June 1, 2022

Honesty and Integrity Affect Both Physical and Mental Health

Results from a cohort study
Older adults who score higher for honesty and integrity have improved physical and mental well-being.


Weziak-Bialowolska D, Bialowolski P, Niemiec RM. Being good, doing good: the role of honesty and integrity for health. Soc Sci Med. 2021;291:114494.

Study Objective

To assess the impact of honesty and integrity on physical health, mental health, and activities of daily living in older adults (aged ≥ 50 years)

Key Takeaway

Older adults who score higher for honesty and integrity have lower risk of lung disease and depression, fewer limitations with mobility, and improved performance with activities of daily living.


Quantitative cohort study


The participants were Americans aged 50 or more years who completed the Health and Retirement Study (HRS), a national survey conducted biennially since 1992. A psychological questionnaire is distributed to a randomly assigned half of the sample group every 4 years.

To reach statistical significance in their data analysis, the researchers included 2 waves of the psychological testing: those who completed the psychological questionnaire in 2008 and again in 2012; and those who completed it in 2010 and again in 2014.

The researchers included only individuals who had responded to the psychosocial questionnaire at baseline and self-assessment of health conditions at prebaseline.

The final cohort included 9,831 respondents.


Researchers used the psychological questionnaire embedded in the HRS that includes a psychosocial component that has been “vigorously validated” in previous studies.

Study Parameters Assessed

The authors focused on the “virtue scale,” a validated subscale of the consciousness scale in the HRS.1-3 The researchers suggest that this was the first epidemiological and observational study that prospectively correlated moral behavior with physical and mental health as well as improvements in activities of daily living.

Primary Outcome

Older adults who scored higher on the Character Strength of Honesty and Integrity (CSHI) scale demonstrated an 18% lower risk of lung disease (6% reduction with each standard deviation increase in the indicator for CSHI) and lower on the depression scale (11%). Those with high CSHI scores also had fewer limitations with mobility and improved performance with instrumental activities of daily living (ie, managing telephone, money, and medication).

Key Findings

While older adults with higher CSHI scores had lower risk of lung disease and depression, improved mobility, and better performance with instrumental activities of daily living, they did not have any change in their risk for other chronic diseases including diabetes, cancer, stroke, heart disease, or high blood pressure.


The authors reported no financial conflict of interest or competing interests. They did not receive grant money for their research. Because the data for this study were publicly available, the authors did not require approval from Harvard Longwood Campus Institutional Review Board.

Practice Implications & Limitations       

Weziak-Bialowolska et al’s findings make a strong case for “positive psychology” supporting improved physical health. Kim et al made similar discoveries based on data from the University of Michigan’s Health and Retirement study, a prospective, nationally representative cohort of 12,998 participants over 50 years of age.4 Kim et al found that participants with increased life satisfaction (as opposed to economic advancement) over a 4-year period reported improvements in physical health including lower risk of pain, physical limitation, and mortality; fewer chronic health conditions; and higher self-rated health. The participants also reported improvements in many psychosocial indicators, including optimism, positive affect, sense of life purpose, and mastery in many areas of their lives. The investigators, however, did not find correlations between improvement in life satisfaction and reduced incidence of specific health conditions, as was reported in Weziak-Bialowolska et al’s work.

Both these research studies underscore the importance of focusing on character strength and psychological well-being to improve physical and mental health for elderly patients.

Honesty and truth-telling are also important for healthcare providers in their interactions with patients. Tuckett points out that cultural expectations today are trending more toward truth-telling than in the past, yet certain individuals and/or their families prefer to avoid accurate reporting of their medical condition.5 Sometimes denial benefits a patient, as evidenced by research with cancer patients.6 Patients actively using distraction to deny their diagnosis were less likely to have emotional reactions that could “amplify noxious physical symptoms.” Those who used passive escape mechanisms, however, undermined their psychological well-being.

Intentionally withholding information from a patient can erode trust.7,8 For most patients, knowing their diagnosis is less stressful than worrying about the unknown.9

Working with dementia patients presents its own ethical challenges. Some practitioners erroneously assume dementia patients are incapable of expressing opinions or have lost all short-term memory.10 Providing accurate information and including dementia patients in their care decisions are vital parts of respecting their autonomy.

For most patients, knowing their diagnosis is less stressful than worrying about the unknown."

One of the major challenges of truth-telling is the reality of uncertainty in medical diagnoses and prognoses. Some authors suggest that truth-telling is never achieved because there is no absolute truth. In lieu of absolute truth, Drickamer and Lachs suggest openly and honestly presenting information as it is “perceived and known.”11

Numminen et al reviewed research on “moral courage” among nurses that included the attribute of honesty—ie, transparency about one’s own shortcomings and mistakes, learning from those errors, and correcting them.12 Honesty also required being able to see through others’ eyes and consider others’ interpretations.13

The bottom line for practitioners: Rely on communication with the patient and the patient’s family about what information to reveal5 and the best way to convey it.14 Present the truth to patients, to the best of your ability. In this way you improve your own physical and mental health while modeling these attributes for your patients.

For patients, encouraging them to practice honesty and integrity with themselves and those around them may improve their physical and mental well-being.

Categorized Under


  1. Roberts BW, Chernyshenko OS, Stark S, Goldberg LR. The structure of conscientiousness: an empirical investigation based on seven major personality questionnaires. Person Psychol. 2005a;58:103-139.
  2. Smith J, Ryan L, Fisher GG, Sonnega A, Weir D. Psychosocial and Lifestyle Questionnaire 2006-2016. Documentation Report Core Section LB. Institute for Social Research, University of Michigan, Ann Arbor, MI; 2017.
  3. Sonnega A, Smith J. Health and retirement study, a longitudinal data resource for psychologists. In: Pachana NA (eds). Encyclopedia of Geropsychology. Springer, Singapore; 2017.
  4. Kim ES, Delaney SW, Tay L, et al. Life satisfaction and subsequent physical, behavioral, and psychosocial health in older adults.” Milbank Q. 2021;99(1):209-239.
  5. Tuckett AG. Truth-telling in clinical practice and the arguments for and against: a review of the literature. Nurs Ethics.2004;11(5):500-513.
  6. Vos MS, de Haes JCJM. Denial in cancer patients, an explorative review. 2007;16(1):12-25.
  7. Mueller PS. Breaking bad news to patients. The SPIKES approach can make this difficult task easier. Postgrad Med.2002;112(3):15-6, 18.
  8. Sprigler GB. When the truth hurts. Plast Surg Nurs. 1996;16(1):51-54.
  9. Fallowfield LJ. Truth may hurt but deceit hurts more: communication in palliative care. Palliat Med. 2000;16(4):297-303.
  10. Feinberg LF, CJ Whitlatch. Are persons with cognitive impairment able to state consistent choices? 2001;41(3):374-382.
  11. Drickamer MA, MS Lachs. Should patients with Alzheimer’s disease be told their diagnosis? N Engl J Med.1992;326(14): 947-951.
  12. Numminen O, Repo H, Leino-Kilpi H. Moral courage in nursing: A concept analysis. Nursing Ethics. 2017;24(8):878-891.
  13. Laabs C. Perceptions of moral integrity: contradictions in need of explanation. Nurs Ethics.2011;18(3):431-440.
  14. Zolkefli Y. The ethics of truth-telling in health-care settings. Malays J Med Sci. 2018;25(3):135-139.