Association of Psychological Resilience with All-Cause and Cardiovascular Mortality in a General Population in Italy: Prospective Findings from the Moli-Sani Study.

Anwal Ghulam,Francesco Gianfagna,Marialaura Bonaccio,Alessandro Gialluisi,Licia Iacoviello,Simona Costanzo,Chiara Cerletti,Augusto Di Castelnuovo,Maria Benedetta Donati,Federica Santonastaso,Giovanni De Gaetano

doi:10.3390/ijerph19010222

Abstract

Psychological resilience (PR) is the capacity to adapt positively in face of adversity. Its role as an independent protective factor has been acknowledged in recent years. We aimed to test the association of PR with all-cause and cardiovascular disease (CVD) mortality in a general adult population. We performed longitudinal analyses on 10,406 CVD-free individuals from the Moli-Sani cohort (follow up = 11.2 year). PR was assessed by the 25-item Connor and Davidson resilience scale. PR factors were identified through polychoric factor analysis. Associations with mortality were tested using multivariable Cox regressions. Higher levels of PR were associated with reduced all-cause mortality in a model including sex and age (HR = 0.78; 95%CI 0.62–1.00). The association decreased after inclusion of socioeconomic, clinical, and behavioral factors into the model (HR = 0.80; 95%CI 0.62–1.03). No relation was observed with cardiovascular mortality in the fully adjusted model (HR = 0.89; 95%CI 0.56–1.39). An inverse association of Factor 1 (reflecting positive acceptance of change) with all-cause mortality (HR = 0.89; 95%CI 0.82–0.98; p value = 0.01) was found. However, at a borderline non-significant way, PR predicts all-cause mortality in a general population of Italian adults. This is supported by the findings demonstrating a significant association between the PR’s domain reflecting a positive acceptance of change and all-cause mortality.

Highlights

Cardiovascular disease (CVD) remains the leading cause of death and disease burden globally [1]; in Europe alone 45% of deaths are attributable to cardiovascular disease (CVD) [2]
We identified five factors that we defined in the following way: Factor 1 was related to positive acceptance of change; Factor 2 was related to faith and hope
Our study in a large sample of Italian adults shows that, even though in a marginally non-significant way, Psychological resilience (PR) score is associated with all-cause mortality

Summary

Introduction

Cardiovascular disease (CVD) remains the leading cause of death and disease burden globally [1]; in Europe alone 45% of deaths are attributable to CVD [2]. Despite the remarkable advancements made in the last century, classical risk factors explain only part of CVD incidence. Much of this research has been conducted from a pathogenesis perspective, which has been the centre of medical research for centuries. In the epidemiological field this research has been translated in the enquiry of risk factors that promote illnesses and mortality. There have been important ramifications in the field, including health promotion [3]. A compelling theory of health promotion is the Salutogenic orientation, which focuses its attention on salutary factors, i.e., potential factors that can promote health instead of

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