Latent Class Analysis of Well-Being in Older Women

Background: Previous efforts to assess well-being and health focused on individual indicators of hedonic, evaluative, or eudaemonic measures or summated scores reflecting all dimensions. The objectives of this study were to develop profiles that preserve distinct dimensions of hedonic, evaluative, and eudemonic well-being while permitting its exploration as a predictor of health endpoints. Methods: A total of 81,148 Women's Health Initiative (WHI) participants with well-being measures collected in 2011-2012 (mean age = 76.4 years) were included. Women were recruited to the WHI Clinical Trial and Observational Cohort, continued participation in WHI Extensions (2005-2010 and 2010-2015), and completed the 2011-2012 questionnaire. Classes were identified from hedonic (life enjoyment, happiness, life satisfaction, quality of life) and eudaemonic (personal growth, purpose in life, environmental mastery, self-mastery, self-control) measures using latent class analysis. Characteristics were described by classes, and associations with all-cause mortality were examined using logistic regression. Results: Four well-being classes were identified. Class 2 (17.8%) had the lowest (worst) well-being scores, and class 4 (53.9%) had the highest (best) well-being scores in all dimensions. Class 1 (6.4%) had high hedonic and moderate eudaemonic with low life enjoyment. Class 3 (21.9%) had high hedonic and moderate eudaemonic scores with low self-mastery. Women in class 4 were younger, more educated, reported higher annual incomes, least likely to smoke, and most likely to drink alcohol daily. Relative to class 4, odds ratios (95% confidence interval) of all-cause mortality were 1.33 (1.24-1.43), 1.75 (1.67-1.84), and 1.26 (1.20-1.31) for classes 1, 2, and 3, respectively, even after adjustment for demographic and behavioral confounders. Conclusion: Latent class analysis identified groups by levels of hedonic and eudaemonic indicators, preserving information about well-being dimensions while supporting interpretation of relationships with well-being important to older women and health research.