Sense of life worth living (ikigai) and mortality in Japan: Ohsaki Study

Ikigai and suicidal ideation in Japan during the COVID-19 pandemic

BACKGROUND

Ikigai i.e., a Japanese concept relating to purpose in life but that is somewhat broader, has been associated with better physical and mental health. However, little is known about its association with suicidality. This study examined the association between ikigai and suicidal ideation in the Japanese general population during the COVID-19 pandemic.

METHODS

Data were analyzed from 3371 adults aged ≥18 who participated in an online survey in March 2023. Information on ikigai and pandemic-related suicidal ideation was obtained from self-reports. Logistic regression was used to examine associations.

RESULTS

In a fully adjusted analysis, compared to those with ikigai, individuals who did not know if they had ikigai (OR: 1.96, 95 % CI: 1.36-2.82) or did not have ikigai (OR: 2.50, 95 % CI: 1.74-3.57) had significantly higher odds of suicidal ideation. In sex- and age-stratified analyses, not having ikigai was associated with significantly higher odds of suicidal ideation in all population subgroups with the highest odds being observed in individuals aged ≥60 (OR: 6.27, 95 % CI: 2.02-19.45).

CONCLUSIONS

An absence of ikigai was associated with higher odds of suicidal ideation during the COVID-19 pandemic. Future research should examine the association between ikigai and suicidal behavior as well as explore the potential mechanisms linking ikigai and suicidality.

Ikigai and probable anxiety among adults in Japan

BACKGROUND

Ikigai is a Japanese concept that has been equated with having a sense of purpose in life. It has previously been linked to better physical health, although, as yet, there has been comparatively little research on its association with mental health outcomes. This study examined the association between ikigai and anxiety in the Japanese general population.

METHODS

Data were analyzed from 3701 adults who participated in an online survey in 2023. Information on ikigai was obtained with a single-item question, while the Generalized Anxiety Disorder-7 (GAD-7) scale was used to assess probable anxiety. Logistic regression was used to examine associations between the variables.

RESULTS

In a fully adjusted analysis, compared to those with ikigai, individuals who reported that they did not have ikigai had over twice the odds of anxiety (OR: 2.04, 95%CI: 1.36-3.06). In a sex-stratified analysis, an absence of ikigai was associated with higher odds of probable anxiety in both men and women. However, when the analysis was stratified by age, in the fully adjusted model, not having ikigai was associated with significantly higher odds of probable anxiety in adults aged 35-59 (OR: 2.97, 95%CI: 1.63-5.41) but not in those aged 18-34 (OR: 1.28, 95%CI: 0.64-2.54) or ≥ 60 years old (OR: 1.59, 95%CI: 0.52-4.87).

LIMITATIONS

This study used cross-sectional data obtained in an online survey.

CONCLUSION

An absence of ikigai is associated with higher odds of probable anxiety among Japanese men and women and middle-aged adults.

How to promote healthy aging across the life cycle

The global rise in aging populations is challenging healthcare systems, especially in developed countries. Despite advancements in healthcare and living standards, the extension of lifespan has not been matched by an equivalent improvement in healthspan, leading to a higher prevalence of chronic diseases and disabilities in older adults. This review examines strategies to promote healthy aging throughout the life cycle, emphasizing the importance of a comprehensive strategy that integrates individual, healthcare, and environmental approaches. Individual strategies include lifestyle factors like diet, physical activity, and social connections. Healthcare approaches focus on improving health literacy, vaccinations, and screenings. Environmental approaches aim to mitigate climate change, reduce pollution, and design longevity-ready cities. A comprehensive strategy combining individual approaches, public health measures, innovative policies, and community support is essential for helping populations live longer, healthier, and more independent lives. Looking forward, this will be complemented by personalized approaches, focusing on individual traits and biological backgrounds. The key to this lies in geroscience, which studies the biological and molecular mechanisms of aging and how they contribute to age-related diseases and functional decline, aiming to design targeted interventions to slow aging and improve quality of life. Artificial intelligence will play a key role in analyzing these complex factors and creating innovative solutions. In conclusion, aging is shaped by various factors, requiring more than one solution. A combination of comprehensive and personalized strategies can bridge the gap between public health measures and personalized care, offering the scientific insights needed to slow aging and enhance quality of life.

Assessment of the link between life purpose and health

BACKGROUND

This study examined the temporal relations between a decline in health and changes in life purpose to better understand the causal direction between life purpose and morbidity.

METHODS

Over a 16-year period, 7598 individuals completed up to four quadrennial surveys, which included information on 14 health metrics (lung function, grip strength, walking speed, balance and diagnoses of hypertension, diabetes, cancer, lung disease, heart condition, stroke, psychiatric problem, arthritis, dementia and Alzheimer's) and life purpose. Ordinary and logistic regressions were used to examine the temporal relations between changes in purpose and changes in health over both the same 4-year period and over the subsequent 8 years.

RESULTS

A decline in health was associated with a 5% standard deviation decline (95% confidence interval -0.08, -0.02) in purpose over the same 4-year period. In contrast, there was no evidence that a decline in purpose was associated with a subsequent decline in health.

CONCLUSIONS

The results fail to support the hypothesis that life purpose causes subsequent morbidity but support the hypothesis that a decline in health causes a decline in purpose. There is little evidence that life-purpose intervention policies will meaningfully impact subsequent morbidity.

Factors Related to Ikigai among Home-visit Rehabilitation Users Aged 75 Years and Older Receiving Home Medical and Nursing Care in Japan

OBJECTIVE

This study investigated the factors that influence Ikigai among people aged 75 years and older using home medical and nursing care with home-visit rehabilitation.

METHODS

This cross-sectional study involved 66 home-visit rehabilitation users aged 75 years or older who received home medical and nursing care at 2 home-care nursing stations. The following attributes were evaluated: Ikigai-9, life-space assessment (LSA), home-based LSA (Hb-LSA), Frenchay activities index (FAI), functional independence measure (FIM), self-efficacy for activities of daily living (SEADL), self-efficacy scale for going out among community-dwelling elderly (SEGE), and physical function. The correlation between Ikigai-9 scores and each assessment was examined. Multiple regression analysis was performed using the Ikigai-9 as the dependent variable and the correlated items as independent variables.

RESULTS

The Hb-LSA, FAI, FIM, SEADL, and SEGE were correlated with Ikigai-9. Among the correlated items, the FAI was selected for multiple regression analysis.

CONCLUSION

Home-visit rehabilitation users aged 75 and over may be more likely to feel Ikigai if they have higher instrumental ADLs.

Lessons Learned From Blue Zones, Lifestyle Medicine Pillars and Beyond: An Update on the Contributions of Behavior and Genetics to Wellbeing and Longevity

Blue Zones are regions of the world that have a higher number of individuals who live longer than the expected average. The current paper revisits principles previously identified to be common in Blue Zones and to be contributing to longevity (move naturally, eat wisely, improve resilience to stress, get adequate sleep, keep strong family ties, stimulate strong community support, respect for the planet and having a purpose in life'), compares these to the 6 pillars of Lifestyle Medicine (healthy eating, exercising, avoidance of smoking and other risky substances, stress management, restorative sleep, and forming and maintaining relationships) and reviews new studies investigating the association between behavioral factors and longevity. In addition to the role of behavior, the review also discusses the important role of genetics and emphasizes the importance of conducting further research to understand how behavioral and genetic factors may affect molecular pathways with consequent effects on wellbeing and longevity.

A model-driven approach for prospective ergonomics: application to ikigai robotics

Prospective Ergonomics requires building a vision of the future, which can be achieved empirically (e.g. analysing unmet needs) and/or creatively (e.g. creating future needs). We develop an alternative way of imagining the future, through a model-driven approach. Based on several developmental models, we provide a global picture of possible future(s) emphasising higher-ordered motivations and values (e.g. meaningfulness, accomplishment). To implement them, we then present a model of human accomplishment reinterpreting the concept of ikigai in light of selected psychological theories (e.g. self-determination, eudaemonic well-being, mindfulness). Finally, we apply it to an Industry 5.0 case study named ikigai robotics: we designed an equipment for railway maintenance following a double design process - a functional design loop and a motivational design loop. The process proved inspirational and the results both original and promising, opening avenues for Prospective Ergonomics to develop a new approach for designing the future.

Testing the Feasibility of a Newly Developed Lifestyle Practice Targeting Social Connections: Narrative Healing Circle Shared Medical Appointments

The aim of this pilot was to assess the feasibility and acceptability of virtual Narrative Healing Circles (NHC), a new form of Shared Medical Appointments (SMA) among mixed diagnosis population within an urban tertiary academic medical center.

METHODS

Multi-method, voluntary recruitment of eligible patients, included referrals, flyers, hospital events page, and patients who participated in an ongoing 7-week integrative oncology SMA series. Two physicians (lifestyle medicine and chaplaincy specialists), both trained in narrative medicine, co-led one-hour long virtual NHC SMAs held every other week for a total of either 4 or 8 sessions. Sessions included a centering meditation, brief check-in, topic introduction, short writing exercise initiated with a written, musical, or visual prompt, followed by time of sharing and listening. Optional electronic pre and post participant surveys were emailed at enrollment (7-questions, response rate 29%) and after 4-8 NHC SMA sessions (12-questions, RR 34%).

RESULTS

Virtual NHC SMA were offered from 2/23/22-8/30/23 with 62 unique participants, 266 total visits. Average age: 57 years (range: 27-84 years). Gender: 85% Female, 15% Male; Ethnicity: 73% White, 16% African American, 6% Asian, 5 % Hispanic. About half lived in underserved areas (Harlem, Bronx, Queens, Brooklyn). Payor mix included 40% Medicare, 60% Commercial insurance. Session attendance: 6 participants (mean); 1-13 (range). The number of sessions attended ranged between 1-28 sessions. Anxiety or fear (89%), depression (61%) and pain (67%) were the top 3 symptoms reported in the pre-survey. After 4-8 sessions, participants reported improvements in anxiety/fear (43%), sadness/depression/hopelessness (33%), irritability/stress (33%), isolation/loneliness (33%). They reported several positive changes: restarting yoga or meditation practice, greater focus on awe, journaling, increased mindfulness, and feeling better equipped to manage stress. 94% reported goals met, 95% would recommend the series to others. The 2 clinician leaders reported increased empathy, personal well-being, and work satisfaction.

CONCLUSION

Virtual NHC SMA series among mixed diagnosis population is feasible, positively affects patients' agency and well-being, and acceptable to patients and providers. A more formal study design with broader representation of diverse population and assessment of causality such as an RCT with longer follow-up is recommended.

Relationship between Ikigai and longitudinal changes in serum HDL cholesterol levels: the Circulatory Risk in Communities Study (CIRCS)

BACKGROUND

Having positive psychological well-being has been associated with serum high-density lipoprotein cholesterol (HDLC), but no longitudinal study to date has examined the association between Ikigai and serum HDLC. Therefore, we examined the association between Ikigai and change in serum HDLC over time using a cohort dataset spanning 2010-2018.

METHODS

The study included 471 men and 776 women aged 40-74 years who underwent a cardiovascular examination in 2010 and were asked their levels of Ikigai. We combined "definitely yes" and "yes" as "with Ikigai" and recorded "a little" as "with a little Ikigai" and "no" as "without Ikigai". We measured serum HDLC using direct methods. The association between Ikigai and serum HDLC levels at baseline, and changes in this relationship during an eight-year period, were analyzed using linear mixed-effect models.

RESULTS

At the baseline, relative to those without Ikigai, women with Ikigai had higher serum HDLC (baseline difference in those with a little Ikigai = 7.52 mg/dl, 95% confidence interval [CI]: 1.12 to 13.9 and in those with Ikigai = 8.11 mg/dl, 95% CI: 1.54 to 14.7). The difference in serum HDLC between women with and without Ikigai remained over the eight-year follow-up period. There were no similar Ikigai-associated differences in the serum HDLC of men.

CONCLUSIONS

Women with Ikigai showed differences in serum HDLC that were observed at baseline and persisted over time.

Biopsychosocial Consideration of Ikigai in Older Adults in Japan through a Cross-Sectional Study

Ikigai-a Japanese concept that includes elements such as life's purpose and meaning-has been reported to be associated with various systemic health conditions, such as the risk of developing physical dysfunction or death in older adults. However, there are no reports that comprehensively examine the psychological and social aspects of Ikigai. We attempted to clarify the characteristics of Ikigai by examining it from a biopsychosocial model using physical, psychological, and social perspectives through a cross-sectional study on sarcopenia, frailty and healthy life expectancy in a hilly and mountainous area of Japan. Koyadaira in Mima City, which is located in a hilly and mountainous region on Shikoku Island in Japan, was targeted. This cross-sectional study included 105 outpatients aged 65 and over, with an average age of 79.02 ± 6.91 years. Ikigai (self-rating score on a scale of 0 (no Ikigai) to 5 (the highest Ikigai)) participants' level of physical activity (the Physical Activity Scale for the Elderly, PASE), degree of depression (the Geriatric Depression-15 Scale, GDS-15), cognitive function (the Mini-Mental State Examination, MMSE) and social isolation (the abbreviated Lubben Social Network Scale, LSNS-6) was assessed. Significant positive correlations were found between PASE and MMSE. The LSNS-6 significantly correlated with the MMSE and GDS-15. In a path model, out of four paths from PASE, GDS-15, MMSE, and LSNS-6 to Ikigai, the path from the GDS-15 alone was significant (correlation coefficient -0.271, p < 0.01). The adaptability of this model was good. This study indicates that depressive status has a large impact on Ikigai, along with physical, cognitive, and social conditions; thus, it is appropriate to consider that an affective psychological status, such as depressive symptoms, is a fundamental condition for having Ikigai.

An Integrated Cognitive-Motivational Model of Ikigai (Purpose in Life) in the Workplace

In the Japanese philosophy of life, 'ikigai' broadly refers to having a 'reason for living', or a purpose in life. From a phenomenological and empirical viewpoint, ikigai is reported to increase human well-being and even life expectancy. However, it remains difficult to translate, define and formalize with regard to contemporary psychological theories. In this respect, the aim of this paper is twofold: to capture as accurately as possible what ikigai is, and to examine whether the concept applies to a professional context. We first offer a comprehensive overview of ikigai, bridge the gap between this specific body of literature and related psychological theoretical frameworks, such as those addressing motivation, well-being, and attention. On this basis, we conceptualize an integrated cognitive-motivational model of ikigai using an IPO (Input-Process-Output) framework: we organize dispositional or situational factors supposedly supporting ikigai as inputs, fueling the core process of ikigai (mainly built from motivational and attentional mechanisms), which produce outcomes (including well-being). A feedback loop completes the model and allows the process to maintain over time. This conceptual proposal is a first step towards applying and testing the model in professional contexts, in order to renew our approach of engagement, well-being, and performance at work as well as inspire workplace evolution.

Understanding the Connection Among Ikigai, Well-Being, and Home Robot Acceptance in Japanese Older Adults: Mixed Methods Study

BACKGROUND

Ikigai (meaning or purpose in life) is a concept understood by most older adults in Japan. The term has also garnered international attention, with recent academic attempts to map it to concepts in the Western well-being literature. In addition, efforts to use social and home robots to increase well-being have grown; however, they have mostly focused on hedonic well-being (eg, increasing happiness and decreasing loneliness) rather than eudaimonic well-being (eg, fostering meaning or purpose in life).

OBJECTIVE

First, we explored how Japanese older adults experience ikigai and relate these to concepts in the Western well-being literature. Second, we investigated how a home robot meant to promote ikigai is perceived by older adults.

METHODS

We used a mixed methods research design-including 20 interviews with older adults, a survey of 50 older adults, and 10 interviews with family caregivers. For interviews, we asked questions about older adults' sources of ikigai, happiness, and social support, along with their perception of the robot (QT). For surveys, a number of well-being scales were used, including 2 ikigai scales-ikigai-9 and K-1-and 6 Patient-Reported Outcomes Measurement Information System scales, measuring meaning and purpose, positive affect, satisfaction with participation in social roles, satisfaction with participation in discretionary social activities, companionship, and emotional support. Questions related to the perception and desired adoption of the robot and older adults' health status were also included.

RESULTS

Our results suggest that health is older adults' most common source of ikigai. Additionally, although self-rated health correlated moderately with ikigai and other well-being measures, reported physical limitation did not. As opposed to social roles (work and family), we found that ikigai is more strongly related to satisfaction with discretionary social activities (leisure, hobbies, and friends) for older adults. Moreover, we found that older adults' sources of ikigai included the eudaimonic aspects of vitality, positive relations with others, contribution, accomplishment, purpose, and personal growth, with the first 3 being most common, and the hedonic aspects of positive affect, life satisfaction, and lack of negative affect, with the first 2 being most common. However, the concept of ikigai was most related to eudaimonic well-being, specifically meaning in life, along the dimension of significance. Finally, we found that Japanese older adults have high expectations of a home robot for well-being, mentioning that it should support them in a multitude of ways before they would likely adopt it. However, we report that those with the highest levels of meaning, and satisfaction with their leisure life and friendships, may be most likely to adopt it.

CONCLUSIONS

We outline several ways to improve the robot to increase its acceptance, such as improving its voice, adding functional features, and designing it to support multiple aspects of well-being.

How Long Would You Like to Live? A 25-year Prospective Observation of the Association Between Desired Longevity and Mortality

BACKGROUND

Desired longevity represents how strongly people esteem possible extensions of their own lifetime. The association between desired longevity and mortality risk has been reported in only one prospective study, which examined a small sample of older participants. We aimed to examine the hypothesis that desired longevity at middle-age predicted long-term survival.

METHODS

In the prospective cohort study, residents aged 40-64 years were asked how long they would like to live and asked to choose one from three options: longer than, as long as, or shorter than the life expectancy. We used Cox proportional hazards model to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality according to the three groups for desired longevity, treating the "longer than" group as the reference. We conducted mediation analysis to investigate the mechanism for the association between desired longevity and mortality.

RESULTS

We recruited 39,902 residents to the study. Risk of all-cause mortality was significantly higher in the "shorter than" group (HR 1.12; 95% CI, 1.04-1.21). The association was independent of sex, age, marital status, education, medical history, and health status. Regarding cause of death, mortality risk of cancer (HR 1.14; 95% CI, 1.00-1.29) and suicide (HR 2.15; 95% CI, 1.37-3.38) were also higher in the "shorter than" group. The unhealthy lifestyle mediated this association with all-cause mortality by 30.4%.

CONCLUSION

Shorter desired longevity was significantly associated with an increased risk of all-cause mortality, and mortality from cancer and suicide. Lifestyle behaviors particularly mediated this association.

Perspectives and experiences of the first geriatricians trained in Canada

Many Canadian-trained geriatricians from the subspecialty's first decade of existence continue to practice today. The objective of this study was to examine the experiences and perspectives of the earliest cohort of geriatricians in Canada. Using qualitative description method, we conducted semi-structured interviews to explore participants' experiences in training and practice. We included geriatricians who trained in Canada between 1980-1989 and were in active clinical practice as of October 2021. Each transcript was coded independently by two investigators. Thematic analysis was used to develop key themes. Fourteen participants (43% female, mean years in practice 35.9) described their choice to enter geriatric medicine, their training process, the roles of a geriatrician, challenges facing the profession and advice for trainees. Two themes were developed from the data: (i) advocacy for the older adult and (ii) geriatrics as "the road less taken". Advocacy was described as the "core mission" of a geriatrician. Participants discussed the importance of advocacy in clinical practice, education, research and disseminating geriatric principles in the health system and society. "The road less taken" reflected the challenges participants faced during training, which led to relatively few geriatricians for the growing number of older adults in Canada. Despite these challenges, participants described rewarding careers and encouraged trainees to consider the profession.

How is the problematic smartphone use affected by social support? A research model supported by the mediation of Ikigai

Social support and ikigai (making life worthwhile) have positive effects on problematic smartphone use and are seen to be related to each other. However, what mediates these relationships has not been adequately analyzed. This study aims to examine how the effect between social support and problematic smartphone use occurs by suggesting the mediator role of ikigai. The study was designed as quantitative and cross-sectional, and 1189 university participants aged 18 and over were reached online. The multidimensional scale of perceived social support, ikigai-9 scale, smartphone application-based addiction scale and sociodemographic information form were used as data collection tools in the study. The data obtained were carried out using SPSS 24 and Amos 25 statistical programs. Established hypotheses were tested with correlation, multiple regression and mediation analyzes. The results confirmed that social support was positively associated with ikigai, and ikigai was negatively associated with problematic smartphone use. In addition, interaction analyzes found that ikigai had a mediating effect. These findings show the importance of implementing specific applications based on the meaning and purpose of life (ikigai), especially for vulnerable groups, to minimize the problems that may arise with the excessive use of smartphones.

Purpose in life (Ikigai) and employment status in relation to cardiovascular mortality: the Japan Collaborative Cohort Study

OBJECTIVES

To investigate whether having a purpose in life (Ikigai) is associated with risk of cardiovascular disease (CVD) mortality and whether the association varies by employment status.

DESIGN

Prospective cohort study.

SETTING

Residents in 45 municipalities, Japan.

PARTICIPANTS

29 517 men and 41 984 women aged 40-79 years, free of CVD and cancer at baseline from 1988 to 1990.

PRIMARY OUTCOME MEASURES

CVD mortality.

RESULTS

During the median follow-up of 19.1 years, 4680 deaths (2393 men and 2287 women) from total CVD were observed. Greater Ikigai was associated with a lower risk of CVD mortality, and the result was stronger for men than for women. Stratified by employment status, the inverse association was confined to unemployed persons. Among unemployed persons, the multivariable HRs of total CVD were higher for moderate and high versus low levels of Ikigai. Multivariable HRs (95% CIs) were 0.74 (0.57 to 0.97) and 0.69 (0.52 to 0.93), P for trend <0.044, respectively in men, and 0.78 (0.64 to 0.95) and 0.77 (0.61 to 0.97), P for trend=0.039 in women. No association was observed among the employed, including part-time workers, self-employed and homemakers for both men and women. Such an inverse association remained even after excluding early deaths within 5 years from the baseline survey.

CONCLUSION

Higher levels of Ikigai were associated with a lower risk of CVD mortality, especially for unemployed men and women.

Employment in old age and all-cause mortality: A systematic review

Social participation promotes and maintains the health of older adults. Working is a type of social participation; however, the effect of employment in old age on health outcomes has not been established. This study aimed to review the relationship between employment in old age (≥60 years) and all-cause mortality. For this systematic review, a computerized search was performed using PubMed, CINAHL and PsycINFO for prospective studies published through June 2020. The observational studies were extracted according to the study participants, indicators, follow-up period, statistical approach and main results. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Of the 37 832 records identified, 14 studies were included in the systematic review based on the inclusion and exclusion criteria. Eight studies were derived from Asian countries (four from Japan, two from Taiwan and one from Thailand and South Korea), three were from the United States, two were from Israel and one was from Brazil. The baseline data of 13 studies were collected before 2000. Thirteen of the 14 studies reported any association between employment in later life and a lower risk of mortality. Four studies examined the sex-related differences in the effect of later-life employment on all-cause mortality, but the association was controversial. Overall, we revealed that working in old age would lower mortality risk. Although more findings based on recent data are required, this study indicates that working later in life is beneficial for promoting and maintaining health. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.

Optimism and Longevity Among Japanese Older Adults

BACKGROUND

Optimism has been linked to better physical health across various outcomes, including greater longevity. However, most evidence is from Western populations, leaving it unclear whether these relationships may generalize to other cultural backgrounds. Using secondary data analysis, we evaluated the associations of optimism among older Japanese adults.

METHODS

Data were from a nationwide cohort study of Japanese older adults aged ≥65 years (Japan Gerontological Evaluation Study; n = 10,472). In 2010, optimism and relevant covariates (i.e., sociodemographic factors, physical health conditions, depressive symptoms, and health behaviors) were self-reported. Optimism was measured using the Japanese version of the Life Orientation Test-Revised (LOT-R). Lifespan was determined using mortality information from the public long-term care insurance database through 2017 (7-year follow-up). Accelerated failure time models examined optimism (quintiles or standardized continuous scores) in relation to percent differences in lifespan. Potential effect modification by gender, income, and education was also investigated.

RESULTS

Overall, 733 individuals (7%) died during the follow-up period. Neither continuous nor categorical levels of optimism were associated with lifespan after progressive adjustment for covariates (e.g., in fully-adjusted models: percent differences in lifespan per 1-SD increase in continuous optimism scores= -1.2%, 95%CI: -3.4, 1.1 higher versus lower optimism quintiles= -4.1%, 95%CI: -11.2, 3.6). The association between optimism and lifespan was null across all sociodemographic strata as well.

CONCLUSION

Contrary to the existing evidence from Western populations, optimism was unrelated to longevity among Japanese older adults. The association between optimism, as evaluated by the LOT-R, and longevity may differ across cultural contexts.

Association between health literacy and purpose in life and life satisfaction among health management specialists: a cross-sectional study

Purpose in life is anchored as a goal in national health promotion plans in several countries. Health literacy is the ability to find, understand, use, and evaluate health-related information; this ability has been investigated in terms of its effect on health outcomes and is said to play a critical role in health promotion. In the context of national health promotion, the effect of health literacy on purpose in life and life satisfaction remains unclear; therefore, this study aims to determine the effect of health literacy. A cross-sectional study was conducted on Japanese health management specialists (N = 1920). Health literacy was measured using the Communicative and Critical Health Literacy scale. Purpose in life and life satisfaction were measured using the Ikigai-9 scale and a Likert scale, respectively. We analyzed the associations between health literacy and purpose in life and life satisfaction with regression analyses. Age, sex, income, education, marital status, psychological stress, and diseases as present illness were adjusted in the statistical models. Our multiple linear regressions indicated that health literacy was significantly associated with purpose in life (β = 0.199, p < 0.001), after adjusting for covariates (age, sex, income, education, marital status, psychological factor, and disease status). Life satisfaction was also significantly associated with health literacy (β = 0.126, p < 0.001). Health literacy is associated with purpose in life and life satisfaction among specialists in health management. Health literacy plays a critical role in lifestyle-related disease prevention and health promotion. Interventions to improve health literacy may be warranted in the context of national health promotion.

Ikigai and subsequent health and wellbeing among Japanese older adults: Longitudinal outcome-wide analysis

BACKGROUND

Having a purpose in life has been linked to improved health and wellbeing; however, it remains unknown whether having "Ikigai"-a related but broader concept in Japan-is also beneficial for various physical and psychosocial outcomes.

METHODS

Using data from a nationwide longitudinal study of Japanese older adults aged ≥65 years, we examined the associations between having Ikigai in 2013 and a wide range of subsequent outcomes assessed in 2016 across two databases (n = 6,441 and n = 8,041), including dimensions of physical health, health behavior, psychological distress, social wellbeing, subjective wellbeing, and pro-social/altruistic behaviors. We adjusted for sociodemographic characteristics and the outcome values (whenever data were available) in the prior wave (2010).

FINDINGS

Having Ikigai (vs. not having Ikigai) was associated with a 31% lower risk of developing functional disability [95% confidence interval (CI) for risk ratio: 0.58, 0.82] and 36% lower risk of developing dementia [95% CI for risk ratio: 0.48, 0.86] during the three-year follow-up. Having Ikigai was associated with decreased depressive symptoms and hopelessness as well as higher happiness, life satisfaction, instrumental activity of daily living, and certain social outcomes (e.g., more frequent participation in hobby clubs). Some of these associations were stronger for men than women, and among individuals with high socioeconomic status (p-values for effect measure modification < 001).

INTERPRETATION

Having Ikigai may promote health and wellbeing outcomes among Japanese older adults, but particularly men and individuals with high socioeconomic status.

FUNDING

NIH, John Templeton Foundation, JSPS, AMED, MHLW, MEXT, and WPE Foundation.

Can Ikigai Predict Anxiety, Depression, and Well-being?

The Japanese construct of ikigai reflects a sense of having 'purpose in life' or a 'reason for living and has been associated with a variety of positive health outcomes. However, to date little research into ikigai exists within Western populations. This study explored the predictive power of ikigai for measures of well-being, depression, and anxiety in an adult Western population. Ninety-four participants (70% female) responded to an online survey. After accounting for the covariates of sex, age, employment status, and student status, multiple hierarchical regression indicated that ikigai positively predicted well-being and negatively predicted depression. While on its own, ikigai negatively predicted anxiety; this was not the case after accounting for the aforementioned covariates. The findings support the importance for investigating ikigai in the West and the need for further exploration of ikigai as a potential means of bringing about benefit in mental well-being.

Trajectories of Pain in Very Old Age: The Role of Eudaimonic Wellbeing and Personality

Pain is common in very old age and in the last years prior to death. However, little is known regarding longitudinal trajectories of pain in very old age and at the end of life. Moreover, whereas medical and morbidity-related factors contributing to pain are established, the role of psychosocial factors, such as eudaimonic wellbeing or personality as potential determinants of late-life pain trajectories has so far not been sufficiently investigated. We used data from the LateLine project. The sample consisted of n = 118 very old adults (M = 90.5 years, SD = 2.8 years) who were living alone at baseline and who had died between 2009 and 2021. They took part in up to 16 measurement occasions (M = 5.2, SD = 4.7, range 1–16) within an observational interval of 7 years. Assessment of pain was based on the SF-36 bodily pain subscale. Key indicators of eudaimonic wellbeing (autonomy, environmental mastery, and purpose in life) as well two of the Big Five personality traits (neuroticism and extraversion) were included as predictors. We controlled in all analyses for gender, education, subjective health, and depressive symptoms. Contrasting pain trajectories over chronological age (time since birth) vs. time to death, a time-to-death-related model resulted in a better model fit and accounted for a larger amount of pain variability than the age-related model. Mean-level change in pain, both over age and time to death, was not significant, but there was substantial interindividual variability in intraindividual trajectories. Age-related change in pain was significantly predicted by autonomy and neuroticism, with increasing pain among those who had lower initial autonomy scores and higher initial neuroticism scores. With regard to time-to-death-related trajectories of pain, higher purpose in life as well as lower extraversion at baseline predicted less increase or even steeper decrease in pain with approaching death. Our findings suggest that, despite overall mean-level stability in pain both over age and time to death, there is a substantial proportion of individuals who reveal deterioration in pain over time. Regarding the role of psychosocial predictors, personality traits and eudaimonic wellbeing are related with late-life pain trajectories both over age and time-to-death.

Social Support and Participation as Factors Relating to Ikigai and Life Satisfaction in Lonely Older Japanese

This study investigated associations among loneliness, social support, social participation, and well-being among the Japanese elderly. We predicted that the negative association between loneliness and well-being would be weaker in people with adequate social support and frequent social participation. We measured ikigai and life satisfaction as indices of well-being. Ikigai and life satisfaction both include satisfaction with a person’s current and past life, yet ikigai also includes unique concepts such as satisfaction with social interactions and positive expectations for the future. Data of 418 Japanese aged 75 and older were analyzed; findings demonstrated that loneliness was negatively related to ikigai but not life satisfaction. There was a significant interaction between loneliness and social support for life satisfaction and ikigai. The interaction between loneliness and the frequency of social participation was significant only for ikigai. Post-hoc analysis indicated that social support and social participation frequency were negatively related to the negative association between loneliness and well-being, especially ikigai. These results suggest that ikigai and life satisfaction have a differential relationship to loneliness and social interaction because the concept of ikigai uniquely included perceived social roles.

A Randomized controlled trial of the Sources of Meaning Card Method: A new meaning-oriented approach predicts depression, anxiety, pain acceptance, and crisis of meaning in chronic pain patients

OBJECTIVE

Although considered the first-line psychological treatment of chronic pain, cognitive behavioural therapy has recently been criticized as being too limited, insufficient, and sometimes ineffective in the treatment of chronic pain patients. Moreover, important existential perspectives are sparsely or not at all integrated into CBT. We therefore propose to complement chronic pain treatment with a meaning-based intervention, the Sources of Meaning Card Method (SoMeCaM). This study tested its efficacy.

DESIGN

A randomized controlled trial was conducted with 42 chronic pain patients, comparing an intervention group (standard care and participation in the SoMeCaM, a meaning-oriented approach) with a control group (standard care). We evaluated both groups at baseline, 1 (t1) and 2 months (t2) after the intervention. The primary outcome assessed was pain acceptance, while depression, anxiety, pain intensity, pain medication, satisfaction with life, meaningfulness, and crisis of meaning were examined as secondary outcomes.

RESULTS

Comparisons within and between groups showed significant treatment effects at t1. Higher increases in pain acceptance and decreases in anxiety, depression and crisis of meaning were observed in the intervention group. Improvements in pain acceptance and anxiety persisted until t2, when pain intensity was also lower. Effect sizes at t2 were medium to large.

CONCLUSION

Our preliminary work demonstrates the importance of the existential perspective in chronic pain therapy.

Culture and Health: Recent Developments and Future Directions 1

Evidence of cultural differences in relationships and emotions has accumulated over the past few decades. As findings on cultural differences in psychological processes have accumulated, there has been growing interest in investigating whether they have implications for other phenomena such as health. Using scientific advances from the MIDUS and MIDJA studies, both publicly available, we examine links between culture and health. We first briefly review the accumulated evidence on cultural influences on health correlates of psychosocial factors. We then feature two recent developments - a more micro-level perspective on biological factors that may be involved in the culture and health linkage, and a more macro-level view of socioeconomic inequality, which also matters for health. Both perspectives inform the pathways through which health effects occur. Finally, we conclude our review by highlighting the changing historical contexts surrounding these cross-cultural investigations. Specifically, we draw attention to widening of economic inequality across cultures and the world-wide COVID-19 pandemic. These happenings bring notable implications for future research on health across cultural contexts.

Interview-Rated Meaning and Survival Over 17 Years in People Living With HIV

OBJECTIVE

The primary purpose of this study was to determine whether meaning in life predicts survival in people living with HIV (PLWH) over 17 years. This study also examined whether interviewer- and transcript-rated meanings predict survival equivalently. A third purpose of the study was to investigate whether meaning in life adds to the prediction of survival over positive emotional expression.

METHODS

A diverse sample of people with HIV (n = 177) completed an interview on stress and coping at baseline and were followed up for survival up to 17 years. Meaning was measured by interviewer rating of four items (meaningful purpose, unfinished business, finding new meaning, and meaningful activities). Transcript-rated meaning was assessed by two independent raters. Cox proportional hazards regression was used to determine whether meaning predicted survival over 17 years.

RESULTS

Meaning in life predicted significantly greater survival, adjusting for biomedical and sociodemographic variables whether assessed by interviewer or by transcript raters. Hazard ratios suggest that the effect is moderate to large (2.66-3.45 for top versus bottom third; 2.05-2.49 for top versus bottom half). Significance was maintained after adjusting for positive emotion.

CONCLUSIONS

Meaning assessed by interview (by both interviewer and transcript ratings) predicted greater survival over 17 years in PLWH and did so above positive emotion. This adds to a literature that is primarily based on self-report questionnaires. Meaning may have beneficial effects for both psychological and physical health in PLWH.

Predictors and Importance of Social Aspects in Ikigai among Older Women

Ikigai is a unique Japanese concept that encompasses not only joy and happiness, but also the purpose and meaning of life. The purpose of this study was to explore the factors that contribute to Ikigai, an important concept in the health of older women, and to clarify the relationship between Ikigai and the enhancement of the social aspects of their health. The participants in this longitudinal study, conducted between October 2017 and February 2020, were physically healthy older women aged 65 years and above (N = 132). Physical function and social activity were used as predictors of Ikigai. In addition, willingness for new interactions was used to examine the social aspects of health. A causal model was created from these factors, and path analysis was performed. The results demonstrated that participating in numerous interpersonal activities was predictive of increased Ikigai, but physical function was not. In addition, Ikigai was found to affect the willingness for new interactions. Further, Ikigai could be related to the willingness for new interactions. To enhance the social aspects of older women’s health, it is necessary to focus on Ikigai.

Maintaining sense of purpose in midlife predicts better physical health

OBJECTIVE

Having a sense of purpose in life is fundamental to psychological and physical well-being. Despite the benefits of purpose, it may be difficult to hold onto purpose as people age. The present research addressed four aims: (1) to estimate average change in sense of purpose during midlife; (2) to test associations between purpose levels and later physical health; (3) to test associations between purpose change and later physical health; (4) to examine the cross-cultural generalizability of findings.

METHODS

We used reliable change indices to estimate change in sense of purpose during midlife in three prospective cohorts: one comprised predominately of White participants in the U.S. (N = 2692), a second predominately of African American participants in the U.S. (N = 248), and a third of Japanese participants in Tokyo (N = 644). Next, we used linear regression to examine associations between purpose levels and purpose change and later self-reported general health and chronic health conditions.

RESULTS

At the group level, purpose declined slightly across time (Cohen's ds = -0.08 to -0.17). At the individual level, 10-14% of participants reliably decreased in purpose, whereas only 6-8% of participants reliably increased in purpose. Consistent with our preregistered hypotheses, higher purpose levels predicted better health in the two larger samples (βs = 0.10-0.18, small effects) and more positive purpose change predicted better health in all three samples (βs = 0.08--0.22., small to medium effects).

CONCLUSION

Together, these findings suggest that both having a sense of purpose and holding onto it may be important for physical health in middle to older adulthood.

[Do elderly people providing nursing or caring for others help the providers maintain their health?]

AIM

The present study clarified the relationship between elderly individuals providing nursing or caring for others, including their spouses, and their own health maintenance over three years.

METHODS

Study participants were those who had completed the "Survey of Needs in the Spheres of Daily Life" distributed to all elderly individuals ≥65 years old in Nanto, Toyama Prefecture, Japan, in both 2014 and 2017. We evaluated data from 6,088 individuals after excluding those with insufficient data. Detailed responses were analyzed in order to understand the situation of the people to whom the respondents were providing nursing or care (e.g. spouses or others), the presence or absence of providing this nursing or care, and the relationship between these factors and the providers' health maintenance over a period of three years using multiple logistic regression analyses.

RESULTS

Even after adjusting for critical variables, including basic attributes, overall health, and functional capacity in elderly men, among the subjects who had partners to whom they provided nursing or care, including a spouse, the number of individuals whose own health was maintained 3 years later was higher than among those who did not provide such nursing or care (odds ratio [OR], 1.67; P = 0.004). Furthermore, compared to women who did not provide nursing or care, the OR for women who did provide care for people others than their spouses was 1.44 (P = 0.045).

CONCLUSIONS

Our results suggest that providing nursing or caring for others (including a spouse for elderly men; excluding a spouse for elderly women) has a positive impact on health maintenance among the elderly.

Does social capital influence purpose in life and life satisfaction among Japanese health-literate professionals?

A strong sense of purpose and satisfaction in life is associated with multiple health benefits. There is also evidence to suggest that social capital predicts better health indicators. While both social capital and purpose and satisfaction in life direct better health, the relationship between social capital and purpose and satisfaction in life in terms of health, remains unclear. A retrospective cohort study was conducted on Japanese health management professionals (N = 4820). We analyzed the cohort’s demographics and reported changes in social capital (social engagement and trust), purpose in life, and life satisfaction using self-reported questionnaires and the Ikigai-9 scale. The cohort was categorized into group 1 (neither changes), group 2 (one changes), and group 3 (both change), based on the number of changes reported in social capital. Purpose in life and life satisfaction scores were then compared among the three groups. The purpose in life score (SD [standard deviation]) for groups 1, 2, and 3 was 30.7 (6.0), 32.5 (5.6), and 35.6 (5.2), respectively. Life satisfaction scores (SD) for groups 1, 2 and 3 were 3.35 (0.8), 3.67 (0.8), and 4.26 (0.7), respectively. We found a statistically significant difference in purpose and satisfaction in life among the three groups (F(2) = 361.4, p < 0.001 and F(2) = 703.9, p < 0.001). Social capital was associated with purpose and satisfaction in life among health-literate professionals. Strengthening social capital may increase individual purpose and satisfaction in life and ultimately yield better health.

Cardiovascular disease and meaning in life: A systematic literature review and conceptual model

OBJECTIVES

Previous studies have shown that psychological stress and mental health problems increase the risk for cardiovascular disease (CVD) events, such as heart attack or stroke. Furthermore, after CVD events, the majority of patients report large stress. However, psychological treatments have only modest effects in CVD patients. Therefore, it has been argued that new conceptual models are needed to understand the aetiology of stress and mental health problems in CVD patients. Therefore, this study included a systematic literature review and a conceptual model on the role of meaning in life for psychological stress, mental health, and CVD risks.

METHODS

A systematic literature review was conducted on relationships between CVD and meaning in life. PRISMA/MOOSE review guidelines were followed. These findings were used to build a conceptual model.

RESULTS

The literature review included 113 studies on meaning and CVD. The included studies described meaning as a predictor of cardiovascular risks and health, meaning-centered needs of patients in conversations with medical staff, meaning-centered changes after CVD events, meaning-centered coping with CVD, meaning as motivator of CVD-related lifestyle changes, and meaning as an element in psychological treatments of CVD patients. In sum, the literature showed that a central clinical concern for patients is their question how to live a meaningful life despite CVD. Meaning-centered concerns seem to lead to lower motivation to make lifestyle changes, more psychological stress, lower quality-of-life, worse physical well-being, and increased CVD risk. The ability to live a meaningful life after CVD events is related with lower stress, better mental health, and several biomarkers.

SIGNIFICANCE OF RESULTS

An evidence-based conceptual framework was developed for the relationship between meaning and CVD. It may be hypothesized CVD patients may benefit from psychological therapies focused on meaning.

Association between healthy lifestyle practices and life purpose among a highly health-literate cohort: a cross-sectional study

BACKGROUND

The national health promotion program in the twenty-first century Japan (HJ21) correlates life purpose with disease prevention, facilitating the adoption of healthy lifestyles. However, the influence of clustered healthy lifestyle practices on life purpose, within the context of this national health campaign remains uninvestigated. This study assessed the association between such practices and life purpose, in line with the HJ21.

METHODS

We performed a nationwide cross-sectional survey on certified specialists in health management. Participants' demographic information, lifestyle, and purpose in life were measured using a validated tool. The cohort was median-split into two groups based on their clustered health-related lifestyle score. The values for health-related lifestyle and purpose were compared between the two groups and the correlation between health-related lifestyle and purpose in life was measured.

RESULTS

Data from 4820 participants were analyzed. The higher-scoring health-related lifestyle group showed a significantly higher life purpose than the lower group (35.3 vs 31.4; t = 23.6, p < 0.001). There was a significant association between the scores of clustered healthy lifestyle practices and life purpose (r = 0.401, p < 0.001). The higher-scoring health-related lifestyle group achieved a higher life purpose than the lower-scoring group. This association between healthy lifestyle practices and life purpose denotes a positive and linear relationship.

CONCLUSIONS

Our results suggest that individuals who have a better health-related lifestyle gain a higher sense of life purpose. In other words, a healthy lifestyle predicts a purpose in life. Our findings posit that examining the causal relationship between healthy lifestyle and purpose in life may be a more efficient approach toward health promotion.

Well-Being and Cooking Behavior: Using the Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA) Model as a Theoretical Framework

The prevalence of psychosocial distress is increasing in the United States. At the same time, the American default lifestyle has steadily displaced household food production with industrial food production, despite increased cultural interest in cooking. An important focus of cooking research to date has been on cooking's association with nutrition and dietary quality. Less focus has been placed on how cooking might foster the qualities that allow for mitigation of psychosocial distress and promote well-being. Rooted in its evolutionary role in the human experience, cooking requires skills and knowledge that have the capacity to encourage aspects of well-being as described by Seligman as flourishing. Evidence for a beneficial role of cooking in psychosocial health exists, but the exploration is limited, potentially due to lack of a theoretical context to explain these benefits. From this perspective, we review the current literature showing the application of Seligman's prominent well-being model, Positive emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA), to cooking, defined as the activity related to the preparation of food or a meal. We propose that the PERMA model as applied to cooking may function as a theoretical framework to explore psychosocial outcomes associated with cooking. Broader application of this approach may also help to further the application of positive psychology in the developing literature around psychosocial health and nutrition-related chronic diseases.

Positive psychological well‐being and cardiovascular disease: Exploring mechanistic and developmental pathways

Empirical research regarding the health benefits of positive psychological well‐being (e.g., positive emotions, life satisfaction, purpose in life, and optimism) has flourished in recent years, particularly with regard to cardiovascular disease. This paper reviews the state of evidence for well‐being's association with cardiovascular disease in both healthy individuals and those diagnosed with a disease. Prospective studies consistently indicate well‐being reduces cardiovascular events in healthy and, to a lesser extent, patient populations. Potential pathways that link well‐being with cardiovascular disease are discussed (including health behaviors, physiological processes, and stress buffering), although the existing evidence is mostly cross‐sectional which limits conclusions about directionality. Issues related to development across the lifespan are considered and childhood is identified as a crucial period for establishing healthy cardiovascular trajectories. Outstanding questions for future research are provided with recommendations to focus on well‐powered and prospective study designs with rigorous assessment of both well‐being and cardiovascular‐related outcomes.

The moderating effect of place attachment on the relationship between economic status and well-being among the older adults in Japan

IKIGAI is culturally defined as a subjective evaluation of well-being in Japan and is believed to be an important factor in achieving a better life. This study determined the association between economic status and well-being using IKIGAI and the moderating effect of place attachment on their association among 499 older adults people over 65 years of age in Japan. The result of hierarchical multiple regression analysis revealed that lower economic status significantly decreased well-being. We also observed a significant interactive effect of place attachment on the association between economic status and well-being (β = 0.085, p = 0.041). In other words, improving place attachment was beneficial in alleviating the impact of lower economic status on well-being for the older adults. As the aged population increases across the globe, the way in which societies can counteract the adverse impact of economic status through place attachment could be highly beneficial.

Are All Purposes Worth Having? Integrating Content and Strength in Purpose Research

A prevailing belief is that a sense of purpose in life is worth having, based on evidence that it predicts greater psychological functioning, social relationships, physical health, and longevity. Yet, whether the benefits of having a sense of purpose persist across all contents – or the actual substance of one’s aspirations – lingers as a critical blind spot within this literature. Here, we contend that an ecological systems perspective is needed to contextualize how purpose content either enables or extinguishes the benefits of feeling purposeful. We nominate congruence (the fit between a purpose and ecological conditions) and feasibility (the ease with which a purpose can be pursued) as measurable features of purpose content that fuse people and contexts and potentiate whether a sense of purpose proves favorable. Greater congruence and feasibility should orchestrate support for purpose-related goals, actions, and justifications, thus amplifying the likelihood of positive outcomes. Practical strategies for integrating the congruence and feasibility of individuals’ aspirations within the study of purpose are discussed.

Factors related to ikigai among older residents participating in hillside residential community-based activities in Nagasaki City, Japan

Objective: The present study aims to investigate the factors related to self-rated ikigai (purpose in life) among older residents participating in hillside residential community-based activities in Nagasaki City.

Methods: A self-administered anonymous questionnaire survey was carried out with older residents participating in two hillside residential community-based activities in Nagasaki City, Japan. The questionnaire included questions on sociodemographic information (age, sex, family structure, education, and self-rated economic satisfaction), self-rated health, mental health status measured using Geriatric Depression Scale-15 (GDS-15), and self-rated ikigai score that was estimated using a visual analog scale.

Results: A total of 32 older residents (7 males, 25 females) participated in the questionnaire survey. Although self-rated ikigai score was not associated with sociodemographic factors, there were associations between the score, self-rated health (P=0.001), and mental health (GDS-15) (P=0.015). Statistically significant correlations between self-rated ikigai score and social participation (ρ=0.426, P=0.017), self-rated health (ρ=−0.485, P=0.007), and mental health (GDS-15) (ρ=−0.523, P=0.007) were observed.

Conclusion: Increasing social participation may increase individual ikigai, preventing poor self-rated health and low mental health status in older people. Maintaining their social participation in the community might be effective for the health promotion of older residents in hillside residential areas of Nagasaki City.

Association Between Kinesiophobia and Life Space Among Community-Dwelling Older People with Chronic Musculoskeletal Pain

OBJECTIVE

Kinesiophobia (i.e., fear of movement caused by pain) is increasingly acknowledged as a determinant of disuse among patients with chronic musculoskeletal pain. Kinesiophobia may affect life space-a crucial indicator of an active lifestyle among older people. This study aimed to investigate the previously unexamined association between kinesiophobia and life space among community-dwelling older people with chronic musculoskeletal pain.

DESIGN

Cross-sectional study.

SETTING

Community.

SUBJECTS

We analyzed data from 194 community-dwelling older people (age ≥65 years, mean age = 75.7 years, 71.6% women) with chronic musculoskeletal pain.

METHODS

Kinesiophobia, life space, and pain severity were assessed using the Tampa Scale for Kinesiophobia, Life Space Assessment, and Brief Pain Inventory. Linear regression models were applied to analyze the associations between kinesiophobia and life space, and pain severity and life space.

RESULTS

In our sample, the prevalence rates for chronic musculoskeletal pain were 10.82% (N = 21) for neck, 55.15% (N = 107) for lower back, 25.26% (N = 49) for shoulder, and 50.00% (N = 97) for knee. The results suggest that higher kinesiophobia is associated with smaller life space (adjusted beta = -0.91, 95% CI = -1.43 to -0.45, P < 0.001), even after adjustment for age, gender, years of education, pain severity, and presence of comorbidity. On the contrary, no significant association between pain severity and life space was observed (adjusted beta = -0.61, 95% CI = -2.92 to 1.72, P = 0.624).

CONCLUSIONS

Our findings suggest that kinesiophobia plays an important role in the determination of life space among older people with chronic musculoskeletal pain.

Does Improvement in Health-Related Lifestyle Habits Increase Purpose in Life among a Health Literate Cohort?

A growing number of studies have revealed the association between health-related lifestyle habits and purpose in life. However, the mechanism linking the two has not been adequately understood. This study aims to examine the effect of changes in health-related lifestyle habits on purpose in life. A retrospective cohort study was conducted on certified professional specialists of health management. We analyzed the cohort’s demographic information, health-related lifestyle behaviors, reported changes in health-related lifestyle habits (exercise, diet, sleep, and other habits), and purpose in life using a validated tool (Ikigai-9). The cohort was divided into four groups based on the number of reported changes in health-related lifestyles. The purpose in life score was compared among the four groups with and without adjusting for lifestyle. In total, there were 4820 participants. The means (and SD) of the Ikigai-9 score for groups 1, 2, 3, and 4 were 31.4 (6.6), 32.2 (5.6), 32.8 (5.8), and 34.9 (5.4), respectively. There was a statistically significant difference in the Ikigai-9 score among the groups. Healthier changes in lifestyle habits increased perceptions of purpose in life. Both purpose in life and health-related lifestyle habits might be the target factors for disease prevention and health promotion.

From Shattered Goals to Meaning in Life: Life Crafting in Times of the COVID-19 Pandemic

The novel COVID-19 pandemic has created an extraordinary situation for our generation, with many countries being on lockdown. With this, new situation comes many psychological challenges not only for health care workers and people suffering from COVID-19 but also for the general population. Adapting to the new situation can be demanding. Experts have suggested that emotions during this situation are very similar to grief, and people experience emptiness and sadness about the loss of their normal lives, which can even lead to a loss of meaning in life. In this paper, we argue that life crafting could offer a way to help people cope with the situation and renew their sense of meaning. A life crafting intervention is based on theoretical insights from multiple areas of research, like positive psychology, expressive writing, and the salutogenesis framework. Life-crafting interventions help people find meaning in life by focusing on their ideal future, and helping them set goals, and make concrete plans to achieve those goals and overcome obstacles. Since having a clear purpose or meaning in life has been shown to have many benefits, we propose that it can also help people to cope with the psychological effects of the pandemic. A life-crafting intervention can offer people a chance to evaluate their goals in a time of uncertainty and rediscover meaning in life to guide them through these difficult times.

Meaning in Life and Self-Control Buffer Stress in Times of COVID-19: Moderating and Mediating Effects With Regard to Mental Distress

BACKGROUND

As evidenced by several studies, mental distress increased substantially during the COVID-19 pandemic. In this period, citizens were asked to exercise a high degree of self-control with regard to personal and social health behavior. At the same time, we witnessed an increase of prosocial acts and shared creative expressions, which are known to serve as sources of meaning. Meaning in life and self-control are acknowledged psychological resources. Especially in times of crisis, meaning in life has been shown to be a crucial factor for resilience and coping. However, threatening and stressful situations can also jeopardize existential security and trigger crises of meaning. The present study aimed to document levels of acute COVID-19 stress and general mental distress in Germany and Austria during the lockdown and in the weeks thereafter. In order to identify potential risk factors related to demographics and living conditions, their associations with COVID-19 stress were analyzed exploratively. The primary objective of the study, however, was to investigate the buffering effect of two psychological resources-meaningfulness and self-control-with regard to the relation between acute COVID-19 stress and general mental distress. Finally, a potential aggravation of mental distress due to the occurrence of crises of meaning was examined.

METHOD

A cross-sectional survey was conducted online during lockdown (survey group 1) and the subsequent weeks characterized by eased restrictions (survey group 2). A total of N = 1,538 German-speaking participants completed a questionnaire battery including a novel measure of acute COVID-19 stress, meaningfulness and crisis of meaning (SoMe), self-control (SCS-KD), and a screening of general mental distress, measured by core symptoms of depression and anxiety (PHQ-4). In a first step, associations between living conditions, demographics, and COVID-19 stress were explored. Second, a moderation and a mediation model were tested. Meaningfulness, a measure of presence of meaning in life, as well as self-control were proposed to serve as buffers in a time of crisis, thus moderating the relation between acute COVID-19 stress and general mental distress (double moderation). Crisis of meaning, operationalizing an experienced lack of meaning in life, was proposed to mediate the relationship between acute COVID-19 stress and general mental distress, with an assumed moderation of the association between COVID-19 stress and crisis of meaning by survey group (lockdown versus eased restrictions after lockdown), and a hypothesized moderation of the link between crisis of meaning and general mental distress by self-control (dual moderated mediation).

RESULTS

COVID-19 stress was slightly right-skewed. Scores were higher during lockdown than in the weeks thereafter. The rate of clinically significant general mental distress was high, exceeding prevalence rates from both the general population and clinical samples of the time before the pandemic. In the weeks following the lockdown (group 2), general mental distress and crisis of meaning were significantly higher than during lockdown (group 1), whereas meaningfulness and self-control were significantly lower. Demographically, age had the strongest association with COVID-19 stress, with older participants perceiving less acute stress (r = -.21). People who were partnered or married suffered less from COVID-19 stress (η2 = .01). Living alone (η2 = .006), living in a room versus a flat or house (η2 = .008), and being unemployed due to the pandemic (η2 = .008) were related to higher experience of COVID-19 stress. COVID-19 stress and general mental distress were strongly related (r = .53). Both meaningfulness and self-control were negatively associated with general mental distress (r = -.40 and -.36, respectively). They also moderated the relationship between COVID-19 stress and general mental distress: When meaningfulness was high, high COVID-19 stress was related to substantially lower PHQ-4 scores than when meaningfulness was low. The same held for self-control: High scores of self-control were associated with lower PHQ-4 scores especially when COVID-19 stress was high. Crisis of meaning mediated the relationship between COVID-19 stress and PHQ-4. There was a higher likelihood of crises of meaning occurring when COVID-19 stress was high; crisis of meaning, in turn, was associated with general mental distress. Survey group moderated the first path of this mediation, i.e., the relationship between COVID-19 stress and crisis of meaning: High scores of COVID-19 stress were associated more strongly with crisis of meaning in the second survey group (after the lockdown). Self-control moderated the second path, i.e., the relationship between crisis of meaning and PHQ-4: When a crisis of meaning was present, self-control could buffer its effect on general mental distress.

CONCLUSIONS

Also in the present study among German-speaking participants, general mental distress was high. Scores were higher after than during the lockdown, indicating an ongoing destabilization for a significant part of the population. People who saw a meaning in their lives and who were capable of self-control reported substantially less mental distress. Meaningfulness and self-control also served as buffers between COVID-19 stress and general mental distress: When COVID-19 stress was high, the presence of meaningfulness and self-control accounted for lower general mental distress. Moreover, people who suffered strongly from COVID-19 stress were more likely to develop a crisis of meaning which, in turn, was associated with higher general mental distress. This suggests that ongoing anxiety and depression might (also) be based on existential struggles. Again here, self-control buffered the impact of crisis of meaning on general mental health. We conclude from these findings that public health policies can support citizens in coping with large-scale crises by enabling experiences of meaningfulness, e.g., through transparent and reliable modes of communicating goals and necessary intermediate steps. Moreover, health professionals are well advised to invite individuals to confront existential questions and struggles, and to encourage them to exercise self-control. The latter can be boosted by keeping higher-order goals salient-which again is inherently linked to an understanding of their meaning.

Epidemiologic Research on Healthy Life Expectancy and Proposal for Its Extension: A Revised English Version of Japanese in the Journal of the Japan Medical Association 2019;148(9):1781-4

Healthy life expectancy is an indicator that represents a composite of data on mortality and health status and is defined as the average number of years that a person can expect to live at a certain level of health. To extend people's healthy life expectancy, my colleague and I conducted a variety of epidemiologic research based upon community-based cohort studies and intervention trials. The findings from our prospective cohort studies included blood pressure reference values measured at home, green tea health benefit, Japanese dietary pattern, and feeling ikigai (a sense of life worth living) at daily life. Based upon these evidence, I have made some proposals toward extension of healthy life expectancy. In 2011, as the Chair of the Planning Committee for the Next National Health Promotion of Ministry of Health, Labor and Welfare (MHLW), I proposed that the Health Japan 21 (second term) should aim to extend healthy life expectancy to exceed the number of years extended in the total life expectancy, thus compressing the duration to be spent in an unhealthy state (compression of morbidity). In the interim evaluation of the Health Japan 21 (second term) in 2018, we were able to demonstrate that this goal is being achieved. Compared with 2010, in 2016, the increase in healthy life expectancy (1.72 years in men and 1.17 years in women) was higher than that of total life expectancy (1.43 years in men and 0.84 years in women). As a result, the duration to be spent in an unhealthy state was reduced by 0.29 years in men and by 0.33 years in women. It is important to note that Japan is the only country that has made progress in achieving compression of morbidity at the national level. We need to maintain this momentum of compressing morbidity.

Optimizing Students' Mental Health and Academic Performance: AI-Enhanced Life Crafting

One in three university students experiences mental health problems during their study. A similar percentage leaves higher education without obtaining the degree for which they enrolled. Research suggests that both mental health problems and academic underperformance could be caused by students lacking control and purpose while they are adjusting to tertiary education. Currently, universities are not designed to cater to all the personal needs and mental health problems of large numbers of students at the start of their studies. Within the literature aimed at preventing mental health problems among students (e.g., anxiety or depression), digital forms of therapy recently have been suggested as potentially scalable solutions to address these problems. Integrative psychological artificial intelligence (AI) in the form of a chatbot, for example, shows great potential as an evidence-based solution. At the same time, within the literature aimed at improving academic performance, the online life-crafting intervention in which students write about values and passions, goals, and goal-attainment plans has shown to improve the academic performance and retention rates of students. Because the life-crafting intervention is delivered through the curriculum and doesn't bear the stigma that is associated with therapy, it can reach larger populations of students. But life-crafting lacks the means for follow-up or the interactiveness that online AI-guided therapy can offer. In this narrative review, we propose to integrate the current literature on chatbot interventions aimed at the mental health of students with research about a life-crafting intervention that uses an inclusive curriculum-wide approach. When a chatbot asks students to prioritize both academic as well as social and health-related goals and provides personalized follow-up coaching, this can prevent -often interrelated- academic and mental health problems. Right on-time delivery, and personalized follow-up questions enhance the effects of both -originally separated- intervention types. Research on this new combination of interventions should use design principles that increase user-friendliness and monitor the technology acceptance of its participants.

Feeling excited or taking a bath: Do distinct pathways underlie the positive affect-health link in the U.S. and Japan?

Feeling good is linked to better health in Western contexts. Recent studies show, however, that the affect-health link is not consistent across cultures. We suggest two reasons for such inconsistency. The first follows from research showing that North American (vs. East Asian) cultures tend to value high arousal positive (HAP) states, for example, excited, more than low arousal positive (LAP) states, for example, calm. The second is one we propose for the first time. Positive affective experience is manifest in internal feelings but also in affective practices, such as taking a bath (a highly valued affective experience in Japan) or a fitness workout (a highly valued affective experience in the United States). We hypothesized that the HAP feelings/practices-health link would be stronger in the United States versus Japan, and the LAP feelings/practices-health link would be stronger in Japan versus the United States. Using survey samples from the United States (N = 640) and Japan (N = 382), we examined how health outcomes are shaped by positive affective feelings and practices varying in arousal. In a first set of analyses, HAP feelings predicted better physical and biological health in the United States but not in Japan. No cultural differences were consistently found for the effect of LAP feelings on health. In addition, engaging in HAP practices predicted better physical and biological health in the United States whereas engaging in LAP practices predicted better physical health in Japan but not in the United States. These findings suggest that the pathways underlying the culture-health link are culturally variable. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Is subjective well-being independently associated with mortality? A 14-year prospective cohort study in a representative sample of 25 139 US men and women

OBJECTIVES

To examine whether the inverse association of subjective well-being with mortality is independent of self-rated health and socioeconomic status in healthy adults.

DESIGN

A population-based prospective cohort study based on an in-person interview. Cox regression was used to examine mortality hazards for happiness alone and for a standardised summary well-being measure that included happiness, life satisfaction and negative emotions. Using prespecified analyses, we first adjusted for age and then additionally adjusted for self-rated health and then race/ethnicity, marital status, smoking and socioeconomic status.

SETTING

Probability sample of adult US residents interviewed in their homes in 2001.

PARTICIPANTS

25 139 adults free of cardiovascular disease and cancer at baseline.

PRIMARY OUTCOME MEASURE

All-cause mortality 14 years after the baseline interview as assessed by probabilistic matching using the National Death Index.

RESULTS

Age-adjusted unhappiness was associated with mortality (HR 1.27; 95% CI 1.11 to 1.45, p=0.001) but the association attenuated after adjusting for self-rated health (HR 1.01; 95% CI 0.88 to 1.16, p=0.85). A similar pattern was seen for the summary well-being measure in fully adjusted models (HR 1.00; 95% CI 0.99 to 1.00, p=0.30). In contrast, self-rated health was strongly associated with mortality. In the fully adjusted model with the summary well-being measure the hazards for good, very good and excellent self-rated health were 0.71 (95% CI 0.62 to 0.80, p<0.001), 0.63 (95% CI 0.55 to 0.71, p<0.001) and 0.45 (95% CI 0.39 to 0.51, p<0.001), respectively.

CONCLUSIONS

In this representative sample of US adults, the association between well-being and mortality was strongly attenuated by self-rated health and to a lesser extent socioeconomic status.