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Eric S . Kim (UBC)
Dr. Eric S. Kim is currently an Assistant Professor in the Department of Psychology at the University of British Columbia (UBC). His program of research focuses on aging adults and aims to identify, understand, and intervene upon the dimensions of psychological well-being (e.g., sense of purpose) that reduce the risk of age-related conditions. This research also aims to understand the influence that the social environment has on the connection between psychological well-being and physical health. His research integrates perspectives from psychology (health, clinical, developmental, social, personality), gerontology, social epidemiology, biology, biostatistics, and translational science. Please visit our lab's website for more information: https://flourishing.psych.ubc.ca/
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an outcome‐wide approach. Across 38 outcomes, perceived neighborhood social cohesion was associated with some: mental health outcomes (i.e., depressive symptoms, suicidal ideation, perceived stress), psychological
well‐being outcomes (i.e., happiness, optimism), social outcomes (i.e., loneliness, romantic relationship quality, satisfaction with parenting), and civic/prosocial outcomes (i.e., volunteering). However, it was not associated with health behaviors nor physical health outcomes.
These results were maintained after robust control for a wide range of potential confounders.
Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.
OBJECTIVE
To examine the association of gratitude with all-cause and cause-specific mortality in later life.
DESIGN, SETTING, AND PARTICIPANTS
This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49,275 US older female registered nurses who participated in the Nurses’ Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.
EXPOSURE
Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one’s tendency to experience grateful affect.
MAIN OUTCOMES AND MEASURES
Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.
RESULTS
Among the 49,275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4,608 incident deaths were identified over 151,496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).
CONCLUSIONS AND RELEVANCE
This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.
Several intergovernmental organizations, including the World Health Organization and United Nations, are urging countries to use well-being indicators for policymaking. This trend, coupled with increasing recognition that positive affect is beneficial for health/well-being, opens new avenues for intervening on positive affect to improve outcomes. However, it remains unclear if positive affect in adolescence shapes health/well-being in adulthood. We examined if increases in positive affect during adolescence were associated with better health/well-being in adulthood across 41 outcomes.
Methods and findings
We conducted a longitudinal cohort study using data from Add Health—a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if increases in positive affect over 1 year (between Wave I; 1994 to 1995 and Wave II; 1995 to 1996) were associated with better health/well-being 11.37 years later (in Wave IV; 2008; N = 11,040) or 20.64 years later (in Wave V; 2016 to 2018; N = 9,003). Participants were aged 15.28 years at study onset, and aged 28.17 or 37.20 years—during the final assessment. Participants with the highest (versus lowest) positive affect had better outcomes on 3 (of 13) physical health outcomes (e.g., higher cognition (β = 0·12, 95% CI = 0·05, 0·19, p = 0.002)), 3 (of 9) health behavior outcomes (e.g., lower physical inactivity (RR = 0·80, CI = 0·66, 0·98, p = 0.029)), 6 (of 7) mental health outcomes (e.g., lower anxiety (RR = 0·81, CI = 0·71, 0·93, p = 0.003)), 2 (of 3) psychological well-being (e.g., higher optimism (β = 0·20, 95% CI = 0·12, 0·28, p < 0.001)), 4 (of 7) social outcomes (e.g., lower loneliness (β = −0·09, 95% CI = −0·16, −0·02, p = 0.015)), and 1 (of 2) civic/prosocial outcomes (e.g., more voting (RR = 1·25, 95% CI = 1·16, 1·36, p < 0.001)). Study limitations include potential unmeasured confounding and reverse causality.
Conclusions
Enhanced positive affect during adolescence is linked with a range of improved health/well-being outcomes in adulthood. These findings suggest the promise of testing scalable positive affect interventions and policies to more definitively assess their impact on outcomes.
(including hedonic and eudaimonic well-being), has been linked with better physical health and greater longevity. Importantly,
psychological well-being can be strengthened with interventions, providing a strategy for improving population health. But
are the effects of well-being interventions meaningful, durable, and scalable enough to improve health at a population-level?
To assess this possibility, a cross-disciplinary group of scholars convened to review current knowledge and develop a research
agenda. Here we summarize and build on the key insights from this convening, which were: (1) existing interventions should
continue to be adapted to achieve a large-enough effect to result in downstream improvements in psychological functioning
and health, (2) research should determine the durability of interventions needed to drive population-level and lasting changes,
(3) a shift from individual-level care and treatment to a public-health model of population-level prevention is needed and
will require new infrastructure that can deliver interventions at scale, (4) interventions should be accessible and effective in
racially, ethnically, and geographically diverse samples. A discussion examining the key future research questions follows.
an outcome‐wide approach. Across 38 outcomes, perceived neighborhood social cohesion was associated with some: mental health outcomes (i.e., depressive symptoms, suicidal ideation, perceived stress), psychological
well‐being outcomes (i.e., happiness, optimism), social outcomes (i.e., loneliness, romantic relationship quality, satisfaction with parenting), and civic/prosocial outcomes (i.e., volunteering). However, it was not associated with health behaviors nor physical health outcomes.
These results were maintained after robust control for a wide range of potential confounders.
Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.
OBJECTIVE
To examine the association of gratitude with all-cause and cause-specific mortality in later life.
DESIGN, SETTING, AND PARTICIPANTS
This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49,275 US older female registered nurses who participated in the Nurses’ Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.
EXPOSURE
Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one’s tendency to experience grateful affect.
MAIN OUTCOMES AND MEASURES
Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.
RESULTS
Among the 49,275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4,608 incident deaths were identified over 151,496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).
CONCLUSIONS AND RELEVANCE
This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.
Several intergovernmental organizations, including the World Health Organization and United Nations, are urging countries to use well-being indicators for policymaking. This trend, coupled with increasing recognition that positive affect is beneficial for health/well-being, opens new avenues for intervening on positive affect to improve outcomes. However, it remains unclear if positive affect in adolescence shapes health/well-being in adulthood. We examined if increases in positive affect during adolescence were associated with better health/well-being in adulthood across 41 outcomes.
Methods and findings
We conducted a longitudinal cohort study using data from Add Health—a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if increases in positive affect over 1 year (between Wave I; 1994 to 1995 and Wave II; 1995 to 1996) were associated with better health/well-being 11.37 years later (in Wave IV; 2008; N = 11,040) or 20.64 years later (in Wave V; 2016 to 2018; N = 9,003). Participants were aged 15.28 years at study onset, and aged 28.17 or 37.20 years—during the final assessment. Participants with the highest (versus lowest) positive affect had better outcomes on 3 (of 13) physical health outcomes (e.g., higher cognition (β = 0·12, 95% CI = 0·05, 0·19, p = 0.002)), 3 (of 9) health behavior outcomes (e.g., lower physical inactivity (RR = 0·80, CI = 0·66, 0·98, p = 0.029)), 6 (of 7) mental health outcomes (e.g., lower anxiety (RR = 0·81, CI = 0·71, 0·93, p = 0.003)), 2 (of 3) psychological well-being (e.g., higher optimism (β = 0·20, 95% CI = 0·12, 0·28, p < 0.001)), 4 (of 7) social outcomes (e.g., lower loneliness (β = −0·09, 95% CI = −0·16, −0·02, p = 0.015)), and 1 (of 2) civic/prosocial outcomes (e.g., more voting (RR = 1·25, 95% CI = 1·16, 1·36, p < 0.001)). Study limitations include potential unmeasured confounding and reverse causality.
Conclusions
Enhanced positive affect during adolescence is linked with a range of improved health/well-being outcomes in adulthood. These findings suggest the promise of testing scalable positive affect interventions and policies to more definitively assess their impact on outcomes.
(including hedonic and eudaimonic well-being), has been linked with better physical health and greater longevity. Importantly,
psychological well-being can be strengthened with interventions, providing a strategy for improving population health. But
are the effects of well-being interventions meaningful, durable, and scalable enough to improve health at a population-level?
To assess this possibility, a cross-disciplinary group of scholars convened to review current knowledge and develop a research
agenda. Here we summarize and build on the key insights from this convening, which were: (1) existing interventions should
continue to be adapted to achieve a large-enough effect to result in downstream improvements in psychological functioning
and health, (2) research should determine the durability of interventions needed to drive population-level and lasting changes,
(3) a shift from individual-level care and treatment to a public-health model of population-level prevention is needed and
will require new infrastructure that can deliver interventions at scale, (4) interventions should be accessible and effective in
racially, ethnically, and geographically diverse samples. A discussion examining the key future research questions follows.