Sunday, February 8, 2015

Do you know what you're trying to accomplish?

While I will be the first to swoon over Victorian literature, and allured by the romance and grandiosity of 15th century French imperial etiquette, I am beyond grateful to be living in a time where I can benefit from modern medicine. In the past century, we have all-but-eliminated over a dozen deadly illnesses all through preventing their spread from person-to-person. However, if you really think about how medicine is different today than it was 100 or even 30 years ago, it’s not that we’ve gotten so much more skilled at treating disease (in some cases we have, but not most), it’s that we have built a healthcare system that is expert at preventing illness from ever reaching a point that would be life-threatening. 

All you have to do is visit your physician and get check-ups at least once per year, and you can avoid the agony and loss and pain of several ailments that have plagued our grandmothers and grandfathers for centuries. Some examples of common preventive actions are flu shots, cholesterol tests, prostate exams, pap smears, mammograms, and colonoscopies. These handful of assessments were developed for early detection of the majority of illnesses that cause pain and suffering in the developed world.

Unfortunately, despite all of these advances, people don’t participate in preventive health care. In fact, in the U.S. only 30% of adults between the ages 50-65 are “up-to-date” on their preventive health, while only 50% of people 65+ are “up-to-date.” What gives?

There are a lot of reasons that people don’t get these assessments done as they should and they are all good reasons. Most people have jobs and responsibilities, most people don’t think getting a colonoscopy sounds very fun, most people don’t want to get bad news, and the list goes on.

When faced with these striking numbers and a lack of explanation for them, my good friend and expert in psychology and public health, Eric S. Kim at the University of Michigan (GO BLUE!) asked whether there were psychological variables that explain who does and does not keep their health under control using these preventive measures. In particular, he was interested in whether people with higher “purpose in life” were more likely to participate in these preventive health measures.

Purpose in life was first introduced by Viktor Frankl in an excellent and ground-breaking book, Man’s Search for Meaning where he shared his observations on the strength of the human spirit during the Holocaust. In psychology, purpose in life is measured by asking individuals, “On a scale of 1 to 6, 6 being strongly agree, how much would you agree with the statement, ‘I enjoy making plans for the future and working to make them a reality?’ or ‘I don’t have a good sense of what it is I’m trying to accomplish in life?’ Purpose in life has come up in a past post, where we learned that people with higher purpose in life live longer.

To answer this question, Kim used data from the Health and Retirement Study (HRS), which is a large, longitudinal data set of over 26,000 adults who have been recruited at age 50 and followed every two years since 1992. Kim used data from 7,168 of these participants (mean age 69) who were followed for 6 years. In the initial assessment, information on each individuals’ current purpose in life, physical health, mental health, and socioeconomic status was collected. Then, every 2 years, the participants reported on whether they had received a flu shot, a colonoscopy, a mammogram for females, a prostate exam for males, or had their cholesterol checked. They also asked each participant whether they had been hospitalized during the past year, and if so, for how many days.

They found that higher purpose in life was associated with a higher likelihood of receiving all but one of the preventive health measures, the flu shot, and that a 1 point increase in purpose in life related to a 17% decrease in the length of hospital stay. Keep in mind that this finding remains even when accounting for family income, type of health insurance, education, marital status, age, and symptoms of depression and anxiety. In other words, people who reported more purpose in life 6 years ago were more like to get a mammogram or a prostate exam, a colonoscopy, and have their cholesterol checked than people with lower reported purpose in life, not to mention when they got sick they had shorter stays in hospitals. The latter finding fits well with past studies showing that more purpose in life is related to less inflammation in the body, meaning that people who have surgery, get sick, or injured will get better faster from the same ailment.

What’s most striking to me is that purpose in life is measured on a 6 point scale. In this study people generally had purpose in life on the higher side, with the average for the “low” group at around a 3, and “high” at around a 5. This means that very small increases in purpose in life can have significant implications for health. Now that we know purpose in life is a magical, health elixir, the million dollar question is whether we can increase purpose in life in order to improve health on a national or even global scale. Programs such as “Well-Being Therapy” are promising. Well-Being Therapy is a cognitive-behavioral intervention designed to prevent depression relapse by helping individuals improve quality of life and experience more fulfillment.

But what if you don’t feel like you have purpose in life right now? Lots of people feel lost at times, direction-less. The research presented here is not causing better health, it is causing behavior that protects health, participation in preventive medicine. The best way to protect your health is to see your primary care physician and regularly.

Kim, E. S., Strecher, V. J., & Ryff, C. D. (2014). Purpose in life and use of preventive health care services. Proceedings of the National Academy of Sciences, 111(46), 16331-16336.

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