Objective: research on the role of positive affect, such as happiness, on health outcomes is burgeoning. Within this context, evidence for an inverse effect of happiness on mortality is inconclusive. Furthermore, few studies link happiness with mortality among older people, and in Asian populations. We examine the association between happiness and all-cause mortality among older people in Singapore.
Methods: data for 4,478 Singaporeans aged ≥60 years enrolled in a nationally-representative longitudinal survey (three waves: 2009; 2011; 2015) were utilised. Happiness, at baseline, in 2009, was measured using three positively-worded items from the Centre for Epidemiological Studies Depression Scale, and considered in two distinct ways in the analyses-continuous ('happiness score' [0-6]) and binary (happy [score = 6]/unhappy). All-cause mortality, until 31 December 2015, was assessed primarily using administrative databases, supplemented by data from survey waves 2 and 3. Multivariable Cox regression models assessed the association of 'happiness score' and the 'binary happiness variable' (separate models for each) with all-cause mortality.
Results: the likelihood of all-cause mortality was lower by 9% (multivariable hazard ratio (HR) [95% confidence interval]: 0.91 [0.87-0.95]) for each unit increase in 'happiness score', and was 19% lower for happy, versus unhappy, older people (HR: 0.81 [0.68-0.97]).
Conclusions: happiness is associated with reduced likelihood of all-cause mortality among older people in an Asian population, with the benefit observed even for incremental increases in happiness. Activities, policies and programs that maintain or improve happiness may be beneficial for a longer life among older people.