Doulberis M, Kountouras J, Kolokytha C, Galanopoulos M, Liatsos C. Impact of occupational stress on irritable bowel syndrome pathophysiology and potential management in active-duty noncombat Greek military personnel: a multicenter prospective survey. Eur J Gastroenterol Hepatol. 2019;31(8):954-63. https://doi.org/10.1097/MEG.0000000000001439 [DOI:10.1097/meg.0000000000001439] [PMID]
31. Bolen B, Irritable Bowel Syndrome in U.S. Veterans. Digestive Health. 2021. https://www.verywellhealth.com/ibs-in-veterans-1944720

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