Välbefinnande – en överblick Jesper Eriksson Avdelningen för Samhällsmedicin och folkhälsa

Välbefinnande och hälsa? Värde i sig? Välbefinnande och hälsa? Välbefinnande och funktionsförmåga? Vad är välbefinnande? Går det att mäta? Hur man blir lycklig

Värde i sig? Individnivå Gruppnivå Samhällsnivå

Välbefinnande och hälsa?

WHOs definition av hälsa: "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity…" WHO Constitution 1948

Sveriges folkhälsomål: “Skapa samhälleliga förutsättningar för en god hälsa på lika villkor för hela befolkningen” Folkhälsoinstitutet 2007

Hälsa = livslängd

Livskvalité Livslängd Större yta Livskvalité Livslängd

Hälsa = frånvaro av symptom…? Både inom psykologi och medicin har kritiken ökat mot ett alltför stort fokus på de negativa aspekterna av hälsobegreppet

Greater optimism is associated with greater longevity and lowered rates of non-fatal heart attacks (Kubzansky et al., 2001) Pleasant emotion expressed at age 22 as women entered a catholic convent predicted their longevity after age 75 (Danner, Snowdon, & Friesen, 2001) Low life satisfaction predicted fatal accidents (Koivumaa-Honkanen et al., 2002) Preoperative well-being predicted better recovery from surgery (Kopp et al., 2003) Well-being of patient entering whiplash rehabilitation predicted whether going back to work after 2 years (Heikkilä, Heikkilä, & Eisenmann, 1998) Patients with end-state renal failure were more likely to survive for 4 years if they were happy than if they were not (Devins, Mann, Mandin, & Leonard, 1990) People high in well-being have easier to cope with pain than people low in well-being (Keefe et al., 2001) People put into a positive mood showed lower blood pressure reactivity to a stressor than controls (Smith, Ruiz, & Uchino, 2001) People reporting high levels of positive emotions were at reduced risk of developing symptoms when exposed to cold viruses (Cohen et al., 2003)

Samband mellan välbefinnande och hälsa Välbefinnande och mortalitet Välbefinnande och minskad sårbarhet Välbefinnande- snabbare rehabilitering Sambandet mellan välbefinnande och hälsa påverkas också av hälsorelaterat beteende som träning, rökning, alkohol, diet

Forskningsmässiga effekter av att vi bortser från välbefinnande? Fokusbias: Well-being distinct from ill-being. 2 biomarkörer stödde spegelhypotesen, 7 stödde hypotesen att well-being och ill-being representerar olika aspekter av hälsa (Ryff et al. 2006)

Distinct or mirrored? Determinants Outcomes/effects

Validitetsbias: Individer som upplevde subjektivt välbefinnande samtidigt som de inte hade ”depression” (completely healthy) hade en lägre prevalens av CVD än de som endast hade ”frånvaro av depression”. Detta indikerar att tidigare forskning kan ha underestimerat risken för exempelvis CVD eftersom risken är jämförd med en väldigt heterogen grupp av ”icke-depressiva” (Keyes, 2004).

Välbefinnande och funktion

Success gives happiness… Robust consistency showing that happiness also precede success. Review of 225 cross-sectional, longitudinal, and experimental studies, 275.000 participants (Lyubomirsky, King, & Diener, 2005) Clear correlation between employee engagement, well-being, and business outcomes (i.e. profit & turnover). Meta analyses of the Gallup studies, hundreds of work units around the world (Harter, Schmidt, & Keyes, 2002) Clear association between well-being and rehabilitation (Kopp et al., 2003, Heikkilä, Heikkilä, & Eisenmann, 1998) Induced positive affect Widens the scope of attention (Fredrickson & Branigan, 2005) Broadens behavioral repertoire (Fredrickson & Branigan, 2005) Increases creativity (Isen, Daubman, & Nowicki, 1987)

Vad är välbefinnande?

Set-point Presence of positive affect Mood Well-being Health Overall life satisfaction Happiness Complete health Subjective well-being Homeostasis Positive psychology Positive health Sense of meaning Flow Absence from negative affect Domain life satisfaction Joy Psychological well-being Contentment Hedonic well-being Quality of life Eudaimonic well-being Objective well-being Relaxation

Går välbefinnande att mäta?

Diener & Seligman, 2004

Quality of Life PA OWB Affection QoL NA SWB + Domain - Cognition + Intensity, frequency, duration? QoL NA SWB + Domain - “…the sum of its parts?” Cognition + Overall -

Affect & cognition? Vardagens ”ups & downs” har inte nödvändigtvis ett starkt samband med ”overall life-satisfaction”

Current state or enduring trait?

Top-down Bottom-up

Homeostasis Major life event Set-point Set-point Set-point Ny set-point

Psychological well-being As a measure of eudaimonic well-being Autonomy – independence and self-determination Environmental mastery – the ability to manage one’s life Personal growth – being open to new experiences Positive relations with others– having satisfying high quality relationships Purpose in life – believing that one’s life is meaningful Self-acceptance – a positive attitude towards oneself and one’s past life. Ryff 2004

Realize that enduring happiness doesn't come from financial success Realize that enduring happiness doesn't come from financial success. People adapt to changing circumstances—even to wealth or a disability. Take control of your time. Happy people feel in control of their lives, often aided by mastering their use of time. Act happy. We can sometimes act ourselves into a frame of mind. Manipulated into a smiling expression, people feel better; when they scowl, the whole world seems to scowl back. So put on a happy face. Seek work and leisure that engages your skills. Happy people often are in a zone called "flow"—absorbed in a task that challenges them without overwhelming them. Join the "movement" movement. An avalanche of research reveals that aerobic exercise not only promotes health and energy, it also is an antidote for mild depression and anxiety. Give your body the sleep it wants. Happy people live active vigorous lives yet reserve time for renewing sleep and solitude. Give priority to close relationships. Intimate friendships with those who care deeply about you can help you weather difficult times. Focus beyond self. Reach out to those in need. Doing good also makes one feel good. Be grateful. People who pause each day to reflect on some positive aspect of their lives experience heightened well-being. Nurture your spiritual self. For many people, faith provides a support community. Nedkortat från David G. Myers, The Pursuit of Happiness (Avon Books) HUR MAN BLIR LYCKLIG

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