Life Purpose Significantly Associated with All-Cause Mortality

COMMENT: This was a prospective cohort study drawn from a sample of 6,985 participants in which purpose of life was assessed and all-cause and cause-specific mortality correlated. Life purpose was protective for all-cause mortality and several cause-specific mortality associations, such as heart, circulatory, and blood conditions. This publication has the same limitations as any analysis of large datasets. However, it did make me think about important questions to ask not only patients, but ourselves. It also caused me to reflect on the anecdotes of the distinguished physician who retires and promptly dies the next week. How do we maintain a meaningful identity outside of medicine that allows us to still live with purpose if/when we leave the medical profession?. —Jennifer A. Villwock, MD

Does an association exist between life purpose and all-cause or cause-specific mortality among people older than 50 years participating in the US Health and Retirement Study?

Bottom Line: Life purpose was significantly associated with all-cause mortality in The Health and Retirement Study (HRS). Some significant cause-specific mortality associations with life purpose were also observed.

Background: A growing body of literature suggests that having a sense of purpose in life is associated with both physical and mental health and overall quality of life. Some studies report that those with a strong purpose in life engage in healthy behaviors and have better health outcomes for sleep disturbances, stroke incidence, post-stroke quality of life, depression, and diabetes. There have been no previous analyses in HRS exploring the association between life purpose and cause-specific mortality using the modified Ryff and Keyes Scales of Psychological Well-Being assessment.

Setting: The Health and Retirement Study (HRS).

Synopsis: Of 6,985 individuals included in the analysis, 4,016 were women, the mean age of all participants was 68.6 years, and the mean survival time for decedents was 31.21 months. Purpose in life was assessed for the 2006 interview period with a seven-item questionnaire from the modified Ryff and Keyes Scales of Psychological Well-being evaluation using a Likert scale ranging from 1 to 6, with higher scores indicating greater purpose in life. Individuals who died were more likely to be a current or former smoker, be non-alcohol drinkers, be physically inactive, and have a lower functional status at the time of completing the life purpose questionnaire in 2006. There was a significant association between life purpose and mortality attributed to heart, circulatory, and blood conditions when the lowest and highest life purpose categories were compared and between life purpose and digestive tract system conditions when the lower life purpose categories and the highest category were compared. For cancer and tumors and respiratory tract system conditions, however, no association with mortality was observed. Limitations included a lack of availability for mediation analysis because of the correlated nature of the psychological constructs and because this is a survival analysis, that life purpose at baseline may have been influenced by the presence of a chronic or life-threatening illness, and potential selection bias.

Citation: Alimujiang A, Wiensch A, Boss J, et al. Association between life purpose and mortality among U.S. adults older than 50 years. JAMA Netw Open. May 24, 2019;2:e194270. doi:10.1001/jamanetworkopen.2019.4270.