bottom 25 per cent (quartiles) indicated that 24 per cent of those in the top quartile
had died compared to 54 per cent of those in the bottom quartile. Similar results have
been reported for men. Everson et al. (1996b) examined the relationship between
hopelessness and health outcomes in a large sample of men. Comparing the top and
bottom 33 per cent (tertiles) showed that those in the top tertile compared to the
bottom tertile for hopelessness were 3.5 times more likely to die from all causes of
death, 4 times more likely to die from cardiovascular disease and 2.5 times more likely
to die from cancer. Similarly, men with AIDS who are optimistic live twice as long
as men who are pessimistic (Reed et al., 1994). More generally, among older
individuals, those with positive attitudes towards ageing live an average of 7.5 years
longer than those with more negative attitudes (Levy et al., 2002).
These studies on health outcomes highlight an important but subtle distinction
between optimism and positive affect. Whereas optimism refers to positive beliefs and
feelings about the future, positive affect reflects a level of pleasurable engagement with
the environment such as happiness, joy, excitement, enthusiasm and contentment.
These two tendencies may overlap substantially as is shown in the Danner et al. (2001)
study. However, recent research has begun to examine the effects of positive affect
independently of optimism (see Pressman and Cohen, 2005, for a review of positive
affect and health; see also Chapter 5). One important issue here is the extent to which
positive affect is the opposite of, or alternatively distinct from, negative affect, a
personality trait we consider below. Currently there is evidence supporting each view
as we discuss below.
The explanation for the relationship between optimism and various health outcomes
is still unclear. One interesting suggestion is that those high in optimism may be more
likely to avoid certain high-risk situations. Some supporting evidence for this view
comes from Peterson et al.(1988) who showed that those with an optimistic
attributional style were less likely to die from accidental or violent causes than those
with a pessimistic style, while the two groups did not differ in respect of mortality
from cancer or cardiovascular disease. A further explanation for the relationship
between optimism and health is through the effects of optimism on coping strategies.
Those high in optimism are more likely to use adaptive and functional strategies for
coping with problems such as acceptance, rational thinking, social support and positive
reframing. For example, Scheier, Weintraub and Carver (1986) conducted a study in
which students had to write about coping with stressful situations. Optimists were
found to be more likely to use strategies such as making a plan and sticking to it,
focusing intently on the problem and seeking social support. Optimists were also less
likely to distract themselves from thinking about the problem. Scheier et al. (1989)
reported similar differences between optimists and pessimists in the way they coped
with recovery from surgery that resulted in faster recovery among the optimists. The
use of more constructive coping strategies may lead to better health outcomes, partly
by helping individuals to avoid negative life events and also by helping them to
confront and deal with problems earlier and more effectively. A further explanation
focuses on the effect of pessimism on physiological reactions to stress in terms of
immune functioning and cardiovascular response (Scheier and Carver, 1987). Some
support of this explanation can be found in studies that have shown immune responses
to be lower in pessimists (Segerstrom et al., 1998).
PERSONALITY AND HEALTH 119