Psychological resources and illness recovery in later life: independent associations of positive mental health and attitudes to aging

Background: Illness recovery represents a critical correlate of functional independence and quality of life among aging populations. This cross-sectional study aimed to examine the independent associations between two distinct psychosocial resources—positive mental health (PMH) and attitudes to aging—and illness recovery outcomes in older adults. Methods: A cross-sectional survey was conducted among 1,200 older adults (mean age = 68.49 ± 7.09 years, 56.9% female) recruited from three provinces in China, with data collection spanning from October 2020 to April 2021. Participants completed (1) the Mental Health Continuum-Short Form (MHC-SF), (2) the Attitudes to Aging Questionnaire-12 (AAQ-12), and (3) the Illness Recovery Questionnaire. Statistical analyses were performed using R 4.4.3, employing logistic ridge regression and ridge regression. Results: Flourishing was associated with higher odds of no-illness status (OR 1.249, 95%CI 1.098 to 1.424), lower odds of high treatment costs (OR 0.819, 95%CI 0.682 to 0.968), fewer treatment methods (β -0.157, 95%CI -0.272 to -0.031) and comorbidities (β -0.503, 95%CI -0.751 to -0.270). Positive attitudes to aging showed similar patterns, with higher odds of no-illness status (OR 1.170, 95%CI 1.019 to 1.320) and lower odds of illness aggravation (OR 0.912, 95%CI 0.866 to 0.976) and moderate-to-high treatment costs (OR 0.827, 95%CI 0.699 to 0.984), as well as reduced comorbidity burden (β -0.258, 95%CI -0.523 to -0.002). In contrast, languishing was associated with lower odds of minimal treatment costs (≤ CNY 500; OR 0.835, 95%CI 0.703 to 0.994). Negative attitudes to aging were associated with higher odds of illness aggravation (OR 1.128, 95%CI 1.013 to 1.251), non-recovery (OR 1.204, 95%CI 1.055 to 1.373), high treatment costs (OR 1.230, 95%CI 1.036 to 1.481), and extended treatment duration (OR 1.154, 95%CI 1.035 to 1.271), as well as greater number of treatment methods (β 0.175, 95%CI 0.050 to 0.307) and higher comorbidity burden (β 0.673, 95%CI 0.385 to 0.953). Conclusions: High positive mental health (flourishing) and positive attitudes to aging were significantly associated with better health and illness recovery outcomes among older adults. These findings emphasize the potential value of integrating positive mental health and positive attitudes to aging in clinical assessment and intervention. Further investigation of the biopsychosocial model incorporating positive psychology principles is warranted to elucidate a bio-positive-psychosocial medical model.