Leslie R. Martin

Childhood conscientiousness and longevity: health behaviors and cause of death.

: Previous research showed that conscientiousness (social dependability) in childhood predicted longevity in an archival prospective cohort study of bright children first studied by Terman in the 1920s (H. S. Friedman et al., 1993). Possible behavioral mechanisms for this robust association are now examined by gathering cause of death information and by considering the possible mediating influences of drinking alcohol, smoking, and overeating. Survival analyses (N = 1,215) suggest that the protective effect of conscientiousness is not primarily due to accident avoidance and cannot be mostly explained by abstinence from unhealthy substance intake. Conscientiousness may have more wide-ranging effects on health-relevant activities.

Psychosocial and Behavioral Predictors of Longevity The Aging and Death of the "Termites"

Impulsive, undercontrolled personalities and major family stresses are known predictors of impaired adjustment, but long-term health effects are unclear. In an archival prospective cohort design, we followed up on L. M. Termans (Terman & Oden, 1947) sample of gifted children by collecting and coding death certificates for the half of the sample that is now dead. Statistical survival analyses were used to predict longevity and cause of death as a function of parental divorce during childhood, unstable marriage patterns in adulthood, childhood personality, adult adjustment, and possible mediating health behaviors. Psychosocial factors emerged as important risks for premature mortality.

Personality and Mortality Risk Across the Life Span: The Importance of Conscientiousness as a Biopsychosocial Attribute

OBJECTIVE This study addressed whether personality in childhood and personality in adulthood are independent predictors of mortality risk and the extent to which behavioral and other psychosocial factors can explain observed relationships between personality and mortality risk. DESIGN This was a prospective longitudinal cohort study of 1,253 male and female Californians over 7 decades (1930-2000). Proportional hazards regressions were the principal analyses. MAIN OUTCOME MEASURES Mortality risk (in the form of relative hazards) was the primary outcome. Additional tests of mediators and moderators ascertained whether associations between personality and mortality risk remained significant when psychosocial and behavioral variables were statistically controlled. RESULTS The findings, including a new 14-year additional follow-up in old age, revealed that conscientiousness, measured independently in childhood and adulthood, predicted mortality risk across the full life span. The link from childhood remained robust when adult conscientiousness and certain behavioral variables were controlled. Psychosocial and behavioral variables partly explained the adult conscientiousness-longevity association. CONCLUSION The findings demonstrate the utility and complexity of modern personality concepts in understanding health and point to conscientiousness as a key underexplored area for future biopsychosocial studies.

Improving patient adherence: a three-factor model to guide practice

Abstract Patient nonadherence is widespread and costly. This paper provides a brief narrative review of research on (non)adherence and validates a clinically useful three-factor heuristic model to guide practitioners as they work with patients to improve adherence. This model is based on the most stable findings from meta-analyses and large-scale empirical studies, reflects the realities of medical practice and offers recommendations for assessing and enhancing patient adherence, particularly in chronic disease management. The model comprises three important clinical actions: (1) insuring that patients have the right information and know how to adhere – including listening to patients’ concerns, encouraging their participation and partnership in decision-making, building trust and empathy, and enhancing recall; (2) helping patients believe in their treatment and become motivated to commit to it – that is, addressing the cognitive, social, cultural normative and contextual factors that affect patients’ beliefs, attitudes and motivation; and (3) assisting patients to overcome practical barriers to treatment adherence and develop a workable strategy for long-term disease management – including assessing and enhancing patients’ social support, identifying and treating their depression and helping patients overcome cost-related treatment barriers.

Catastrophizing and Untimely Death

Participants in the Terman Life-Cycle Study completed open-ended questionnaires in 1936 and 1940, and these responses were blindly scored for explanatory style by content analysis. Catastrophizing (attributing bad events to global causes) predicted mortality as of 1991, especially among males, and predicted accidental or violent deaths especially well. These results are the first to show that a dimension of explanatory style is a risk factor for mortality in a large sample of initially healthy individuals, and they imply that one of the mechanisms linking explanatory style and death involves lifestyle.

A Life Course Perspective on Childhood Cheerfulness and its Relation to Mortality Risk

Under some conditions, cheerfulness promotes health, but cheerfulness also has been associated with unfavorable health outcomes. This study follows up the inverse relation between childhood cheerfulness and longevity found among 1,215 men and women first assessed as children by Lewis Terman in 1922. Risky hobbies, smoking, drinking, and obesity, as well as cause of death, are examined, along with adulthood personality and adjustment. Several hypotheses about mediating variables can be eliminated by these analyses; these data do hint, however, that cheerful children grow up to be more careless about their health. Although correlational and survival analyses suggest that health behaviors play a role, they are unable to explain the observed cheerfulness-mortality link, thus supporting the idea that cheerfulness is multifaceted and should not be assumed to be related to health in a simple manner.

Stability of physical activity across the lifespan.

Physical activity is associated with various health-relevant psychosocial and physiological processes, but activity stability across extended time periods is inadequately understood. This lifespan longitudinal cohort study examined activity levels of 723 males and 554 females. Associations across time were computed and structural equation modeling compared a one factor model and a simplex model. Results showed activity levels are somewhat stable from childhood through middle and late adulthood. Further, a simplex model provided a better fit than a one factor model. Successful models and interventions to improve health will likely require a more nuanced, pattern-sensitive understanding of physical activity across time.

Comparing personality scales across time: an illustrative study of validity and consistency in life-span archival data.

The goals of this study were: (a) to examine whether personality scales, meaningful in contemporary terms, could be derived from archival data; and (b) to use these scales to aid our understanding of the relation of personality to mortality. NEO PI-R data and a battery of archival items, taken from Termans Life Cycle Study, were collected on two new samples (sample 1 mean age = 11.9, n = 167; sample 2 mean age = 22.2, n = 203). Measurement invariance of the archival scales was assessed, and validity was examined using both rational analyses and associations with the Five Factor Model. It was demonstrated that interpretable scales can be derived from 50- to 70-year-old archival data. The archival adult personality data were then used to predict mortality. Conscientiousness remains the strongest personality predictor of longevity. Criteria for establishing the validity of archivally derived scales are suggested.

A model of nonverbal exchange in physician-patient expectations for patient involvement

This paper reviews the literature on the nonverbal aspects of physician-patient interaction, focusing on how expectations about patient involvement are conveyed and negotiated by physicians and patients. Important outcomes of this process, such as satisfaction, adherence, and patient health, are examined. A model of physician-patient negotiation involving four interaction styles is presented to examine the negotiation process and the effects of patient involvement on outcomes.

An archival prospective study of mental health and longevity.

The relationship between mental health status and longevity was examined in an archival prospective cohort study (N = 1,103) derived from work begun by Lewis Terman in the 1920s. Degree of psychological maladjustment, cumulatively rated by Terman and his colleagues as of 1950, was found to be related to higher risk of all-cause mortality over a 4-decade follow-up period. The differences among causes of death were nonsignificant, but there was some indication that mental health problems were more strongly related to deaths from injury and cardiovascular disease. The overall relationship was significant for men but weaker for women. The effect was not substantially mediated by alcohol consumption, obesity, or cigarette smoking.