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Evidence for the independence of positive and negative well-being: Implications for quality of life

Felicia A. Huppert & Joyce E. Whittington
Department of Psychiatry, University of Cambridge

Published in 'British Journal of Health Psychology', 8, 107-122, 2003

The object of this study was to identify the characteristics and determinants of positive and negative well-being within a representative population sample of community-dwelling adults (aged 18+).  6,317 participants, who were resident in England, Scotland or Wales during 1984 to 1985, completed various demographic and health instruments, including the General Health Questionnaire (GHQ-30), and a follow-up survey was carried out 7 years later, with 3,778 of the original participants responding.  

The findings indicated that positive well-being scores decreased with age among female participants and negative well-being scores increased.  Positive well-being also declined with age among male participants however negative well-being was at its highest during middle age and lowest during old age.  It was expected that high scores for positive well-being would be associated with lower psychiatric symptoms, and that a high number of psychiatric symptoms would be associated with lower scores for positive well-being.  However, the study found that over one third of the sample demonstrated either low scores on both the positive and negative well-being scales or high scores on both scales.  Participants with low scores on both scales exhibited few psychiatric symptoms but lacked positive emotions whereas those with high scores on both scales demonstrated some symptoms along with an element of positive affectivity.  The results suggest that positive and negative affect are not opposite ends of a continuum nor are they entirely independent of one another.  The researchers suggest that the scores on the two scales demonstrate a moderate degree of independence.

In contrast to previous research, this study found that disability and lack of social support did not appear to have a significantly negative effect on positive well-being, although current illness did reduce feelings of positivity.  The researchers emphasise how the expression of positive well-being, which included sociability and feelings of life satisfaction, in the presence of disability has important implications for quality of life assessment.  They argue that inaccurate conclusions regarding health issues may be drawn by professionals assessing quality of life if they focus entirely on negative well-being, without considering the positive aspect as well.  Therefore the authors highlight the need for positive well-being to be included in valid quality of life measurements.

The study also found that 7-year mortality was predicted more strongly by the absence of positive well-being than by the presence of psychological symptoms.  Moreover, despite the widely held assertion that unemployment is associated with depression, a lack of paid employment was also more strongly associated with reduced positive well-being rather than increased depressive symptoms.  This effect was the same across all age groups and gender, and regardless of the reason for not having paid work.  Interestingly, women over the age of 65 who were in some form of paid employment reported relatively high levels of positive well-being.  The researchers suggest that the reason their findings deviate from the norm may be the result of positive and negative affect being measured in depression scales and scores are determined using a symptom approach.  For example, depression is apparent if the participant responds negatively to a positively worded question or positively to a negative question.  Positive affect is merely considered if the participant responds in the opposite direction.  The researchers therefore argue for additional measures of positive well-being and affectivity to be routinely included in psychological assessments within clinical and research settings.

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