本文摘選自《柳葉刀》(The Lancet)，題目為Does happiness itself directly affect mortality? The prospective UK million women study，發(fā)表于2016年2-3月間。前人的研究認(rèn)為，快樂與健康狀況密切相關(guān)，不快樂可能會影響身體健康，增加死亡率。本文認(rèn)為，前人的研究弄錯了因果關(guān)系，健康狀況不好可能會讓人不快樂，而不快樂又可能導(dǎo)致如抽煙這樣的不良生活方式。反過來，不良生活方式既會導(dǎo)致不快樂，又會導(dǎo)致較差的健康狀況，不快樂和較差的健康狀況是平行的，并非不快樂增加了死亡率，快樂與死亡率沒有直接聯(lián)系。請看文章摘要。

Background背景

Poor health can cause unhappiness and poor health increases mortality. Previous reports of reduced mortality associated with happiness could be due to the increased mortality of people who are unhappy because of their poor health. Also, unhappiness might be associated with lifestyle factors that can affect mortality.

健康狀況不佳會導(dǎo)致不快樂，也會增加死亡率。前人的研究顯示，死亡率降低與快樂相關(guān)，這可能是由于健康狀況不佳既會讓人感到不快樂，也會增加死亡率。而且，不快樂可能與影響死亡率的生活方式有關(guān)。

We aimed to establish whether, after allowing for the poor health and lifestyle of people who are unhappy, any robust evidence remains that happiness or related subjective measures of wellbeing directly reduce mortality.

不快樂的人的身體健康狀況和生活方式可能也較差。在此前提下，本文還要確定是否仍然存在有力的證據(jù)證明快樂或相關(guān)的主觀快樂指標(biāo)直接降低了死亡率。

Method 方法

The Million Women Study is a prospective study of UK women recruited between 1996 and 2001 and followed electronically for cause-specific mortality.

這項(xiàng)“百萬婦女研究”是對1996年至2001年間招募的英國女性進(jìn)行的前瞻性研究，并通過電子方式追蹤特定原因?qū)е碌乃劳雎省?/p>

3 years after recruitment, the baseline questionnaire for the present report asked women to self-rate their health, happiness, stress, feelings of control, and whether they felt relaxed.

招募3年后，本報(bào)告的基線調(diào)查問卷要求女性對自己的健康狀況、快樂、壓力、控制感以及是否感到放松作自我評價。

The main analyses were of mortality before Jan 1, 2012, from all causes, from ischaemic heart disease, and from cancer in women who did not have heart disease, stroke, chronic obstructive lung disease, or cancer at the time they answered this baseline questionnaire.

本文主要分析2012年1月1日之前婦女因各種原因?qū)е碌乃劳雎?、因缺血性心臟病導(dǎo)致的死亡率以及因癌癥導(dǎo)致的死亡率。在回答此基線調(diào)查問卷時，這些婦女沒有心臟病、中風(fēng)、慢性阻塞性肺病或癌癥。

We used Cox regression, adjusted for baseline self-rated health and lifestyle factors, to calculate mortality rate ratios (RRs) comparing mortality in women who reported being unhappy (ie, happy sometimes, rarely, or never) with those who reported being happy most of the time.

我們根據(jù)基線自評健康和生活方式因素調(diào)整Cox回歸分析，以計(jì)算死亡率比率（RR），比較不快樂（有時、很少或從不快樂）女性與大多數(shù)時間都快樂的女性的死亡率。

Findings結(jié)果

Of 719?671 women in the main analyses (median age 59 years [IQR 55–63]), 39% (282?619) reported being happy most of the time, 44% (315?874) usually happy, and 17% (121?178) unhappy.

主要分析中共有719671名女性（中位年齡59歲[IQR 55-63]），其中有39％（282619）大部分時間都很快樂，44％（315874）通常都快樂，17％（121178））不快樂。

During 10 years (SD 2) follow-up, 4% (31?531) of participants died. Self-rated poor health at baseline was strongly associated with unhappiness.

在10年（SD 2）隨訪期間，4％（31531）參與研究的女性死亡。調(diào)查時自評較差的健康狀況與不快樂有很強(qiáng)的相關(guān)性。

But after adjustment for self-rated health, treatment for hypertension, diabetes, asthma, arthritis, depression, or anxiety, and several sociodemographic and lifestyle factors (including smoking, deprivation, and body-mass index), unhappiness was not associated with mortality from all causes (adjusted RR for unhappy vs happy most of the time 0·98, 95% CI 0·94–1·01), from ischaemic heart disease (0·97, 0·87–1·10), or from cancer (0·98, 0·93–1·02). Findings were similarly null for related measures such as stress or lack of control.

但在調(diào)整自評健康，調(diào)整高血壓、糖尿病、哮喘、關(guān)節(jié)炎、抑郁或焦慮治療，以及調(diào)整一些社會人口和生活方式因素（包括吸煙、剝奪和體重指數(shù)）后，不快樂與各種原因（大多數(shù)時候，不快樂對快樂的調(diào)整后RR為0.98, 95％CI 0.94-1.01）導(dǎo)致的死亡率、因缺血性心臟?。?.97, 0.87-1.10）或癌癥（0.98, 0.93-1.02）導(dǎo)致的死亡率都無關(guān)。對于壓力或缺乏控制等相關(guān)指標(biāo)，結(jié)果同樣為零。

Interpretation 討論

In middle-aged women, poor health can cause unhappiness. After allowing for this association and adjusting for potential confounders, happiness and related measures of wellbeing do not appear to have any direct effect on mortality.

在中年婦女中，健康狀況不佳會導(dǎo)致不快樂。在考慮這種關(guān)聯(lián)并調(diào)整潛在的混雜因素后，發(fā)現(xiàn)快樂及相關(guān)的快樂指標(biāo)對死亡率沒有直接影響。