Table 4.
E values for effect measures and for CI limits for associations between strengths of moral character and subsequent health (survey data 2018–2019 merged with health insurance data 2017–2019, United States, N = 1209)
| Strengths of moral character (0–10) | Mental health outcomes | Physical health outcomes | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Self-reported mental health | Anxiety | Depression | Self-reported physical health | Cardiovascular disease | ||||||
| Effect estimate† | CI limit‡ | Effect estimate† | CI limit‡ | Effect estimate† | CI limit‡ | Effect estimate† | CI limit‡ | Effect estimate† | CI limit‡ | |
| Moral compass | ||||||||||
| I always know the right thing to do | – | – | – | – | 2.24 | 1.57 | – | – | – | – |
| Orientation to promoting good | ||||||||||
| I am willing to face difficulties in order to do what is right | 1.31 | 1.13 | – | – | 2.20 | 1.68 | – | – | – | – |
| I give up personal pleasures whenever it is possible to do some good instead | 1.26 | 1.04 | – | – | 2.57 | 1.82 | – | – | – | – |
| I always act to promote good in all circumstances, even in difficult and challenging situations | 1.37 | 1.21 | – | – | 2.06 | 1.38 | 1.35 | 1.19 | – | – |
| Use of strengths | ||||||||||
| I get to use my strengths to help others (0–10) | 1.30 | 1.10 | – | – | 2.61 | 1.82 | 1.37 | 1.20 | 4.58 | 1.77 |
| Kindness | ||||||||||
| I always treat everyone with kindness, fairness and respect | 1.30 | 1.12 | – | – | 1.83 | 1.09 | – | – | – | – |
| Delayed gratification | ||||||||||
| I am always able to give up some happiness now for greater happiness later | – | – | 1.82 | 1.18 | 2.12 | 1.44 | 1.26 | 1.02 | – | – |
| Strengths of moral character scale (SMC-WBA) | 1.47 | 1.26 | – | – | 3.53 | 2.31 | 1.40 | 1.18 | – | – |
See VanderWeele and Ding [58] for the formula for calculating E-values
†The E values for effect estimates are the minimum strength of association on the risk ratio scale that an unmeasured confounder would need to have with both the exposure and the outcome to fully explain away the observed association between the exposure and outcome, conditional on the measured covariates. For example, in the studied population an unmeasured confounder would need to be associated with both using one’s strengths to help others and cardiovascular disease by risk ratios of 4.58 each, above and beyond the measured covariates, to fully explain away the observed association between the two variables
‡The E values for the limit of the 95% confidence interval (CI) closest to the null denote the minimum strength of association on the risk ratio scale that an unmeasured confounder would need to have with both the exposure and the outcome to shift the confidence interval to include the null value, conditional on the measured covariates. For example, in the studied population, an unmeasured confounder would need to be associated with both using one’s strengths to help others and cardiovascular disease by 1.77-fold each, above and beyond the measured covariates, to shift the upper limit of the confidence interval to include the null