A Review of Psychological Well-Being and Mortality Risk

Abstract

Psychological well-being (PWB) is associated with lower chronic disease and mortality risk and may be enhanced with relatively low-cost interventions. Such interventions target specific dimensions of PWB (e.g., optimism, purpose in life), although distinct PWB dimensions may differentially impact physical health outcomes. The effectiveness of PWB interventions to improve physical health will be limited and difficult to assess without attention to these dimensions. Research has considered multiple PWB dimensions in relation to mortality risk, but a comparison of findings across studies has not been done. The authors summarize the relationships between all-cause mortality and multiple dimensions of PWB (e.g., life purpose, mastery, positive affect, life satisfaction, optimism). They then review biological (e.g., inflammation, antioxidants) and behavioral (e.g., smoking, physical activity) mechanistic pathways that could explain these associations. The authors discuss methodological considerations targeting the protective role of PWB in risk of mortality (and other health-related outcomes) and offer recommendations for future directions.

Why does purpose in life predict mortality in older adults?

“…Some suggest that controlling for self-rated health may be an “overadjustment” because self-rated health, 17 “…is both defined and influenced by functional health, physical conditions, and, most importantly, psychological distress and well-being…” 29,44 Thus, Model 1B replaces self-rated health with a more objective health metric—the broad limitations index. The result in the final column reveal that the broad limitations metric also substantially attenuates the relation between purpose and longevity as the excess risk of low purpose respondents is reduced by 32% relative to the baseline Model 1 (i.e., 1-(2·21-1)/(2·77-1)) in the initial four-year period, reduced by 63% (i.e., 1-(1·66-1)/(2·77-1)) in the next four years, and reduced by 84% (i.e., 1-(1·28-1)/(2·77-1)) in the final four-year period.…”

“…Causality, however, is the key remaining question as another potential interpretation of the evidence is that, by definition, poorer baseline health causes increased mortality risk, but could also cause lower life purpose. 14–17,26 That is, causation may run primarily from health to purpose rather than from purpose to health. Following suggestions in recent surveys, 15,17 we adopt a two-pronged approach to examining causality by (1) using more comprehensive measures of current health, and (2) evaluating a longer follow-up period.…”

“…14–24 As recent studies point out, this evidence is exciting because it represents a potential low-cost lever—life purpose intervention—to improve health and longevity. 1,3,10,14,16,17,25…”

“…14–17,26 That is, causation may run primarily from health to purpose rather than from purpose to health. Following suggestions in recent surveys, 15,17 we adopt a two-pronged approach to examining causality by (1) using more comprehensive measures of current health, and (2) evaluating a longer follow-up period.…”

Health shocks and changes in life purpose: Understanding the link between purpose and longevity

“…33 The biennial core HRS survey also asks respondents a series of questions regarding medical diagnoses since their previous interview including a new diagnosis of hypertension, diabetes, cancer, lung disease, heart problem, stroke, psychological problem, arthritis, dementia, and Alzheimer’s disease. Because self-rated health may be impacted by “psychological distress and well-being,” 7 the 14 measures of changes in health are objective—either measured directly (e.g., grip strength) or diagnosed by a physician. The appendix (pp 1-5) provides details for all metrics.…”