A new study published in Communications Medicine suggests that experiencing suffering can predict worse well-being across multiple areas of life roughly a year later. These findings provide evidence that addressing everyday emotional and physical distress is an important step toward improving overall human flourishing on a global scale.
Human life involves a wide range of difficulties, inconveniences, and adversities. Sometimes, these challenging events lead to a state of suffering. Suffering is generally defined as a deeply distressing personal experience that lasts a considerable amount of time and involves the loss of something a person perceives as good. While suffering often overlaps with physical pain or depression, scientists note that it is a distinct experience with its own unique characteristics.
For example, a person might endure the intense physical pain of athletic training because they desire the health outcome, meaning they are in pain but they are not suffering. On the other hand, someone might suffer deeply because a minor injury prevents them from pursuing a highly prized life goal. Suffering also differs from clinical depression. A person can experience a prolonged low mood without feeling a strong, persistent desire for their current situation to stop, which is a defining feature of suffering.
Because suffering is a diffuse experience that can permeate all aspects of a person’s life, it has the potential to impact many different dimensions of well-being. Researchers increasingly view well-being through the broad lens of human flourishing. Human flourishing is a holistic concept that looks at how well a person is doing across all areas of human existence. This includes their physical health, mental health, social relationships, financial stability, and personal character.
Most past research on suffering has focused on very specific segments of the population, such as older adults, hospitalized individuals, or patients receiving palliative care for terminal illnesses. Richard G. Cowden, a research scientist at the Human Flourishing Program and the Department of Epidemiology at the Harvard T.H. Chan School of Public Health, wanted to broaden this focus. “Suffering is common, and it is not limited to people facing severe illness or crisis,” Cowden said.
Cowden noted that earlier data highlighted how widespread the issue truly is. “In prior work using Wave 1 of the Global Flourishing Study, approximately 44% of adults across 22 countries reported ‘some’ or ‘a lot’ of suffering, suggesting that a nontrivial number of people in the general population experience suffering,” Cowden explained.
To build a better understanding of how suffering operates in the general population, scientists needed to look at everyday distress in a wide variety of cultures. “In this study, we used two waves of longitudinal data from the Global Flourishing Study to address a major gap,” Cowden said. “No prior work had tested whether suffering predicts subsequent well-being across a wide range of outcomes, including happiness, physical health, relationships, character, and financial security, in nationally representative samples across many countries.”
To explore these ideas, the researchers analyzed data from the Global Flourishing Study. This massive scientific project includes nationally representative survey data from 207,919 adults living in 23 different countries and territories. The countries were specifically chosen to represent diverse geographic, cultural, and religious backgrounds. In total, the sampled countries cover roughly two thirds of the global human population.
The authors looked at two distinct waves of data collected approximately one year apart. In the first wave, participants answered a direct survey question asking to what extent they were currently suffering, with instructions noting that this could include any type of physical or mental suffering. The participants chose between not at all, not very much, some, and a lot. The researchers then grouped these responses to compare people who reported at least some suffering with those who reported little to none.
During the second wave of data collection a year later, the participants completed surveys assessing 56 specific indicators of well-being. These outcomes were grouped into eight main categories. The categories included psychological well-being, psychological distress, social well-being, social distress, social participation, character and prosocial behavior, physical health, and socioeconomic outcomes.
The scientists utilized an outcome-wide analytic design. This statistical approach involves testing a single exposure against dozens of different outcomes simultaneously. By using this method, researchers avoid selectively reporting only the positive or interesting results. It provides a highly transparent and comprehensive look at how one factor might influence an entire system of well-being.
To ensure their statistical models were as accurate as possible, the researchers controlled for several variables from the first wave of data. These variables included demographic characteristics like age, gender, education, employment status, and marital status. They also adjusted for retrospectively recalled childhood experiences. These included the quality of the participants’ relationships with their parents, childhood financial status, and any history of abuse while growing up.
The scientists found consistent evidence that suffering during the first wave of the study predicted worse well-being across a wide range of outcomes one year later. People who reported some or a lot of suffering tended to score lower on two broad composite measures of human flourishing. They also showed worse outcomes on most of the specific well-being indicators across the globe.
“One thing that stood out was how broad the pattern was; suffering was associated with worse well-being on many outcomes across various domains of well-being,” Cowden told PsyPost. The strength of these associations varied depending on the specific area of life being measured. The researchers observed the strongest negative links between suffering and psychological well-being, psychological distress, and physical health.
For instance, early suffering predicted lower life satisfaction, less happiness, more severe depression symptoms, and worse self-rated physical health a year later. Suffering also predicted worse outcomes in the social and socioeconomic domains. People who suffered in the first wave reported lower relationship satisfaction, higher levels of loneliness, and less financial security in the second wave.
Interestingly, suffering showed very little association with indicators of social participation or character. Ancient philosophical and religious traditions often suggest that suffering can act as a crucible for building virtue or character. Yet, the authors found that suffering was associated with a very small decline in character traits like gratitude and hope.
However, Cowden noted that the impact of suffering occasionally produced unexpected positive changes depending on the cultural context. “At the same time, the findings were not uniformly negative in every case: in a few countries, suffering was positively associated with selected outcomes, such as life balance in India, volunteering in Poland, and helping strangers in Poland, Sweden, and the United States,” Cowden explained.
This specific finding about helping strangers aligns with a concept known as altruism born of suffering, which suggests that enduring hardships can sometimes increase a person’s empathy for other vulnerable people. “These associations were very small and should not be overinterpreted, but they suggest that the relationship between suffering and later well-being may sometimes be more complex than a uniformly negative pattern,” Cowden added.
The study also revealed some differences in the results across the 23 countries and territories. In places like Sweden, Japan, the United Kingdom, and the United States, suffering was linked to worse well-being across almost all of the measured outcomes. In contrast, countries like Nigeria, the Philippines, and South Africa showed much less consistent evidence of these negative associations. The scientists suggest that a country’s age demographics, such as having a larger older adult population, might influence how strongly suffering impacts its citizens.
While this study provides an impressive look at suffering on a global scale, there are a few limitations to keep in mind. The research relies entirely on self-reported survey data. This type of data can sometimes be influenced by response biases, such as participants answering in ways they think are socially acceptable or leaning toward extreme answers.
Additionally, many of the concepts were measured using single questions rather than comprehensive questionnaires. A single question might not capture the full complexity of a person’s suffering. For example, the survey question cannot distinguish between emotional suffering caused by a severe social betrayal and physical suffering caused by a chronic illness.
Readers should also avoid misinterpreting the findings as definitive proof of a strict cause-and-effect relationship. “This was a longitudinal observational study, so the results show prospective associations but do not definitively prove that suffering caused the later outcomes,” Cowden warned.
Although the study tracked people over time and controlled for many outside factors, unmeasured variables could still be influencing both the initial suffering and the later well-being. “The study also used two waves of data, so future work with more waves will be important for understanding longer-term patterns and possible bidirectional relationships,” Cowden said.
A one-year follow-up period might also be too short to capture changes in outcomes that develop slowly. Things like educational attainment, having children, or making significant shifts in personal character take a long time to unfold. Associations involving these slower moving life events should be viewed with a degree of caution.
The authors recommend that public health officials consider strategies to address everyday suffering in the general population. “Suffering is not rare, and it is not confined to clinical, palliative care, or crisis settings,” Cowden noted. “We found that people in the general population who reported they were suffering tended to have worse well-being about a year later across many outcomes.”
Finding accessible ways to provide psychological support could help reduce population-wide suffering. “The practical takeaway is that suffering should be taken seriously as part of public health and human flourishing,” Cowden said. “Where suffering can be prevented, we should work to reduce it; where it cannot be fully avoided, we should make meaningful supports and resources more available to those who experience suffering.”
Future research will continue to build on these global findings as more data becomes available. “We hope this work contributes to an ‘epidemiology of suffering’ that can inform public health, clinical practice, community support, and policy, though much more needs to be done,” Cowden explained.
Tracking participants over longer periods will help explain the biological and social pathways that link distress to poor health and social outcomes. “Many important avenues could be pursued to build on this study,” Cowden said. “One involves developing a better understanding of why suffering is more strongly linked with some outcomes than others, why these patterns vary across countries, and what scalable resources could help mitigate the adverse effects of suffering when it arises.”
“One especially important point is that suffering is distinct from other types of negative affective-laden experiences, such as pain or depression,” he added. “These experiences often overlap, but they are not identical: a person may have physical pain without feeling as though they are suffering, or they may be suffering for reasons other than the physical pain they are experiencing. Our study suggests that suffering may have broad implications for well-being across many areas of life, which is why it deserves attention as a distinct human experience in research, practice, and public health.”
The study, “Longitudinal associations of suffering with subsequent multidimensional well-being in the Global Flourishing Study,” was authored by Richard G. Cowden, R. Noah Padgett, Chris Felton, Renae Wilkinson, Lucía Macchia, Zhuo Job Chen, Dorota Weziak-Bialowolska, Stephanie M. Koning, Craig Gundersen, Byron R. Johnson, and Tyler J. VanderWeele.
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