The sense of coherence and risk of injuries: role of alcohol consumption and occupation.

STUDY OBJECTIVE: To test the hypothesis that individuals with a strong sense of coherence (SOC) have a decreased incidence of external cause injuries and to study the role of alcohol consumption and occupational category in that association. DESIGN: Participants of the Helsinki Heart Study were followed up for injuries for eight years through the national hospital discharge register and cause of death statistics. Cox proportional hazards models were used to calculate the relative risks. SETTING: The Helsinki Heart Study, a clinical trial to prevent coronary heart disease. PARTICIPANTS: 4405 Finnish middle-aged employed men. MAIN RESULTS: The SOC was inversely associated with the risk of injuries, with a significant 25% lower incidence in the highest tertile of SOC (7.6 per 1000 person-years) compared with the lowest (10.2 per 1000 person-years). The association remained significant if adjusted for age, but not if adjusted additionally for alcohol consumption or occupation. When considered jointly with occupational category, the injury risk showed a decreasing trend (p = 0.02) with increasing SOC among blue collar but not among white collar workers. The use of alcohol had a great impact on injury risk among those with weak SOC, with incidences of 7.7, 10.2, and 14.9 per 1000 person-years in the non/light, medium, and heavy categories of consumption (p for trend 0.01). No such trend was seen in other SOC tertiles. CONCLUSIONS: There was an effect of SOC on the incidence of injury especially among blue collar workers. A substantial part of the effect was mediated by alcohol consumption.

The sense of coherence, occupation and all-cause mortality in the Helsinki Heart Study.

BACKGROUND: The aim of this study was to test the hypothesis that people with a strong sense of coherence (SOC) have decreased all-cause mortality. METHODS: The effect of occupation and the SOC on all-cause mortality was studied among 4405 Finnish middle-aged employed men in a prospective 8-year follow-up study. RESULTS: Using Cox proportional hazards models the crude relative risk for all-cause mortality for the low SOC tertile when compared to the high SOC tertile was 1.23 (95% CI: 0.90-1.68). Adjusting for age, smoking, alcohol and occupation increased the risk slightly to 1.35. Occupation was an effect modifier, since among white-collar workers the corresponding relative risk of the low SOC tertile was 2.27 (95% CI: 1.12-4.59, p = 0.02) and among blue-collar workers the relative risk for all-cause mortality was stable (1.33-1.52) in each SOC tertile. The classic risk factors, smoking and alcohol, showed higher relative risks than the SOC. CONCLUSIONS: The effect of the health-promoting qualities of the SOC upon all-cause mortality was significant among white-collar workers, but not among blue-collar workers.

The sense of coherence, occupation and the risk of coronary heart disease in the Helsinki Heart Study.

The risk of coronary heart disease (CHD) was studied in 4405 Finnish middle-aged working men in different occupations according to their sense of coherence (SOC). The study design was prospective and the follow-up time was eight years. Clinical findings such as total cholesterol, systolic blood pressure and body-mass index showed differences when comparing blue and white collar workers. Lifestyle factors such as smoking also differed, but leisure time physical activity depended on SOC. In the white collar work environment the low SOC tertile had a high CHD incidence of 20.1 per 1000 person-years; the incidences in the medium and high SOC tertiles were 10.9 and 12.3, respectively. A similar effect was not observed in the blue collar work environment. There, contrary to theoretical expectations, the low SOC tertile had the lowest incidence of CHD. The difference in the CHD incidence pattern depended on the blue and white collar dichotomy and not on the branch (state agencies vs. industry). The SOC had a salutogenic effect among white collar workers, but failed to have any consequent effect on the health of blue collar workers. Further study is needed to look at the psychosocial factors among blue collar workers.