If You Want Mentally Healthy Children, Start Promoting It

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


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



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



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


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





19.2%22.3%

17.2%

63.6% 60.4%

17.3%



67.5%

18.6%

13.9%

1995 2005





19.2% 22.3%

17.2%

63.6% 60.4%

17.3%45.7%


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


Moderate MentalHealth


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



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

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If You Want Mentally Healthy Children, Start Promoting It