Research Article
Volume 7 Issue 3 - 2020
Validation of a Questionnaire for Assessment of Happiness, with Reference to Social Classes among Indians
Ram B Singh1*, Agnieszka Wilczynska2, Jan Fedacko3, Masaki Mogi4, Shuyang Liu4, MA Niaz5, Ghizal Fatima6 and Kumar Kartikey1
1Halberg Hospital and Research Institute, Moradabad, India
2The Tsim Tsoum Institute, Krakow, Poland
3PJ Safaric University, Kosice, Slovakia
4Department of Pharmacology, Ehime University, Graduate School of Medicine, Tohon, Ehime, Japan
5Center of Nutrition Research, Halberg Hospital and Research Institute, Moradabad, India
6Department of Biotechnology, Era Medical College, Lucknow, India
*Corresponding Author: Ram B Singh, Professor, Halberg Hospital and Research Institute, Moradabad, India.
Received: December 09, 2019 Published: February 29, 2020


Background: Cohort studies indicate that the risk of chronic anxiety, aggression and depression may vary according to social class and grade of happiness, which may predispose poor physical health, leading to cardio-metabolic diseases (CMDs). The most important attribute of happiness is satisfaction, which may also vary according to social classes. This study aims to validate a questionnaire for assessment of happiness to find out the association of happiness with social classes.

Subjects and Methods: After written informed consent and approval from hospital ethic committee, this cross-sectional survey was conducted at Halberg Hospital and Research Institute, Moradabad, India. All subjects; 980 urban (495 men and 485 women), 900 rural (510 men and 390 women) above 25 years of age were randomly selected and recruited from urban and rural populations. Clinical data as well as risk factors were recorded with the help of case record form and validated questionnaires. Assessment of happiness was made by a new modified validated questionnaire for assessment of happiness with attributes related to social, psychological and spritual behaviors. Social classes were assessed based on attributes of occupation, housing, per capita income, consumer durables, education. and health education.

Results: The findings reveal that this modified questionnaire can be successfully validated for assessment of happiness. The overall prevalence of happy and satisfied people, among both urban and rural populations, combined, was significantly high (62.8% (n = 1181) vs 37.2% (n = 699), P < 0.01) compared to total of unhappy or neutral subjects, respectively. Among both urban and rural populations, the overall prevalence of happy and satisfied subjects were also independently, significantly greater among urban (62.4% vs 37.5%, P < 0.01) and rural (62.8% vs 37.2%, P < 0.01) populations, compared to unhappy or neutral subjects. The prevalence of grades of happiness; very happy and satisfied, moderately happy and satisfied and modestly happy and satisfied, were independently, significantly lower among both urban and rural subjects compared to unhappy or neutral subjects. In both urban and rural subjects, the prevalence of happiness was significantly greater among subjects in social class 2 to social class 4, compared to social class 1 and social class 5, respectively; urban, 567, (71.9%) vs 152 (48.2% and n = 52 (53.0%), P < 0.01) rural; n = 508, (73.8%) vs n = 150 (49.8%) and n = 44 (48.3%), P < 0.01). The overall prevalence of happiness was also significantly greater among social class 2 to 4 than other social classes. The trend of prevalence of happiness in various social classes from social class 1 (highest) to social class 5 (lowest) was non-significant. The frequency of CAD was significantly lower among subjects with happiness compared to subjects without happiness, respectively both in urban (n = 31 (5.06% vs 45 (12.2%, p < 0.02) as well as among rural populations, respectively (n = 14 (2.09%) vs n = 13 (3.92%, P < 0.05). The overall prevalence of CAD among urban subjects was 7.75% (n = 76) and among rural 3.0% (n = 27) and the difference was significant (P < 0.02). The prevalence of CAD was significantly more common among higher social classes 1 - 3, compared to lower social classes 4 and 5, respectively (n = 88 (5.95%) vs n = 15 (2.88%), P < 0.01). There were no gender differences in prevalence of happiness.

Conclusion: It is clear that this modified questionnaire can be successfully validated for assessment of happiness among various social classes. The questionnaire allowed us to identify overall 62.8% (n = 1181) subjects with happiness, including in social class 1 to 5. Happiness was significantly greater among social class 2 to 4, compared to social class 1 and 5 subjects, among both urban and rural subjects. The prevalence of CAD was significantly more common among higher social classes 1 - 3, compared to lower social classes 4 and 5 among both urban and rural populations.


Keywords: Western Diet; Sedentary Behavior; Mastication; Cardiovascular Diseases


  1. Singh RB., et al. “Practicing the Eight-Fold Paths of Buddha could modify unhealthy behaviors and reduce non-communicable diseases, to advance sustainable developmental goals of the united nations: a mini review”. World Heart Journal 11.1 (2019): 79-91. 
  2. Singh RB., et al. “Development and validation of a questionnaire for assessment of happiness. the happiness rating scale”. World Heart Journal 11 (2020).
  3. Singh RB., et al. “Diet and lifestyle guidelines and desirable levels of risk factors and protective factors for prevention of dementia: A Scientific State¬ment from Joint Symposium of JAAS and APCNS”. Biomedical Journal of Scientific and Technical Research 17.3 (2019). 
  4. WHO. Comprehensive mental health action plan 2013 (2020). 
  5. One in Five Youth Face Mental Health Problems, Secretary-General Says, Calling for Attitude Change to End Stigma, in Message for International Observance (2019).
  6. Nugent R., et al. “Investing in non-communicable disease prevention and management to advance the sustainable development goals”. Lancet 391 (2018): 2029-2035. 
  7. Itharat A., et al. “Holistic approaches for health education and health promotion”. World Heart Journal 9 (2017): 64-81. 
  8. Loonen AJM and Ivanova SA. “Circuits regulating pleasure and happiness-mechanisms of depression. Hypothesis and theory article”. Frontiers in Human Neuroscience 2016.
  9. McEwen BS. “Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators”. European Journal of Pharmacology 583.2-3 (2008): 174-185. 
  10. Eddie MW Tong., et al. “Concurrent and temporal relationships between humility and emotional and psychological well-being”. Jour of Happiness 20 (2019): 1343-1358. 
  11. Wijnand AP., et al “Dreaming of a brighter future: Anticipating happiness instills meaning in life”. Journal of Happiness Studies 20 (2019): 541-559. 
  12. John A. Russell. “Fifty years of advances in neuroendocrinology”. Brain and Neuroscience Advances 2018.
  13. Singh RB., et al. “Angiotensin converting enzyme a possible risk promotor during transition from undernutrition to chronic diseases of affluence”. Cardiovascular News. World Heart Journal 6 (2014): 209-215. 
  14. Singh RB., et al. “Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India”. European Heart Journal 18 (1997): 728-735. 
  15. Singh RB., et al. “Prevalence and risk factors for prehypertension and hypertension in five Indian cities”. Acta Cardiologica 66 (2011): 29-36. 
  16. Singh RB., et al. “Association of chrono- physiological and psychological risk factors among patients with acute coronary syndromes”. World Heart Journal 9.2 (2017): 123-134. 
  17. Wilczynska A., et al. “A modified questionnaire to find out the association of depression with increased mortality, among urban decedents, dying due to various causes”. The Open Nutraceuticals Journal 8 (2015): 5-15. 
  18. Wilczynska A., et al. “Validation of type A behaviour questionnaire in relation to social class and coronary artery disease: The Indian rating scale for type A behavior”. Journal of Cardiology and Therapy 5.1 (2018): 707-712.
  19. Miret M., et al. “Health and happiness: cross-sectional household surveys in Finland, Poland and Spain”. Bulletin of the World Health Organization 92.10 (2014): 716-725. 
  20. Brzezinski M. “Diagnosing unhappiness dynamics: evidence from Poland and Russia”. Journal of Happiness Studies (2018).
  21. Lelkes O. “Minimizing misery: A new strategy for public policies instead of maximizing happiness?” Social Indicators Research 114.1 (2013): 121-137. 
  22. Akin A and Ozkaya S. “Adaptation of the Orientations to Happiness Scale Short Form to Turkish: Validity and Reliability Study”. Journal of European Education 5 (2017): 28-35. 
  23. Russel JA. “Fifty years of advances in neuroendocrinology”. Brain and Neuroscience Advances 2 (2018): 1-20. 
  24. Farhud D., et al. “Happiness and health: The biological factors- systematic review article”. Iranian Journal of Public Health 43.11 (2014): 1468-1477. 
  25. World Happiness Report (2018). 
  26. Halliwell JF., et al. “Changing World Happiness” (2019). 
  27. Singh RB., et al. “Social class and coronary artery disease in India”. Lancet 353 (1999): 154. 
  28. Singh RB. “Coronary artery disease risk factors in South Asians and Americans”. The American Journal of Clinical Nutrition 70 (1999): 112-113. 
  29. Yaya S., et al. “Subjective happiness, health and quality of life and their sociocultural correlates among younger population in Malawi”. Social Sciences 8 (2019): 55.
  30. Aschbacher K., et al. “Chronic stress increases vulnerability to diet-related abdominal fat, oxidative stress, and metabolic risk”. Psychoneuroendocrinology 46 (2014): 14- 22. 
  31. Ghose B., et al. “Lifestyle behaviors, subjective health, and quality of life among Chinese men living with type 2 diabetes”. American Journal of Men’s Health 11 (2017): 357-364. 
  32. Singh RB., et al. “Larger circadian amplitude of heart rate associated with active prayer in Hindu Indians in Asia”. World Heart Journal 1 (2009): 219-222. 
  33. Boelens P., et al. “The effect of prayer on depression and anxiety: Maintenance of positive influence one year after prayer intervention”. International Journal of Psychiatry in Medicine 43 (2012): 85-98. 
  34. Li S., et al. “Association of religious service attendance with mortality among women”. Journal of the American Medicine Association Internal Medicine 176.6 (2016): 777-785. 
  35. Benjamin Daniel J., et al. “What do you think would make you happier? What do you think you would choose?”. The American Economic Review 102 (2012): 2083-2110. 
  36. Jyotsana R., et al. “Autonomic functions in Raja-Yoga meditators”. Indian Journal of Physiology and Pharmacology 59.4 (2015): 396-401.
  37. Sukhsohale Neelam D., et al. “Does Raja Yoga meditation bring out physiological and psychological general well being among practitioners of it?”. International Journal of Collaborative Research on Internal Medicine and Public Health 4.12 (2012): 2000-2012.
  38. Mencarini L., et al. “Life satisfaction favors reproduction. The universal positive effect of life satisfaction on childbearing in contemporary low fertility countries”. PLoS ONE 13.12 (2018): e0206202. 
  39. Lagraauw HM., et al. “Acute and chronic psychological stress as risk factors for cardiovascular disease: Insights gained from epidemiological, clinical and experimental studies”. Brain, Behavior, and Immunity 50 (2015): 18-30. 
  40. Singh RB., et al. “Antidepressive Therapy in Myocardial Infarction, Prevents Recurrent Cardiovascular Events?”. Biomedical Journal of Scientific and Technical Research 13.4 (2019). 
  41. Thackeray JT., et al. “Myocardial inflammation predicts remodeling and neuro-inflammation after myocardial infarction”. Journal of the American College of Cardiology 71.3 (2018): 263-275. 
  42. Makovac E., et al. “Fear processing is differentially affected by lateralized stimulation of carotid baroreceptors”. Cortex 99 (2018): 200-212. 
  43. Bernardi I., et al. “Effects of controlled breathing, mental activity and mental stress with or without verbalization on heart rate variability”. Journal of the American College of Cardiology 35 (2000): 1462-1469. 
  44. Rogowski O., et al. “Heart rate and microinflammation in men: a relevant atherothrombotic link”. Heart 93 (2007): 940-944. 
  45. Rokade PB. “Release of endorphin hormone and its effects on our body and Moods: A Review”. International Conference on Chemical, Biological and Environment Sciences (2011). 
  46. Farhud DD and Tahavorgar A. “Melatonin hormone, metabolism and its clinical effects: a review”. Iranian Journal of Endocrinology and Metabolism 15.2 (2013): 211-223. 
  47. Campbell A. “Oxytocin and human social behavior”. Personality and Social Psychology Review 14.3 (2010): 281-295. 
  48. Carter CS. “Neuroendocrine perspectives on love and attachment”. Psychoneuroimmunoendocrinology 23 (1998): 779-818.
  49. Mitchell RLC and Phillips LH. “The psychological, neurochemical and functional neuroanatomical mediators of the effects of positive and negative mood on executive functions”. Journal of Neuropsychology 45 (2007): 617-629.
  50. Rozanski A., et al. “Association of Optimism with Cardiovascular Events and All-Cause Mortality A Systematic Review and Meta-analysis”. Journal of the American Medicine Association Network 2.9 (2019): e1912200.
  51. Burke HM., et al. “Depression and cortisol responses to psychological stress: A meta-analysis”. Psychoneuroendocrinology 30.9 (2005): 846-856. 
  52. Ryff CD., et al. “Positive health: Connecting well-being with biology”. Philosophical Transactions of the Royal Society of London 359 (2005): 1383-1394. 
  53. Love A. “The Relations Between Morning Cortisol Secretion Pattern: Morning Cortisol levels, and Affective States”. University of British Colombia, Department of PSCS (2007). 
  54. Zak PJ. “The Physiology of Moral Sentiments”. Journal of Economic Behavior and Organization 77 (2011): 53-65. 
  55. Diener E and Seligman MEP. “Very happy people”. Psychological Science 13 (2002): 80-83. 
  56. Lima BB., et al. “Association of Transient Endothelial Dysfunction Induced by Mental Stress With Major Adverse Cardiovascular Events in Men and Women With Coronary Artery Disease”. Journal of the American Medicine Association Cardiology (2019). 
  57. Singh RB., et al. “Identification of new brain targets by neuro-imaging technology for treatment of Neurocardiac Disorders”. Biomedical Journal of Scientific and Technical Research 14.1-2019.
  58. Raichle ME. “Cognitive neuroscience. Bold insights”. Nature 412.6843 (2001): 128-130. 
  59. Alosco ML and Hayes SM. “Structural brain alterations in heart failure: a review of the literature and implications for risk of Alzheimer's disease”. Heart Failure Reviews 20.5 (2015): 561-571.
  60. Logothetis NK., et al. “Neurophysiological investigation of the basis of the fMRI signal”. Nature 412.6843 (2001): 150-157. 
  61. Zunhammer M., et al. “Placebo effects on the neurologic pain signature a meta-analysis of individual participant functional magnetic resonance imaging data”. Journal of the American Medicine Association Neurology 75.11 (2018): 1321-1330. 
  62. Chauveau F., et al. “Prevention of stress-impaired fear extinction through neuropeptides action in the lateral amygdala”. Neuropsycho-pharmacology 37.7 (2012): 1588- 1599. 
  63. Phan KL., et al. “Functional neuroanatomy of emotion: a meta-analysis of emotion activation studies in PET and fMRI”. Neuroimage 16.2 (2002): 331-348. 
  64. Abumaria N., et al. “Effects of elevation of brain magnesium on fear conditioning, fear extinction, and synaptic plasticity in the infralimbic prefrontal cortex and lateral amygdala”. The Journal of Neuroscience 31.42 (2011): 14871-14881. 
  65. Ressler KJ. “Amygdala activity, fear, and anxiety: modulation by stress”. Biology Psychiatry 67.12 (2010): 1117-1119. 
  66. Tawakol A., et al. “Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study”. Lancet 389.10071 (2017): 834-845. 
  67. Singh RB., et al. “Physiological imaging a new approach for assessment of neuropsychiatric and cardiovascular diseases”. World Heart Journal 10 (2018): 321-336. 
  68. Mier W and Mier D. “Advantages in functional imaging of the brain”. Frontiers in Human Neuroscience 9 (2015): 249. 
  69. Logothetis NK., et al. “Neurophysiological investigation of the basis of the FMRI signal”. Nature 412.6843 (2001): 150-157. 
  70. Raichle ME. “Cognitive neuroscience. Bold insights”. Nature 412.6843 (2001): 128-130. 
Citation: Ram B Singh., et al. “Validation of a Questionnaire for Assessment of Happiness, with Reference to Social Classes among Indians”. EC Cardiology 7.3 (2020): 01-12.

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