Publications

A systems perspective explains dynamics of human flourishing based on the relations between its constituents. Using cross-sectional data from emerging adults (ages 18–29) in 10 countries (N = 7221), this study explored the interrelatedness among constituents of flourishing – happiness & satisfaction with life, mental & physical health, meaning & purpose, character & virtue, close social relationships, and financial & material stability – within and across countries. Each country’s sample was characterized by a unique flourishing network, although there were similarities. Except for financial & material stability, all constituents were positively related across samples. Financial & material stability showed the highest cross-country heterogeneity in its relations. Happiness & satisfaction with life and meaning & purpose showed the strongest interrelations. A higher level of one constituent was associated with lower network connectivity. This systems perspective extends existing knowledge about the conceptualization of flourishing and how people can be supported to achieve and maintain complete well-being.

Background:

Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors.

Objectives:

We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed ∼9y∼9y post-disaster.

Methods:

We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n=3,350n=3,350 and n=2,028n=2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available.

Results:

After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference=0.50standardized difference=0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (−0.36−0.36; 95% CI: −0.53−0.53, −0.18−0.18), lower community attachment (−0.60−0.60; 95% CI: −0.75−0.75, −0.45−0.45), and lower prosociality (−0.39−0.39; 95% CI: −0.55−0.55, −0.24−0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes.

Discussion:

Home loss due to a disaster may have long-lasting adverse impacts on the cognitive social capital, mental health, and prosociality of older adult survivors. https://doi.org/10.1289/EHP10903

The use of methods for causal mediation analysis has expanded dramatically in epidemiology over the past decade. Epidemiologic journals have themselves been the source of many of the methodologic developments. With the use of mediation methods steadily increasing in epidemiology, there is need also to reflect upon reporting practices when these methods are employed in empirical studies. These considerations in part motivated the development of AGReMA, a Guideline for Reporting Mediation Analyses of randomized trials and observational studies.

Background: A higher sense of purpose in life has been linked with reduced risk of age-related chronic health conditions that share elevated inflammation as a key risk factor (e.g., neurodegenerative diseases, heart disease, and diabetes). While prior research has documented cross-sectional associations between higher sense of purpose and lower inflammation, few studies have examined the association between purpose and changes in inflammation over time.

Objectives: Evidence on social stimuli associated with mental health is based mostly on self-reported health measures. We aimed to examine prospective associations between social connectedness and clinical diagnosis of depression and of anxiety. Methods: Longitudinal observational data merged with health insurance data comprising medical information on diagnosis of depression and anxiety were used. 1,209 randomly sampled employees of a US employer provided data for the analysis. Robust Poisson regression models were used. Multiple imputation was conducted to handle missing data on covariates. Results: Better social connectedness was associated with lower risks of subsequently diagnosed depression and anxiety, over a one-year follow-up period. Reports of feeling lonely were associated with increased risks of depression and anxiety. Association between community-related social connectedness and subsequent diagnosis of depression, but not of anxiety, was found. The associations were independent of demographics, socioeconomic status, lifestyle, and work characteristics. They were also robust to unmeasured confounding, missing data patterns, and prior health conditions. Conclusion: Social connectedness may be an important factor for reducing risks of depression and anxiety. Loneliness should be perceived as a risk factor for depression and anxiety.

The apolipoprotein E allele 4 (APOE-ε4) is established as a major genetic risk factor for cognitive decline and late-onset Alzheimer's disease. Accumulating evidence has linked ε4 carriership to abnormal structural brain changes across the adult lifespan. To better understand the underlying causal mechanisms, we investigated the extent to which the effect of the ε4 allele on cognition is mediated by structural brain imaging markers in the population-based Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-Reykjavik). This study included 4527 participants (aged 76.3 ± 5.4 at baseline) who underwent the brain magnetic resonance imaging assessment (of brain tissue volumes, white matter lesion volume, subcortical and cortical infarcts, and cerebral microbleeds) and a battery of neuropsychological tests at baseline. Causal mediation analysis was used to quantify the mediation of the ε4 effect on cognition by these MRI markers, both individually and jointly. We observed that about 9% of the total effect of ε4 carriership on cognition was mediated by white matter lesion volume. This proportion increased to 25% when total brain tissue volume was jointly considered with white matter lesion volume. In analyses separating ε4 homozygotes from ε4 heterozygotes, the effect on global cognition of specifically ε4 homozygosity appeared to be partially mediated by cerebral microbleeds, particularly lobar microbleeds. There was no evidence of mediation of the ε4 effect by cortical or subcortical infarcts. This study shows that the ε4 effect on cognition is partly mediated by white matter lesion volume and total brain tissue volume. These findings suggest the joint role of cerebral small vessel disease and neurodegeneration in the ε4-cognition relationship.

We examined the associations of lockdown stringency and duration with Google searches for four mental health concepts (i.e., “Anxiety,” “Depression,” “Suicide,” “Mental Health”) in nine countries (i.e., Hungary, India, Iran, Italy, Paraguay, Serbia, South Africa, Spain, Turkey) during the COVID-19 pandemic.

At least since Augustine, Christian theology, especially but not only in the Latin West, has been dominated by an account of angelic origins in which the Incarnation was a response to humanity’s fall, itself occasioned by the prior angelic fall, whose cause in turn was the proud desire to be like God. (We’ll call this the ‘pride-account’). Nonetheless, that Augustinian view has been balanced from the beginning by an ‘envy-account’, which stresses instead Wisdom’s claim, ‘Through the Devil’s envy, death entered the world’ (Wisd. 2:24). The earliest extra-biblical versions of the envy-account – developed in the Latin, Syriac, and Arabic ‘Life of Adam and Eve’ traditions – take the object of Satan’s envy to have been Adam in particular. In the thirteenth century, however, Robert Grosseteste, as part of his extended defense of the idea that the Son would have been incarnate even without sin, argued instead that the Devil and his angels fell in rejecting the to-be-incarnate Christ, whose merits serve to ‘justify’ not only unfallen humanity, but even the holy angels. On this view, which arguably has biblical roots in Hebrews 1 and Revelation 12, and which reached its apogee in Milton’s Paradise Lost, ‘the Devil’s envy’ was directed at the God-man in particular.

This article engages the considerations of imagination in Kierkegaard and Ricoeur to argue for a moral dimension of the imagination and its objects. Imaginary objects are taken to be mental representations in images and narratives of people or courses of action that are not real in the sense that they are not actual, or have not yet happened. Three claims are made in the article. First, by drawing on the category of possibility, a conceptual distinction is established between imagination and fantasy, (1) I claim that imagination has a moral dimension because it is engaged in considering real-life possibilities. Second, (2) drawing on Kierkegaard and Ricoeur, it is argued that mental representations of selfhood in imagination have a moral dimension because they essentially allow people to understand the development of agency in human selfhood by means of representations of would-be selves and narrative figurations of the self. Third, (3) mental representations of human selves have a moral dimension because they form important points of reference for moral orientations in the field of human praxis (moral pointers).

Estimates of effect heterogeneity (i.e. the extent to which the causal effect of one exposure varies across strata of a second exposure) can be biased if the exposure–outcome relationship is subject to uncontrolled confounding whose severity differs across strata of the second exposure.

Health and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time.

Is being overweight associated with all-cause mortality, and if so, could the association simply be an artifact of uncontrolled confounding? This question has been controversial, with 2 prominent meta-analyses of nonrandomized studies reporting opposing conclusions. Flegal et al¹ reported a protective association of being overweight (but not having obesity) vs having normal weight (hazard ratio [HR], 0.94 [95% CI, 0.91-0.96]), whereas the Global Body Mass Index (BMI) Mortality Collaboration² (GBMC) reported a detrimental association (HR, 1.11 [95% CI, 1.10-1.11]). Just as individual nonrandomized studies can be biased because of uncontrolled confounding,³ so can meta-analyses.⁴ In both meta-analyses, many of the included studies did not control for probable confounders (eMethods in the Supplement). We investigated the extent to which potential uncontrolled confounding may have biased these meta-analyses' observed associations.

There is a growing cohort of head and neck cancer (HNC) patients affected by late- and long-term posttreatment side effects. Our study evaluates the relationship between the demographics, clinical characteristics, and posttreatment symptom burden with the subjective sense of flourishing among HNC survivors.

During the COVID-19 pandemic, the United Kingdom (UK) government introduced public health safety measures to mitigate the spikes in infection rates. This included stay-at-home orders that prevented people from leaving their homes for work or study, except for urgent medical care or buying essential items. This practice could have both short and long-term implications for health and wellbeing of people in the UK. Using longitudinal data of 10,630 UK adults, this study prospectively examined the association between home confnement status during the stringent lockdown in the UK (March 23-May 13, 2020) and 20 indicators of subjective well-being, social well-being, pro-social/altruistic behaviors, psychological distress, and health behaviors assessed approximately one month after the stringent lockdown ended. All analyses adjusted for socio-demographic characteristics and social isolation status in the beginning of the pandemic. Home confnement during the lockdown was associated with greater subsequent compliance with COVID-19 rules, more perceived major stressors, and a lower prevalence of physical activity. There was modest evidence of associations with lower life satisfaction, greater loneliness, greater depressive symptoms, greater anxiety symptoms, and more perceived minor stressors post-lockdown. However, there was little evidence that home confnement was associated with other indices of subsequent health and wellbeing. While our study shows that home confnement impacts some indices of subsequent health and wellbeing outcomes even after lockdown, the degree of the psychological adaptation to the difcult confnement behavior remains unclear and should be further studied.