Response to Letter Regarding Article, “Optimism, Cynical Hostility, and Incident Coronary Heart Disease and Mortality in the Women’s Health Initiative”
We thank Drs Lucchetti and Granero for their commentary on our work1 on psychological attitudes and mortality and thank the editors for an opportunity to respond. We agree that the biopsychosocial model,2 which incorporates psychological, religious/spiritual, and social domains, adds critical dimensions to the understanding of each individual patient’s health. As Drs Lucchetti and Granero point out, spirituality and religiosity have been related to health in a variety of populations,3 including the Women’s Health Initiative.4 Although spirituality and religiosity may probe different aspects of human experience, they are often considered together in the literature. The hypothesis that individuals who regularly attend religious services may in turn be more optimistic is a reasonable one, suggesting that the relationship between optimism and all-cause mortality may be mediated by religious attendance.
In our published report of 97 253 postmenopausal women participating in the Women’s Health Initiative, trait optimism (as measured by the Life Orientation Test-Revised5 and defined as positive future expectation), trait cynical hostility (as measured by the Cook Medley cynicism subscale6 and defined as the general mistrust of others), and religious attendance (not at all, 1 to 3 times per month, >1 time per week) were measured at baseline entry into the study. Optimism, but not cynical hostility, was related to religious attendance. The Spearman correlation between religious attendance and optimism was 0.05 in the full sample. Women scoring in the highest quartile of the Life Orientation Test-Revised (“optimists”) were more likely than women scoring in the lowest quartile (“pessimists”) to report attending religious services >1 time per week (47% versus 41%, respectively; P<0.001). In contrast, among both women scoring in the highest and women scoring in the lowest quartiles on the cynical hostility questionnaire, 45% reported attending religious services >1 time per week.
When religious attendance was added to the multivariable Cox proportional-hazard models, the adjusted hazard of total mortality over 8 years of follow-up among optimists (compared with pessimists) remained 14% lower (indicating no change from the estimate in our published article). For completeness, we also added religious attendance to the cynical hostility analyses but, as expected, found no changes. In the full models, religious attendance itself was independently related to the outcome of total mortality, as expected from earlier published work.4 In summary, we did not find evidence that religious attendance influenced the relationship between optimism and mortality.
Tindle HA, Chang Y, Kuller LH, Manson JE, Robinson JG, Rosal MC, Siegle GJ, Matthews KA. Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women’s Health Initiative. Circulation. 2009; 120: 656–662.
Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977; 196: 129–136.
Schnall E, Wasserthiel-Smoller S, Swencionis C, Zemon V, Tinker L, O'Sullivan MJ, Van Horn L, Goodwin M. The relationship between religion and cardiovascular outcomes and all-cause mortality in the Women’s Health Initiative Observational Study. Psychology & Health. 2008.