Background: Increasing evidence suggests that psychological well-being (PWB) is associated with lower disease and mortality risk, and may be enhanced with relatively low-cost interventions. Yet, dissemination of these interventions remains limited, in part because insufficient attention has been paid to distinct PWB dimensions, which may impact physical health outcomes differently. Methods: This essay first reviews the empirical evidence regarding differential relationships between all-cause mortality and multiple dimensions of PWB (e.g., life purpose, mastery, positive affect, life satisfaction, optimism). Then, individual-level positive psychology interventions aimed at increasing PWB and tested in randomized-controlled trials are reviewed as these allow for easy implementation and potentially broad outreach to improve population well-being, in concert with efforts targeting other established social determinants of health. Results: Several PWB dimensions relate to mortality, with varying strength of evidence. Many of positive psychology trials indicate small-to-moderate improvements in PWB; rigorous institution-level interventions are comparatively few, but preliminary results suggest benefits as well. Examples of existing health policies geared towards the improvement of population well-being are also presented. Future avenues of well-being epidemiological and intervention research, as well as policy implications, are discussed. Conclusions: Although research in the fields of behavioral and psychosomatic medicine, as well as health psychology have substantially contributed to the science of PWB, this body of work has been somewhat overlooked by the public health community. Yet, the growing interest in documenting well-being, in addition to examining its determinants and consequences at a population level may provoke a shift in perspective. To cultivate optimal well-being—mental, physical, social, and spiritual—consideration of a broader set of well-being measures, rigorous studies, and interventions that can be disseminated is critically needed.

Measures of well-being have proliferated over the past decades. Very little guidance has been available as to which measures to use in what contexts. This paper provides a series of recommendations, based on the present state of knowledge and the existing measures available, of what measures might be preferred in which contexts. The recommendations came out of an interdisciplinary workshop on the measurement of well-being. The recommendations are shaped around the number of items that can be included in a survey, and also based on the differing potential contexts and purposes of data collection such as, for example, government surveys, or multi-use cohort studies, or studies specifically about psychological well-being. The recommendations are not intended to be definitive, but to stimulate discussion and refinement, and to provide guidance to those relatively new to the study of well-being.

Most research on exceptional longevity has investigated biomedical factors associated with survival, but recent work suggests nonbiological factors are also important. Thus, we tested whether higher optimism was associated with longer life span and greater likelihood of exceptional longevity. Data are from 2 cohorts, women from the Nurses’ Health Study (NHS) and men from the Veterans Affairs Normative Aging Study (NAS), with follow-up of 10 y (2004 to 2014) and 30 y (1986 to 2016), respectively. Optimism was assessed using the Life Orientation Test–Revised in NHS and the Revised Optimism–Pessimism Scale from the Minnesota Multiphasic Personality Inventory-2 in NAS. Exceptional longevity was defined as survival to age 85 or older. Primary analyses used accelerated failure time models to assess differences in life span associated with optimism; models adjusted for demographic confounders and health conditions, and subsequently considered the role of health behaviors. Further analyses used logistic regression to evaluate the likelihood of exceptional longevity. In both sexes, we found a dose-dependent association of higher optimism levels at baseline with increased longevity (P trend < 0.01). For example, adjusting for demographics and health conditions, women in the highest versus lowest optimism quartile had 14.9% (95% confidence interval, 11.9 to 18.0) longer life span. Findings were similar in men. Participants with highest versus lowest optimism levels had 1.5 (women) and 1.7 (men) greater odds of surviving to age 85; these relationships were maintained after adjusting for health behaviors. Given work indicating optimism is modifiable, these findings suggest optimism may provide a valuable target to test for strategies to promote longevity. Significance Optimism is a psychological attribute characterized as the general expectation that good things will happen, or the belief that the future will be favorable because one can control important outcomes. Previous studies reported that more optimistic individuals are less likely to suffer from chronic diseases and die prematurely. Our results further suggest that optimism is specifically related to 11 to 15% longer life span, on average, and to greater odds of achieving “exceptional longevity,” that is, living to the age of 85 or beyond. These relations were independent of socioeconomic status, health conditions, depression, social integration, and health behaviors (e.g., smoking, diet, and alcohol use). Overall, findings suggest optimism may be an important psychosocial resource for extending life span in older adults.

Breast cancer is a leading cause of cancer death in women. Sleep has been linked with mortality among cancer-free population; however, its association with survival among women with breast cancer is understudied. Breast cancer patients (N=3682) reported their average sleep duration post diagnosis. Subsamples also provided their pre-diagnosis sleep duration (n=1949) and post-diagnosis sleep difficulties (n=1353). Multivariate Cox models estimated hazard ratios (HR) and confidence intervals (CI) of all-cause, breast cancer, and non-breast cancer mortality. At diagnosis, the mean age was 64.9 years and 91.7% were stage I or II. Women sleeping ⩾9 h per night post diagnosis had a strong higher risk of all-cause (multivariate HRs: MV-HR=1.37, CI=1.10-1.71), breast cancer (MV-HR=1.46, CI=1.02-2.07), and non-breast cancer mortality (MV-HR=1.34, CI=1.01-1.79), compared to women sleeping 8 h per night. Increased sleep duration post diagnosis (vs unchanged) and regular sleep difficulties (vs rare/none) were associated with a strong elevated risk of all-cause mortality (MV-HRincreased duration=1.35, CI=1.04-1.74; MV-HRregular difficulties=1.49, CI=1.02-2.19) and a moderate greater risk of breast cancer and non-breast cancer mortality. Various facets of sleep were associated with higher all-cause mortality risk. If replicated, these findings support evaluation of breast cancer patients' sleep duration and difficulties to identify those at risk for poorer outcomes.

Having a purpose in life has been linked to improved health and wellbeing; however, it remains unknown whether having “Ikigai”—a related but broader concept in Japan—is also beneficial for various physical and psychosocial outcomes. Using data from a nationwide longitudinal study of Japanese older adults aged ≥65 years, we examined the associations between having Ikigai in 2013 and a wide range of subsequent outcomes assessed in 2016 across two databases (n = 6,441 and n = 8,041), including dimensions of physical health, health behavior, psychological distress, social wellbeing, subjective wellbeing, and pro-social/altruistic behaviors. We adjusted for sociodemographic characteristics and the outcome values (whenever data were available) in the prior wave (2010). Having Ikigai (vs. not having Ikigai) was associated with a 31% lower risk of developing functional disability [95% confidence interval (CI) for risk ratio: 0.58, 0.82] and 36% lower risk of developing dementia [95% CI for risk ratio: 0.48, 0.86] during the three-year follow-up. Having Ikigai was associated with decreased depressive symptoms and hopelessness as well as higher happiness, life satisfaction, instrumental activity of daily living, and certain social outcomes (e.g., more frequent participation in hobby clubs). Some of these associations were stronger for men than women, and among individuals with high socioeconomic status (p-values for effect measure modification < 001). Having Ikigai may promote health and wellbeing outcomes among Japanese older adults, but particularly men and individuals with high socioeconomic status. NIH, John Templeton Foundation, JSPS, AMED, MHLW, MEXT, and WPE Foundation.