Meaningfulness and mortality: exploring the sense of coherence in Eastern Finnish men.

AIMS: The sense of coherence scale has been shown to have an epidemiological relationship with mortality. This study aimed to investigate how the three components of sense of coherence (meaningfulness, comprehensibility and manageability) and the individual items of these components relate to mortality. METHODS: Eastern Finnish men (n=2315) aged 42-60 years at baseline in the 1980s completed a 12-item sense of coherence scale and were followed for 25 years, on average, until death or until the end of 2019. Hazard ratios for mortality were calculated using two models: one adjusted for age and the second for an additional 12 mortality risk factors. RESULTS: Of the three sense of coherence components, only meaningfulness was associated with all-cause mortality, and in the fully adjusted model, those in the weakest tertile had a 1.14 (95% confidence interval 1.01-1.29, P=0.042) times higher hazard ratio for mortality than those in the strongest tertile. Of the individual sense of coherence items, only the first question, 'How often do you have the feeling that you really don't care about what is going on around you?', was associated with all-cause mortality, and in the fully adjusted Cox model, the hazard ratio of weak versus strong was 1.18 (95% confidence interval 1.03-1.36, P=0.020). CONCLUSIONS: The sense of coherence component related to meaningfulness, including its first item, 'Caring about what goes on around you', plays a significant role in the association with mortality among middle-aged men in Eastern Finland. This item should be considered a noteworthy patient-reported variable when predicting mortality in public health settings.

Change in sense of coherence mediates the association between economic recession and mortality among middle-aged men: A population-based cohort study from Eastern Finland.

A financial recession has been associated with a decrease in all-cause mortality, but little is known about how psychosocial fluctuations in stress tolerance or orientation to life affect this association. Sense of Coherence (SOC) is a core construct in the Salutogenic Model of Health and is determined by generalized resistance resources and measures one's orientation to life by comprehensibility, manageability, and meaningfulness. We followed the mortality of a cohort of middle-aged Finnish men (n = 854) from the 1980s to the end of 2019. The cohort baseline was stratified into four age groups at baseline: 42, 48, 54, and 60. SOC was measured twice, at the baseline and at the 11-year follow-up visit. Between these SOC measurements, Finland confronted a deep financial recession, the effects of which were examined at the follow-up visit by questionnaires related to economic hardship (sum of nine items) and experience of the recession (one item). Using age group, marital status, employment status, and education as covariates, the change in SOC mediated both the economic hardship and the experience of recession relations to mortality: the indirect effects -19.57 (95% CI -43.23 to -0.92), and -26.82 (95% CI -59.52 to -0.61), respectively. Every one-point increase in economic hardship predicted about 2 and a half weeks shorter life expectancy, and those who experienced very strong disadvantages of economic recession had about 3 and a half months lower life expectancy by the end of 2019 than those who fully avoided the disadvantages. Furthermore, the younger age groups, 42 and 48, experienced the recession more severely than the older groups, 54 and 60. We conclude that following how orientation to life changes among middle-aged might be an informative approach after a recession.

Long-term changes in sense of coherence and mortality among middle-aged men: A population -based follow-up study.

Sense of coherence (SOC) scale measures one's orientation to life. SOC is the core construct in Antonovsky's salutogenic model of health. It has been shown that weak SOC correlates with poor perceived health, low quality of life, and increased mortality. Some studies have indicated that SOC is not stable across life, but there are no previous studies on how a change of SOC is reflected in mortality. However, there is some evidence that a change in perceived quality of life is associated with mortality. The study explores the association between the change in SOC and mortality using longitudinal data from a cohort of middle-aged Finnish men recruited between 1986 and 1989. Approximately 11 years after the baseline examinations, between 1998 and 2001, 854 men returned the SOC questionnaire a second time. The baseline SOC was adjusted for the regression to the mean phenomenon between the two measurements. The hazard ratios of the SOC difference scores were adjusted for initial SOC age and 12 somatic risk factors of mortality (alcohol consumption, blood pressure, body mass index, cholesterol concentration, physical activity, education, smoking, marital status, employment status, history of cancer, history of cardiovascular disease and diabetes). SOC was not stable among middle-aged Finnish men and a decline in SOC was associated with an increased hazard of all-cause mortality. In the fully adjusted model, a decrease of one standard deviation (SD) of the SOC mean difference increased the mortality hazard by about 35 %, two SDs decrease about 70 %, and 2.5 SDs about 100 %. Strengthening SOC showed a limited association with decreasing mortality hazards in the age-adjusted model. Policies, strategies, or plans, supporting SOC in the middle-age may help to decrease mortality and increase quality of life in later years.

Sense of Coherence and Mortality: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of the study was to investigate the association between sense of coherence (SOC) and all-cause mortality in the general adult population. METHODS: We conducted a systematic review and meta-analysis of prospective cohort studies. We searched eight electronic bibliographic databases for eligible studies. A random effects model and the restricted maximum likelihood method were used to calculate the pooled effect size. RESULTS: Eight studies were eligible for the meta-analysis. The studies included 48,138 participants, of whom 5307 died during a median follow-up of 14.1 years (range, 8-29.5 years). Their age ranged from 20 to 80 years, and 53% of them were men. In the meta-analysis model of crude values, the risk of all-cause mortality for individuals with a weak SOC (lowest tertile) was 1.30 (95% confidence interval [CI] = 1.09-1.55, p = .003, I = 78.84%) compared with individuals with a strong SOC (highest tertile). In the model adjusted for age, the risk remained almost the same (risk ratio = 1.26, 95% CI = 1.15-1.38, p < .001, I = 69.59%). In the model adjusted for several other risk factors for mortality, the risk was still 1.17 (95% CI = 1.07-1.27, p < .001, I = 57.85%). CONCLUSIONS: This meta-analysis shows that a weak SOC is associated with an increased risk of all-cause mortality in the general adult population. Future studies are needed to further develop assessment tools for SOC with good psychometric properties and to determine the disease processes that mediate the association of SOC with mortality.