This is one of the kinds of studies which is valuable and so easily misused.

This study looked at females only. Similar results have been found in other studies of males.

The only thing that is accomplished by telling people who meet the objective standard for “cynical hostility” or “pessimism” is to make them feel more of what they already feel: pessimistic and, yes, hostile to the people who sound as if they are telling them that they are wrong for being their cynical selves.

In fact, many of them are successful. In fact, many pessimists or cynics perceive optimists as foolish people who are not paying attention to what is going on around them. In other words, optimists deserve the “dumb but happy” label. They would be unhappy if they understood better what was happening.

There is a scene in a movie, Steel Magnolias, in which a female character announces she is not crazy. “I’ve just been in a bad mood for 25 years.” Yet, in this movie, she had friends and a busy life.  These women are all around, with clear explanations for their world view. A bitter divorce is a good example. Everyone nods. Oh, well, of course. However, women who tell themselves there are “good reasons” for clinically measurable pessimism or clinical hostility need to talk to their doctors about what help there is for them.

If you care about someone whose profile fits the “pessimist” description, recognize that as a risk factor for killer diseases and earlier death. Don’t preach. Do try to offer support as possible. I have known dozens of women who fit into this mold.  Every one of them was worth the effort it takes to support them into getting medical attention—-whether she thought so at the time or not.

Ask your own doctor how to approach a patient like this if you think you have tried everything already or do not know how to broach the subject.

These coping styles are no way to live. These women won’t live as long as they could if they had a different perspective.

A pill alone cannot correct this although other studies have shown that medication can help jump start patient treatment.  If medication is appropriate, she still will have to learn new ways of relating to people—-most of whom know her as the pessimist—-with therapy.

Patients with this world view present a tricky, tricky area for doctors. Cognitive behavior therapy has shown itself to be effective in promoting “learned optimism,” for example. Note: The study below does not name recommended treatment. It recommends studies to examine whether “interventions” (treatments of various kinds compared in clinical trials) leads to “reduced risk.” Only the patient’s doctor can assess what is most appropriate treatment. Depending on the patient’s perceived reasons for her attitudes, a treatment plan which works will have to have her cooperation.

Major Findings:

This is a study of nearly 100,000 women in the Women’s Health Initiative Study who were, at the time of the study, cancer-free and free of heart disease.

- Optimists had a lower age-adjusted rate for coronary heart disease and total mortality.

- Optimists had a lower hazard of cancer-related mortality and a higher rate of total mortality. (This measure showed the effect to be pronounced in black women.)

Circulation

“Participants were 97 253 women (89 259 white, 7994 black) from the Women’s Health Initiative who were free of cancer and cardiovascular disease at study entry. Optimism was assessed by the Life Orientation Test–Revised and cynical hostility by the cynicism subscale of the Cook Medley Questionnaire. Cox proportional hazard models produced adjusted hazard ratios (AHRs) for incident CHD (myocardial infarction, angina, percutaneous coronary angioplasty, or coronary artery bypass surgery) and total mortality (CHD, cardiovascular disease, or cancer related) over 8 years.

“Optimists (top versus bottom quartile ["pessimists"]) had lower age-adjusted rates (per 10 000) of CHD (43 versus 60) and total mortality (46 versus 63). The most cynical, hostile women (top versus bottom quartile) had higher rates of CHD (56 versus 44) and total mortality (63 versus 46). Optimists (versus pessimists) had a lower hazard of CHD (AHR 0.91, 95% CI 0.83 to 0.99), CHD-related mortality (AHR 0.70, 95% CI 0.55 to 0.90), cancer-related mortality (blacks only; AHR 0.56, 95% CI 0.35 to 0.88), and total mortality (AHR 0.86, 95% CI 0.79 to 0.93). Most (versus least) cynical, hostile women had a higher hazard of cancer-related mortality (AHR 1.23, 95% CI 1.09 to 1.40) and total mortality (AHR 1.16, 95% CI 1.07 to 1.27; this effect was pronounced in blacks). Effects of optimism and cynical hostility were independent.

Conclusions—Optimism and cynical hostility are independently associated with important health outcomes in black and white women. Future research should examine whether interventions designed to change attitudes would lead to altered risk.

Citation: Circulation, 2009 (Published online before print August 10, 2009, doi: 10.1161/CIRCULATIONAHA.108.827642)