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2, 133–139 Special issue: Psychobiological approaches to stress and health
Life satisfaction and inﬂammatory biomarkers: The 2008 Scottish Health Survey1
MARK HAMER* University College London
YOICHI CHIDA2 Happy Smile Clinic
Abstract: Positive psychological attributes have been associated with better health outcomes, although the mechanisms remain poorly understood. This study examined associations between life satisfaction and inﬂammatory biomarkers. Participants were 369 men and 428 women (aged 52.1 16.8 years) recruited from the general population. Participants were required to rate their life satisfaction on a scale ranging from 0 (extremely dissatisﬁed) to 10 (extremely satisﬁed). Blood was collected for the measurement of C-reactive protein (CRP) and ﬁbrinogen. In comparison with participants that were dissatisﬁed with life (5.8% of the sample), those that reported high life satisfaction demonstrated a lower CRP concentration (beta coefﬁcient = -.24, 95% CI, -.47, -.02) and lower ﬁbrinogen (b = -.24, 95% CI, -.45, -.04) after adjusting for age, sex, education, smoking, body mass index, and depressive symptoms. Life dissatisfaction was also associated with smoking, lower education, and depressive symptoms. In summary, lower levels of circulating inﬂammatory markers might be an important psychobiological process through which positive psychological attributes protect against disease risk. Key words: positive affect, depression, C-reactive protein, ﬁbrinogen, cardiovascular disease, psychobiology.
An emerging body of evidence has suggested that positive psychological attributes are associated with better health (Pressman & Cohen, 2005). Life satisfaction or perceived level of life enjoyment represents a positive psychological state, and has been associated with a lower risk of future cardiovascular disease and mortality (Chida & Steptoe, 2008; Koivumaa-Honkanen, Honkanen, Viinamäki, Heikkilä, Kaprio, & Koskenvuo, 2000; Shirai, Iso, Ohira, Ikeda,
Noda, Honjo, Inoue, Tsugane, & Japan Public Health Center-Based Study Group, 2009). Life dissatisfaction is associated with increased risk of suicide (Koivumaa-Honkanen, Honkanen, Viinamäki, Heikkilä, Kaprio, & Koskenvuo, 2001), future depression (KoivumaaHonkanen, Kaprio, Honkanen, Viinamäki, & Koskenvuo, 2004) and poor self-rated health and disability (Strine, Chapman, Balluz, Moriarty,& Mokdad,2008).As positive psychological
*Correspondence concerning this article should be sent to: Mark Hamer, Psychobiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK. (E-mail: email@example.com)
The Scottish Health Survey is funded by the Scottish Executive. The views expressed in this article are those of the author and not necessarily of the funding bodies. Dr Hamer is supported by the British Heart Foundation (RG 05/006). Yoichi Chida, Happy Smile Clinic, West Canyon II 3F, 1-12-20, Mizonoguchi, Takatsu-ku, Kawasaki 213-0001, Japan. (E-mail: firstname.lastname@example.org) Dr. Chida was supported by a grant from the NOBUKO-DAIKOKU medical research funding.
© 2011 Japanese Psychological Association. Published by Blackwell Publishing Ltd.
2008). Wardle. Participants gave full informed consent to participate in the study and ethical approval was obtained from the Multi-Centre Research Ethics Committee for Wales (REC reference number: 07/ MRE09/55). O’Donnell. Participants were required to rate their satisfaction with life on a scale ranging from 0 (extremely dissatisﬁed) to 10 (extremely satisﬁed).5%).02) than those included. and with lower cortisol output post-awakening and throughout the day (Brummett. p = . Nurse visit and biomarker data On a separate visit. As inﬂammatory processes have been linked with various health outcomes. within several days of the interview. Badrick. The sample was drawn using multistage stratiﬁed probability sampling with postcode sectors selected at the ﬁrst stage and household addresses selected at the second stage. Assessment of behavioral and psychosocial variables Interviewers were fully briefed on the administration of the survey. but did not differ in other key characteristics such as education (% with no qualiﬁcations. All nurses were professionally qualiﬁed and proﬁcient in taking blood before joining the Health Survey team. positive affect was inversely associated with levels of C-reactive protein (CRP) and interleukin (IL)-6 in women but not men (Steptoe.8 vs. and took anthropometry variables (height. The aim of this study was to investigate the association between life satisfaction and inﬂammatory biomarkers. Steptoe. and hypothalamicpituitary-adrenal (HPA) axis responses to standardized mental stress tasks. smoking). and blood samples from consenting adults. weight). including a practice session. The response rate to the household survey was 61% and comprised 6313 participants. independently from depressive symptoms and other related factors such as smoking and obesity.134 M. ﬁbrinogen. Boyle. & Marmot. The biological mechanisms of positive psychology remain poorly understood. 2008. as adiposity is a major production site of inﬂammatory markers (Hamer & Stamatakis. Libby & Crea. Because previous evidence has suggested an association between obesity and life satisfaction (Strine et al. nationally representative sample of the general population living in households (The Scottish Government.4% vs. It was hypothesized that high life satisfaction would be associated with lower inﬂammatory biomarkers. 24. Ebrahim. Chida attributes are often inversely associated with negative affect such as depression and anxiety it is important to demonstrate that any associations of positive affect on health outcomes are independent from measures of negative affect.g. Within the nurse sample. & Lawlor. & Marmot. those participants that were excluded from the present analyses were slightly younger (50. 2009.1 years. as it might be a key confounder in the association between life satisfaction and inﬂammatory biomarkers. 52. Kumari. health behaviors (e. 2005). this could be a key mechanism in explaining the protective health beneﬁts of positive psychology. 2008). A subsample (n = 1835) of participants was approached for a nurse’s visit and 797 of them provided full data to be included in the present analyses. Siegler. education). They attended a 1. Hamer and Y. 2008). 2010). They were given training in measuring height and weight. 24.. such as cardiovascular disease and cancer (Heikkilä. The present analyses used data from the 2008 SHS in adults aged 18 years and older. Obesity is strongly associated with CRP. Positive affect has been associated with blunted cardiovascular.g.5-day training session at which they Methods Participants and study design The Scottish Health Survey (SHS) is a periodic survey (typically every 3–5 years) that draws a © Japanese Psychological Association 2011. 2008). nurses collected information on medical history. we made an a priori decision to adjust for body mass index. 2007. . Kuhn. & Williams. Anxiety and depressive symptoms were measured using the revised version of the Clinical Interview Schedule (CIS-R). Chida & Hamer. Survey interviewers visited eligible households and collected data on demographics (e. In a sample of 2873 healthy participants from the Whitehall II cohort.
higher national diploma. with a CV of less than 10%.7 13.6 30. All analyses were performed using SPSS (version 14) and all tests of statistical signiﬁcance were based on two-sided probability. Log transformations were used to normalize CRP values.4 4. very high satisfaction (9–10). Results The full sample consisted of 369 men and 428 women (aged 52.0 Very high (n = 273) 54. standard grade. other school qualiﬁcation. Fibrinogen levels were determined using the Organon Teknika MDA 180 analyser. Finally the model was adjusted for anxious and depressive symptoms (ranging from 0–4) in order to examine if associations of life satisfaction was independent from negative psychological states. Life satisfaction scores were recategorized into four groups.2 26.4 29.2 Life satisfaction group Moderate (n = 103) 54.8 years) for all analyses involving CRP.5 54.3 28. moderate satisfaction (5–6). overweight.9 16. The limit of detection was 0.6 10.8 8.17 mg/L and the coefﬁcient of variation (CV) was less than 6% for this assay. . All blood samples were frozen at –70°C until assay.4 17.1 16. Additionally. Statistical analysis A large number of quality control measures was built into the survey at both data collection and subsequent stages to check on the quality of interviewer and nurse performance.2 27.3 43. high satisfaction (7–8).6 27.4 45.4 47. These associations were © Japanese Psychological Association 2011.2 13. and have lower anxious and depressive symptoms (Table 1).8% of participants were dissatisﬁed with life (a rating score of 0–4). not smoke. > 25–30.4 received equipment training and were briefed on the speciﬁc requirements of the survey with respect to taking blood and other measures.7 17. body mass index category (underweight.5 22. previous. normal 18.4 High (n = 375) 49. although a reduced sample size was used for ﬁbrinogen analyses because 185 participants had missing data. no qualiﬁcation).5 21. obese. The analysis of CRP levels from serum was performed using the N Latex high sensitivity CRP mono immunoassay on the Behring Nephelometer II analyser. General linear models were employed to examine associations between life satisfaction and inﬂammatory biomarkers. < 18. representing low satisfaction (rating score of 0–4). Participants reporting high life satisfaction were more likely to be educated. using a modiﬁcation of the Clauss thrombin clotting method. smoking (never. current). higher grade. > 30 kg/ m2).1 41.0. we performed linear regression analyses treating the life satisfaction score (0–10) as a continuous variable.Life satisfaction and C-reactive protein 135 Table 1 Descriptive characteristics of the study sample in relation to life satisfaction (n = 797) Variable Lowest (n = 46) Age (years) Men (%) Education (% no qualiﬁcation) Current smokers (%) Obesity (% > 30 kg/m2) Depressive symptoms (% any) Anxious symptoms (% any) 52. and further models included adjustment for education (university degree or higher.1 18.3% of the sample and 5. In the basic model we adjusted for age and sex.2 24.5–25. All analyses were carried out in the same laboratory according to Standard Operating Procedures by State Registered Medical Laboratory Scientiﬁc Ofﬁcers.3 30.0 43. Peripheral blood was collected in serum tubes and spun at room temperature.7 44.4 50.3 22. Life satisfaction was linearly and inversely associated with both CRP (Table 2) and ﬁbrinogen (Table 3). Very high life satisfaction (a rating of 9 or 10) was reported in 34.5.
body mass index. education. -.42.40..29 (-.43.001 Model 2 b (95% CI) Reference -.136 M.11) .22 (-.-.47. those that had high life satisfaction demonstrated lower CRP concentration (multivariate adjusted beta coefﬁcient = -.4 1.3 3.08) -.55.54. . -.04) . . and the results were slightly strengthened. Data are adjusted regression coefﬁcients (95% CI) Life satisfaction Low Medium High Very high p-trend Mean ﬁbrinogen SEM (g\L) 3.-.03 Model 1 b (95% CI) Reference -. -. and these associations were independent of anxious and depressive symptoms. Model 2 further adjusted for smoking.3 3. the life satisfaction © Japanese Psychological Association 2011.42.28.01) after adjustments for age.25 (-. -. These ﬁndings are partly consistent with a previous study of healthy participants from the Whitehall II cohort.11 (-.14) -. -.008).5 3.47.44. somewhat attenuated after adjustment for possible confounders.13) -.36 (-.35. Model 1 adjusted from age and sex.58. Table 3 Association between life satisfaction and ﬁbrinogen (n = 612).01) -. We repeated the analyses using life satisfaction as a continuous variable in linear regression models in order to retain greater statistical power.23 (-.28. body mass index.10) .007. 95% CI. Chida Table 2 Association between life satisfaction and C-reactive proteina (n = 797). Model 1 adjusted from age and sex. Model 3 further adjusted for anxious and depressive symptoms.13 (-. -.11 Note. although the .03) .03) -.23 (-. in comparison with participants that were dissatisﬁed with life. p = .000. 2008).6 . . 95% CI.031. score remained inversely associated with log CRP (b = -. and anxious and depressive symptoms.2 3.-. -. p = . In the present study there were no clear differences in results between men and women.51. sex.-.35.14) -. . -.04) -.20 (-.096 Note.48.10 (-. p = .34 (-.00) .32 (-.0 3. .011 Model 3 b (95% CI) Reference -.36 (-.008 Model 2 b (95% CI) Reference -.3 4. In these analyses.18) < .21 (-. .05) -.3 Model 1 b (95% CI) Reference -.07. which demonstrated an inverse association between positive affect and levels of CRP and IL-6 in women only (Steptoe et al. These analyses were repeated after removing 69 participants who reported a history of cardiovascular disease (angina. -.26 (-. p = .045 Model 3 b (95% CI) Reference -. a All regression coefﬁcients are from log transformed data. education.2 .05) and ﬁbrinogen (b = -.08) -.028. smoking. -. inverse association between life satisfaction and two inﬂammatory markers. Model 2 further adjusted for smoking. Hamer and Y. -.24 (-. Discussion and conclusions The results of the present study demonstrate a linear.03. 95% CI.03 .17 (-.0 . . -.055 to -. and remained marginally signiﬁcant after accounting for anxious and depressive symptoms.44.48. Model 3 further adjusted for anxious and depressive symptoms. The covariate that accounted for the largest attenuation in effect size in model 2 was smoking. There were no clear differences in our results between men and women. body mass index.37. heart attack.19 (-.57.14) -.02) -.03) and ﬁbrinogen (b = -. Data are adjusted regression coefﬁcients (95% CI) Life satisfaction Low Medium High Very high p-trend Mean C-reactive protein SEM (mg\L) 5.47.34. 95% CI. or stroke).2 . -.1 .1 .03) -.056 to . education.
which is a representative sample of the US population (Strine et al.. Lapidus. dysregulated HPA activity may promote glucocorticoid receptor resistance and subsequent diminished responsiveness of immune cells to regulation by cortisol (Miller. Galanos. By contrast. & Bjorntorp. . Life satisfaction was assessed from one question and therefore may not effectively convey the diverse components comprising this construct. Thus. Kaprio. Hamer. Viinamäki. & Silverstein. which is not entirely consistent with prior studies. The proportion of the sample that reported that they were dissatisﬁed/very dissatisﬁed with life is very similar to data reported from the Behavioral Risk Factor Surveillance System. 2005). and Kluger (1995) showed that glucocorticoids in the physiological range induce IL-6 and TNF-a when administered at either basal (35 ng/ml) or stressrelated (350 ng/ml) levels in an in situ liver perfusion. 1993. Steptoe et al. Marin. & Ritchey. & Chida. -1. 1999). so the effects of changes in this variable cannot be accounted for. 95% CI. 2002). although others have suggested that it might be modiﬁed by experiences in the past decade and expectations of the © Japanese Psychological Association 2011. These cytokines critically contribute to the production of CRP from the liver. predicted weight gain in older women (Korkeila. 2008). & Sorensen. The sympathetic nervous system might also be implicated as a potential mechanism. 2009.. Swain. One possible explanation for the association between life satisfaction and circulating inﬂammatory markers might be linked with HPA axis function.096). Several limitations should also be highlighted. Kunkel. and the well characterized study members. Wong.. In the present study there was a weak inverse association between life satisfaction and systolic blood pressure (age and sex adjusted b = -. 1998) and waist/hip circumference ratio was negatively associated with life satisfaction among middle-aged men (Rosmond. life satisfaction was only measured once. The strengths of the study include the sampling of a large. Liao. the ﬁnal HPA axis effector hormones. & Le. Freudenberg. However. Kaprio. This study has several strengths and limitations. We did not observe any association between life satisfaction and obesity. Rissanen. The inclusion of other measures on general positive affect would therefore have strengthened the results. stress perception may be involved in life satisfaction and may partly explain the present ﬁndings. The present data also replicated other ﬁndings from that study. 2008). Keiser. because direct measures of HPA activity and glucocorticoid receptor resistance were not available from this study we can only speculate about the mechanisms. 2007). the doses of GCs used in the above studies were in the pharmacological range. Johnson. Scales. p = . at both the transcriptional and translational levels (Gonzalez. Chida & Hamer. Morrison. Indeed. Previous evidence suggests that life satisfaction is stable and trait-like (KoivumaaHonkanen. which might suggest lower sympathetic activation in participants with higher life satisfaction. a low level of life satisfaction was associated with obesity in the general adult US population (Strine et al. However. Appleyard. Cohen. which suggests that GCs do not consistently suppress the production of proinﬂammatory cytokines. & Koskenvuo. the association between life satisfaction and inﬂammatory markers might be partly explained by HPA axis function. Honkanen. Koshenvuo. as in the Whitehall II study. Given that acute mental stress can evoke inﬂammatory responses (Steptoe. are generally thought to inhibit the production of pro-inﬂammatory cytokines of IL-6 and tumor necrosis factor (TNF)-a. Wallace. representative general population-based group. 1996).09 mmHg. Glucocorticoids (GCs). smoking and depressive symptoms. For example.Life satisfaction and C-reactive protein 137 present sample contained participants from the general population and was not restricted to a working sample. 2008.11 to .51. 2005). Secondly. which showed associations of life dissatisfaction with poor education. given previous ﬁndings that positive affect was associated with blunted HPA axis responses to standardized mental stress tasks and with lower cortisol output post-awakening and throughout the day (Brummett et al. which facilitates insights into the role of potential confounding factors.
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