摘要
目的:抑郁障碍和焦虑障碍是全球最常见的2种精神障碍,且与不良生活方式相关。美国心脏协会提出的Life’s Simple 7(LS7)中指出,可通过改善饮食、运动等行为降低心血管风险,但其对精神健康的作用尚不明确。本研究旨在探究成年体检人群LS7评分与焦虑抑郁症状的相关性。方法:选取2015年5月至2024年12月于中南大学湘雅三医院健康管理中心(以下简称“本中心”)体检的体检者数据(涵盖健康体检者基线数据、基本健康状况、检查结果及LS7、精神健康评分)。所有的参与者均完成了LS7评分、抑郁自评量表(Self-Rating Depression Scale,SDS)和焦虑自评量表(Self-Rating Anxiety Scale,SAS)评估。根据LS7总评分分为低分(≤7)、平均(8~9)、良好(10)、优秀(11~14)组。将SAS或SDS评分≥50的人群划分为精神障碍组,反之为非精神障碍组;将精神障碍组中SAS评分≥50的人群划分为焦虑组,SDS评分≥50的人群划分为抑郁组,SAS和SDS评分均≥50的人群则划分为焦虑抑郁共患组。进行二元Logistic回归分析LS7总分及各组分类与精神症状(包括焦虑、抑郁及焦虑抑郁共患)风险的相关性,并计算优势比(odds ratio,OR)和95%置信区间(confidence interval,CI)。此外,采用限制性立方样条(restricted cubic spline,RCS)回归模型分析LS7评分(连续变量)与精神症状风险之间的剂量反应关系,模型在LS7评分的第5、35、65和95百分位数处设置节点,以第5百分位数为参考点,所有模型均根据性别、年龄、是否独居、饮酒情况、教育水平和睡眠质量等协变量进行调整,使用Logistic回归框架进行拟合计算调整的OR(adjusted OR,aOR)和95%CI;并进行非线性关系检验。通过亚组分析探讨性别、年龄、饮酒习惯、教育水平等因素与LS7评分在影响精神症状风险方面的交互作用。结果:共纳入5449名研究参与者,其中1363名(25.01%)具有抑郁症状,398例(7.30%)患者具有焦虑症状,259例(4.75%)患者焦虑抑郁共患。精神症状(焦虑、抑郁或焦虑抑郁共患)总体患病率随LS7评分的提高呈显著递减趋势。单因素和多因素Logistic回归分析均显示LS7评分≥8时是精神症状的保护因素;多因素Logistic回归分析显示模型对出现精神症状的判别能力尚可(AUC=0.672),提示模型具有统计学意义,但其区分病例与非病例的能力有限。在焦虑、抑郁和焦虑抑郁共患的患者中,低分、平均、良好和优秀的LS7评分均呈递减趋势。多因素Logistic回归分析显示优秀的LS7评分抑郁症状风险可降低39%(aOR=0.61,95%CI 0.47~0.78,P<0.001);焦虑症状风险降低63%(aOR=0.37,95%CI 0.22~0.59,P<0.001);焦虑抑郁共患风险显著降低66%(aOR=0.34,95%CI 0.17~0.62,P=0.001);焦虑模型、抑郁模型和焦虑抑郁共患模型的AUC值分别为0.632、0.672和0.619,所有模型均显示中等判别能力,具有统计学意义,但其区分病例与非病例的能力有限。剂量反应关系结果进一步证实LS7评分与精神症状风险呈线性负相关,不吸烟和规律运动是关键保护性行为因素,敏感性分析表明结果稳健。亚组分析提示该保护效应在男性、较年轻人群(≤60岁)、不饮酒者及大学及以上教育程度者中更为显著,且饮酒习惯与LS7评分在影响精神症状风险方面存在显著交互作用(P_(交互)=0.021),提示饮酒可能削弱LS7的保护效应。结论:拥有理想的生活方式与较低的成年人焦虑抑郁障碍患病风险相关。在临床实践和日常生活中,推荐以理想的LS7健康生活指标作为标准可能是一种简便有效的抑郁焦虑预防和管理策略。
Objective:Depressive and anxiety disorders are among the most common mental disorders worldwide and are associated with unhealthy lifestyle behaviors.The Life’s Simple 7(LS7)guideline proposed by the American Heart Association aims to reduce cardiovascular risk by improving behaviors such as diet and physical activity,but its impact on mental health is not yet fully clear.This study examined the association between LS7 scores and symptoms of anxiety and depression in adults undergoing routine health examinations.Methods:Data were collected from individuals who underwent health examinations from May 2015 to December 2024 at the Health Management Center of the Third Xiangya Hospital.All participants completed the LS7 assessments,the Self-Rating Depression Scale(SDS),and the Self-Rating Anxiety Scale(SAS).Participants were categorized into 4 LS7 score groups:Low(≤7),average(8−9),good(10),and excellent(11−14).Those with SDS or SAS≥50 were classified as having mental disorder symptoms;with this group,SAS≥50 indicated anxiety,SDS≥50 indicated depression,and SDS and SAS≥50 indicated comorbid anxiety-depression.Binary logistic regression was used to assess associations between LS7 score and mental symptoms,calculating odds ratio(OR)and 95%confidence interval(CI).A restricted cubic spline(RCS)regression model was used to analyze the dose-response relationship between LS7 score(continuous variable)and the risk of mental symptoms.Nodes were set at the 5th,35th,65th,and 95th percentiles of the LS7 score,with the 5th percentile as the reference point.All models were adjusted for covariates such as gender,age,living alone,drinking status,education level,and sleep quality.Logistic regression framework was used to fit and calculate the adjusted OR(aOR)and 95%CI.Nonlinear relationship tests were also conducted.Subgroup analysis was performed to explore the interaction between gender,age,drinking habits,education level,and other factors and the LS7 score in influencing the risk of mental symptoms.Results:A total of 5449 participants were included;1363(25.01%)had depressive symptoms,398(7.30%)had anxiety symptoms,and 259(4.75%)had comorbid anxietydepression.The prevalence of mental symptoms decreased significantly as LS7 scores increased.Univariate and multivariate Logistic regression indicated that LS7 score≥8 was protective against mental symptoms.Multivariate Logistic regression demonstrated moderate discriminative ability(AUC=0.672).Among individuals with anxiety,depression,or comorbid symptoms,LS7 score distributions showed a graded decrease from poor to excellent groups.After adjustment,an excellent LS7 score was associated with a 39%lower risk of depression(aOR=0.61,95%CI 0.47 to 0.78,P<0.001),a 63%lower risk of anxiety(aOR=0.37,95%CI 0.22 to 0.59,P<0.001),and a 66%lower risk of comorbid anxiety-depression(aOR=0.34,95%CI 0.17 to 0.62,P=0.001).The AUC values of the anxiety model,depression model,and comorbid anxiety and depression model were 0.632,0.672,and 0.619,respectively.All models demonstrated moderate discriminatory ability,which was statistically significant,but their capacity to distinguish cases from non-cases was limited.RCS analysis confirmed a linear inverse relationship between LS7 score and mental symptom risk.Not smoking and regular physical activity were the strongest protective behaviors.Subgroup analysis suggested stronger protective effects in men,younger adults(≤60),non-drinkers,and those with higher education levels,and revealed a significant interaction between alcohol use and LS7 score(P for interaction=0.021),indicating that alcohol consumption may weaken the protective effect of LS7.Conclusion:Ideal healthy lifestyle behaviors,as reflected by higher LS7 scores,are associated with lower risks of anxiety and depression in adults.Promoting LS7-based lifestyle practices may serve as a practical and effective strategy for the prevention and management of anxiety and depression in both clinical and daily life settings.
作者
于杨依依
柳佳乐
彭仆
袁挺
曾金容
鲁建云
YU Yangyiyi;LIU Jiale;PENG Pu;YUAN Ting;ZENG Jinrong;LU Jianyun(Department of Dermatology,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Mental Health,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310000;Health Management Medical Center,Third Xiangya Hospital,Central South University,Changsha 410013,China)
出处
《中南大学学报(医学版)》
北大核心
2025年第8期1428-1442,共15页
Journal of Central South University (Medical Science)
基金
湖南省科技创新计划(2024RC3064)。
