Can your ‘sense of coherence’ influence your health?

The concept of sense of coherence (SOC) was put forward by Aaron Antonovsky in 1979 to explain why some people become ill under stress and others stay healthy. It arose from the salutogenic approach, that is, the search for the origins of health rather than the causes of disease. The SOC gained widespread attention and has since been linked to health outcomes in many studies.

The SOC is defined as: “The extent to which one has a pervasive, enduring though dynamic, feeling of confidence that one’s environment is predictable and that things will work out as well as can reasonably be expected.” In other words, it’s a mixture of optimism and control. It has three components – comprehensibility, manageability, and meaningfulness.

Comprehensibility is the extent to which events are perceived as making logical sense, that they are ordered, consistent, and structured. Manageability is the extent to which a person feels they can cope. Meaningfulness is how much one feels that life makes sense, and challenges are worthy of commitment.

Professor Antonovsky believed that, in general, a person with a strong SOC is more likely to feel less stress and tension, and to believe that he or she can meet demands. The SOC was developed to apply across cultures, and versions of the questionnaire have been used in at least 32 countries.

The concept interacts with a person’s natural coping style, upbringing, financial assets, and social support – the extent to which these are available is a major determinant in the development of a strong or weak SOC.

How might it affect health?

Pain Stress is known to alter the pain threshold, so SOC has been put forward as a factor in pain perception and symptom reporting. This link has been investigated in many studies over the past fifteen years. They show that a low SOC predicts musculoskeletal symptoms (neck, shoulder, and low-back) in later life, and is a predictor of response to pain management programs for chronic pain sufferers. It is linked to pain levels in cancer patients. SOC also predicts the outcome of low-back surgery, possibly through increasing ability to cope with pain. In arthritis patients, lower SOC is linked to pain levels, as well as greater difficulty in performing daily activities and general health.

Depression Having a strong SOC may protect against depression, so SOC may be useful for identifying people who may be helped by psychological interventions. A strong SOC also improves life satisfaction, and is linked with reduced fatigue, loneliness, and anxiety.

One descriptive study looked at the links between self-assessment of health, health status, and SOC in African-American women. Women who categorized themselves as having no serious health problems had a significantly higher SOC.

It is possible that, rather than signifying patients’ previous personality, serious health problems are a large enough stressor to lower SOC levels. It is not surprising that those with serious health problems score lower on meaningfulness, and their sense of manageability may be eroded by high levels of pain. Is SOC the cause or the effect of the symptoms, or is it a parallel issue? When both are assessed simultaneously, no firm conclusion can be drawn.

Another consideration is that symptom questionnaires and the SOC questionnaire often are both self-reported, so could be picking up on the same characteristics. Both might be measuring a tendency to dissatisfaction, for example. An additional drawback is that SOC may not be as stable over the lifetime as first envisioned.

Antonovsky believed the SOC remains relatively stable as long as “radical and enduring changes in one’s life situation” do not occur. Some studies appear to confirm this, although in one large study, SOC was significantly lower in the youngest age group and increased with age.

In the same study SOC was highest in the highest social classes. The relationships between SOC and childhood conditions, adult social class and adult health were examined further to investigate how SOC inequalities arise. The study concluded that the association between SOC and illness is likely to be causal.

Questions remain about what SOC actually measures. However, it may be useful in clinical practice to identify people who are particularly vulnerable to depression, even when they are not clinically depressed. Counseling and stress management could then be considered. But knowledge about how SOC changes, and how it can be influenced, remains incomplete.