Sense of Purpose in Life and Cardiovascular Disease: Underlying Mechanisms and Future Directions

A review of the literature on wellbeing and modifiable dementia risk factors

Wellbeing-defined broadly as experiencing one's life as enjoyable and fulfilling-has been associated with lower risk for Alzheimer's disease and related dementias. The mechanisms underlying this association are largely unknown. However, prior research and theory suggest that wellbeing impacts health behaviors and biological systems that are relevant to cognitive and brain health. Several of these factors have also been identified by the 2020 Lancet Commission on Dementia Prevention, Intervention, and Care as modifiable dementia risk factors. In the current review, we summarize and evaluate the evidence for associations between wellbeing and each of the 12 Lancet Commission risk factors. We found relatively consistent evidence for associations between higher wellbeing and lower levels of most of the risk factors: physical inactivity, social isolation, smoking, depression, hypertension, diabetes, hearing loss, traumatic brain injury, and air pollution. By contrast, we found evidence for only modest associations between wellbeing and education and mixed evidence for associations of wellbeing with alcohol use and body weight. Although most of the reviewed evidence was observational, longitudinal and experimental evidence suggests that many of the observed associations are likely bidirectional. These findings suggest that modifiable dementia risk factors may be mediators (i.e., intermediate steps in the causal chain) and/or confounders (i.e., variables that impact both wellbeing and dementia, and thus could induce a spurious association) of the association between wellbeing and dementia. We conclude by discussing next steps to test mediation hypotheses and to account for potential confounding in the relation between wellbeing and dementia.

Bidirectional associations between meaning in life and the health, emotional ill-being and daily life functioning outcomes among older adults

OBJECTIVE

Meaning and purpose in life are recognised health determinants. Evidence on the factors contributing to the experience of meaning and purpose in life is limited. The bidirectional associations between the experience of meaning in life and physical health, emotional ill-being and daily life functioning from a 6-year perspective are examined.

METHODS AND MEASURES

Longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed using generalised estimating equations. The sample included 16,361 middle-aged and older adults from 13 countries.

RESULTS

Living a meaningful life was found to be associated with subsequent reduced risks of depression, loneliness, limitations in activities of daily living, and heart attack (at the 6-year follow-up). It was also found that prior experience of depression, loneliness and limited activities of daily living were associated with subsequent reduced sense of meaningful life. These associations were independent of demographics, socioeconomic status, personality, prior history of diseases and lifestyle. The sensitivity analyses provided evidence for the robustness of these associations.

CONCLUSIONS

Evidence for health practitioners and policymakers on factors that may hamper the development and maintenance of meaningful life as well as on the role of sense of meaning in life for healthy aging was presented.

Purpose in life and slow walking speed: cross-sectional and longitudinal associations

The present research examines the association between purpose in life - a component of well-being defined as the feeling that one's life is goal-oriented and has direction - and slow walking speed and the risk of developing slow walking speed over time. Participants (N = 18,825) were from three established longitudinal studies of older adults. At baseline, participants reported on their purpose in life, and interviewers measured their usual walking speed. Walking speed was measured at annual or biannual follow-up waves up to 16 years later. Random-effects meta-analysis was used to summarize the estimates from the individual studies. Every standard deviation higher in purpose in life (as a continuous measure) was associated with a lower likelihood of cross-sectional slow walking speed at baseline (meta-analytic OR = .80, 95% CI = .77-.83). Among participants who did not have slow walking speed at baseline (n = 8,448), every standard deviation higher purpose in life was associated with a lower likelihood of developing slow walking speed over the up to 16 years of follow-up (meta-analytic HR = .93, 95% CI = .89-.96). Physical activity and disease burden accounted for 25% and 14% of the cross-sectional and longitudinal associations, respectively. The associations were independent of age, sex, race, ethnicity, and education and not moderated by these factors. Higher purpose in life is associated with a lower risk of slow walking speed and a lower risk of developing slow walking speed over time. Purpose in life is a psychological resource that may help to support aspects of physical function, such as walking speed, and may help support better function with age.

Fulfilled Mind, Healthy Gut? Relationships of Eudaimonic Psychological Well-Being With the Gut Microbiome in Postmenopausal Women

OBJECTIVE

Eudaimonic facets of psychological well-being (PWB), like purpose in life and sense of mastery, are associated with healthy aging. Variation in the gut microbiome may be one pathway by which mental health influences age-related health outcomes. However, associations between eudaimonic PWB and the gut microbiome are understudied. We examined whether purpose in life and sense of mastery, separately, were associated with features of the gut microbiome in older women.

METHODS

Participants were from the Mind-Body Study ( N = 206, mean age = 61 years), a substudy of the Nurses' Health Study II cohort. In 2013, participants completed the Life Engagement Test and the Pearlin Mastery Scale. Three months later, up to two pairs of stool samples were collected, 6 months apart. Covariates included sociodemographics, depression, health status, and health behaviors. Analyses examined associations of PWB with gut microbiome taxonomic diversity, overall community structure, and specific species/pathways. To account for multiple testing, statistical significance was established using Benjamini-Hochberg adjusted p values (i.e., q values ≤0.25).

RESULTS

We found no evidence of an association between PWB and gut microbiome alpha diversity. In multivariate analysis, higher purpose levels were significantly associated with lower abundance of species previously linked with poorer health outcomes, notably Blautia hydrogenotrophica and Eubacterium ventriosum ( q values ≤0.25). No significant associations were found between PWB and metabolic pathways.

CONCLUSIONS

These findings offer early evidence suggesting that eudaimonic PWB is linked with variation in the gut microbiome, and this might be one pathway by which PWB promotes healthy aging.

Contributing to 'a sense of purpose' - Evaluating consumer recovery progress after attending a therapeutic-recreation intervention programme: A quantitative analysis

INTRODUCTION

The recommended objective for mental health plans and policies is the adoption of recovery approaches to mental healthcare. Mental health recovery is no longer defined by symptom resolution but as a journey towards a meaningful life from the consumer's own perspective. Recovery approaches focus on consumers' strengths, feelings of well-being and the achievement of personal goals. Designing recovery-oriented interventions is crucial for supporting people in their personal recovery journey.

AIM

This study sought to evaluate how attending a recovery-oriented intervention impacts the recovery of attending people living with serious mental illness.

METHODS

A quasi-experimental approach was utilised to examine changes in self-reported recovery progress in a purposive sample of consumers living with enduring mental illness (N = 105). Recovery progress was evaluated via the Recovery Assessment Scale - Domains and Stages (RAS-DS). Data were collected at entry and exit to a therapeutic recreation programme grounded in principles of recovery-oriented care and social contact theory. Pre-post scores were analysed via a repeated-measures multivariate analysis of variance (RM-MANOVA) per the four RAS-DS recovery domains.

RESULTS

After attending the therapeutic recreation programme, consumer recovery scores significantly increased in the functional, personal, and social recovery RAS-DS domains as measured by 'Doing Things I Value', 'Looking Forward', and 'Connecting and Belonging' (respectively). No changes were observed to consumers' clinical recovery progress, as assessed via the recovery domain 'Mastering my Illness'.

CONCLUSION

The results of this study demonstrate that therapeutic recreation camps can provide a recovery-based approach to mental healthcare, with positive effects on the three areas of: a purposeful life; connection and belonging; and optimism and hope. Recovery Camp has been previously identified by the Productivity Commission as having potential person-centred recovery benefits for mental health consumers. The results of this study now establish these benefits as evidence based and can be used to guide mental health practice and policy for the implementation of therapeutic recreation camps for mental health recovery.

Purpose in life moderates the relationship between loneliness and caregiving stress among family caregivers of people with mental health problems

OBJECTIVE

Providing care to others can exert a profound impact on caregivers' sense of purpose or meaning in life, thereby reciprocally influencing the caregivers' overall health and well-being. This study aims to investigate whether the sense of purpose in life moderates the association between loneliness and caregiving stress among family caregivers of people with mental health problems.

METHODS

A sample of family caregivers of people with mental health problems (N = 468, 57.1 % female) drawn from the 2020 survey of the Caregiving in the U.S. was investigated. Descriptive statistics, correlation analysis, and a multiple regression with an interaction term were performed.

RESULTS

Higher levels of loneliness were associated with enhanced caregiving stress. Moreover, after demographic and care-related factors were controlled for, the association between loneliness and caregiving stress was moderated by purpose in life; namely, as the sense of purpose in life increased, so did the intensity of the relationship between loneliness and caregiving stress.

CONCLUSION

Reducing loneliness or strengthening the sense of purpose helps alleviate caregiving stress, and lonely family caregivers with a strong sense of purpose deserve extra attention.

Purpose in life and cognitive health: a 28-year prospective study

OBJECTIVES

To examine the prospective association between purpose in life measured at three points across middle and older adulthood and cognitive outcomes assessed 8-28 years later.

DESIGN

Prospective Study.

SETTING

Wisconsin Longitudinal Study of Aging (WLS).

PARTICIPANTS

WLS participants who reported on their purpose in life at Round 4 (1992-1994; Mage = 52.58), Round 5 (2003-2007; Mage = 63.74), and/or Round 6 (2010-2012; Mage = 70.25) and were administered a cognitive battery at Round 7 (2020; Mage = 79.94) were included in the analysis (N = 4,632).

MEASUREMENTS

Participants completed the Ryff measure of purpose in life and were administered the telephone interview for cognitive status and measures of verbal fluency, digit ordering, and numeric reasoning.

RESULTS

Purpose in life measured at age 52 was related to better global cognitive function and verbal fluency but unrelated to dementia at age 80. In contrast, purpose in life at ages 63-70 was associated with lower likelihood of dementia, as well as better global cognitive function and verbal fluency at age 80. The effect sizes were modest (median Beta coefficient = .05; median odds ratio = .85). A slightly steeper decline in purpose in life between ages 52 and 70 was found for individuals with dementia at age 80.

CONCLUSIONS

Purpose in life is associated with healthier cognitive function measured up to 28 years later. Individuals with lower purpose, especially in their 60s or older, and with steeper declines in purpose, are more likely to have dementia at age 80.

Purpose in life as a resilience factor for brain health: diffusion MRI findings from the Midlife in the U.S. study

Introduction

A greater sense of purpose in life is associated with several health benefits relevant for active aging, but the mechanisms remain unclear. We evaluated if purpose in life was associated with indices of brain health.

Methods

We examined data from the Midlife in the United States (MIDUS) Neuroscience Project. Diffusion weighted magnetic resonance imaging data (n=138; mean age 65.2 years, age range 48-95; 80 females; 37 black, indigenous, and people of color) were used to estimate microstructural indices of brain health such as axonal density, and axonal orientation. The seven-item purpose in life scale was used. Permutation analysis of linear models was used to examine associations between purpose in life scores and the diffusion metrics in white matter and in the bilateral hippocampus, adjusting for age, sex, education, and race.

Results and discussion

Greater sense of purpose in life was associated with brain microstructural features consistent with better brain health. Positive associations were found in both white matter and the right hippocampus, where multiple convergent associations were detected. The hippocampus is a brain structure involved in learning and memory that is vulnerable to stress but retains the capacity to grow and adapt through old age. Our findings suggest pathways through which an enhanced sense of purpose in life may contribute to better brain health and promote healthy aging. Since purpose in life is known to decline with age, interventions and policy changes that facilitate a greater sense of purpose may extend and improve the brain health of individuals and thus improve public health.

Changes in Purpose in Life and Low-Grade Chronic Inflammation Across Older Adulthood

Background: Older adults often experience an increase in low-grade chronic inflammation. Purpose in life could act as a protective factor as it is associated with beneficial health outcomes. Purpose in life may exert part of its adaptive function by promoting persistence in goal pursuit. During older adulthood, however, when many individuals experience an increase in intractable stressors and declining resources, the adaptive function of purpose could become reduced. Purpose: We examined whether the association between inter- and intra-individual differences in purpose in life and chronic inflammation differed across older adulthood. Method: We assessed four waves of data among 129 older adults (63-91 years old) across 6 years. Results: Hierarchical linear modeling demonstrated that within-person increases in purpose in life predicted reduced levels of chronic inflammation in early old age (25th percentile or 73 years, coefficient = -.016, p < .01), but not in advanced old age (75th percentile or 81 years, coefficient = .002, p = .67). Between-person differences in purpose were not related to chronic inflammation. Conclusions: These results suggest that greater within-person increases in purpose may protect health processes particularly in early old age but become less effective in advanced old age.

Examining changes in sense of purpose before, during, and after COVID-19 vaccination

Multiple studies have focused on the role of psychosocial factors as predictors of COVID-19 vaccination willingness and uptake, with less attention paid to whether vaccination itself could influence wellbeing. The current study evaluated this possibility with respect to sense of purpose, the perception one has goals and a direction in life, building on previous evidence this factor may influence vaccination willingness and decision-making. Across seven waves of monthly data from February to August 2021, participants (n = 2169, mage = 48.0 years) across Canada and the United States reported on their sense of purpose and vaccination status. Using piecewise regression models, results indicated that sense of purpose did not appear to fluctuate in the month prior to, during, or following COVID-19 vaccination. However, across most months of the survey, vaccinated participants did report greater sense of purpose relative to unvaccinated participants. These findings are discussed with respect to whether health behaviors, such as vaccination, should be viewed as behaviors indicative of leading a purposeful life.

Relationships Between Meaning in Life and Positive and Negative Spirituality in a Field Setting in Japan

This study examined the relationships between positive/negative spirituality and meaning in life at two religious sites in Japan. Participants reported greater sadness and less meaning in life at Koyasan Okunoin, a temple with graves surrounded by nature, than at Nachi Kumano Taisha, a shrine with a waterfall. However, greater feelings of happiness protected meaning in life in the presence of sadness at Koyasan. Additionally, participants who felt a sense of awe reported greater meaning in life through self-liberation, regardless of the sites. The results provide new insights into meaning in life from the two sides of spirituality.

Can Creativity and Cognitive Reserve Predict Psychological Well-Being in Older Adults? The Role of Divergent Thinking in Healthy Aging

The maintenance of psychological well-being (PWB) in the older adult population is a pivotal goal for our rapidly aging society. PWB is a multicomponent construct that can be influenced by several factors in the lifespan. The beneficial role of divergent thinking (DT) and cognitive reserve (CR) in sustaining older subjects' PWB has been scarcely investigated so far. The present study aims to investigate the relationships between DT, CR, and PWB in a sample of 121 healthy older adults (61 females; M age: 73.39 ± 6.66 years; M education: 11.33 ± 4.81 years). The results highlight that better DT performance predicts higher CR, which mediates an indirect positive effect of DT on emotional competence, one of the PWB factors. It follows that DT and CR can be considered protective factors in aging, and their effects go beyond cognitive functioning, revealing a positive effect even on some PWB components. The practical implications regarding targeted health interventions for prevention in the older adult population to support well-being and promote healthy aging are discussed.

Purpose in life and stress: An individual-participant meta-analysis of 16 samples

Background

Purpose in life is a psychological resource that has been associated with better regulation of stress. The present research reports a coordinated analysis of the association between purpose in life and subjective stress and evaluates potential sociodemographic and mental health moderators of this association.

Methods

With individual participant data from 16 samples (total N=108,391), linear regression examined the association between purpose in life and general subjective feelings of stress, controlling for sociodemographic characteristics.

Results

Greater purpose in life was associated with less subjective stress (meta-analytic estimate=-.228, 95% Confidence Interval=-.292, -.164; p<.001). Interaction terms between sociodemographic factors and purpose tested in the individual samples and synthesized with meta-analysis were not significant, which indicated that the association between purpose and stress was similar across age, sex, race, ethnicity, and education. The association was also not moderated by psychological distress. Meta-regressions further indicated that this association was generally similar across scale length, content of the purpose measure, and across samples from Eastern and Western countries.

Limitations

The associations reported are observational. Experimental work is needed to evaluate causality.

Conclusions

Purpose in life is associated with less subjective stress across populations. Less subjective stress may be one mechanism through which purpose contributes to better mental and physical health.

Contributions of Eudaimonic Well-Being to Mental Health Practice

Purpose

Synergies between a eudaimonic model of psychological well-being (Ryff, 1989) and mental health practice are examined. The model grew out of clinical, developmental, existential, and humanistic perspectives that emphasized psychological strengths and capacities, in contrast to the focus on emotional distress and dysfunction in clinical psychology.

Design/Approach

Conceptual foundations of the eudaimonic approach are described, along with the six components positive functioning that are used to measure well-being. These qualities may be important in facilitating the recovery experiences, which are of interest in Mental Health and Social Inclusion.

Findings

Four categories of empirical evidence about eudaimonia are reviewed: (1) how it changes with aging, (2) how it matters for health, (3) what are its biological and neurological underpinnings, and (4) whether it can be promoted. Major contemporary forces against eudaimonia are also considered, including ever-widening inequality, the enduring pandemic, and world-wide strife. In contrast, encounters with the arts and nature are put forth as forces for eudaimonia. The relevance of these ideas for mental health research and practice is considered.

Originality

Mental health is often defined as the absence of mental illness. The novelty of the eudaimonic approach is to define mental health as the presence of well-being, assessed with different components of positive functioning.

Practical Implications

Enormous suffering defines our contemporary world. Such realities call for greater attention to factors that undermine as well as nurture the realization of human potential, the core of eudaimonic well-being.

Healthy Eating as Potential Mediator of Inverse Association between Purpose in Life and Waist Circumference: Emerging Evidence from US and Chilean Cohorts

High sense of purpose in life, a fundamental domain of eudaimonic well-being, has been consistently associated with lower risk for various obesity-related chronic diseases. Although this psychological feature correlates with some health behaviors as potential mediators, its association with healthy eating remains less explored. In addition, studies of these psycho-behavioral and health relationships in the South American population are lacking. This research sought to assess: (1) the cross-sectional association between self-reported purpose in life and overall healthy eating patterns, and (2) healthy food intake as a potential mediator of the inverse relationship between purpose in life and waist circumference. Data collected of 2060 US adults from the MIDUS study (5 ± 12 years, 55% women, mostly white people, and 42.5% obese) and 223 Chilean adults from the CHILEMED study (46.6 ± 9 years, 58.3% women, and 71.3% obese) were used. Anthropometric and sociodemographic variables were collected. Sense of purpose was assessed using the purpose in life subscale of the Ryff's psychological well-being questionnaire. Diet quality was evaluated using healthy eating or low-fat diet indexes, according to extant food intake data in each cohort. The relationship between these variables was estimated by bivariate and multivariate linear regressions with appropriate adjustments. To establish whether a better diet quality could mediate a link of purpose in life and improved nutritional status (assessed by waist circumference), the association between these three variables was tested by bootstrapping-based mediation analysis. Our results show significant associations of sense of purpose with healthy eating and low-fat dietary patterns in both US and Chilean cohorts, respectively, even after adjusting for sociodemographic variables. According to the mediation analysis, the relationship between sense of purpose and waist circumference, as an indicator of abdominal obesity, appears to be partially mediated by healthier food intake in both samples. In conclusion, our findings suggest a plausible mechanism underlying the favorable impact of this well-being dimension on physical health. Given its protective effects, interventions aimed at increasing purpose in life may facilitate adherence to better dietary patterns, which, in turn, will reduce the risk for obesity-related chronic diseases.

Purpose in life and markers of immunity and inflammation: Testing pathways of episodic memory

OBJECTIVE

This prospective cohort study examines whether purpose in life is associated with markers of immunity and inflammation and tests these markers as mediators between purpose and episodic memory.

METHODS

Participants from the Venous Blood Study of the Health and Retirement Study reported on their purpose in life, had their blood assayed for markers of immunity and inflammation, and were administered an episodic memory task (N = 8999). Regression analyses tested the association between purpose and each marker. Prospective mediation analyses (N = 6092) tested whether these markers measured in 2016 were mediators between purpose measured in 2012/2014 and episodic memory measured in 2018.

RESULTS

Higher purpose in life was associated with lower neutrophil counts (β = -0.08, p < .001), lower ratio of neutrophils/lymphocytes (β = -0.05, p < .001), and lower systemic immune inflammation index (β = -0.04, p < .001); purpose was unrelated to monocyte, platelet, and lymphocyte counts or the ratio of platelets/lymphocytes (all ns). Purpose was associated negatively with c-reactive protein (β = -0.07, p < .001), Interleukin-6 (β = -0.08, p < .001), Interleukin-10 (β = -0.07, p < .001), Interleukin-1ra (β = -0.08, p < .001), and soluble Tumor Necrosis Factor Receptor 1 (sTNFR1; β = -0.10, p < .001); purpose was unrelated to Transforming Growth Factor beta 1. These associations were largely not moderated by age, sex, race, ethnicity, and education. Lower neutrophils, Interleukin-6, and sTNFR1 were associated prospectively with better episodic memory and mediated the association between purpose and episodic memory.

CONCLUSION

Purpose in life is associated with markers of immunity and inflammation, some of which are one mechanism in the pathway between purpose and healthier episodic memory.

The longitudinal directional associations of meaningful work with mental well-being - initial findings from an exploratory investigation

BACKGROUND

An increasing number of studies reveal that more meaning in life is positively related to mental well-being. Meaning in life can be derived from different sources, including the workplace. The aim of this study was to explore the longitudinal directional association of meaningful work with mental well-being.

METHODS

Prospective data from 292 persons at two timepoints (two-week interval) were used to estimate the cross-lagged relationship and directionality of meaningful work with mental well-being.

RESULTS

The cross-lagged panel model had a good fit to the data (Chi2 ms(90) = 150.9; p < 0.001; RMSEA = 0.048; p = 0.576; CFI = 0.984; TLI = 0.979; SRMR = 0.040) and showed that levels of meaningful work at t1 had a positive effect on mental well-being at t2 (β = 0.15, p = 0.010). But mental well-being at t1 did not affect meaningful work at t2 (β = 0.02, p = 0.652). Sub-analyses revealed the effects to be mainly driven by women (as opposed to men) and white-collar workers (as opposed to blue-collar workers).

CONCLUSION

This study confirmed a directional association of meaningful work on mental well-being, indicating that more meaningful work has beneficial mental well-being effects.

Mediterranean diet and psychological well-being intervention to reverse metabolic syndrome in Chile (CHILEMED trial)

Psychosocial status and lifestyle are key risk factors of non-communicable diseases (NCDs), which, in turn, are main drivers of healthcare costs and morbimortality worldwide, including Chile. Mediterranean diet (MedDiet) is one of the healthiest dietary patterns under study. However, its impact on high-risk conditions, such as metabolic syndrome (MetS), and NCDs outside the Mediterranean Basin remains mostly unexplored. Even though Central Chile has an environment, food production, and culinary traditions comparable to those present in Mediterranean countries, few studies -some with significant methodological limitations- have evaluated the effect of MedDiet on health and/or disease in Chilean subjects. Importantly, a Mediterranean lifestyle is a modus vivendi that integrates physical health with mental and social well-being. Psychological well-being (PWB) is associated with healthy behaviors, positive health outcomes, and longevity, thereby emerging as a novel healthcare goal. We report here an ongoing randomized controlled clinical trial in Chilean patients with MetS seeking to test whether (1) a PWB theory-based intervention facilitates induction to and increases long-term adherence to a locally adapted MedDiet, and (2) a MedDiet intervention -implemented alone or combined with well-being promotion- is more effective at reversing MetS compared to individuals following a low-fat diet without psychological support. The CHILEan MEDiterranean (CHILEMED) diet intervention study is a 1-year trial including patients with MetS living in Chile. Participants will be assigned randomly by a computer-generated random number sequence to one of the three intervention arms: a) low-fat diet as control group, b) MedDiet alone, and c) MedDiet plus well-being support. Patients will be followed-up by individual and/or group online nutritional sessions or phone cal as well as 6- and 12-month in-person re-assessment of medical history, medication use, food intake, PWB, anthropometrics/physical exam, and blood collection for laboratory analysis. The primary outcome of the trial will be the effect of the MedDiet -with or without PWB intervention- on overall reversal of MetS compared to low-fat diet alone. Based on a statistical superiority trial, expected impact, and patient loss, the estimated study sample is 339 subjects (113 individuals per arm in 3 equal-sized groups). Currently, we have enrolled 179 patients, predominantly women, evenly distributed by age (group means ranging from 45.7 to 48,9 years-old), 3/4 are obese with almost all of them showing abdominal obesity, 70% are hypertensive, whereas <10% exhibit diabetes. If findings turn out as expected (e.g., MedDiet -with or without PWB intervention- is better than the low-fat diet for reversion of MetS at 1-year follow-up), CHILEMED will provide further beneficial evidence of the MedDiet on NCD risk conditions beyond the Mediterranean region.

Purpose in life as an asset for well-being and a protective factor against depression in adolescents

Purpose in life, which is a central component of the eudaimonic paradigm of well-being, has been sparsely examined in adolescence. This is unfortunate as adolescence is characterised by identity development and is a key period for the onset of mental disorders. To inform future research on well-being and purpose in life in adolescents, we drew factors from several fields of research, including mental health and psychological factors, and explored which factors were most strongly associated with purpose in life. Data were collected in a sample of 444 Italian adolescents (Mage = 16.30 [SD = 1.50], range: 14 to 20 years; 58% girls) and associations with mental health (stress, anxiety, depression, anger), psychological traits (mindfulness, self-hate, self-inadequacy, self-reassurance, isolation), and sociodemographic variables (age, sex, place of birth) were examined. Regression, dominance, and network analyses indicated that a stronger sense of purpose in life was associated with lower depressive symptoms, higher levels of self-reassurance, and being born in Italy. Our findings suggest that purpose in life is an important asset for well-being in adolescents and may protect against depression. Future longitudinal and/or experimental research should examine the potential protective role of purpose in life in relation to adolescent depression and how self-reassurance and sociodemographic factors (e.g., immigrant background) are involved.

The impact of gratitude interventions on patients with cardiovascular disease: a systematic review

Positive psychological factors play a pivotal role in improving cardiovascular outcomes. Gratitude interventions are among the most effective positive psychological interventions, with potential clinical applications in cardiology practice. To better understand the potential clinical effects of gratitude interventions in cardiovascular disease, four databases (Web of Science, Scopus, PubMed, and PsycArticles) were searched from 2005 to 2023 for relevant studies. Randomized controlled trials of gratitude interventions as the intervention and that reported physiological or psychosocial outcomes were eligible for inclusion. In total, 19 studies were identified, reporting results from 2951 participants from 19 to 71 years old from both healthy populations and those with clinical diagnoses. The studies showed that gratitude not only promotes mental health and adherence to healthy behaviors but also improves cardiovascular outcomes. Gratitude may have a positive impact on biomarkers of cardiovascular disease risk, especially asymptomatic heart failure, cardiovascular function, and autonomic nervous system activity.

Reduced Epigenetic Age in Older Adults With High Sense of Purpose in Life

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.

Associations for Sense of Purpose with Smoking and Health Outcomes Among Adults with Diabetes

BACKGROUND

Health complications from diabetes place major strain on individuals, financially and emotionally. The onset and severity of these complications are largely driven by patients' behaviors, making psychosocial factors that influence behaviors key targets for interventions. One promising factor is sense of purpose or the degree to which a person believes their life has direction.

METHOD

The current study investigated whether sense of purpose predicts self-rated health, cardiovascular disease, and smoking status among adults with diabetes concurrently and prospectively. Moreover, it tested whether these associations held across multiple samples and cultures. Coordinated analysis using 12 datasets cross-sectionally and eight longitudinally (total N = 7277) estimated the degree to which sense of purpose is associated with subjective health, smoking status, and cardiovascular disease among adults with diabetes. Coordinated analysis allows for greater generalizability of results across cultures, time periods, and measurement instruments. Datasets were included if they concurrently included a measure of sense of purpose and diabetes status and at least one health measure: self-rated health, current smoking status, or heart condition status.

RESULTS

Sense of purpose was associated with higher self-rated health, smoking status, and cardiovascular disease cross-sectionally and self-rated health prospectively. Purpose was unassociated with changes in health over time.

CONCLUSION

These results highlight the relationship of a key individual difference, sense of purpose, to the behaviors and outcomes of adults with diabetes. While more research is needed to determine the boundaries of this relationship, it seems sense of purpose may be considered in the future as a potential target for intervention.

The pursuit of health: A vitality based perspective

The larger number of adults who enter their senior years with a high burden of chronic diseases has led to new metrics designed to promote health pro-activity, such as the calculation of one's "healthspan". These efforts call for re-evaluation as to what is meant by "health". A large body of epidemiologic and clinical investigation identifies that good health is shaped by specific health behaviors (aerobic exercise, resistance training, sleep, and good diet quality) and four psychological determinants (positive emotions, positive mindsets, purposeful living, and social connectivity). In common, each of these determinants produce "vitality", which can be defined as having the pleasing sensation of feeling energetic. Having a strong sense of vitality produces a sense of agency, provides resilience, and serves as a leading indicator of good health. Importantly, vitality can be assessed as a single item "vital sign" in clinical practice and can be promoted by recommending simple steps to patients, such as suggesting that they initiate walking or other aerobic activities. Because health habits and psychological determinants of health are inter-related, such simple steps can initiate a "virtuous cycle" of health improvement. An emphasis on vitality can also encourage patients to become more cognizant of their level of energy and manage it through health-promoting behaviors rather than quick fix behaviors. Finally, vitality assessment and prescription can promote more successful aging. In sum, an updated and more clinically useful definition of health recognizes that it is a dynamic entity that is influenced at any time by one's engagement in physical and psychological practices that promote health. Accordingly, an updated definition of health is proposed: good health is characterized by physical and psychological well-being and is associated with vitality.

Negative health outcomes in depressed cardiac patients are associated with both low and high psychological well-being dimensions

Literature supports the positive effects of psychological well-being (P.W.B.) on health. However, most studies focused on the unitary construct of P.W.B., neglecting the different role played by distinct P.W.B. dimensions on health-related outcomes. The aim of this study was to determine whether unbalanced (i.e. low or high) levels of P.W.B. dimensions could differentially affect cardiac course after acute coronary syndrome (A.C.S.), in terms of participation in secondary prevention (S.P.) and/or survival. The sample included 136 depressed and/or demoralized A.C.S. patients referred for a S.P. program on lifestyle modification, in addition to routine cardiac visits provided by the hospital where they were admitted. Psychological assessment included validated interviews on depression and demoralization, Symptom Questionnaire and Psychological Well-Being scales. 100 patients joined the S.P. program, 36 did not. Logistic regression revealed that older age (B = 0.051; p < 0.05), higher autonomy (B = 0.070; p < 0.05) and lower personal growth (B = -0.073; p < 0.05) levels were associated with non-participation in S.P. Moreover, only among patients who did not join the program, those presenting with an impaired level of P.W.B. 'positive relations' dimension (i.e. below the 25^th percentile) showed a worse cardiac prognosis (Log Rank: χ²₍₁₎ = 4.654; p = 0.031). Negative health outcomes in depressed cardiac patients, such as non-participation in S.P. and worse cardiac course, are associated with both high and low levels of certain P.W.B. dimensions. Psychotherapeutic approaches geared to a balance in P.W.B. dimensions could represent promising new additions to S.P. programs.

Older Adults Place Greater Importance Than Younger Adults on a Purposeful Retirement

Objective: Regarding retirement, some but not all people decline in sense of purpose, and retirees may view maintaining a sense of purpose as nonessential. These findings suggest individual differences both in the importance placed on being purposeful during retirement in general and the discrepancy for purpose importance prior to and during retirement. Method: This study surveyed U.S. adults (n = 2009, M_age = 48.51) asking them about how they viewed having a purpose in two life stages: before and during retirement, as well as personality and demographic questions. Results: Findings suggest that, overall, people believe it is important to have a purpose and direction during retirement. This tendency was greater among older adults, and those higher on conscientiousness or lower on neuroticism. However, working status did not play a role in the perceived importance of purpose during the retirement period. Moreover, age differentiated who perceives during-retirement purpose as more important than prior-to-retirement purpose. Conclusion: The current findings add to our understanding of when individuals expect to be purposeful and counter the claims that older adults may place less importance on being purposeful. Instead, these findings point to the need for continuing work on how to help older adults maintain or find a purpose in life following retirement.

Interventions to Modify Psychological Well-Being: Progress, Promises, and an Agenda for Future Research

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.

The PATHS to Purpose: A New Framework Toward Understanding Purpose Development

Academic and lay interest has accrued over recent years with respect to how people develop a purpose in life. However, few theoretical models exist for understanding this developmental process as well as how to connect one’s overarching purpose in life to their daily feelings of purposefulness. The current article presents the PATHS (Purpose As Trait, Habit, and State) model, borrowing from clinical and personality development literatures. This framework allows researchers to consider purpose as a more enduring life direction (trait level), as an automatized routine acting in accordance with one’s goals (habit level), and as a more momentary reflection or feeling that one is engaged in purposeful pursuits (state level). Using this framework provides researchers with a valuable tool toward explaining how people progress toward purpose, via natural development or intervention, as well as the potential influences in this process.

Sense of purpose as a potential buffer between mental health and subjective cognitive decline

OBJECTIVES

Purposeful adults may experience greater cognitive resilience because sense of purpose may help buffer against the effects of depressive symptoms and loneliness. We also evaluated whether these associations differed by race.

DESIGN

This study uses a wave of self-report data from the SPAN study of psychosocial aging.

SETTING

Participants come from a representative sample of older adults in St. Louis.

PARTICIPANTS

Participants (N = 595) ages range from 65 to 78 (Mage = 71.46), with 18.3% of participants identifying as Black/African-American.

MEASURES

Sense of purpose was assessed with the Life Engagement Test, depressive symptoms with the Beck Depression Inventory-II, loneliness with the UCLA Loneliness Scale, and subjective cognitive decline with the AD-8.

RESULTS

Correlational analyses supported predictions that sense of purpose was negatively related to subjective cognitive decline, whereas depressive symptoms and loneliness were positively related (|r|s > .30, ps < .001). For loneliness, but not depression, this association was moderated by sense of purpose (b = -0.43, p < .001). A relatively high sense of purpose attenuated associations between loneliness and subjective cognitive decline. A three-way race × purpose × loneliness interaction (b = -0.25, p = .021) revealed that the buffering effects of sense of purpose on subjective cognitive decline were stronger for Black adults.

DISCUSSION

This study provided partial support for the buffering hypothesis, showing that sense of purpose may help mitigate the cognitive decrements associated with loneliness. Future research needs to consider how purpose-promoting programs may support healthy cognitive aging, particularly among Black older adults and those who experience greater social isolation.

Purpose in life and 8-year mortality by gender and race/ethnicity among older adults in the U.S

We examined the associations between a sense of purpose and all-cause mortality by gender and race/ethnicity groups. Data were from the Health and Retirement Study, a nationally representative cohort study of U.S. adults aged >50 (n = 13,159). Sense of purpose was self-reported at baseline (2006/2008), and risk of all-cause mortality was assessed over an 8-year follow-up period. We also formally tested for potential effect modification by gender and race/ethnicity. We observed the associations between higher purpose and lower all-cause mortality risk across all gender and race/ethnicity groups. There was modest evidence that the highest level of purpose (versus lowest quartile) was associated with even lower risk of all-cause mortality among women (risk ratio = 0.66, 95% confidence interval: 0.56, 0.77) compared to men (risk ratio = 0.80, 95% confidence interval: 0.69, 0.93; p-value for multiplicative effect modification =0.07). However, we observed no evidence of effect modification by race/ethnicity. Having a higher sense of purpose appears protective against all-cause mortality regardless of gender and race/ethnicity. Purpose, a potentially modifiable factor, might be a health asset across diverse populations.

What makes life purposeful? Identifying the antecedents of a sense of purpose in life using a lagged exposure-wide approach

Aims

Prior research documents strong associations between an increased sense of purpose in life and improved health and well-being outcomes. However, less is known about candidate antecedents that lead to more purpose among older adults.

Methods

We used data from 13,771 participants in the Health and Retirement Study (HRS) — a diverse, national panel study of adults aged >50 in the United States, to evaluate a large number of candidate predictors of purpose. Specifically, using linear regression with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (between t₀;2006/2008 and t₁;2010/2012) were associated with purpose four years later (t₂;2014/2016) after adjustment for a rich set of baseline covariates.

Results

Some health behaviors (e.g., physical activity ≥1x/week [β = 0.14, 95% CI: 0.09, 0.19]), physical health conditions (e.g., stroke [β = −0.25, 95% CI: −0.40, −0.10]), and psychosocial factors (e.g., depression [β = −0.21, 95% CI: −0.27, −0.15]) were associated with subsequent purpose four years later. However, there was little evidence that other health behaviors, physical health conditions, and psychosocial factors such as smoking, drinking, or financial strain, were associated with subsequent purpose.

Conclusions

Several of our candidate predictors such as volunteering, time with friends, and physical activity may be important targets for interventions and policies aiming to increase purpose among older adults. However, some effect sizes were modest and contrast with prior work on younger populations, suggesting purpose may be more easily formed earlier in life.

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Factors that lead to increased purpose in life in older adults remain unclear.

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We leveraged a large and prospective cohort of US adults aged >50.

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We evaluated associations between 61 predictors and subsequent purpose in life.

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Some health/well-being factors were associated with purpose in life 4 years later, but not others.

Purposeful retirement expectations and their associations with retirement planning

OBJECTIVE

Previous research has demonstrated that retirees tend to report lower levels for sense of purpose compared to working adults. However, it remains unclear whether adults show differences in the extent to which they expect to be purposeful during retirement, and what that may mean for the propensity to plan for retirement.

METHOD

The current study examined this question in a cross-sectional sample of 492 adults (Age: M = 39.28, SD = 8.35) prior to retirement. Participants completed an adapted measure to capture expected purposeful engagement during retirement, along with sense of purpose, retirement planning, and the Big Five personality traits.

RESULTS

Factor analyses and zero-order correlations suggested that purposeful retirement perceptions are related yet distinct from sense of purpose in general, and adults on average expect a moderately purposeful retirement. Purposeful retirement scores were associated with multiple retirement planning scales, and remained predictive of retirement preparation even when accounting for the Big Five and demographic factors.

CONCLUSION

Adults differ in how purposeful they expect to be during their future retirement. Moreover, these differences may be a valuable consideration when understanding how to promote retirement planning.

Can adherence to moral standards and ethical behaviors help maintain a sense of purpose in life? Evidence from a longitudinal study of middle-aged and older adults

Personal factors, such as character strengths, have been shown to be favorably associated with concurrent and future well-being. Positive associations have also been reported between purpose in life and concurrent and subsequent health and well-being. Evidence on antecedents of purpose in life is, however, limited. This study examines whether the adherence to moral standards and ethical behaviors (AMSEB) is associated with subsequent purpose in life. Data from the Health and Retirement Study obtained from a sample of 8,788 middle-aged and older adults in the US (mean age = 64.9 years, age range 50–96 years) were used. The prospective associations between AMSEB and purpose in life were examined using generalized linear models. A rich set of covariates and prior outcomes were used as controls to reduce the risk of reverse causation. The robustness analyses included computation of sensitivity measures, E-values, and running a set of secondary analyses conducted on subsamples of respondents and using a limited set of covariates. It was found that middle-aged and older adults who demonstrated higher AMSEB reported a higher sense of purpose in life after the 4-year follow-up period. This association was found to be monotonic, moderately robust to potential unmeasured confounding and independent of demographics, prior socioeconomic status, prior health conditions, and health behaviors as well as prior psychological predispositions such as dispositional optimism and life satisfaction. It was also robust to missing data patterns. Policymakers and health practitioners may consider a predisposition to adherence to moral standards and ethical behaviors as a potential intervention target, as its improvement and/or maintenance has the potential to improve longevity and to help promote healthy and purposeful aging.

Effect of Stanford Youth Diabetes Coaches' Program on Youth and Adults in Diverse Communities

The Stanford Youth Diabetes Coaches' Program (SYDCP) trains high school students to become diabetes coaches for friends and adult family members. The objective of this study was to assess effects of SYDCP participation on youth and adults from a rural and urban underserved high school community. We used a mixed-methods approach. Patient-Reported Outcomes Measurement Information System (PROMIS) measures for Pediatric Sense of Meaning and Purpose were measured in high school students. PROMIS Adult Global Health and Self-Efficacy was measured in coached adults. Paired t tests compared pre- and postintervention and 6-month follow-up scores. Thematic analysis was used to analyze focus group discussion of adults. Twenty-five students participated, 15 students coached adults with diabetes or prediabetes. Students' sense of meaning and purpose significantly improved postintervention compared to preintervention. Diet and physical activity behaviors improved. Adolescent-adult relationships mediated participation benefits. Our study showed SYDCP improved adolescents' sense of meaning and purpose. In addition, youth and adult relatedness led to improved health behaviors. These findings have important implications, as a sense of purpose and youth-adult connectedness are associated with health behaviors and psychological well-being. Further larger studies of health education programs that engage related youth-adult dyads and assess long-term behaviors and health outcomes are needed.

Sense of purpose in life and inflammation in healthy older adults: A longitudinal study

BACKGROUND

A higher sense of purpose in life has been linked with reduced risk of age-related chronic health conditions that share elevated inflammation as a key risk factor (e.g., neurodegenerative diseases, heart disease, and diabetes). While prior research has documented cross-sectional associations between higher sense of purpose and lower inflammation, few studies have examined the association between purpose and changes in inflammation over time.

OBJECTIVE

We tested if a higher sense of purpose was prospectively associated with lower likelihood of developing unhealthy C-reactive protein levels in older adults who initially had healthy CRP levels (i.e., <3 ug/mL).

METHODS

Participants were 6925 adults aged > 50 in the Health and Retirement Study who were followed for 8 years. Participants completed the purpose in life subscale of the Ryff Psychological Well-being Scales at study baseline in 2006/2008. CRP was obtained from blood spots collected at baseline and after 4 and 8 years of follow-up. Pooled logistic regression estimated discrete-time hazard ratios (HR) and 95% confidence intervals (CI) for the association between baseline purpose and onset of unhealthy CRP levels (>3 ug/mL).

RESULTS

There was no strong evidence of an association between baseline continuous purpose scores and onset of unhealthy CRP levels over time in the overall analytic sample. In sex-stratified models, higher purpose was associated with lower hazards of developing unhealthy CRP levels among men, while associations were null in women (e.g., in sociodemographics-adjusted model, men: HR=0.89, 95% CI: 0.79-0.99; women: HR=0.96, 95% CI: 0.85-1.08; interaction between continuous purpose scores and sex p = 0.15).

CONCLUSIONS

Findings suggest that a higher versus lower sense of purpose is associated with lower inflammation levels in older men. In specific populations, purpose may serve as a novel target for future interventions aimed at reducing inflammation.

Association between health literacy and purpose in life and life satisfaction among health management specialists: a cross-sectional study

Purpose in life is anchored as a goal in national health promotion plans in several countries. Health literacy is the ability to find, understand, use, and evaluate health-related information; this ability has been investigated in terms of its effect on health outcomes and is said to play a critical role in health promotion. In the context of national health promotion, the effect of health literacy on purpose in life and life satisfaction remains unclear; therefore, this study aims to determine the effect of health literacy. A cross-sectional study was conducted on Japanese health management specialists (N = 1920). Health literacy was measured using the Communicative and Critical Health Literacy scale. Purpose in life and life satisfaction were measured using the Ikigai-9 scale and a Likert scale, respectively. We analyzed the associations between health literacy and purpose in life and life satisfaction with regression analyses. Age, sex, income, education, marital status, psychological stress, and diseases as present illness were adjusted in the statistical models. Our multiple linear regressions indicated that health literacy was significantly associated with purpose in life (β = 0.199, p < 0.001), after adjusting for covariates (age, sex, income, education, marital status, psychological factor, and disease status). Life satisfaction was also significantly associated with health literacy (β = 0.126, p < 0.001). Health literacy is associated with purpose in life and life satisfaction among specialists in health management. Health literacy plays a critical role in lifestyle-related disease prevention and health promotion. Interventions to improve health literacy may be warranted in the context of national health promotion.

Negative marital interaction, purpose in life, and depressive symptoms among middle-aged and older couples: evidence from the Health and Retirement Study

OBJECTIVE

Negative marital interaction and purpose in life have been associated with depressive symptoms. Yet, these associations have not been fully explored in a dyadic context. This study examines the actor (intra-individual) and partner (cross-spousal) effects of negative marital interaction on depressive symptoms in couples and the potential mediating role of purpose in life.

METHODS

Data came from 1186 heterosexual married couples who participated in the 2016 (T1) and 2018 (T2) waves of the Health and Retirement Study and completed the psychosocial questionnaire in 2016. Structural equation modeling was used to estimate the direct and indirect associations among T1 negative marital interaction, T1 purpose in life, and T2 depressive symptoms at the actor and partner levels. Models controlled for age, race, educational level, self-rated health, and length of marriage.

RESULTS

At the actor level, a greater negative marital interaction was associated with significantly lower levels of purpose in life for husbands and wives. Negative marital interaction was also associated with depressive symptoms for wives. Purpose in life mediated the relationship between negative marital interaction and depressive symptoms. At the partner level, wives' negative marital interaction was negatively associated with husbands' purpose in life, independent of husbands' own effects.

CONCLUSION

The findings support the dominant marital discord model of depression and highlight gender differences in the cross-spousal effects of negative marital interaction on purpose in life. Positive psychology interventions can be beneficial to promote purpose in life and subsequently improve mental health outcomes among couples.

Ikigai and subsequent health and wellbeing among Japanese older adults: Longitudinal outcome-wide analysis

Background

Methods

Findings

Interpretation

Funding

Sense of Purpose in Life and Markers of Hearing Function: Replicated Associations across Two Longitudinal Cohorts

INTRODUCTION

A sense of purpose in life is a psychological resource that is associated with healthier outcomes. The present research examines whether a greater sense of purpose in life is associated with subjective and objective markers of hearing health and whether hearing acuity contributes to the association between purpose and episodic memory. We sought to evaluate whether these associations were replicable across 2 independent samples.

METHODS

Participants in the Health and Retirement Study (N = 14,291) and the English Longitudinal Study of Ageing (N = 8,844) reported on their purpose in life and perceived hearing quality at baseline. Hearing acuity was measured using an audiometer 2-4 years later, and episodic memory was measured at baseline and 6-8 years later.

RESULTS

In both samples, higher purpose in life was associated with better hearing quality measured concurrently, lower risk of either subjective or objective hearing impairment, and hearing acuity accounted for some of the longitudinal relation between sense of purpose and better episodic memory.

DISCUSSION

Across samples, measures, and analytical approaches, the present research indicates replicable associations between sense of purpose in life and hearing health. It further indicates that hearing may be one factor that associates purpose with better episodic memory.

Life satisfaction and coronary atherosclerosis: The SCAPIS study

BACKGROUND

There is an increasing interest in the potential health benefits of positive psychological states, especially with regard to cardiovascular health. Life satisfaction is thought to be a constituent component of psychological well-being; however, among the few previous studies that have investigated its associations with early stages of the cardiovascular disease process, only one small study has focused on coronary atherosclerosis. The present study aimed to explore associations between life satisfaction and coronary artery disease.

METHODS

The study used cross-sectional data from SCAPIS Malmö (n = 6251 randomly selected men and women, aged 50-64 years), including assessment of life satisfaction and coronary artery calcification. Adjustments were made for sociodemographic factors, depression, and cardiovascular risk factors as assessed with the SCORE instrument.

RESULTS

Higher levels of life satisfaction were associated with lower odds of increased coronary artery calcification. This association persisted after adjusting for sociodemographic factors and depression, but lost significance after adjusting for cardiovascular risk factors. Sub-analyses revealed a significant dose-response relationship between higher life satisfaction and lower grade of coronary calcification in all investigated coronary artery regions.

CONCLUSION

In this population-based sample, life satisfaction was associated with better coronary artery health. However, this association was largely explained by cardiovascular risk factors, indicating that life satisfaction is linked to coronary atherosclerosis through a decreased load of cardiovascular risk factors.

Sense of purpose in life, cognitive function, and the phenomenology of autobiographical memory

There are individual differences in the phenomenological re-experiencing of autobiographical memories. We examine whether sense of purpose in life and cognitive function are associated with the phenomenology of a recent memory related to the coronavirus pandemic. Participants reported on their sense purpose and completed tasks that measured processing speed and visuospatial ability before the pandemic in January-February 2020 and subsequently retrieved and rated a memory related to the pandemic in July 2020 (N=796; M_age=58.05, SD=14.14, range 19-85). Participants with a greater sense of purpose reported memories that were more phenomenologically rich (e.g., more vivid, coherent, accessible), whereas cognitive function was primarily related to greater perceived accessibility of the memory but not to most other aspects of phenomenology. The pattern of associations was similar when accounting for depressive symptoms, and none of the associations was moderated by age. The present research suggests that individuals with a higher sense of purpose in life have autobiographical memories with richer phenomenology. To the extent that memories function to sustain well-being, social connections, and cognitive health, rich phenomenology may be one pathway through which purpose leads to these better outcomes.

Sense of Purpose in Life and Subsequent Physical, Behavioral, and Psychosocial Health: An Outcome-Wide Approach

PURPOSE

Growing evidence indicates that a higher sense of purpose in life (purpose) is associated with reduced risk of chronic diseases and mortality. However, epidemiological studies have not evaluated if change in purpose is associated with subsequent health and well-being outcomes.

DESIGN

We evaluated if positive change in purpose (between t₀; 2006/2008 and t₁;2010/2012) was associated with better outcomes on 35 indicators of physical health, health behaviors, and psychosocial well-being (at t₂;2014/2016).

SAMPLE

We used data from 12,998 participants in the Health and Retirement study-a prospective and nationally representative cohort of U.S. adults aged >50.

ANALYSIS

We conducted multiple linear-, logistic-, and generalized linear regressions.

RESULTS

Over the 4-year follow-up period, people with the highest (versus lowest) purpose had better subsequent physical health outcomes (e.g., 46% reduced risk of mortality (95% CI [0.44, 0.66])), health behaviors (e.g., 13% reduced risk of sleep problems (95% CI [0.77, 0.99])), and psychosocial outcomes (e.g., higher optimism (β = 0.41, 95% CI [0.35, 0.47]), 43% reduced risk of depression (95% CI [0.46, 0.69]), lower loneliness (β = -0.35, 95% CI [-0.41, -0.29])). Importantly, however, purpose was not associated with other physical health outcomes, health behaviors, and social factors.

CONCLUSION

With further research, these results suggest that sense of purpose might be a valuable target for innovative policy and intervention work aimed at improving health and well-being.

Prevalence and Prognostic Value of Psychological Stress Events in Patients with First Myocardial Infarction-Long-Term Follow-Up Study

While there is good evidence that symptoms of depression determine prognosis of patients with coronary heart disease (CHD), the role of psychological stress is less clear. We evaluated the prognostic value of stressful events in patients with initial myocardial infarction (MI) with respect to subsequent cardiovascular events. The KAROLA-study included patients with CHD who participated in an in-patient rehabilitation program. A total of 577 patients with initial MI were included and self-reported psychological stressful events before their MI was assessed by a structured questionnaire. Hazard ratios were used to evaluate the long-term association of stressful events with secondary cardiovascular events. Additionally, associations of stressful events with depression, anxiety and other cardiovascular risk factors were investigated. Unusual stress at work (26.5%) and sleep disorder (23.4%) were the most frequently reported stressful events that occurred in the last 4 weeks before MI. However, only death of a family member showed a statistically significant increase in risk for subsequent cardiovascular events (HR: 1.59; 95%-CI: 1.01–2.50) and this result was not corrected for multiple testing. Notably, we found higher symptom scores of anxiety and depression associated with all single stressful event items. In conclusion, we found no clear patterns that psychological stressful events before MI would increase the long-term risk of subsequent adverse CHD events directly. However, we saw increased symptom scores of anxiety and depression in persons with stressful events.

Associations Between Purpose in Life and Mortality by SES

INTRODUCTION

Having a higher purpose in life has been linked to favorable health outcomes. However, little research has examined whether the purpose-health association persists across different levels of SES. This study assesses whether the association between higher purpose in life and lower mortality is similar across the levels of SES.

METHODS

A national sample of 13,159 U.S. adults aged >50 years from the Health and Retirement Study was analyzed. The baseline year was 2006‒2008. Purpose in life was assessed at baseline using Purpose in Life Subscale of the Ryff Psychological Well-being Scales. The risk of death during an 8-year follow-up was assessed. SES was measured using education, income, and wealth. Using multivariable Poisson regression, effect modification by SES was tested on both the additive and multiplicative scales. Analyses were done in 2020.

RESULTS

In analyses stratified by SES, people with the highest level of purpose consistently tended to have lower mortality risk across the levels of SES than those with the lowest level of purpose. However, people with middle-range purpose levels had lower mortality risk only if they also had mid-to-high education, income, and wealth. When formally testing the effect modification by SES, there was modest evidence that the associations between higher purpose and lower mortality were stronger among individuals with high education, income, and wealth.

CONCLUSIONS

The highest level of purpose appeared protective against all-cause mortality regardless of the levels of SES. By contrast, when levels of purpose were more modest, people with lower SES may benefit less health-wise from having a purpose.

The positive influence of sense of control on physical, behavioral, and psychosocial health in older adults: An outcome-wide approach

Accumulating research indicates robust associations between sense of control and salutary health and well-being outcomes. However, whether change in sense of control is associated with subsequent outcomes has been under-evaluated. Participants (N = 12,998) were from the Health and Retirement Study-a diverse, nationally representative, and longitudinal sample of U.S. adults aged >50 years. We examined how increase in sense of control (from t₀:2006/2008 to t₁: 2010/2012) was associated with better outcomes on 35 indicators of: physical-, behavioral-, and psychosocial-health (t₂:2014/2016). We used multiple logistic-, linear-, and generalized-linear regression models and controlled for sociodemographic characteristics, personality traits, sense of control, and all outcomes in the pre-baseline wave (t₀:2006/2008). During the 4-year follow-up, people in the highest (vs. lowest) quartile of sense of control, conditional on prior sense of control, had reduced risk of mortality and improved physical-health outcomes (lower risk of: stroke, lung disease, physical limitations, cognitive impairment, chronic pain and higher self-rated health). Sense of control was related to better health-behaviors (increased physical activity, reduced sleep problems), higher psychological well-being (positive affect, life satisfaction, optimism, purpose, personal-, health-, financial-mastery), lower psychological distress (depression, hopelessness, negative affect, perceived constraints), decreased loneliness, and increased contact with friends. Sense of control was unrelated to other physical health indicators (diabetes, hypertension, heart disease, cancer, arthritis, overweight/obesity), health behaviors (binge drinking, smoking), and social factors (living with spouse/partner, frequency of contact with children and other family). These findings underscore the importance of sense of control as a potential intervention target for fostering physical-, behavioral-, and psychosocial-health.

Purposefulness and daily life in a pandemic: Predicting daily affect and physical symptoms during the first weeks of the COVID-19 response

OBJECTIVE

Sense of purpose has been associated with greater health and well-being, even in daily contexts. However, it is unclear whether effects would hold in daily life during COVID-19, when people may have difficulty seeing a path towards their life goals.

DESIGN

The current study investigated whether purposefulness predicted daily positive affect, negative affect, and physical symptoms. Participants (n = 831) reported on these variables during the first weeks of the COVID-19 response in North America.

MAIN OUTCOME MEASURES

Participants completed daily surveys asking them for daily positive events, stressors, positive affect, negative affect, physical symptoms, and purposefulness.

RESULTS

Purposefulness at between- and within-person levels predicted less negative affect and physical symptoms, but more positive affect at the daily level. Between-person purposefulness interacted with positive events when predicting negative and positive affect, suggesting that purposeful people may be less reactive to positive events. However, between-person purposefulness also interacted with daily stressors, insofar that stressors predicted greater declines in positive affect for purposeful people.

CONCLUSION

Being a purposeful person holds positive implications for daily health and well-being, even during the pandemic context. However, purposefulness may hold some consequences unique to the COVID-19 context, which merit attention in future research.

Association between healthy lifestyle practices and life purpose among a highly health-literate cohort: a cross-sectional study

BACKGROUND

The national health promotion program in the twenty-first century Japan (HJ21) correlates life purpose with disease prevention, facilitating the adoption of healthy lifestyles. However, the influence of clustered healthy lifestyle practices on life purpose, within the context of this national health campaign remains uninvestigated. This study assessed the association between such practices and life purpose, in line with the HJ21.

METHODS

We performed a nationwide cross-sectional survey on certified specialists in health management. Participants' demographic information, lifestyle, and purpose in life were measured using a validated tool. The cohort was median-split into two groups based on their clustered health-related lifestyle score. The values for health-related lifestyle and purpose were compared between the two groups and the correlation between health-related lifestyle and purpose in life was measured.

RESULTS

Data from 4820 participants were analyzed. The higher-scoring health-related lifestyle group showed a significantly higher life purpose than the lower group (35.3 vs 31.4; t = 23.6, p < 0.001). There was a significant association between the scores of clustered healthy lifestyle practices and life purpose (r = 0.401, p < 0.001). The higher-scoring health-related lifestyle group achieved a higher life purpose than the lower-scoring group. This association between healthy lifestyle practices and life purpose denotes a positive and linear relationship.

CONCLUSIONS

Our results suggest that individuals who have a better health-related lifestyle gain a higher sense of life purpose. In other words, a healthy lifestyle predicts a purpose in life. Our findings posit that examining the causal relationship between healthy lifestyle and purpose in life may be a more efficient approach toward health promotion.

Resilient Aging: Psychological Well-Being and Social Well-Being as Targets for the Promotion of Healthy Aging

Population aging is one of the most important social trends of the 21st century and in the United States, the number of people aged ≥65 is projected to increase by nearly 50% in the next 15 years. Most biomedical and public health efforts have focused on reducing harmful risk factors when targeting chronic disease—an approach that has contributed greatly to prevention and treatment programs. However, evidence suggests that the number of years lost to disability is increasing and historic gains we have made in life expectancy are eroding, and even reversing in some groups. As our society ages and grapples with these issues, expanding the focus to include resilience, as well as psychosocial assets in our prevention and treatment programs might help inform the multidisciplinary response effort we need. Here we synthesize research evaluating associations between different dimensions of psychological well-being (e.g., purpose in life, optimism, life satisfaction) and social well-being (e.g., structural, functional, quality) with chronic conditions. We also evaluate evidence around three biopsychosocial pathways hypothesized to underlie these associations. These factors are meaningful, measurable, and potentially modifiable; thus, further pursuing this line of inquiry might unveil innovative paths to enhancing the health of our rapidly aging society.