Validating a self-report measure of global subjective well-being to predict adverse clinical outcomes

Objectives: To examine the relationship between a single-item indicator of subjective well-being (SWB) and (1) medical conditions frequently associated with adverse clinical outcomes, (2) health-related quality of life and depressive symptoms, (3) global self-rated health (SRH), and (4) increased risk of adverse clinical outcomes. Methods: Self-reports of depressive symptoms and HRQoL were obtained by mail surveys from 2317 men and women with hypertension and coronary artery disease. Subjects rated their overall SWB at clinic visits. Mean scores of subjects reporting excellent SWB were compared to scores of subjects rating SWB for HRQoL domains and depressive symptom scores using ANOVA. The association between SWB and individual endpoints was assessed using the chi(2) test. The adjusted association between SWB and the composite endpoint of mortality, nonfatal stroke or nonfatal myocardial infarction was estimated using binary logistic regression. Results: Excellent SWB was associated with fewer depressive symptoms and more favorable HRQoL scores. The proportion of subjects suffering one of the adverse health outcomes within 1 year increased (p < 0.002) with poorer reported SWB. One-year mortality was higher in subjects with poor/fair SWB (5.7%) than in subjects with good or excellent SWB (3.4 and 4.5%, respectively; p = 0.05). Subjects rating their SWB as poor/fair were more likely to suffer a nonfatal stroke (unadjusted RR = 2.67, 95% CI = 1.24, 5.74). SWB added to the prediction of adverse outcomes after adjusting for demographics, baseline medical conditions, and SRH (OR = 2.49, 95% CI = 1.51, 4.11). Conclusion: A global indicator of SWB may be a useful addition to a screening instrument for identifying persons at increased risk for adverse health outcomes.