Sadly, Happiness Doesn't Appear to Make You Live Longer

[Dean Pomerleau]

This new study in the Lancet [1] (popular account here) is sad news for us happy people. In the study, researchers polled 700,000 women in 1996-2001 about their level of happiness, and other health markers. Then the followed up in 2012 to see how many had died, and if there was a correlation between self-reported happiness and mortality that was independent of baseline health and other (socioeconomic) factors. 

 

From the full text, here is an interesting chart of what lifestyle and health parameters made these women the most happy or unhappy - i.e. factors that correlated with self-reported happiness. The most happiness-inducing was being married with children. The most unhappiness-inducing was sleeping less than 7h per night. If I'm reading it right, it also appears the more education the women had, the less happy they reported themselves to be.

 

 

 

Anyway, what these researchers were interested was the relationship of happiness and health/longevity. First, they eliminated women who reported having "life threatening health disorders" (e.g. cancer, heart disease, etc.) at baseline, to avoid their (presumed) unhappiness from interfering with the analysis. In the disease-free women that remained, they found unhappy women were 30% more likely to die than those who reported being happy "most of the time" or "usually happy":

 

In crude analyses adjusted only for age, unhappiness remained associated with increased mortality (RR 1·29, 95% CI 1·25–1·33)

 

But they found that women who self-rated their health as fair or poor were 67% more likely to die during follow-up than those who rated it good or excellent. Once they adjusted for the correlation between self-rated health and happiness, the association between happiness and reduced mortality disappeared:

 

]O]nce we adjusted for self-rated health, unhappiness was no longer significantly associated with all-cause mortality (RR 1·02, 0·98–1·05; table).

 

Here is the most relevant graph, showing just how flat the mortality rate (vertical axis) is across different levels of reported happiness (horizontal axis), but that people with poor self-reported health have a mortality curve shifted much higher than those reporting themselves to be in good or excellent health:

 

 

In short, this study appears to suggest that self-rated poorer health, even among women free from life threatening health conditions, was a predictor of unhappiness at the time of the survey and increased subsequent mortality. But self-reported (un)happiness itself was not an independent predictor of mortality. Another measure of well-being the researchers surveyed, and found not to be independently associated with reduced subsequent mortality was whether the women reported feeling "in control, relaxed, or not stressed".

 

So it looks like from this study being happy and stress-free makes one's life more pleasant, but not any longer.

 

--Dean

 

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[1] The Lancet 09 December 2015

      http://dx.doi.org/10.1016/S0140-6736(15)01087-9

 

Does happiness itself directly affect mortality? The prospective UK Million Women Study

 

Bette Liu, Sarah Floud, Kirstin Pirie, Prof Jane Green, Prof Richard Peto, Prof Valerie Beral

 

Free full text: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01087-9/fulltext

 

Summary

Background

Poor health can cause unhappiness and poor health increases mortality. Previous reports of reduced mortality associated with happiness could be due to the increased mortality of people who are unhappy because of their poor health. Also, unhappiness might be associated with lifestyle factors that can affect mortality. We aimed to establish whether, after allowing for the poor health and lifestyle of people who are unhappy, any robust evidence remains that happiness or related subjective measures of wellbeing directly reduce mortality.

 

Methods

The Million Women Study is a prospective study of UK women recruited between 1996 and 2001 and followed electronically for cause-specific mortality. 3 years after recruitment, the baseline questionnaire for the present report asked women to self-rate their health, happiness, stress, feelings of control, and whether they felt relaxed. The main analyses were of mortality before Jan 1, 2012, from all causes, from ischaemic heart disease, and from cancer in women who did not have heart disease, stroke, chronic obstructive lung disease, or cancer at the time they answered this baseline questionnaire. We used Cox regression, adjusted for baseline self-rated health and lifestyle factors, to calculate mortality rate ratios (RRs) comparing mortality in women who reported being unhappy (ie, happy sometimes, rarely, or never) with those who reported being happy most of the time.

 

Findings

Of 719 671 women in the main analyses (median age 59 years [iQR 55–63]), 39% (282 619) reported being happy most of the time, 44% (315 874) usually happy, and 17% (121 178) unhappy. During 10 years (SD 2) follow-up, 4% (31 531) of participants died. Self-rated poor health at baseline was strongly associated with unhappiness. But after adjustment for self-rated health, treatment for hypertension, diabetes, asthma, arthritis, depression, or anxiety, and several sociodemographic and lifestyle factors (including smoking, deprivation, and body-mass index), unhappiness was not associated with mortality from all causes (adjusted RR for unhappy vs happy most of the time 0·98, 95% CI 0·94–1·01), from ischaemic heart disease (0·97, 0·87–1·10), or from cancer (0·98, 0·93–1·02). Findings were similarly null for related measures such as stress or lack of control.

 

Interpretation

In middle-aged women, poor health can cause unhappiness. After allowing for this association and adjusting for potential confounders, happiness and related measures of wellbeing do not appear to have any direct effect on mortality.

 

PMID: 26684609

[Dean Pomerleau]

There are some happiness researchers who aren't very happy with the conclusion of the study above,namely that once health is corrected for (since it impacts both health and longevity), happiness alone doesn't make you live longer.

 

In this review / editorial in the LA Times by three well-known happiness researchers, including Sonja Lyubomirsky, author of The How of Happiness: A Scientific Approach to Getting the Life You Want, raise several credible criticisms of UK Million Women Study on happiness discussed above, including:

• The researchers only asking one question about happiness on their survey given to the women, and it was question #306 in the 316-question survey. They reasonably question just how unhappy the subjects may have been by the time they reached question 306, and how that may have impacted their response. They say in fact that around 400k of the million women quit before even getting to the happiness question!
• They criticized the question the researchers asked ("How often do you feel happy?" from “rarely/never” to “most of the time”) as not the best way to gauge happiness. Here is a whole article on how tricky it is to gauge a person's happiness / well-being, and how researchers use a number of different questions to get at different components/types of happiness - e.g. "how satisfied are you with your life nowadays?" or "how happy did you feel yesterday?" or "to what extent do you feel the things you do in your life are worthwhile?"
• The critics say that the average age of women at the beginning of the study was 59, and that by that time it is quite conceivable that low level of happiness earlier in their life may have lead them to bad choices which impacted their health. So factoring out health status at baseline may have washed out effects of happiness on health and longevity that may have already occurred. The critics say the study was really answering the question “does happiness at 59 predict lifespan beyond its effects during the first six decades?”
• Similarly, the authors factored out other lifestyle choices that are known to be impacted by one's happiness. " For example, research has shown that positive individuals sleep better, smoke less and exercise more, all of which are known to predict longevity. Thus, when the authors control for all these variables, they are taking away a major path through which happiness is likely to influence longevity."
• They cite the famous study of Catholic nuns [1], which found nuns who were happy in their earlier twenties (as judged from their personal diaries, rather than a single question on a questionnaire) had a 2.5x lower mortality rate when in their 70s, 80s and 90s than nuns who were unhappy as young adults. Here is a cool graph of survival probability by age among different quartiles of happiness in the nuns:

 

 

The critics summarize their criticism as follows:

 

We believe what the authors of the Lancet study found was not whether happiness is related to longevity but this: Whether a one-item happiness question will predict a shortened life in healthy middle-aged women, if you delete how happiness has affected their health for their first six decades and if you erase the influence of key pathways to health such as social support, smoking and body mass index [all of which are likely to be influenced by one's level of happiness]. 

 

So maybe happiness can contribute to good health and longevity after all.

 

--Dean

 

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[1] Danner, D., Snowdon, D., & Friesen, W. (2001).  Positive emotions in early life and longevity:  Findings from the nun study.  Journal of  Personality and Social Psychology, 80, 804-813. Full text: https://www.apa.org/pubs/journals/releases/psp805804.pdf

[nicholson]

.............  and then there's this:

 

http://www.ox.ac.uk/news/2014-05-23-many-mental-illnesses-reduce-life-expectancy-more-heavy-smoking

 

Rodney.

 

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"The unverified conventional wisdom is almost invariably mistaken."

[Dean Pomerleau]

All,

 

Dr. Greger's video for today, titled "Are Happier People Actually Healthier?" (embedded below) addresses many of the same questions discussed above. He reviews a bunch of literature, but surprisingly leaves off the recent UK Million Women study I opened this thread with (PMID: 26684609). He spends the first half of the video discussing evidence from prospective studies and especially this meta-analysis of prospective studies [1] that show happiness is associated with almost a 20% lower mortality rate in people who reported being healthy at the beginning of the study, even after controlling for the fact that happy people take better care of their body (i.e. sleep better, smoke less, exercise more, etc.). He does point out the problem with determining causality - i.e. does happiness itself result directly in better health & longevity, or does better health cause both happiness and longevity (as PMID 26684609 seems to suggest above)? 

 

He spends the second half of the video talking about a couple of interventional trials (from Carnegie Mellon researchers - yeah!) that attempt to tease apart the relationship between health and happiness by actively exposing healthy people with naturally positive or negative affect to cold [3] or flu [4] viruses to see which ones get sick. Sure enough, the happy people were less likely to come down with the cold or flu as a result of exposure, independent of sleep quality/quantity, exercise, levels of stress hormones. So that settles it - right? Happiness leads to better health, rather than the other way around - right?

 

Not so fast. Sure, the happier people could have a stronger immune system because happiness boosts immunity. But it could also be the case that healthier people have a stronger immune system and are naturally happier, in part because they don't get sick as often. These two studies can't adjudicate between these alternatives. In short, the only way to really tease apart this happiness/healthiness chicken-and-egg problem would be a true randomized control trials, in which initially healthy subjects of average happiness would be randomly assigned be made happy (or sad) for a few weeks (or a few years!), and then tested to see which ones got sick when exposed to the cold or flu, or even got sick more often naturally. As far as I know such happiness intervention trials don't exist, probably because they'd be very hard to conduct (how would you make everybody happier for an extended period?), not to mention the difficulty of getting approval from your institution's human subjects review board - although if you just made the happy group happier (give them money, or better grades) and left the control group alone (rather than intervening to make them sad), it might be doable... 

 

I my mind, there are three models of the relationship between happiness, health and longevity, illustrated below:

 

 

The positive psychology folks like the authors of [1] (and the people behind the Catholic Nun study [2]) think it is Model A, where happiness causes health which in turn results in people living longer.

 

Skeptics of positive psychology, such as the authors of PMID 26684609, lean towards Model B, where health causes both happiness and longevity.

 

I personally think it is most likely to be something like Model C, where there is a positive feedback loop between happiness and health, with the latter probably being a bigger influence on the former than visa versa (see size of arrows in Model C below) per PMID 26684609. Happiness likely improves health directly (e.g. fewer stress hormones, less inflammation, etc.) but perhaps more importantly, indirectly, e.g. happy people have more motivation to exercise, sleep better, which leads to better health. But at the same time, it is hard to deny that once you start down the road to poor health (for whatever reason), it impacts your happiness. It's very hard to be happy when you are sick or debilitated. Which of the two arrows is bigger and how much bigger is an open question, and probably varies from individual to individual.

 

--Dean

 

 

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[1] 1. Psychosom Med. 2008 Sep;70(7):741-56. doi: 10.1097/PSY.0b013e31818105ba. Epub

2008 Aug 25.

 

Positive psychological well-being and mortality: a quantitative review of

prospective observational studies.

 

Chida Y(1), Steptoe A.

 

Author information: 

(1)Psychobiology Group, Department of Epidemiology and Public Health, University 

College London, 1-19 Torrington Place, London WC1E 6BT, UK. y.chida@ucl.ac.uk

 

Comment in

    Evid Based Ment Health. 2009 May;12(2):41.

 

OBJECTIVE: To review systematically prospective, observational, cohort studies of

the association between positive well-being and mortality using meta-analytic

methods. Recent years have witnessed increased interest in the relationship

between positive psychological well-being and physical health.

METHODS: We searched general bibliographic databases: Medline, PsycINFO, Web of

Science, and PubMed up to January 2008. Two reviewers independently extracted

data on study characteristics, quality, and estimates of associations.

RESULTS: There were 35 studies (26 articles) investigating mortality in initially

healthy populations and 35 studies (28 articles) of disease populations. The

meta-analyses showed that positive psychological well-being was associated with

reduced mortality in both the healthy population (combined hazard ratio (HR) =

0.82; 95% Confidence Interval (CI) = 0.76-0.89; p < .001) and the disease

population (combined HR = 0.98; CI = 0.95-1.00; p = .030) studies. There were

indications of publication bias in this literature, although the fail-safe

numbers were 2444 and 1397 for healthy and disease population studies,

respectively. Intriguingly, meta-analysis of studies that controlled for negative

affect showed that the protective effects of positive psychological well-being

were independent of negative affect. Both positive affect (e.g., emotional

well-being, positive mood, joy, happiness, vigor, energy) and positive trait-like

dispositions (e.g., life satisfaction, hopefulness, optimism, sense of humor)

were associated with reduced mortality in healthy population studies. Positive

psychological well-being was significantly associated with reduced cardiovascular

mortality in healthy population studies, and with reduced death rates in patients

with renal failure and with human immunodeficiency virus-infection.

CONCLUSIONS: The current review suggests that positive psychological well-being

has a favorable effect on survival in both healthy and diseased populations.

 

PMID: 18725425  [PubMed - indexed for MEDLINE]

 

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[2] Danner, D., Snowdon, D., & Friesen, W. (2001).  Positive emotions in early life and longevity:  Findings from the nun study.  Journal of  Personality and Social Psychology, 80, 804-813. Free Full text: https://www.apa.org/pubs/journals/releases/psp805804.pdf

 

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[3] sychosom Med. 2003 Jul-Aug;65(4):652-7.

Emotional style and susceptibility to the common cold.

Cohen S(1), Doyle WJ, Turner RB, Alper CM, Skoner DP.

Author information:
(1)Department of Psychology, Carnegie Mellon University, Pittsburgh, PA
15213-3890, USA. scohen@cmu.edu

OBJECTIVE: It has been hypothesized that people who typically report experiencing
negative emotions are at greater risk for disease and those who typically report
positive emotions are at less risk. We tested these hypotheses for host
resistance to the common cold.
METHODS: Three hundred thirty-four healthy volunteers aged 18 to 54 years were
assessed for their tendency to experience positive emotions such as happy,
pleased, and relaxed; and for negative emotions such as anxious, hostile, and
depressed. Subsequently, they were given nasal drops containing one of two
rhinoviruses and monitored in quarantine for the development of a common cold
(illness in the presence of verified infection).
RESULTS: For both viruses, increased positive emotional style (PES) was
associated (in a dose-response manner) with lower risk of developing a cold. This
relationship was maintained after controlling for prechallenge virus-specific
antibody, virus-type, age, sex, education, race, body mass, and season (adjusted
relative risk comparing lowest-to-highest tertile = 2.9). Negative emotional
style (NES) was not associated with colds and the association of positive style
and colds was independent of negative style. Although PES was associated with
lower levels of endocrine hormones and better health practices, these differences
could not account for different risks for illness. In separate analyses, NES was
associated with reporting more unfounded (independent of objective markers of
disease) symptoms, and PES with reporting fewer.
CONCLUSIONS: The tendency to experience positive emotions was associated with
greater resistance to objectively verifiable colds. PES was also associated with
reporting fewer unfounded symptoms and NES with reporting more.

PMID: 12883117

 

------------------------

[4] Psychosom Med. 2006 Nov-Dec;68(6):809-15. Epub 2006 Nov 13.

Positive emotional style predicts resistance to illness after experimental
exposure to rhinovirus or influenza a virus.

Cohen S(1), Alper CM, Doyle WJ, Treanor JJ, Turner RB.

Author information:
(1)Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue,
Pittsburgh, PA 15213-3890. scohen@cmu.edu

OBJECTIVE: In an earlier study, positive emotional style (PES) was associated
with resistance to the common cold and a bias to underreport (relative to
objective disease markers) symptom severity. This work did not control for social
and cognitive factors closely associated with PES. We replicate the original
study using a different virus and controls for these alternative explanations.
METHODS: One hundred ninety-three healthy volunteers ages 21 to 55 years were
assessed for a PES characterized by being happy, lively, and calm; a negative
emotional style (NES) characterized by being anxious, hostile, and depressed;
other cognitive and social dispositions; and self-reported health. Subsequently,
they were exposed by nasal drops to a rhinovirus or influenza virus and monitored
in quarantine for objective signs of illness and self-reported symptoms.
RESULTS: For both viruses, increased PES was associated with lower risk of
developing an upper respiratory illness as defined by objective criteria
(adjusted odds ratio comparing lowest with highest tertile = 2.9) and with
reporting fewer symptoms than expected from concurrent objective markers of
illness. These associations were independent of prechallenge virus-specific
antibody, virus type, age, sex, education, race, body mass, season, and NES. They
were also independent of optimism, extraversion, mastery, self-esteem, purpose,
and self-reported health.
CONCLUSIONS: We replicated the prospective association of PES and colds and PES
and biased symptom reporting, extended those results to infection with an
influenza virus, and "ruled out" alternative hypotheses. These results indicate
that PES may play a more important role in health than previously thought.

PMID: 17101814 

[Sthira]

Slap yourself on the back for having randomly been born with some cheerful sunshine genes that may allow you to be generally happy when others generally aren't. Genes and epigenetics may have given you better cholesterol levels, too, and maybe you'll be less likely to develop CVD or Alzheimer's. Little surprise you'll probably get to happily live longer, too. And maybe you were born with white skin in a white-skin favoring culture. Great work choosing your parents well.

 

Some people may eat healthy, exercise regularly, not smoke, not do drugs, not drink alcohol, sleep well, try to maintain friendships, try do good work (employment-wise) volunteer, utilize counseling, meditate, and yet still be mostly miserable. How would these studies account for that misery? Some people may be even more miserable when lacking all of those healthy attributes, and so it seems like the level of happiness is mostly random chance. Tweak some happy here and some happy there to lower it or raise it -- kinda like cholesterol -- but there's a genetic baseline to reckon with despite wise lifestyle choices.

[Dean Pomerleau]

Sthira,

 

Slap yourself on the back for having randomly been born with some cheerful sunshine genes that may allow you to be generally happy when others generally aren't...

 

...there's a genetic baseline to reckon with despite wise lifestyle choices. 

 

I'm not sure if this comment is directed specifically at me, or is more rhetorical. But I (and more importantly, the research) agree with you. There is by now pretty overwhelming evidence that happiness has a genetic component to it, and there is an individual happiness setpoint towards which people gravitate. I am grateful to have inherited genes that give me a relatively high happiness setpoint. Such a high setpoint, coupled with the psychological benefits of CR, have got me through some pretty rough times of late...

 

Rather than (or in addition to) life extension, maybe you should be rooting for David Pearce's Abolitionist Project and Paradise Engineering. Do you know of David Pearce's ideas? Here is a good video of David discussing it: