If You Want Mentally Healthy Children,
Start Promoting It
Corey KeyesProfessor of Sociology
Mental Health
Why Conception Matters
– From trephening, exorcism, whirling, confinement, bloodletting, burning at the stake;
– To asylums;– To mesmerism, hypnosis, and psychoanalysis;– To institutionalization, sedating, restraining, shocking;– To de-institutionalization;– To community mental health centers;– To proliferation of talk therapies;– To SSRI’s and deep brain stimulation;– To …?
Prognosis: Mental Illness ca 21st Century
Good News
• 10-14 Disorders • 80-90% Benefit• SSRIs
fewer side-effects helps 7 of 10
• Public awareness
Bad News
• Brief Remission • 3 of 10 Drug-Resistant• Prevalent
20 to 30% Annually50% Lifetime
• Comorbid• Age-of-Onset• Recurrent
Prognosis: Mental Health ca 21st Century
Palliative
How Would You Describe the Current Approach to Population
Mental Health?
The definition of insanity is doing the same thing over
and over and expecting different results
Benjamin Franklin
What We Say
• The mission of public health is “to protect and improve American health”
– (www.surgeongeneral.gov)
• . . . assure society’s collective interest in creating the conditions in which people can be healthy
– (Institute of Medicine, 1988, 1996, 2003)
• . . . ensure that good health, as well as long life, are enjoyed by all – (www.healthypeople.gov)
What We Do
• Reduce leading causes of death
• Reduce incidence and prevalence of illness
• The NIMH seeks “To improve this nation’s mental health . . . “ by supporting ”. . . a wide range of research related to the etiology, diagnosis, treatment, and prevention of mental disorders“ – (National Institute of Mental Health, 1995, p.1).
– Cure therapeutics (Insel & Scolnick, 2006)
We Must Stop
Saying One Thing
and Doing Another
Pathos Salus
Hale
Triangulation of Health
Flourishing
Eudaimonia Hedonia
Mental Health From the Salutogenic Perspective
??
Appetite or Weight Change
Insomnia or Hypersomnia
Worthlessness or Guilt
Fatigue, Loss of Energy
Indecisiveness, Lack Concentration
Psychomotor Agitation, Retardation
Major Depression
Malfunctioning Anhedonia
Loss of Pleasure or Interest in Life
Depressed Mood
Suicide Ideation
Mental Health from the Pathogenic Perspective
Hedonia
Positive Affect
• cheerful • in good spirits• happy• calm and peaceful• satisfied• full of life
Avowed QOL
• Satisfaction with life• Happy with life• Interest in life
Emotional Well-Being
Eudaimonia
1. Self-Acceptance2. Personal Growth3. Purpose in Life4. Environmental Mastery5. Positive Relations 6. Autonomy
1. Social Acceptance2. Social Growth/Potential3. Social Contribution4. Social Interest/Coherence5. Social Integration
Psychological
Well-Being
Me or I
Social
Well-Being
We or Us
During the past two weeks, how often did you feel …
NEVER
ONCE OR
TWICE
ABOUT ONCE A WEEK
ABOUT 2 OR 3 TIMES A
WEEKALMOST
EVERY DAYEVERY
DAY
1. happy
2. interested in life
3. satisfied
4. that you had something important to contribute to society
5. that you belonged to a community (like a social group, or your neighborhood)
6. that our society is becoming a better place for people like you
7. that people are basically good
8. that the way our society works makes sense to you
9. that you liked most parts of your personality
10. good at managing the responsibilities of your daily life
11. that you had warm and trusting relationships with others
12. that you have experiences that challenge you to grow and become a better person
13. confident to think or express your own ideas and opinions
14. that your life has a sense of direction or meaning to it
Mental Health Continuum-Short Form
Flourishing
Eudaimonia Hedonia
Mental Health From the Salutogenic Perspective
Psychological Well-Being
Social Well-Being
Emotional Well-Being
Feeling and Functioning Well
• Three Factor Structure
– In U.S. Adolescents • (Keyes, 2004)
– In U.S. College Students • (Robitschek & Keyes, in press)• (Keyes and Eisenberg, in progress)
– In U.S. Adults • (Keyes, 1996)
– In Black Setswana-speaking South African Adults• (Keyes et al., 2008)
– In Dutch Adult Population • (Westerhof & Keyes, in progress)
The DSM Approach to the Mental Health Continuum
• Flourishing– “almost every day” or “every day”
• 1 of 3 emotional well-being• 6 of 11 positive functioning
• Moderate Mental Health
• Languishing– “once or twice” or “never”
• 1 of 3 emotional well-being• 6 of 11 positive functioning
Are We Stuck in One Dimension?
The Dual Continua Model
High HDL
Low HDL
High LDL Low LDL
Mental Health
- .68
Emotional Well-Being
Psychological Well-Being
Social Well-Being
Mental Illness
CDI-10
Item 1
CDI-10
Item 9
CDI-10
Item 10
. . .
The Structure of Mental Health and Illness
U.S. Adolescent Population (Keyes, 2008)
Mental Health
- .52
Emotional Well-Being
Psychological Well-Being
Social Well-Being
Mental Illness
Major Depression
Panic Disorder
Generalized Anxiety
The Structure of Mental Health and Illness
U.S. Adult Population (Keyes, 2005)
Although the concept of positive mental health is one worth keeping in mind, it is not very helpful in classifying different persons, groups, or populations.
p. 2
Unfounded Biases Continue
Low
Low
High Mental Health
Symptoms
High Mental Illness
Symptoms
#1 Flourishing
#2 Moderate
#3 Languishing#6
Languishing & Mental Illness
Mental Health
#4 Flourishing & Mental
Illness
#5 Moderate Mental Health
& Mental Illness
The Hale Perspective
CDS 2002 Data, Ages 12-18
Summary of Research To Date:Anything Less Than Flourishing
In Adults• Chronic Physical Illness with Age (Keyes, 2005b)
• Cardiovascular Disease (Keyes, 2004a)
• Psychosocial Liabilities (Keyes, 2005b)
• Disability (Keyes, 2002)
• Productivity Losses (Keyes, 2002, 2007; Keyes & Grzywacz, 2005)
• Healthcare Use (Keyes & Grzywacz, 2005)
– Overnight Hospitalizations– Medical Visits
• Physical Health • Mental-Emotional Professional
– Prescription MedicationsIn Adolescents• Conduct Problems (Keyes, 2006)
• Psychosocial Deficits (Keyes, 2006)
• Missed Days of School (Keyes, in progress)
• Schooling Aspirations (Keyes, in progress)
1995 TotalScore on
MHC
2005Chronic
Conditions-.11
u2
1995 ChronicConditions
.54
1995 - 2005Total Score
on MHC
-.12
-.42
-.24
2005 TotalScore on
MHC
1995 - 2005Chronic
Conditions
-.11
.63
-.10
-.42
u1
-.09
.05
.05
Working Paper #1: MIDUS Adults in 1995 and 2005
6.5
8.6
43.7
2.2
1.5
1
4.6
0
1
2
3
4
5
6
7
8
9
10
Languishing 1995Languishing 2005
Flourishing orModerate MH 1995Languishing 2005
Languishing 1995Moderate MH 2005
Moderate MH 1995Moderate MH 2005
Flourishing 1995Moderate MH 2005
Languishing orModerate MH 1995
Flourishing 2005
Flourishing 1995Flourishing 2005
Any Mental Illness1995
Adjusted* Odds Ratio of any 2005 Mental Illness (MDE, GAD or Panic Disorder) by Change in Mental
Health Status (*Adjusted for Race, Age, Sex, Education, and Any Chronic Physical Condition in 2005)
ns
1995 2005
Flourishing Flourishing
Moderate Mental Health
Moderate Mental Health
Languishing Languishing
19.2% 22.3%
17.2%
63.6% 60.4%
17.3%
3.1%
46.3%
50.6%
Change in Adults’ Mental Health Status: Destinations and Origins
Flourishing
1995 2005
Flourishing Flourishing
Moderate Mental Health
Moderate Mental Health
Languishing Languishing
19.2%22.3%
17.2%
63.6% 60.4%
17.3%
Change in Adults’ Mental Health Status: Destinations and Origins
Moderate Mental Health
67.5%
18.6%
13.9%
1995 2005
Flourishing Flourishing
Moderate Mental Health
Moderate Mental Health
Languishing Languishing
19.2% 22.3%
17.2%
63.6% 60.4%
17.3%45.7%
Change in Adults’ Mental Health Status: Destinations and Origins
Languishing
50.2%
4.1%
Surely Most People Are Flourishing?
21.2
50.1
6.110.3
11.2
1.1
05
101520253035404550556065
Mental I llnessand
Languishing
Mental I llnessand ModerateMental Health
Mental I llnessand
Flourishing
Languishing ModerateMental Health
Flourishing
Point Prevalence of Complete Mental Health U.S. Adult Population, ages 35-84 in 2005
(MIDUS follow-up, n = 1,760)
37
46.2
1.92.7
9.7
2.5
0
5
10
15
20
25
30
35
40
45
50
55
60
Screens forDepression and
Languishing
Screens forDepression and
Moderate MentalHealth
Screens forDepression and
Flourishing
Languishing Moderate MentalHealth
Flourishing
Prevalence of Complete Mental Health U.S. Adolescent Population Ages 12-18
in the 2002 CDS Sample, n= 1,290
Universities That Participatedin Fall 2007 Healthy Minds Study
1. Miami (Ohio)2. University of North Carolina Greensboro3. Yeshiva4. University of Illinois, Springfield5. Emory6. New Mexico State7. UNC, Chapel Hill8. Chico State9. University of Michigan10.Tufts11.Penn State12.University of Illinois, Urbana/Champaign13.University of Illinois, Chicago
Association of Prevalence Screen for Depression (PHQ-9) by Diagnosed as Flourishing (MHC-SF)
at n=13 Participating Universities in 2007 Healthy Minds Study
0.1
0.12
0.14
0.16
0.18
0.2
0.22
0.24
0.26
0.28
0.43 0.48 0.51 0.52 0.52 0.52 0.54 0.55 0.55 0.57 0.58 0.61 0.62
Prevalence of Flourishing
Pearson r = - .50 p < .05 (one-tailed)
Level of Depression (PHQ-9) by Level of Mental Health 2007 Healthy Minds Data
91.8
66.9
26.3
6.5
21.5
23.9
1.7
11.6
49.8
0%5%
10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%
100%
Languishing Moderate Flourishing
PHQ Score 15 to 27 (7.9%)
PHQ Score 10 to 14 (13.8%)
PHQ Score 9 or Lower (78.3%)
Mental Illness by Level of Mental Health in the 2007 Healthy Minds Data
4.3
12.9
15.2
2.3
5
11.2
1.9
8.7
28.9
1.9
9
25.4
0
5
10
15
20
25
30
35
40
Languishing Moderate Flourishing
Minor Depression
Panic Disorder
Generalized Anxiety
Any Suicidality
46
27.6
5.82.8
16.9
0.80
5
10
15
20
25
30
35
40
45
50
55
60
Screens for MIand Languishing
Screens for MIand ModerateMental Health
Screens for MIand Flourishing
Languishing Moderate MentalHealth
Flourishing
Prevalence of Complete Mental Health 2007 Healthy Minds Data
(n = 5,750)
Scientific Reasons For Closing the “Wanting-Doing Gap”
1. Illness is specific, and health is ‘something positive’; We have population measures for mental health as flourishing
2. Health and illness form a single continuum; Science supports the two continua model
3. Mental illness is a burden; Anything less than flourishing is a burden
4. Too much mental illness; Too little flourishing
5. Treatment and Cures; Promotion ergo I Prevent
6. Illness is more serious; The absence of health is more serious
– Pathogenic and Salutogenic ‘strike the balance’
Start Where; Do What?
Campaign to Increase Awareness, Priorities, and Allure of Ingredients
of Flourishing (complement to stigma reduction of mental illness)
Texas Tech UndergraduatesPerceived Importance of Each Domainof Flourishing
(Note: All paired samples t-test contrasts were significant at p < .05)
7.8
7.2
5.8
0 1 2 3 4 5 6 7 8 9
Emotional Well-Being
Psychological Well-Being
Social Well-Being
Not at All Important Very Important
Texas Tech UndergraduatesPerceived Importance of Dimensions of Flourishing
8.2
7.9
7.4
6.6
6
5.8
5.5
5.4
7.7
7.7
7.6
7.5
7.1
5.8
0 1 2 3 4 5 6 7 8 9
Happiness
Satisfaction
Self Acceptance
Purpose in Life
Positive Relations
Personal Growth
Positive Affect
Autonomy
Social Acceptance
Social Contribution
Environmental Mastery
Social Integration
Social Actualization
Social Coherence
Not at All Important Very Important
Texas Tech UndergraduatesCorrelations of Perceived Importance
With Level of the Three Components of Flourishing
0.39
0.29
0.180.21
0.37
0.19
0.14
0.21
0.16
0
0.1
0.2
0.3
0.4
0.5
0.6
Importance of Social Well-Being
Importance ofPsychological Well-Being
Importance of EmotionalWell-Being
Social Well-Being Scale Psychological Well-Being Scale Emotional Well-Being Scale
Top Related