By Paul J. Rosch, M.D.
President, The American Institute of Stress
Clinical Professor of Medicine and Psychiatry
New York Medical College
Originally published in the Health and Stress, the newsletter (July 2005) of The American Institute of Stress
Numerous studies support the belief that people with an upbeat and positive perspective tend to be healthier and enjoy longer lives than those who are generally gloomy and cynical about the future. Always expecting the worst was linked to a 25 percent higher risk of dying before age 65 in a very long-term California study of 1,500 healthy pre-adolescent boys who had been followed since 1921. (Seligman ME. Mayo Clin Proc. 2000;75:133-4)
In another report on senior citizens, researchers rated 1,000 Dutch men and women aged 65-85 with respect to their degree of optimism, health and longevity. Over the next 10 years, participants classified as being very optimistic had 55 percent fewer deaths from all causes and 23 percent less heart-related deaths than highly pessimistic controls. These benefits of optimism were stronger in men than women. (Giltay E. Archives of General Psychiatry, 2004; 61:1126-1135)
Stay Happy And Save Your Life
Harvard researchers also found cardioprotective effects when they followed 1,306 men who had been rated for optimism and pessimism based on responses to a questionnaire administered in 1986.
During the next 10 years, there were 31 deaths due to coronary disease, 243 instances of non-fatal myocardial infarction or documented evidence of coronary heart disease and 60 patients had complaints of angina. Men reporting high levels of optimism had almost half the risk of suffering any of these complications compared to peers classified as being very pessimistic. In addition, a dose-response relationship was demonstrated between levels of optimism and each of the above adverse developments. (Kubzansky LD et al. Psychosomatic Medicine, 2001; 63:910-916)
It had previously been shown that highly optimistic patients had faster recovery rates following coronary artery bypass surgery and were half as likely to be rehospitalized over the next six months for complications or the need for a repeat corrective surgical procedure. (Scheier MF et al. J Pers Soc Psychol 1989; 57:1024–40, Scheier MF et al. Arch Intern Med 1999; 159:829–350)
Cheerful and optimistic heart disease patients were also more likely to live longer than others in a Duke report on 866 cardiac catheterization patients who were asked how much joy they typically felt and completed questionnaires to rate optimism and pessimism.
Over the next 11.5 years there were 415 deaths. It was found that cheerful patients with a positive outlook were 20 percent more likely to be alive than pessimists even after taking into account other factors like smoking and how ill the participants were at the time of catheterization. (Brummett BH et al. Int J Cardiol. 2005; 100:213-216)
Optimism Affects Your Stroke Risks
Optimists and happy people may be less likely to suffer a stroke according to a University of Texas study of 2,478 black and white senior citizens in North Carolina who completed a depression questionnaire consisting of yes or no answers to 20 items.
Sixteen of these were negative pronouncements such as "I felt that I could not shake off the blues, even with the help of my family and friends," "I thought that my life had been a failure" and "I felt fearful." The other four statements were positive: "I felt that I was just as good as other people" and "I felt hopeful about the future."
Baseline interviews conducted to gather information on sociodemographic, psychosocial and health status revealed no history of stroke. Similar studies were conducted annually for the following six years during which there were 340 strokes, 75 of which were fatal. Researchers confirmed that increasing depression ratings were associated with a significantly higher incidence of stroke. But they also found that for each "yes" answer to a positive statement there was a 26 percent decrease in the risk of stroke.
Thus, "yes" answers to all four questions were associated with complete protection from stroke, which is the leading cause of long-term disability and the third most common cause of death in the elderly. This is one of the few studies to suggest that the benefits of optimism are not necessarily due to the absence of pessimism. (Oster GV et al. Psychosomatic Medicine 2001; 63:210-215)
Get Older, Be Happy
Similar rewards were reported in a study of 600 people over age 50 in a small Ohio town, who, in 1975, completed another questionnaire that included items dealing with attitudes about aging. They had been asked to rate their agreement or disagreement with such statements as "Things keep getting worse as I get older," "I have as much pep as I did last year" and "I am as happy now as I was when I was younger."
When researchers checked to see which participants were still alive in 1998, they found that optimists who viewed aging as a positive experience lived about 7.5 years longer than participants with a much darker perspective. One might argue that people in poorer health would be more apt to have negative responses and also more likely to die over the next 23 years.
However, even when self-reported health, socioeconomic status, overall morale, loneliness, race, sex, and other possible confounding factors were taken into account, a positive view of aging was still highly correlated with significantly increased longevity. Indeed, this advantage was far greater than that afforded by lowering blood pressure or reducing cholesterol, each of which was found to lengthen life about four years. It was also superior to exercise, not smoking and maintaining a healthy weight that increased longevity by only one to three years.
So why did the optimists live so much longer? The investigators suspected that it might be due to their greater will to live.
Previous studies have shown that people of all cultures are more likely to die in the days and weeks after holidays, anniversaries and other celebrations than they are in similar time periods leading up to them. They checked back to see how the respondents had answered other questions in the original survey in which they had been asked to choose from three pairs of adjectives (empty-full, hopeless-hopeful and worthless-worthy) that best described their lives. Those who answered "full," "hopeful" and "worthy" were classified as having a greater will to live.
Although this appeared to have some predictive value, it still did not completely explain why people with positive views lived so much longer so other factors must contribute to this. It was suggested that one likely candidate is how people respond to stress since older people with a negative view of aging exhibited higher stress levels. (Levy B et al. Journal of Personality & Social Psychology. 2002; 83:261-270)
Between 1962-1965, 839 Mayo Clinic patients completed the same questionnaire used in the Harvard study and 124 were classified as optimists, 197 as pessimists with 518 falling in between. Thirty years later, an analysis of data that was available on 723 of these patients showed that the optimists had a significantly better survival rate than anticipated and lived 20 percent longer than pessimists. (Maruta T et al. Mayo Clinic Proc, 2000; 75:140-143)
In a follow-up study, 447 patients of this group (average age 60) also completed a 36–item physical and mental health survey in 1994. There were 101 optimists, 74 pessimists and 272 did not fall into either classification based on responses to the original questionnaire completed three decades previously. Pessimists scored lower in all physical and mental health categories and optimists were far more likely to report:
- Having fewer limitations due to physical health.
- Having less pain.
- Feeling more energetic most of the time.
- Feeling more peaceful and happy most of the time.
- Having fewer problems with work or other daily activities as a result of their emotional state. (Maruta T et al. Mayo Clin Proc 2002;77:748-53)
Studies show that older optimists also tend to have better pulmonary function than pessimists and that this improvement increases progressively over time.
In one report of middle-aged men who received periodic pulmonary function studies the difference between optimists and pessimists after 10 years on one procedure was comparable to the significant difference between smokers and nonsmokers. (Kubzansky et al. Annals of Behavioral Medicine 2002; 24:345-353)