Relationship between common non-communicable diseases (NCDs), risk factors and happiness in Shahrekord PERSIAN Cohort Study: a path analysis model in Iran

Happiness is an important component of subjective well-being and has been increasingly recognized as a determinant of health. Although growing evidence suggests associations between happiness, health status, and chronic diseases, the complex pathways linking happiness with non-communicable diseases (NCDs) and their risk factors remain insufficiently understood. This study aimed to investigate the epidemiology of happiness and model its relationships with common NCDs and related risk factors among adults participating in the Shahrekord Cohort Study. This population-based cross-sectional study was conducted among 707 adults aged 35–70 years participating in the Shahrekord component of the PERSIAN Cohort Study in southwestern Iran. Data on NCDs, behavioral risk factors, happiness, general health status, and quality of life (QoL) were obtained from the cohort database using standardized validated assessment tools. Path analysis was performed using Stata to examine direct and indirect pathways. Demographic, socioeconomic, clinical, and behavioral factors were specified as exogenous predictors of general health status and QoL, which were modeled as mediators and subsequently predicted happiness. The mean age was 53.25 ± 9.03 years, and 52.8% were women. The mean happiness score was 43.92 ± 12.50. In the path analysis model higher socioeconomic status, employment, and being married were positively associated with happiness, whereas female gender and poorer general health status had negative effects on happiness. Indirect effects were examined through mediating pathways, and total effects were calculated as the sum of direct and indirect effects. Overall, QoL, general health status, higher socioeconomic status, male gender, and total HDL cholesterol were the most important significant determinants of happiness. The final path model showed excellent fit (CFI = 0.98, SRMR = 0.017, RMSEA = 0.031). Happiness was strongly associated with QoL, general health, chronic diseases, and socioeconomic and behavioral factors. The findings suggest that interventions targeting stress reduction, physical activity promotion, chronic disease management, and QoL improvement may enhance happiness and health outcomes. Integrating happiness into health promotion and NCD prevention programs may provide an additional strategy for improving population well-being. These findings highlight the importance of integrated biopsychosocial approaches in promoting population-level happiness.