The Sense of Coherence and Mental Health Among First Responders: a scoping review and critical analysis of causation

Introduction: Public safety personnel (PSP) experience three to five times higher rates of occupatio-nal stress injuries and adverse mental health outcomes. Sense of coherence (SOC) is a psychological trait that reflects coping capacity to deal with stressors, shown to act as a protective factor against adverse mental health outcomes. Methods: This review was conducted using the five-stage scoping review framework to answer two questions: 1) what is the extent, nature, and quality of research that has investigated the SOC and PSP mental health, and 2) what is the current state of the causal inference between SOC and post-traumatic stress symptoms (PTSS) and how does this guide next steps for research. Articles were identified through seven databases, “grey” literature, and hand-searching. Publication details, me-thodology, participant information, and results were extracted and summarized using descriptive statistics. A quality and causal analysis were performed using the Quality in Prognostic Studies tool and Bradford Hill Criteria for causation. Results: Eleven articles were included in this review. The publication years ranged from 2000 to 2020, 91% of the articles originated from the European Union, and 64% had a medium to high risk-ofbias. The PSP population of interest included police officers, firefighters, and paramedics. Most studies (73%) used a cross-sectional design to assess the relationship between SOC and PTSS. All studies reported that lower PTSS were low to moderately associated with higher SOC scores (r= -0.17 to -0.47, p< 0.05 to 0.001 and β = -0.31, p= 0.009). There was insufficient research to support a causal relationship between the SOC and PTSS, as the literature did not support several criteria (i.e., strength, consistency, temporality, and experimental evidence). Conclusions: While SOC evidence is preliminary, associations are sufficient to warrant future longi-tudinal and interventional studies.