- Research article
- Open Access
Sense of coherence is associated with reduced psychological responses to job stressors among Japanese factory workers
© Urakawa et al.; licensee BioMed Central Ltd. 2012
- Received: 15 October 2011
- Accepted: 20 May 2012
- Published: 6 July 2012
Job stress is associated with adverse health effects. The present study was conducted to examine the association between sense of coherence (SOC), as advocated by Antonovsky, and psychological responses to job stressors among Japanese workers.
A self-administered questionnaire containing a Japanese version of the 13-item SOC scale, the Brief Job Stress Questionnaire, and a self-rated health item were distributed to 1968 workers in X Prefecture. Anonymous responses were recovered by postal mail.
Complete responses were received from 299 workers (response rate 15.2%, 191 males and 108 females) who consented to participate in the study. Participants were 186 office clerks, 38 sales representatives, 22 technical engineers, 16 service trade workers, eight information processing workers, eight technical experts, and 21 other workers of various types. SOC scores were associated with age, self-rated health, job title, and marriage status. According to regression analyses stratified by gender, SOC was inversely associated with tension, fatigue, anxiety, depression and subjective symptoms in males, and tension, depression and subjective symptoms in females. SOC was positively associated with vigor in both males and females.
Having a strong SOC may reduce worker’s negative job stress responses and increase their vigor. Longitudinal studies are required to confirm this finding.
- Sense of coherence
- Job stress
- Brief Job Stress Questionnaire
- Stress reduction
Approximately 30 years have passed since Aaron Antonovsky  proposed the salutogenic model of health. The sense of coherence (SOC) concept, which is based on the salutogenic model, has attracted research attention in the population health field. One’s SOC is believed to express the extent to which they have a persistent, enduring but dynamic feeling of confidence that: (1) the stimuli deriving from their internal and external environments in the course of living are structured, predictable, and explicable (comprehensibility); (2) resources are available to them to meet the demands posed by these stimuli (manageability); and (3) such demands are challenges, worthy of investment and engagement (meaningfulness) [1–3]. SOC in individuals is assessed by a 13-item scale .
Several studies have indicated that SOC modifies of job stress responses. For example, having a strong SOC protects individuals from the effects of stressors at work . Health social workers with a strong SOC experience less burnout than those with a weak SOC . SOC buffers the effects of stressful life events on individuals’ mental health status . A study of Japanese civil servants indicated that having a stronger SOC was associated with fewer days of absence from work and fewer adverse physical health symptoms . Among resident physicians, an increase in psychiatric complaints as measured by General Health Questionnaire (GHQ) scores was associated with a weak SOC and adverse work conditions as assessed by the Brief Job Stress Questionnaire (BJSQ) .
Developed in Japan for use in occupational health check-ups, the BJSQ assesses job stressors and stress responses . The BJSQ is a multi-dimensional questionnaire using four-point Likert scale response options (1 “strongly disagree” to 4 “strongly agree”) to measure job stressors and psychological distress such as tension, fatigue, anxiety, depression, and vigor (three items for each) and subjective symptoms (10 items). Quantitative job demand, qualitative job demand, job decision latitude (three items for each) and social support (nine items) are the job stressors measured by the BJSQ, which is essentially based on the demand–control–support model [11, 12] (in addition, physical job load is measured by one item). All of the BJSQ scales have acceptable levels of internal consistency, reliability and factor-based validity [13, 14].
Our previous study  demonstrated that GHQ scores were positively associated with job demands as measured by the BJSQ, whereas the scores were inversely associated with SOC scores among Japanese workers in the manufacturing industry, suggesting that having a stronger SOC can reduce the adverse effects of job stress such as psychiatric complaints. The purpose of the present study was to test this hypothesis by examining the association between SOC and the stress responses assessed by the BJSQ. In addition, one item evaluated self-rated health as a stress response, because it is reported to be a sensitive indicator of health status among community residents .
Study participants were employees of 50 small enterprises (2–49 employees) in X Prefecture, Japan. We asked a representative from each company to distribute self-administered questionnaires containing a Japanese version of the SOC scale , the BJSQ , the self-rated health item and socio-demographic items to their employees. A total of 1968 workers received the questionnaire. The purpose of the study was explained to the workers by their supervisors as being “to investigate the relationships between mental health status and job stress”. They were instructed to anonymously complete the questionnaire and return it by postal mail. Of the 1968 workers invited to participate, 299 returned the questionnaire (15.2%, 191 males and 108 females). They consisted of 186 office clerks, 38 sales representatives, 22 technical engineers, 16 service trade workers, eight information processing workers, eight technical experts, and 21 other workers of various types. The SOC scale  consisted of 13 items assessing comprehensibility, manageability and meaningfulness. Participants were asked to rate each item (1–7 points), and the points were summed into an SOC score. They were also asked to complete the BJSQ. Self-rated health was evaluated by asking participants to rate their own health status (1 “very healthy”, 2 “rather healthy”, 3 “not so healthy”, 4 “unhealthy”); the rating was reversed for use in further analysis.
Associations between SOC and BJSQ scores, and self-rated health and socio-demographic variables were analyzed by U-tests, Chi-square tests and stepwise multiple regression using SPSS version 11.0 for Windows. In the multiple regression analysis, stress responses evaluated by the BJSQ and self-rated health scores were the dependent variables, and age, duration of work, managerial work (yes = 1, no = 0), marriage (married = 1, not married = 0), SOC scores, and job stressors assessed by the BJSQ were the independent variables. In the first models (model 1), all independent variables were entered into (p ≤ 0.05) or removed from (p > 0.05) the regression equations based on the significance level of the partial regression coefficient. In the second models (model 2), age, duration of work, managerial work, and marriage were entered into the equations as possible confounders, and then the stepwise method was used for the remaining variables.
Because gender differences have been found in the effects of SOC on health status [7, 17] and in the association between job stress and health behaviors , the analyses were performed separately for each gender.
The study design was reviewed and approved by the Research Ethics Committee of Mie University Graduate School of Medicine.
The 299 participants had a mean age of 49.3 years (SD = 11.4). The mean SOC score was 58.8 (SD = 14.0) with a Cronbach’s alpha coefficient of 0.863. Male participants were significantly older than female participants (mean age 50.7 versus 46.4 years, respectively, p < 0.05). Males had significantly higher SOC scores (mean = 60.4, SD = 13.7) than females (mean = 56.7, SD = 13.6, p < 0.01). There were no significant differences in BJSQ or self-rated health scores between the genders.
Differences in socio-demographic variables, self-rated health and BJSQ scores between SOC groups a
Mean (standard deviation)
Job demand (quantity)c
Job demand (quality) c
Low job latitude
Low support (supervisor)
Low support (coworkers)
Low support (friends and family)
Physical job load c
Associations of stress responses and self-rated health with SOC and stressors in 190 male workers: model 1 a
Independent variables (partial regression coefficient) b
Job demand (quantity) (−0.193**)
Job demand (quantity) (−0.357***)
Job demand (quality) (−0.349***)
Low support from supervisor (0.187*)
Low support from supervisor (0.197**)
Job demand (quantity) (−0.158*)
Low job aptitude (−0.206**)
Low support from supervisor (−0.254***)
Physical job load (−0.183**)
Work duration (0.182*)
Low support from colleagues (−0.157*)
Associations of stress responses and self-rated health with SOC and stressors in 190 male workers: model 2 a
Independent variables (partial regression coefficient) b
Managerial work (0.201*)
Job demand (quantity) (−0.162*)
Job demand (quantity) (−0.321***)
Job demand (quality) (−0.332***)
Low support from supervisor (0.180*)
Low support from supervisor (0.188**)
Job demand (quantity) (−0.158*)
Low support from supervisor (−0.269***)
Physical job load (−0.194**)
Low job aptitude (−0.195*)
Associations of stress responses and self-rated health with SOC and stressors in 101 female workers: model 1 a
Independent variables (partial regression coefficient) b
Job demand (quantity) (−0.321**)
Job demand (quantity) (−0.488***)
Job demand (quantity) (−0.438***)
Low support from supervisor (0.267*)
Job demand (quantity) (−0.283**)
Work duration (0.260**)
Low support from friends and family (0.236*)
Low support from friends and family (−0.268***)
Associations of stress responses and self-rated health with SOC and stressors in 101 female workers: model 2 a
Independent variables (partial regression coefficient) b
Job demand (quantity) (−0.326**)
Job demand (quantity) (−0.511***)
Job demand (quantity) (−0.435***)
Job demand (quantity) (−0.280**)
Low support from supervisor (0.270*)
Low support from friends and family (−0.257*)
Correlation coefficients for SOC and stressors in 190 male and 101 female workers
Results of the multiple regression analysis
We found that among both male and female workers, stress responses such as tension, fatigue, depression, and anxiety, as well as positive mood (vigor) were inversely associated with job stressors as measured by the BJSQ. SOC had the opposite association with stress responses, indicating that having a stronger SOC can reduce the adverse effects of job stress on psychological status among workers of both genders. Thus, not only psychiatric complaints as measured by the GHQ, but also job stress responses are affected by one’s SOC.
Interestingly, marriage was positively associated with anxiety and depression in female workers, but inversely associated with depression in male workers. This is in contrast with a recent study conducted over 23 European countries on gender differences in depression, which demonstrated that a lower risk of depression was associated with marriage for both genders . Marriage-related psychological distress may be greater in Japanese women than men. It was reported that among infertile Japanese women, having a lack of husband support was associated with increased depression and anxiety .
According to a previous review, there is a strong association between SOC and mental health . For example, because SOC is inversely associated with anxiety, hopelessness, depression, and perceived stressors, and positively associated with optimism, hardiness, self-esteem, self-efficacy, and social skills, it would appear that people with a stronger SOC tend to positively view their health. The narrower SOC concepts, i.e. comprehensibility (how to understand reality) and manageability (ability to manage without great difficulty), may affect one’s perception of stress. It is suggested that reducing negative job stress responses by supporting workers’ self-perceptions as well as increasing their SOC and vigor can help them maintain a healthy life.
Eriksson et al.  demonstrated that SOC was significantly related to the self-rated health of 1013 Finland residents. We did not identify this association in our regression analyses, although the high SOC group had higher self-rated health scores than the low SOC group. This inconsistency between the studies may have resulted from differences in participant characteristics, and/or the smaller number of participants in our study. However, because self-rated health can predict one’s ability to cope with stress to some extent, self-rated health is verified as a simple and effective indicator that can be used in health screening to predict changes in future health conditions .
Characteristics of high SOC workers
In our study, having a stronger SOC was associated with older age and job title (Table 1), although the groups were based on the mean SOC score, rather than a validated cut-off point. This association may be attributable to a number of causes. First, older people are more likely to be appointed to managerial positions. Second, people who are promoted to management positions will develop stress tolerance with experience . Third, people who have a consistently good mental health status and can manage stress tend to be selected for management positions . The positive association of SOC with older age and job title seems reasonable if SOC is not an inborn or innate capacity but a learned sense that is acquired a posteriori through various life experiences and becomes deeply ingrained to shape personality .
The positive association between marriage and SOC identified in the present study may also be attributable to the age of married people. According to Eriksson and Lindström , SOC tends to increase with age through the whole life span. Whether the increases in individual SOC are an effect of natural selection of people (healthy people survive) or a question of people developing a strong SOC staying well is not clear. They suggest the second explanation. Males usually have a stronger SOC than females, although the differences are small . This agrees with the observation of a stronger SOC in males than in females in the present study.
Significance of SOC at workplace
Horita  reported that SOC scores were significantly higher in healthy workers who had a high level of satisfaction with their work and life. According to a review of SOC and quality of life (QOL) , SOC seems to be a resource that directly enhances one’s QOL, or enhances it via good health perceptions. A stronger SOC and increased job control resulted in better subjective feelings of well-being in a 1-year follow-up study of Japanese civil servants . On the other hand, a weak SOC is assumed to have either a direct relationship with poor psychological well-being or an indirect relationship via the development of lifestyle problems such as a lack of exercise, obesity or smoking . These findings, together with the “antagonistic” effects of having a weak SOC on responses to job stressors demonstrated in the present study, indicate that enhancing workers’ SOC is essential for health at work and in daily life. Health education programs can improve workers’ SOC , and therefore worksite intervention programs should be developed in further studies.
The present study was based on relatively small number of participants with a low response rate. This may have distorted the findings because the participants may have been more concerned about mental illness in relation to job stress than non-participants. Although it has been reported that the SOC and BJSQ scales have good reliability and/or validity [13, 14, 26], it remains to be elucidated whether the different scales used in the present study really measured the same underlying psychological constructs. Our findings may have been dependent on the participants’ general satisfaction or mood status, as the study was cross-sectional and used subjective-report variables. We only examined stress-related outcomes. In future studies, the prevalence/incidence of somatic or psychological disorders should be used as outcomes in relation to SOC and the stressors measured by the BJSQ; because, for example, coronary heart disease risk is significantly related to job stress [11, 12]. A well-designed longitudinal study following a larger number of participants is necessary to further confirm that SOC reduces the adverse health effects of job stress.
It is suggested that increasing one’s SOC may reduce their negative job stress responses and subjective symptoms, and enhance their vigor. The positive association of SOC with older age and job title indicates that SOC is not an inborn or innate capacity but a learned sense. Interventions for increasing workers’ SOC should be developed.
Kayoko Urakawa and Kazuhito Yokoyama contributed equally to this work.
The authors thank Dr. Yoshihiko Yamazaki, Graduate School of Medicine, The University of Tokyo, for his valuable suggestions. The present study was supported by Grants-in-Aid from the Ministry of Health, Labour and Welfare of Japan.
- Yamazaki Y: SOC, a theory on salutogenesis and health promoting ability from newly developed view points for health. Quality Nursing. 1999, 5: 824-832. (in Japanese)Google Scholar
- Antonovsky A: Health, stress, and coping: New perspective on mental and physical well-being. 1979, San Francisco, CA, Jossey-Bass PublishersGoogle Scholar
- Antonovsky A: Unraveling the mystery of health, How people manage stress and stay well. 1987, Jossey-Bass Publishers, San Francisco, CA, [Translated in to Japanese by Yamazaki Y and Yoshii K: Tokyo, Yushindo 2001]Google Scholar
- Feldt T, Lintula H, Suominen S, Koskenvuo M: Structural validity and temporal stability of the 13-item sense of coherence scale: Prospective evidence from the population-based HeSSup study. Quality of Life Research. 2006, 16: 483-493.PubMedView ArticleGoogle Scholar
- Feldt T: The role of sense of coherence in well-being at work: analysis of main and moderator effects. Work Stress. 1997, 11: 134-147. 10.1080/02678379708256830.View ArticleGoogle Scholar
- Gilbar O: Relationship between burnout and sense of coherence in health social workers. Soc Work Health Care. 1998, 26: 39-49. 10.1300/J010v26n03_03.PubMedView ArticleGoogle Scholar
- Takayama T, Asano Y, Yamazaki Y, Yoshii K, Nagasaka Y, Fukada J, Furusawa Y, Takahashi S, Seki Y: Sense of coherence, stressful life events and psychological health. Jpn J Public Health. 1999, 11: 965-975. (in Japanese)Google Scholar
- Nasermoaddeli A, Sekine M, Hamanishi S, Kagaminori S: Associations of sense of coherence with sickness absence and reported symptoms of illness in Japanese civil servants. Industrial Health. 2003, 45: 231-233.Google Scholar
- Haoka T, Sasahara S, Tomotsube Y, Yoshino S, Maeno T, Matsuzaki I: The effect of stress-related factors on mental health status among resident doctors in Japan. Medical Education. 2010, 44: 826-834. 10.1111/j.1365-2923.2010.03725.x.PubMedView ArticleGoogle Scholar
- Japan Industrial Safety and Health Association (Website): Stress Check [http://www.jisha.or.jp/mental_health/stress_check.html] (access on August 15, 2011)
- Johnson JV, Hall EM: Job strain, workplace social support, and cardiovascular disease: a cross-sectional study of a random sample of the Swedish working population. American J Public Health. 1988, 78: 1336-1342. 10.2105/AJPH.78.10.1336.View ArticleGoogle Scholar
- Johnson JV, Hall EM, Theorell T: Combined effects of job strain and social isolation on cardiovascular disease morbidity and mortality in a random sample of the Swedish male working population. Scand J Work Environ Health. 1989, 15: 271-279. 10.5271/sjweh.1852.PubMedView ArticleGoogle Scholar
- Shimomitsu T, Haratani T, Ohno Y, et al: The Ministry of Labour sponsored grant for the prevention of work-related illness, The 1999 Report. Edited by: Kato M. 2000, Tokyo Medical College, Tokyo, 126-164. (in Japanese)Google Scholar
- Kawada T, Otsula T: Relationships between job stress, occupational position and job satisfaction using a brief job stress questionnaire. Work. 2011, 40: 393-399.PubMedGoogle Scholar
- Urakawa K, Yokoyama K: Sense of Coherence (SOC) may reduce the effects of occupational stress on mental health status among Japanese factory workers. Industrial Health. 2009, 47: 503-508. 10.2486/indhealth.47.503.PubMedView ArticleGoogle Scholar
- Idler EL, Benyamini Y: Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behavior. 1997, 38: 21-37. 10.2307/2955359.View ArticleGoogle Scholar
- Ogawa Y, Nakamura H, Nagase H, Ogino K, Ooshita Y, Tsukahara S: Structural analysis for psychosocial factors including health locus of control (HLC) and sense of coherence (SOC) associated with lifestyle-related diseases. Jpn J Hyg. 2001, 55: 597-606. 10.1265/jjh.55.597. (in Japanese)View ArticleGoogle Scholar
- Hellerstedt W, Jeffery RW: The association of job strain and health behaviours in men and women. International Journal of Epidemiology. 1997, 26: 575-583. 10.1093/ije/26.3.575.PubMedView ArticleGoogle Scholar
- deVelde SV, Bracke P, Levecque P: Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. Social Science and Medicine. 2010, 71: 305-313. 10.1016/j.socscimed.2010.03.035.View ArticleGoogle Scholar
- Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Kondo A, Makino T: Increased depression and anxiety in infertile Japanese women resulting from lack of husband’s support and feeling of stress. General Hospital Psychiatry. 2004, 26: 398-404. 10.1016/j.genhosppsych.2004.05.002.PubMedView ArticleGoogle Scholar
- Eriksson M, Lindström B: Antonovsky’s sense of coherence scale and the relation with health; a systematic review. J Epidemiol Community Health. 2006, 60: 376-381. 10.1136/jech.2005.041616.PubMedPubMed CentralView ArticleGoogle Scholar
- Eriksson M, Lindström B, Lilja J: A sense of coherence and health. Salutogenesis in a societal context: Ålanad, a special case?. J Epidemiol Community Health. 2007, 61: 684-688. 10.1136/jech.2006.047498.PubMedPubMed CentralView ArticleGoogle Scholar
- Haratani T: Factors affecting mental health status of KANRISHOKU. Digest of Science of Laboure. 1993, 48: 336-339. (in Japanese)Google Scholar
- Poppius E, Tenkanen L, Kalimo R, Heinsalmi P: The sense of coherence, occupation and the risk of coronary heart disease in the Helsinki Heart Study. SocSci Med. 1991, 49: 109-120.View ArticleGoogle Scholar
- Stephens T, Culberg C, Joubert N: Mental health of the Canadian population: a comprehensive analysis. Chronic Dis. 1999, 20: 118-126.Google Scholar
- Eriksson M, Lindström B: Validity of Antonovsky’s sense of coherence scale: a systematic review. J Epidemiol Community Health. 2005, 59: 460-466. 10.1136/jech.2003.018085.PubMedPubMed CentralView ArticleGoogle Scholar
- Horita M, Koshida E, Hirao Y, Matsuo Y, et al: Relationships of Sense of Coherence (SOC) scale (short-form) to stress response and consultation with physicians. The Teishinigaku. 2007, 59: 246-249. (in Japanese)Google Scholar
- Eriksson M, Lindström B: Antonovsky’s sense of coherence scale and its relation with quality of life; a systematic review. J Epidemiol Community Health. 2007, 61: 938-944. 10.1136/jech.2006.056028.PubMedPubMed CentralView ArticleGoogle Scholar
- Nasermoaddeli A, Sekine M, Hamanishi S, Kagamimori S: Associations between Sense of Coherence and psychological work characteristics with changes in Quality of Life in Japanese civil servants; A 1-year follow-up study. Industrial Health. 2003, 41: 236-241. 10.2486/indhealth.41.236.PubMedView ArticleGoogle Scholar
- Matsuzaki I, Sagara T, Ohshita Y, Nagase H, Ogino K, Eboshida A, Sasahara S, Nakamura H: Psychological factors including sense of coherence and some lifestyles are related to general health questionnaire-12 (GHQ-12) in elderly workers in Japan. Environmental Health and Preventive Medicine. 2007, 12: 71-77. 10.1007/BF02898152.PubMedPubMed CentralView ArticleGoogle Scholar
- Nakamura H, Matsuzaki I, Sasahara S, Hatta K, Nagase H, Oshita Y, Ogawa Y, Nobukini Y, Kambayashi Y, Ogino K: Enhancement of a sense of coherence and natural killer cell activity occurred in subjects who improved their exercise habits through health education in the workplace. Journal of Occupational Health. 2003, 45: 278-285. 10.1539/joh.45.278.PubMedView ArticleGoogle Scholar
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