CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands.
J Clin Psychiatry. 2013 Jul;74(7):716-22. doi: 10.4088/JCP.12m08022.
Positive affect can improve survival, but the mechanisms responsible for this association are unknown. We sought to evaluate the association between positive affect and mortality in patients with stable coronary heart disease and to determine biological and behavioral factors that might explain this association.
The Heart and Soul Study is a prospective cohort study of 1,018 outpatients with stable coronary heart disease. Participants were recruited between September 11, 2000, and December 20, 2002, and were followed up to June 2011. Baseline positive affect was assessed by using the 10-item positive affect subscale of the Positive and Negative Affect Schedule. Cox proportional hazards regression was used to estimate the risk of mortality (primary outcome measure) and cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack) associated with positive affect, adjusting for baseline cardiac disease severity and depression. We also evaluated the extent to which these associations were explained by potential biological and behavioral mediators.
A total of 369 patients (36%) died during a mean ± SD follow-up period of 7.1 ± 2.5 years. Positive affect was not significantly associated with cardiovascular events (hazard ratio [HR]: 0.89; 95% CI, 0.79-1.00; P = .06). However, each standard deviation (8.8-point) increase in positive affect score was associated with a 16% decreased risk of all-cause mortality (HR: 0.84; 95% CI, 0.76-0.92; P = .001). After adjustment for cardiac disease severity and depressive symptoms, positive affect remained significantly associated with improved survival (HR: 0.87; 95% CI, 0.78-0.97; P = .01). The association was no longer significant after adjustment for behavioral factors, and particularly physical activity (HR: 0.92; 95% CI, 0.82-1.03; P = .16). Further adjustment for C-reactive protein and omega-3 fatty acids did not result in any meaningful changes (HR: 0.94; 95% CI, 0.84-1.06; P = .31).
In this sample of outpatients with coronary heart disease, positive affect was associated with improved survival. This association was largely explained by physical activity.
积极情绪可以改善生存，但导致这种关联的机制尚不清楚。我们试图评估稳定型冠心病患者积极情绪与死亡率之间的关系，并确定可能解释这种关联的生物学和行为因素。
“心脏与灵魂研究”是一项针对 1018 名稳定型冠心病门诊患者的前瞻性队列研究。参与者于 2000 年 9 月 11 日至 2002 年 12 月 20 日招募，并随访至 2011 年 6 月。使用积极与消极情绪量表的 10 项积极情绪子量表评估基线积极情绪。使用 Cox 比例风险回归估计积极情绪与死亡率（主要结局指标）和心血管事件（心力衰竭、心肌梗死、中风、短暂性脑缺血发作）相关的风险，调整基线心脏疾病严重程度和抑郁。我们还评估了这些关联在多大程度上可以通过潜在的生物学和行为中介来解释。
在平均随访 7.1±2.5 年期间，共有 369 名患者（36%）死亡。积极情绪与心血管事件无显著相关性（风险比[HR]：0.89；95%置信区间，0.79-1.00；P=0.06）。然而，积极情绪评分每增加一个标准差（8.8 分），全因死亡率的风险降低 16%（HR：0.84；95%置信区间，0.76-0.92；P=0.001）。调整心脏疾病严重程度和抑郁症状后，积极情绪与生存改善仍显著相关（HR：0.87；95%置信区间，0.78-0.97；P=0.01）。调整行为因素，特别是体力活动后，相关性不再显著（HR：0.92；95%置信区间，0.82-1.03；P=0.16）。进一步调整 C 反应蛋白和ω-3 脂肪酸并没有导致任何有意义的变化（HR：0.94；95%置信区间，0.84-1.06；P=0.31）。
在这项冠心病门诊患者样本中，积极情绪与生存改善相关。这种关联主要是通过体力活动来解释的。
