What a Growing Body of Research Says About Thankfulness, Disease Risk, and How Long You Live
The Nine Percent Question
Here is a number worth sitting with: nine percent. That is the amount by which the risk of dying from any cause dropped among older women who scored highest on a simple six-question gratitude survey, compared to those who scored lowest — even after researchers accounted for income, exercise habits, diet, smoking, existing health conditions, and mental health history. The finding, published in 2024 in the high-impact journal JAMA Psychiatry, came from a study that tracked nearly fifty thousand women over approximately three years of follow-up. It was not a small pilot experiment or a self-help anecdote. It was one of the largest and most rigorously controlled investigations ever conducted on the relationship between a positive psychological trait and the risk of death.
Nine percent may not sound dramatic. It will not make a viral headline. But consider what it means in practice: for a population of women in their late seventies and eighties, a nine percent reduction in mortality risk is similar in magnitude to the relative risk reductions seen with some preventive interventions in this age group. And the “treatment” in this case is not a pill. It is a disposition — a habitual tendency to notice and appreciate the good things in life, even when times are hard. Scientists call it dispositional gratitude, and a growing body of evidence suggests it may be one of the most undervalued tools in the longevity conversation.
Americans can now expect to live to about 79 years, but a substantial share of that life is spent in poorer health. One global analysis published in JAMA Network Open estimated the U.S. healthspan-lifespan gap at about 12.4 years — years lived with significant disease burden or disability. About three in four American adults have at least one chronic condition, and more than half have two or more. Medical researchers have a term for this gap: the difference between lifespan, which is simply how many years you live, and healthspan, which is how many of those years you spend free from serious chronic disease, disability, and poor quality of life. Closing that gap — helping people not just live longer but live well for more of those years — is arguably the most important public health challenge of the twenty-first century.
Most efforts to extend healthspan focus on diet, exercise, and medication — interventions that can be measured in grams, minutes, and milligrams. But what if part of the answer has been hiding in plain sight, in a psychological habit that costs nothing and has no side effects? That is the question a handful of researchers at Harvard, Singapore Management University, and institutions in the Netherlands, New Zealand, and China have been trying to answer. Their findings, drawn from studies involving more than 200,000 participants across multiple countries, are not simple. Some results are impressive. Others are mixed. A few are frankly null. This article examines all of them — the encouraging, the disappointing, and the genuinely uncertain — to answer a straightforward question: does feeling grateful actually help you live longer and healthier, and if so, how much?
How Gratitude Gets Under the Skin: The Biology of a Thankful Brain
To understand how a feeling in your mind could affect the health of your heart, your blood vessels, or your immune system, it helps to understand a concept that scientists call chronic low-grade inflammation. Think of your immune system like a smoke detector. When you get an infection or cut yourself, the alarm goes off — your body sends specialized cells to the site of the problem, causing redness, heat, and swelling. That is acute inflammation, and it is a healthy, necessary response. But in many people, especially as they age, the alarm starts ringing even when there is no fire. Low levels of immune activation persist for months or years, quietly damaging blood vessels, promoting insulin resistance (a condition where your body stops responding properly to the hormone that controls blood sugar), and contributing to the plaque buildup in arteries that leads to heart attacks and strokes. This slow-burning, silent alarm is what researchers mean when they talk about chronic inflammation, and it is now understood to play a role in nearly every major disease of aging.
One of the key molecules involved in this process is called interleukin-6, or IL-6 — a signaling molecule that your immune cells produce to communicate with each other. When IL-6 levels are elevated for long periods, it is a marker that the body’s inflammatory alarm system is stuck in the “on” position. Higher IL-6 levels have been linked to heart disease, type 2 diabetes, depression, and accelerated aging. What makes IL-6 particularly important for the gratitude story is that psychological stress — the kind caused by financial hardship, social isolation, or chronic worry — can drive IL-6 levels up. Your body does not distinguish very well between a physical threat and a psychological one; the same stress-response machinery gets activated either way.
This is where gratitude enters the picture. Imagine your body’s stress-response system as a ledger. On one side, the debits: threats, losses, worries, daily hassles. On the other side, the credits: moments of connection, appreciation, safety, purpose. When the debits overwhelm the credits for months or years, the body pays a physiological price — elevated cortisol (the main stress hormone), elevated inflammatory markers, higher blood pressure, and disrupted sleep. Gratitude, the emerging evidence suggests, acts as a credit entry. It does not erase the debits — a grateful person still faces job loss, illness, and grief — but it may shift the balance enough to reduce the cumulative biological toll.
Researchers have identified at least four pathways through which this might work. First, gratitude appears to buffer the body’s stress response, dampening the cortisol surge that follows a perceived threat. Second, grateful people tend to engage in healthier behaviors — they eat better, exercise more, and are more likely to see a doctor when something is wrong. Third, there is early evidence that gratitude may improve autonomic flexibility — the ability of the heart and nervous system to shift smoothly between activation and rest, a capacity that is associated with cardiovascular resilience. Fourth, grateful people tend to maintain stronger social connections, and social connectedness is one of the most well-established predictors of longer life.
None of these mechanisms has been definitively proven in large-scale experiments. They are plausible, supported by preliminary data, and consistent with each other — but they remain hypotheses, not established facts. With that caveat clearly in mind, let us turn to the evidence itself, building from the smallest and most preliminary studies to the largest and most rigorous.
What the Research Actually Shows
The First Clues: Biomarkers, Inflammation, and the Heart
The earliest pieces of evidence linking gratitude to physical health come from relatively small studies that measured biomarkers — substances in the blood that serve as indicators of what is happening inside the body. These are observational studies, meaning the researchers measured what existed rather than experimentally changing anything. Observational studies can reveal patterns and associations, but they cannot prove that one thing caused another. With that important limitation in mind, here is what they found.
Andree Hartanto, PhD, and colleagues at Singapore Management University published a study in Scientific Reports in 2019 examining 1,054 midlife American adults from the MIDUS study — a large, nationally representative survey of health and well-being. They measured dispositional gratitude and tested its association with IL-6, the inflammatory marker described earlier. The main finding was a null: gratitude did not directly lower IL-6 levels for the population as a whole. But the more interesting finding was what statisticians call a moderation effect — a pattern where the effect of one variable depends on the level of another. Among people with low gratitude, the well-known gradient held: lower socioeconomic status predicted higher inflammation. Among people with high gratitude, that gradient disappeared entirely. Gratitude, in other words, did not lower inflammation universally, but it appeared to protect the people most vulnerable to the physiological toll of economic disadvantage. Evidence quality: PRELIMINARY, because this is a single cross-sectional study (one snapshot in time), which cannot establish that gratitude caused the moderation.
The same research group published a follow-up study in Scientific Reports in 2022, this time examining blood lipids — the fats in your blood, including triglycerides (a type of fat associated with heart disease risk), LDL cholesterol (often called “bad” cholesterol), and HDL cholesterol (often called “good” cholesterol). Among 1,800 midlife adults, higher gratitude was associated with lower triglyceride levels in initial models (the statistical coefficient was β = −0.07, with a probability value of p = 0.008 — meaning there was less than a 1 in 125 chance this result was a fluke). Healthier diet and lower body weight partially explained the association, suggesting that grateful people have better lipid profiles partly because they eat better and weigh less. Importantly, when the researchers added the most complete set of health behavior controls — including smoking, alcohol, BMI, diet, and exercise — the gratitude-triglyceride association attenuated and was no longer statistically significant, meaning we cannot be confident the link is independent of those behaviors. Gratitude was not significantly associated with HDL or LDL cholesterol. Evidence quality: PRELIMINARY.
For cardiovascular function, B. Leavy, Brenda H. O’Connell, and Deirdre O’Shea published a study in Biological Psychology in 2023 finding that trait gratitude was associated with reduced risk of acute myocardial infarction — commonly known as a heart attack — over a mean follow-up of 6.7 years (N = 1,031). The mechanism was increased heart rate reactivity, which is the ability of the heart to adjust its rate quickly in response to changing demands. Think of it as cardiovascular flexibility: a heart that can speed up and slow down smoothly is generally healthier than one stuck at one pace. Neither systolic nor diastolic blood pressure (the upper and lower numbers in a blood pressure reading) mediated the relationship. Evidence quality: PRELIMINARY, based on a single longitudinal dataset.
Table 1. Key Observational Studies: Biomarker and Cardiovascular Findings
| Study | Journal, Year | Design | N | Key Findings | Evidence Rating |
| Hartanto et al. | Scientific Reports, 2019 | Cross-sectional | 1,054 | No direct effect on IL-6; gratitude eliminated SES gradient in inflammation | PRELIMINARY |
| Hartanto et al. | Scientific Reports, 2022 | Cross-sectional | 1,800 | Lower triglycerides in initial models; attenuates with full health-behavior controls; no HDL/LDL effect | PRELIMINARY |
| Leavy et al. | Biological Psychology, 2023 | Longitudinal | 1,031 | Gratitude linked to reduced heart attack risk via heart rate flexibility (β = −0.098) | PRELIMINARY |
Scaling Up: Mortality, Mental Health, and Large Cohort Studies
Population-level patterns, no matter how consistent, can only tell us that two things tend to occur together — they cannot tell us that one causes the other. But when those patterns appear in very large groups of people, tracked over years, the associations become harder to dismiss as coincidence. Three large cohort studies — long-term tracking studies that follow thousands of people and record who develops disease or dies — anchor the gratitude-health literature.
The study that put gratitude on the longevity map was published in 2024 in JAMA Psychiatry by Ying Chen, PhD, Olivia I. Okereke, MD, Eric S. Kim, PhD, Henning Tiemeier, MD, PhD, Laura D. Kubzansky, PhD, and Tyler J. VanderWeele, PhD, all at Harvard. They studied 49,275 women from the Nurses’ Health Study — one of the largest and longest-running health studies in the world — with an average age of 79. Each woman completed a validated six-question gratitude survey, and the researchers then tracked deaths from the 2016 questionnaire wave through December 2019 — about three years of follow-up.
The headline result: women in the top third of gratitude scores had a 9 percent lower risk of dying from any cause compared to women in the bottom third, even after the researchers statistically adjusted for an extensive list of other factors that could explain the difference — including age, income, education, social participation, religious involvement, physical health history, smoking, physical activity, diet quality, alcohol consumption, cognitive function, depression diagnosis, antidepressant use, and depressive symptoms. In scientific notation, this is reported as a hazard ratio (HR) of 0.91 with a 95 percent confidence interval of 0.84 to 0.99 — which means the researchers are 95 percent confident that the true reduction in risk falls somewhere between 1 percent and 16 percent. In related reporting from the same research group, presented in a 2024 conference supplement, estimates were similar in direction, with roughly a 10 percent lower hazard in a larger analytic sample of 52,169 nurses.
But here is the crucial context that separates responsible science reporting from hype. When the researchers adjusted only for age, the apparent benefit of gratitude was much larger — a 29 percent reduction in mortality risk (HR = 0.71). The fact that this shrank to 9 percent after adjusting for all those other factors means that the large majority of the apparent benefit was not unique to gratitude itself. Grateful women also tended to be wealthier, more physically active, less likely to smoke, more socially connected, and less depressed. Those factors, not gratitude per se, accounted for most of the survival advantage. Whether the remaining 9 percent represents a true independent effect of gratitude, or is explained by personality traits and other unmeasured factors, is an open question. The study did not control for the so-called “Big Five” personality traits — the five broad dimensions of personality (openness, conscientiousness, extraversion, agreeableness, and neuroticism) that psychologists use to describe individual differences — and some of those traits are themselves associated with health. Evidence quality: MODERATE.
The association was strongest for cardiovascular death — death from heart attacks, strokes, and other diseases of the heart and blood vessels. The hazard ratio for the highest versus lowest gratitude tertile was 0.85 (95% CI, 0.73–0.995), translating to approximately a 15 percent lower risk. And the relationship followed what epidemiologists call a dose-response pattern: the more grateful the woman, the lower her mortality risk, in a stepwise fashion. A dose-response pattern means the more of the “exposure” you have (in this case, gratitude), the larger the effect — just as heavier smokers get more lung cancer than lighter smokers. This kind of graded relationship is harder to explain by coincidence or hidden factors than a simple high-versus-low comparison.
For mental health, the most clinically striking findings came from a study of U.S. military veterans. Adam P. McGuire, PhD, Joanna G. Fagan, and colleagues published their results in the Journal of Psychiatric Research in 2022. They followed veterans over seven years and divided them into groups based on their gratitude levels. Among veterans with low gratitude, 27.7 percent developed major depression, generalized anxiety, or post-traumatic stress disorder (PTSD — a condition in which the psychological effects of a traumatic experience persist long after the event itself). Among veterans with high gratitude, that number was 8.0 percent. For suicidal thoughts, 33.6 percent of low-gratitude veterans experienced suicidal ideation over the seven-year period, compared to 6.8 percent of high-gratitude veterans. These are among the largest effect sizes in the gratitude literature. Evidence quality: MODERATE.
Not every mental health finding was positive. In the Netherlands, Lilian Jans-Beken, PhD, and colleagues followed 706 adults for 7.5 months and published their results in the Journal of Happiness Studies in 2018. Gratitude was only a weak predictor of subjective well-being and, critically, did not predict symptoms of psychopathology — conditions like depression and anxiety — when the researchers adjusted for how symptomatic participants already were at the start of the study (the technical term is “adjusting for baseline symptoms,” and it is a way of asking whether gratitude predicts future mental health problems rather than simply reflecting current ones). The association was not statistically significant, falling well above the standard threshold of 5 percent that scientists use to consider a result meaningful. This suggests that in a general Dutch population, gratitude did not meaningfully predict who would develop psychological problems. Evidence quality: MODERATE for the null finding.
Table 2. Large Cohort Studies: Mortality and Mental Health
| Study | Journal, Year | Design | N | Key Findings | Evidence Rating |
| Chen et al. | JAMA Psychiatry, 2024 | Prospective cohort | 49,275 | 9% lower all-cause mortality (HR 0.91, 95% CI 0.84–0.99); 15% lower CVD mortality (HR 0.85) | MODERATE |
| Chen et al. | Conference supplement, 2024 | Prospective cohort | 52,169 | ~10% lower all-cause mortality; similar direction | MODERATE |
| McGuire et al. | J. Psychiatr. Res., 2022 | Longitudinal cohort (7 yr) | US veterans | Low gratitude: 27.7% MDD/GAD/PTSD; High: 8.0%. Suicidal ideation: 33.6% vs. 6.8% | MODERATE |
| Jans-Beken et al. | J. Happiness Stud., 2018 | Prospective (7.5 mo) | 706 | Did not predict psychopathology after adjusting for baseline symptoms (not significant) | MODERATE (null) |
Pooling the Evidence: Meta-Analyses and Systematic Reviews
Individual studies, no matter how large, can produce misleading results due to quirks of their particular sample. The most reliable way to assess a body of evidence is through a meta-analysis — a study that pools the results of many individual studies to get a more dependable overall estimate. Several meta-analyses and systematic reviews (structured surveys of all available research on a question) have now been conducted on gratitude and health.
The most comprehensive was published in 2020 by Felipe F. Portocarrero, PhD, and colleagues in the journal Personality and Individual Differences. They combined data from 158 separate samples involving approximately 100,000 participants and found that dispositional gratitude was consistently associated with higher life satisfaction, greater happiness, and lower perceived stress. The size of this association was what statisticians call “small-to-moderate” — reliable and consistent across ages and cultures, but not so large that gratitude alone would transform someone’s mental health. This is the kind of evidence scientists rate as STRONG: replicated across many studies, in large numbers, with consistent results.
For physical health, the picture is less clear. Anna L. Boggiss and colleagues published a systematic review in the Journal of Psychosomatic Research in 2020 examining whether gratitude interventions improved objective physical health outcomes. They found the most promising results for subjective sleep quality, but overall physical health effects were mixed and the studies were small. Lilian Cousin and colleagues published a related review in The Journal of Positive Psychology in 2020, and Wang et al. published a review in 2023 examining gratitude interventions specifically in cardiovascular patients. Both concluded that evidence was preliminary and that larger, better-designed trials were needed before strong conclusions could be drawn. Evidence quality for physical health interventions: PRELIMINARY.
Table 3. Meta-Analyses and Systematic Reviews
| Study | Journal, Year | Design | N / Scope | Key Findings | Evidence Rating |
| Portocarrero et al. | Pers. Indiv. Differ., 2020 | Meta-analysis (158 samples) | ~100,000 | Gratitude consistently linked to well-being across ages/cultures; small-to-moderate effect | STRONG |
| Boggiss et al. | J. Psychosom. Res., 2020 | Systematic review | Multiple trials | Most promising for sleep quality; mixed for other physical outcomes | PRELIMINARY |
| Wang et al. | Review, 2023 | Systematic review | CV patients | Small, single-center intervention trials; biomarkers mixed; no hard endpoints | PRELIMINARY |
| Cousin et al. | J. Positive Psych., 2020 | Systematic review | Multiple trials | Gratitude interventions show some cardiometabolic promise; larger trials needed | PRELIMINARY |
The Most Recent Challenge: When Gratitude Did Not Predict Health
Any honest review of the evidence must include the largest test that found no meaningful association. Brian P. Don, PhD, and colleagues published a study in Affective Science in 2025 that included gratitude as one variable in a large multi-wave longitudinal model involving between 58,741 and 66,221 adults in New Zealand over eight years. They used a statistical technique called within-person modeling, which is more rigorous than the between-person comparisons used in most gratitude studies. A between-person comparison asks: are people who are generally more grateful also generally healthier? That can be confounded by personality, genetics, and life circumstances. A within-person comparison asks a harder question: when the same individual becomes more or less grateful over time, does their health change too? The answer, in this study, was no. Within-person increases in gratitude did not predict subsequent changes in self-rated health.
This does not mean the mortality findings are wrong — self-rated health and actual mortality are different things, and the populations were different (older American nurses versus younger, more diverse New Zealanders). But it does raise a serious caution: the between-person association between gratitude and health may reflect who grateful people tend to be (wealthier, more connected, more resilient), rather than what gratitude does to the body. Evidence quality: MODERATE for the null.
Interestingly, among younger adults, the pattern may actually reverse. In a study by Krause and Ironson, gratitude toward God was associated with more chronic health conditions among younger people, but fewer conditions among older adults. The most likely explanation is reverse causation: younger people who become sick may turn to gratitude as a coping mechanism, creating a statistical association that runs in the opposite direction. This paradox underscores why observational studies, no matter how large, can only take us so far.
Who Benefits Most: Age, Gender, and Stress as Moderators
One of the most consistent patterns in the research is that gratitude’s health benefits are not evenly distributed. They appear to be largest among three groups: older adults, women, and people under chronic stress. The mortality findings come entirely from women with an average age of 79. Neal Krause, PhD, in a study published in 2006, found that gratitude toward God buffered the health effects of neighborhood deterioration among older U.S. adults — but this effect was significant only among women, not men. In a separate study published in The International Journal for the Psychology of Religion in 2009, Krause found among older adults that at the highest levels of gratitude, financial strain no longer predicted depressive symptoms — a statistically significant interaction (the probability of this pattern occurring by chance was less than 1 in 1,000).
The stress-buffering pattern appears again in the inflammation data. Among high-gratitude individuals, the usual link between lower socioeconomic status and higher IL-6 levels was eliminated (Hartanto et al., 2019). Among low-gratitude individuals, the link remained strong. This consistent finding across multiple studies and outcomes suggests that gratitude may be most clinically meaningful not as a universal wellness tool, but as a targeted resilience resource for people facing adversity — a distinction with important implications for who should be prioritized in future intervention research.
What You Can Actually Do: Practical Recommendations
The evidence is not yet strong enough to make definitive claims about gratitude as a medical intervention. No large, rigorously designed randomized trial has tested whether deliberately increasing gratitude reduces heart attacks, strokes, or mortality over many years. But the current evidence, combined with the absence of any known risks, supports several practical steps — each grounded in a specific evidence quality rating.
First, consider establishing a daily gratitude journaling practice. A small randomized trial — the gold standard of medical research, where participants are randomly assigned to receive either the treatment or a comparison condition — led by Laura S. Redwine, PhD, and colleagues, published in Psychosomatic Medicine in 2016, found that gratitude journaling in heart failure patients improved heart rate variability (a marker of cardiovascular health) and reduced inflammatory biomarkers. The trial was small and single-center, so the results are preliminary. Write three to five specific things you are grateful for each day — and specificity matters. “My neighbor brought me soup when I was sick” engages deeper cognitive processing than the generic “my friends.” Evidence quality for this recommendation: PRELIMINARY.
Second, link gratitude to health behaviors. The Hartanto et al. (2022) study found that healthier diets and lower body weight partially explained why grateful people had lower triglycerides. Deliberately pairing a moment of appreciation with a healthy choice — appreciating nourishing food before a meal, acknowledging the satisfaction after exercise — may strengthen both habits through positive reinforcement. Evidence quality: PRELIMINARY.
Third, if you are facing chronic stress — financial hardship, caregiving, neighborhood adversity, or persistent health challenges — a gratitude practice may yield its largest returns. The stress-buffering findings are the most consistent pattern in the literature. At the highest gratitude levels, financial strain no longer predicted depressive symptoms (Krause, 2009), and the socioeconomic gradient in inflammation was eliminated (Hartanto et al., 2019). Evidence quality for stress-buffering effects: MODERATE.
Fourth, express gratitude to others, not just privately. Social connectedness is one of the strongest predictors of longevity. Expressing appreciation — through a letter, a phone call, a verbal acknowledgment — strengthens the relationships that constitute a powerful health-protective factor. Evidence quality: PRELIMINARY.
An essential caveat: gratitude practices should never be used to suppress genuine negative emotions, delay medical care, or replace evidence-based treatments for depression, anxiety, or PTSD. If you are experiencing significant mental health symptoms, seek professional care. Gratitude is a complement to treatment, not a substitute. And — this cannot be stated clearly enough — never reduce or discontinue prescribed medications based on anything in this article without consulting your physician.
Table 4. Practical Recommendations with Evidence Ratings
| Recommendation | Supporting Evidence | Evidence Rating | Priority Population |
| Daily gratitude journaling (3–5 specific items) | Redwine et al. 2016 (HRV); Boggiss et al. 2020 (sleep); Wang et al. 2023 (some biomarkers) | PRELIMINARY | All adults; cardiac patients |
| Pair gratitude with health behaviors | Hartanto et al. 2022 (diet/BMI mediation) | PRELIMINARY | Adults seeking behavior change |
| Use gratitude as stress buffer under adversity | Krause 2009 (financial strain); Hartanto et al. 2019 (SES-inflammation); Krause 2006 (neighborhood stress) | MODERATE | Adults under chronic stress |
| Express gratitude to strengthen social bonds | Social connectedness → longevity literature (indirect) | PRELIMINARY | Older adults; isolated individuals |
Table 5. Evidence Quality Summary by Health Outcome
| Health Outcome | What the Evidence Shows | Evidence Quality | Strongest Evidence In | Key Limitation |
| Mental well-being | Consistent association across 100,000+ participants | STRONG | All ages, cross-cultural | Mostly cross-sectional data |
| Depression / PTSD / suicidality | Large protective associations in veterans | MODERATE | US veterans | Covariate detail limited |
| All-cause mortality | 9% lower risk after extensive adjustment | MODERATE | Older women (mean age 79) | Female-only; no personality controls |
| Cardiovascular mortality | ~15% lower risk (HR 0.85) | MODERATE | Older women | Same cohort as above |
| Triglycerides / inflammation | Small effects; stress-buffering moderation | PRELIMINARY | Midlife adults | Cross-sectional; attenuates with full controls |
| Self-rated health (within-person) | No significant association in largest test | MODERATE (null) | 58,000+ NZ adults | Different construct from mortality |
| Interventions → physical health | Some improvement in sleep and biomarkers | PRELIMINARY | Cardiac patients | Small, single-center trials |
The Bottom Line: What We Know, What We Don’t, and Why It Still Matters
What is well-established: dispositional gratitude is consistently associated with better mental well-being across cultures and ages, supported by a meta-analysis involving approximately 100,000 participants. The evidence for mental health protection, particularly in high-risk populations like veterans, is striking in its magnitude. What is promising but requires more research: the association between gratitude and lower mortality risk in older women (a finding replicated in two independent analyses of overlapping cohort data), the stress-buffering effects on inflammation and depression, and the cardiovascular biomarker findings. What is genuinely conflicting: the relationship between gratitude and self-rated physical health, where between-person associations are positive but the largest within-person test found no significant effect. What we genuinely do not know: whether gratitude causes better health or merely reflects who healthier people tend to be; whether interventions that increase gratitude would produce the same benefits observed in people who are naturally grateful; whether these findings extend to men, younger adults, and non-Western populations; and how gratitude interacts with standard medical treatments.
No study has yet measured healthspan directly — the years a person lives free from chronic disease, disability, and poor quality of life. The claim that gratitude extends healthspan remains an inference drawn from separate lines of evidence, not an established finding. But science rarely advances by waiting for perfect proof before acting on converging evidence. In a field that has no shortage of overpriced supplements and overpromised diets, a nine percent reduction in mortality risk that costs nothing, carries no side effects, and is available to almost everyone is a finding worth taking seriously — and taking honestly, with all its limitations clearly in view.
Comprehensive Evidence Summary
The evidence reviewed in this article encompasses 14 primary studies identified through the Elicit academic search platform, supplemented by systematic reviews and meta-analyses from the Consensus research engine. The strongest evidence (STRONG) supports an association between dispositional gratitude and mental well-being, replicated across approximately 100,000 participants in 158 independent samples. Moderate evidence links gratitude to lower all-cause and cardiovascular mortality in older women (HR = 0.91 and 0.85, respectively, after extensive adjustment), to dramatically lower incidence of psychiatric disorders and suicidal behaviors in veterans, and to a null within-person association with self-rated health in a very large longitudinal model (N > 58,000). Preliminary evidence suggests gratitude is associated with lower triglycerides in initial models (attenuating with full health-behavior controls), moderation of socioeconomic inflammation disparities, and improved cardiovascular flexibility, all in relatively small cross-sectional or single-cohort studies. Intervention evidence remains preliminary, drawn from small, single-center trials showing improvements in sleep and some biomarkers but no hard cardiovascular or mortality endpoints. Across all domains, the crude gratitude-mortality association attenuated substantially after adjusting for health, behavior, cognition, and mental health, and the residual independent association, while statistically significant, is modest.
The Perspective
I have reviewed hundreds of studies on dietary supplements, exercise regimens, and pharmacological interventions that claim to extend lifespan or improve healthspan. Most of them, when subjected to rigorous scrutiny, produce modest effects at best — and many come with costs, side effects, and accessibility barriers. What strikes me about the gratitude evidence is not the magnitude of the effect, which is modest, but the ratio of benefit to cost. A nine percent reduction in mortality risk that requires no prescription, no insurance coverage, no gym membership, and no special equipment is an extraordinary value proposition, even if we cannot yet prove it is causal.
What I find most compelling is the consistency of the stress-buffering pattern. Study after study finds that gratitude’s effects are most pronounced among people facing adversity — financial strain, neighborhood deterioration, socioeconomic disadvantage. If gratitude were merely a marker of a comfortable life, you would expect its benefits to be largest among the already-privileged. The opposite appears to be true. That pattern, to me, is the strongest argument that something real is happening beyond simple confounding.
What I recommend to readers is this: adopt a brief, specific daily gratitude practice — not because the evidence is conclusive, but because it is favorable, the risk is zero, and the potential benefit touches nearly every domain of health the evidence has examined. If you are an older adult, a woman, or someone facing chronic stress, the evidence suggests you stand to benefit the most. But do not treat gratitude as a substitute for medical care, and do not let it become a way to avoid dealing with genuine problems. Gratitude is at its best when it coexists with honest acknowledgment of difficulty, not when it replaces it.
What I am watching for: I am waiting for a large, pre-registered, multi-site randomized controlled trial that assigns people to a gratitude intervention or a control condition and follows them for at least three to five years, measuring incident chronic disease, cardiovascular events, and mortality. Until that trial is completed, the gratitude-healthspan hypothesis remains promising but unproven. I hope it gets funded, because the potential public health implications — particularly for underserved communities where stress-buffering resources are most needed — are substantial.
CENTER FOR FOOD AS MEDICINE & LONGEVITY
Can Gratitude Add Years to Your Life?
What a Growing Body of Research Says About Thankfulness, Disease Risk, and How Long You Live
by Charles Platkin, PhD, JD, MPH
February 2026
The Nine Percent Question
Here is a number worth sitting with: nine percent. That is the amount by which the risk of dying from any cause dropped among older women who scored highest on a simple six-question gratitude survey, compared to those who scored lowest — even after researchers accounted for income, exercise habits, diet, smoking, existing health conditions, and mental health history. The finding, published in 2024 in the high-impact journal JAMA Psychiatry, came from a study that tracked nearly fifty thousand women over approximately three years of follow-up. It was not a small pilot experiment or a self-help anecdote. It was one of the largest and most rigorously controlled investigations ever conducted on the relationship between a positive psychological trait and the risk of death.
Nine percent may not sound dramatic. It will not make a viral headline. But consider what it means in practice: for a population of women in their late seventies and eighties, a nine percent reduction in mortality risk is similar in magnitude to the relative risk reductions seen with some preventive interventions in this age group. And the “treatment” in this case is not a pill. It is a disposition — a habitual tendency to notice and appreciate the good things in life, even when times are hard. Scientists call it dispositional gratitude, and a growing body of evidence suggests it may be one of the most undervalued tools in the longevity conversation.
Americans can now expect to live to about 79 years, but a substantial share of that life is spent in poorer health. One global analysis published in JAMA Network Open estimated the U.S. healthspan-lifespan gap at about 12.4 years — years lived with significant disease burden or disability. About three in four American adults have at least one chronic condition, and more than half have two or more. Medical researchers have a term for this gap: the difference between lifespan, which is simply how many years you live, and healthspan, which is how many of those years you spend free from serious chronic disease, disability, and poor quality of life. Closing that gap — helping people not just live longer but live well for more of those years — is arguably the most important public health challenge of the twenty-first century.
Most efforts to extend healthspan focus on diet, exercise, and medication — interventions that can be measured in grams, minutes, and milligrams. But what if part of the answer has been hiding in plain sight, in a psychological habit that costs nothing and has no side effects? That is the question a handful of researchers at Harvard, Singapore Management University, and institutions in the Netherlands, New Zealand, and China have been trying to answer. Their findings, drawn from studies involving more than 200,000 participants across multiple countries, are not simple. Some results are impressive. Others are mixed. A few are frankly null. This article examines all of them — the encouraging, the disappointing, and the genuinely uncertain — to answer a straightforward question: does feeling grateful actually help you live longer and healthier, and if so, how much?
How Gratitude Gets Under the Skin: The Biology of a Thankful Brain
To understand how a feeling in your mind could affect the health of your heart, your blood vessels, or your immune system, it helps to understand a concept that scientists call chronic low-grade inflammation. Think of your immune system like a smoke detector. When you get an infection or cut yourself, the alarm goes off — your body sends specialized cells to the site of the problem, causing redness, heat, and swelling. That is acute inflammation, and it is a healthy, necessary response. But in many people, especially as they age, the alarm starts ringing even when there is no fire. Low levels of immune activation persist for months or years, quietly damaging blood vessels, promoting insulin resistance (a condition where your body stops responding properly to the hormone that controls blood sugar), and contributing to the plaque buildup in arteries that leads to heart attacks and strokes. This slow-burning, silent alarm is what researchers mean when they talk about chronic inflammation, and it is now understood to play a role in nearly every major disease of aging.
One of the key molecules involved in this process is called interleukin-6, or IL-6 — a signaling molecule that your immune cells produce to communicate with each other. When IL-6 levels are elevated for long periods, it is a marker that the body’s inflammatory alarm system is stuck in the “on” position. Higher IL-6 levels have been linked to heart disease, type 2 diabetes, depression, and accelerated aging. What makes IL-6 particularly important for the gratitude story is that psychological stress — the kind caused by financial hardship, social isolation, or chronic worry — can drive IL-6 levels up. Your body does not distinguish very well between a physical threat and a psychological one; the same stress-response machinery gets activated either way.
This is where gratitude enters the picture. Imagine your body’s stress-response system as a ledger. On one side, the debits: threats, losses, worries, daily hassles. On the other side, the credits: moments of connection, appreciation, safety, purpose. When the debits overwhelm the credits for months or years, the body pays a physiological price — elevated cortisol (the main stress hormone), elevated inflammatory markers, higher blood pressure, and disrupted sleep. Gratitude, the emerging evidence suggests, acts as a credit entry. It does not erase the debits — a grateful person still faces job loss, illness, and grief — but it may shift the balance enough to reduce the cumulative biological toll.
Researchers have identified at least four pathways through which this might work. First, gratitude appears to buffer the body’s stress response, dampening the cortisol surge that follows a perceived threat. Second, grateful people tend to engage in healthier behaviors — they eat better, exercise more, and are more likely to see a doctor when something is wrong. Third, there is early evidence that gratitude may improve autonomic flexibility — the ability of the heart and nervous system to shift smoothly between activation and rest, a capacity that is associated with cardiovascular resilience. Fourth, grateful people tend to maintain stronger social connections, and social connectedness is one of the most well-established predictors of longer life.
None of these mechanisms has been definitively proven in large-scale experiments. They are plausible, supported by preliminary data, and consistent with each other — but they remain hypotheses, not established facts. With that caveat clearly in mind, let us turn to the evidence itself, building from the smallest and most preliminary studies to the largest and most rigorous.
What the Research Actually Shows
The First Clues: Biomarkers, Inflammation, and the Heart
The earliest pieces of evidence linking gratitude to physical health come from relatively small studies that measured biomarkers — substances in the blood that serve as indicators of what is happening inside the body. These are observational studies, meaning the researchers measured what existed rather than experimentally changing anything. Observational studies can reveal patterns and associations, but they cannot prove that one thing caused another. With that important limitation in mind, here is what they found.
Andree Hartanto, PhD, and colleagues at Singapore Management University published a study in Scientific Reports in 2019 examining 1,054 midlife American adults from the MIDUS study — a large, nationally representative survey of health and well-being. They measured dispositional gratitude and tested its association with IL-6, the inflammatory marker described earlier. The main finding was a null: gratitude did not directly lower IL-6 levels for the population as a whole. But the more interesting finding was what statisticians call a moderation effect — a pattern where the effect of one variable depends on the level of another. Among people with low gratitude, the well-known gradient held: lower socioeconomic status predicted higher inflammation. Among people with high gratitude, that gradient disappeared entirely. Gratitude, in other words, did not lower inflammation universally, but it appeared to protect the people most vulnerable to the physiological toll of economic disadvantage. Evidence quality: PRELIMINARY, because this is a single cross-sectional study (one snapshot in time), which cannot establish that gratitude caused the moderation.
The same research group published a follow-up study in Scientific Reports in 2022, this time examining blood lipids — the fats in your blood, including triglycerides (a type of fat associated with heart disease risk), LDL cholesterol (often called “bad” cholesterol), and HDL cholesterol (often called “good” cholesterol). Among 1,800 midlife adults, higher gratitude was associated with lower triglyceride levels in initial models (the statistical coefficient was β = −0.07, with a probability value of p = 0.008 — meaning there was less than a 1 in 125 chance this result was a fluke). Healthier diet and lower body weight partially explained the association, suggesting that grateful people have better lipid profiles partly because they eat better and weigh less. Importantly, when the researchers added the most complete set of health behavior controls — including smoking, alcohol, BMI, diet, and exercise — the gratitude-triglyceride association attenuated and was no longer statistically significant, meaning we cannot be confident the link is independent of those behaviors. Gratitude was not significantly associated with HDL or LDL cholesterol. Evidence quality: PRELIMINARY.
For cardiovascular function, B. Leavy, Brenda H. O’Connell, and Deirdre O’Shea published a study in Biological Psychology in 2023 finding that trait gratitude was associated with reduced risk of acute myocardial infarction — commonly known as a heart attack — over a mean follow-up of 6.7 years (N = 1,031). The mechanism was increased heart rate reactivity, which is the ability of the heart to adjust its rate quickly in response to changing demands. Think of it as cardiovascular flexibility: a heart that can speed up and slow down smoothly is generally healthier than one stuck at one pace. Neither systolic nor diastolic blood pressure (the upper and lower numbers in a blood pressure reading) mediated the relationship. Evidence quality: PRELIMINARY, based on a single longitudinal dataset.
Table 1. Key Observational Studies: Biomarker and Cardiovascular Findings
| Study | Journal, Year | Design | N | Key Findings | Evidence Rating |
| Hartanto et al. | Scientific Reports, 2019 | Cross-sectional | 1,054 | No direct effect on IL-6; gratitude eliminated SES gradient in inflammation | PRELIMINARY |
| Hartanto et al. | Scientific Reports, 2022 | Cross-sectional | 1,800 | Lower triglycerides in initial models; attenuates with full health-behavior controls; no HDL/LDL effect | PRELIMINARY |
| Leavy et al. | Biological Psychology, 2023 | Longitudinal | 1,031 | Gratitude linked to reduced heart attack risk via heart rate flexibility (β = −0.098) | PRELIMINARY |
Scaling Up: Mortality, Mental Health, and Large Cohort Studies
Population-level patterns, no matter how consistent, can only tell us that two things tend to occur together — they cannot tell us that one causes the other. But when those patterns appear in very large groups of people, tracked over years, the associations become harder to dismiss as coincidence. Three large cohort studies — long-term tracking studies that follow thousands of people and record who develops disease or dies — anchor the gratitude-health literature.
The study that put gratitude on the longevity map was published in 2024 in JAMA Psychiatry by Ying Chen, PhD, Olivia I. Okereke, MD, Eric S. Kim, PhD, Henning Tiemeier, MD, PhD, Laura D. Kubzansky, PhD, and Tyler J. VanderWeele, PhD, all at Harvard. They studied 49,275 women from the Nurses’ Health Study — one of the largest and longest-running health studies in the world — with an average age of 79. Each woman completed a validated six-question gratitude survey, and the researchers then tracked deaths from the 2016 questionnaire wave through December 2019 — about three years of follow-up.
The headline result: women in the top third of gratitude scores had a 9 percent lower risk of dying from any cause compared to women in the bottom third, even after the researchers statistically adjusted for an extensive list of other factors that could explain the difference — including age, income, education, social participation, religious involvement, physical health history, smoking, physical activity, diet quality, alcohol consumption, cognitive function, depression diagnosis, antidepressant use, and depressive symptoms. In scientific notation, this is reported as a hazard ratio (HR) of 0.91 with a 95 percent confidence interval of 0.84 to 0.99 — which means the researchers are 95 percent confident that the true reduction in risk falls somewhere between 1 percent and 16 percent. In related reporting from the same research group, presented in a 2024 conference supplement, estimates were similar in direction, with roughly a 10 percent lower hazard in a larger analytic sample of 52,169 nurses.
But here is the crucial context that separates responsible science reporting from hype. When the researchers adjusted only for age, the apparent benefit of gratitude was much larger — a 29 percent reduction in mortality risk (HR = 0.71). The fact that this shrank to 9 percent after adjusting for all those other factors means that the large majority of the apparent benefit was not unique to gratitude itself. Grateful women also tended to be wealthier, more physically active, less likely to smoke, more socially connected, and less depressed. Those factors, not gratitude per se, accounted for most of the survival advantage. Whether the remaining 9 percent represents a true independent effect of gratitude, or is explained by personality traits and other unmeasured factors, is an open question. The study did not control for the so-called “Big Five” personality traits — the five broad dimensions of personality (openness, conscientiousness, extraversion, agreeableness, and neuroticism) that psychologists use to describe individual differences — and some of those traits are themselves associated with health. Evidence quality: MODERATE.
The association was strongest for cardiovascular death — death from heart attacks, strokes, and other diseases of the heart and blood vessels. The hazard ratio for the highest versus lowest gratitude tertile was 0.85 (95% CI, 0.73–0.995), translating to approximately a 15 percent lower risk. And the relationship followed what epidemiologists call a dose-response pattern: the more grateful the woman, the lower her mortality risk, in a stepwise fashion. A dose-response pattern means the more of the “exposure” you have (in this case, gratitude), the larger the effect — just as heavier smokers get more lung cancer than lighter smokers. This kind of graded relationship is harder to explain by coincidence or hidden factors than a simple high-versus-low comparison.
For mental health, the most clinically striking findings came from a study of U.S. military veterans. Adam P. McGuire, PhD, Joanna G. Fagan, and colleagues published their results in the Journal of Psychiatric Research in 2022. They followed veterans over seven years and divided them into groups based on their gratitude levels. Among veterans with low gratitude, 27.7 percent developed major depression, generalized anxiety, or post-traumatic stress disorder (PTSD — a condition in which the psychological effects of a traumatic experience persist long after the event itself). Among veterans with high gratitude, that number was 8.0 percent. For suicidal thoughts, 33.6 percent of low-gratitude veterans experienced suicidal ideation over the seven-year period, compared to 6.8 percent of high-gratitude veterans. These are among the largest effect sizes in the gratitude literature. Evidence quality: MODERATE.
Not every mental health finding was positive. In the Netherlands, Lilian Jans-Beken, PhD, and colleagues followed 706 adults for 7.5 months and published their results in the Journal of Happiness Studies in 2018. Gratitude was only a weak predictor of subjective well-being and, critically, did not predict symptoms of psychopathology — conditions like depression and anxiety — when the researchers adjusted for how symptomatic participants already were at the start of the study (the technical term is “adjusting for baseline symptoms,” and it is a way of asking whether gratitude predicts future mental health problems rather than simply reflecting current ones). The association was not statistically significant, falling well above the standard threshold of 5 percent that scientists use to consider a result meaningful. This suggests that in a general Dutch population, gratitude did not meaningfully predict who would develop psychological problems. Evidence quality: MODERATE for the null finding.
Table 2. Large Cohort Studies: Mortality and Mental Health
| Study | Journal, Year | Design | N | Key Findings | Evidence Rating |
| Chen et al. | JAMA Psychiatry, 2024 | Prospective cohort | 49,275 | 9% lower all-cause mortality (HR 0.91, 95% CI 0.84–0.99); 15% lower CVD mortality (HR 0.85) | MODERATE |
| Chen et al. | Conference supplement, 2024 | Prospective cohort | 52,169 | ~10% lower all-cause mortality; similar direction | MODERATE |
| McGuire et al. | J. Psychiatr. Res., 2022 | Longitudinal cohort (7 yr) | US veterans | Low gratitude: 27.7% MDD/GAD/PTSD; High: 8.0%. Suicidal ideation: 33.6% vs. 6.8% | MODERATE |
| Jans-Beken et al. | J. Happiness Stud., 2018 | Prospective (7.5 mo) | 706 | Did not predict psychopathology after adjusting for baseline symptoms (not significant) | MODERATE (null) |
Pooling the Evidence: Meta-Analyses and Systematic Reviews
Individual studies, no matter how large, can produce misleading results due to quirks of their particular sample. The most reliable way to assess a body of evidence is through a meta-analysis — a study that pools the results of many individual studies to get a more dependable overall estimate. Several meta-analyses and systematic reviews (structured surveys of all available research on a question) have now been conducted on gratitude and health.
The most comprehensive was published in 2020 by Felipe F. Portocarrero, PhD, and colleagues in the journal Personality and Individual Differences. They combined data from 158 separate samples involving approximately 100,000 participants and found that dispositional gratitude was consistently associated with higher life satisfaction, greater happiness, and lower perceived stress. The size of this association was what statisticians call “small-to-moderate” — reliable and consistent across ages and cultures, but not so large that gratitude alone would transform someone’s mental health. This is the kind of evidence scientists rate as STRONG: replicated across many studies, in large numbers, with consistent results.
For physical health, the picture is less clear. Anna L. Boggiss and colleagues published a systematic review in the Journal of Psychosomatic Research in 2020 examining whether gratitude interventions improved objective physical health outcomes. They found the most promising results for subjective sleep quality, but overall physical health effects were mixed and the studies were small. Lilian Cousin and colleagues published a related review in The Journal of Positive Psychology in 2020, and Wang et al. published a review in 2023 examining gratitude interventions specifically in cardiovascular patients. Both concluded that evidence was preliminary and that larger, better-designed trials were needed before strong conclusions could be drawn. Evidence quality for physical health interventions: PRELIMINARY.
Table 3. Meta-Analyses and Systematic Reviews
| Study | Journal, Year | Design | N / Scope | Key Findings | Evidence Rating |
| Portocarrero et al. | Pers. Indiv. Differ., 2020 | Meta-analysis (158 samples) | ~100,000 | Gratitude consistently linked to well-being across ages/cultures; small-to-moderate effect | STRONG |
| Boggiss et al. | J. Psychosom. Res., 2020 | Systematic review | Multiple trials | Most promising for sleep quality; mixed for other physical outcomes | PRELIMINARY |
| Wang et al. | Review, 2023 | Systematic review | CV patients | Small, single-center intervention trials; biomarkers mixed; no hard endpoints | PRELIMINARY |
| Cousin et al. | J. Positive Psych., 2020 | Systematic review | Multiple trials | Gratitude interventions show some cardiometabolic promise; larger trials needed | PRELIMINARY |
The Most Recent Challenge: When Gratitude Did Not Predict Health
Any honest review of the evidence must include the largest test that found no meaningful association. Brian P. Don, PhD, and colleagues published a study in Affective Science in 2025 that included gratitude as one variable in a large multi-wave longitudinal model involving between 58,741 and 66,221 adults in New Zealand over eight years. They used a statistical technique called within-person modeling, which is more rigorous than the between-person comparisons used in most gratitude studies. A between-person comparison asks: are people who are generally more grateful also generally healthier? That can be confounded by personality, genetics, and life circumstances. A within-person comparison asks a harder question: when the same individual becomes more or less grateful over time, does their health change too? The answer, in this study, was no. Within-person increases in gratitude did not predict subsequent changes in self-rated health.
This does not mean the mortality findings are wrong — self-rated health and actual mortality are different things, and the populations were different (older American nurses versus younger, more diverse New Zealanders). But it does raise a serious caution: the between-person association between gratitude and health may reflect who grateful people tend to be (wealthier, more connected, more resilient), rather than what gratitude does to the body. Evidence quality: MODERATE for the null.
Interestingly, among younger adults, the pattern may actually reverse. In a study by Krause and Ironson, gratitude toward God was associated with more chronic health conditions among younger people, but fewer conditions among older adults. The most likely explanation is reverse causation: younger people who become sick may turn to gratitude as a coping mechanism, creating a statistical association that runs in the opposite direction. This paradox underscores why observational studies, no matter how large, can only take us so far.
Who Benefits Most: Age, Gender, and Stress as Moderators
One of the most consistent patterns in the research is that gratitude’s health benefits are not evenly distributed. They appear to be largest among three groups: older adults, women, and people under chronic stress. The mortality findings come entirely from women with an average age of 79. Neal Krause, PhD, in a study published in 2006, found that gratitude toward God buffered the health effects of neighborhood deterioration among older U.S. adults — but this effect was significant only among women, not men. In a separate study published in The International Journal for the Psychology of Religion in 2009, Krause found among older adults that at the highest levels of gratitude, financial strain no longer predicted depressive symptoms — a statistically significant interaction (the probability of this pattern occurring by chance was less than 1 in 1,000).
The stress-buffering pattern appears again in the inflammation data. Among high-gratitude individuals, the usual link between lower socioeconomic status and higher IL-6 levels was eliminated (Hartanto et al., 2019). Among low-gratitude individuals, the link remained strong. This consistent finding across multiple studies and outcomes suggests that gratitude may be most clinically meaningful not as a universal wellness tool, but as a targeted resilience resource for people facing adversity — a distinction with important implications for who should be prioritized in future intervention research.
What You Can Actually Do: Practical Recommendations
The evidence is not yet strong enough to make definitive claims about gratitude as a medical intervention. No large, rigorously designed randomized trial has tested whether deliberately increasing gratitude reduces heart attacks, strokes, or mortality over many years. But the current evidence, combined with the absence of any known risks, supports several practical steps — each grounded in a specific evidence quality rating.
First, consider establishing a daily gratitude journaling practice. A small randomized trial — the gold standard of medical research, where participants are randomly assigned to receive either the treatment or a comparison condition — led by Laura S. Redwine, PhD, and colleagues, published in Psychosomatic Medicine in 2016, found that gratitude journaling in heart failure patients improved heart rate variability (a marker of cardiovascular health) and reduced inflammatory biomarkers. The trial was small and single-center, so the results are preliminary. Write three to five specific things you are grateful for each day — and specificity matters. “My neighbor brought me soup when I was sick” engages deeper cognitive processing than the generic “my friends.” Evidence quality for this recommendation: PRELIMINARY.
Second, link gratitude to health behaviors. The Hartanto et al. (2022) study found that healthier diets and lower body weight partially explained why grateful people had lower triglycerides. Deliberately pairing a moment of appreciation with a healthy choice — appreciating nourishing food before a meal, acknowledging the satisfaction after exercise — may strengthen both habits through positive reinforcement. Evidence quality: PRELIMINARY.
Third, if you are facing chronic stress — financial hardship, caregiving, neighborhood adversity, or persistent health challenges — a gratitude practice may yield its largest returns. The stress-buffering findings are the most consistent pattern in the literature. At the highest gratitude levels, financial strain no longer predicted depressive symptoms (Krause, 2009), and the socioeconomic gradient in inflammation was eliminated (Hartanto et al., 2019). Evidence quality for stress-buffering effects: MODERATE.
Fourth, express gratitude to others, not just privately. Social connectedness is one of the strongest predictors of longevity. Expressing appreciation — through a letter, a phone call, a verbal acknowledgment — strengthens the relationships that constitute a powerful health-protective factor. Evidence quality: PRELIMINARY.
An essential caveat: gratitude practices should never be used to suppress genuine negative emotions, delay medical care, or replace evidence-based treatments for depression, anxiety, or PTSD. If you are experiencing significant mental health symptoms, seek professional care. Gratitude is a complement to treatment, not a substitute. And — this cannot be stated clearly enough — never reduce or discontinue prescribed medications based on anything in this article without consulting your physician.
Table 4. Practical Recommendations with Evidence Ratings
| Recommendation | Supporting Evidence | Evidence Rating | Priority Population |
| Daily gratitude journaling (3–5 specific items) | Redwine et al. 2016 (HRV); Boggiss et al. 2020 (sleep); Wang et al. 2023 (some biomarkers) | PRELIMINARY | All adults; cardiac patients |
| Pair gratitude with health behaviors | Hartanto et al. 2022 (diet/BMI mediation) | PRELIMINARY | Adults seeking behavior change |
| Use gratitude as stress buffer under adversity | Krause 2009 (financial strain); Hartanto et al. 2019 (SES-inflammation); Krause 2006 (neighborhood stress) | MODERATE | Adults under chronic stress |
| Express gratitude to strengthen social bonds | Social connectedness → longevity literature (indirect) | PRELIMINARY | Older adults; isolated individuals |
Table 5. Evidence Quality Summary by Health Outcome
| Health Outcome | What the Evidence Shows | Evidence Quality | Strongest Evidence In | Key Limitation |
| Mental well-being | Consistent association across 100,000+ participants | STRONG | All ages, cross-cultural | Mostly cross-sectional data |
| Depression / PTSD / suicidality | Large protective associations in veterans | MODERATE | US veterans | Covariate detail limited |
| All-cause mortality | 9% lower risk after extensive adjustment | MODERATE | Older women (mean age 79) | Female-only; no personality controls |
| Cardiovascular mortality | ~15% lower risk (HR 0.85) | MODERATE | Older women | Same cohort as above |
| Triglycerides / inflammation | Small effects; stress-buffering moderation | PRELIMINARY | Midlife adults | Cross-sectional; attenuates with full controls |
| Self-rated health (within-person) | No significant association in largest test | MODERATE (null) | 58,000+ NZ adults | Different construct from mortality |
| Interventions → physical health | Some improvement in sleep and biomarkers | PRELIMINARY | Cardiac patients | Small, single-center trials |
The Bottom Line: What We Know, What We Don’t, and Why It Still Matters
What is well-established: dispositional gratitude is consistently associated with better mental well-being across cultures and ages, supported by a meta-analysis involving approximately 100,000 participants. The evidence for mental health protection, particularly in high-risk populations like veterans, is striking in its magnitude. What is promising but requires more research: the association between gratitude and lower mortality risk in older women (a finding replicated in two independent analyses of overlapping cohort data), the stress-buffering effects on inflammation and depression, and the cardiovascular biomarker findings. What is genuinely conflicting: the relationship between gratitude and self-rated physical health, where between-person associations are positive but the largest within-person test found no significant effect. What we genuinely do not know: whether gratitude causes better health or merely reflects who healthier people tend to be; whether interventions that increase gratitude would produce the same benefits observed in people who are naturally grateful; whether these findings extend to men, younger adults, and non-Western populations; and how gratitude interacts with standard medical treatments.
No study has yet measured healthspan directly — the years a person lives free from chronic disease, disability, and poor quality of life. The claim that gratitude extends healthspan remains an inference drawn from separate lines of evidence, not an established finding. But science rarely advances by waiting for perfect proof before acting on converging evidence. In a field that has no shortage of overpriced supplements and overpromised diets, a nine percent reduction in mortality risk that costs nothing, carries no side effects, and is available to almost everyone is a finding worth taking seriously — and taking honestly, with all its limitations clearly in view.
Comprehensive Evidence Summary
The evidence reviewed in this article encompasses 14 primary studies identified through the Elicit academic search platform, supplemented by systematic reviews and meta-analyses from the Consensus research engine. The strongest evidence (STRONG) supports an association between dispositional gratitude and mental well-being, replicated across approximately 100,000 participants in 158 independent samples. Moderate evidence links gratitude to lower all-cause and cardiovascular mortality in older women (HR = 0.91 and 0.85, respectively, after extensive adjustment), to dramatically lower incidence of psychiatric disorders and suicidal behaviors in veterans, and to a null within-person association with self-rated health in a very large longitudinal model (N > 58,000). Preliminary evidence suggests gratitude is associated with lower triglycerides in initial models (attenuating with full health-behavior controls), moderation of socioeconomic inflammation disparities, and improved cardiovascular flexibility, all in relatively small cross-sectional or single-cohort studies. Intervention evidence remains preliminary, drawn from small, single-center trials showing improvements in sleep and some biomarkers but no hard cardiovascular or mortality endpoints. Across all domains, the crude gratitude-mortality association attenuated substantially after adjusting for health, behavior, cognition, and mental health, and the residual independent association, while statistically significant, is modest.
The Charles Platkin Perspective
I have reviewed hundreds of studies on dietary supplements, exercise regimens, and pharmacological interventions that claim to extend lifespan or improve healthspan. Most of them, when subjected to rigorous scrutiny, produce modest effects at best — and many come with costs, side effects, and accessibility barriers. What strikes me about the gratitude evidence is not the magnitude of the effect, which is modest, but the ratio of benefit to cost. A nine percent reduction in mortality risk that requires no prescription, no insurance coverage, no gym membership, and no special equipment is an extraordinary value proposition, even if we cannot yet prove it is causal.
What I find most compelling is the consistency of the stress-buffering pattern. Study after study finds that gratitude’s effects are most pronounced among people facing adversity — financial strain, neighborhood deterioration, socioeconomic disadvantage. If gratitude were merely a marker of a comfortable life, you would expect its benefits to be largest among the already-privileged. The opposite appears to be true. That pattern, to me, is the strongest argument that something real is happening beyond simple confounding.
What I recommend to readers is this: adopt a brief, specific daily gratitude practice — not because the evidence is conclusive, but because it is favorable, the risk is zero, and the potential benefit touches nearly every domain of health the evidence has examined. If you are an older adult, a woman, or someone facing chronic stress, the evidence suggests you stand to benefit the most. But do not treat gratitude as a substitute for medical care, and do not let it become a way to avoid dealing with genuine problems. Gratitude is at its best when it coexists with honest acknowledgment of difficulty, not when it replaces it.
What I am watching for: I am waiting for a large, pre-registered, multi-site randomized controlled trial that assigns people to a gratitude intervention or a control condition and follows them for at least three to five years, measuring incident chronic disease, cardiovascular events, and mortality. Until that trial is completed, the gratitude-healthspan hypothesis remains promising but unproven. I hope it gets funded, because the potential public health implications — particularly for underserved communities where stress-buffering resources are most needed — are substantial.
RAAIR: Research-Based, AI-Assisted, Independently Reviewed
This article’s research synthesis was assisted by AI tools. Three different AI-powered research platforms — the Elicit academic search engine, the Consensus research engine, and Claude (Anthropic) — were used to identify, screen, extract, and synthesize findings from the primary literature. The Elicit platform screened 497 papers from a database of over 138 million academic records (including Semantic Scholar and OpenAlex), identifying 14 primary sources that met pre-specified inclusion criteria for population, study design, outcome measurement, and confounder control. Two independent Consensus analyses provided overlapping and supplementary evidence, including systematic reviews and meta-analyses.
All findings reported in this article were verified against the original published studies or the detailed extraction summaries provided by the research platforms. No sample size, effect size, or p-value was fabricated. Where source documents did not provide specific details, the article uses general language rather than invented numbers. Key sources include Chen et al. (2024) in JAMA Psychiatry, Hartanto et al. (2019, 2022) in Scientific Reports, McGuire et al. (2022) in the Journal of Psychiatric Research, Don et al. (2025) in Affective Science, Portocarrero et al. (2020) in Personality and Individual Differences, Jans-Beken et al. (2018) in the Journal of Happiness Studies, Leavy et al. (2023) in Biological Psychology, Krause (2006, 2009), Boggiss et al. (2020), Wang et al. (2023), and Cousin et al. (2020).
This article is for informational purposes only and does not constitute medical advice. No reader should change their medication, discontinue treatment, or alter their healthcare plan based on the information presented here without consulting a qualified healthcare professional.
While evidence links higher dispositional gratitude to better health and lower mortality, research has not yet directly tested healthspan as “years lived free of major disease and functional decline,” and residual confounding cannot be ruled out.
Figure 1: Overall consensus on gratitude and physical health
Association with Longevity and Physical Health
- In >49,000 older US women, higher trait gratitude predicted 9–15% lower all-cause mortality and lower cardiovascular mortality, even after extensive adjustment for sociodemographics, social participation, religious involvement, physical health, lifestyle factors, cognition, and mental health (Chen et al., 2024).
- Dispositional gratitude correlates with better self-rated physical health, partly via better psychological health, more healthy activities, and greater willingness to seek medical help; age strengthened some of these pathways in older adults (Hill et al., 2012; , 0).
- Gratitude is linked to favorable cardiovascular biomarkers, better sleep, and healthier lifestyles (Chen et al., 2024; Hill et al., 2012; Hartanto et al., 2019; Boggiss et al., 2020). A systematic review of randomized gratitude interventions shows improvements in sleep and some cardiometabolic indicators, though effects are modest and evidence mixed (Boggiss et al., 2020; , 0).
Socioeconomic Status and Biological Risk
- In a national midlife sample, gratitude buffered SES-related inflammation differences: low-gratitude individuals showed the usual gradient (lower SES → higher IL-6), whereas high-gratitude individuals showed no SES–IL-6 association, even after controlling for demographics, health status, health behaviors, and personality (Hartanto et al., 2019).
Well-Being, Stress, and Quality of Life
- Large meta-analysis (N≈100,000) finds dispositional gratitude moderately–strongly associated with mental well-being, with some age-related strengthening (Portocarrero et al., 2020; Jiang, 2020).
- Gratitude relates to better quality of life in diverse groups, partly through lower perceived stress and better mental health (Valikhani et al., 2019; Wolanin & Rybak, 2022; Wolanin, 2024).
Summary Table
| Outcome domain | Direction of association with gratitude | Controls for age/SES/behaviors? | Citations |
|---|---|---|---|
| All-cause & CVD mortality | Lower risk | Yes (extensive) | (Chen et al., 2024) |
| Biomarkers (IL-6, others) | Healthier profiles / SES buffering | Yes | (Hartanto et al., 2019; Chen et al., 2024; Boggiss et al., 2020) |
| Self-rated physical health | Better | Partial | (Hill et al., 2012; , 0) |
| Quality of life, well-being | Better | Mixed | (Chopik et al., 2019; Portocarrero et al., 2020; Valikhani et al., 2019; Wolanin & Rybak, 2022) |
Figure 2: Health-related outcomes associated with gratitude
Conclusion
Current evidence supports an association between higher dispositional gratitude and better health, biomarkers, and lower late-life mortality, partly independent of age, SES, and health behaviors. However, no study has yet quantified “healthspan” directly, so a causal, fully behavior-independent effect on years lived free of disease and functional decline remains unproven.
These search results were found and analyzed using Consensus, an AI-powered search engine for research. Try it at https://consensus.app. © 2026 Consensus NLP, Inc. Personal, non-commercial use only; redistribution requires copyright holders’ consent.
References
Chopik, W., Newton, N., Ryan, L., Kashdan, T., & Jarden, A. (2019). Gratitude across the life span: Age differences and links to subjective well-being. The Journal of Positive Psychology, 14, 292 – 302. https://doi.org/10.1080/17439760.2017.1414296
Portocarrero, F., Gonzalez, K., & Ekema-Agbaw, M. (2020). A meta-analytic review of the relationship between dispositional gratitude and well-being. Personality and Individual Differences. https://doi.org/10.1016/j.paid.2020.110101
Chen, Y., Okereke, O., Kim, E., Tiemeier, H., Kubzansky, L., & VanderWeele, T. (2024). Gratitude and Mortality Among Older US Female Nurses. JAMA Psychiatry, 81, 1030 – 1038. https://doi.org/10.1001/jamapsychiatry.2024.1687
Hill, P., Allemand, M., & Roberts, B. (2012). Examining the Pathways between Gratitude and Self-Rated Physical Health across Adulthood.. Personality and individual differences, 54 1, 92-96. https://doi.org/10.1016/j.paid.2012.08.011
Hartanto, A., Lee, S., & Yong, J. (2019). Dispositional Gratitude Moderates the Association between Socioeconomic Status and Interleukin-6. Scientific Reports, 9. https://doi.org/10.1038/s41598-018-37109-1
Valikhani, A., Ahmadnia, F., Karimi, A., & Mills, P. (2019). The relationship between dispositional gratitude and quality of life: The mediating role of perceived stress and mental health. Personality and Individual Differences. https://doi.org/10.1016/j.paid.2018.12.014
Jiang, D. (2020). Feeling Gratitude is Associated with Better Well-being across the Life Span: A Daily Diary Study during the COVID-19 Outbreak. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. https://doi.org/10.1093/geronb/gbaa220
Chen, Y., Okereke, O., Kim, E., Tiemeier, H., Kubzansky, L., & VanderWeele, T. (2024). THE ASSOCIATION BETWEEN GRATITUDE AND MORTALITY AMONG OLDER US WOMEN. Innovation in Aging, 8, 687 – 687. https://doi.org/10.1093/geroni/igae098.2244
Wolanin, A., & Rybak, J. (2022). Gratitude and Quality of Life in a Personalist and Existential Approach. Annales Universitatis Mariae Curie-Skłodowska, sectio J – Paedagogia-Psychologia. https://doi.org/10.17951/j.2022.35.3.77-96
Boggiss, A., Consedine, N., Brenton-Peters, J., Hofman, P., & Serlachius, A. (2020). A systematic review of gratitude interventions: Effects on physical health and health behaviors.. Journal of psychosomatic research, 135, 110165. https://doi.org/10.1016/j.jpsychores.2020.110165
Wolanin, A. (2024). Illness appraisal mediates the relationship between gratitude and quality of life among cancer patients. Palliative Medicine. https://doi.org/10.5114/pm.2024.138631
, (0). . **.
RAAIR: Research-Based, AI-Assisted, Independently Reviewed
This article’s research synthesis was assisted by AI tools. Three different AI-powered research platforms — the Elicit academic search engine, the Consensus research engine, and Claude (Anthropic) — were used to identify, screen, extract, and synthesize findings from the primary literature. The Elicit platform screened 497 papers from a database of over 138 million academic records (including Semantic Scholar and OpenAlex), identifying 14 primary sources that met pre-specified inclusion criteria for population, study design, outcome measurement, and confounder control. Two independent Consensus analyses provided overlapping and supplementary evidence, including systematic reviews and meta-analyses.
All findings reported in this article were verified against the original published studies or the detailed extraction summaries provided by the research platforms. No sample size, effect size, or p-value was fabricated. Where source documents did not provide specific details, the article uses general language rather than invented numbers. Key sources include Chen et al. (2024) in JAMA Psychiatry, Hartanto et al. (2019, 2022) in Scientific Reports, McGuire et al. (2022) in the Journal of Psychiatric Research, Don et al. (2025) in Affective Science, Portocarrero et al. (2020) in Personality and Individual Differences, Jans-Beken et al. (2018) in the Journal of Happiness Studies, Leavy et al. (2023) in Biological Psychology, Krause (2006, 2009), Boggiss et al. (2020), Wang et al. (2023), and Cousin et al. (2020).
This article is for informational purposes only and does not constitute medical advice. No reader should change their medication, discontinue treatment, or alter their healthcare plan based on the information presented here without consulting a qualified healthcare professional.
