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Optimism and Health

Optimism and Health Invited Commentary | Cardiology Where Do We Go From Here? Jeff C. Huffman, MD Rozanski and colleagues have completed a careful and comprehensive meta-analysis examining the Related article prospective associations of optimism with cardiovascular events and all-cause mortality across a Author affiliations and article information are total of 15 studies and more than 200 000 participants. The authors reported that, across a mean listed at the end of this article. follow-up period of 13.8 years, optimism was significantly associated with a lower risk of incident cardiovascular events and all-cause mortality. Such findings largely held even when only considering studies that controlled for depression, physical activity, and other factors. These results are consistent with a large and growing literature finding that positive psychological well-being in general and optimism in particular appear to have an independent association with cardiovascular and overall health outcomes. It appears that one’s psychological well-being is associated with future health and that the association between well-being and health is beyond the association of other factors, such as sociodemographic variables, medical comorbidity, and the adverse effects of depression. At the same time, it is important to parse 2 key questions: (1) which specific positive psychological constructs are associated with medical health, and (2) which constructs are modifiable in a clinical or population-level intervention? Regarding the first question, as observed by Rozanski and colleagues, the specific construct that has been most consistently associated with medical health outcomes is dispositional optimism, measured by the Life Orientation Test–Revised. This is an important issue, given that optimism as conceptualized by this scale is a largely stable trait, as opposed to potentially more modifiable optimism-related constructs, such as positive expectancies or state optimism. If it is largely a person’s inherent optimistic nature from which they derive health benefit, such a trait may be difficult to modify with an intervention. In terms of which well-being–related constructs could be modified with an intervention, not surprisingly, the greatest data exist for more state-based concepts, such as positive affect or happiness. Meta-analyses have consistently found that specific, positive psychology interventions (which focus on deliberately and systematically promoting well-being) increase positive affect, and even in medically ill populations such interventions appear to be effective in modifying this factor. Fortunately, positive affect itself (and other concepts, such as gratitude) have been associated with 5,6 reduced mortality and other beneficial health effects in medical populations. Where does the field go from here? In terms of longitudinal studies, conducting studies that continue to examine the associations of more modifiable or state-based constructs with health outcomes will help to define clear, plausible, and important targets for intervention. These studies could also include more novel methods for assessing well-being, including ecological momentary assessment or day reconstruction methods that address the challenges with single or retrospective sampling. Regarding intervention studies, interventions should focus on improving and measuring not only well-being, but also important additional downstream outcomes (eg, physical activity and biomarkers) that are associated with health. Ongoing studies should also determine whether programs to promote psychological well-being might be best used alone or in conjunction with other, established behavioral interventions to boost their effect. Open Access. This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2019;2(9):e1912211. doi:10.1001/jamanetworkopen.2019.12211 (Reprinted) September 27, 2019 1/2 JAMA Network Open | Cardiology Optimism and Health ARTICLE INFORMATION Published: September 27, 2019. doi:10.1001/jamanetworkopen.2019.12211 Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Huffman JC. JAMA Network Open. Corresponding Author: Jeff C. Huffman, MD, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (jhuffman@partners.org). Author Affiliations: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston. Conflict of Interest Disclosures: Dr Huffman reported receiving research funding from the National Institutes of Health and the American Diabetes Association to study well-being interventions in patients with medical illness. REFERENCES 1. Rozanski A, Bavishi C, Kubzansky LD, Cohen R. Association of optimism with cardiovascular events and all-cause mortality: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(9):e1912200. doi:10.1001/ jamanetworkopen.2019.12200 2. Kubzansky LD, Huffman JC, Boehm JK, et al. Positive psychological well-being and cardiovascular disease: JACC health promotion series. J Am Coll Cardiol. 2018;72(12):1382-1396. doi:10.1016/j.jacc.2018.07.042 3. Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Pers Soc Psychol. 1994;67(6):1063-1078. doi:10. 1037/0022-3514.67.6.1063 4. Moskowitz JT, Carrico AW, Duncan LG, et al. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol. 2017;85(5):409-423. doi:10.1037/ccp0000188 5. Moskowitz JT, Epel ES, Acree M. Positive affect uniquely predicts lower risk of mortality in people with diabetes. Health Psychol. 2008;27(1)(suppl):S73-S82. doi:10.1037/0278-6133.27.1.S73 6. Petrie KJ, Pressman SD, Pennebaker JW, Øverland S, Tell GS, Sivertsen B. Which aspects of positive affect are related to mortality? results from a general population longitudinal study. Ann Behav Med. 2018;52(7):571-581. doi:10.1093/abm/kax018 7. Huffman JC, Feig EH, Millstein RA, et al. Usefulness of a positive psychology–motivational interviewing intervention to promote positive affect and physical activity after an acute coronary syndrome. Am J Cardiol. 2019;123(12):1906-1914. doi:10.1016/j.amjcard.2019.03.023 JAMA Network Open. 2019;2(9):e1912211. doi:10.1001/jamanetworkopen.2019.12211 (Reprinted) September 27, 2019 2/2 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Network Open American Medical Association

Optimism and Health

JAMA Network Open , Volume 2 (9) – Sep 27, 2019

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References (8)

Publisher
American Medical Association
Copyright
Copyright 2019 Huffman JC. JAMA Network Open.
eISSN
2574-3805
DOI
10.1001/jamanetworkopen.2019.12211
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Abstract

Invited Commentary | Cardiology Where Do We Go From Here? Jeff C. Huffman, MD Rozanski and colleagues have completed a careful and comprehensive meta-analysis examining the Related article prospective associations of optimism with cardiovascular events and all-cause mortality across a Author affiliations and article information are total of 15 studies and more than 200 000 participants. The authors reported that, across a mean listed at the end of this article. follow-up period of 13.8 years, optimism was significantly associated with a lower risk of incident cardiovascular events and all-cause mortality. Such findings largely held even when only considering studies that controlled for depression, physical activity, and other factors. These results are consistent with a large and growing literature finding that positive psychological well-being in general and optimism in particular appear to have an independent association with cardiovascular and overall health outcomes. It appears that one’s psychological well-being is associated with future health and that the association between well-being and health is beyond the association of other factors, such as sociodemographic variables, medical comorbidity, and the adverse effects of depression. At the same time, it is important to parse 2 key questions: (1) which specific positive psychological constructs are associated with medical health, and (2) which constructs are modifiable in a clinical or population-level intervention? Regarding the first question, as observed by Rozanski and colleagues, the specific construct that has been most consistently associated with medical health outcomes is dispositional optimism, measured by the Life Orientation Test–Revised. This is an important issue, given that optimism as conceptualized by this scale is a largely stable trait, as opposed to potentially more modifiable optimism-related constructs, such as positive expectancies or state optimism. If it is largely a person’s inherent optimistic nature from which they derive health benefit, such a trait may be difficult to modify with an intervention. In terms of which well-being–related constructs could be modified with an intervention, not surprisingly, the greatest data exist for more state-based concepts, such as positive affect or happiness. Meta-analyses have consistently found that specific, positive psychology interventions (which focus on deliberately and systematically promoting well-being) increase positive affect, and even in medically ill populations such interventions appear to be effective in modifying this factor. Fortunately, positive affect itself (and other concepts, such as gratitude) have been associated with 5,6 reduced mortality and other beneficial health effects in medical populations. Where does the field go from here? In terms of longitudinal studies, conducting studies that continue to examine the associations of more modifiable or state-based constructs with health outcomes will help to define clear, plausible, and important targets for intervention. These studies could also include more novel methods for assessing well-being, including ecological momentary assessment or day reconstruction methods that address the challenges with single or retrospective sampling. Regarding intervention studies, interventions should focus on improving and measuring not only well-being, but also important additional downstream outcomes (eg, physical activity and biomarkers) that are associated with health. Ongoing studies should also determine whether programs to promote psychological well-being might be best used alone or in conjunction with other, established behavioral interventions to boost their effect. Open Access. This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2019;2(9):e1912211. doi:10.1001/jamanetworkopen.2019.12211 (Reprinted) September 27, 2019 1/2 JAMA Network Open | Cardiology Optimism and Health ARTICLE INFORMATION Published: September 27, 2019. doi:10.1001/jamanetworkopen.2019.12211 Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Huffman JC. JAMA Network Open. Corresponding Author: Jeff C. Huffman, MD, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (jhuffman@partners.org). Author Affiliations: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston. Conflict of Interest Disclosures: Dr Huffman reported receiving research funding from the National Institutes of Health and the American Diabetes Association to study well-being interventions in patients with medical illness. REFERENCES 1. Rozanski A, Bavishi C, Kubzansky LD, Cohen R. Association of optimism with cardiovascular events and all-cause mortality: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(9):e1912200. doi:10.1001/ jamanetworkopen.2019.12200 2. Kubzansky LD, Huffman JC, Boehm JK, et al. Positive psychological well-being and cardiovascular disease: JACC health promotion series. J Am Coll Cardiol. 2018;72(12):1382-1396. doi:10.1016/j.jacc.2018.07.042 3. Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Pers Soc Psychol. 1994;67(6):1063-1078. doi:10. 1037/0022-3514.67.6.1063 4. Moskowitz JT, Carrico AW, Duncan LG, et al. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol. 2017;85(5):409-423. doi:10.1037/ccp0000188 5. Moskowitz JT, Epel ES, Acree M. Positive affect uniquely predicts lower risk of mortality in people with diabetes. Health Psychol. 2008;27(1)(suppl):S73-S82. doi:10.1037/0278-6133.27.1.S73 6. Petrie KJ, Pressman SD, Pennebaker JW, Øverland S, Tell GS, Sivertsen B. Which aspects of positive affect are related to mortality? results from a general population longitudinal study. Ann Behav Med. 2018;52(7):571-581. doi:10.1093/abm/kax018 7. Huffman JC, Feig EH, Millstein RA, et al. Usefulness of a positive psychology–motivational interviewing intervention to promote positive affect and physical activity after an acute coronary syndrome. Am J Cardiol. 2019;123(12):1906-1914. doi:10.1016/j.amjcard.2019.03.023 JAMA Network Open. 2019;2(9):e1912211. doi:10.1001/jamanetworkopen.2019.12211 (Reprinted) September 27, 2019 2/2

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JAMA Network OpenAmerican Medical Association

Published: Sep 27, 2019

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