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Invited Commentary
September 27, 2019

Optimism and Health: Where Do We Go From Here?

Author Affiliations
  • 1Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
  • 2Department of Psychiatry, Massachusetts General Hospital, Boston
JAMA Netw Open. 2019;2(9):e1912211. doi:10.1001/jamanetworkopen.2019.12211

Rozanski and colleagues1 have completed a careful and comprehensive meta-analysis examining the prospective associations of optimism with cardiovascular events and all-cause mortality across a total of 15 studies and more than 200 000 participants. The authors reported that, across a mean follow-up period of 13.8 years, optimism was significantly associated with a lower risk of incident cardiovascular events and all-cause mortality. Such findings largely held even when only considering studies that controlled for depression, physical activity, and other factors.

These results are consistent with a large and growing literature finding that positive psychological well-being in general and optimism in particular appear to have an independent association with cardiovascular and overall health outcomes.2 It appears that one’s psychological well-being is associated with future health and that the association between well-being and health is beyond the association of other factors, such as sociodemographic variables, medical comorbidity, and the adverse effects of depression. At the same time, it is important to parse 2 key questions: (1) which specific positive psychological constructs are associated with medical health, and (2) which constructs are modifiable in a clinical or population-level intervention?

Regarding the first question, as observed by Rozanski and colleagues,1 the specific construct that has been most consistently associated with medical health outcomes is dispositional optimism, measured by the Life Orientation Test–Revised.3 This is an important issue, given that optimism as conceptualized by this scale is a largely stable trait, as opposed to potentially more modifiable optimism-related constructs, such as positive expectancies or state optimism. If it is largely a person’s inherent optimistic nature from which they derive health benefit, such a trait may be difficult to modify with an intervention.

In terms of which well-being–related constructs could be modified with an intervention, not surprisingly, the greatest data exist for more state-based concepts, such as positive affect or happiness. Meta-analyses have consistently found that specific, positive psychology interventions (which focus on deliberately and systematically promoting well-being) increase positive affect, and even in medically ill populations such interventions appear to be effective in modifying this factor.4 Fortunately, positive affect itself (and other concepts, such as gratitude) have been associated with reduced mortality and other beneficial health effects in medical populations.5,6

Where does the field go from here? In terms of longitudinal studies, conducting studies that continue to examine the associations of more modifiable or state-based constructs with health outcomes will help to define clear, plausible, and important targets for intervention. These studies could also include more novel methods for assessing well-being, including ecological momentary assessment or day reconstruction methods that address the challenges with single or retrospective sampling. Regarding intervention studies, interventions should focus on improving and measuring not only well-being, but also important additional downstream outcomes (eg, physical activity and biomarkers) that are associated with health. Ongoing studies should also determine whether programs to promote psychological well-being might be best used alone or in conjunction with other, established behavioral interventions to boost their effect.7

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Article Information

Published: September 27, 2019. doi:10.1001/jamanetworkopen.2019.12211

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Huffman JC. JAMA Network Open.

Corresponding Author: Jeff C. Huffman, MD, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (jhuffman@partners.org).

Conflict of Interest Disclosures: Dr Huffman reported receiving research funding from the National Institutes of Health and the American Diabetes Association to study well-being interventions in patients with medical illness.

Rozanski  A, Bavishi  C, Kubzansky  LD, Cohen  R.  Association of optimism with cardiovascular events and all-cause mortality: a systematic review and meta-analysis.  JAMA Netw Open. 2019;2(9):e1912200. doi:10.1001/jamanetworkopen.2019.12200Google Scholar
Kubzansky  LD, Huffman  JC, Boehm  JK,  et al.  Positive psychological well-being and cardiovascular disease: JACC health promotion series.  J Am Coll Cardiol. 2018;72(12):1382-1396. doi:10.1016/j.jacc.2018.07.042PubMedGoogle ScholarCrossref
Scheier  MF, Carver  CS, Bridges  MW.  Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test.  J Pers Soc Psychol. 1994;67(6):1063-1078. doi:10.1037/0022-3514.67.6.1063PubMedGoogle ScholarCrossref
Moskowitz  JT, Carrico  AW, Duncan  LG,  et al.  Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV.  J Consult Clin Psychol. 2017;85(5):409-423. doi:10.1037/ccp0000188PubMedGoogle ScholarCrossref
Moskowitz  JT, Epel  ES, Acree  M.  Positive affect uniquely predicts lower risk of mortality in people with diabetes.  Health Psychol. 2008;27(1)(suppl):S73-S82. doi:10.1037/0278-6133.27.1.S73PubMedGoogle ScholarCrossref
Petrie  KJ, Pressman  SD, Pennebaker  JW, Øverland  S, Tell  GS, Sivertsen  B.  Which aspects of positive affect are related to mortality? results from a general population longitudinal study.  Ann Behav Med. 2018;52(7):571-581. doi:10.1093/abm/kax018PubMedGoogle ScholarCrossref
Huffman  JC, Feig  EH, Millstein  RA,  et al.  Usefulness of a positive psychology–motivational interviewing intervention to promote positive affect and physical activity after an acute coronary syndrome.  Am J Cardiol. 2019;123(12):1906-1914. doi:10.1016/j.amjcard.2019.03.023PubMedGoogle ScholarCrossref
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    1 Comment for this article
    Public health
    Michael Mundorff, MBA, MHSA | integrated healthcare delivery system (retired)
    There it is, then: aside from the whole ACA repeal thing, Trump is bad for the public health. For the left, he makes them despair of the future of the nation and democracy in general. For the right, he makes them baselessly afraid of a socialist takeover.