Feeling of hopelessness increases risk of dying

Those who lack hope about the future may be at risk of dying prematurely, suggest the results of a study of nearly 800 elderly Americans.

"Why do some people die while others, who may be no less ill, continue to live? One answer to this question may lie in the presence or absence of hope," says lead study author Stephen L. Stern, M.D., of the department of psychiatry at The University of Texas Health Science Center at San Antonio.

Approximately half of the study participants were Mexican American, the fastest growing group of elderly Americans. Other studies also have found hopelessness to predict death, but these studies have generally focused on Europeans or European Americans.

To assess hopelessness, Stern and colleagues asked the study participants one question: "Are you hopeful about the future?" Approximately 10 percent of participants answered "no" to this question and were classified as "hopeless."

During a three-to-seven year period after answering this question, significantly more hopeless study participants died than hopeful participants. Specifically, 29 percent of the hopeless participants died, compared with 11 percent of the hopeful participants.

The study results are published in the May issue of the journal Psychosomatic Medicine.

The researchers noted several study limitations, one being their measurement of hopelessness by a single question, which prevented them from assessing how different degrees of hopelessness affect mortality.

They also called for more research on the causes of hopelessness, as well as on the effectiveness of various treatments, such as antidepressants and psychotherapy. The effects of hopelessness may vary among individuals depending on factors such as cultural background, childhood experiences, economic security and whether hopeless individuals also are experiencing depression, according to the study.

More research is also needed on the exact mechanisms by which hopelessness may increase the risk of death, according to the study. Hopelessness may lead to biochemical and nervous system abnormalities.

Another explanation could be that "hopeless or pessimistic individuals may be less likely to engage in health-promoting behaviors, such as eating well, exercising, following their doctor's recommendations and taking their medications as prescribed," Stern notes.

"A better understanding of the mechanisms that underlie this phenomenon may help us to extend the duration and improve the quality of our patients' lives," Stern says.

This study was funded by the National Institute on Aging.

Psychosomatic Medicine is the official bimonthly peer-reviewed journal of the American Psychosomatic Society. For information about the journal, contact Joel E. Dimsdale, MD, at (619) 543-5468.

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