Promoting mental health and salutogenesis in transcultural organizational and work contexts

Mental health and sense of coherence (SOC) have been researched interdisciplinarily in various social, organizational, cultural and scientific contexts, based on various methodological approaches. SOC has been introduced as a salutogenic, culture-general and universal life orientation that primarily develops in childhood. Recent research has shown that SOC in adults is influenced by (organizational) work contexts, since people spend a large amount of their lifetime in work organizations (Mayer, 2011). It has been stated as well that specific interventions can increase SOC particularly in adulthood. However, SOC has scarcely been studied and these interventions have barely been described, assessed or evaluated regarding their mechanisms of actions and their transcultural adaptability.

With regard to the globalizing work contexts, the rapid changing challenges, the overload of information, the rising expectations and complexities in international and transcultural work places, the individual's need to maintain mental health and promote SOC is growing. Due to an increase in stress-related symptoms, ill-health and the decrease in mental health, organizations are affected globally by health-related absenteeism and lack of job performance. Therefore, there is an urgent need to exchange ideas on and address transcultural salutogenic interventions to promote salutogenesis in work contexts to maintain and build mental health in individuals and organizations across cultures.

This special issue of the International Review of Psychiatry focuses on promoting mental health and salutogenesis in transcultural organizational and work contexts to raise issues and questions on the sense of coherence which are of scientific interest and which have hardly been addressed before. The overall aim of this special issue is to fill the void by connecting the concept of salutogenesis to culture and transculturality within the work place. Various authors from different disciplinary and cultural backgrounds have been invited to submit theoretical and empirical manuscripts on these issues and illuminate them from different points of view. Therefore, this special issue focuses on drawing together culture-specific and transcultural knowledge referring to salutogenesis as well as reflecting health, culture and transculturality in the particular context of work. This special issue adds to the interdisciplinary body of knowledge and thereby contributes to the body of knowledge on salutogenesis in transcultural (organizational) settings.

Salutogenesis in transcultural work and organizational contexts

Changes within the new and globalized work environment impact on general health and well-being at the workplace. Ill-health is often ascribed to negative impacts such as the increasing importance of the service sector, unemployment, changes in employment practices, ageing, downsizing and restructuring processes, customer orientation and quality management (ENWHP, 2005, p. 1). Other work-related issues, such as rapid technological development and intensified competition (Badura et al., 2001, pp. 14–16), an increasing demand for a higher degree of participation and responsibility (Köhler, 2004, p. 62), decentralization of production and services, outsourcing processes and the increase of individual requirements lead to ‘mental overload’ (Bedner, 2001, pp. 73–76) and thereby to a decrease of health and well-being.

However, scientists emphasize the ‘positive impact of work’ (Köhler, 2004, p. 60) and the increase of ‘health knowledge’ (Brinkmann, 1993, p. 34) in organizations, rather than focusing on stressors. Since employees spend a considerable amount of time at work, physical and mental health and well-being need special consideration. A strongly developed sense of coherence equates to a higher probability of successful stress management and, consequently, a positive impact on health. At the same time, the organizational environment influences health, well-being and stress management through its structures and organizational values and culture (Köhler, 2004, p. 18). Individual and organizational health and well-being are strongly inter-related (Grant & Mack, 2004). The ILO (2003), therefore, requires radical changes in organizations to improve work conditions and employee health in terms of physical, psychological and social well-being (Goldstein et al., 2001).

Promoting salutogenesis and sense of coherence transculturally at work and in organizations

Health promotion in organizations requires an integrated approach that includes individual and organizational characteristics, as well as external influences (Johanson et al., 2007, p. 84). Increasing criticism on healthcare, along with a growing interest in the topic, led the World Health Organization (WHO, 1986) to release the Ottawa Charter which summarizes the general principles of health promotion and provides perspectives as for action. The Ottawa Charter serves as the master document for health promotion in organizations and incorporates five principles (Europäische Stiftung, 1998, pp. 10–11) of health promotion: needs to be adapted to all employees, focuses on causes of diseases, includes different procedures, targets the effective participation of employees, and is not a medical treatment, but part of the work organization. Obviously these principles are based on the bio-medical paradigm of health which focuses on diseases, illness and sickness, rather than on a salutogenic approach that focuses on the health and well-being.

Healthy organizations are defined as promoting trustful relationships, positive feedback, common values and clear rules in the organization (Münch et al., 2003, p. 18). They provide predictable requirements (comprehensibility), the possibility to respond to change and development (manageability), as well as the possibility to achieve individual and collective objectives (meaningfulness) (Rosenbrock, 1996, p. 13). Low levels of stress, high organizational commitment and job satisfaction, low incidence of sickness and employee absenteeism, staff turnover below the national average, positive industrial relations and infrequent strikes are aspects of healthy organizations. They usually offer training, leadership development programmes, are an equal opportunity employers and promote mental health (Johanson et al., 2007, p. 144).

In recent research studies (Johanson et al., 2007, pp. 125–127), it has been promoted that traditional pathogenic organizational health management and promotion need to be replaced with salutogenic models which focus on proactive actions, view health as a company asset, consider health promotion as part of the business strategy, promote de-medicalization, comprise implicitly and explicitly health promoting activities and focus on employees and their personal development.

This change from pathogenic to salutogenic health promotion requires organizational support and a systemic and strategic approach (Westermeyer & Bähr, 1994, p. 51) and needs to be implemented through services and interventions for employees.

SOC has been researched with regard to work (Du Buisson-Narsai, 2005; Hobkirk, 2003; Jackson, 2002; Kossuth, 1998; Kossuth & Cilliers, 2002; Lochner, 2000; Mayer & Boness, 2009; Mayer et al., 2010; Moerane, 2005; Nel et al., 2004; Pillay, 2008; Rothmann, 2001; Rothmann et al., 2002; Strümpfer & de Bruin, 2009; Strümpfer & Mlonzi, 2001), focusing on stress and burnout (Els, 2005a, 2005b; Fourie et al., 2008; Kerr-Hutchinson et al., 2007; Naudé & Rothmann, 2006; Rothmann et al., 2006; Sullivan, 1995; van der Colff, 2006; van der Colff & Rothmann, 2006), as well as on stress-resistance and coping (Bach, 2000; Basson, 2003; Cairns, 2002; Naidu, 2003; Strijdom, 2000). Studies have indicated that SOC is positively related to job commitment (Du Buisson-Narsai, 2005), work engagement (Fourie et al., 2008; Pillay, 2008; Rothmann et al., 2005), job satisfaction (Rothmann, 2001; Strümpfer et al., 1998), competence and life satisfaction (Kalimo & Vuori, 1990), general well-being (Feldt, 1997) and active coping with stressors (Redelinghuys & Rothmann, 2005). Within the management context it has been shown that with regard to SOC, manageability and comprehensibility are more important to managers than meaningfulness (Mayer et al., 2010). Job attitudes (Strümpfer & Mlonzi, 2001), work outcomes (Rothmann et al., 2002), goal orientation (Nel et al., 2004), job satisfaction (Rothmann, 2001), job satisfaction and work engagement (Fourie et al., 2008), performance orientation (Kossuth, 1998; Moerane, 2005), leadership (Kossuth & Cilliers, 2002), change and adaptable solutions (Slabbert & de Villiers, 1998; Veldsman, 1997) and work orientation (Viviers & Cilliers, 1999) have been researched with regard to SOC. SOC has later been correlated with organizational change and stress and organizational culture, job satisfaction and personality (Strydom & Roodt, 2007).

SOC has been evaluated as being influential towards mobilizing and generating organizational change (Williams et al., 2003) and social resources in the workplace: SOC is viewed as having a significant effect on how managers perceive the demands and resources at work (Fourie et al., 2008) and how managers resolve transcultural conflicts in the workplace (Mayer & Boness, 2009).

SOC is negatively related to burnout (Fourie et al., 2008; Rothmann et al., 2005), anxiety and neuroticism (Flannery & Flannery, 1990; Frenz et al., 1990, 1993), as well as depression and job stress (Feldt, 1997). SOC has been studied extensively in the context of occupational stress (Cope, 2003; Oosthuizen, 2005; Rothmann et al., 2006; van der Colff, 2006; van der Colff & Rothmann, 2009) and coping with stressors in work situations (Bach, 2000; Basson, 2003; Cairns, 2002; Kerr-Hutchinson et al., 2007; Naidu, 2003; Strijdom, 2000).

Finally, it has been shown that individuals with a low SOC tend to be motivated by extrinsic resources, such salaries, whilst individuals with a strong SOC seem to be motivated by the ‘intrinsic nature of the work’ which they perceive as engaging and satisfying (Muller & Rothmann, 2009, p. 3).

Salutogenesis, culture and transculturality

Salutogenesis has been studied in various countries, particularly in Scandinavian countries, Israel, Germany, and South Africa (Mayer, 2011). The SOC scale has been validated transculturally; however, only a few studies explicitly focus on SOC in transcultural and inter-cultural settings. These include South African organizations (Mayer, 2011), Brazilian transcultural settings (Bonanato et al., 2009), Japanese rural and urban settings (Tsuno & Yamazaki, 2007) and Arab and Jewish students (Cohen et al., 2008). Accordingly, it is assumed that the SOC scale is valid across cultures.

Internationally, SOC has barely been studied with regard to transcultural interactions, communication and international (business) contacts and interactions in transcultural organizational settings. It has been proven that stress in individuals can be caused by transcultural interactions and communication (Barna, 1994; Redmond, 2000), international business situations and conflicts in international business (Jamal, 1999; Johnson et al., 2006) and moving into new cultures (Zapf, 1991). Research (Peterson & Wilson, 2002) has found that work stress is as much a managerial and organizational concern as a health concern and that culture and transculturality plays a significant role in international and global organizational contexts. However, the interlinkages of salutogenesis, culture and transculture/interculture/cross-culture within the organizational contexts particularly have been ignored and therefore gain special attention within this special issue.

Articles published here refer to current relevant research questions on salutogenesis, sense of coherence, culture and diversity from theoretical as well as from empirical perspectives.

This special issue provides the reader with an in-depth insight into the recent theoretical debate as well as current empiric research findings in the field of salutogenesis and mental health in transcultural contexts. It aims at providing various international as well as interdisciplinary perspectives, understanding and approaches to the topic of promoting health. It presents articles from authors who argue from different disciplinary perspectives including social sciences, medical sciences, medical sociology, psychology and pedagogics as well as socio-cultural anthropology and ethnography. Examples, research results and findings from different countries and ethnic, cultural, organizational and regional contexts provide the reader with a broad insight into the complexity of salutogenesis, mental health and culture studies. These articles at the same time address the topic by using various theoretical models as well as different methodological approaches from positivist to social constructivist and interpretative paradigms, and thereby explicitly contribute to presenting a broad variety of perspectives and research data.

The first four articles refer directly to the topics of salutogenesis, SOC and culture within organizational settings from empirical as well as theoretical perspectives.

Frans Cilliers focuses on individual diversity management in a selected organization in South Africa. The author refers to the question how individual managers engage with and experience diversity situations within work settings. The aim of the research was to investigate whether and how sense of coherence acts as differentiator between ineffective and effective diversity management amongst managers. By using a mixed method research approach, the author presents results on the connection between SOC scores, identity forming, effective interpersonal relationship and (individual) diversity management. It is recommended that organizations design their diversity programmes based on salutogenesis as theoretical model.

The article by Silke Gräser provides an overview of salutogenic factors for mental health promotion in work settings and organizations. The author refers to salutogenic perspectives to provide a promising approach to identifying supportive factors and resources of mental health promotion in organizations. She develops a new concept – an organization-based sense of coherence scale – to identify potential salutogenic factors within a university context in Germany. Statistical analysis yielded significant correlations between mental health and the organization-based SOC. Focusing particularly on the transcultural dimension, the author discusses the potential salutogenic factors and elaborates the development of salutogenic interventions in work settings and organizations to support the potential of promoting mental health in organizations.

Claude-Hélène Mayer and Christian Boness contribute to this special issue by referring to interventions which can assist the development of SOC in transcultural work settings. The authors thereby concentrate on presenting the state of the art on salutogenic interventions and on developing transcultural competences. An example of promoting SOC and transculturality within a selected German educational setting is given. Recommendations on how professionals in educational contexts can contribute to a healthy and transcultural educational organizational setting are provided. The ‘Team-Ombuds-Model’ to promote transcultural resources and mental health in the described context is presented.

By ‘Developing sense of coherence in educational contexts: making progress in promoting mental health in children’, Christina Krause also refers to the educational context. She discusses on the one hand which individual and universal resources should be promoted. On the other hand she refers to the question how the resources can be activated. Responding to these two areas of research, selected empirical findings will be presented, which show that the educational formal system can contribute highly effectively to the development of SOC. However, the findings show that professionals need to be trained to realize salutogenic education. At the same time the development of SOC also needs the cooperation of the parents to support the professional educators. The author presents salutogenic educational programmes. The issue of transculturality is referred to since the concept is transculturally implementable.

The following three articles particularly focus on culture and salutogenesis in various cultural groups and national contexts.

Very important insights are presented by Orna Braun-Lewensohn and Shifra Sagy who particularly focus on ‘Salutogenesis and culture: Personal and community sense of coherence among adolescents belonging to three different cultural groups.’ In the centre of the article stands the assumption that in seeking to understand how the SOC works; it is culture that defines which resources and which strategies are appropriate to choose to remain or become healthy. The aim of this paper is to examine this theoretical assumption of Antonovsky by analysing data on personal and community SOC as well as coping strategies after the last fire in different cultural groups (Jews, Druze, Muslims) in Northern Israel in December 2010. Personal and community SOC in explaining stress reactions in the three different cultures are emphasized and explained with regard to Antonovsky's theory.

Yesim Erim, Eva Morawa, Halil Atay, Sanem Aygün and Wolfgang Senf focus on salutogenesis in Turkish patients in Germany and Turkey. The aim of this article is to examine SOC as a salutogenic resource in immigrants with regard to their cultural and migration context. A total of 96 patients of the native-language outpatient unit for Turkish patients in Germany as well as 60 patients of an outpatient unit of a psychiatric hospital in Turkey have participated in the described study using the Sense of Coherence Scale (SOC-29) and the Beck Depression Inventory (BDI). The authors conclude that SOC is a protective factor for depression in patients with Turkish migration background in Germany and in local Turkish patients.

Benyamin Moaz, one of the pioneers in salutogenesis, and his two colleagues Hadar Shaley and Asher Shiber, explore the potential collisions between western and non-western cultures which might interfere in the process of psychiatric and psychotherapeutic treatment. The authors demonstrate the importance of a culture sensitive approach and therapy and the usefulness of specific culture sensitive services for certain non-western populations. They illustrate this approach by exemplifying the unique ways of treatment carried out by the Bedouins of the Negev region of Israel.

The following three articles approach salutogenesis and culture from various theoretical perspectives by highlighting different foci.

Gerald Hüther and Ingrid Flaig address mental health and healing from a neurobiological perspective and emphasize that neurobiology has shown that all healing is self-healing. Medical interventions can support the self-healing process, but cannot cause it. The authors state that control mechanisms of the central nervous system responsible for the re-activation of self-healing capacities are easily obstructed, e.g. by fear. Therefore it takes a combination of cognitive and emotional interventions to change the mindsets which block the way to the self-healing powers anchored in the brain stem. The authors focus on the idea that being familiar with cultural differences and/or similarities and knowing how to address them in a trustful way is essential for the success of the healing process.

By pointing out migration and the increase of cross-cultural dimensions of psychological disorders, Jeanette Riedel, Ulrich Wiesmann and Hans-Joachim Hannich approach the main factors affecting an individual's adaptation in a new cultural context. In their theoretical paper, the authors provide an integrative framework of acculturation and salutogenesis that helps to integrate inconsistent findings in the migrant mental health literature. The article focuses on the effect of resource factors for positive mental health outcomes in the migrant population and provides implications for future research.

Theodor D. Petzold and Nadja Lehmann focus on the topic of salutogenesis as a global orientation from a theoretical perspective. In their article the authors focus on an evolutionary and systemic view of a healthy life development which can increase with humanity. With regard to humanity, the deeper meaning of cultural values and rituals play a key role in healthy life development. Therefore, it is primarily important to appreciate the personal resonance with regard to a particular culture and at the same time to enter a so-called ‘transcultural dimension’. The authors focus on transcultural salutogenic communication and emphasize the individual resonance and its impact on global human relations with regard to the development of, for example, universal ethics.

The articles presented in this special issue bring about new thoughts and ideas to the salutogenic approach and the promotion of mental health in transcultural contexts in organizations and particular cultural groups. They are to stimulate further debate, research and discussion on promoting and maintaining salutogenesis across various cultures. You are now welcome to read on and be stimulated to move the discussion forward, in a constructive, salutogenic, but controversial way.