Tag: Psychological Well-being

What is Subjective Well-Being (Questionnaire)?

Published on by Andrew Marshall1 Comment

Introduction

Subjective well-being (SWB) is a self-reported measure of well-being, typically obtained by questionnaire.

Ed Diener developed a tripartite model of subjective well-being in 1984, which describes how people experience the quality of their lives and includes both emotional reactions and cognitive judgments. It posits “three distinct but often related components of wellbeing: frequent positive affect, infrequent negative affect, and cognitive evaluations such as life satisfaction.” Subjective well-being is an overarching ideology that encompasses such things as “high levels of pleasant emotions and moods, low levels of negative emotions and moods, and high life-satisfaction.”

SWB therefore encompasses moods and emotions as well as evaluations of one’s satisfaction with general and specific areas of one’s life. SWB is one definition of happiness.

Although SWB tends to be stable over the time and is strongly related to personality traits, the emotional component of SWB can be impacted by situations; for example, the onset of the COVID-19 outbreak, lowered emotional well-being by 74%. There is evidence that health and SWB may mutually influence each other, as good health tends to be associated with greater happiness, and a number of studies have found that positive emotions and optimism can have a beneficial influence on health.

Construction of SWB

Diener argued that the various components of SWB represent distinct constructs that need to be understood separately, even though they are closely related. Hence, SWB may be considered “a general area of scientific interest rather than a single specific construct”. Due to the specific focus on the subjective aspects of well-being, definitions of SWB typically exclude objective conditions such as material conditions or health, although these can influence ratings of SWB. Definitions of SWB therefore focus on how a person evaluates his/her own life, including emotional experiences of pleasure versus pain in response to specific events and cognitive evaluations of what a person considers a good life. Components of SWB relating to affect include positive affect (experiencing pleasant emotions and moods) and low negative affect (experiencing unpleasant, distressing emotions and moods), as well as “overall affect” or “hedonic balance”, defined as the overall equilibrium between positive and negative affect, and usually measured as the difference between the two. High positive affect and low negative affect are often highly correlated, but not always.

Components of SWB

There are three components of SWB:

  • Affect (hedonic measures);
  • Life satisfaction (cognitive measures); and
  • Eudaimonia (a sense of meaning and purpose).

Affect

Affect refers to the emotions, moods, and feelings a person has. These can be all positive, all negative, or a combination of both positive and negative. Some research shows also that feelings of reward are separate from positive and negative affect.

Life Satisfaction

Life satisfaction (global judgments of one’s life) and satisfaction with specific life domains (e.g. work satisfaction) are considered cognitive components of SWB. The term “happiness” is sometimes used in regards to SWB and has been defined variously as “satisfaction of desires and goals” (therefore related to life satisfaction), as a “preponderance of positive over negative affect” (therefore related to emotional components of SWB), as “contentment”, and as a “consistent, optimistic mood state”[8] and may imply an affective evaluation of one’s life as a whole. Life satisfaction can also be known as the “stable” component in one’s life. Affective concepts of SWB can be considered in terms of momentary emotional states as well as in terms of longer-term moods and tendencies (i.e. how much positive and/or negative affect a person generally experiences over any given period of time).Life satisfaction and in some research happiness are typically considered over long durations, up to one’s lifetime. “Quality of life” has also been studied as a conceptualisation of SWB. Although its exact definition varies, it is usually measured as an aggregation of well-being across several life domains and may include both subjective and objective components.

Eudaimonia

Eudaimonic measures seek to quantify traits like virtue and wisdom as well as concepts related to fulfilling our potential such as meaning, purpose, and flourishing. Eudaimonic measures are often regarded as a core component of SWB, particularly in the field of positive psychology. However, it is unclear whether measures of meaning are really measures of wellbeing and little data has been collected on them.

Measurement

Life satisfaction and Affect balance are generally measured separately and independently.

  • Life satisfaction is generally measured using a self-report method. A common measurement for life satisfaction is questionnaires.
  • Affective balance is also generally measured using a self-report method. An example of a measurement of affective balance is the PANAS (Positive Affect Negative Affect Schedule).

Sometimes a single SWB question attempts to capture an overall picture. For example, the World Happiness Report uses a Cantril ladder survey, in which respondents are asked to think of a ladder, with the best possible life for them being a 10, and the worst possible life being a 0, and are then asked to rate their own current lives on that 0 to 10 scale.

The issue with the such measurements of life satisfaction and affective balance is that they are self-reports. The problem with self-reports is that the participants may be lying or at least not telling the whole truth on the questionnaires. Participants may be lying or holding back from revealing certain things because they are either embarrassed or they may be filling in what they believe the researcher wants to see in the results. To gain more accurate results, other methods of measurement have been used to determine one’s SWB.

Another way to corroborate or confirm that the self-report results are accurate is through informant reports. Informant reports are given to the participant’s closest friends and family and they are asked to fill out either a survey or a form asking about the participants mood, emotions, and overall lifestyle. The participant may write in the self-report that they are very happy, however that participant’s friends and family record that he/she is always depressed. This would obviously be a contradiction in results which would ultimately lead to inaccurate results.

Another method of gaining a better understanding of the true results is through ESM, or the Experience Sampling Method. In this measure, participants are given a beeper/pager that will randomly ring throughout the day. Whenever the beeper/pager sounds, the participant will stop what he/she is doing and record the activity they are currently engaged in and their current mood and feelings. Tracking this over a period of a week or a month will give researchers a better understanding of the true emotions, moods, and feelings the participant is experiencing, and how these factors interact with other thoughts and behaviours. A third measurement to ensure validity is the Day Reconstruction Method. In this measure, participants fill out a diary of the previous days’ activities. The participant is then asked to describe each activity and provide a report of how they were feeling, what mood they were experiencing, and any emotions that surfaced. Thus to ensure valid results, a researcher may tend to use self-reports along with another form of measurement mentioned above. Someone with a high level of life satisfaction and a positive affective balance is said to have a high level of SWB.

Theories

Theories of the causes of SWB tend to emphasize either top-down or bottom-up influences.

Top-Down Perspective

In the top-down view, global features of personality influence the way a person perceives events. Individuals may therefore have a global tendency to perceive life in a consistently positive or negative manner, depending on their stable personality traits. Top-down theories of SWB suggest that people have a genetic predisposition to be happy or unhappy and this predisposition determines their SWB “setpoint”. Set Point theory implies that a person’s baseline or equilibrium level of SWB is a consequence of hereditary characteristics and therefore, almost entirely predetermined at birth. Evidence for this genetic predisposition derives from behaviour-genetic studies that have found that positive and negative affectivity each have high heritability (40% and 55% respectively in one study). Numerous twin studies confirm the notion of set point theory, however, they do not rule out the possibility that is it possible for individuals to experience long term changes in SWB.

Diener et al. note that heritability studies are limited in that they describe long-term SWB in a sample of people in a modern western society but may not be applicable to more extreme environments that might influence SWB and do not provide absolute indicators of genetic effects. Additionally, heritability estimates are inconsistent across studies.

Further evidence for a genetically influenced predisposition to SWB comes from findings that personality has a large influence on long-term SWB. This has led to the dynamic equilibrium model of SWB. This model proposes that personality provides a baseline for emotional responses. External events may move people away from the baseline, sometimes dramatically, but these movements tend to be of limited duration, with most people returning to their baseline eventually.

Bottom-Up Perspective

From a bottom-up perspective, happiness is created from happy experiences. Bottom-up influences include external events, and broad situational and demographic factors, including health and marital status. Bottom-up approaches are based on the idea that there are universal basic human needs and that happiness results from their fulfilment. In support of this view, there is evidence that daily pleasurable events are associated with increased positive affect, and daily unpleasant events or hassles are associated with increased negative affect.

However, research suggests that external events account for a much smaller proportion of the variance in self-reports of SWB than top-down factors, such as personality. A theory proposed to explain the limited impact of external events on SWB is hedonic adaptation. Based originally on the concept of a “hedonic treadmill”, this theory proposes that positive or negative external events temporarily increase or decrease feelings of SWB, but as time passes people tend to become habituated to their circumstances and have a tendency to return to a personal SWB “setpoint” or baseline level.

The hedonic treadmill theory originally proposed that most people return to a neutral level of SWB (i.e. neither happy nor unhappy) as they habituate to events. However, subsequent research has shown that for most people, the baseline level of SWB is at least mildly positive, as most people tend to report being at least somewhat happy in general and tend to experience positive mood when no adverse events are occurring. Additional refinements to this theory have shown that people do not adapt to all life events equally, as people tend to adapt rapidly to some events (e.g. imprisonment), slowly to others (e.g. the death of a loved one), and not at all to others (e.g. noise and sex).

Factors

Personality and Genetics

A number of studies have found that SWB constructs are strongly associated with a range of personality traits, including those in the five factor model. Findings from numerous personality studies show that genetics account for 20–48% of the variance in the Five-Factor Model and the variance in subjective well-being is also heritable. Specifically, neuroticism predicts poorer subjective well-being whilst extraversion, agreeableness, conscientiousness and openness to experience tend to predict higher subjective well-being. A Meta-analyses found that neuroticism, extraversion, agreeableness, and conscientiousness were significantly related to all facets of SWB examined (positive, negative, and overall affect; happiness; life satisfaction; and quality of life). Meta-analytic research shows that neuroticism is the strongest predictor of overall SWB and is the strongest predictor of negative affect.

A large number of personality traits are related to SWB constructs, although intelligence has negligible relationships. Positive affect is most strongly predicted by extraversion, to a lesser extent agreeableness, and more weakly by openness to experience. Happiness was most strongly predicted by extraversion, and also strongly predicted by neuroticism, and to a lesser extent by the other three factors. Life satisfaction was significantly predicted by neuroticism, extraversion, agreeableness, and conscientiousness. Quality of life was very strongly predicted by neuroticism, and also strongly predicted by extraversion and conscientiousness, and to a modest extent by agreeableness and openness to experience. One study found that subjective well-being was genetically indistinct from personality traits, especially those that reflected emotional stability (low Neuroticism), and social and physical activity (high Extraversion), and constraint (high Conscientiousness).

DeNeve (1999) argued that there are three trends in the relationship between personality and SWB. Firstly, SWB is closely tied to traits associated with emotional tendencies (emotional stability, positive affectivity, and tension). Secondly, relationship enhancing traits (e.g. trust, affiliation) are important for subjective well-being. Happy people tend to have strong relationships and be good at fostering them. Thirdly, the way people think about and explain events is important for subjective well-being. Appraising events in an optimistic fashion, having a sense of control, and making active coping efforts facilitates subjective well-being. Trust, a trait substantially related to SWB, as opposed to cynicism involves making positive rather than negative attributions about others. Making positive, optimistic attributions rather than negative pessimistic ones facilitates subjective well-being.

The related trait of eudaimonia or psychological well-being, is also heritable. Evidence from one study supports 5 independent genetic mechanisms underlying the Ryff facets of psychological well-being, leading to a genetic construct of eudaimonia in terms of general self-control, and four subsidiary biological mechanisms enabling the psychological capabilities of purpose, agency, growth, and positive social relations.

Social Influences

A person’s level of subjective well-being is determined by many different factors and social influences prove to be a strong one. Results from the famous Framingham Heart Study indicate that friends three degrees of separation away (that is, friends of friends of friends) can affect a person’s happiness. From abstract: “A friend who lives within a mile (about 1.6 km) and who becomes happy increases the probability that a person is happy by 25%.”

Family

Research has not demonstrated that there are significant differences in subjective well-being between childless couples and couples with children. A research study by Pollmann-Schult (2014) found that when holding finances and time costs constant, parents are happier and show increased life satisfaction than non-parents.

Wealth

Research indicates that wealth is related to many positive outcomes in life. Such outcomes include: improved health and mental health, greater longevity, lower rates of infant mortality, experience fewer stressful life events, and less frequently the victims of violent crimes However, research suggests that wealth has a smaller impact on SWB than people generally think, even though higher incomes do correlate substantially with life satisfaction reports.

The relative influence of wealth together with other material components on overall subjective well-being of a person is being studied through new research. The Well-being Project at Human Science Lab investigates how material well-being and perceptual well-being works as relative determinants in conditioning our mind for positive emotions.

In a study done by Aknin, Norton, & Dunn (2009), researchers asked participants from across the income spectrum to report their own happiness and to predict the happiness of others and themselves at different income levels. In study 1, predicted happiness ranged between 2.4 and 7.9, and actual happiness ranged between 5.2 and 7.7. In study 2, predicted happiness ranged between 15-80 and actual happiness ranged between 50 and 80. These findings show that people believe that money does more for happiness than it really does. However, some research indicates that while socioeconomic measures of status do not correspond to greater happiness, measures of sociometric status (status compared to people encountered face-to-face on a daily basis) do correlate to increased subjective well-being, above and beyond the effects of extroversion and other factors.

The Easterlin Paradox also suggests that there is no connection between a society’s economic development and its average level of happiness. Through time, the Easterlin has looked at the relationship between happiness and gross domestic product (GDP) across countries and within countries. There are three different phenomena to look at when examining the connection between money and Subjective well-being; rising GDP within a country, relative income within a country, and differences in GDP between countries.

More specifically, when making comparisons between countries, a principle called the Diminishing Marginal Utility of Income (DMUI) stands strong. Veenhoven (1991) said, “[W]e not only see a clear positive relationship [between happiness and GNP per capita], but also a curvilinear pattern; which suggest that wealth is subject to a law of diminishing happiness returns.” Meaning a $1,000 increase in real income, becomes progressively smaller the higher the initial level of income, having less of an impact on subjective well-being. Easterlin (1995) proved that the DMUI is true when comparing countries, but not when looking at rising gross domestic product within countries.

Health

There are substantial positive associations between health and SWB so that people who rate their general health as “good” or “excellent” tend to experience better SWB compared to those who rate their health as “fair” or “poor”. A meta-analysis found that self-ratings of general health were more strongly related to SWB than physician ratings of health. The relationship between health and SWB may be bidirectional. There is evidence that good subjective well-being contributes to better health. A review of longitudinal studies found that measures of baseline subjective well-being constructs such as optimism and positive affect predicted longer-term health status and mortality. Conversely, a number of studies found that baseline depression predicted poorer longer-term health status and mortality. Baseline health may well have a causal influence on subjective well-being so causality is difficult to establish. A number of studies found that positive emotions and optimism had a beneficial impact on cardiovascular health and on immune functioning. Changes in mood are also known to be associated with changes in immune and cardiovascular response. There is evidence that interventions that are successful in improving subjective well-being can have beneficial effects on aspects of health. For example, meditation and relaxation training have been found to increase positive affect and to reduce blood pressure. The effect of specific types of subjective well-being is not entirely clear. For example, how durable the effects of mood and emotions on health are remains unclear. Whether some types of subjective well-being predict health independently of others is also unclear. Meditation has the power to increase happiness because it can improve self-confidence and reduces anxiety, which increases your well-being. Cultivating personal strengths and resources, like humour, social/animal company, and daily occupations, also appears to help people preserve acceptable levels of SWB despite the presence of symptoms of depression, anxiety, and stress.

Research suggests that probing a patient’s happiness is one of the most important things a doctor can do to predict that patient’s health and longevity. In health-conscious modern societies, most people overlook the emotions as a vital component of one’s health, while over focusing on diet and exercise. According to Diener & Biswas-Diener, people who are happy become less sick than people who are unhappy. There are three types of health: morbidity, survival, and longevity. Evidence suggests that all three can be improved through happiness:

  1. Morbidity, simply put, is whether or not someone develops a serious illness, such as the flu or cancer. In a 30-year longitudinal study, participants who were high in positive emotions were found to have lower rates of many health problems. Some of these illnesses/problems include lower death rates from heart disease, suicide, accidents, homicides, mental illnesses, drug dependency, and liver disease related to alcoholism. Additionally, results showed that depressed participants were more likely to have heart attacks and recurrences of heart attacks when compared to happy people.
  2. Survival is the term used for what happens to a person after he/she has already developed or contracted a serious illness. Although happiness has been shown to increase health, with survival, this may not be the case. Survival may be the only area of health that evidence suggests happiness may actually be sometimes detrimental. It is unclear why exactly research results suggest this is the case, however Diener & Biswas-Diener offer an explanation. It is possible that happy people fail to report symptoms of the illness, which can ultimately lead to no treatment or inadequate treatment. Another possible reason may be that happy people tend to be optimistic, leading them to take their symptoms too lightly, seek treatment too late, and/or follow the doctor’s instructions half-heartedly. And lastly, Diener & Biswas-Diener suggest that people with serious illnesses may be more likely to choose to live out the rest of their days without painful or invasive treatments.
  3. Longevity, the third area of health, is measured by an individual’s age of death. Head researcher Deborah Danner of the University of Kentucky researched links between an individual’s happiness and that individual’s longevity. Danner recruited 180 Catholic nuns from a nearby convent as the participants of her study. She chose nuns because they live very similar lives. This eliminates many confounding variables that might be present in other samples, which can lead to inaccurate results. Such confounding variables could include substance use, diet, and sexual risk-taking. Since there are few differences among the nuns as far as the confounding variables, this sample offered the best option to match a controlled laboratory setting. Results showed that nuns who were considered happy or positive in their manner and language on average lived 10 years longer than the nuns who were considered unhappy or negative in their manner and language. A follow-up study by health researcher Sarah Pressman examined 96 famous psychologists to determine if similar results from the nun research would be seen as well. Pressman’s results showed that the positive or happy psychologists lived, on average, 6 years longer. The psychologists who were considered negative or unhappy lived, on average, 5 years less.

Physical Characteristics

A positive relationship has been found between the volume of gray matter in the right precuneus area of the brain, and the subject’s subjective happiness score. A six-week mindfulness based intervention was found to correlate with a significant gray matter increase within the precuneus.

Leisure

There are a number of domains that are thought to contribute to subjective well-being. In a study by Hribernik and Mussap (2010), leisure satisfaction was found to predict unique variance in life satisfaction, supporting its inclusion as a distinct life domain contributing to subjective well-being. Additionally, relationship status interacted with age group and gender on differences in leisure satisfaction. The relationship between leisure satisfaction and life satisfaction, however, was reduced when considering the impact of core affect (underlying mood state). This suggests that leisure satisfaction may primarily be influenced by an individual’s subjective well-being level as represented by core affect. This has implications for possible limitations in the extent to which leisure satisfaction may be improved beyond pre-existing levels of well-being and mood in individuals.

Cultural Variations

Although all cultures seem to value happiness, cultures vary in how they define happiness. There is also evidence that people in more individualistic cultures tend to rate themselves as higher in subjective well-being compared to people in more collectivistic cultures.

In Western cultures, predictors of happiness include elements that support personal independence, a sense of personal agency, and self-expression. In Eastern cultures, predictors of happiness focus on an interdependent self that is inseparable from significant others. Compared to people in individualistic cultures, people in collectivistic cultures are more likely to base their judgments of life satisfaction on how significant others appraise their life than on the balance of inner emotions experienced as pleasant versus unpleasant. Pleasant emotional experiences have a stronger social component in East Asian cultures compared to Western ones. For example, people in Japan are more likely to associate happiness with interpersonally engaging emotions (such as friendly feelings), whereas people in the United States are more likely to associate happiness with interpersonally disengaging emotions (pride, for example). There are also cultural differences in motives and goals associated with happiness. For example, Asian Americans tend to experience greater happiness after achieving goals that are pleasing to or approved of by significant others compared to European Americans. There is also evidence that high self-esteem, a sense of personal control and a consistent sense of identity relate more strongly to SWB in Western cultures than they do in Eastern ones. However, this is not to say that these things are unimportant to SWB in Eastern cultures. Research has found that even within Eastern cultures, people with high self-esteem and a more consistent sense of identity are somewhat happier than those who are low in these characteristics. There is no evidence that low self-esteem and so on are actually beneficial to SWB in any known culture.

A large body of research evidence has confirmed that people in individualistic societies report higher levels of happiness than people in collectivistic ones and that socioeconomic factors alone are insufficient to explain this difference. In addition to political and economic differences, individualistic versus collectivistic nations reliably differ in a variety of psychological characteristics that are related to SWB, such as emotion norms and attitudes to the expression of individual needs. Collectivistic cultures are based around the belief that the individual exists for the benefit of the larger social unit, whereas more individualistic cultures assume the opposite. Collectivistic cultures emphasize maintaining social order and harmony and therefore expect members to suppress their personal desires when necessary in order to promote collective interests. Such cultures therefore consider self-regulation more important than self-expression or than individual rights. Individualistic cultures by contrast emphasize the inalienable value of each person and expect individuals to become self-directive and self-sufficient. Although people in collectivistic cultures may gain happiness from the social approval they receive from suppressing self-interest, research seems to suggest that self-expression produces a greater happiness “payoff” compared to seeking approval outside oneself.

Despite westerners reporting higher levels of subjective well-being than easterners, they also have more frequent reports of depression. The differing beliefs on self-expression help explain what may at first seem paradoxical. Westerners tend to encourage individual expression, which leads to a greater focus on one’s own emotions. This increased self-awareness combines with the normative belief that joy should be more common than sadness. People living under these conditions can catastrophize their own negative emotions; feeling increased sadness over the fact that they are either not currently happy or frequently happy. Easterners tend to be more concerned about their collective’s feelings over their own individual feelings. They do not typically catastrophise their sadness, and learn to brush it off.

Positive Psychology

Positive psychology is particularly concerned with the study of SWB. Positive psychology was founded by Seligman and Csikszentmihalyi (2000) who identified that psychology is not just the study of pathology, weakness, and damage; but it is also the study of strength and virtue. Researchers in positive psychology have pointed out that in almost every culture studied the pursuit of happiness is regarded as one of the most valued goals in life. Understanding individual differences in SWB is of key interest in positive psychology, particularly the issue of why some people are happier than others. Some people continue to be happy in the face of adversity whereas others are chronically unhappy at the best of times.

Positive psychology has investigated how people might improve their level of SWB and maintain these improvements over the longer term, rather than returning to baseline. Lyubomirsky (2001) argued that SWB is influenced by a combination of personality/genetics (studies have found that genetic influences usually account for 35-50% of the variance in happiness measures), external circumstances, and activities that affect SWB. She argued that changing one’s external circumstances tends to have only a temporary effect on SWB, whereas engaging in activities (mental and/or physical) that enhance SWB can lead to more lasting improvements in SWB.

Use in Happiness Economics

SWB is often used in appraising the wellbeing of populations.

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What is Social Psychiatry?

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Introduction

Social psychiatry is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental wellbeing.

It involves a sometimes disparate set of theories and approaches, with work stretching from epidemiological survey research on the one hand, to an indistinct boundary with individual or group psychotherapy on the other. Social psychiatry combines a medical training and perspective with fields such as social anthropology, social psychology, cultural psychiatry, sociology and other disciplines relating to mental distress and disorder. Social psychiatry has been particularly associated with the development of therapeutic communities, and to highlighting the effect of socioeconomic factors on mental illness. Social psychiatry can be contrasted with biopsychiatry, with the latter focused on genetics, brain neurochemistry and medication. Social psychiatry was the dominant form of psychiatry for periods of the 20th century but is currently less visible than biopsychiatry.

After reviewing the history and activities of social psychiatry, Vincenzo Di Nicola reviews three major questions for social psychiatry and concludes with a manifesto for a 21st-century social psychiatry:

  1. What is social about psychiatry? This addresses definitional problems that arise, such as binary thinking, and the need for a common language.
  2. What are the theory and practice of social psychiatry? Issues include social psychiatry’s core principles, values, and operational criteria; the social determinants of health and the Global Mental Health (GMH) Movement; and the need for translational research. This part of the review establishes the minimal criteria for a coherent theory of social psychiatry and the view of persons that emerges from such a theory, the social self.
  3. Why the time has come for a manifesto for social psychiatry. This manifesto outlines the parameters for a theory of social psychiatry, based on both the social self and the social determinants of health, to offer an inclusive social definition of health, concluding with a call for action.

Brief History

The events of the first half of the 20th century brought the issue of the relationship between the individual and the community to the fore. Psychiatrists who showed a willingness to confront these issues at home, after the war, called themselves social psychiatrists. Psychoanalytic psychotherapy and all its offshoots were grounded in an approach to the patient that focused almost exclusively on the individual – the relational aspects of therapy were implicit in the relationship between therapist and patient, but the main source of problem and motivation for change was seen as being intrapsychic (within the individual). The social and political contexts were largely disregarded. Sarason observed in 1981, that:

“it is as though society does not exist for the psychologist. Society is a vague, amorphous background that can be disregarded in one’s efforts to fathom the laws of behavior” (Sarason 1981).

Early landmarks in social psychiatry included: Karen Horney, MD, who wrote about personality as it interacts with other people (1937); Erik Erikson, who discussed the influence of society on development (1950); Harry Stack Sullivan’s (1953) integration of sociological and psychodynamic concepts, and his work on the role of early interpersonal interactions in the development of the self; Cornell University’s Midtown Manhattan Study, which looked at the prevalence of mental illness in Manhattan; August Hollingshead, PhD, and Frederick Redlich, MD, looked at the influence of social class on psychiatric conditions (1958); Alexander H. Leighton, MD, looked at the relationship between social disintegration and mental illness (1959); Burrow was an early pioneer of the social causes of mental disorder and suggested “Sociatry” as the name for this new discipline.

Over the years many sociologists have contributed theories and research which has enlightened psychiatry in this area (e.g. Avison and Robins); The relationship between social factors and mental illness was demonstrated by the early work of Hollingshead and Readlich in Chicago in the 1930s, who found a high concentration of individuals diagnosed with schizophrenia in deprived areas of the city has been replicated numerous times throughout the world, although controversy still exists as to the extent of drift of vulnerable individuals to these areas or of a higher incidence of the disorder in the socially disadvantaged; the Midtown Manhattan Study conducted in the 1950s by Cornell University hinted at widespread psychopathology among the general population of New York City (Srole, Sanger, Michael, Opler, and Rennie, 1962); the Three Hospitals Study (Wing, J.K. and Brown, G.W. (1967) Social Treatments of Chronic Schizophrenia: a comparative survey of three mental hospitals. Journal of Mental Science. 107, pp.847-861) was a very influential work that has been replicated, that demonstrated forcefully that the poverty of the environment in poor mental hospitals lead to greater handicaps in the patients.

Social psychiatry was instrumental in the development of therapeutic communities. Under the influence of Maxwell Jones, Main, Wilmer and others (Caudill, 1958; Rapoport, 1960), combined with the publications of critiques of the existing mental health system (Greenblatt et al., 1957, Stanton and Schwartz, 1954) and the sociopolitical influences that permeated the psychiatric world, the concept of the therapeutic community and its attenuated form – the therapeutic milieu – caught on and dominated the field of inpatient psychiatry throughout the 1960s. The aim of therapeutic communities was a more democratic, user-led form of therapeutic environment, avoiding the authoritarian and demeaning practices of many psychiatric establishments of the time. The central philosophy is that clients are active participants in their own and each other’s mental health treatment and that responsibility for the daily running of the community is shared among the clients and the staff. “TCs” have often eschewed or limited medication in favour of psychoanalytically derived group-based insight therapies.

Current Work

Social psychiatry can be most effectively applied in helping to develop mental health promotion and prevent certain mental illnesses by educating individuals, families, and societies.

Social psychiatry has been important in developing the concept of major “life events” as precipitants of mental ill health, including, for example, bereavement, promotion, moving house, or having a child.

Originally inpatient centres, many therapeutic communities now operate as day centres, often focused on borderline personality disorder and run by psychotherapists or art therapists rather than psychiatrists.

Social psychiatrists help test the cross-cultural use of psychiatric diagnoses and assessments of need or disadvantage, showing particular links between mental illness and unemployment, overcrowding and single parent families.

Social psychiatrists also work to link concepts such as self-esteem and self-efficacy to mental health, and in turn to socioeconomic factors.

Social psychiatrists work on social firms in regard to people with mental health problems. These are regular businesses in the market that employ a significant number of people with disabilities, who are paid regular wages and work on the basis of regular work contracts. There are approximately 2,000 social firms in Europe and a large percentage of people with disabilities who work in social firms have a psychiatric disability. Some are specifically for people with psychiatric disabilities. (Schwarz, G., & Higgins, G, (1999) Marienthal the social firms network Supporting the Development of Social Firms in Europe, UK).

Social psychiatrists often focus on rehabilitation in a social context, rather than “treatment” per se. A related approach is community psychiatry.

Facilitating the social inclusion of people with mental health problems is a major focus of modern social psychiatry.

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What is the Six-Factor Model of Psychological Well-Being?

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Introduction

The Six-factor Model of Psychological Well-being is a theory developed by Carol Ryff which determines six factors which contribute to an individual’s psychological well-being, contentment, and happiness.

Psychological well-being consists of positive relationships with others, personal mastery, autonomy, a feeling of purpose and meaning in life, and personal growth and development. Psychological well-being is attained by achieving a state of balance affected by both challenging and rewarding life events.

Refer to Euthymia.

Measurement

The Ryff Scale of Measurement is a psychometric inventory consisting of two forms (either 54 or 84 items) in which respondents rate statements on a scale of 1 to 6, where 1 indicates strong disagreement and 6 indicates strong agreement. Ryff’s model is not based on merely feeling happy, but is based on Aristotle’s Nicomachean Ethics, “where the goal of life isn’t feeling good, but is instead about living virtuously”.

The Ryff Scale is based on six factors: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Higher total scores indicate higher psychological well-being. Following are explanations of each criterion, and an example statement from the Ryff Inventory to measure each criterion.

  • Autonomy:
    • High scores indicate that the respondent is independent and regulates their behaviour independent of social pressures.
    • An example statement for this criterion is “I have confidence in my opinions, even if they are contrary to the general consensus”.
  • Environmental Mastery:
    • High scores indicate that the respondent makes effective use of opportunities and has a sense of mastery in managing environmental factors and activities, including managing everyday affairs and creating situations to benefit personal needs.
    • An example statement for this criterion is “In general, I feel I am in charge of the situation in which I live”.
  • Personal Growth:
    • High scores indicate that the respondent continues to develop, is welcoming to new experiences, and recognises improvement in behaviour and self over time.
    • An example statement for this criterion is “I think it is important to have new experiences that challenge how you think about yourself and the world”.
  • Positive Relations with Others:
    • High scores reflect the respondent’s engagement in meaningful relationships with others that include reciprocal empathy, intimacy, and affection.
    • An example statement for this criterion is “People would describe me as a giving person, willing to share my time with others”.
  • Purpose in Life:
    • High scores reflect the respondent’s strong goal orientation and conviction that life holds meaning.
    • An example statement for this criterion is “Some people wander aimlessly through life, but I am not one of them”.
  • Self-Acceptance:
    • High scores reflect the respondent’s positive attitude about his or her self.
    • An example statement for this criterion is “I like most aspects of my personality”

Applications and Research Findings

Contributing Factors

Positive Contributing Factors

Positive psychological well-being may emerge from numerous sources. A happy marriage is contributive, for example, as is a satisfying job or a meaningful relationship with another person. When marriages include forgiveness, optimistic expectations, positive thoughts about one’s spouse, and kindness, a marriage significantly improves psychological well-being. A propensity to unrealistic optimism and over-exaggerated self-evaluations can be useful. These positive illusions are especially important when an individual receives threatening negative feedback, as the illusions allow for adaptation in these circumstances to protect psychological well-being and self-confidence (Taylor & Brown, 1988). Optimism also can help an individual cope with stresses to their well-being.

Negative Contributing Factors

Psychological well-being can also be affected negatively, as is the case with a degrading and unrewarding work environment, unfulfilling obligations and unsatisfying relationships. Social interaction has a strong effect on well-being as negative social outcomes are more strongly related to well-being than are positive social outcomes. Childhood traumatic experiences diminish psychological well-being throughout adult life, and can damage psychological resilience in children, adolescents, and adults. Perceived stigma also diminished psychological well-being, particularly stigma in relation to obesity and other physical ailments or disabilities.

Extrinsic and Intrinsic Psychological Needs

A study conducted in the early 1990s exploring the relationship between well-being and those aspects of positive functioning that were put forth in Ryff’s model indicates that persons who aspired more for financial success relative to affiliation with others or their community scored lower on various measures of well-being.

Individuals that strive for a life defined by affiliation, intimacy, and contributing to one’s community can be described as aspiring to fulfil their intrinsic psychological needs. In contrast, those individuals who aspire for wealth and material, social recognition, fame, image, or attractiveness can be described as aiming to fulfil their extrinsic psychological needs. The strength of an individual’s intrinsic (relative to extrinsic) aspirations as indicated by rankings of importance correlates with an array of psychological outcomes. Positive correlations have been found with indications of psychological well-being: positive affect, vitality, and self-actualisation. Negative correlations have been found with indicators of psychological ill-being: negative affect, depression, and anxiety.

Relations with Others

A more recent study confirming Ryff’s notion of maintaining positive relations with others as a way of leading a meaningful life involved comparing levels of self-reported life satisfaction and subjective well-being (positive/negative affect). Results suggested that individuals whose actions had underlying eudaimonic tendencies as indicated by their self-reports (e.g. “I seek out situations that challenge my skills and abilities”) were found to possess higher subjective well-being and life satisfaction scores compared to participants who did not. Individuals were grouped according to their chosen paths/strategies to happiness as identified by their answers on an Orientation to Happiness Questionnaire. The questionnaire describes and differentiates individuals on the basis of three orientations to happiness which can be pursued, though some individuals do not pursue any. The “pleasure” orientation describes a path to happiness that is associated with adopting hedonistic life goals to satisfy only one’s extrinsic needs. Engagement and meaning orientations describe a pursuit of happiness that integrates two positive psychology constructs “flow/engagement” and “eudaimonia/meaning”. Both of the latter orientations are also associated with aspiring to meet intrinsic needs for affiliation and community and were amalgamated by Anić and Tončić into a single “eudaimonic” path to happiness that elicited high scores on all measures of well-being and life satisfaction. Importantly, she also produced scales for assessing mental health. This factor structure has been debated, but has generated much research in wellbeing, health, and successful ageing.

Heritability

Individual differences in both overall Eudaimonia, identified loosely with self-control and in the facets of eudaimonia are heritable. Evidence from one study supports 5 independent genetic mechanisms underlying the Ryff facets of this trait, leading to a genetic construct of eudaimonia in terms of general self-control, and four subsidiary biological mechanisms enabling the psychological capabilities of purpose, agency, growth, and positive social relations.

Well-Being Therapy

According to Seligman, positive interventions to attain positive human experience should not be at the expense of disregarding human suffering, weakness, and disorder. A therapy based on Ryff’s six elements was developed by Fava and others in this regards.

What are the Components of Good Mental Well-Being?

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Outline

The components of good mental well-being include:

  • Connecting with Others.
  • Remaining Active.
  • Continuing to Learn.
  • Giving to Others.
  • Being Mindful.
  • Being Able to Express Emotions.
  • Being Able to Cope with Stress.
  • Being Adaptable in Times of Change.
  • Being Confident and Having Good Self-Esteem.
  • Being Productive.

Connecting with Others

It is argued that this is the most important aspect of good mental well-being, as it enables individuals to feel part of their community or their own support group, knowing that they have somewhere to turn in times of need and that they are able to help others as well.

Making new friends into adulthood helps individuals to feel wanted and liked and this is beneficial for their confidence and self-esteem.

Remaining Active

Stating both mentally and physically active helps individuals to remain well in both of these areas, with the link between good mental and good physical health being clearly established.

Individuals who are physically well may be less likely to develop mental health issues related to long-term illness, and the benefits of exercise helps boost the release of ‘happy hormones’ such as serotonin, which enhance mood and make individuals feel good.

Continuing to Learn

It is recommended that people never stop learning, and this should continue even into late adulthood.

Learning a new skill or information about a new subject is not only useful for ongoing cognitive functioning but it can help people to remain social as well, such as by attending a college course or a book club where there are lots of opportunities to connect with other people.

Giving to Others

Any form of giving to other people is mutually beneficial; that is to say that the person giving to others feels good about themselves and the person receiving what is given fells good as well.

Giving to others may mean being active in the community, such as doing volunteer work, or it can mean doing charity events, such as sponsored walks or collecting items for a local food bank.

Being Mindful

mindfulness means that a person is able to live in the present moment without worrying about what is coming in the future or what has happened in the past.

It enables people to focus solely on what is happening in their current surroundings and is thought to be an excellent way of reducing stress and anxiety, which can be the foundation of some forms of mental ill health.

Being Able to Express Emotions

Most people will have heard the saying that it is better to speak up about something than to keep things ‘bottled up’.

When people are unable to express their emotions effectively, this can mean that they eventually become overwhelmed by their feelings, and this can lead to stress, anxiety, depression and other difficulties that may prevent them from going about their daily activities.

Being Able to Cope with Stress

The concept of resilience is closely linked to being able to cope with stress.

Resilience enables individuals to react positively in the face of adversity and to find a way of moving forwards that is not detrimental to their mental health.

Being Adaptable in Times of Change

Resilience is also linked to being able to cope successfully when there are changes in life.

This can be a minor change such as having to move to a different office at work, or a major change like moving house, losing a loved one, or being diagnosed with a serious illness.

Being Confident and Having Good Self-Esteem

Being confident and having a high level of self-esteem helps individuals to feel good about themselves. which enables them to connect with others, make positive decisions, and be resilient when times become challenging.

Being Productive

Being productive within a community, family, or workplace helps individuals to feel good about themselves, increases their self-esteem, and can help them to connect with others as well.

It also gives individuals a sense of achievement. which helps increase confidence and gives individuals a positive outlook for the future.

Is the Mental Wellbeing of Doctors Becoming an Increasing Concern?

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Research Paper Title

Depressive symptoms in residents of a tertiary training hospital in Malaysia: The prevalence and associated factors.

Background

The mental wellbeing of doctors is becoming an increasing concern in the world today.

In Malaysia, residency is a challenging period in a doctor’s life, with many changes professionally and possibly in their personal lives as well.

This study aims to determine the prevalence of depressive symptoms and the socio-demographic correlates among residents in a tertiary training hospital in Malaysia.

It is a cross sectional study and all residents were approached to participate in the study.

Methods

The instruments used were a socio-demographic questionnaire and the Patient Health Questionnaire 9 (PHQ-9).

Chi-square test was used to explore the association between the socio-demographic correlates, and those that were found to have significant associations were further tested using multivariate logistic regression.

Results

The prevalence of depression among residents was 25.1 %. Longer working hours, missing meals, and working in Department of Surgery and Department of Anaesthesia was significantly positively associated while having protected study time, CME/lectures, leisure/hobbies and exercise were negatively associated with depression.

The Department of Rehabilitation Medicine had a significantly negative association with depression. After logistic regression, longer working hours and a lack of protected study time was significantly associated with depression in the respective departments.

Conclusions

In summary, the prevalence of depression among residents is high and is associated with longer working hours, missing meals and a lack of protected study time are significantly associated with depression.

Remedial steps should be taken to improve the mental health among residents.

Reference

Nair, N., Ng, C.G. & Sulaiman, A.H. (2021) Depressive symptoms in residents of a tertiary training hospital in Malaysia: The prevalence and associated factors. Asian Journal of Psychiatry. doi: 10.1016/j.ajp.2021.102548. Online ahead of print.

The Truth About … Improving Your Mental Health (2021)

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Introduction

Professor Tanya Byron and Alex Scott uncover the latest science on how to improve your mental health and wellbeing – and reveal some surprising new techniques.

Part of the BBC’s The Truth About series (you can currently view all episodes on the BBC iPlayer).

Outline

Clinical psychologist Professor Tanya Byron teams up with former England footballer Alex Scott, who has suffered from depression, to discover how the latest science can help us gain greater control over our state of mind and improve our mental health and wellbeing.

Even in normal times, one in four of us will experience mental health difficulties, but living through a global pandemic has put our mental health under unprecedented strain. Over the past year, a team from Imperial College London, in collaboration with the BBC, have surveyed the mental health of over 350,000 people across the UK. This unique study provides a snapshot before and during the pandemic, revealing its shocking impact.

Production & Filming Details

  • Presenter(s): Tanya Byron and Alex Scott.
  • Director(s): Ruhi Hamid.
  • Producer(s):
    • Matthew Barrett … series producer (as Matt Barrett).
    • Tom Coveney … commissioning editor.
    • Fay Finlay … assistant producer.
    • Ruhi Hamid … producer (produced by).
    • Christine Johnston … producer: Cohort.
    • Mairead Maclean … assistant producer.
    • Jane McLaughlin … talent executive.
    • Paul Overton … executive producer.
    • Jacqueline Smith … executive producer.
  • Writer(s): Claudia Lewis (developed by).
  • Music:
  • Cinematography:
  • Editor(s): Clyde Wallbanks and Lauri White.
  • Production:
  • Distributor(s): BBC One.
  • Release Date: 20 January 2021 (UK).
  • Running Time: 57 minutes.
  • Rating: Unknown.
  • Country: US.
  • Language: English.

Video Link

Book: Design for Wellbeing

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Book Title:

Design for Wellbeing – An Applied Approach.

Author(s): Ann Petermans and Rebecca Cain (Editors).

Year: 2019.

Edition: First (1st).

Publisher: Routledge.

Type(s): Hardcover and Kindle.

Synopsis:

Design for Wellbeing charts the development and application of design research to improve the personal and societal wellbeing and happiness of people. It draws together contributions from internationally leading academics and designers to demonstrate the latest thinking and research on the design of products, technologies, environments, services and experiences for wellbeing.

  • Part I starts by conceptualising wellbeing and takes an in-depth look at the rise of the design for wellbeing movement.
  • Part II then goes on to demonstrate design for wellbeing in practice through a broad range of domains from products and environments to services. Among others, we see emerging trends in the design of interiors and urban spaces to support wellbeing, designing to enable and support connectedness and social interaction, and designing for behaviour change to tackle unhealthy eating behaviour in children. Significantly, the body of work on subjective wellbeing, design for happiness, is increasing, and several case studies are provided on this, demonstrating how design can contribute to support the wellbeing of people.
  • Part III provides practical guidance for designing for wellbeing through a range of examples of tools, methods and approaches, which are highly user-centric, participatory, critical and speculative.
  • Finally, the book concludes in Part IV with a look at future challenges for design for wellbeing.

This book provides students, researchers and practitioners with a detailed assessment of design for wellbeing, taking a distinctive global approach to design practice and theory in context. Design for Wellbeing concerns designers and organisations but also defines its broader contribution to society, culture and economy.

What does mental health have to do with well-being?

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Research Paper Title

What does mental health have to do with well-being?

Background

Positive mental health involves not the absence of mental disorder but rather the presence of certain mental goods.

Institutions, practitioners, and theorists often identify positive mental health with well-being.

There are strong reasons, however, to keep the concepts of well-being and positive mental health separate.

Someone with high positive mental health can have low well-being, someone with high well-being can have low positive mental health, and well-being and positive mental health sometimes conflict.

But, while positive mental health and well-being are not identical, there is an informative conceptual connection between them.

Positive mental health usually contributes instrumentally to the living of a good human life, where a good human life includes (but is not limited to) well-being.

Reference

Keller, S. (2020) What does mental health have to do with well-being? Bioethics. 34(3), pp.228-234. doi: 10.1111/bioe.12702. Epub 2019 Nov 29.

Book: SNAP Matters

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Book Title:

Snap Matters – How Food Stamps Affect Health And Well-Being (Studies in Social Inequality).

Author(s): Judith Bartfield, Craig Gundersen, Timothy Smeeding, and James P. Ziliak (Editors).

Year: 2015.

Edition: First (1st).

Publisher: Stanford University Press.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

In 1963, President Kennedy proposed making permanent a small pilot project called the Food Stamp Programme (FSP). By 2013, the programme’s fiftieth year, more than one in seven Americans received benefits at a cost of nearly $80 billion. Renamed the Supplemental Nutrition Assistance Programme (SNAP) in 2008, it currently faces sharp political pressure, but the social science research necessary to guide policy is still nascent.

In SNAP Matters, Judith Bartfeld, Craig Gundersen, Timothy M. Smeeding, and James P. Ziliak bring together top scholars to begin asking and answering the questions that matter. For example, what are the antipoverty effects of SNAP? Does SNAP cause obesity? Or does it improve nutrition and health more broadly? To what extent does SNAP work in tandem with other programmes, such as school breakfast and lunch? Overall, the volume concludes that SNAP is highly responsive to macroeconomic pressures and is one of the most effective antipoverty programmes in the safety net, but the volume also encourages policymakers, students, and researchers to continue examining this major pillar of social assistance in America.

What is the Intergenerational Impact of War on Mental Health & Psychosocial Wellbeing?

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Research Paper Title

The intergenerational impact of war on mental health and psychosocial wellbeing: lessons from the longitudinal study of war-affected youth in Sierra Leone.

Background

Globally, one in four children lives in a country affected by armed conflict or disaster often accompanied by exposure to a range of adversities including violent trauma and loss. Children involved with armed groups (often referred to as “child soldiers”) typically exhibit high levels of mental health needs linked to their experiences.

The Longitudinal Study of War-Affected Youth (LSWAY) in Sierra Leone is a seventeen-year prospective longitudinal study of the long-term effects of children’s experiences in the country’s eleven-year (1991-2002) civil war on their adult mental health and functioning in addition to exploring the potential mechanisms by which intergenerational transmission of emotional and behavioral disruptions due to war trauma may operate.

LSWAY illuminates how war-related and post-conflict experiences shape long-term adult functioning, family dynamics, and developmental outcomes in offspring

Discussion

The LSWAY study utilises mixed methodologies that incorporate qualitative and quantitative data to unpack risk and protective factors involved in social reintegration, psychosocial adjustment, parenting, and interpersonal relationships.

To date, study findings demonstrate striking levels of persistent mental health problems among former child soldiers as adults with consequences for their families, but also risk and protective patterns that involve family- and community-level factors.

This case study examines the course of LSWAY from inception through implementation and dissemination, including building on the study results to design and evaluate several intervention models.

Conclusions

The case study offers a unique perspective on challenges and field realities of health research in a fragile, post-conflict setting common in the context of humanitarian emergencies.

LSWAY findings along with lessons learned from the field can inform future research as well as intervention research and implementation science to address the mental health and development of war-affected young people.

With four waves of data collection and a planned fifth wave, LSWAY also provides rare insights into the intergenerational effects of humanitarian crises on children, youth, and families across generations.

Reference

Betancourt, T.S., Keegan, K., Farrar, J. & Brennan, R.T. (2020) The intergenerational impact of war on mental health and psychosocial wellbeing: lessons from the longitudinal study of war-affected youth in Sierra Leone. Conflict and Health. 14:62. doi: 10.1186/s13031-020-00308-7. eCollection 2020.