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Background <p>Public health centers (PHCs) played a critical role in managing health crises during the coronavirus disease (COVID-19) pandemic in Japan. Sense of coherence (SOC), comprising comprehensibility, manageability, and meaningfulness–a key framework for stress resilience–is important for mental health, with meaningfulness especially being important. This study examined the associations between SOC components and mental health among PHC directors during the pandemic.</p> Methods <p>A nationwide cross-sectional questionnaire survey was conducted among all 468 PHC directors in Japan between September and November 2022. Mental health was assessed using the six-item Kessler Psychological Distress Scale (K6), and SOC using the University of Tokyo Health Sociology version of the SOC3 scale (SOC3-UTHS). Information on the maximum number of consecutive working days and average sleep duration during the most demanding pandemic period were obtained. Logistic regression analyses were performed with K6 as the outcome and total SOC3-UTHS or each component as explanatory variables, adjusting for consecutive working days or sleep duration, and the interaction with SOC component.</p> Results <p>Overall, 189 valid responses were analyzed. After adjusting for the number of consecutive working days, higher K6 scores were significantly associated with lower total SOC3-UTHS scores (Odds Ratio (OR) = 0.349), comprehensibility (OR = 0.413) and manageability (OR = 0.278), but not meaningfulness. Similar associations were observed after adjusting for average sleep duration. However, the interaction between comprehensibility and consecutive working days suggests the protective association of higher comprehensibility with mental health may be attenuated under prolonged working conditions. Shorter sleep duration also tended to be associated with worse mental health.</p> Conclusions <p>SOC components may play different roles for leaders operating under crisis conditions, and comprehensibility, manageability, and adequate sleep may warrant attention in this context.</p>

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Differential roles of sense of coherence components in mental health during the COVID-19 pandemic in a nationwide survey of public health center directors in Japan

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  • 发表日期：

    2026年6月29日

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  • Yuri Akamatsu,
  • Toshiyuki Ojima,
  • Hiroko Shimada,
  • Rie Fujita,
  • Sanae Haruyama

摘要

Background

Public health centers (PHCs) played a critical role in managing health crises during the coronavirus disease (COVID-19) pandemic in Japan. Sense of coherence (SOC), comprising comprehensibility, manageability, and meaningfulness–a key framework for stress resilience–is important for mental health, with meaningfulness especially being important. This study examined the associations between SOC components and mental health among PHC directors during the pandemic.

Methods

A nationwide cross-sectional questionnaire survey was conducted among all 468 PHC directors in Japan between September and November 2022. Mental health was assessed using the six-item Kessler Psychological Distress Scale (K6), and SOC using the University of Tokyo Health Sociology version of the SOC3 scale (SOC3-UTHS). Information on the maximum number of consecutive working days and average sleep duration during the most demanding pandemic period were obtained. Logistic regression analyses were performed with K6 as the outcome and total SOC3-UTHS or each component as explanatory variables, adjusting for consecutive working days or sleep duration, and the interaction with SOC component.

Results

Overall, 189 valid responses were analyzed. After adjusting for the number of consecutive working days, higher K6 scores were significantly associated with lower total SOC3-UTHS scores (Odds Ratio (OR) = 0.349), comprehensibility (OR = 0.413) and manageability (OR = 0.278), but not meaningfulness. Similar associations were observed after adjusting for average sleep duration. However, the interaction between comprehensibility and consecutive working days suggests the protective association of higher comprehensibility with mental health may be attenuated under prolonged working conditions. Shorter sleep duration also tended to be associated with worse mental health.

Conclusions

SOC components may play different roles for leaders operating under crisis conditions, and comprehensibility, manageability, and adequate sleep may warrant attention in this context.