Abstract
BACKGROUND: The Sense of Coherence (SOC) scale was designed to measure an individual's ability to perceive life as comprehensible, manageable, and meaningful. While low SOC is associated with various psychiatric disorders, its association with bipolar disorder remains unclear. This study explores SOC in individuals with bipolar disorder, its associations with clinical characteristics, and its stability and predictive value over 14 years. METHODS: We included 248 individuals with bipolar disorder and 113 healthy controls from the St. Göran Bipolar Project. SOC was assessed using Antonovsky's 29-item scale at baseline and after 14 years. Clinical measures included the Montgomery-Åsberg Depression Rating Scale (MADRS), Sheehan Disability Scale, and comorbid psychiatric diagnoses. SOC's predictive value for relapse, suicide attempts, and self-harm was evaluated using data from a 7-year follow-up visit. RESULTS: SOC scores were lower in individuals with bipolar disorder than in healthy controls (p < 0.001). Lower SOC correlated with greater functional impairment, residual depressive symptoms, and comorbid anxiety disorders. SOC was stable over 14 years, with modest increases in both groups. In the bipolar disorder group, baseline SOC predicted self-harm during the initial 7-year follow-up (p = 0.012) but was not associated with mood episode relapse or suicide attempts. CONCLUSION: Although individuals with bipolar disorder exhibit lower SOC than healthy controls, the difference probably reflects broader psychopathology rather than core bipolar symptoms. SOC predicted self-harm during the 7-year follow-up period, but not mood episode relapse or suicide attempts. Targeting SOC in interventions may benefit comorbid conditions, but is unlikely to impact bipolar-specific outcomes.