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

Social support, social constraint, and psychological adjustment in patients with colorectal cancer

Cancer patients' social networks, particularly their spouses or romantic partners, can promote or undermine their psychological adjustment. This study examined the relative associations of partner social support and social constraint with patients' psychological adjustment and further tested gender's moderating role in these associations. Participants were 124 patients newly diagnosed with colorectal cancer (M age = 56.6 years, 34% female), who completed questionnaires on perceived spousal social support and social constraint, depressive symptoms, and life satisfaction. Findings revealed that greater social constraint was significantly associated with lower life satisfaction regardless of gender; however, greater social constraint was only associated with greater depressive symptoms in male patients. No significant associations or interactions with social support were found. Findings highlight the importance for patients-especially male patients-with cancer to feel able to disclose cancer-related thoughts and feelings to their partners and call for more consistent operationalization and measurement when studying patients' social functioning.

Mental well-being in Swedish adolescents 2014-2023: A repeated population-based cross-sectional study focusing on temporal variations and differences between groups

Mental well-being is more than merely the absence of mental illness; it is a multidimensional concept that includes both emotional and functional well-being, which are valuable resources during adolescence. In order to develop relevant interventions and policies to strengthen adolescent mental health, a continuous monitoring of the population well-being becomes important. The aim of the study was to examine the level, distribution, and changes in mental well-being over time in a Swedish adolescent population. Current study is based on four waves (2014-2017-2020-2023) of a cross-sectional student survey (N = 16288, Mage = 16.23). The outcome was measured with the Mental Health Continuum Short Form. Ten explanatory factors were chosen to examine differences in mental well-being in the study population: Grade, Sex, Sexual orientation, Socioeconomic status, Country of birth, Visual, Hearing or Mobility impairment, Specific learning disorder and Neurodevelopmental disorder. Differences in mental well-being between groups as well as temporal trends were examined and evaluated through statistical testing and hierarchical multiple linear regressions modeling. Girls, non-heterosexual adolescents, and adolescents with low socioeconomic status or impairments have lower levels of mental well-being than boys, heterosexual adolescents, and adolescents with higher socioeconomic status or without impairments, respectively. A deterioration in mental well-being is seen over time for several groups; however, results of the multivariable analysis indicates that the deterioration is mainly an effect of sex and the significant decline in mental well-being seen among girls. The most significant factor for explaining the variation in mental well-being in this study is socioeconomic status. This study elucidates temporal changes and differences in levels of mental well-being between social groups in the adolescent population. The overall differences are small, but their potential implications for public health warrant careful consideration since they concern a significant part of the population. The results underscore the imperative of promoting mental well-being in adolescents, particularly among vulnerable groups.

Direct and indirect effects of a digital Five Ways to Wellbeing intervention: A network intervention analysis

While digital positive psychology interventions demonstrate effectiveness in promoting wellbeing and reducing illbeing in the general population, their pathways of change are relatively underexplored. The wellbeing promotive digital intervention, Five Ways to Wellbeing for All (5waysA), has been shown effective (Cohens' d effect sizes from .20 to .49) in a large (N = 963) randomized controlled trial (Prydz et al., 2024). In the present study, network intervention analysis (NIA) was applied to identify putative direct and indirect effects linking the 5waysA intervention to a set of wellbeing outcomes. Following the 10-week intervention period, the NIA revealed that only positive emotions on an aggregate level were conditionally dependent on the treatment allocation variable. These findings suggest that the effectiveness of the 5waysA intervention primarily reflects the direct enhancement of positive emotions. Our findings provide insights of potential importance for advancing the theoretical framework of the Five Ways to Wellbeing and other mental health and wellbeing promoting interventions.

Low life satisfaction predicts mortality in a cohort study of very old men-the Manitoba follow up study

OBJECTIVES

(1) To determine the life satisfaction (LS) of members of a cohort study of aging men; (2) to determine if LS predicts death at various ages amongst members of a cohort study.

METHODS

We analyzed a prospective cohort study of men who qualified for air crew training in the Second World War. In 2005, 860 participants with a mean age of 85, were alive and responded to the annual questionnaire - which is sent to participants living in the community. Since 2005, LS was measured annually. Kaplan-Meier plots were constructed, and median survival times were calculated. Cox proportional hazards models were constructed comparing those with 'Poor/Bad'; 'Fair'; 'Good; and 'Very Good' to 'Excellent' LS.

RESULTS

Throughout the study period from 2005 to 2024, most men were satisfied with life. Lower LS predicted mortality throughout the course of the study, even at very old ages and even after accounting for the effect of chronic diseases.

CONCLUSIONS

LS appears relatively stable in community living old men, and predicts mortality even into advanced age.

The longitudinal association of optimism with quality of life after percutaneous coronary intervention for coronary heart disease; The THORESCI study

BACKGROUND

Positive psychological factors such as optimism are predictive of favorable clinical outcomes in patients with cardiac disease. Evidence suggests that trait optimism can vary over time, especially after a coronary event. We therefore examined whether the level and change in optimism across the one-year time period after percutaneous coronary intervention (PCI) were associated with changes in quality of life (QoL) over time. The analyses were adjusted for negative psychological functioning and health behavior adherence as potential explanatory factors.

METHODS

Patients who underwent PCI (n = 1759, 21 % female, mean age = 64 ± 10 years) filled out a psychological survey including positive (optimism; LOT-R) and negative psychological factors (depression (PHQ9) and anxiety (GAD7)), QoL (WHOQOL-BREF), and health behavior adherence (MOS-GAS) at inclusion and one year later (n = 1474). Data were analyzed using hierarchical linear mixed modeling with time-varying predictors and covariates.

RESULTS

Optimism levels increased from baseline (MeanBL = 7.6 (SD = 2.1) to 1-year follow-up in 43 % of the patients, whereas optimism decreased in 36 %; rintraclass = 0.53). Optimism was associated with a higher level of overall QoL (B = 1.96, se = 0.09, p < .001) and more positive 1-year change in QoL (B = 0.55, se = 0.09, p < .001), adjusting for demographic and clinical covariates, with similar findings for all subdomains. Adding depression and anxiety (both significant negatively correlated with of QoL) explained part of the associations of optimism with physical, psychological and environmental QoL, but not with social QoL. Health behavior adherence was significantly correlated with most QoL components, but adherence did not affect the association between optimism and QoL.

CONCLUSION

These data indicate marked individual differences in the magnitude of changes in optimism following PCI. Both higher levels and increases in optimism were associated with higher and improving QoL. Depression and anxiety, but not health behavior adherence, explained part of this relationship. Optimism might be an important psychological factor to address in cardiac rehabilitation.

Positive Psychological Factors Relate to Domain-Specific Cognition and Daily Functioning in Middle-Aged and Older Adults with HIV

Understanding positive psychological factors (PPFs; internal strengths, socioemotional support) that promote optimal health outcomes among people with HIV (PWH) is increasingly important. 122 PWH and 98 people without HIV (PWoH) were included in multivariable regressions, testing interactions between HIV status and PPFs on 7 cognitive domains and 2 daily functioning outcomes, controlling for depressive symptoms. Overall, higher internal strengths were related to better learning and memory, whereas higher socioemotional support was related to better processing speed and psychomotor speed. PWH had a stronger positive relationship between PPFs and verbal fluency than PWoH. Overall, higher internal strengths were associated with fewer daily functioning impairments; however, only PWoH showed fewer functional declines with higher socioemotional support. PWH may require greater socioemotional support to accommodate an increased burden of comorbidities leading to functional difficulties. Among PWH, bolstering PPFs may improve cognition; however, internal strengths may particularly benefit daily functioning.

Psychological resilience, cardiovascular disease, and mortality - Insights from the German Gutenberg Health Study

OBJECTIVE

Psychological distress is associated with a higher risk of cardiovascular disease (CVD) and mortality, whereas psychological resilience may confer a protective effect. However, evidence on these relationships remains limited. This study aimed to examine the associations between psychological resilience, CVD, and all-cause mortality within a large general population cohort.

METHODS

Data from 12,675 participants in the German Gutenberg Health Study were analyzed. Psychological resilience was assessed using the Brief Resilient Coping Scale (BRCS). CVD prevalence and mortality data were obtained from medical records and registry updates. Logistic and Cox regression analyses examined the associations between resilience, CVD, and mortality, with adjustments for socio-demographics, lifestyle, and clinical factors.

RESULTS

Cross-sectionally, lower resilience was linked to higher odds of any CVD (odds ratio (OR) 1.030, 95 % confidence interval [CI] 1.009-1.051). Participants with low resilience had 38 % higher odds of CVD and 61 % higher odds of peripheral artery disease compared to those with high resilience. Longitudinally, low resilience was associated with the highest all-cause mortality risk (log-rank test, p < 0.0001). This association remained significant in Cox models after adjusting for confounders (hazard ratio (HR) 1.362, 95 % CI 1.002-1.852).

CONCLUSIONS

Lower psychological resilience is associated with increased CVD prevalence and all-cause mortality. These findings highlight resilience as a potential target for cardiovascular risk assessment and intervention. Incorporating resilience measures in clinical practice may help identify vulnerable individuals who could benefit from strategies to enhance adaptive coping, improving cardiovascular and overall health outcomes.

Enhancing well-being in later life: the interplay of mobility limitation, psychological adaptation, and assistive technology

Purpose: The experience of mobility limitations can compromise well-being in older adulthood. This study aimed to investigate the psychological mechanisms through which mobility limitations affect well-being and to evaluate how assistive technology might support these underlying processes among older adults.

Materials and methods: Using data from the 2015-2017 rounds of the National Health and Aging Trends Study (N = 5,091), we conducted mediation analysis to determine if dispositional tenacity and flexibility in 2016 linked mobility limitations in 2015 to well-being in 2017. Moderation analysis evaluated whether assistive technology use in 2015 supported tenacity and flexibility in the subsequent year.

Results: In 2015, 693 (13.6%) and 685 (13.5%) older adults reported mobility limitations when going outside and getting around inside, respectively. Mobility limitations had negative direct and indirect associations with well-being through pathways of reduced dispositional tenacity and flexibility. In the context of going outside, assistive technology use mitigated the impact of mobility limitation and supported the dual processes of tenacity and flexibility. However, for getting around inside, assistive technology use was associated with reduced dispositional tenacity and flexibility and further exacerbated the negative impact of mobility limitation.

Conclusions: This study highlights the psychological mechanisms that connect mobility limitations to well-being. Findings suggest that deploying tailored assistive technology may protect older adults' well-being by supporting their psychological adaptation to age-related challenges.

The influence of intergenerational relationships on depressive symptoms in elderly patients with multiple chronic conditions: the mediating roles of self-rated health and well-being

BACKGROUND

The superimposition of multiple chronic conditions places a heavy physical burden and life pressure on older adults, making them more prone to psychological distress and significantly increasing their risk of depression, which has become an urgent public health issue. Intergenerational relationships, as the main source of social support for older adults, have a profound effect on their mental health. This study aims to explore the potential mediating mechanisms by which intergenerational relationships influence depressive symptoms among older adults within the context of the Chinese "filial piety" culture, providing a theoretical foundation for optimizing intergenerational support and improving the psychological well-being of older adults.

METHODS

Data from the 2020 China Family Panel Study (CFPS) were used, and 739 elderly patients with multiple chronic conditions were selected as the study subjects. Data on intergenerational relationships, self-rated health, well-being, and depressive symptoms were also obtained. A chain mediation model was developed using SPSS PROCESS macro model 6, and one-way ANOVA, Pearson correlation analysis, and mediation effect tests were performed to investigate the effects of intergenerational relationships, self-rated health, and well-being on depressive symptoms in elderly patients with multiple chronic conditions.

RESULTS

Intergenerational relationships, self-rated health, and well-being were found to be significantly correlated with depressive symptoms (P < 0.05). Intergenerational relationships negatively predicted depressive symptoms (β = -0.610, P < 0.01). Self-rated health (β = -1.115, P < 0.001) and well-being (β = -0.653, P < 0.001) mediated the effect of intergenerational relationships on depressive symptoms. Additionally, self-rated health and well-being were identified as chain mediators in this relationship for elderly patients with multiple chronic conditions (β = -1.118, P < 0.001).

CONCLUSION

Intergenerational relationships can reduce depressive symptoms among elderly patients with multiple chronic conditions by enhancing self-rated health and well-being. These findings highlight the importance of family support and emotional communication in mental health interventions for older adults. Therefore, healthcare professionals should incorporate family support and encourage positive intergenerational relationships when designing interventions to foster a supportive environment and improve quality of life.

Do positive psychosocial factors contribute to the prediction of coronary artery disease? A UK Biobank-based machine learning approach

AIMS

Most prediction models for coronary artery disease (CAD) compile biomedical and behavioural risk factors using linear multivariate models. This study explores the potential of integrating positive psychosocial factors (PPFs), including happiness, satisfaction with life, and social support, into conventional and machine learning-based CAD-prediction models.

METHODS AND RESULTS

We included UK Biobank (UKB) participants without CAD at baseline. First, we estimated associations of individual PPFs with subsequent acute myocardial infarction (AMI) and chronic ischaemic heart disease (CIHD) using logistic regression. Then, we compared the performances of logistic regression and eXtreme Gradient Boosting (XGBoost) prediction models when adding PPFs as predictors to the Framingham Risk Score (FRS). Based on a sample size between 160 226 and 441 419 of UKB participants, happiness, satisfaction with health and life, and participation in social activities were linked to lower AMI and CIHD risk (all P-for-trend ≤ 0.04), while social support was not. In a validation sample, adding PPFs to the FRS using logistic regression and XGBoost prediction models improved neither AMI [area under the receiver operating characteristic curve (AUC) change: 0.02 and 0.90%, respectively] nor CIHD (AUC change: -1.10 and -0.88%, respectively) prediction.

CONCLUSION

Positive psychosocial factors were individually linked to CAD risk, in line with previous studies, and as reflected by the new European Society of Cardiology guidelines on cardiovascular disease prevention. However, including available PPFs in CAD-prediction models did not improve prediction compared with the FRS alone. Future studies should explore whether PPFs may act as CAD-risk modifiers, especially if the individual's risk is close to a decision threshold.

Life satisfaction as a protective factor against frailty among Japanese adults aged 60 and older: A cohort study

OBJECTIVES

Subjective well-being is linked to healthy aging as it decreases disease-related risk factors. Frailty is associated with biological factors such as inflammatory markers. However, the relationship between life satisfaction, a type of subjective well-being, and the onset of frailty is not sufficiently clear. This study investigated the relationship between life satisfaction and the onset of frailty among Japanese adults aged 60 years and older.

DESIGN

A prospective cohort study was conducted.

SETTING AND PARTICIPANTS

The sample comprised 1760 individuals aged ≥60 years living in Japan.

METHODS

A baseline assessment was followed by a further assessment 2.5 years later. The main outcome, frailty, was defined as a score of 7 or more on the Kihon checklist. The independent variable was score on a life satisfaction scale. A logistic regression model was used to examine the relationship between the onset of frailty and quartiles on the life satisfaction scale, and odds ratios and 95 % confidence intervals were calculated.

RESULTS

A total of 216 participants (12.2 %) developed frailty during the follow-up. Score on the life satisfaction scale at baseline for all participants was 39.7 ± 5.0. The odds ratio (95 % confidence intervals) for life satisfaction scale quartiles for the onset of frailty was 0.50 (0.33-0.75) for the Q2 group, 0.45 (0.28-0.72) for the Q3 group, and 0.43 (0.26-0.67) for the Q4 group, compared with the Q1 (lowest life satisfaction score) group.

CONCLUSIONS AND IMPLICATIONS

The results suggest that high life satisfaction is a protective factor against frailty. Increasing the life satisfaction of Japanese adults aged 60 years and older may contribute to the prevention of frailty.

The role of optimism, connectedness, and neighborhood collective efficacy as moderators of harsh parenting on telomere length

Research to date has examined telomere length in relation to adverse childhood events but few studies have examined whether protective factors act as a buffer to offset this effect. Further, research is lacking examining whether protective factors vary among minoritized youth. Data were from the Future Families and Child Wellbeing Study, a stratified, multistage sample of 4898 children born in large U.S. cities between 1998 and 2000. Births to unmarried mothers were oversampled by a 3-1 ratio, which resulted in the inclusion of a multi-ethnic and economically diverse sample (48 % Black; 27 % Hispanic; 21 % White; 4 % other racial and ethnic minorities). The current study examined optimism, social connectedness, and neighborhood collective efficacy at age 15 as potential protective factors against the effects of harsh parenting on telomere length in adolescence (analytic N = 1168 youth). This study examines cumulative exposure to harsh parenting across childhood (ages 3, 5, and 9 years). Results from analyses stratified by race/ethnicity show optimism, connectedness, and neighborhood collective efficacy serve as protective factors; however, unique protective factors emerged among different racial and ethnic youth suggesting the need to examine context-specific protective factors. Implications of these findings provide evidence for considering intersectionality in terms of protective factors for biomarkers among minoritized youth.

Mobilizing community health assets through intersectoral collaboration for social connection: Associations with social support and well-being in a nationwide population-based study in Catalonia

BACKGROUND

Limited social connection among older adults poses a global public health challenge, reducing sources of support and affecting health and well-being. National public health strategies that leverage local intersectoral collaboration between key sectors such as primary and social care, community organizations, and society, have been advocated, yet their impact remains underexplored.

OBJECTIVE

This study examines the regional variability in the uptake of a public health strategy in Catalonia that mobilizes community health assets, such as social clubs and leisure activities, through intersectoral collaboration and its associations with social support and mental well-being in older adults.

METHODS

We conducted a population-based cross-sectional study using the Catalan Health Survey (2017-2021) with 6011 adults aged ≥ 60 years across 31 Health Sectors. Survey data were linked with area-level uptake metrics, generated using data analytic techniques. Individuals were categorized into three uptake groups based on the number and territorial distribution of asset-based initiatives within their area of residence. Multilevel regressions tested associations with social support (OSSS-3) and mental well-being (SWEMWBS), controlling for individual, contextual, and temporal factors.

RESULTS

Participants' average age was 74.1 years ±  10.0 with 53.3% women. From 2017 to 2021, 2312 asset-based initiatives were registered across Health Sectors, ranging from 0 to 342 per sector. Residing in sectors with the highest uptake of initiatives (>15 initiatives per 10,000 population) was associated with higher social support (β = .34, p < .01) and mental well-being scores (β =  1.11, p < .01).

CONCLUSION

Residing in areas with greater health assets mobilized through intersectoral collaboration was associated with higher social support and well-being among older adults. This study represents one of the first national evaluations of an intersectoral strategy aimed at mitigating the mental health impacts of limited social networks. Future public health strategies should prioritize equitable access for inclusive benefits.

Mapping Psychological Well-Being in Morbid Obesity: A Network Analysis Approach

Background/Objectives: Identifying key psychological well-being factors in morbid obesity is crucial for designing effective mental health and weight management interventions. This study explores the interconnections between the dimensions of psychological well-being in a large sample of adults with morbid obesity enrolled in an inpatient nutritional rehabilitation program. Methods: A sample of 3212 participants (F = 58%; mean age = 57.18 years; mean Body Mass Index = 43.40 kg/m2) completed the Psychological General Well-Being Index (PGWBI) upon admission to the clinic. A network analysis approach examined the relationships among the PGWBI dimensions (anxiety, depression, positive well-being, self-control, vitality, and general health). Results: Network analysis revealed that vitality and positive well-being exhibited the highest values across closeness (1.432; 0.353), strength (0.853; 0.917), and expected influence (0.853; 0917), indicating their key role in psychological well-being. Depression also demonstrated moderate relevance, suggesting its connection to other well-being factors, though it was not the primary determinant. In contrast, self-control and general health had negative strength and expected influence values (-0.660; -1.641), indicating a less central role in the network. Additionally, anxiety and depression displayed negative betweenness (-0.645), reinforcing their more peripheral position. Conversely, positive well-being and vitality showed the highest betweenness (1.291), highlighting their role as key connecting nodes within the well-being network. Conclusions: Findings suggest interventions targeting positive well-being and vitality may most effectively enhance psychological well-being in morbid obesity, emphasizing strength-based approaches that foster positive affect, motivation, and resilience rather than focusing solely on reducing distress or weight-related concerns.

Obstructive sleep apnea's causal links to depression, well-being, and negative moods: a bidirectional mendelian randomized study

Previous observational studies showed associations between obstructive sleep apnea (OSA) and depression and other negative moods. However, the causality has not been determined. Single nucleotide polymorphisms were identified as instrumental variables by screening from genome-wide association studies. Bidirectional two-sample mendelian randomization (MR) was applied to assess the potential causal relationship between OSA and depression, subjective well-being, negative moods. Inverse variance weighting (IVW) method and weight median were chosen as the main methods to estimate possible causal effects. MR-Egger, MR pleiotropy residual sum and outlier and leave-one-out analysis methods, were used as sensitivity analysis methods to ensure robust results. MR analyses indicated significantly causal association of OSA on depression (OR = 1.22, P = .010) and major depressive disorder (OR = 1.02, P = .006). Furthermore, genetically predicted OSA was negatively associated with subjective well-being (βIVW = -0.06, P = .009), and was positively associated with negative moods including depressed affect (OR = 1.04, P = .012), irritable mood (P = .006), feeling lonely (P = .011), feeling fed-up (P = .005) and mood swings (P = .017). There is no reverse effect of the above psychiatric traits on OSA. Genetic predisposition to OSA causally increased depression and major depressive disorder. Consistently, OSA has causal impacts on both subjective well-being, representing positive emotions, and negative moods.

Negative Life Events as a Mediator of the Relationship Between Optimism and Cardiovascular Reactivity

Blunted cardiovascular reactivity (CVR) is associated with adverse health outcomes such as depression, obesity, and increased carotid intima-media thickness. Research indicates that significant negative life events (NLE) contribute to reduced CVR and related health issues, with individual perceptions and coping mechanisms playing a crucial role. Optimism, which is linked to fewer reported NLEs and better cardiovascular health, may improve coping processes, thereby reducing NLE's impact on CVR. This study investigated how NLEs mediate the relationship between optimism and CVR. The sample consisted of 199 adults recruited from universities in Ecuador. Participants completed psychological assessments prior to a controlled 45-min experimental session, which included baseline cardiac activity measurements followed by the PASAT task. The findings indicated that the number of NLEs mediates the relationship between optimism and diastolic blood pressure (DBP) reactivity, while optimism also exerts a direct effect on CVR beyond this mediation. Specifically, a significant inverse relationship was observed between the number of NLEs and DBP reactivity, alongside a positive relationship between optimism and DBP reactivity. Additionally, pessimism was associated with reduced systolic blood pressure (SBP) reactivity, though neither pessimism nor NLEs showed any effect on heart rate. These results highlight the protective role of optimism in modulating stress-related impacts on CVR and align with previous research suggesting that low CVR might be a result of maladaptive stress responses.

Adherence to rehabilitation exercise and influencing factors among people with acute stroke: a cross-sectional study

Background

Post-stroke rehabilitation exercise is recognized as the most effective and preferred intervention to reduce disability rates in patients. However, adherence to exercise is low among stroke patients. Previous research has mainly focused on the negative psychological factors influencing adherence, while the positive psychological aspects remain underexplored. Therefore, this study aims to investigate the factors influencing adherence to rehabilitation exercises in acute stroke patients, especially the positive psychological factors, in order to reduce the disability rate of stroke.

Methods

From October 2023 to March 2024, a total of 227 patients with acute stroke were selected from a Grade-A hospital in Chongqing, China, using total sampling method. The patients' general demographic data, Stroke Functional Exercise Adherence Questionnaire Scale (EAQ), Hospital Anxiety and Depression Scale (HAD), and Index of Subjective Well-Being Scale (IWB) were assessed. ANOVA, t-test analysis, correlation analysis, and multiple linear regression models were used to explore the influencing factors in people with acute stroke.

Results

The total score for rehabilitation exercise adherence in acute stroke patients was 38.41 ± 11.13, corresponding to a mean adherence rate of 68.6%. Factors influencing adherence to rehabilitation exercise in acute stroke patients were identified, including age (p < 0.0001), presence of ICU stay (p = 0.03), National Institutes of Health Stroke Scale (NIHSS) score (p < 0.0001), and subjective well-being (p < 0.01).

Conclusion

Adherence to rehabilitation exercises in acute stroke patients was found to be medium. Our findings highlight that age, presence of ICU stay, and NIHSS score were found to have negative correlations with adherence. While a positive correlation was observed with subjective well-being.

Core features of positive mental health in adolescents and their protective role against psychopathology

Mental health is more than the absence of mental illnesses. However, while we acknowledge the importance of positive mental health, there is a lack of comprehensive understanding about positive mental health in adolescents and how it protects against psychopathology. This study seeks to understand adolescent positive mental health as a complex system by estimating the networks of components associated with positive mental health and their relationships to indicators of negative mental health. We analyzed data from 1909 adolescents aged 16-19 in Singapore using regular Gaussian Graphic models and Bayesian Directed Acyclic Graphs. Here we report positive self-image as a central upstream node with significant downstream effects on various aspects of well-being. Conversely, positive affect, social skills, perseverance and poor stress management are identified as downstream nodes with limited influence on other components. Our findings highlight the complex interplay between different dimensions of adolescent mental health and underscore the importance of positive self-image as a critical determinant of overall well-being. These results provide valuable insights for designing targeted interventions to enhance positive self-image to promote positive mental health and mitigate the risk of adverse outcomes among adolescents.

Optimization of a digital health intervention to enhance well-being among adolescent and young adult cancer survivors: Design and methods of the EMPOWER full factorial trial

Adolescent and young adult cancer survivors (AYAs) experience clinically significant distress and have limited access to supportive care services. Interventions to enhance psychological well-being have improved positive affect and reduced depression in clinical and healthy populations and have not been routinely tested in AYA survivors. We are optimizing a web-based positive skills intervention for AYA cancer survivors called Enhancing Management of Psychological Outcomes With Emotion Regulation (EMPOWER) by: (1) determining which intervention components have the strongest effects on well-being and (2) identifying demographic and individual difference variables that mediate and moderate EMPOWER's efficacy. EMPOWER is a five-session online intervention that teaches behavioral and cognitive skills for increasing psychological well-being. Guided by the Multiphase Optimization Strategy (MOST), we assign two levels (yes, no) to each of five intervention components (positive events, capitalizing, & gratitude; mindfulness; positive reappraisal; personal strengths & goal-setting; acts of kindness), allowing us to evaluate the effects of individual and combined intervention components on positive affect in a full factorial design. Post-treatment AYA cancer survivors (N = 352) are recruited from participating NCI-designated comprehensive cancer centers and randomized to one of 32 experimental conditions. Our primary outcome is positive affect; potential mediating and moderating variables include coping self-efficacy and emotional support, respectively. Upon trial completion, we will have an optimized, digital health intervention to enhance psychological well-being among AYA cancer survivors. EMPOWER will be scalable and primed for a large, multi-site trial among AYAs who would otherwise not have access to supportive care interventions to manage distress and enhance well-being.

Can Online Exercise Using Wearable Devices Improve Perceived Well-Being? A Study Among Patients with Coronary Artery Disease

Today, cardiovascular diseases contribute to approximately 17.9 million deaths annually worldwide. With reference to Europe, coronary artery disease (CAD) causes about 3.9 million deaths annually. Considering the positive physical and psychological outcomes of on-site exercise for CAD patients, this study aimed to expand the literature by examining the effects of a 6-month online exercise training program using wearable devices on CAD patients' perceived well-being, measured with the PERMA profiler. Individual well-being is considered today as an important prerequisite for healthy societies. Thirty patients with a recent myocardial infarction (i.e., <4 weeks) were randomly assigned to either the online home-based or the community-based exercise group. Both groups followed the same 24-week exercise-based cardiac rehabilitation program three times per week. Each session consisted of a 30-min aerobic, followed by a 15-min strength workout, and then a 15-min balance and flexibility training. The results of the Mann-Whitney U tests and the z scores indicated that the Meaning of Life, Health, Accomplishment, Engagement, and Positive Relationship dimensions of the PERMA were statistically improved, and Negative Emotions were decreased. These findings support the importance of cardiac telerehabilitation for patients' psychological health, demonstrating that online exercise using wearable devices can be a meaningful alternative to on-site exercise for patients with recent myocardial infarction. These results have policy implications as they provide arguments for providing online exercise for CAD patients as an alternative means for improving their psychological health.

Improving Mental Health and Well-Being Through the Paradym App: Quantitative Study of Real-World Data

BACKGROUND

With growing evidence suggesting that levels of emotional well-being have been decreasing globally over the past few years, demand for easily accessible, convenient, and affordable well-being and mental health support has increased. Although mental health apps designed to tackle this demand by targeting diagnosed conditions have been shown to be beneficial, less research has focused on apps aiming to improve emotional well-being. There is also a dearth of research on well-being apps structured around users' lived experiences and emotional patterns and a lack of integration of real-world evidence of app usage. Thus, the potential benefits of these apps need to be evaluated using robust real-world data.

OBJECTIVE

This study aimed to explore usage patterns and preliminary outcomes related to mental health and well-being among users of an app (Paradym; Paradym Ltd) designed to promote emotional well-being and positive mental health.

METHODS

This is a pre-post, single-arm evaluation of real-world data provided by users of the Paradym app. Data were provided as part of optional built-in self-assessments that users completed to test their levels of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), life satisfaction (Satisfaction With Life Scale), and overall well-being (World Health Organization-5 Well-Being Index) when they first started using the app and at regular intervals following initial usage. Usage patterns, including the number of assessments completed and the length of time between assessments, were recorded. Data were analyzed using within-subjects t tests, and Cohen d estimates were used to measure effect sizes.

RESULTS

A total of 3237 app users completed at least 1 self-assessment, and 787 users completed a follow-up assessment. The sample was diverse, with 2000 users (61.8%) being located outside of the United States. At baseline, many users reported experiencing strong feelings of burnout (677/1627, 41.6%), strong insecurities (73/211, 34.6%), and low levels of thriving (140/260, 53.8%). Users also experienced symptoms of depression (mean 9.85, SD 5.55) and anxiety (mean 14.27, SD 6.77) and reported low levels of life satisfaction (mean 12.14, SD 7.42) and general well-being (mean 9.88, SD 5.51). On average, users had been using the app for 74 days when they completed a follow-up assessment. Following app usage, small but significant improvements were reported across all outcomes of interest, with anxiety and depression scores improving by 1.20 and 1.26 points on average, respectively, and life satisfaction and well-being scores improving by 0.71 and 0.97 points, respectively.

CONCLUSIONS

This real-world data analysis and evaluation provided positive preliminary evidence for the Paradym app's effectiveness in improving mental health and well-being, supporting its use as a scalable intervention for emotional well-being, with potential applications across diverse populations and settings, and encourages the use of built-in assessments in mental health app research.

Within- and Between-Person Correlates of Affect and Sleep Health Among Health Science Students

BACKGROUND/OBJECTIVES

To examine the relationships between state affect and sleep health at within- and between-person levels among health science students.

METHODS

A correlational design was used and 54 health science students were included. The participants completed baseline and 7-day ambulatory assessments in a free-living setting. Daily sleep and affect were measured using the Consensus Sleep Diary and Positive and Negative Affect Schedule. Mixed-effect models were used to examine the effects of affect on sleep health.

RESULTS

The participants were 19.8 (SD, 0.6) years and 92.6% were females. Approximately 40% had poor sleep quality. Controlling for the potential confounders (e.g., age, sex, and bedtime procrastination), higher within-person negative affect predicted shorter sleep duration, lower sleep efficiency, longer sleep onset latency, and less feeling rested. Higher between-person negative affect predicted shorter sleep duration. Higher within-person positive affect predicted longer sleep onset latency. Higher within- and between-person positive affect predicted more feeling rested.

CONCLUSIONS

Negative affect was most consistently associated with sleep health at the individual level. Affect regulation should be considered when delivering personalized interventions targeting sleep health among health science students.

Neighborhood social environment and mental health of older adults in China: the mediating role of subjective well-being and the moderating role of green space

Introduction

With the continuous development of the global aging trend, the mental health of older adults has been a concern by the world. The living space of older adults is limited due to the decline of their activity function. Neighborhood environment, especially the neighborhood social environment, has become an important factor affecting the mental health of older adults. Therefore, this study explores the mechanism that influences the social environment of the neighborhood and the mental health of older adults, the mediating effect of subjective well-being (SWB), and the moderating effect of green space.

Methods

Based on the 2018 China Labor Dynamics Survey, this study used the structural equation model to explore the mediating effect of neighborhood social environment (neighborhood ties, social trust, community security) on the mental health of older adults through SWB and the moderating effect of green space.

Results

Social trust and community security are both directly and positively associated with older adults' mental health. At the same time, neighborhood ties, social trust, and community security can promote the mental health of older adults by positively affecting SWB, while green space has an enhanced moderating effect between neighborhood ties and mental health.

Discussion

This study enriches the empirical research on neighborhood social environment and mental health. First of all, older adults living in communities with good safety conditions and high social trust are less affected by negative emotions and tend to have good mental health. Second, deeper neighborhood ties, higher social trust, and safer community environments help older adults to be less disturbed by negative situations, have a positive effect on their SWB, and indirectly promote mental health. At the same time, green space can provide a place for older adults to socialize, enhance the positive impact of neighborhood ties on SWB, and further promote the mental health of older adults. Finally, this study suggests that the government and community managers pay attention to the construction of neighborhood social environment and green space, and provide support for "healthy community" and "healthy aging" planning.

Mindfulness-based psychosocial interventions and psychological wellbeing in cancer survivorship: a meta-analysis

PURPOSE

Among cancer survivors, mindfulness-based interventions appear promising in decreasing distress for cancer patients, but little attention has been paid to the ultimate mindfulness goal of increasing psychological wellbeing. This meta-analysis aims to summarise and synthesise available evidence concerning the effectiveness of MBIs on positive psychological outcomes reflecting key aspects of psychological wellbeing in heterogeneous cancer patients.

METHODS

A literature search of mindfulness-based randomised clinical trials in cancer survivors was conducted across six electronic databases. Two reviewers independently screened studies and extracted data. Meta-analyses were conducted using R; standardised mean difference (SMD) was used to determine intervention effect. Moderators examined included therapeutic orientation, control group type, treatment modality, treatment target, heterogeneous vs. homogeneous cancer type, and facet of wellbeing.

RESULTS

Thirty-one studies were included (N = 2651). Those who received mindfulness-based interventions reported significantly higher eudaimonic, hedonic, and social wellbeing than respondents in control groups (SMD = 0.599). Interventions were equally effective across therapeutic orientation, control group type, treatment modality and treatment target. There were trend level differences favouring homogeneous cancer diagnosis groups over heterogeneous diagnosis groups.

CONCLUSION

MBIs provide an effective treatment for increasing psychological wellbeing in cancer survivors. This finding has important implications for clinical practice.

Predictors of employee well-being: A global measurements using reflective-formative model

Background

Employee well-being (EW) is an integral part of occupational safety & health. Therefore, measuring EW is very important for holistically evaluating well-being instruments and measurement models. This research aimed to identify and confirm dimensions that significantly contribute to EW and also to examine the reliability and validity of the formative model of EW.

Methods

The survey consisted of 89 items from a well-being questionnaire administered to 426 employees in the coal mining industry, covering five domains. Measurements were analyzed using partial least squares-structural equation modelling (PLS-SEM) with SmartPLS 4.1.1. The measurement and analysis were conducted in two stages, the first of which used a reflective model. Subsequently, the results of the first stage were used in the second stage as a formative model to measure EW globally.

Result and conclusion

Home, Community, and Society (HCS), Health Status (HS), Workplace Environment and Experience (WEE), Workplace Policies and Culture (WPC), as well as Workplace Environment and Safety Climate (WPE) domain significantly contributed to EW, as identified through first-order reflective and second-order formative models.

Contribution

This research developed a measurement model for EW with two orders: first-order reflective and second-order formative. It also offered practical insights for organizations and companies to measure and understand EW, providing a basis for implementing effective interventions.

Psychological well-being modulates neural synchrony during naturalistic fMRI

Psychological well-being (PWB) is a combination of feeling good and functioning efficiently, and has a significant relationship with physical and mental health. Previous research has shown that PWB is associated with improvements in selective attention, mindfulness, semantic self-images, and adaptive decision making, however, it is unclear how these differences manifest in the brain. Naturalistic stimuli better encapsulate everyday experiences and can elicit more "true-to-life" neural responses. The current study seeks to identify how differing levels of PWB modulate neural synchrony in response to an audiovisual film. With consideration of the inherent variability of the literature, we aim to ascertain the validity of the regions previously associated with PWB. We identified that higher levels of PWB were associated with heightened stimulus driven neural synchrony in the bilateral superior parietal lobule, right planum temporale, and left superior temporal gyrus, and that lower levels of PWB were associated with heightened neural synchrony in the bilateral lateral occipital cortex and precuneus. Taken together, this research suggests that there is an association between differing levels of PWB and differential neural synchrony during movie-watching. PWB may therefore have an effect on complex, multimodal processing.

Bidirectional Relations Among Maternal Positive Emotion, Infant Positive Emotionality, and Infant Physiological Regulation Across the First 18 Months of Life

Respiratory sinus arrhythmia (RSA), a marker of self-regulation, has been linked to developmental outcomes in young children. Although positive emotions may have the potential to facilitate physiological self-regulation, and enhanced self-regulation could underlie the development of positive emotions in early childhood, the relation between positive emotions and physiological self-regulation in infancy has been relatively overlooked. The current study examined the bidirectional associations among maternal positive emotion, infant positive emotionality, and infant resting RSA across the first 18 months of life. We used data from the Longitudinal Attention and Temperament Study (LanTs; N = 309 in the current analysis) to test the within- and between-person relations of study variables over time using a random-intercepts cross-lagged panel model. We found that infants with higher overall levels of positive emotionality also displayed greater resting RSA, and their mothers exhibited higher levels of positive emotion. However, there were negative cross-lagged associations within-person; higher than average infant positive emotionality predicted lower levels of infant resting RSA at the subsequent timepoint during early infancy, whereas higher than average infant RSA subsequently predicted decreased levels of infant positive emotionality later in infancy. Results highlight the importance of considering transactional relations between positive emotion and physiological self-regulation in infancy.

Associations of global and specific components of positive psychological well-being with mortality risk: Findings from two cohort studies

Previous studies have examined how various aspects of positive psychological well-being (PPWB) independently relate to healthy aging, yet a notable gap remains in understanding the effects of their overlap (i.e., shared variance). We used data from two longitudinal cohorts, the Midlife Development in the United States Study and the Health and Retirement Study (N = 3,302 and 7,209), each of which assessed hedonic and eudaimonic facets of PPWB (positive affect, purpose in life, personal growth, and self-acceptance) and tracked mortality status across 14-15 years of follow-up. We derived a global factor identifying elements common across PPWB facets and also specific PPWB factors from a bifactor model. Then, we examined if higher PPWB levels (global and specific) are associated with mortality risk. Across cohorts, higher global well-being factor levels were associated with reduced mortality risk, even after adjusting for a range of potential confounders. Fewer independent associations were evident with the specific PPWB factors. Findings suggest that variance common across hedonic and eudaimonic facets of PPWB is associated with lower mortality risk. Considering the shared versus unique effects of different PPWB facets can offer valuable insights for theorizing mechanisms underlying health benefits of PPWB and guiding decisions about intervention targets.

Positive affect longitudinally buffers the negative effect of health anxiety on gastrointestinal symptoms

People with significant health anxiety may experience brain-gut dysregulation, leading to increased visceral sensitivity and greater gastrointestinal (GI) symptoms. Positive affect (PA), on the other hand, may serve as a protective characteristic, buffering the negative impact of health anxiety on GI symptoms. This study investigated interrelationships between health anxiety, PA, and GI symptoms. Longitudinal data were collected on health anxiety, PA, and GI symptoms via an online survey from 861 adults at two timepoints, 4 weeks apart. Regression models were conducted to examine the moderating effect of PA at baseline on future GI symptoms. Greater health anxiety at baseline predicted GI symptoms at follow-up, whereas higher levels of PA predicted reduced GI symptoms at follow-up. Post hoc testing revealed that PA significantly moderated the relationship between health anxiety and GI symptoms over time, such that higher levels of PA attenuated the effect of health anxiety on belly pain, nausea and vomiting, and reflux at follow-up. This study provides preliminary evidence PA may buffer the negative impact of health anxiety on GI symptoms. Future studies should explore whether the promotion of PA through interventions similarly attenuates health related anxiety's impact on GI symptoms.

Positive psychological well-being and cardiovascular health

Positive psychological well-being (PPWB) is increasingly recognized as a critical factor in cardiovascular health of both healthy individuals and those with cardiovascular diseases (CVD). This mini-review synthesizes the current state of knowledge on the relationship between PPWB and cardiovascular health, examining relevant studies on PPWB in both populations. The conceptualization of PPWB encompasses hedonic and eudaimonic facets, with constructs such as optimism, purpose in life, and vitality playing crucial roles. Studies among healthy individuals show a significant association between PPWB and improved cardiovascular health indicators, while research among cardiac patients highlights the importance of PPWB in predicting outcomes such as mortality and rehospitalization. Mechanistic pathways linking PPWB and cardiovascular health include biological processes, health behavior changes, and additional psychological resources that mitigate stress. Despite the growing evidence, questions remain unanswered, necessitating further research to understand these relationships and develop effective interventions. Promoting psychological well-being alongside physical health can enhance cardiovascular disease prevention and management, offering a comprehensive approach to improving patient outcomes and overall well-being.

Association between positive affect, flourishing, quality of life, and psychological distress in allogeneic hematopoietic stem cell transplantation

PURPOSE

To examine the associations between state positive psychological well-being (PPWB) constructs, mood, and quality of life (QOL) in hematopoietic stem cell transplantation (HSCT) survivors.

DESIGN

The study was a secondary analysis of cross-sectional data.

SAMPLE/METHODS

We analyzed self-report data assessing positive affect, flourishing, QOL, depression and anxiety, and PTSD symptoms from 158 allogeneic HSCT recipients at day-100 post-transplant enrolled in supportive care studies.

FINDINGS

Univariate analysis showed that factors associated with greater levels of various state PPWB constructs include older age, disability status, greater social support, and presence of graft-versus-host disease. Multivariate analysis showed that state PPWB constructs-greater levels of positive affect and flourishing-were significantly associated with better QOL and lower PTSD, anxiety, and depression symptomatology.

IMPLICATIONS

Our findings suggest that longitudinal studies are needed to examine the links between state PPWB constructs and HSCT outcomes, which may inform population specific interventions and opportunities to improve outcomes.

Age-related shifts in mental health determinants from a deprived area in the European Union: informing the national healthy aging program of Hungary

Mental disorders are among the leading causes of disability worldwide, disproportionately affecting older people. This study aims to assess the mental health of elderly individuals living in a deprived region of Hungary, and to identify and estimate the weight of different determinants of mental health across different age groups. A cross-sectional study was conducted with randomly selected samples of individuals (n = 860) aged 18 years and older in Northeast Hungary. The World Health Organization Well-Being Index (WHO-5), the single-item Life Satisfaction Scale, and the 12-item General Health Questionnaire (GHQ-12) were used to measure mental health of the participants. Multiple linear regression analysis was performed to measure the association between sociodemographic and health-related variables and mental health. Overall, the mean WHO-5 score was 69.2 ± 18.1 and it showed a significant decrease by age (p < 0.001), with the lowest score observed in aged 75 years and above (p < 0.001). The mean life satisfaction score was 7.5 ± 1.9 and it showed a significant decreasing trend over the life course (p < 0.001). The highest level of psychological distress as assessed by GHQ-12 was observed in the group aged 75 years or older (11.5 ± 6.0, p < 0.001). Multiple linear regression indicated that self-reported financial status, social support, sense of control over their health, activity limitation and pain intensity were the most important determinants of mental health among older adults. Interventions to improve the mental health of older adults should focus on the positive impact of social support, the reduction of financial insecurity and the use of effective pain relief medications.

Primary Care Organizational Support for Nurse Practitioner Practice and Emotional Health Care Delivery

OBJECTIVES

Nurse practitioners (NPs) are key to delivery of primary care services. However, poor organizational support for independent NP practice, such as lack of access to clinic resources, may lead to prioritizing patient physical health over emotional health. We investigated the relationship between organizational support for independent NP practice and emotional health care delivery.

METHODS

This was a secondary analysis of cross-sectional survey data collected from 397 NPs in 2017. We measured organizational support for independent NP practice using the independent practice and support subscale of the NP Primary Care Organizational Climate Questionnaire. Emotional health care delivery was measured by asking NPs how frequently they addressed emotional concerns of patients. We utilized multilevel mixed effects linear regression models, adjusting for NP and practice covariates.

RESULTS

Controlling for NP age, gender, marital status, race, and ethnicity, along with practice setting and size, as the independent practice and support score increased, NPs reported addressing emotional concerns of patients more frequently (beta = 0.34, 95% confidence interval = 0.02-0.66, P = 0.04). This indicates that as organizations provided more support for independent NP practice, NPs were able to more frequently address emotional concerns of patients.

CONCLUSIONS

Organizational support for independent NP practice is associated with addressing emotional concerns of patients. To support NP practice, primary care organizations should ensure that NPs manage patients independently and have access to ancillary staff and support for care management.

Statistical analysis of the effect of socio-political factors on individual life satisfaction

Life satisfaction refers to an individual's cognitive evaluation of the quality of their life. The aim of the present study is to develop the current understanding of how perceived corruption, attitudes toward migration, perceived security, and strength of national identity influence life satisfaction. Additionally, the study examines how demographic variables of relationship status, social class, sex, religious affiliation, and country impact life satisfaction in the provided cultural context. Ordinal logistic regression analysis, Confirmatory Factor Analysis, and Structural Equation Modeling are used to analyze data from the World Values Survey. Findings from the analyses indicate that perceived corruption, perceived security, and strength of national identity have a significant impact on life satisfaction, whereas migration has an indirect effect on life satisfaction through perceived security. The present research can develop our current understanding of life satisfaction from a socio-political perspective.

Creating arts and crafting positively predicts subjective wellbeing

Introduction

This study explored whether engagement with Creating Arts and Crafting (CAC) predicted subjective wellbeing and loneliness, above and beyond known sociodemographic predictors.

Methods

Secondary data from 7,182 adults living in England from the Taking Part Survey (a 2019-2020 UK household survey of culture and sport participation) were analyzed. Hierarchical Linear regressions were used to explore the predictive effect of engagement with CAC on aspects of subjective wellbeing (anxiety, happiness, life satisfaction and a sense that life is worthwhile) and loneliness. Covariates included gender, Index of Multiple Deprivation (IMD), age group, health and employment status.

Results

Engaging in CAC significantly predicted increased life satisfaction, a sense that life is worthwhile and happiness, above and beyond known sociodemographic predictors.

Conclusion

Our study provides support for the wellbeing benefits of engagement with creating arts and crafting, and we suggest that this will be a useful tool at a public health level, noting that relative accessibility and affordability creating arts and crafting.

Happy people are always similar: The evidence from brain morphological and functional inter-subject correlations

A fundamental question in the study of happiness is whether there is neural evidence to support a well-known hypothesis that happy people are always similar while unfortunate people have their own misfortunes. To investigate this, we employed several happiness-related questionnaires to identify potential components of happiness, and further investigated and confirmed their associations with personality, mood, aggressive behaviors, and amygdala reactivity to fearful faces within a substantial sample size of college students (n = 570). Additionally, we examined the functional and morphological similarities and differences among happy individuals using the inter-subject representational similarity analysis (IS-RSA). IS-RSA emphasizes the geometric properties in a high-dimensional space constructed by brain or behavioral patterns and focuses on individual subjects. Our behavioral findings unveiled two factors of happiness: individual and social, both of which mediated the effect of personality traits on individual aggression. Subsequently, mood mediated the impact of happiness on aggressive behaviors across two subgroup splits. Functional imaging data revealed that individuals with higher levels of happiness exhibited reduced amygdala reactivity to fearful faces, as evidenced by a conventional face-matching task (n = 104). Moreover, IS-RSA demonstrated that these participants manifested similar neural activation patterns when processing fearful faces within the visual pathway, but not within the emotional network (e.g., amygdala). Morphological observations (n = 425) indicated that individuals with similar high happiness levels exhibited comparable gray matter volume patterns within several networks, including the default mode network, fronto-parietal network, visual network, and attention network. Collectively, these findings offer early neural evidence supporting the proposition that happy individuals may share common neural characteristics.

Diversity in productive activities enhances life satisfaction among Japanese community-dwelling older adults: A cross-sectional study

Few studies have reported an association between diversity in productive activities and life satisfaction; hence, this cross-sectional study conducted in Japan aimed to clarify this association. We assessed the life satisfaction of 4,498 Japanese community-dwelling older adults engaged in productive activities (e.g., paid work, volunteering, taking care of children, and supporting others) using the Life Satisfaction Scale. We took the sum of the number of engaging productive activities as the diversity in productive activities score. A dose-response relationship was observed for each additional productive activity on life satisfaction. Participants who engaged in one, two, three, or four productive activities were more likely to have higher life satisfaction than those who did not engage; the odds ratios (95 % confidence intervals) were 1.19 (1.02-1.39), 1.19 (1.00-1.42), 1.71 (1.37-2.13), and 2.27 (1.58-3.27), respectively. Diversity in productive activities may enhance higher life satisfaction likelihood among Japanese community-dwelling older adults.

The Development of a New Model of Educational Leadership: Leadership for Teacher Flourishing

This paper contributes to a broader movement in which the telos of leadership is flourishing, and the primary role of a leader is to promote the flourishing of their team members through creating a loving environment. In support of this, we propose a new perspective on, and associated model, of educational leadership: 'leadership for teacher flourishing' (LFTF). This model was developed through a literature review and a mixed methods research project across 78 British schools with collaborative and participatory elements which asked how school leaders could improve the flourishing of teachers. The quantitative and qualitative findings suggested that key factors in enabling teachers to flourish, and therefore incorporated into the model 'LFTF', were positive relationships; opportunities for growth; positive impact on subjective wellbeing; and increasing teachers' sense of meaning at work. The ways leaders could impact these factors were reported as: being supportive and compassionate; being trustworthy; giving teachers autonomy; enabling teachers to grow; being appreciative and focusing on strengths; and enabling teachers to do meaningful work. It was also found that not only leaders could influence flourishing; teachers with no formal leadership role could also positively impact teacher flourishing. It is suggested that virtuous dispositions in leaders are required to ensure they are consistent in acting in ways that promote flourishing. We argue that this integration of virtue and a desire to promote flourishing is properly understood as love. The participatory and collaborative phase of the research showed that teachers wanted autonomy in deciding what would help them to flourish. The conclusion sets out the implications of this research for policy on the training and selection of school leaders, to improve not only the flourishing of teachers, but also pupils and communities.

A Web-Based Intervention Using "Five Ways to Wellbeing" to Promote Well-Being and Mental Health: Randomized Controlled Trial

BACKGROUND

Compromised well-being and mental health problems pose a significant threat to individuals and societies worldwide. Resource-intensive psychological treatments alone cannot alleviate this burden. There is a need for low-cost, evidence-based interventions aimed at preventing illness and promoting well-being. Five activity domains appear to be linked with well-being promotion across populations: connecting with others, being active, taking notice, learning, and being generous/giving. The activities mentioned are part of the Five Ways to Wellbeing framework and the web-based intervention Five Ways to Wellbeing for All (5waysA).

OBJECTIVE

This randomized controlled trial aims to test the effects of the 5waysA intervention, a web-based, low-cost, well-being-promoting measure targeting the general population. To date, the Five Ways to Wellbeing framework has not been tested in this specific format. The 5waysA intervention comprises 2 webinars and SMS text message reminders delivered over a 10-week period.

METHODS

In 2021, a total of 969 study participants from various regions across Norway were openly recruited through a web page. They were then randomly assigned to either an intervention group or 1 of 2 waiting list control groups, namely, active or passive. Self-reported life satisfaction (Satisfaction With Life Scale [SWLS]), flourishing (Flourishing Scale [FS]), positive emotions, anxiety, and depression symptoms (Hopkins Symptom Checklist-8 [HSCL-8]) were assessed before the intervention, at 4 weeks into the intervention, and 1-2 weeks after the intervention (over 10 weeks). Data analysis was conducted using linear mixed (multilevel) models.

RESULTS

After 10 weeks, 453 participants (171 in the intervention group and 282 in the waiting list control group) were assessed on outcome variables, with a dropout rate of 53.2% (516/969). Results revealed a significantly greater increase in the intervention group compared with the controls for SWLS (b=0.13, 95% CI 0.03-0.23; P=.001), FS (b=0.19, 95% CI 0.08-0.30; P=.001), positive emotions (b=0.43, 95% CI 0.27-0.60; P<.001), and these factors combined into a global well-being measure (b=0.28, CI 0.16-0.39; P<.001). Effect sizes (Cohen d) for the well-being outcomes ranged from 0.30 to 0.49. In addition, a significant decrease in anxiety and depressive symptoms was observed (b=-0.17, 95% CI -0.30 to -0.04; P=.001) with an effect size (Cohen d) of -0.20.

CONCLUSIONS

The findings suggest that the web-based 5waysA intervention could serve as an effective approach for enhancing well-being and mental health within the general population. This study offers individuals, policy makers, and local stakeholders an accessible and potentially cost-effective well-being intervention that could be easily implemented.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04784871; https://clinicaltrials.gov/study/NCT04784871.

Well-Being Inequality Among Adolescents and Young Adults

PURPOSE

This study aimed to examine patterns of well-being across developmental stages and patterns of inequality in well-being among young adults and adolescents. Well-being exists when adolescents and young adults thrive and can achieve their full potential.

METHODS

We used individual-level survey data from the Gallup World Poll from 164 countries between 2009 and 2017 (N = 446,934). Regression analyses were used to determine associations.

RESULTS

We documented substantial inequality in well-being across three developmental stages (adolescence, early adulthood, young adulthood). Health, education, income, and social relations are strongly associated with mean well-being and well-being inequality. We showed, for mean well-being, the relative importance of these factors varies over life-cycle stages. For inequality, most factors were consistent across developmental groups; however, we identified certain characteristics that were only relevant at certain developmental stages.

DISCUSSION

Given the policy importance of well-being at all stages of life and the significance of adolescence and early adulthood in developing positive health-related behaviors, policies and programs targeting the highlighted characteristics are likely to be effective but require a multisectoral approach.

Daily time spent on screens and psychological well-being: Cross-sectional association within the SUN cohort

BACKGROUND

The impact of various lifestyles on psychological well-being (PWB) remains under-studied. We aimed to explore the cross-sectional association between daily screen use (television, tablet and mobile phone) and PWB within the SUN cohort.

METHODS

PWB was assessed using the 29-item Ryff scale (ranging from 29 to 174), and participants with scores >75th percentile were considered as having optimal PWB. Participants were categorized based on their self-reported weekly screen usage hours. Postestimation logistic regression models assessing the prevalence likelihood of not achieving optimal PWB were adjusted for sociodemographic, psychological, personality and lifestyles factors. Isotemporal substitution models explored the potential impact on PWB resulting from replacing 1 h/day of screen time with 1 h/day of exercise.

RESULTS

The study included 3051 participants (55.8% women, mean age 57.3 ± 11.1 years, mean Ryff's score: 139.1 ± 17.4 points). Daily screen use for ≥2 h was associated with a higher prevalence likelihood of not achieving an optimal PWB (Prevalence Ratio [PR]:1.09; 95% CI:1.01-1.18). Among PWB dimensions, screen use ≥2 h/day was linked to an increased likelihood of not achieving optimal scores in environmental mastery (PR:1.11; 95% CI:1.02-1.20), life purpose (PR:1.10; 95% CI:1.02-1.18), and personal growth (PR:1.09; 95% CI:1.01-1.18). Replacing 1 h of daily screens time with 1 h of exercise may lead to potential improvements in environmental mastery (Odds Ratio [OR]:0.87; 95% CI:0.76-0.99), purpose in life (OR:0.86; 95% CI: 0.76-0.98), personal growth (OR:0.84; 95% CI:0.73-0.96) and positive interpersonal relationships (OR:0.86; 95% CI:0.75-0.99).

CONCLUSIONS

These findings highlight the importance of reducing screen use activities and increasing physical exercise for achieving optimal PWB.

Psychosocial correlates of flourishing in the late lifespan

BACKGROUND

Flourishing is a primary dimension of psychological well-being that contributes massively to the development of an active, purposeful, and respectful life, full of meaning, values, and personal interests that nurture social ties.

AIMS

This study primarily intended to examine the contribution of satisfaction with family relations, resilience, metacognitive efficiency, and crystallized intelligence in predicting a flourishing measure in cognitively healthy older adults. Moreover, the impact of gender was investigated on flourishing, satisfaction with family ties, resilience, and metacognitive efficiency.

METHODS

One hundred and eighty 65-94-year-old community dwellers were recruited in Sardinia (Italy). Participants self-rated their flourishing, satisfaction with their family connections, psychological hardness (i.e., a dimension of resilience), and cognitive function, whereas global cognitive efficiency and vocabulary were assessed through two internationally validated objective tests.

RESULTS

A hierarchical regression analysis revealed that 30% of the variance in the flourishing condition was explained by satisfaction with family ties, resilience, and metacognitive efficiency. In addition, males exhibited higher flourishing and satisfaction with family ties than females, and the former group also reported being more autonomous and acting proactively to influence its destiny.

CONCLUSION

Emotional support and rewarding relations with family members, the ability to face stressful events, and a good perception of one's cognitive efficiency play a crucial role in promoting flourishing in late adulthood.

Chronotype and Affective Response to Sleep Restriction and Subsequent Sleep Deprivation

Prior research indicates that sleep restriction, sleep deprivation, and circadian misalignment diminish positive affect, whereas effects on negative affect are inconsistent. One potential factor that may influence an individual's affective response to sleep restriction, sleep deprivation, and circadian misalignment is chronotype. Later chronotypes generally report higher negative affect and lower positive affect under typical sleep conditions; however, there is mixed evidence for an influence of chronotype on affective responses to sleep restriction and sleep deprivation. The present study examined the effect of chronotype on positive and negative affect during sleep restriction and subsequent total sleep deprivation. Sixteen healthy adults (Mage = 28.2 years, SDage = 11.6 years) were classified as earlier or later chronotypes using multiple chronotype definitions: morningness-eveningness (MEQ), mid-sleep on free days corrected (MSFsc), habitual mid-sleep timing, dim light melatonin onset (DLMO), and phase relationship between DLMO and bedtime. Participants completed a 10-day protocol with one night of sleep restriction and subsequent 28 h total sleep deprivation. Affect was assessed hourly during scheduled wakefulness with the Positive and Negative Affect Schedule (PANAS). Data were analyzed with mixed-model analyses of variance (ANOVAs). During sleep restriction and subsequent sleep deprivation, positive affect decreased and negative affect increased. Across all chronotype measures, relatively later chronotypes demonstrated vulnerability to increased negative affect during sleep loss. The influence of chronotype on positive affect during sleep loss varied by chronotype measure. These findings suggest later chronotypes are more vulnerable to affective impairments during sleep loss and circadian misalignment, even when late chronotype is not extreme.

A Community-Based Intervention to Enhance Subjective Well-Being in Older Adults: Study Design and Baseline Participant Profiles

Promoting subjective well-being is a crucial challenge in aging societies. In 2022, we launched a community-based intervention trial (the Chofu-Digital-Choju Movement). This initiative centered on fostering in-person and online social connections to enhance the subjective well-being of older adults. This paper describes the study design and baseline survey. This quasi-experimental study involved community-dwelling older adults aged 65-84 years in Chofu City, Tokyo, Japan. A self-administered questionnaire was distributed to 3742 residents (1681 men and 2061 women), and a baseline survey was conducted in January 2022. We assessed subjective well-being (primary outcome); psychosocial, physical, and dietary factors; and the use of information and communication technology variables (secondary outcomes) among the participants. After the intervention involving online classes, community hubs, and community events, a 2-year follow-up survey will be conducted to evaluate the effects of the intervention, comparing the intervention group (participants) with the control group (non-participants). We received 2503 questionnaires (66.9% response rate); of these, the analysis included 2343 questionnaires (62.6% valid response rate; mean age, 74.4 (standard deviation, 5.4) years; 43.7% male). The mean subjective well-being score was 7.2 (standard deviation, 1.9). This study will contribute to the development of a prototype subjective well-being strategy for older adults.

Positive Psychological Well-Being in Early Palliative Care: A Narrative Review of the Roles of Hope, Gratitude, and Death Acceptance

In the advanced cancer setting, low psychological functioning is a common symptom and its deleterious impact on health outcomes is well established. Yet, the beneficial role of positive psychological well-being (PPWB) on several clinical conditions has been demonstrated. Early palliative care (EPC) is a recent value-based model consisting of the early integration of palliative care into standard care for solid tumors and hematologic malignancies. While the late palliative care primary offers short-term interventions, predominantly pharmacological in nature and limited to physical symptom reduction, EPC has the potential to act over a longer term, enabling specific interventions aimed at promoting PPWB. This narrative review examines nine English studies retrieved from MEDLINE/PubMed, published up to October 2023, focusing on EPC and three dimensions of PPWB: hope, gratitude, and death acceptance. These dimensions consistently emerge in our clinical experience within the EPC setting for advanced cancer patients and appear to contribute to its clinical efficacy. The choice of a narrative review reflects the novelty of the topic, the limited existing research, and the need to incorporate a variety of methodological approaches for a comprehensive exploration.

The combination of physical activity with fruit and vegetable intake associated with life satisfaction among middle-aged and older adults: a 16-year population-based cohort study

BACKGROUND

Life satisfaction (LS) is part of a positive psychological feeling that protects individuals from a physical decline in old age. A healthy lifestyle, including physical activity (PA) and a healthy diet, such as the intake of fruits and vegetables (F&V), can lead to a better experience of LS in older adults. However, the association between PA and F&V intake habits when occurring together in older adults is still unclear for LS. The study aimed to investigate the combined association of PA and F&V intake on LS among a cohort of older Taiwanese adults.

METHODS

Five waves of population-based data gathered by the Taiwan Longitudinal Survey on Aging between 1999 and 2015 were analyzed. The year 1999 was set as the baseline, and the number of respondents was 4,440. The independent variables included the frequency, duration, and intensity of PA and the frequency of F&V intake. LS was assessed by using the Life Satisfaction Index. We performed generalized estimating equations (GEE) analysis with adjustment for covariates of health behaviors and health indicators.

RESULTS

After adjusting for confounders, model 1 showed that moderate and high-PA levels significantly correlated with LS (odds ratio [OR] = 1.41, 95% CI = 1.12-1.79) and OR = 1.74, 95% CI = 1.50-2.02). Moreover, high-F&V intake significantly correlated with LS (OR = 2.07, 95% CI = 1.69-2.53). Regarding the combined association shown in model 2, compared with both the low PA and F&V intake group, there were significantly higher LS in the both-high-group (OR = 4.69, 95% CI = 3.49-6.31), only-high-F&V intake (OR = 2.87, 95% CI = 2.14-3.85), only-high-PA (OR = 2.48, 95% CI = 1.74-3.52).

CONCLUSIONS

Our findings show the significant combined association of PA and F&V intake on LS among older adults. In addition, older adults who engaged in higher frequency, duration, and intensity of daily PA combined more than seven times a week of F&V intake had significantly higher LS than those who only engaged in low PA or only intake less F&V. Adopting multiple healthy behaviors in daily life is a safe and effective approach to promote LS among older adults.

Well-Being Therapy for Depression

Well-being therapy (WBT) is a short-term psychotherapeutic strategy, based on the technique of self-observation via the use of a structured diary and the guide of a therapist, with the goal of increasing psychological well-being, thus reaching euthymia and a balance among psychic forces. WBT showed to be suitable for application in residual symptoms of unipolar and bipolar depression, since the sequential combination with cognitive-behavioural therapy (CBT) led to a decrease in the relapse rate of recurrent depression. WBT also showed clinical utility in the treatment of cyclothymia, which represents one of the stages of bipolar disorder. Further, WBT seems to have efficacy in treatment-resistant depression and in case of withdrawal syndromes (in particular the so-called persistent post-withdrawal disorder) following antidepressant decrease, switch or discontinuation. In brief, WBT is a rather new but promising therapeutic strategy in the management of unipolar and bipolar depression. This chapter offers an overview of WBT possible applications.

Can adult children's education prevent parental health decline in the short term and long term? Evidence from rural China

This paper presents the first evidence of the causal relationship between adult children's schooling and changes in parental health in the short and long term. By using supply-side variation in schooling as an instrument for adult children's education and a representative dataset for rural China, we find that adult children' education has a positive influence on the long-term changes in parental health, with limited evidence of any short-term effect. Our results remain consistent after a variety of sensitivity tests. The heterogeneous analyses show differences in socio-economic status and gender, with low-educated parents and mothers being the primary beneficiaries of children's schooling. Potential mechanisms for the long-term effects of adult children's education on changes in parental health include better chronic disease management, improved access to health, sanitation, and clean fuel facilities, improved psychological well-being, and reduced smoking behaviours.

The Endogenous Opioid System as a Pathway of Positive Emotions

Pleasant emotions take a variety of forms and are a key part of the human experience. Although negative emotions have often been a focus of research, positive emotions, e.g., joy, pleasure, and love, have recently gained more attention. Each of these emotions is rich and complex in its own right. However, positive emotions appear to serve key evolutionary functions, which are mediated by complex biological substrates. This chapter summarizes key research and explores the biological underpinnings of positive emotions, with an emphasis on the roles that endogenous opioids play in the experience, expression, and development of positive emotions. The necessity of emphasizing positive emotions in research is also discussed.

Effect of the Radical Remission Multimodal Intervention on Quality of Life of People with Cancer

Introduction: The Radical Remission Multimodal Intervention (RRMI) was developed by Kelly A. Turner, PhD, after analyzing more than 1500 cases of cancer survivors experiencing radical remission (a.k.a. spontaneous regression) across all cancer types and extracting key lifestyle factors shared by these cancer survivors. The RRMI workshops provide instruction on these lifestyle factors to participants with cancer and give them tools to help navigate their cancer recovery journey. This pilot study aimed to evaluate the effect of the RRMI on the quality of life (QOL) of people with cancer. Methods: This was a pre-post outcome study. Data were collected, between January 2019 and January 2022, from 200 eligible adults of all cancer types, who attended the RRMI workshops (online and in-person). Participants were asked to complete questionnaires online, at baseline (i.e., before the intervention) and at month 1 and month 6 post-intervention. The RRMI workshops were led by certified Radical Remission health coaches. Participants completed the RRMI with personalized action plans for them to implement. The primary outcome QOL measure was the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Mixed-effects regression models were used to examine differences in FACIT-Sp score between month 1 and baseline, as well as month 6 and baseline. Models controlled for baseline score, covariates (including age, ethnic group, and body mass index), timepoints (month 1 or 6), training type (online or in-person), adherence score, and interaction between timepoints and adherence score. Results: 92% of participants were women, 77% were Non-Hispanic White, 88% were living in the US, and 66.5% were not living alone. One-quarter had breast cancer. Mean age ± SD was 55.3 ± 11.5 years. Final mixed-effects model analyses showed a significant increase in FACIT-Sp score of 9.5 (95% confidence interval [CI]: 6.2-12.8) points at month 1 (P < .0001) and 9.7 (95% CI: 6.4-13.0) points at month 6 (P < .0001) compared with baseline, a 7.7% and 10.8% improvement, respectively. Conclusion: The RRMI was found to significantly improve the overall QOL of participants at month 1. This improvement was maintained at month 6 post-intervention. Our findings suggest that people with cancer can benefit from the RRMI.