Honesty and integrity impact both physical and mental health

Relation

Weziak-Bialowolska D, Bialowolski P, Niemiec RM. Being Good, Doing Good: The Role of Honesty and Integrity in Health.Soc Sci Med. 2021;291:114494.

Study objective

Assessing the Effects of Honesty and Integrity on Physical Health, Mental Health, and Activities of Daily Living in Older Adults (Aged ≥50 Years)

Key to take away

Older adults who score higher on honesty and integrity have a lower risk of lung disease and depression, fewer limitations in mobility, and improved performance in activities of daily living.

Draft

Quantitative cohort study

Participant

Participants were Americans aged 50 or older who participated in the Health and Retirement Study (HRS), a national survey conducted every two years since 1992. Every 4 years, a psychological questionnaire is distributed to a randomly selected half of the sample group.

To achieve statistical significance in their data analysis, the researchers included two waves of psychological testing: those who completed the psychological questionnaire in 2008 and again in 2012; and those who completed it in 2010 and again in 2014.

The researchers only included people who answered the baseline psychosocial questionnaire and the pre-study self-assessment of health status.

The final cohort included 9,831 respondents.

intervention

The researchers used the HRS-embedded psychological questionnaire, which includes a psychosocial component that has been “strongly validated” in previous studies.

Study parameters assessed

The authors focused on the “Virtue Scale,” a validated subscale of the Consciousness Scale in the HRS.^1-3The researchers suggest that this was the first epidemiological and observational study to prospectively correlate moral behavior with physical and mental health and improvements in activities of daily living.

Primary outcome

Older adults who scored higher on the Character Strength of Honesty and Integrity (CSHI) scale had an 18% lower risk of lung disease (6% reduction with each increase in the standard deviation of the indicator for CSHI) and a lower one on the depression scale (11%). Those with high CSHI scores also had fewer limitations in mobility and improved performance in instrumental activities of daily living (e.g., handling telephones, money, and medications).

Key insights

While older adults with higher CSHI scores had lower risk of lung disease and depression, improved mobility, and better performance in instrumental activities of daily living, they had no change in their risk of other chronic diseases, including diabetes, cancer, stroke, heart disease, or high blood pressure.

transparency

The authors reported no financial conflicts of interest or competing interests. They received no grant for their research. Because the data for this study were publicly available, the authors did not require approval from the Harvard Longwood Campus Institutional Review Board.

Effects and limitations of practice

The results of Weziak-Bialowolska et al. are strong arguments for “positive psychology” that supports improved physical health. Kim et al. made similar discoveries based on data from the University of Michigan Health and Retirement Study, a prospective, nationally representative cohort of 12,998 participants over the age of 50.⁴Kim et al. found that participants with increased life satisfaction (as opposed to economic progress) reported improvements in physical health over a 4-year period, including reduced risk of pain, physical limitations, and mortality; fewer chronic diseases; and higher self-rated health. Participants also reported improvements in many psychosocial indicators, including optimism, positive affect, sense of purpose, and mastery in many areas of their lives. However, researchers found no correlations between improvements in life satisfaction and lower incidence of certain health conditions, as in the work by Weziak-Bialowolska et al. was reported.

These two research studies highlight the importance of focusing on character strength and psychological well-being to improve the physical and mental health of older patients.

Honesty and truthfulness are also important for healthcare providers when dealing with patients. Tuckett points out that today, more than in the past, cultural expectations tend to favor telling the truth, but certain individuals and/or their families prefer to avoid accurate reporting of their health status.⁵Sometimes denial benefits a patient, as research with cancer patients shows.⁶Patients who actively used distraction to deny their diagnosis were less likely to have emotional reactions that could “increase harmful physical symptoms.” However, those who used passive escape mechanisms undermined their psychological well-being.

Intentionally withholding information from a patient can undermine trust.^7.8For most patients, knowing their diagnosis is less stressful than worrying about the unknown.⁹

Working with dementia patients presents its own ethical challenges. Some practitioners incorrectly assume that dementia patients are unable to express opinions or have lost all short-term memory.¹⁰Providing accurate information and involving dementia patients in their care decisions are essential parts of respecting their autonomy.

For most patients, knowing their diagnosis is less stressful than worrying about the unknown.”

One of the greatest challenges to truth-telling is the reality of uncertainty in medical diagnoses and prognoses. Some authors suggest that telling the truth never succeeds because there is no absolute truth. Instead of absolute truth, Drickamer and Lachs suggest presenting information openly and honestly as it is “perceived and known.”¹¹

Numminen et al. reviewed research on “civil courage” among nurses, which included the attribute of honesty – that is, being transparent about one's shortcomings and mistakes, learning from and correcting those mistakes.¹²Honesty also required the ability to see through others' eyes and consider others' interpretations.¹³

The bottom line for practitioners: rely on communication with the patient and the patient's family about what information to disclose⁵and how best to convey it.¹⁴Present the truth to patients as best you can. By doing this, you will improve your own physical and mental health and model these characteristics for your patients.

For patients, encouraging them to practice honesty and integrity with themselves and those around them can improve their physical and mental well-being.