Objective The aim of the study was to assess the predictive value and clinical significance of the sense of coherence (SOC) in the assessment of work ability in psychiatric patients with prolonged and complicated disability. SOC is a strong determinant of positive health and successful coping.

Methods Our cohort consists of 100 consecutive and consented patients whose work ability was assessed at the Outpatient Psychiatric Unit of the Helsinki University Hospital in 2010–2011. SOC was measured by Antonovsky’s model using a short questionnaire SOC-13. After one year follow-up altogether 90 patients were reached for a phone interview. We studied how SOC associated with the diagnostic group and other functional measurements (such as Sheehan Disability Scale [SDS], Return to work Self Efficacy [RTW-SE] and Social and Occupational Functioning Assessment Scale [SOFAS]), and how SOC predicts return to work.

Results Patients with mood disorders (65%) showed the lowest (mean 45.9) and psychotic patients (6%) showed the highest SOC scores (mean 62.5), (p < 0.0005). SOC correlated with baseline RTW-SE (B = 0.715 and p < 0.0005), SDS (B = −0.076 and p < 0.0005 the scale being inverted) and SOFAS (B = 0.193 and p = 0.005). 28% of the patients had returned to competitive and 69% to any kind of working life activities as 31% were disable to work. SOC did not predict the return to competitive employment (B = 0.0024 and p = 0.124) but predicted the return to any working life activity (B = 0.056 and p = 0.002).

Conclusions SOC predicted work ability after one year of follow-up independent of psychiatric illness and was associated with common psychiatric functional measurements (SDS, RTW-SE, SOFAS). Psychological resources are worth measuring and focusing on in return to work practices.