Felicia A. Huppert

Flourishing Across Europe: Application of a New Conceptual Framework for Defining Well-Being

Governments around the world are recognising the importance of measuring subjective well-being as an indicator of progress. But how should well-being be measured? A conceptual framework is offered which equates high well-being with positive mental health. Well-being is seen as lying at the opposite end of a spectrum to the common mental disorders (depression, anxiety). By examining internationally agreed criteria for depression and anxiety (DSM and ICD classifications), and defining the opposite of each symptom, we identify ten features of positive well-being. These combine feeling and functioning, i.e. hedonic and eudaimonic aspects of well-being: competence, emotional stability, engagement, meaning, optimism, positive emotion, positive relationships, resilience, self esteem, and vitality. An operational definition of flourishing is developed, based on psychometric analysis of indicators of these ten features, using data from a representative sample of 43,000 Europeans. Application of this definition to respondents from the 23 countries which participated in the European Social Survey (Round 3) reveals a four-fold difference in flourishing rate, from 41% in Denmark to less than 10% in Slovakia, Russia and Portugal. There are also striking differences in country profiles across the 10 features. These profiles offer fresh insight into cultural differences in well-being, and indicate which features may provide the most promising targets for policies to improve well-being. Comparison with a life satisfaction measure shows that valuable information would be lost if well-being was measured by life satisfaction. Taken together, our findings reinforce the need to measure subjective well-being as a multi-dimensional construct in future surveys.

Evidence for the independence of positive and negative well-being: implications for quality of life assessment.

OBJECTIVES Evidence is accumulating that positive mental states are more than the absence of symptoms, and may play an independent role in health outcomes. The aim of this study is to compare the characteristics and determinants of positive and negative mental states in a population sample. DESIGN A novel analysis of data was undertaken from the General Health Questionnaire (GHQ-30) which was completed by 6,317 participants in the Health and Lifestyle Survey at Time 1 and 3,778 at Time 2, 7 years later. METHODS We derived a positive well-being scale (POS-GHQ) based on positive responses to the positive items of the GHQ-30, and compared it to a standard symptom measure (CGHQ). Discriminant function analyses were performed to establish which demographic, health and social variables best accounted for scores on each scale. RESULTS The distributional properties of the two scales, together with the results of the discriminant analyses, demonstrate a degree of independence between positive and negative well-being. Over one third of the sample obtained either low scores on both positive and negative well-being measures or high scores on both measures. Disability and lack of social roles were important determinants of psychological symptoms, but had less influence on positive well-being. Having paid employment was an important determinant of positive well-being but had less influence on psychological symptoms. We also found that 7-year mortality was predicted more strongly by the absence of positive well-being than by the presence of psychological symptoms. CONCLUSIONS These findings point to the need to include measures of positive well-being in studies of health outcomes and quality of life assessment.

The GPCOG: a new screening test for dementia designed for general practice.

To design and test a brief, efficient dementia‐screening instrument for use by general practitioners (GPs).

Recognition memory in amnesic patients: effect of temporal context and familiarity of material.

In Experiment I recognition memory for pictures, high frequency words and low frequency words was examined in Korsakoff patients and alcoholic controls at retention intervals of 10 minutes, one week and seven weeks. Korsakoffs showed (1) surprisingly good recognition of pictures and low frequency words, scoring well above chance even at the longest retention interval; (2) no evidence of a faster than normal rate of forgetting. In experiment II the familiarity of pictures was varied in such a way that correct recognition involved either (a) explicit decisions as to whether items were seen 10 minutes or 24 hours previously or (b)decisions as to whether items had ever been seen before. Korsakoffs were severely impaired in making the first type of discrimination but had little difficulty with the second type. It is suggested that the primary defect in amnesia may concern contextual memory rather than memory for items as such.

A controlled trial of mindfulness training in schools: The importance of practice for an impact on well-being

We report the results of a short programme of mindfulness training administered to adolescent boys in a classroom setting. Intervention and control groups (N = 155) were compared on measures of mindfulness, resilience and psychological well-being. Although the overall differences between the two groups failed to reach significance, we found that within the mindfulness group, there was a significant positive association between the amount of individual practice outside the classroom and improvement in psychological well-being and mindfulness. We also found that the improvement in well-being was related to personality variables (agreeableness and emotional stability). Most students reported enjoying and benefiting from the mindfulness training, and 74% said they would like to continue with it in the future. The results of this preliminary study are encouraging. Further work is needed to refine the training programme and undertake a definitive randomised controlled trial, using both subjective and objective outcome measures, with long-term follow-up.

Staging of Cytoskeletal and β-Amyloid Changes in Human Isocortex Reveals Biphasic Synaptic Protein Response during Progression of Alzheimer’s Disease

We have examined the relationships between dementia, loss of synaptic proteins, changes in the cytoskeleton, and deposition of beta-amyloid plaques in the neocortex in a clinicopathologically staged epidemiological cohort using a combination of biochemical and morphometric techniques. We report that loss of synaptic proteins is a late-stage phenomenon, occurring only at Braak stages 5 and 6, or at moderate to severe clinical grades of dementia. Loss of synaptic proteins was seen only after the emergence of the full spectrum of tau and beta-amyloid pathology in the neocortex at stage 4, but not in the presence of beta-amyloid plaques alone. Contrary to previous studies, we report increases in the levels of synaptophysin, syntaxin, and SNAP-25 at stage 3 and of alpha-synuclein and MAP2 at stage 4. Minimal and mild clinical grades of dementia were associated with either unchanged or elevated levels of synaptic proteins in the neocortex. Progressive aggregation of paired helical filament (PHF)-tau protein could be detected biochemically from stage 2 onwards, and this was earliest change relative to the normal aging background defined by Braak stage 1 that we were able to detect in the neocortex. These results are consistent with the possibility that failure of axonal transport associated with early aggregation of tau protein elicits a transient adaptive synaptic response to partial de-afferentation that may be mediated by trophic factors. This early abnormality in cytoskeletal function may contribute directly to the earliest clinically detectable stages of dementia.

Normal and abnormal forgetting in organic amnesia: effect of locus of lesion.

Speed of forgetting by the patient H.M. was examined in two experiments using picture recognition tests. In both experiments stimulus duration was manipulated to equalize initial performance by H.M. and others, and speed of forgetting was investigated over a period of one week. In the first experiment, where initial performance was high, H,M. appeared to forget faster than normal controls. In the second experiment, where initial performance was somewhat lower, H.M. was shown to forget faster than both controls and Korsakoff patients (who forget at a normal rate). These results suggest a functional difference between the amnesia with hippocampal lesions and the amnesia of Korsakoffs disease.

Salivary cortisol and DHEA: association with measures of cognition and well-being in normal older men, and effects of three months of DHEA supplementation

Dehydroepiandrosterone (DHEA) is a steroid that shows a marked age-related decline in humans. Previous research suggests potential for DHEA replacement in old age to enhance cognition and well-being. We conducted a clinical trial to test these hypotheses in a non-clinical sample of 46 men aged 62-76. Participants received either 50 mg DHEA daily for 13 weeks, followed by placebo for 13 weeks, or the reverse, in a randomised double-blind cross-over trial design. Levels of salivary cortisol and DHEA were measured at 0800 h and 2000 h prior to each assessment session. Cognition was assessed with tests of speed, attention and episodic memory. Well-being was measured with questionnaires of mood and perceived health. Mood questionnaires were completed at the assessment session as well as concurrently with saliva sampling.A correlational analysis of baseline behavioural data with hormonal data, controlling for age, revealed that higher morning DHEA was associated with lower confusion (r=-0.33; P=0.04), while higher evening DHEA was associated with lower anxiety (r=-0.35; P=0.03) and lower current negative mood in the morning (r=-0.37; P=0.03). Conversely, higher morning cortisol and a morning cortisol/DHEA ratio were associated with higher anxiety (r=0.35; P=0.03), (r=0.46; P=0.004), general mood disturbance (r=0.32; P=0.046), (r=0.32; P=0.04) and higher current negative mood in the evening (r=0.37; P=0.03), (r=0.38; P=0.03). A higher morning cortisol/DHEA ratio was also associated with higher confusion (r=0.39; P=0.01) and lower visuo-spatial memory performance (r=-0.39; P=0.01). Unexpectedly, higher evening cortisol was associated with faster choice reaction time (r=-0.33; P=0.04). These findings are consistent with an impairing effect of high cortisol on episodic memory and mood in older men, which may be attenuated by DHEA. When treatment effects were analysed, no significant effects of DHEA were observed on any of the trial outcomes, providing no support for benefits of DHEA supplementation for cognition or well-being in normal older men in the shorter-term.

Vascular Risks and Incident Dementia: Results from a Cohort Study of the Very Old

The contribution of vascular pathology to the manifestation of dementia and the importance of vascular risk to measures of cognitive function is being increasingly recognized. In particular, confirmation of this risk points towards approaches for prevention in large sections of the population. Information on determinants of incident dementia is increasing, but still relatively few studies of risk have been based on incident cases of dementia in very elderly populations. In this study based on incident cases of dementia in a population aged 75 and over, vascular risks were obtained from informants of the respondents with incident dementia. When compared with controls the factors associated with incident dementia were history of heart attack (odds ratio 2.9), transient ischaemic attacks (4.8), cerebrovascular accidents (3.4), family history of first-degree relatives with dementia (4.0), and occupational exposure to vibrating instruments (1.4). If only Alzheimer’s disease, clinically diagnosed, was included, diabetes (1.4) and a history of dementia in first-degree relatives (6.6) emerged. Thus, vascular risk continues to be of importance in the oldest age groups.

The role of trace strength in recency and frequency judgements by amnesic and control subjects.

Amnesic and control subjects were required to judge the recency and frequency of presentation of complex pictures. The pictures were shown either once or three times 10 min or 24 h before testing. In both groups recency judgements were influenced by frequency of presentation, and frequency judgements by recency of presentation. Because the amnesic patients were unable to discriminate between the effects of repeated presentation and recent presentation, it was concluded that their judgements were determined solely by trace strength. Because controls showed some ability to make this discrimination, it was concluded that their judgements were determined jointly by trace strength and specific information about time and frequency of presentation.