Is subjective well-being independently associated with mortality? A 14-year prospective cohort study in a representative sample of 25 139 US men and women

OBJECTIVES: To examine whether the inverse association of subjective well-being with mortality is independent of self-rated health and socioeconomic status in healthy adults. DESIGN: A population-based prospective cohort study based on an in-person interview. Cox regression was used to examine mortality hazards for happiness alone and for a standardised summary well-being measure that included happiness, life satisfaction and negative emotions. Using prespecified analyses, we first adjusted for age and then additionally adjusted for self-rated health and then race/ethnicity, marital status, smoking and socioeconomic status. SETTING: Probability sample of adult US residents interviewed in their homes in 2001. PARTICIPANTS: 25 139 adults free of cardiovascular disease and cancer at baseline. PRIMARY OUTCOME MEASURE: All-cause mortality 14 years after the baseline interview as assessed by probabilistic matching using the National Death Index. RESULTS: Age-adjusted unhappiness was associated with mortality (HR 1.27; 95% CI 1.11 to 1.45, p=0.001) but the association attenuated after adjusting for self-rated health (HR 1.01; 95% CI 0.88 to 1.16, p=0.85). A similar pattern was seen for the summary well-being measure in fully adjusted models (HR 1.00; 95% CI 0.99 to 1.00, p=0.30). In contrast, self-rated health was strongly associated with mortality. In the fully adjusted model with the summary well-being measure the hazards for good, very good and excellent self-rated health were 0.71 (95% CI 0.62 to 0.80, p<0.001), 0.63 (95% CI 0.55 to 0.71, p<0.001) and 0.45 (95% CI 0.39 to 0.51, p<0.001), respectively. CONCLUSIONS: In this representative sample of US adults, the association between well-being and mortality was strongly attenuated by self-rated health and to a lesser extent socioeconomic status.