Mental well-being is a foundation for general health and better quality of life (Thieme et al., Reference Thieme, Wallace, Meyer and Oliver2015). Extant research has identified two forms of mental well-being – “hedonic well-being,” and “eudaimonic well-being” (Fredrickson et al., Reference Fredrickson2013; Huta and Waterman, Reference Huta and Waterman2014). Hedonic well-being is defined as gratifying positive affective experiences and the absence of negative ones, whereas eudaimonic well-being is more of a product of thriving toward meaning and purpose in life. Eudaimonic well-being has been linked to an increased expression in antiviral response genes, as well as a decrease in expression of proinflammatory genes, while the opposite was true for hedonic well-being (Fredrickson et al., Reference Fredrickson2013). These findings thus suggest a possible biological and evolutionary advantage of eudaimonic well-being for the thriving of the human species. Although the definition of eudaimonic well-being varies widely, meaning/purpose in life is found to be a core component in most or all definitions (Huta and Waterman, Reference Huta and Waterman2014).
In an effort to further understanding of the components related to eudaimonic well-being, Fischer and colleagues examined the sociodemographic, military, health, and psychosocial correlates of purpose in life using data on predominantly older 4,069 U.S. military veterans (Mean age = 62.2) from the National Health and Resilience and Veterans Study (Fischer et al., Reference Fischer2023). Purpose in life was measured using the four-item Purpose in Life Test-Short Form (Schulenberg et al., Reference Schulenberg, Schnetzer and Buchanan2010). Results of this study revealed that the strongest correlates of purpose in life, in order of magnitude, were resilience, dispositional optimism, lower depressive symptoms, community integration, dispositional gratitude, lower loneliness, social support, conscientiousness, openness to experience, and intrinsic religiosity. Of note, while the aforementioned characteristics explained more than half of the variance in purpose in life scores, almost all of the observed associations were small in magnitude. This finding suggests that a broad range of psychosocial factors may be linked to greater purpose in life. While longitudinal studies are needed to disentangle the direction of the observed associations, the authors suggested that interventions to target these positive psychosocial factors may help increase purpose in life and mitigate risk for adverse health outcomes in the U.S. military veteran population.
Results of Fischer and colleagues (Fischer et al., Reference Fischer2023) study extend those of a recent prospective meta-analysis of more than 140,000 adults from 32 countries from North and South America, Europe, and the Middle East that examined the cross-sectional association between purpose and meaning in life and cognitive functions (Sutin et al., Reference Sutin, Luchetti, Stephan, Strickhouser and Terracciano2022). Purpose in life was measured with either a 7- or 6-item version of Ryff’s purpose in life scale (Ryff, Reference Ryff1989). In this study, purpose and meaning in life were associated with better performance on measures of episodic memory and verbal fluency. Further, there was modest evidence that these associations were mildly stronger in relatively lower income countries, suggesting that purpose/meaning may operate as a psychological resource for cognitive functioning in economically less robust environment. Yet, there was less consistent evidence that these associations varied by sociodemographic factors such as age, gender, or education. More specifically, purpose and meaning in life was beneficial across different age groups (mildly stronger at older ages in terms of memory), all genders, and education level (mildly stronger at lower education level in terms of memory). Possible mechanisms suggested by the authors include robust associations between purpose and meaning in life, and healthy lifestyle behaviors, positive personality traits (e.g. emotional stability, extraversion, and conscientiousness), and larger social network size. The authors concluded that purpose and meaning in life may be an effective target for interventions to promote healthier cognitive aging. Similarly, in another study of 138 older adults aged 65 years or older with Alzheimer’s disease who were living in a residential care setting, higher meaning in life scores, assessed using the Presence of Meaning subscale of the Meaning in Life Questionnaire-Short Form (Steger and Samman, Reference Steger and Samman2012), were associated with greater life satisfaction scores and lower depressive symptoms after adjusting for demographic variables (i.e. age, sex, and marital status) and cognition (Dewitte et al., Reference Dewitte, Vandenbulcke and Dezutter2019). Interestingly, post hoc analyses suggested a possible interaction between meaning in life and cognitive status in predicting both life satisfaction scores and depressive symptoms. The authors concluded that meaning in life was related to critical well-being measures for older adults with Alzheimer’s disease and that further research on interventions to promote meaning in life in this population may be warranted.
The study by Fischer and colleagues (Fischer et al., Reference Fischer2023) has several notable strengths. First, the large, nationally representative sample of U.S. military veterans reflect contemporary U.S. Census data on veterans and thus has high external generalizability to this population. Second, this study administered a broad range of assessments of psychosocial characteristics such as purpose in life, social support, dispositional optimism, dispositional gratitude, “Big 5” personality dimensions, and religiosity/spirituality. Third, the National Health and Resilience in Veterans Study provides assessments of clinical characteristics such as mental and physical health diagnoses, which allowed the investigators to investigate associations of clinical and protective psychosocial factors associated with purpose in life. Fourth, the analytic approach was systematic and utilized a machine learning approach (i.e. elastic net regression) and relative importance analysis, which quantified the variance in purpose in life scores that was explained by each of the key correlates that were identified.
However, there were also some limitations of the study. First, the cross-sectional nature of the dataset did not allow the investigators to disentangle temporal/causal associations between purpose in life and clinical and psychosocial factors. Further research utilizing longitudinal designs is needed to elucidate the nature of these associations. Second, while the study considered a broad range of sociodemographic, military, health, and psychosocial variables as potential confounders, there are several other important confounders, such as cognitive functioning (Sutin et al., Reference Sutin, Luchetti, Stephan, Strickhouser and Terracciano2022), lifestyle and health behaviors (Mei et al., Reference Mei2021), and physical exercise (Ryff, Reference Ryff2014) that were not included in the analyses. Third, all data were assessed via self-report screening instruments. Future research using structured clinical interviews is needed to replicate the results of this study. Lastly, as the authors mention, the protective psychosocial characteristics examined in this study may share conceptual similarities with purpose in life, which may have inflated strengths of some of the observed associations.
Despite these limitations, results of Fischer and colleagues’ study (Fischer et al., Reference Fischer2023) provide more granularity to factors that might be associated with purpose in life, a core component of eudaimonic well-being, of U.S. military veterans. This is a timely topic given the recent “Whole Health” initiative put forth by the U.S. Department of Veterans Affairs (VA), which emphasizes a person-centered, values-based approach to health and well-being (U.S. Department of Veterans Affairs, 2021). In support of this movement, the National Academies of Science, Engineering, and Medicine recently published, “Achieving Whole Health: A New Approach for Veterans and the Nation,” which provides recommendations for transitioning from a reactive disease-oriented medical care system to one that prioritizes disease prevention, health, and well-being (National Academies of Sciences, Engineering, and Medicine, 2023).
Paralleling such efforts, in the field of psychiatry, “Positive Psychiatry” has been gaining more attention from clinicians and researchers alike (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015). Positive psychiatry is defined as the science and practice of psychiatry that seeks to understand and promote well-being through assessments and interventions targeting positive psychosocial constructs, such as resilience, social support, wisdom, optimism, gratitude, and purpose in life (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015). While the research focus of traditional psychiatry has been on risk factors and psycho/neuropathology, positive psychiatry puts more weight on protective factors and psycho/neuroplasticity (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015). Accordingly, the main treatments for positive psychiatry tend to be less medication- and somatically oriented and consist mainly of psychosocial and behavioral interventions designed to enhance positive psychosocial factors (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015).
The study by Fischer and colleagues (Fischer et al., Reference Fischer2023) shed light on potential targets that may contribute to enhancing purpose in life, which is a core aspect of eudaimonic well-being in veterans. There are a number of evidence-based clinical interventions that have been developed to enhance and promote purpose in life, such as acceptance and commitment therapy (Hayes et al., Reference Hayes, Luoma, Bond, Masuda and Lillis2006), logotherapy (Marshall and Marshall, Reference Marshall and Marshall2012), and dignity therapy (Chochinov et al., Reference Chochinov, Hack, Hassard, Kristjanson, McClement and Harlos2006). In addition to these evidence-based interventions that directly target purpose in life, there are also psychosocial interventions that enhance key correlates of purpose in life identified in this study, such as gratitude, optimism, social support, and religiosity. For example, a recent meta-analysis of 15 studies that examined the effect of psychosocial interventions targeting gratitude (e.g. gratitude list journaling, activities involving the expression of gratitude to another person, psycho-educational groups) showed a moderate effect size relative to an alternative-activity condition (Davis et al., Reference Davis2016). Another meta-analysis of 29 studies showed that psychological interventions designed to enhance optimism (e.g. best possible self, counting blessing, and cognitive behavioral training) had a moderate effect size (Malouff and Schutte, Reference Malouff and Schutte2016). Further, the VA offers services to enhance religiosity/spirituality through chaplain care, as well as to bolster social connectedness through a virtual social prescription program called Compassionate Contact Corps (Taylor, Reference Taylor2021). Further research is needed to examine whether such evidence-based psychosocial interventions designed to target salutogenic factors may help promote eudaimonic well-being in veterans and the population at large.
The results of Fischer and colleagues’ (Fischer et al., Reference Fischer2023) study, as well as movements in mental health and medical field toward well-being and whole health, underscore the need for the health care community to become more attuned to positive psychosocial factors in both clinical and research settings. Further, they highlight the importance of more concentrated efforts to develop comprehensive strategies to enhance eudaimonic well-being.
You have
Access
Mental well-being is a foundation for general health and better quality of life (Thieme et al., Reference Thieme, Wallace, Meyer and Oliver2015). Extant research has identified two forms of mental well-being – “hedonic well-being,” and “eudaimonic well-being” (Fredrickson et al., Reference Fredrickson2013; Huta and Waterman, Reference Huta and Waterman2014). Hedonic well-being is defined as gratifying positive affective experiences and the absence of negative ones, whereas eudaimonic well-being is more of a product of thriving toward meaning and purpose in life. Eudaimonic well-being has been linked to an increased expression in antiviral response genes, as well as a decrease in expression of proinflammatory genes, while the opposite was true for hedonic well-being (Fredrickson et al., Reference Fredrickson2013). These findings thus suggest a possible biological and evolutionary advantage of eudaimonic well-being for the thriving of the human species. Although the definition of eudaimonic well-being varies widely, meaning/purpose in life is found to be a core component in most or all definitions (Huta and Waterman, Reference Huta and Waterman2014).
In an effort to further understanding of the components related to eudaimonic well-being, Fischer and colleagues examined the sociodemographic, military, health, and psychosocial correlates of purpose in life using data on predominantly older 4,069 U.S. military veterans (Mean age = 62.2) from the National Health and Resilience and Veterans Study (Fischer et al., Reference Fischer2023). Purpose in life was measured using the four-item Purpose in Life Test-Short Form (Schulenberg et al., Reference Schulenberg, Schnetzer and Buchanan2010). Results of this study revealed that the strongest correlates of purpose in life, in order of magnitude, were resilience, dispositional optimism, lower depressive symptoms, community integration, dispositional gratitude, lower loneliness, social support, conscientiousness, openness to experience, and intrinsic religiosity. Of note, while the aforementioned characteristics explained more than half of the variance in purpose in life scores, almost all of the observed associations were small in magnitude. This finding suggests that a broad range of psychosocial factors may be linked to greater purpose in life. While longitudinal studies are needed to disentangle the direction of the observed associations, the authors suggested that interventions to target these positive psychosocial factors may help increase purpose in life and mitigate risk for adverse health outcomes in the U.S. military veteran population.
Results of Fischer and colleagues (Fischer et al., Reference Fischer2023) study extend those of a recent prospective meta-analysis of more than 140,000 adults from 32 countries from North and South America, Europe, and the Middle East that examined the cross-sectional association between purpose and meaning in life and cognitive functions (Sutin et al., Reference Sutin, Luchetti, Stephan, Strickhouser and Terracciano2022). Purpose in life was measured with either a 7- or 6-item version of Ryff’s purpose in life scale (Ryff, Reference Ryff1989). In this study, purpose and meaning in life were associated with better performance on measures of episodic memory and verbal fluency. Further, there was modest evidence that these associations were mildly stronger in relatively lower income countries, suggesting that purpose/meaning may operate as a psychological resource for cognitive functioning in economically less robust environment. Yet, there was less consistent evidence that these associations varied by sociodemographic factors such as age, gender, or education. More specifically, purpose and meaning in life was beneficial across different age groups (mildly stronger at older ages in terms of memory), all genders, and education level (mildly stronger at lower education level in terms of memory). Possible mechanisms suggested by the authors include robust associations between purpose and meaning in life, and healthy lifestyle behaviors, positive personality traits (e.g. emotional stability, extraversion, and conscientiousness), and larger social network size. The authors concluded that purpose and meaning in life may be an effective target for interventions to promote healthier cognitive aging. Similarly, in another study of 138 older adults aged 65 years or older with Alzheimer’s disease who were living in a residential care setting, higher meaning in life scores, assessed using the Presence of Meaning subscale of the Meaning in Life Questionnaire-Short Form (Steger and Samman, Reference Steger and Samman2012), were associated with greater life satisfaction scores and lower depressive symptoms after adjusting for demographic variables (i.e. age, sex, and marital status) and cognition (Dewitte et al., Reference Dewitte, Vandenbulcke and Dezutter2019). Interestingly, post hoc analyses suggested a possible interaction between meaning in life and cognitive status in predicting both life satisfaction scores and depressive symptoms. The authors concluded that meaning in life was related to critical well-being measures for older adults with Alzheimer’s disease and that further research on interventions to promote meaning in life in this population may be warranted.
The study by Fischer and colleagues (Fischer et al., Reference Fischer2023) has several notable strengths. First, the large, nationally representative sample of U.S. military veterans reflect contemporary U.S. Census data on veterans and thus has high external generalizability to this population. Second, this study administered a broad range of assessments of psychosocial characteristics such as purpose in life, social support, dispositional optimism, dispositional gratitude, “Big 5” personality dimensions, and religiosity/spirituality. Third, the National Health and Resilience in Veterans Study provides assessments of clinical characteristics such as mental and physical health diagnoses, which allowed the investigators to investigate associations of clinical and protective psychosocial factors associated with purpose in life. Fourth, the analytic approach was systematic and utilized a machine learning approach (i.e. elastic net regression) and relative importance analysis, which quantified the variance in purpose in life scores that was explained by each of the key correlates that were identified.
However, there were also some limitations of the study. First, the cross-sectional nature of the dataset did not allow the investigators to disentangle temporal/causal associations between purpose in life and clinical and psychosocial factors. Further research utilizing longitudinal designs is needed to elucidate the nature of these associations. Second, while the study considered a broad range of sociodemographic, military, health, and psychosocial variables as potential confounders, there are several other important confounders, such as cognitive functioning (Sutin et al., Reference Sutin, Luchetti, Stephan, Strickhouser and Terracciano2022), lifestyle and health behaviors (Mei et al., Reference Mei2021), and physical exercise (Ryff, Reference Ryff2014) that were not included in the analyses. Third, all data were assessed via self-report screening instruments. Future research using structured clinical interviews is needed to replicate the results of this study. Lastly, as the authors mention, the protective psychosocial characteristics examined in this study may share conceptual similarities with purpose in life, which may have inflated strengths of some of the observed associations.
Despite these limitations, results of Fischer and colleagues’ study (Fischer et al., Reference Fischer2023) provide more granularity to factors that might be associated with purpose in life, a core component of eudaimonic well-being, of U.S. military veterans. This is a timely topic given the recent “Whole Health” initiative put forth by the U.S. Department of Veterans Affairs (VA), which emphasizes a person-centered, values-based approach to health and well-being (U.S. Department of Veterans Affairs, 2021). In support of this movement, the National Academies of Science, Engineering, and Medicine recently published, “Achieving Whole Health: A New Approach for Veterans and the Nation,” which provides recommendations for transitioning from a reactive disease-oriented medical care system to one that prioritizes disease prevention, health, and well-being (National Academies of Sciences, Engineering, and Medicine, 2023).
Paralleling such efforts, in the field of psychiatry, “Positive Psychiatry” has been gaining more attention from clinicians and researchers alike (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015). Positive psychiatry is defined as the science and practice of psychiatry that seeks to understand and promote well-being through assessments and interventions targeting positive psychosocial constructs, such as resilience, social support, wisdom, optimism, gratitude, and purpose in life (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015). While the research focus of traditional psychiatry has been on risk factors and psycho/neuropathology, positive psychiatry puts more weight on protective factors and psycho/neuroplasticity (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015). Accordingly, the main treatments for positive psychiatry tend to be less medication- and somatically oriented and consist mainly of psychosocial and behavioral interventions designed to enhance positive psychosocial factors (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015).
The study by Fischer and colleagues (Fischer et al., Reference Fischer2023) shed light on potential targets that may contribute to enhancing purpose in life, which is a core aspect of eudaimonic well-being in veterans. There are a number of evidence-based clinical interventions that have been developed to enhance and promote purpose in life, such as acceptance and commitment therapy (Hayes et al., Reference Hayes, Luoma, Bond, Masuda and Lillis2006), logotherapy (Marshall and Marshall, Reference Marshall and Marshall2012), and dignity therapy (Chochinov et al., Reference Chochinov, Hack, Hassard, Kristjanson, McClement and Harlos2006). In addition to these evidence-based interventions that directly target purpose in life, there are also psychosocial interventions that enhance key correlates of purpose in life identified in this study, such as gratitude, optimism, social support, and religiosity. For example, a recent meta-analysis of 15 studies that examined the effect of psychosocial interventions targeting gratitude (e.g. gratitude list journaling, activities involving the expression of gratitude to another person, psycho-educational groups) showed a moderate effect size relative to an alternative-activity condition (Davis et al., Reference Davis2016). Another meta-analysis of 29 studies showed that psychological interventions designed to enhance optimism (e.g. best possible self, counting blessing, and cognitive behavioral training) had a moderate effect size (Malouff and Schutte, Reference Malouff and Schutte2016). Further, the VA offers services to enhance religiosity/spirituality through chaplain care, as well as to bolster social connectedness through a virtual social prescription program called Compassionate Contact Corps (Taylor, Reference Taylor2021). Further research is needed to examine whether such evidence-based psychosocial interventions designed to target salutogenic factors may help promote eudaimonic well-being in veterans and the population at large.
The results of Fischer and colleagues’ (Fischer et al., Reference Fischer2023) study, as well as movements in mental health and medical field toward well-being and whole health, underscore the need for the health care community to become more attuned to positive psychosocial factors in both clinical and research settings. Further, they highlight the importance of more concentrated efforts to develop comprehensive strategies to enhance eudaimonic well-being.
Conflict of interest
The author have no conflict of interest to disclose.