美国中年人心理弹性预测心血管健康状况的研究

Psychological resilience predicting cardiometabolic conditions in adulthood in the Midlife in the United States Study

—原载《美国国家科学院院刊》（PNAS）2021年8月第118卷第32期—

<Proceedings of the National Academy of Sciences of the United States of America>, 2021,118 (32)

【摘要】一个人心理上的忧虑，可能是这个人早年生活中经历的逆境与其不良心血管健康问题相关联的中介因素。然而，并不是每个遭遇逆境的人都会产生心理上的忧虑和痛苦。尽管经历逆境，心理弹性和积极的心理健康或许能够保护我们避免产生不良的心血管健康问题。通过一项在美国开展的研究，我们调查了3254名中年人早期的生活逆境情况、心理弹性和心血管疾病风险。其中，早期在1994到1995年第一批次数据中关于心理逆境和心理健康的数据结果对心理弹性变量进行定义，具体通过对逆境（处于逆境/不处于逆境）、心理健康（高/低）进行交叉分类得出。此外，研究中也将逆境经历的数量和心理症状的数量作为独立变量。从第二批次（2004-2005年）和第三批次（2013-2014年）的调查中得到被试心血管疾病（如：心脏病、中风、糖尿病）的有关数据。二次分析使用了第二批次数据中的可用的生物指标对被试进行了心血管疾病风险的评估。随后，调整了有关的协变量，通过逻辑回归和泊松回归，评估了心理弹性和心血管疾病风险之间的关系。在以上样本中，相比于心理弹性高的人（处于逆境，心理健康水平较高），心理弹性低的人（处于逆境，心理健康水平较低）发生心血管疾病的风险几率要高出43% (95% CI 1.10 - 1.85)。这些心理弹性强的个体，其发生心血管疾病的几率，与没有处于逆境、心理健康水平较高的人的几率相似。逆境经历与心血管疾病风险的增加有关，然而良好的心理健康与心血管疾病风险的降低有关，且在很大程度上二者的效应相互独立。这些模式与客观的心血管疾病风险评估相似。总体而言，中年人的心理弹性可以防止早期逆境对心血管健康的负面影响。

【关键词】心理弹性；心脏代谢疾病；早期的逆境；生物标志物

[Abstract] Early adversity is associated with poor cardiometabolic health, potentially via psychological distress. However, not everyone exposed to adversity develops significant distress. Psychological resilience and positive psychological health despite adversity may protect against unfavorable cardiometabolic outcomes that are otherwise more likely. We examined early adversity, psychological resilience, and cardiometabolic risk among 3,254 adults in the Midlife in the United States Study. Psychological resilience was defined according to both early psychosocial adversity and adult psychological health (characterized by low distress and high wellbeing) at Wave1 (1994 to 1995). Categorical resilience was derived by cross-classifying adversity (exposed versus unexposed) and psychological health (higher versus lower). We also assessed count of adversities experienced and psychological symptoms as separate variables. Incident cardiometabolic conditions (e.g., heart attack, stroke, and diabetes) were self-reported at Waves 2 (2004 to2005) and 3 (2013 to 2014). Secondary analyses examined biological cardiometabolic risk using a composite of biomarkers available within a Wave-2subsample. Logistic and Poisson regressions evaluated associations of resilience with cardiometabolic health across 20 follow-up y, adjusting for relevant covariates. In this initially healthy sample, nonresilient (adversity-exposed, lower psychological health) versus resilient (adversity-exposed, high psychological health) individuals had 43% higher odds of cardiometabolic conditions (95% CI 1.10 to 1.85). Odds of cardiometabolic conditions were similar among resilient versus unexposed, psychologically healthy individuals. More adversity experiences were associated with increased odds, while better psychological health with decreased odds of cardiometabolic conditions, and effects were largely independent. Patterns were similar for objectively assessed cardiometabolic risk. Psychological resilience in midlife may protect against negative cardiometabolic impacts of early adversity.

[Key words] psychological resilience; cardiometabolic disease; early adversity; biomarkers

论文原文：Nishimi, M. K., Koenen, C. K., Coull, A. B., Chen, R., Kubzansky, D. L..(2021). Psychological resilience predicting cardiometabolic conditions in adulthood in the Midlife in the United States Study. Proceedings of the National Academy of Sciences of the United States of America, 118(32), https://doi.org/10.1073/pnas.2102619118