Sense of coherence and intentions to retire early among Finnish women and men

The theory of sense of coherence (SOC) was developed in the 1970's as the initiator of the theory, Aaron Antonovsky, examined factors that promote and maintain good health. By focusing on people's resources and capacities to create health, Antonovsky shifted the approach from the pathogenic to the salutogenic. His theory of SOC is the core of that salutogenic model.

SOC is a health promoting psychological resource which strengthens one's capacity to deal with environmental strain [1, 2]. Strong SOC is regarded as a characteristic that helps people to identify, use and reuse available resources and therefore minimizes the feelings of tension and stress in life further improving the prospects of staying health. The development of SOC begins in early childhood, and therefore the living circumstances during that time are essential regarding the level of SOC in adulthood. In addition to childhood circumstances, also many other factors called as generalized resistance resources, most importantly education, socio-economic position, social support and work-related factors promote SOC [1, 2].

In both cross-sectional and longitudinal study settings, SOC has been found to be positively associated with subjective state of health [3], and negatively with sickness absences [4], circulatory problems [5] and coronary heart disease morbidity and mortality [6‐8]. Furthermore, a positive association between SOC and emotional coping and quality of life among people with chronic illness [9, 10], health behaviour [11], and self-esteem [12] has been found. In addition earlier research has demonstrated that SOC has a strong negative correlation with anxiety and depression and a strong positive correlation with optimism [13].

Table 1 shows the prevalences for intentions to retire early by the background variables as well as means of SOC for all intention groups. The mean SOC was strongest among respondents with no intentions to retire early being 65.4 among women and 66.9 among men. Women scored lowest in the weak intention group (mean SOC 63.6) and men in the strong intention group (mean SOC 63.8). Among respondents aged 50-54 years, 42% of women and 53% of men reported some degree intentions to retire early. Finnish speaking women and men reported more often intentions to retire early (weak and strong) compared to Swedish speaking Finns. In both genders, the prevalence of both weak and strong intentions was highest if difficulties in childhood home existed. The prevalence of strong intentions was highest among those women and men who got drunk once a week or more. Among men the effect of smoking on both weak and strong intentions was clear. In both genders having or having had at least one somatic disease diagnosed by a physician and depression strongly increased intentions to retire early. Over 80% of women and men reported no depression, whereas 63% of women and 60% of men reported a previous or present disease diagnosed by physician.

In the further analyses we combined weak and strong intentions. Since both somatic and mental health problems strongly increased the risk of reporting intention to retire early, further analyses were stratified by health status. Thus analyses were made separately among those somatically or mentally unhealthy women (N = 5882) and men (N = 3784), and healthy women (N = 1527) and men (N = 1082). Of the unhealthy women, 4772 (81%) reported no intention to retire, and 1110 (19%) reported intentions to retire. Among men the corresponding figures were 2715 (72%) and 1069 (28%). Of the somatically and mentally healthy women, 1364 (89%) reported no intentions to retire early, and 163 (10%) reported intentions to retire early. Among men the corresponding figures were 972 (86%) and 155 (14%) (data not shown).

Table 2 presents results of logistic regression models for intentions to retire early (weak and strong intentions combined) among somatically or mentally unhealthy and somatically and mentally healthy women. Among ill women, SOC had a statistically significant association with intention to retire early both in Model 1 age-adjusted and Model 2 with all background factors adjusted for. Regarding model 2 with all the background factors adjusted for, the OR of SOC was 0.97, i.e., each additional SOC score reduced the risk of intentions to retire early by 3% in somatically and/or mentally ill women. Further, socio-economic, psychosocial and work and health behaviour related factors did not influence the association between SOC and intentions to retire early among somatically or mentally unhealthy women; adding the background factors in the model 2 had no influence to the odds ratios of SOC in intentions to retire early.

As shown in Table 2, among somatically or mentally unhealthy women, after adjustment for the background variables (model 2), in addition to SOC (OR 0.97, 95% CI 0.96-0.98) higher secondary, lower secondary and primary education (OR 1.42, 95% CI 1.07-1.87; OR 1.41, 95% CI 1.02-1.95; OR 1.46, 95% CI 1.08-1.99, correspondingly) remained associated with intentions to retire early. Among somatically and mentally healthy women the association between SOC and intention to retire early was weaker and non-significant, as were the rest of the variables in model 2.

As for women, also among somatically or mentally unhealthy men SOC was associated with intentions to retire early both in Model 1 (age-adjusted) and Model 2 (with all background factors adjusted for) (Table 3). Regarding model 2 with all the background factors adjusted for, the OR of SOC was 0.97 (95% CI 0.96-0.98) i.e., each additional SOC score reduced the risk of intentions to retire early by 3% among somatically and/or mentally unhealthy men. Further, socio-economic, psychosocial and work and health behaviour related factors had almost no influence on the association between SOC and intentions to retire early (the OR of SOC increased from 0.96 to 0.97). However, unlike among somatically and mentally healthy women, among healthy men the association between SOC and intention to retire early remained in both models 1 and 2.

Among somatically or mentally unhealthy men (Table 3) in addition to SOC, language, difficulties at childhood, education, high job demands and heavy smoking remained associated in Model 2 with all the background factors adjusted for. Somatically or mentally unhealthy Swedish speakers reported less intentions to retire early compared to Finnish speakers (OR 0.67, 95% CI 0.48-0.94). Further, among unhealthy men, having had difficulties at childhood increased the risk of intention to retire early compared to the group of no difficulties (OR 1.26, 95% CI 1.01-1.57). Also higher secondary, lower secondary and primary education increased the risk of intentions to retire early among unhealthy men compared to highest education group (OR 1.56, 95% CI 1.14-2.13; OR1.82, 95% CI 1.31-2.54; OR 1.80, 95% CI 1.29-2.51, correspondingly). Finally, high job demands showed an association with intentions to retire early (OR 1.46, 95% CI 1.05-2.04), as well as smoking over five cigarettes per day (OR 1.33, 95% CI 1.00-1.76) in Model 2 with all background variables adjusted for.

Among healthy men, in addition to SOC, relationship with parents, difficulties at childhood, primary education and heavy smoking had statistically significant association with intention to retire early in model 1. In model 2 with all background variables adjusted for in addition to SOC, heavy smoking remained associated

We did the same analyses as in model 2 (with all the variables adjusted for) having the SOC scale divided into quartiles to test the linearity of the association. The reference category for the intentions to retire early was the highest quartile. The OR of intentions increased gradually toward the lowest quartile among somatically or mentally unhealthy women: 1.2 (CI 95% 0.96-1.63), 1.5 (CI 95% 1.13-1.98) and 2.0 (CI 95% 1.49-2.66) and among somatically or mentally unhealthy men: 1.0 (CI 95% 0.76-1.35), 1.3 (CI 95% 0.94-1.72) and 1.9 (CI 95% 1.36-2.60), respectively. Further, the parameters of SOC increased gradually also among somatically and mentally healthy men (OR 1.60, 95% CI 0.87-2.94; OR 1.9, 95% CI 0.99-3.8; OR 2.4, 95% CI 0.96-6.03) suggesting a dose-response relationship between SOC and intention to retire early. Among mentally or somatically unhealthy women the two lowest SOC quartiles clearly represented a risk of intention to retire early whereas among men only the lowest SOC quartile had a similar effect.

There was no interaction neither between language and SOC, nor between gender and SOC when predicting early retirement.

SOC was clearly associated with intentions to retire early among somatically or mentally unhealthy women and men, and this association remained even after adjusting for a range of socio-economic, psychosocial and work and health behaviour related background factors. Further, among healthy men, in addition to smoking SOC was the only significant predictor of intention to retire early. Among healthy women no significant association between SOC and intention to retire early was found.

Among unhealthy women, in addition to SOC, age and education were associated with intentions to retire early when all the background factors were adjusted for, i.e. the effects of these factors on intentions to retire early were independent. Among unhealthy men, in addition to these, also language, difficulties at childhood, education, high job demands and heavy smoking were independently associated with intentions to retire early. The effects of education and job demands are evident: Important factors associated with health status are working conditions [20], which often are socioeconomically patterned.

However, due to differences in occupational status, occupational requirements and work and family related psychosocial environment and life situations among employees, the same disease and impairment in a medical sense may lead to different degrees of disability [19]. Further, subjective evaluation of one's health, well-being and resources may affect one's attitudes toward retirement [20]. The strong and independent association between SOC and intentions to retire early is noticeable since after adjusting for several factors known to affect the retirement process, the association between SOC and intentions to retire early did remain constant.

Considering the nature of SOC and salutogenesis, it seems plausible that the level of SOC may determine people's decisions regarding the continuation of work. A person with strong SOC stands the life and its challenges in health promoting manner: without "unnecessary" feeling of stress arising from the confidence that adequate resources will be at hand when needed. It is presumable that this confidential attitude - strong SOC - enhances people's trust that they have the resources needed to overcome the risk factors and challenges posed by their work, and that the work they do is meaningful and important. Whereas a person with a poor SOC may stand his/her work as life in general, it is chaotic, unmanageable, and meaningless, and hence be reluctant to continue working (until old-age retirement).

Additionally research has shown that among people with different kind of chronic illnesses, those having strong SOC deal better with the strain arising from illness [30]. Therefore among people with health complaints, SOC may be a factor preventing early retirement. Additionally, SOC is associated with perceived health [3], self-esteem [13] and attitudes such as optimism and hostility [14]. Optimism/pessimism and hostility have also been associated with the retirement process [31]. Additionally, earlier studies have shown that early rehabilitation is associated with higher average retirement age [32, 33]. According to Kaiser et al. [33], SOC is related to coping style and thus is a prerequisite for engaging in rehabilitation.

It has also been shown that the climate at work and working circumstances of people who still are working are highlighted as factors affecting intentions to retire early. In a Finnish study [34] low job control, poor teamwork and unjust supervision were associated with retirement thoughts and retirement preferences among hospital physicians. The association remained after control for indicators of health and social circumstances. In another Finnish study [35] the association between low job control and intentions to retire early was stronger if job demand were high. The present study partly confirmed the role of psychosocial working conditions on retirement process: high job demands at work remained associated with intentions to retire early after full adjustment for other confounding factors among men. According to our earlier research, SOC has been associated positively with ability to use skills, decision authority and skill utilization at work, and negatively with high psychological job demands [26, 36]. Moreover, the main effect of SOC on well-being at work and some support for a moderating role of SOC on the relationship between perceived work characteristics and well-being has been reported [37]. To sum up, SOC may influence the retirement process in several ways, i.e. directly determining the process of consideration regarding the continuation of work, or indirectly through better adaptability to ill-health, working circumstances, and engagement in rehabilitation.

Another way to discuss the role of SOC in the retirement process is its role in the retirement developmental transition, especially among people with ambiguous attitudes toward retirement. According to Antonovsky, people with a strong SOC are more prone to substitute work activity with other meaningful activities instead of ending up feeling worthless. Antonovsky et al. [38] showed in their study that a strong SOC is an important factor in coping with the retirement developmental transition for it helps adopting functional attitudes toward the retirement. Further, Smith [39] examined the role of family worldview (incl. SOC) on retirement process and showed that the way family views the world is important for a positive level of individual adaptation as well as family unit adaptation during retirement. It seems that SOC is an important factor not only preventing early retirement process but also promoting the readjustment to the old-age pension.

Since earlier studies have shown that Swedish speaking Finns retire later than their Finnish speaking counterparts [40], the language was included in the present study. Compared to Swedish speaking men, Finnish speaking men reported more often intentions to retire early. This association remained even after full adjustment for the background variables. Hence it seems that Finnish and Swedish speaking men show to some extent different attitudes already in the first phase of the retirement process.

The weakness of the present study is that the response rate of the baseline survey was only 40%. However, according to the non-response analysis, only minor differences in socio-demographic and health-related issues were found between the respondents and non-respondents [25]. Further studies would also benefit from a wider range of family and work related psychosocial factors as well as social support compared to the present study. An advantage of the present study is a large nationwide population sample with prospective study design. Also the response rate of the follow-up was good being 80%.

According to the present paper SOC has an independent effect on intentions to retire early and therefore a strong SOC may have a potential to prevent early retirement in groups otherwise at risk. In the present study unhealthy people with low SOC and low education were in greatest risk to have reported intention to retire early. Determining SOC would help to identify individuals at risk for early retirement and focus supportive measures more effectively. Moreover, several recent studies [41‐44] have supported Antonovsky's original hypotheses that intentional modification of SOC through an intervention is possible. An important challenge would be to target the resources of SOC, including working circumstances and social support, to the most vulnerable and design appropriate interventions in order to strengthen the level of SOC and hence prolong working years of the aging employees. More research on individual choices based on personality and attitudes is needed in order to better understand the multi-faceted mechanisms between SOC and retirement decisions.