• Overview
• Definition
• Incidence, prevalence and trends
• Risk factors
• Health consequences
• Costs
• Contributors

Incidence, Prevalence and Trends

Overview

Much of the literature on positive mental health relies on one or other of the two main perspectives of positive mental health: the hedononic (pleasure/happiness) and the eudaimonic (meaning/fulfilment). Hence, there are different approaches to measurement. The hedonic school measures subjective well-being which has three components: satisfaction with life; presence of positive mood; and absence of negative mood. ¹ . Most people are positively mentally healthy if a single measure of subjective well-being alone is used. ² The eudaimonic school of positive mental health is more concerned with psychological well-being leading to fulfilment and expression of your true nature (eudaimon). Ryan and Deci argue ³ that the key factors that foster psychological well-being are feelings of autonomy, competence and positive personal relationships, whereas Keyes identified six factors, listed below:

• Self acceptance;
• Positive relations with others;
• Autonomy (ability to think for yourself);
• Environmental mastery (the ability to feel you can change your circumstances for the better);
• Purpose in life (having goals and not feeling helpless; and
• Personal growth (being able to learn from the stresses and challenges of life). ⁴

The most rigorous studies measure combinations of these two axes and tend to report lower proportions with good positive mental health ⁴ .

Positive mental health

USA

The proportion of people with positive mental health varies with the definition used. Using the most rigorous definition, 16.6% of people were completely mentally healthy in a community sample in the USA. ⁴ Less rigorous definitions identify 47% to 75% as having good or moderate positive mental health. ^{2 5}

Keyes found in a 1994/1995 USA national probability sample of 3,032 respondents aged 25-74 yrs that 18% of people were “flourishing” and 19% of people were “languishing”. ⁴ 65% of people lay within these two scores.

Taking into account the presence or absence of mental illness (in this case one of four conditions: major depressive disorder, generalised anxiety disorder, panic disorder and alcohol dependency) alongside positive mental health, Keyes found that: 16.6 % were completely mentally healthy (flourishing and no mental illness); 50.6 % were moderately mentally healthy (moderate positive mental health and no mental illness); 9.8 % were pure languishing (low levels of positive mental health and no mental illness); 15.9 % had pure mental illness (mental illness and moderate or flourishing levels of positive mental health; and 7% had mental illness and were languishing

UK

A similar picture of mixed positive mental health with mental illness was found by Huppert and Whittington in a UK random sample of 6317 community dwelling adults aged 18 and over, conducted in 1984/1985 and repeated in 1991/1992 with 3778 survivors. ⁵ Using the positive answers to the positively worded questions of the General Health Questionnaire (GHQ30), overall, 47% had scores in the upper half of the range. The positively worded questions in the GHQ covered both hedononic (“been feeling reasonably happy all things considered”; been able to enjoy normal day-to-day activities) and heudaimonic elements of psychological functioning (questions covering how well tasks were done, how well you were managing and facing up to problems; how well decisions were made and how good social relationships were).

The usual scoring for the GHQ measures psychological distress. Combining this with the positive GHQ score, the following was found: 29.6% were mentally healthy (i.e. were in the lower half of the mental health problem score of the GHQ and were in the upper half of positive mental health scores); 18.1% had no mental health problems and low positive mental health (similar to the pure languishing group); 17% had mental health problems and good positive mental health; and 35% had mental health problems and low positive mental health.

Europe

The European Commission Eurobarometer survey for 2005 reported that 75% of people in the UK were happy “all or most of the time” compared to 65% average in Europe. The top three countries were Holland (83%), Ireland 82%, and Belgium 80%. ²

Trends in positive mental health

A study by Diener compiled data in the United States that shows no rise in levels of subjective well-being over forty years in America (Figure 1). During this time income levels rose 240% after adjusting for inflation. ⁶

Figure 1. United States income and subjective well-being (SWB), 1946–1989. Income is percentage of after-tax disposable personal income in 1946 dollars (adjusted for inflation). Subjective wellbeing is reports of happiness as percentage values of the 1946 values. ⁶

Common mental illnesses

An estimated one in six adults in the UK have a common mental illness (16.4%): 19.4% of women and 13.5% of men. ⁷ Figure 2 shows that mixed anxiety and depression is the most common disorder and panic disorder the least common.

There has been no significant change in rates of common mental illness between 1993 and 2000. In 1993, the overall rate of any common mental illness was 16.3 per 1000. ⁷

Rates of any common mental illness are higher among women, those aged 40 to 54 years, people who are separated or divorced, and those living as a one person family unit or as a lone parent. Those from a South Asian background (Indian, Pakistani or Bangladeshi) had higher rates (19.2%), whilst those from ethnic backgrounds other than white, black or South Asian had the highest rates (20.4%). People living in the North West of England had the highest rates of any common mental illness (20.3%) and those in Scotland had the lowest (14.1%). ⁷

Severe mental illnesses

The most common severe mental illnesses are psychotic disorders such as schizophrenia and bipolar affective disorders. The Office of National Statistics survey conducted in 2000 screened for psychotic disorders by identifying the number who were positive on two or more of the following criteria: ⁷

1. A self-reported diagnosis or symptoms (such as mood swings or hearing voices) indicative of psychotic disorder;
2. Receiving anti-psychotic medication;
3. A history of admission to a mental hospital; and
4. A positive answer to the question in the Psychosis Screening Questionnaire that referred to auditory hallucinations.

A proportion of the group positive on any of these criteria were checked by diagnostic interview and this result counted for those individuals. The resulting estimates are thought to be an underestimate as a result of this method but provide the best data estimates available for the UK.

Overall, 5 per 1000 people in the UK were thought to have a probable psychotic disorder between the ages of 16 and 74 years. Men and women had similar rates (6 per 1000 and 5 per 1000 respectively). The highest rates were between the ages of 30 and 54 years. For men, the peak was in the 30-34 year age group: 13 per 1000 and in women the peak rate was later in the 40-44 year age group: 12 per 1000. ⁵ Both black men and women had rates three times higher than white men and women. The rate was 18 per 1000 for black populations in the UK.