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More happy, more healthy? Associations of positive psychological well-being with future lifestyle among midlife women

Claudia Trudel-Fitzgerald, PhD

Research Associate Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health Affiliate Scientist Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health Clinical psychologist Ordre des Psychologues du Québec

Presentation given at the International Positive Psychology Association conference July 16th, 2017 – Montreal, Canada

Positive Psychological Well-Being & Health

• Disease outcomes

 CVD  Diabetes  Hypertension

• Mortality

 All-cause  CVD-related

Ameringer et al., 2015; Boehm & Kubzansky, 2012; Boehm et al., 2015; Hingle et al., 2014; Kim et al., 2016; Martin-Maria et al., 2016; Rasmussen et al., 2009; Sin, 2016; Steptoe et al., 2009; Trudel-Fitzgerald et al., 2014/2015

Methods

• Women from the Nurses’ Health Study cohort, free of chronic disease

Baseline happiness 1992 Health behaviors 1994 (T2) Health behaviors 1998 (T3) Health behaviors 2002 (T4) Health behaviors 2006 (T5) Health behaviors 2010 (T6) Baseline

• ptimism

2004 Health behaviors 2006 (T1) Health behaviors 2010 (T2) 1 item: “How much of the time during the past 4 weeks have you been a happy person?” 6 items (LOT-R): e.g., “In uncertain times I usually expect the best”

18 years of follow-up; Nhappiness = 52,070 6 years of follow-up; Noptimism= 36,799

Lifestyle: Physical activity Diet Alcohol intake Smoking BMI Lifestyle: Physical activity Diet Alcohol intake Smoking BMI

Results

Optimism Happiness Continuous Dichotomized Continuous Dichotomized

(1 SD) (High vs. moderate or low) (1 SD) (High vs. moderate or low)

Sample size 36,799 36,799 52,070 52,070

(women with ≥ 1 healthy lifestyle

• ver the course of

follow-up) (16,130) (16,130) (31,609) (31,609)

Odds Ratio 1.18**** 1.33**** 1.14**** 1.29****

(95% CI) (1.16-1.21) (1.28-1.38) (1.12-1.16) (1.25-1.34)

*p≤0.05, **p≤0.01, ***p≤0.001, ****p≤0.0001; SD=standard deviation; CI=confidence intervals.

• Logistic regression models

 Inverse probability weights to account for bias due to differential drop out  Adjustment for age, education, marital status, physical exam in the last 2 years

Discussion

• Positive psychological well-being is related to a greater likelihood of

ever reporting a healthy lifestyle over a period of 6 to 18 years

 Higher (vs. moderate/low) happiness = 29%  Higher (vs. moderate/low) optimism = 33%  For each 1-SD increase as well

• Relationships remained robust

 after adjusting for traditional confounders and psychological distress  regardless of women’s baseline set of health behaviors

• However, results cannot be generalized to

 midlife women with a chronic medical condition  younger women, men, or minorities

• Future directions

 Investigate other psychological well-being dimensions with subsequent lifestyle  Verify whether increasing well-being truly improves lifestyle in clinical studies

Acknowledgements

• Co-authors

 Julia K. Boehm, PhD  Shelley S. Tworoger, PhD  Laura D. Kubzansky, PhD, MPH

• Participants and staff of the Nurses’ Health Study cohort
• Related institutions

 Harvard T.H. Chan School of Public Health  Harvard Medical School  Brigham and Women’s Hospital  Lee Kum Sheung Center for Health and Happiness

• Financial support

 Lee Kum Sheung Center for Health and Happiness (Harvard School of Public Health)  Canadian Institute of Health Research  Fonds de Recherche du Québec – Santé

Questions? ctrudel@hsph.harvard.edu Thank you!

Selected references

 Ameringer, K. J., Chou, C. P., & Leventhal, A. M. (2015). Shared versus specific features of psychological symptoms and cigarettes per day: Structural relations and mediation by negative- and positive-reinforcement smoking. Journal of Behavioral Medicine, 38(2), 224-236.  Boehm, J. K., & Kubzansky, L. D. (2012). The heart's content: The association between positive psychological well-being and cardiovascular health. Psychological Bulletin, 138(4), 655-691.  Boehm, J. K., Trudel-Fitzgerald, C., Kivimaki, M., & Kubzansky, L. D. (2015). The prospective association between positive psychological well-being and diabetes. Health Psychology, 34(10), 1013-1021.  Hingle, M. D., Wertheim, B. C., Tindle, H. A., Tinker, L., Seguin, R. A., Rosal, M. C., et al. (2014). Optimism and diet quality in the Women's Health Initiative. J Acad Nutr Diet, 114(7), 1036-1045.  Kim, E. S., Kubzansky, L. D., Soo, J., & Boehm, J. K. (2016). Maintaining healthy behavior: A prospective study of psychological well-being and physical activity. Annals of Behavioral Medicine.  Martin-Maria, N., Miret, M., Caballero, F. F., Rico-Uribe, L. A., Steptoe, A., Chatterji, S., et al. (2017). The impact of subjective well-being on mortality: A meta-analysis of longitudinal studies in the general population. Psychosomatic Medicine.  Rasmussen, H. N., Scheier, M. F., & Greenhouse, J. B. (2009). Optimism and physical health: A meta-analytic review. Annals of Behavioral Medicine, 37(3), 239-256.  Sin, N. L. (2016). The protective role of positive well-being in cardiovascular disease: Review of current evidence, mechanisms, and clinical

• implications. Current Cardiology Reports, 18(11), 106.

 Steptoe, A., Dockray, S., & Wardle, J. (2009). Positive affect and psychobiological processes relevant to health. Journal of Personality, 77(6), 1747-1776.  Trudel-Fitzgerald, C., Boehm, J. K., Kivimaki, M., & Kubzansky, L. D. (2014). Taking the tension out of hypertension: a prospective study of psychological well being and hypertension. Journal of Hypertenssion, 32(6), 1222-1228.  Trudel-Fitzgerald, C., Gilsanz, P., Mittleman, M. A., & Kubzansky, L. D. (2015). Dysregulated blood pressure: Can regulating emotions help? Current Hypertension Reports, 17(12), 92.