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Does happiness itself directly affect mortality? The prospective UK Million Women Study
Open accessAbstract
BACKGROUND: Poor health can cause unhappiness and poor health increases mortality. Previous reports of reduced mortality associated with happiness could be due to the increased mortality of people who are unhappy because of their poor health. Also, unhappiness might be associated with lifestyle factors that can affect mortality. We aimed to establish whether, after allowing for the poor health and lifestyle of people who are unhappy, any robust evidence remains that happiness or related subjective measures of wellbeing directly reduce mortality. METHODS: The Million Women Study is a prospective study of UK women recruited between 1996 and 2001 and followed electronically for cause-specific mortality. 3 years after recruitment, the baseline questionnaire for the present report asked women to self-rate their health, happiness, stress, feelings of control, and whether they felt relaxed. The main analyses were of mortality before Jan 1, 2012, from all causes, from ischaemic heart disease, and from cancer in women who did not have heart disease, stroke, chronic obstructive lung disease, or cancer at the time they answered this baseline questionnaire. We used Cox regression, adjusted for baseline self-rated health and lifestyle factors, to calculate mortality rate ratios (RRs) comparing mortality in women who reported being unhappy (ie, happy sometimes, rarely, or never) with those who reported being happy most of the time. FINDINGS: Of 719,671 women in the main analyses (median age 59 years [IQR 55-63]), 39% (282,619) reported being happy most of the time, 44% (315,874) usually happy, and 17% (121,178) unhappy. During 10 years (SD 2) follow-up, 4% (31,531) of participants died. Self-rated poor health at baseline was strongly associated with unhappiness. But after adjustment for self-rated health, treatment for hypertension, diabetes, asthma, arthritis, depression, or anxiety, and several sociodemographic and lifestyle factors (including smoking, deprivation, and body-mass index), unhappiness was not associated with mortality from all causes (adjusted RR for unhappy vs happy most of the time 0·98, 95% CI 0·94-1·01), from ischaemic heart disease (0·97, 0·87-1·10), or from cancer (0·98, 0·93-1·02). Findings were similarly null for related measures such as stress or lack of control. INTERPRETATION: In middle-aged women, poor health can cause unhappiness. After allowing for this association and adjusting for potential confounders, happiness and related measures of wellbeing do not appear to have any direct effect on mortality. FUNDING: UK Medical Research Council, Cancer Research UK.
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“However, in the Million Women Study, there was no association of happiness with risk of mortality after accounting for health status, although concerns have been raised about the study methodology. 79,80”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [79]
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“The most recent evidence suggests that the health causing happiness is predominant (Liu et al. 2016), and we follow it here.”
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“In contrast, other longitudinal studies have found little evidence that well-being predicts subsequent health—especially once baseline health is controlled (Gana et al., 2013; Liu et al., 2016; Martín-María et al., 2016).”
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“This theory posits that positive psychological resources such as resilience and RE [15, 16] can help individuals build their personal capabilities, are associated with better psychological and physical health, independent of the effects of negative affect [17, 18].”
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“…promote sustainable growth internationally.5 Research shows ample evidence that higher SWB is associated with better health and lower mortality (e.g., Acosta-González and Marcenaro-Gutiérrez 2021; Liu et al. 2016), a relationship that holds across cultures (Ngamaba, Panagioti, and Armitage 2017).”
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Who is happier among preclinical medical students: the impact of chronotype preference
Tan, M. N., Mevsim, V., Cifci, M. P., Sayan, H., Ercan, A. E., Ergin, O. F., Oksuz, U., & Ensari, S. (2020) · Chronobiology International · doi:10.1080/07420528.2020.1761373 · Cited by 23
Welsh, J., Korda, R., Joshy, G., Butterworth, P., Brown, A. D. H., & Banks, E. (2017) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2017-209535 · Cited by 21
Moving more, ageing happy: findings from six low- and middle-income countries
Félez-Nóbrega, M., Haro, J. M., Stubbs, B., Smith, L., & Koyanagi, A. (2020) · Age and Ageing · doi:10.1093/ageing/afaa137 · Cited by 25
“In turn, according to a large study examining sociodemographic and health correlates of happiness, anxiety was one of the strongest correlates of unhappiness [53].”
BackgroundHappy people live longer because they are healthy people
Song, C. F., Tay, P. K. C., Gwee, X., Wee, S. L., & Ng, T. P. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04030-w · Cited by 20
“On the other hand, analyzing data from 719,671 women in the United Kingdom, Liu, Floud [20] concluded that happiness was not related to mortality after controlling for similar covariates which included self-rated health, various physical and mental health condition, and lifestyle and sociodemographic variables.”
MethodResultInfluentialWhat’s in a smile? A review of the benefits of the clinician’s smile
Beamish, A., Foster, J. J., Edwards, H., & Olbers, T. (2019) · Postgraduate medical journal · doi:10.1136/postgradmedj-2018-136286 · Cited by 17
Reprint of: Positive Psychological Well-Being and Cardiovascular Disease
Kubzansky, L. D., Huffman, J. C., Boehm, J. K., Hernández, R., Kim, E. S., Koga, H. K., Feig, E. H., Lloyd‐Jones, D. M., Seligman, M. E. P., & Labarthe, D. R. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.023 · Cited by 21
“Earlier studies identified a protective effect of positive affect on CVD risk, but one recent large study showed null results (25).”
ResultHealth Effects of Happiness in China
Wang, W., Sun, Y., Yong, C., Bu, Y., & Li, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116686 · Cited by 19
“, (2016) recently reported that although chronic illness caused unhappiness, unhappiness itself had no direct effect on mortality [22].”
BackgroundHernández, R., Wilund, K., Solai, K., Tamayo, D., Fast, D., Venkatesan, P., Lash, J. P., Lora, C. M., Martinez, L., Alemañy, G. M., et al. (2023) · JMIR Research Protocols · doi:10.2196/45100 · Cited by 19
Unravelling the associations between social isolation, loneliness, and mortality
Liu, B. C., & Floud, S. (2017) · The Lancet Public Health · doi:10.1016/s2468-2667(17)30090-7 · Cited by 18
Self-citationPsychological Wellbeing and Aortic Stiffness
Ikeda, A., Steptoe, A., Shipley, M., Wilkinson, I., Mceniery, C., Tanigawa, T., Singh-Manoux, A., Kivimaki, M., & Brunner, E. (2020) · HYPERTENSION · doi:10.1161/hypertensionaha.119.14284 · Cited by 9
Positive Affect Is Inversely Associated with Mortality in Individuals without Depression
Martín‐María, N., Caballero, F. F., Olaya, B., Rodríguez‐Artalejo, F., Haro, J. M., Miret, M., & Ayuso‐Mateos, J. L. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01040 · Cited by 18
“Hedges’ g (unpaired t-test) and Cramer’s V (χ2-test) were reported as effect size measures in case of significant differences at the 95% confidence level.”
MethodBarger, S. D., Broom, T. W., Esposito, M. V., & Lane, T. S. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-031776 · Cited by 17
Salsman, J. M., McLouth, L. E. S., Cohn, M., Tooze, J. A., Sorkin, M., & Moskowitz, J. T. (2020) · JMIR Research Protocols · doi:10.2196/17078 · Cited by 18
“Psychological well-being is significantly associated with better health outcomes (better physical health [25] and lower risk of mortality in healthy and chronically ill samples [26-30]), is unique from the influence of distress, and includes domains that are inherently valued by patients (better relationships, more cr…”
Duque, L., Brown, L., Celano, C. M., Healy, B. C., & Huffman, J. C. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2019.06.001 · Cited by 19
Does exercise participation promote happiness?: Mediations and heterogeneities
Li, C., Ning, G., & Xia, Y. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1033157 · Cited by 19
“Model (13) 2SLS (14) 2SLS (15) 2SLS (16) 2SLS (17) 2SLS (18) 2SLS”
BackgroundFontesse, S., Fournier, V., Gérain, P., Dassonneville, C., Lelorain, S., Duprez, C., Christophe, V., Piessen, G., & Grynberg, D. (2023) · Psycho-Oncology · doi:10.1002/pon.6224 · Cited by 17
“13 Noteworthy, discrepancies in the observations could be explained by diversity of positive affect, measures of interest, or cancer localizations.”
BackgroundMontgomery, R. M., Boucher, E. M., Honomichl, R. D., Powell, T. A., Guyton, S. L., Bernecker, S. L., Stoeckl, S. E., & Parks, A. C. (2021) · JMIR Cardio · doi:10.2196/32351 · Cited by 19
Optimism during pregnancy and obstetrical outcomes: A systematic review
Giangiordano, I., Sahani, H., Mascio, D. D., Saccone, G., Bellussi, F., Berghella, A. P., Braverman, A. M., & Berghella, V. (2020) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2020.03.029 · Cited by 16
Robinson, M. D., & Sedikides, C. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.031 · Cited by 18
The Five-Factor Model of Personality: Consensus and Controversy
McCrae, R. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.013 · Cited by 20
Dual trajectories of depression and social participation among Chinese older adults
Pan, C., & Cao, N. (2023) · Geriatric Nursing · doi:10.1016/j.gerinurse.2023.07.013 · Cited by 17
The Role of Affect on Physical Health Over Time: A Cross‐Lagged Panel Analysis Over 20 Years
Wiese, C. W., Chen, Z. J., Tay, L., Friedman, E. M., & Rector, J. L. (2018) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12149 · Cited by 14
“Despite this interest, research on this topic remains equivocal (e.g. Diener, Pressman, & Lyubomirsky, 2015; Liu et al., 2016) and there is a need for additional research to explore extended temporal dynamics between affect and health.”
BackgroundHappiness, health, and mortality
Kubzansky, L. D., Kim, E. S., Salinas, J., Huffman, J. C., & Kawachi, I. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30896-0 · Cited by 14
Counterfactual and interventionist approach to cure risk factor epidemiology
Chioléro, A. (2016) · International Journal of Epidemiology · doi:10.1093/ije/dyw159 · Cited by 14
Freak‐Poli, R., Ikram, M. A., Franco, O. H., Albert Hofman, D., & Tiemeier, H. W. (2017) · Depression and Anxiety · doi:10.1002/da.22689 · Cited by 13
“Finally, it is important to specify that mental health (whether it be depression or positive affect) may not directly impact CVD or mortality [46], but rather may contribute to microlevel changes such as worse or better health behavior, which over time contribute to mortality or survival.”
BackgroundHistoria, investigación y discurso de la Psicología Positiva: Un abordaje crítico
Ríos, L. F., & Vázquez, M. V. (2018) · Terapia psicológica · doi:10.4067/s0718-48082018000200123 · Cited by 16
Metadata
- Authors
- Liu, B., Floud, S., Pirie, K., Green, J., Peto, R., & Beral, V.
- Affiliations
- UNSW Sydney (AU)
- University of Oxford (GB)
- Corresponding author
- Liu, Bette
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 387
- Issue
- 10021
- Pages
- 874-881
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC5075047
- OpenAlex
- W2192905344
- Cited by
- 259
- References
- 32
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 14 · 2023: 20 · 2022: 19 · 2021: 18 · 2020: 64 · 2019: 19 · 2018: 27 · 2017: 33 · 2016: 18
- FWCI
- 43.20
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The Lancet (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by)
- Funders
- Cancer Research UK (16491)
- British Heart Foundation
- Medical Research Council (MR/K02700X/1)
- National Health and Medical Research Council
- Topics
- Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
- Keywords
- happiness, mortality, subjective well-being, self-rated health, ischemic heart disease, cancer mortality, stress, perceived control, relaxation, lifestyle factors, women's health, Million Women Study, anxiety and depression, smoking, socioeconomic deprivation, body mass index, hypertension, diabetes mellitus, asthma, arthritis, cause-specific mortality
- MeSH terms
- Aged, Female, Follow-Up Studies, United Kingdom, Happiness, Health Status, Humans, Middle Aged, Mortality, Neoplasms, Prospective Studies, Proportional Hazards Models, Myocardial Ischemia
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