目的:本研究使用美国健康与退休研究中7,698人的数据,量化了48种社会心理结构对全因死亡率的影响。
方法:使用潜在类别分析将参与者分为相互排斥的社会心理健康组(好,平均,或较差),随后被视为暴露。然后进行中介分析,以确定社会心理健康群体的直接影响以及身体健康(功能状态和合并症)和生活方式因素(身体活动,吸烟,和饮酒)对总体生存率的影响。我们还创建了一个综合健康指数度量,代表了介体的总结性效应。
结果:我们观察到生存时间和社会心理健康组之间具有很强的统计学意义的总效应(TE)(生存时间比(SR)=1.73,95%置信区间(CI):1.50,2.01当比较好与差时)。中介分析显示,通过心理健康组的直接作用占TE的一半以上(SR=1.46,95%CI:1.27,1.67)。综合健康指数测量介导了36.2%的TE,自然间接效应SR为1.18(95%CI:1.13,1.22)。
结论:我们的研究结果证明了心理健康与身体健康和生活方式因素之间的相互联系。
OBJECTIVE: This study quantified the effect of 48 psychosocial constructs on all-cause mortality using data from 7,698 individuals in the U.S. Health and Retirement Study.
METHODS: Latent class analysis was used to divide participants into mutually exclusive psychosocial wellbeing groups (good, average, or poor) which was subsequently considered as the exposure. Mediation analysis was then conducted to determine the direct effect of the psychosocial wellbeing groups and the indirect (mediating) effects of physical health (functional status and comorbid conditions) and lifestyle factors (physical activity, smoking, and alcohol consumption) on overall survival. We also created a composite health index measure representing the summative effect of the mediators.
RESULTS: We observed a strong and statistically significant total effect (TE) between survival time and psychosocial wellbeing group (survival time ratio (SR) = 1.73, 95% confidence interval (CI):1.50,2.01 when comparing good to poor). Mediation analysis revealed that the direct effect via psychosocial wellbeing group accounted for more than half of the TE (SR = 1.46, 95% CI:1.27,1.67). The composite health index measure mediated 36.2% of the TE with the natural indirect effect SR of 1.18 (95% CI:1.13,1.22).
CONCLUSIONS: Our findings demonstrate the interconnectedness between psychosocial wellbeing and physical health and lifestyle factors on survival.