title: A weak sense of coherence is associated with a higher mortality risk.
abstract: BACKGROUND
  Sense of coherence (SOC) is a health-promoting resource within the salutogenic theory that reflects an individual's coping ability. The association between SOC and mental health has been confirmed, but its association with mortality is less clear. We examined the association between SOC and all-cause mortality in an adult Dutch population.
  
  
  METHODS
  Between 1996 and 1998, a postal questionnaire, including the three-item SOC scale, was completed by 12 024 men and women aged 20-65 years, who had participated in a health examination (MORGEN project) 6 months to 3 years earlier. Vital status was recorded up to November 2011; in total, 603 deaths were registered (5%). The participants were divided into three groups with a weak (21.1%), intermediate (60.3%) or strong (18.6%) SOC. Cox proportional hazard models were used with an intermediate SOC as the reference group. Adjustments were made for sex, age, socioeconomic factors, indicators of health status and lifestyle.
  
  
  RESULTS
  A weak SOC, as compared with an intermediate SOC, was associated with a higher all-cause mortality risk after, on average, 13.5 years of follow-up and adjusted for sex and age (HR=1.40, 95% CI 1.14 to 1.70). After additional adjustments, the higher all-cause mortality risk remained statistically significant (HR=1.27, 95% CI 1.01 to 1.59). Mortality risk for the strong SOC group did not differ from that for the intermediate group.
  
  
  CONCLUSIONS
  A weak SOC was associated with a higher risk of all-cause mortality. Health promotion focusing on strengthening SOC may be a promising new strategy, potentially affecting not only mental health but also mortality.
authors.affiliation: Master Applied Communication Science, Master Health and Society, Wageningen University, Internship at the National Institute for Public Health and Environment, , Bilthoven, Netherlands.
authors.forename: Sabina
authors.initials: S
authors.lastname: Super
authors.forename: W M Monique
authors.initials: WM
authors.lastname: Verschuren
authors.forename: Else M
authors.initials: EM
authors.lastname: Zantinge
authors.forename: M Annemarie E
authors.initials: MA
authors.lastname: Wagemakers
authors.forename: H Susan J
authors.initials: HS
authors.lastname: Picavet
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009426:Netherlands / Q000453:epidemiology; D010808:Physical Examination; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D060685:Sense of Coherence; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D055815:Young Adult
keywords: Cognition; Mental Health; Mortality; Psychosocial Factors