the sense of coherence ( soc ) , which was proposed by antonovsky is based on the salutogenic model of health .
the soc is composed of three factors ; ( 1 ) the stimuli derived from internal and external environments in the course of living are structured , predictable , and explicable ( comprehensibility ) ; ( 2 ) resources are available to meet the demands posed by these stimuli ( manageability ) ; and ( 3 ) such demands are challenges , worthy of investment and engagement ( meaningfulness ) .
antonovsky defined the soc as a personality dimension that is hypothesized to influence stress recognition style , facilitate stress management , and contribute to overall well - being .
people with a strong soc have a high ability to cope with stress and maintain good physical and mental health . to the best of our knowledge
, six studies have investigated the association between soc , job stress , and mental health .
findings from these studies suggest that soc modified the effect of job stress on mental health . to the best of our knowledge
, only four studies have investigated the relationship between the soc and depressive symptoms , one used the brief job stress questionnaire and the other three used general health questionnaire .
these studies suggested that a weak soc was a strong predictor of mental distress , including depressive symptoms .
nurses are exposed to high - stress work environments , including irregular work schedules , shift work , and interaction with patients and other hospital staff members .
therefore , preventing mental distress , including depressive state , is an important issue for nurses .
the aim of this study was to investigate the relationship between depressive state , job stress , and soc among nurses in japanese general hospital .
in february 2013 , supervisors distributed a questionnaire to all nurses ( n = 710 ) in a general hospital with 611 beds in an urban area in japan .
nurse specialties included intensive care , pediatrics , surgery , oncology , and emergency medicine .
an explanation of the nature of the survey accompanied the questionnaire , which was anonymous and voluntary .
the study was approved by both the local direction board and the committee for the prevention of physical disease and mental illness among health care workers at the general hospital .
the questionnaire collected data on age , hours of work ( full - time or part - time ) , shift work , overtime hours per week , and job rank ( manager , middle manager or staff nurse ) .
we measured job stress using the japanese version of the effort - reward imbalance ( eri ) scale ( 23 items ) translated by tsutsumi et al .
the eri consists of three subscales ; effort ( 6 items ) , reward ( 11 items ) and over - commitment ( 6 items ) .
the reward subscale is further divided into three subgroups : esteem , job security , and promotion .
the eri model indicates that job stress is related to high effort with low reward .
four eri ratios ( eri , effort - esteem imbalance , effort - promotion imbalance , and effort - job security imbalance ) were calculated based on the total scores according to tsutsumi et al . the soc scale consisted of 29 items assessing comprehensibility , manageability , and meaningfulness .
scores for each item ranged from 1 to 7 points , and the total score was calculated as the soc score .
we measured depressive state using the k6 short screening questionnaire that was developed in accordance with the world health organization translation guidelines .
the k6 consists of six items on depression and anxiety , each of which is measured on a 5-point scale ( 0 - 4 ) .
higher scores indicate a more depressive state . the k6 was translated into japanese and showed good validity with the diagnostic and statistical manual of mental disorders , fourth edition , mood , and anxiety disorders in a community sample .
we used pearson 's correlation to investigate the relationship among age , work related - factors , job stress , soc , and depressive state . to examine factors with a significant effect on depressive state ,
stepwise multiple regression analyses were conducted with the k6 total score as the dependent variable and variables related to the depressive state as independent variables .
completed questionnaires were returned by 420 out of 710 nurses ( response rate , 59.2% ) .
male nurses were excluded from the analysis because only 28 of the 42 ( 66.7% ) male nurses responded .
subjects with missing values for job stress , soc , or depressive state were also excluded ( n = 43 ) . the final sample for analysis consisted of 348 female nurses ( 52.1% ) , including nurses who were managers and middle managers .
overtime was reported in hours per week , which was voluntary but limited to 45 h / month .
shift work categories included :  no shift work ,   shift work with rotation to night shift ,  or 
characteristics of study subjects table 2 shows the pearson 's correlation coefficients between age , overtime hours , eri ratios , soc , and the depressive state .
depressive state moderately correlated with three eri ratios , over - commitment , and soc .
pearson 's coreration between work environments , eri ratios , over - commitment , soc and depressive state table 3 shows the influence of work - related factors , eri ratios , and soc on depressive state .
soc , over - commitment , effort - esteem ratio , and age were significantly correlated with depressive state (  = 0.46 , p < 0.001 ;  = 0.27 , p < 0.001 ;  = 0.16 , p < 0.001 ,  = 0.10 , p < 0.01 , respectively ) .
the coefficient of multiple determination ( r ) was 0.56 ( f = 106.56 p < 0.001 ) .
we found that soc , over - commitment , effort - esteem ratio , and age were predictors of depressive state among female nurses in the general hospital .
the soc was inversely associated with depressive state , which was similar to previous studies .
the present findings contribute to the literature investigating the relationship between depressive state , job stress , and soc .
strength of our study is that we investigated the independent contribution of three ratios of eri ( effort - esteem , effort - job security , and effort - promotion ) , over - commitment , and soc to the depressive state . according to our previous study ,
the present findings suggest that a depressive state of nurses was associated with not only job stress but also both over - commitment and soc .
age correlated positively with soc [ table 2 ] , which was also similar to a previous study by harri who suggested that soc tends to increase with age .
previous studies suggested that an increasing soc of workers may reduce negative job stress responses and mental health problems .
intervention support enhancing the soc could be effective in preventing nurses from experiencing a depressive state .
first , the sample size was small and included nurses from only one general hospital .
our findings provide insight into some factors associated with a depressive state among nurses in a general hospital . from a practical perspective
, the influence of soc on a depressive state should be considered for health care professionals .
intervention support such as group cognitive psychotherapy to strengthen comprehensibility , manageability , and meaningfulness may help nurses cope better with job stress and reduce their risk of depression .
 background : people with a strong sense of coherence ( soc ) have a high ability to cope with stress and maintain good physical and mental health.aims:the aim of this study was to investigate the relationship between depressive state , job stress , and soc among nurses in a japanese general hospital.materials and methods : a self - reporting survey was conducted among 348 female nurses in a general hospital . 
 job stress was measured using the japanese version of the effort - reward imbalance ( eri ) scale . 
 depressive state was assessed by the k6 scale . 
 soc was assessed with the soc scale , which includes 29 items . 
 stepwise multiple regression analysis was conducted to examine factors that significantly affect depressive state.results:soc , over - commitment , effort - esteem ratio , and age were significantly correlated with the depressive state (  = 0.46 , p < 
 0.001 ;  = 0.27 , p < 0.001 ;  = 0.16 , p < 0.001 ;  = 0.10 , p < 0.001 , respectively).conclusions : soc may have a major influence on the depressive state among female nurses in a japanese general hospital . from a practical perspective 
 , health care professionals should try to enhance the soc of nurses . 
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
CONCLUSION