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Sense of coherence and psychiatric morbidity: a 19-year register-based prospective study
  1. Anne M Kouvonen1,
  2. Ari Väänänen2,
  3. Jussi Vahtera2,
  4. Tarja Heponiemi3,
  5. Aki Koskinen2,
  6. Sara J Cox1,
  7. Mika Kivimäki4
  1. 1Institute of Work, Health & Organisations, University of Nottingham, Nottingham, UK
  2. 2Finnish Institute of Occupational Health, Helsinki, Finland
  3. 3National Institute for Health and Welfare, Helsinki, Finland
  4. 4Department of Epidemiology and Public Health, University College London Medical School, London, UK
  1. Correspondence to Dr Ari Väänänen, Finnish Institute of Occupational Health, Centre of Expertise for Work Organizations, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland; ari.vaananen{at}


Background Most prospective studies on the relationship between sense of coherence (SOC) and mental health have been conducted using subjective health indicators and short-term follow-ups. The objective of this prospective occupational cohort study was to examine whether a strong sense of coherence is a protective factor against psychiatric disorders over a long period of time.

Methods The study was conducted in a multinational forest industry corporation with domicile in Finland. Participants were 8029 Finnish industrial employees aged 18–65 at baseline (1986). Questionnaire survey data on SOC and other factors were collected at baseline; records of hospital admissions for psychiatric disorders and suicide attempt were derived from the National Hospital Discharge Register, while records of deaths due to suicide were derived from the National Death Registry up until 2006.

Results During the 19-year follow-up, 406 participants with no prior admissions were admitted to hospital for psychiatric disorders (n=351) or suicide attempt (n=25) or committed a suicide (n=30). A strong SOC was associated with about 40% decreased risk of psychiatric disorder. This association was not accounted for by mental health-related baseline characteristics, such as sex, age, marital status, education, occupational status, work environment, risk behaviours or psychological distress. The result was replicated in a subcohort of participants who did not report an elevated level of psychological distress at baseline (hazard ratio=0.59, 95% CI 0.40 to 0.86).

Conclusions A strong SOC is associated with reduced risk of psychiatric disorders during a long time period.

  • Psychiatric morbidity
  • prospective studies
  • sense of coherence
  • depression
  • morbidity
  • psychiatric
  • psychosocial epidemiology
  • psychosocial influen

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  • Funding The study was supported by grants from the Academy of Finland (project 110451) and the Finnish Work Environment Fund (project 106417; AV). MK, JV (projects 117604, 124271 and 124322) and AV (project 128089) were also supported by the Academy of Finland.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Ethics Committee of the Finnish Institute of Occupational Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.