Psychological resilience, cardiovascular disease, and mortality : insights from the German Gutenberg Health Study

Abstract

Objective Psychological distress is associated with a higher risk of cardiovascular disease (CVD) and mortality, whereas psychological resilience may confer a protective effect. However, evidence on these relationships remains limited. This study aimed to examine the associations between psychological resilience, CVD, and all-cause mortality within a large general population cohort. Methods Data from 12,675 participants in the German Gutenberg Health Study were analyzed. Psychological resilience was assessed using the Brief Resilient Coping Scale (BRCS). CVD prevalence and mortality data were obtained from medical records and registry updates. Logistic and Cox regression analyses examined the associations between resilience, CVD, and mortality, with adjustments for socio-demographics, lifestyle, and clinical factors. Results Cross-sectionally, lower resilience was linked to higher odds of any CVD (odds ratio (OR) 1.030, 95 % confidence interval [CI] 1.009–1.051). Participants with low resilience had 38 % higher odds of CVD and 61 % higher odds of peripheral artery disease compared to those with high resilience. Longitudinally, low resilience was associated with the highest all-cause mortality risk (log-rank test, p < 0.0001). This association remained significant in Cox models after adjusting for confounders (hazard ratio (HR) 1.362, 95 % CI 1.002–1.852). Conclusions Lower psychological resilience is associated with increased CVD prevalence and all-cause mortality. These findings highlight resilience as a potential target for cardiovascular risk assessment and intervention. Incorporating resilience measures in clinical practice may help identify vulnerable individuals who could benefit from strategies to enhance adaptive coping, improving cardiovascular and overall health outcomes.