Objectives The purpose of this review was to evaluate whether the Penn Resiliency Program (PRP), a group cognitive-behavioral intervention, is effective in targeting depressive symptoms in youth. Data sources We identified 17 controlled evaluations of PRP (N = 2498) measuring depressive symptoms via an online search of PsycInfo, Medline, ERIC, and ProQuest Dissertations and Theses, and by requesting data from PRP researchers. Review methods We combined effect sizes (ESs; Glass’s d), using random effects models at post-intervention and two follow-up assessments. Results PRP participants reported fewer depressive symptoms at post-intervention and both follow-up assessments compared to youth receiving no intervention, with ESs ranging from 0.11 to 0.21. Limited data show no evidence that PRP is superior to active control conditions. Subgroup analyses showed that PRP’s effects were significant at 1 or more follow-up assessments among studies using both targeted and universal approaches, when group leaders were research team members and community providers, among participants with both low and elevated baseline symptoms, and among boys and girls. Preliminary analyses suggest that PRP’s effects on depressive disorders may be smaller than those reported in a larger meta-analysis of depression prevention programs for older adolescents and adults. Conclusion We found evidence that PRP significantly reduces depressive symptoms through at least 1 year post-intervention. Future PRP research should examine whether PRP’s effects on depressive symptoms lead to clinically meaningful benefits for its participants, whether the program is cost-effective, whether CBT skills mediate program effects, and whether PRP is effective when delivered under real-world conditions.

Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes.

Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/ X-ray (OR = 1.27, 95% CI = 1.16-1.39) or pap smear (OR = 1.16, 95% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17% fewer nights spent in the hospital (rate ratio = 0.83, 95% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.purpose in life | meaning in life | well-being | health screening T hree factors converge to underscore the heightened importance of preventive health care services among United States adults. First, there is the rapidly aging population: by 2050, the number of United States adults over the age of 65 is estimated to double (1). Second, there is the rising cost of medical care: chronic illnesses and end-of-life issues that older adults face are expensive. The Congressional Budget office projects that spending on Medicare will nearly double as a share of gross domestic product (GDP), from 3.7% in 2012 to 7.3% by 2050 (2). Third, despite spending more on health care than any country in the world, United States adults generally have poorer health and lower life expectancies than those in other developed countries (3,4). This health disadvantage is not solely attributable to those who are poor and underprivileged, because even wealthy, educated Americans are in poorer health than their counterparts in comparable countries (3, 4).These troublesome realities could be offset by greater use of preventive health care services, which are known to enhance health and reduce health care costs. However, in 2007 the Brookings Institution estimated that only 4% of the $1.7 trillion spent on national health expenditures was for prevention (5). Older adults, in particular, use less prev...

This study examined whether purpose in life was associated with myocardial infarction among a sample of older adults with coronary heart disease after adjusting for relevant sociodemographic, behavioral, biological, and psychological factors. Prospective data from the Health and Retirement Study-a nationally representative panel study of American adults over the age of 50-were used. Analyses were conducted on the subset of 1,546 individuals who had coronary heart disease at baseline. Greater baseline purpose in life was associated with lower odds of having a myocardial infarction during the 2-year follow-up period. On a six-point purpose in life measure, each unit increase was associated with a multivariate-adjusted odds ratio of 0.73 for myocardial infarction (95% CI, 0.57-0.93, P = .01). The association remained significant after controlling for coronary heart disease severity, self-rated health, and a comprehensive set of possible confounds. Higher purpose in life may play an important role in protecting against myocardial infarction among older American adults with coronary heart disease.

Growing evidence has linked positive psychological attributes like optimism to a lower risk of poor health outcomes, especially cardiovascular disease. It has been demonstrated in randomized trials that optimism can be learned. If associations between optimism and broader health outcomes are established, it may lead to novel interventions that improve public health and longevity. In the present study, we evaluated the association between optimism and cause-specific mortality in women after considering the role of potential confounding (sociodemographic characteristics, depression) and intermediary (health behaviors, health conditions) variables. We used prospective data from the Nurses' Health Study (n = 70,021). Dispositional optimism was measured in 2004; allcause and cause-specific mortality rates were assessed from 2006 to 2012. Using Cox proportional hazard models, we found that a higher degree of optimism was associated with a lower mortality risk. After adjustment for sociodemographic confounders, compared with women in the lowest quartile of optimism, women in the highest quartile had a hazard ratio of 0.71 (95% confidence interval: 0.66, 0.76) for all-cause mortality. Adding health behaviors, health conditions, and depression attenuated but did not eliminate the associations (hazard ratio = 0.91, 95% confidence interval: 0.85, 0.97). Associations were maintained for various causes of death, including cancer, heart disease, stroke, respiratory disease, and infection. Given that optimism was associated with numerous causes of mortality, it may provide a valuable target for new research on strategies to improve health. health psychology; optimism; psychological well-being; resilience Abbreviations: CI, confidence interval; HR, hazard ratio; MET, metabolic equivalent of task.

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We propose to synthesize a control policy for a Markov decision process (MDP) such that the resulting traces of the MDP satisfy a linear temporal logic (LTL) property. We construct a product MDP that incorporates a deterministic Rabin automaton generated from the desired LTL property. The reward function of the product MDP is defined from the acceptance condition of the Rabin automaton. This construction allows us to apply techniques from learning theory to the problem of synthesis for LTL specifications even when the transition probabilities are not known a priori. We prove that our method is guaranteed to find a controller that satisfies the LTL property with probability one if such a policy exists, and we suggest empirically with a case study in traffic control that our method produces reasonable control strategies even when the LTL property cannot be satisfied with probability one.

Little is known about how optimism differs by age and changes over time, particularly among older adults. Even less is known about how changes in optimism are related to changes in physical health. We examined age differences and longitudinal changes in optimism in 9,790 older adults over a four-year period. We found an inverted U-shaped pattern between optimism and age both cross-sectionally and longitudinally, such that optimism generally increased in older adults before decreasing. Increases in optimism over a four-year period were associated with improvements in self-rated health and fewer chronic illnesses over the same time frame. The findings from the current study are consistent with changes in emotion regulation strategies employed by older adults and age-related changes in well-being.