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Erik J. Giltay, MD, PhD; Johanna M. Geleijnse, PhD; Frans G. Zitman, MD, PhD; Tiny Hoekstra, PhD; Evert G. Schouten, MD, PhD

Arch Gen Psychiatry. 2004;61:1126-1135.

Background  Major depression is known to be related to higher cardiovascular mortality. However, epidemiological data regarding dispositional optimism in relation to mortality are scanty.

Objective  To test whether subjects who are optimistic live longer than those who are pessimistic.

Design  Our analysis formed part of a prospective population-based cohort study in the Netherlands (Arnhem Elderly Study).

Setting  General community.

Participants  Elderly subjects aged 65 to 85 years (999 men and women) completed the 30-item validated Dutch Scale of Subjective Well-being for Older Persons, with 5 subscales: health, self-respect, morale, optimism, and contacts. A total of 941 subjects (466 men and 475 women) had complete dispositional optimism data, and these subjects were divided into quartiles.

Main Outcome Measure  Number of deaths during the follow-up period.

Results  During the follow-up period of 9.1 years (1991-2001), there were 397 deaths. Compared with subjects with a high level of pessimism, those reporting a high level of optimism had an age- and sex-adjusted hazard ratio of 0.55 (95% confidence interval, 0.42-0.74; upper vs lower quartile) for all-cause mortality. For cardiovascular mortality, the hazard ratio was 0.23 (95% confidence interval, 0.10-0.55) when adjusted for age, sex, chronic disease, education, smoking, alcohol consumption, history of cardiovascular disease or hypertension, body mass index, and total cholesterol level. Protective trend relationships were observed between the level of optimism and all-cause and cardiovascular mortality (P<.001 and P = .001 for trend, respectively). Interaction with sex (P = .04) supported a stronger protective effect of optimism in men than women for all-cause mortality but not for cardiovascular mortality.

Conclusions  Our results provide support for a graded and independent protective relationship between dispositional optimism and all-cause mortality in old age. Prevention of cardiovascular mortality accounted for much of the effect.

Author Affiliations: Psychiatric Center GGZ Delfland, Delft (Dr Giltay); Division of Human Nutrition, Wageningen University, Wageningen (Drs Geleijnse, Hoekstra, and Schouten); and Leiden University Medical Center, Department of Psychiatry, Leiden (Dr Zitman), the Netherlands.

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