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Purpose in life: reduces dementia risk, increases life expectancy, treats depression and builds wellbeing

I was struck by a paper published this month in the journal Archives of General Psychiatry - "Effect of purpose in life on the relation between Alzheimer disease pathologic changes on cognitive function in advanced age".  The authors wrote "In recent years, systematic examination has shown that purpose in life is associated with a substantially reduced risk of incident AD (Alzheimer disease), mild cognitive impairment, disability, and death. In this study, we sought to extend these findings by examining the neurobiologic basis of the protective effect of purpose in life on cognition."  The same research group published a fascinating paper a couple of years ago - "Purpose in life Is associated with mortality among community-dwelling older persons" - with its abstract reading "Objective: To assess the association between purpose in life and all-cause mortality in community-dwelling elderly persons. Methods: We used data from 1238 older persons without dementia from two longitudinal cohort studies (Rush Memory and Aging Project and Minority Aging Research Study) with baseline evaluations of purpose in life and up to 5 years of follow-up to test the hypothesis that greater purpose in life is associated with a reduced risk of mortality among community-dwelling older persons. Results: The mean {+/-} standard deviation score on the purpose in life measure at baseline was 3.7 {+/-} 0.5 (range = 2-5), with higher scores indicating greater purpose in life. During the 5-year follow-up (mean = 2.7 years), 151 of 1238 persons (12.2%) died. In a proportional hazards model adjusted for age, sex, education, and race, a higher level of purpose in life was associated with a substantially reduced risk of mortality (hazard ratio = 0.60, 95% Confidence Interval = 0.42, 0.87). Thus, the hazard rate for a person with a high score on the purpose in life measure (score = 4.2, 90th percentile) was about 57% of the hazard rate of a person with a low score (score = 3.1, 10th percentile). The association of purpose in life with mortality did not differ among men and women or whites and blacks. Further, the finding persisted after the addition of terms for several potential confounders, including depressive symptoms, disability, neuroticism, the number of chronic medical conditions, and income. Conclusion: Greater purpose in life is associated with a reduced risk of all-cause mortality among community-dwelling older persons."

And these findings aren't only relevant for older people.  So Steger & colleagues recently reported in their paper "Meaning in life across the life span: Levels and correlates of meaning in life from emerging adulthood to older adulthood" that "Meaning in life is thought to be important to well-being throughout the human life span. We assessed the structure, levels, and correlates of the presence of meaning in life, and the search for meaning, within four life stage groups: emerging adulthood, young adulthood, middle-age adulthood, and older adulthood. Results from a sample of Internet users (N = 8756) demonstrated the structural invariance of the meaning measure used across life stages. Those at later life stages generally reported a greater presence of meaning in their lives, whereas those at earlier life stages reported higher levels of searching for meaning. Correlations revealed that the presence of meaning has similar relations to well-being across life stages, whereas searching for meaning is more strongly associated with well-being deficits at later life stages."  And in a similar vein, Cotton Bronk et al wrote in "Purpose, hope, and life satisfaction in three age groups" that "Using the Revised Youth Purpose Survey (Bundick et al., 2006), the Trait Hope Scale (Snyder et al., 1991), and the Satisfaction with Life Scale (Diener, Emmons, Larsen & Griffin, 1985), the present study examined the relationship among purpose, hope, and life satisfaction among 153 adolescents, 237 emerging adults, and 416 adults (N = 806). Results of this cross-sectional study revealed that having identified a purpose in life was associated with greater life satisfaction at these three stages of life. However, searching for a purpose was only associated with increased life satisfaction during adolescence and emerging adulthood. Additionally, aspects of hope mediated the relationship between purpose and life satisfaction at all three stages of life. Implications of these results for effectively fostering purpose are discussed."

These findings have such wide relevance - for how we raise & educate our children, for our own health & wellbeing, and for our work as health professionals.  There are fascinating potential implications for psychotherapy.  See, for example, Jonathan Adler's paper published this year -  "Living into the story: agency and coherence in a longitudinal study of narrative identity development and mental health over the course of psychotherapy"  - with its abstract reading "Narrative identity is the internalized, evolving story of the self that each person crafts to provide his or her life with a sense of purpose and unity. A proliferation of empirical research studies focused on narrative identity have explored its relationship with psychological well-being. The present study is the first prospective, multiwave longitudinal investigation to examine short-term personality change via an emphasis on narrative identity as it relates to mental health. Forty-seven adults wrote rich personal narratives prior to beginning psychotherapy and after every session over 12 assessment points while concurrently completing a measure of mental health. Narratives were coded for the themes of agency and coherence, which capture the dual aims of narrative identity: purpose and unity ... Results indicated that, across participants, the theme of agency (purpose) ... increased over the course of time. In addition, increases in agency were related to improvements in participants' mental health. Finally, lagged growth curve models revealed that changes in the theme of agency occurred prior to the associated improvements in mental health."  See too last year's findings by Vilhauer et al in "Treating major depression by creating positive expectations for the future" where they reported "The study examined a new manualized treatment designed to help people anticipate a more positive future ... compared to depressed patients in the same clinic who enrolled in traditional cognitive-based group psychotherapy."  A description of the research commented "Recent imaging studies show that depressed patients have reduced functioning in the regions of the brain responsible for optimism ... Also, people with depression tend to have fewer skills to help them develop a better future. They have less ability to set goals, problem solve or plan for future events ... Future-Directed Therapy is designed to reduce depression by teaching people the skills they need to think more positively about the future and take the action required to create positive future experiences ... (it) helps people shift their attention constructing visions of what they want more of in the future and it helps them develop the skills that they will need to eventually get there."  The results of the comparison trial were clearly encouraging with this future-orientated approach producing greater improvements than traditional cognitive-behavioural therapy in depression, anxiety and overall life satisfaction & enjoyment.

I will write soon about how one can assess & monitor levels of purpose in life - see "Purpose in life: how do you score on the questionnaire & why does it matter?" 

(This post on the importance of purpose in life for health & wellbeing and the next one on purpose in life questionnaires have been combined into a handout that is downloadable both as a Word doc and as a PDF file)

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