New research published in communication medicine Our results suggest that experiencing suffering may predict worse well-being in various areas of life approximately one year later. These findings provide evidence that addressing everyday emotional and physical suffering is a critical step toward improving collective human flourishing on a global scale.
Human life is full of various difficulties, inconveniences, and adversities. In some cases, these difficult events can lead to a state of suffering. Suffering is generally defined as an extremely painful personal experience that lasts for a significant period of time and involves the loss of something that a person perceives as good. Suffering often overlaps with physical pain and depression, but scientists point out that it is a separate experience with its own characteristics.
For example, a person may endure severe physical pain during athletic training because they desire health outcomes. In other words, you are in pain, but you are not suffering. On the other hand, some people may suffer deeply from minor injuries that prevent them from pursuing very important life goals. Suffering is also different from clinical depression. A person may experience a prolonged depressive mood without feeling a strong and persistent desire to stop the current situation, which is characteristic of suffering.
Suffering is a diffuse experience that permeates all aspects of a person’s life and therefore can affect many aspects of well-being. Researchers are increasingly viewing well-being through the broader lens of human flourishing. Human flourishing is a comprehensive concept that examines how well a person is doing in all areas of human existence. This includes physical health, mental health, social relationships, financial stability, and personal personality.
Most previous research on suffering has focused on very specific segments of the population, such as the elderly, hospitalized patients, and terminally ill patients receiving palliative care. Richard G. Cowden, a research fellow in the Human Thriving Program and the Department of Epidemiology at the Harvard T.H. Chan School of Public Health, wanted to expand this focus even further. “Suffering is common and it is not limited to people who are seriously ill or in crisis,” Cowden said.
Cowden noted that previous data highlights how widespread the problem really is. “In previous research using Wave 1 of the World Prosperity Survey, approximately 44% of adults in 22 countries reported ‘some’ or ‘a lot’ of suffering, suggesting that a significant number of people in the general population are experiencing suffering,” Cowden explained.
To better understand how suffering affects ordinary people, scientists needed to examine everyday suffering in different cultures. “In this study, we used two waves of longitudinal data from the Global Prosperity Study to address a major gap,” Cowden said. “No previous study has examined whether suffering predicts later well-being across a wide range of outcomes, including happiness, physical health, relationships, personality, and economic security, in a representative sample of many countries.”
To explore these ideas, researchers analyzed data from the World Prosperity Survey. This large-scale scientific project includes nationally representative survey data from 207,919 adults living in 23 countries and territories. These countries were specifically chosen to represent a diversity of geographic, cultural, and religious backgrounds. In total, the sampled countries cover approximately two-thirds of the world’s population.
The authors looked at two different waves of data collected about a year apart. In the first phase, participants answered a direct survey question asking how much they were currently suffering, with instructions that this could include any type of physical or mental pain. Participants chose from not at all, not much, a little, and a lot. The researchers then grouped these responses and compared those who reported at least some suffering to those who reported little or none.
During a second wave of data collection one year later, participants completed a survey assessing 56 specific health indicators. These results were grouped into eight major categories. Categories include psychological well-being, psychological distress, social well-being, social distress, social participation, personality and prosocial behavior, physical health, and socio-economic outcomes.
The scientists utilized an analytic design across the results. This statistical approach involves testing a single exposure against dozens of different outcomes simultaneously. By using this method, researchers avoid selectively reporting only positive or interesting results. This provides a transparent and comprehensive view of how a single factor can impact the entire system of well-being.
To ensure the statistical model was as accurate as possible, the researchers controlled for several variables from the first wave of data. These variables include demographic characteristics such as age, gender, education, employment status, and marital status. They also adapted to childhood experiences that were recalled retrospectively. These include the quality of the participants’ relationship with their parents, their childhood economic circumstances, and their history of abuse while growing up.
The scientists found consistent evidence that suffering in the first wave of the study predicted widespread deterioration in health a year later. People who reported some or a lot of suffering tended to score lower on two broad composite measures of human flourishing. It also showed worse results in most specific well-being indicators around the world.
“One thing that stood out was the breadth of the pattern: across many outcomes across different domains of well-being, suffering was associated with worse well-being,” Cowden told Cypost. The strength of these associations varies depending on the specific area of life being measured. Researchers observed the strongest negative links between suffering and psychological well-being, psychological distress, and physical health.
For example, early suffering predicted lower life satisfaction, lower happiness, more severe depressive symptoms, and worse self-rated physical health one year later. Suffering also predicted worse outcomes in social and socio-economic domains. Those affected in the first wave reported lower relationship satisfaction, increased loneliness, and decreased financial security in the second wave.
Interestingly, suffering showed little association with indicators of social participation or personality. Ancient philosophical and religious traditions often suggest that suffering can serve as a crucible for building virtue and character. However, the authors found that suffering was associated with minimal declines in personality traits such as gratitude and hope.
However, Cowden pointed out that depending on the cultural context, the effects of suffering can sometimes produce unexpected positive changes. “At the same time, the findings were not uniformly negative in all cases. In several countries, suffering was positively associated with selected outcomes, including life balance in India, volunteering in Poland, and helping strangers in Poland, Sweden, and the United States,” Cowden explained.
This particular finding regarding helping strangers is consistent with a concept known as altruism born of suffering, which suggests that enduring hardship can increase empathy for other vulnerable people. “While these associations are very small and should not be taken too lightly, they do suggest that the relationship between suffering and subsequent well-being may be more complex than a uniformly negative pattern,” Cowden added.
The study also revealed some differences in results among the 23 countries and territories. In countries such as Sweden, Japan, the United Kingdom and the United States, suffering was associated with worse well-being in nearly every outcome measured. In contrast, countries such as Nigeria, the Philippines, and South Africa showed much less consistent evidence of these negative associations. Scientists have suggested that a country’s age demographics, such as its large elderly population, can influence how strongly suffering affects its population.
Although this study provides an impressive perspective on global suffering, there are some limitations to keep in mind. This study relies entirely on self-reported survey data. This type of data can be subject to response bias, such as participants answering in ways they think are socially acceptable or leaning toward extreme answers.
Additionally, many of the concepts were measured using single questions rather than comprehensive questionnaires. A single question may not capture the full complexity of a person’s suffering. For example, survey questions cannot distinguish between the psychological pain caused by severe social betrayal and the physical pain caused by a chronic illness.
Readers should also avoid mistaking this finding as conclusive evidence of a strict causal relationship. “This is a long-term observational study, so while the results indicate a prospective association, they do not conclusively prove that suffering caused subsequent outcomes,” Cowden cautioned.
Although the study followed people over time and controlled for many external factors, unmeasured variables may still influence both early suffering and later well-being. “This study also used two waves of data, so future studies with more waves will be important to understand long-term patterns and possible bidirectional relationships,” Cowden said.
Additionally, a 1-year follow-up period may be too short to capture slowly evolving changes in outcome. Things like educational attainment, having children, and major changes in personal personality take a long time to manifest. Anything associated with such slow life events should be observed with some caution.
The authors encourage public health authorities to consider strategies to address everyday suffering in the general population. “Suffering is not uncommon, and it is not limited to clinical, palliative care, or crisis situations,” Cowden said. “We found that people in the general population who reported being distressed tended to have worse well-being after about a year across many outcomes.”
Finding accessible ways to provide psychological support could help alleviate suffering across the population. “The practical lesson is that suffering should be taken seriously as part of public health and human flourishing,” Cowden said. “Where suffering can be prevented, we should strive to alleviate it, and when we cannot avoid it completely, we should provide more meaningful support and resources to those experiencing it.”
Future research will continue to build on these global findings as more data becomes available. “We hope this research will contribute to an ‘epidemiology of suffering’ that can inform public health, clinical practice, community support and policy, but more needs to be done,” Cowden explained.
Following participants over time will help explain the biological and social pathways that link distress to poor health and social outcomes. “A number of important avenues could be pursued based on this research,” Cowden said. “One is to better understand why suffering is more strongly associated with some outcomes than others, why these patterns vary across countries, and what scalable resources can help alleviate the negative effects of suffering when it occurs.”
“One particularly important point is that suffering is different from other types of experiences that involve negative emotions, such as pain or depression,” he added. “These experiences often overlap, but they are not identical. People may have physical pain without feeling like they are suffering, or they may be suffering for reasons other than the physical pain they are experiencing. Our research suggests that suffering can have pervasive effects on well-being across many areas of life, which is why this suffering deserves attention as a distinct human experience in research, practice, and public health.”
The study, “Longitudinal associations between suffering and subsequent multidimensional well-being in the Global Prosperity Study,” was authored by Richard G. Cowden, R. Noah Padgett, Chris Felton, Renae Wilkinson, Lucia Macchia, Zhuo Job Chen, Dorota Wesiak-Bialoworska, Stephanie M. Koning, Craig Gundersen, Byron R. Johnson, and Tyler J. Johnson. Vanderweel.
