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Does Happiness Improve Health? Evidence From a Randomized Controlled Trial

Affiliations.

1 Department of Psychology, Georgetown University.
2 Department of Psychology, Rutgers University, Newark.
3 Department of Psychology, University of British Columbia.
4 Department of Psychology, University of Virginia.
PMID: 32579432
DOI: 10.1177/0956797620919673

Happier people are healthier, but does becoming happier lead to better health? In the current study, we deployed a comprehensive, 3-month positive psychological intervention as an experimental tool to examine the effects of increasing subjective well-being on physical health in a nonclinical population. In a 6-month randomized controlled trial with 155 community adults, we found effects of treatment on self-reported physical health-the number of days in the previous month that participants felt healthy or sick, as assessed by questions from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System Questionnaire. In a subsample of 100 participants, we also found evidence that improvements in subjective well-being over the course of the program predicted subsequent decreases in the number of sick days. Combining experimental and longitudinal methodologies, this work provides some evidence for a causal effect of subjective well-being on self-reported physical health.

Trial registration: ClinicalTrials.gov NCT02782611 .

Keywords: happiness; health; life satisfaction; open data; open materials; preregistered; randomized controlled trial; well-being.

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What the Longest Study on Human Happiness Found Is the Key to a Good Life

The Harvard Study of Adult Development has established a strong correlation between deep relationships and well-being. The question is, how does a person nurture those deep relationships?

This article was featured in One Story to Read Today, a newsletter in which our editors recommend a single must-read from The Atlantic , Monday through Friday. Sign up for it here.

T urn your mind for a moment to a friend or family member you cherish but don’t spend as much time with as you would like. This needn’t be your most significant relationship, just someone who makes you feel energized when you’re with them, and whom you’d like to see more regularly.

How often do you see that person? Every day? Once a month? Once a year? Do the math and project how many hours annually you spend with them. Write this number down and hang on to it.

For us, Bob and Marc, though we work closely together and meet every week by phone or video call, we see each other in person for only a total of about two days (48 hours) every year.

How does this add up for the coming years? Bob is 71 years old. Marc is 60. Let’s be (very) generous and say we will both be around to celebrate Bob’s 100th birthday. At two days a year for 29 years, that’s 58 days that we have left to spend together in our lifetimes.

Fifty-eight out of 10,585 days.

Of course, this is assuming a lot of good fortune, and the real number is almost certainly going to be lower.

Since 1938, the Harvard Study of Adult Development has been investigating what makes people flourish. After starting with 724 participants—boys from disadvantaged and troubled families in Boston, and Harvard undergraduates—the study incorporated the spouses of the original men and, more recently, more than 1,300 descendants of the initial group. Researchers periodically interview participants, ask them to fill out questionnaires, and collect information about their physical health. As the study’s director (Bob) and associate director (Marc), we’ve been able to watch participants fall in and out of relationships, find success and failure at their jobs, become mothers and fathers. It’s the longest in-depth longitudinal study on human life ever done, and it’s brought us to a simple and profound conclusion: Good relationships lead to health and happiness. The trick is that those relationships must be nurtured.

From the June 2009 issue: What makes us happy?

We don’t always put our relationships first. Consider the fact that the average American in 2018 spent 11 hours every day on solitary activities such as watching television and listening to the radio. Spending 58 days over 29 years with a friend is infinitesimal compared with the 4,851 days that Americans will spend interacting with media during that same time period. Distractions are hard to avoid.

Thinking about these numbers can help us put our own relationships in perspective. Try figuring out how much time you spend with a good friend or family member. We don’t have to spend every hour with our friends, and some relationships work because they’re exercised sparingly. But nearly all of us have people in our lives whom we’d like to see more. Are you spending time with the people you most care about? Is there a relationship in your life that would benefit both of you if you could spend more time together? Many of these are untapped resources, waiting for us to put them to use. And, enriching these relationships can in turn nourish our minds and bodies.

Y ou don’t have to examine scientific findings to recognize that relationships affect you physically. All you have to do is notice the invigoration you feel when you believe that someone has really understood you during a good conversation, or the tension and distress you feel after an argument, or how little sleep you get during a period of romantic strife.

In this sense, having healthy, fulfilling relationships is its own kind of fitness—social fitness—and like physical fitness, it takes work to maintain. Unlike stepping on the scale, taking a quick look in the mirror, or getting readouts for blood pressure and cholesterol, assessing our social fitness requires a bit more sustained self-reflection. It requires stepping back from the crush of modern life, taking stock of our relationships, and being honest with ourselves about where we’re devoting our time and whether we are tending to the connections that help us thrive. Finding the time for this type of reflection can be hard, and sometimes it’s uncomfortable. But it can yield enormous benefits.

Many of our Harvard Study participants have told us that filling out questionnaires every two years and being interviewed regularly have given them a welcome perspective on their life and relationships. We ask them to really think about themselves and the people they love, and that process of self-reflection helps some of them.

Read: 10 practical ways to improve happiness

This is a practice that could help anyone. Looking in the mirror and thinking honestly about where your life stands is a first step in trying to live a good life. Noticing where you are can help put into relief where you would like to be. Having some reservations about this kind of self-reflection is understandable. Our study participants were not always keen on filling out our questionnaires, or eager to consider the larger picture of their life. Some would skip difficult questions or leave entire pages blank, and some would just not return certain surveys. Some even wrote comments in the margins of their questionnaires about what they thought of our requests. “What kinds of questions are these!?” is a response we received occasionally, often from participants who preferred not to think about difficulties in their life. The experiences of the people who skipped questions or entire questionnaires were also important, though—they were just as crucial in understanding adult development as the experiences of people eager to share. A lot of useful data and gems of experience were buried in the shadowed corners of their lives. We just had to go through a little extra effort to excavate them.

One of these people was a man we’ll call Sterling Ainsley. (We are using a pseudonym to protect his confidentiality as a study participant.)

Black line drawing illustration of a person inside a bubble of curly cues

S terling Ainsley was a hopeful guy. He graduated from Harvard in the 1940s and then served in World War II. After he left the service, he got a job as a scientist and retired in his 60s. When asked to describe his philosophy for getting through hard times, he said, “You try not to let life get to you. You remember your victories and take a positive attitude.”

The year was 1986. George Vaillant, the then-director of the study, was on a long interview trek, driving through the Rocky Mountains to visit the study’s participants who lived in Colorado, Utah, Idaho, and Montana. Sterling had not returned the most recent survey, and there was some catching up to do. He met Vaillant at a hotel to give him a ride to the diner where Sterling wanted to do his scheduled interview. When Vaillant buckled himself into the passenger seat of Sterling’s car, the seat belt left a stripe of dust across his chest. “I was left to wonder,” he wrote, “the last time somebody had used it.”

Sterling was technically married, but his wife lived far away, and they hadn’t slept in the same room in years. They spoke only every few months.

Read: The six forces that fuel friendship

When asked why they had not gotten a divorce, he said, “I wouldn’t want to do that to the children,” even though his kids were grown and had children of their own. Sterling was proud of his kids and beamed when he spoke of them, saying they were the most important thing in his life. But he rarely saw them and seemed to prefer to keep his relationships with them thriving mostly in his imagination. Vaillant noted that Sterling seemed to be using optimism to push away some of his fears and avoid challenges in his life. Putting a positive spin on every matter and then pushing it out of his mind made it possible for him to believe that nothing was wrong, he was fine, he was happy, his kids didn’t need him.

He didn’t travel to see his son’s new home abroad, because he didn’t “want to be a burden”—even though he’d been learning a new language to prepare for the trip. He had another child who lived closer, but he hadn’t visited in more than a year. He didn’t have a relationship with his grandchildren, and he wasn’t in contact with any friends.

When asked about his older sister, Sterling seemed startled. “My sister?” he said.

Yes, the sister he had told the study so much about when he was younger.

Sterling thought about it for a long time, and then told Vaillant that it must have been decades since he last spoke with her. A frightened expression came over his face. “Would she still be living?” he said.

Sterling tried not to think about his relationships, and he was even less inclined to talk about them. This is a common experience. We don’t always know why we do things or why we don’t do things, and we may not understand what is holding us at a distance from the people in our life. Taking some time to look in the mirror can help. Sometimes there are needs inside of us that are looking for a voice, a way to get out. They might be things that we have never seen or articulated to ourselves.

This seemed to be the case with Sterling. Asked how he spent his evenings, he said he spent time with an elderly woman who lived in a nearby trailer. Each night he would walk over, and they’d watch TV and talk. Eventually she would fall asleep, and he would help her into bed and wash her dishes and close the shades before walking home. She was the closest thing he had to a confidant.

“I don’t know what I’ll do if she dies,” he said.

Listen to Robert Waldinger in conversation with Arthur Brooks and Rebecca Rashid on "How to Build a Happy Life":

L oneliness has a physical effect on the body. It can render people more sensitive to pain, suppress their immune system, diminish brain function, and disrupt sleep, which in turn can make an already lonely person even more tired and irritable. Research has found that, for older adults, loneliness is far more dangerous than obesity. Ongoing loneliness raises a person’s odds of death by 26 percent in any given year. A study in the U.K., the Environmental Risk (E-Risk) Longitudinal Twin Study, recently reported on the connections between loneliness and poorer health and self-care in young adults. This ongoing study includes more than 2,200 people born in England and Wales in 1994 and 1995. When they were 18, the researchers asked them how lonely they were. Those who reported being lonelier had a greater chance of facing mental-health issues, partaking in unsafe physical-health behaviors, and coping with stress in negative ways. Add to this the fact that a tide of loneliness is flooding through modern societies, and we have a serious problem. Recent stats should make us take notice.

In a study conducted online that sampled 55,000 respondents from across the world, one out of every three people of all ages reported that they often feel lonely. Among these, the loneliest group were 16-to-24-year-olds, 40 percent of whom reported feeling lonely “often or very often.” In the U.K., the economic cost of this loneliness—because lonely people are less productive and more prone to employment turnover—is estimated at more than £2.5 billion (about $3.1 billion) annually and helped lead to the establishment of a U.K. Ministry of Loneliness.

Read: Why do we look down on lonely people?

In Japan, 32 percent of adults expected to feel lonely most of the time during 2020. In the United States, a 2019 study suggested that three out of four adults felt moderate to high levels of loneliness. As of this writing, the long-term effects of the coronavirus pandemic, which separated us from one another on a massive scale and left many feeling more isolated than ever, are still being studied.

Alleviating this epidemic of loneliness is difficult because what makes one person feel lonely might have no effect on someone else. We can’t rely entirely on easily observed indicators such as whether or not one lives alone, because loneliness is a subjective experience. One person might have a significant other and too many friends to count and yet feel lonely, while another person might live alone and have a few close contacts and yet feel very connected. The objective facts of a person’s life are not enough to explain why someone is lonely. Regardless of your race or class or gender, the feeling resides in the difference between the kind of social contact you want and the social contact you actually have.

Black line drawing of two people connected by curly line

I t never hurts —especially if you’ve been feeling low—to take a minute to reflect on how your relationships are faring and what you wish could be different about them. If you’re the scheduling type, you could make it a regular thing; perhaps every year on New Year’s Day or the morning of your birthday, take a few moments to draw up your current social universe, and consider what you’re receiving, what you’re giving, and where you would like to be in another year. You could keep your chart or relationships assessment in a special place, so you know where to look the next time you want to peek at it to see how things have changed.

If nothing else, doing this reminds us of what’s most important. Repeatedly, when the participants in our study reached old age, they would make a point to say that what they treasured most were their relationships. Sterling Ainsley himself made that point. He loved his older sister deeply—but he lost touch with her. Some of his fondest memories were of his friends—whom he never contacted. There was nothing he cared more about than his children—whom he rarely saw. From the outside it might look like he didn’t care. That was not the case. Sterling was quite emotional in his recounting of his most cherished relationships, and his reluctance to answer certain study questions was clearly connected to the pain that keeping his distance had caused him over the years. Sterling never sat down to really think about how he might conduct his relationships or what he might do to properly care for the people he loved most.

Sterling’s life reminds us of the fragility of our connections, and it echoes the lessons of science: Relationships keep us happier and healthier throughout our life spans. We neglect our connections with others at our peril. Investing in our social fitness is possible each day, each week of our lives. Even small investments today in our relationships with others can create long-term ripples of well-being.

This article is adapted from Robert Waldinger and Marc Schulz’s new book, The Good Life: Lessons From the World’s Longest Scientific Study of Happiness .

When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

happy is healthy medical research has found

When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

About the Authors

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Int J Environ Res Public Health

Health, Hope, and Harmony: A Systematic Review of the Determinants of Happiness across Cultures and Countries

Sunitha singh.

1 Centre for Entrepreneurship and Innovation, American University in Dubai, Dubai 28282, United Arab Emirates

Sowmya Kshtriya

2 Department of Psychology, Montclair State University, Montclair, NJ 07043, USA

Reimara Valk

3 School of Business and Management, American University in Dubai, Dubai 28282, United Arab Emirates

Associated Data

The data presented in this study are available in the Appendix A .

The aim of this study was to review the literature on what constitutes happiness across cultures and countries to advance scholarly knowledge on the happiness construct. A systematic review was conducted to examine the determinants of happiness in samples across cultures and countries. Five different databases, including APA PsycNet, EBSCO-Academic, EBSCO-Business, Project MUSE, and Google Scholar, grey literature, and in-text references from relevant review articles were used. A total of 155 articles were included in the review, encompassing studies from over 100 countries and 44 cultures. Myriad determinants of happiness were found that were placed into three broad categories labeled Health, Hope, and Harmony. The predominant happiness determinants were mental, emotional, and physical well-being, a purposeful holistic work–life balance, nurturing social relationships, caring for self and others, and being in harmony with one’s culture, traditions, community, religion, and environment. This study engendered an “Integrated Model of the Determinants of Happiness” to provide a universally applicable conceptualization of the happiness construct. By examining studies on determinants of happiness across the globe in the past 90 years, this review uncovered that happiness constitutes multiple determinants that fall under three major categories: ‘Health’, ‘Hope’, and ‘Harmony’.

1. Introduction

“Happiness is the meaning and the purpose of life, the whole aim, and the end of human existence.” The ancient Greek philosopher Aristotle said these words more than 2000 years ago, and they still ring true today. In Aristotle’s Nicomachean Ethics, happiness is described as the human good that we all aim for its sake alone, and Freud emphasized that happiness is something we strive towards, desire to attain, and maintain throughout our lives [ 1 , 2 , 3 ]. The 1776 U.S. Declaration of Independence states that all men have a right to “the pursuit of happiness,” where the notion of happiness is equated to the attainment of a worthy life [ 4 ].

Moreover, the concept of happiness is gaining increasing popularity within and across cultures [ 5 , 6 , 7 ], so much so that in recent years, there has been a shift in measuring economic production to measuring happiness as an indicator of social development and individual welfare across nations [ 8 ].

Since the advent of the field of positive psychology in the late 1990s, scientific investigations have uncovered happiness as an essential psychological ingredient for optimal human functioning that makes life worth living [ 9 ]. Happiness is conceptualized as an appraisal of life [ 8 ], a state of mind [ 6 ], a psychological state [ 5 ], and a positive health indicator [ 8 ], and is synonymous with subjective well-being [ 7 , 9 ]. All in all, happiness has been defined in various ways.

Happiness as overall satisfaction with life: Happiness has been conceptualized as an evaluation of life [ 8 ], as overall satisfaction with everyday life [ 10 ], and as the overall quality of one’s life [ 11 ].

Happiness resulting from positive experiences and positive outcomes: Traditionally, happiness has been defined by the experience of more frequent positive affective states than negative ones [ 12 ]. Happiness is more than just a personally important goal or a set of pleasant mood states [ 13 ], and is related to, precedes, and causes a variety of favorable life outcomes [ 14 ]. Furthermore, across studies, happiness has been defined as a positive subjective experience [ 15 ].

Happiness as a psychological state of mind, and well-being: Studies have also defined happiness as a psychological state [ 5 ], a state of mind [ 6 ], a “state of being” [ 16 ], a positive attitude toward life [ 17 ], a healthy mental status, emotional balance, hope for the future [ 17 ], and subjective well-being (SWB) [ 7 ], which is the psychological state of well-being, joy, and contentment [ 14 , 18 ]. Happiness as an emotional state is linked to one’s physiological reactions to life events [ 19 ] based on the Hedonic Adaptation Theory of Brickman and Campbell [ 20 ] and the Set-Point Theory [ 21 ].

Happiness as a health indicator: In a study, 785 participants were asked to list associations that came to mind on hearing the word happiness [ 22 ]. The participants associated happiness mostly with health and relationships.

Happiness as a transient state: Happiness is defined as a transient mood state of enthusiasm and joy, and it reflects the person’s effect on one’s current state [ 15 ].

Despite the myriad conceptualizations of happiness, there are several questions that remain unanswered. The research questions that guided this inquiry were: Is happiness a temporary state of mind or emotion? Is happiness something we are born with, attain with time, or both? Or Is happiness a period of long-term life satisfaction and general well-being that we all aspire to have in our lives?

This systematic review attempts to answer these questions and other novel questions that may emerge during the research. The aim of this systematic review [ 23 ] is to advance scholarly knowledge by critically reviewing [ 24 , 25 ] the available literature on what constitutes happiness across cultures and countries. In so doing, the reviewers attempt to present a comprehensive conceptualization of happiness that encompasses its determinants coherently and to arrive at a universally applicable conceptualization of happiness supporting the attainment of the following United Nations Sustainable Developmental Goals (SDGs): Good Health and Well-Being (Goal 3), Decent Work and Economic Growth (Goal 8), and Responsible Consumption and Production (Goal 12).

2. Materials and Methods

2.1. literature search and study selection.

A systematic review [ 23 ], was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA model, Figure 1 ) [ 26 ], and the Critical Appraisal Skill Program (CASP) Checklist [ 23 , 24 , 25 ]. These protocols were followed to examine the literature on what constitutes happiness across cultures and countries.

An external file that holds a picture, illustration, etc.
Object name is ijerph-20-03306-g001.jpg

PRISMA flow diagram of the systematic review performed that included searches of databases (19 May to 30 July 2020). Note. Hx: happiness variable, IV: independent variable.

2.2. Articles Search and Counts

In a meta-analysis [ 27 ] (p. 2695), the following keywords that were derived [ 28 ] were highlighted, which included terms such as, “happiness” OR “fulfillment” OR “satisfaction” OR “subjective well-being” OR “meaning” OR “pleasure.” Thus, for this systematic review [ 23 ], searches were conducted using the Boolean search strategy that utilized similar keywords, “happiness” OR “well-being” OR “health” OR “life-satisfaction” OR “hope” OR “pleasure” OR “harmony.” The justification for the use of these keywords was to examine happiness and its underlying determinants. Using these keywords, initial studies were identified from the following databases: APA PsycNet—384 studies, EBSCO Academic—1260 studies, EBSCO Business—206, Google Scholar—379, and Project MUSE—446. A total number of 2675 studies relating to happiness and its underlying determinants were shortlisted for review.

The procedure for shortlisting included first reviewing titles that examined happiness, after which, the corresponding abstracts were read. Other published works such as book chapters, case studies, commentaries, or grey literature were initially screened but excluded due to the lack of focus on their empirical quality in assessing the happiness variable. In total, 2238 articles were removed that did not meet the authors’ generic and the three specific inclusion criteria. Furthermore, 223 articles were sought for retrieval using Mendeley research software, at which point, 3 were further removed for overlaps found ( Figure 1 ).

For consistency in the search and quality assurance, all searches were performed using specific inclusion criteria, (i) the happiness variable was measured specifically within the study, (ii) happiness was a dependent variable only and not an independent variable, and (iii) happiness was measured quantitatively. Based on the search results, the inclusion criteria for the literature search and study selection included selecting studies, (i) between 1930 and the present that included the oldest empirical study of happiness [ 29 ], (ii) the article type that was peer-reviewed empirical research, and scholarly journals with an impact factor closer to 10 (between 8 and 10), and (iii) all studies had at least one of the search keywords mentioned above. The data were sought to arrive at the underlying determinants of happiness across cultures and countries, through the investigation of the concept of happiness. The extraction criteria were based on the PRISMA model of systematic reviews ( Figure 1 ) [ 23 , 26 ].

Identification: During the identification stage, an initial 2675 peer-reviewed articles related to happiness from 1930 to current (90 years) were found. Before screening, a total of 214 duplicate articles were removed from articles downloaded from four databases ( Table 1 ). In total, 14 duplicate articles were found in APA PsycNet, 43 duplicate articles were found in EBSCO Academic, 21 duplicate articles were found in EBSCO Business, and 136 articles were found in the Project MUSE database ( Table 1 ).

Initial articles were downloaded from five databases.

Databases	Total	Articles Overlap	Total Peer-Reviewed Articles
APA PsycNet	384	14	370
EBSCO–Academic	1260	43	1217
EBSCO–Business Source	206	21	185
Google Scholar	379	0	379
Project MUSE	446	136	310
	2675	214	2461

Screening: During the screening stage, a total of 2461 abstracts were selected after removing 214 redundancies (overlaps/duplicates). The abstracts for all 2461 articles were downloaded and further screened for articles that aligned with the authors’ generic and specific inclusion criteria. A total of 220 articles were thus chosen as eligible for a detailed systematic review. These were downloaded onto Mendeley’s research software.

A detailed study of each of the 220 articles led to a further exclusion of 65 articles that comprised 18 review articles and 47 articles that were screened out by the authors’ exclusion criteria where (i) no happiness variable was measured specifically within the study, or, (ii) happiness was an independent variable only and not a dependent variable, or, (iii) happiness was only measured qualitatively.

After the studies were identified, duplicate records were removed and screened, and studies were sought for retrieval and assessed for eligibility (PRISMA model, Figure 1 ), and chosen for review ( Figure 1 ) [ 26 ]. In total, 155 studies were shortlisted for review after applying the exclusion and inclusion criteria and the CASP checklist [ 24 ]. Studies were selected for a full review if they helped respond to the following questions: What constitutes happiness? Or what contributes to happiness? Or what does happiness consist of?

2.3. Critical Appraisal and Assessment Procedure

The critical appraisal [ 24 , 25 ] further involved specific inclusion and assessment criteria that validated each study regarding its thoroughness and credibility. The studies that we included in the systematic review were mainly empirical studies. The three inclusion criteria applied within the study, (i) the happiness variable was measured specifically within the study, (ii) happiness was a dependent variable only and not an independent variable, and (iii) happiness was measured quantitatively. It involved looking at crucial elements such as (i) the study’s purpose, (ii) objectives, (iii) a methodological design that included p -value significance testing ( p ≤ 0.05), (iv) the use of valid and reliable happiness measures that showed high Cronbach’s alpha coefficient values (0.7 or higher) for the population in each study, (v) sample demographics such as size, age, gender distributions, geographic, or ethnic distributions, and (vi) institutional review board-compliant studies. Ranking the research methodology was also performed based on (i) methodology quality—prevent systematic errors, (ii) precision—random errors (width of confidence around the results), (iii) external validity—the extent to which we applied results to the target population and, (iv) conclusion—expressed on the bases of exploration of ‘what ifs’ and sensitivity analysis. Finally, the following three exclusion criteria were applied for excluding studies beyond the scope of this systematic review, (i) no happiness variable was measured specifically within the study, (ii) happiness was an independent variable only and not a dependent variable, and (iii) happiness was only measured qualitatively.

The Critical Appraisal Skill Program (CASP) checklist [ 24 ] for systematic reviews [ 23 ], was used to appraise the studies and extract data. Three broad issues were considered when appraising the studies: (i) Are the results of the study valid? (ii) What are the results? (iii) Will the results help locally? Moreover, based on the 10 questions from the CASP Checklist [ 24 ], the reviewers evaluated the three broad issues systematically. The 10 questions comprised some screening questions that were answered with either a ‘yes’ or ‘no’. The 10 questions and their responses were,

i. Whether the review addresses a focused question? Yes, the focused question was to examine what constitutes happiness across cultures and countries.
ii. Did the reviewers look for the right type of papers? Yes, studies with an appropriate study design and set inclusion/exclusion criteria were selected.
iii. Whether all relevant studies were included? Yes, the reviewers looked at the reference list and bibliographic databases that were used in addition to the chosen academic databases to saturate the search on relevant articles pertaining to this study.
iv. Did the reviewers assess the quality of the studies included? Yes, the reviewers considered the rigor of the studies as identified in the inclusion and exclusion criteria.
v. Was it reasonable to combine the results of the studies? Yes, when the results from different studies were similar in terms of the determinants of happiness then the results were combined and shown under the positive and negative associations of these determinants with happiness under the Section 3 .
vi. What were the overall results of the review? These are shown in each of the tables under findings and correlation analysis.
vii. How precise were the results? The precision was assessed based on how neatly the outcomes matched the study samples with a low rate of errors.
viii. Are the results of the study valid? p -value significance testing ( p = < 0.05) was considered to ensure the validity of the results in each study.
ix. Will the results help locally? Yes, as studies explored happiness in local contexts such as specific countries.
x. Were all important outcomes considered? Yes, the information gathered was large and comprehensive.

The total number of studies was equally divided amongst the authors for individual manuscript review. Using the CASP checklist, each author assessed a set number of studies (e.g., around 50+ studies per author) and created a table to organize the key points from each study, including study journal, happiness measure, sample size/range, and variable findings ( Appendix A : Table A1 , Table A2 and Table A3 ). Using this method, all studies were referenced, noting each study’s participant demographics and the results where happiness was the dependent variable, and its determinants were the independent variables. Thus, out of the initial 2675 articles identified from the databases ( Table 1 ), a final count of 155 empirical studies on happiness was shortlisted and included in the review ( Figure 1 ).

The 155 manuscripts that were included in the review were equally and randomly divided amongst the three reviewers. Each reviewer was responsible for reviewing around 50 articles. All three authors reviewed the literature and read the abstracts and articles. Based on the CASP checklist [ 24 ] appraisal and the inclusion and exclusion criteria, the three reviewers agreed on which studies to include or exclude. All three reviewers reached a consensus on the criteria for the studies. Subsequently, each reviewer extracted the data, populated tables, compiled the manuscript findings, organized the references, and formatted the tables for their designated set of studies. All three reviewers collectively discussed and put together the thematic and characterization work and developed the universal model of happiness based on the common determinants that emerged during the systematic review.

Whereas the systematic review was not based on any specific theoretical model, the happiness findings uncovered used many theoretical models ranging from the integrative model of sustainable happiness [ 14 ], philosophy and psychological theory, where to the average individual, personal happiness is generally held to be the ultimate aim of all human endeavor [ 30 ], the ‘theory of Seligman’ [ 28 ], which offers three possibilities: happiness can be reached through pleasure, meaning, or engagement [ 31 ], the implicit theory framework of happiness to foster a more complete understanding of the processes underlying well-being [ 32 ], the theory of personality, where happiness is a personality variable for which a biological basis can be considered [ 33 ], and the theory of positive psychology [ 14 ].

The final 155 studies revealed manifold determinants of happiness ( Table A1 , Table A2 and Table A3 ). Based on the commonalities between these determinants across the findings, we placed these happiness determinants into three broad categories, labeled as, Health, Hope, and Harmony. We conceptualized the first category, “Health”, as a complete state of mental, emotional, and physical well-being. We conceptualized the second category “Hope” as the highest degree of well-founded expectation such as goal achievement and personal and economic growth. Lastly, we conceptualized the third category “Harmony” as a state of being in alignment with aspects of social, familial, cultural, and environmental determinants. The relationships between all categorized determinants and happiness are further elucidated below ( Figure 2 ).

An external file that holds a picture, illustration, etc.
Object name is ijerph-20-03306-g002.jpg

Process flow diagram of the findings of the search and selection process. Note. IV: independent variable; DV: dependent variable.

3.1. Health and Happiness

A total of 56 studies ( Table A1 ) examined the determinants of health. For precision and simplicity, the Health determinants were categorized under mental, emotional, and physical determinants based on the patterns that emerged across the studies.

3.1.1. Mental Health and Happiness

A total of nineteen studies examined the effects of mental health on happiness. The age range of the participants across these studies was between 10 and 99 years, and the participants were from China, Europe, Germany, India, Iran, Korea, New Zealand, Romania, Spain, Thailand, Turkey, the UK, and the USA. These studies used both female and male participants where a majority were male (55% female, 45% male).

Thirteen studies showed an increase in happiness caused by mental health determinants such as positive general mental health, mindfulness, decreased posttraumatic stress symptoms, creativity, and self-affirmation. Six studies showed a decrease in happiness caused by the determinants of mental health such as adverse mental health outcomes, depression, poor perception of health, lifetime trauma, addiction, and heavy use of screen-based media. These determinants were seen to have a negative relationship with happiness across Asian, American, Black, Hispanic, Native American, Mixed, and White cultures and ethnic groups.

Several studies investigated mental health treatment and its relationship with happiness. A group of researchers showed that meditation (seven-day intensive Vipassana retreat) enhanced happiness [ 34 ]. Another research study found that a greater number of sessions per client and decreased post-traumatic stress symptoms were associated with greater counselor happiness [ 35 ]. Mindfulness, grit, and coping competence were found to positively predict happiness [ 9 , 36 , 37 , 38 ]. Hope and mindfulness were found to share a positive relationship with happiness, and the recognition of new possibilities and personal strength predicted happiness [ 39 , 40 ]. Another group of researchers showed that engaging in spontaneous self-affirmation was related to greater happiness and that self-esteem is an antecedent of happiness [ 41 , 42 ].

Several studies examined negative determinants of happiness. A research study found that a poorer perception of mental health was associated with less happiness [ 43 ]. Another study showed daily subtle negative experiences were related to adverse mental health outcomes, such as depression, suicidality, and decreased happiness [ 44 ]. A study that examined alexithymia, depression, anxiety, stress, and the relationship of fatigue with happiness, found that decreased posttraumatic stress symptoms were associated with greater counselor happiness [ 45 ]. Higher rates of current depression were associated with higher levels of happiness seeking, and greater distress (behavioral health) was associated with lower global happiness [ 46 ]. Research showed depression was significantly and negatively associated with pleasure [ 47 ], which in turn is associated with happiness. Research revealed an association between creativity and depression and happiness ratings [ 48 ]. Other studies examined traumatic life events and happiness. The relationship between lifetime trauma and happiness found that bereavement of a child was associated with lower levels of happiness [ 49 , 50 ]. A negative relationship between stressful life events and happiness was found among humbler people [ 51 ].

Studies that examined the association between addiction and happiness found that heavy screen-based media use was associated with less happiness [ 52 ], and higher addiction led to lower levels of happiness [ 53 ]. A study found internet addiction significantly related to subjective unhappiness [ 18 ].

3.1.2. Emotional Health and Happiness

A total of nine studies examined the effects of emotional health on happiness. The age range of the participants across these studies was between 9 and 64 years, and the participants were from Asia, Africa, Australia, Canada, China, Europe, India, the Middle East, the UK, and the USA. These studies also used both female and male participants (50% female, 50% male).

All nine studies showed an increase in happiness across countries caused by myriad emotional health determinants that included psychological well-being, Big Five personality traits, humor, gratitude, efficacy, caring climate, and positive emotions. These determinants were seen to have a positive association with happiness.

A study found that psychopathic personality traits such as fearless dominance positively correlated with higher durable happiness and negatively correlated with fluctuating happiness [ 54 ]. Fluctuating happiness was described as a sudden increase in happiness, followed by a sudden decrease [ 54 ]. Big Five personality traits of extraversion, agreeableness, neuroticism, conscientiousness, and openness to experiences were found to be associated with subjective happiness [ 33 ]. Holistic wellness and resilience were found to be determinants of happiness [ 33 , 55 ]. Similarly, psychological well-being was found to have a significant positive association with subjective happiness [ 56 ]. Research showed a positive association between positive emotions and greater happiness [ 57 ]. Positivity predicted positive emotions with greater happiness [ 14 ].

Efficacy and a caring climate were positively associated with happiness (emotional health) [ 58 ]. Adaptive humor styles (affiliative humor and self-enhancing humor) significantly predicted subjective happiness, whereas maladaptive humor styles (aggressive humor and self-defeating humor) did not strongly predict subjective happiness [ 59 ]. Gratitude practice was found to bolster happiness [ 59 ].

Various studies investigated psychological determinants of subjective happiness. Three positive psychology determinants that included gratitude visits, three good things in life, and using signature strengths in a new way, were found to increase happiness [ 28 ]. Positive psychological intervention improved happiness of patients undergoing in vitro fertilization as a treatment to become pregnant [ 60 ].

3.1.3. Physical Health and Happiness

A total of 28 studies examined the effects of physical health on happiness. The age range of participants across these studies was between 5 and 100 years, and the participants were from 44 countries including Africa, Canada, 15 European countries, the Far East, France, Germany, Georgia, Greece, India, Iran, Italy, Netherlands, Nicaragua, Palestine, Poland, South America, Taiwan, the UK, and the USA. These studies also used most male participants (45% female, 55% male).

A total of 16 studies showed an increase in happiness caused by various physical health determinants that included regular physical activity, general physical health, the health of parents, a healthy diet, health insurance, cochlear implantation surgery, and home dialysis, and nine studies showed a decrease in happiness caused by various determinants of physical health such as poor health, disability, handicap, abuse, advancing age, disfigurement, transition to adulthood, older transgender youth, perceived illness, and health problems.

A study by a group of researchers showed that general health is associated with general happiness [ 61 ]. Similarly, health was found to positively associate with happiness [ 22 ]. Physical activity was associated with higher levels of happiness [ 62 ] and increasing the volume of physical activity was found to be associated with higher levels of happiness [ 63 ]. Another study found that individuals who are more physically active are happier [ 64 ]. A study also found that regular physical activity was associated with greater happiness [ 65 ].

Some studies examined severe disability and illness with happiness. A group of researchers found increased levels of perceived illness to be significantly associated with decreased happiness [ 66 ]. More health problems and greater perceived seriousness of the health problems/effects were found to be associated with less happiness [ 67 ]. Disability was found to be associated with moderate to large drops in happiness over time [ 68 ]. Positive meta-stereotype (positive image) and better perceived general health were associated with higher overall happiness, whereas feelings of loneliness and disability/handicap were associated with lower overall happiness [ 69 ]. Suffering from a severe disability was associated with less happiness, and higher BMI was associated with steeper declines in happiness [ 70 ]. Conversely, greater happiness was also found among handicapped youth vs. control handicapped youth [ 16 ]. People with disfigurements were subjectively judged as being less happy [ 71 ].

Several studies investigated medical health policies and the perceptions of health and their relation to happiness. A study showed that national health insurance significantly increased happiness [ 72 ]. Cochlear implantation surgery was found to increase happiness in mothers of children with hearing loss [ 73 ]. Higher levels of happiness were found among home dialysis patients [ 66 ]. Another study reported greater happiness post-renal transplant [ 74 ]. Use of a microswitch-based program for Rett syndrome (promotes locomotion fluency) was found to increase happiness [ 75 ].

Some studies established relationships between age and happiness in general and based on early trauma and stressful events experienced throughout life. Some studies found no significant difference in the happiness levels between children, adolescents, and adults [ 10 , 76 ]. Another study showed individual happiness determined by age and found a U-shaped relationship between age and happiness [ 77 ]. Studies also found a trend in the trajectory of happiness from early adulthood to midlife [ 8 , 78 ]; they showed that older adults who experienced traumatic events during childhood vs. after the transition to adulthood exhibited lower subjective happiness; as age increased, happiness levels decreased. Transition to adulthood exhibited lower subjective happiness and happiness showed a downward trend in the older age groups [ 79 , 80 ]. Research showed a negative association between a past-negative time perspective and happiness with aging [ 81 ]. A study found that older transgender youth experienced lower happiness than younger patients [ 82 ]. Being younger, widowed, or separated from a spouse and experiencing high levels of stress had significant direct effects on diminishing happiness with low levels of health satisfaction [ 83 ]. Another study showed that eudaimonia and hedonic happiness remained relatively stable across the lifespan only in the most affluent nations [ 84 ]. This showed the role of determinants in the relationship between age and happiness.

3.2. Hope and Happiness

Hope was an emergent happiness theme. A total of 23 studies ( Table A2 ) examined the hope-based determinants of happiness, classified into the categories of purpose and goal achievement, personal growth, and economic growth, based on the patterns that emerged across the studies. Within these categories, goal achievement, task performance, a greater set of goals to pursue, the enjoyment of and success at work, life satisfaction, and positive thinking about the future had a positive association with happiness; socioeconomic status, economic scarcity, and unemployment had a positive association with happiness.

3.2.1. Goal Achievement and Happiness

A total of 10 studies identified a range of work- and study-related determinants that influenced happiness through hope for goal achievement. The age range of participants was between 15 and 94 years, and the participants were from 32 countries including Asia, China, Europe, Germany, Iran, and the USA. Both female and male participants were present in these studies, with a majority being female (55% female, 45% male).

All 10 studies showed an increase in happiness caused by the determinants of goal and purpose that included occupation, task performance, goal focus, a greater set of goals to pursue, education, the enjoyment of and success at work, occupational control, compensation, scholastic achievement, self-employment, job training, and need-supplies across different communities.

Mastery-approach goals were found to facilitate higher levels of happiness with task performance than performance-approach goals in conditions of unfavorable social comparisons [ 85 ]. Greater elective selection (choosing a particular goal or set of goals to pursue), loss-based selection (selecting goals in the face of resource loss), optimization (enhancing or acquiring resources to achieve a goal), and compensation (reallocating resources towards another goal to maintain functioning at a specific level) were found related to greater happiness [ 86 ]. A person’s valence success at a task predicted greater happiness when they succeeded, but greater unhappiness when they failed [ 87 ]. High core self-evaluation and needs-supplies fit (congruence between employees’ needs and the rewards received for work) significantly predicted greater happiness [ 88 ]. Enjoyment of and success in work and serious hard-working living were determinants contributing to happiness [ 29 ]. Job training, cognition, health, social network, and extraversion explained a substantial proportion of variance in happiness [ 89 ]. Higher occupational status corresponded to greater happiness [ 90 ]. Similarly, more education, higher personal income, and greater occupational control were related to increased happiness (in men) [ 91 ]. Job satisfaction in self-employed workers vs. organizational workers is related to greater happiness [ 92 ]. Nations with better scholastic achievement performances (mathematics, reading, and scientific literacy) displayed higher happiness scores [ 93 ].

3.2.2. Personal Growth and Happiness

A total of eight studies examined the effects of personal growth on happiness. The age range of the participants across these studies was between 18 and 91 years, and the participants were from Ghana, Slovenia, Switzerland, and the USA. Both female and male participants were present in these studies, with the majority being female (55% female, 45% male). The determinants of personal growth on happiness that emerged were life satisfaction, positive thinking about oneself, growth mindsets, opportunities for learning, perceived power, personal meaning, and positive engagement.

All studies showed an increase in happiness caused by personal growth determinants such as personal growth, life satisfaction, positive thinking about oneself, growth mindsets, opportunities for learning, perceived power, personal meaning, and positive engagement.

Emotional intelligence, personal growth initiative, and life satisfaction showed an association with happiness [ 94 ]. Growth mindsets led to stronger beliefs in the changeable nature of happiness and were found associated with greater well-being and greater relationship satisfaction [ 32 ]. Perceived power was positively related to happiness [ 95 ]. Other studies examined the association between meaning, positive engagement in happiness showed that meaning and engagement were positively associated with happiness [ 31 ]. Orientation to pleasure, meaning, and engagement (dimension-centered approach) was positively associated with happiness [ 96 ]. Rumination inducing messages led to less happiness, whereas hope-inducing messages led to greater happiness [ 97 ]. Higher personal mastery and positive health behaviors were positively correlated with happiness [ 98 ]. Higher resilience was associated with greater joviality and happiness [ 99 ].

3.2.3. Economic Growth and Happiness

A total of five studies examined the effects of economic growth on happiness. These studies employed the following happiness measures: The age range of the participants across these studies was between 15 and 91 years, and the participants were from 32 cultures across 6 continents and 100 countries that included Asia, Africa, America, China, Indonesia, National Survey, Pakistan, Philippines, and Thailand. Both female and male participants were present in these studies, the majority being female (52% female, 48% male).

Three studies showed an increase in happiness caused by the determinants of economic growth that included increased economic growth, socio-economic status, and fiscal decentralization across economically diverse communities. Two studies showed a negative impact on happiness caused by the determinants of economic growth that included less economic freedom, economic scarcity, the earnings of others, unemployment, and economic disparity across communities.

The determinants of economic growth on happiness, such as socioeconomic status, and fiscal decentralization increased happiness ( Table A2 ). Less economic freedom, economic scarcity, the earnings of others, unemployment, and economic disparity were determinants of economic growth that harmed happiness, as reported in the three studies referenced below.

Subjective socioeconomic status and coming from a higher-income country positively correlated with happiness [ 100 ]. Rapid economic growth and rises in the price of housing led to greater happiness in older people than the youth [ 101 ]. Income did not affect the level of happiness of those who lived in either urban or rural areas [ 102 ]. Fiscal decentralization (improved capacity of districts to deliver public services) significantly increased citizen happiness [ 103 ].

Other studies looked at the impact of economic scarcity on happiness. Individuals with unemployment and low health status reported lower happiness [ 104 ]. A study found less economic freedom was negatively associated with happiness [ 105 ]. These studies show that social comparison rather than absolute earnings or economic status has a great influence on the assessment of happiness. Collectively, these studies show the impact of one’s economic status on happiness, whereas lower status has a greater negative impact on happiness.

3.3. Harmony and Happiness

Harmony emerged as a happiness determinants category, where 76 studies ( Table A3 ) examined the determinants of harmony on happiness. For precision and simplicity, the harmony determinants were categorized under social, family, culture, and environment determinants based on the patterns that emerged across the studies.

3.3.1. Social Harmony and Happiness

A total of 12 studies examined the effects of social relationships on happiness and found a positive relationship between them. The age range of the participants across these studies was between 16 and 79 years, and the participants were from 34 countries including Asia, the Americas, Spain, Canada, Germany, South Africa, Slovak, Uganda, the UK, and the USA. Both female and male participants were present in these studies, the majority being female (54% female, 46% male).

In total, 11 studies showed an increase in happiness caused by the determinants of social context that included prosocial behavior, social relations, life balance, leisure, social support, sense of community, socializing, developing positive thinking about social groups, nurturing social relationships, and social context. One study showed no significant relationship between social support and happiness.

Study showed that individual-level happiness was determined by social context, i.e., age, education, employer status, and health [ 106 ]. Prosocial actions (acts of kindness towards others) led to greater increase in happiness than self-focused actions and neutral behaviors [ 107 ]. Prosocial spending was consistently associated with greater happiness [ 108 ]. Influence, social relations, life balance, optimism, work, and leisure were all positively associated with happiness levels [ 15 ]. Social relations, higher social support, and a sense of community, even online (Facebook), contributed to decreased loneliness and increased happiness [ 109 , 110 , 111 ]. School belonging mediated the association between social and academic competence and students’ concurrent happiness [ 112 ]. However, a study found no significant relationship between social support and happiness [ 113 ].

These studies collectively show that a sense of belonging, good social relations, and support are important determinants of happiness. Other studies examined the effect of social activities on happiness. Training programs in happiness that centered on fundamentals such as keeping busy, spending more time socializing, developing positive thinking, and working on a healthy personality demonstrated significant happiness increase over a control group receiving summary instruction in the program [ 30 ]. Activities endorsed by happiness seekers included nurturing social relationships, practicing acts of kindness, pursuing goals, practicing religion and/or spirituality, using strategies to cope with stress or adversity, avoiding overthinking and social comparison, practicing meditation, goal evaluation and tracking, savoring the moment, gratitude journaling, thinking optimistically, remembering happy days, and strengthening social relationships [ 13 ].

3.3.2. Family Harmony and Happiness

A total of 33 studies examined the effects of harmony in the family on happiness and found a positive relationship between them. The age range of participants across these studies was between 3 and 96 years, and the participants were from Africa, China, Egypt, Europe, the Far East, Iceland, India, Iran, Japan, Korea, New Zealand, Nicaragua, Pakistan, Portugal, South Africa, South America, Spain, the UK, and the USA. These studies used both female and male participants, where the majority were female (65% female, 35% male).

A total of 29 studies showed an increase in happiness caused by the determinants of family, which included family support, family communication, good connections with family, emotional support, home-dwelling elders, time spent with parents, positive mothering, positive marital relationship, entering cohabitation, perceived help from spouse, gender levels, women’s self-esteem, quality of experience in wife’s role, pregnant women, work-family conciliation, higher resilience, and women with higher affective intensity.

Studies that revolved around family communication, emotional support, and family social support, showed that improved subjective happiness led to family happiness [ 114 , 115 , 116 , 117 ]. Happiness was found to be positively associated with good connections with family and friends, school, regular exercise, and meals with family [ 118 ]. Family social support, i.e., cohesion, expressiveness, and conflict, showed a positive association with happiness [ 119 ]. Family communication, family well-being, and gratitude intervention improved family happiness [ 114 , 120 ]. Similarly, family communication, emotional support, and family social support were found leading to improved subjective happiness and family happiness [ 115 ].

Some studies examined the relationship between elders and happiness. Highly successful and home-dwelling elders demonstrated significantly higher happiness [ 121 ]. Emotional support from parents together with time spent with parents had the largest positive influence on happiness [ 122 ]. Higher perceptions of work–family conciliation predicted higher happiness [ 123 ]. Positive mothering led to increased joy and pleasure [ 124 ] and emotional deregulation [ 114 ].

Several studies examined marital relationships and happiness. Studies found that success in dealing with marriage contributed to happiness [ 29 ]; and that a positive relationship existed between marriage and happiness [ 125 ]. Higher happiness was found in a balanced marriage [ 126 ]; while fewer difficulties in a marital relationship status positively related to happiness and showed that perceived help from the spouse increased partners’ happiness [ 127 ]. A more balanced marriage with intra-couple education (both husband and wife are well-educated) demonstrated higher happiness [ 126 ]. Unhappily married couples showed a deficit in problem-solving, in more unresolved problems, less involvement with one another, and less shared sexuality [ 128 ]. Less happiness in marriage was caused by viewing explicit sexual movies [ 129 ]. Other forms of close, intimate relationships also contributed to happiness. Studies found that entering cohabitation is as beneficial as entering marriage and contributed to a peoples’ happiness [ 19 , 130 ].

Moreover, successful marital and parental relations were also positively associated with happiness. Therapist contact programs improved marital happiness [ 131 ]. In a study that was conducted in the USA with a racial/ethnic composition of the total enrolled sample that included both mothers and children, with 18% African American/Black, 79% Latino/Hispanic, and 1% of mixed racial/ethnic background, found that children of mothers living with HIV who underwent the Teaching, Raising, and Communicating with Kids (TRACK) program, exhibited increase in happiness [ 132 ].

Some studies examined women’s gender role’s impact on happiness. Self-esteem, the number of roles a woman occupied (e.g., paid worker, wife, mother), family income, being a paid worker, and quality of experience in a wife’s role were significantly, positively associated with pleasure [ 47 , 133 ]. Women declared a lower level of happiness compared to men in post-socialist countries [ 134 ]. By contrast, women with higher affective intensity than men were as happy as men [ 79 ]. Women disagreeing with subservient gender attitudes reported higher happiness [ 8 , 135 ], and research showed males had higher happiness levels than females [ 136 ]. Most pregnant women, of maternal age (21–40), and with no smoking history independently correlated with higher happiness [ 17 ]. Women with more planned pregnancies, and who had more difficulty in deciding to terminate, experienced lower levels of happiness when it came to deciding about abortions [ 137 ]. Most of the women in poverty/victims of intimate partner violence (IPV) showed an optimistic outlook, and higher feelings of social support led to greater happiness [ 138 ].

Finally, studies showed a decrease in happiness caused by various determinants of the family such as unhappy couples, negative marital relationships, viewing explicit sexual movies, and women terminating pregnancies [ 139 , 140 ].

3.3.3. Cultural Harmony and Happiness

A total of seven studies examined the effects of culture on happiness. The age range of participants across these studies was between 11 and 90 years, and the participants were from Australia, Canada, China, Germany, Ghana/Sub-Saharan Africa, India, Japan, Malaysia, Netherlands, Rwanda, Taiwan, Thailand, Turkey, and the USA. Both female and male participants were used in these studies, where the majority were female (56% female, 44% male). Six studies showed an increase in happiness caused by the determinants of culture, ethnicity, indigenous culture, multiculturalism, segregation, self-identification, and ethnic identification. Only one study showed a decrease in happiness caused by the determinants of culture.

All studies showed an increase in happiness caused by the determinants of culture that included culture, ethnicity, religion, spirituality indigenous culture, multiculturalism, segregation, self-identification, ethnic identification, faith, forgiveness, religious attendance, tolerance, and spirituality.

Studies found that the characterization of a happy person differed at a cultural level, [ 12 , 141 ], and found culture and polymorphism interacted to influence the perception of happiness. Some studies examined the role of indigenous culture on happiness. Indigenous Australians in remote areas reported higher levels of happiness [ 142 ]. Mountain indigenous peoples, females, the elderly, and those who were healthier, wealthier, highly educated, with western beliefs, who received medical benefits, and were without housing problems or financial difficulties were more likely to be happy [ 143 ]. Other researchers reported higher levels of happiness among indigenous people [ 142 , 143 ]. Other studies examined the role of identity, multiculturism, and segregation on happiness. National identification, ethnic identification, self-identification, strict identity duality, perceived acceptance, and feeling at home were significantly positively associated with happiness [ 144 ]. A positive relationship was found between perceived school multiculturalism and subjective happiness [ 145 ]. Decreased segregation was associated with a reduction in happiness among Black populations [ 146 ].

3.3.4. Religious Harmony and Happiness

A total of 12 studies examined the effects of religion on happiness. The age range of the participants across these studies was between 11 and 90 years, and the participants were from Australia, Canada, China, Germany, Ghana/Sub-Saharan Africa, India, Japan, Malaysia, Netherlands, Rwanda, Taiwan, Thailand, Turkey, and the USA. Both female and male participants were used in these studies, where the majority were female (56% female, 44% male).

A total of 10 studies showed an increase in happiness caused by the determinants of religion, faith, forgiveness, religious attendance, tolerance, and spirituality. Two studies showed a decrease in happiness caused by spiritual struggles.

Some studies examined the role of religious faith and forgiveness on happiness. The relationship between lifetime trauma and happiness was fully moderated for people who experienced a religious transformation [ 147 ]. A significant positive contribution of forgiveness (self, others, situation) was found to lead towards greater happiness [ 148 ]. Personal happiness was predicted by active religious involvement and regular attendance to religious services [ 149 , 150 ]. Religious attendance and religiosity were significant positive predictors of happiness [ 151 ]. Synagogue attendance, prayer and religious attendance were associated with greater happiness [ 152 ]. Happiness positively correlated with the characteristics of tolerance, helpfulness, beliefs, spirituality, responsibility, purposefulness, worthiness, trust, and reliability [ 153 ]. Religiousness positively affected with happiness [ 154 ]. Practicing Islamic-based gratitude exercises (associating blessings with Allah) raised participants’ happiness levels [ 155 ]. Subjective happiness was positively correlated with non-organized religious activity and intrinsic religiosity [ 156 ]. Other studies examined the role of spiritual struggles and forgiveness on happiness. More spiritual struggles were associated with less happiness [ 157 ]. Specifically, all five types of the religious and spiritual struggles assessed (divine, demonic, interpersonal, moral, and ultimate meaning) correlated significantly negatively with happiness [ 158 ].

3.3.5. Environmental Harmony and Happiness

A total of 10 studies examined the effects of the environment on happiness. The age range of participants across these studies was between 18 and 93 years, and the participants were from Australia, Taiwan, the UK, and the USA. Both female and male participants were used in these studies, where the majority were female (60% female, 40% male).

Nine studies showed an increase in happiness caused by the determinants of environment such as ecology, aesthetic neighborhoods, park visitation, green environment, green space, more water, better air quality, quiet neighborhoods, dog ownership, horticulture therapy, and increased environmentally friendly fruit and vegetable consumption. One study showed a decrease in happiness caused by the determinant of environment that included disaster, whereas one study showed a decrease in happiness.

Living in urban vs. rural areas was associated with greater happiness [ 65 ]. Park visitation and greater diversity of park activities were found to stimulate happiness [ 159 , 160 ]. Neighborhoods with higher levels of aesthetics, more water, green space, and higher perceived safety were associated with greater happiness [ 11 ]. Better air quality/less pollution and quietness in the neighborhood, a higher level of ecological diversity derived from a green environment, diversity of species, and perceived naturalness enhanced happiness [ 161 ]. Horticulture therapy that included plant cultivation and plant-related material application significantly improved happiness [ 162 ]. Whereas these studies show the relationship between harmony with the local environment and happiness, other studies show the relationship between the foreign environment and happiness. A study showed that travel created short-term happiness through emotional and relational experiences [ 163 ]. Harmony with the environment also pertained to environmentally friendly food consumption. Increased fruit and vegetable consumption was predictive of increased happiness [ 100 , 164 ]. Dog ownership increased happiness [ 165 ]. This study indicates harmony with species in the immediate environment, important to happiness.

On the negative side, a study showed that environmental disasters significantly decreased happiness [ 115 ]. Age, leisure activity engagement, and the earnings of others in the neighborhood were negatively associated with happiness [ 166 , 167 ].

The findings of this systematic review and the subsequent categorization of the predominant emerging happiness determinants resolve previous disputes or indecisive issues about happiness by presenting determinants of happiness that were supported by most studies. Presenting these determinants under three consistent categories of Health, Hope, and Harmony have been depicted in Figure 2 as a process flow diagram.

4. Discussion

The purpose of this systematic review was to advance scholarly knowledge by critically reviewing [ 23 , 24 , 25 ] the literature on what constitutes happiness and the determinants of happiness across cultures and countries. We identified and analyzed 155 empirical studies that examined the effects of different determinants on happiness from over 100 countries and 44 cultures. Based on the patterns that emerged among these studies, the myriad happiness determinants were placed into three major categories: Health, Hope, and Harmony ( Appendix A : Table A1 , Table A2 and Table A3 ).

The research questions that guided this inquiry were: Is happiness a temporary state of mind or emotion? Is happiness something we are born with, attain with time, or both? Or Is happiness a period of long-term life satisfaction and general well-being that we all aspire to have in our lives? The findings of this study revealed that happiness can be attained, decreased, and increased over one’s lifetime. Happiness can also be a state infused by a period of long-term life satisfaction and general well-being. The happiness determinants derived from the reviewed studies support the transient nature of happiness and its influence by internal and external determinants and circumstances.

Health (mental, emotional, and physical health) and happiness studies show that by focusing on positive health determinants, one may promote the individual’s and society’s well-being for all ages, thus contributing to SDG Good Health and Well-Being (Goal 3).

Hope (goal achievement, personal, and emotional growth) and happiness studies show that by focusing on positive hope determinants, one may promote inclusivity and lifelong learning, sustainable economic growth, and employment opportunity for all ages, supporting SDG Decent Work and Economic Growth (Goal 8).

Harmony (social, familial, cultural, and environmental) and happiness studies show that by focusing on positive Harmony determinants, cities, and human settlements can become inclusive, safe, resilient, and sustainable through sustainable consumption and production patterns, supporting SDG Responsible Consumption and Production (Goal 12) through evidence-based research.

Happiness is conceptualized as an experience that occurs intermittently over one’s lifetime. This fluctuating experience occurs because of the permutations and combinations of various mental, emotional, physical, goal achievement, personal, economic growth, social, family, cultural, religious, and environmental determinants, which can be categorized comprehensively as one’s holistic aspirations for Health, Hope, and/or Harmony. These determinants can positively or negatively impact the experience of happiness and make it fluctuate (either increase or decrease) at different times in one’s life journey. This fluctuating experience of happiness is a result of either a positive or a negative influence of the determinant/s during a given period. For example and to name a few, determinants such as mental depression, addiction, physical disability, economic poverty, social loneliness, separation from a spouse, the death of a loved one, and pollution that have a negative impact vs. determinants such as creativity, humor, relaxation, success at work, doing well at school, financial independence, national pride, religious faith, and pet ownership that have a positive impact can either result in a decrease or increase in one’s happiness experience at a particular given time when the determinant exists.

The conceptualization of happiness has been depicted as an “Integrated Model of the Determinants of Happiness” ( Figure 3 ).

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Integrated Model of the Determinants of Happiness. Note. Figure 3 depicts the three key categories of happiness and their underlying determinants. Health: a complete state of mental, emotional, and physical well-being. Hope: the highest degree of a well-founded expectation of goal achievement, personal, and economic growth. Harmony: a state of being in alignment with aspects of social, familial, cultural, religion, and environmental. + shows a positive impact. − shows a negative impact.

4.1. Theoretical Contribution

This review paper contributes to the literature in the interdisciplinary area of environmental health sciences and public health, by presenting an “Integrated Model of the Determinants of Happiness” applicable across cultures and countries. The determinants of happiness are depicted by the authors in the inductively derived “Integrated Model of the Determinants of Happiness” ( Figure 3 ). The model depicts that the three main determinants of happiness, i.e., Health, Hope, and Harmony, are interrelated and interact with each other in a symbiotic manner to determine the happiness of individuals and societies. The “Integrated Model of the Determinants of Happiness” provides a holistic framework that empowers individuals and societies to take control of their happiness ( Figure 3 ).

4.2. Implications for Policies and Practice

The systematic review [ 23 ] has several implications for policy and practice. The “Integrated Model of the Determinants of Happiness” serves as a foundation and tool for building happiness assessments for measuring the categories of Health, Hope, and Harmony. The results of such assessment can help policymakers and public health practitioners design and implement evidence-based happiness policies and clinical practices that will help individuals and families work on creating their happiness and making societies happier overall. The clinical public health implications are to implement policies and practices at a national level that foster the happiness of individuals as this will result in more productive, vital members of society that can meaningfully contribute to the prosperity of a country. Ultimately, this will lead to beneficial individual, familial, organizational, and economic outcomes, because happy people are more productive people.

4.3. Social Implications

The current times of geopolitical upheaval and disruption as well as the COVID-19 pandemic have resulted in instability and uncertainty in the external environment [ 168 , 169 ]. Given these exogenous shock events and global disruptions and distress, “the Integrated Model of the Determinants of Happiness” has great significance, relevance, and impact as it depicts the elements of life that are vital for happiness—something we all strive towards and desire to attain and maintain throughout our lives.

The impacts of anthropogenic determinants on the quality of the environment, the interrelationships between environmental health and the quality of life and happiness, as well as the sociocultural, political, and economic related to happiness across the globe, are noteworthy considerations in fostering the happiness of individuals and societies.

4.4. Limitations and Future Research

Some overlap was seen among research studies grouped under the three categories of Health, Hope, and Harmony. However, as a strict demarcation was not possible due to the interrelated and symbiotic nature of the three categories of happiness, the Health, Hope, and Harmony findings were grouped based on the dominant and common underlying determinants that emerged under each category. Future research can address this limitation.

Moreover, this research was conducted before and during the COVID-19 pandemic, whereas happiness studies conducted before the pandemic were analyzed. Therefore, we cannot make any inferences about how happiness has changed among individuals and societies during the pandemic, nor can we make any inferences about whether certain determinants of happiness become more prominent than others during times of crises and adversity.

There is scope for research in this field as each of the categories of happiness can be an area of further research considering external, global exogenous events such as the COVID-19 pandemic. Advanced statistical tools such as confirmatory factor analyses or path modeling can make for a more robust understanding of the pathways to explain happiness, thereby allowing for the statistical generalization of authors’ findings to populations across the globe.

5. Conclusions

This systematic review [ 23 ] investigated the happiness construct to arrive at a universally applicable conceptualization of the determinants of happiness across the globe. By examining studies on determinants of happiness across 44 cultures and 100 countries in the past 90 years, this systematic review uncovered that happiness is constituted by multiple determinants that can be placed into three main categories: ‘Health’, ‘Hope’, and ‘Harmony’. The happiness determinants are one’s mental, emotional, and physical well-being (Health), having a purposeful holistic encompassing work–life balance, nurturing social relationships, caring for self and others (Hope), and being in harmony with one’s culture, traditions, community, and the environment moderated by economic, social, cultural, and environmental conditions that impact individual and societal happiness (Harmony).

Acknowledgments

Not applicable.

Health and Happiness, final count (N = 56).

						Health	67 Unique
Se	Study	Journal	Happiness Measure	Sample	Correlation of Happiness in Findings	Reviewers’ Agglutination of the Findings with the Three Categories Identified	Country	Culture	Quality Score (h5 Median)
					Males higher happiness levels age increased, happiness levels decreased. Happiness higher in cities , in never married or married persons academic education employed persons. The WHO defined different aspects of positive health as life satisfaction, quality of life, happiness, and self-rated health, and developed appropriate scales to measure positive health. Criterion validity of scales with a 40-question national happiness scale was examined in this research. The correlation coefficient of scales with a 40-item happiness scale was between 0.49, 0.53, 0.57, and 0.60 for ‘health status’, ‘happiness’, ‘quality of life’, and ‘life satisfaction’, respectively”.
					religious/spiritual struggles (divine, demonic, interpersonal, moral, ultimate meaning) negatively happiness.
					Incidence of addiction higher lower levels of happiness but was not statistically significant. Correlational analyses revealed that all 5 types of the struggles assessed (i.e., divine, demonic, interpersonal, moral, ultimate meaning) correlated significantly positively with both depressive symptoms and generalized anxiety, and significantly negatively with both satisfaction with life and happiness.		Iran	Iranian
					Self-esteem, number of roles a woman occupied , family income, paid worker, and quality of experience in a wife’s role , positively pleasure. Depression negatively pleasure. .		USA
				participants from Germany (Mean Age = 26.54, SD = 4.00, Age Range = 18–60 years; 45% Female, 55% Male), Russia (Mean Age = 20.3, SD = 2.4, Age Range = 14–42 years;	cultural level, happy person differed. , happiness is defined by the experience of more frequent positive affective states than negative ones .		Germany, Russia, China	German, Russian, Chinese
					Greater inferior frontal gyrus and a cluster including the right fusiform gyrus, right cerebellum, and right lingual gyrus greater happiness ratings. Greater cuneus and a cluster including the left occipital pole, the left fusiform gyrus, and the left lingual gyrus lower happiness
					Health positively associated happiness. In total,		Poland	Polish
					Felt power positively related happiness not positional power. , happiness can be labeled as serenity .		Switzerland	Swiss
					Heavy screen-based media (SBM) less happiness. Greater participation in sports higher happiness.		UK	British
					Greater happiness handicapped youth . Male handicapped participants more frequently happy academic and recess settings. Happiness is a “state of being” concept
					High in prioritizing positivity greater happiness.
					Rumination- less happiness. Hope- greater happiness.
					Being younger, widowed, or separated from a spouse, experiencing high levels of stress and levels of health satisfaction diminishing happiness. . Health and stress factors are determinants of happiness ratings
					Greater numbers of sessions per client decreased posttraumatic stress symptoms greater counselor happiness.
					Grit positively interdependent happiness.		Philippines	Philippines
					Higher levels of happiness home dialysis patients . Increased levels of perceived illness intrusiveness decreased happiness. < 0.05, and self-esteem, r(95) = −0.37, < 0.01.
					Task involvement positively happiness. The
					Persons’ valence success at a task greater happiness succeeded greater unhappiness failed.
					—Fearless dominance positively higher durable happiness fluctuating happiness. Impulsive antisociality negatively durable happiness positively fluctuating happiness.		Europe, , Asia, Middle East, Africa, Canada	European, , Asian, Middle Easter, African, Canadian
					More health problems perceived seriousness of the health problems/effects less happiness. Happiness is defined as a transient mood state	,	Greece	Greece
					Negative and positive affective self-regulatory efficacy caring climate positively associated happiness. Hope has been positively associated with academic performance, positive thinking, and adaptive coping methods.
					Women higher affective intensity happy as men.
					Holistic wellness resilience greater happiness.
					upward trend happiness early adulthood to midlife.
					Suffering severe disability less happiness. Higher BMI steeper declines in happiness. Participants living with a partner happier
					Fears of happiness positively alexithymia, depression, anxiety, stress.
					Internet addiction subjective unhappiness. psychological state of well-being, joy, and contentment		Korea	Korean
							, Far East, South America,	, Far Eastern, South American, African
					Higher fatigue lower happiness. The		New Zealand	New Zealanders
					People with “disfigurements” subjectively judged as less happy.
					Job training, cognition, health, social network, and extraversion happiness.
					lifetime trauma and happiness fully moderated religious transformation. The
					negative relationship stressful life events happiness reduced people who were humbler. < 0.001).
					Emotional intelligence personal growth initiative positively associated subjective happiness. The		Ghana	Ghanian
					Psychological well-being positively subjective happiness. The		India	Indian
		(1), e0160589.			more physically active happier. < 0.001, d = 0.43, and negatively with crying, r(9164) = −0.18, < 0.001, d = 0.38.
					more unhealthy days, poorer perception of their health, satisfaction with their food-related lives less happy. define happiness as the degree to which someone positively evaluates the overall quality of his or her present, ‘life as a whole’		China	Chinese
					Disability moderate to large drops in happiness
					Culture CNR1 polymorphism perception of happiness. subjective happiness level highest Japanese individuals with the CC genotype, Canadian participants, with the TT genotype. genotype on situation-specific happiness were also different between the groups. Happiness accompanied by being surrounded by happy people highest Japanese individuals with the CC genotype, Canadian individuals, highest in TT genotype carriers. Genotypes on happiness might differ among different cultures because the concept of happiness varies by culture. In Japan, favorable external circumstances determine the concept of happiness, and in Canada, the concept of happiness centers on positive feelings.		Japan	Japanese
					Increased fruit and vegetable consumption increased happiness.		Australia	Australian
					Children Teaching, Raising, Additionally, Communicating with Kids (TRACK) program increases in happiness.
					Older adults who experienced traumatic events during childhood lower subjective happiness.
					fruit and vegetable consumption positively happiness.		28 countries from Asia, Africa, and the Americas	29 cultures from Asia, Africa, and the Americas
					Most pregnant women, maternal age (21–40), no smoking history higher happiness.
					The bereavement of a child lower levels of happiness.
					Increasing physical activity volume higher levels of happiness.		15 European Countries	16 European Cultures
					Older adults who experienced a traumatic event during childhood lower subjective happiness.
					Women with more planned pregnancies more difficulty deciding to terminate lower levels of happiness
					Cochlear implantation surgery increases happiness < 0.001). Cochlear implantation surgery increases happiness and self-esteem in mothers of children with hearing loss.
					Three positive psychology interventions— —increased happiness.
					microswitch-based program for Rett syndrome increased happiness.		Italy	Italian
					Encouraging growth mindsets led to stronger beliefs in the changeable nature of happiness. Happiness growth mindsets associated greater well-being greater relationship satisfaction. implicit theory framework
					No significant difference the happiness levels between adolescents and adults. Happiness is about our lives as a whole;
					Grateful remembering practices present happiness. = 0.004), self-control (β = 0.23, < 0.002), and patience (β = 0.04, = 0.656) together accounted for 15% of happiness scores.
					Adaptive humor styles (affiliative humor and self-enhancing humor) predicted subjective happiness. Maladaptive humor styles (aggressive humor and self-defeating humor) did not predict happiness.
					positive psychological intervention improved the happiness
					positive happiness extraversion, agreeableness, neuroticism, conscientiousness, and openness to experiences. < 0.001) and each of the personality trait dimensions of extraversion ( < 0.001, r = 0.594), agreeableness ( < 0.001, r = 0.431), neuroticism ( < 0.001, r = 0.368), conscientiousness ( < 0.001, r = 0.351), and openness to experiences ( < 0.001, r = 0.151). According to the theory of personality [ ].

Hope and Happiness, final count (N = 23).

						Health	42 Unique
Se	Study	Journal	Happiness Measure	Sample	Correlation of Happiness in Findings	Reviewers’ Agglutination of the Findings with the Three Categories Identified	Country	Culture	Quality Score (h5 Median)




					< 0.01.

Harmony and Happiness, final count (N = 76).

						Health	74 Unique
Se	Study	Journal	Happiness Measure	Sample	Correlation of Happiness in Findings	Reviewers’ Agglutination of the Findings with the Three Categories Identified	Country	Culture	Quality Score (h5 Median)

					Personal happiness economic (upper income), upper social class, social capital (freedom of choice and honesty), community engagement, perceived good health status, active religious involvement/regular attendance to religious services, ethnicity/culture (Akan).		, Sub-Saharan Africa	, Sub-Sahara African

					< 0.01). Items related to subjective happiness investigated the degree of happiness in relation to various life events. Non-organized religious activity (NORA) had a significant ( < 0.01) and a moderate positive correlation with IR (+0.172) and subjective happiness (+0.182). IR was positively correlated (+0.241) with subjective happiness with statistical significance ( < 0.01).




















					<0.05), and happiness was directly related to mental health, ( <0.05). Happiness, which is an essential dimension of life and related to functioning and success, generally is considered to comprise three main components—frequency and degree of positive affect or joy; absence of negative feelings, such as depression or anxiety; and the average level of satisfaction over a period.





















					< 0.001) and improving partner well-being (B = 0.20, 95% CI [0.12, 0.28], φ = 0.16, < 0.001).

(+) indicates positive influence of the determinants with happiness categories (Health, Hope, Harmony). While (−) indicates a negative influence of the determinant on happiness. SD—‘Standard Deviation’.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, S.S. and R.V.; methodology, S.S. and S.K.; software, S.K. and S.S.; validation, S.S., S.K. and R.V.; formal analysis, S.S., S.K. and R.V.; investigation, S.S., S.K. and R.V.; resources, S.S. and S.K.; data curation, S.S. and S.K.; writing—original draft preparation, S.S. and S.K.; writing—review and editing, S.K. and R.V.; visualization, S.K. and R.V.; supervision, S.K. and S.S.; project administration, S.K. and S.S.; funding acquisition, S.S. and R.V. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest.

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Health and Happiness Depend on Each Other, Psychological Science Says

Mindfulness

Summary: New research adds to the growing body of evidence that happiness not only feels good, it is good for your physical health, too.

Good health and a happy outlook on life may seem like equally worthy yet independent goals. A growing body of research , however, bolsters the case that a happy outlook can have a very real impact on your physical well-being.

New research published in the journal Psychological Science shows that both online and in-person psychological interventions—tactics specifically designed to boost subjective well-being—have positive effects on self-reported physical health. The online and in-person interventions were equally effective.

“Our research is one of the first randomized controlled trials to suggest that increasing the psychological well-being even of generally healthy adults can have benefits to their physical health.” Kostadin Kushlev [Georgetown University]

“Though prior studies have shown that happier people tend to have better cardiovascular health and immune-system responses than their less happy counterparts,” said Kostadin Kushlev , a professor in Georgetown University’s Department of Psychology and one of the authors of the paper, “our research is one of the first randomized controlled trials to suggest that increasing the psychological well-being even of generally healthy adults can have benefits to their physical health.”

Intervention for Healthy Outcomes

Over the course of six months, Kushlev and his colleagues at the University of Virginia and the University of British Columbia examined how improving the subjective well-being of people who were not hospitalized or otherwise undergoing medical treatment affected their physical health.

A group of 155 adults between the ages of 25 and 75 were randomly assigned either to a wait-list control condition or a 12-week positive psychological intervention that addressed three different sources of happiness: the “Core Self,” the “Experiential Self,” and the “Social Self.”

The first 3 weeks of the program focused on the Core Self, helping individuals identify their personal values, strengths, and goals. The next 5 weeks focused on the Experiential Self, covering emotion regulation and mindfulness. This phase also gave participants tools to identify maladaptive patterns of thinking. The final 4 weeks of the program addressed the Social Self, teaching techniques to cultivate gratitude, foster positive social interactions, and engage more with their community.

The program, called Enduring Happiness and Continued Self-Enhancement (ENHANCE), consisted of weekly modules either led by a trained clinician or completed individually using a customized online platform. None of the modules focused on promoting physical health or health behaviors, such as sleep, exercise, or diet.

Each module featured an hour-long lesson with information and exercises; a weekly writing assignment, such as journaling; and an active behavioral component, such as guided meditation .

“All of the activities were evidence-based tools to increase subjective well-being,” Kushlev noted.

When the program concluded, the participants were given individual evaluations and recommendations of which modules would be most effective at improving their happiness in the long term. Three months after the conclusion of the trial, researchers followed up with the participants to evaluate their well-being and health.

A Happy Future

Participants who received the intervention reported increasing levels of subjective well-being over the course of the 12-week program. They also reported fewer sick days than control participants throughout the program and 3 months after it ended.

The online mode of administering the program was shown to be as effective as the in-person mode led by trained facilitators.

“These results speak to the potential of such interventions to be scaled in ways that reach more people in environments such as college campuses to help increase happiness and promote better mental health among students,” Kushlev said.

Psychological Science , the flagship journal of APS, is the leading peer-reviewed journal publishing empirical research spanning the entire spectrum of the science of psychology. For a copy of this article, “ Does Happiness Improve Health? Evidence From a Randomized Controlled Trial ,” and access to other research in Psychological Science , contact [email protected] .

Kushlev, K., et al, (2020) Does Happiness Improve Health? Evidence From a Randomized Controlled Trial. Psychological Science , https://doi.org/10.1177/0956797620919673

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Scientists Look Beyond the WEIRD World of Happiness

Psychological scientists once equated happiness with well-being, but recent research suggests that there is significant cultural variation in the ingredients of a good life.

Teaching: Shared Emotions / Positives of Psychological Disorders

Lesson plans about the emotions within and between us and the positives of autism, ASD, and other psychological disorders.

Ed Diener, Who Studied Happiness, Dies

The founding editor of APS’s Perspectives on Psychological Science journal, he received the APS William James Fellow Award in 2013.

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All About Happiness: Definition, Health Effects, and How to Be Happier Every Day

What leads to happiness? The 2022 World Happiness Report (WHR) identified Finland as the happiest country. The United States slotted in at No. 16 — not bad when you consider the report ranked 146 countries.

Every year, lists like the WHR attempt to measure and quantify happiness. (It’s a collaborative effort of universities, research groups, and Gallup World Poll data.)

But this task is easier said than done. What makes a country and its people happy? Is it their overall sense of well-being? Or their daily experiences of positive emotions like laughter or enjoyment? The WHR relies on these and many other measures to assemble its list, and its authors acknowledge that even defining the word “happiness” can be tricky.

Psychologists who study happiness agree. “When we ask people what it means to be happy, we get a huge variety of responses,” says Iris Mauss, PhD , a professor of psychology at the University of California in Berkeley. “A lot of people say happiness means having positive feelings, but then if we ask them what feelings specifically, some say it means to be excited and others say it means to be peaceful.”

Other people, she says, don’t talk about emotions at all. They say that happiness is knowing that their life is better now than it was in the past or that their life has meaning and purpose . Dr. Mauss and her colleagues have also found that people from different cultures sometimes define happiness in starkly different ways.

Happiness, in other words, is a slippery concept to get a handle on. But there is some consistency in the ways that experts define and evaluate it. And their work has found that greater happiness is both achievable and associated with a range of health benefits.

What Is Happiness?

The American Psychological Association (APA) defines happiness as “an emotion of joy, gladness, satisfaction, and well-being.”

Many of us would agree with the APA’s definition, yet the more you look at it, the more it can seem incomplete. For example, you may feel all of those emotions at one moment, but an hour later you may feel none of them. So are you a happy person or not?

“When people talk about happiness, they’re usually talking about their overall well-being,” says Robin Stern, PhD , a psychoanalyst and the associate director of the Yale Center for Emotional Intelligence in New Haven, Connecticut. Emotions like joy and excitement can contribute to well-being, she says, but so do broader feelings of fulfillment, contentment, and achievement.

If you read through the published research on happiness, you find that most of it actually focuses on well-being. And experts who study well-being often break down that concept into two categories: hedonia and eudaimonia.

“Hedonic well-being focuses on feelings of positive affect and life satisfaction,” according to the authors of a study published in 2021 in Psychological Review (PDF) . “Eudaimonic well-being focuses on a sense of optimal functioning and realizing potential.”

Any complete definition of happiness probably needs to acknowledge both sides of the well-being coin.

Types of Happiness

As the APA’s definition makes plain, happiness can mean a lot of things. Pleasure, joy, excitement, contentment, and satisfaction could all be considered types or shades of happiness. But so could deeper senses of contentment or life satisfaction, Dr. Stern says.

Apart from these distinctions, researchers have also found that people in different parts of the world may define happiness in different ways.

“Cross-culturally, there are differences in how people think about happiness,” Mauss says. “In the West, we tend to understand happiness as more of an individualistic state, but in some East Asian cultures, it’s more a social concern.”

For example, an American may define happiness in terms of their own feelings or successes. But some of Mauss’ research shows that people in many East Asian cultures think of happiness as a state of social harmony, family connectedness, and community well-being. In other words, some people’s idea of happiness is less about personal joy or achievement and more strongly associated with community cohesion and harmony.

Interestingly, more of her research has found that when people in the United States and other Western nations place a high value on being happy, this emphasis is associated with higher rates of depression symptoms and diagnoses . While being happy is great, her work suggests that actively trying to be happier can backfire. (More on what psychologists say actually works to boost happiness below.)

What Happiness Feels Like

Going back to the APA’s definition, happiness is associated with feelings like joy, gladness, satisfaction, and well-being.

Other researchers have found that, at least in the United States, many people say that happiness involves no negative feelings. (In most other countries, people don’t see happiness as a total absence of negative feelings.) According to a study published in Frontiers in Psychology , feelings of inner harmony, meaning, and positive emotions also describe what happiness feels like.

How Happiness Affects Your Health

“Happier people are healthier.” That’s according to the authors of a study published in 2020 in Psychological Science .

Like most of the research on happiness, that study defines happiness in terms of subjective well-being. Researchers asked participants questions about how they feel and used the answers to determine their well-being. The authors say that there’s ample evidence linking higher levels of subjective well-being to health benefits.

Some of those research-backed health benefits include:

Improved heart health
Better immune functioning
Longer lifespan
Slower disease progression
Faster recovery from injury or illness
Reductions in pain
Lower levels of stress and anxiety , per a study published in Social Science & Medicine
Better sleep , per research

How could subjective well-being contribute to all these health benefits? A lot of research, including the aforementioned paper linking happiness to lower stress and anxiety, points to the effect of well-being on the body’s nervous system. Specifically, elevated levels of well-being are associated with less activation of the body’s sympathetic nervous system, also known as the fight-or-flight system.

Happiness and positive attitudes toward life may prevent activation of physiological reactions to some life events that could otherwise have cumulative detrimental effects on health, researchers explained in the Social Science & Medicine paper. That study cites reduced activation of the automatic nervous system, which includes the fight-or-flight response, as one of the likeliest benefits of improved well-being.

While there’s ample evidence linking happiness and well-being with health benefits, it’s less clear if becoming happier will make you healthier. Some research, including the 2020 Psychological Science paper, has found that when people improved their well-being, they experienced fewer sick days. “This work provides some evidence for a causal effect of subjective well-being on self-reported physical health,” according to the authors.

When Happiness Is Healthy and When It’s Not

Can you be too happy? Not really. If you feel good, that’s a good thing.

However, psychologists have begun to examine a concept called “toxic positivity,” which researchers at the University of Winnipeg in Canada have described as a tendency to “reject, deny, or displace” any negative feelings or experiences in an attempt to see the world through rose-colored glasses.

It’s trying to force happiness or positivity when neither is naturally present that can backfire.

“To think that on a gray day, with a backdrop of a recent death in the family, or stress at work , or illness, or other bad news, that you should feel positive or happy, that’s not realistic or even healthy,” Stern says.

While we may regard some feelings as negative or difficult, they are still normal and healthy aspects of emotional experience, she says.

They can also be valuable pieces of feedback. “If you feel afraid or upset or anxious because of an unhealthy relationship or work environment, those feelings are information that can help you make decisions,” she says. They may help lead you to make positive, constructive changes in your life.

How to Be a Happier Person: 3 Tips

Many books, blogs, articles, and motivational speakers have attempted to answer this question. The list of things you could do to boost your happiness and well-being is long, and the specifics are in large part determined by your individual preferences and goals. But here are some do's and don’ts supported by both experts and newer research.

1. Prioritize Relationships and Experiences, Not Stuff

Recent research (PDF) suggests that “psychological richness” may be a major component of well-being. “We define psychological richness as a life full of interesting and perspective-changing experiences,” says Shigehiro Oishi, PhD , a professor of psychology at the University of Chicago and coauthor of that research.

“Novel activities, games, sports, and arts help us deal with boredom inherent in life,” he adds.

New experiences also foster curiosity, which research shows is a major contributor to well-being. Likewise, a lot of research has linked strong social relationships to improved happiness and well-being.

“Close relationships and warm connections with other people are one of the biggest elements of happiness,” Stern says. “If work or personal achievement or improvement are the only things in your life, you may be missing a big piece of what makes us humans happy or content.”

She says that when most people recall their happiest moments, most of those memories are centered around social connections and relationships, not solitary pursuits.

2. Cultivate Gratitude

According to a review published in 2021 , there’s strong evidence linking feelings of gratitude to higher levels of happiness and well-being. Studies have also found that cultivating gratitude can actually boost happiness.

“Gratitude is our best weapon — an ally to counter these internal and external threats that rob us of sustainable joy,” says Robert Emmons, PhD , a professor of psychology at the University of California in Davis.

He says that making an effort to tell the people in your life that you’re grateful for them — and why — is one way to cultivate gratitude. Another is taking time each day to think about the things you are grateful for.

Some of Dr. Emmons' work has found that keeping a daily journal in which you write what you’re grateful for can also lead to greater levels of positivity (Stern was a coauthor).

3. Practice Mindfulness

Mindfulness comes up so often these days that it almost feels like a cliche. But research continues to find that practicing mindfulness really can improve well-being. “Mindfulness-based practices have broadly been found to have several benefits including, but not limited to, reducing stress, anxiety, and depression, as well as enhancing attentional focus, working memory capacity, cognitive flexibility, positive mood, resilience, immune functioning, interpersonal relationships, and well-being,” per the authors of a study published in 2020 in Frontiers in Psychology . Their work found that just three minutes of daily practice may be enough to improve measures of well-being.

Another important point: For these changes to work, your heart has to be in it. “There are no shoulds with emotions,” Stern says. “It’s all about if you want to.”

She has helped develop an app called Mood Meter that encourages users to regularly note how they’re feeling by marking their emotion on a color-coded axis. “If you are using the app regularly, you will start to notice patterns,” she says. “That information is useful and, for many, surprising.” It may help you identify times or activities that sour your mood, as well as those that tend to make you happier.

Happiness is a wonderful thing. We all deserve plenty of it in our lives. But there’s a lot more to it than feeling positive emotions like joy or elation.

Favorite Online Resources for Information

American Psychological Association

One of the country’s premier mental health organizations offers in-depth information on all topics to do with emotional health and well-being.

Centers for Disease Control and Prevention: Emotional Well-Being

This webpage offers a wealth of evidence-backed resources on all aspects of happiness and well-being. That includes research on well-being at home, in the workplace, and as you age.

National Health Service

One of the world’s leading public health organizations, the U.K. National Health Service offers clear, straightforward, and research-backed advice on many emotional health topics, including happiness and well-being.

National Institutes of Health

The agency's emotional wellness toolkit is a comprehensive guide to building a lifestyle that supports happiness and other positive emotions.

Favorite Resource for Parents

U.S. Department of Health and Human Services

The department's Early Childhood Learning and Knowledge Center offers resources for adults who want to ensure that the kids in their lives are growing up happy and emotionally healthy.

Favorite Podcast

Speaking of Psychology

The APA’s Speaking of Psychology podcast offers an encyclopedic examination of happiness, what supports it, and what interferes with it.

Favorite App

Countless apps can help bolster your happiness. Waking Up nests its well-being resources in discussions of meditation, ancient wisdom, and other bigger picture topics.

Common Questions & Answers

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

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Cacioppo JT, Cacioppo S. Social Relationships and Health: The Toxic Effects of Perceived Social Isolation. Social and Personality Psychology Compass . February 2014.
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Seth Gillihan, PhD

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Harvard study, almost 80 years old, has proved that embracing community helps us live longer, and be happier

Part of the Tackling Issues of Aging series

A series on how Harvard researchers are tackling the problematic issues of aging.

W hen scientists began tracking the health of 268 Harvard sophomores in 1938 during the Great Depression, they hoped the longitudinal study would reveal clues to leading healthy and happy lives.

They got more than they wanted.

After following the surviving Crimson men for nearly 80 years as part of the Harvard Study of Adult Development , one of the world’s longest studies of adult life, researchers have collected a cornucopia of data on their physical and mental health.

Of the original Harvard cohort recruited as part of the Grant Study, only 19 are still alive, all in their mid-90s. Among the original recruits were eventual President John F. Kennedy and longtime Washington Post editor Ben Bradlee. (Women weren’t in the original study because the College was still all male.)

In addition, scientists eventually expanded their research to include the men’s offspring, who now number 1,300 and are in their 50s and 60s, to find out how early-life experiences affect health and aging over time. Some participants went on to become successful businessmen, doctors, lawyers, and others ended up as schizophrenics or alcoholics, but not on inevitable tracks.

“Loneliness kills. It’s as powerful as smoking or alcoholism.” Robert Waldinger, psychiatrist, Massachusetts General Hospital

During the intervening decades, the control groups have expanded. In the 1970s, 456 Boston inner-city residents were enlisted as part of the Glueck Study, and 40 of them are still alive. More than a decade ago, researchers began including wives in the Grant and Glueck studies.

Over the years, researchers have studied the participants’ health trajectories and their broader lives, including their triumphs and failures in careers and marriage, and the finding have produced startling lessons, and not only for the researchers.

“The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health,” said Robert Waldinger , director of the study, a psychiatrist at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School . “Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation.”

Close relationships, more than money or fame, are what keep people happy throughout their lives, the study revealed. Those ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes. That finding proved true across the board among both the Harvard men and the inner-city participants.

Dr. Robert Waldinger at his West Newton home with wife Jennifer Stone

“The people who were the most satisfied in their relationships at age 50 were the healthiest at age 80,” said Robert Waldinger with his wife Jennifer Stone.

Rose Lincoln/Harvard Staff Photographer

The long-term research has received funding from private foundations, but has been financed largely by grants from the National Institutes of Health, first through the National Institute of Mental Health, and more recently through the National Institute on Aging.

Researchers who have pored through data, including vast medical records and hundreds of in-person interviews and questionnaires, found a strong correlation between men’s flourishing lives and their relationships with family, friends, and community. Several studies found that people’s level of satisfaction with their relationships at age 50 was a better predictor of physical health than their cholesterol levels were.

“When we gathered together everything we knew about them about at age 50, it wasn’t their middle-age cholesterol levels that predicted how they were going to grow old,” said Waldinger in a popular TED Talk . “It was how satisfied they were in their relationships. The people who were the most satisfied in their relationships at age 50 were the healthiest at age 80.”

He recorded his TED talk, titled “What Makes a Good Life? Lessons from the Longest Study on Happiness,” in 2015, and it has been viewed 13,000,000 times.

The researchers also found that marital satisfaction has a protective effect on people’s mental health. Part of a study found that people who had happy marriages in their 80s reported that their moods didn’t suffer even on the days when they had more physical pain. Those who had unhappy marriages felt both more emotional and physical pain.

Those who kept warm relationships got to live longer and happier, said Waldinger, and the loners often died earlier. “Loneliness kills,” he said. “It’s as powerful as smoking or alcoholism.”

According to the study, those who lived longer and enjoyed sound health avoided smoking and alcohol in excess. Researchers also found that those with strong social support experienced less mental deterioration as they aged.

In part of a recent study , researchers found that women who felt securely attached to their partners were less depressed and more happy in their relationships two-and-a-half years later, and also had better memory functions than those with frequent marital conflicts.

“When the study began, nobody cared about empathy or attachment. But the key to healthy aging is relationships, relationships, relationships.” George Vaillant, psychiatrist

“Good relationships don’t just protect our bodies; they protect our brains,” said Waldinger in his TED talk. “And those good relationships, they don’t have to be smooth all the time. Some of our octogenarian couples could bicker with each other day in and day out, but as long as they felt that they could really count on the other when the going got tough, those arguments didn’t take a toll on their memories.”

Since aging starts at birth, people should start taking care of themselves at every stage of life, the researchers say.

“Aging is a continuous process,” Waldinger said. “You can see how people can start to differ in their health trajectory in their 30s, so that by taking good care of yourself early in life you can set yourself on a better course for aging. The best advice I can give is ‘Take care of your body as though you were going to need it for 100 years,’ because you might.”

The study, like its remaining original subjects, has had a long life, spanning four directors, whose tenures reflected their medical interests and views of the time.

Under the first director, Clark Heath, who stayed from 1938 until 1954, the study mirrored the era’s dominant view of genetics and biological determinism. Early researchers believed that physical constitution, intellectual ability, and personality traits determined adult development. They made detailed anthropometric measurements of skulls, brow bridges, and moles, wrote in-depth notes on the functioning of major organs, examined brain activity through electroencephalograms, and even analyzed the men’s handwriting.

Now, researchers draw men’s blood for DNA testing and put them into MRI scanners to examine organs and tissues in their bodies, procedures that would have sounded like science fiction back in 1938. In that sense, the study itself represents a history of the changes that life brings.

6 factors predicting healthy aging According to George Vaillant’s book “Aging Well,” from observations of Harvard men in long-term aging study

Physically active.

Absence of alcohol abuse and smoking

Having mature mechanisms to cope with life’s ups and downs

Healthy weight

Stable marriage.

Psychiatrist George Vaillant, who joined the team as a researcher in 1966, led the study from 1972 until 2004. Trained as a psychoanalyst, Vaillant emphasized the role of relationships, and came to recognize the crucial role they played in people living long and pleasant lives.

In a book called “Aging Well,” Vaillant wrote that six factors predicted healthy aging for the Harvard men: physical activity, absence of alcohol abuse and smoking, having mature mechanisms to cope with life’s ups and downs, and enjoying both a healthy weight and a stable marriage. For the inner-city men, education was an additional factor. “The more education the inner city men obtained,” wrote Vaillant, “the more likely they were to stop smoking, eat sensibly, and use alcohol in moderation.”

Vaillant’s research highlighted the role of these protective factors in healthy aging. The more factors the subjects had in place, the better the odds they had for longer, happier lives.

“When the study began, nobody cared about empathy or attachment,” said Vaillant. “But the key to healthy aging is relationships, relationships, relationships.”

“We want to find out how it is that a difficult childhood reaches across decades to break down the body in middle age and later.” Robert Waldinger

The study showed that the role of genetics and long-lived ancestors proved less important to longevity than the level of satisfaction with relationships in midlife, now recognized as a good predictor of healthy aging. The research also debunked the idea that people’s personalities “set like plaster” by age 30 and cannot be changed.

“Those who were clearly train wrecks when they were in their 20s or 25s turned out to be wonderful octogenarians,” he said. “On the other hand, alcoholism and major depression could take people who started life as stars and leave them at the end of their lives as train wrecks.”

The study’s fourth director, Waldinger has expanded research to the wives and children of the original men. That is the second-generation study, and Waldinger hopes to expand it into the third and fourth generations. “It will probably never be replicated,” he said of the lengthy research, adding that there is yet more to learn.

“We’re trying to see how people manage stress, whether their bodies are in a sort of chronic ‘fight or flight’ mode,” Waldinger said. “We want to find out how it is that a difficult childhood reaches across decades to break down the body in middle age and later.”

Lara Tang ’18, a human and evolutionary biology concentrator who recently joined the team as a research assistant, relishes the opportunity to help find some of those answers. She joined the effort after coming across Waldinger’s TED talk in one of her classes.

“That motivated me to do more research on adult development,” said Tang. “I want to see how childhood experiences affect developments of physical health, mental health, and happiness later in life.”

Asked what lessons he has learned from the study, Waldinger, who is a Zen priest, said he practices meditation daily and invests time and energy in his relationships, more than before.

“It’s easy to get isolated, to get caught up in work and not remembering, ‘Oh, I haven’t seen these friends in a long time,’ ” Waldinger said. “So I try to pay more attention to my relationships than I used to.”

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Review Article
Open access
Published: 16 September 2020

Determinants of happiness among healthcare professionals between 2009 and 2019: a systematic review

Rose Nabi Deborah Karimi Muthuri ORCID: orcid.org/0000-0003-0353-8132 1 ,
Flavia Senkubuge 1 &
Charles Hongoro 1 , 2 , 3 , 4

Humanities and Social Sciences Communications volume 7 , Article number: 98 ( 2020 ) Cite this article

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Health humanities
Medical humanities

Happiness is characterized by experiencing positive emotions while simultaneously perceiving one’s life as meaningful and worthwhile. Research on the mental health of healthcare professionals usually focuses on psychopathology as opposed to the positive aspects of mental health. Thus, the purpose of this study is to examine recent literature on individual-level and organization-level determinants of healthcare professionals happiness. The EBSCOhost, PubMed, Scopus, and Web of Science databases were searched for articles published between 2009 and 2019 that focused on happiness among healthcare professionals. Based on the eligibility criteria, both quantitative and qualitative studies were selected for this systematic review. The final review included a total of 18 studies. The main measures of healthcare professionals happiness in cross-sectional and intervention studies were self-report measures, and the main measures of happiness in qualitative studies were interviews. Multiple determinants of healthcare professionals happiness were identified in this systematic review. The interplay between individual-level and organization-level determinants collectively contributes to the happiness of healthcare professionals. Existing evidence highlights the importance of healthcare professionals happiness in the strengthening of the healthcare workforce and healthcare systems. This review also highlights the importance of health policy makers, health authorities and healthcare professionals in creating and effectively implementing policies and strategies to increase healthcare professionals happiness. Future similar studies should use large and more heterogeneous samples of healthcare professionals from various settings to generate contextually relevant and robust evidence regarding methods to enhance healthcare professionals happiness and ultimately the performance of health systems globally.

Perceiving societal pressure to be happy is linked to poor well-being, especially in happy nations

A systematic review of the strength of evidence for the most commonly recommended happiness strategies in mainstream media

The association between healthcare needs, socioeconomic status, and life satisfaction from a Chinese rural population cohort, 2012–2018

Introduction.

For centuries, happiness has been viewed as an essential component in human life (Pollock et al., 2016 ). Ancient Greek philosopher Aristotle (384–322 BC) believed that happiness was the ultimate motivator of peoples’ choices and actions (Pollock et al., 2016 ). Additionally, the United Nations (UN) has recognized the pursuit of happiness as an important human goal (Paiva et al., 2016 ). On July 12, 2012, the United Nations General Assembly comprising of all 193 presidents of the UN member states, passed a resolution (A/Res/66/281) declaring every 20 March the International day of happiness; this was following the authorization of a prior resolution (A/Res/65/281) titled, Happiness: towards a holistic approach to development (United Nations, 2012 ). Both resolutions encourage policy makers to aim to achieve and enhance happiness and well-being when creating or modifying policies (United Nations, 2012 ). Since 2012, the United Nations Sustainable Development Solutions Network (UNSDSN) has published the World Happiness Report (WHR) and has ranked countries according to the World Happiness Index annually.

The UN and various researchers have recognized the significance of happiness not only as an individual endeavor but also as a public endeavor (Paiva et al., 2016 ). Veenhoven explains the importance of governments applying a utilitarianism approach to happiness (Veenhoven, 2017 ). A utilitarianism approach to happiness means authorities should aim to achieve greater happiness for the greater numbers within their populations (Veenhoven, 2017 ). Basing happiness policy on factual and logical reasoning such as research findings will potentially result in individuals being more optimistic about living and working towards a better life (Veenhoven, 2017 ). Thus, it is essential that policy creation and the implementation of effective strategies pertaining to happiness be based on contextually relevant characteristics (Paiva et al., 2016 ).

Positive psychology theorists believe that research and policy needs to move from solely focusing on psychopathological aspects, i.e., individuals’ weaknesses, to optimizing the positive aspects, i.e., individuals’ strengths (Seligman and Csikszentmihalyi, 2000 ). There are several definitions of happiness as a construct, and these definitions generally imply the experience of a positive state of emotion (Paiva et al., 2016 ). Positive psychologists advocate for the understanding of how an individual’s happiness and well-being influence his or her productivity and optimal functionality to fully achieve his or her potential in life (Seligman and Csikszentmihalyi, 2000 ). Happiness is an attitudinal phenomenon, meaning one’s perceptions and beliefs of happiness influence the actual experience of happiness (Veenhoven, 2017 ; Joshanloo et al., 2017 ).

Happiness is the hallmark of positive affect, which entails both experiencing positive emotions in conjunction with perceiving one’s life as virtuous, meaningful and worthwhile (Berkland et al., 2017 ; Walsh et al., 2018 ; Lyubomirsky et al., 2005 ). In 2017, the WHR reported that happiness at work is associated with increased productivity and consistency (Jan-Emmanuel De Neve, 2017 ). The World Health Organization (WHO) Health System Framework consists of six building blocks, one of which is the health workforce (World Health Organization, 2007 ). In 2012, researchers stated that the health workforce is at the core of every health system (Anand and Bärnighausen, 2012 ). Healthcare professionals are part of the health workforce. Healthcare professionals are individuals who are formally trained in providing healthcare services to human beings that are curative, preventive, and/or promotive in nature (World Health Organization, 2013 ).

Nevertheless, mental health research among healthcare professionals within health systems is largely focused on reporting their weaknesses and pathologies as opposed to positive aspects of their mental health. For instance, there is more evidence on healthcare professionals experiences of higher levels of distress, burnout syndrome, depressive symptoms, and suicidal ideations more than among other professionals in other sectors (Brand et al., 2017 ; Kokonya et al., 2014 ; Dyrbye et al., 2017 ; Lafreniere et al., 2016 ). It is essential to recognize problems and challenges, but it is equally important to promote the optimistic aspects of mental health. Although positive attitudes and experiences may not eliminate difficult experiences, they act as a buffer that is paramount for healthcare professionals (Einarsdottir, 2012 ).

In 2018, scholars reported that happiness is a significant factor of health system efficiency (See and Yen, 2018 ). Recently, empirical studies assessing and reporting happiness among healthcare professionals have been increasing. Hence, this study aims to systematically review recent literature to determine the role of individuals and organizations in healthcare professionals happiness. Systematic reviews are important tools used for summarizing evidence in a precise and reliable way (Liberati et al., 2009 ). Using a systematic review, the purpose of this study was to examine the individual and organizational determinants of healthcare professionals happiness. Specifically, we performed a narrative synthesis of recent literature between 2009 and 2019.

The main research questions of this study were, ‘ What are the individual and organizational determinants of healthcare professionals happiness and how can they be applied in happiness-related policies and strategies ?’ Though there have been various empirical studies on healthcare professionals happiness, to the best of our knowledge, there is no systematic review reporting or answering this research question. This systematic review will also provide up-to-date information for decision makers to make informed decisions regarding healthcare professionals happiness behavioral interventions (Liberati et al., 2009 ). Based on the belief that we can achieve “… better health outcomes through better informed decisions.” p. 1040 (Atkins et al., 2005 ), this systematic review aims to summarize recent literature in order to inform policy makers and to identify the significant roles of individuals (i.e., healthcare professionals) and organizations (e.g., health facilities and the national health systems) in enhancing healthcare professionals happiness. Happiness-related studies have improved and informed decision-making processes in terms of policies and regulations based on legal, organizational and national happiness interventions (Huang, 2010 ). Finally, this review identifies research gaps and provides for future directions for studies in this area.

The protocol of this systematic review was registered in advance, and the PROSPERO registration number is CRD42020145855. The protocol is available at elsewhere Footnote 1 .

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines (Moher, 2015 ). The results of the systematic selection process are illustrated in a PRISMA flowchart that is shown in Fig. 1 (Moher, 2015 ). Additionally, to ascertain the quality of this systematic review, we applied the guidelines provided by the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS). The ROBIS has been used to assess and strengthen systematic reviews in healthcare-related fields that influence health policy in specialties such as public health and quality of health care, among others (Whiting et al., 2016 ).

As adapted from source: Moher ( 2015 ).

Eligibility criteria

The selection process of this systematic review was based on eligibility criteria for both inclusion and exclusion. The inclusion criteria included selecting empirically peer-reviewed studies that report on the determinants or factors of healthcare professionals happiness that were published in the English language between 2009 and 2019, and the studies must have clearly indicated the measure of happiness. Focusing on this 10-year period allowed us to examine recent literature on healthcare professionals happiness in this systematic review. This was essential because systematic reviews are among the ideal sources of evidence-based health policy, and they often use recent literature to facilitate relevant, informed decision making (Shojania et al., 2007 ). Since there is currently no gold standard tool for measuring happiness, various tools were used in the included studies (Paiva et al., 2016 ). Both quantitative and qualitative studies were reviewed.

Exclusion criteria included nonempirical studies, reviews, gray literature, non-peer-reviewed studies, studies that were not published in the English language, and studies not published between 2009 and 2019. In addition, studies on happiness among workers in other sectors, students and non-medically trained caregivers were also excluded. Additionally, studies with no specific measure for happiness were excluded. Studies that claimed to assess happiness then reported on a different construct, even ones related to mental health, were also excluded.

The PRISMA flow diagram shown in Fig. 1 presents the number of articles included and excluded during the selection process as per the PRISMA statement and study eligibility criteria (Moher, 2015 ).

Number of studies included by country

The eleven countries represented in this review included the United States of America (USA) ( n = 7 studies), Iran ( n = 2 studies), Iceland ( n = 1 study), Brazil ( n = 1 study), India ( n = 1 study), Romania ( n = 1 study), South Africa ( n = 1 study), Canada ( n = 1 study), Croatia ( n = 1 study), Thailand ( n = 1 study), and Spain ( n = 1 study) (see Fig. 2 ).

Source: Authors own.

Data sources and search strategy

The databases used to systematically search for relevant articles were EBSCOhost, PubMed, Scopus, and Web of Science. These databases are credible platforms that are sources of scholarly and peer-reviewed information with search tools that enable access to dates of coverage and provide a platform to identify studies in a systematic way (Liberati et al., 2009 ). These databases were selected because they contain literature related to various disciplines of health, including healthcare professionals, and health policy. Therefore, through these four databases, we obtained scholarly data from studies on our topic of focus from reliable researchers and experts.

The search terms used were “happiness” AND “healthcare professionals”, “healthcare workers”, “health personnel”, “happy doctors”, “happy physicians”, and “happy nurses”. A multidisciplinary search using various combinations of keywords and MeSH terms was used and differed accordingly between databases. Boolean operators such as “AND” and “OR” were applied to accommodate different terminology related to our review.

From the databases, citations were exported into Endnote X8™ (Clarivate Analytics, Philadelphia, PA, United States of America), a referencing manager software. Duplicates were removed on Endnote X8™. Articles that failed to meet the inclusion criteria were excluded. The final selection of the articles was based on the independently selected articles and approved by the review team.

Data extraction

Publication metadata were extracted using a data extraction template that was created and modified according to all the studies reviewed. The publication details were captured and summarized in a tabular format developed by the authors of this review. The publication metadata were as follows: author(s), year of publication, country of study, main goal of study, sample size, measure of happiness, statistical procedure used and main findings of the reviewed studies. Discrepancies were discussed and resolved through discussion by the review team.

Risk of bias

Using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist tools, we performed quality assessments on the risk of bias for each study in this systematic review ( Joanna Briggs Institute ). The quality assessment was performed according to the study design of each study reviewed, such as cross-sectional studies, cohort studies, randomized controlled trials and qualitative research studies. After assessing the risk of bias, the review team selected a total of 18 studies.

In this review, based on a systematic search of the Scopus, PubMed, EBSCOhost, and Web of Science databases, 3689 records were identified. The 3689 records were exported into Endnote X8 TM , and 1262 duplicate records were eliminated, leaving 2427 records. After screening the titles, 2046 records were excluded, leaving 381 records. After screening the abstracts, 31 records remained. After full-text screening, 13 records were excluded. The reasons for excluding studies were either lack of a specific measure for happiness n = 7, reporting a different construct other than happiness n = 4 or reporting on participants who are not healthcare professionals n = 2. In total, 18 studies were eligible for this review, including 15 quantitative studies and 3 qualitative studies (see Fig. 1 and Tables 1 – 3 ). The total number of healthcare professionals represented across all articles included was N = 3501.

Of the 18 eligible studies included in this review, six different measures of happiness were identified in the quantitative studies. The Subjective Happiness Scale (SHS) (Lyubomirsky and Lepper, 1999 ) was used in six studies to assess overall happiness on a 7-point Likert-type scale. The Oxford Happiness Questionnaire (OHQ) (Hills and Argyle, 2002 ) was used in three studies to measure happiness on a 6-point Likert scale. The Oxford Happiness Inventory (OHI) (Argyle et al., 1989 ) assessed happiness in two studies on a 6-point Likert scale. The Happiness Measure Questionnaire (Appel et al., 2013 ) was used in one study to assess happiness with a 10-point scale. The Pemberton Happiness Index (PHI) (Hervás and Vázquez, 2013 ) measured happiness in one study with an 11-point Likert scale. Two studies used a single item to measure happiness; one study used an item with a 5-point Likert scale (Petriş et al., 2013 ), and the other used an item with a 10-point Likert scale (Prizmic et al., 2009 ). The three remaining studies that applied a qualitative approach used interviews and/or participant observations to measure happiness.

Methodological quality

As shown in Table 4 , all 18 reviewed studies underwent methodological quality assessments and were of high quality due to their low risk of bias. Nonetheless, two studies with unclear critical appraisal outcomes were found, due to confounding variables. Nevertheless, these issues were appropriately addressed in the multivariate analysis performed in both quantitative studies.

Determinants of healthcare professionals happiness in the cross-sectional studies

In this systematic review, there were eleven cross-sectional studies that included approximately 86.1% of the total number of healthcare professionals ( n = 3014/3501). The types of healthcare professionals represented in the cross-sectional studies included counselors (Chaverri et al., 2018 ), cardiologists (Petriş et al., 2013 ), dentists (Kaipa et al., 2017 ), nurses (Abdollahi et al., 2014 ; Khosrojerdi et al., 2018 ), physiotherapists (Elliot et al., 2018 ), psychiatrists (Machado et al., 2016 ), physicians (family, general and fellowship graduate) (Eckleberry-Hunt et al., 2016 ; Duffrin and Larsen, 2014 ), and general healthcare workers (Prizmic et al., 2009 ; Benzo et al., 2017 ). The measures used in the cross-sectional studies to assess healthcare professionals happiness included the OHI, the OHQ, the SHS and single-item measures, as presented in Table 1 .

In Iran, moderate happiness was reported both in 2014 among 252 nurses (Abdollahi et al., 2014 ) and 2018 among 422 nurses (Khosrojerdi et al., 2018 ). In 2014, nurses reported higher levels of happiness among nurses with greater hardiness (the ability to adapt oneself in problematic life situations) (Abdollahi et al., 2014 ). Lower scores of perceived stress result in higher happiness scores among nurses, which was depicted by the negative correlation between stress and happiness scores (Abdollahi et al., 2014 ). Four years later, in 2018, another study among nurses in Iran reported that 50.3% of the variance in happiness was attributed to 10 determinants (Khosrojerdi et al., 2018 ). The determinants included monthly income, satisfaction with income, job satisfaction, quality of life, current hospital ward, length of working in the current ward, work shift, age and satisfaction with physicians’ conduct and performance (Khosrojerdi et al., 2018 ). Among the 10 determinants, the most significant determinant was satisfaction with mental health, which explained 13% of the variance in nurses’ happiness (Khosrojerdi et al., 2018 ).

Average to moderately high scores of happiness were reported in India, Romania and South Africa across different types of healthcare professionals. In India, moderately high scores of happiness were reported among dentists ( n = 194), with the most important determinant of happiness being the type of profession. The dentists who were both clinicians and academicians reported experiencing more happiness than the dentistry professionals who were either clinicians or academicians (Kaipa et al., 2017 ). In Romania, among cardiologists ( n = 187), an average level of happiness was reported (Petriş et al., 2013 ). The determinants of happiness among the cardiologists included age, number of vacation days per year and single marital status (Petriş et al., 2013 ). Among physiotherapists ( n = 395), moderately high scores of happiness were reported (Elliot et al., 2018 ). Approximately 60% of the variance in physiotherapist happiness was explained by high scores on four determinants, namely, life balance, leisure, influence and optimism (Elliot et al., 2018 ).

Among mental healthcare professionals, specifically counselors ( n = 153) in the United States of America (USA) and physiatrists in Brazil ( n = 104), moderate to moderately high scores of happiness were reported. In 2018, among counselors, higher happiness scores were predicted by an increased number of sessions per client and low severity of posttraumatic stress symptoms experienced by the counselor (Chaverri et al., 2018 ). In Brazil, researchers reported that 50.2% of their happiness was explained by the following determinants: having children, good quality sleep and the use of three defense styles related to mature factors, namely, anticipation, humor, and the use of neurotic factors (e.g., annulment) (Machado et al., 2016 ). Hence, the less psychiatrists reported using the defense mechanism of acting out (an immature factor) in their profession, the happier they were (Machado et al., 2016 ).

Two studies in the USA reported moderately high happiness scores among family physicians. In 2014, general family physicians reported lower scores of happiness compared to fellowship-trained family physicians (Duffrin and Larsen, 2014 ). The type of physician training as a determinant of happiness explained 10% of the variance in happiness scores (Duffrin and Larsen, 2014 ). In addition, gender differences were found, such that male family medicine physicians reported significantly higher happiness scores than their female counterparts (Duffrin and Larsen, 2014 ). In 2016, among family physicians ( n = 449), happiness was significantly determined by four factors, including experiencing a sense of career purpose, a sense of personal accomplishment, less distress and a higher perceived ability to manage their workload experience (Eckleberry-Hunt et al., 2016 ). Workload manageability among family physicians explained ~35.8% of their subjective happiness (Eckleberry-Hunt et al., 2016 ).

In the USA, scholars examined two determinants of healthcare workers’ ( n = 400) happiness, namely, self-compassion and weekly exercise (Benzo et al., 2017 ). These factors explained ~39% and 40% of the variance in healthcare workers’ happiness, respectively (Benzo et al., 2017 ). In Croatia, average scores of overall happiness were reported, and age was the only noteworthy determinant of overall happiness among the healthcare workers ( n = 185) (Prizmic et al., 2009 ). Younger healthcare workers reported being happier (Prizmic et al., 2009 ).

Determinants of healthcare professionals happiness in the intervention studies

The four intervention studies examined in this review included ~11.9% ( n = 418/3501) of the healthcare professionals in this review. The healthcare professionals represented included medical surgical nurses (Appel et al., 2013 ), oncologists (Clemons et al., 2019 ), and healthcare workers’/professionals in general (Sexton and Adair, 2019 ; Coo and Salanova, 2018 ). Like the cross-sectional studies, the intervention studies all used self-report measures to assess happiness, namely, the Happiness Measure Questionnaire, the OHQ, the PHI and the SHS. A summary of the intervention studies on healthcare professionals happiness in this systematic review is presented in Table 2 .

In North America (specifically in the USA and Canada), three studies assessed happiness following different interventions. In a study among medical surgical nurses in the USA ( n = 91), no statistically significant differences in general happiness scores were found between the control group ( n = 43) and group that completed an intervention involved the impact of journaling on perceived happiness ( n = 48) (Appel et al., 2013 ). However, the variance in the quality of care provided by the nurses was explained by baseline happiness scores both pre- and postintervention (Appel et al., 2013 ). Additionally, in the USA, another study among healthcare workers ( n = 280) who completed the Three Good Things intervention revealed increases in subjective happiness over time (Sexton and Adair, 2019 ). In a Canadian study among oncologists ( n = 13), an intervention involving a 13-week self-improvement virtuous program led to no statistically significant improvements in oncologists’ happiness (Clemons et al., 2019 ) (see Table 2 ).

In Spain, a trial involving a mindfulness-based intervention (MBI) with three 150-min sessions among healthcare workers ( n = 34) (intervention group n = 19 and control group = 15) was carried out (Coo and Salanova, 2018 ). Both interaction and time effects of the intervention and control groups were reported (Coo and Salanova, 2018 ). Scholars reported that the MBI program of three (150-min) sessions led to an increase in happiness among healthcare workers (Coo and Salanova, 2018 ).

Determinants of healthcare professionals happiness in the qualitative studies

The three qualitative studies reviewed herein included ~2% ( n = 69/3501) of the healthcare professionals. Across the three qualitative studies, a total of 18 determinants of healthcare professionals happiness were reported (as shown in Table 3 ). Among the three studies were two ethnographic and one narrative inquiry.

An ethnographic study among pediatricians and nursing personnel ( n = 40) in the NICU in Iceland identified approximately four considerable emerging determinants of happiness (Einarsdottir, 2012 ). The determinants of healthcare professionals happiness in the NICU reported include the opportunity to do good via the provision of professional healthcare to children, professional pride, love for the well-being of the children, and a belief that happiness supersedes ethical dilemmas.

In the USA, another ethnographic study among physiotherapists ( n = 15) reported four substantial determinants of physiotherapist happiness (Gannotti et al., 2019 ). The determinants of the physiotherapists’ happiness included feeling and believing that one’s work is meaningful and purposeful, the chance to be altruistic by helping the patients learn new and healthy skills to increase their independence, having an opportunity for quality time with family and friends and leisure time to do recreational activities (Gannotti et al., 2019 ).

The third qualitative study performed in Thailand involved the qualitative research design known as narrative inquiry. From a total of nine advanced practice nurses, 10 substantial determinants of happiness were reported among APNs (Buaklee et al., 2017 ) (see Table 3 ). The determinants that led to increased happiness among APNs were being more optimistic by changing one’s perspective from problem-focused to solution-focused, engaging in self-empowerment personally or professionally, striving to be a role model, time management, professional pride, exercising patience as one seeks opportunities to achieve their professional goals, helping, teaching, and coaching junior nurses and colleagues, and seeking spiritual support.

In this systematic review, we aimed to examine the individual- and organization-level determinants of healthcare professionals happiness globally between 2009 and 2019. Happiness is the degree to which an individual enjoys his or her present life (Veenhoven, 2017 ). The happier healthcare professionals are, the better the quality of health care and services they provide (Khosrojerdi et al., 2018 ; Kaipa et al., 2017 ). Since happiness is an attitudinal concept, we cannot measure it solely based on observing behavior; instead, assessments are a better way of comprehensively measuring the subjective delight of one’s life (Veenhoven, 2017 ). Thus, the studies reviewed herein applied different forms of questioning, such as self-report measures and interviews. The determinants of happiness reported in this review indicate the roles of the individual and organizations in the happiness of healthcare professionals.

Individual determinants of healthcare professionals happiness

In this review, individual determinants are the inimitable factors that contribute to healthcare professionals happiness. From the research findings reported in this review, individual determinants refer to the role of attitudes, perceptions, knowledge and skills on healthcare professionals happiness.

Age is an individual determinant of happiness and was reported in four studies with differing outcomes (Khosrojerdi et al., 2018 ; Petriş et al., 2013 ; Kaipa et al., 2017 ; Prizmic et al., 2009 ). Among Romanian cardiologists, older cardiologists (specifically those above 65 years) were happier (Petriş et al., 2013 ), which was similar to the findings among dentists from India (Kaipa et al., 2017 ). However, in Croatia, the opposite was true; the younger healthcare workers were, the happier they were (Prizmic et al., 2009 ). These differences could be attributed to contextual factors. Although both countries are in Europe, they are different countries, and cultural differences cannot entirely be dismissed. In addition, the period during which the studies were performed could influence the results. For example, the two studies reported findings in two years, i.e., 2009 in Croatia (Prizmic et al., 2009 ) and 2013 in Romania (Petriş et al., 2013 ), thus partially explaining the varied findings on the phenomenon of age and happiness.

Gender is a social construct that defines and describes human behavior in terms of perceptions of masculinity and femininity (Muthuri, 2016 ). Gender differences among healthcare professionals happiness were reported in two cross-sectional studies. In the USA, for instance, female fellowship graduate physicians were happier than their male counterparts (Duffrin and Larsen, 2014 ). In India, among dentists, males are happier than their female counterparts (Kaipa et al., 2017 ). This could be attributed to cultural perceptions of masculinity and femininity in the different countries. According to Hofstede, masculinity and femininity are based on societal perceived values assigned between males and females, which vary across cultures and contexts (Hofstede, 2011 ). To create and effectively implement factual and relevant happiness policies, collaboration between healthcare professionals, researchers and policy makers is paramount. The collaboration in the research capturing, the perceptions of gender and how it impacts healthcare professionals happiness could be done across different contexts, either regional, national or rural versus urban.

The results of the present review reveal the role of attitude on healthcare professionals happiness. Attitude is both cognitive and affective in nature and has been found to influence health behavioral change (Lawton et al., 2009 ). A positive attitude is a signature strength that contributes to authentic happiness (Seligman, 2004 ). In this review, adopting positive attitudes resulted in increased happiness among healthcare professionals. A positive attitude involving self-empowering attitudes, adopting the attitude that happiness supersedes ethical dilemmas, allowed healthcare professionals to view challenges from a problem to a solution-focused point (Buaklee et al., 2017 ; Einarsdottir, 2012 ). A positive attitude among healthcare professionals allowed them to achieve a sense of purpose and personal accomplishment (Elliot et al., 2018 ; Eckleberry-Hunt et al., 2016 ; Seligman, 2004 ; Peterson et al., 2005 ).

Acquiring a sense of meaning and purpose in one’s life has been reported to result in the long-term experience of happiness (Peterson et al., 2005 ). As a result, healthcare professionals professional pride allows them to strive to be role models for their colleagues (Einarsdottir, 2012 ; Buaklee et al., 2017 ). The more compassionate healthcare professionals were to themselves, the happier they were (Benzo et al., 2017 ). Thus, policy makers should not only emphasize compassion towards others but also self-compassion, thus enabling individuals to provide compassion to others. Generosity is another signature strength (Seligman, 2004 ), referred to as altruism in this review; this trait contributed to healthcare professionals happiness.

Altruism was a universal emerging theme across the qualitative studies in this systematic review. Altruistic behavior involves helping another individual enhance their welfare (Muthuri, 2018 ). In the WHR 2012, altruism was one of the causes of increased happiness, implying that the more altruistic an individual is, the happier they are (Richard Layard and Claudia, 2012 ). The healthcare professionals reported finding happiness by helping patients learn skills to enhance their independence (Gannotti et al., 2019 ), doing good by helping preterm infants and their parents during the challenging times (Einarsdottir, 2012 ), and helping colleagues by coaching and teaching new skills and techniques to enhance their performance (Buaklee et al., 2017 ). The nature of healthcare professions involves having a desire to help others effectively perform and provide quality healthcare. Health authorities could provide opportunities for healthcare professionals to express their generosity or altruism, which has been found to increase happiness. For example, creating mentorship programs recognizable within health facilities and the health system to encourage altruistic behavior could result in increased happiness among healthcare professionals.

Researchers have suggested future research and policy to shift focus from mental illness to mental health (Seligman and Csikszentmihalyi, 2000 ). In this review, satisfaction with mental health was a determinant of happiness to increase happiness healthcare professionals cope in various ways, such as by perceiving stress as minimal and using defense mechanisms such as optimistic anticipation and humor (Abdollahi et al., 2014 ; Eckleberry-Hunt et al., 2016 ; Khosrojerdi et al., 2018 ; Machado et al., 2016 ). These findings highlight the importance of implementing programs promoting mental health strategies. Strategies related to generating healthy coping mechanisms and increasing happiness among healthcare professionals to optimize their productivity at an individual and organizational level.

Quality of life is a cognitive concept that is used as a basis for lifestyle decision making based on an individual’s perception of consequences (Susniene and Jurkauskas, 2009 ). As constructs, happiness and quality of life are closely associated but are not identical (Susniene and Jurkauskas, 2009 ). In this review, quality of life was a determining factor of healthcare professionals happiness. Some decisions, such as participating in recreational activities, taking vacations and breaks, spending quality time with their friends and family, and good quality sleep, are related to quality of life among healthcare professionals, thus contributing to their happiness (Khosrojerdi et al., 2018 ; Petriş et al., 2013 ; Machado et al., 2016 ; Gannotti et al., 2019 ). Policies and programs allowing for enhanced quality of life can enable healthcare professionals to revitalize and reenergize themselves through some of the ways reported in this systematic review. The examination of the individual determinants of healthcare professionals happiness illustrates the role of individuals in their own happiness as well as the role of organizations they work for.

Organizational determinants of healthcare professionals happiness

Organizational determinants of healthcare professionals happiness are related to organization dynamics, structure and behavior within health facilities and/or health systems at large.

In 2008, researchers stated that not only can career success result in happiness but also happiness can result in career/workplace success (Boehm and Lyubomirsky, 2008 ). Career development, specifically vocational identity achievement, has been associated with pursuit engagement and meaning as orientations of happiness (Hirschi, 2011 ). Career development is a progressive process involving the diversification of oneself through various actions to acquire better knowledge and skills. Findings from this review showed that healthcare professionals career development was a determinant of happiness; through increasing their work experience, acquiring higher qualifications, being both clinicians and academicians, were some of the career development and success strategies that contributed to the healthcare professionals happiness (Kaipa et al., 2017 ; Petriş et al., 2013 ). This implies that opportunities for career development within health organizations and health systems need to be considered when developing happiness policies and strategies.

Among healthcare professionals in this review, time management, workload manageability, satisfaction with income, satisfaction with colleagues conduct and performance, having more sessions with clients, job rotation in the hospital wards and shifts were among the organizational dynamics that contributed to their happiness (Buaklee et al., 2017 ; Eckleberry-Hunt et al., 2016 ; Khosrojerdi et al., 2018 ). The more satisfaction one experiences both at work and in life, the happier they are likely to be and the better they are likely to perform (Argan et al., 2018 ; Streimikiene and Grundey, 2009 ). Therefore, policy makers should not only consider financial satisfaction but also enhance job satisfaction by improving organizational culture and dynamics.

Intervention studies such as other types of studies provide insight into promising strategies through developing research-based capacity-building interventions in policy settings (Haynes et al., 2018 ). In this review, two other studies reported a significant improvement in healthcare professionals happiness using two interventions, namely, the Three Good Things intervention (3GT) (Sexton and Adair, 2019 ) and the Mindfulness Based Intervention (MBI) (Coo and Salanova, 2018 ). However, another two intervention studies showed no significant improvement in healthcare professionals happiness when using journaling as an intervention (Appel et al., 2013 ) or the 13-virtuous self-improvement program (Clemons et al., 2019 ). The findings from this review suggest that some interventions could work, and others may not. The success or failure of an intervention is based on its interaction with the context (Haynes et al., 2018 ). An ideal intervention involves components such as contextually based interventions, goals and genuine collaboration of persons and partners (Haynes et al., 2018 ). Therefore, health policy makers and researchers could consider adopting an open mindset when exploring the effectiveness of happiness interventions among populations such as healthcare professionals in varied organizational contexts.

Work–life balance involves taking actions towards effectively managing the demands and responsibilities of both work and life (such as the self, family and friends) (Otken and Erben, 2013 ). The opposite of work–life balance is work–life conflict. As a result of work–life conflict, some organizations chose to develop policies and strategies geared towards empowering their employees to achieve work–life balance (Otken and Erben, 2013 ). In this review, achieving work–life balance was a determinant of happiness among healthcare professionals balance (Petriş et al., 2013 ; Machado et al., 2016 ; Elliot et al., 2018 ). In Turkey, research has reported that the happiness of employees increases when they are driven both in their work and life domains (Otken and Erben, 2013 ). Therefore, evidence-based policies and strategies geared towards energizing and empowering healthcare professionals to feel better at home and work are significant in increasing their happiness.

Physical health is paramount, but people also strive for happiness, sense of meaning and purpose and being a good person with healthy relationships (VanderWeele et al., 2020 ). All these factors contribute to a healthy and full life. A study based on global data on happiness found that the greater happiness, the better health and longevity the population is likely to experience, thus reflecting human flourishing (Veenhoven, 2017 ). In this review, exercising and having leisure time to perform recreational activities were determinants of healthcare professionals happiness (Gannotti et al., 2019 ; Benzo et al., 2017 ). In this review, it is evident that healthcare professionals are human beings who strive to be healthy and need physical, psychological, and social support to be healthier and happier.

Policies and implementation of strategies geared towards training healthcare professionals holistic development are essential. Interventions empowering healthcare professionals to enhance the synergy between their intrapersonal and interpersonal development are paramount for their happiness. From an individual standpoint, happiness is a result of being in harmony with one’s life (Streimikiene and Grundey, 2009 ). Based on evidence in this review, individual determinants of healthcare professionals happiness do not operate mutually exclusively from the organizational determinants. Healthcare professionals happiness is a result of an interplay between the healthcare professionals (as individuals) and the organization (health facilities and health system). In the research area of healthcare professionals happiness, there are knowledge gaps that still exist. In the following section, we identify limitations and research gaps in the current literature to inform future research on healthcare professionals happiness.

Limitations and recommendations for future studies

Various limitations were noted in this review, which are possible avenues for further research. The most cited limitation was a small sample size across both quantitative and qualitative studies (Buaklee et al., 2017 ; Gannotti et al., 2019 ; Coo and Salanova, 2018 ; Clemons et al., 2019 ; Duffrin and Larsen, 2014 ; Chaverri et al., 2018 ; Machado et al., 2016 ; Petriş et al., 2013 ). According to researchers, a small sample size results in lower power for statistical comparison (Gannotti et al., 2019 ), an inability to generalize results (Abdollahi et al., 2014 ; Coo and Salanova, 2018 ; Machado et al., 2016 ), seemingly erroneous data (Clemons et al., 2019 ), sample bias (Elliot et al., 2018 ; Abdollahi et al., 2014 ), selection bias (Chaverri et al., 2018 ; Eckleberry-Hunt et al., 2016 ; Kaipa et al., 2017 ), response bias (Abdollahi et al., 2014 ; Benzo et al., 2017 ), and low response rates (Duffrin and Larsen, 2014 ).

While larger samples were highly recommended, the same is true for heterogeneous samples; future studies should include various groups of healthcare professionals (Coo and Salanova, 2018 ; Clemons et al., 2019 ; Prizmic et al., 2009 ; Elliot et al., 2018 ; Duffrin and Larsen, 2014 ; Benzo et al., 2017 ; Machado et al., 2016 ; Eckleberry-Hunt et al., 2016 ). Some researchers pointed out that heterogeneous sampling is essential in cases where there is no gender balance or when there is an overrepresentation of a healthcare profession (Sexton and Adair, 2019 ). Researchers recommend that future studies consider using complementary approaches or multidimensional approaches when assessing happiness both methodologically and theoretically to provide a comprehensive understanding of the concept of happiness among healthcare professionals (Einarsdottir, 2012 ; Coo and Salanova, 2018 ; Buaklee et al., 2017 ).

Additional limitations included high attrition rates in intervention studies (Coo and Salanova, 2018 ); inaccurately completed questionnaires or answers, some of which were attributed to limited understanding of a concept (Abdollahi et al., 2014 ; Buaklee et al., 2017 ); measurement error due to the use of only self-report assessments that could result in positive or negative tendencies (Kaipa et al., 2017 ; Coo and Salanova, 2018 ); and the timing of the studies, as receiving negative news on disasters could affect individuals’ happiness (Appel et al., 2013 ).

In addition, more comparative studies between healthcare professionals happiness and other psychological factors are needed (Abdollahi et al., 2014 ), as well as studies on the role of organizational culture on the quality of services provided by healthcare professionals (Coo and Salanova, 2018 ). Other behavioral indicators should also be used, such as ratings from a second person and not solely focusing on self-report measures (Coo and Salanova, 2018 ). Similar studies should be done in various settings (Buaklee et al., 2017 ; Duffrin and Larsen, 2014 ) to discover the impact of happiness on health systems in different countries across the seven continents. Last, longitudinal studies were recommended by various researchers to assess healthcare professionals happiness over time (Elliot et al., 2018 ).

Conclusions

In this review, the authors examined the role of healthcare professionals (as individuals) and organizations (health facilities and health systems) in determining healthcare professionals happiness. Happiness is a significant component of healthcare professionals optimal functioning. Based on an examination of recent literature, it is evident that the individual and organizational determinants are not mutually exclusive but interdependently function to achieve healthcare professionals happiness. Thus, ideal and effective happiness policies and implementation strategies need to apply a collaborative approach between healthcare professionals and health authorities at the organization and health system levels. Health policy makers should consider continuously increasing the happiness of healthcare professionals, as it has a significant role in improving the quality of healthcare delivery and health outcomes within health systems. By promoting evidence-based contextually relevant healthcare professionals happiness policies, programs and strategies, health workforce strengthening, and health system strengthening are likely to occur. This review sets the stage for subsequent research contributions aimed at promoting healthcare professionals happiness. Based on the research gaps highlighted in this study, more research on healthcare professionals happiness is needed across all continents. Thus, researchers should explore and contribute to bridging the knowledge gaps regarding healthcare professionals happiness in various contexts.

Data availability

All the data (reviewed articles) used, were from already published empirical articles, retrieved from databases. All data generated or analyzed during this study are included in this published article.

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Acknowledgements

The authors thank Estelle Grobler of the Medical School Library at the University of Pretoria, for her support as an information specialist during our comprehensive systematic search across the databases. We are deeply grateful to God for meeting all our needs during the entire process of the study reported in this paper.

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Muthuri, R.N.D.K., Senkubuge, F. & Hongoro, C. Determinants of happiness among healthcare professionals between 2009 and 2019: a systematic review. Humanit Soc Sci Commun 7 , 98 (2020). https://doi.org/10.1057/s41599-020-00592-x

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DOI : https://doi.org/10.1057/s41599-020-00592-x

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To date, this project has followed 724 men from various socioeconomic backgrounds—from the original group of 268 Harvard undergrads to inner-city Boston neighborhoods—in one of the world’s longest studies of adult life.

Over the years, the researchers have collected and analyzed a vast array of information from each participant’s health records, as well as in-person interviews, questionnaires, and interviews with family members about their lives and their mental and emotional wellness at two-year intervals. The results indicate that specific traits and behaviors are linked with increased happiness levels across the entire group and over time.

Contrary to what you might think, the most important ingredient in health and happiness is not career achievement, material success, exercise, or diet . The most consistent finding over 85 years of research is that–more than any other factor, by far—positive relationships with family, friends, and community keep us happier and healthier and help us live longer. 1

Psychiatrist George Vaillant joined the Harvard study team as a researcher in 1966 and led the study from 1972 until 2004. Trained as a psychoanalyst , Vaillant came to recognize that relationships were the key to healthy aging and the ability of people to live long and satisfying lives.

Researchers also found that those with strong social support experienced less mental deterioration as they aged. Human beings are hard-wired to connect with others, which creates mental and emotional stimulation that activates the parasympathetic division of the automatic nervous system and boosts mood, whereas a sense of social isolation generates loneliness and deflates mood. This suggests the health and wellness value of focusing on enhancing positive relationships and downsizing negative people in your life—by being intentionally selective about your interactions with them or even letting go of the relationship altogether.

While the role of genetics is still significant, it turns out to be less important to longevity than the level of satisfaction with relationships in midlife . Other meaningful protective factors are reasonable physical activity, the absence of alcohol abuse and smoking , having mature mechanisms to cope with life’s ups and downs, and a healthy weight. The more these study participants evidenced, the better their chances for longer, happier lives.

Primary relationship/marital satisfaction has a particularly protective effect on people’s mental health. Related research by the Harvard study’s current director, Robert Waldinger, a psychiatrist, and Zen priest, found that people who had happy marriages in their 80s reported that their moods didn’t suffer, even on days when they had more physical pain. Those with unhappy marriages felt both more emotional and physical pain. 2

Steps to Cultivate and Enhance the Quality of Your Relationships

Practice “relational fitness.” We tend to think that they will take care of themselves once we establish friendships and intimate relationships. But our social relationships are living systems that evolve and require attention and action to sustain healthy connections over time and changing life circumstances. Relational fitness requires taking an ongoing inventory of our connections with others. This involves evaluating them with an eye toward whether they continue to serve our health and well-being. Which of your relationships have meaning and value to you? Which contribute to the quality of your life, which ones tend to detract from it, and which ones do you wish were better? More specifically, a helpful approach to assessing your relational fitness includes the following areas:
Safety and security. Who can you turn to in moments of uncertainty and/or crisis?
Learning and growth. Who encourages you to try new things, take healthy risks by going outside your comfort zone, and pursue your life's goals ?
Emotional closeness and trust. Who can you trust and call on when you are struggling and be honest about your feelings?
Identity affirmation and shared experience. Who in your life has shared important experiences with you? Who helps you strengthen your sense of who you are and your priorities?
Romantic intimacy . Do you have a healthy amount of romantic connection and intimacy in your life?
Help both informational and practical. Who do you turn to when you need guidance or assistance solving a practical problem (e.g., home repair, fixing your WiFi connection)?
Fun and relaxation. Who makes you laugh? Who do you call to see a movie or go on a road trip with? Who makes you feel connected and at ease?
Smile intentionally and often. A genuine smile is a small yet profound act of kindness and generosity that also elevates mood by triggering the release of the feel-good neurotransmitters serotonin and dopamine .
Greet people when you encounter them. Say “hello,” “good morning,” and “good afternoon.” Whenever possible, greet people by name, which symbolizes recognition and connection and is among the most understated yet powerfully validating experiences a person can have.
Express gratitude /appreciation. Say “thank you.” It’s a way of recognizing others and honoring their efforts.
Make some time for conversations. A newly published study suggests that the simple act of reaching out to a friend for conversation—at least once a day, if possible—increases happiness and lowers stress . 3
Engage in forms of caring touch (whenever appropriate and emotionally safe), such as gently putting a hand on another’s shoulder to communicate support or sharing a heartfelt hug. Caring touch has multiple physiological and emotional benefits for both people. It reduces blood pressure, lowers the stress hormone cortisol, and stimulates the release of oxytocin , the bonding hormone.
When you love people, tell them. Whether a spouse/partner, child, parent, or friend—rather than assume they know you love them, communicate it directly. James Taylor hit this nail squarely on the head: “Shower the people you love with love.”
Get involved in some form of being of service to others. Volunteering time and energy for a cause close to your heart is an effective way to connect with more people with similar interests and priorities. Volunteering is also another way to boost happiness by providing a sense of purpose. Research demonstrates that this benefit is especially potent among people ages 45 to 80 and older. 4

It's never too late to expand and deepen the relationships that matter to you. Being active in connecting and reconnecting with the people in your life to enrich your relationship with them has profound bio-psycho-social- spiritual benefits. Not only can these benefits last a lifetime, but they can also help extend your lifetime. Whether it's a thoughtful text, a DM via social media , an email, a phone call, or in-person contact, all moments of dedicated attention have meaning and value.

Facebook image: oneinchpunch/Shutterstock

LinkedIn image: SeventyFour/Shutterstock

[1] https://news.harvard.edu/gazette/story/2017/04/over-nearly-80-years-har…

[2] Waldinger RJ, Schulz MS. What's love got to do with it? Social functioning, perceived health, and daily happiness in married octogenarians. Psychol Aging. 2010 Jun;25(2):422-31. doi: 10.1037/a0019087. PMID: 20545426; PMCID: PMC2896234.

[3] Hall, J. A., Holmstrom, A. J., Pennington, N., Perrault, E. K., & Totzkay, D. (2023). Quality Conversation Can Increase Daily Well-Being. Communication Research, 0(0). https://doi.org/10.1177/00936502221139363

[4] Association of volunteering with mental well-being: a lifecourse analysis of a national population-based longitudinal study in the UK, BMJ Open 2016;6:e011327. doi: 10.1136/bmjopen-2016-011327

Dan Mager, MSW is the author of Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain and Roots and Wings: Mindful Parenting in Recovery .

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This Famous Harvard Study Reveals the Greatest Predictor of Health and Happiness in 5 Words

Valuable insights from one of the longest happiness studies ever conducted..

If you want to lead a long, happy, and fulfilling life marked by good health and vitality, then you should take a close look at the Harvard Study of Adult Development . This is one of the longest-running studies of adult life, having started in 1938. Over the past 85-plus years, the study has followed the lives of more than 700 original participants and over 1,300 of their descendants.

The study's main goal was to identify the key factors contributing to human happiness and well-being. Researchers collected vast amounts of data through interviews, medical exams, questionnaires, and even brain scans, tracking various aspects of the participants' lives, such as physical health, mental health , career, relationships, and overall satisfaction.

The secret to good health and happiness in five words

Robert Waldinger, the study director, whose TED Talk has been viewed nearly 50 million times, said one of the study's most significant findings is that the quality of our relationships has a profound impact on our well-being.

The quality of our relationships.

Waldinger and his research team were amazed to discover that individuals who had the strongest bonds with others tended to lead happier, healthier, and longer lives as they aged. In turn, having good relationships was the most important factor in predicting who would enjoy a fulfilled and healthy life in old age.

Waldinger shared a profound truth in a recent episode of the Curiosity Chronicle podcast that could greatly improve your quality of life decades from now. He said:

Relationship satisfaction at age 50 was the single greatest predictor of physical health at age 80.

When I'm 80, and my physical health is in tiptop shape, there's no question that my emotional and mental health will also function on all cylinders. That is to say, anyone living that kind of vibrant life into their 80s will achieve a level of happiness unlike that of their peers at the same age. All of this is realized by choosing to develop healthy relationships and friendships earlier in life. Who doesn't want that?

It may be time to reframe what we think leads to happiness. For example:

Thinking that material wealth equals happiness. It's a classic one. Sure, money can make life easier and provide opportunities, but it doesn't guarantee happiness. Studies show that beyond a certain income threshold, additional wealth doesn't significantly increase happiness. In other words, if you're rich and miserable, more money won't help. It's more about how you use your resources and the quality of your relationships.

Thinking that success and achievements equal happiness. Many people believe that achieving certain career goals or milestones will lead to everlasting happiness. While accomplishments can bring some joy, it's often fleeting. True happiness tends to come from within and isn't solely reliant on external achievements.

On that last point, Waldinger expands further in his own words in an interview with McKinsey's Author Talks :

What we find is that the badges of achievement don't make people happy. We had people who were CEOs, who made lots of money, or who became famous. Those things did not relate to happiness. But, to the extent that achieving things that are important to you is fulfilling, that does make a difference in well-being. What we found is that the people who were the happiest were not isolated. They were not workaholics who didn't pay any attention to their relationships. Those people were some of the saddest folks in our study and were filled with regret when they were in their 80s and we asked them to look back on their lives.

Wow. So, the bottom line is simple and attainable, but not everybody will get there. Ultimately, at the end of the road, having strong, supportive relationships with family, friends, and community is crucial for leading a happy, healthy and fulfilling life. That about nails it.

A refreshed look at leadership from the desk of CEO and chief content officer Stephanie Mehta

Bed-sharing is unlikely to harm children's psychological health, study finds

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Parental bed-sharing is unlikely to impact children's psychological development, new research has found.

The study from the University of Essex looked at nearly 17,000 British babies and tracked them for 11 years – finding kids who shared beds were happy and healthy.

Dr. Ayten Bilgin, from the Department of Psychology, found no association between bed-sharing at 9 months and childhood emotional or behavioral problems.

The practice is mired in controversy as some experts previously thought it negatively affected children's development.

However, others say it helps both parents and children as they are nearby for feeding and if they wake in the night.

Despite the ongoing debate about the potential long-term harms and benefits of bed-sharing, little scientific research has been conducted on this topic. Parents can rest assured that as long as it's practiced safely, bed-sharing is unlikely to have any negative impact on children's emotional and behavioral development. There is a lot of guilt and shame around bed-sharing - but it is a parental choice." Dr. Ayten Bilgin, Department of Psychology, University of Essex

The study, published in Attachment and Human Development, used data from the UK Millennium Cohort Study which follows the lives of 16,599 children born in the UK.

Parents reported on bed-sharing at 9 months and on their children's internalizing behavior – such as depression and anxiety - and externalizing, like aggression and hyperactivity, when they were 3, 5, 7 and 11 years old.

University of Essex

Bilgin, A., et al . (2024). Associations between bed-sharing in infancy and childhood internalizing and externalizing symptoms. Attachment & Human Development . doi.org/10.1080/14616734.2024.2380427 .

Posted in: Child Health News | Medical Research News

Tags: Anxiety , Children , Depression , Hyperactivity , Psychology , Research

Global and Local Efforts to Take Action Against Hepatitis

Lindsey Hiebert and James Amugsi

In this interview, we explore global and local efforts to combat viral hepatitis with Lindsey Hiebert, Deputy Director of the Coalition for Global Hepatitis Elimination (CGHE), and James Amugsi, a Mandela Washington Fellow and Physician Assistant at Sandema Hospital in Ghana. Together, they provide valuable insights into the challenges, successes, and the importance of partnerships in the fight against hepatitis.

Global and Local Efforts to Take Action Against Hepatitis

Addressing Important Cardiac Biology Questions with Shotgun Top-Down Proteomics

In this interview conducted at Pittcon 2024, we spoke to Professor John Yates about capturing cardiomyocyte cell-to-cell heterogeneity via shotgun top-down proteomics.

A Discussion with Hologic’s Tim Simpson on the Future of Cervical Cancer Screening

Tim Simpson

Hologic’s Tim Simpson Discusses the Future of Cervical Cancer Screening.

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6 Scientific Facts That Link Happiness with Good Health

Need some extra motivation to get happier check out the ways science has proven that happiness is good for your health..

Happiness and health are a virtuous circle ( Unsplash )

By Kira M. Newman, Greater Good Over the past decade, an entire industry has sprouted up promising the secrets to happiness. There are best-selling books like The Happiness Project and The How of Happiness , and happiness programs like Happify and Tal-Ben Shahar’s Wholebeing Institute. The Greater Good Science Center offers an online course on “The Science of Happiness” and boast a collection of research-based happiness practices on our new website, Greater Good in Action . READ: The Essential Toolkit for Happiness But all of these books and classes raise the question: Why bother? Many of us might prefer to focus on boosting our productivity and success rather than our positive emotions. Or perhaps we’ve tried to get happier but always seem to get leveled by setbacks. Why keep trying? Recently, a critical mass of research has provided what might be the most basic and irrefutable argument in favor of happiness: Happiness and good health go hand-in-hand. Indeed, scientific studies have been finding that happiness can make our hearts healthier, our immune systems stronger, and our lives longer. Several of the studies cited below suggest that happiness causes better health; others suggest only that the two are correlated—perhaps good health causes happiness but not the other way around. Happiness and health may indeed be a virtuous circle, but researchers are still trying to untangle their relationship. In the meantime, if you need some extra motivation to get happier , check out these six ways that happiness has been linked to good health.

1. HAPPINESS PROTECTS YOUR HEART

Love and happiness may not actually originate in the heart, but they are good for it. For example, a 2005 paper found that happiness predicts lower heart rate and blood pressure. In the study, participants rated their happiness over 30 times in one day and then again three years later. The initially happiest participants had a lower heart rate on follow-up (about six beats slower per minute), and the happiest participants during the follow-up had better blood pressure. Research has also uncovered a link between happiness and another measure of heart health: heart rate variability, which refers to the time interval between heartbeats and is associated with risk for various diseases. In a 2008 study , researchers monitored 76 patients suspected to have coronary artery disease. Was happiness linked to healthier hearts even among people who might have heart problems? It seemed so: The participants who rated themselves as happiest on the day their hearts were tested had a healthier pattern of heart rate variability on that day. Over time, these effects can add up to serious differences in heart health. In a 2010 study , researchers invited nearly 2,000 Canadians into the lab to talk about their anger and stress at work. Observers rated them on a scale of one to five for the extent to which they expressed positive emotions like joy, happiness, excitement, enthusiasm, and contentment. Ten years later, the researchers checked in with the participants to see how they were doing—and it turned out that the happier ones were less likely to have developed coronary heart disease. In fact, for each one-point increase in positive emotions they had expressed, their heart disease risk was 22 percent lower.

2. HAPPINESS STRENGTHENS YOUR IMMUNE SYSTEM

Do you know a grumpy person who always seems to be getting sick? That may be no coincidence: Research is now finding a link between happiness and a stronger immune system. In a 2003 experiment , 350 adults volunteered to get exposed to the common cold (don’t worry, they were well-compensated). Before exposure, researchers called them six times in two weeks and asked how much they had experienced nine positive emotions—such as feeling energetic, pleased, and calm—that day. After five days in quarantine, the participants with the most positive emotions were less likely to have developed a cold. Some of the same researchers wanted to investigate why happier people might be less susceptible to sickness, so in a 2006 study they gave 81 graduate students the hepatitis B vaccine. After receiving the first two doses, participants rated themselves on those same nine positive emotions. The ones who were high in positive emotion were nearly twice as likely to have a high antibody response to the vaccine—a sign of a robust immune system. Instead of merely affecting symptoms, happiness seemed to be literally working on a cellular level. A much earlier experiment found that immune system activity in the same individual goes up and down depending on their happiness. For two months, 30 male dental students took pills containing a harmless blood protein from rabbits, which causes an immune response in humans. They also rated whether they had experienced various positive moods that day. On days when they were happier, participants had a better immune response, as measured by the presence of an antibody in their saliva that defends against foreign substances.

Happy kids are healthy kids ( Unsplash )

3. HAPPINESS COMBATS STRESS

Stress is not only upsetting on a psychological level but also triggers biological changes in our hormones and blood pressure. Happiness seems to temper these effects, or at least help us recover more quickly. In the study mentioned above, where participants rated their happiness more than 30 times in a day, researchers also found associations between happiness and stress. The happiest participants had 23 percent lower levels of the stress hormone cortisol than the least happy, and another indicator of stress—the level of a blood-clotting protein that increases after stress—was 12 times lower. Happiness also seems to carry benefits even when stress is inevitable. In a 2009 study , some diabolically cruel researchers decided to stress out psychology students and see how they reacted. The students were led to a soundproof chamber, where they first answered questions indicating whether they generally felt 10 feelings like enthusiasm or pride. Then came their worst nightmare: They had to answer an exceedingly difficult statistics question while being videotaped, and they were told that their professor would evaluate their response. Throughout the process, their heart was measured with an electrocardiogram (EKG) machine and a blood pressure monitor. In the wake of such stress, the hearts of the happiest students recovered most quickly.

4. HAPPY PEOPLE HAVE FEWER ACHES AND PAINS

A 2001 study asked participants to rate their recent experience of positive emotions, then (five weeks later) how much they had experienced negative symptoms like muscle strain, dizziness, and heartburn since the study began. People who reported the highest levels of positive emotion at the beginning actually became healthier over the course of the study, and ended up healthier than their unhappy counterparts. The fact that their health improved over five weeks (and the health of the unhappiest participants declined) suggests that the results aren’t merely evidence of people in a good mood giving rosier ratings of their health than people in a bad mood. A 2005 study suggests that positive emotion also mitigates pain in the context of disease. Women with arthritis and chronic pain rated themselves weekly on positive emotions like interest, enthusiasm, and inspiration for about three months. Over the course of the study, those with higher ratings overall were less likely to experience increases in pain.

Happy days = less pain ( Dimedrol68 / Shutterstock.com )

5. HAPPINESS COMBATS DISEASE AND DISABILITY

Happiness is associated with improvements in more severe, long-term conditions as well, not just shorter-term aches and pains. In a 2008 study of nearly 10,000 Australians, participants who reported being happy and satisfied with life most or all of the time were about 1.5 times less likely to have long-term health conditions (like chronic pain and serious vision problems) two years later. Another study in the same year found that women with breast cancer recalled being less happy and optimistic before their diagnosis than women without breast cancer, suggesting that happiness and optimism may be protective against the disease. As adults become elderly, another condition that often afflicts them is frailty, which is characterized by impaired strength, endurance, and balance and puts them at risk of disability and death. In a 2004 study, over 1,550 Mexican Americans ages 65 and older rated how much self-esteem, hope, happiness, and enjoyment they felt over the past week. After seven years, the participants with more positive emotion ratings were less likely to be frail. Some of the same researchers also found that happier elderly people (by the same measure of positive emotion) were less likely to have a stroke in the subsequent six years; this was particularly true for men.

6. HAPPINESS LENGTHENS OUR LIVES

In the end, the ultimate health indicator might be longevity - and here, especially, happiness comes into play. In perhaps the most famous study of happiness and longevity, the life expectancy of Catholic nuns was linked to the amount of positive emotion they expressed in an autobiographical essay they wrote upon entering their convent decades earlier, typically in their 20s. Researchers combed through these writing samples for expressions of feelings like amusement, contentment, gratitude, and love. In the end, the happiest-seeming nuns lived a whopping 7-10 years longer than the least happy. You don’t have to be a nun to experience the life-extending benefits of happiness, though. In a 2011 study , almost 4,000 English adults ages 52-79 reported how happy, excited, and content they were multiple times in a single day. Here, happier people were 35 percent less likely to die over the course of about five years than their unhappier counterparts. These two studies both measured specific positive emotions, but overall satisfaction with one’s life—another major indicator of happiness—is also linked to longevity. A 2010 study followed almost 7,000 people from California’s Alameda County for nearly three decades, finding that the people who were more satisfied with life at the beginning were less likely to die during the course of the study.

Longevity is the ultimate indicator of health - and happiness plays an important role (Shutterstock)

As the science of happiness and health matures, researchers are trying to determine what role, if any, happiness actually plays in causing health benefits. They’re also trying to distinguish the effects of different forms of happiness (including positive emotions and life satisfaction), the effects of “extreme” happiness, and other factors. For example, a new study suggests that we should look not just at life satisfaction levels but life satisfaction variability: Researchers found that low life satisfaction with lots of fluctuations—i.e., an unstable level of happiness—was linked to even earlier death than low life satisfaction alone. All that said, the study of the health benefits of happiness is still young. It will take time to figure out the exact mechanisms by which happiness influences health, and how factors like social relationships and exercise fit in. But in the meantime, it seems safe to imagine that a happier you will be healthier, too.

YOU MIGHT ALSO LIKE:

7 Stats About How Happy People Live Their Lives What Will Make You Happy? [QUIZ] This article originally appeared on Greater Good , the online magazine of UC Berkeley's Greater Good Science Center. View the original article here .

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Study suggests even mild concussions can have lifelong brain impacts

by Bob Yirka , Medical Xpress

A team of neuroscientists, brain specialists and psychiatrists, led by a group at Cambridge University, in the U.K, has found evidence suggesting that minor brain injuries that occur early in life, may have health impacts later on.

In their paper published in the journal JAMA Network Open , the group describes how they analyzed and compared MRI scans from hundreds of people participating in the U.K.'s Prevent Dementia study.

Prior research has suggested that some forms of dementia could be related to some types of brain injuries. In this new effort, the research team, hoping to learn more about the impact of concussions or other minor brain injuries on dementia, looked at MRI scans of 617 people between the ages of 40 to 59 who had volunteered to take part in the Prevent Dementia study and who had undergone at least three MRI scans. They also studied their medical histories, focusing most specifically on whether they had had brain injuries anytime during their life.

The research team noted that 36.1% of the volunteers reported having experienced at least one brain injury that was serious enough to have caused them to be unconscious for a short period of time—such injuries are classified as traumatic brain injuries (TBIs).

Looking at the MRI scans, the researchers found higher than normal instances of cerebral microbleeds (1 in 6 of them) and other symptoms of what they describe as evidence of small vessel disease of the brain. They also found that those patients with at least one TBI were more likely to smoke cigarettes, had more sleep problems , were more likely to have gait issues and to suffer from depression. They also noted that the more TBIs a person had, the more such problems became apparent.

Another thing that stood out, the team notes, was that those people who had experienced a TBI when younger had a higher risk of memory problems than did patients with cardiovascular disease , high blood pressure or diabetes, a possible clue about their likelihood of developing dementia.

The researchers conclude by suggesting that more work needs to be done to learn about the long-term impacts of TBIs, particularly regarding memory retention problems and possible associations with the development of dementia. They further suggest that their work hints at the possibility of unknown health consequences years after people suffer head injuries.

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Yes, Single People Can Be Happy and Healthy

F orget everything you think you know about being single—starting with the assumption that it means ready to mingle.

More people than ever before are living solo: Nearly 40% of adults in the U.S. are unpartnered, up from 29% in 1990, according to the Pew Research Center . And about half aren’t interested in dating or a relationship.

Take Bella DePaulo, a 69-year-old in Santa Barbara, Calif., who has been single her entire life. For years, she thought she would eventually develop a desire to marry or enter a long-term relationship—but she’s since realized that single life is her best life. “I had never heard of such a thing as being happily single and wanting to stay single,” says DePaulo, a social psychologist who’s the author of books including Singled Out: How Singles Are Stereotyped, Stigmatized, and Ignored, and Still Live Happily Ever After and Alone: The Badass Psychology of People Who Like Being Alone . “Once I realized that single was who I really was, and that was never going to change, it was wonderful.” She describes her solo life as authentic, fulfilling, meaningful, and psychologically rich.

Researchers are only beginning to fully understand all the dimensions of singlehood—including who it appeals to and why, its challenges and joys, and how it affects health and happiness . For years, singles were hardly studied. Why? In part, probably because “science isn’t independent of society’s values and norms,” says Geoff MacDonald, a psychology professor at the University of Toronto who researches relationships and singlehood. “We’ve been going along with society’s story about single people, and there have been structural incentives to kind of make single people the punching bag.”

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But that’s beginning to change. The marriage rate has been decreasing for decades , and those who do get married often wait until later in life. Marriage is no longer a necessity for having a family or achieving financial comfort; it’s only one path among many that can lead to joy.

Overall, MacDonald says, the available evidence indicates that people in romantic relationships enjoy greater well-being than singles: They tend to be happier and report higher levels of life satisfaction . However, marriage doesn’t necessarily make you happy; there’s evidence that, more likely, happier people choose to get married. And there are lots of variables at play. For instance, some people who are single might be exceptionally happy, while others in relationships are miserable. ( Research has found that people in unhappy marriages have equal or worse health outcomes compared to those who were never married.)

Another important caveat: The singles who have the hardest time with their relationship status tend to be divorced people. Traditionally, research hasn’t accounted for the fact that about 39% of marriages end in divorce. “There’s evidence suggesting that when people get divorced, it can have lasting negative effects,” MacDonald says. Widowhood is also associated with poor mental health, and can lead to grief, depressive symptoms, and loneliness.

As the new science of singlehood crystallizes, here are some of the most intriguing insights that researchers have uncovered.

People prefer being single for many reasons.

Long-term singles tend to have certain values in common, says Elyakim Kislev, a faculty member at the Hebrew University of Jerusalem and author of books including Happy Singlehood . These are people who “cherish freedom, independence, and even creativity and nonconformity more than others,” he says.

Research backs that up. In one study published in 2022, hundreds of men and women were surveyed about what makes single life attractive, and they rated the top benefits as having more time for themselves, being able to focus on their goals, and not having anyone else dictate their actions.

Another study , co-authored by MacDonald, zeroed in on what unpartnered people prioritize the most—and the results suggest they care about being mentally and physically healthy and fostering strong family relationships. Sex and dating were among participants’ least important priorities. Additional research suggests certain traits might hardwire people to be single. Among them: sociosexuality (or the willingness to have sex outside a committed relationship) and high career focus, especially among young women.

“Some people just don’t want to organize their lives around a romantic partner,” says DePaulo, the happily single social psychologist. “They want to take advantage of the freedom to curate lives of their own.”

Wanting a relationship when you’re not in one is correlated with lower life satisfaction.

Some people believe a romantic relationship is essential for their happiness and well-being, while others find fulfillment and satisfaction without a partner. Those in the latter group tend to fare better. “Wanting a relationship more only emphasizes the gap between one’s reality and one’s desire,” Kislev says. People who focus on what they don’t have “often find themselves miserable, which only feeds into more failed dates in a vicious circle.” His research indicates that the more someone wants a relationship, the less satisfied they’ll be with their life.

What’s a single longing for love to do? Kislev says it’s key to find ways to enjoy your current relationship status. Even if you eventually want to couple up—based on your own desires, not those of, say, your parents—take stock of the benefits of your singleness. Regularly engaging in hobbies and self-care activities can boost self-esteem and overall life satisfaction, he says. So can a sense of purpose, achieved perhaps by volunteering or pursuing a passion.

Being alone doesn’t mean being lonely.

People who are coupled up often turn inwards to their partners and families—researchers call it “the greedy marriage,” Kislev says. As a result, “coupled people, especially men, may lose their friends over time and find themselves lonely later in life.”

Singles, on the other hand, typically have stronger social ties, which researchers consistently name as the bedrock of happiness . Research suggests that those without a partner are more likely to support and visit their parents and siblings than people who are currently or previously married, and they usually have more friends . Singles are also more likely to socialize with those friends and to give and receive help from them.

Not all single people live alone, but social scientists have found that those who do tend to be actively involved in the lives of their cities and neighborhoods. “They aren’t just staying home, the way people who live with others often do,” DePaulo says. “They walk out the door and meet other people.” One study found that people who lived with others—not those who lived alone—actually had the highest levels of loneliness.

Kislev has studied the connection between loneliness and marital status in old age, and his findings indicate that married seniors are the least lonely group, followed by those who never married. Both groups were less lonely than people who were widowed, divorced, or separated. The findings indicate that “long-term singles, in particular, develop strong social ties, self-sufficiency, and a sense of purpose over their lifetime,” he says.

People who are satisfied with their sex life are happier to be single.

Ask a married person to describe singles’ sex lives, and they might imagine something more exciting than reality. There’s an assumption that those who aren’t in a relationship have “amazing sexual opportunities for variety and exploration,” MacDonald says. “But our data suggest quite clearly that people have more sex in romantic relationships than they do if they’re single.” That makes sense, he adds, considering the convenience factor.

Still, MacDonald’s research indicates that the extent to which single people are happy with their sex lives predicts their satisfaction with their relationship status. Those with higher sexual satisfaction tend to report less desire to marry and hold stronger beliefs that singletons can be happy, he says.

People become more satisfied with being single around age 40.

There’s a common misconception that older singles are the least happy with their relationship status. But actually, MacDonald’s research suggests that starting around age 40, singletons become more satisfied with their solo lives.

There are likely a couple reasons for this, he says. For one thing, by the time they’ve reached midlife, many people have “filtered into the stream that they’re looking for,” he says. “If you’re somebody who wants a romantic relationship, oftentimes you’ve gotten there, and so unhappy singles have kind of been selected out of the single group.”

Plus, MacDonald adds, there’s evidence that overall well-being tends to increase after midlife, so the connection might not be unique to singlehood.

Social stigma continues—and can be damaging.

Even now, as more people choose solo lives, single-shaming persists. A study published in 2020 found that being prejudiced against singles is considered more acceptable than prejudice toward certain nationalities or sexual orientation groups—and it might manifest, for example, as a landlord disclosing that they’d rather rent an apartment to a married couple than a single person. “Singlism,” as it’s sometimes called, could also mean excluding singles from social events, pressuring them to “settle down,” or making assumptions that certain shortcomings must be keeping them from finding a match.

Kislev points to research in which undergraduate students were asked to list characteristics they associated with married and single individuals. Married people were referred to as mature, happy, kind, honest, and loving. Singles, on the other hand, were perceived as immature, insecure, self-centered, unhappy, lonely, and even ugly. Many people, he says, continue to see singlehood as a transitory stage on the way to a romantic relationship—and as “a second-best option or a failure to find a partner.”

In reality, there’s no one-size-fits-all definition of “happily ever after,” DePaulo says, and it’s possible to reach that vaunted place alone. If you’re single but worried about what others think of you, “live your single life fully, joyfully, and unapologetically,” she advises. “People who try to stigmatize you are the ones who should be embarrassed—not you.”

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NEWS... BUT NOT AS YOU KNOW IT

Microplastics found in the brain could be linked to rise in Alzheimer’s cases

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Close up side shot of microplastics lay on people hand.Concept of water pollution and global warming. Climate change idea.; Shutterstock ID 1972889006; purchase_order: -; job: -; client: -; other: -

New research has shown a potential link between microplastics in the human brain and the global rise in Alzheimer’s disease.

The University of New Mexico study, which has yet to be reviewed by other scientists, has shown that the highest concentration of microplastics was found in 12 brain samples from people that died with dementia, including Alzheimer’s disease.

Researchers analysed microplastic concentrations in 51 liver, kidney, and brain samples collected in 2016 and 2024.

While particles could be found in all these organs, the brain samples showed the highest concentration, seven to 30 times more than liver or kidney samples.

12 brain samples from people that died with dementia or Alzheimer’s were shown to contain up to 10 times more plastic by weight than healthy samples, as reported in the New Lede .

FILE - A doctor points to PET scan results that are part of a study on Alzheimer's disease at Georgetown University Hospital, on Tuesday, May 19, 2015, in Washington. (AP Photo/Evan Vucci, File)

While these early findings alone do not go far enough to prove that there is a link between microplastics in the brain and incidence of dementia or Alzheimer’s, they do suggest a need for further research.

As researchers stated in their report, the incidence of these diseases is rising across the globe. At the same time, the amount of plastic in brains has increased over 50 percent in the past eight years.

Previous studies in mice also linked nanoplastics (plastic particles that are even smaller than microplastics) in the brain to cognitive changes and other conditions of the brain.

A person holding microplastics gathered from the ocean in his hand. The concept for plastic pollution and climate change.; Shutterstock ID 2330159395; purchase_order: -; job: -; client: -; other: -

A different study, published in the journal Science Advances in 2023, found that nanoplastics can interact with a protein called alpha-synuclein, which plays a role in nerve cell communication.

It is said that these particles can bind tightly to alpha-synuclein, which can result in the formation toxic clumps similar to what is seen in Parkinson’s disease

‘It’s pretty alarming,’ Matthew Campen, toxicologist at the University of New Mexico and lead author of the study, told the New Lede.

‘There’s much more plastic in our brains than I ever would have imagined or been comfortable with.’

The extent to which these particles, which are present in air, water, and food, affect human health is not fully understood yet.

According to a 2022 study published in the Lancet Public Health , Global dementia cases are on track to triple by 2050.

But more research is needed in order to explain the possible link microplastics to this trend, scientists have concluded.

This week, it emerged the ‘groundbreaking’ drug lecanemab will not be made available on the NHS because it’s too costly .

The National Institute for Health and Care Excellence (Nice) said the benefits of the medication are ‘just too small to justify the significant cost to the NHS’.

Get in touch with our news team by emailing us at [email protected] .

For more stories like this, check our news page .

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Can AI help ease medicine’s empathy problem?

Doctors often fail to express empathy. artificial intelligence — done right — might be able to help them.

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A realistic image of a female doctor created using generative AI to illustrate how AI doctors on screen may be used for healthcare in the future.

By Evan Selinger and Thomas Carroll

Aug. 15, 2024

Selinger is a professor of philosophy at the Rochester Institute of Technology, and Carroll is an associate professor of medicine at the University of Rochester Medical Center.

Modern medicine has an empathy problem. Artificial intelligence — done right — might be able to help ease it.

Despite the proliferation of communication training programs over the past decade or two, doctors often fail to express empathy, especially in stressful moments when patients and their families are struggling to hear bad news and make difficult decisions. Since empathy has been shown to enhance what patients understand and how much they trust their medical team, falling short compromises the quality of patient care.

Can AI help? That might sound like an ironic question, because doctors who struggle to express empathy can come across as robotic. Yet researchers and health care professionals are increasingly asking it, and not just because we’re living through an AI hype cycle .

One reason for the growing interest in AI to help solve medicine’s empathy problem is that this aspect of medical care has proven particularly hard to improve. This isn’t surprising, given that physicians face ever-increasing pressures to quickly see large numbers of patients while finding themselves drowning in paperwork and a myriad of administrative duties. These taxing conditions lead to both a lack of time and, perhaps more importantly, a lack of emotional energy. An American Medical Association report indicated that 48% of doctors experienced burnout last year .

Given the magnitude of the empathy problem and its significant clinical and ethical stakes, various possible uses of AI are being explored. None of them are likely to be silver bullets and, while each is well-intentioned, the entire endeavor is fraught with risks.

One rather extreme option has been suggested by Dr. Arthur Garson Jr., a member of the National Academy of Medicine and a clinical professor of health systems and population health sciences the University of Houston. He urges us to prepare for a time when some human doctors are replaced with AI avatars . Garson thinks it’s possible, even likely, that AI-powered avatars displayed on computer screens could be programmed to look “exactly like a physician” and have “in-depth conversations” with “the patient and family” that are customized to provide “highly appropriate reactions” to a patient’s moods and words.

Whether AI will ever get this advanced raises tricky questions about the ethics of empathy, including the risk of creating negative dehumanizing effects for patients because, for the foreseeable future, computer programs can’t experience empathy . To be sure, not all human doctors who sound empathetic truly feel that way in the moment. Nevertheless, while doctors can’t always control their own feelings, they can recognize and respond appropriately to patients’ emotions, even in the midst of trying circumstances.

Simulated AI “doctors,” no matter how apparently smart, cannot truly care about patients unless they somehow become capable of having the human experience of empathy. Until that day comes — and it may never arise — bot-generated phrases like “I’m sorry to inform you” seem to cheapen the very idea of empathy.

A more moderate vision revolves around various applications of generative AI to support doctors’ communication with patients in real time. Anecdotal evidence suggests this use of this technology is promising, like Dr. Joshua Tamayo-Sarver’s moving account of how ChatGPT saved the day in a California emergency department when he struggled to find the right words to connect with a patient’s distraught family. Preliminary academic research, like a much-discussed article in JAMA Internal Medicine, also suggests generative AI programs based on large language models can effectively simulate empathetic discourse.

Another recent study , however, suggests that while the content of an empathic message matters, so does the messenger’s identity. People rate AI-generated empathic statements as better on average than human-generated ones if they don’t know who or what wrote them. But the machine’s advantage disappears once the recipient learns that the words had been generated by a bot.

In a forthcoming book, “Move Slow and Upgrade,” one of us (E.S.) proposes the following possibility: integrating a version of generative AI into patient portals to help doctors sound more empathetic. Patients see portals as a lifeline, but doctors spend so much time fielding inbox messages that the correspondence contributes to their burnout . Perhaps a win-win is possible. Doctors might improve patient satisfaction and reduce the number of follow-up questions patients ask by pushing an empathy button that edits their draft messages.

While this application of AI-generated empathy is promising in a number of ways, it also runs many risks even if the obvious challenges are resolved, like the technology consistently performs well, is routinely audited, is configured to be HIPAA compliant, neither doctors nor patients are forced to use it, and doctors use it transparently and responsibly. Many tricky issues would still remain. For example, how can doctors use AI quickly and oversee its outputs without placing too much trust in the technology’s performance? What happens if the technology creates a multiple persona problem, where a doctor sounds like a saint online but is a robot in person? And how can a new form of AI dependence be created to avoid further deterioration of human communication?

Some visions capitalize on AI’s potential to enhance doctors’ communication skills. For example, one of us (T.C.) is involved with the SOPHIE Project , an initiative at the University of Rochester to create an AI avatar trained to portray a patient and provide personalized feedback. It could help doctors improve their ability to appropriately express empathy. Preliminary data are promising, although it is too soon to draw firm conclusions, and further clinical trials are ongoing.

This approach has the advantages of being reproducible, scalable, and relatively inexpensive. It will, however, likely have many of the same limitations as traditional, human-actor-based communication training courses. For example, on the individual level, communication skills tend to degrade over time, requiring repeated training. Another issue is that the doctors who most need communication training may be least likely to participate in it. It is also unrealistic to expect SOPHIE-like training programs to overcome system-level stresses and dysfunction, which are a major contributor to the empathy problem in the first place.

Because technology changes so quickly, now is the time to have thoughtful and inclusive conversations about the possibilities we’ve highlighted here. While the two of us don’t have all the answers, we hope discussions about AI and empathic communication are guided by an appreciation that both the messages and the messengers matter. Focusing too much on what AI can do can lead to overestimating the value of its outputs and undervaluing essential relationships of care — relationships that, at least for the foreseeable future, and perhaps fundamentally, can occur only between human beings. At the same time, prematurely concluding that AI can’t help may unnecessarily contribute to preserving a dysfunctional system that leaves far too many patients seeing doctors as robotic.

Evan Selinger, Ph.D., is a professor of philosophy at Rochester Institute of Technology and the co-author, with Albert Fox Cahn, of the forthcoming book “ Move Slow and Upgrade: The Power of Incremental Innovation” (Cambridge University Press). Thomas Carroll, M.D., Ph.D., is an associate professor of medicine at the University of Rochester Medical Center.

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About the reporting

STAT’s investigation is based on interviews with nearly 100 people around the country, including incarcerated patients and grieving families, prison officials, and legal and medical experts. Reporter Nicholas Florko also filed more than 225 public records requests and combed through thousands of pages of legal filings to tell these stories. His analysis of deaths in custody is based on a special data use agreement between STAT and the Department of Justice.

You can read more about the reporting for this project and the methodology behind our calculations.

The series is the culmination of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.

Evan Selinger

Thomas Carroll

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Health, Hope, and Harmony: A Systematic Review of the Determinants of Happiness across Cultures and Countries

Sowmya Kshtriya

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1. Introduction

2. Materials and Methods

2.2. Articles Search and Counts

2.3. Critical Appraisal and Assessment Procedure

3.1. Health and Happiness

3.1.1. Mental Health and Happiness

3.1.2. Emotional Health and Happiness

3.1.3. Physical Health and Happiness

3.2. Hope and Happiness

3.2.1. Goal Achievement and Happiness

3.2.2. Personal Growth and Happiness

3.2.3. Economic Growth and Happiness

3.3. Harmony and Happiness

3.3.1. Social Harmony and Happiness

3.3.2. Family Harmony and Happiness

3.3.3. Cultural Harmony and Happiness

3.3.4. Religious Harmony and Happiness

3.3.5. Environmental Harmony and Happiness

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4.2. Implications for Policies and Practice

4.3. Social Implications

4.4. Limitations and Future Research

5. Conclusions

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Seth Gillihan, PhD

Markham Heid

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Implantable device responds to opioid overdose

Study detects ‘hidden consciousness’ in brain injury patients

Examining new weight-loss drugs, pediatric bariatric patients

Part of the Tackling Issues of Aging series

6 factors predicting healthy aging According to George Vaillant’s book “Aging Well,” from observations of Harvard men in long-term aging study

Healthy weight

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Probe of Alzheimer’s follows paths of infection

To age better, eat better

The balance in healthy aging

How old can we get? It might be written in stem cells

Plotting the demise of Alzheimer’s

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