Dr. Eric S. Kim is currently an Assistant Professor in the Department of Psychology at the University of British Columbia (UBC). His program of research focuses on aging adults and aims to identify, understand, and intervene upon the dimensions of psychological well-being (e.g., sense of purpose) that reduce the risk of age-related conditions. This research also aims to understand the influence that the social environment has on the connection between psychological well-being and physical health. His research integrates perspectives from psychology (health, clinical, developmental, social, personality), gerontology, social epidemiology, biology, biostatistics, and translational science. Please visit our lab's website for more information: https://flourishing.psych.ubc.ca/
Purpose: Intergovernmental organizations, such as the World Health Organization, policymakers, sc... more Purpose: Intergovernmental organizations, such as the World Health Organization, policymakers, scientists, and the public alike are recognizing the importance of loneliness for health/well-being outcomes. However, it remains unclear if loneliness in adolescence shapes health/well-being in adulthood. We examined if an increase in loneliness during adolescence was associated with worse health/well-being in adulthood, across 41 outcomes.
Methods: We conducted a longitudinal study using data from Add Health, a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if an increase in loneliness over 1 year (between Wave I, 1994–1995 and Wave II, 1996) was associated with worse health/well-being outcomes 11.37 years later (in Wave IV, 2008; N = 11,040) or 20.64 years later (in Wave V, 2016–2018; N = 9,003). Participants were aged 15.28 years at study onset and aged 28.17 or 37.20 years during the final assessment.
Results: Participants with the highest (vs. lowest) loneliness had worse outcomes on 4 (of 7) mental health outcomes (e.g., higher likelihood of depression (relative risk = 1.25, confidence interval [CI] = 1.06, 1.49, p = .010)), 3 (of 4) psychological well-being outcomes (e.g., lower optimism [b = −0.12, 95% CI = −0.23, −0.01, p = .030]), 2 (of 7) social outcomes (e.g., lower romantic relationship quality (b = −0.10, 95% CI = −0.19, 0.00, p = .043)), one (of 13) physical health outcomes (e.g., higher likelihood of asthma (relative risk = 1.24, 95% CI = 1.01, 1.53, p = .041)), and 0 (of 9) health behavior outcomes and 0 (of 2) civic/prosocial outcomes.
Discussion: These findings suggest the promise of testing scalable loneliness interventions and policies during adolescence to better determine their impact on various outcomes.
Many middle-aged to older adults do not engage in regular exercise at all, despite its importance... more Many middle-aged to older adults do not engage in regular exercise at all, despite its importance for healthy aging. Extensive research grounded in behavioral and social science theories has identified numerous determinants of exercise. However, few studies used an exposure-wide approach, a data-driven exploratory method particularly useful for identifying novel determinants.
Methods: We used data from 13 771 participants in the Health and Retirement Study, a diverse, national panel study of adults aged >50 years in the United States, to evaluate 62 candidate determinants of exercise participation. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. We used Poisson regression with robust error variance to individually regress exercise in the outcome wave (t2: 2014/2016) on baseline candidate predictors (at t1: 2010/2012) controlling for all covariates in the previous wave (t0: 2006/2008).
Results: Some physical health conditions (eg, physical functioning limitations and lung disease), psychological factors (eg, health mastery, purpose in life, and positive affect), and social factors (eg, helping others, religious service attendance, and volunteering) were robustly associated with increased subsequent exercise. Among factors related to psychological distress, perceived constraints stood out as a factor in reducing exercise.
Conclusions: We identified potentially novel exercise determinants, such as helping friends/neighbors/relatives, religious attendance, and volunteering, that have not been captured using a theory-driven approach. Future studies validating these findings experimentally in midlife and older adults are needed.
Accumulating studies have documented strong associations between a higher sense of control and im... more Accumulating studies have documented strong associations between a higher sense of control and improved health and well-being outcomes. However, less is known about the determinants of increased sense of control. Our analysis used data from 13,771 older adults in the Health and Retirement Study (HRS)—a diverse, longitudinal, and national study of adults aged >50 in the United States. Using generalized linear regression models, with a lagged exposure-wide approach, we evaluated how changes in 59 predictors (i.e., physical health, health behavior, and psychosocial factors) over a 4-year period (between t0;2006/2008 and t1;2010/2012) might lead to changes in sense of control another 4 years later (t2;2014/2016). After adjusting for a rich set of baseline covariates, changes in some health behaviors (e.g., sleep problems), physical health conditions (e.g., physical functioning limitations, eyesight), and psychosocial factors (e.g., positive affect, purpose in life) were associated with changes in sense of control four years later. However, there was little evidence that other factors were associated with a subsequent sense of control. A key challenge in advancing intervention development is the identification of antecedents that predict a sense of control. Our results identified several novel targets for interventions and policies aimed at increasing a sense of control.
In the present study, we examined the prospective associations of both spousal support and spousa... more In the present study, we examined the prospective associations of both spousal support and spousal strain with a wide range of health and well-being outcomes in married older adults. Applying the analytic template for outcome-wide designs, three waves of longitudinal data from the Health and Retirement Study (n = 7788, Mage = 64.2 years) were analyzed using linear regression, logistic regression, and generalized linear models. A set of models was performed for spousal support and another set of models for spousal strain (2010/2012, t1). Outcomes included 35 different aspects of physical health, health behaviors, psychological well-being, psychological distress, and social factors (2014/2016, t2). All models adjusted for pre-baseline levels of sociodemographic covariates and all outcomes (2006/2008, t0). Spousal support evidenced positive associations with five psychological well-being outcomes, as well as negative associations with five psychological distress outcomes and loneliness. Conversely, spousal strain evidenced negative associations with three psychological well-being outcomes, in addition to positive associations with three psychological distress outcomes and loneliness. The magnitude of these associations was generally small, although some effect estimates were somewhat larger. Associations of both spousal support and strain with other social and health-related outcomes were more negligible. Both support and strain within a marital relationship have the potential to impact various aspects of psychological well-being, psychological distress, and loneliness in the aging population.
Using longitudinal data from the Health and Retirement Study, we examined the association between... more Using longitudinal data from the Health and Retirement Study, we examined the association between optimism/ pessimism before the pandemic and adaptation during the COVID-19 pandemic. Overall, optimism was associated with behaviors that reduce COVID-19 transmission and higher psychological well-being (βs>|.196|) through changes in social contacts (indirect effect βs> |.004|) and/or increases in physical activity (βs=|.01|). Separating optimism and pessimism, we found that only pessimism was associated with behaviors that reduce risk, but both optimism and pessimism were associated with psychological well-being. By investigating them in the context of new public health challenges, we found that while the presence of optimism and absence of pessimism may both be resources for well-being, the absence of pessimism may be particularly important for health-relevant behaviors.
Meaning, a fundamental component of human well-being, can be categorized into seven interrelated ... more Meaning, a fundamental component of human well-being, can be categorized into seven interrelated subdomains, as our study provides evidence for. These categories nest within a previously established tripartite classification of meaning in life (e.g. coherence, significance, and direction/purpose). We present the psychological and philosophical distinctions that led to the development of the Comprehensive Measure of Meaning (CMM). We provide empirical evidence for the reliability of scores and validity of the CMM using a longitudinal sample of college students (N = 4058) and a large, diverse sample from a Latin American financial institution (N = 8794). The measurement of individuals’ perception of their meaning in life is internally consistent, and we present results based on an innovative method to explore conceptual distinctions. Finally, we provide recommendations on using the CMM as a measure of individuals’ perceptions of their meaning in life and avenues for potentially beneficial modifications researchers might consider based on their intended uses.
Objective: Positive affect may influence health by promoting physical activity, but evidence eval... more Objective: Positive affect may influence health by promoting physical activity, but evidence evaluating this association is mostly cross-sectional and cannot discern directionality. This study used a counterfactual-based framework to estimate the causal effect of positive affect on physical activity patterns over 25 years, accounting for potential reverse associations. Method: Data were from 3,352 participants in the Coronary Artery Risk Development in Young Adults study. Repeated assessments of positive affect and physical activity were collected from 1990 to 2016. Longitudinal associations were evaluated in two ways: (a) using baseline positive affect in traditional linear mixed models that accounted for reverse causal associations by adjusting for baseline physical activity, and (b) using marginal structural models that treated positive affect as a time-varying exposure, thus accounting for dynamic reverse causal associations due to bidirectional relationships. Results: Fully adjusted traditional models found no association with physical activity at the first follow-up assessment, but positive affect was related to a slower decline in physical activity over time. Marginal structural models similarly found that positive affect was unrelated to physical activity at the first follow-up assessment but robustly associated with a slower decline in activity levels (5-year change: β = −3.33, 95% confidence interval [CI] = −5.80, −0.86; difference in 5-year change per 1 − SD positive affect: β = 4.99, 95% CI = 2.52, 7.46). Conclusions: Positive affect may play a causal role in slowing the decline in physical activity adults generally experience during through midlife. Efforts to enhance positive affect at the population level may be a promising new approach to help individuals stay active as they age. Public Significance Statement This study examined the impact of positive affect on physical activity trajectories from young adulthood through midlife using existing data from a large-scale cohort study. Results found a relationship with slower declines in activity levels over time, suggesting positive affect may be a viable future target for population-based efforts to help adults stay active during the transition to midlife.
Does higher perceived neighborhood social cohesion in adolescence lead to better health and well‐... more Does higher perceived neighborhood social cohesion in adolescence lead to better health and well‐being 10–12 years later? We evaluated this question using data from a large, prospective, and nationally representative sample of US adolescents (Add Health; N = 10,963), and an outcome‐wide approach. Across 38 outcomes, perceived neighborhood social cohesion was associated with some: mental health outcomes (i.e., depressive symptoms, suicidal ideation, perceived stress), psychological well‐being outcomes (i.e., happiness, optimism), social outcomes (i.e., loneliness, romantic relationship quality, satisfaction with parenting), and civic/prosocial outcomes (i.e., volunteering). However, it was not associated with health behaviors nor physical health outcomes. These results were maintained after robust control for a wide range of potential confounders.
IMPORTANCE
Supporting healthy aging is a US public health priority, and gratitude is a potential... more IMPORTANCE
Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.
OBJECTIVE
To examine the association of gratitude with all-cause and cause-specific mortality in later life.
DESIGN, SETTING, AND PARTICIPANTS
This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49,275 US older female registered nurses who participated in the Nurses’ Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.
EXPOSURE
Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one’s tendency to experience grateful affect.
MAIN OUTCOMES AND MEASURES
Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.
RESULTS
Among the 49,275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4,608 incident deaths were identified over 151,496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).
CONCLUSIONS AND RELEVANCE
This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.
Background
Several intergovernmental organizations, including the World Health Organization and U... more Background Several intergovernmental organizations, including the World Health Organization and United Nations, are urging countries to use well-being indicators for policymaking. This trend, coupled with increasing recognition that positive affect is beneficial for health/well-being, opens new avenues for intervening on positive affect to improve outcomes. However, it remains unclear if positive affect in adolescence shapes health/well-being in adulthood. We examined if increases in positive affect during adolescence were associated with better health/well-being in adulthood across 41 outcomes.
Methods and findings We conducted a longitudinal cohort study using data from Add Health—a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if increases in positive affect over 1 year (between Wave I; 1994 to 1995 and Wave II; 1995 to 1996) were associated with better health/well-being 11.37 years later (in Wave IV; 2008; N = 11,040) or 20.64 years later (in Wave V; 2016 to 2018; N = 9,003). Participants were aged 15.28 years at study onset, and aged 28.17 or 37.20 years—during the final assessment. Participants with the highest (versus lowest) positive affect had better outcomes on 3 (of 13) physical health outcomes (e.g., higher cognition (β = 0·12, 95% CI = 0·05, 0·19, p = 0.002)), 3 (of 9) health behavior outcomes (e.g., lower physical inactivity (RR = 0·80, CI = 0·66, 0·98, p = 0.029)), 6 (of 7) mental health outcomes (e.g., lower anxiety (RR = 0·81, CI = 0·71, 0·93, p = 0.003)), 2 (of 3) psychological well-being (e.g., higher optimism (β = 0·20, 95% CI = 0·12, 0·28, p < 0.001)), 4 (of 7) social outcomes (e.g., lower loneliness (β = −0·09, 95% CI = −0·16, −0·02, p = 0.015)), and 1 (of 2) civic/prosocial outcomes (e.g., more voting (RR = 1·25, 95% CI = 1·16, 1·36, p < 0.001)). Study limitations include potential unmeasured confounding and reverse causality.
Conclusions Enhanced positive affect during adolescence is linked with a range of improved health/well-being outcomes in adulthood. These findings suggest the promise of testing scalable positive affect interventions and policies to more definitively assess their impact on outcomes.
Background. A large and accumulating body of evidence shows that loneliness is detrimental for va... more Background. A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness. Methods. We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t 0 ;2006/2008 to t 1 ;2010/2012) were associated with subsequent loneliness 4 years later (t 2 ;2014/2016). Results. Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness. Conclusions. Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.
Background Community belonging, an important constituent of subjective well-being, is an importan... more Background Community belonging, an important constituent of subjective well-being, is an important target for improving population health. Ageing involves transitioning across different social conditions thus, community belonging on health may vary across the life course. Using a nationally representative cohort, this study estimates the life stage-specific impact of community belonging on premature mortality. Methods Six cycles of the Canadian Community Health Survey (2000-2012) were combined and linked to the Canadian Vital Statistics Database (2000-2017). Respondents were followed for up to 5 years. Multivariable-adjusted modified Poisson regression models were used to estimate the relative risk of premature mortality for three life stages: early adulthood (18-35 years), middle adulthood (36-55 years) and late adulthood (56-70 years). Results The final analytical sample included 477 100 respondents. Most reported a 'somewhat strong' sense of belonging (45.9%). Compared with their 'somewhat strong' counterparts, young adults reporting a 'somewhat weak' sense of belonging exhibited an increased relative risk (RR) of 1.76 (95% CI 1.27 to 2.43) for premature mortality, whereas middle-aged adults reporting the same exhibited a decreased RR of 0.82 (95% CI 0.69, 0.98). Among older adults, groups reporting a 'very strong' (RR 1.10, 95% CI 1.01, 1.21) or a 'very weak' sense (RR 1.14, 95% CI 1.01, 1.28) of belonging exhibited higher RRs for premature mortality. Conclusion The results demonstrate how community belonging relates to premature mortality differs across age groups underscoring the importance of considering life stage-specific perspectives when researching and developing approaches to strengthen belonging. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ Developing effective policies and programmatic interventions, including social prescribing, to improve sense of community belonging requires consideration of life-stage-specific evidence.
Background: While informal helping has been linked to a reduced risk of mortality, it remains unc... more Background: While informal helping has been linked to a reduced risk of mortality, it remains unclear if this association persists across different levels of key social structural moderators. Purpose To examine whether the longitudinal association between informal helping and all-cause mortality differs by specific social structural moderators (including age, gender, race/ethnicity, wealth, income, and education) in a large, prospective, national, and diverse sample of older U.S. adults. Methods: We analyzed data from the Health and Retirement Study, a national sample of U.S. adults aged >50 (N = 9,662). Using multivariable Poisson regression, we assessed effect modification by six social structural moderators (age, gender, race/ethnicity, wealth, income, and education) for the informal helping (2006/2008) to mortality (2010-2016/2012-2018) association on the additive and multiplicative scales. Results: Participants who reported ≥100 hr/year of informal helping (vs. 0 hr/year), had a lower mortality risk. Those who engaged in 1-49 hr/ year most consistently displayed lower mortality risk across moderators, while those who engaged in 50-99 and ≥100 hr/year only showed decreased mortality risk across some moderators. When formally testing effect modification, there was evidence that the informal helping-mortality associations were stronger among women and the wealthiest. Conclusions: Informal helping is associated with decreased mortality. Yet, there appear to be key differences in who benefits from higher amounts of informal helping across social structural moderators. Further research is needed to evaluate how the associations between informal helping and health and well-being are patterned across key social structural moderators.
Social Science & Medicine - Population Health, 2023
The detrimental effects of loneliness and social isolation on health and well-being outcomes are ... more The detrimental effects of loneliness and social isolation on health and well-being outcomes are well documented. In response, governments, corporations, and community-based organizations have begun leveraging tools to create interventions and policies aimed at reducing loneliness and social isolation at scale. However, these efforts are frequently hampered by a key knowledge gap: when attempting to improve specific health and well-being outcomes, decision-makers are often unsure whether to target loneliness, social isolation, or both. Filling this knowledge gap will inform the development and refinement of effective interventions. Using data from the Health and Retirement Study (13,752 participants (59% women and 41% men, mean [SD] age = 67 [10] years)), we examined how changes in loneliness and social isolation over a 4-year follow-up period (from t0:2008/2010 to t1:2012/2014) were associated with 32 indicators of physical-, behavioral-, and psychosocialhealth outcomes 4-years later (t2:2016/2018). We used multiple logistic-, linear-, and generalized-linear regression models, and adjusted for sociodemographic, personality traits, pre-baseline levels of both exposures (loneliness and social isolation), and all outcomes (t0:2008/2010). We incorporated data from all participants into the overall estimate, regardless of whether their levels of loneliness and social isolation changed from the pre-baseline to baseline waves. After adjusting for a wide range of covariates, we observed that both loneliness and social isolation were associated with several physical health outcomes and health behaviors. However, social isolation was more predictive of mortality risk and loneliness was a stronger predictor of psychological outcomes. Loneliness and social isolation have independent effects on various health and well-being outcomes and thus constitute distinct targets for interventions aimed at improving population health and well-being.
Background Growing evidence suggests that informal helping (unpaid volunteering not coordinated b... more Background Growing evidence suggests that informal helping (unpaid volunteering not coordinated by an organization or institution) is associated with improved health and well-being outcomes. However, studies have not investigated whether changes in informal helping are associated with subsequent health and well-being. Methods This study evaluated if changes in informal helping (between t 0 ;2006/2008 and t 1 ;2010/2012) were associated with 35 indicators of physical, behavioral, and psychosocial health and well-being (at t 2 ;2014/2016) using data from 12,998 participants in the Health and Retirement study-a national cohort of US adults aged > 50. Results Over the four-year follow-up period, informal helping ≥ 100 (versus 0) hours/year was associated with a 32% lower mortality risk (95% CI [0.54, 0.86]), and improved physical health (e.g., 20% reduced risk of stroke (95% CI [0.65, 0.98])), health behaviors (e.g., 11% increased likelihood of frequent physical activity (95% CI [1.04, 1.20])), and psychosocial outcomes (e.g., higher purpose in life (β = 0.15, 95% CI [0.07, 0.22])). However, there was little evidence of associations with various other outcomes. In secondary analyses, this study adjusted for formal volunteering and a variety of social factors (e.g., social network factors, receiving social support, and social participation) and results were largely unchanged. Conclusions Encouraging informal helping may improve various aspects of individuals' health and well-being and also promote societal well-being.
Psychosocial risk factors have been linked with accelerated epigenetic aging, but little is known... more Psychosocial risk factors have been linked with accelerated epigenetic aging, but little is known about whether psychosocial resilience factors (eg, Sense of Purpose in Life) might reduce epigenetic age acceleration. In this study, we tested if older adults who experience high levels of Purpose might show reduced epigenetic age acceleration. We evaluated the relationship between Purpose and epigenetic age acceleration as measured by 13 DNA methylation (DNAm) "epigenetic clocks" assessed in 1 572 older adults from the Health and Retirement Study (mean age 70 years). We quantified the total association between Purpose and DNAm age acceleration as well as the extent to which that total association might be attributable to demographic factors, chronic disease, other psychosocial variables (eg, positive affect), and health-related behaviors (heavy drinking, smoking, physical activity, and body mass index [BMI]). Purpose in Life was associated with reduced epigenetic age acceleration across 4 "second-generation" DNAm clocks optimized for predicting health and longevity (false discovery rate [FDR] q < 0.0001: PhenoAge, GrimAge, Zhang epigenetic mortality index; FDR q < 0.05: DunedinPoAm). These associations were independent of demographic and psychosocial factors, but substantially attenuated after adjusting for health-related behaviors (drinking, smoking, physical activity, and BMI). Purpose showed no significant association with 9 "first-generation" DNAm epigenetic clocks trained on chronological age. Older adults with greater Purpose in Life show "younger" DNAm epigenetic age acceleration. These results may be due in part to associated differences in health-related behaviors. Results suggest new opportunities to reduce biological age acceleration by enhancing Purpose and its behavioral sequelae in late adulthood.
Psychological ill-being is on the rise, with 1 in 5 Americans suffering from a mental disorder in... more Psychological ill-being is on the rise, with 1 in 5 Americans suffering from a mental disorder in any given year. Additional evidence demonstrates that psychological well-being has also decreased over time. These trends are particularly worrisome given the substantial and growing body of evidence demonstrating that psychological ill-being (e.g., depression, anxiety, anger) is associated with an elevated risk of developing chronic diseases and premature mortality, while aspects of psychological well-being (e.g., positive affect, sense of purpose and meaning, life satisfaction) are independently associated with improved physical health outcomes. An underexplored but promising approach to enhancing both psychological and physical health is through developing a set of tools that specifically target psychological well-being (often referred to as positive psychological interventions (PPIs) although many interventions developed outside the field of positive psychology also achieve these goals). Such interventions hold promise as a strategy for improving population health. However, critical knowledge gaps hold us back, and we have not yet developed a robust set of intervention strategies that can improve psychological well-being in meaningful, durable, and scalable ways that would also have downstream effects on physical health. The goal of this special issue is to help address these knowledge gaps by bringing together current conceptual frameworks, critical examination of key constructs, and novel empirical evidence needed to identify and examine interventions that can modify psychological well-being, particularly those that have the potential to be scaled at the population level and with durable effects.
Journal of Social and Personal Relationships, 2023
Social relationships contribute to well-being across the life course and may be especially vital ... more Social relationships contribute to well-being across the life course and may be especially vital resources for supporting healthy aging among older adults. This research examined associations between perceptions of social support and social strain from children assessed by older adult parents and 35 indicators of physical, behavioral, and psychosocial health and well-being. We utilized three waves of data from the Health and Retirement Study (HRS; N = 11,609), a diverse, national sample of U.S. adults over age 50. We found that increases in social support were associated with better subsequent outcomes on all psychological indicators (higher positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints) and most social factors (lower loneliness, greater likelihood of contact with children and other family) over the four-year follow-up period. Results also showed that increases in social strain were subsequently related to worse functioning across all indicators of psychological well-being and select social factors (i.e., higher loneliness) and psychological distress outcomes (i.e., higher hopelessness, negative affect, and perceived constraints). However, we did not find evidence that changes in social support and social strain were associated with physical health or health behavior outcomes.
Psychological well-being, characterized by feelings, cognitions, and strategies that are associat... more Psychological well-being, characterized by feelings, cognitions, and strategies that are associated with positive functioning (including hedonic and eudaimonic well-being), has been linked with better physical health and greater longevity. Importantly, psychological well-being can be strengthened with interventions, providing a strategy for improving population health. But are the effects of well-being interventions meaningful, durable, and scalable enough to improve health at a population-level? To assess this possibility, a cross-disciplinary group of scholars convened to review current knowledge and develop a research agenda. Here we summarize and build on the key insights from this convening, which were: (1) existing interventions should continue to be adapted to achieve a large-enough effect to result in downstream improvements in psychological functioning and health, (2) research should determine the durability of interventions needed to drive population-level and lasting changes, (3) a shift from individual-level care and treatment to a public-health model of population-level prevention is needed and will require new infrastructure that can deliver interventions at scale, (4) interventions should be accessible and effective in racially, ethnically, and geographically diverse samples. A discussion examining the key future research questions follows.
Purpose: Intergovernmental organizations, such as the World Health Organization, policymakers, sc... more Purpose: Intergovernmental organizations, such as the World Health Organization, policymakers, scientists, and the public alike are recognizing the importance of loneliness for health/well-being outcomes. However, it remains unclear if loneliness in adolescence shapes health/well-being in adulthood. We examined if an increase in loneliness during adolescence was associated with worse health/well-being in adulthood, across 41 outcomes.
Methods: We conducted a longitudinal study using data from Add Health, a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if an increase in loneliness over 1 year (between Wave I, 1994–1995 and Wave II, 1996) was associated with worse health/well-being outcomes 11.37 years later (in Wave IV, 2008; N = 11,040) or 20.64 years later (in Wave V, 2016–2018; N = 9,003). Participants were aged 15.28 years at study onset and aged 28.17 or 37.20 years during the final assessment.
Results: Participants with the highest (vs. lowest) loneliness had worse outcomes on 4 (of 7) mental health outcomes (e.g., higher likelihood of depression (relative risk = 1.25, confidence interval [CI] = 1.06, 1.49, p = .010)), 3 (of 4) psychological well-being outcomes (e.g., lower optimism [b = −0.12, 95% CI = −0.23, −0.01, p = .030]), 2 (of 7) social outcomes (e.g., lower romantic relationship quality (b = −0.10, 95% CI = −0.19, 0.00, p = .043)), one (of 13) physical health outcomes (e.g., higher likelihood of asthma (relative risk = 1.24, 95% CI = 1.01, 1.53, p = .041)), and 0 (of 9) health behavior outcomes and 0 (of 2) civic/prosocial outcomes.
Discussion: These findings suggest the promise of testing scalable loneliness interventions and policies during adolescence to better determine their impact on various outcomes.
Many middle-aged to older adults do not engage in regular exercise at all, despite its importance... more Many middle-aged to older adults do not engage in regular exercise at all, despite its importance for healthy aging. Extensive research grounded in behavioral and social science theories has identified numerous determinants of exercise. However, few studies used an exposure-wide approach, a data-driven exploratory method particularly useful for identifying novel determinants.
Methods: We used data from 13 771 participants in the Health and Retirement Study, a diverse, national panel study of adults aged >50 years in the United States, to evaluate 62 candidate determinants of exercise participation. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. We used Poisson regression with robust error variance to individually regress exercise in the outcome wave (t2: 2014/2016) on baseline candidate predictors (at t1: 2010/2012) controlling for all covariates in the previous wave (t0: 2006/2008).
Results: Some physical health conditions (eg, physical functioning limitations and lung disease), psychological factors (eg, health mastery, purpose in life, and positive affect), and social factors (eg, helping others, religious service attendance, and volunteering) were robustly associated with increased subsequent exercise. Among factors related to psychological distress, perceived constraints stood out as a factor in reducing exercise.
Conclusions: We identified potentially novel exercise determinants, such as helping friends/neighbors/relatives, religious attendance, and volunteering, that have not been captured using a theory-driven approach. Future studies validating these findings experimentally in midlife and older adults are needed.
Accumulating studies have documented strong associations between a higher sense of control and im... more Accumulating studies have documented strong associations between a higher sense of control and improved health and well-being outcomes. However, less is known about the determinants of increased sense of control. Our analysis used data from 13,771 older adults in the Health and Retirement Study (HRS)—a diverse, longitudinal, and national study of adults aged >50 in the United States. Using generalized linear regression models, with a lagged exposure-wide approach, we evaluated how changes in 59 predictors (i.e., physical health, health behavior, and psychosocial factors) over a 4-year period (between t0;2006/2008 and t1;2010/2012) might lead to changes in sense of control another 4 years later (t2;2014/2016). After adjusting for a rich set of baseline covariates, changes in some health behaviors (e.g., sleep problems), physical health conditions (e.g., physical functioning limitations, eyesight), and psychosocial factors (e.g., positive affect, purpose in life) were associated with changes in sense of control four years later. However, there was little evidence that other factors were associated with a subsequent sense of control. A key challenge in advancing intervention development is the identification of antecedents that predict a sense of control. Our results identified several novel targets for interventions and policies aimed at increasing a sense of control.
In the present study, we examined the prospective associations of both spousal support and spousa... more In the present study, we examined the prospective associations of both spousal support and spousal strain with a wide range of health and well-being outcomes in married older adults. Applying the analytic template for outcome-wide designs, three waves of longitudinal data from the Health and Retirement Study (n = 7788, Mage = 64.2 years) were analyzed using linear regression, logistic regression, and generalized linear models. A set of models was performed for spousal support and another set of models for spousal strain (2010/2012, t1). Outcomes included 35 different aspects of physical health, health behaviors, psychological well-being, psychological distress, and social factors (2014/2016, t2). All models adjusted for pre-baseline levels of sociodemographic covariates and all outcomes (2006/2008, t0). Spousal support evidenced positive associations with five psychological well-being outcomes, as well as negative associations with five psychological distress outcomes and loneliness. Conversely, spousal strain evidenced negative associations with three psychological well-being outcomes, in addition to positive associations with three psychological distress outcomes and loneliness. The magnitude of these associations was generally small, although some effect estimates were somewhat larger. Associations of both spousal support and strain with other social and health-related outcomes were more negligible. Both support and strain within a marital relationship have the potential to impact various aspects of psychological well-being, psychological distress, and loneliness in the aging population.
Using longitudinal data from the Health and Retirement Study, we examined the association between... more Using longitudinal data from the Health and Retirement Study, we examined the association between optimism/ pessimism before the pandemic and adaptation during the COVID-19 pandemic. Overall, optimism was associated with behaviors that reduce COVID-19 transmission and higher psychological well-being (βs>|.196|) through changes in social contacts (indirect effect βs> |.004|) and/or increases in physical activity (βs=|.01|). Separating optimism and pessimism, we found that only pessimism was associated with behaviors that reduce risk, but both optimism and pessimism were associated with psychological well-being. By investigating them in the context of new public health challenges, we found that while the presence of optimism and absence of pessimism may both be resources for well-being, the absence of pessimism may be particularly important for health-relevant behaviors.
Meaning, a fundamental component of human well-being, can be categorized into seven interrelated ... more Meaning, a fundamental component of human well-being, can be categorized into seven interrelated subdomains, as our study provides evidence for. These categories nest within a previously established tripartite classification of meaning in life (e.g. coherence, significance, and direction/purpose). We present the psychological and philosophical distinctions that led to the development of the Comprehensive Measure of Meaning (CMM). We provide empirical evidence for the reliability of scores and validity of the CMM using a longitudinal sample of college students (N = 4058) and a large, diverse sample from a Latin American financial institution (N = 8794). The measurement of individuals’ perception of their meaning in life is internally consistent, and we present results based on an innovative method to explore conceptual distinctions. Finally, we provide recommendations on using the CMM as a measure of individuals’ perceptions of their meaning in life and avenues for potentially beneficial modifications researchers might consider based on their intended uses.
Objective: Positive affect may influence health by promoting physical activity, but evidence eval... more Objective: Positive affect may influence health by promoting physical activity, but evidence evaluating this association is mostly cross-sectional and cannot discern directionality. This study used a counterfactual-based framework to estimate the causal effect of positive affect on physical activity patterns over 25 years, accounting for potential reverse associations. Method: Data were from 3,352 participants in the Coronary Artery Risk Development in Young Adults study. Repeated assessments of positive affect and physical activity were collected from 1990 to 2016. Longitudinal associations were evaluated in two ways: (a) using baseline positive affect in traditional linear mixed models that accounted for reverse causal associations by adjusting for baseline physical activity, and (b) using marginal structural models that treated positive affect as a time-varying exposure, thus accounting for dynamic reverse causal associations due to bidirectional relationships. Results: Fully adjusted traditional models found no association with physical activity at the first follow-up assessment, but positive affect was related to a slower decline in physical activity over time. Marginal structural models similarly found that positive affect was unrelated to physical activity at the first follow-up assessment but robustly associated with a slower decline in activity levels (5-year change: β = −3.33, 95% confidence interval [CI] = −5.80, −0.86; difference in 5-year change per 1 − SD positive affect: β = 4.99, 95% CI = 2.52, 7.46). Conclusions: Positive affect may play a causal role in slowing the decline in physical activity adults generally experience during through midlife. Efforts to enhance positive affect at the population level may be a promising new approach to help individuals stay active as they age. Public Significance Statement This study examined the impact of positive affect on physical activity trajectories from young adulthood through midlife using existing data from a large-scale cohort study. Results found a relationship with slower declines in activity levels over time, suggesting positive affect may be a viable future target for population-based efforts to help adults stay active during the transition to midlife.
Does higher perceived neighborhood social cohesion in adolescence lead to better health and well‐... more Does higher perceived neighborhood social cohesion in adolescence lead to better health and well‐being 10–12 years later? We evaluated this question using data from a large, prospective, and nationally representative sample of US adolescents (Add Health; N = 10,963), and an outcome‐wide approach. Across 38 outcomes, perceived neighborhood social cohesion was associated with some: mental health outcomes (i.e., depressive symptoms, suicidal ideation, perceived stress), psychological well‐being outcomes (i.e., happiness, optimism), social outcomes (i.e., loneliness, romantic relationship quality, satisfaction with parenting), and civic/prosocial outcomes (i.e., volunteering). However, it was not associated with health behaviors nor physical health outcomes. These results were maintained after robust control for a wide range of potential confounders.
IMPORTANCE
Supporting healthy aging is a US public health priority, and gratitude is a potential... more IMPORTANCE
Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.
OBJECTIVE
To examine the association of gratitude with all-cause and cause-specific mortality in later life.
DESIGN, SETTING, AND PARTICIPANTS
This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49,275 US older female registered nurses who participated in the Nurses’ Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.
EXPOSURE
Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one’s tendency to experience grateful affect.
MAIN OUTCOMES AND MEASURES
Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.
RESULTS
Among the 49,275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4,608 incident deaths were identified over 151,496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).
CONCLUSIONS AND RELEVANCE
This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.
Background
Several intergovernmental organizations, including the World Health Organization and U... more Background Several intergovernmental organizations, including the World Health Organization and United Nations, are urging countries to use well-being indicators for policymaking. This trend, coupled with increasing recognition that positive affect is beneficial for health/well-being, opens new avenues for intervening on positive affect to improve outcomes. However, it remains unclear if positive affect in adolescence shapes health/well-being in adulthood. We examined if increases in positive affect during adolescence were associated with better health/well-being in adulthood across 41 outcomes.
Methods and findings We conducted a longitudinal cohort study using data from Add Health—a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if increases in positive affect over 1 year (between Wave I; 1994 to 1995 and Wave II; 1995 to 1996) were associated with better health/well-being 11.37 years later (in Wave IV; 2008; N = 11,040) or 20.64 years later (in Wave V; 2016 to 2018; N = 9,003). Participants were aged 15.28 years at study onset, and aged 28.17 or 37.20 years—during the final assessment. Participants with the highest (versus lowest) positive affect had better outcomes on 3 (of 13) physical health outcomes (e.g., higher cognition (β = 0·12, 95% CI = 0·05, 0·19, p = 0.002)), 3 (of 9) health behavior outcomes (e.g., lower physical inactivity (RR = 0·80, CI = 0·66, 0·98, p = 0.029)), 6 (of 7) mental health outcomes (e.g., lower anxiety (RR = 0·81, CI = 0·71, 0·93, p = 0.003)), 2 (of 3) psychological well-being (e.g., higher optimism (β = 0·20, 95% CI = 0·12, 0·28, p < 0.001)), 4 (of 7) social outcomes (e.g., lower loneliness (β = −0·09, 95% CI = −0·16, −0·02, p = 0.015)), and 1 (of 2) civic/prosocial outcomes (e.g., more voting (RR = 1·25, 95% CI = 1·16, 1·36, p < 0.001)). Study limitations include potential unmeasured confounding and reverse causality.
Conclusions Enhanced positive affect during adolescence is linked with a range of improved health/well-being outcomes in adulthood. These findings suggest the promise of testing scalable positive affect interventions and policies to more definitively assess their impact on outcomes.
Background. A large and accumulating body of evidence shows that loneliness is detrimental for va... more Background. A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness. Methods. We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t 0 ;2006/2008 to t 1 ;2010/2012) were associated with subsequent loneliness 4 years later (t 2 ;2014/2016). Results. Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness. Conclusions. Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.
Background Community belonging, an important constituent of subjective well-being, is an importan... more Background Community belonging, an important constituent of subjective well-being, is an important target for improving population health. Ageing involves transitioning across different social conditions thus, community belonging on health may vary across the life course. Using a nationally representative cohort, this study estimates the life stage-specific impact of community belonging on premature mortality. Methods Six cycles of the Canadian Community Health Survey (2000-2012) were combined and linked to the Canadian Vital Statistics Database (2000-2017). Respondents were followed for up to 5 years. Multivariable-adjusted modified Poisson regression models were used to estimate the relative risk of premature mortality for three life stages: early adulthood (18-35 years), middle adulthood (36-55 years) and late adulthood (56-70 years). Results The final analytical sample included 477 100 respondents. Most reported a 'somewhat strong' sense of belonging (45.9%). Compared with their 'somewhat strong' counterparts, young adults reporting a 'somewhat weak' sense of belonging exhibited an increased relative risk (RR) of 1.76 (95% CI 1.27 to 2.43) for premature mortality, whereas middle-aged adults reporting the same exhibited a decreased RR of 0.82 (95% CI 0.69, 0.98). Among older adults, groups reporting a 'very strong' (RR 1.10, 95% CI 1.01, 1.21) or a 'very weak' sense (RR 1.14, 95% CI 1.01, 1.28) of belonging exhibited higher RRs for premature mortality. Conclusion The results demonstrate how community belonging relates to premature mortality differs across age groups underscoring the importance of considering life stage-specific perspectives when researching and developing approaches to strengthen belonging. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ Developing effective policies and programmatic interventions, including social prescribing, to improve sense of community belonging requires consideration of life-stage-specific evidence.
Background: While informal helping has been linked to a reduced risk of mortality, it remains unc... more Background: While informal helping has been linked to a reduced risk of mortality, it remains unclear if this association persists across different levels of key social structural moderators. Purpose To examine whether the longitudinal association between informal helping and all-cause mortality differs by specific social structural moderators (including age, gender, race/ethnicity, wealth, income, and education) in a large, prospective, national, and diverse sample of older U.S. adults. Methods: We analyzed data from the Health and Retirement Study, a national sample of U.S. adults aged >50 (N = 9,662). Using multivariable Poisson regression, we assessed effect modification by six social structural moderators (age, gender, race/ethnicity, wealth, income, and education) for the informal helping (2006/2008) to mortality (2010-2016/2012-2018) association on the additive and multiplicative scales. Results: Participants who reported ≥100 hr/year of informal helping (vs. 0 hr/year), had a lower mortality risk. Those who engaged in 1-49 hr/ year most consistently displayed lower mortality risk across moderators, while those who engaged in 50-99 and ≥100 hr/year only showed decreased mortality risk across some moderators. When formally testing effect modification, there was evidence that the informal helping-mortality associations were stronger among women and the wealthiest. Conclusions: Informal helping is associated with decreased mortality. Yet, there appear to be key differences in who benefits from higher amounts of informal helping across social structural moderators. Further research is needed to evaluate how the associations between informal helping and health and well-being are patterned across key social structural moderators.
Social Science & Medicine - Population Health, 2023
The detrimental effects of loneliness and social isolation on health and well-being outcomes are ... more The detrimental effects of loneliness and social isolation on health and well-being outcomes are well documented. In response, governments, corporations, and community-based organizations have begun leveraging tools to create interventions and policies aimed at reducing loneliness and social isolation at scale. However, these efforts are frequently hampered by a key knowledge gap: when attempting to improve specific health and well-being outcomes, decision-makers are often unsure whether to target loneliness, social isolation, or both. Filling this knowledge gap will inform the development and refinement of effective interventions. Using data from the Health and Retirement Study (13,752 participants (59% women and 41% men, mean [SD] age = 67 [10] years)), we examined how changes in loneliness and social isolation over a 4-year follow-up period (from t0:2008/2010 to t1:2012/2014) were associated with 32 indicators of physical-, behavioral-, and psychosocialhealth outcomes 4-years later (t2:2016/2018). We used multiple logistic-, linear-, and generalized-linear regression models, and adjusted for sociodemographic, personality traits, pre-baseline levels of both exposures (loneliness and social isolation), and all outcomes (t0:2008/2010). We incorporated data from all participants into the overall estimate, regardless of whether their levels of loneliness and social isolation changed from the pre-baseline to baseline waves. After adjusting for a wide range of covariates, we observed that both loneliness and social isolation were associated with several physical health outcomes and health behaviors. However, social isolation was more predictive of mortality risk and loneliness was a stronger predictor of psychological outcomes. Loneliness and social isolation have independent effects on various health and well-being outcomes and thus constitute distinct targets for interventions aimed at improving population health and well-being.
Background Growing evidence suggests that informal helping (unpaid volunteering not coordinated b... more Background Growing evidence suggests that informal helping (unpaid volunteering not coordinated by an organization or institution) is associated with improved health and well-being outcomes. However, studies have not investigated whether changes in informal helping are associated with subsequent health and well-being. Methods This study evaluated if changes in informal helping (between t 0 ;2006/2008 and t 1 ;2010/2012) were associated with 35 indicators of physical, behavioral, and psychosocial health and well-being (at t 2 ;2014/2016) using data from 12,998 participants in the Health and Retirement study-a national cohort of US adults aged > 50. Results Over the four-year follow-up period, informal helping ≥ 100 (versus 0) hours/year was associated with a 32% lower mortality risk (95% CI [0.54, 0.86]), and improved physical health (e.g., 20% reduced risk of stroke (95% CI [0.65, 0.98])), health behaviors (e.g., 11% increased likelihood of frequent physical activity (95% CI [1.04, 1.20])), and psychosocial outcomes (e.g., higher purpose in life (β = 0.15, 95% CI [0.07, 0.22])). However, there was little evidence of associations with various other outcomes. In secondary analyses, this study adjusted for formal volunteering and a variety of social factors (e.g., social network factors, receiving social support, and social participation) and results were largely unchanged. Conclusions Encouraging informal helping may improve various aspects of individuals' health and well-being and also promote societal well-being.
Psychosocial risk factors have been linked with accelerated epigenetic aging, but little is known... more Psychosocial risk factors have been linked with accelerated epigenetic aging, but little is known about whether psychosocial resilience factors (eg, Sense of Purpose in Life) might reduce epigenetic age acceleration. In this study, we tested if older adults who experience high levels of Purpose might show reduced epigenetic age acceleration. We evaluated the relationship between Purpose and epigenetic age acceleration as measured by 13 DNA methylation (DNAm) "epigenetic clocks" assessed in 1 572 older adults from the Health and Retirement Study (mean age 70 years). We quantified the total association between Purpose and DNAm age acceleration as well as the extent to which that total association might be attributable to demographic factors, chronic disease, other psychosocial variables (eg, positive affect), and health-related behaviors (heavy drinking, smoking, physical activity, and body mass index [BMI]). Purpose in Life was associated with reduced epigenetic age acceleration across 4 "second-generation" DNAm clocks optimized for predicting health and longevity (false discovery rate [FDR] q < 0.0001: PhenoAge, GrimAge, Zhang epigenetic mortality index; FDR q < 0.05: DunedinPoAm). These associations were independent of demographic and psychosocial factors, but substantially attenuated after adjusting for health-related behaviors (drinking, smoking, physical activity, and BMI). Purpose showed no significant association with 9 "first-generation" DNAm epigenetic clocks trained on chronological age. Older adults with greater Purpose in Life show "younger" DNAm epigenetic age acceleration. These results may be due in part to associated differences in health-related behaviors. Results suggest new opportunities to reduce biological age acceleration by enhancing Purpose and its behavioral sequelae in late adulthood.
Psychological ill-being is on the rise, with 1 in 5 Americans suffering from a mental disorder in... more Psychological ill-being is on the rise, with 1 in 5 Americans suffering from a mental disorder in any given year. Additional evidence demonstrates that psychological well-being has also decreased over time. These trends are particularly worrisome given the substantial and growing body of evidence demonstrating that psychological ill-being (e.g., depression, anxiety, anger) is associated with an elevated risk of developing chronic diseases and premature mortality, while aspects of psychological well-being (e.g., positive affect, sense of purpose and meaning, life satisfaction) are independently associated with improved physical health outcomes. An underexplored but promising approach to enhancing both psychological and physical health is through developing a set of tools that specifically target psychological well-being (often referred to as positive psychological interventions (PPIs) although many interventions developed outside the field of positive psychology also achieve these goals). Such interventions hold promise as a strategy for improving population health. However, critical knowledge gaps hold us back, and we have not yet developed a robust set of intervention strategies that can improve psychological well-being in meaningful, durable, and scalable ways that would also have downstream effects on physical health. The goal of this special issue is to help address these knowledge gaps by bringing together current conceptual frameworks, critical examination of key constructs, and novel empirical evidence needed to identify and examine interventions that can modify psychological well-being, particularly those that have the potential to be scaled at the population level and with durable effects.
Journal of Social and Personal Relationships, 2023
Social relationships contribute to well-being across the life course and may be especially vital ... more Social relationships contribute to well-being across the life course and may be especially vital resources for supporting healthy aging among older adults. This research examined associations between perceptions of social support and social strain from children assessed by older adult parents and 35 indicators of physical, behavioral, and psychosocial health and well-being. We utilized three waves of data from the Health and Retirement Study (HRS; N = 11,609), a diverse, national sample of U.S. adults over age 50. We found that increases in social support were associated with better subsequent outcomes on all psychological indicators (higher positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints) and most social factors (lower loneliness, greater likelihood of contact with children and other family) over the four-year follow-up period. Results also showed that increases in social strain were subsequently related to worse functioning across all indicators of psychological well-being and select social factors (i.e., higher loneliness) and psychological distress outcomes (i.e., higher hopelessness, negative affect, and perceived constraints). However, we did not find evidence that changes in social support and social strain were associated with physical health or health behavior outcomes.
Psychological well-being, characterized by feelings, cognitions, and strategies that are associat... more Psychological well-being, characterized by feelings, cognitions, and strategies that are associated with positive functioning (including hedonic and eudaimonic well-being), has been linked with better physical health and greater longevity. Importantly, psychological well-being can be strengthened with interventions, providing a strategy for improving population health. But are the effects of well-being interventions meaningful, durable, and scalable enough to improve health at a population-level? To assess this possibility, a cross-disciplinary group of scholars convened to review current knowledge and develop a research agenda. Here we summarize and build on the key insights from this convening, which were: (1) existing interventions should continue to be adapted to achieve a large-enough effect to result in downstream improvements in psychological functioning and health, (2) research should determine the durability of interventions needed to drive population-level and lasting changes, (3) a shift from individual-level care and treatment to a public-health model of population-level prevention is needed and will require new infrastructure that can deliver interventions at scale, (4) interventions should be accessible and effective in racially, ethnically, and geographically diverse samples. A discussion examining the key future research questions follows.
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Papers by Eric S . Kim (UBC)
Methods: We conducted a longitudinal study using data from Add Health, a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if an increase in loneliness over 1 year (between Wave I, 1994–1995 and Wave II, 1996) was associated with worse health/well-being outcomes 11.37 years later (in Wave IV, 2008; N = 11,040) or 20.64 years later (in Wave V, 2016–2018; N = 9,003). Participants were aged 15.28 years at study onset and aged 28.17 or 37.20 years during the final assessment.
Results: Participants with the highest (vs. lowest) loneliness had worse outcomes on 4 (of 7) mental health outcomes (e.g., higher likelihood of depression (relative risk = 1.25, confidence interval [CI] = 1.06, 1.49, p = .010)), 3 (of 4) psychological well-being outcomes (e.g., lower optimism [b = −0.12, 95% CI = −0.23, −0.01, p = .030]), 2 (of 7) social outcomes (e.g., lower romantic relationship quality (b = −0.10, 95% CI = −0.19, 0.00, p = .043)), one (of 13) physical health outcomes (e.g., higher likelihood of asthma (relative risk = 1.24, 95% CI = 1.01, 1.53, p = .041)), and 0 (of 9) health behavior outcomes and 0 (of 2) civic/prosocial outcomes.
Discussion: These findings suggest the promise of testing scalable loneliness interventions and policies during adolescence to better determine their impact on various outcomes.
Methods: We used data from 13 771 participants in the Health and Retirement Study, a diverse, national panel study of adults aged >50 years in the United States, to evaluate 62 candidate determinants of exercise participation. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. We used Poisson regression with robust error variance to individually regress exercise in the outcome wave (t2: 2014/2016) on baseline candidate predictors (at t1: 2010/2012) controlling for all covariates in the previous wave (t0: 2006/2008).
Results: Some physical health conditions (eg, physical functioning limitations and lung disease), psychological factors (eg, health mastery, purpose in life, and positive affect), and social factors (eg, helping others, religious service attendance, and volunteering) were robustly associated with increased subsequent exercise. Among factors related to psychological distress, perceived constraints stood out as a factor in reducing exercise.
Conclusions: We identified potentially novel exercise determinants, such as helping friends/neighbors/relatives, religious attendance, and volunteering, that have not been captured using a theory-driven approach. Future studies validating these findings experimentally in midlife and older adults are needed.
an outcome‐wide approach. Across 38 outcomes, perceived neighborhood social cohesion was associated with some: mental health outcomes (i.e., depressive symptoms, suicidal ideation, perceived stress), psychological
well‐being outcomes (i.e., happiness, optimism), social outcomes (i.e., loneliness, romantic relationship quality, satisfaction with parenting), and civic/prosocial outcomes (i.e., volunteering). However, it was not associated with health behaviors nor physical health outcomes.
These results were maintained after robust control for a wide range of potential confounders.
Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.
OBJECTIVE
To examine the association of gratitude with all-cause and cause-specific mortality in later life.
DESIGN, SETTING, AND PARTICIPANTS
This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49,275 US older female registered nurses who participated in the Nurses’ Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.
EXPOSURE
Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one’s tendency to experience grateful affect.
MAIN OUTCOMES AND MEASURES
Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.
RESULTS
Among the 49,275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4,608 incident deaths were identified over 151,496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).
CONCLUSIONS AND RELEVANCE
This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.
Several intergovernmental organizations, including the World Health Organization and United Nations, are urging countries to use well-being indicators for policymaking. This trend, coupled with increasing recognition that positive affect is beneficial for health/well-being, opens new avenues for intervening on positive affect to improve outcomes. However, it remains unclear if positive affect in adolescence shapes health/well-being in adulthood. We examined if increases in positive affect during adolescence were associated with better health/well-being in adulthood across 41 outcomes.
Methods and findings
We conducted a longitudinal cohort study using data from Add Health—a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if increases in positive affect over 1 year (between Wave I; 1994 to 1995 and Wave II; 1995 to 1996) were associated with better health/well-being 11.37 years later (in Wave IV; 2008; N = 11,040) or 20.64 years later (in Wave V; 2016 to 2018; N = 9,003). Participants were aged 15.28 years at study onset, and aged 28.17 or 37.20 years—during the final assessment. Participants with the highest (versus lowest) positive affect had better outcomes on 3 (of 13) physical health outcomes (e.g., higher cognition (β = 0·12, 95% CI = 0·05, 0·19, p = 0.002)), 3 (of 9) health behavior outcomes (e.g., lower physical inactivity (RR = 0·80, CI = 0·66, 0·98, p = 0.029)), 6 (of 7) mental health outcomes (e.g., lower anxiety (RR = 0·81, CI = 0·71, 0·93, p = 0.003)), 2 (of 3) psychological well-being (e.g., higher optimism (β = 0·20, 95% CI = 0·12, 0·28, p < 0.001)), 4 (of 7) social outcomes (e.g., lower loneliness (β = −0·09, 95% CI = −0·16, −0·02, p = 0.015)), and 1 (of 2) civic/prosocial outcomes (e.g., more voting (RR = 1·25, 95% CI = 1·16, 1·36, p < 0.001)). Study limitations include potential unmeasured confounding and reverse causality.
Conclusions
Enhanced positive affect during adolescence is linked with a range of improved health/well-being outcomes in adulthood. These findings suggest the promise of testing scalable positive affect interventions and policies to more definitively assess their impact on outcomes.
(including hedonic and eudaimonic well-being), has been linked with better physical health and greater longevity. Importantly,
psychological well-being can be strengthened with interventions, providing a strategy for improving population health. But
are the effects of well-being interventions meaningful, durable, and scalable enough to improve health at a population-level?
To assess this possibility, a cross-disciplinary group of scholars convened to review current knowledge and develop a research
agenda. Here we summarize and build on the key insights from this convening, which were: (1) existing interventions should
continue to be adapted to achieve a large-enough effect to result in downstream improvements in psychological functioning
and health, (2) research should determine the durability of interventions needed to drive population-level and lasting changes,
(3) a shift from individual-level care and treatment to a public-health model of population-level prevention is needed and
will require new infrastructure that can deliver interventions at scale, (4) interventions should be accessible and effective in
racially, ethnically, and geographically diverse samples. A discussion examining the key future research questions follows.
Methods: We conducted a longitudinal study using data from Add Health, a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if an increase in loneliness over 1 year (between Wave I, 1994–1995 and Wave II, 1996) was associated with worse health/well-being outcomes 11.37 years later (in Wave IV, 2008; N = 11,040) or 20.64 years later (in Wave V, 2016–2018; N = 9,003). Participants were aged 15.28 years at study onset and aged 28.17 or 37.20 years during the final assessment.
Results: Participants with the highest (vs. lowest) loneliness had worse outcomes on 4 (of 7) mental health outcomes (e.g., higher likelihood of depression (relative risk = 1.25, confidence interval [CI] = 1.06, 1.49, p = .010)), 3 (of 4) psychological well-being outcomes (e.g., lower optimism [b = −0.12, 95% CI = −0.23, −0.01, p = .030]), 2 (of 7) social outcomes (e.g., lower romantic relationship quality (b = −0.10, 95% CI = −0.19, 0.00, p = .043)), one (of 13) physical health outcomes (e.g., higher likelihood of asthma (relative risk = 1.24, 95% CI = 1.01, 1.53, p = .041)), and 0 (of 9) health behavior outcomes and 0 (of 2) civic/prosocial outcomes.
Discussion: These findings suggest the promise of testing scalable loneliness interventions and policies during adolescence to better determine their impact on various outcomes.
Methods: We used data from 13 771 participants in the Health and Retirement Study, a diverse, national panel study of adults aged >50 years in the United States, to evaluate 62 candidate determinants of exercise participation. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. We used Poisson regression with robust error variance to individually regress exercise in the outcome wave (t2: 2014/2016) on baseline candidate predictors (at t1: 2010/2012) controlling for all covariates in the previous wave (t0: 2006/2008).
Results: Some physical health conditions (eg, physical functioning limitations and lung disease), psychological factors (eg, health mastery, purpose in life, and positive affect), and social factors (eg, helping others, religious service attendance, and volunteering) were robustly associated with increased subsequent exercise. Among factors related to psychological distress, perceived constraints stood out as a factor in reducing exercise.
Conclusions: We identified potentially novel exercise determinants, such as helping friends/neighbors/relatives, religious attendance, and volunteering, that have not been captured using a theory-driven approach. Future studies validating these findings experimentally in midlife and older adults are needed.
an outcome‐wide approach. Across 38 outcomes, perceived neighborhood social cohesion was associated with some: mental health outcomes (i.e., depressive symptoms, suicidal ideation, perceived stress), psychological
well‐being outcomes (i.e., happiness, optimism), social outcomes (i.e., loneliness, romantic relationship quality, satisfaction with parenting), and civic/prosocial outcomes (i.e., volunteering). However, it was not associated with health behaviors nor physical health outcomes.
These results were maintained after robust control for a wide range of potential confounders.
Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.
OBJECTIVE
To examine the association of gratitude with all-cause and cause-specific mortality in later life.
DESIGN, SETTING, AND PARTICIPANTS
This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49,275 US older female registered nurses who participated in the Nurses’ Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.
EXPOSURE
Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one’s tendency to experience grateful affect.
MAIN OUTCOMES AND MEASURES
Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.
RESULTS
Among the 49,275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4,608 incident deaths were identified over 151,496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).
CONCLUSIONS AND RELEVANCE
This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.
Several intergovernmental organizations, including the World Health Organization and United Nations, are urging countries to use well-being indicators for policymaking. This trend, coupled with increasing recognition that positive affect is beneficial for health/well-being, opens new avenues for intervening on positive affect to improve outcomes. However, it remains unclear if positive affect in adolescence shapes health/well-being in adulthood. We examined if increases in positive affect during adolescence were associated with better health/well-being in adulthood across 41 outcomes.
Methods and findings
We conducted a longitudinal cohort study using data from Add Health—a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if increases in positive affect over 1 year (between Wave I; 1994 to 1995 and Wave II; 1995 to 1996) were associated with better health/well-being 11.37 years later (in Wave IV; 2008; N = 11,040) or 20.64 years later (in Wave V; 2016 to 2018; N = 9,003). Participants were aged 15.28 years at study onset, and aged 28.17 or 37.20 years—during the final assessment. Participants with the highest (versus lowest) positive affect had better outcomes on 3 (of 13) physical health outcomes (e.g., higher cognition (β = 0·12, 95% CI = 0·05, 0·19, p = 0.002)), 3 (of 9) health behavior outcomes (e.g., lower physical inactivity (RR = 0·80, CI = 0·66, 0·98, p = 0.029)), 6 (of 7) mental health outcomes (e.g., lower anxiety (RR = 0·81, CI = 0·71, 0·93, p = 0.003)), 2 (of 3) psychological well-being (e.g., higher optimism (β = 0·20, 95% CI = 0·12, 0·28, p < 0.001)), 4 (of 7) social outcomes (e.g., lower loneliness (β = −0·09, 95% CI = −0·16, −0·02, p = 0.015)), and 1 (of 2) civic/prosocial outcomes (e.g., more voting (RR = 1·25, 95% CI = 1·16, 1·36, p < 0.001)). Study limitations include potential unmeasured confounding and reverse causality.
Conclusions
Enhanced positive affect during adolescence is linked with a range of improved health/well-being outcomes in adulthood. These findings suggest the promise of testing scalable positive affect interventions and policies to more definitively assess their impact on outcomes.
(including hedonic and eudaimonic well-being), has been linked with better physical health and greater longevity. Importantly,
psychological well-being can be strengthened with interventions, providing a strategy for improving population health. But
are the effects of well-being interventions meaningful, durable, and scalable enough to improve health at a population-level?
To assess this possibility, a cross-disciplinary group of scholars convened to review current knowledge and develop a research
agenda. Here we summarize and build on the key insights from this convening, which were: (1) existing interventions should
continue to be adapted to achieve a large-enough effect to result in downstream improvements in psychological functioning
and health, (2) research should determine the durability of interventions needed to drive population-level and lasting changes,
(3) a shift from individual-level care and treatment to a public-health model of population-level prevention is needed and
will require new infrastructure that can deliver interventions at scale, (4) interventions should be accessible and effective in
racially, ethnically, and geographically diverse samples. A discussion examining the key future research questions follows.