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How Healthy are We?: A National Study of Well-Being at Midlife

How Healthy are We?: A National Study of Well-Being at Midlife

by Orville Gilbert Brim (Editor), Carol D. Ryff (Editor), Ronald C. Kessler (Editor)

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Childhood, adolescence, even the "twilight years" have been extensively researched and documented. But the vast terrain known as midlife—the longest segment of the life course—has remained uncharted. How physically and psychologically healthy are Americans at midlife? And why do some experience greater well-being than others?

The MacArthur Foundation


Childhood, adolescence, even the "twilight years" have been extensively researched and documented. But the vast terrain known as midlife—the longest segment of the life course—has remained uncharted. How physically and psychologically healthy are Americans at midlife? And why do some experience greater well-being than others?

The MacArthur Foundation addressed these questions head-on by funding a landmark study known as "Midlife in the U.S.," or MIDUS. For the first time in a single study, researchers were able to integrate epidemiological, sociological, and psychological assessments, as well as innovative new measures to evaluate how work and family life influence each other.

How Healthy Are We? presents the key findings from the survey in three sections: physical health, quality of life and psychological well-being, and the contexts (family, work) of the midlife. The topics covered by almost forty scholars in a wide variety of fields are vast, including everything from how health and well-being vary with socioeconomic standing, gender, race, or region of the country to how middle-aged people differ from younger or older adults in their emotional experience and quality of life. This health—the study measures not only health-the absence of illness—but also reports on the presence of wellness in middle-aged Americans.

The culmination of a decade and a half of research by leading scholars, How Healthy Are We? will dramatically alter the way we think about health in middle age and the factors that influence it. Researchers, policymakers, and others concerned about the quality of midlife in contemporary America will welcome its insights.

* Having a good life means having good relationships with others to almost 70% of those surveyed. Less than 40% mentioned their careers.

* Reports of disruptive daily stressors vary by age, with young adults and those in midlife experiencing more than those in later adulthood.

* Men have higher assessments of their physical and mental health than woman until the age of 60.

Editorial Reviews

Library Journal
This important book reports the findings of a landmark study 16 years in the making. Funded by the John D. and Catherine T. MacArthur Foundation, "Midlife in the U.S." (a.k.a. MIDUS) was undertaken by a group of leading researchers in a wide variety of disciplines to find answers to the following questions: how healthy are Americans at midlife? Why do some Americans enjoy greater well-being in middle age than others? The results cross epidemiological, medical, sociological, and psychological realms. Thus, Part 1 focuses on midlife issues of physical health; Part 2 addresses quality of life, psychological well-being, and emotions in middle age; and Part 3 summarizes midlife attitudes toward family, work, community, and ethnicity. Editors Brim (former director, MacArthur Fdn. Research Network on Successful Midlife Development), Carol D. Ryff (psychology, Univ. of Wisconsin, Madison), and Ronald C. Kessler (healthcare policy, Harvard Medical Sch.) note that until this research was undertaken, midlife was the "last uncharted territory of the life course." This lengthy volume charts this time of life, narratively and statistically, and identifies features of a healthy middle age (e.g., having good relationships). Although probably too detailed for most public libraries, this volume should definitely be acquired by academic and health sciences libraries.-Linda M.G. Katz, Drexel Univ. Health Sciences Libs., Philadelphia Copyright 2003 Reed Business Information.

Product Details

University of Chicago Press
Publication date:
John D. and Catherine T. MacArthur Foundation Series on Mental Health and De Series
Edition description:
Product dimensions:
6.00(w) x 9.00(h) x 1.80(d)

Read an Excerpt

How Healthy Are We?: a National Study of Well-Being at Midlife

By Ronald C. Kessler

University of Chicago Press

Copyright © 2004 Ronald C. Kessler
All right reserved.

ISBN: 0226074757

Chapter One - The MIDUS National Survey: An Overview

Orville Gilbert Brim, Carol D. Ryff, and Ronald C. Kessler

Midlife has been described as the "last uncharted territory" of the life course. Extensive prior literatures have been devoted to early life and childhood, adolescence, and more recently, old age, but surprisingly little attention has been given to the middle years, which, for most individuals, constitute the longest segment of their life. The John D. and Catherine T. MacArthur Foundation established the Research Network on Successful Midlife Development (MIDMAC), directed by Orville Gilbert Brim, to advance knowledge of this neglected period of the life course. A multidisciplinary team of investigators was brought together to organize existing work on midlife development and, importantly, to generate new understanding of the challenges faced by individuals in the middle decades of life, including the contexts that create or minimize difficulties, as well as the strengths and weaknesses that midlife adults bring to their life tasks.

A major activity of the MIDMAC network was to conceive of and implement a national survey of midlife Americans. This study, known as MIDUS, which stands for Midlife in the United States, is the raison d'etre for the present volume. The central objective of this collection is to summarize the rich array of new findings generated by the MIDUS national survey. To put this endeavor in context, we first describe the background and history of the MIDMAC network, including the ideas and intentions that led to its members' creation of a national survey focused on midlife Americans.

We clarify the numerous dimensions along which this study was innovative and groundbreaking. We then briefly describe the sample, design, and measures of the MIDUS study, providing along the way links to web-sites and technical reports that review this material in greater detail. After the description of MIDUS, we provide an overview of the chapters that follow, highlighting their major questions and findings. This introductory chapter then concludes with a brief glimpse at the extent to which MIDUS has captured the interest of investigators across diverse scientific fields, in the United States and beyond, and what the future may hold for this one-of-a-kind study of midlife development.

At the outset, it is important to clarify our use of the terms health and well-being, as evident in our title, How Healthy Are We? A National Study of Well-Being at Midlife. By health, we endorse a multidisciplinary definition of the term that includes not only physical health but also psychological and social health. A major objective of MIDMAC was, in fact, to broaden the purview of what has traditionally been included under the rubric of health. Understanding how these multiple levels interact is part of a growing concern for integrative approaches to health (Singer and Ryff 2001a). By well-being, we give explicit emphasis to the positive side of these multiple levels of health. That is, we challenge the preoccupation with health conceived exclusively as illness and disease (physical or mental) and instead call for greater attention to the upside of human functioning (Ryff and Singer 1998). MIDUS provided the opportunity to measure health not just as the absence of illness but also as the presence of wellness.

History of the Midlife Network

The Research Network on Successful Midlife Development was established in 1990. Its mission was to identify the major biomedical, psychological, and social factors that permit some toflourish in the middle years, achieving good health and psychological well-being, and exercising social responsibility. Although there was explicit interest in understanding such positive midlife trajectories, the network was also interested in identifying the factors that undermine and limit good health, well-being, and social responsibility in midlife. A team of thirteen scholars from the fields of anthropology, demography, epidemiology, health care policy, medicine, psychology, and sociology was assembled to carry out this task. Over its ten-year history, MIDMAC also brought in fifteen junior scholars as network associates. Their backgrounds reflected the same diversity of fields. The chapters that follow are authored by the members and associates of MIDMAC, along with their collaborators.

The collective goals of the MIDMAC team were to (1) develop indicators (physical, psychological, social) for assessing successful midlife development; (2) establish an empirical basis of what happens in midlife-the who, what, when, where, and why of midlife events and the beliefs people hold about them; (3) identify factors that influence the course of midlife development, including illness, life stresses, work and family interactions, and culture; and (4) illuminate the psychological and behavioral strategies that people use to understand and deal with the challenges of midlife, thereby elaborating the variety of individual differences in how midlife is negotiated.

These broad interests were pursued via numerous initiatives (e.g., conferences, new data collection, and analyses), many of which culminated in topically organized edited volumes, such as Sexuality across the Life Course (Rossi 1994); The Parental Experience in Midlife (Ryff and Seltzer 1996); Multiple Paths of Midlife Development (Lachman and James 1997); Welcome to Middle Age! (And Other Cultural Fictions) (Shweder 1998); and Caring and Doing for Others (Rossi 2001). With the exception of the latter volume, scientific findings across these endeavors were based on earlier studies, not on the MIDUS national survey. In fact, it was in working with earlier studies that the disciplinary limitations became apparent. Rather than approach midlife one discipline at a time, where the focus is exclusively on psychological, or social, or biomedical aspects, what was needed was an investigation of all of these levels combined. This realization was the genesis of the plan to carry out a national survey of midlife Americans in which information would be collected across a wide array of topics so that the intersections of psychological, social, and biomedical processes could be brought into focus.

Strengths of the MIDUS Survey

Creating a national survey via a multidisciplinary team approach was innovative on multiple levels. Among the unique strengths of this integrative study, we highlight the following. First, MIDUS provided a groundbreaking assessment of numerous psychological constructs (e.g., personality traits, sense of control, positive and negative affect, goal commitments, well-being) in a national sample of Americans. Such variables define mainstream research in life-course studies of personality, affect, and well-being (McCrae and Costa 1990; Helson 1993; Ryff, Kwan, and Singer 2001), and the psychology of adulthood and aging (Birren and Schaie 1996, 2001), but extant knowledge has been generated with select samples having limited generalizability to the larger population. Thus, MIDUS provided an unprecedented opportunity to bring core psychological constructs to a large and diverse sample of midlife Americans. The diversity in educational level, income, and occupational status, as well as race/ethnicity and region of the country, proved to be extremely fruitful in the scientific findings generated.

Second, MIDUS afforded new directions for fields of demography, epidemiology, and sociology, where national surveys are standard fare, but where typical sociodemographic and health variables (e.g., marital status, employment status, socioeconomic standing, family structure, health status, health care utilization) are rarely linked to mainstream psychological and social constructs. MIDUS provided the opportunity to build bridges between these largely disciplinary-specific realms of knowledge.

Third, before conducting the study, the multidisciplinary team of investigators carried out painstaking pilot research, involving six separate studies (some involving national samples), to develop short-form assessments of many key psychosocial constructs. Thus, another first of MIDUS was the creation of condensed psychological assessment inventories that could be used with large population samples, where the trade-offs between sampling scope and depth of measurement must be negotiated. MIDUS demonstrated how these trade-offs can be accomplished via pilot research designed to maintain the conceptual and theoretical integrity of the constructs that personality, social, and cognitive psychologists bring to the table, but at the same time, sharply reduce the number of questions/items asked to probe such constructs.

Fourth, MIDUS made creative use of satellite studies, essentially studies within a study, so that greater depth could be obtained in certain areas. For example, a subset of MIDUS respondents not only completed the telephone interview and self-administered questionnaire given to all members of the national sample but they also participated in a diary study of daily stress, involving additional data collection over a period of eight days. The nature and scope of the satellite studies are described in greater detail later in this chapter. For now, the generic point is that the use of the satellites built around the main study provided a compelling solution to the competing forces of sampling scope, variability, and generalizability, on the one hand, and in-depth assessments of core constructs on the other. The MIDUS design encompassed both.

Finally, because of these innovations in assessment and design, MIDUS had an exceptionally expansive scientific scope. A synopsis of the substantive areas included in the study is provided in tables 1 and 2. The main categories of assessment are elaborated later in this chapter in discussion of the MIDUS measures. Here we highlight the unprecedented breadth of content in the MIDUS survey. Thus, one of the main advances of this investigation was to demonstrate that a population-level inquiry covering such wide territory could actually be done. That is, MIDUS changed the social scientific understanding of the boundary conditions under which research is conducted. We found that through a well-crafted, engaging interview, combined with a lengthy self-administered questionnaire, it was possible to collect an unprecedented amount of information about a very large number of Americans. In that sense, MIDUS broke through long-standing barriers, implicit and explicit, of what is possible in a national survey.

The collective innovations of the study were accomplished by bringing together the scientific disciplines, represented by the MIDMAC members and associates, and through years of regular meetings and working out differences in research priorities. In the fields of sociology, demography, and epidemiology, primary resources are frequently channeled into recruiting large, representative samples. Alternately, in psychology and anthropology, greater emphasis is given to developing in-depth assessment procedures-interviews, observations, questionnaires. The net effect of these differing conceptions of quality research is that much comprehensive, detailed data collection has been carried out on small, biased samples. Studies of large, representative samples, in turn, have frequently been limited in depth of assessment, particularly in psychosocial realms. MIDUS effectively bridged these competing priorities, thereby allowing the psychologists and anthropologists in the group to investigate their questions in a diverse sample of Americans, while at the same time, sociologists, demographers, and epidemiologists had the benefit of adding new psychosocial content to their inquiries. It cannot be overemphasized that this novel synthesis required compromise and trade-offs on all sides. All players had to retreat somewhat on their own priorities for this new, integrative inquiry to work.

MIDUS Samples, Design, and Measures

Detailed information about the MIDUS national survey is available in previous publications (Brim 2000) and at the MIDMAC website. In the present chapter we provide a condensed description of this information as entree to the researching findings that follow.

Sample: Who Was in the Study?

Overall, the MIDUS survey was administered to a national sample of 7189 non-institutionalized, English-speaking adults. All respondents, aged 25-74, were recruited by telephone to participate in the study. The rationale for the wide age range was that those in the middle years (40-60) could be compared with those younger and older. Respondents completed a telephone interview (approximately forty-five minutes in length) and a self-administered questionnaire (approximately two hours in length). Of the general population sample, which did not include twins, siblings, or city over samples, 3032 respondents completed both the telephone survey and the questionnaire. Another 453 respondents completed only the telephone survey. These data were collected primarily in 1995.

The response rate for the telephone interview was 70 percent, which is generally considered quite good for a population survey. Among the telephone respondents, 86.8 percent completed the lengthy self-administered questionnaire, yielding an overall response rate of 60.8 percent. Comparison of the MIDUS main sample with the Current Population Survey (U.S. Census Bureau 1995) revealed that the sample underrepresented those with a high school education or less and African Americans. Presumably, the lengthy content of the survey (phone and questionnaire) would not have been possible without some underrepresentation of the least educated. Alternately, by design the sample overrepresented older males so as to facilitate gender comparisons by age.

In addition, MIDUS included oversamples (N = 757) in select metropolitan areas. The purpose of these was to facilitate in-depth data collection for satellite studies. To investigate familial and genetic influences on questions of interest to MIDUS investigators, the study also included siblings (N = 951; allowing for 1614 pairs of siblings) of the main sample respondents, plus a separate sample of twins (N = 1996; 998 pairs). The phone interview and questionnaire mentioned earlier were also used with the sibling and twin samples. These data were collected primarily in 1995-96.


Excerpted from How Healthy Are We?: a National Study of Well-Being at Midlife by Ronald C. Kessler Copyright © 2004 by Ronald C. Kessler. Excerpted by permission.
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Meet the Author

Orville Gilbert Brim is the former director of the MacArthur Foundation Research Network on Successful Midlife Development. Carol D. Ryff is a professor of psychology and director of the Institute on Aging at the University of Wisconsin-Madison. Ronald C. Kessler is a professor in the Department of Health Care Policy at the Harvard Medical School.

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