Sense of Coherence and Mortality: The Curious Case of Caring

Photo copyright: Rémi Walle, Unsplash.com

Posted by: Ilkka Piiroinen

Aaron Antonovsky stated that “Without caring, one soon comes to fall behind in one’s understanding and lose one’s command of resources” (Antonovsky, 1987, p. 21). Furthermore, he theorized that the motivational aspect of meaningfulness is the most critical sense of coherence (SOC) component, as high levels of comprehensibility or manageability would be transient without it (Antonovsky, 1987). Until now, there has been little empirical evidence to support these premises.

A recent doctoral thesis (Piiroinen, 2024) explores the associations between SOC and all-cause mortality. It includes three studies, which incorporate several confounding variables. The first is a meta-analysis pooling eight longitudinal cohort studies consisting of over 48,000 participants. Results indicated that those in the weakest SOC tertile had a 17% higher mortality risk compared to those in the strongest tertile. The second study investigated how a change in SOC was associated with mortality hazards among Eastern Finnish middle-aged men. Among 854 participants who answered a 12-item SOC questionnaire at the baseline and 11 years after, a 6% weakening in scores was associated with a 35% higher mortality hazard during a follow-up period spanning over two decades.

Perhaps the most intriguing results were obtained from the third study of the thesis. Among 2,315 Eastern Finnish men, only the meaningfulness component predicted mortality over an average of 25 years: men in the weakest tertile for meaningfulness had a 14% higher hazard of mortality than the strongest tertile. Moreover, of all items, only the question “How often do you have the feeling that you don’t really care about what is going on around you?” predicted mortality: participants in the weakest tertile had an 18% higher hazard for mortality than those in the highest tertile.

The findings of the third study support Antonovsky’s premise that motivation and caring are the most fundamental aspects of SOC in relation to health. The underlying reasons for this can be multifactorial and are discussed more profoundly in the thesis. However, for this blog, one could refer to neuroscientist Antonio Damasio (1994). In his book Descartes’ Error: emotion, reason and the human brain, he describes a patient named Elliot. Elliot had lost his ability for emotions due to a brain tumor. Despite Elliot maintaining his excellent intelligence and ability to reason, he lost his job, could not maintain relationships, and made several poor and destructive lifestyle choices. And still, Elliot did not care. This extreme example describes how fundamentally important emotions and motivation are. They drive us and point the direction of our cognition—just as Antonovsky postulated.

References

Antonovsky, A. (1987) Unraveling the mystery of health: how people manage stress and stay well. 1st ed. San Francisco: Jossey-Bass (A Joint publication in the Jossey-Bass social and behavioral science series and the Jossey-Bass health series).

Damasio, D. (1994) Descartes’ error: emotion, reason and the human brain. 1st ed. New York: Quill.

Piiroinen, I. (2024) Associations between sense of coherence and mortality: A study based on data from the Kuopio Ischaemic Heart Disease Risk Factor Study. Kuopio: University of Eastern Finland. https://erepo.uef.fi/handle/123456789/32809