Optimism and How Long You Live
The longevity figure everybody quotes is the model before health behaviour, and the same paper prints the behaviour-adjusted version a few lines below it. The harder finding is what happens when the questionnaire is split in two: the man who built the scale convened a consortium of 221,133 people and found the optimistic half predicting almost nothing. Something at the pessimistic end shortens life, which is a different claim from optimism lengthening it.
Answer to the question
What does research on optimism and health show?
After adjustment for demographics, existing illness and depression, the most optimistic quarter of 69,744 women in the Nurses' Health Study lived 14.9 per cent longer than the least optimistic quarter. Adding smoking, alcohol, diet, activity, body mass index and screening attendance brings that to 8.7 per cent, and separating the scale's two halves puts almost all of the signal at the pessimistic pole.
Key takeaways
- Adjusted for demographics, existing illness and depression, the most optimistic quarter of 69,744 women lived 14.9 per cent longer and the most optimistic men 10.9 per cent.
- Adding smoking, alcohol, diet, activity, body mass index and screening attendance cuts the women's figure to 8.7 per cent, and formal mediation in a larger cohort puts the behavioural share at 24 per cent.
- Split the questionnaire in two and the optimistic half predicts physical health at a correlation of about 0.011, which goes away if two studies are dropped, in a reanalysis of 221,133 people run by the scale's own author.
- No Mendelian randomisation or co-twin design has been run on dispositional optimism and death, and the large direct tests of patient attitude against cancer survival find no benefit at the positive pole.
This article is general information about research on optimism and health. It is not medical advice, and nothing in it is a reason to change any treatment or to stop seeking care. Speak to a GP or another clinician about your own health. Medical review:.
Fourteen point nine per cent. That is how much longer the most optimistic quarter of 69,744 American nurses lived than the least optimistic quarter, after adjustment for demographics, existing illness and depression. It is the best-known number in the research on optimism and health, and it is one of three the same table prints.
A stable disposition measured against a death record is a different design from an experiment that manipulates what somebody expects. A small randomised trial can say that an expectation [caused the side effects people felt](https://thewhyweproject.com/articles/when-expecting-side-effects-causes-them). A thirty-year cohort cannot say that optimism caused anybody's extra years, and work on [how active people believe they are](https://thewhyweproject.com/articles/how-active-you-think-you-are-matters) ends in the same difficulty.
The seed book, Sumit Paul-Choudhury's The Bright Side, opens its taxonomy with the right sentence, that optimism is not one thing, and separates three kinds with an instrument for each. The printed volume carries no endnotes and no bibliography, its copyright page putting the sourcing on an external website, so a reader cannot check a claim in it. It makes no longevity claim anywhere, which is the first thing a reader will assume it says.
The cohort evidence and its adjustments
Lee and colleagues in 2019 followed 69,744 women in the Nurses' Health Study for ten years and 1,429 men in a veterans' ageing study for thirty. Adjusted for demographics, baseline conditions and depression, the most optimistic quarter of the women lived 14.9 per cent longer, on an interval of 11.9 to 18.0. The men were split into fifths rather than quarters, their instrument having a broader scoring range, and the highest fifth lived 10.9 per cent longer, on an interval from 1.3 to 21.5. The published abstract gives the women's figure alone and calls the men's findings similar.
| Model for the women | Longer life span |
|---|---|
| Demographics | 18.6 per cent |
| Plus health conditions and depression | 14.9 per cent |
| Plus health behaviours | 8.7 per cent |
The nurses' models included her own education, her husband's education and her father's occupation. In the same model, never having been diagnosed with type 2 diabetes was worth 17.0 per cent.
Koga and colleagues replicated it in 159,255 Women's Health Initiative participants followed up to twenty-six years, finding 5.4 per cent longer life span. Their baseline table shows the problem. Comparing the least with the most optimistic quarter: 22 per cent depressed against 4 per cent, and 23 per cent on a family income under twenty thousand dollars against 10 per cent. Both teams say their cohorts were whiter, better educated and longer lived than the general population.
The behavioural share of the gap
Add smoking, alcohol, physical activity, diet, body mass index and attendance at a screening examination, and the women's 14.9 per cent becomes 8.7. That is a drop of 6.2 points, about 40 per cent of the estimate. The men's estimate barely moves, and nobody has explained the sex difference. Koga's team ran formal causal mediation, with the lifestyle score measured three years after the questionnaire, and put the mediated share at 24 per cent, calling the contribution of lifestyle modest.
The behavioural share of the research on optimism and health is therefore knowable, somewhere between 24 and 42 per cent. Lee and colleagues write that health behaviours may be confounders in this association and may also lie on the pathway. If they are confounders, the answer is 8.7 per cent; if they are the mechanism, 14.9. Both figures are printed in the paper, and only one of them travels.
Both figures are printed in the same paper, a few lines apart, and only one of them travels.
The pathway is thinner than that share implies. Boehm and colleagues pooled the behavioural studies and found correlations of around 0.07 for physical activity, 0.12 for diet and 0.07 for smoking, mostly cross-sectional, mostly unadjusted for socio-economic position, and graded relatively low quality by their own authors. One behaviour runs backwards: Progovac and colleagues, in 48,291 women from the same cohort, found the least optimistic receiving about 5 per cent more frequent screening mammograms after full adjustment, against the authors' own stated hypothesis, an effect they attribute mainly to women over seventy-five after a 2009 guideline change.
The asymmetry at the pessimistic pole
Michael Scheier, who built the Life Orientation Test, convened a consortium in 2020 that asked the original authors of sixty-one samples, 221,133 people in all, to reanalyse their own data with the scale's two halves separated. Pooled, the combined index predicted physical health at a correlation of about 0.026, the absence of pessimism at 0.029 and the presence of optimism at 0.011, with the pessimism effect significantly larger. Dropping two studies made the optimism half non-significant altogether, and Scheier published that himself.
The asymmetry shows up across designs in the optimism and health literature. Koga's subscales put the most pessimistic quarter at 5.2 per cent shorter life span and the most optimistic quarter at 2.5 per cent longer. The nearest thing to a causal design, Wootton and colleagues on subjective wellbeing, found no clear evidence of a causal effect on cardiometabolic health in either direction, with the one positive result resting on a composite its authors say is driven mainly by depressive symptoms; no Mendelian randomisation study of dispositional optimism itself exists, and we searched for one.
One caution about that spine. These correlations are around three hundredths, and the gap between the two halves of the scale is a fraction of that again. At that size, measurement error and study selection can move the ordering, so the asymmetry is consistent across designs rather than precisely estimated in any one.
Paul-Choudhury has the hypothesis that would explain it, in a footnote on page 69, noting that pessimism may be a biologically distinct trait with different genetic and neurological underpinnings, and he goes no further. Nor does pessimism look pathological: Norem and Cantor's defensive pessimists, sixty-nine undergraduates expecting to do badly on an anagram task, performed no worse than the optimists and were no less satisfied after failure, on a word puzzle rather than a death record. Behind all of it sits [a shrunken literature on positive thinking](https://thewhyweproject.com/articles/the-psychology-you-learned-didnt-replicate).
The cancer claim and its provenance
The pooled cardiovascular estimate contains no cancer patients: Rozanski and colleagues excluded them by design, to avoid confounding secondary to terminal sickness. The cancer question in the optimism and health literature has been asked separately. The attitude-and-survival idea traces to a 1989 group therapy trial in metastatic breast cancer not designed to test survival, and press records of a 2001 replication in 235 women report no survival difference between the therapy and control groups.
Watson and colleagues followed a population-based breast cancer cohort for ten years. Helplessness and hopelessness predicted worse disease-free survival, at about half again the risk, and a high fighting spirit conferred no survival advantage; her team's recommendation was to screen for helplessness so psychological care can be targeted. Emotional wellbeing did not predict survival in roughly 1,100 head and neck cancer patients with 646 deaths, as reported in an American Cancer Society release, and optimism did not predict survival in Schofield's lung cancer trial.
Schofield asked in print whether it is valuable to encourage optimism if it leads a patient to conceal distress in the misguided belief that this will afford survival benefits. [What happens when physical illness is attributed to the mind](https://thewhyweproject.com/articles/when-symptoms-get-called-psychological) is its own article here.
Here is our position on optimism and health. The cohort evidence is strong and the headline is not what it says. Something at the pessimistic end of the scale shortens life, and that is a different claim from optimism lengthening it.
Something at the pessimistic end of the scale shortens life, and that is a different claim from optimism lengthening it.
The circulated four-years figure is Koga's own extrapolation, labelled as one, and the circulated eleven to fifteen per cent is the model before behaviour. No registered report has tested an optimism intervention against a hard health outcome, and Rozanski's team say in print that nobody knows whether induced optimism carries the benefits of the naturally occurring kind.
Three things separate a usable finding from a slogan. A longevity figure is worth checking against the model it came from, since the behaviour-adjusted version is a little over half the size. A claim about the optimistic pole is worth keeping apart from a claim about the pessimistic one. And persistent hopelessness is a reason to talk to a clinician, which is a point about getting help and not about anybody's attitude.
Common questions
What does research on optimism and health show?
Large cohorts find the most optimistic quarter of older women living roughly 15 per cent longer than the least optimistic, falling to under 9 per cent once health behaviours and weight are included. No design in the optimism and health literature can show that optimism caused the difference.
Do optimists live four years longer?
That figure is an extrapolation and its authors label it as one. Koga and colleagues took their measured result, a 5.4 per cent longer life span, multiplied it by the life expectancy of American women in 2018, and reported the product as roughly four years in one sentence of the discussion.
Does a positive attitude improve cancer survival?
Three studies have tested patient attitude against cancer survival and none found a benefit at the positive pole, though two reach us through press coverage rather than the papers and one is a lung cancer trial. A high fighting spirit conferred no survival advantage at ten years in a breast cancer cohort. Helplessness and hopelessness did predict worse disease-free survival, and that cohort's authors recommended screening for it so support can be targeted.
Sources
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