The Mediating Role of Healthy Lifestyle Behaviours on the Association between Perceived Stress and Self-Rated Health in People with Non-Communicable Disease
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Context
2.2. Sample
2.3. Data Collection
2.3.1. Dependent Variable
2.3.2. Independent Variable
2.3.3. Mediator Variables
2.4. Data Management and Statistical Analyses
- The independent variable must be correlated with the dependent variable.
- The independent variable must be correlated with the mediator.
- The mediator must be correlated with the dependent variable when controlled for the independent variable.
- The effect of the mediator on the dependent variable is controlled. If the independent variable is no longer correlated with the dependent variable, there is a complete mediation. If the correlation between the independent variable and the dependent variable is reduced, there is a partial mediation. If the direct relationship of the independent variable to the dependent variable is less in the fourth regression than in the first, partial mediation is present, which, according to Baron and Kenny [32] is more realistic than perfect mediation.
3. Results
3.1. Model Testing and Mediation Model Analysis
3.1.1. No Diagnosis
3.1.2. One Diagnosis
3.1.3. Two Diagnoses
3.1.4. Three or Four Diagnoses
4. Discussion
Methodological Considerations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Total; n (%) | 2016; n (%) | 2019; n (%) | p. |
---|---|---|---|---|
Sex | 0.162 | |||
-male | 4868 (46.0) | 2695 (46.2) | 2173 (45.8) | |
-female | 5593 (52.8) | 3020 (51.7) | 2573 (54.2) | |
Age | 0.472 | |||
-40 | 2900 (27.4) | 1574 (27.0) | 1326 (27.9) | |
-50 | 3770 (35.6) | 2091 (35.8) | 1679 (35.4) | |
-60 | 3800 (35.9) | 2059 (35.3) | 1741 (36.7) | |
Country of birth | 0.002 | |||
-Sweden | 8184 (77.3) | 4559 (78.1) | 3625 (76.4) | |
-Nordic countries except Sweden | 441 (4.2) | 237 (4.1) | 204 (4.3) | |
-Europe except Nordic countries | 400 (3.8) | 207 (3.5) | 193 (4.1) | |
-outside Europe | 1440 (13.6) | 728 (12.5) | 712 (15.0) | |
Education level | 0.004 | |||
-elementary school | 1665 (15.7) | 946 (16.2) | 719 (15.1) | |
-upper secondary school | 5149 (48.7) | 2859 (49.0) | 2290 (48.3) | |
-higher education | 3579 (33.8) | 1880 (32.2) | 1699 (35.8) | |
Employment status | 0.017 | |||
-employed | 7418 (70.1) | 4023 (68.9) | 3395 (71.5) | |
-self-employed | 946 (8.9) | 545 (9.3) | 401 (8.4) | |
-unemployed | 499 (4.7) | 300 (5.1) | 199 (4.2) | |
-sickness benefit/sickness or activity compensation | 565 (5.3) | 329 (5.6) | 236 (5.0) | |
-other | 1155 (10.9) | 640 (11.0) | 515 (10.9) |
Variables | 2016 | 2019 | Total | ||||||
---|---|---|---|---|---|---|---|---|---|
All | Male | Female | All | Male | Female | All | Male | Female | |
n (%) | |||||||||
Self-rated health | |||||||||
-very good/good | 4252 (73.1) | 2030 (75.4) | 2144 (71.2) | 3431 (72.3) | 1631 (75.1) | 1800 (70.0) | 7683 (72.7) | 3661 (75.2) | 3944 (70.5) |
-fair/poor/very poor | 1566 (26.9) | 662 (24.6) | 867 (28.7) | 1315 (27.7) | 542 (24.9) | 773 (30.0) | 2880 (27.3) | 1204 (24.7) | 1640 (29.3) |
Felt stress | |||||||||
-not at all | 647 (13.5) | 353 (16.0) | 274 (11.0) | 811 (17.2) | 455 (21.0) | 356 (13.9) | 1458 (15.3) | 808 (16.6) | 630 (11.3) |
-yes, some/yes, pretty much/yes, a lot | 4156 (86.5) | 1851 (68.7) | 2228 (73.8) | 3913 (82.8) | 1708 (78.6) | 2205 (85.7) | 8069 (84.7) | 3559 (73.1) | 4433 (79.3) |
Sedentary behaviour | |||||||||
-≤7 h per day | 4096 (70.7) | 1801 (66.8) | 2212 (73.2) | 3590 (75.8) | 1600 (73.6) | 1990 (77.3) | 7686 (73.0) | 3401 (69.9) | 4202 (75.1) |
->7 h per day | 1694 (29.3) | 876 (32.5) | 782 (25.9) | 1149 (24.2) | 570 (26.2) | 579 (22.5) | 2844 (23.0) | 1446 (29.7) | 1361 (24.3) |
Daily physical activity | |||||||||
-<150 min per week | 3615 (62.2) | 1717 (63.7) | 1821 (60.3) | 2897 (61.2) | 1397 (64.3) | 1500 (58.3) | 6512 (61.8) | 3114 (64.0) | 3321 (59.4) |
-≥150 min per week | 2193 (37.8) | 970 (36.0) | 1182 (39.1) | 1838 (38.8) | 771 (35.5) | 1067 (41.5) | 4031 (38.2) | 1741 (35.8) | 2249 (40.2) |
Physical exercise | |||||||||
-<1 h per week | 3636 (62.7) | 1692 (62.8) | 1869 (61.9) | 2822 (59.6) | 1275 (58.7) | 1547 (60.1) | 6458 (61.3) | 2967 (60.9) | 3416 (61.1) |
-≥1 h per week | 2166 (37.3) | 997 (37.0) | 1124 (37.2) | 1911 (40.4) | 895 (41.2) | 1016 (39.5) | 4077 (38.7) | 1892 (38.9) | 2140 (38.3) |
Dietary habits | |||||||||
-very healthy/healthy | 1722 (30.5) | 580 (21.5) | 1103 (36.5) | 1300 (27.7) | 419 (19.3) | 881 (34.2) | 3022 (29.2) | 999 (20.5) | 1984 (35.5) |
-somewhat unhealthy/unhealthy | 3921 (69.5) | 2032 (75.4) | 1816 (60.1) | 3390 (72.3) | 1727 (79.5) | 1663 (64.6) | 7311 (70.8) | 3759 (77.2) | 3479 (62.2) |
Diagnosis | |||||||||
-hypertension | 1703 (29.2) | 822 (30.5) | 844 (27.9) | 1449 (30.5) | 714 (32.9) | 735 (28.6) | 3152 (29.8) | 1536 (31.6) | 1579 (28.2) |
-diabetes | 218 (3.7) | 132 (4.9) | 84 (2.8) | 192 (4.0) | 107 (4.9) | 85 (3.3) | 410 (3.9) | 239 (4.9) | 169 (3.0) |
-myocardial infarction | 142 (2.4) | 90 (3.3) | 45 (1.5) | 76 (1.6) | 54 (2.5) | 22 (0.9) | 218 (2.1) | 144 (3.0) | 67 (1.2) |
-stroke | 98 (1.7) | 52 (1.9) | 44 (1.5) | 91 (1.9) | 50 (2.3) | 41 (1.6) | 189 (1.8) | 102 (2.1) | 85 (1.5) |
Number of diagnoses | |||||||||
-no diagnosis | 3958 (67.8) | 1775 (65.9) | 2101 (69.6) | 3170 (66.8) | 1400 (64.4) | 1770 (68.8) | 7128 (67.4) | 3175 (65.2) | 3871 (69.2) |
-one diagnosis | 1625 (27.8) | 765 (28.4) | 827 (27.4) | 1366 (28.8) | 637 (29.3) | 729 (28.3) | 2991 (28.3) | 1402 (28.8) | 1556 (27.8) |
-two diagnoses | 227 (3.9) | 135 (5.0) | 86 (2.8) | 192 (4.0) | 122 (5.6) | 70 (2.7) | 419 (4.0) | 257 (5.3) | 156 (2.8) |
-three diagnoses | 26 (0.4) | 19 (0.7) | 6 (0.2) | 14 (0.3) | 12 (0.6) | 2 (0.1) | 40 (0.4) | 31 (0.6) | 8 (0.1) |
-four diagnoses | 1 (0.02) | 1 (0.04) | - | 4 (0.1) | 2 (0.1) | 2 (0.1) | 5 (0.05) | 3 (0.1) | 2 (0.04) |
Variables | Adj R2 | F-Value | p-Value | df 1, df 2 | β | p (for β) |
---|---|---|---|---|---|---|
Step 1 | ||||||
Stress—self-rated health | 0.09 | 642.5 | <0.001 | 1, 6394 | 0.30 | <0.001 |
Step 2 | ||||||
Stress—sedentary behaviour | 0.01 | 30.5 | <0.001 | 1, 6379 | 0.07 | <0.001 |
Stress—daily physical activity | 0.01 | 46.2 | <0.001 | 1, 6386 | −0.08 | <0.001 |
Stress—physical exercise | 0.01 | 46.5 | <0.001 | 1, 6379 | −0.08 | <0.001 |
Stress—dietary habits | 0.001 | 6.1 | 0.013 | 1, 6283 | 0.03 | 0.013 |
Effect | No Diagnosis (n = 7128) | One Diagnosis (n = 2991) | Two Diagnoses (n = 419) |
---|---|---|---|
Direct effect (perceived stress) | 0.24 | 0.28 | 0.17 |
Indirect effect | 0.02 * | 0.03 ** | 0.06 *** |
Total effect (direct + indirect) | 0.26 | 0.31 | 0.23 |
Variables | Adj R2 | F-Value | p-Value | df 1, df 2 | β | p (for β) |
---|---|---|---|---|---|---|
Step 1 | ||||||
Stress—self-rated health | 0.10 | 295.5 | <0.001 | 1, 2695 | 0.31 | <0.001 |
Step 2 | ||||||
Stress—sedentary behaviour | 0.01 | 16.4 | <0.001 | 1, 2692 | 0.08 | <0.001 |
Stress—daily physical activity | 0.01 | 22.2 | <0.001 | 1, 2695 | −0.09 | <0.001 |
Stress—physical exercise | 0.01 | 16.1 | <0.001 | 1, 2695 | −0.08 | <0.001 |
Stress—dietary habits | 0.0002 | 0.4 | 0.517 | 1, 2648 | 0.01 | 0.517 |
Variables | Adj R2 | F-Value | p-Value | df 1, df 2 | β | p (for β) |
---|---|---|---|---|---|---|
Step 1 | ||||||
Stress—self-rated health | 0.51 | 21.38 | <0.001 | 1, 375 | 0.23 | <0.001 |
Step 2 | ||||||
Stress—sedentary behaviour | 0.01 | 1.78 | 0.182 | 1, 372 | 0.07 | 0.182 |
Stress—daily physical activity | 0.01 | 0.96 | 0.328 | 1, 375 | −0.05 | 0.328 |
Stress—physical exercise | 0.05 | 19.74 | <0.001 | 1, 375 | −0.22 | <0.001 |
Stress—dietary habits | −0.003 | 0.01 | 0.919 | 1, 363 | −0.005 | 0.919 |
Variables | Adj R2 | F-Value | p Value | df 1, df 2 | β | P (for β) |
---|---|---|---|---|---|---|
Step 1 | ||||||
Stress—self-rated health | 0.13 | 6.72 | 0.013 | 1, 38 | 0.39 | 0.013 |
Step 2 | ||||||
Stress—sedentary behaviour | 0.04 | 2.39 | 0.131 | 1, 37 | −0.25 | 0.131 |
Stress—daily physical activity | −0.03 | 0.0005 | 0.983 | 1, 37 | −0.01 | 0.983 |
Stress—physical exercise | −0.01 | 0.50 | 0.483 | 1, 37 | −0.12 | 0.483 |
Stress—dietary habits | −0.02 | 0.27 | 0.609 | 1, 37 | 0.08 | 0.609 |
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Nordgren, L.; von Heideken Wågert, P.; Söderlund, A.; Elvén, M. The Mediating Role of Healthy Lifestyle Behaviours on the Association between Perceived Stress and Self-Rated Health in People with Non-Communicable Disease. Int. J. Environ. Res. Public Health 2022, 19, 12071. https://doi.org/10.3390/ijerph191912071
Nordgren L, von Heideken Wågert P, Söderlund A, Elvén M. The Mediating Role of Healthy Lifestyle Behaviours on the Association between Perceived Stress and Self-Rated Health in People with Non-Communicable Disease. International Journal of Environmental Research and Public Health. 2022; 19(19):12071. https://doi.org/10.3390/ijerph191912071
Chicago/Turabian StyleNordgren, Lena, Petra von Heideken Wågert, Anne Söderlund, and Maria Elvén. 2022. "The Mediating Role of Healthy Lifestyle Behaviours on the Association between Perceived Stress and Self-Rated Health in People with Non-Communicable Disease" International Journal of Environmental Research and Public Health 19, no. 19: 12071. https://doi.org/10.3390/ijerph191912071