The field of medicine has long focused on how negative psychological functioning is associated with disease – for example, how anxiety and depression increase the risk of heart attacks.
Health, however, is more than the mere absence of disease. In an article published this week in the Psychological Bulletin, my colleague Laura Kubzansky and I demonstrate that positive psychological well-being – which includes feeling optimistic, happy, satisfied, and purposeful – is beneficial for cardiovascular health.
In an investigation of more than 200 studies, we found that these psychological assets are associated with a reduced risk of cardiovascular disease, the leading cause of death in the United States. This relationship was present regardless of a person’s age, socioeconomic status, smoking status, or body mass index.
Moreover, positive psychological well-being seems to be connected to better cardiovascular outcomes because people with greater well-being tend to engage in healthier behaviors like exercising and have healthier biological function like low cholesterol. These findings align with the American Heart Association’s recent emphasis on ideal cardiovascular health, which it defines as more than the absence of risk factors.
This perspective on health does not end with one study. Robert Wood Johnson Foundation’s Pioneer Portfolio is funding ongoing investigation into Positive Health, an emerging body of research into health assets that help people achieve and maintain good health. These assets may include subjective factors like an optimistic outlook, functional factors like a stable marriage, and biological factors like low blood pressure. All of these assets are desirable in their own right, but researchers are also exploring how they may enhance overall well-being and protect against physical illness.
Although more research is needed to gain a deeper understanding of how psychological well-being protects against cardiovascular disease over time, our findings have important implications for prevention and intervention strategies. In addition to repairing psychological deficits like depression, bolstering psychological strengths like optimism may help to foster cardiovascular health.
Julia K. Boehm, PhD, is a post-doctoral research fellow at the Harvard School of Public Health. Boehm is the co-author of “The Heart’s Content: The Association between Positive Psychological Well-Being and Cardiovascular Health.”
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Good point, Bobby. We tried to address this concern by looking only at studies in which well-being was measured before the occurrence of a heart attack or stroke. For example, healthy individuals without any evidence of heart disease would indicate how satisfied they were, how optimistic they felt about the future, or how much meaning they had in their lives. Researchers then followed these people for many years and even decades to see who eventually experienced a heart attack or stroke. Because all participants initially started off healthy, we can get closer to determining whether greater well-being precedes cardiovascular events. Given that experimental studies in this area are not feasible, longitudinal and prospective studies like I describe provide the strongest possible test for whether well-being influences disease rather than vice versa.
I should also note, however, that this ‘chicken and egg’ problem is very much an issue for the evidence regarding well-being’s association with healthier behaviors and biology. There is just not enough research yet to determine the direction of effects. If it turns out that greater well-being precedes better health behaviors and biological function, then there are important implications for the development of prevention and intervention strategies. Only additional experimental and longitudinal studies will help us figure that out though.
Thanks. Yeah. Doing semi-qualitative observational research is fraught.
I’m about to begin a longitudinal “improved sense of wellness” self experimental study of n=1, df=0 (LOL), taking up Aikido, mainly so I can get over being such a snarky hardass at times. Visiting dojos this week, trying to find the right place.
Sounds great, but, I had an immediate waft of “circular reasoning” concern.
petitio principii?
If your health is better (as objectively measured), your experience of “well-being” is better?
Chicken-Egg-Chicken…