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He Q, Tong H, Liu JB. How Does Inequality Affect the Residents' Subjective Well-Being: Inequality of Opportunity and Inequality of Effort. Front Psychol 2022; 13:843854. [PMID: 35465572 PMCID: PMC9019070 DOI: 10.3389/fpsyg.2022.843854] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Based on the Chinese General Social Survey database (2010-2015), this article explores the relationship between income inequality and residents' subjective well-being from the perspective of inequality of opportunity and inequality of effort. We find that inequality of opportunity has a negative impact on subjective well-being in China, where inequality of effort has a positive impact. Our empirical results are robust for changing the inequality indicators. In the sub-sample studies, consistent conclusions are obtained in rural areas, whereas in urban areas only inequality of effort has a significant impact. The results of mechanism study show that inequality of opportunity decreases residents' sense of fairness, and inequality of effort increases residents' sense of fairness, thus affecting their subjective well-being. The results of this study provide a good response to the inconclusive research findings on the impact of income inequality on subjective well-being.
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Affiliation(s)
- Qizhi He
- School of Statistics and Mathematics, Zhejiang Gongshang University, Hangzhou, China
- Collaborative Innovation Center for Statistical Data Engineering Technology and Application, Zhejiang Gongshang University, Hangzhou, China
| | - Hao Tong
- School of Statistics and Mathematics, Zhejiang Gongshang University, Hangzhou, China
- School of Economics and Management, Huaibei Normal University, Huaibei, China
| | - Jia-Bao Liu
- School of Mathematics and Physics, Anhui Jianzhu University, Hefei, China
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2
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Life Conditions as Mediators of Welfare State Effect on Mental Wellbeing among Oldest Old in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074363. [PMID: 35410040 PMCID: PMC8998964 DOI: 10.3390/ijerph19074363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
Abstract
Background: Mental wellbeing is formed by our daily environments, which are, in turn, influenced by public policies, such as the welfare state. This paper looks at how different aspects of life conditions may mediate the welfare state effect on mental wellbeing in oldest old age. Methods: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. Results: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables. Conclusions: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.
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Espinosa JC, Antón C, Grueso Hinestroza MP. Helping Others Helps Me: Prosocial Behavior and Satisfaction With Life During the COVID-19 Pandemic. Front Psychol 2022; 13:762445. [PMID: 35153950 PMCID: PMC8828552 DOI: 10.3389/fpsyg.2022.762445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/03/2022] [Indexed: 01/10/2023] Open
Abstract
Prosocial behavior (PsB) and its effects have been analyzed in times of crisis and natural disasters, although never before in the face of such exceptional circumstances as those created by the COVID-19 pandemic. This research analyzes the role of PsB on satisfaction with life (SWL) in Colombia, considering the negative emotional impact of events that began in February 2020. We conduct an exploratory analysis using a sample of Colombia’s general population (N = 2,574; 53.2% women) with an average age of 44.66 years (SD = 15.36). Using the Classification Tree technique, we find that engaging in one or more PsBs (e.g., donating money or sharing food) enhances SWL and decreases the impact of negative emotions such as pessimism, indecisiveness, and irritability that have emerged during the COVID-19 pandemic. These findings are significant because they confirm the importance of life satisfaction as a personal resource for coping with complex situations and provide evidence of the benefits of PsB on one’s wellbeing.
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Affiliation(s)
- Juan C Espinosa
- School of Business and Management, Universidad del Rosario, Bogotá, Colombia
| | - Concha Antón
- Department of Social Psychology and Anthropology, Universidad de Salamanca, Salamanca, Spain
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Bittmann F. How Trust Makes a Difference: The Impact of the First Wave of the COVID-19 Pandemic on Life Satisfaction in Germany. APPLIED RESEARCH IN QUALITY OF LIFE 2022; 17:1389-1405. [PMID: 34367359 PMCID: PMC8326641 DOI: 10.1007/s11482-021-09956-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/18/2021] [Indexed: 05/21/2023]
Abstract
The extraordinary COVID-19 pandemic is one of the most severe disruptions of human life since the end of World War II, even in rich and industrialized countries like Germany. The introduction of a rather comprehensive "lockdown" and the restriction of multiple basic civil rights have affected the population in many areas of life, like employment, economic prosperity, health and trust in public institutions. The question arises how life satisfaction is influenced by these measures in detail and whether there are interactions between institutional trust, life satisfaction and time of crisis. Fixed-effect regression analyses using German National Educational Panel Study (NEPS) data demonstrate that life satisfaction has fallen sharply after the onset of the crisis and that interaction effects with institutional trust are present. Individuals with low levels of pre-crisis trust in institutions like the government, courts or the media report a stronger decrease of satisfaction than individuals with higher levels of trust. We believe that these results are relevant to explain the role of institutions in times of crisis and might serve as foundations for interventions to strengthen trust and increase overall satisfaction.
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Affiliation(s)
- Felix Bittmann
- Leibniz Institute for Educational Trajectories, Wilhelmsplatz 3, 96047 Bamberg, Germany
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Costa C, Santana P. Trends of amenable deaths due to healthcare within the European Union countries. Exploring the association with the economic crisis and education. SSM Popul Health 2021; 16:100982. [PMID: 34926783 PMCID: PMC8648806 DOI: 10.1016/j.ssmph.2021.100982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/03/2023] Open
Abstract
The study of premature deaths from causes that are generally preventable given the current availability of healthcare - called amenable deaths due to healthcare - provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the association between amenable deaths due to healthcare and health determinants, such as education, might be the key to preventing these deaths in the future. Still unclear however, is how this works and how amenable deaths due to healthcare are distributed and evolve within the European Union (EU) below the national level. We therefore studied the geographical and temporal patterns of amenable deaths due to healthcare in the 259 EU regions from 1999 to 2016, including the 2007-2008 financial crisis and the post-2008 economic downturn, and identified whether any association with education exists. A cross-sectional ecological study was carried out. Using a hierarchical Bayesian model, we estimated the average smoothed Standardized Mortality Ratios (sSMR). A regression model was also applied to measure the relative risks (RR) at 95% credible intervals for cause-specific mortality association with education. Results show that amenable deaths due to healthcare decreased globally. Nevertheless, the decrease is not the same across all regions, and inequalities within countries do persist, with lower mortality ratios seen in regions from Central European countries and higher mortality ratios in regions from Eastern European countries. Also, the evolution trend reveals that after the financial crisis, the number of these deaths increased in regions across almost all EU countries. Moreover, educational disparities in mortality emerged, and a statistical association was found between amenable deaths due to healthcare and early exit from education and training. These results confirm that identifying and understanding the background of regional differences may lead to a better understanding of the amenable deaths due to healthcare and allow for the application of more effective policies.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
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6
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Navarro-Carrillo G, Valor-Segura I, Moya M. The consequences of the perceived impact of the Spanish economic crisis on subjective well-being: The explanatory role of personal uncertainty. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00506-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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7
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Clench-Aas J, Bergande I, Nes RB, Holte A. Trust Buffers Against Reduced Life Satisfaction When Faced With Financial Crisis. Front Psychol 2021; 12:632585. [PMID: 34248740 PMCID: PMC8264375 DOI: 10.3389/fpsyg.2021.632585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In light of the coronavirus disease 2019 (COVID-19) pandemic and its large economic consequences, we used a three-layer nested structural model (individual, community, and country), each with a corresponding measure of income, trust, and satisfaction, to assess change in their interrelationships following a global crisis; which, in this study, is the 2008/2009 financial crisis. Methods: With multilevel techniques, we analyzed data from two waves (2006 and 2012) of the European Social Survey (ESS) in 19 countries (weighted N = 73,636) grouped according to their levels of trust. Results: In high trust countries, personal life satisfaction (LS) was not related to personal, community, or national income before or after the crisis. In contrast, in low trust countries, LS was strongly related to all three forms of income, especially after the crisis. In all country groups, personal, social, and political trust moderated their respective effects of income on LS ("the buffer hypothesis"). Political trust moderated the effects of income more strongly in low trust countries. The moderating effect of political trust increased sharply after the crisis. After the crisis, national-level factors (e.g., political trust, national income) increased their importance for LS more than the factors at the local and individual levels. However, the relative importance of all the three forms of income to LS increased after the crisis, to the detriment of trust. Conclusion: Economic crises seem to influence personal LS less in high trust countries compared with low trust countries. Hence, high trust at a national level appears to buffer the negative impact of a financial crisis on personal satisfaction. Overall, the factors at the national level increased their impact during the financial crisis. When facing a global crisis, the actions taken by institutions at the country level may, thus, become even more important than those taken before the crisis.
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Affiliation(s)
- Jocelyne Clench-Aas
- Division of Mental and Physical Health, Department of Public Health Science, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingrid Bergande
- Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - Ragnhild Bang Nes
- Division of Mental and Physical Health, Department of Public Health Science, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, Promenta Research Center, University of Oslo, Oslo, Norway
| | - Arne Holte
- Division of Mental and Physical Health, Department of Public Health Science, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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Thompson K, Wagemakers A, van Ophem J. Assessing health outcomes in the aftermath of the great recession: a comparison of Spain and the Netherlands. Int J Equity Health 2020; 19:84. [PMID: 32503561 PMCID: PMC7275523 DOI: 10.1186/s12939-020-01203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Background Across time and space, financial security has been shown to impact health outcomes, with the acute loss of financial security being particularly detrimental. We compare financial security’s association with health in Spain and the Netherlands. These countries respectively exemplify low and high levels of financial security, general trends that have been exacerbated by the Great Recession of the 2010s. Methods We exploit the Spanish (n = 1001) and Dutch (n = 1010) editions of the European Social Survey 7, conducted in 2014, and condense relevant financial security- and health-related survey questions into latent variables using factor analyses. Using the component loadings as quasi-weightings, we generate one financial security variable and three health variables (mental, physical and social). Then, we run ordinary least squares regressions interacting financial security and nationality, for each of the three health outcomes. Results In unadjusted models, we find that financial security (p < 0.01) is positively associated with the three health outcomes, while being Spanish relative to being Dutch (p < 0.01) is associated with worse health outcomes. However, the results of the interaction term show that being Spanish relative to being Dutch weakens the relationship between physical health and social health, although not mental health. Conclusions We find evidence that financial security’s influence on health outcomes may vary in different contexts. This may be an important aspect of determining the Great Recession’s influence on health outcomes. Our study is a first step in understanding how the relationships between financial security and health may differ in countries with different experiences of the Great Recession.
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Affiliation(s)
- Kristina Thompson
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annemarie Wagemakers
- Health and Society Group, Wageningen University & Research, Wageningen, the Netherlands.
| | - Johan van Ophem
- Urban Economics Group, Wageningen University & Research, Wageningen, the Netherlands
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Connecting perceived economic threat and prosocial tendencies: The explanatory role of empathic concern. PLoS One 2020; 15:e0232608. [PMID: 32365125 PMCID: PMC7197816 DOI: 10.1371/journal.pone.0232608] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/18/2020] [Indexed: 11/19/2022] Open
Abstract
Recent research suggests that perceived economic threat constitutes a valid predictor of people’s attitudes and behaviors. While accumulated empirical evidence has mostly underlined the deleterious psychological effects (e.g., reduced psychological well-being) of perceived economic threat in times of economic strain, we postulate that individuals experiencing higher economic threat linked to the Spanish economic crisis are more prone to engage in other-beneficial prosocial behavior. Across two independently collected community samples, we tested this theoretical formulation and examined the potential mediating roles of empathic concern (Studies 1 & 2) and identification (Study 2). Study 1 (N = 306) revealed that participants who descended in the social scale due to the negative national economic context were engaged in a larger number of helping behaviors over the last three months compared to participants who did not descend the social ladder—independently of several sociodemographic and ideological factors. Moreover, our data indicated these effects were driven by increased empathic concern. Study 2 (N = 588), in which two hypothetical helping-behavior scenarios were randomly administered (crisis-related vs. control), showed that participants under high perceived financial threat exhibited an undifferentiated pattern of prosociality. However, moderated-mediation analyses indicated that empathic concern explained the perceived financial threat-helping behavior link in the hypothetical crisis-related scenario but not in the hypothetical control scenario. Together, these findings extend prior literature on the psychosocial effects of perceived economic threat and the determinants of other-oriented behavior. Implications of these findings and suggestions for further research are discussed.
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10
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Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, Kim ES, Koga HK, Feig EH, Lloyd-Jones DM, Seligman MEP, Labarthe DR. Reprint of: Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series. J Am Coll Cardiol 2018; 72:3012-3026. [PMID: 30522634 DOI: 10.1016/j.jacc.2018.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 02/08/2023]
Abstract
Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes.
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Affiliation(s)
| | - Jeff C Huffman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Julia K Boehm
- Department of Psychology, Chapman University, Orange, California
| | - Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Eric S Kim
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hayami K Koga
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emily H Feig
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Martin E P Seligman
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Darwin R Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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11
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Clench-Aas J, Holte A. Measures that increase social equality are effective in improving life satisfaction in times of economic crisis. BMC Public Health 2018; 18:1233. [PMID: 30400974 PMCID: PMC6218958 DOI: 10.1186/s12889-018-6076-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The financial crisis of 2008/2009, for some also in 2011, was accompanied by increasing social inequality and unemployment, which strained the welfare generosity systems in many countries. Welfare generosity redistributes internal resources to decrease poverty and increase equal opportunities. This was used by many countries to combat the crisis. We investigated the effects of increased social inequality, unemployment and welfare generosity on life satisfaction (LS) before and after the crisis. METHODS A representative sample from the European Social Survey (2002 to 2014) with data from 26 countries was used (N = 301,559). Time from start of crisis (either 2008 or 2010-2012) was determined separately for each case. LS was measured with a single question with 11 response alternatives. Social inequality was measured using the Gini index. Unemployment was measured by a single question (No/Yes). Welfare generosity was measured using expenditure on social protection (PPS) per inhabitant (Eurostat). Data were analyzed by multilevel analysis and multilevel mediation analysis. RESULTS Welfare generosity was associated with decreased levels of social inequality. The negative relationship between social inequality and LS was weakened when controlling for welfare generosity after the financial crisis. This effect of welfare generosity was not seen for the negative impact of unemployment on LS. CONCLUSION The financial crisis stimulated the use of welfare generosity in Europe and strengthened the positive relationship between welfare generosity and LS. Social inequality, unemployment and welfare generosity played significant mediator roles between the crisis and LS, with increased welfare generosity far more strongly associated with increased LS. Measures that increase social equality in a country and thereby increase equal opportunity for all social classes, may be assumed to be effective in improving the general LS of the population in a country in times of economic crisis.
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Affiliation(s)
- Jocelyne Clench-Aas
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PB 4404, Nydalen, NO-0403, Oslo, Norway.
| | - Arne Holte
- Department of Psychology, University of Oslo, Oslo, Norway
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12
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Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, Kim ES, Koga HK, Feig EH, Lloyd-Jones DM, Seligman MEP, Labarthe DR. Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series. J Am Coll Cardiol 2018; 72:1382-1396. [PMID: 30213332 PMCID: PMC6289282 DOI: 10.1016/j.jacc.2018.07.042] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
Abstract
Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes.
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Affiliation(s)
| | - Jeff C Huffman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Julia K Boehm
- Department of Psychology, Chapman University, Orange, California
| | - Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Eric S Kim
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hayami K Koga
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emily H Feig
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Martin E P Seligman
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Darwin R Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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