Beyond Ryff's scale: Comprehensive measures of eudaimonic well-being in clinical populations. A systematic review

Utilizing digital technologies to promote well-being in university students: the 'DigiWell' research protocol

The COVID-19 pandemic has significantly impacted the well-being of university students, particularly those in healthcare and medical programs. Psychological interventions rooted in positive psychology have proven effective in enhancing mental health, with online and digital delivery methods proving to be equally viable. This study aims to enhance mental health among Italian university students through digital interventions, including virtual reality, utilizing a stepped care approach. Specific objectives include implementing online positive interventions for students experiencing mild distress (DigiWell_Step 1), evaluating a Virtual-Reality intervention for moderate distress (DigiWell_Step 2), and identifying students experiencing high distress or optimal well-being. Cluster analyses and linear models will assess intervention outcomes. It is anticipated that students undergoing these steps will experience significant improvements in well-being and distress reduction, with sustained benefits at a three-month follow-up. This research contributes to understanding the efficacy of mental health interventions for university students, leveraging digital technologies to enhance accessibility and user engagement. The integration of digital technologies enhances the cost-effectiveness and engagement of interventions delivered through a stepped care approach tailored to the targeted population.

Measurement of flourishing: a scoping review

Introduction

Flourishing is an evolving wellbeing construct and outcome of interest across the social and biological sciences. Despite some conceptual advancements, there remains limited consensus on how to measure flourishing, as well as how to distinguish it from closely related wellbeing constructs, such as thriving and life satisfaction. This paper aims to provide an overview and comparison of the diverse scales that have been developed to measure flourishing among adolescent and adult populations to provide recommendations for future studies seeking to use flourishing as an outcome in social and biological research.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we conducted a scoping review across PubMed and EMBASE of studies introducing original flourishing scales (defined as a previously unpublished measure of mental health or wellbeing that used "flourishing" in its definition). Studies focusing on adult populations that were published before April 28, 2023 were considered eligible for inclusion.

Results

Out of 781 studies retrieved, we identified seven eligible studies covering seven unique flourishing scales. We find that all seven scales are multidimensional and assess features over monthly or yearly intervals. While most of the scales (six out of seven) include indicators of both hedonic and eudaimonic wellbeing, the operationalization of these dimensions of wellbeing varies considerably between scales. Several of the scales have been translated and validated across multiple geographical contexts, including higher- and lower-income countries.

Discussion

Complementing self-report measures with other social, economic, regional, and biological indicators of flourishing may be useful to provide holistic and widely applicable measures of wellbeing. This review contributes to concept validation efforts that can guide strategies to sustain flourishing societies.

Guiding Principles for the Practice of Integrative Physical Therapy

Integrative health is an emerging specialty inside multiple disciplines within the medical community, yet the practice of integrative physical therapy remains undefined. This perspective paper suggests a set of guiding principles to support the role of physical therapy in integrative health. These guiding principles, including therapeutic partnership, whole person health, living systems, movement as an integrative experience, and salutogenesis, are described and explored in-depth as they relate to all aspects of patient care and clinician experience. These guiding principles are articulated within the context of social determinants of health and the interrelated roles that environment, trauma, stress, and lifestyle all play within an integrative physical therapy plan of care. Examples of current integrative physical therapy practices that embody these principles are described. The 5 guiding principles are designed to elicit interprofessional inquiry into how integrative health models can be applied to the art and science of physical therapy practice. The expansion of integrative health into the field of physical therapy has the potential to improve individual and population health, as integrative physical therapy can be used to address prevention, health promotion, primary care, and wellness while acknowledging the complex, dynamic, and interconnected nature of the human condition.

IMPACT

This perspective article presents 5 guiding principles to establish a framework to define and shape the growing application of an integrative health model to physical therapy practice. These integrative physical therapy guiding principles aim to improve the quality of whole-person, patient-centered care.

Correlates between temporomandibular disorder severity, emotional distress, and eudaimonic well-being among young adults

OBJECTIVES

This study examined the correlates between severity of temporomandibular disorders (TMDs), emotional distress, and eudaimonic well-being.

SUBJECTS AND METHODS

TMD severity, negative emotions, and eudaimonia were assessed with the Fonseca Anamnestic Index (FAI), Depression, Anxiety, Stress Scales-21 (DASS-21), and Psychological Well-being Scale-18 (PWBS-18) in a cohort of community young adults. Statistical evaluations were done with non-parametric tests/correlation and multivariate regression analyses (α = 0.05).

RESULTS

Amongst the 873 participants (mean age 19.8 ± 1.66 years), 40.7%, 49.0%, and 10.3% had no (NT), mild (MT), and moderate-to-severe (ST) TMD, respectively. Significant differences in total-DASS, depression, anxiety, and stress were ST ≥ MT > NT. Significant variances in total-PWSB and self-acceptance were NT > MT > ST while that for environmental mastery, positive relations, and purpose in life were NT > MT, ST. An inverse relationship was discerned between total-DASS and total-PWBS (correlation coefficient = -0.54). The prospect of ST was increased by anxiety but reduced by positive relations and self-acceptance.

CONCLUSIONS

Young adults with mild and moderate-to-severe TMD experienced substantially higher emotional distress and lower eudaimonia than those with no TMD. As emotional distress and eudaimonic well-being are interrelated, positive psychological interventions may be beneficial for managing TMD-related psychosocial disabilities.

Crossover of Engagement Among Academic Staff and Students During COVID-19

Purpose

Globally, the pandemic had adverse consequences on the engagement and overall well-being of individuals. From a positive psychological perspective, this study drew on processes of social exchange, Kahn's theory on personal engagement and crossover theory, to explore the impact of mutual influences among academic staff and students on the engagement of both parties. Subsequently, the study explored the positive outcomes of engagement for both academic staff and students.

Participants and Methods

Purposive, non-probability sampling was used, and cross-sectional data were collected through electronic surveys. The sample consisted of a total of 1594 students who were nested within 160 academic staff members.

Results

Findings highlighted the influence of interpersonal factors such as high student leader-member exchange on student engagement and the impact of students' lack of reciprocity on the emotional engagement of academic staff. Findings further revealed that student engagement was positively related to a deep-learning approach and negatively related to a surface-learning approach. Furthermore, this study found a positive significant association between the emotional engagement and the psychological well-being of academic staff.

Conclusion

Against the backdrop of the COVID-19 pandemic and to reduce the negative psychological and behavioural challenges resulting from the pandemic, this research intended to inform policy-makers in higher education of the impact that mutual influences among academic staff and students have on their engagement and the benefits of engagement in cultivating a culture of life-long learning among students and improving the psychological well-being of academic staff.

Effects of Neuroticism on Differences in Symptom Structure of Life Satisfaction and Depression-Anxiety among College Students: A Network Analysis

Object: Numerous studies show that depression and anxiety have an adverse effect on life satisfaction among college students. Moreover, neuroticism affects depression, anxiety, and life satisfaction. Comparing the low-neuroticism and high-neuroticism groups, the current study used network analysis to examine the relationship between depression, anxiety, and life satisfaction among college students. Methods: A sample consisted of 1233 college students from China who completed the Big Five Inventory-2 (BFI-2), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Satisfaction With Life Scale (SWLS).All students were divided into two groups according to levels of neuroticism. Depression-anxiety symptom networks and flow networks were formed. Results: "Insomnia" (SAS19) and "Sleep disturbance" (SDS4) are bridge symptoms of groups with varying neuroticism. In addition, compared to the group with low levels of neuroticism, the group with high levels of neuroticism showed more depression symptoms in bridge symptoms and greater global strength. Many depression-anxiety symptoms are negatively associated with life satisfaction, and "Emptiness" (SDS18) is an important symptom in the high-neuroticism group's flow network. Conclusion: This study contributes to our understanding of the connection between depression, anxiety, neuroticism, and life satisfaction. In addition, the current study identified the essential symptoms to target in depression and anxiety intervention and life satisfaction enhancement among college students.

Student athlete well-being framework: an empirical examination of elite college student athletes

The current study proposes a multidimensional student athlete well-being framework (SAWBF). The authors used 12 items to capture SAWBF comprised of four well-being dimensions (i.e., physical, hedonic, psychological, and social well-being). To empirically assess the reliability and validity of the framework, data from elite collegiate student athletes in Japan (N = 546) were procured. The results indicated sufficient convergent and discriminant validities of SAWBF. The authors also assessed predictive validity correlations of the framework by focusing on the oft-supported well-being outcome-organizational citizenship behavior, which were also found to be associated with SAWBF. The findings indicated the usefulness of SAWBF; and coaches and staff members can utilize the framework to multi-dimensionally understand well-being status of their student athletes, potentially boosting adaptive behaviors.

Humility, Personality, and Psychological Functioning

As part of the shift to a more positive psychology, researchers have demonstrated a relatively new and intense fascination with humility. Following a discussion of this construct and its correlates, we investigate how humility relates to personality dimensions, anxiety and depression, love of life and happiness, and self-efficacy in two samples-college students and adult Mturk workers. In both studies, we used the Dual Dimension Humility Scale, a measure that does not conflate the construct with honesty. Among students (N = 399), aspects humility correlated with dimensions of personality (more conscientiousness and openness, and less agreeableness and neuroticism), less depression, more love of life and happiness, and stronger social self-efficacy. Although fewer associations were found, overall, among adults (N = 509), aspects of humility correlated with dimensions of personality, less anxiety, and some dimensions of psychological well-being. The most unique contributions of this study include linking humility with college students' love of life and self-efficacy, and with adults' well-being. We conclude with a discussion of ideas for future research and potential applications to boost humility.

Eudaimonic well-being in individuals with mild to moderate intellectual disability

BACKGROUND

Subjective well-being research in individuals with intellectual disability (ID) has a large hedonic focus and eudaimonic well-being is understudied in this population. Knowledge on eudaimonic well-being of individuals with ID is however necessary to improve their experienced well-being and support them in leading meaningful and flourishing lives.

AIMS

The current study adopted a qualitative design to examine whether and how people with ID experience elements of eudaimonic well-being.

METHODS AND PROCEDURES

Eleven adults with mild to moderate ID participated in individual semi-structured interviews about their subjective well-being. Interviews with their relatives and their direct support providers were conducted to contextualize the data.

OUTCOMES AND RESULTS

By means of an interpretative phenomenological analysis, social relationships, accomplishment, purpose and balance, individuality, autonomy, and growth could be identified as relevant elements of eudaimonic well-being. Eudaimonic well-being of individuals with ID seemed to be mediated by acceptance of others.

CONCLUSIONS AND IMPLICATIONS

The results provide insight in eudaimonic indicators of well-being, expanding the current view on well-being in individuals with ID. Efforts to use these elements in the care and support for individuals with ID are discussed.

Development and validation of the Thai mental well-being scale

Mental well-being is a state of positive mental health, but there is currently no valid tool for assessing mental well-being in the Thai population. The purpose of this research was to develop and validate a mental well-being scale for Thai people. Data from 2000 Thai citizens were analyzed to explore the structural components of mental well-being. Exploratory factor analysis (n = 1000) was conducted and determined a mental well-being factor structure consisting of three factors: 1) positive emotion and thinking, 2) positive relationship and 3) positive functioning. Confirmatory factor analysis of a validation group (n = 1000) identified 10 items within these three factors of mental well-being. Psychometric analyses supported internal consistency reliability, as well as convergent and discriminant validity of the scale. The findings suggest that the construction of this new mental well-being scale for Thai people is reliable and valid. This scale will be a useful tool for addressing and identifying mental health problems among the Thai population.

Development and psychometric assessment of a psychological well-being instrument for adults with mild intellectual disability or borderline intellectual functioning

BACKGROUND

Measuring eudaimonic well-being is important to gain a complete picture of the well-being of individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF), but there is no measurement instrument available for this population coding for multiple dimensions of eudaimonic well-being.

AIMS

The current study developed and piloted a new instrument coding for eudaimonic well-being in individuals with MID-BIF.

METHODS AND PROCEDURES

The instrument (SPWB-ID) was adapted from Ryff's scales of psychological well-being, including subscales addressing purpose in life, environmental mastery, positive relationships, self-acceptance, personal growth, and autonomy. Adaptations were based on the literature and interviews with people with MID-BIF and experts in the field. The SPWB-ID was piloted among 103 adults with MID-BIF.

OUTCOMES AND RESULTS

The trimmed version of the SPWB-ID showed sufficient to good internal consistency and test-retest reliability. Hypothesis testing for construct validity suggested the subscales of the SPWB-ID measured well-being, showing moderate to high correlations with quality of life, and differences in eudaimonic well-being between participants with and without clinically relevant depression scores.

CONCLUSIONS AND IMPLICATIONS

The SPWB-ID reliably measures eudaimonic well-being in individuals with MID-BIF. This enables support providers to collect information on eudaimonic well-being, providing input for person-centred care and support for individuals with MID-BIF.

Positive and meaningful lives: Systematic review and meta-analysis of eudaimonic well-being in first-episode psychosis

BACKGROUND

First-episode psychosis typically has its onset during adolescence. Prolonged deficits in social functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for understanding these deficits. Eudaimonic well-being (EWB), or positive self-development, is a developmental psychology construct that has been shown to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP.

AIM

Our aim was to systematically review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP.

METHODS

Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for full screening which produced 17 final papers with 2459 participants.

RESULTS

Studies comprised six RCTs, eight prospective follow-up studies and three case-controlled studies. Self-esteem and self-efficacy were the most commonly measured components. A meta-analysis of RCTs revealed no statistically significant effect of interventions on self-esteem. The extant research indicates that character strengths may be associated with higher EWB. Self-esteem may be lower in FEP compared with age matched controls but not different from ultra-high risk patients. Self-esteem appears to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed studies were apparent.

CONCLUSIONS

The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP.

The relationship between depressive symptoms, general psychopathology, and well-being in patients with major depressive disorder

OBJECTIVE

In mental health care, treatment effects are commonly monitored by symptom severity measures. This study aimed to investigate the relationship between symptom severity and well-being in the treatment of patients with major depressive disorder (MDD).

METHODS

Adult MDD outpatients (n = 77) were administered the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR), the Outcome Questionnaire (OQ-45), and the Mental Health Continuum-Short Form (MHC-SF) before treatment and 6 months later.

RESULTS

Symptom severity correlated moderately with well-being at baseline and strongly at follow-up. Reliable change index scores showed improvement on the QIDS-SR, OQ-45, and MHC-SF in 65%, 59%, and 40%, respectively. A quarter of patients improved in symptom severity but not well-being (Inventory of Depressive Symptomatology-Self-Report [IDS-SR]: 25%; OQ-45: 24%).

CONCLUSION

Findings suggest that symptom severity and subjective well-being are related, but distinct concepts. Several reasons for the stronger improvements in symptoms than in well-being are discussed.

Optimal Well-being, Depression, and Caregiving: An Explorative Investigation

OBJECTIVES

Recent studies documented the protective role of hedonic and psychological well-being for mental and physical health of aging individuals. However, the combination of these two dimensions of well-being (conceptualized as optimal well-being) has been rarely evaluated in association with providing caregiving. This exploratory investigation aimed to: (1) cluster a group of community dwellers according to levels of hedonic and psychological well-being (low well-being-LWB; moderate well-being-MWB; high well-being HWB); and (2) to identify their psychosocial correlates of their optimal well-being, including providing daily caregiving.

METHODS

217 community dwellers (60-90 years) completed questionnaires concerning psychological well-being, life satisfaction, and caregivers' distress. They were classified into three groups (LWB, MWB, HWB), following a k mean cluster analysis. Chi-square and GLM were used to compare the three clusters. Regression analyses were performed to evaluate the correlates of hedonic and psychological well-being.

RESULTS

Fifty-two individuals belonged to the HWB cluster, 68 to the LWB cluster and 97 to the MWB cluster. Individuals in the LWB cluster showed higher levels of anxiety and depression, and 61 of them reported to provide caregiving. Members of the HWB cluster were the oldest. Psychological and hedonic well-being negatively correlated with depression and caregiving.

CONCLUSIONS

These results indicate that only a small proportion of community dwellers reported optimal well-being.

CLINICAL IMPLICATIONS

Addressing depression and alleviating caregiver distress may constitute ingredients for promoting optimal well-being among older community dwellers.

Spotlight on eudaimonia and depression. A systematic review of the literature over the past 5 years

BACKGROUND AND AIM

Recent investigations pointed out to the important role of well-being in influencing physical and mental health, with robust findings for the dimension of depression. The aim of this systematic review is to provide an updated summary of articles focused on eudaimonia and depression, including psychosocial interventions that addressed both issues.

METHOD

The literature search was performed by entering the keywords: "eudaimonia" OR "eudaimonic well-being (EWB)" and "depression" and by limiting to "journal article" and to the English language. To be included in this, review articles had to present at least one EWB measure and one depression measure, and had to investigate young and adult populations, including populations with mental health disorders. Articles were excluded if they were published before 2014.

RESULTS

Thirty-four articles were included, with a total of 81,987 participants. About the majority of participants were recruited in two twin studies, followed by college students, and by adults belonging to the general and clinical populations. Sixteen different instruments assessed eudaimonia, being Ryff's psychological well-being scale the most frequently used. The most used instrument for assessing depression was the Depression Anxiety Stress Scale, followed by Center for Epidemiological Studies Depression Scale. The studies confirmed the robust, inverse correlation between eudaimonia and depression, which was only partially explained by genetic common factors and which was mediated by other factors, as self-compassion, personality traits, and defense mechanisms. Various interventions were found to be effective both in promoting eudaimonia and in addressing depression, ranging from cognitive-behavioral therapy, acceptance and commitment therapy, mindfulness, to positive psychotherapy.

CONCLUSION

Clinicians, counselors, and practitioners can select different strategies to promote EWB and to address depression. The findings also suggest the need for a larger consensus on the definition of eudaimonia and on the specific measure(s) to evaluate it in different populations and in different life stages.

Recovery from mood and anxiety disorders: The influence of positive mental health

BACKGROUND

Mood and anxiety disorders are associated with growing burden of disease. Recent evidence shows that monitoring and enhancing positive mental health might be one direction to reduce this burden. The aim was to determine whether positive mental health predict recovery from mental disorders.

METHODS

The study population consisted of 414 participants with a 12-month disorder from the representative general population Netherlands Mental Health Survey and Incidence Study-2. Independent positive mental health indicators were mental well-being, its subscales emotional, social and psychological well-being and the category flourishing mental health. Recovery was defined as no longer fulfilling DSM-IV criteria of the index disorder 3 years later.

RESULTS

Despite meeting the criteria of a 12-month mental disorder, 19% with anxiety disorder were flourishing and 14% with mood disorder. Logistic regression analyses controlled for sociodemographics, physical health, life-events, service use, psychotropic medication, comorbidity and clinical severity showed that positive mental health positively influenced recovery from anxiety disorder (mainly by emotional and psychological well-being) and did not influence recovery from mood disorder.

LIMITATIONS

The results are not generalizable to psychiatric patients in treatment settings and might differ for specific disorders within each DSM-IV category.

CONCLUSIONS

Clinicians are encouraged to measure positive mental health in their patients and to improve positive mental health particularly in people with an anxiety disorder. The non-significant relation between positive mental health and recovery from mood disorder warrants further research, for example through using more in-depth assessment of positive mental health components and by investigating recovery from less severe mood disorders.

Eudaimonic Well-Being and Coping with Stress in University Students: The Mediating/Moderating Role of Self-Efficacy

The importance of personal psychological resources in preventing academic stress has enjoyed little attention to date, despite the high rates of stress that exist among university students. This article analyzes the effect of eudaimonic well-being on the use of adaptive strategies for coping with academic stress. Moreover, it analyzes the role of self-efficacy as a mediator and moderator of this relationship. In the mediation model, gender is included as a co-variable; in the moderation model, gender is included as a moderator. A total of 1402 university students participated in the study. The data were gathered through validated self-report instruments. The mediation analyses were performed using the PROCESS module of the statistical package, SPSS. The moderating effects of self-efficacy and gender were analyzed through hierarchical regression analysis. The results indicate that self-efficacy partially mediates but does not moderate the relationship between eudaimonic well-being and adaptive coping strategies. This finding reveals the benefits of using these two personal resources to enhance effective coping with academic stress while attending university.

Validation of the Mental Health Continuum-Short Form and the dual continua model of well-being and psychopathology in an adult mental health setting

OBJECTIVE

The growing evidence for the dual continua model of psychopathology and well-being has important implications for measuring outcomes in mental health care. The aim of the current study is to validate a measure of well-being as well as the dual continua model in adults with mood, anxiety, personality, and developmental disorders.

METHODS

472 adult psychiatric outpatients filled out the Mental Health Continuum-Short Form (MHC-SF) and the Outcome Questionnaire before start of treatment.

RESULTS

Confirmatory factor analyses (CFA) confirmed the three-factor structure of emotional, psychological, and social well-being of the MHC-SF. The dual continua model had the best fit in the complete sample and the different diagnostic groups.

CONCLUSION

The MHC-SF is a reliable and valid instrument to measure well-being in the psychiatric population. Although relatively high correlations between psychopathology and well-being exist, the results underline the importance to measure well-being in addition to psychopathology in mental health care.

Adolescents' Psychological Well-Being: A Multidimensional Measure

Over the last few years, different theoretical approaches have emerged advocating for a positive understanding of adolescence, recognizing it as a stage characterized by plasticity, the acquisition of competences and the achievement of satisfactory levels of well-being and positive adjustment. Based on Ryff's multidimensional model of psychological well-being, this study aims: (1) to develop an adjusted measuring instrument for adolescents (Brief Scale of Psychological Well-Being for Adolescents), as well as analysing its psychometric properties; and (2) to conduct a descriptive analysis of the levels of psychological and subjective well-being among adolescent boys and girls. A sample of 1590 Andalusian adolescents (51% girls), aged between 13 and 19 years old participated in this study. The Confirmatory Factor Analysis (CFA) showed the validity of the instrument, with a multidimensional factorial solution of four factors (self-acceptance, positive interpersonal relationships, autonomy and life development) with good levels of internal consistency. Descriptive analyses showed good scores of psychological and subjective well-being among the adolescents, with a significant impact of sex and age in both measures of well-being. The results are discussed in terms of the importance of considering adolescent well-being from a multidimensional view and the need to promote positive development from a multifactorial perspective which takes into account the diversity of the variables involved.