An Overview of Salutogenesis


Salutogenesis is the study of the origins of health and focuses on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis).

More specifically, the “salutogenic model” was originally concerned with the relationship between health, stress, and coping through a study of Holocaust survivors. Despite going through the dramatic tragedy of the holocaust, some survivors were able to thrive later in life. The discovery that there must be powerful health causing factors led to the development of salutogenesis. The term was coined by Aaron Antonovsky, a professor of medical sociology. The salutogenic question posed by Aaron Antonovsky is, “How can this person be helped to move toward greater health?”

Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum”. Salutogenesis now encompasses more than the origins of health and has evolved to be about multidimensional causes of higher levels of health. Models associated with salutogenesis generally include wholistic approaches related to at least the physical, social, emotional, spiritual, intellectual, vocational, and environmental dimensions.

Refer to Positive Psychology.


The word “salutogenesis” comes from the Latin salus (meaning health) and the Greek genesis (meaning origin). Antonovsky developed the term from his studies of “how people manage stress and stay well” (unlike pathogenesis which studies the causes of diseases). He observed that stress is ubiquitous, but not all individuals have negative health outcomes in response to stress. Instead, some people achieve health despite their exposure to potentially disabling stress factors.


In his 1979 book, Health, Stress and Coping, Antonovsky described a variety of influences that led him to the question of how people survive, adapt, and overcome in the face of even the most punishing life-stress experiences. In his 1987 book, Unravelling the Mysteries of Health, he focused more specifically on a study of women and aging; he found that 29% of women who had survived Nazi concentration camps had positive emotional health, compared to 51% of a control group. His insight was that 29% of the survivors were not emotionally impaired by the stress. Antonovsky wrote: “this for me was the dramatic experience that consciously set me on the road to formulating what I came to call the ‘salutogenic model’.”

In salutogenic theory, people continually battle with the effects of hardship. These ubiquitous forces are called generalised resource deficits (GRDs). On the other hand, there are generalised resistance resources (GRRs), which are all of the resources that help a person cope and are effective in avoiding or combating a range of psychosocial stressors. Examples are resources such as money, ego-strength, and social support.

GRDs will cause the coping mechanisms to fail whenever the sense of coherence is not robust to weather the current situation. This causes illness and possibly even death. However, if the sense of coherence is high, a stressor will not necessarily be harmful. But it is the balance between GRDs and GRRs that determines whether a factor will be pathogenic, neutral, or salutary.

Antonovsky’s formulation was that the GRRs enabled individuals to make sense of and manage events. He argued that over time, in response to positive experiences provided by successful use of different resources, an individual would develop an attitude that was “in itself the essential tool for coping”.

Sense of Coherence

The “sense of coherence” is a theoretical formulation that provides a central explanation for the role of stress in human functioning. “Beyond the specific stress factors that one might encounter in life, and beyond your perception and response to those events, what determines whether stress will cause you harm is whether or not the stress violates your sense of coherence.” Antonovsky defined Sense of Coherence as:

“a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement.”

In his formulation, the sense of coherence has three components:

  • Comprehensibility: a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.
  • Manageability: a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.
  • Meaningfulness: a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.

According to Antonovsky, the third element is the most important. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His essential argument is that “salutogenesis” depends on experiencing a strong “sense of coherence”. His research demonstrated that the sense of coherence predicts positive health outcomes.

Fields of Application

Health and Medicine

Antonovsky viewed his work as primarily addressed to the fields of health psychology, behavioural medicine, and the sociology of health. It has been adopted as a term to describe contemporary approaches to nursing, psychiatry, integrative medicine, and healthcare architecture. The salutogenic framework has also been adapted as a method for decision making on the fly; the method has been applied for emergency care and for healthcare architecture. Incorporating concepts from salutogenesis can support a transition from curative to preventive medicine.


The sense of coherence with its three components meaningfulness, manageability and understandability has also been applied to the workplace.

Meaningfulness is considered to be related to the feeling of participation and motivation and to a perceived meaning of the work. The meaningfulness component has also been linked with job control and task significance. Job control implies that employees have more authority to make decisions concerning their work and the working process. Task significance involves “the experience of congruence between personal values and work activities, which is accompanied by strong feelings of identification with the attitudes, values or goals of the working tasks and feelings of motivation and involvement”.

The manageability component is considered to be linked to job control as well as to access to resources. It has also been considered to be linked with social skills and trust. Social relations relate also to the meaningfulness component.

The comprehensibility component may be influenced by consistent feedback at work, for example concerning the performance appraisal.

Salutogenics perspectives are also considered in the design of offices.

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Book: Physical Health and Schizophrenia

Book Title:

Physical Health and Schizophrenia (Oxford Psychiatry Library Series).

Author(s): David J. Castle, Peter F. Buckley, and Fiona P. Gaughran.

Year: 2017.

Edition: First (1st), Illustrated Edition.

Publisher: Oxford University Press.

Type(s): Paperback and Kindle.


In comparison to the general population, people with schizophrenia and related disorders have poorer physical health and increased mortality. Whilst it is recognized that serious mental illnesses such as schizophrenia carry a reduced life expectancy, it is often assumed that suicide is the main cause of this disparity. In actuality, suicide accounts for no more than a third of the early mortality associated with schizophrenia: the vast majority is due to cardiovascular factors

Physical Health and Schizophreniaoffers a user-friendly guide to the physical health problems associated with schizophrenia and a clear overview of strategies and interventions to tackle these issues. Spanning eight chapters this resource covers the essential topics in a practical and easy-to-read format to suit the needs of busy clinicians. It also includes an appendix designed specifically for patients and carers, with practical tips on how to be actively involved in monitoring and managing physical health problems.

Part of the Oxford Psychiatry Library series, Physical Health and Schizophrenia offers readers a fully up-to-date and valuable insight into this complex issue. With helpful key points at the start of each chapter and a clear layout, this is an essential resource for busy clinicians and researchers in any mental health field as well as those working in primary care.

What are the Risk factors of Hospitalisation for any Medical Condition among Patients with Prior Emergency Department Visits for Mental Health Conditions?

Research Paper Title

Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions.


This longitudinal study identified risk factors for frequency of hospitalisation among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis.


Records of n = 11,367 patients were investigated using administrative databanks (2012-13/2014-15). Hospitalisation rates in the 12 months after a first ED visit in 2014-15 were categorised as no hospitalisations (0 times), moderate hospitalisations (1-2 times), and frequent hospitalisations (3+ times). Based on the Andersen Behavioural Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014-2015, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalisation rate.


Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialized care, were risk factors for both moderate and frequent hospitalisations. Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12-17 years) were risk factors for moderate hospitalisations, while higher numbers (4+) of overall interventions in local community health service centres were a risk factor for frequent hospitalisations only. Patients with personality disorders, drug-related disorders, suicidal behaviours, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalised. Less urgent and non-urgent illness acuity prevented moderate hospitalisations only.


Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalisations as compared with non-hospitalised patients. Patients at risk for frequent hospitalisations were more vulnerable overall and had important biopsychosocial problems. Improved primary care and integrated outpatient services may prevent post-ED hospitalisation.


Penzenstadler, L., Gentil, L., Grenier, G., Khazaal, Y. & Fleury, M-J. (2020) Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions. BMC Psychiatry. 20(1), pp.431. doi: 10.1186/s12888-020-02835-2.

Book: Mental Causation – A Counterfactual Theory

Book Title:

Mental Causation – A Counterfactual Theory.

Author(s): Thomas Kroedel.

Year: 2019.

Edition: First (1st).

Publisher: Cambridge University Press.

Type(s): Hardcover and Kindle.


Our minds have physical effects. This happens, for instance, when we move our bodies when we act. How is this possible?

Thomas Kroedel defends an account of mental causation in terms of difference-making: if our minds had been different, the physical world would have been different; therefore, the mind causes events in the physical world.

His account not only explains how the mind has physical effects at all, but solves the exclusion problem – the problem of how those effects can have both mental and physical causes. It is also unprecedented in scope, because it is available to dualists about the mind as well as physicalists, drawing on traditional views of causation as well as on the latest developments in the field of causal modelling.

It will be of interest to a range of readers in philosophy of mind and philosophy of science. This book is also available as Open Access.

Book: The Everyday Ayurveda Guide to Self-Care

Book Title:

The Everyday Ayurveda Guide to Self-Care – Rhythms, Routines, and Home Remedies for Natural Healing.

Author(s): Kate O’Donnell.

Year: 2020.

Edition: First (1st).

Publisher: Shambhala Publications Inc.

Type(s): Paperback and Kindle.


Embrace the ancient principles of Ayurveda to become a more integrated, whole, and healthy version of yourself. This detailed guide walks you through the steps of foundational Ayurvedic practices that can be easily integrated into your existing self-care routine – from self-massage, oil pulling, and tongue scraping to breathing practices, meditation exercises, and eating with intention – to uplift your physical health and state of mind.

In The Everyday Ayurveda Guide to Self-Care, you will:

  • Get acquainted with the tradition of Ayurveda and better understand your doshas (metabolic tendencies) and basic Ayurvedic anatomy.
  • Discover the art of self-care by exploring daily routines and seasonal practices to prevent imbalances in the body and mind.
  • Find out what foods, spices, and herbs carry medicinal qualities that support cleansing, rejuvenation, and management of common ailments.

Can High-Intensity Interval Training Improve Physical & Mental Health Outcomes?

Research Paper Title

Can high-intensity interval training improve physical and mental health outcomes? A meta-review of 33 systematic reviews across the lifespan.


High-intensity-interval-training (HIIT) has been suggested to have beneficial effects in multiple populations across individual systematic reviews, although there is a lack of clarity in the totality of the evidence whether HIIT is effective and safe across different populations and outcomes.

The aim of this meta-review was to establish the benefits, safety and adherence of HIIT interventions across all populations from systematic reviews and meta-analyses.


Major databases were searched for systematic reviews (with/without meta-analyses) of randomised & non-randomised trials that compared HIIT to a control.

Thirty-three systematic reviews (including 25 meta-analyses) were retrieved encompassing healthy subjects and people with physical health complications.


Evidence suggested HIIT improved cardiorespiratory fitness, anthropometric measures, blood glucose and glycaemic control, arterial compliance and vascular function, cardiac function, heart rate, some inflammatory markers, exercise capacity and muscle mass, versus non-active controls.

Compared to active controls, HIIT improved cardiorespiratory fitness, some inflammatory markers and muscle structure.

Improvements in anxiety and depression were seen compared to pre-training.

Additionally, no acute injuries were reported, and mean adherence rates surpassed 80% in most systematic reviews.


Thus, HIIT is associated with multiple benefits.

Further large-scale high-quality studies are needed to reaffirm and expand these findings.


Martland, R., Mondelli, V., Gaughran, F. & Stubbs, B. (2020) Can high-intensity interval training improve physical and mental health outcomes? A meta-review of 33 systematic reviews across the lifespan. Journal of Sports Sciences. 38(4), pp.430-469. doi: 10.1080/02640414.2019.1706829. Epub 2019 Dec 31.

Is Having a Mental Health Disorder Associated with Spending More on other Medical Conditions?

Research Paper Title

Association of Mental Health Disorders With Health Care Spending in the Medicare Population.


The degree to which the presence of mental health disorders is associated with additional medical spending on non-mental health conditions is largely unknown.

Therefore, the purpose of this study was to determine the proportion and degree of total spending directly associated with mental health conditions vs spending on other non-mental health conditions.


This retrospective cohort study of 4 358 975 fee-for-service Medicare beneficiaries in the US in 2015 compared spending and health care utilisation among Medicare patients with serious mental illness (SMI; defined as bipolar disease, schizophrenia or related psychotic disorders, and major depressive disorder), patients with other common mental health disorders (defined as anxiety disorders, personality disorders, and post-traumatic stress disorder), and patients with no known mental health disorders. Data analysis was conducted from February to October 2019.

Exposure: Diagnosis of an SMI or other common mental health disorder.

Main outcomes and measures: Risk-adjusted, standardised spending and health care utilisation. Multi-variable linear regression models were used to adjust for patient characteristics, including demographic characteristics and other medical co-morbidities, using hospital referral region fixed effects.


Of 4,358,975 Medicare beneficiaries, 987,379 (22.7%) had an SMI, 326,991 (7.5%) had another common mental health disorder, and 3,044,587 (69.8%) had no known mental illness.

Compared with patients with no known mental illness, patients with an SMI were younger (mean [SD] age, 72.3 [11.6] years vs 67.4 [15.7] years; P < .001) and more likely to have dual eligibility (633 274 [20.8%] vs 434 447 [44.0%]; P < .001).

Patients with an SMI incurred more mean (SE) spending on mental health services than those with other common mental health disorders or no known mental illness ($2024 [3.9] vs $343 [6.2] vs $189 [2.1], respectively; P < .001).

Patients with an SMI also had substantially higher mean (SE) spending on medical services for physical conditions than those with other common mental health disorders or no known mental illness ($17 651 [23.6] vs $15 253 [38.2] vs $12 883 [12.8], respectively; P < .001), reflecting $4768 (95% CI, $4713-$4823; 37% increase) more in costs for patients with an SMI and $2370 (95% CI, $2290-$2449; 18.4% increase) more in costs for patients with other common mental health disorders.

Among Medicare beneficiaries, $2,686,016,110 of $64,326,262,104 total Medicare spending (4.2%) went to mental health services and an additional $5,482,791,747 (8.5%) went to additional medical spending associated with mental illness, representing a total of 12.7% of spending associated with mental health disorders.


In this study, having a mental health disorder was associated with spending substantially more on other medical conditions.

These findings quantify the extent of additional spending in the Medicare fee-for-service population associated with a diagnosis of a mental health disorder.


Figueroa, J.F., Phelan, J., Orav, E.J., Patel, V. & Jha, A.K. (2020) Association of Mental Health Disorders With Health Care Spending in the Medicare Population. JAMA Network Open. 3(3):e201210. doi: 10.1001/jamanetworkopen.2020.1210.

Mental Health and Stress in Humanitarian Expatriates.

Research Paper Title

Mental Health and Stress in Humanitarian Expatriates.


Humanitarian work is stressful and can have an impact on the mental health of humanitarian expatriates.

In order to reduce stress and its consequences, humanitarian organisations are implementing various measures to keep their staff healthy.

Humanitarian workers, on the other hand, must take care of themselves and apply self-protection mechanisms. Most humanitarian workers are doing well.

The treating doctor plays a key role in detecting people and behaviour at risk. they encourage the expatriate to use their resources and provide the adequate support and medical follow-up if necessary.

Collaboration with the staff health units of humanitarian organisations allows for optimal care of humanitarian workers’ medical conditions.


Perone, S.A., BAvarel, M., Suzic, D. & Chappuis, F. (2020) [Mental Health and Stress in Humanitarian Expatriates] [Article in French]. Revue Medicale Suisse. 16(693), pp.993-997.

Book: The Wellness Sense

Book Title:

The Wellness Sense – A Practical Guide to your Physical and Emotional Health based on Ayurvedic and Yogic Wisdom.

Author(s): Om Swami.

Year: 2015.

Edition: First (1ed).

Publisher: Black Lotus.

Type(s): Paperback, Audiobook, and Kindle.


Why do certain foods harm some people and help others? How come the same weight loss program shows different results on different individuals? And, why do some people fall sick more often than others?

Answers to these questions and many more lie in Ayurveda where your body is not just looked upon a holder of flesh and bones but the finest vehicle of experiencing all pleasures and sorrows.

In Ayurveda, as in yoga and tantra, the health of an individual is not just the state of his physical body but an aggregate of the body, senses, mind and soul. Your body is a sacred space, it is the seat of your consciousness.

The Sanskrit word for health is svasthya; it means self-dependence or a sound state of the body and mind. If examined further, it means your natural state; sva means natural and sthya means state or place.

Ayurveda aims to restore your natural state, balance so you may be free of mental and physical afflictions.

More often than not, and certainly in adults, most physical disorders are the result of a repressed and bruised consciousness. Mental afflictions create diseases in the physical body and physical diseases, in turn, disturb the state of mind.

You can treat the disease in the physical body but that’s merely treating the symptom. It is not the permanent solution.

The modern system of medicine is mostly symptom driven. If I have a headache, it’ll tell me to take a pain-killer. Ayurveda does not believe in treating the symptoms. Its advocates understanding the patient and treating the cause of the symptom and not the symptom itself.

In order to do that, the ancient scriptures took a far more holistic approach to health by combining our lifestyle with our natural tendencies (which vary from one person to another). In other words, it understood that one man’s medicine could be another man’s poison.

Expounding on the esoteric aspects of the ancient wisdom, in simple terms, this book shows you how to take care of yourself better and how to lead a healthier life in our present world – a world where we have all the comforts yet we are restless.

We have organic breakfast on the table but no time to eat it, we have the comfiest mattress but little sleep. The key to wholesome living and your well-being is entirely in your hands. This book is a must read for those who are serious about their health.

Are Studies into Severe Mental Illness Robust Enough?

Research Paper Title

Multidimensional impact of severe mental illness on family members: systematic review.


The impact of severe mental illnesses (SMIs) is not limited to the person with the illness but extends to their family members and the community where the patient comes from.

In this review, the researchers systematically analyse the available evidence of impacts of SMI on family members, including parents, grandparents, siblings, spouses and children.


PubMed, PsycINFO, Embase and Global Index Medicus were searched from the inception of each database up to 9 November 2019. They also did manual searches of grey literature.

The researchers included studies that assessed the impacts of SMI on any family member. They excluded studies in admitted clinics and acute wards to rule out the acute effect of hospitalisation.

Two reviewers extracted data independently using the Cochrane handbook guideline for systematic reviews and agreed on the final inclusion of identified studies.

The quality of the included studies was assessed using effective public health practice project quality assessment tool for quantitative studies. The review protocol was registered in the PROSPERO database.


The researchers screened a total of 12,107 duplicate free articles and included 39 articles in the review.

The multidimensional impact of SMI included physical health problems (sleeplessness, headache and extreme tiredness.), psychological difficulties (depression and other psychological problems) and socioeconomic drift (less likely to marry and higher divorce rate and greater food insecurity).

Impacts on children included higher mortality, poor school performance and nutritional problems. However, the quality of one in five studies was considered weak.


The review indicated a high level of multidimensional impact across multiple generations.

The serious nature of the impact calls for interventions to address the multi-dimensional and multi-generational impact of SMI, particularly in low/middle-income countries.

Given the relatively high number of studies rated methodologically weak, more robust studies are indicated.


Fekadu, W., Mihiretu, A., Craig, T.K.J. & Fekadu, A. (2019) Multidimensional impact of severe mental illness on family members: systematic review. BMJ Open. 9(12):e032391. doi: 10.1136/bmjopen-2019-032391.