Inverse association of sense of coherence with psychological distress during the coronavirus disease-2019 pandemic: the Toon Health Study.

Objective: The coronavirus disease 2019 (COVID-19) pandemic disrupted daily life, including work, leisure, and social interactions, potentially contributing to psychological distress (PD). However, resilience varies across individuals, and protective factors remain unclear. Sense of coherence (SOC), a core concept of salutogenesis, reflects the capacity to perceive life as comprehensible, manageable, and meaningful. This study examined the longitudinal association between pre-pandemic SOC and PD during COVID-19 in a community-based Japanese population. Materials and Methods: We analyzed data from 1,262 participants (436 men and 826 women) aged 30-84 years, excluding individuals with previous depression or poor mental health status. SOC was assessed at baseline (2014-2018) using a 13-item scale, and participants were classified into tertiles (low, middle, and high). PD was defined as a Kessler Psychological Distress Scale (K6) score ≥5 in 2021. Logistic regression analyses estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for PD, after adjusting for age, living status, education, BMI, smoking, alcohol use, physical activity, medical history, and baseline mental health (MCS score). Results: During follow-up, the cumulative incidence of PD was higher in the low-SOC group (men: 37.0%, women: 48.3%) than in the middle-SOC group (men: 17.0%, women: 26.5%) and high-SOC group (men: 7.4%, women: 14.9%). Compared with the low-SOC group, the middle-SOC group had lower odds of PD (men: AOR 0.38, 95% CI 0.20-0.70; women: AOR 0.45, 95% CI 0.31-0.66), and the high-SOC group had the lowest odds (men: AOR 0.19, 95% CI 0.09-0.42; women: AOR 0.25, 95% CI 0.16-0.40), independent of confounders including baseline MCS. Conclusion: Higher pre-pandemic SOC was strongly associated with lower PD during the COVID-19 pandemic, suggesting that SOC may function as a resilience-related factor. Interventions aimed at enhancing SOC and psychosocial resources may help support mental health during societal stressors.