DienerChanHealth.docx
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DienerChanHealth.docx
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DienerChanHealth
HappyPeopleLiveLonger:
SubjectiveWell-Being
ContributestoHealthandLongevity
EdDiener
UniversityofIllinoisandTheGallupOrganization
MicaelaChan
UniversityofTexasatDallas
RunningHead:
HealthBenefitsofHappiness
DraftDate:
October29,2010
Sendreprintrequeststo:
EdDiener
DepartmentofPsychology
UniversityofIllinois
603E.DanielStreet
Champaign,IL61820
email:
ediener@illinois.edu
Abstract
Seventypesofevidencearereviewedthatindicatethathighsubjectivewell-being(suchaslifesatisfaction,absenceofnegativeemotions,optimism,andpositiveemotions)causesbetterhealthandlongevity.Forexample,prospectivelongitudinalstudiesofnormalpopulationsprovideevidencethatvarioustypesofsubjectivewell-beingsuchaspositiveaffectpredicthealthandlongevity,controllingforhealthandsocioeconomicstatusatbaseline.Combinedwithexperimentalhumanandanimalresearch,aswellasnaturalisticstudiesofchangesofsubjectivewell-beingandphysiologicalprocessesovertime,thecasethatsubjectivewell-beinginfluenceshealthandlongevityinhealthypopulationsiscompelling.However,theclaimthatsubjectivewell-beinglengthensthelivesofthosewithcertaindiseasessuchascancerremainscontroversial.Anumberofstudiesindicatethatpositivefeelingspredictlongevityandhealthbeyondnegativefeelings.However,evidencesuggeststhatintenselyarousedormanicpositiveaffectcanbedetrimentaltohealth.Issuessuchascausality,effectsize,typesofsubjectivewell-being,andstatisticalcontrolsarediscussed.Researchisneededthatexaminesinmoredepththepsychologicalandphysiologicalpathwaysbywhichvarioustypesofsubjectivewell-beinginfluencehealthandlongevity.
HappyPeopleLiveLonger:
SubjectiveWell-BeingContributestoHealthandLongevity
Whenpeoplelistthecharacteristicsofagoodlife,theyarelikelytoincludehappiness,health,andlongevity.Similarly,scholarssuchasEdgerton(1995)definegoodculturesasthoseinwhichhealthandhappinessflourish.Inthispaperwedescribetheevidencethatsubjectivewell-being(SWB)causallyaffectshealthandlongevity.InterventionstoraiseSWB,aswellasthetheoriesthatexplainwhySWBaffectsphysiology,arebeyondthepagelimitationsandscopeofthisreview.
WedescribetheevidencethatrevealsthatSWBcausallyinfluencesbothhealthandlongevity.BySWBwemeanpeople’sevaluationsoftheirlives,whichcanbejudgmentssuchaslifesatisfaction,andevaluationsbasedonfeelings,includingmoodsandemotions.Whenpeoplefeelasadmoodorajoyfulemotionitisbecausetheyevaluatesomethingintheirlivesasgoingwellorbadly.Thus,SWBisaheterogeneouscategorythatincludesdiversephenomenarangingfromoptimismtolowangertoworksatisfaction.ThroughmostofthepaperwereviewmeasuresofdiverseSWBconceptstogetherasthoughtheyhavesimilareffectsonhealth,andonlyoccasionallymentionwhentheseeffectsdiverge.ThereasonweconflatethedifferenttypesofSWBisthatrarelyhavetherebeenstudiesthatdifferentiateandassessmultipletypesofSWB.Thus,wearenotabletodrawstrongconclusionsaboutwhichtypesoffeelingsaremostrelatedtohealth.Evidencehasaccumulatedtoshowthatpositiveandnegativefeelingshaveindependenteffects,butinmostcaseswehaveonlyaninitialideaofhowSWBconceptsoverlaporareindependentintheireffectsonhealth.InalatersectionofthepaperwedescribetheresearchthatisneededtomorefinelydissecthowvarioustypesofSWBinfluencehealth.
EarlyresearchonSWBandhealthestablishedacorrelationbetweenthetwo.Butbecausethestudieswerelargelycross-sectional,oftenwithsmallsamplesofconvenience,itwasimpossibletodeterminethecausaldirectionbetweenSWBandhealth.However,thefieldhasnowprogressedtothepointwheremanyformsofevidenceareavailable.TherearenowanumberofconverginglinesofevidencebasedondiversemethodologiessupportingtheconclusionthatSWBinfluenceshealthandlongevity.
1.Long-termlongitudinal(prospective)studiesinwhichsubjectsamplesarefollowedovertime,andinitiallevelsofsubjectivewell-beingarerelatedtolaterhealthandlongevity.Thesestudiesaremostpowerfulwhenbaselinelevelsofhealtharecontrolled,andSESisoftencontrolledaswell.Survivalinillpopulationshasbeenstudied,aswellasmorbidityandmortalityininitiallyhealthypopulations.
2.StudiesinwhichnaturallevelsofSWBarerelatedtospecificphysiologicalprocessesthatcanaffecthealthandlongevity,aswellasstudiesofwhennaturalchangesinSWBarerelatedtochangesinphysiologicalmeasures.
3.Studiesinwhichmoodsandemotionsareexperimentallymanipulated,andeffectsonphysiologicalvariablesthatcouldaffecthealthareassessed.
4.Animalstudiesinwhichthereisexperimentalcontrolovertheenvironmentoftheanimals,andphysiologicalandhealthmeasuresareassessedinanimalslikelytodifferinSWB.
5.Quasi-experimentalstudiesinnaturalsettings,inwhichnaturaleventscanbeexaminedfortheireffectsonhealthoutcomes.
6.Experimentalinterventionstudiesinwhichtreatmentsareadministeredthatcaninfluencepeople’slong-termSWB.ThetreatmentgroupsarecomparedtocontrolgroupsintermsofbothSWBandphysiologicalmeasures.
7.Studiesonhowqualityoflifefactorssuchaspainandmobilityarerelatedto
subjectivewell-being.
Wedescribeexamplesofeachofthetypesofevidence,aswellasdiscussissuessuchascausality,effectsize,methodologicalrigor,whethertoomuchhappinesscanbedetrimentaltohealth,andwhetherthereisathresholdeffectforSWB.Wefocusonlarge-scalerecentresearch,aswellasstudiesthatarediverseinthepopulationstheysampleandinitialhealth-status.Wedescribeanumberofsystematicreviewsandmeta-analysesthatarealreadyavailableinspecificareas,whichprovidemorecompletesummariesofspecifictopics.
EmpiricalEvidencebyMethodologicalCategory
LongitudinalProspectiveStudiesofSWB,Health,andLongevity
Wearefortunatethatanumberofreviewsandmeta-analysesareavailableonthepredictivepowerofSWBonhealthandlongevity.Studieswithverylargesamplesizeshavebeenfollowedforadecadeormore.IntheseimpressivelylargestudiesSWBisusuallypredictiveofmortality,controllingforinitialhealth.HemingwayandMarmot(1999)foundinareviewoftheliteraturethatamongstudiesthatpassedtheir“qualityfilter,”in11of11prospectivestudiesdepressionandanxietypredictedcoronaryheartdiseaseinhealthypeople,andinsixofsixstudiestheypredicteddiseaseprogressioninthosewithcardiovasculardisease.Theauthorssuggestthatthecausalroleofthementalstatesisfurthersupportedbyhumanandprimateevidenceonbiologicalandbehavioralpathwaysmediatingtheseeffects.
Lyubomirsky,King,andDiener(2005),inameta-analysisoflongitudinalstudies,foundaneffectsizeof.18,indicatingthestandarddeviationdifferencesinhealthoutcomesforlowversushighSWBindividuals.Similarly,Howell,Kern,andLyubomirsky(2007)reviewed49prospectivestudiestestingthepredictivepoweroflong-termwell-beingandill-being,andfoundanoveralleffectsizeof.14forlongevity,comparinghighandlowSWBsubjects.
ChidaandSteptoe(2008)conductedameta-analysisoftheprospectivestudiesexaminingtheassociationbetweenpositivewell-beingandmortalityinbothhealthyanddiseasedpopulations.Positivepsychologicalwell-beingwasrelatedtolowermortalityinbothhealthyanddiseasedpopulations,independentlyofnegativeeffect.Positivemoodssuchasjoy,happiness,andenergy,aswellascharacteristicssuchaslifesatisfaction,hopefulness,optimism,andsenseofhumorwereassociatedwithreducedriskofmortalityinhealthypopulations,andpredictedlongevity,controllingfornegativestates.PositivestateswereassociatedwithreduceddeathratesinpatientswithHIVandrenalfailure.Inthehealthypopulationstudies,higherqualitystudiesyieldedevidenceofgreaterprotectiveeffects.Inthediseasepopulationstudiestheprotectiveeffectsweregreaterwhenbaselinediseaseandtreatmentwerecontrolled.
Rugulies(2002)reportedameta-analysisof11studiesexaminingwhetherdepressionpredictscoronaryheartdisease.Itwasconcludedthatdepressionpredictscardiovasculardiseaseininitiallyhealthypeople,withagreaterriskforclinicaldepressionthanfordepressedmood(riskratiosof2.69and1.49,respectively).StudiesthatexcludedparticipantswithasuspiciousEEGatbaseline,andthosewithcardiaceventsearlyinthefollow-upperiodshowedariskratioof1.51.
WilliamsandSchneiderman(2002)arguethatthereisnowstrongevidencethatSWBispredictiveofcardiovasculardiseaseishealthypopulations.TheyalsoconcludethatSWBispredictiveofcancerincidenceandsurvival,althoughtheevidenceislimited.PressmanandCohen(2005)reviewevidencesuggestingthatpositiveaffectisassociatedwithphysicalhealthandlongevityinnormalpopulations,butconcludedthattheevidenceismixedforpositiveaffectpredictingsurvivalinthosewithexistingdisease.Thus,anumberofliteraturereviewsandmeta-analysesallconcludethatSWBpredictshealthandlongevityinhealthypopulations.
InTable1wepresentexamplesofprospectivestudiesintheareaofSWBandlongevity.Thetableisdesignedtogiveanideaoftheextent,range,anddiversityofthefindings.Severalofthesestudieshaveoverlappingsamples,butdifferentmeasuresandtimeperiods.Ascanbeseen,SWB,especiallyintheformofpositiveaf
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