Health and Longevity Abstracts

Friedman, H. S. (2008). The multiple linkages of personality and disease. Brain, Behavior, and Immunity, 22, 668-675.

Associations between personality and health and longevity are increasingly well-documented, but the causal inter-connections are often much more complex than originally anticipated. Multiple causal pathways may operate simultaneously as the individual travels an idiosyncratic route across the lifespan. Therefore, a straightforward model of personality, immunity, and disease may never be established and validated, because it overlooks other key elements of the causal processes. Psychoneuroimmunology research may profit from closer integration into the broader conceptual understandings of personality and health, using a new lifespan epidemiological personality approach.

Friedman, H. S., Martin, L. R. Tucker, J. S. Criqui, M.E., Kern, M. L. & Reynolds, C. (2008). Stability of physical activity across the life-span. Journal of Health Psychology, 13, 966-978.

Physical activity is associated with various health-relevant psychosocial and physiological processes, but activity stability across extended time periods is inadequately understood. This lifespan longitudinal cohort study examined activity levels of 723 males and 554 females. Associations across time were computed and structural equation modeling compared a one factor model and a simplex model. Results showed activity levels are somewhat stable from childhood through middle and late adulthood. Further, a simplex model provided a better fit than a one factor model. Successful models and interventions to improve health will likely require a more nuanced, pattern-sensitive understanding of physical activity across time.

Kern, M. L. & Friedman, H. S. (2008). Early educational milestones as predictors of lifelong academic achievement, midlife adjustment, and longevity. Journal of Applied Developmental Psychology.

This study gathered follow-up data from the Terman Life Cycle Study (N = 1,023) to examine how age at first reading and age at school entry relate to grade school academic performance, lifelong educational attainment, midlife health and mental adjustment, and longevity across eight decades. Early reading was associated with early academic success, but less lifelong educational attainment and worse midlife adjustment. Early school entry was associated with less educational attainment, worse midlife adjustment, and most importantly, increased mortality risk. Personality, midlife adjustment, and educational attainment partially mediated the school entry-longevity association (controlling for age, sex, personal characteristics, and home environment factors). Although the sample is limited in some respects and care should be taken in generalizing the results, findings do confirm the importance of lifespan approaches in understanding the effects of education on individual patterns within social contexts.

Kern, M.L. & Friedman, H. S. (2008). Do conscientious individuals live longer? A quantitative review. Health Psychology, 27.

Objective: Following up on growing evidence that higher levels of conscientiousness are associated with greater health protection, we conducted a meta-analysis of the association between conscientiousness-related traits and longevity. Design: Using a random-effects analysis model, we statistically combined twenty independent samples. In addition, we employed fixed-effects analyses to examine specific facets of conscientiousness and study characteristics as potential moderators of this relationship. Main outcome measures: Effect sizes were computed for each individual sample as the correlation coefficient r, based on the relationship between conscientiousness and mortality risk (all-cause mortality risk, longevity, or length of survival). Results: Higher levels of conscientiousness were significantly and positively related to longevity (r = .11, 95% confidence interval = .05, .17). Associations were strongest for the achievement (persistent, industrious) and order (organized, disciplined) facets of conscientiousness. Conclusion: Results strongly support the importance of conscientiousness-related traits to health across the lifespan. Future research and interventions should consider how individual differences in conscientiousness may cause and be shaped by health-relevant biopsychosocial events across many years.

Hampson, S. & Friedman, H. S. (2008). Personality and health: A life span perspective. In O. P. John, R. W. Robins, & L. Pervin (Eds.). The Handbook of Personality (3rd ed.). New York: Guilford, pp. 770-794.

It is time to bury the old models of personality and health and replace them with theories and models that employ the most modern concepts from personality psychology. It has long been understood that some individuals are more prone to illness and premature mortality than are others. Indeed, assumptions about variations in disease-proneness form part of the basis for clinical judgments by medical practitioners about their individual patients, the predictions of epidemiologists and insurance companies about health trends and costs, and much targeted preventive medical screening. Yet the extant models, both implicit and explicit, of the links between individual differences and health generally have relied on primitive and incomplete conceptions. understanding the likelihood of disease for the individual is often as important as knowing the general causes of disease. Much of this variation can be captured by a concept that encapsulates the biopsychosocial nature of the individual across time, namely the modern concept of personality.

Friedman, H.S. & Adler, N.E. (2007). The history and background of health psychology.  In H. S. Friedman & R. C. Silver (eds.), Foundations of Health Psychology.  NY:  Oxford University Press, pp. 3-18.

Health psychology, the most modern major domain of psychology, flows from ancient intellectual wellsprings.  From the biblical proverb which taught that “A merry heart does good like a medicine” (Proverbs ch. 17, v. 22) to the definitional “heart-ache” of Shakespeare’s Hamlet (Act III, Sc. 1), the psyche and the soma have long been sensed to be linked.  Yet although such notions of close ties between health and thoughts, feelings, and behaviors date back thousands of years, the scientific discipline of health psychology did not take shape until the 1970's.  Why is health psychology such a latecomer to the scene, especially given its ancient provenance and the obvious general importance of health and longevity?  The answer is a complex one, rooted in longstanding conceptions of disease, illness, and health, and compounded by structural divisions in societal approaches to health and well-being. 

Friedman, H.S. (2007). Personality, disease, and self-healing.  In H. S. Friedman & R.C. Silver (eds.), Foundations of Health Psychology.  NY:  Oxford University Press.

All too often, when dealing with illness, medical investigators (as well as laypersons) think they are asking the question, “Why do people become sick?” but they are really often studying “Who becomes sick?” There is astounding variability in susceptibility to various illnesses and in the speed and likelihood of recovery.  This variability in vulnerability and recuperation is usually at least as important as the average levels of disease, but yet is under-appreciated and under-studied. Such matters point to the existence of a fundamental conceptual problem regarding disease-proneness.

Friedman, H. S. & Martin, L.R. (2007). A life-span approach to personality and longevity: The case of conscientiousness.  In C. Aldwin, C. Park & A. Spiro (eds.).  Handbook of Health Psychology and Aging.  NY:  Guilford.

It has long been recognized that individuals vary considerably in their likelihood of illness or premature mortality, but efforts to characterize these individual differences have often proved inconclusive.  We intuitively understand and research confirms that a person who is distressed, depressed, hostile, bored, frustrated, isolated, or helpless is more likely to become ill (and die prematurely) than is someone who feels emotionally-balanced and efficacious, is in a fulfilling and interesting career, has stable and supportive social relationships, and is well integrated into the community, but efforts to measure, identify, and characterize such people, however, have often led to a morass of weak and hard to replicate findings. Taking a broader, integrative perspective, the question of “Who gets sick and who stays well?” can be addressed with empirically-based concepts that Friedman has termed disease-prone personalities and self-healing personalities.

Martin, L.R., Friedman, H.S., & Schwartz, J. E. (2007).  Personality and mortality risk across the lifespan: The importance of conscientiousness as a biopsychosocial attribute. Health Psychology.

This study addresses whether personality in childhood and adulthood are independent predictors of mortality risk, and the extent to which behavioral and other psychosocial factors can explain observed relationships between personality and mortality risk.  Design: This is a prospective longitudinal cohort study of 1,253 male and female Californians over seven decades (1930 - 2000).  Proportional hazards regressions are the principal analyses.  Main Outcome Measures: Mortality risk (in the form of relative hazards) is the primary outcome.  Additional tests of mediators and moderators ascertain whether associations between personality and mortality risk remain significant when psychosocial and behavioral variables are statistically controlled.  Results: The findings, including new 14-year additional follow-up in old age, reveal that conscientiousness, measured independently in childhood and adulthood, predicts mortality risk across the full lifespan.  The link from childhood remains robust when adult conscientiousness and certain behavioral variables are controlled. Psychosocial and behavioral variables partly explain the adult conscientiousness-longevity association.  Conclusion: The findings demonstrate the utility and complexity of modern personality concepts in understanding health, and point to conscientiousness as a key under-explored area for future biopsychosocial studies. 

Goodwin, R. G. & Friedman, H.S. (2006). Health status and the Five Factor personality traits in a nationally representative sample. Journal of Health Psychology, 11, 643-654.

To determine the association between the personality trait, conscientiousness, and mental and physical disorders among adults in the United States, the Midlife Development in the United States Survey, a nationally representative sample of 3,032 adults, was used to determine the association between the five-factor traits of personality and common mental and physical disorders.  Conscientiousness (protectively) and neuroticism (adversely) were found to be meaningfully associated with illness. Further, among adults with physical illnesses, associations were found between decreased likelihood of physical limitations and personality, especially conscientiousness.  Our findings are consistent with and extend previous results showing that conscientiousness is associated with significantly reduced risk of a wide range of mental and physical disorders among adults in the general population. These findings provide a framework upon which research on complex causal processes may proceed.

Despues, D. & Friedman, H.S. (2006).  Ethnic differences in health behaviors among college students. Journal of Applied Social Psychology.

Ethnic minority groups in the U.S. show significant health disparities, many of which likely arise in part from psychosocial influences on health behaviors. This study explores the extent to which ethnicity and acculturation relate to health behaviors among 521 college students. Participants completed a questionnaire assessing healthy eating habits (eating vegetables, fruits, salad), unhealthy eating habits (eating french-fries, pizza, hamburgers), preventative health behaviors (physical exams, dental visits, exercise) and health-harming behaviors (smoking and drinking), as well as a modified acculturation scale (Marin et al., 1987). Results showed that ethnicity and acculturation likely have both positive and negative effects on health behaviors. Despite the equality of education, conceptually meaningful group differences in health behaviors were revealed, pointing toward future research on understanding and modifying the psychosocial aspects of ethnic health disparities.

Taga, K. A., Markey, C. N.  & Friedman, H.S.  (2006). A longitudinal investigation of associations between boys’ pubertal timing and adult behavioral health and well-being. Journal of Youth and Adolescence, 380-390.

To extend research linking pubertal timing and adolescent health outcomes, this study examines boys’ pubertal timing and subsequent interpersonal success and health behaviors in mid adulthood. Past research has shown that boys’ pubertal timing is associated with both positive and negative developmental outcomes in the short term, and so it is unclear how pubertal timing is consequential for adjustment across the long term. Data from 460 boys from the Terman Life-Cycle Study were examined over a 39-year period to relate age of pubertal onset to later marital success, career success, and adult health behaviors. Boys who reached puberty earlier than their peers achieved greater success in their careers and experienced more satisfaction in their marriages. Early-developing boys were not found to be more likely than their peers to smoke cigarettes or drink alcohol as adults. Findings are discussed in terms of the importance of pubertal timing for life-span development.

Friedman, H.S. (2006).  Applying psychology to promote health.  In S. I. Donaldson, D. E. Berger & K. Pezdek (Eds.)  Applied Psychology: New Frontiers & Rewarding Careers.  Mawah, NJ: Erlbaum Associates, pp. 201-220.

Health psychology is re-integrating social, psychological, cultural, and behavioral aspects with the more physiologic, biochemical, and medical aspects of health and well-being.  As an academic discipline, health psychology involves the broadly-construed scientific study of psychological processes related to health and health care.  As a professional and policy field, health psychology uses the findings from basic psychological theory and peer-reviewed research to understand and encourage thoughts, feelings, and behaviors that promote health.  Health psychology, building on many disciplines, provides novel pathways for the application of psychology to issues of health.

Martin, L.R., Friedman, H.S., Clark, K. M., & Tucker, J.S. (2005). Longevity following the experience of parental divorce. Social Science and Medicine, 61, 2177-2189.

An archival prospective design was used to study mediating and moderating variables for the association between parental divorce and increased mortality risk, using a sub-group (n =1183) of individuals from the US Terman Life Cycle Study covering the period 1921–2000. In childhood, both socioeconomic status (SES) and family psychosocial environment were related to parental divorce but did little to explain its effects. The higher mortality risk associated with experiencing parental divorce was ameliorated among individuals (especially men) who achieved a sense of personal satisfaction by mid-life. Behaviorally, smoking was the strongest mediator of the divorce-mortality link. This study extends previous work on the long-term effects of parental divorce and reveals some reasons why the stress of parental divorce in childhood need not necessarily lead to negative later-life outcomes.

Friedman, H.S. (2003). Healthy life-style across the life-span: The heck with the Surgeon General! In J. Suls & K. Wallston (eds.), Social Psychological Foundations of Health and Illness (pp. 3-21). Boston: Blackwell Publishing.

Health promotion efforts and our public health systems are too often built around a pathology model, derived from traditional conceptions of “treating” disease.  These approaches often ignore the social context of people's lives, and the psychosocial influences that push and pull them in healthy or unhealthy directions across time.  In the scientific arena, this orientation often means that each result from a particular scientific study is seen as an important and direct causal step on the road to disease.  Anything that seems to be associated with an increase in a risk factor is a threat!  Thus we encounter a litany of health advice – do’s and don’t's sometimes relevant to the proximal causes of ill health but ignorant of the long-term causal patterns.

Friedman, H. S. & Markey, C.N. (2003). Paths to longevity in the highly intelligent Terman cohort. In C.E. Finch, J-M. Robine & Y. Christen (eds.), Brain and Longevity (pp. 165-175). NY: Springer.

Although highly intelligent people may have certain advantages in maintaining health, there are no simple nor strong relationships between intelligence and longevity. This chapter analyzes the risks to longevity among 1528 highly intelligent children who were first studied by Lewis Terman in 1922 when they were about 10 years old. Data assessing their substance use, mental health, life stress, social relations,  and personality have been collected and refined. Importantly, we have collected death certificates. Findings suggest that although this cohort lives longer than average, these intelligent people faced many of the challenges and threats to health faced by ordinary people. Health-related behaviors (substance use), psychological adjustment, personality, and social relationships are all important predictors of longevity.  We conclude that while intelligent people may have certain advantages in maintaining their health, they are not invincible to the key behavioral and psychosocial influences that interact with biology to determine mortality risk. Going beyond biology, the broader patterns of individual life paths need to be taken into account in understanding longevity and in designing health-relevant interventions.

Martin, L. R., Friedman, H.S., Tucker, J.S., Tomlinson-Keasey, C., Criqui, M.H. & Schwartz, J.E. (2002). A life course perspective on childhood cheerfulness and its relation to mortality risk. Personality and Social Psychology Bulletin, 28, 1155-1165.

Abstract: Under some conditions, cheerfulness promotes health, but cheerfulness also has been associated with unfavorable health out-comes. This study follows up the inverse relation between childhood cheerfulness and longevity found among 1,215 men and women first assessed as children by Lewis Terman in 1922. Risky hobbies, smoking, drinking, and obesity, as well as cause of death, are examined, along with adulthood personality and adjustment. Several hypotheses about mediating variables can be eliminated by these analyses; these data do hint, however, that cheerful children grow up to be more careless about their health. Although correlational and survival analyses suggest that health behaviors play a role, they are unable to explain the observed cheerfulness-mortality link, thus supporting the idea that cheerfulness is multifaceted and should not be assumed to be related to health in a simple manner.

Seldin, D. R. , Friedman, H.S. & Martin, L.R. (2002). Sexual activity as a predictor of life-span mortality risk. Personality and Individual Differences, 33, 409-425.

Abstract: The relationship, across the life span, between sexual activity and subsequent mortality risk was examined using data from an archival prospective study begun in the 1920s by Lewis Terman [Terman, L. M. et al. (1925). Genetic studies of genius: mental and physical traits of a thousand gifted children, Vol. 1. Stanford, CA: Stanford University Press]. The current study included 1113 participants (620 males and 493 females). Survival analyses were used to determine the association of sexual activity and sexual satisfaction with longevity. Teenage sexual activity was predictive of increased mortality risk across the life span. Though marginally significant, frequency of orgasm for married females was found to be somewhat protective against mortality risk. Personality, psychosocial, and behavioral variables, which were found to correlate with teenage sexual activity and married female frequency of orgasm, were then tested as potential mediators of the relationship. Childhood conscientiousness, adulthood alcohol use, and cumulative level of education were all found to be important in the explanation of the inverse relation between teenage sexual activity and longevity, particularly for males.

Friedman, H.S. (2001). Personality and health. In N.J. Smelser & P.B. Baltes (eds.), International Encyclopedia of the Social and Behavioral Sciences. pp. 11264- 11270. NY: Elsevier.

Ideas about associations between personality and health have been studied since their roots in the bodily humors of ancient Greece. Empirical research began in earnest in the mid-twentieth century with the idea of Type A behavior, supposedly a cause of coronary heart disease, but efforts have now broadened and deepened. There are a number of ways that personality is related to health, including through symptom reporting and medical usage, disease-caused personality changes, temperamental underlying third variables, and personality-caused illness. The mediating mechanisms of personality-caused illness include poor coping, unhealthy behaviors, physiological reactivity, and tropisms to unhealthy situations. Specific disease-prone traits examined here include extraversion, neuroticism, hostility, depression, conscientiousness, impulsivity, repression, and lack of disclosure. Finally, new notions of a self-healing personality are considered.

Martin, Leslie R.; Friedman, Howard S. (2000). Comparing personality scales across time: An illustrative study of validity and consistency in life-span archival data. Journal of Personality, 68, 85-110.

Abstract: This study (1) examined whether personality scales, meaningful in contemporary terms, could be derived from archival data; and (2) used these scales to aid in the understanding of the relation of personality to mortality. Revised NEO Personality Inventory data and a battery of archival items, taken from Terman's Life Cycle Study, were collected on 2 new samples. The 1st sample included 167 9-15 yr old Subjects and the 2nd sample included 203 18-36 yr old Subjects. Measurement invariance of the archival scales was assessed, and validity was examined using both rational analyses and associations with the Five Factor Model. It was demonstrated that interpretable scales can be derived from 50- and 70-yr-old archival data. The archival adult personality data were then used to predict mortality. Conscientiousness remains the strongest personality predictor of longevity. Criteria for establishing the validity of archivally derived scales are suggested.

Lippa, Richard A.; Martin, Leslie R.; Friedman, Howard S. (2000). Gender-related individual differences and mortality in the Terman longitudinal study: Is masculinity hazardous to your health? Personality & Social Psychology Bulletin, 26, 1560-1570.

Abstract: Data were collected, refined, and analyzed on 654 men and 210 women in Lewis Terman's "gifted children" longitudinal study to examine links between masculinity and mortality. Masculinity measures included gender diagnosticity (GD) scores, measuring the male- or female-typicality of occupational preferences in 1940 and masculinity-femininity (M-F) scores from the Strong Vocational Interest Blank (SVIB). Hazard analyses show GD was significantly related to mortality for both men and women, with masculine women and masculine men more likely to die at any given age. SVIB M-F was similarly related to mortality for both men and women. The effects remained significant after controlling for certain health behaviors and Big Five traits.

Friedman, H.S. (2000). Long-term relations of personality and health: Dynamisms, mechanisms, tropisms. Journal of Personality, 68, 1089-1108.

Abstract: There is now little doubt that individuals who are well-adjusted, socially stable, and well-integrated into their communities are at significantly lower risk for disease and premature mortality than those who are more unstable, impulsive, isolated, and alienated. The reasons for these associations, however, are complex and the pathways insufficiently studied. This paper employs a life-span data set to explore how childhood personality relates to health-related growth and development (dynamisms), patterns of reactions and health behaviors (mechanisms), and movements towards and away from suitable environments (tropisms). Illustrations from the seven-decade Terman longitudinal data reveal important areas in which previous, cross-sectional research has misinterpreted associations between personality and health. In particular, Sociability has been over-rated as a life-span health risk factor, Conscientiousness has been under-rated, and Neuroticism has been confused. Without sufficient attention to the processes underlying the associations between personality and health, significant sub-optimal allocations of intervention resources result.

Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology & Aging, 14, 564-571.

Abstract: Age-related changes in the associations of social network ties with mortality risk were investigated using data from the Terman Life-Cycle Study (L. M. Terman, 1925; L. M. Terman & M. H. Oden, 1947, 1959). Marital status, number of living children, number of living siblings, and number of group memberships in 1940, 1950, 1960, and 1977 were reported across middle adulthood by 697 men and 544 women, with mortality follow-up as of 1991. Initial analyses confirmed previous work indicating that marital history (men only), number of children (both genders), and organizational memberships (both genders) are predictive of mortality risk. Further analyses compared the associations between these social ties and mortality prior to age 70 and at age 70 and older. Results indicated that for men, experiencing marital dissolution and subsequently remarrying is a stronger predictor of mortality risk prior to age 70 (p = .05), whereas for women, number of children (p < .05) is a stronger predictor of mortality risk after age 70. Implications of these age-related changes in social ties and mortality risk are discussed.

Clark, K. M., Friedman, H. S., & Martin, L. M. (1999). The impact of religiosity on mortality risk. Journal of Health Psychology, 4, 381-391.

Abstract: The relation of adult religiosity to longevity was studied in 993 participants from Terman's 70-year Life-Cycle Study. Key social and behavioral variables of physical health, psychological well-being, socio-economic status, social support, and health behaviors were also considered. Results indicate that women who viewed themselves as more religious in adulthood (approximately age 40) had a lower risk for premature mortality than those who were less religiously inclined. These women had healthier behaviors, more positive feelings about their futures, and reported being somewhat happier than their less religiously inclined peers. In this bright, middle-class, 20th century sample, religiosity among women seems to be part of a generally healthy lifestyle, but not necessarily a direct cause of it.

Peterson, C., Seligman, M. E. P., Yurko, K. H., Martin, L. R., & Friedman, H. S. (1998). Catastrophizing and untimely death. Psychological Science, 1998 Mar, v9 (n2):127-130.

Abstract:Investigated explanatory style and mortality among Subjects in the Terman Life-Cycle Study (L. M. Terman and M. H. Oden, 1947). The original sample of preadolescents (all born around 1910) has been followed from the 1920s to the present. Subjects completed open-ended questionnaires in 1936 and 1940, and these responses were blindly scored for explanatory style by content analysis. Catastrophizing (attributing bad events to global causes) predicted mortality as of 1991, especially among males, and predicted accidental or violent deaths especially well. These results are the first to show that a dimension of explanatory style is a risk factor for mortality in a large sample of initially healthy individuals, and they imply that one of the mechanisms linking explanatory style and death involves lifestyle.

Friedman, Howard S.; Tucker, Joan S.; Reise, Steven P. Personality dimensions and measures potentially relevant to health: A focus on hostility. Annals of Behavioral Medicine, 1995 Summer, v17 (n3):245-253.

Abstract: Evaluated 36 hostility-related, reliable, commonly-used personality scales considered to be relevant to health-related negative patterns, using 454 undergraduates. The scales included the Buss-Durkee Hostility-Guilt Inventory, the State-Trait Anger Expression Inventory, Eysenck Personality Questionnaire, NEO Personality Inventory, a measure of locus of control, Life Orientation Test, Jenkins Activity Survey, and the Beck Depression Inventory. It is suggested that while research and theory refine the best concepts and measures, studies predicting health from chronic negative patterns may want to include at least 4 measures: aggressive overt hostility, alienated bitterness, introversion, and anxiety/depression. A measure of conscientiousness is also useful.

Tucker, Joan S.; Friedman, Howard S.; Wingard, Deborah L.; Schwartz, Joseph E. Marital history at midlife as a predictor of longevity: Alternative explanations to the protective effect of marriage. Health Psychology, 1996 Mar, v15 (n2):94-101.

Abstract: The association between marital history at midlife (in 1950) and mortality (as of 1991) was studied in a group of intelligent, educated men and women ( N = 1,077) who participated in the Terman Life-Cycle Study initiated by Lewis Terman in 1921. Results confirm that consistently married people live longer than those who have experienced marital breakup but suggest that this is not necessarily due to the protective effects of marriage itself. Individuals who were currently married, but had previously experienced a divorce, were at significantly higher mortality risk compared with consistently married individuals. Furthermore, individuals who had not married by midlife were not at higher mortality risk compared with consistently married individuals. Part of the relationship between marital history and mortality risk may be explained by childhood psychosocial variables, which were associated with both future marital history and mortality risk.

Tucker, Joan S.; Friedman, Howard S.; Tomlinson-Keasey, Carol; Schwartz, Joseph E.; and others. Childhood psychosocial predictors of adulthood smoking, alcohol consumption, and physical activity. Journal of Applied Social Psychology, 1995 Nov, v25 (n21):1884-1899.

Abstract: Examined whether aspects of the childhood home environment (SES and parental divorce) and personality would predict smoking, alcohol consumption, and physical activity in middle adulthood. Subjects were 972 adults who participated in the Terman Life-Cycle Study (conducted from 1921 to 1991). Results of hierarchical regression analyses indicated that childhood unconscientiousness, cheerfulness, and parental divorce predicted adult smoking. Childhood unconscientiousness and sociability predicted adult alcohol consumption. Physical activity was predicted by a higher energy/activity level in childhood. Results suggest that previously found associations between childhood characteristics and health-related behaviors over shorter periods are not simply reflective of early experimentation with such behaviors, but may be indicative of long-term lifestyle patterns.

Schwartz, Joseph E.; Friedman, Howard S.; Tucker, Joan S.; Tomlinson-Keasey, Carol; and others. Sociodemographic and psychosocial factors in childhood as predictors of adult mortality. American Journal of Public Health, 1995 Sep, v85 (n9):1237-1245.

Abstract: Studied the effect of childhood sociodemographic, psychosocial and environmental factors on adult life and longevity. Data were collected on 1285 Subjects, born between 1904-1915. They were analyzed over the period from 1930 until the date of their death or till the most recent date of participation. Results reveal that parental divorce during childhood predicted decreased longevity. Other potential social predictors failed to show significant associations with longevity. Three dimensions of childhood personality: Conscientiousness, lack of cheerfulness and permanency of mood, predicted increased longevity mainly in males. The effects of parental divorce and childhood personality were largely independent and did not account for the gender difference in mortality. It was concluded that a small number of childhood factors significantly predict mortality across the life span.

Martin, Leslie R.; Friedman, Howard S.; Tucker, Joan S.; Schwartz, Joseph E.; and others. An archival prospective study of mental health and longevity. Special Section: The interface of mental and physical health. Health Psychology, 1995 Sep, v14 (n5):381-387.

Abstract: The relationship between mental health status and longevity was examined in an archival prospective cohort study ( N = 1,103) derived from work begun by Lewis Terman in the 1920s. Degree of psychological maladjustment, cumulatively rated by Terman and his colleagues as of 1950, was found to be related to higher risk of all-cause mortality over a 4-decade follow-up period. The differences among causes of death were nonsignificant, but there was some indication that mental health problems were more strongly related to deaths from injury and cardiovascular disease. The overall relationship was significant for men but weaker for women. The effect was not substantially mediated by alcohol consumption, obesity, or cigarette smoking.

Tucker, Joan S., Friedman, Howard, S., Schwartz, Joseph, E., Criqui, Michael, H., Tomlinson-Keasey, Carol, Wingard, Deborah, L., & Martin, Leslie, R. (1997). Parental divorce: Effects on individual behavior and longevity. Journal of Personality and Social Psychology, 73, 381-391.

Abstract: In an archival prospective design, associations between parental divorce occurring during the subjects' childhood and mortality over the life-span were studied in a subgroup (N = 1028) of bright men and women who participated in the Terman Life Cycle Study (1921-1991). Children from divorced families grew up to show a higher risk of premature mortality across the life-span (statistically significant for the total sample and men). Although parental divorce remained an independent predictor of mortality risk, the higher mortality risk was explained, in part, when four mediating factors were controlled: children of divorce were more likely to have their own marriages end in divorce; they obtained less education; they smoked more; and they experienced greater mental difficulties in adulthood. The findings significantly extend previous work on the negative sequelae of parental divorce.

Friedman, Howard S.; Tucker, Joan S.; Schwartz, Joseph E.; Martin, Leslie R.; and others. Childhood conscientiousness and longevity: Health behaviors and cause of death. Journal of Personality & Social Psychology, 1995 Apr, v68 (n4):696-703.

Abstract: Previous research showed that conscientiousness (social dependability) in childhood predicted longevity in an archival prospective cohort study of bright children first studied by Terman in the 1920s (H. S. Friedman et al., see PA, Vol 80:40908). Possible behavioral mechanisms for this robust association are now examined by gathering cause of death information and by considering the possible mediating influences of drinking alcohol, smoking, and overeating. Survival analyses ( N = 1,215) suggest that the protective effect of conscientiousness is not primarily due to accident avoidance and cannot be mostly explained by abstinence from unhealthy substance intake. Conscientiousness may have more wide-ranging effects on health-relevant activities.

Tucker, Joan S.; Friedman, Howard S.; Tsai, Catherine M.; Martin, Leslie R. Playing with pets and longevity among older people. Psychology & Aging, 1995 Mar, v10 (n1):3-7.

Abstract: Models of the relations between contact with pets and better health are examined in an archival prospective study using data derived from the longitudinal study initiated by Terman in 1921 (current N = 343 men, 300 women) . In survival analyses of documented longevity, playing with pets in 1977 ( M age = 67 years) was not associated with mortality risk through 1991 for the total sample nor for those who were unmarried or those who were less satisfied with their human relationships. Playing with pets was not associated with health-prone attributes or healthy behaviors such as personality, social ties, education, and smoking.

Friedman, Howard S.; Tucker, Joan S.; Schwartz, Joseph E.; Tomlinson-Keasey, Carol; and others. Psychosocial and behavioral predictors of longevity: The aging and death of the "Termites." American Psychologist, 1995 Feb, v50 (n2):69-78.

Abstract: Impulsive, undercontrolled personalities and major family stresses are known predictors of impaired adjustment, but long-term health effects are unclear. In an archival prospective cohort design, we followed up on L. M. Terman's (Terman & M. H. Oden, 1947) sample of gifted children by collecting and coding death certificates for the half of the sample that is now dead. Statistical survival analyses were used to predict longevity and cause of death as a function of parental divorce during childhood, unstable marriage patterns in adulthood, childhood personality, adult adjustment, and possible mediating health behaviors. Psychosocial factors emerged as important risks for premature mortality.

Friedman, Howard S.; Hawley, P. H.; Tucker, Joan S. Personality, health, and longevity. Current Directions in Psychological Science, 1994 Apr, v3 (n2):37-41.

Abstract: Argues that certain people are psychologically vulnerable or resilient as a result of a combination of temperament and early socialization. Evidence is presented for associations between stable characteristics of the individual to health and longevity. Psychophysiological and behavioral mechanisms that play a role in health are examined, and biological predispositions related to both personality and health are explored. Final sections evaluate the self-healing personality and the common misconceptions surrounding stress, work, and health.

Wingard, Debroah L., Criqui, Michael H., Edelstein, Sharon L., Tucker, Joan, Tomlinson-Keasey, Carol, Schwartz, Joseph E., & Friedman, Howard S. (1994). Is breast-feeding in infancy associated with adult longevity? American Journal of Public Health, 84, 1458-1462.

The purpose of the study was to determine whether breast-feeding is associated with increased longevity or cause-specific survival. Teachers throughout California identified intellectually gifted children as part of a prospective study begun in the 1920s by Lewis Terman. Information on breast-feeding was available on 1170 subjects, who have been followed for more than 65 years. Survival analysis (Cox proportional hazards model) indicated that breast-feeding was associated with increased longevity, even after adjustment of age at baseline, birthweight, infant health, and childhood socioeconomic status, but only among men, and the association was not significant (P = .15). Neither cardiovascular disease nor cancer survival was significantly associated with duration of breast-feeding for either sex. Survival from deaths due to injuries was positively associated with breast-feeding after adjustment (P = .03) and demonstrated a clear gradient with duration, but only among men. Overall, the present study does not provide strong evidence that breast-feeding is associated with adult longevity. The reduced risk of death from injury may reflect chance, in that the association was significant only for men, or it may reflect psychosocial correlates of breast-feeding practices.

Friedman, Howard S.; Tucker, Joan S.; Tomlinson-Keasey, Carol; Schwartz, Joseph E.; and others. Does childhood personality predict longevity? Journal of Personality & Social Psychology, 1993 Jul, v65 (n1):176-185.

Abstract: Key models relating personality and health predict that personality in childhood is indicative of later health and longevity. Longevity predictions are tested using data derived from the 2-decade longitudinal study initiated by L. M. Terman in 1921 (Terman and M. H. Oden, 1947). Variables representing major dimensions of personality are used in statistical survival analyses of longevity in 1,178 males and females. Conscientiousness in childhood was clearly related to survival in middle to old age. This finding (1) establishes that childhood personality is related to survival decades into the future, (2) confirms the validity of the conscientiousness dimension in conceptualizing personality, and (3) points to likely and unlikely pathways linking personality to health. Contrary to expectation, cheerfulness (optimism and sense of humor) was inversely related to longevity, suggesting a possible need for reconceptualization of its health relevance.


Friedman, Howard S. Interpersonal expectations and the maintenance of health. IN: Interpersonal expectations: Theory, research, and applications. Studies in emotion and social interaction.; Peter David Blanck, Ed. Cambridge University Press, New York, NY, US; Editions de la Maison des Sciences de l'Homme; Paris, France. 1993. p. 179-193.

Abstract: (from the preface) deals with the role of interpersonal expectations and the maintenance of health; addresses whether people's expectations about their health, derived from others, have a meaningful effect on their psychobiological functioning; the concept of the self healing personality and the link between health outcomes and interpersonal expectations are examined.

Friedman, Howard S.; VandenBos, Gary R Disease-prone and self-healing personalities. Hospital & Community Psychiatry, 1992 Dec, v43 (n12):1177-1179.

Abstract: Developments in epidemiology, clinical studies of stress, assessment of emotional coping, and laboratory animal research are beginning to paint a coherent picture of disease-prone and self-healing personalities. Substantial evidence suggests that chronic hostility, depression, and repression and their concomitants negatively affect physical health and negatively influence recovery from illness. Scientific attention is now turning to identification of the proactive elements of mental health that promote physical health. One conceptualization of such elements is that of a self-healing personality, which can be briefly described as a personality characterized by enthusiasm.


Friedman, Howard S.; DiMatteo, M. Robin. Patient-physician interactions. IN: The handbook of health behavior change.; Sally A. Shumaker, Eleanor B. Schron, Judith K. Ockene, Christine T. Parker, Jeffrey L. Probstfield, Joan M. Wolle, Eds. Springer Publishing Co, Inc, New York, NY, US. 1990. p. 84-101.

Abstract: (from the chapter) the noncompliance of patients with medical regimens is dangerous to patients (since they may develop serious complications from their conditions), and it is a costly waste of medical resources; how can we explain it and prevent it; specifically, what is the role played by the doctor-patient relationship... models of the doctor-patient relationship; other reasons for mutual participation...assessment strategies; a historical perspective; interviewing; nonverbal communication; following up... influence strategies; physician credibility and power; cognitive consistency; changes in self-concept: the social self... the physician's limits.

Friedman, Howard S.; Booth-Kewley, Stephanie. Validity of the Type A construct: A reprise. Psychological Bulletin, 1988 Nov, v104 (n3):381-384.

Abstract: The recent application of meta-analytic techniques to the topic of coronary proneness has proved useful in promoting a sound construct-validation approach, an approach that should have been used years ago. However, the meta-analytic methods and statistics themselves are subject to some degree of interpretation. This article explains and comments on some of the important conclusions and some key limitations that emerge from three recent meta-analyses of the Type A behavior pattern. Both methodological and conceptual issues are addressed. All in all, there is a remarkable degree of consensus about what we know and what we need to know. Strong evidence emerges that Type A behavior (assessed by the Structured Interview) is a significant risk factor for coronary heart disease, but the Type A construct still has not been adequately defined.

Friedman, Howard S.; Booth-Kewley, Stephanie. Personality, Type A behavior, and coronary heart disease: The role of emotional expression. Journal of Personality & Social Psychology, 1987 Oct, v53 (n4):783-792.

Abstract: The nature of the relation between personality factors and coronary heart disease (CHD, the nation's greatest killer) is one of the most important if controversial issues in the field of psychology and health. Although there is still a great deal of conceptual confusion, progress is being made in refining the key components of a predisposition to heart disease. In this article we examine the construct of a coronary-prone personality in the context of the relations among personality, emotional expression, and disease. Special consideration is given to mode of measurement of the Type A behavior pattern--Structured Interview (SI) versus Jenkins Activity Survey (JAS)--and to components and non-Type A correlates of the general coronary-prone construct. Fifty middle-aged men who had had a myocardial infarction were compared with 50 healthy controls in terms of relevant aspects of their psychological functioning. Results indicate that the SI is better than the JAS as a predictor of coronary heart disease (CHD) because of its attention to emotional expressive style. Traditional emphases on hurry sickness in coronary proneness are deemed wholly inadequate. Furthermore, the results indicate that depression, anxiety, or both may relate to CHD independently of and in addition to Type A behavior. Other aspects of personality and social support are also discussed in the context of improving the construct of coronary proneness.

Friedman, Howard S.; Booth-Kewley, Stephanie. The "disease-prone personality": A meta-analytic view of the construct. American Psychologist, 1987 Jun, v42 (n6):539-555.

Abstract: This article examines the notion that personality plays a causal role in the development of disease. In particular, this article develops the heuristic strategy of simultaneously comparing several emotional aspects of personality and several diseases, with close attention to the strength of the links between personality and disease. The published literature on personality correlates of five diseases with so-called "psychosomatic" components--asthma, arthritis, ulcers, headaches, and coronary heart disease--is reviewed and discussed, with a focus on construct validity. The statistical technique of meta-analysis is used to provide an easily viewed comparative summary. The results point to the probable existence of a generic "disease-prone" personality that involves depression, anger/hostility, anxiety, and possibly other aspects of personality. However, except in the case of coronary heart disease, the evidence is weak. Nevertheless, there is sufficient evidence to argue for a key role for psychological research on the prevention and treatment of disease. Specific directions for future research are described.

Booth-Kewley, Stephanie; Friedman, Howard S. Psychological predictors of heart disease: A quantitative review. Psychological Bulletin, 1987 May, v101 (n3):343-362.

Abstract: A meta-analysis, or quantitative review, was performed to integrate and organize the results of studies that investigated certain personality variables in relation to coronary heart disease (CHD). The personality variables included were anger, hostility, aggression, depression, extroversion, anxiety, Type A, and the major components of Type A. The meta-analytic framework helps focus attention on issues needing clarification. The results indicate that modest but reliable associations exist between some of the personality variables and CHD. The strongest associations were found for Type A and, surprisingly, for depression, but anger/hostility/aggression and anxiety also related reliably to CHD. The Structured Interview diagnosis of Type A was shown to be clearly superior to the Jenkins Activity Survey as a predictor of CHD. The Type A-CHD relation was smaller in prospective than in cross-sectional studies and smaller in recent than in less recent studies. This review also revealed that information about the interrelations of personality predictors of CHD is sorely needed. The picture of coronary-proneness revealed by this review is not one of a hurried, impatient workaholic but instead is one of a person with one or more negative emotions.

Keesling, Barbara; Friedman, Howard S. Psychosocial factors in sunbathing and sunscreen use. Health Psychology, 1987, v6 (n5):477-493.

Abstract: Interviewed 120 sunbathing and nonsunbathing beachgoers about their health practices, knowledge about skin cancer, moods, and social rewards obtained through sunbathing. Subjects also completed personality questionnaires. Data were considered using a theoretical perspective combining aspects of health belief, social influence, social learning, and risk-taking models. Results indicate that sunbathing was related to having a positive attitude toward risk taking, having little knowledge about skin cancer, reporting a relaxed mood, having friends who sunbathe, and engaging in activities related to maintaining a positive physical appearance. Sunscreen use was related to sex, having knowledge about skin cancer, knowing people who have had cancer, and reporting high levels of anxiety.

DiMatteo, M. Robin; Friedman, Howard S. A model course in social psychology and health. Health Psychology, 1982 Spring, v1 (n2):181-193.

Abstract: Describes a model course for social science and premedical undergraduates concerned with interpersonal aspects of psychology as they relate to health and illness. The course is based on (1) the results of a survey of faculty (N = 112) in medicine and health psychology; (2) the 2-yr teaching experiences of the authors; (3) input of experts in the field; and (4) evaluations from students in psychology, sociology, and the health sciences.

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