老年人对终生创伤的心理复原力与心血管代谢疾病风险及死亡率：一项纵向队列研究。
Psychological resilience to lifetime trauma and risk for cardiometabolic disease and mortality in older adults: A longitudinal cohort study.
作者信息
Nishimi Kristen, Bürgin David, O'Donovan Aoife
机构信息
Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA.
Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland; Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland.
出版信息
J Psychosom Res. 2023 Oct 27;175:111539. doi: 10.1016/j.jpsychores.2023.111539.
OBJECTIVE
Trauma exposure is associated with risk for cardiometabolic disease and mortality, in part through negative psychological sequelae. In contrast, psychological resilience, showing positive psychological health despite experiencing trauma, may offset some of this risk. We examined longitudinal associations of psychological resilience to lifetime trauma and cardiometabolic outcomes and mortality in a large sample of older adults.
METHODS
Using data from 6596 US Health and Retirement Study participants who had experienced lifetime trauma (mean age 64), we defined manifested psychological resilience based on trauma burden and psychological health (composite of low distress and high psychological well-being) through 2012. New onset cardiometabolic disease (heart problems, stroke, diabetes) and mortality were assessed across eight years of follow-up (through 2020). Repeated measures regressions determined associations between psychological resilience and outcomes over follow-up, adjusting for sociodemographic factors and prior disease.
RESULTS
Higher levels of manifested psychological resilience were associated with lower risk for developing any cardiometabolic outcomes (relative risk for one SD higher resilience score, RR = 0.91, 95%CI 0.88-0.94) and for all-cause mortality (RR = 0.73, 95%CI 0.63, 0.86), adjusting for sociodemographic confounders. When examining individual diseases, resilience was significantly associated with lower risk for certain heart problems (i.e., congestive heart failure) and diabetes. Associations generally held when additionally adjusting for adult psychosocial and biobehavioral factors that could be potential pathway variables.
CONCLUSION
Psychological resilience to lifetime trauma may be linked to better cardiometabolic health even later in life. Promoting recovery and psychological resilience to trauma may be a target for more favorable health and longevity.
目的
创伤暴露与心血管代谢疾病风险及死亡率相关，部分原因是负面心理后遗症。相比之下，心理韧性（即尽管经历创伤仍表现出积极的心理健康）可能会抵消部分此类风险。我们在一大群老年人中研究了心理韧性与终生创伤、心血管代谢结局及死亡率之间的纵向关联。
方法
利用来自6596名经历过终生创伤的美国健康与退休研究参与者（平均年龄64岁）的数据，我们根据创伤负担和心理健康（低痛苦与高心理健康的综合指标）定义了截至2012年表现出的心理韧性。在八年随访期（至2020年）内评估新发心血管代谢疾病（心脏问题、中风、糖尿病）和死亡率。重复测量回归确定随访期间心理韧性与结局之间的关联，并对社会人口学因素和既往疾病进行了调整。
结果
在调整社会人口学混杂因素后，较高水平的表现出的心理韧性与发生任何心血管代谢结局的较低风险（韧性得分每增加一个标准差的相对风险，RR = 0.91，95%CI 0.88 - 0.94）以及全因死亡率（RR = 0.73，95%CI 0.63，0.86）相关。在检查个别疾病时，韧性与某些心脏问题（即充血性心力衰竭）和糖尿病的较低风险显著相关。在进一步调整可能是潜在途径变量的成人心理社会和生物行为因素后，这些关联通常仍然成立。
结论
对终生创伤的心理韧性可能与晚年更好的心血管代谢健康相关。促进创伤后的恢复和心理韧性可能是实现更良好健康和长寿的一个目标。
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