Major depression is known to be related to higher cardiovascular mortality.
However, epidemiological data regarding dispositional optimism in relation
to mortality are scanty.
To test whether subjects who are optimistic live longer than those who
Our analysis formed part of a prospective population-based cohort study
in the Netherlands (Arnhem Elderly Study).
Elderly subjects aged 65 to 85 years (999 men and women) completed the
30-item validated Dutch Scale of Subjective Well-being for Older Persons,
with 5 subscales: health, self-respect, morale, optimism, and contacts. A
total of 941 subjects (466 men and 475 women) had complete dispositional optimism
data, and these subjects were divided into quartiles.
Main Outcome Measure
Number of deaths during the follow-up period.
During the follow-up period of 9.1 years (1991-2001), there were 397
deaths. Compared with subjects with a high level of pessimism, those reporting
a high level of optimism had an age- and sex-adjusted hazard ratio of 0.55
(95% confidence interval, 0.42-0.74; upper vs lower quartile) for all-cause
mortality. For cardiovascular mortality, the hazard ratio was 0.23 (95% confidence
interval, 0.10-0.55) when adjusted for age, sex, chronic disease, education,
smoking, alcohol consumption, history of cardiovascular disease or hypertension,
body mass index, and total cholesterol level. Protective trend relationships
were observed between the level of optimism and all-cause and cardiovascular
mortality (P<.001 and P = .001
for trend, respectively). Interaction with sex (P = .04)
supported a stronger protective effect of optimism in men than women for all-cause
mortality but not for cardiovascular mortality.
Our results provide support for a graded and independent protective
relationship between dispositional optimism and all-cause mortality in old
age. Prevention of cardiovascular mortality accounted for much of the effect.