Advancing our understanding of mental wellbeing and mental health: The call to embrace complexity over simplification

A review of the literature on wellbeing and modifiable dementia risk factors

Wellbeing-defined broadly as experiencing one's life as enjoyable and fulfilling-has been associated with lower risk for Alzheimer's disease and related dementias. The mechanisms underlying this association are largely unknown. However, prior research and theory suggest that wellbeing impacts health behaviors and biological systems that are relevant to cognitive and brain health. Several of these factors have also been identified by the 2020 Lancet Commission on Dementia Prevention, Intervention, and Care as modifiable dementia risk factors. In the current review, we summarize and evaluate the evidence for associations between wellbeing and each of the 12 Lancet Commission risk factors. We found relatively consistent evidence for associations between higher wellbeing and lower levels of most of the risk factors: physical inactivity, social isolation, smoking, depression, hypertension, diabetes, hearing loss, traumatic brain injury, and air pollution. By contrast, we found evidence for only modest associations between wellbeing and education and mixed evidence for associations of wellbeing with alcohol use and body weight. Although most of the reviewed evidence was observational, longitudinal and experimental evidence suggests that many of the observed associations are likely bidirectional. These findings suggest that modifiable dementia risk factors may be mediators (i.e., intermediate steps in the causal chain) and/or confounders (i.e., variables that impact both wellbeing and dementia, and thus could induce a spurious association) of the association between wellbeing and dementia. We conclude by discussing next steps to test mediation hypotheses and to account for potential confounding in the relation between wellbeing and dementia.

Psychometric validation of the PERMA-profiler for well-being in Chinese adults

Well-being is one of the central topics in psychology, and research on this topic has shifted from emotional experiences to flourishing life in recent years. Seligman's PERMA model is a prominent theory in this shift. However, this model is proposed in Western culture and has yet to be empirically validated in the Chinese context. The present research aims to examine the applicability of the five-dimension PERMA-Profiler in Chinese culture, which has been developed based on the PERMA model. A sample of 1468 Chinese adults participated in the research. After translation and validation, a series of psychometric analyses were conducted to examine the internal consistency reliability, construct validity, convergent and discriminant validity, and factorial invariance across genders. The PERMA-Profiler Chinese showed high Cronbach's alpha coefficients (α = 0.79-0.88), good divergent (r = -0.19 to -0.38) and convergent validity (r = 0.53-0.85), as well as satisfactory structural validity. Results of the structural validity demonstrated a better fit to the first-order model with five correlated factors after modification (χ2/df = 4.65, RMSEA = 0.058, SRMR = 0.030, CFI = 0.943, TLI = 0.924) than the second-order model with a higher-order factor of well-being. However, the engagement dimension of the PERMA-Profiler Chinese could be improved further. In conclusion, the PERMA model is applicable to the Chinese culture, and the PERMA-Profiler provides a valid measure of well-being for Chinese adults.

Psychological distress, wellbeing and resilience: modelling adolescent mental health profiles during the COVID-19 pandemic

There has been concern about adolescent mental health during the pandemic. The current study examined adolescent mental health during the initial phase of the COVID-19 pandemic in the UK. Using indicator of psychological distress, wellbeing and resilience, latent profile analysis was used to identify homogeneous mental health groups among young people aged 13-24 (N = 1971). Multinomial logistic regression was then used to examine which sociodemographic and psychosocial variables predicted latent class membership. Four classes were found. The largest class (Class 1, 37.2%) was characterised by moderate symptomology and moderate wellbeing. Class 2 (34.2%) was characterised by low symptomology and high wellbeing, while Class 3 (25.4%) was characterised by moderate symptomology and high wellbeing. Finally, Class 4 was the smallest (3.2%) and was characterised by high symptomology and low wellbeing. Compared to the low symptomology, high wellbeing class, all other classes were associated with less social engagement with friends, poorer family functioning, greater somatic symptoms, and a less positive model of self. A number of unique associations between the classes and predictor variables were identified. Although around two-thirds of adolescents reported moderate-to-high symptomology, most of these individuals also reported concurrent moderate-to-high levels of wellbeing, reflecting resilience. Furthermore, these findings demonstrate how a more comprehensive picture of mental health can be gained through adopting a dual-continua conceptualisation of mental health that incorporates both pathology and well-being. In this way, at-risk youth can be identified and interventions and resources targeted appropriately.

Temporomandibular disorder pain in older adolescents-young adults: Interrelationship with somatic burden, mental ill-being, and well-being

OBJECTIVES

The associations of Temporomandibular disorder (TMD) pain with somatic symptoms, mental ill-being/distress, and well-being were explored, along with the mental correlates of TMD (TS) and somatic symptom (SS) burden in older adolescents-young adults.

METHODS

TMD/somatic symptoms were appraised with the five quintessential symptoms (5Ts) of the DC/TMD/Somatic Symptom Scale-8, whereas mental distress/well-being was assessed with the Depression, Anxiety, Stress Scales-21/Scales of Psychological Well-being-18. Data were examined using Chi-square/non-parametric tests and multivariate analyses (α = .05).

RESULTS

Among the 366 participants, 51.4%, 28.1%, 6.8%, and 13.7% had no TMD (NT), TMD pain (TP), TMD dysfunction (TD), and combined TMD (CT) respectively. Though mental distress varied substantially (CT, TP>NT, TD), no significant differences in well-being were discerned. SS burden, but not TS burden, was moderately correlated to distress.

CONCLUSIONS

The prospect of TMD pain was increased by being female, depressed, and anxious but reduced by "positive relations with others" and "self-acceptance".

Identification of Predictors of Mood Disorder Misdiagnosis and Subsequent Help-Seeking Behavior in Individuals With Depressive Symptoms: Gradient-Boosted Tree Machine Learning Approach

BACKGROUND

Misdiagnosis and delayed help-seeking cause significant burden for individuals with mood disorders such as major depressive disorder and bipolar disorder. Misdiagnosis can lead to inappropriate treatment, while delayed help-seeking can result in more severe symptoms, functional impairment, and poor treatment response. Such challenges are common in individuals with major depressive disorder and bipolar disorder due to the overlap of symptoms with other mental and physical health conditions, as well as, stigma and insufficient understanding of these disorders.

OBJECTIVE

In this study, we aimed to identify factors that may contribute to mood disorder misdiagnosis and delayed help-seeking.

METHODS

Participants with current depressive symptoms were recruited online and data were collected using an extensive digital mental health questionnaire, with the World Health Organization World Mental Health Composite International Diagnostic Interview delivered via telephone. A series of predictive gradient-boosted tree algorithms were trained and validated to identify the most important predictors of misdiagnosis and subsequent help-seeking in misdiagnosed individuals.

RESULTS

The analysis included data from 924 symptomatic individuals for predicting misdiagnosis and from a subset of 379 misdiagnosed participants who provided follow-up information when predicting help-seeking. Models achieved good predictive power, with area under the receiver operating characteristic curve of 0.75 and 0.71 for misdiagnosis and help-seeking, respectively. The most predictive features with respect to misdiagnosis were high severity of depressed mood, instability of self-image, the involvement of a psychiatrist in diagnosing depression, higher age at depression diagnosis, and reckless spending. Regarding help-seeking behavior, the strongest predictors included shorter time elapsed since last speaking to a general practitioner about mental health, sleep problems disrupting daily tasks, taking antidepressant medication, and being diagnosed with depression at younger ages.

CONCLUSIONS

This study provides a novel, machine learning-based approach to understand the interplay of factors that may contribute to the misdiagnosis and subsequent help-seeking in patients experiencing low mood. The present findings can inform the development of targeted interventions to improve early detection and appropriate treatment of individuals with mood disorders.

Wellbeing-responsive community: a growth target for intentional mental health promotion

With mental illness remaining a significant burden of disease, there is an ongoing need for community-based health promotion, prevention, and responses (or "mental health promotion activities"). The health promotion, community development, and positive psychology literature identifies significant heterogeneity in the design and delivery of these activities. This variability spans: (1) individual vs. group outcomes, (2) psychological vs. sociological determinants of change, (3) promoting wellbeing vs. reducing mental health symptoms, and (4) the degree activities are contextualized vs. standardized in design and delivery. Mental health promotion activities do not easily accomplish this level of complexity within design and implementation. This has led to the emergence of the complexity-informed health promotion literature and the need for innovative tools, methods, and theories to drive this endeavor. This article directly responds to this call. It introduces "wellbeing-responsive community": a vision and outcome hierarchy (or growth target) for intentionally delivered mental health promotion. The construct enables the design and implementation of interventions that intentionally respond to complexity and contextualization through the drivers of co-creation, intentionality, and local empowerment. It represents a community (support team, programme, agency, network, school, or region) that has the shared language, knowledge, methods, and skills to work together in shared intent. In other words, to integrate best-practice science with their local knowledge systems and existing strengths, and intentionally co-create and deliver contextualized wellbeing solutions at both the individual and community levels that span the "system" (e.g., whole-of-community) to the "moment" (e.g., intentional support and care). Co-creation, as applied through a transdisciplinary lens, is emerging as an evidence-based method to respond to complexity. This article describes the rationale and evidence underpinning the conceptualization of a wellbeing-responsive community through the integration of three key disciplines: (1) positive psychology, (2) ecological or systems approaches, and (3) intentional practice (implementation science). A definitional, contextual, and applied overview of the wellbeing-responsive community is provided, including a hierarchy of outcomes and associated definitions. Its purported application across education, mental health, community service, and organizational settings is discussed, including its potential role in making complexity-informed health promotion practical for all knowledge users.

Reciprocal Associations between Depressive Symptoms, Life Satisfaction, and Eudaimonic Well-Being in Older Adults over a 16-Year Period

The dual-continua model of mental health distinguishes between mental illness (presence of mental disorders, such as depression) and mental well-being (presence of positive traits and abilities). This model also distinguishes between hedonic well-being (e.g., affect balance and life satisfaction) and eudaimonic well-being (i.e., optimal psychological and social functioning, as indicated for example by having a purpose in life). We examined the relationships between depressive symptoms (a common indicator of mental illness), life satisfaction, and eudaimonic well-being. The study used a sample of 17,056 participants from England whose data were collected at eight intervals of approximately two years over a 16-year period, from 2004 to 2019. The mean age of the sample in the first wave was 58.843 years, with a standard deviation of 12.617 years (women = 55.2%). We disentangled within- and between-person sources of variance to examine whether increases or decreases in one variable preceded changes in the other variables at the next time point. We found positive reciprocal relationships between life satisfaction and eudaimonic well-being and negative reciprocal relationships between the two well-being dimensions and depressive symptoms. These results suggest that within-person increases in well-being are followed by future decreases in depressive symptoms, and within-person increases in depressive symptoms are followed by future decreases in well-being. Therefore, low levels of mental well-being in older adults may be considered a risk factor for depression, and well-being interventions (such as those focused on meaning-making) may serve as a protective factor against depression in older adults.

Character strengths and mental health as complex systems: a network analysis to identify bridge strengths

The network approach poses an alternative focus to understand psychological constructs as emerging from mutual interactions among indicators. Network psychometrics has been applied to psychopathology to unravel the connections between symptoms, but it can also be applied to the study of well-being. The role of character strengths in mental health is at the forefront of research attention. Previous findings suggest that heart character strengths are more predictive of mental health than mind character strengths. Nevertheless, researchers have rarely applied the network approach in this context. The present study examines, from the network approach, the connections between heart and mind character strengths and mental health. Building upon the dual-factor model of mental health, positive (i.e., happiness and life satisfaction) and negative indicators (i.e., depression) were included in the assessment of this construct. A sample of 597 Spanish undergraduates (M = 23.52; SD = 5.25; 75.6% females) completed cross-sectional self-report measures. Network analysis was used to estimate a network composed of two communities: character strengths and mental health. We used centrality analysis to calculate the importance of each node and bridge centrality to examine the interactions between the communities. The results indicated that the heart strengths of love, zest, hope, and gratitude reported the highest bridge strength centrality, suggesting that they played an intermediary role activating and deactivating components of mental health. Adopting the network approach to explore the connections between character strengths and mental health can help design focused intervention strategies in psychology.

Caring for carers: Understanding the physical and psychological well-being of carers of veterans in Australia

Carers of veterans tend to put their own physical and psychological well-being needs behind the needs of the person they are caring for and often do not seek assistance for their own physical and psychological well-being. Combined, these factors lead to increased risk of acute and chronic illness and mental health issues. It is acknowledged that physical activity independently contributes to improved physical and mental health and may be a driver for mental well-being in carers. The aim of this pilot research was to understand how movement behaviour and health behaviours of carers of veterans in Australia relate to carers' physical and psychological well-being. Assessment occurred between February and July 2019 and included objective, validated measures to examine physical and psychological well-being. To assess the association between physical and psychological factors, correlational analyses were performed. Twenty-eight carers participated in the pilot study (96% female, mean age 61.6 years). Exercise capacity varied, and 84% of carers met the recommended 150 min of physical activity per week, with carers spending 8.6% of their time in moderate-to-vigorous physical activity; and 37.9% of the day sedentary. Psychological health outcomes reflect a population with high distress levels and lower than average mental well-being, but with normal resilience scores. Carers with higher levels of resilience had greater exercise capacity, covering further distance in the 6-min walk test, and as resilience increased, number of sedentary bouts decreased. This research demonstrates that there is a relationship between health behaviours and psychological well-being in carers of veterans and serving personnel. Based on the findings of this pilot study, programmes to support family carers should include information about physical activity, reducing sedentary time, and increasing resilience. Interventions designed to improve physical and psychological well-being should be trialled and evaluated for effectiveness.

Acceptability, Engagement, and Exploratory Outcomes of an Emotional Well-being App: Mixed Methods Preliminary Evaluation and Descriptive Analysis

BACKGROUND

There is growing evidence suggesting that the emotional well-being of the public has been negatively affected in the past year. Consequently, demand for well-being support has increased. Although there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional well-being apps. Among existing well-being apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance users' understanding of their emotional patterns. Thus, the acceptability of these novel apps requires further evaluation before upscaling.

OBJECTIVE

This evaluation aims to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional well-being and positive mental health.

METHODS

This is a pre-post, mixed-methods, single-arm evaluation that is aggregated with digital analytics data. We anonymously collected real-world data on the demographics and well-being of the participants as well as the usability and acceptance of the app using validated questionnaires and open-ended questions. Participants tested the app for a minimum of 2 weeks before completing the follow-up measures. Google Analytics was used to record the level of app engagement. Chi-square and 2-tailed t tests were conducted to analyze quantitative data, and a thematic analysis approach was adopted for qualitative data.

RESULTS

A total of 115 participants completed baseline questionnaires, of which 79.1% (91/115) users downloaded the app. The sample was diverse in terms of ethnicity, including 43.4% (50/115) people who self-identified as belonging to minority ethnic groups. Most of the participants were female (78/115, 67.8%) and between the ages of 18 and 25 years (39/115, 33.9%). A total of 34 app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform the future directions of Paradym. Favorable themes emerged describing the app's content, functionality, and underlying principles. Although usability feedback varied across items, a considerable number of participants (22/34, 64%) found that the app was easy to use. Google Analytics revealed that at least 79% (27/34) of people used the app daily. On the basis of preliminary observations, app users experience increased mental well-being. Post hoc analyses indicated that the reduction in depression scores (t₃₃=-2.16) and the increase in the well-being measures (t₃₃=2.87) were statistically significant. No adverse events were reported during the follow-up period.

CONCLUSIONS

The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app.

Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study

BACKGROUND

During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level.

OBJECTIVE

This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress).

METHODS

A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively.

RESULTS

The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks Λ=.71; partial η2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (η2=.22 and η2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only.

CONCLUSIONS

The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness.

Attitude toward Aging Mediates the Relationship between Personality and Mental Health in Older Adults

This study aimed to examine attitude toward aging as a potential mediator of the relationship between personality factors and mental health in terms of depression and life satisfaction among older adults. A cross-sectional study was conducted with 438 Ethiopian elderly individuals aged 60 to 69. The results of the regression-based path analysis showed that after adjusting for demographic data, the relationship between agreeableness and depression in older adults was partially mediated by attitude toward aging. Likewise, attitude toward physical change due to aging and psychological growth subscales jointly mediated the correlation between neuroticism and depression. However, a significant direct path between neuroticism and depression persisted. On the contrary, openness had no significant direct association with depression apart from an indirect through psychosocial loss. The link between life satisfaction and agreeableness as well as openness to experience were partially mediated by psychosocial loss. Therefore, a person’s attitude toward aging and personality characteristics should be taken into consideration while designing interventions for managing mental health issues among older adults.

A systematic review and meta-analysis of psychological interventions to improve mental wellbeing

Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.