Socioeconomic Disparities in Optimism and Pessimism

Body appreciation is associated with optimism/pessimism in patients with chronic kidney disease: Results from a cross-sectional study and validation of the Arabic version of the Optimism-Pessimism Short Scale-2

BACKGROUND

Chronic Kidney Disease (CKD) patients encounter many obstacles that affect their physical and psychological well-being. The primary objective of the present study was to investigate potential correlates of optimism/pessimism in a sample of patients with CKD, including socio-demographics, body appreciation and disordered eating symptoms. As a secondary objective, we proposed to examine the psychometric properties of an Arabic translation of the Optimism-Pessimism Short Scale-2 (SOP2) before its use in our sample.

METHODS

A cross-sectional study was carried out between April and May 2023, enrolling 108 participants from three hospitals in Lebanon providing insights into their sociodemographic characteristics, physical activity levels, body appreciation, optimism, pessimism, and eating attitudes.

RESULTS

Results indicated that the Arabic-language adaptation of the SOP2 has good reliability coefficients. The two facets of the scale displayed a strong correlation to each other, and highly similar correlations with external study variables (i.e., household crowding index, physical activity, body appreciation, disordered eating), suggesting that the SOP2 can be interpreted as a unidimensional measure for the psychological dispositional optimism as proposed by the developers. Furthermore, findings revealed a strong positive correlation between body appreciation and optimism, suggesting that CKD patients who appreciate their bodies tend to exhibit a more optimistic outlook on life. Conversely, higher body appreciation is associated with lower pessimism, indicating that a positive body image may mitigate feelings of hopelessness and despair in CKD patients.

CONCLUSION

This study contributes to the literature in two ways. First, it offers the Arabic SOP2 as an brief tool to administer, and psychometrically sound instrument that can be useful for clinical and research purposes. Second, it unveils a clear correlation between higher body appreciation and a more optimistic, less pessimistic mindset in patients with CKD.

Optimism in dire times: The buffering role of optimism in the relationship between food insecurity and mental health during the COVID-19 pandemic

Considering the need to gain a deeper understanding of the protective factors associated with coping with food insecurity, specifically in times of severe prolonged stress, the current longitudinal study seeks to examine the role of optimism in the relationship between food insecurity and adverse mental health outcomes during the COVID-19 pandemic. A three-wave longitudinal study involving 1921 Israeli adults was performed during the COVID-19 pandemic. Participants completed questionnaires assessing food insecurity, anxiety, depression, optimism, and socio-demographic characteristics. To explore the relationship between food insecurity and symptoms of anxiety and depression, as well as the moderating role of optimism in this relationship, we employed a set of panel regression models with individual fixed effects. Our results indicate that the degree and change in food insecurity over time were positively associated with both anxiety and depression symptoms, whereas the degree and change in optimism were negatively correlated. Optimism was found to moderate the association between food insecurity and anxiety symptoms over time, but not the association between food insecurity and depression symptoms. A subgroup analysis revealed that optimism moderated the relationship between food insecurity and anxiety and depression for women, but not for men; for married/coupled individuals but not for singles; for non-parents with regard to anxiety, and for parents with regard to depression. Our results highlight the need to practice and enhance optimism in times of great despair, uncertainty, and hardship, especially in situations of food insecurity where tangible change may take time.

The Effect of Income and Wealth on Behavioral Strategies, Personality Traits, and Preferences

Individuals living in either harsh or favorable environments display well-documented psychological and behavioral differences. For example, people in favorable environments tend to be more future-oriented, trust strangers more, and have more explorative preferences. To account for such differences, psychologists have turned to evolutionary biology and behavioral ecology, in particular, the literature on life-history theory and pace-of-life syndrome. However, critics have found that the theoretical foundations of these approaches are fragile and that differences in life expectancy cannot explain vast psychological and behavioral differences. In this article, we build on the theory of optimal resource allocation to propose an alternative framework. We hypothesize that the quantity of resources available, such as income, has downstream consequences on psychological traits, leading to the emergence of behavioral syndromes. We show that more resources lead to more long-term orientation, more tolerance of variance, and more investment in low marginal-benefit needs. At the behavioral level, this translates, among others, into more large-scale cooperation, more investment in health, and more exploration. These individual-level differences in behavior, in turn, account for cultural phenomena such as puritanism, authoritarianism, and innovation.

Mental resources, mental health and sociodemography: a cluster analysis based on a representative population survey in a large German city

BACKGROUND

Mental resources such as optimism and social support are important to face different stressors. The aim of this study is to identify groups in the population that are similar in terms of their mental resources.

METHODS

For this purpose, a randomly selected general population community sample was used, representative for the city of Leipzig, Germany. In a two-stage process, three clusters were identified using hierarchical cluster analysis and the K-means method and then tested with a multinomial logistic regression analysis for differences in sociodemographic characteristics.

RESULTS

Three clusters were identified which vary in their extent of social support and optimism. In distinguishing between those with higher and lower (medium or poor) mental resources, male gender, unemployment, being born abroad and low household income are risk factors for having fewer mental resources. Internal migrants from West Germany and persons with children at home have a higher chance of being in the type with good mental resources. The groups with medium and lower mental resources differ significantly only by variables living with a partner and employment.

CONCLUSION

Our results indicate that good mental resources are associated with good mental health. Special mental health care programs, focusing in particular on the needs of vulnerable groups with poor mental resources within a society, should be implemented.

Pessimistic cognitive biases mediate socioeconomic status and children's mental health problems

Low socioeconomic status (SES) is associated with higher rates of emotional disorders in childhood and beyond. Here we assessed one possible contributor to this disparity, a cognitive bias in the interpretation of negative events, in a group of 341 9-year-olds (49% female, 94% White) ranging widely in SES. This cognitive bias, known as pessimism in the attributional style literature, is the tendency to interpret negative events as persistent (Stable) and pervasive (Global). It was found to be more common among lower SES children (effect sizes = 0.18-0.24 depending on SES measures: income to needs ratio, proportion of poverty from birth to age 9, and parental educational attainment). Moreover, persistent, pervasive adversity in children's lives predicted this bias and mediated the SES-pessimism link. Pessimistic attributional style, in turn, was related to childhood emotional problems and mediated the relation between SES and these problems. Finally, evidence for serial mediation of the SES-mental health problems relationship was found via persistent, pervasive adversity and pessimism, respectively.

Socioeconomic, Behavioural, and Social Health Correlates of Optimism and Pessimism in Older Men and Women: A Cross-Sectional Study

BACKGROUND

Optimism is a disposition characterised by positive future expectancies, while pessimism is characterised by expecting the worst. High optimism and low pessimism promote the health of older adults and may potentiate full engagement in life. We identified socioeconomic, behavioural, and social factors associated with optimism and pessimism in older adults.

METHODS

Participants included 10,146 community-dwelling, apparently healthy Australian adults aged 70 years and over from the ASPREE Longitudinal Study of Older Persons (ALSOP). Optimism and pessimism were measured using the revised Life Orientation Test. Cross-sectional ordinal logistic regression was used to determine the socioeconomic, behavioural, and social health factors associated with optimism and pessimism.

RESULTS

Higher education, greater physical activity, lower loneliness, and volunteering were associated with higher optimism and lower pessimism. Low social support was associated with higher pessimism. Higher socioeconomic advantage, greater income, and living alone were associated with lower pessimism. Women were more optimistic and less pessimistic than men. The association of age, smoking status, and alcohol consumption with optimism and pessimism differed for men and women.

CONCLUSIONS

Factors associated with higher optimism and lower pessimism were also those demonstrated to support healthy ageing. Health-promotion action at the individual level (e.g., smoking cessation or regular physical activity), health professional level (e.g., social prescribing or improving access and quality of care for all older adults), and community level (e.g., opportunities for volunteer work or low-cost social activities for older adults) may improve optimism and reduce pessimism, possibly also promoting healthy ageing.

What are common barriers and helpful solutions to colorectal cancer screening? A cross-sectional survey to develop intervention content for a planning support tool

OBJECTIVE

Colorectal screening using faecal immunochemical tests (FITs) can save lives if the people invited participate. In Scotland, most people intend to complete a FIT but this is not reflected in uptake rates. Planning interventions can bridge this intention-behaviour gap. To develop a tool supporting people willing to do colorectal screening with planning to complete a FIT, this study aimed to identify frequently experienced barriers and solutions to these barriers.

DESIGN

This is a cross-sectional study.

SETTING

Participants were recruited through the Scottish Bowel Screening Programme to complete a mailed questionnaire.

PARTICIPANTS

The study included 2387 participants who had completed a FIT (mean age 65 years, 40% female) and 359 participants who had not completed a FIT but were inclined to do so (mean age 63 years, 39% female).

OUTCOME MEASURES

The questionnaire assessed frequency of endorsement of colorectal screening barriers and solutions.

RESULTS

Participants who had not completed a FIT endorsed significantly more barriers than those who had completed a FIT, when demographic, health and behavioural covariates were held constant (F(1,2053)=13.40, p<0.001, partial η2=0.01). Participants who completed a FIT endorsed significantly more solutions than those who did not (U=301 585.50, z=-3.21, p<0.001, r=0.06). This difference became insignificant when covariates were controlled. Participants agreed on the most common barriers and solutions regardless of screening history. Barriers included procrastination, forgetting, fear of the test result, screening anxiety, disgust and low self-efficacy. Solutions included hand-washing, doing the FIT in private, reading the FIT instructions, benefit of early detection, feelings of responsibility, high self-efficacy and seeing oneself as a person who looks after one's health.

CONCLUSION

This survey identified six barriers and seven solutions as key content to include in the development of a planning tool for colorectal screening using the FIT. Participatory research is required to codesign an engaging and accessible planning tool.

Development and psychometric testing of the self-regulatory questionnaire for lung cancer screening (SRQ-LCS)

BACKGROUND

Research implicates psychological factors in low uptake of lung cancer screening. We developed and psychometrically tested a standardised measure of these psychological determinants in preparation for a prospective, longitudinal cohort study of screening uptake.

METHODS

Leventhal's Common-Sense Model of Self-Regulation of Health and Illness provided the theoretical framework to generate the initial item pool. Items were refined during expert review and cognitive interviews which tested for face validity, redundancy, acceptability and comprehensibility. An online survey piloted the refined pool with 1500 current and former (quit ≤ 15 years) smokers aged 55-80. The response distributions, internal reliability and factor structure determined the final retained constructs. Regression analyses examined these constructs' associations with screening intention, smoking status and demographics.

RESULTS

The final measure included seven factor-derived subscales (consequences, personal control, treatment control, illness coherence, emotional representation, behavioural response and appraisal, risk perception) with Cronbach's alphas ranging from 0.59 to 0.91 and four single-item questions (response efficacy for smoking cessation, treatment intention, perceived stigma and lung cancer survival). Most constructs were associated with smoking status and screening intention (p's < .05).

CONCLUSIONS

The Self-Regulatory Questionnaire for Lung Cancer Screening (SRQ-LCS) is an acceptable, reliable and valid measure for investigating the psychological determinants of screening uptake.

Understanding the impact of exposure to adverse socioeconomic conditions on chronic stress from a complexity science perspective

BACKGROUND

Chronic stress increases chronic disease risk and may underlie the association between exposure to adverse socioeconomic conditions and adverse health outcomes. The relationship between exposure to such conditions and chronic stress is complex due to feedback loops between stressor exposure and psychological processes, encompassing different temporal (acute stress response to repeated exposure over the life course) and spatial (biological/psychological/social) scales. We examined the mechanisms underlying the relationship between exposure to adverse socioeconomic conditions and chronic stress from a complexity science perspective, focusing on amplifying feedback loops across different scales.

METHODS

We developed a causal loop diagram (CLD) to interpret available evidence from this perspective. The CLD was drafted by an interdisciplinary group of researchers. Evidence from literature was used to confirm/contest the variables and causal links included in the conceptual framework and refine their conceptualisation. Our findings were evaluated by eight independent researchers.

RESULTS

Adverse socioeconomic conditions imply an accumulation of stressors and increase the likelihood of exposure to uncontrollable childhood and life course stressors. Repetition of such stressors may activate mechanisms that can affect coping resources and coping strategies and stimulate appraisal of subsequent stressors as uncontrollable. We identified five feedback loops describing these mechanisms: (1) progressive deterioration of access to coping resources because of repeated insolvability of stressors; (2) perception of stressors as uncontrollable due to learned helplessness; (3) tax on cognitive bandwidth caused by stress; (4) stimulation of problem avoidance to provide relief from the stress response and free up cognitive bandwidth; and (5) susceptibility to appraising stimuli as stressors against a background of stress.

CONCLUSIONS

Taking a complexity science perspective reveals that exposure to adverse socioeconomic conditions implies recurrent stressor exposure which impacts chronic stress via amplifying feedback loops that together could be conceptualised as one vicious cycle. This means that in order for individual-level psychological interventions to be effective, the context of exposure to adverse socioeconomic conditions also needs to be addressed.

Dispositional Optimism and All-Cause Mortality in Older Adults: A Cohort Study

OBJECTIVE

Optimism is modifiable and may be associated with healthy aging. We aim to investigate whether dispositional optimism is associated with all-cause mortality in adults 70 years and older.

METHODS

Between 2010 and 2014, older adults free of serious cardiovascular disease and dementia were recruited through primary care physicians and enrolled in the Aspirin Reducing Events in the Elderly (ASPREE) clinical trial. Australian ASPREE participants were invited to participate in the ASPREE Longitudinal Study of Older Persons (ALSOP) that was running in parallel to ASPREE. Optimism was assessed at baseline using the Life Orientation Test-Revised. The association between optimism, divided into quartiles, and all-cause mortality was assessed using Cox proportional hazards models.

RESULTS

A total of 11,701 participants (mean [standard deviation] age = 75.1 [4.24] years; 46.6% men) returned the ALSOP Social questionnaire and completed the Life Orientation Test-Revised. During a median follow-up of 4.7 years, 469 deaths occurred. The fully adjusted model was not significant (hazard ratio = 0.78, 95% confidence interval = 0.58-1.06). There was evidence that age was an effect modifier of the association between optimism and longevity. Higher optimism was associated with lower mortality risk in the oldest individuals only (77+ years; hazard ratio = 0.61, 95% confidence interval = 0.39-0.96).

CONCLUSIONS

We observed no independent relationship between optimism and all-cause mortality in the total sample, although optimism seemed to be associated with lower risk among the oldest old (adults 77 years and older).

Curvilinear Sexism and Its Links to Men's Perceived Mate Value

We tested the novel hypothesis that men lower in status-linked variables-that is, subjective social status and perceived mate value-are relatively disinclined to offset their high hostile sexism with high benevolent sexism. Findings revealed that mate value, but not social status, moderates the hostile-benevolent sexism link among men: Whereas men high in perceived mate value endorse hostile and benevolent sexism linearly across the attitude range, men low in mate value show curvilinear sexism, characterized by declining benevolence as hostility increases above the midpoint. Study 1 (N = 15,205) establishes the curvilinear sexism effect and shows that it is stronger among men than women. Studies 2 (N = 328) and 3 (N = 471) show that the curve is stronger among men low versus high in perceived mate value, and especially if they lack a serious relationship partner (Study 3). Discussion considers the relevance of these findings for understanding misogyny.

Positive psychological well‐being and cardiovascular disease: Exploring mechanistic and developmental pathways

Empirical research regarding the health benefits of positive psychological well‐being (e.g., positive emotions, life satisfaction, purpose in life, and optimism) has flourished in recent years, particularly with regard to cardiovascular disease. This paper reviews the state of evidence for well‐being's association with cardiovascular disease in both healthy individuals and those diagnosed with a disease. Prospective studies consistently indicate well‐being reduces cardiovascular events in healthy and, to a lesser extent, patient populations. Potential pathways that link well‐being with cardiovascular disease are discussed (including health behaviors, physiological processes, and stress buffering), although the existing evidence is mostly cross‐sectional which limits conclusions about directionality. Issues related to development across the lifespan are considered and childhood is identified as a crucial period for establishing healthy cardiovascular trajectories. Outstanding questions for future research are provided with recommendations to focus on well‐powered and prospective study designs with rigorous assessment of both well‐being and cardiovascular‐related outcomes.

Environmental adversity is associated with lower investment in collective actions

Environmental adversity is associated with a wide range of biological outcomes and behaviors that seem to fulfill a need to favor immediate over long-term benefits. Adversity is also associated with decreased investment in cooperation, which is defined as a long-term strategy. Beyond establishing the correlation between adversity and cooperation, the channel through which this relationship arises remains unclear. We propose that this relationship is mediated by a present bias at the psychological level, which is embodied in the reproduction-maintenance trade-off at the biological level. We report two pre-registered studies applying structural equation models to test this relationship on large-scale datasets (the European Values Study and the World Values Survey). The present study replicates existing research linking adverse environments (both in childhood and in adulthood) with decreased investment in adult cooperation and finds that this association is indeed mediated by variations in individuals’ reproduction-maintenance trade-off.

Social Inequalities and Loneliness as Predictors of Ageing Well: A Trend Analysis Using Mixed Models

Background: This study examines if education, income, and loneliness are associated with physical functioning and optimism in an ageing population in Germany. Furthermore, time trends of physical functioning and optimism as well as of associations with social inequality and loneliness are analyzed. Methods: The German Ageing Survey (DEAS), a longitudinal population-based survey of individuals aged 40 years and older, was used (four waves between 2008 and 2017, total sample size N = 23,572). Physical functioning and optimism were introduced as indicators of ageing well. Educational level, net equivalent income, and loneliness were used as predictors in linear mixed models for longitudinal data. Results: Time trends show that physical functioning decreases over time, while optimism slightly increases. Education and income are positively associated with physical functioning, while higher loneliness correlates with lower physical functioning. Higher optimism was associated with higher income and particularly with lower loneliness. Income and notable educational inequalities in physical functioning increase over time. Time trends of the associations with optimism show decreasing income inequalities and increasing disparities in loneliness. Conclusions: Increasing educational inequalities in physical functioning and a strong association of loneliness with optimism provide information for further interventions. Targeted health promotion among the aged and addressing maladaptive social cognition are options to tackle these issues. Key areas for action on healthy ageing include, for instance, the alignment of health systems to the needs of older populations or the creation of age-friendly environments.

Neurostructural correlates of optimism: Gray matter density in the putamen predicts dispositional optimism in late adolescence

Dispositional optimism reflects one's generalized positive expectancies for future outcomes and plays a crucial role in personal developmental outcomes and health (e.g., counteracting related mental disorders such as depression and anxiety). Increasing evidence has suggested that extraversion is an important personality factor contributing to dispositional optimism. However, less is known about the association between dispositional optimism and brain structure and the role of extraversion in this association. Here, we examined these issues in 231 healthy high school students aged 16 to 20 years (110 males, mean age = 18.48 years, SD = 0.54) by estimating regional gray matter density (rGMD) using a voxel-based morphometry method via structural magnetic resonance imaging. Whole-brain regression analyses revealed a significant positive correlation between dispositional optimism and the rGMD of the bilateral putamen after adjusting for age, sex, family socioeconomic status (SES), general intelligence, and total gray matter volume (TGMV). Moreover, prediction analyses using fourfold balanced cross-validation combined with linear regression confirmed a significant connection between dispositional optimism and putamen density after adjusting for age, sex, and family SES. More importantly, subsequent mediation analysis showed that extraversion may account for the association between putamen density and dispositional optimism after adjusting for age, sex, family SES, general intelligence, TGMV, and the other four Big Five personality traits. Taken together, the current study provides new evidence regarding the neurostructural basis underlying dispositional optimism in adolescents and underscores the importance of extraversion as an essential personality factor for dispositional optimism acquisition.

Preference for Deliberation and Perceived Usefulness of Standard- and Narrative-Style Leaflet Designs: Implications for Equitable Cancer-Screening Communication

BACKGROUND

In the UK, cancer-screening invitations are mailed with information styled in a standard, didactic way to allow for informed choice. Information processing theory suggests this "standard style" could be more appealing to people who prefer deliberative thinking. People less likely to engage in deliberative thinking may be disenfranchised by the design of current standard-style information.

PURPOSE

To examine the distribution of preference for deliberative thinking across demographic groups (Study 1) and explore associations between preference for deliberative thinking and perceived usefulness of standard- and narrative-style screening information (Study 2).

METHODS

In Study 1, adults aged 45-59 (n = 4,241) were mailed a questionnaire via primary care assessing preference for deliberative thinking and demographic characteristics. In Study 2, a separate cohort of adults aged 45-59 (n = 2,058) were mailed standard- and narrative-style leaflets and a questionnaire assessing demographic characteristics, preference for deliberative thinking, and perceived leaflet usefulness. Data were analyzed using multiple regression.

RESULTS

In Study 1 (n = 1,783) and Study 2 (n = 650), having lower socioeconomic status, being a women, and being of nonwhite ethnicity was associated with lower preference for deliberative thinking. In Study 2, the standard-style leaflet was perceived as less useful among participants with lower preference for deliberative thinking, while perceived usefulness of the narrative-style leaflet did not differ by preference for deliberative thinking.

CONCLUSIONS

Information leaflets using a standard style may disadvantage women and those experiencing greater socioeconomic deprivation. More work is required to identify design styles that have a greater appeal for people with low preference for deliberative thinking.

Optimism and Wishful Thinking: Consistency Across Populations in Children's Expectations for the Future

Two studies investigated 5- to 10-year-olds' (N = 194) positivity bias when forecasting the future. Children from two geographic locations (mostly Caucasian, higher income college town; mostly African American, lower income urban community) completed a future expectations task (FET). For multiple scenarios, children predicted whether a positive versus negative (optimism items) or a positive versus extraordinary positive (wishful thinking items) outcome would occur, including its likelihood. In both samples, optimism and wishful thinking decreased with age, optimism was higher than wishful thinking, children did not show a comparative self-optimism bias, and individual differences in the FET optimism score correlated with self-reported dispositional optimism and hope. Exploratory comparisons revealed between-sample equivalence in responses to all measures, except for less tempered wishful thinking in the urban community.

Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.

Hope, the Household Environment, and Sexual Risk Behaviors Among Young Women in Rural South Africa (HPTN 068)

We assessed the psychological trait of hope as an explanatory mediator in the relationship between the home environment and sexual risk behaviors among 2533 young women in rural South Africa. Hope mediated the relationship between average household age and sexual debut (mediated effect = - 0.003, p < 0.05), and between household consumption and sexual debut (mediated effect = - 0.019, p < 0.05). Both higher average household age (β = 0.01; 95% CI 0.00, 0.01) and greater household consumption (β = 0.05; 95% CI 0.02, 0.08) were marginally associated with higher hope. In turn, greater hope was associated with lower odds of sexual debut (aOR = 0.62; 95% CI 0.52, 0.74). These results provide important preliminary evidence of the role of the home environment in shaping protective psychological assets and healthy sexual behaviors. Continued exploration of the relationship between hope and the home environment may help to explain why young women in this context have a disproportionate risk for HIV.

Psychological origins of the Industrial Revolution

Since the Industrial Revolution, human societies have experienced high and sustained rates of economic growth. Recent explanations of this sudden and massive change in economic history have held that modern growth results from an acceleration of innovation. But it is unclear why the rate of innovation drastically accelerated in England in the eighteenth century. An important factor might be the alteration of individual preferences with regard to innovation resulting from the unprecedented living standards of the English during that period, for two reasons. First, recent developments in economic history challenge the standard Malthusian view according to which living standards were stagnant until the Industrial Revolution. Pre-industrial England enjoyed a level of affluence that was unprecedented in history. Second, behavioral sciences have demonstrated that the human brain is designed to respond adaptively to variations in resources in the local environment. In particular, Life History Theory, a branch of evolutionary biology, suggests that a more favorable environment (high resources, low mortality) should trigger the expression of future-oriented preferences. In this paper, I argue that some of these psychological traits - a lower level of time discounting, a higher level of optimism, decreased materialistic orientation, and a higher level of trust in others - are likely to increase the rate of innovation. I review the evidence regarding the impact of affluence on preferences in contemporary as well as past populations, and conclude that the impact of affluence on neurocognitive systems may partly explain the modern acceleration of technological innovations and the associated economic growth.

The behavioural constellation of deprivation: Causes and consequences

Socioeconomic differences in behaviour are pervasive and well documented, but their causes are not yet well understood. Here, we make the case that a cluster of behaviours is associated with lower socioeconomic status (SES), which we call “the behavioural constellation of deprivation.” We propose that the relatively limited control associated with lower SES curtails the extent to which people can expect to realise deferred rewards, leading to more present-oriented behaviour in a range of domains. We illustrate this idea using the specific factor of extrinsic mortality risk, an important factor in evolutionary theoretical models. We emphasise the idea that the present-oriented behaviours of the constellation are a contextually appropriate response to structural and ecological factors rather than a pathology or a failure of willpower. We highlight some principles from evolutionary theoretical models that can deepen our understanding of how socioeconomic inequalities can become amplified and embedded. These principles are that (1) small initial disparities can lead to larger eventual inequalities, (2) feedback loops can embed early-life circumstances, (3) constraints can breed further constraints, and (4) feedback loops can operate over generations. We discuss some of the mechanisms by which SES may influence behaviour. We then review how the contextually appropriate response perspective that we have outlined fits with other findings about control and temporal discounting. Finally, we discuss the implications of this interpretation for research and policy.

Socioeconomic inequalities in attitudes towards cancer: an international cancer benchmarking partnership study

Socioeconomic status (SES) differences in attitudes towards cancer have been implicated in the differential screening uptake and the timeliness of symptomatic presentation. However, the predominant emphasis of this work has been on cancer fatalism, and many studies focus on specific community subgroups. This study aimed to assess SES differences in positive and negative attitudes towards cancer in UK adults. A population-based sample of UK adults (n=6965, age≥50 years) completed the Awareness and Beliefs about Cancer scale, including six belief items: three positively framed (e.g. ‘Cancer can often be cured’) and three negatively framed (e.g. ‘A cancer diagnosis is a death sentence’). SES was indexed by education. Analyses controlled for sex, ethnicity, marital status, age, self-rated health, and cancer experience. There were few education-level differences for the positive statements, and overall agreement was high (all>90%). In contrast, there were strong differences for negative statements (all Ps<0.001). Among respondents with lower education levels, 57% agreed that ‘treatment is worse than cancer’, 27% that cancer is ‘a death sentence’ and 16% ‘would not want to know if I have cancer’. Among those with university education, the respective proportions were 34, 17 and 6%. Differences were not explained by cancer experience or health status. In conclusion, positive statements about cancer outcomes attract near-universal agreement. However, this optimistic perspective coexists alongside widespread fears about survival and treatment, especially among less-educated groups. Health education campaigns targeting socioeconomically disadvantaged groups might benefit from a focus on reducing negative attitudes, which is not necessarily achieved by promoting positive attitudes.

Unequally distributed psychological assets: are there social disparities in optimism, life satisfaction, and positive affect?

Socioeconomic status is associated with health disparities, but underlying psychosocial mechanisms have not been fully identified. Dispositional optimism may be a psychosocial process linking socioeconomic status with health. We hypothesized that lower optimism would be associated with greater social disadvantage and poorer social mobility. We also investigated whether life satisfaction and positive affect showed similar patterns. Participants from the Midlife in the United States study self-reported their optimism, satisfaction, positive affect, and socioeconomic status (gender, race/ethnicity, education, occupational class and prestige, income). Social disparities in optimism were evident. Optimistic individuals tended to be white and highly educated, had an educated parent, belonged to higher occupational classes with more prestige, and had higher incomes. Findings were generally similar for satisfaction, but not positive affect. Greater optimism and satisfaction were also associated with educational achievement across generations. Optimism and life satisfaction are consistently linked with socioeconomic advantage and may be one conduit by which social disparities influence health.

Barriers to healthcare seeking, beliefs about cancer and the role of socio-economic position. A Danish population-based study

BACKGROUND

Cancer-related health behaviours may be affected by barriers to healthcare seeking and beliefs about cancer. The aim was to assess anticipated barriers to healthcare seeking and beliefs about cancer in a sample of the Danish population and to assess the association with socio-economic position.

METHODS

A population-based telephone interview with 3000 randomly sampled persons aged 30 years or older was performed using the Awareness and Beliefs about Cancer measure from 31 May to 4 July 2011. The Awareness and Beliefs about Cancer measure includes statements about four anticipated barriers to healthcare seeking and three positively and three negatively framed beliefs about cancer. For all persons, register-based information on socio-economic position was obtained through Statistics Denmark.

RESULTS

Two anticipated barriers, worry about what the doctor might find and worry about wasting the doctor's time, were present among 27% and 15% of the respondents, respectively. Overall, a high proportion of respondents concurred with positive beliefs about cancer; fewer concurred with negative beliefs. Having a low educational level and a low household income were strongly associated with having negative beliefs about cancer.

CONCLUSION

The fact that worry about what the doctor might find and worry about wasting the doctor's time were commonly reported barriers call for initiatives in general practice. The association between low educational level and low household income and negative beliefs about cancer might to some degree explain the negative socio-economic gradient in cancer outcome.

Perceived economic situation, but not education level, is associated with disability prevalence in the Spanish elderly: observational study

BACKGROUND

The aim of this paper is to ascertain if the subjective perception of the economic situation of a household is associated with the prevalence of disability in old age, net of education level. Subjective economic perception is less non-response biased. Knowing if the self-perceived economic situation is related to disability over and above education level has important implications both for understanding the mechanisms that lead to disability and for selecting policies to reduce it.

METHODS

This is a transversal study based on the pilot of the ELES survey, which is a representative survey of non-institutionalised Spaniards aged 50 and over. Only individuals whose job income levels were fixed before becoming disabled were selected to avoid the main source of reverse causality. Disability was defined as having difficulty in carrying out any of 12 activities of daily living. Education level, difficulty in making ends meet, self-perceived relative economic position of the household, age, gender, psychological disposition, and alcohol and tobacco consumption were introduced as independent variables in binary logistic models.

RESULTS

The working sample is made up of 704 individuals of aged 60 and over. The subjective household economic situation, measured in two different ways, is strongly and consistently related with the prevalence of disability net of age, gender, education level and psychological disposition. After adjusting for age and gender, education level is no longer associated with disability. However, having economic difficulties has the same effect on disability prevalence as being 10 years older, or being a woman instead of a man.

CONCLUSIONS

As the economic situation of the elderly is much easier to improve than their formal education, our findings support feasible interventions which could lead to a reduction in the prevalence of disability.

Imagining the White Picket Fence

Previous research has established that individuals from a lower social class report lower relationship quality. However, to date, no studies have examined interdependence processes within the relationship as a mechanism underlying this association. The present research investigates the role of planned tangible investments as a mediator between social class and relationship quality. Across two studies, we test this hypothesis correlationally (Study 1) and experimentally (Study 2). As predicted, lower-class individuals reported fewer planned tangible investments, which in turn were associated with lower relationship satisfaction and commitment (Studies 1 and 2), as well as overall satisfaction with life (Study 2). Together, these studies suggest the importance of perceived ability to make future plans for individual and relationship well-being. This research has implications for understanding relationship quality and mental health among lower-class populations, and the findings are discussed in relation to the growing literature on social class and romantic relationships.

Optimism and pessimism as predictors of initiating and ending an antidepressant medication treatment

BACKGROUND

The personality variables optimism and pessimism are potential risk factors for disorders commonly treated with antidepressants.

AIMS

To evaluate optimism and pessimism as predictors of initiating and ending an antidepressant treatment.

METHODS

Data consisted of 29,930 public sector employees with no record of diagnosed depression. Optimism and pessimism were measured using the Revised Life Orientation Test (LOT-R) at baseline. The data of purchases of antidepressants were from the national Drug Prescription Register.

RESULTS

During the mean follow-up of 4.4 years, 1681 participants initiated and of them 1288 ended an antidepressant treatment lasting at least 100 days. In the adjusted model, high optimism was associated with a lower likelihood of starting antidepressant medication treatment (hazard ratios, HR, 0.67, 95% CI 0.62-0.73) and a higher likelihood of stopping the treatment (HR = 1.18, 95% CI 1.08-1.30). High pessimism was associated with a higher likelihood of starting antidepressant medication treatment (HR = 1.27, 95% CI 1.16-1.38) and a lower likelihood of stopping it (HR = 0.89, 95% CI 0.80-0.98). These associations remained after optimism score was adjusted for pessimism and vice versa or those with symptoms of mental health problems at baseline were removed from the analyses.

CONCLUSIONS

Low optimism and high pessimism are independently associated with an increased likelihood of initiating antidepressant medication treatment, but with a decreased likelihood of ending it during the follow-up.

Childhood and adult socioeconomic position, cumulative lead levels, and pessimism in later life: the VA Normative Aging Study

Pessimism, a general tendency toward negative expectancies, is a risk factor for depression and also heart disease, stroke, and reduced cancer survival. There is evidence that individuals with higher lead exposure have poorer health. However, low socioeconomic status (SES) is linked with higher lead levels and greater pessimism, and it is unclear whether lead influences psychological functioning independently of other social factors. The authors considered interrelations among childhood and adult SES, lead levels, and psychological functioning in data collected on 412 Boston area men between 1991 and 2002 in a subgroup of the VA Normative Aging Study. Pessimism was measured by using the Life Orientation Test. Cumulative (tibia) lead was measured by x-ray fluorescence. Structural equation modeling was used to quantify the relations as mediated by childhood and adult SES, controlling for age, health behaviors, and health status. An interquartile range increase in lead quartile was associated with a 0.37 increase in pessimism score (P < 0.05). Low childhood and adult SES were related to higher tibia lead levels, and both were also independently associated with higher pessimism. Lead maintained an independent association with pessimism even after childhood and adult SES were considered. Results demonstrate an interrelated role of lead burden and SES over the life course in relation to psychological functioning in older age.

Low level of optimism predicts initiation of psychotherapy for depression: results from the Finnish Public Sector Study

BACKGROUND

The patient's personality may be one of the many factors that contribute to the decision to initiate a certain treatment for depression. The aim of this study was to examine whether dispositional optimism and pessimism play a role in the initiation of psychotherapy as the treatment for new-onset depression in previously nondepressed public sector employees.

METHODS

This prospective observational cohort study included 38,717 (mean age: 45 years; 76% female) public sector employees who responded to a survey in 1997, 2000-2001 and/or 2004 and had no history of depression at cohort entry. Dispositional optimism and pessimism were assessed via the revised Life Orientation Test and linked to individual records of indicators of depression onset in comprehensive national health registers, and of long-term psychotherapy for depression in particular.

RESULTS

During a mean follow-up of 4.0 years, 1,616 (4%) incident cases of depression were observed. Of them, 79 started long-term, state-subsidized psychotherapy for depression. A 1-unit increase in mean optimism score was associated with a 38% lower likelihood of initiating psychotherapy as a treatment for depression and a 32% lower likelihood of depressive disorder in general during follow-up. Pessimism score was not associated with initiation of psychotherapy for depression, but a 1-unit increase in pessimism score was associated with a 28% increase in the likelihood of depressive disorder. These findings were robust to adjustments for demographics, health risk behaviors and somatic diseases at baseline.

CONCLUSION

This study suggests that although both low optimism and high pessimism increase the risk for depression, only low optimism influences the initiation of psychotherapy as a treatment modality for depression. This could imply that depressed patients with low optimism should receive more attention in the beginning of the depressive episode than patients with high optimism.

Cancer fatalism and poor self-rated health mediate the association between socioeconomic status and uptake of colorectal cancer screening in England

BACKGROUND

Little is known about the psychological predictors of colorectal screening uptake in England and mediators of associations between uptake and socioeconomic status (SES). This study tested the hypotheses that although higher threat and efficacy beliefs, lower cancer fatalism, lower depression, and better self-rated health would predict higher screening uptake, only efficacy beliefs, fatalism, depression, and self-rated health would mediate associations between uptake and SES.

METHODS

Data from 529 adults aged 60 to 69 who had completed a postal survey in 2005-2006 were linked with data on fecal occult blood test (FOBt) uptake recorded at the screening "hub" following its introduction in 2007, resulting in a prospective study.

RESULTS

Screening uptake was 56% and was higher among people with higher SES, better self-rated health, higher self-efficacy beliefs, and lower cancer fatalism in univariate analyses. Path analysis on participants with complete data (n = 515) showed that both better self-rated health and lower cancer fatalism were directly associated with higher uptake of FOBt screening and significantly mediated pathways from SES to uptake. Lower depression only had an indirect effect on uptake through better self-rated health. Efficacy beliefs did not mediate the relationship between SES and uptake.

CONCLUSION

SES differences in uptake of FOBt in England are partially explained by differences in cancer fatalism, self-rated health, and depression.

IMPACT

This is one of only a few studies to examine mediators of the relationship between SES and screening uptake, and future research could test the effectiveness of interventions to reduce fatalistic beliefs to increase equality of uptake.

Maternal reports of child health status and health conditions: the influence of self-reported maternal health status

OBJECTIVE

The aim of this study was to examine the influence of maternal health status (MHS) on the relationship between child health conditions and child health status (CHS).

METHODS

The study sample included 38 207 children aged 5 to 17 years in the 2001 to 2008 National Health Interview Surveys whose mothers were the survey respondent for the child and herself. Information was collected about CHS, MHS, diagnosed child health conditions, and sociodemographic characteristics. Responses to a question on general health status were used to rate CHS and MHS as "better" (excellent/very good health) or "worse" (good/fair/poor health). The percentage of children with worse CHS, adjusted for sociodemographic characteristics, was estimated using logistic regression.

RESULTS

Adjusting for child and family sociodemographic characteristics had a negligible effect on the association between CHS and a 4-level variable that classified children by both MHS and child health conditions. The adjusted percentage of children with worse CHS was higher among children whose mothers had worse MHS compared with children whose mothers had better MHS. Moreover, among children whose mothers had worse MHS, there was a weak relationship between child health conditions and worse CHS. Among children whose mothers had better MHS, there was a strong relationship between child health conditions and worse CHS.

CONCLUSION

Because mother-reported CHS is used widely in epidemiological studies as a measure of a child's actual state of health, it is important to consider how maternal characteristics may influence a mother's report of a child's status. In particular, CHS reported by mothers with worse health status merits further investigation.

Psychosocial determinants of socioeconomic inequalities in cancer screening participation: a conceptual framework

Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.

Why are there social gradients in preventative health behavior? A perspective from behavioral ecology

Background

Within affluent populations, there are marked socioeconomic gradients in health behavior, with people of lower socioeconomic position smoking more, exercising less, having poorer diets, complying less well with therapy, using medical services less, ignoring health and safety advice more, and being less health-conscious overall, than their more affluent peers. Whilst the proximate mechanisms underlying these behavioral differences have been investigated, the ultimate causes have not.

Methodology/Principal Findings

This paper presents a theoretical model of why socioeconomic gradients in health behavior might be found. I conjecture that lower socioeconomic position is associated with greater exposure to extrinsic mortality risks (that is, risks that cannot be mitigated through behavior), and that health behavior competes for people's time and energy against other activities which contribute to their fitness. Under these two assumptions, the model shows that the optimal amount of health behavior to perform is indeed less for people of lower socioeconomic position.

Conclusions/Significance

The model predicts an exacerbatory dynamic of poverty, whereby the greater exposure of poor people to unavoidable harms engenders a disinvestment in health behavior, resulting in a final inequality in health outcomes which is greater than the initial inequality in material conditions. I discuss the assumptions of the model, and its implications for strategies for the reduction of health inequalities.