INTRODUCTION

Happiness corresponds to the area of psychology linked to positive health. Emotions such as happiness, contentment or enjo yment expand the repertoire of “thought-action” of people at any given time, therefore, they become more durable personal resources and would serve to prevent and treat problems rooted in negative emotions, such as anxiety, depression or others related to stress ¹. Positive health has also been found to be linked to biological correlations such as survival in people with coronary heart disease ², and even longevity ³. Other authors claim that economic growth is not necessarily associated with happiness. Therefore, the latter is a population priority and a need for research ⁴.

The World Happiness Report, a publication of the General Assembly of the United Nations, used two questions to estimate happiness in countries (“in general, how happy are you?”; and “taking all your life into account, how satisfied do you feel?”) and found out that Peru ranked 65th out of 104 countries, and 9th in Latin America, just ahead of Venezuela. According to this study, the external factors that determined happiness were income, work, satisfaction with the community and governance, values and religion; and the personal factors —physical and mental health, family experience, education, sex and age ⁵. This study found that rich countries tended to be happier, although social factors such as strength of social support, absence of corruption and personal freedom were more important for happiness than income. Other studies have related adverse early experiences and parenting styles to subjective well-being in adulthood, although less so to feelings of happiness ^6-8.

As far as we know, there are no other population studies in the region that have specifically explored the feeling of happi ness and its relationship with early experiences. Therefore, the objective of this study was to estimate the socio-demographic factors and early life events associated with happiness in the adult population of Metropolitan Lima.

MATERIALS AND METHODS

Instruments

The following instruments were used in this study and they have been validated in previous studies conducted by the National Insti tute of Mental Health (INSM in Spanish) in different regions of Peru ⁹:

Mezzich’s Quality of Life Index. It is composed of 10 dimensions, which evaluate aspects related to the quality of life. Each item is to be rated on a 10-point line.

Summarized and modified version of My memories of upbringing or EMBU (Egna Minen av Bardoms Uppfostran). In previous INSM studies, they prepared a summarized version of 13 questions, and then they added 5 questions about “machis mo”, personal autonomy, overprotection and control without affection ⁸. The internal consistency of this psychometric analy sis of 18 questions was of 0.74 as per the Cronbach Alpha. Three dimensions were identified —affective attitudes (rejection or affection), sibling favoritism, and overprotection or demands ⁹.

Negative life events before the age of 18. The study included 8 situations of adverse life events related to threats and living conditions determined by other parental behaviors. The INSM experts considered that said situations were important in the country context (Table 5).

Table 5 Adverse life events associated with happiness in adults in Metropolitan Lima 

^a Adjusted for sex, marital status, education and poverty

CI: confidence interval

Andrews’ Happiness Item (IUFA) ¹⁰. A single question with categorical and polytomous answer options. In a score from 1 to 5, 5 is the highest feeling of happiness —Would you describe yourself as happy and interested in life? (5 points), somewhat happy? (4 points), somewhat unhappy? (3 points), unhappy and with little interest in life? (2 points), so unhappy that life has no meaning? (1 point).

Diener’s Satisfaction with Life Scale (SWLS) ^11,12. There are 5 items on a 5-point Likert scale that measure the perception of satisfaction with one’s life. The score goes from 5 to 25, and 15 is considered a neutral score. Finally, we obtain 5 categories very dissatisfied (5-9), dissatisfied (10-14), neither satisfied nor dissatisfied (15), satisfied (16-20), and very satisfied (21-25). For this study, scores from 1 to 5 were reassigned to the categories according to the level of satisfaction, where one point corresponded to extremely dissatisfied and five points to extremely satisfied.

Happiness Index (HI). This index results from the addition of IUFA scores to the SWLS reassigned scores mentioned above. Therefore, the HI score was from 2 to 10. The cut-off points were intentionally set by taking the extremes first, i. e., those people who responded to the IUFA as “somewhat unhappy” (3 points) and “neither satisfied nor dissatisfied” (3 points) in the SWLS score were considered to be people with low happiness, with a score of 6. Thus, “low happiness” was determined when the score was 6 or less in the HI and it included people who were considered so unhappy that life had no meaning and were dissatisfied with life; “high or very high happiness” when the responses to one of the instruments had a maximum score of 5 and the other instrument at least a score of 4 (9 10 points); and “medium happiness” (7 8 points) for the rest of the combinations of responses with both instruments. The study was programmed to estimate the convergent validity of the index created and its categories (supplementary material).

Demographic data and poverty indicators. They included questions from the National Household Survey (ENAHO in Spanish) 2000 ⁽¹³ about age, sex, marital status, educational level, employment situation, area of residence and the assigned healthcare system, in addition to variables for calculating poverty, according to the unsatisfied basic needs (UBN) method, such as housing characteristics, etc. ⁽¹⁴⁾ The presence of two or more UBNs corresponds to families in extreme poverty, one UBN to poor families and the absence of UBNs to non-poor families.

RESULTS

A total of 4445 adults were interviewed. The weighted sample was distributed to 48.0% men and 52.0% women. The average age was 42.6 years (95% CI, 41.8-43.3). Most of the people surveyed were married or cohabiting (56.6%) with high school education (44.8%); an illiteracy frequency of 3.1% (95% CI, 2.5-3.8). 63.7% (95% CI, 61.9-65.4) of the sample had a paid job the previous week; and 21.5% of the population was in poverty according to UBN.

According to the HI, 8.4% (95% CI 7.4-9.4) of the population expressed low or no happiness; 29.9% (95% CI 28.1-31.7) had a medium level of happiness; and 61.7% (95% CI 59.7-63.7) of the population manifested high or very high happiness. The type of happiness reported at the time of the survey according to socio-demographic factors is shown in Table 1.

Table 1 Socio-demographic characteristics according to levels of self-reported happiness by adults in Metropolitan Lima 

CI: confidence interval

The bivariate analyses showed a significant association with sex, marital status, educational level, poverty level, native ton gue, illiteracy and unemployment, with the exception of age. However, in the multivariate analysis, the native tongue, illiteracy and unemployment variables did not continue to show significant differences. With respect to sex, it is observed that men are 1.79 times more likely to have “high or very high happiness” over “low happiness” compared to women. The group that was once attached (separated, divorced or widowed) shows a lower probability of having “high happiness” compared to people who were attached (married or cohabiting). People with higher education are 3.18 times more likely than people with lower education to have “high happiness” versus “low happiness”. Non-poor people are 2.54 times more likely than extremely poor people to have “high or very high happiness” versus the “low happiness” category (Table 2).

Table 2 Socio-demographic characteristics associated with happiness in adults in Metropolitan Lima 

^a Adjusted for sex, marital status, education and poverty, illiteracy, mother tongue and unemployment

CI: confidence interval

It was found that there is a significant relationship between the quality of life index dimensions and the HI according to the scores obtained in the bivariate analysis and between each of the categories adjusted with socio-demographic variables (Table 3).

Table 3 Quality of life associated with happiness in adults in Metropolitan Lima 

^a ANOVA; ^b multinomial regression; ^c adjusted for sex, marital status, education and poverty

SE: Standard error

CI: confidence interval; SE: standard error

Some of the parenting style variables are inversely linked to happiness, especially those related to rejection and “macho” attitudes, and directly linked to styles involving emotional warmth. Among the variables with a more intense association there is “you were given more punishments than deserved”. On the other hand, the positive style most strongly associated with happiness was “there was love and tenderness between you and your parents”, people with this background were 3.18 times more likely to have high or very high happiness. No parenting styles that involved favoritism or overprotection were statistically associated with happiness (Table 4).

Table 4 Parenting styles associated with happiness in adults in Metropolitan Lima 

^a Adjusted for sex, marital status, education and poverty

CI: 95% confidence intervals

With respect to adverse life events all the situations considered showed a significant association and an intense inverse relationship with happiness, highlighting situations such as “one of your parents threatened to kill you” and “one of your parents threatened to stop loving you” (Table 5).

DISCUSSION

The present study is one of the first in Peru to relate the variables exposed. The study provides evidence about the importance of the relationship between socio-demographic aspects and happiness, as well as elements of personal history that could influence in people’s emotional future.

A large proportion of Lima’s adult population considers themselves to experience a high or very high level of happiness. These findings are similar to the Survey on Happiness, Hope and Economic Optimism, conducted by Gallup International, which found that 59% of the world’s population reported feeling happy, or very happy, Latin America showed 69% ¹⁷. With respect to socio-demographic variables, this study found a significant association with sex, marital status, educational level and poverty. These findings are compatible with another study conducted in Iran ¹⁸. Other variables such as illiteracy, native tongue and unemployment, although significantly associated with happiness in the bivariate analyses, did not retain the as sociation at the time of comparing to other socio-demographic variables. Likewise, some studies did not find any association between sex and happiness ¹⁹.

With regard to the relationship between poverty and happiness, some authors postulate that the perception of social diffe rences with other people leads to the search for satisfying material or physical needs that affect, to the detriment of the time dedicated to social relations, which are considered to generate happiness in people ⁴. However, we must emphasize that a sig nificant proportion of people in extreme poverty were at the level of high or very high happiness. Some authors highlight that the situation of poverty can favor collectivism or the propensity to integrate into social groups and would explain why some poor countries would have a higher perception of happiness than some rich countries ²⁰.

In relation to quality of life and happiness, this study set out to analyze the relationship between both variables as a way of validating the HI —used as an instrument to measure happiness, and found a significant association between all the dimen sions of the quality of life index and the levels of happiness and corroborated other authors’ proposals regarding the correlation between the variables ¹⁵. This relationship is also expressed in the findings that would indicate that happiness is associated with diverse results of success in work, income, community involvement, interpersonal relationships, and health in general, all related to the concept of quality of life ²¹.

With respect to parenting styles, early adverse events are not only associated with mental disorder problems in adulthood ²², but are also associated with aspects of positive health, such as happiness. A study of 3,292 people in Japan found out that adverse expe riences in childhood were related to subjective well being in adulthood, regardless of socio economic factors ⁷. In contrast, the study developed by Caycho and collaborators from Lima university students ⁶ found no significant relationship between happiness and overprotective and favoring parenting styles. One explanation may lie in the age and socio economic context of the participants, since Caycho’s study was conducted on young adults from private universities. However, it cannot be ruled out that the relationship between adverse events in childhood and happiness is mediated by other factors. In this sense, one study reported that self-esteem is an important moderator between parental styles and happiness and that the mother’s democratic style, linked to self-esteem, was the most associated with happiness.

A negative relationship was found between adverse life events and happiness. These findings are consistent with a community study that reported a relationship between the intensity of abuse in childhood and the state of mental health in adulthood ²³. Other authors have found that childhood abuse is negatively correlated with various indicators of adult well-being, self-esteem, happiness and life satisfaction ²⁴. One explanation for this relationship may be that early traumatic experiences have been asso ciated with emotional dysregulation ²⁵, and follow-up studies of emotional dysregulation in childhood 14 years later reported a greater increase of emotional problems in adulthood ²⁶. A study of 17,337 primary care adults showed a cumulative effect of adverse experiences in childhood on various emotional and behavioral domains in adulthood, which could possibly explain the reduced happiness of people who lived adverse events in childhood ²⁷.

Within happiness, it has been considered to develop tolerance ²⁸, to nurture spirituality, to give priority to close relationships, acting positively in the face of circumstances, managing stressful emotions, providing a pleasant physical environment, promoting healthy physical activities, seeking jobs compatible with their abilities, including recreation, not making comparisons, and caring about others ²⁹. Little attention is given in primary care to the identification of adverse experiences in childhood, despite the impact it has ³⁰. Putting happiness at the center of government policy is suggested by the fact that economic growth in developed countries has not been accompanied by improvement in happiness surveys. However, controversies related to high subjectivity still persist ³¹.

The results of this study should be considered with the following limitations —the happiness indicator used was created for this study and, despite having evidence of its convergent validity, other validation studies may be necessary; this study explored only some aspects of early events and some parenting styles, and did not integrate all the factors that may mediate and be important for happiness. Likewise, we cannot dismiss the influence of memory and social desirability in interviewees’ responses.

In conclusion, the findings show the importance of both negative and positive early life events for developing happiness and contribute with relevant information for a paradigm shift in the study of mental health with a public health approach not focused on diseases but on health as a whole. This study adds evidence on the importance of developing programs aimed during the first years of life, with promotional and preventive measures in the development of healthy parenting behaviors and environments conducive to the welfare of people’s life.