Accumulating evidence suggests that a global sense of meaning in life is related to physical health, including increased longevity and reduced morbidity. However, the mechanisms responsible for these relationships remain largely unknown and uninvestigated. Moreover, there is no unifying conceptual framework linking meaning in life to physical health. Our aims are to (a) review the literature linking meaning in life to potential mechanisms associated with better physical health; (b) offer a comprehensive conceptual framework associating meaning in life with physical health; and (c) introduce a new construct, meaning salience, as a potentially important intermediary mechanism. Specifically, we review the evidence suggesting that meaning in life is associated with reduced stress, more adaptive coping, and greater engagement in health-promoting behaviors. Our model proposes that effects of global sense of meaning are potentiated through increased meaning salience, or daily awareness of meaning in the moment, which enhances self-regulation. Suggestions are proposed for empirically examining this new model.

Previous research has shown that purpose in life, the belief that one’s life is meaningful and goal-directed, is associated with greater engagement in self-reported physical activity. The purpose of this study was to examine the relationship between purpose in life and accelerometer-measured physical activity. Community volunteers (N = 104) completed measures of purpose in life and potential confounds and wore accelerometers for three consecutive days. Purpose in life was positively associated with objectively measured movement, moderate to vigorous physical activity, and with self-reported activity. These relationships were largely unchanged after controlling for potential confounds. These results suggest that purpose in life is a reliable correlate of physical activity.

Engagement in personally meaningful activities is associated with greater well-being. However, most studies use cross-sectional or recall methods, and the researchers pre-determine which activities are ‘meaningful.’ This study examined an idiographic measure of meaningful activity participation in relation to well-being. Participants (N = 160; M age = 43.3 years; 77% female) rated the meaningfulness of 46 daily activities at baseline and reported their activities on eight random days over the next 4 weeks. Half the participants also completed measures of meaning salience and mood on the same days. All participants reported on psychological well-being at baseline and 4-week follow-up. Meaningful activity participation was positively associated with meaning salience and positive mood. Average engagement in meaningful activities over 8 days was positively associated with subjective vitality, life satisfaction, and purpose in life at follow-up. An idiographic measure of meaningful activity participation may further be understanding of the relationship between meaningful activity participation and well-being. Abbreviations: ACT - Acceptance and Commitment Therapy; LET - Life Engagement Test; MALM - Meaningful Activity and Life Meaning; MAPA - Meaningful Activities Participation Assessment; PANAS - Positive and Negative Affect Schedule; PHQ-8 - Patient Health Questionnaire-8; SDT - Self-determination Theory; SVS - Subjective Vitality Scale; SWLS - Satisfaction with Life Scale; TOMS - Thoughts of Meaning Scale

Background: Heart failure is a progressive condition characterized by frequent hospitalizations for exacerbated symptoms. Informal family caregivers may help patients improve self-care, which may in turn reduce hospitalizations. However, little is known about how mutuality, defined as the quality of the patient–caregiver relationship, and caregiver burden affect self-care. Objective: This study examines the associations among mutuality, patient self-care confidence (beliefs in abilities to engage in self-care behaviors) and maintenance (behaviors such as medication adherence, activity, and low salt intake), caregiver confidence in and maintenance of patient care, and caregiver perceived burden. Methods: This study used cross-sectional baseline data from a multi-site randomized clinical trial of a symptom and psychosocial care intervention. Patient–caregiver dyads ( N=99) completed self-report surveys of mutuality and self-care confidence and maintenance, and caregivers completed a measure of caregiver burden. Path analysis, with actor (effects within a person) partner (effects across the dyad) interdependence model paths and regression models were used to examine the associations among mutuality, caregiver burden, and self-care. Results: The majority of patients ( M age=66, 21% female) and caregivers ( M age=57, 81% female) were spouses (60%). The path model demonstrated significant actor effects; patients and caregivers with better mutuality were more confident in patient self-care ( p<.05). Partner effects were not significant. Regression models indicated that caregivers with greater mutuality reported less perceived burden ( p<.01). Conclusions: Mutuality in patient–caregiver dyads is associated with patient self-care and caregiver burden and may be an important intervention target to improve self-care and reduce hospitalizations.

Background: To compare estimated 10‐year and 30‐year cardiovascular risk in primary care patients with and without serious mental illness (SMI; bipolar disorder, schizophrenia, or schizoaffective disorder). Methods and Results: All patients aged 18 to 75 years with a primary care visit in January 2016 to September 2018 were included and were grouped into those with and without SMI using diagnosis codes. Ten‐year cardiovascular risk was estimated using atherosclerotic cardiovascular disease scores for patients aged 40 to 75 years without cardiovascular disease; 30‐year cardiovascular risk was estimated using Framingham risk scores for patients aged 18 to 59 years without cardiovascular disease. Demographic, vital sign, medication, diagnosis, and health insurance data were collected from the electronic health record by a clinical decision support system. Descriptive statistics examined unadjusted differences, while general linear models examined differences for continuous variables and logistic regression models for categorical variables. Models were then adjusted for age, sex, race, ethnicity, and insurance type. A total of 11 333 patients with SMI and 579 924 patients without SMI were included. After covariate adjustment, 10‐year cardiovascular risk was significantly higher in patients with SMI (mean, 9.44%; 95% CI, 9.29%–9.60%) compared with patients without SMI (mean, 7.99%; 95% CI, 7.97–8.02). Similarly, 30‐year cardiovascular risk was significantly higher in those with SMI (25% of patients with SMI in the highest‐risk group compared with 11% of patients without SMI; P <0.001). The individual cardiovascular risk factors contributing most to increased risk for those with SMI were elevated body mass index and smoking. Among SMI subtypes, patients with bipolar disorder had the highest 10‐year cardiovascular risk, while patients with schizoaffective disorder had the highest 30‐year cardiovascular risk. Conclusions: The significantly increased cardiovascular risk associated with SMI is evident even in young adults. This suggests the importance of addressing uncontrolled major cardiovascular risk factors in those with SMI at as early an age as possible. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02451670.