Most healthy people assume that living with a chronic illness or disability would make life miserable. Surely one can’t be as happy when dealing with a serious health condition. After all, one of the key factors to happiness is having one’s health. Isn’t it?

In fact, previous research shows that serious health conditions do not impact well-being to the extent assumed by healthy individuals. It seems that a discrepancy exists between the actual versus perceived happiness of people with chronic illnesses, but the cause of this discrepancy is still being studied. Is it that healthy people are biased, thinking that these health impairments are worse than they are? Or is it that people with chronic illnesses exaggerate and report a higher quality of life than they are actually experiencing? Or perhaps do healthy people understate their own well-being?

A new study in the February 2005 issue of the Journal of Experimental Psychology set out to examine happiness among people with and without chronic health conditions, and possibly determine the causes of a discrepancy between actual versus perceived happiness of unhealthy individuals.

About the Study

The study included 49 patients with kidney failure who were receiving dialysis treatment three times per week, and 49 healthy individuals (controls) who were similar to the patients in age, race, gender, and education. The average age of both groups was 49.

Researchers provided each participant with a PDA (personal digital assistant, such as a Palm Pilot) to carry with them every day for a period of seven days or more. The PDA was set up to prompt participants to answer questions at random times throughout the day. The same 12 questions were asked 90% of the time and focused on mood, emotions, pain, and fatigue. On 10% of the prompts an additional question was asked, concerning overall life satisfaction.

There were three phases to the study:

  • The entry interview, where participants estimated the percent of time during a typical week that they would experience each of five mood levels ranging from “very pleasant” to “very unpleasant.”
  • The Ecological Momentary Assessment (EMA), where participants answered questions throughout the day as prompted by their PDA.
  • The exit interview, where participants rated their moods as they had during the entry interview, but also answered questions aimed at determining the cause of the discrepancy. For example, healthy participants were presented with a scenario about a dialysis patient and then asked to estimate their typical moods as that patient. Likewise, the dialysis patients were asked to estimate the percent of time they would spend in each mood level had they never had kidney problems or needed dialysis.

The Findings

There was no difference between the patients and controls in the average EMA rating of their overall mood. Average EMA responses were also similar between the two groups for the other questions, which focused on positive emotions, negative emotions, pain, tiredness, and overall life satisfaction.

In general, patients slightly overestimated their average mood during a typical week, while controls significantly underestimated their average mood. Similarly, patients’ recollection of their moods accurately reflected their EMA responses, while controls significantly underestimated their moods. Controls also significantly underestimated the average mood of a dialysis patient, while patients overestimated the average mood of the controls. Finally, patients estimated that their own average mood would be higher had they never needed dialysis treatment.

How Does This Affect You?

In line with previous research, this study found no evidence that people living with a serious chronic illness experience lower moods than healthy individuals.

To answer critics’ contention that those subjects who agreed to participate are likely to have different mood levels than those who did not, the researchers performed a brief survey of subjects who declined to be in the study. They found that the average mood of non-participants was similar to that of participants.

Interestingly, the patients predicted that they would be significantly happier if they had their full health back. This suggests that the patients were not aware of the extent to which they had adapted to their condition. It may also suggest that happiness is relative. The patients in this study may have adjusted, but is their rating of “very pleasant” the same as a healthy person’s rating of “very pleasant?” This we do not know.

Not surprisingly, the controls in this study predicted they would be significantly unhappier if they were in the shoes of the dialysis patients. Challenging this discrepancy has important implications for health care: a healthy individual’s misperception of what life would be like with a serious illness may adversely influence their treatment choices when confronted with such an illness.

The results of this study leave us with a better, although not complete, understanding of the cause of this discrepancy. They suggest that while patients do not exaggerate their mood, healthy individuals tend to understate their mood. Additionally they suggest a bias on the part of healthy people, in that healthy people—not having experienced a serious chronic illness or disability themselves—assume health impairments are worse than they are. Apparently, many of us are able to cope with more than we think.