Objective: To investigate the association between the sense of life worth living (ikigai) and the cause-specific mortality risk. The psychological factors play important roles in morbidity and mortality risks. However, the association between the negative psychological factors and the risk of mortality is inconclusive. Methods: The Ohsaki Study, a prospective cohort study, was initiated on 43,391 Japanese adults. To assess if the subjects found a sense of ikigai, they were asked the question, Do you have ikigai in your life? We used Cox regression analysis to calculate the hazard ratio of the all-cause and cause-specific mortality according to the sense of ikigai categories. Results: Over 7 years' follow-up, 3048 of the subjects died. The risk of all-cause mortality was significantly higher among the subjects who did not find a sense of ikigai as compared with that in the subjects who found a sense of ikigai; the multivariate adjusted hazard ratio (95% confidence interval) was 1.5 (1.3-1.7). As for the cause-specific mortality, subjects who did not find a sense of ikigai were significantly associated with an increased risk of cardiovascular disease (1.6; 1.3-2.0) and external cause mortality (1.9; 1.1-3.3), but not of the cancer mortality (1.3; 1.0-1.6). Conclusions: In this prospective cohort study, subjects who did not find a sense of ikigai were associated with an increased risk of all-cause mortality. The increase in mortality risk was attributable to cardiovascular disease and external causes, but not cancer.
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