title: Does happiness itself directly affect mortality? The prospective UK Million Women Study.
abstract: BACKGROUND
  Poor health can cause unhappiness and poor health increases mortality. Previous reports of reduced mortality associated with happiness could be due to the increased mortality of people who are unhappy because of their poor health. Also, unhappiness might be associated with lifestyle factors that can affect mortality. We aimed to establish whether, after allowing for the poor health and lifestyle of people who are unhappy, any robust evidence remains that happiness or related subjective measures of wellbeing directly reduce mortality.
  
  
  METHODS
  The Million Women Study is a prospective study of UK women recruited between 1996 and 2001 and followed electronically for cause-specific mortality. 3 years after recruitment, the baseline questionnaire for the present report asked women to self-rate their health, happiness, stress, feelings of control, and whether they felt relaxed. The main analyses were of mortality before Jan 1, 2012, from all causes, from ischaemic heart disease, and from cancer in women who did not have heart disease, stroke, chronic obstructive lung disease, or cancer at the time they answered this baseline questionnaire. We used Cox regression, adjusted for baseline self-rated health and lifestyle factors, to calculate mortality rate ratios (RRs) comparing mortality in women who reported being unhappy (ie, happy sometimes, rarely, or never) with those who reported being happy most of the time.
  
  
  RESULTS
  Of 719,671 women in the main analyses (median age 59 years [IQR 55-63]), 39% (282,619) reported being happy most of the time, 44% (315,874) usually happy, and 17% (121,178) unhappy. During 10 years (SD 2) follow-up, 4% (31,531) of participants died. Self-rated poor health at baseline was strongly associated with unhappiness. But after adjustment for self-rated health, treatment for hypertension, diabetes, asthma, arthritis, depression, or anxiety, and several sociodemographic and lifestyle factors (including smoking, deprivation, and body-mass index), unhappiness was not associated with mortality from all causes (adjusted RR for unhappy vs happy most of the time 0·98, 95% CI 0·94-1·01), from ischaemic heart disease (0·97, 0·87-1·10), or from cancer (0·98, 0·93-1·02). Findings were similarly null for related measures such as stress or lack of control.
  
  
  CONCLUSIONS
  In middle-aged women, poor health can cause unhappiness. After allowing for this association and adjusting for potential confounders, happiness and related measures of wellbeing do not appear to have any direct effect on mortality.
  
  
  BACKGROUND
  UK Medical Research Council, Cancer Research UK.
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. Electronic address: bette.liu@unsw.edu.au.
authors.forename: Bette
authors.initials: B
authors.lastname: Liu
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Floud
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Kirstin
authors.initials: K
authors.lastname: Pirie
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Green
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Peto
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Valerie
authors.initials: V
authors.lastname: Beral
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006240:Happiness; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D009026:Mortality; D017202:Myocardial Ischemia / Q000401:mortality; D009369:Neoplasms / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006113:United Kingdom