title: Sense of coherence, depressive symptoms, cardiovascular diseases, and all-cause mortality.
abstract: OBJECTIVE
  There is increasing interest in whether positive and negative psychological constructs are bipolar opposites of the same phenomenon. We examine whether a positive construct--sense of coherence (SOC)--has independent predictive power over and above depressive symptoms for cardiovascular disease (CVD) and all-cause mortality.
  
  
  METHODS
  Participants included 3850 men and 4083 women aged 25 to 74 years who had participated in risk factor surveys conducted in 1992 or 1997. Antonovsky's 13-item SOC scale was used to measure SOC, and had a correlation of -0.60 with the Beck Depression Inventory.
  
  
  RESULTS
  During a mean follow-up time of 14.2 years, there were 670 deaths and 487 nonfatal and fatal CVD events. Higher SOC scores were associated with a lower risk of all-cause mortality (relative risk [RR] = 0.90, 95% confidence interval [CI] = 0.84-0.97 per unit), especially among men, but this association became nonsignificant after adjustment for depressive symptoms (RR = 0.99, 95% CI = 0.90-1.08). Among participants without a history of CVD, higher SOC scores were related to a lower risk for CVD (RR = 0.90, 95% CI = 0.83-0.98), but this association disappeared after adjustment for cardiovascular risk factors. Depressive symptoms remained significant predictors of CVD among women in a model including also SOC (RR = 1.24, 95% CI = 1.06-1.46).
  
  
  CONCLUSIONS
  SOC was related to all-cause mortality among men; the association with CVD events was modest. Measures for SOC and depressive symptoms were significantly correlated, which might result in overlap in their associations with adverse disease and mortality outcomes.
authors.affiliation: Department of Social Research, University of Helsinki, PO Box 54, 00014 Helsinki, Finland. ari.haukkala@helsinki.fi
authors.forename: Ari
authors.initials: A
authors.lastname: Haukkala
authors.forename: Hanna
authors.initials: H
authors.lastname: Konttinen
authors.forename: Elviira
authors.initials: E
authors.lastname: Lehto
authors.forename: Antti
authors.initials: A
authors.lastname: Uutela
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Tiina
authors.initials: T
authors.lastname: Laatikainen
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000886:Anthropometry; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010808:Physical Examination; D011584:Psychology; D057566:Self Report; D060685:Sense of Coherence; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: cardiovascular disease; depression; mortality; positive psychology; risk factors; sense of coherence