Do Misconceptions About Health-Related Quality of Life Affect General Population Valuations of Health States?

OBJECTIVES: Healthcare resource allocation decisions are often informed by the expected gains in patients' quality-adjusted life-years. Misconceptions about ill-health's consequences for quality of life (QOL) may however affect evaluations of health states by the general population and hence affect resource allocation decisions informed by quality-adjusted life-years. We examine whether people selectively misestimate the QOL consequences of moderate anxiety or depression compared with other dimensions of health, and we test whether informing people of actual changes in QOL associated with health states changes appraisals of their relative undesirability. METHODS: UK general population participants (N = 1259; in 2017) expressed preferences over moderate problems: anxiety or depression, self-care, and pain or discomfort. A randomized control trial design was used whereby a control group was given a functional description of each health state, and 2 intervention groups were additionally given information on the actual differences in either life satisfaction (LS) or day affect (DA) associated with experiencing each health state. RESULTS: The LS (DA) group reported a higher preference for avoiding living with moderate anxiety or depression, being 13.4% (13.9%) more likely to choose it as most undesirable. CONCLUSION: Informing people of the change in LS or DA associated with health states before they appraise them is a feasible way to obtain informed preferences.

Money, well-being, and loss aversion: does an income loss have a greater effect on well-being than an equivalent income gain?

Higher income is associated with greater well-being, but do income gains and losses affect well-being differently? Loss aversion, whereby losses loom larger than gains, is typically examined in relation to decisions about anticipated outcomes. Here, using subjective-well-being data from Germany (N = 28,723) and the United Kingdom (N = 20,570), we found that losses in income have a larger effect on well-being than equivalent income gains and that this effect is not explained by diminishing marginal benefits of income to well-being. Our findings show that loss aversion applies to experienced losses, challenging suggestions that loss aversion is only an affective-forecasting error. By failing to account for loss aversion, longitudinal studies of the relationship between income and well-being may have overestimated the positive effect of income on well-being. Moreover, societal well-being might best be served by small and stable income increases, even if such stability impairs long-term income growth.

Do people become healthier after being promoted?

This paper examines the hypothesis that greater job status makes a person healthier. It begins by successfully replicating the well-known cross-section association between health and job seniority. Then, however, it turns to longitudinal patterns. Worryingly for the hypothesis, the data-on a large sample of randomly selected British workers through time-suggest that people who start with good health go on later to be promoted. The paper can find relatively little evidence that health improves after promotion. In fact, promoted individuals suffer a significant deterioration in their psychological well-being (on a standard General Health Questionnaire (GHQ) mental ill-health measure).

Personality prior to disability determines adaptation: agreeable individuals recover lost life satisfaction faster and more completely.

Personality traits prior to the onset of illness or disability may influence how well an individual psychologically adjusts after the illness or disability has occurred. Previous research has shown that after the onset of a disability, people initially experience sharp drops in life satisfaction, and the ability to regain lost life satisfaction is at best partial. However, such research has not investigated the role of individual differences in adaptation to disability. We suggest that predisability personality determines the speed and extent of adaptation. We analyzed measures of personality traits in a sample of 11,680 individuals, 307 of whom became disabled over a 4-year period. We show that although becoming disabled has a severe impact on life satisfaction, this effect is significantly moderated by predisability personality. After 4 years of disability, moderately agreeable individuals had levels of life satisfaction 0.32 standard deviations higher than those of moderately disagreeable individuals. Agreeable individuals adapt more quickly and fully to disability; disagreeable individuals may need additional support to adapt.

Inequality and Social Rank: Income Increases Buy More Life Satisfaction in More Equal Countries.

How do income and income inequality combine to influence subjective well-being? We examined the relation between income and life satisfaction in different societies, and found large effects of income inequality within a society on the relationship between individuals' incomes and their life satisfaction. The income-satisfaction gradient is steeper in countries with more equal income distributions, such that the positive effect of a 10% increase in income on life satisfaction is more than twice as large in a country with low income inequality as it is in a country with high income inequality. These findings are predicted by an income rank hypothesis according to which life satisfaction is derived from social rank. A fixed increment in income confers a greater increment in social position in a more equal society. Income inequality may influence people's preferences, such that in unequal countries people's life satisfaction is determined more strongly by their income.

Money and happiness: rank of income, not income, affects life satisfaction.

Does money buy happiness, or does happiness come indirectly from the higher rank in society that money brings? We tested a rank-income hypothesis, according to which people gain utility from the ranked position of their income within a comparison group. The rank hypothesis contrasts with traditional reference-income hypotheses, which suggest that utility from income depends on comparison to a social reference-group norm. We found that the ranked position of an individual's income predicts general life satisfaction, whereas absolute income and reference income have no effect. Furthermore, individuals weight upward comparisons more heavily than downward comparisons. According to the rank hypothesis, income and utility are not directly linked: Increasing an individual's income will increase his or her utility only if ranked position also increases and will necessarily reduce the utility of others who will lose rank.

Valuing the Q in QALYs: Does providing patients' ratings affect population values?

OBJECTIVE: Quality-adjusted life years (QALYs) are used to measure the health benefits associated with treatments. QALYs are derived from objective mortality data weighted by assessments made by the general population of the impact on health-related quality of life associated with particular health states. In this study, a simple change is introduced to improve the validity of QALYs by giving raters information about how people living in the health states rate the health states. METHOD: Participants from the general population (N = 155) judged 3 health states using a standard valuation technique after being randomly allocated to 1 of 2 groups. The intervention group was given patients' mean ratings of their own health states from worst to best imaginable health (0-100 scale) before providing their valuations, while the control group was given this information only after providing their valuations. The participants in both groups also indicated whether patients' mean ratings were higher, broadly similar, or lower than they previously expected. RESULTS: When the mean ratings given by patients were higher (lower) than expected, participants in the intervention group provided significantly higher (lower) valuations than participants in the control group. These findings show that participants adjust their valuations of a health state in the direction of the appraisals of those experiencing that state. CONCLUSION: Insofar as policymakers are committed to valuing health states using valuations given by people from the general population, it is desirable to elicit more informed values by providing people with information on how patients rate those states. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Great Recession and subjective well-being: How did the life satisfaction of people living in the United Kingdom change following the financial crisis?

The financial crisis of 2007/08 precipitated a severe global economic downturn, typically referred to as the Great Recession. However, in the United Kingdom this period has been marked by limited change in national indicators of subjective well-being. We assessed the life satisfaction change in response to the Great Recession in a sample of British adults (N = 8,661). We first show that on average the life satisfaction change across the sample was limited. However, average effects may mask substantial amounts of heterogeneity in the data. We therefore explore beyond this average effect to determine whether there were disproportionate changes (losses and gains) in life satisfaction in key sub-groups of the population. We found that individuals experiencing unemployment, who lost income, were sick or disabled, experienced the greatest well-being reductions. Contrastingly the life satisfaction of many individuals did not greatly change following the Great Recession and for some it may have even improved. Our work highlights vulnerable groups that may need additional help during recession periods and also cautions against the over reliance on average measures of well-being.

Central bank interest rate decisions, household indebtedness, and psychiatric morbidity and distress: Evidence from the UK.

BACKGROUND: Central banks set economy-wide interest rates to meet exclusively economic objectives. There is a strong link between indebtedness and psychiatric morbidity at the individual level, with interest rates being an important factor determining ability to repay debt. However, no prior research has explored whether central bank interest rate changes directly influence mental health, nor whether this varies by levels of indebtedness. METHODS: We use British data (N = 93,255) to explore whether the Bank of England base-rate affected how perceived burden of non-mortgage debt (low, medium, and high) influenced psychiatric morbidity. Psychiatric morbidity was measured using the General Health Questionnaire (GHQ-12). Our primary outcome measure was a binary indicator of "psychiatric caseness" (>3 on a 0-12 scale). We also used the GHQ-12 as a continuous measure of distress. RESULTS: When interest rates are high (low) there is an increased (decreased) risk of psychiatric morbidity only among those with a high debt burden (b = 0.026, p =  0.02). This result was robust to alternative explanations. Thus a 1 percentage point base-rate increase is associated with a 2.6% increase that someone with a high debt burden will experience psychiatric morbidity. LIMITATIONS: Our study uses subjective indicators of debt burden. We were unable to determine the mechanism behind our effect. CONCLUSIONS: Changes in central bank interest rates to meet economic objectives pose a threat to mental health. Mental health support is needed for those in debt and central banks may need to consider how their decisions influence population mental health.

Modeling bivariate change in individual differences: Prospective associations between personality and life satisfaction.

A number of structural equation models have been developed to examine change in 1 variable or the longitudinal association between 2 variables. The most common of these are the latent growth model, the autoregressive cross-lagged model, the autoregressive latent trajectory model, and the latent change score model. The authors first overview each of these models through evaluating their different assumptions surrounding the nature of change and how these assumptions may result in different data interpretations. They then, to elucidate these issues in an empirical example, examine the longitudinal association between personality traits and life satisfaction. In a representative Dutch sample (N = 8,320), with participants providing data on both personality and life satisfaction measures every 2 years over an 8-year period, the authors reproduce findings from previous research. However, some of the structural equation models overviewed have not previously been applied to the personality-life satisfaction relation. The extended empirical examination suggests intraindividual changes in life satisfaction predict subsequent intraindividual changes in personality traits. The availability of data sets with 3 or more assessment waves allows the application of more advanced structural equation models such as the autoregressive latent trajectory or the extended latent change score model, which accounts for the complex dynamic nature of change processes and allows stronger inferences on the nature of the association between variables. However, the choice of model should be determined by theories of change processes in the variables being studied. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Adolescent conscientiousness predicts lower lifetime unemployment.

Existing research on Big Five personality and unemployment has relied on personality measures elicited after the respondents had already spent years in the labor market, an experience that could change personality. We clarify the direction of influence by using the British Cohort Study (N = 4,206) to examine whether conscientiousness and other Big Five personality traits at age 16-17 predict unemployment over age 16-42. Our hypothesis that higher conscientiousness in adolescence would predict lower unemployment was supported. In analyses controlling for intelligence, gender, and parental socioeconomic status, the less conscientious (-1 SD) had a predicted probability of unemployment twice as high (3.4% vs. 1.7%) as the highly conscientious (+1 SD), an effect size comparable to intelligence. Mediation analysis revealed that academic motivation and educational attainment explained only 8.9% of this association. Fostering conscientiousness in early life may be an effective way to reduce unemployment throughout adulthood. (PsycINFO Database Record

Individual Differences in Loss Aversion: Conscientiousness Predicts How Life Satisfaction Responds to Losses Versus Gains in Income.

Loss aversion is considered a general pervasive bias occurring regardless of the context or the person making the decision. We hypothesized that conscientiousness would predict an aversion to losses in the financial domain. We index loss aversion by the relative impact of income losses and gains on life satisfaction. In a representative German sample (N = 105,558; replicated in a British sample, N = 33,848), with conscientiousness measured at baseline, those high on conscientiousness have the strongest reactions to income losses, suggesting a pronounced loss aversion effect, whereas for those moderately unconscientious, there is no loss aversion effect. Our research (a) provides the first evidence of personality moderation of any loss aversion phenomena, (b) supports contextual perspectives that both personality and situational factors need to be examined in combination, (c) shows that the small but robust relationship between income and life satisfaction is driven primarily by a subset of people experiencing highly impactful losses.

Personality change following unemployment.

Unemployment has a strongly negative influence on well-being, but it is unclear whether it also alters basic personality traits. Whether personality changes arise through natural maturation processes or contextual/environmental factors is still a matter of debate. Unemployment, a relatively unexpected and commonly occurring life event, may shed light on the relevance of context for personality change. We examined, using a latent change model, the influence of unemployment on the five-factor model of personality in a sample of 6,769 German adults, who completed personality measures at 2 time points 4 years apart. All participants were employed at the first time point, and a subset became unemployed over the course of the study. By the second time point, participants had either remained in employment, been unemployed from 1 to 4 years, or had experienced some unemployment but become reemployed. Compared with those who had remained in employment, unemployed men and women experienced significant patterns of change in their mean levels of agreeableness, conscientiousness, and openness, whereas reemployed individuals experienced limited change. The results indicate that unemployment has wider psychological implications than previously thought. In addition, the results are consistent with the view that personality changes as a function of contextual and environmental factors.

An Existential-Humanistic View of Personality Change: Co-Occurring Changes with Psychological Well-Being in a 10 Year Cohort Study.

Increasingly, psychological research has indicated that an individual's personality changes across the lifespan. We aim to better understand personality change by examining if personality change is linked to striving towards fulfilment, as suggested by existential-humanistic theories of personality dynamics. Using the Wisconsin Longitudinal Study, a cohort of 4,733 mid-life individuals across 10 years, we show that personality change was significantly associated with change in existential well-being, represented by psychological well-being (PWB). Moreover, personality change was more strongly related to change in PWB than changes in other well-being indicators such as depression, hostility and life satisfaction. Personality changed to a similar degree and explained greater variation in our well-being measures than changes in socioeconomic variables. The findings indicate personality change is necessary for the holistic development of an individual, supporting a greater need to understand personality change and increasing room for use of personality measures as indicators of well-being and policy making.

An evolutionary based social rank explanation of why low income predicts mental distress: a 17 year cohort study of 30,000 people.

BACKGROUND: This paper presents a new psychological model of why low income increases risk of mental distress. Consistent with evolutionary perspectives on disorder, income was predicted to relate to mental distress only through acting as an indirect proxy for social rank. METHODS: Participants were part of a longitudinal cohort sample of 30,000 people who were representative of the British population and who completed measures annually for up to 17 years. Mental distress was assessed via the General Health Questionnaire which measures anxiety, depression, and general functioning. RESULTS: Both income and the rank of the income within the region (and the rank of income within other comparison groups, such as similar individuals) predicted current and future distress. However, when distress was jointly regressed on income and income rank, only income rank remained a significant predictor. LIMITATIONS: The outcome measure was self-report (although the predictor was objective). CONCLUSIONS: The results support psychosocial rather than material explanations of why income relates to distress, and suggest that a concern for social rank is the mechanism through which these effects occur. This mechanism is consistent with an evolutionarily based "involuntary defeat syndrome" where hard wired responses to low social rank increase risk for disorder and the Decision by Sampling model of how people make relative judgments. Negative cognitions associated with low social rank (particularly defeat and entrapment) may be clinically targetable in both prevention and treatment programs to reduce socio-economic mental health disparities.

Money or mental health: the cost of alleviating psychological distress with monetary compensation versus psychological therapy.

AbstractMoney is the default way in which intangible losses, such as pain and suffering, are currently valued and compensated in law courts. Economists have suggested that subjective well-being regressions can be used to guide compensation payouts for psychological distress following traumatic life events. We bring together studies from law, economic, psychology and medical journals to show that alleviating psychological distress through psychological therapy could be at least 32 times more cost effective than financial compensation. This result is not only important for law courts but has important implications for public health. Mental health is deteriorating across the world - improvements to mental health care might be a more efficient way to increase the health and happiness of our nations than pure income growth.