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

Salutogenic health measures: Psychometric properties of the Danish versions of the Flourish Index and the Secure Flourish Index

Measurement of human flourishing represents a salutogenic approach to epidemiological and behavioral research emphasizing factors contributing to "good lives" rather than pathology. The objective of this study was to translate and psychometrically test the 10-item Flourish Index (FI) and 12-item Secure Flourish Index (SFI) in a convenience sample of Danish adults. A total of 325 participants completed a cross-sectional survey, with 148 of those participants completing the survey a second time (retest). Confirmatory factor analysis in a structural equation modelling framework was used to establish structural validity by comparing four different pre-specified models of the indexes. Additionally, internal consistency, convergent and incremental validity, and retest reliability were examined. The FI models exhibited superior structural validity compared with similar models of the SFI, although all models had good fits. Internal consistencies with McDonald's omega were 0.89 and 0.87 for the FI and SFI, respectively. The five (FI) or six (SFI) domains were happiness & life satisfaction, mental & physical health, meaning & purpose, character & virtue, close social relationships, and financial & material stability (λ4 = 0.51-0.91). Convergent and incremental validity tests supported predefined hypotheses. Retest analyses with the FI and SFI showed a high degree of retest reliability. Based on the psychometric evidence reported in this study, the Danish Flourish Index and Secure Flourish Index seem suitable for use with healthy adult Danes. The authors hope that this psychometric evaluation of the FI and SFI will stimulate research on patterns, health and economic outcomes, and predictors of human flourishing in Denmark.

Combined Exercise and Mindset Training During a Pediatric Cardiac Fitness and Rehabilitation Program Benefits Youth with a Range of Congenital Heart Disease

Pediatric cardiac fitness and rehabilitation programs vary widely in structure and content. The Cardiac Fitness Program (CFP) is built on traditional training pillars of aerobic, strength, and flexibility, and adds a fourth, training a positive mindset. This study assesses whether the systematic and comprehensive framework of the CFP results in broad benefits for a range of patients with congenital heart disease (CHD). Data from participants between 01/2017 and 12/2022 were analyzed. Pre- and post-CFP cardiopulmonary exercise test parameters, strength and flexibility metrics, and mindset survey results were compared overall, and by sex, age, diagnosis, and hemodynamic level. Of 62 participants (median age 15.5 years, range 8 to 23, 50% female), 3% had simple, 37% complex, 24% single ventricle CHD, and 35% arrhythmia, cardiomyopathy, or transplant. Significant improvements were noted in aerobic fitness (mean 9 ± 15% increase in % predicted peak oxygen consumption, p < 0.001). Strength metrics significantly improved (each p < 0.001), as did flexibility (p < 0.001). Patient-reported positive mindset scores did not improve significantly (mean increase 1.8 ± 5.1, p = 0.10, n = 25), whereas parents reported significant improvements (5.9 ± 10.4, p = 0.02, n = 20). Improvements were not significantly different by sex, age, diagnosis, or hemodynamic level. Comprehensive training across four pillars of fitness yields significant improvements in aerobic fitness, strength, flexibility, and parent-reported mindset scores for pediatric CHD patients, regardless of patient characteristics, diagnosis type, or severity of hemodynamic limitation. Further study is warranted into optimal standardization of training and whether a comprehensive approach amplifies individual pillars to create more than the sum of its parts.

The role of spirituality, religiosity, and self-care on infection preventionist well-being: Results from a national survey in the United States

BACKGROUND

The degree to which religiosity, spirituality, and self-care practices can improve well-being among infection preventionists is not well understood.

METHODS

We surveyed infection preventionists from a random sample of United States hospitals in 2021. Multivariable logistic regression models were used to examine the associations between measures of spirituality, religiosity, and self-care and well-being.

RESULTS

Our response rate was 47% (415/881). A total of 49% of respondents reported burnout, 17% reported increased feelings of uncaring, and 69% would choose to become an infection preventionist again. Most respondents found importance in spiritual well-being (88%), religious beliefs (82%), and self-care practices (87%). Spiritual well-being was associated with increased odds of choosing to become an infection preventionist again (odds ratio = 2.32, 95% confidence interval = 1.19-4.53, P = .01).

DISCUSSION

Our national survey provides evidence that spiritual importance is associated with career satisfaction among infection preventionists. Our findings contribute to a general body of evidence suggesting spiritual importance may translate to higher flourishing and well-being via serving a higher purpose.

CONCLUSIONS

Promoting spiritual well-being may positively influence career satisfaction and overall well-being among infection preventionists.

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.

The shifts in intergenerational relations in Cameroon and their potential impact on the health of older adults

INTRODUCTION

Africa is experiencing a gradual demographic shift due to rising life expectancy and increasing urbanisation. In sub-Saharan Africa, elderly individuals typically reside with their children. The rise in life expectancy by almost a decade and the prevalence of precarious living conditions raise concerns about the sustainability of the healthcare system, which has traditionally relied on intergenerational solidarity.

METHODS

The research aims to analyse the evolving role of older adults in Cameroonian society and to examine the potential impact of this change on intergenerational relationships and the health of older adults. A qualitative methodology was employed, using intergenerational focus groups in Cameroon.

RESULTS

Traditionally, older adults held a central role in knowledge transmission through discourse. However, the modernisation of society is challenging this position.The emergence of new technologies, particularly communication tools, is leading to a questioning of older adults' experiential knowledge. Societal changes are contributing to a decline in respect for older adults in discourse. Older adults deplore these societal changes and fear for their place in society while young people are questioning the central role of older people in society.

DISCUSSION

These changes could reduce the sense of usefulness of older people, with negative consequences for their health. Several studies have highlighted the impacts of ageism on the health of older adults in industrialised countries. However, there are little data on the impact of the marginalisation of older adults on their health in industrialising societies. Further research is needed to study the impact on the health of older adults.

Measuring the purpose in life in the adult population: A scoping review

Background

The purpose in life can motivate individuals to realize that life is essential for existence and well-being. Adults might experience crises that can lead to a lack of purpose in life. Consequently, promoting purpose in life is necessary, but it requires a suitable measurement scale.

Objective

This scoping review aimed to identify and map the content, psychometric properties, and answer option scales of instruments intended to measure purpose in life in adult populations.

Design

A scoping review was employed.

Data Sources

The database used was PubMed. The libraries were APA PsycNet, Wiley Online Library, and Cochrane Library. The search strategy was performed between 1 November 2023 and 14 February 2024.

Review Methods

This review used the scoping review framework described by Arksey and O'Malley. The identified instruments were assessed for quality based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. This study also used the PRISMA Extension for Scoping Reviews (PRISMA-ScR) reporting guideline.

Results

A total of 348 studies were identified, and seven articles were involved in the final synthesis. These seven articles included five instruments measuring the concept of purpose in life, of which two instruments had two versions: 1) Purpose in Life Test (20 items, 4 items); 2) Life Engagement Test (6 items); 3) Psychological Well-Being (120 items, 18 items); 4) Self-Assessment Goal Achievement (9 items); and 5) National Institutes of Health Tuberculosis Meaning and Purpose Scale Age 18+ (18 items). The validity of all instruments was tested using factor analysis, known groups, face, concurrent, convergent, discriminant, and construct validity. The reliability of four instruments was tested by Cronbach's alpha and Spearman-Brown formula.

Conclusion

Five instruments measuring purpose in life in the adult population with adequate psychometric properties were identified. The clinical implication of this study suggests that nurses may consider employing an appropriate instrument to assess the purpose of life in the adult population, thus enabling them to offer holistic, individualized care to adults, particularly addressing the spiritual dimension.

Daily time spent on screens and psychological well-being: Cross-sectional association within the SUN cohort

BACKGROUND

The impact of various lifestyles on psychological well-being (PWB) remains under-studied. We aimed to explore the cross-sectional association between daily screen use (television, tablet and mobile phone) and PWB within the SUN cohort.

METHODS

PWB was assessed using the 29-item Ryff scale (ranging from 29 to 174), and participants with scores >75th percentile were considered as having optimal PWB. Participants were categorized based on their self-reported weekly screen usage hours. Postestimation logistic regression models assessing the prevalence likelihood of not achieving optimal PWB were adjusted for sociodemographic, psychological, personality and lifestyles factors. Isotemporal substitution models explored the potential impact on PWB resulting from replacing 1 h/day of screen time with 1 h/day of exercise.

RESULTS

The study included 3051 participants (55.8% women, mean age 57.3 ± 11.1 years, mean Ryff's score: 139.1 ± 17.4 points). Daily screen use for ≥2 h was associated with a higher prevalence likelihood of not achieving an optimal PWB (Prevalence Ratio [PR]:1.09; 95% CI:1.01-1.18). Among PWB dimensions, screen use ≥2 h/day was linked to an increased likelihood of not achieving optimal scores in environmental mastery (PR:1.11; 95% CI:1.02-1.20), life purpose (PR:1.10; 95% CI:1.02-1.18), and personal growth (PR:1.09; 95% CI:1.01-1.18). Replacing 1 h of daily screens time with 1 h of exercise may lead to potential improvements in environmental mastery (Odds Ratio [OR]:0.87; 95% CI:0.76-0.99), purpose in life (OR:0.86; 95% CI: 0.76-0.98), personal growth (OR:0.84; 95% CI:0.73-0.96) and positive interpersonal relationships (OR:0.86; 95% CI:0.75-0.99).

CONCLUSIONS

These findings highlight the importance of reducing screen use activities and increasing physical exercise for achieving optimal PWB.

Purpose in life and cognitive performance and informant ratings of cognitive decline, affect, and activities

OBJECTIVE

To examine (1) the association between purpose in life and multiple domains of cognitive function and informant-rated cognitive decline, affect, and activities; (2) whether these associations are moderated by sociodemographic factors, cognitive impairment, or depression; (3) whether the associations are independent of other aspects of well-being and depressive symptoms.

METHOD

As part of the 2016 Harmonized Cognitive Assessment Protocol from the Health and Retirement Study, participants completed a battery of cognitive tests and nominated a knowledgeable informant to rate their cognitive decline, affect, and activities. Participants with information available on their purpose in life from the 2014/2016 Leave Behind Questionnaire were included in the analytic sample (N = 2,812).

RESULTS

Purpose in life was associated with better performance in every cognitive domain examined (episodic memory, speed-attention, visuospatial skills, language, numeric reasoning; median β =.10, p <.001; median d =.53). Purpose was likewise associated with informant-rated cognitive decline and informant-rated affective and activity profiles beneficial for cognitive health (median β =.18, p < .001; median d =.55). There was little evidence of moderation by sociodemographic or other factors (e.g., depression). Life satisfaction, optimism, positive affect, and mastery were generally associated with cognition. When tested simultaneously with each other and depressive symptoms, most dimensions were reduced to non-significance; purpose remained a significant predictor.

CONCLUSIONS

Purpose in life is associated with better performance across numerous domains of cognition and with emotional and behavioral patterns beneficial for cognitive health that are observable by knowledgeable others. These associations largely generalize across demographic and clinical groups and are independent of other aspects of well-being.

Higher purpose in life and education were associated with better cognition among older adults

BACKGROUND

 With aging, some cognitive abilities change because of neurobiological processes. Cognition may also be influenced by psychosocial aspects.

OBJECTIVE

 To describe the relationship between a measure of neuroticism, depression symptoms, purpose in life, and cognitive performance in community-dwelling older adults.

METHODS

 This was a cross-sectional analysis based on the data from the second wave of the Frailty in Brazilian Older Adults (FIBRA) study, carried out between 2016 and 2017. The sample consisted of 419 older people (≥ 72 years old) cognitively unimpaired and mostly with low education. The variables of interest were sociodemographic, Neuroticism domain from the NEO-PI-R, Geriatric Depression Scale (GDS), Purpose in Life (PiL) scale, and a cognitive composite score which included the Mini-Mental State Examination (MMSE), and the scores for the sub-items of the Mini-Addenbrooke's Cognitive Examination (M-ACE), namely, Verbal Fluency (VF) - Animal, Clock Drawing Test (CDT), Episodic Memory (name and address).

RESULTS

 There was a greater number of women (70%), with older age (median = 80 years, IQR = 77-82), and low education (median = 4 years, IQR = 2-5). In the bivariate correlations, years of education (ρ = 0.415; p < 0.001) and PiL (ρ = 0.220; p < 0.001) were positively associated with cognition. Neuroticism (ρ = -0.175; p < 0.001) and depression symptoms (ρ = -0.185; p < 0.001) were negatively associated with cognition. In the logistic regression, after including confounding variables, the associations between cognition and PiL (OR = 2.04; p = 0.007) and education (OR = 1.32; p < 0.001) remained significant.

CONCLUSION

 Low PiL and low education levels were associated with worse cognition among older adults. Such results may be of relevance in programs that aim to improve cognition among older adults.

The link between spirituality and longevity

We are facing an inverted demographic pyramid with continuously growing aged populations around the world. However, the advances that prolong physical life not always contemplate its psychological and social dimensions. Longevity is a complex outcome influenced by a wide range of factors, including genetics, lifestyle choices, access to healthcare, socio-economic conditions, and other environmental factors. These factors have been generally considered in the compelling research that seeks the determinants of longevity, particularly those concerning personal lifestyle choices, socioeconomic conditions, and molecular mechanisms proposed to mediate these effects. Nonetheless, fundamental aspects that can affect health and well-being, such as spirituality and religiosity, have been somehow left aside despite numerous epidemiological studies showing that higher levels of spirituality/religiosity are associated with lower risk of mortality, even after adjusting for relevant confounders. Because spirituality/religiosity are dimensions of great value for patients, overlooking them can leave them with feelings of neglect and lack of connection with the health system and with the clinicians in charge of their care. Integrating spirituality and religiosity assessment and intervention programs into clinical care can help each person obtain better and complete well-being and also allowing clinicians to achieve the highest standards of health with holistic, person-centered care. The present narrative review aims to explore the available evidence of a relationship between spirituality/religiosity and longevity and discusses the possible mechanisms that can help explain such relationship.

Purpose in Life and Risk of Falls: A Meta-Analysis of Cross-Sectional and Prospective Associations

Background and Aim: Purpose in life is an aspect of well-being that is associated with better health outcomes in older adulthood. We examine the association between purpose in life and likelihood of a recent fall and risk of an incident fall over time. Methods: Purpose in life and falls were reported concurrently and falls were reported again up to 16 years later in four established longitudinal studies of older adults (total N = 25,418). Results: A random-effects meta-analysis of the four samples indicated that purpose was associated with a 14% lower likelihood of having fallen recently at baseline (meta-analytic OR = 0.88, 95% CI [0.84-0.92]). Among participants who reported no falls at baseline (N = 15,632), purpose was associated with a nearly 10% lower risk of an incident fall over the up to 16-year follow-up (meta-analytic HR = 0.92, 95% CI [0.90-0.94]). These associations were independent of age, sex, race, ethnicity, and education, were not moderated by these factors, and persisted controlling for physical activity and disease burden. Conclusion and Recommendations: Purpose in life is a meaningful aspect of well-being that may be useful to identify individuals at risk for falling, particularly among individuals without traditional risk factors, and be a target of intervention to reduce fall risk.

Purposeful and purposeless aging: Structural issues for sense of purpose and their implications for predicting life outcomes

Despite the value of sense of purpose during older adulthood, this construct often declines with age. With some older adults reconsidering the relevance of purpose later in life, the measurement of purpose may suffer from variance issues with age. The current study investigated whether sense of purpose functions similarly across ages and evaluated if the predictive power of purpose on mental, physical, cognitive, and financial outcomes changes when accounting for a less age-affected measurement structure. Utilizing data from two nationwide panel studies (Health and Retirement Study: n = 14,481; Midlife in the United States: n = 4,030), the current study conducted local structural equation modeling and found two factors for the positively and negatively valenced purpose items in the Purpose in Life subscale (Ryff, 1989), deemed the purposeful and purposeless factor. These factors become less associated with each other at higher ages. When reproducing past findings with this two-factor structure, the current study found that the purposeful and purposeless factors predicted these outcomes in the same direction as would be suggested by past research, but the magnitude of these effects differed for some outcomes. The discussion focuses on the implications of what this means for our understanding of sense of purpose across the lifespan. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Beyond the single-outcome approach: A comparison of outcome-wide analysis methods for exposome research

Outcome-wide analysis can offer several benefits, including increased power to detect weak signals and the ability to identify exposures with multiple effects on health, which may be good targets for preventive measures. Recently, advanced statistical multivariate techniques for outcome-wide analysis have been developed, but they have been rarely applied to exposome analysis. In this work, we provide an overview of a selection of methods that are well-suited for outcome-wide exposome analysis and are implemented in the R statistical software. Our work brings together six different methods presenting innovative solutions for typical problems arising from outcome-wide approaches in the context of the exposome, including dependencies among outcomes, high dimensionality, mixed-type outcomes, missing data records, and confounding effects. The identified methods can be grouped into four main categories: regularized multivariate regression techniques, multi-task learning approaches, dimensionality reduction approaches, and bayesian extensions of the multivariate regression framework. Here, we compare each technique presenting its main rationale, strengths, and limitations, and provide codes and guidelines for their application to exposome data. Additionally, we apply all selected methods to a real exposome dataset from the Human Early-Life Exposome (HELIX) project, demonstrating their suitability for exposome research. Although the choice of the best method will always depend on the challenges to be faced in each application, for an exposome-like analysis we find dimensionality reduction and bayesian methods such as reduced rank regression (RRR) or multivariate bayesian shrinkage priors (MBSP) particularly useful, given their ability to deal with critical issues such as collinearity, high-dimensionality, missing data or quantification of uncertainty.

The relationship between purpose in life and depression and anxiety: A meta-analysis

Purpose in life consists of having a sense of meaning and purpose regarding one's activities as well as an overall sense that life is meaningful. This study reports a comprehensive assessment of the relationship of purpose in life with depression and anxiety. A meta-analysis (total n = 66,468, total k = 99) investigated the association of purpose in life with depression and anxiety. Across samples, greater purpose in life was significantly associated with lower levels of depression and anxiety. The mean weighted effect size between purpose in life and depression was r = -0.49, [95% confidence intervals, CIs: -0.52, -0.45], p < 0.001. For the purpose in life and anxiety the mean weighted effect size was r = -0.36, [95% CIs: -0.40, -0.32], p < 0.001. The association of purpose in life with mental health was stronger for clinical populations, especially with regard to the relationship with anxiety. Both approach deficits and avoidance motivation are argued to play a role in the relationship between purpose and psychopathology, with greater purpose potentially limiting avoidance tendencies and reducing the effects of depression and anxiety. Understanding the role that purpose in life may play in depression and anxiety could help to inform current conceptualizations of these disorders and improve treatment outcomes.

Transition from Paediatric to adult health services: Aspirations and practices of human flourishing

BACKGROUND

Transition from paediatric to adult care is challenging for youths with a chronic condition. Most transition programmes place high value in autonomy and independence. We undertook a qualitative study to: (1) identify the needs and aspirations of youths and (2) better understand the well-being and flourishing of youths.

METHODS

Semi-structured interviews were conducted with youths, parents of youths and healthcare professionals recruited from four clinics. Thematic analysis focused on: (1) perceptions of transition; (2) key aspects of human flourishing during transition; and (3) salient concerns with respect to the transition and dimensions of human flourishing.

RESULTS

54 interviews were conducted. Perceptions of transition clustered around: (1) apprehension about adult care; (2) lack of clarity about the transition process; (3) emotional attachment to paediatric healthcare professionals; (4) the significance of the coinciding transition into adulthood. Fourteen salient concerns (e.g., Knowledge and information about the transition, Parental involvement in healthcare) were identified with corresponding recommendations. Salient concerns related to important dimensions of human flourishing (e.g., environmental mastery, autonomy).

DISCUSSION AND CONCLUSION

The flourishing of youths is affected by suboptimal transition practices. We discuss the implications of our findings for environmental mastery, contextual autonomy, and the holistic and humanistic aspects of transition.

Testing the Reciprocal Relationship Between Social Networks and Purpose in Life Among Older Adults: Application of a Random Intercept Cross-Lagged Panel Model

Objectives: The purpose of this study is to examine if there are longitudinal reciprocal effects between social network size and purpose in life among older adults. Methods: Using data from the National Health and Aging Trends Study, the sample included 1485 male and 2058 female adults 65 years and older. We first computed t-tests to assess gender differences in social network size and purpose in life. In order to examine the reciprocal effects between social network size and purpose in life over four time points (2017, 2018, 2019, and 2020), a RI-CLPM (Model 1) was computed. In addition to the main model, two multiple group RI-CLPM analyses (Model 2 and 3) were computed to test the moderated gender effect on the relationship with models estimating unconstrained and constrained cross-lagged parameters. Results: The results of the t-tests denoted significant gender differences in social network size and purpose in life. The results indicated that Model 1 fit the data well. The carry-over effects of social networks and purpose in life and spill-over effect from wave 3 purpose in life on wave 4 social networks were significant. There were no significant differences between the constrained and unconstrained models testing for moderated gender effects. Discussion: The findings of the study highlight the significant carry-over effect of purpose in life and social network size over four years and the positive spill-over effect from purpose in life on social network size at the subsequent wave, which only appeared at the last time point.

Improving Purpose in Life in School Settings

Background and aim: The dimension of purpose in life (PiL) is one of the core features of eudaimonia and plays a crucial role in developmental settings. However, few studies have examined purpose in life in younger generations and verified if it is amenable to improvements following a wellbeing-promoting intervention. The aim of the present investigation is to explore correlates and predictors of purpose in life in school children and to test if it can be ameliorated after school-based wellbeing interventions. Methods: A total of 614 students were recruited in various schools in Northern Italy. Of these, 456 belonged to junior high and high schools and were randomly assigned to receive a protocol of School Well-Being Therapy (WBT) or a psychoeducational intervention (controls). A total of 158 students were enrolled in elementary schools and received a positive narrative intervention based on fairytales or were randomly assigned to controlled conditions. All students were assessed pre- and post- intervention with Ryff scales of eudaimonic wellbeing (short version) and with other self-report measures of anxiety, depression and somatization. Additionally, the Strengths and Difficulties Questionnaire (SDQ) was administered to their schoolteachers as observed-rated evaluation. Results: In both elementary and high schools, purpose in life after the intervention was predicted by initial depressive symptoms and by group assignment (positive interventions vs. controls). In older students, PiL was predicted by female gender and anxiety levels, while no specific strengths identified by teachers were associated with PiL. Conclusions: PiL plays an important and strategic role in developmental settings, where students can develop skills and capacities to set meaningful goals in life. Depressive symptoms and anxiety can be obstacles to developing PiL in students, while positive school-based interventions can promote this core dimension of eudaimonia.

Purpose in life, stress mindset, and perceived stress: Test of a mediational model

Purpose in life is associated with less perceived stress and more positive worldviews. This study examined whether people with more purpose adopt a mindset that views stress as beneficial rather than harmful and whether this mindset is one mechanism between purpose and less stress. We used a short-term longitudinal study (N=2,147) to test stress mindset as a mediator between purpose in life measured prior to the pandemic and stress measured early in the pandemic. We also tested Covid-related worry as a mechanism, given the measurement period spanned pre-pandemic to the first shutdowns in the United States. In contrast to expectations, purpose was unrelated to whether stress was conceptualized as beneficial or harmful (b=.00, SE=.02; p=.710) and thus stress mindset did not mediate the prospective association between purpose and stress. Both purpose in life (b=-.41, SE=.04, p<.001) and stress mindset (b=-.24, SE=.04; p<.001) were independent prospective predictors of stress. Purpose was related to less Covid-related worry, which was a significant mechanism between purpose and stress (indirect effect=-.03, SE=.01; p=.023). A stress-is-enhancing mindset predicted less stress but did not explain why purpose was associated with less perceived stress, whereas fewer Covid-related worries was one pathway from purpose to less stress.

Young para-athletes display more hedonic well-being than people with disabilities not taking part in competitive sports: insights from a multi-country survey

Hedonic well-being relates to how individuals experience and rate their lives. People with disabilities due to their pathology may more frequently suffer from anxiety and depressive disorders than their able-bodied counterparts. Sports participation is an essential way to cope with disability. On the other hand, compared with their able-bodied peers, para-athletes undergo a unique series of stressors. Little is known in terms of hedonic well-being in this specific population. We present the results of a multi-country survey of self-perceived hedonic well-being by para-athletes of different sports disciplines and a control group (disabled individuals not playing competitive sports), using the "Psychological General Well-Being Index" (PGWBI). We included 1,208 participants, aged 17.39 years, 58.4% male, 41.6% female, and 70.3% para-athletes. Para-athletes exhibited higher well-being than disabled people, for all domains of the PGWBI scale. The nature of disability/impairment was significant, with those with acquired disability reporting lower well-being. Those taking part in wheelchair basketball, para-athletics, and para-swimming competitions had a higher likelihood of reporting well-being, whereas those engaged in wheelchair rugby exhibited lower well-being compared with controls. This large-scale investigation can enable a better understanding of the self-perceived hedonic well-being of disabled people.

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.

Beyond Finding Purpose: Motivating a Translational Science of Purpose Acquisition

A broad interest in finding purpose is understandable, as having purpose is situated in notions of "the good life" and is linked in studies to greater health and wellbeing. Yet, the empirical basis for whether purpose is truly findable is inadequate, lacking guidance from theories predicting behavioral capacities that drive its acquisition. If feeling purposeful is as favorable as studies suggest, then more transparent and precise explanations of how it is derived are needed; otherwise, the field risks illuminating this resource while leaving the pathways to it unlit. Here, I call for a translational science of purpose acquisition directed at gathering and disseminating evidence of the processes by which this sense can be cultivated. I introduce a minimal viable framework for integrating basic and applied investigations into purpose by bridging laboratory research, intervention and implementation efforts, community-engaged practices, and policies to accelerate testing and strategies for enhancing this salubrious sense in people's lives.

Positive mindset and exercise capacity in school-aged children and adolescents with congenital heart disease

Introduction

Patients with congenital heart disease (CHD) have variable degrees of peak oxygen consumption (VO₂) that can be improved with supervised fitness training. The ability to exercise is affected by anatomy, hemodynamics, and motivation. Motivation is in part related to mindset, or personal attitudes and beliefs, and a more positive mindset around exercise has been associated with better outcomes. It is unknown whether variations in measured peak VO₂ in patients with CHD are related to having a positive mindset.

Methods

Patient's ages 8-17 years with CHD were administered quality of life and physical activity questionnaires at the time of their routine cardiopulmonary exercise test. Those with severe hemodynamic burden were excluded. Patients were grouped based on disease classification. Mindset was evaluated via validated questionnaires including a PROMIS Meaning and Purpose (MaP) survey and an Anxiety survey. Pearson correlation coefficients were calculated to estimate the magnitude of the association between percent predicted peak oxygen consumption (pppVO₂) and questionnaire scores overall and within CHD subgroups.

Results

Eighty-five patients participated; median age was 14.7 years, 53% were female, 66% had complex CHD, 20% had simple CHD, and 14% had single ventricle heart disease. Mean MaP scores were significantly lower in all CHD groups compared to population norms (p < 0.001). As a group, MaP scores were positively associated with the amount of reported physical activity (p = 0.017). In patients with simple CHD, MaP scores were positively associated with pppVO₂ (p = 0.015). The association was even stronger for MaP:Anxiety, with worse ratios associated with lower pppVO₂ (p = 0.005). Patients with complex and single ventricle CHD did not show a similar association.

Conclusions

Patients with CHD, regardless of severity, had lower meaning and purpose scores than the general population, and these scores were associated with amount of reported physical activity. In the simple CHD subset, having a more positive mindset was associated with higher peak VO₂ and a more negative mindset with lower peak VO₂. This relationship was not seen with more significant CHD. While underlying CHD diagnoses are not modifiable, mindset and peak VO₂ are, and consideration should be given to measuring both as each may be a target for intervention.

Purpose in Life: Addressing Transdiagnostic Psychopathologies Concerning Patients' Sense of Purpose

ABSTRACT

Having a purpose in life is strongly associated with well-being and quality of life. Some individuals develop their sense of purpose early in life and can sustain lifelong ideals. In contrast, we identify four transdiagnostic syndromes where purpose in life is impaired: 1) deficiencies in generating purpose; 2) loss of purpose due to traumatic events such as catastrophic illnesses or bereavements; 3) conflicts due to crossed purposes; and 4) maladaptive purposes, such as life-limiting single-minded goals, dominating others, or exacting revenge. Several psychotherapies associated with positive and existential psychologies help patients construct, reconstruct, or retain a sense of purpose. However, given the strong links between a sense of purpose and beneficial health and mental health outcomes, the authors suggest that many patients in psychiatric treatment including psychotherapies will benefit from attention to these issues. This article reviews approaches for assessing and addressing purpose in life in psychiatric treatment, to enhance patients' healthy sense of purpose where this characteristic is impaired.

Biopsychosocial Factors That Influence the Purpose in Life among Working Adults and Retirees

This study aimed to identify and characterize biopsychosocial factors that impact the purpose in life (PIL) among adults that are working or already retired. This cross-sectional study includes a sample of 1330 participants, of whom 62.2% were female, with ages ranging from 55 and 84 years, with a mean of 61.93 years and a standard deviation of 7.65. Results suggest that the education level, stress, spirituality (religion) and optimism, social support from friends, and quality of life related to physical health seem to contribute positively to the PIL for both groups. However, some variables such as age, marital status and environmental quality of life help explain the PIL of retired people and the quality of life related to social support helps explain the PIL of working adults. Overall, the reported findings suggest that the purpose in life is strongly related to physical, psychological, social and environmental health factors. It is highlighted that working adults and retired people have their purpose in life related to similar factors and others specific to each life stage, suggesting the need for crucial interventions to promote a healthier and more positive aging process.

Purpose in life and physical health in older U.S. military veterans: Cross-sectional results from the National Health and Resilience in Veterans Study

General population studies suggest purpose in life (PIL) is associated with a number of positive outcomes, including better mental and physical health. At present, however, scarce research has examined how PIL relates to these outcomes in veterans. The goal of this study was to determine the current prevalence of different levels of PIL and their associations with reported physical health in a nationally representative sample of predominantly older U.S. veterans. Cross-sectional data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (N = 4069; M_(age) = 62.2). Veterans were classified into low, average, and high PIL. Self-report assessments were administered to assess physical health conditions and physical functioning. Results showed most veterans endorsed average PIL (71.7%), while 16.0% endorsed low PIL and 12.3% endorsed high PIL. Low PIL was associated with lower overall self-reported health and physical and cognitive functioning, as well as higher bodily pain, somatic symptoms, and physical role limitations (Cohen's d = 0.06-0.77). Low PIL was also associated with elevated rates of several physical health conditions, including sleep disorders, as well as obesity and disability with activities of daily living (i.e., ADLs) or instrumental activities of daily living (i.e., IADLs). These results suggest low PIL is associated with physical health difficulties, and underscore the importance of assessing and monitoring PIL, and evaluating whether interventions to promote PIL may help improve physical health and vice versa.

Reciprocal Associations between Depressive Symptoms, Life Satisfaction, and Eudaimonic Well-Being in Older Adults over a 16-Year Period

The dual-continua model of mental health distinguishes between mental illness (presence of mental disorders, such as depression) and mental well-being (presence of positive traits and abilities). This model also distinguishes between hedonic well-being (e.g., affect balance and life satisfaction) and eudaimonic well-being (i.e., optimal psychological and social functioning, as indicated for example by having a purpose in life). We examined the relationships between depressive symptoms (a common indicator of mental illness), life satisfaction, and eudaimonic well-being. The study used a sample of 17,056 participants from England whose data were collected at eight intervals of approximately two years over a 16-year period, from 2004 to 2019. The mean age of the sample in the first wave was 58.843 years, with a standard deviation of 12.617 years (women = 55.2%). We disentangled within- and between-person sources of variance to examine whether increases or decreases in one variable preceded changes in the other variables at the next time point. We found positive reciprocal relationships between life satisfaction and eudaimonic well-being and negative reciprocal relationships between the two well-being dimensions and depressive symptoms. These results suggest that within-person increases in well-being are followed by future decreases in depressive symptoms, and within-person increases in depressive symptoms are followed by future decreases in well-being. Therefore, low levels of mental well-being in older adults may be considered a risk factor for depression, and well-being interventions (such as those focused on meaning-making) may serve as a protective factor against depression in older adults.

Mediation effects of cognitive, physical, and motivational reserves on cognitive performance in older people

Introduction

We study from a multidimensional perspective the different factors that help prevent the development of cognitive impairment in old aging.

Methods

This study analyzed in 300 elderly subjects the relationship between cognitive reserve (CR), physical reserve (PR) and motivational reserve (MR) with cognitive impairment. This study also takes into consideration different variables (sex, age, educational level, and institutionalization) that might affect the results in the different types of reserves (CR, physical and MR) and cognitive impairment.

Results

The results show that people with a higher cognitive reserve, physical reserve and motivational reserve have less cognitive impairment.

Discussion

Therefore, it is important to consider measuring the CR as a variable to diagnose neurodegenerative illnesses but it is also essential to consider the physical state and physical activity, as well as the motivational dimension. With the cognitive reserve and sex variables no significant differences were observed. Age had a negative effect on strategic flexibility, but those with higher CR had better cognitive flexibility and the educational.

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.

Psychological well‐being and salivary markers of inflammation: The moderating effect of age

Increasing evidence suggests a significant impact of higher psychological well-being (PWB) on health outcomes; however, such associations have been studied exclusively in middle-aged to older adults. This study examined the aging effect on PWB measures as well as the moderating effect of age on the link between PWB and inflammation, using salivary markers by comparing the younger adults (n = 127; M_age  = 22.98 years) versus older adults (n = 75; M_age  = 75.60 years). Older adults showed significantly lower levels of PWB, particularly regarding purpose in life and personal growth. Moreover, higher purpose in life was associated with lower salivary IL-1ß and IL-6 (b = 0.83, p < .001; b = 0.81, p < .01) only in the older adult group but not in younger adults. These findings highlight the potential buffering effect of the sense of living well on physiological pathways in later life.

Protocol for EXICODE: the EXIstential health COhort DEnmark-a register and survey study of adult Danes

INTRODUCTION

We established the EXIstential health COhort DEnmark (EXICODE) to examine how existential and spiritual needs, practices and orientations in a secular culture are linked to health outcomes, illness trajectory and overall cost of care in patients. Substantial literature demonstrates that existential and spiritual well-being has positive effects on health. While people turn to existential and spiritual orientations and practices during ageing, struggle with illness and approaching death, patients with severe illnesses like, for example, cancer similarly experience existential and spiritual needs. These needs are often unmet in secular societies leading to spiritual pain, unnecessary suffering, worse quality of life and higher medical costs of care.

METHODS AND ANALYSIS

EXICODE is a national cohort comprising a 10% random sample of the adult Danish population with individual-level register and survey data. Specific patient subgroups are oversampled to ensure diseased respondents. The questionnaire used in the survey consists of a collection of validated instruments on existential and spiritual constructs suited for secular culture as well as some ad hoc questions compiled in the comprehensive EXICODE Questionnaire.

ETHICS AND DISSEMINATION

The project is registered for legal and GDPR concerns by the University of Southern Denmark, journal number: 10.367. Ethical approval was not required by Danish law since EXICODE collects only interview, survey and register data, but due to institutional best-practice policy an ethical evaluation and approval were nevertheless obtained from the University of Southern Denmark Research Ethics Committee (institutional review board), journal number: 20/39546. The project follows The Danish Code of Conduct for Research Integrity and is carried out in accordance with the Helsinki Declaration. Results will be disseminated widely through publications in peer-reviewed scientific journals, international conferences, patient societies as well as mass and social media.

Bireysel Psikoloji’nin Maneviyatla İlişkisi Üzerine Bir Derleme Çalışması

Bireysel psikoloji, Alfred Adler tarafından geliştirilmiş ve psikoloji literatürüne hem teorik hem de pratik olarak önemli katkılar sağlamış bir teoridir. Maneviyat ise insan hayatında göz ardı edilemeyecek bir alandır. Bu makale, bireysel psikolojinin maneviyata yönelik bakış açısını, maneviyatla ilişkisini, manevi değerlendirmeleri nasıl yaptığını ve manevi/ dini yönelimli danışanlarla nasıl kullanılabileceğini içeren bir derleme çalışmasıdır. Derleme, hem Adler’in kendi metinlerini hem de onun teorik yönelimini benimseyen daha sonraki araştırmacıların makalelerini ele almaktadır. Bireysel psikoloji, her bireyi kendi fenomenolojik alanını dikkate alarak değerlendirmektedir. Bu nedenle danışma sürecinde danışanların manevi/dini boyutlarını göz ardı etmez ve maneviyatın bireylerin hayatında önemli bir yere sahip olduğunu kabul eder. Maneviyatın önemli bir başa çıkma mekanizması sağlarken iyilik, umut ve içgörüyü destekleyen bir yapıya sahip olduğu düşünüldüğünde, Adler’in teorisine maneviyatı dahil etmesi önemli görünmektedir. Makalede yer alan vaka örnekleri de bunu desteklemekte ve bireysel psikolojinin psikolojik danışma sürecinde maneviyatı nasıl ele aldığını ve değerlendirdiğini genel hatlarıyla ortaya koymaktadır.

Associations Between Satisfaction With Aging and Health and Well-being Outcomes Among Older US Adults

IMPORTANCE

Researchers and policy makers are expanding the focus from risk factors of disease to seek potentially modifiable health factors that enhance people's health and well-being. Understanding if and to what degree aging satisfaction (one's beliefs about their own aging) is associated with a range of health and well-being outcomes aligns with the interests of older adults, researchers, health systems, and politicians.

OBJECTIVES

To evaluate associations between changes in aging satisfaction and 35 subsequent health and well-being outcomes.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from the Health and Retirement Study, a national, diverse, and longitudinal sample of 13 752 US adults older than 50 years, to evaluate if changes in aging satisfaction (between combined cohorts from 2008 and 2010 and 4 years later, in 2012 and 2014) were subsequently associated with 35 indicators of physical, behavioral, and psychosocial health and well-being in 2016 and 2018. Statistical analysis was conducted from July 24, 2020, to November 6, 2021.

EXPOSURE

Aging satisfaction.

MAIN OUTCOMES AND MEASURES

A total of 35 physical (eg, stroke), behavioral (eg, sleep problems), and psychosocial (eg, depression) outcomes were evaluated using multiple linear and generalized linear regression models. Data from all participants, irrespective of how their levels of aging satisfaction changed from the prebaseline to baseline waves, were incorporated into the overall estimate, which was conditional on prior satisfaction.

RESULTS

During the 4-year follow-up period, participants (N = 13 752; 8120 women [59%]; mean [SD] age, 65 [10] years; median age, 64 years [IQR, 56-72 years]; 7507 of 11 824 married [64%]) in the highest (vs lowest) quartile of aging satisfaction had improved physical health (eg, 43% reduced risk of mortality [risk ratio, 0.57; 95% CI, 0.46-0.71]), better health behaviors (eg, 23% increased likelihood of frequent physical activity [risk ratio, 1.23; 95% CI, 1.12-1.34]), and improved psychosocial well-being (eg, higher positive affect [β = 0.51; 95% CI, 0.44-0.58] and lower loneliness [β = -0.41; 95% CI, -0.48 to -0.33]), conditional on prebaseline aging satisfaction.

CONCLUSIONS AND RELEVANCE

This study suggests that higher aging satisfaction is associated with improved subsequent health and well-being. These findings highlight potential outcomes if scalable aging satisfaction interventions were developed and deployed at scale; they also inform the efforts of policy makers and interventionists who aim to enhance specific health and well-being outcomes. Aging satisfaction may be an important target for future interventions aiming to improve later-life health and well-being.