| The Outline of Healthy China 2030 highlights the importance of people’s whole life cycle in the development of health protection.Happiness is the original intention of government in formulating public policy,as well as the ultimate goal of humanity.Women’s health and well-being make a significant contribution to the health of the population and is an important cornerstone for the healthy development of society.Individuals in different life cycles have significant differences in their physical and psychological states,their perceptions and understandings of happiness are also different,and the factors that affect their subjective well-being also have their own characteristics.In middle age,women carry heavy multiple roles,not only have to keep their own jobs,but also have to take care of their families and children,and find themselves in a social situation of “being old in the upper class and young in the lower class”.Physiologically,most women go through perimenopause in middle age,and the syndrome of autonomic nervous system dysfunction with neuropsychological symptoms is likely to occur due to the decline in oestrogen levels.Therefore,studying subjective well-being from the perspective of health,understanding the physical and mental health status of middle-aged women,analysing the influencing factors of subjective well-being from different angles,and exploring the path relationship between the influencing factors and subjective well-being will not only help to improve the health and well-being of middle-aged women and improve the quality of life,but also be of great significance to promoting the development of women’s health in China and helping to build a healthy China and a happy society.ObjectivesThe aim of this study was to analyse the factors influencing the subjective well-being of middle-aged women from a social demographic characteristics,behavioural lifestyle,physiological factors,psychological factors and social factors.Based on stress process theory,this study analysed the path relationship between life stress and subjective well-being,and further discussed the moderating role of social support and physical activity in the overall path model of life stress and subjective well-being based on stress buffer theory.Based on the emotional theory,this study analysed the pathway relationship between autonomic nerve function and subjective well-being,and clarified the pathway of autonomic nerve function on subjective well-being physiologically.Based on the results of empirical research and the theory of health promotion,this paper proposed strategies to improve subjective well-being,so as to provide health policy makers with a reference for improving the quality of life of middle-aged women,promoting the development of women’s health in China,building a happy society,and optimising the women’s health care system.MethodsThis study was conducted on 1133 middle-aged women who had participated in routine physical examination in the physical examination center of a top-level hospital from July to September in 2019 were selected as the research objects.Through questionnaire survey,routine physical examination and autonomic nerve function test,relevant data of the subjects were collected and analyzed.Heart rate variability was used as an index to assess the function of the autonomic nervous system,in which total frequency power(TP)was used to reflect the overall activity and regulatory capacity of the autonomic nervous system.Low frequency/high frequency(LF/HF)was used to reflect the balance between sympathetic and parasympathetic nerve activity,and a normal LF/HF indicated that the autonomic nervous system was in a balanced state.A high LF/HF indicated that the autonomic nervous system was unbalanced and biased towards the sympathetic nervous system.A low LF/HF indicated that the autonomic nervous system was unbalanced and biased towards the parasympathetic nervous system.The chi-square test was used for the comparison of classified variables,and the t-test or one-way analysis of variance was used for continuity variables.The multiple linear regression model was used to analyse the independent factors influencing subjective well-being,and the random forest model was used to further analyse the order of importance of the influence of the independent factors on subjective well-being.The pathway relationship between life stress and subjective well-being was explored using a chain mediation effect model and path analysis.The chain mediation effect model was used to explore the pathway relationship between autonomic nervous function and subjective well-being.Epidata3.1 software was used for data entry and IBM SPSS 24.0 software,SPSS-PROCESS 3.4 plug-in,AMOS 23.0 software and R software version 4.1.0 were used for data analysis.Bilateral P<0.05 indicated that the difference was statistically significant.ResultsResearch 1: Analysis of subjective well-being and its influencing factorsBased on the understanding of the physical and mental health of middle-aged women,this study thoroughly analysed the overall situation of subjective well-being and analysed the independent influencing factors of subjective well-being from social demographic characteristics,behavioural lifestyle,physiological factors,psychological factors and social factors.The main results were as follows:(1)In terms of physical health,the proportion of middle-aged women with low autonomic nervous system function was 80.6%,the proportion with autonomic nervous system dysfunction was 67.2%,the detection rate of perimenopausal somatic symptoms was 90.0%,the detection rate of perimenopausal urogenital symptoms was61.6%,and the detection rate of metabolic syndrome was 11.0%.In terms of mental health,the detection rate of depressive symptoms was 23.7% and the detection rate of anxiety symptoms was 16.7%.(2)The subjective well-being score for middle-aged women was 89.96±12.81,with 51.1% at a high level and 48.9% at a low level.(3)The analysis results of the multiple linear regression model showed that among the socio-demographic characteristics,the higher the average monthly income of individuals,the higher the level of subjective well-being(β=0.057,P=0.012).In terms of lifestyle,the subjective well-being of people with extensive interests/hobbies was higher than that of people with non-extensive interests/hobbies(β=0.080,P=0.001).Among the physiological factors,the subjective well-being of subjects with somatic symptoms was lower than that of subjects without somatic symptoms(β=-0.046,P=0.042).The subjective well-being level of subjects with urogenital symptoms was lower than that of subjects without urogenital symptoms(β=-0.129,P<0.001).Compared with those with normal LF/HF,those with low LF/HF had lower subjective well-being(β=-0.054,P=0.035).The better the self-rated health,the higher the level of subjective well-being(β=0.117,P<0.001).Among the psychological factors,positive coping style positively predicted subjective well-being(β=0.300,P<0.001),whereas negative coping style negatively predicted subjective well-being(β=-0.147,P<0.001).The higher the level of life stress,the lower the level of subjective well-being(β=-0.132,P<0.001).The subjective well-being level of subjects with depressive symptoms was lower than that of subjects without depressive symptoms(β=-0.145,P<0.001).The subjective well-being level of subjects with anxiety symptoms was lower than that of subjects without anxiety symptoms(β=-0.095,P<0.001).Among the social factors,the subjective well-being of people with good relationships with other people was higher than that of people with poor relationships with other people(β=0.097,P<0.001).Compared with non-high social supporters,high social supporters had a higher level of subjective well-being(β=0.145,P<0.001).(4)The results of the random forest model showed that the independent factors were ranked in descending order of importance for subjective well-being as follows:positive coping style,depressive symptoms,negative coping style,self-rated health,life stress,anxiety symptoms,social support,personal monthly income,LF/HF,relationship with people,urogenital symptoms,interests/hobbies and somatic symptoms.Research 2: The path relationship between life stress and subjective well-beingBased on the stress process theory,this study discussed the path relationship between life stress and subjective well-being,with life stress as the stressor,coping style as an intermediate variable,somatic symptoms and urogenital symptoms as the physiological stress response,and anxiety symptoms and depressive symptoms as the psychological stress response.Based on the stress buffer theory,this study further analysed the moderating role of social support and physical activity in the overall path model of life stress and subjective well-being.The main results were as follows:(1)In the overall path model of life stress and subjective well-being,the total effect value of life stress on subjective well-being was-0.293,the direct effect value was-0.145 and the indirect effect value was-0.148.The total effect value of positive coping style on subjective well-being was 0.494,the direct effect value was 0.292,and the indirect effect value was 0.202.The total effect value of negative coping style on subjective well-being was-0.234,the direct effect value was-0.136,and the indirect effect value was-0.098.The direct effect value of somatic symptoms on subjective well-being was-0.069.The direct effect value of urogenital symptoms on subjective well-being was-0.114.The direct effect value of depressive symptoms on subjective well-being was-0.374.The influence pathways of life stress on subjective well-being include: life stress→subjective well-being;life stress→positive coping style→subjective well-being;life stress→somatic symptoms→subjective well-being;life stress→urogenital symptoms→subjective well-being;life stress→depressive symptoms→subjective well-being;life stress→positive coping style→somatic symptoms→subjective well-being;life stress→positive coping style→depressive symptoms→subjective well-being.(2)The analysis of the moderating effect of social support in the overall path model of life stress and subjective well-being showed that social support can moderate the path “life stress → physical symptoms”(The value of the parameter difference was-2.234).(3)The analysis of the moderating effect of physical activity in the overall path model of life stress and subjective well-being showed that physical activity can moderate the paths “negative coping style → somatic symptoms”,“negative coping style→depressive symptoms”,and “negative coping style→anxiety symptoms”(The values of the parameter difference were-2.152,-2.029 and-2.356 respectively).Research 3: The path relationship between autonomic nervous function and subjective well-beingBased on the emotional theory,this study analysed the path relationship between autonomic nervous function and subjective well-being by using the chain mediation effect model,and examined the role of somatic symptoms/urogenital symptoms,anxiety symptoms,and depressive symptoms in the path relationship between autonomic nervous function and subjective well-being.The main results were as follows:(1)In the path model of TP,somatic symptoms,anxiety symptoms,depressive symptoms and subjective well-being,the direct effect of TP on subjective well-being was not significant(Effect=-1.1558,95%CI=[-2.6465,0.3349]).And there were three indirect paths for the influence of TP on subjective well-being: TP → somatic symptoms→subjective well-being(Effect=-0.1687,95%CI=[-0.3832,-0.0077]);TP→anxiety symptoms → depressive symptoms → subjective well-being(Effect=-0.7365,95%CI=[-1.3448,-0.1539]);TP → somatic symptoms → anxiety symptoms →depressive symptoms → subjective well-being(Effect=-0.4307,95%CI=[-0.8474,-0.0278]).In the path model of TP,urogenital symptoms,anxiety symptoms,depressive symptoms and subjective well-being,the direct effect of TP on subjective well-being was not significant(Effect=-1.3310,95%CI=[-2.8178,0.1558]).And there were two indirect paths for the influence of TP on subjective well-being: TP → somatic symptoms→subjective well-being(Effect=-0.2744,95% CI=[-0.5979,-0.0365]);TP→anxiety symptoms→depressive symptoms→subjective well-being(Effect=-1.1563,95%CI=[-1.8359,-0.5110]).(2)In the path model of LF/HF influencing subjective well-being through somatic symptoms,anxiety symptoms and depressive symptoms,the results of the relative intermediate analysis based on normal LF/HF showed that the direct influence of LF/HF on subjective well-being was not significant(low LF/HF: Effect=-0.8925,95%CI=[-2.2682,0.4833];high LF/HF: Effect=1.4796,95%CI=[-0.0629,3.0222]).There were four indirect pathways for the influence of LF/HF on subjective well-being: with normal LF/HF as reference,high LF/HF → somatic symptoms →subjective well-being(Effect=-0.2893,95%CI=[-0.5810,-0.0745]);high LF/HF →somatic symptoms → anxiety symptoms → subjective well-being(Effect=-0.1399,95%CI=[-0.3341,-0.0006]);high LF/HF→somatic symptoms→anxiety symptoms→depressive symptoms → subjective well-being(Effect=-0.7157,95%CI=[-1.1847,-0.2700]);low LF/HF→depressive symptoms→subjective well-being(Effect=-0.6958,95%CI=[-1.3328,-0.0674]).In the path model of LF/HF influencing subjective well-being through urogenital symptoms,anxiety symptoms and depressive symptoms,the results of the relative intermediate analysis based on normal LF/HF showed that the direct influence of LF/HF on subjective well-being was not significant(low LF/HF: Effect=-0.7392,95%CI=[-2.1147,0.6363];high LF/HF: Effect=1.4229,95%CI=[-0.1137,2.9596]).There were six indirect pathways for the influence of LF/HF on subjective well-being:with normal LF/HF as reference,low LF/HF → urogenital symptoms → subjective well-being(Effect=-0.2779,95%CI=[-0.5152,-0.0904]);high LF/HF → anxiety symptoms→subjective well-being(Effect=-0.2373,95%CI=[-0.5417,-0.0337]);low LF/HF → depressive symptoms → subjective well-being(Effect=-0.6637,95%CI=[-1.3142,-0.0372]);low LF/HF→urogenital symptoms→anxiety symptoms→subjective well-being(Effect=-0.0970,95%CI=[-0.2027,-0.0185]);high LF/HF→anxiety symptoms → depressive symptoms → subjective well-being(Effect=-0.9096,95%CI=[-1.5996,-0.2356]);low LF/HF→urogenital symptoms→anxiety symptoms→ depressive symptoms → subjective well-being(Effect=-0.3718,95%CI=[-0.6243,-0.1397]).Conclusions(1)The physical and mental health status of middle-aged women was not optimistic.The regulatory function of the autonomic nervous system was low and unbalanced,and the physiological and psychological symptoms of perimenopause were relatively severe,suggesting that appropriate measures should be actively taken to improve the physical and mental health of middle-aged women.(2)The subjective well-being of middle-aged women needed to be improved.Socio-demographic characteristics(personal average monthly income),behavioural lifestyle(interests/hobbies),physiological factors(somatic symptoms,urogenital symptoms,LF/HF,self-rated health),psychological factors(life stress,positive coping style,negative coping style,anxiety symptoms,depression symptoms)and social factors(social support,relationship with people around)were independent the associated factors of subjective well-being.Individuals with a higher average monthly income,a wider range of interests/hobbies,better self-rated health,better relationships with people around them and high social support had higher levels of subjective well-being.Positive coping style positively predicted subjective well-being,while negative coping style negatively predicted subjective well-being.Individuals with somatic symptoms,urogenital symptoms,low LF/HF,higher life pressure,depressive symptoms and anxiety symptoms had lower subjective well-being.(3)Based on stress process theory and physical and mental health characteristics of middle-aged women,this study revealed the pathway process of life stress on subjective well-being through intermediate variables(coping style)and stress response(somatic symptoms/urogenital symptoms/anxiety symptoms/depressive symptoms).In the overall path model of life stress and subjective well-being,life stress has a direct negative predictive effect on subjective well-being,and life stress may indirectly affect subjective well-being through the independent mediation or chain mediation of positive coping style,somatic symptoms/urogenital symptoms/depressive symptoms.Furthermore,based on the theoretical model of the stress process,the test of the moderating mechanism was extended,suggesting that social support can moderate the negative effects of life stress on somatic symptoms and that physical activity can moderate the negative effects of negative coping styles on somatic symptoms,anxiety symptoms and depressive symptoms.(4)There was an important path relationship between autonomic nervous function and subjective well-being.Based on the emotional theory,this study revealed the pathway of autonomic nervous function affecting subjective well-being through somatic/urogenital symptoms,anxiety symptoms and depressive symptoms,and clarified the pathway relationship between autonomic nervous function and subjective well-being from the physiological level.It was suggested that improving the regulatory capacity of the autonomic nervous system and promoting balance in the autonomic nervous system were helpful in alleviating the physiological symptoms of perimenopause,alleviating the bad emotional experience and increasing the level of subjective well-being.(5)Promoting the subjective well-being of middle-aged women required the combined efforts of society,organisations and individuals.At the social and organisational level,we should lay the foundation for ensuring the health and well-being of middle-aged women by improving the women’s health policy system and strengthening the construction of the perimenopausal medical service system.At the individual level,we should focus on strengthening the social support system,implementing mental health management and improving autonomic nervous function to form a collective force to promote health and well-being,thus promoting subjective well-being. |
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