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IPPA Newsletter   Volume 6 - Issue 1  - June 2013

The Multifaceted Interaction Between Health & Well-Being

In the last few decades, the relationship between physical conditions and well-being has increasingly attracted the interest of researchers and professionals within the most diverse disciplines. Positive psychology, with its emphasis on prevention and well-being promotion, has provided crucial contributions to the advancement of knowledge and intervention in this domain.

The identification of the personal and contextual factors that promote health in its broadest meaning – including physical, mental and social components – is especially important today. Around the world, higher life expectancy has increased the number of years spent living with chronic physical diseases and mental disorders. Currently, the estimated prevalence rate of disability in the adult population ranges from 11.8% in higher income countries to 18% in lower income countries (WHO, 2011). This phenomenon has direct implications on research, intervention programs, and social policies, especially as concerns three major areas. The first one is represented by primary prevention: more resources should be invested in this domain in order to avoid or delay the onset of diseases. The second area refers to disability and chronic diseases: intervention programs are needed to promote well-being and quality of life among the increasing amount of people dealing with these conditions. Finally, special attention must be paid to elderly people, who represent a growing percentage of the population in most countries, and who are exposed to the challenges of physical, psychological and social transitions entailed in their life stage. The following paragraphs will briefly summarize some of the most recent findings in these three areas.

As concerns prevention, in the last few years, several longitudinal studies have highlighted the causal relationship between subjective well-being and physical conditions. In particular, happiness predicts good physical health in healthy populations (Veenhoven, 2008). Positive emotions are effective predictors of physical health and longevity (Chida & Steptoe, 2008; Diener & Chan, 2011). Flourishing people report the lowest incidence of chronic diseases and the highest probability of survival 10 years later, compared to people with moderate mental health or languishing (Keyes, Dhingra & Simoes, 2010). Self-efficacy beliefs are important mediators in supporting the process of lifestyle change in situations of addiction and overweight. They also play an important role in promoting adherence to screening programs (e.g., breast cancer, colo-rectal cancer; Schwarzer, 2011). Clear connections were also detected between social support and health: experimental studies suggest that this may be due to the reduced physiological response to stressors (Dickerson & Zoccola, 2009). Finally, the relevance of religion and spirituality in providing people with individual and collective meanings and values is widely acknowledged. A recent meta-analysis of studies evaluating the association between religiosity/spirituality and mortality (Chida, Steptoe, & Powell, 2009) detected the protective role of organizational activities connected to religion (e.g., church attendance) for the survival of healthy populations. Other biopsychosocial factors related to religion, such as family lifestyle, stress buffering, social support, promotion of life satisfaction and positive emotions, are involved in this process as well (Howell, Kern, & Lyubomirsky, 2007).

The impact of personal and social resources on well-being becomes even more evident in conditions of chronic disease. Recent studies have highlighted that positive emotions promote adaptive coping, through distancing from unsolvable problems and a more objective risk assessment (Isen, 2009). High levels of hope are associated with more active search for medical information, better treatment adherence and lower perception of symptoms in chronic conditions (Berg et al., 2007). Social support reduces the intensity and duration of depressive symptoms and positively influences survival rates (Revenson & DeLongis, 2011). This is especially evident in studies investigating the impact of caregivers on disabled children’s well-being. A recent longitudinal study (Cramm & Nieboer, 2012) highlighted that parents enjoying an active and gratifying social life report lower levels of stress, higher levels of well-being, and a better relationship with their children. They are also more effective in promoting their children’s social integration. While all these studies provide evidence of the amazing amount of resources that individuals and families can effectively mobilize in facing a chronic disease, the influence of environmental and social factors is much more controversial. A recent study conducted among people with psychiatric disorders involved in a psychosocial rehabilitation programs (Bassi et al., 2012) highlighted that situation-contingent factors – the type of activity in which they were involved and its level of complexity - predicted participants’ quality of experience over and above clinical factors such as global functioning and rehabilitation duration. In addition, complex rehabilitation activities were prominently associated with optimal experience. While these results suggest the importance of promoting engagement in challenging tasks in order to pursue an effective rehabilitation, people with psychiatric disorders spend the largest portion of their daily life in low-challenging activities and social isolation. The crucial role of social and contextual facilitators and barriers in well-being promotion was confirmed in a study involving adults with achondroplasia (Cortinovis et al., 2011). Participants spent most of their free time with their family of origin or alone; nevertheless, they reported a great investment in social relations, which represented a relevant but rarely available source of positive experiences.

With regard to aging, optimism and cultivation of purpose contribute to well-being in this stage of life (Kotter-Gruhn & Smith, 2011). However, the most relevant finding is the so-called "well-being paradox", which refers to the positive psychological functioning reported by older persons despite progressive physical limitations. Various researchers have provided possible interpretations of this phenomenon. Most of them agree about the key role of resilience factors, such as sense of coherence, self efficacy and self-esteem, that allow older people to maintain high levels of mental health while facing the challenges related to the decline of physical strength and the changes in social roles (Ryff & Singer, 2009; Wiesmann & Hannich, 2013).

Consequently, a brief review of research indicates that the connection between well-being and health crosses multiple domains, including prevention, intervention, and age. Other domains of interest may include policy issues (e.g. social equality in the access to health services, risk exposure of specific groups of citizens, gender-related components of health), and cultural issues, such as differences in the conceptualization of health and disease across cultures and the approach to health in traditional systems of medicine. Although this brief outline is far from exhaustive, it attempts to stimulate further questions and research, particularly those questions relevant to societal and policy implications.

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References

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Berg C.J., Rapoff M.A., Snyder C.R. & Belmont J.R. (2007). The relationship of children’s hope to pediatric asthma treatment adherence. Journal of Positive Psychology, 2, 176-184.

Chida, Y., & Steptoe, A. (2008). Positive psychological well-being and mortality: A quantitative review of prospective observational studies. Psychosomatic Medicine, 70, 741-756.

Chida, Y., Steptoe A., & Powell, L.H. (2009). Religiosity/ spirituality and mortality. Psychotherapy and Psychosomatics, 78, 81-90.

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Diener, E., & Chan, M. (2011). Happy people live longer: Subjective well-being contributes to health and longevity. Applied Psychology: Health and Well-being, 3, 1-43.

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Revenson T.A. & Delongis A. (2011). Couples coping with chronic illness. In S. Folkman (Ed.) Oxford handbook of stress, health and coping(pp. 101-123). New York: Oxford University Press.

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Wiesmann, U., & Hannich, H.-J. (2013). A salutogenic analysis of the well-being paradox in older age. Journal of Happiness Studies, online first March 7, DOI 10.1007/s10902-013-9425-z

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