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
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 (firstname.lastname@example.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.
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Huffman JC. Optimism and Health: Where Do We Go From Here? JAMA Netw Open. 2019;2(9):e1912211. doi:10.1001/jamanetworkopen.2019.12211
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