摘要：Objectives. We investigated whether positive mental health predicts all-cause mortality. Methods. Data were from the Midlife in the United States (MIDUS) study (n = 3032), which at baseline in 1995 measured positive mental health (flourishing and not) and past-year mental illness (major depressive episode, panic attacks, and generalized anxiety disorders), and linked respondents with National Death Index records in a 10-year follow-up ending in 2005. Covariates were age, gender, race, education, any past-year mental illness, smoking, physical inactivity, physical diseases, and physical disease risk factors. Results. A total of 6.3% of participants died during the study period. The final and fully adjusted odds ratio of mortality was 1.62 (95% confidence interval [CI] = 1.00, 2.62; P = .05) for adults who were not flourishing, relative to participants with flourishing mental health. Age, gender, race, education, smoking, physical inactivity, cardiovascular disease, and HIV/AIDS were significant predictors of death during the study period. Conclusions. The absence of positive mental health increased the probability of all-cause mortality for men and women at all ages after adjustment for known causes of death. Historically, mental health has been viewed as the absence of mental disorder, despite conceptions that health in general is something positive and consists of well-being and not merely the absence of illness. 1 Mental well-being—i.e., positive mental health—is now a focus of national policy and science. The World Health Organization’s report on mental health defined it as a state of well–being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. 2 (p10) Mental health has been operationalized under the rubric of subjective well-being, or individuals’ evaluations of the quality of their lives. The nature of subjective well-being has been divided into 2 streams of research. The first approach equates well-being with feeling good and the second with functioning well in life. These 2 streams of subjective well-being research grew from 2 distinct philosophical viewpoints on happiness—one reflecting the hedonic tradition, which champions pleasure (i.e., positive feelings), and the other following the eudaimonic tradition, which emphasizes striving toward excellence or a good life as an individual and a citizen. The hedonic tradition is reflected in research on emotional well-being, where scholars use measures of satisfaction with life and positive affect (e.g., cheerfulness, happiness, and contentment). 3 The tradition of eudaimonia is reflected in research on psychological 4 and social 5 well-being. Here, scholars use multidimensional scales that ask individuals to evaluate how well they see themselves functioning as they strive to achieve sufficient levels of purpose, contribution, integration, autonomy, intimacy, acceptance, and mastery in life. Studies support the tripartite model of emotional, psychological, and social well-being in US adults and youths. 6–8 Although evidence links subjective well-being to mortality, most research has focused on emotional well-being. Reviews conclude that lower levels of positive emotions such as joy and happiness and lower levels of satisfaction with life are prospectively associated with increased risk of all-cause mortality in healthy populations 9–12 and in populations with preexisting physical illnesses. 9,11 In their review of 49 longitudinal studies, Howell et al. found an overall effect size of 0.14 for mortality between individuals with high and low emotional well-being (i.e., positive affect or life satisfaction). 11 A few studies have investigated constructs reflecting psychological or social well-being. 13–18 These reports suggest that the dimensions of psychological well-being (e.g., purpose in life) and social well-being (e.g., social coherence—the belief that life makes sense and is predictable—and a sense of contribution to society) are also predictive of mortality. Adults with higher levels of purpose in life 13–15 ; who find life more meaningful, manageable, and predictable 16,17 ; and who feel more useful to other people 18 have a lower adjusted risk of all-cause mortality. Published analyses of the Midlife in the United States (MIDUS) data identified an effect of positive mental health—on a continuum from languishing to moderate to flourishing mental health—on future mental illness. 19 We used data from the MIDUS cohort study 20 to extend the existing literature by investigating the risk of all-cause mortality by each of the components and the algorithm-derived categories of the mental health continuum, 21 incorporating measurement of psychological and social well-being in addition to emotional well-being. We examined whether the integration of the 3 types of well-being into the categorization of positive mental health (i.e., flourishing or not flourishing) predicted 10-year all-cause mortality. We also investigated the extent to which 12-month diagnosis of internalizing psychopathology (major depressive episode, panic attacks, and generalized anxiety), education, gender, race, age, risk behaviors (physical inactivity and smoking), and preexisting physical illness confounded or explained the association between positive mental health and mortality. 22–27
