GALVESTON, Texas - First the good news: Being happy - or, in psychiatric jargon, having "high levels of positive affect" - seems to protect older people against stroke, according to a study published March 23, 2001, in Psychosomatic Medicine, the Journal of the American Psychosomatic Society. And the happier older folks are, the more protective the effect appears to be.

Now for the bad news: Those elderly people who often feel blue - "individuals with high levels of depressive symptoms" - tend to have more strokes than older adults who aren't depressed.

About 400,000 new cases of stroke-the sudden diminishing or loss of consciousness, sensation and voluntary motion caused by a rupture or obstruction, such as a blood clot, of an artery in the brain-occur each year in the United States, the study's authors note. They point out that stroke is the third most common cause of death and is a leading cause of long-term disability among the elderly

Researchers at the University of Texas Medical Branch at Galveston reached their conclusions about the apparently protective effect of happiness after analyzing data on 2,478 white and black men and women 65 years of age or older from five North Carolina counties. That information was drawn from a previously conducted, six-year-long study called the North Carolina Established Population for the Epidemiolgic Study of the Elderly that looked at a total of 4,162 older people. None of the people in the group whose data was re-examined by the Texas researchers reported having had a stroke at the beginning of the study, when interviewers had asked about their "sociodemographic, psychosocial, and health-related characteristics." Subsequently those individuals were tracked with annual interviews, during which time 340 strokes occurred, 75 of them fatal.

Risk factors that individuals can't change influencing propensity for stroke include age, male sex, race, and other hereditary factors. Risk factors that can be modified or controlled include smoking, obesity, excessive use of alcohol, low rates of exercise, hypertension and diabetes. In interpreting their data, the investigators adjusted for all these risk factors.

The interviewers had asked their subjects to answer "yes" or "no" to 20 statements designed to elicit whether those interviewed had experienced certain feelings or symptoms in the past week, 16 of the sentences suggesting negative emotions or experiences. These included pronouncements such as "I felt that I could not shake off the blues even with the help of my family and friends"; "I thought that my life had been a failure"; "I felt fearful"; "I felt lonely"; "I had crying spells"; "I was bothered by things that usually don't bother me;" "People were unfriendly"; and "I had trouble keeping my mind on what I was doing." Four assertions indicated positive attitude: "I felt that I was just as good as other people"; "I felt hopeful about the future"; "I was happy"; and "I enjoyed life."

Each "yes" answer to one of the four declarations suggesting positive attitude corresponded to a 26 percent decreased risk of stroke. For all 20 statements, each "yes" answer to a negative assertion or "no" to a positive assertion correlated with a 4 percent increased risk of stroke. For the 772 men included in the study, however, the results were even more dramatic. Each "yes" to a positive statement was associated with a 41 percent decreased risk of stroke (versus 18 percent for the 1,706 women). For all 20 statements collectively, each "yes" to a negative assertion or "no" to a positive assertion was associated with a 9 percent increase in men's stroke incidence. Women's "yes" answers to negative statements and "no" responses to positive ones each resulted in a 3 percent increase in strokes, but the researchers said those figures weren't statistically significant.

Authors of the paper, titled "The association between emotional well-being and the incidence of stroke in older adults," were Glenn V. Ostir, Kyriakos S. Markides, M. Kristen Peek, and James S. Goodwin, all of the University of Texas Medical Branch at Galveston. They cautioned that "various mechanisms could be proposed to account for the association between positive affect" (i.e., happiness) and stroke incidence.

For example, they note: "Positive affect is related to a number of characteristics known to improve health and be protective of chronic disease. Individuals who report high levels of positive affect may be more likely to exercise, to maintain a healthy lifestyle and adhere to medical therapy." Moreover, the researchers observe that "the recently described associations between moderate alcohol consumption and lower risk of stroke might be linked to our findings of a protective effect of positive affect on stroke." That is, happier people may tend to drink more moderate amounts of alcohol, moderate alcohol consumption may tend to make people feel happier, something in alcohol may exert its own anti-stroke effect, or perhaps all three.

As for whether it's possible to find ways for older people to boost their happiness quotient in a way that lessens their risk of stroke, authors of the paper say that will require another study.

---University of Texas Medical Branch at Galveston

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