The ability to cope well with adversity in old age is associated with a lower risk of mortality

The ability to cope and adapt to challenging life circumstances and events in old age is associated with a lower risk of death, according to a large, nationally representative study published in the open-access journal BMJ Mental Health.

The findings highlight the importance of efforts to increase mental resilience, the researchers conclude.

The available evidence suggests that mental resilience is a dynamic and active process influenced by several factors, including gender, hormones and the genes that regulate the body’s stress response. This capacity would develop and vary at different times of the life cycle, the researchers say.

In old age, good coping skills can help offset the negative impact of long-term conditions and subsequent disability. And while the ability to physically recover from illness and trauma is associated with slower aging and risk of death, it’s not clear whether mental resilience can have similar effects, they explain.

To investigate this further, researchers examined the U.S. Health and Retirement Study (HRS), a long-term, nationally representative study of American adults aged at least 50. The study began in 1992 and includes information on participants’ economic, health, marital, and family status that is monitored every two years.

The researchers drew on two waves (2006–2008) of HRS data, when questions on mental resilience were first collected, and included a total of 10,569 participants with complete data in the final analysis. Their average age was 66; 59% of them were women.

Mental resilience was assessed using a validated scale that includes qualities such as perseverance, calmness, a sense of purpose, self-reliance, and the recognition that certain experiences must be endured alone. The mean score for the entire sample was 9.18 (range 0-12).

Participants were followed until death or the end of May 2021, whichever came first. During an average tracking period of 12 years, 3,489 people died.

An almost linear relationship was found between mental resilience score and all-cause mortality: the higher the score, the lower the risk of death. This relationship was stronger in women than in men.

Resilience scores were divided into quartiles (25%) and linked to 10-year survival rates. These were 61% for those in the bottom quartile (1), rising to 72% and 79% for the middle quartiles (2 and 3), and 84% for those in the top quartile (4).

Survival analyses found that people in the highest quartile were 53% less likely to die in the next 10 years than people in the lowest quartile.

This association remained statistically significant after adjusting for marital status, sex, race and weight (BMI), but decreased to 46% after accounting for poor health (diabetes, cancer and cardiovascular disease) and to 38% after accounting for unhealthy lifestyle.

Overall, the risk of death was 20% lower (2nd quartile), 27% lower (3rd), and 38% lower (4th) among those with higher mental resilience scores than among those with the lowest scores (1st quartile), after accounting for potentially confounding factors.

This is an observational study and as such no firm conclusions can be drawn about causality. And the researchers acknowledge that the potential influence of genetic and hormonal factors and childhood adversity were not considered. The analysis was also based on baseline data, ignoring potentially influential changes during the monitoring period.

“Several factors have been identified that may influence psychological resilience, including but not limited to meaning in life, positive emotions, self-reported health, and satisfaction with social support,” they explain.

“Activating these positive emotions may enhance the protective effects of psychological resilience and mitigate the negative impact of accumulated adversity on adult mental health.”

They conclude: “The findings highlight the potential effectiveness of interventions aimed at promoting psychological resilience to reduce mortality risk.”