Page 101 - 南京医科大学自然版

第46卷第8期 陈芳怡，王 威，胡馨茹，等. 心理韧性与中国老年人全因死亡率关联强度的异质性：一项前瞻性队列
2026年8月 研究［J］. 南京医科大学学报（自然科学版），2026，46（8）：1197-1210 ·1207 ·

Conversely，once a certain threshold was surpassed， tality among older adults. A dual ⁃ pronged approach，
higher degrees of obesity did not substantially affect aimed at alleviating depression，anxiety，stress，and
the magnitude of the protective benefit. Older adults loneliness while enhancing optimism and self⁃control，
with higher ABSI experienced higher all⁃cause mortali⁃ is proposed as a viable pathway to bolster psychologi⁃
ty than those with lower ABSI，highlighting the impor⁃ cal resilience in this demographic. Concurrently，de⁃
tance of addressing psychological resilience among pression，stress，loneliness，and obesity exhibit bidirec⁃
those with an ABSI over 0.87. For these subpopula⁃ tional associations，wherein obesity may in turn precipi⁃
tions，maintaining greater psychological resilience tate depressive symptoms，anxiety，and psychological
［30-31］
would yield considerable health benefits. BRI and distress . Depression，anxiety，psychological stress，
WHtR exhibited similar HR progression patterns，with and obesity have been demonstrated to exhibit complex
no significant downward trends identified for either in⁃ bidirectional interactions，intertwined through multidi⁃
dex. This phenomenon may relate to the U⁃shaped asso⁃ mensional biological，behavioral，and sociological path⁃
［14］
ciation between BRI and mortality，as well as the J ⁃ ways .
shaped association between WHtR and mortality. For Along with population aging，increasing challeng⁃
BMI，the complexity in HR changes could be attribut⁃ es have arisen for both society and individuals. From
ed to the inverse U ⁃ shaped association between BMI the perspective of public health，our study provides
［22，24］
and all⁃cause mortality and its limitation . Firstly， some support for formulating health intervention poli⁃
BMI cannot distinguish between fat mass and muscle cies aimed at older adults with obesity and overweight.
mass，making it incapable of differentiating obese and For primary prevention，communities are supposed to
muscular individuals of identical weight and height. organize more activities conducive to both physical and
Secondly，BMI shows suboptimal accuracy in discrimi⁃ mental health，such as practicing health Qigong，play⁃
nating between central and peripheral obesity. ing chess，and card games. Ideally，integrating four
High psychological resilience was more strongly obesity indices could help identify which populations
associated with reduced all ⁃ cause mortality among require greater psychological and behavioral interven⁃
overweight older adults. For individuals facing height⁃ tions in the community，aligning with the principles of
ened physiological or social risk，the relative contribu⁃ precision medicine. For secondary prevention，the het⁃
tion of psychological resilience to psychological adapta⁃ erogeneity in the association strength between psycho⁃
tion becomes more readily amplified，even at equiva⁃ logical resilience and all⁃cause mortality across differ⁃
［25-26］
lent levels of intensity . Additionally，social stigma ent obesity statuses among older adults indicates which
and discrimination associated with obesity have been populations warrant prioritized attention in clinical in⁃
shown to heighten external pressures and diminish terventions. Individuals with low psychological resil⁃
available resources. Individuals with greater resilience ience can improve their adaptive capacity through posi⁃
exhibit a more pronounced buffering effect against stig⁃ tive interventions，such as cognitive behavioral therapy
ma⁃induced psychological distress through more effec⁃ （CBT），and increasing engagement in ADL. Older
tive emotional regulation，problem⁃solving，and mobili⁃ adults with severe obesity warrant focused attention re⁃
［27-28］
zation of social support . Consequently，this protec⁃ garding their psychological resilience，necessitating tar⁃
tive effect is more pronounced among individuals with geted positive interventions to enhance resilience
a higher weight. Individuals who exhibit greater resil⁃ alongside effective weight management strategies.
ience are more likely to adopt health⁃promoting behav⁃ Our study has four key strengths. First，the CL⁃
iors，thereby enhancing their quality of life，mitigating HLS cohort is a well⁃representative longitudinal sam⁃
weight ⁃ related complications，and improving mood， ple with a large participant size，capturing a diverse
［29］
which may result in amplified beneficial outcomes . range of older adults from all provinces and regions of
Interventions targeting psychological resilience have China. Second，multiple Cox regression analysis based
been demonstrated to reduce the risk of all⁃cause mor⁃ on PSM and IPW was employed. By adjusting for vari⁃