Family Sense of Coherence and Family Adaptation Among Childbearing Couples

CLINICAL SCHOLARSHIP

Family Sense of Coherence and Family Adaptation AmongChildbearing CouplesFei-Wan Ngai, PhD1 & Siew-Fei Ngu, MBBS (London), MRCOG2

1 Assistant Professor, School of Nursing, The Li Ka Shing Faculty of Medicine, The University of Hong Kong2 Clinical Assistant Professor, Department of Obstetrics and Gynaecology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, Hong Kong

Key wordsChildbearing couples, depressive symptoms,

family and marital functioning, family sense of

coherence

CorrespondenceDr. Fei-Wan Ngai, The Li Ka Shing Faculty of

Medicine, The University of Hong Kong, Room

417, 4/F, William M W Mong Block, 21 Sassoon

Road, Pokfulam, Hong Kong.

E-mail: [email protected]

Accepted: July 24, 2013

doi: 10.1111/jnu.12045

Abstract

Purpose: A family sense of coherence is important to successful family adap-tation during parental transition. The purpose of this study was to examinethe relationships between family sense of coherence, stress, family and maritalfunctioning, and depressive symptoms among Chinese childbearing couples.Design: A cross-sectional design was used. Two hundred and twenty-fourChinese childbearing couples were recruited at the antenatal clinic betweenJanuary and May 2011.Methods: Data were collected using the Family Sense of Competence Scale,Social Readjustment Rating Scale, Medical Outcome Study Family and MaritalFunctioning Measures, and General Health Questionnaire. Path analysis wasemployed.Findings: Family sense of coherence had a direct impact on family and maritalfunctioning and depressive symptoms among both couples. Family sense ofcoherence also mediated the effect of stress on family and marital functioningand depressive symptoms among the pregnant women.Conclusions: The study provides evidence that family sense of coherenceplays a significant role in promoting family functioning and reducing depres-sive symptoms during the transition to parenthood.Clinical Relevance: Knowledge of the impact of family sense of coherencein parental transition can better equip healthcare professionals for developingcouple-based and culturally sensitive care to assist childbearing couples to copewith the stress and demands of the parental role, thereby promoting positivefamily functioning and well-being.

New parenthood is a key transition in the family cyclethat requires major adjustment of couples’ lives (Lu et al.,2012). While many couples can manage the demands ofnew parenthood and are content with their parental role,there is evidence that new parenthood poses significantstress on the couples, which threatens their family func-tioning and increases the risk of developing depressivesymptoms (Paulson & Bazemore, 2010). In a systematicreview of 43 studies involving 16 Western countries, bothwomen (23.8%) and men (11%–12%) were reportedto suffer from depression during pregnancy (Paulson &Bazemore, 2010), indicating that parental transition isa stressor that also affects the men during the prenatal

period. Furthermore, a significant relationship has beenfound between maternal and paternal depression (Gao,Chan, & Mao, 2009; Paulson & Bazemore, 2010), whichindicates the need for understanding family as a socialsystem in which the parents experience stressors and en-gage in active adaptation of the new parenthood.

The impacts of parental depression on the family canbe life-long and have adverse effects on parent–child re-lationships (Field, 2010) and affect the behavioral andemotional health of the child (Paulson, Keefe, & Leifer-man, 2009). Ramchandani et al. (2008) conducted apopulation-based longitudinal study of 7,601 families inthe United Kingdom and found that paternal depression

82 Journal of Nursing Scholarship, 2014; 46:2, 82–90.C© 2013 Sigma Theta Tau International

Ngai & Ngu Family Coherence and Adaptation

in the perinatal period increased the risk for behavioraland emotional problems in their offspring. Given thesubstantial impacts of paternal depression on the wholefamily and their significant association with each other,understanding the way of family coping and develop-ing effective intervention programs to help both parentsdeal with the stressful demands of parenthood are ofparamount importance.

The theoretical underpinning of this research is basedon Antonovsky’s Salutogenic Model (1987), which fo-cuses on people’s strengths and capacity for success-ful adjustment to life stressors. Family sense of coher-ence is a crucial coping resource that can contribute tofamily resilience and facilitates active adaptation duringparental transition (Antonovsky & Sourani, 1988). Fam-ily sense of coherence is defined as the family’s globalorientation that the environment is well structured, pre-dictable, and explicable (comprehensible); there are re-sources for the family to cope with demands (manage-able); and the demands are challenges and worthy ofinvestment (meaningful; Antonovsky & Sourani, 1988).During the parental transition, family sense of coherencerepresents the extent to which the couples see their fam-ily worldview as coherent (Antonovsky, 1987). Accord-ing to Antonovsky and Sourani (1988), a strong sense offamily coherence, in particular the one shared by couples,provides the perceptual, behavioral, and motivational ba-sis for effective management of the demands posed byparental stressors; thus, they have better emotional well-being and are satisfied with their family life. For exam-ple, family sense of coherence was found to positivelypredict family functioning and adaptation, explaining 7%of the total variance, among 116 families with mentallyretarded children in the United States (Lustig & Akey,1999). In another study of 78 families with chronic ill-ness in the United States, family sense of coherence wasalso found to strongly predict the quality of family life, ex-plaining over 30% of the variance, and mediated the ef-fect of stress on family quality of life (Anderson, 1998). InNgai and Ngu’s (2011) study of 128 Chinese childbearingcouples in Hong Kong, couples who possessed a strongerfamily sense of coherence were found to report a lowerlevel of anxiety and better family functioning. The ev-idence suggests a potential influence of family sense ofcoherence on the family’s capability to deal with stress,thereby enhancing positive functioning and well-being ofthe family.

Although family sense of coherence has been stud-ied in families with chronic illness and disabilities(Anderson, 1998; Ylven, Bjork-Akesson, & Granlund,2006), evidence is limited regarding the influence offamily sense of coherence in the perinatal period, par-ticularly for Chinese families. The family sense of co-

herence can be regarded as a family resilience resourceto stress during parental transition and thereby maymediate the relation between parental stressors andfamily functioning. We therefore expect that strong fam-ily sense of coherence will be significantly and posi-tively related to satisfaction with family and marital func-tioning, and negatively related to stress and depressivesymptoms during the transition to parenthood. We alsoexpected that scores on family sense of coherence, fam-ily and marital functioning, and depressive symptoms inwomen will be positively related to those in their partners(Figure 1).

Furthermore, most of the studies on paternal depres-sion were conducted with predominantly White pop-ulations (Paulson & Bazemore, 2010). Only one studyexamined depression in Chinese fathers, but only at post-partum (Gao et al., 2009). No studies to date have ex-amined paternal depression during pregnancy and itsrelation to maternal depression in the Chinese popu-lation. Given that paternal engagement during preg-nancy has a positive impact on the health of the en-tire family (Ramchandani et al., 2011); knowledge offamily sense of coherence and parental depression dur-ing pregnancy would facilitate the provision of cul-turally competent care and help to promote success-ful adaptation during parental transition. Thus, the aimsof this study were (a) to investigate the relationshipsbetween family sense of coherence, stress, family andmarital functioning, and depressive symptoms in first-time Chinese childbearing couples; and (b) to determinewhether family sense of coherence mediated the effect ofstress on family and marital functioning and depressivesymptoms.

Methods

Design, Setting, and Sample

This study used a cross-sectional design. Two hun-dred and twenty-four pairs of childbearing couples wererecruited at the antenatal clinic in a public hospital be-tween January and May 2011 using convenience sam-pling. The sample inclusion criteria consisted of first-time childbearing couples who were 18 years of age orolder, could read Chinese, Hong Kong residents, and didnot have a family or past history of psychiatric illness.The sample size was based on 200 people required toachieve a power of 0.80 in testing mediation (Hoyle &Kenny, 1999), with an attrition rate of 10%. This studywas conducted with a different sample from the valida-tion study of the Family Sense of Coherence Scale (Ngai& Ngu, 2011).

Journal of Nursing Scholarship, 2014; 46:2, 82–90. 83C© 2013 Sigma Theta Tau International

Family Coherence and Adaptation Ngai & Ngu

Stress(mother)

Family sense of coherence (mother)

Family and Marital Functioning (father)

Family and Marital Functioning (mother)

+

+

Depressive symptoms (father)

+

–

–

+

++

Stress(father)

Depressive symptoms (mother)

– –

++

Family sense of coherence (father)

+

–

–

Figure 1. Theoretical relationships between study variables.

Measures

Family sense of coherence. The Family Sense ofCoherence Scale short form (FSOC-S) consists of 12 itemsmeasuring the extent that the family regards the environ-ment as comprehensible, meaningful, and manageable(Sagy, 1998). Each item is rated on a 7-point scale, withtotal scores ranging from 7 to 84. A higher score indicatesperception of better family life coherence. The FSOC-Shas good internal consistency of 0.81 (Sagy, 1998). TheChinese version of the FSOC-S has been validated amongHong Kong Chinese childbearing couples. Internal consis-tency was 0.83 and test–retest reliability 0.75. Constructvalidity was demonstrated by significant correlations withsense of coherence, anxiety, and social support (Ngai& Ngu, 2011). The internal consistencies in the presentstudy were 0.87 and 0.83, respectively, for the mothersand fathers.

Stressful life event. The Social Readjustment Rat-ing Scale (SRRS) includes 43 major life events (Holmes& Rahe, 1967). Each event has an assigned life changeunit to indicate the severity of such a life event. A highervalue indicates more stress associated with the event. Themodified Chinese version includes 39 major life eventsthat were validated among Hong Kong Chinese parents(Shek & Mak, 1987). Validity was demonstrated by posi-

tive correlations with depressive symptoms (Lee, Yip, Le-ung, & Chung, 2004). The internal consistencies in thepresent study were 0.77 and 0.74, respectively, for themothers and fathers.

Family and marital functioning. The MedicalOutcomes Study Family and Marital Functioning Mea-sures (MOS–FMFM) consist of 10 items measuring fam-ily life satisfaction (FFM), overall happiness with fam-ily life, and marital functioning (MFM; Sherbourne &Kamberg, 1992). Both FFM and MFM are rated on 5-point scales and the overall happiness with family life ona 6-point scale. Scores range from 10 to 51, with a higherscore indicating more satisfaction with family life andmarital functioning. The Chinese version has been vali-dated with Chinese childbearing couples in Hong Kong.Internal consistency was 0.79 and test–retest reliability0.74. Validity was demonstrated by significant correla-tions with anxiety and social support (Ngai & Ngu, 2012).The internal consistencies in the present study were 0.78and 0.77, respectively, for the mothers and fathers.

Depressive symptoms. The General Health Ques-tionnaire (GHQ) consists of 12 items assessing psycho-logical distress (Goldberg & Williams, 1988). Items arerated on a 4-point scale. Scores range from 0 to 12 us-ing a bi-modal (0–0–1–1) scoring method. The higher



the score, the more distressed the respondent. The Chi-nese version has a sensitivity of 88% and specificityof 89% using a cutoff score of 4/5. Concurrent valid-ity was demonstrated with satisfactory correlations withthe Beck Depression Inventory and Edinburgh Postna-tal Depression Scale (Lee, Yip, Chiu, Leung, & Cheung,2001). The internal consistencies in the present studywere 0.84 and 0.78, respectively, for the mothers andfathers.

Data Collection Procedure

After obtaining the ethical approval from the studyhospital, childbearing couples who were eligible for thestudy were recruited at the antenatal clinics. The na-ture of the study was explained and confidentialitywas ensured. A written consent was signed by coupleswho agreed to participate. Both members of the couplecompleted four instruments: the FSOC-S, SRRS, MOS–FMFM, and GHQ independently, but within the sametime frame at the antenatal clinics.

Statistical Analysis

The Statistical Package for Social Sciences (SPSS; SPSSInc., Chicago, IL, USA) was used for the analysis of data.Descriptive analysis was conducted for the backgroundcharacteristics of the participants. Pearson’s correlationswere employed to examine the relations among the studyvariables with a Bonferonni adjustment. Analysis of Mo-ment Structures (AMOS) was employed for path analysis.Goodness-of-fit indices were evaluated to examine theoverall data fit. A nonsignificant chi square (χ2) value, anincremental fit index (IFI), a comparative fit index (CFI),and a Tucker-Lewis index (TLI) of > 0.90, and a rootmean square of approximation (RMSEA) of < 0.08 in-dicates a good model fit (Kline, 2011). The hypothesizedmodel was evaluated with modifications to enhance theoverall model fit (see Figure 1).

Results

Characteristics of the Participants

Participants’ characteristics are shown in Table 1.The majority of childbearing couples had attained asecondary school level of education or above (99%).All the fathers were employed, and over 80% ofmothers were also employed. The median incomewas HK$33,698 (US$4,320) per month, indicating thatmost of the participants were middle-class childbearingcouples.

Table 1. Demographic and Obstetric Characteristics of the Participants

(N = 448)

Subgroup of mothers Subgroup of fathers

(n = 224) (n = 224)

Characteristics n (%) n (%)

Age (mean years ± SD) 31.7 ± 4.4 33.9 ± 4.8

Education level

Primary 1 (0.4) 1 (0.4)

Secondary 75 (33.5) 72 (32.1)

Tertiary 32 (14.3) 27 (12.1)

University or above 116 (51.8) 124 (55.3)

Employment status

Unemployed 33 (14.7) 0

Employed 191 (85.3) 224 (100)

Monthly household income

< HK$10,000 17 (7.6)

HK$10,001–20,000 35 (15.6)

HK$20,000–30,000 44 (19.7)

HK$30,001–40,000 43 (19.2)

HK$40,001–50,000 33 (14.7)

> HK$50,000 52 (23.3)

Gestation

1st trimester 24 (10.7)

2nd trimester 116 (51.8)

3rd trimester 84 (37.5)

Table 2. Means and Standard Deviations of Study Variables (N = 448)

Subgroup of mothers Subgroup of fathers

(n = 224) (n = 224)

Variables M (SD) M (SD)

Family Sense of Coherence

Scale

65.0 (9.2) 64.9 (8.8)

Social Readjustment

Rating Scale

232.7 (149.1) 195.4 (148.6)

Medical Outcomes Study

Family and Marital

Functioning Measures

40.2 (4.8) 40.0 (5.1)

General Health

Questionnaire

2.2 (4.5) 1.4 (1.9)

Paternal and Maternal Depressive Symptoms

The study variables’ means and standard deviationsare illustrated in Table 2. The prevalence rate of de-pressive symptoms was 8.0% (n = 18) and 15.6% (n

= 35) for the fathers and mothers, respectively. The fa-thers’ severity of depressive symptoms was significantlylower than the mothers’ (t = 4.11, p < .001). Corre-lation between maternal and paternal depressive symp-toms was statistically significant but weak (r = 0.17,p < .01).



Table 3. Pearson’s Correlations Between Study Variables (n = 224)

1 2 3 4 5 6 7

1. Stress (mother) 1

2. Family sense of coherence (mother) −0.15 1

3. Family and marital functioning (mother) −0.05 0.73∗ 1

4. Depressive symptoms (mother) 0.20∗ −0.37∗ −0.31∗ 1

5. Stress (father) 0.36∗ −0.13 −0.14 0.06 1

6. Family sense of coherence (father) 0.06 0.44∗ 0.43∗ −0.14 −0.11

7. Family and marital functioning (father) 0.03 0.38∗ 0.46∗ −0.10 −0.04 0.67∗ 1

8. Depressive symptoms (father) −0.04 −0.15 −0.18 0.17 0.10 −0.37∗ −0.30∗

∗p < .006.

Relationships Between Study Variables

Table 3 shows the correlations among the study vari-ables. The couples’ scores on family sense of coherence,family and marital functioning, and stress were signifi-cantly correlated with each other. Women reported sig-nificantly higher stress than did their partners duringpregnancy (t = 2.65, p < .01). Stronger family senseof coherence correlated significantly with better familyand marital functioning, less stress, and fewer depressivesymptoms among both couples. The hypothesized modelrevealed a modest fit with four paths showing nonsignif-icant regression weights. These paths involving the rela-tion of stress on the family and marital functioning forboth couples and the relation of stress on family sense ofcoherence and depressive symptoms for the fathers wereremoved from the model. The modified model demon-strated a good model fit (χ2 [12] = 19.53, p = .08, GFI =0.98; IFI = 0.98, CFI = 0.98, TLI = 0.97, RMSEA = 0.05),

with significant paths at p < .05 (Figure 2). The resultsshowed that family sense of coherence had a direct im-pact on the family and marital functioning and depres-sive symptoms. Family sense of coherence also mediatedthe effect of stress on family and marital functioning anddepressive symptoms for the pregnant women. The fi-nal model explained 52% and 43% of the total variancein the family and marital functioning for the pregnantwomen and their partners, respectively, and 16% and14% of the variance in depressive symptoms for the preg-nant women and their partners, respectively.

Discussion

The present findings indicate that family sense of co-herence facilitates positive adaptation during childbear-ing by promoting couples’ emotional well-being and theirsense of satisfaction with family and marital functioning.

Stress(mother)

Family and Marital Functioning (father)

Family and Marital Functioning (mother)

Depressive symptoms (father)

+Depressive symptoms (mother)

-.17-.35

-.37

.45

.72

.66

.21

Family sense of coherence (father)

.15

.14

Family sense of coherence (mother)

Figure 2. Path model of relationships between study variables.



Family sense of coherence also mediates the effect ofstress on the family and marital functioning and depres-sive symptoms among pregnant women, but not theirpartners, during the transition to parenthood. The Chi-nese childbearing couples in this study had a higher meanof the family sense of coherence score compared withthose reported for Israeli high school students (Sagy,1998). Antonovsky (1987) postulated that the sense ofcoherence would be built up from early socialization ex-periences during childhood and adolescence and stabi-lized in adulthood. The older age of couples in this studyand their life experience, such as bearing a child, maystrengthen the meaningfulness of couples’ lives and pro-vide them with motivation to seek resolution to the de-mands of new parenthood, thus enhancing their sense ofcoherence of family life.

The results show that family sense of coherence hasa direct impact on family and marital functioning anddepressive symptoms, and it also mediates the relation-ship between stress and the family and marital function-ing and depressive symptoms. Consistent with the Salu-togenic Model, family sense of coherence may serve asa stress-resisting resource and influences positive familyfunctioning in the transition to parenthood (Antonovsky& Sourani, 1988; Ylven et al., 2006). Experiencing highlevels of stress may threaten women’s family sense of co-herence, which in turn may affect their ability to effec-tively mobilize available resources to cope with the de-mands of parenthood, thus leading to poor family andmarital functioning and increasing the risk for depres-sion. The findings support Antonovsky’s (1987) view thatrisk factors, such as stressful life events, may generatea state of tension and a variety of unpredictable experi-ences, which inevitably result in a significant weakeningof one’s sense of coherence.

On the other hand, family sense of coherence mayserve as a resilience factor that mediates stress experi-ences and may protect against the development of de-pression (Antonovsky & Sourani, 1988). A strong senseof family coherence can help couples conceptualize theworld as organized and understandable, thereby play-ing an important role in the way they perceive chal-lenges during the transition to parenthood (Antonovsky& Sourani, 1988). Furthermore, couples with a high fam-ily sense of coherence probably share a common goal anda common experience in pursuit of bearing a child andperhaps are drawn closer together; thus, they are morecontent with their family and marital functioning andhave better emotional well-being. The findings are in linewith previous studies that families who have a greaterfamily sense of coherence tend to have better family func-tioning and less emotional disturbance when stressful sit-uations are encountered (Sagy, 1998; Ylven et al., 2006).

The transition to parenthood leads to substantialchanges in couples’ lives. It is not surprising that themothers reported higher stress and depressive symptomsthan the fathers. Among women, major changes in thebody and physical appearance, as well as in lifestyles,roles, and relationships, lead to a need for greater ad-justment; thus, they are more vulnerable than men todepressive symptoms. This finding corresponds to previ-ous studies demonstrating a relatively higher rate of de-pressive symptoms for women than men during parentaltransition (Gao et al., 2009; Paulson & Bazemore, 2010).Moreover, the present study showed that the majorityof mothers were working and the stressful work envi-ronments in Hong Kong may have added extra burdenon the mothers (So, 2011). In addition to long hoursat work, many women in contemporary Hong Kong so-ciety need to take care of household tasks (Ho, 2007).Although more husbands are willing to share domesticwork with their wives, traditional values about genderroles in the household continue to construct the divisionof labor, and women still shoulder the major responsibil-ity of domestic work (Ho, 2007). Thus, the dual burden ofwork and household chores may have contributed to theincreased stressors and depressive symptoms experiencedby the Chinese mothers in this study.

Although the transition to parenthood among fathersinvolves less radical changes, it indicates that men areprogressing to a major developmental stage in their fam-ily life requiring substantial adjustment in life structureand role expectations, which also has consequences fortheir well-being. The present study revealed that Chi-nese fathers were reporting clinically significant depres-sive symptoms during the prenatal period, similar to therates of depression found in Western studies (Paulson &Bazemore, 2010). The Confucian tradition stresses theimportance of parental obligations to young and vul-nerable family members (Park & Chesla, 2007). Oncethe woman is pregnant, it is the father’s responsibilityto support motherhood by protecting, encouraging, andhelping the mother to take good care of herself and thefetus (Park & Chesla, 2007). Given that all the Chinesefathers in this study had a full-time job, the dual role of abreadwinner in the family and the fulfillment of culturalobligations of an expectant father may have added extraburden to men’s adjustment to first-time parenthood.

The result of positive association between maternaland paternal depressive symptoms is in line with pre-vious studies (Gao et al., 2009; Paulson & Bazemore,2010), suggesting a close relationship between maternaland paternal depression in the perinatal period. Evidencesuggests that depression is contagious among individualsin close relationships, especially between couples (Papp,Goeke-Morey, & Cummings, 2007). It is possible that



childbearing couples suffering with depression are morelikely to express, and elicit, negative emotions in inter-actions with their partners, thus strengthening their de-pressive symptoms during parental transition. The closerelation between maternal and paternal depression mayalso reflect the close ties among family members in Chi-nese society, where one’s mental health can affect theemotional well-being of the partner and the entire family(Park & Chesla, 2007).

This study is limited by the cross-sectional design thatdoes not allow for conclusions regarding causality. Themajority of our participants were well educated and ofmiddle socio-economic status, the results may not there-fore be entirely generalizable. In Hong Kong, the deliv-ery rate has declined in the past three decades; recently,there is a rebound probably due to the increasing num-ber of children born to new immigrants from mainlandChina (Hong Kong Census and Statistics Department,2007). Most of the new immigrant families are in thelower social class, with a median income of HK$12,000(US$1,500) per month, and less than 8% of them havecompleted post-secondary education (Hong Kong Censusand Statistics Department, 2007). This group of new im-migrant families is particularly vulnerable to greater stressand poor perinatal outcomes, such as anxiety and depres-sion (Lee et al., 2007). As stated by Antonovsky (1990),the greater the stressor load, the more important the roleof salutary factors. Thus, we expect that family sense ofcoherence will play a more substantial role in facilitat-ing a positive transition among the new immigrant fami-lies. It would be worthwhile to evaluate the role of familysense of coherence among these families to increase thegeneralizability of the results, and to facilitate future de-velopment of intervention for vulnerable families to helpthem cope with the stress of new parenthood and en-hance positive family functioning. Replication of this re-search with different culture groups and Chinese familiesliving outside of China is also recommended.

Conclusions

This study provides evidence that family sense of co-herence plays a substantial role in promoting family andmarital functioning and reducing depressive symptomsduring the transition to parenthood. The presence of de-pressive symptoms in fathers suggests that men, simi-lar to women, who are facing transition into first-timefatherhood may be particularly at risk for depression inthe prenatal period. The findings have implications fortheory, research, and clinical practice. Paternal as wellas maternal psychopathology should be assessed duringpregnancy when healthcare professionals are evaluatinginterventions to promote perinatal health. Interventions

during pregnancy mostly focus on the health of motherand baby. As pregnancy is not solely about motherhoodbut also involves important significant others, usually thefather, intervention programs that encourage fathers toparticipate should also be developed and begin as early aspregnancy. Such interventions need a life-long approachas men’s nurturing capability take time to cultivate overtheir entire life course, not just during parental transition.

Although family sense of coherence has been shown tobe predictive of successful adaptation, there is a paucityof research on family sense of coherence during parentaltransition, particularly in a Chinese population. Thisstudy contributes to the theoretical development andclinical applications of applying the concept of familysense of coherence to the care of childbearing couples.The antenatal period provides a golden opportunity forhealthcare professionals to engage childbearing familiesin preventive care. Knowledge of the impact of familysense of coherence during family transition can betterequip healthcare professionals to develop culturally sen-sitive care to strengthen couples’ family sense of coher-ence. As proposed by Antonovsky (1987), modificationof sense of coherence through therapeutic interventionsis possible, which has been supported in recent researchin promoting mental health (Langeland et al., 2006) andcoping with re-employment (Vastamaki, Moser, & Paul,2009). Thus, intervention strategies that help childbear-ing families identify their internal and external coping re-sources, and derive meaning from and comprehend theirfamily life during pregnancy, could be incorporated intoantenatal classes. Such interventions would potentiallybolster family strengths and facilitate a positive adapta-tion process. In summary, the results of this study pro-vide contextual evidence to develop effective interven-tions focusing on building couples’ family sense of coher-ence with the goal of enhancing family resilience, therebypromoting positive family adaptation and well-being inChinese society.

Acknowledgments

We would like to express our sincere thanks to allchildbearing couples participated in the study and thefunding support by the Research Grant of the Universityof Hong Kong, Pokfulam, Hong Kong.

Clinical Resources� Mental health: http://psychcentral.com� Perinatal health: http://www.womensmentalhealth.

org� Family relationships: http://www.apa.org



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Documents

Family Sense of Coherence and Family Adaptation Among Childbearing Couples