Demographic Predictors of Complete Well-Being

Individual, intergenerational, and contextual factors associated with coping strategies, coping variability, and perceived coping efficacy among young adults

PURPOSE

Stress-related coping is an important mechanism of mental health functioning. However, the distribution of coping processes across various factors (e.g., individual like sex, contextual like perceived social status) remain under-explored. This study identified individual, intergenerational, and contextual factors associated with coping strategies, variability in their use (as a proxy for using strategies flexibly across contexts), and perceived coping efficacy to handle stressors among young adults.

METHODS

Participants from the Nicotine Dependence in Teens study (NDIT; N = 827) completed the validated Coping Inventory for Stressful Situations scale in 2011-12 (age ~ 24). Data on many factors, including race/ethnicity, intergenerational education patterns, and perceived social status, were collected from 1999-2000 (at NDIT inception; age 12-13) to 2011-12. Linear and multinominal regressions modeled the associations between individual, intergenerational, and contextual factors and coping strategies, variability, and efficacy, separately.

RESULTS

Women versus men reported more frequent use of emotion-, distraction-, and social diversion-oriented strategies and higher variability levels (e.g., Bemotion=0.40, 95%CI = 0.28, 0.51), but less frequent use of task-oriented strategies and lower coping efficacy (e.g., Befficacy=-0.46, 95%CI=-0.59, -0.32). Higher incomes, more educated mothers, and higher perceived social status in the community were associated with more frequent use of task-oriented strategies and coping efficacy, and less frequent use of emotion-oriented strategies. Other factors, including race/ethnicity, marital status, and school socio-economic status, were not robustly related to coping processes.

CONCLUSION

Findings document the distribution of coping processes across individual, intergenerational, and contextual factors among young adults, which may more broadly increase understanding of social disparities in mental health.

Variations in character involving an orientation to promote good across sociodemographic groups in 22 countries

An orientation to promote good (i.e., a disposition to take actions that contribute to the good of oneself and others) has been associated with better health and well-being outcomes. However, less is known about how orientation to promote good differs across countries and across sociodemographic groups within different countries. Using a sample of 202,898 adults from 22 diverse countries, this study examined the distribution of orientation to promote good across key sociodemographic groups within each country separately, and cross-nationally by pooling estimates across countries. Our results suggest that population mean levels of promoting good vary substantially across countries. In the pooled results, the means of promoting good also vary across most of the sociodemographic factors that we examined. Specifically, individuals who are older, female, married, employed or retired, highly educated, attending religious services frequently, and native-born reported higher means of promoting good than those in other demographic groups. In country-specific analyses, the sociodemographic variation in promoting good also differs across countries, indicating diverse societal influences. This study provides novel insights into the social distribution of orientation to promote good, which paves the way for future investigations into sociocultural influences that may shape individuals' expression of character across different national contexts.

Flourishing During the COVID-19 Pandemic: A Longitudinal Study in South Africa

In this longitudinal study, we examine changes in psychological distress and multidimensional well-being from before to during the COVID-19 pandemic among South African adults. As a secondary purpose, we explore whether pre-pandemic flourishing is protective against subsequent psychological distress during the public health crisis. The analytic sample (n = 293; Mage = 44.27, SD = 14.28; female = 65.19%) completed measures of anxiety symptoms, depression symptoms, and well-being shortly before the stringent nationwide lockdown started in South Africa (T1). A follow-up assessment was completed approximately 6 months later (T2). Paired samples t-tests supported very small improvements in anxiety (d = -0.09) and depression symptoms (d = -0.13). For domains of well-being, small increases were found in close social relationships (d = 0.25) and financial and material stability (d = 0.19). Positive changes in the domains of character and virtue (d = 0.10) and meaning and purpose (d = 0.07) were very small. Changes in physical and mental health (d = -0.03) and life satisfaction and happiness (d = 0.02) were more negligible. Results from the generalized linear models indicated that continuous scores of secure flourishing assessed before the COVID-19 pandemic were associated with lower subsequent psychological distress (particularly depression symptoms) during the public health crisis. We discuss the implications of the findings for the development and delivery of interventions to promote and sustain human flourishing during public health crises, especially in contexts of social-structural vulnerability.

The impact of social isolation and loneliness on the well-being of carers of a person with dementia in aotearoa New Zealand

Dementia is a leading cause of disability, and as the population ages, there will be a greater need for friends and family to care for people with Dementia. Unfortunately, informal care for a person with dementia is associated with poor psychological and physical health and lower quality of life of the caregiver. The aim of the present study was to understand how to best support caregivers within their communities by examining their experience of loneliness, isolation, and their relationship with well-being. The study used a representative sample of the New Zealand population in terms of ethnicity, age, gender, education, and income and asked people if they were a primary caregiver of a person with Alzheimer's Disease or related disorder. Both loneliness and isolation were linked to overall well-being; however, loneliness was a stronger predictor of satisfaction with relationships and feeling part of one's community. The findings highlight the importance of examining the multi-factorial constructs of social connectedness and question research attributing loneliness solely to reduced social involvement. As such, interventions for caregivers of a person with dementia need to target feelings of loneliness as well as their social isolation.

Is the PHQ-2 a Good Measure to Inform Providers About Patient Well-Being and Functioning? Data From the Veterans Health and Life Survey

BACKGROUND

Health care systems are increasingly focused on assessing patient well-being and functioning. The objective of the current analysis was to evaluate a pragmatic question: to what extent and in what way can the PHQ-2, a routinely collected screening measure, be used to help clinicians and a learning health system understand the well-being and functioning of its beneficiaries?

METHODS

The current analysis focused on 2872 Veterans who completed a large-scale longitudinal survey about health and wellness for whom we were able to link survey responses to PHQ-2 scores recorded in their electronic health records (EHR). Regression analyses examined the cross-sectional and longitudinal associations between PHQ-2 scores recorded in the EHR and measures of well-being (life satisfaction, purpose in life, and social health) and functioning (pain severity and interference, physical and mental health, and perceived stress).

RESULTS

Veterans were aged 65 years on average (11% women). PHQ-2 scores were correlated cross-sectionally with all well-being and functioning measures; however, there was minimal variance accounted for. Changes in the PHQ-2 over time were associated with 3 measures: purpose in life (b = -0.19; 95% CI: -0.34, -0.04), mental health functioning (b = -0.29, 95% CI: -0.54, -0.04), and perceived stress (b = 0.13; 95% CI: 0.02, 0.24).

CONCLUSIONS

The PHQ-2 was minimally associated with patient well-being and functioning, with more work needed on how the PHQ-2 may be used in large health care settings within the context of VA Whole Health. Assessment of well-being is critical as VA's Whole Health transformation continues, and identifying strategies for well-being measurement is an integral next step.

Positive epidemiology, revisited: the case for centering human rights and economic justice

In recent years, a growing body of research in positive epidemiology has sought to expand the traditional focus of epidemiologic research beyond risk factors for disease and towards a more holistic understanding of health that includes the study of positive assets that shape well-being more broadly. While this paradigm shift holds great promise for transforming people's lives for the better, it is also critiqued for showcasing decontextualized perspectives that could cause great harm to the public's health if translated uncritically into population-based interventions. In this commentary, we argue for orienting positive epidemiology within a human rights and economic justice framework to mitigate this threat, and we discuss two examples of previously proposed health assets (religious involvement and marriage) that demonstrate the urgent need for positive epidemiologic research to center health equity. Finally, to advance the field, we provide recommendations for how future research can address shortcomings of the extant literature by moving from individual-level to societal-level applications. In doing so, we believe that positive epidemiology can be transformed into a powerful force for health equity. This article is part of a Special Collection on Mental Health.

Well-being balance and lived experiences assessment: a valid, comprehensive measure of positive well-being

Introduction

Widely used measures of self-reported subjective well-being and flourishing generally do not directly measure positive experiences that have been demonstrated to improve subjective well-being and flourishing, which could aid in developing personalized interventions to improve individuals' well-being. The present study evaluated the validity of the Well-being Balance and Lived Experience (WBAL) Model and Assessment, a new model of well-being and corresponding assessment instrument that evaluates the self-reported frequency of positive experiences and positive feelings of well-being, balanced across activation and arousal levels.

Methods

A total of 496 evaluable subjects completed the WBAL Assessment, the PERMA+ Profiler (PERMA+) and the Well-Being Assessment Adult 24-item (WBA-24). A confirmatory factor model corresponding to the WBAL construct was created, and internal and external validity of the WBAL Assessment were interrogated.

Results

The confirmatory factor model showed good fit, indicating that each of the model factors are related but distinct and all items load significantly onto their factors. The WBAL Assessment demonstrated high internal consistency (Cronbach's α = 0.95) and internal validity across well-being factors and Feelings (r = 0.96) and Experiences (r = 0.94) domains. The WBAL Assessment demonstrated strong convergent validity in comparison to PERMA+ (r = 0.80) and WBA-24 (r = 0.75), indicating that the WBAL Assessment measures a similar overall concept of well-being and flourishing. Discriminant validity of WBAL factors was demonstrated for an average of 14.3 of 17 comparator domains. The main differences between instruments are WBAL's assessment of positive Experiences, the comparator instruments' inclusion of feelings with negative valence, and WBA-24's inclusion of financial stability.

Discussion

The WBAL Assessment is a reliable and valid instrument to comprehensively measure positive aspects of well-being that evaluates multiple modifiable contributors to individuals' well-being to guide design of personalized assessment and intervention programs to enhance positive well-being.

Exploring determinants of flourishing: a comprehensive network analysis of retirees in Taiwan

BACKGROUND

Human flourishing is an emerging concept, extending beyond the conventional boundaries of subjective well-being and evolving into a comprehensive capture of the diverse dimensions of human life within complex societal structures. Therefore, moving away from traditional approaches centered on the single latent construct, this study aims to explore the multiple aspects of human flourishing and the intricate interplay of their contributing factors.

METHODS

Data were collected from the Health and Living Environments Survey of Taiwanese Retirees during 2023 (valid sample n = 1,111). Human flourishing was measured using the Secure Flourish Index developed by Harvard University, which includes 12 indicators: (1) life satisfaction, (2) happiness, (3) mental health, (4) physical health, (5) meaning in life, (6) sense of purpose, (7) promoting good, (8) delaying gratification, (9) content relationships, (10) satisfying relationships, (11) financial stability, and (12) material stability. A mixed graphical network analysis was employed to analyze the related determinants, divided into four groups: (a) sociodemographic factors, (b) physical functions and health status, (c) social and family engagement, and (d) community environmental characteristics as nodes.

RESULTS

We analyzed 31 variables and identified 133 nonzero edges out of 465 potential connections in the comprehensive network. Results showed that happiness and promoting good were the two most critical indicators influencing retirees' overall flourishing. Different flourishing indicators were also associated with various influential factors. For instance, personal characteristics, especially gender and education, emerged as central factors. Family caregiving negatively affected happiness and financial stability, whereas social engagement was positively associated with life satisfaction and meaning in life. Employment status had mixed effects, negatively associated with life satisfaction but positively associated with mental health. Community environments, such as a sense of community and neighborhood safety, generally enhanced flourishing. However, the accessibility of neighborhood resources was paradoxically associated with material stability, pointing to the complexity of environmental factors in human flourishing.

CONCLUSION

This study provides a comprehensive network analysis that reveals intricate connections between personal, behavioral, and environmental factors, offering profound insights for targeted interventions to foster human flourishing.

Helping and Volunteering During COVID-19: Associations With Well-Being and Psychological Distress

INTRODUCTION

Salutogenic effects of volunteering and helping activities have been well recognized in the pre-COVID-19 era. This study examines associations between helping others as well as additional volunteer activities during the first wave of the COVID-19 pandemic and 6 psychological distress and well-being outcomes one year later.

METHODS

Longitudinal data collected between 2019 and 2021 were used. Analyses were based on data from 42,005 middle-aged and older adults from 27 European countries who participated in the Survey of Health, Ageing, and Retirement in Europe (SHARE) and two SHARE Corona Surveys. Prospective associations were examined using generalized estimating equations. A series of secondary analyses and the sensitivity of the associations to unmeasured confounding provided evidence for the robustness of results. All analyses were conducted in December 2022.

RESULTS

Helping others outside one's home in the first wave of COVID-19 was associated with subsequent increased risks of depression and anxiety. It was concurrently associated with an increased probability of an uplifting, hope, and happiness-inducing experience. Engagement in volunteer activities conducted in addition to helping was found to be prospectively associated with higher probability of an uplifting experience, but not with depression and anxiety. These associations were independent of demographic and socioeconomic characteristics, personality traits, prior quality of life and health history as well as pre-COVID-19 engagement in altruistic activities.

CONCLUSIONS

Helping and volunteering during the COVID-19 pandemic likely led to positive experiences. However, a negative impact on psychological distress of the same activities was also noted.

Divine struggles and whole person functioning: a 9-year longitudinal study of middle-aged U.S. adults

OBJECTIVE

This longitudinal study examined the associations of divine struggles with 25 psychological distress, psychological well-being, social well-being, prosociality, physical health, and health behavior outcomes assessed approximately nine years later.

METHODS

We used three waves of data from the National Survey of Midlife Development in the United States (N = 4041): M1 (1995-1996), M2 (2004-2006), and M3 (2013-2014). Following the analytic template for outcome-wide longitudinal designs, our primary analysis employed a series of regression models to estimate the associations between a continuous measure of divine struggles assessed at M2 with each outcome assessed at M3. All models adjusted for a rich set of covariates, including prior values of all outcomes.

RESULTS

There was modest evidence suggesting that divine struggles were associated with worse subsequent functioning on one or more outcomes for each domain except health behaviors (effect sizes were generally very small).

CONCLUSIONS

Divine struggles have the potential to degrade long-term functioning across multiple domains of life. Practitioners should attend to and address divine struggles in their clinical work.

Exposure to negative life events, change in their perceived impact, and subsequent well-being among U.S. adults: A longitudinal outcome-wide analysis

OBJECTIVE

Negative life events have the potential to undermine an individual's ability to function and thrive, but less is known about the implications of changes in subjective appraisals of those events for long-term well-being. This research examines how exposure to negative life events and subsequent changes in the perceived impact of those events are related to longer-term well-being in adulthood.

METHOD

Drawing on three waves of data from the Midlife in the United States study (M1: 1995-1996, M2: 2004-2006, M3: 2013-2014), we applied the analytic template for outcome-wide longitudinal designs to investigate associations of (a) negative life event exposure between M1 and M2 and (b) change in the perceived impact of negative life event exposure assessed at M2 with 25 outcomes across several domains of well-being assessed approximately 9 years later at M3: psychological distress, psychological well-being, social well-being, prosociality, physical health, and health behavior.

RESULTS

Whereas negative life event exposure was associated with worse subsequent well-being on selected outcomes (5/25 in total) in some domains, positive change in the perceived impact of negative life event exposure was associated with better well-being on one or more outcomes in most domains (11/25 in total). Effect sizes in both sets of analyses were generally small, with more consistent associations found for psychological and social outcomes.

CONCLUSION

Subjective appraisals of negative life events (particularly positive changes in those appraisals over time) may be more closely related to individual well-being in the long run than mere exposure to negative life events themselves. The findings bring attention to the possibility that positive changes in a person's subjective appraisal of negative life events could have beneficial consequences for long-term well-being.

The road to postpandemic recovery in the USA: a repeated cross-sectional survey of multidimensional well-being over two years

OBJECTIVES

Examine differences in multidimensional well-being from before (January 2020) to three timepoints during the COVID-19 pandemic (June 2020, January 2021, January 2022).

STUDY DESIGN

Repeated cross-sectional design.

METHODS

Nationally representative cross-sectional cohorts of US adults completed the Secure Flourish Index before (January 2020 cohort: N = 1010) and during the COVID-19 pandemic (June 2020 cohort: N = 3020; January 2021 cohort: N = 3366; January 2022 cohort: N = 2598). We estimated differences in indicators, domains, and composite well-being between the January 2020 cohort and each of the subsequent cohorts. We also explored whether changes in well-being between January 2020 and January 2022 varied based on age, gender, and race/ethnicity.

RESULTS

Initial declines in well-being observed by June 2020 were largely followed by a return to prepandemic levels in January 2022, with some exceptions. Notably, general declines in mental health have persisted through to January 2022. On the other hand, there was evidence of general improvements in character & virtue that exceeded prepandemic levels in January 2022. Young adults and racial/ethnic minorities reported lower financial & material stability in January 2022 compared to before the COVID-19 pandemic.

CONCLUSIONS

Although there are promising signs that the well-being of US adults has mostly recovered to prepandemic levels, a coordinated response is urgently needed to support population mental health and the financial security of vulnerable groups. As society continues the journey toward postpandemic recovery, continued tracking of multidimensional well-being will be important for making informed decisions about public health priorities.

Associations of suffering with facets of health and well-being among working adults: longitudinal evidence from two samples

Suffering is an experiential state that every person encounters at one time or another, yet little is known about suffering and its consequences for the health and well-being of nonclinical adult populations. In a pair of longitudinal studies, we used two waves of data from garment factory workers (Study 1 [T1: 2017, T2: 2019]: n = 344) and flight attendants (Study 2 [T1: 2017/2018, T2: 2020]: n = 1402) to examine the prospective associations of suffering with 16 outcomes across different domains of health and well-being: physical health, health behavior, mental health, psychological well-being, character strengths, and social well-being. The primary analysis involved a series of regression analyses in which each T2 outcome was regressed on overall suffering assessed at T1, adjusting for relevant sociodemographic characteristics and the baseline value (or close proxy) of the outcome assessed at T1. In Study 1, associations of overall suffering with worse subsequent health and well-being were limited to a single outcome on each of the domains of physical health and mental health. Overall suffering was more consistently related to worse subsequent health and well-being in Study 2, with associations emerging for all but two outcomes. The pattern of findings for each study was largely similar when aspects of suffering were modeled individually, although associations for some aspects of suffering differed from those that emerged for overall suffering. Our findings suggest that suffering may have important implications for the health and well-being of worker populations.