To flourish or not: positive mental health and all-cause mortality

Cumulative associations between health behaviours, mental well-being, and health over 30 years

BACKGROUND

Both the number of risky health behaviours and the duration of exposure to these behaviours over time may increase the risk of later adverse outcomes. This study examined cumulative associations of risky health behaviours with both positive and negative aspects of mental well-being and health. It has a uniquely long follow-up period of over 30 years, from early adulthood to the beginning of late adulthood.

MATERIALS AND METHODS

The data were from the Jyväskylä Longitudinal Study of Personality and Social Development. The participants represent the Finnish age cohort born in 1959. This study utilized data collected at ages 27 (1986), 36 (1995), 42 (2001), 50 (2009), and 61 (2020-2021) (n = 206-326). Risk scores indicating the current number of risky behaviours of smoking, heavy alcohol consumption, and physical inactivity and their temporal accumulation over time were calculated. The associations of risk scores with mental well-being (depressive symptoms, psychological well-being) and health (self-rated health, number of metabolic risk factors) from age 36 onwards were analyzed with linear multilevel models adjusted for gender and education.

RESULTS

More current risky behaviours were associated with more depressive symptoms (B = 0.10, p = 0.032), lower psychological well-being (B = -0.10, p = 0.010), lower self-rated health (B = -0.45, p < 0.001), and more metabolic risk factors (B = 0.53, p = 0.013). The associations of temporal risk scores with the outcomes were even stronger (depressive symptoms: B = 0.38, p < 0.001; psychological well-being: B = -0.15, p = 0.046; self-rated health: B = -0.82, p < 0.001; metabolic risk factors: B = 1.49, p < 0.001). Among individual behaviours, the temporal risk score of alcohol consumption was negatively associated with most outcomes, while smoking was associated with poorer mental well-being and physical inactivity with poorer health.

CONCLUSIONS

The current and temporal accumulation of multiple risky health behaviours were associated with poorer mental well-being and health. Preventing these behaviours early in adulthood and midlife is crucial to avoid their accumulation and subsequent health risks.

Well-being inequities in eleven rural Georgia communities: A latent profile analysis

Personal well-being is a broad term that encompasses life domains that are not strictly health related, including social, emotional, financial, and environmental factors. Well-being is highly correlated with a range of sociodemographics and health outcomes. Little is known about well-being in rural communities, although the literature suggests that rural communities may be structurally and demographically disadvantaged regarding well-being. This cross-sectional study examined sociodemographic and health-related differences in key well-being domains, using the Personal Well-being Index (PWI). Latent Profile Analysis was used to identify demographic traits and health-related factors associated with differing levels of well-being. As part of a cross-site evaluation of a rural health initiative, we conducted a random, population-based mail survey in 11 rural counties in Georgia (USA). Between December 2018 and June 2019, surveys were mailed to 10,621 households, with 2,788 individuals completing the survey (26.2% response rate). We observed consistent differences in PWI scores and for each domain comprising the PWI across all sociodemographic categories, with characteristics that have historically conferred advantages in the USA (e.g., male gender, White race) generally being associated with greater well-being. The Latent Profile Analysis revealed five distinct well-being profiles reflecting different levels of well-being, with most respondents falling into the Very High or High well-being profile groups. Despite structural and demographic disadvantages, well-being and its sociodemographic and health-related correlates in this rural sample were comparable to that of urban settings. Coalitions working in partnership with researchers and evaluators may be an effective mechanism for identifying the factors that influence well-being and health. Interventions on social determinants of health may help determine what approaches are successful and best promote well-being, in addition to health, while also reducing socioeconomic inequities.

Healthy, moderate, or distressed: identification of latent profiles of mental health of a Chilean older primary care user sample

BACKGROUND

In older adults, medium and high levels of life satisfaction can coexist with mental health symptoms. The combination of these variables continues to be a challenge for public mental health; even more so for middle-income countries where evidence is scarce. This study aimed to identify latent mental health profiles in a sample of older adults attending primary healthcare centres (PHC) in the Province of Concepción, Chile.

METHODS

A convenience sample of individuals aged 65 and older who sought care in 15 PHC centres was recruited. Perception of well-being and the presence of anxiety and depression symptoms, all of these in relation to variables such as age, sex, cohabitation, health history, alcohol use, social participation, social support, loneliness, stressful events, presence of previous major depressive episodes, and generalized anxiety disorders. The relationship between the variables was analysed using a latent profile model.

RESULTS

A total of 573 interviews were conducted, with 7.85% having a psychiatric diagnosis in the last year. Four latent profiles were identified: healthy (15%); moderate mental health with lower anxiety (22%), moderate mental health with higher anxiety (34%), and distressed (29%). The multinomial regression model for predictor variables significantly predicted the class for each subject. Key predictors include loneliness, stressful events, satisfaction with health status, and sex.

CONCLUSIONS

The combined assessment of mental distress variables (anxiety and depressive symptoms) and well-being forms a gradient ranging from positive (healthy) and negative (distressed) mental health, with anxiety playing a crucial role in its differentiation.

The association of non-exercise estimated cardiorespiratory fitness with hypertension and all-cause mortality in American and Chinese populations: evidence from NHANES and CHARLS

Background

The Non-Exercise Estimated Cardiorespiratory Fitness (NEE-CRF) method has gained attention in recent years due to its simplicity and effectiveness. Hypertension and all-cause mortality are significant public health issues worldwide, highlighting the importance of exploring the association between NEE-CRF and these two conditions.

Methods

The data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS) were utilized to validate the association between NEE-CRF and hypertension as well as all-cause mortality. NEE-CRF was calculated using a sex-specific longitudinal non-exercise equation. To investigate the relationship between hypertension and all-cause mortality, multivariable regression analysis, generalized additive models, smooth curve fittings, and threshold effect analysis were employed. Logistic regression was used for hypertension analysis, while Cox proportional hazards regression was applied for all-cause mortality. Additionally, we conducted stratified analyses and interaction tests among different groups.

Results

In the NHANES, after fully adjusting for covariates, each unit increase in NEE-CRF was associated with a 24% reduction in the risk of hypertension (OR: 0.76, 95% CI: 0.74-0.78) and a 12% reduction in the risk of all-cause mortality (HR: 0.88, 95% CI: 0.79-0.86). Subgroup analyses showed that the relationship between NEE-CRF and both hypertension and all-cause mortality remained negatively correlated across different subgroups. The negative association was also validated in the CHARLS.

Conclusions

Higher NEE-CRF levels may reduce the risk of developing hypertension and all-cause mortality.

Association between sleep duration, sleep trouble and all-cause mortality in individuals with hyperuricemia in the United States

Objectives

Despite the crucial role of sleep quality in hyperuricemia onset and progression, there is limited evidence on sleep interventions to improve outcomes for hyperuricemic individuals. This study aims to investigate the effects of sleep duration and sleep difficulties on all-cause mortality in this population.

Materials and methods

We conducted a secondary analysis of the National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2018, including 5,837 participants. We employed weighted multivariable Cox proportional hazard models to evaluate the independent predictive value of sleep duration and trouble for all-cause mortality. Restricted cubic splines and segmented Cox proportional hazard models were used to examine threshold effects.

Results

During a mean follow-up of 6.5 years, 906 participants experienced all-cause mortality. After adjusting for confounders, both short (< 7 h; HR = 1.25; 95%CI: 1.04, 1.51; p = 0.018) and long (>9 h; HR = 1.50; 95%CI: 1.10, 2.04; p = 0.011) sleep durations were associated with increased all-cause mortality. The threshold analysis identified an optimal sleep duration of 7.23 h, and when sleep duration was below 7.23 h, it was inversely related to mortality (HR: 0.879; 95% CI: 0.788, 0.981; p = 0.022). Conversely, when sleep duration exceeded 7.23 h, it was positively associated with mortality (HR: 1.187; 95% CI: 1.066, 1.320; p = 0.002).

Conclusion

Sleep duration is U-shapedly associated with all-cause mortality among individuals with hyperuricemia in the United States. However sleep trouble was not associated with all-cause mortality. Maintaining optimal sleep duration helps improve the prognostic survival rates of those with hyperuricemia.

The impact and mechanism of neighbourhood social capital on mental health: a cross-sectional survey based on the floating elderly population in China

BACKGROUND

Under the definition of positive mental health, the present study focused on the emerging group of floating elderly to explore the impact and mediating mechanisms of bonding and bridging neighbourhood social capital on their mental health.

METHODS

The data were sourced from community surveys in three major cities in Guangdong Province, China, with a total of 659 respondents aged 55 and above. Structural equation modelling was used to verify the hypotheses proposed in this study.

RESULTS

The latent variables of bonding and bridging neighbourhood social capital were established. After controlling for the main demographic and social characteristic variables, bonding neighbourhood social capital had a significant positive impact on the happiness of floating elderly (beta=0.484, p<0.05). Bridging neighbourhood social capital was beneficial for alleviating the tendency towards mental illness (beta=-0.545, p<0.05). Physical exercise and psychological integration were mediating mechanisms that connected bonding neighbourhood social capital and happiness (RIT=0.313, p<0.05; RIT=0.674, p<0.001). Social adaptation was found to have a mediating effect on the relationship between bridging neighbourhood social capital and mental illness (RIT=0.088, p<0.05).

CONCLUSIONS

By incorporating the geographical concept of neighbours into the discussion, the findings support the utility of social capital theory in the context of the floating elderly population and Chinese cities. By classifying neighbourhood social capital, the impact of bonding and bridging social capital on different dimensions of mental health is revealed, further expanding the mechanism of the mental health effect of social capital. Cultivating neighbourhood social capital and transforming individual interaction needs into practical actions should be included in the construction of mental health promotion policies.

Surviving Bad News: Health Information Without Treatment Options

When there is no treatment available for a life-threatening disease, providing personal health information could lead to despair or fatalistic behaviors resulting in negative health outcomes. We document this possibility utilizing an experiment in Malawi that randomized incentives to learn HIV testing results in a context where anti-retroviral treatment was not yet available. Six years after the experiment, among HIV+s, those who learned their status were 23 percentage points less likely to survive than those who did not, with effects persisting after 15 years. Receiving an HIV+ diagnosis resulted in riskier health behaviors, greater anxiety, and higher discount rates.

Using a causal decomposition approach to estimate the contribution of employment to differences in mental health profiles between men and women

Background

Mental health disorders are known to manifest differently in men and women, however our understanding of how gender interacts with mental health and well-being as a broader construct remains limited. Employment is a key determinant of mental health and there are historical differences in occupational roles among men and women that continue to influence working lives (Bonde, 2008; Cabezas-Rodríguez, Utzet, & Bacigalupe, 2021; Drolet, 2022; Gedikli, Miraglia, Connolly, Bryan, & Watson, 2023; Moyser, 2017; Niedhammer, Bertrais, & Witt, 2021; Stier & Yaish, 2014; Van der Doef & Maes, 1999). This study aims to explore differences in multidimensional mental health between men and women, and to quantify how these differences may change if women had the same employment characteristics as men.

Methods

Working-age adults (25-64) were identified through a household survey in Ontario, Canada during 2012. We created multifaceted measures of employment to capture both employment and job quality, as well as multidimensional mental health profiles that capture mental health disorders and well-being using survey data. A causal decomposition approach with Monte Carlo simulation methods estimated the change in differences in mental health profiles between men and women, if women had the same employment characteristics as men.

Results

Among 2458 eligible respondents, women were more likely to exhibit clinical mood disorders compared to men, with men more likely to exhibit absence of flourishing without a diagnosable disorder. Among those who were flourishing, women more often expressed at least some life stress compared to men. When women were assigned men's employment characteristics, which amounted to an increase in employment and higher quality employment, some of the gender differences in risk of clinical mood disorder decreased. However, differences between men and women in the remaining mental health profiles increased.

Conclusions

This study provided an estimate of the contribution of employment to the observed differences in multidimensional mental health between men and women. This adds to the literature by including a broader range of mental health indicators than disorders alone, and by formalizing the causal framework used to study these relationships.

Psychological well-being and emotional intelligence in undergraduate nursing students as predictors of academic success

BACKGROUND

Academic performance is influenced by a complex interplay of multiple factors whose relationships often do not follow straightforward patterns. Despite extensive research, understanding of these dynamics remains inconclusive. In particular, several studies highlight that higher emotional intelligence is associated with better academic outcomes and that people with elevated levels of psychological well-being also tend to achieve higher grades.

OBJECTIVE

This study examines the associations between emotional intelligence, psychological well-being and academic performance among undergraduate nursing students. Specifically, it seeks to deepen our understanding of how emotional intelligence affects academic achievement, with psychological well-being potentially serving as a mediator.

DESIGN

A cross-sectional correlational design was employed.

SETTINGS

The study involved a convenience sample of undergraduate nursing students from various degree programmes affiliated with the primary author.

PARTICIPANTS

394 undergraduate nursing students participated in the study, 249 identified as female and 145 as male.

METHODS

Participants completed a quantitative survey during class hours, providing data on demographics, academic average scores and self-report measures of perceived emotional intelligence and psychological well-being. Data were evaluated using Pearson's correlations and serial multiple mediation analyses.

RESULTS

The findings revealed significant positive relationships between emotional intelligence, psychological well-being and academic performance. Serial mediation assessments indicated that dimensions of emotional intelligence influence academic performance both directly and indirectly through psychological well-being. Specifically, flourishing partially mediated the relationship between emotional intelligence and academic performance, directly influencing academic outcomes.

CONCLUSIONS

This study underscores the critical role of emotional management skills in academic performance, with psychological well-being acting as a partial mediator in this relationship. Consequently, undergraduate nursing students with enhanced emotional management abilities and higher levels of psychological well-being are likely to achieve better academic outcomes.

Exploring the interplay of living arrangements, social support, and depression among older adults in rural northwest China

BACKGROUND

With the intensification of aging, depression among the older adults has become a significant global health challenge, especially in developing countries where the problem is particularly severe. This study aims to explore the association between living arrangements and depression, with a specific focus on examining the mediating role of social support in rural northwest China.

METHODS

Data were collected from 501 individuals aged 60 and above in rural Shaanxi Province, northwest China. Living arrangements were assessed based on co-residing family members. Depression was measured using the Geriatric Depression Scale-30, and social support was evaluated with the Social Support Rating Scale. Ordinary Least Squares Regression, Quantile Regression, Generalized Linear Regression, and Ordered Regression analyzed the association between living arrangements and depression. Hierarchical multiple linear regression examined the mediating role of social support. A heterogeneity analysis by gender and socio-economic status was also conducted.

RESULTS

The depression rates were 51.84% for non-empty nests, 67.92% for individuals living alone, and 46.80% for individuals only living with a spouse. The regression analysis did not reveal a significant difference in depressive between empty nests compared to non-empty nests. However, older adults living alone exhibited a higher susceptibility to depression symptoms (β = 2.594, P < 0.05). The mediating analysis showed that empty nesters living alone experience higher rates of depression due to receiving less social support compared to those living with a spouse or in non-empty nest arrangements, particularly concerning subjective social support (β = 0.481, P < 0.05). Heterogeneity analysis identified specific vulnerable groups among older adults, emphasizing the higher susceptibility to depressive symptoms among those living alone, especially among male older adults or those from non-poor families.

CONCLUSIONS

Our findings emphasize a significant prevalence of depression among older adults in rural areas, particularly highlighting the vulnerability of those living alone. This underscores the urgent need for government attention to address the mental health challenges faced by the older adults. Future interventions should focus on improving social support networks to mitigate the impact of living alone on depression symptoms among this population.

Exploring the Influence of Demographic Factors and Flourishing on Workplace Distractions: A Cross-Country Analysis

Objective: To explore the influence of demographic factors and flourishing on workplace distractions in a cross-country analysis of Saudi Arabia and Jordan. Methods: This cross-sectional comparative study was conducted in two government hospitals: one in eastern Saudi Arabia and the other in northern Jordan. Data were collected from the nurses using convenience sampling. The required sample size was determined using the G∗Power software, with a target of 242 nurses per country, resulting in 484 participants. Ultimately, the final sample consisted of 437 nurses: 222 from Saudi Arabia and 215 from Jordan. Two online instruments were used to collect data on the distractions and flourishing. Results: The study found that "using the Internet" and "using the phone" were the most time-consuming distractions among nurses, while "watching TV" was the least time-consuming. There were significant associations between demographics and distractions, with participants from Saudi Arabia having lower distraction scores than participants from Jordan. Younger participants were more distracted than older participants, whereas male participants were more distracted than female participants were. Smokers and individuals with less expertise exhibit higher levels of distraction. Furthermore, degree of education was associated with higher levels of distraction. Nurses in Saudi Arabia experience a much greater loss of productivity due to distractions than their Jordanian counterparts. Regression analysis revealed that experience, "Mental and Physical Health" domain scores, smoking status, and educational level all highly predicted distraction levels among Saudi Arabian and Jordanian nurses, accounting for approximately 9.6% of the differences in distraction. Conclusion: In this cross-country study on workplace distractions among Saudi and Jordanian nurses, "using the Internet" and "using the phone" emerged as the most time-consuming distractions. Younger age, male sex, smoking, and less experience are associated with higher distraction levels. Additionally, higher education levels were linked to increased distraction. Implementing employee flourishing activities can help reduce distractions and enhance productivity. This study offers valuable insights into improving nurses' performance and well-being.

The synergy of depression and flourishing/languishing on suicidal thoughts and behaviors: Findings from a national sample of emerging adult students in higher education in the United States

BACKGROUND

Suicide is a leading cause of death among students in higher education, driven in large part by mental illness, but also mental wellness. Relatively few studies have examined the extent to which depression and flourishing/languishing interact in relation to suicidal thoughts and behaviors.

METHODS

We analyzed data from the Healthy Minds Study (2020-2021; emerging adult students aged 18-29; N = 101,435), and calculated interaction contrast ratios to estimate the interaction between depression and flourishing/languishing on suicidal thoughts and behaviors, using an additive scale, adjusting for age, gender, race/ethnicity, and food insecurity.

RESULTS

When compared with students who were flourishing without depression, the students who were languishing without depression, and the students who were depressed but still flourishing had significantly greater odds of suicidal thoughts and behaviors. However, students who were depressed and languishing had the greatest odds, exceeding the sum of the individual effects.

CONCLUSION

The interaction of depression and flourishing/languishing produced a synergy that increased odds of suicidal thoughts and behaviors. Flourishing interventions may prove to be an effective strategy for universal suicide prevention.

Decomposing the association of psychosocial wellbeing with all-cause mortality: the mediating role of physical health and lifestyle factors

PURPOSE

This study quantified the effect of 48 psychosocial constructs on all-cause mortality using data from 7,698 individuals in the U.S. Health and Retirement Study.

METHODS

Latent class analysis was used to divide participants into mutually exclusive psychosocial wellbeing groups (good, average, or poor) which was subsequently considered as the exposure. Mediation analysis was then conducted to determine the direct effect of the psychosocial wellbeing groups and the indirect (mediating) effects of physical health (functional status and comorbid conditions) and lifestyle factors (physical activity, smoking, and alcohol consumption) on overall survival. We also created a composite health index measure representing the summative effect of the mediators.

RESULTS

We observed a strong and statistically significant total effect (TE) between survival time and psychosocial wellbeing group (survival time ratio (SR) = 1.73, 95% confidence interval (CI):1.50,2.01 when comparing good to poor). Mediation analysis revealed that the direct effect via psychosocial wellbeing group accounted for more than half of the TE (SR = 1.46, 95% CI:1.27,1.67). The composite health index measure mediated 36.2% of the TE with the natural indirect effect SR of 1.18 (95% CI:1.13,1.22).

CONCLUSION

Our findings demonstrate the interconnectedness between psychosocial wellbeing and physical health and lifestyle factors on survival.

Milk Fat Globule Membranes for Mental Health across the Human Lifespan

The milk fat globule membrane (MFGM) contains bioactive proteins, carbohydrates, and lipids. Polar lipids found in the MFGM play a critical role in maintaining cell membrane integrity and neuronal signalling capacity, thereby supporting brain health. This review summarises the literature on the MFGM and its phospholipid constituents for improvement of mental health across three key stages of the human lifespan, i.e., infancy, adulthood, and older age. MFGM supplementation may improve mental health by reducing neuroinflammation and supporting neurotransmitter synthesis through the gut-brain axis. Fortification of infant formula with MFGMs is designed to mimic the composition of breastmilk and optimise early gut and central nervous system development. Early behavioural and emotional development sets the stage for future mental health. In adults, promising results suggest that MFGMs can reduce the negative consequences of situational stress. Preclinical models of age-related cognitive decline suggest a role for the MFGM in supporting brain health in older age and reducing depressive symptoms. While there is preclinical and clinical evidence to support the use of MFGM supplementation for improved mental health, human studies with mental health as the primary target outcome are sparce. Further high-quality clinical trials examining the potential of the MFGM for psychological health improvement are important.

Flourishing in Education: Psychometric Properties of the Flourishing Scale in a Sample of Romanian Teachers

The Flourishing Scale (FS) is one of the most well-known tools for assessing psychological flourishing. However, its psychometric properties have been little analyzed in the case of teachers. This study aimed to examine the validity of the scale in the case of a sample of Romanian teachers and to analyze the latter's level of flourishing. In this regard, 323 Romanian teachers from the pre-university education system were recruited. Confirmatory factor analysis (CFA) was used to assess the construct validity of the scale, and Cronbach's α and McDonald's ω indices were used to assess internal consistency. The convergent validity was assessed by associating the FS with other instruments related to well-being: the Mental Health Continuum-Short Form and the Scale of Positive and Negative Experience. Network analysis was performed to examine the items that are particularly influential in the scale. As a result of the CFA, the one-factor structure of the scale was certified (χ2/df = 1.39; CFI = 0.99; RMSEA = 0.035). The internal consistency is excellent (both α and ω = 0.89). The FS correlates with both of the scales which operationalize components of well-being. The teachers' flourishing level is above average. The network approach showed that the items related to self-acceptance, optimism, and respect had the highest indicators of centrality, and the item related to supportive social relationships was the least informative in the network. For the male subsample, flourishing means optimism about the future and respect for others, and for the female respondents, it is related to self-acceptance and respect. The results provide support for using the scale in assessing flourishing among teachers.

Rural-urban differences in social and emotional protective factors and their association with child health and flourishing

BACKGROUND

Children in rural communities experience higher mortality rates and less access to health care services than those in urban communities. Protective factors like social support also vary by geography, but their contribution to differences in child health is understudied. Understanding geographic variation in protective health factors could provide insight into their impact on health and guide future intervention strategies.

RESEARCH OBJECTIVE

To examine protective factors' association with child flourishing and child health status in rural and urban communities.

METHODS

Publicly available data from the National Survey of Children's Health, 2018-2021, with nonmissing geographic data (N = 150,493) were used to assess the relationship between protective factors and child flourishing and health by rurality. Multivariate survey-weighted probit models examined these relationships, adjusting for child and caregiver characteristics.

FINDINGS

More than a third of children were not flourishing, according to parental report. An estimated 62% of rural children were flourishing compared to 66% of urban children (P<0.001). Urban caregivers also were more likely to report better adult mental and physical health status. Nevertheless, rural children were reported to receive more social support than urban children, while their caregivers reported more emotional support and living in supportive and safe neighborhoods (P<0.001). Rural caregivers reported more support from places of worship and less from counselors/other mental health care providers than urban caregivers.

CONCLUSIONS

Despite higher reported caregiver emotional support and child social support, fewer rural children are flourishing. Health systems and community organizations able to leverage these existing social and emotional protective factors in rural communities could help close this gap.

Enhancing mental wellbeing by changing mindsets? Results from two randomized controlled trials

Improving mental wellbeing is often targeted with behavioral interventions, while mindset interventions might be more appealing as they require less time and effort. In addition to recent experimental studies demonstrating that attributional beliefs can be changed to improve emotional wellbeing and performance, the current study examines whether a positive change in people's beliefs about stress and life philosophy enhances emotional, social and psychological wellbeing using brief educational interventions. Two parallel double-blind randomized controlled trials were conducted. Study 1 (N = 106; 62.3% female, mean age 36.0) compared an educational video about the benefits of a stress-is-enhancing mindset versus an active control video. In Study 2 (N = 136; 57.4% female, mean age 35.7), educational texts about the benefits of a stress-is-enhancing mindset and holding a life-is-long-and-easy mindset were compared to an active control text. Results of multilevel growth curve modeling showed that a stress mindset could be significantly changed using an educational video or text, while the change in the philosophies of life mindset did not significantly differ between conditions. Furthermore, none of the manipulations were able to sustain the positive change in mindset which might explain why there was no significant increase in mental wellbeing compared to control. To have a lasting effect on people's mental wellbeing, a change in mindset might need to be embodied in everyday life. Future research should investigate simple versus intensive interventions with longer follow-up time to examine whether and how a mindset can be sustainably changed to promote flourishing mental health in the general population.

On religious ambiguity: Childhood family religiosity and adult flourishing in a twin sample

Ambiguity is an important notion in sociology, denoting situations where social actors and groups carry on without shared meaning. The current article applies this concept to the context of religiosity during people's upbringing, recognizing that multiple factors make family-level religion a complex experience. Indeed, though recent research portrays household religiosity in childhood as a sociocultural exposure with long-term implications for well-being, existing studies have yet to incorporate multiple inputs to consider the cohesiveness of that exposure. Using twin data from a national sample, we investigate whether consistency in recalled household religiosity is associated with mid-life flourishing. Multi-level linear regression models reveal that similarity in twin reports matter, above and beyond the actual level of religiosity individuals report and net of dis/similarity across other childhood recollections. We conclude that coherence in religious upbringing-whether religion was understood to be important or not-is a key ingredient for thriving later in life and then reflect more broadly on manifestations of sociocultural ambiguity in families and in larger social units.

Association of positive childhood experiences with flourishing among children with ADHD: A population-based study in the United States

BACKGROUND

Child flourishing includes healthy social and emotional development and an open, engaged approach to learning. However, there remains a significant knowledge gap concerning a minority of children with ADHD who may demonstrate flourishing in one or more areas of functioning. This study investigated the association between positive childhood experiences (PCEs) and flourishing among children with ADHD.

METHOD

Data were derived from the 2021 National Survey of Children's Health in the United States. The analysis included a final sample of 3727 children with ADHD. Logistic regression, restricted cubic splines, and random forest were used to examine the associations between seven PCEs and flourishing.

RESULTS

The adjusted odds of flourishing were 72% lower (odds ratio [OR] = 0.28,95% confidence interval [CI] = 0.21, 0.38) among children with PCE scores of 0-2 compared to those with scores of 3-5. In addition, the adjusted odds of flourishing were 2.45 times (95%CI = 2.00, 2.99) greater for children with PCE scores of 6-7 compared to those with scores of 3-5. These associations were consistent regardless of the level of adverse childhood experiences. Having a "connected caregiver" was the PCE most closely related to flourishing (unweighted OR = 3.24, 95%CI = 2.72, 3.89).

CONCLUSIONS

Our findings revealed a positive association between higher levels of PCEs and greater flourishing among children with ADHD, regardless of the level of childhood adversity they experienced. These results highlight the importance of positive experiences in the lives of children with ADHD, with a specific focus on nurturing supportive relationships within families.

Depression and Suicidality: The Roles of Social Support and Positive Mental Health

OBJECTIVE

Despite being preventable, suicide remains a leading cause of death globally, with depression being one of the more prominent risk factors. This study examines the roles of social support and positive mental health in the depression-suicidality pathway.

METHODS

We utilized data from the Singapore Mental Health Study 2016. Social support and positive mental health were examined as mediators in the relationship between 12-month depression and 12-month suicidality using survey-weighted generalized structural equation modeling.

RESULTS

Overall positive mental health was found to partially mediate the relationship between depression and suicide. Of the discrete positive mental health domains, the depression-suicidality relationship was partially mediated by general coping and fully mediated by personal growth and autonomy.

CONCLUSION

While findings regarding social support were inconclusive, positive mental health may play a significant role in alleviating the effects of depression on suicidality. This highlights the multifaceted nature of suicidality and reveals positive mental health as a new area in assessing and treating at-risk people, to improve clinical outcomes.HIGHLIGHTSThe effect of depression on suicidality was partially mediated by overall positive mental health.General coping partially mediated the relationship between depression and suicidality.Personal growth and autonomy fully mediated the relationship between depression and suicidality.

Guiding Principles for the Practice of Integrative Physical Therapy

Integrative health is an emerging specialty inside multiple disciplines within the medical community, yet the practice of integrative physical therapy remains undefined. This perspective paper suggests a set of guiding principles to support the role of physical therapy in integrative health. These guiding principles, including therapeutic partnership, whole person health, living systems, movement as an integrative experience, and salutogenesis, are described and explored in-depth as they relate to all aspects of patient care and clinician experience. These guiding principles are articulated within the context of social determinants of health and the interrelated roles that environment, trauma, stress, and lifestyle all play within an integrative physical therapy plan of care. Examples of current integrative physical therapy practices that embody these principles are described. The 5 guiding principles are designed to elicit interprofessional inquiry into how integrative health models can be applied to the art and science of physical therapy practice. The expansion of integrative health into the field of physical therapy has the potential to improve individual and population health, as integrative physical therapy can be used to address prevention, health promotion, primary care, and wellness while acknowledging the complex, dynamic, and interconnected nature of the human condition.

IMPACT

This perspective article presents 5 guiding principles to establish a framework to define and shape the growing application of an integrative health model to physical therapy practice. These integrative physical therapy guiding principles aim to improve the quality of whole-person, patient-centered care.

Positive Mental Health Questionnaire (PMHQ) for Healthcare Workers: A Psychometric Evaluation

The Positive Mental Health Questionnaire (PMHQ) has been validated across various populations but has displayed diverse psychometric structures depending on the procedures used. The original version of the PMHQ includes 39 items organized into 6 factors, although there are reports that indicate a reduced structure of between 1 and 4 factors. The aim of this study was to assess the psychometric properties of the PMHQ with 1, 4 and 6 factors. A total of 360 healthcare workers aged 23 to 77 (M = 37.06; SD = 10.79) participated. Construct validity was assessed through confirmatory factor analysis using weighted root mean square residual. The original 6-factor (χ2/df: 3.40; RMSEA: 0.085; CFI: 0.913; TLI: 0.906) and a reduced 4-factor (χ2/df: 2.90; RMSEA: 0.072; CFI: 0.931; TLI: 0.926) structure showed acceptable fit. The fit of the 1-factor model was unacceptable. The internal consistency was evaluated through McDonald's ω, and it was acceptable for 4 of 6 factors of the original structure and for 3 of 4 factors of the reduced structure. In conclusion, these findings suggest that the 6-factor and 4-factor models are valid for measuring positive mental health. However, issues with internal consistency must be investigated.

Targeted health promotion with guided nature walks or group exercise: a controlled trial in primary care

Background

Contact with nature promotes wellbeing through diverse pathways, providing a potential way of supporting health especially in primary care, where patients commonly suffer from multimorbidity and poor general health. Social prescribing is a non-pharmaceutical approach for improving health as well as social inclusion. This field study explores and compares the effects of a nature-based and an exercise-based social prescribing scheme on mental wellbeing and sleep, in a primary care population.

Methods

Primary care patients identified to benefit from a general improvement to their health were recruited by nurses, doctors, or social workers to this non-randomized, intention-to-treat, pilot field-study. Participants (n = 79) chose between the group interventions, either taking part in guided walks in nature, including immersion in a forest with high biodiversity, or participating in a versatile sports program. Mental wellbeing was assessed with the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), with additional questions evaluating self-rated health and sleep. Impact on mental wellbeing was explored in relation to perceived health. The amount and quality of sleep was measured with wrist-worn accelerometers. With a focus on everyday life impacts, the assessments took place before and after the 8-week intervention. All participants lived in Sipoo, Finland, an area with abundant accessible green space.

Results

Participants (mean age 57 years, 79% female) rated their general and mental health lower than the general population. Participation in the Nature-group resulted in improved mental wellbeing (change in WEMWBS by 3.15, p = 0.008), with a positive change for feeling relaxed, being cheerful, having energy to spare, feeling able to deal well with problems, feeling good about oneself and feeling close to other people. The Sports-group was beneficial for those initially rating their health as good. Sleep duration improved in the Sports-group, while participants in the Nature-group reported better sleep quality. Following the interventions there was improvement in perceived health and ability to function in both groups, while perceived mental health improved only in the Nature-group.

Conclusion

We attest that even in areas surrounded by greenery, active interventions can further improve health in a primary care population, and that nature-based interventions are beneficial for those in poor health.

Clinical trial registration

ClinicalTrials.gov, Identifier NCT05893212.

Dashboards as Mechanisms for Community Empowerment: Developing a Prototype for Child and Adolescent Well-being in California

CONTEXT

In recent years, stakeholders in public health have emphasized measuring young peoples' well-being as a more holistic and upstream approach to understanding their health and development. However, summarizing the available indicators of well-being in ways that strengthen ongoing policy and community efforts remains a challenge.

PROGRAM

Our objective was to develop a measurement framework of young peoples' well-being that would be engaging and actionable to a broad and diverse set of stakeholders in California.

IMPLEMENTATION

We began with a scan of the relevant literature documenting previous efforts to measure young peoples' well-being, both within the United States and internationally. Subsequently, we individually interviewed a set of key informants and then convened a multidisciplinary panel of experts to solicit feedback on our approach. Throughout this iterative and collaborative process, we developed and refined a measurement framework based on the information provided across these various sources.

EVALUATION

Findings suggest data dashboards are a promising approach for presenting a parsimonious yet holistic picture of young peoples' well-being. Dashboards can highlight well-being's multidimensionality by categorizing indicators over different domains. Our framework organizes indicators over 5 types: child-centric, subjective well-being, contextual determinants, developmental, and equity-focused. The design and flexibility of dashboards can also highlight important gaps in data collection that are of interest to end users such as indicators not yet collected among the broader population. Furthermore, dashboards can include interactive features, such as selecting key data elements, that can help communities articulate priority areas for policy action, thereby generating momentum and enthusiasm for future iterations and improvements.

DISCUSSION

Data dashboards are well suited for engaging a variety of stakeholders on complex multidimensional concepts such as young peoples' well-being. However, to fulfill their promise, they should be codesigned and codeveloped through an iterative process with the stakeholders and community members they intend to serve.

Associations between trajectories of adolescent conduct problems and psychological well-being in young women

INTRODUCTION

Despite the clinical relevance, little is known about variability in positive adult outcomes (i.e., flourishing, life satisfaction) of female adolescent conduct problems (CP), or interpersonal factors that promote these types of well-being. We hypothesized differential associations between adolescent CP trajectories and indicators of adult well-being due to level of positive relationships with caregivers during ages 12-17.

METHOD

Data were drawn from participants (N = 1965) of the Pittsburgh Girls Study, a longitudinal study of girls' development. Caregiver reported CP, adolescent reports of parental trust and positive parenting, and adolescent-reported peer delinquency were assessed annually between ages 12-17. Well-being in young adulthood was measured using self-reported flourishing and life satisfaction between ages 18-22.

RESULTS

Latent class growth analysis of adolescent CP revealed four trajectories characterized as low stable (20.0%), moderate stable (63.9%), adolescent-onset (8.1%), and high quadratic (8.0%). Main effects of trust and positive relationships with caregivers during adolescence on well-being in early adulthood were found. Positive parenting was found to moderate the association between CP trajectory and flourishing. The magnitude of the negative association between the high quadratic trajectory group and life satisfaction decreased as positive parenting increased.

CONCLUSION

These results support the importance of intervention in adolescence to focus on increasing trusting and positive relationships with caregivers for all females, as this may increase well-being in adulthood regardless of adolescent CP history.

Positive Mental Health Scale (PMHS) in Parents of Children with Cancer: A Psychometric Evaluation Using Item Response Theory

Mental health is currently a public health issue worldwide. However, evidence is lacking regarding the validity of the instruments used to measure and assess positive mental health in specific populations. The objective of this study was to evaluate the psychometric properties of the PMHS using IRT. A cross-sectional retrospective study with non-probabilistic convenience sampling was conducted with 623 parents of children undergoing cancer treatment at the National Institute of Health in Mexico City. The participants responded to a battery of tests, including a sociodemographic questionnaire, the PMHS, Measurement Scale of Resilience, Beck Depression Inventory, Inventory of Quality of Life, Beck Anxiety Inventory, an interview regarding caregiver burden, and the World Health Organization Well-Being Index. PMHS responses were analyzed using Samejima's graded response model. The PMHS findings indicated that the IRT-based graded response model validated the single latent trait model. The scale scores were independent of depression, anxiety, well-being, caregiver burden, quality of life, and resilience. The PMHS scores were associated with low subjective well-being. The PMHS findings reveal that from an IRT-based perspective, this scale is unidimensional and is a valid, reliable, and culturally relevant instrument for assessing positive mental health in parents of children with chronic diseases.

Exploring the Effects of Volunteering on the Social, Mental, and Physical Health and Well-being of Volunteers: An Umbrella Review

Volunteering provides unique benefits to organisations, recipients, and potentially the volunteers themselves. This umbrella review examined the benefits of volunteering and their potential moderators. Eleven databases were searched for systematic reviews on the social, mental, physical, or general health benefits of volunteering, published up to July 2022. AMSTAR 2 was used to assess quality and overlap of included primary studies was calculated. Twenty-eight reviews were included; participants were mainly older adults based in the USA. Although overlap between reviews was low, quality was generally poor. Benefits were found in all three domains, with reduced mortality and increased functioning exerting the largest effects. Older age, reflection, religious volunteering, and altruistic motivations increased benefits most consistently. Referral of social prescribing clients to volunteering is recommended. Limitations include the need to align results to research conducted after the COVID-19 pandemic. (PROSPERO registration number: CRD42022349703).

Supplementary Information

The online version contains supplementary material available at 10.1007/s11266-023-00573-z.

The Moderating Roles of Intrinsic and Extrinsic Religiosity on the Relationship between Social Networks and Flourishing: A Study on Community-Dwelling Widowed Older Adults in Malaysia

Widowhood affects the social networks and well-being of older adults. Religion might moderate the relationship between a stressor and well-being. This study aimed to identify the moderating roles of intrinsic and extrinsic religiosity on the relationship between social networks and flourishing among widowed older people and whether this relationship varied across gender. This study involved 655 community-dwelling widowed older Malaysians from Wave 1 (2012-2013) of "Identifying Psychosocial Risks and Quantifying the Economic Costs of Age-Related Cognitive Decline among Older Malaysians" in Peninsula Malaysia. The moderated hierarchical multiple linear regression analysis was conducted to examine the moderating roles of religiosity. Results showed that the moderating effect of religiosity on the relationship between social networks and flourishing was only observed for extrinsic religiosity, not intrinsic religiosity. In terms of gender differences, extrinsic religiosity moderated the relationship between social networks, flourishing only among widows but not widowers. Widows with low levels of extrinsic religiosity should join activities or programs that could expand their social networks to promote higher well-being despite widowhood.

Association Between Positive Childhood Experiences and Childhood Flourishing Among US Children

OBJECTIVE

There has been limited research examining the fostering of positive childhood experiences (PCEs) that could promote flourishing among children. The purpose of this study is to examine the relationship between 7 selected PCEs and the outcome of flourishing, among a nationally based population-level survey sample of children aged 6 to 17 years.

METHODS

Data were drawn from the 2018 to 2019 National Survey of Children's Health, with children aged 6 years and older included (n = 40,561). Children were designated as flourishing if they had responses of always or usually to all 3 flourishing items measured by the National Survey of Children's Health, which were (1) showing an interest and curiosity in learning new things, (2) working to finish the task they started, and (3) staying calm and in control when faced with a challenge. To examine the association between PCEs and flourishing, multivariable logistic regression models were used.

RESULTS

Children who experienced each type of PCE had higher odds of flourishing: after-school activities (adjusted odds ratio [aOR], 1.81; 95% confidence interval [CI], 1.58-2.07), community volunteer (aOR, 1.63; 95% CI, 1.47-1.80), guiding mentor (aOR, 1.66; 95% CI, 1.39-2.00), resilient family (aOR, 2.35; 95% CI, 2.08-2.67), safe neighborhood (aOR, 1.43; 95% CI, 1.29-1.60), supportive neighborhood (aOR, 1.57; 95% CI, 1.42-1.74), and connected caregiver (aOR, 3.26; 95% CI, 2.93-3.64).

CONCLUSION

Findings demonstrating a significant association between PCEs and flourishing have implications for population-wide approaches to improving the prevalence of flourishing among children and youth.

Validation and psychometric properties of the bangla version of positive mental health scale (PMH-scale)

Positive mental health is crucial to individuals' total well-being and especially to their emotional, psychological, and social functioning. To assess the positive aspects of mental health, the Positive Mental Health Scale (PMH-scale) is being used as one of the most significant and practical short unidimensional psychological tools. However, the PMH-scale has not yet been validated for the Bangladeshi population nor has it been translated into Bangla. Therefore, the purpose of this study was to investigate the psychometric properties of the Bangla version of PMH-scale and validate it with the Brief Aggression Questionnaire (BAQ) and Brunel Mood Scale (BRUMS). The sample of the study consisted of 3145 university students (61.8% men) aged from 17 to 27 (M = 22.07, SD = 1.74) and 298 general population (53.4% men) aged from 30 to 65 (M = 41.05, SD = 7.88) of Bangladesh. The factor structure of the PMH-scale as well as measurement invariance for sex and age (age ≤30 years; age >30 years) were tested, using the confirmatory factor analysis (CFA). The CFA revealed that the originally proposed unidimensional model of PMH-scale had a good fit in the current sample which confirms factorial validity of the Bangla version of PMH-scale. The value of Cronbach's alpha (for both groups combined α = 0.85; for the student sample α = .85; and for the general sample α = .73) ensured the high internal consistency of the items. Concurrent validity of the PMH-scale was confirmed through the expected correlation with aggression (BAQ) and mood (BRUMS). The PMH-scale was also partially invariant over groups (student, general, men and women) indicating that the PMH-scale is equally applicable to student, general, men and women population. Therefore, this study tells us that the Bangla version of PMH-scale is a quick and easy-to-administer tool for assessing positive mental health in different groups of people in Bangladeshi culture. This work will also be useful for mental health studies in Bangladesh.

How mentally healthy we are during the pandemic? Findings from changed travel behavior

Background

Many people changed their travel behavior during the coronavirus pandemic with more telecommuting, fewer trip frequencies, and less use of transit and ride-hailing to avoid infection. The lack of outdoor activities may result in social isolation and then trigger anxiety or depressive symptoms.

Research objective

This study examines the relationship between anxiety and depression, and correlates various sociodemographic, income, job status, health-related factors, and travel behavior changes in six large U.S. cities.

Data

U.S. Census Household Pulse Survey Phases 3.0 and 3.1 are employed.

Method

GAD-2 and PHQ-2 are used to screen the scores of anxiety and depression. The synthetic minority oversampling technique is applied to correct sample distribution. The multivariate mixed model is employed to examine relationships.

Results

(1) Anxiety and depression are positively correlated, and the percentage of high anxiety is greater than the percentage of high depression. (2) The levels of anxiety and depression significantly vary across the six cities. (3) Women, young, singles, and white people have higher levels of anxiety and depression during the pandemic. (4) People who are willing to receive vaccination tend to have higher levels of anxiety and depression. (5) The prevalence of depressive disorders is significantly lower in the high-income group. (6) People who applied for unemployment insurance and experienced expense difficulties are more likely to suffer high levels of anxiety and depression. (7) Travel behavior changes, measured by increased telecommuting, reduced trip frequency, and reduced use of transit and ride-hailing, all suggest positive correlations with anxiety and depression.

Conclusions

More assistance and attention should be given to women, singles, and low-income households to reduce the prevalence of mental stress in vulnerable groups. Telecommuting can be but need to work with other travel demand management strategies. Travel and outdoor activities should be promoted under the new normal.

Religion/Spirituality, Mental Health, and the Lifespan: Findings from a Representative Sample of Canadian Adults

Theories of adult development and aging suggest that older adults turn towards religion and spirituality (R/S) to increase meaning and purpose in life, and to assist in coping with adverse experience. We sought to examine the relationship between R/S and positive mental health and mental illness (i.e., psychological distress) in adulthood, and to determine the potential moderating role of age. Data from the 2012 Canadian Community Health Survey - Mental Health (CCHS-MH), a national population health study, were used. A multivariable linear regression model revealed a significant R/S by age interaction for positive mental health (p = 0.001). Although R/S was associated with positive mental health among all participants, there was a stronger relationship between R/S and positive mental health for older adults. No statistically significant relationship between R/S and psychological distress was observed. Findings highlight the importance of R/S to positive mental health across the adult lifespan. The differential relationships among R/S, positive mental health, and mental illness underscore the utility of using the dual-continua of mental health and mental illness in order to understand their respective determinants.

Psychological Well-being across the Perinatal Period: Life Satisfaction and Flourishing in a Longitudinal Study of Black and White American Women

Psychological well-being (life satisfaction and flourishing) during the perinatal period has implications for both maternal and child health. However, few studies have investigated the extent to which psychological well-being changes from preconception to postpartum periods, particularly among diverse samples of women. Using prospectively collected data from an ongoing longitudinal study, we investigated changes in two dimensions of psychological well-being from preconception to postpartum among 173 Black and White American women. Results showed that changes in life satisfaction (i.e., global quality of life) and flourishing (e.g., self-acceptance, sense of purpose) over the perinatal period were moderated by race. For life satisfaction, White women reported an increase from preconception to pregnancy with increased life satisfaction levels remaining stable from pregnancy to postpartum. However, Black women reported no changes in life satisfaction across these timepoints. In contrast, both Black and White women reported an increase in flourishing levels across the perinatal period, although the timing of these changes differed. Findings highlight a need for greater clinical and empirical attention to the way in which psychological well-being changes during the perinatal period to optimize health and inform strengths-based intervention targets.

Moving suicide prevention upstream by understanding the effect of flourishing on suicidal ideation in midlife: an instrumental variable approach

Prior research has examined the association between flourishing and suicidal ideation, but it is unknown whether this association is causal. Understanding the causality between flourishing and suicidal ideation is important for clinicians and policymakers to determine the value of innovative suicide prevention programs by improving flourishing in at-risk groups. Using a linked nationwide longitudinal sample of 1619 middle-aged adults (mean age 53, 53% female, 88% White) from the National Survey of Midlife Development in the United States (MIDUS), this retrospective cohort study aims to assess the causal relationship between flourishing and suicidal ideation among middle-aged adults in the US. Flourishing is a theory-informed 13-scale index covering three domains: emotional, psychological, and social well-being. Suicidal ideation was self-reported in a follow-up interview conducted after measuring flourishing. We estimated instrumental variable models to examine the potential causal relationship between flourishing and suicidal ideation. High-level flourishing (binary) was reported by 486 (30.0%) individuals, and was associated with an 18.6% reduction in any suicidal ideation (binary) (95% CI, - 29.3- - 8.0). Using alternative measures, a one standard deviation increase in flourishing (z-score) was associated with a 0.518 (95% CI, 0.069, 0.968) standard deviation decrease in suicidal ideation (z-score). Our results suggest that prevention programs that increase flourishing in midlife should result in meaningful reductions in suicide risk. Strengthening population-level collaboration between policymakers, clinical practitioners, and non-medical partners to promote flourishing can support our collective ability to reduce suicide risks across social, economic, and other structural circumstances.

Decreasing patterns of depression in living alone across middle-aged and older men and women using a longitudinal mixed-effects model

There is little evidence regarding the association between living arrangement and depression, and no studies have examined the age- and gender-specific differences in this association. The present study sought to examine the longitudinal changes in depression patterns between isolative living versus living in company among middle-aged and older men and women by obtaining data from waves 1-7 of the Korean Longitudinal Study of Aging (KloSA), which comprises a sample of persons at least 45 years of age in the Republic of Korea (2273 middle-aged and 1387 older men, 2805 middle aged and 1862 older women). Depression scores were based on the self-reported Center for Epidemiologic Studies Depression Scale (CES-D-10) short forms. Using mixed-effect linear regression models, we estimated depression patterns by living arrangement across age- and gender groups. Our findings from the mixed-effects model revealed that over a 14-year follow-up period, there were significant decreasing patterns of depression were among middle-aged men and women, and older men living alone compared to living with a spouse and living with others. However, living alone still had the highest depression compared to other living arrangement types. On the other hand, the depression of older women living alone changed to a level similar to those living with others during the follow-up period. In conclusion, these findings indicate that living alone significantly increases the risk of depression, but the risk decreases over time. Additionally, depression patterns by living arrangement proved to differ across age and gender groups.

COVID-19 infection: Positive mental health, psychological vulnerability and sex: Cross-sectional study

Since mid-March 2020, a state of emergency was decreed in Portugal due to the COVID-19 pandemic and, consequently, measures were implemented to protect public health, such as social isolation, which will certainly have a notable impact on the mental health of the population, especially in the most vulnerable groups. Positive Mental Health (PMH) is essential to deal with adversity, in this case with the pandemic, and to live better and with greater satisfaction. We consider it relevant to investigate how PMH was used as a resource to deal with the pandemic, depending on the level of vulnerability and sex. A, cross-sectional study was carried out whose the aim was to evaluate the levels of PMH and psychological vulnerability in people with COVOD-19 infection and analyze the association between PMH and psychological vulnerability among men and women.

METHODS

The instruments used were a sociodemographic characterization questionnaire, the Positive Mental Health Questionnaire, and the Psychological Vulnerability Scale (PVS), that were sent and filled out online. A quantitative, cross-sectional, descriptive, and correlational study was carried out.

RESULTS

After analyzing the results, it was found that approximately 50.4% of the respondents (n = 387) had global PMH values that place them in quartile 50. There was also a statistically significant difference between female and male PMH, with women showing greater psychological vulnerability and lower overall PMH.

CONCLUSIONS

We conclude that the women present a greater psychological vulnerability and a lower level of PMH when compared to men.

RELEVANCE TO CLINICAL PRACTICE

Considering the study's statistically significant results, when we talk about mental health, we should always consider the sex variable as a vulnerability factor, in a pandemic or non-pandemic phase.

Flourishing or physical activity?: Identifying temporal precedence in supporting the transition to university

Objective: Flourishing is a mental health indicator that helps students function optimally, which may be important for first-year university students. Physical activity (PA) also contributes to optimal functioning, yet the flourishing and PA relationship has received little attention. The bidirectional relationships between flourishing and meeting moderate-to-vigorous PA (MVPA) guidelines were assessed during the first year of university. Methods: First-year university students completed surveys (September [T1], March [T2]). Reciprocal effects were examined in a cross-lagged path model. Results: Over 40% of the sample was not meeting MVPA guidelines at T1 or T2. Controlling for sex, higher T1 flourishing was associated with higher odds of meeting T2 MVPA guidelines. T1 MVPA did not predict T2 flourishing. Conclusions: The findings provide preliminary evidence that flourishing may support meeting MVPA guidelines for first-year students. Given low rates of meeting guidelines, flourishing and PA could be targeted to foster MVPA, supporting a healthy university transition.

The relationship of diverse leisure activities with flourishing

The relationship between leisure and wellbeing is of great interest in the field of leisure studies. Keyes (2002) developed a typology of flourishing vs. languishing that encompasses subjective, psychological, and social wellbeing and is linked with physical health and functioning. However, little research has been done to show how participation in various forms of leisure might be associated with this flourishing typology. Drawing on data from community data with over 5,000 adult participants, we assessed how leisure is associated with a flourishing typology. For the present analyses, we focus on scales that assessed social leisure (e.g., socializing with friends), cultural leisure (e.g., festival attendance), home-based leisure (e.g., reading books for pleasure), physically active leisure (e.g., moderate or vigorous), and media-based leisure (e.g., time spent playing computer games or watching TV). A flourishing typology was constructed from single-item ratings on life satisfaction (subjective wellbeing), psychological well-being (self-perceptions that one's life activities are worthwhile), and social wellbeing (sense of belonging). Flourishing was linked to greater participation in cultural, social, home-based, and physically active leisure. Greater time spent playing computer games and watching TV was associated with languishing. Thus, certain forms of leisure reflect flourishing and others are linked with languishing. The nature of these associations remains to be explored, in particular, whether leisure contributes to flourishing or if flourishing facilitates certain forms of leisure participation.

Exploring factors associated with complete mental health of pregnant women during the COVID-19 pandemic

OBJECTIVE

To explore a wide range of factors associated with complete mental health (i.e., positive mental health - the presence of flourishing, and the absence of mental illness - depressive and anxious symptoms) among Portuguese pregnant women, during the COVID-19 pandemic.

DESIGN

Quantitative cross-sectional study.

SETTING

Data were collected through an online survey placed on social media websites targeting pregnant Portuguese adult women between October 2020 and April 2021.

PARTICIPANTS

The sample comprised 207 pregnant women.

RESULTS

A multivariate logistic regression model showed that higher levels of self-compassion and higher engagement in mindful self-care practices increased the likelihood of reporting complete mental health during pregnancy.

CONCLUSIONS

Promoting self-compassion and mindful self-care may be particularly important in pregnant women, as these psychological factors appear to contribute to complete mental health during COVID-19 pandemic.

IMPLICATIONS FOR PRACTICE

The COVID-19 pandemic represented a demanding period for pregnant women. Our findings highlight that targeting the promotion of self-compassion and mindful self-care practices during stressful periods could significantly contribute to their overall mental health.

Pre-pandemic resilience to trauma and mental health outcomes during COVID-19

PURPOSE

The stress-sensitization hypothesis posits that individuals with prior trauma are at elevated risk for poor mental health when faced with subsequent stressors. Little work has examined whether those who have demonstrated psychological resilience to prior trauma would show either increased resilience or vulnerability to subsequent stressors. We examined pre-pandemic psychological resilience to lifetime trauma in relation to mental health outcomes amid the coronavirus disease 2019 (COVID-19) pandemic, a major societal stressor.

METHODS

The sample included 16,900 trauma-exposed women from the Nurses' Health Study II. Pre-pandemic resilience was defined by psychological health in 2017-2019 (characterized by levels of both distress and positive emotional well-being) relative to lifetime trauma. Resilience was defined categorically by cross-classifying unfavorable, adequate, and favorable psychological health by higher versus lower trauma burden, and continuously as the residual difference in predicted versus actual psychological health regressed on trauma burden. Mental health outcomes as of May-August 2020 included psychological distress symptoms and overall positive emotional well-being. Associations were assessed using covariate-adjusted regression models.

RESULTS

Pre-pandemic resilience was associated with lower distress and higher well-being early in the COVID-19 pandemic. Relative to the women showing highest resilience (favorable psychological health despite higher trauma), only those with lower trauma and favorable prior psychological health had significantly lower distress and higher positive emotional well-being during the pandemic. Higher continuous pre-pandemic resilience was also significantly associated with lower distress and higher positive emotional well-being during the pandemic.

CONCLUSION

Preventing mental health problems following trauma may contribute to protecting population well-being amid major stressors.

Psychometric properties of a Saudi Arabian version of the Positive Mental Health (PMH) scale

The Positive Mental Health (PMH) scale has been shown to be a reliable and valid tool for assessing positive mental health and well-being in different languages and cultures. However, the PMH scale has not yet been translated into Arabic and validated for the Saudi Arabian population. Therefore, the current study aimed to translate the English version of the PMH scale into Arabic for the Saudi Arabian context and validate the translated scale. A total of 1148 adult participants from Saudi public universities took part in the study. Based on exploratory and confirmatory factor analyses in different subsamples, the results of the current study revealed that the unifactorial model satisfactorily fits the data. Additionally, the Arabic version of the PMH scale demonstrated sufficient levels of reliability and had a high negative correlation with the Beck Depression Inventory-II, indicating convergent validity. Taken together, the findings of the current study suggest that the Arabic version of the PMH scale has appropriate levels of validity and reliability for the Saudi Arabian population.

Demographic Predictors of Complete Well-Being

This paper examines demographic differences in flourishing, defined as "complete well-being" and consisting of six domains: emotional health, physical health, purpose, character strengths, social connectedness, and financial security. Results are based on a random, cross-sectional sample of 2363 survey respondents drawn from employees of a large, national, self-insured employer based in the United States. We found that well-being across domains tends to increase with age, although there are some variations. Results are similar across most domains for men and women, although women score higher on character strengths, while men had higher scores on financial security. Racial and ethnic differences were striking. Black employees score higher than the reference group (White employees) on the emotional, purpose, and character strengths domains, but considerably lower on financial security. Hispanics also score lower on financial security (though not as low as Blacks), but higher than Whites on purpose, character strengths, and social connectedness. Asians reported higher well-being than Whites across all domains except purpose.

Using Decision Trees to Examine Environmental and Behavioural Factors Associated with Youth Anxiety, Depression, and Flourishing

Modifiable environmental and behavioural factors influence youth mental health; however, past studies have primarily used regression models that quantify population average effects. Decision trees are an analytic technique that examine complex relationships between factors and identify high-risk subgroups to whom intervention measures can be targeted. This study used decision trees to examine associations of various risk factors with youth anxiety, depression, and flourishing. Data were collected from 74,501 students across Canadian high schools participating in the 2018-2019 COMPASS Study. Students completed a questionnaire including validated mental health scales and 23 covariates. Decision trees were grown to identify key factors and subgroups for anxiety, depression, and flourishing outcomes. Females lacking both happy home life and sense of connection to school were at greatest risk for higher anxiety and depression levels. In contrast with previous literature, behavioural factors such as diet, movement and substance use did not emerge as differentiators. This study highlights the influence of home and school environments on youth mental health using a novel decision tree analysis. While having a happy home life is most important in protecting against youth anxiety and depression, a sense of connection to school may mitigate the negative influence of a poor home environment.

The Child and Adolescent Thriving Index 1.0: Developing a Measure of the Outcome Indicators of Well-Being for Population Health Assessment

The well-being of children and adolescents is emerging as an area of interest for population health measurement. Previous approaches assessing national and state trends in well-being have relied on composite indices. However, these methodologies suffer from several weaknesses. This paper develops an improved index for the United States that is measurable with existing population-data resources. It derives the appropriate weights for items in this index using a longitudinal panel of 2,942 children in the Panel Study of Income Dynamics. Candidate component measures are selected for the index based on their demonstrated association with several subjective scales assessed during young adulthood. The final index demonstrates that a broad range of measures indicate higher levels of population-level well-being. The predictive validity of the index for outcomes during young adulthood is also assessed: a one-standard-deviation increase in the index score is associated with a 7.9-percentage-point decrease [95% CI: 5.9 - 9.8] in ever reporting fair or poor health, a 6.3-percentage-point decrease [95% CI: 4.6 - 8.0] in ever reporting depression, and a 17.2% [95% CI: 13.7% - 20.5%] increase in peak earnings. These values for predictive validity are slightly higher than those of existing methodologies. We also find that incorporating contextual indicators from childhood and adolescence does not substantively improve predictive validity. Policy-makers and government agencies interested in population-level well-being of children and adolescents can continue to use existing indices as reasonable proxies, but should also commit to upgrading data systems to make them more child-centric in the future.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12187-022-09962-0.

Cost-utility of a web-based intervention to promote maternal mental health among postpartum women presenting low risk for postpartum depression

OBJECTIVES

Web-based interventions for the promotion of maternal mental health could represent a cost-effective strategy to reduce the burden associated with perinatal mental illness. This study aimed to evaluate the cost-utility of Be a Mom, a self-guided web-based cognitive behavioral therapy intervention, compared with a waiting-list control.

METHODS

The economic evaluation alongside a randomized controlled trial was conducted from a societal perspective over a 14-month time frame. Postpartum women presenting low risk for postpartum depression were randomized to the intervention (n = 191) or control (n = 176) group and assessed at baseline, postintervention and 4 and 12 months after postintervention. Data regarding healthcare use, productive losses and quality-adjusted life years (QALYs) were collected and used to calculate incremental cost-effectiveness ratios (ICERs). Uncertainty was accounted for with nonparametric bootstrapping and sensitivity analyses.

RESULTS

At 14 months, and after accounting for a 3.5 percent discount rate, the intervention resulted in a yearly cost-saving of EUR 165.47 (-361.77, 28.51) and a QALY gain of 0.0064 (-0.0116, 0.0244). Bootstrapping results revealed a dominant ICER for the intervention group. Although results were statistically nonsignificant, cost-effectiveness acceptability curves showed that at a EUR 0 willingness to pay threshold, there is a 96 percent probability that the intervention is cost-effective when compared with the control group. The sensitivity analyses generally supported the acceptable likelihood of the intervention being more cost-effective than the control group.

CONCLUSIONS

From a societal perspective, the implementation of Be a Mom among low-risk postpartum women could be a cost-effective way to improve perinatal mental health.

The potential of psychological connectedness: Mitigating the impacts of COVID-19 through sense of community and community resilience

The purpose of this study was to identify patterns of relationships connecting sense of community (SOC) and community resilience with psychological wellbeing, via the mediation of coronavirus disease 2019 (COVID-19) impacts on life domains. Survey data were collected from an international sample of adults (n = 824) during the COVID-19 outbreak (June-September 2020). Using a structural equation model, we tested a mediation model to identify the associations between SOC and community resilience with the perceived impacts of the emergency situation and with psychological wellbeing. Results revealed that SOC mitigated the impacts of COVID-19 on multiple life domains, and it was also positively associated with wellbeing. Community resilience was correlated with SOC and wellbeing but showed no significant relationship with COVID-19 impacts. The findings support that SOC has a protective function and can contribute to mitigating the impacts of difficult life situations. SOC can also be leveraged as an intervention aimed at protecting the wellbeing of people and communities, particularly in times of crisiss.

The Impact of Juvenile Drug Treatment Courts on Substance Use, Mental Health, and Recidivism: Results from a Multisite Experimental Evaluation

Juvenile Drug Treatment Courts (JDTC) emerged in the mid-1990s as a potential solution to concern about substance use among youth in the juvenile justice system (JJS). Despite substantial research, findings on the JDTC effectiveness for reducing recidivism and substance use remain inconsistent, hampered by methodological problems. In 2016, the Office of Juvenile Justice and Delinquency Prevention published research-based JDTC Guidelines for best practices, and funded technical assistance for implementation and a multisite national outcomes study among JDTCs implementing the Guidelines. Ten sites were originally selected for this study, with a JDTC and Traditional Juvenile Court (TJC) participating. In two sites, moderate- to high-risk youth were randomized to JDTC or TJC, and in eight sites, a regression discontinuity design assigned moderate- to high-risk youth to JDTC, and other youth to TJC. Findings from four sites with sufficient cases and follow-up rates indicated that JDTCs reduced cannabis use, increased access to mental health services, and reduced recidivism. However, the effects were small to moderate, with positive impacts mainly observed among high-risk youth. The impacts of JDTCs may have been attenuated because Guidelines implementation was inconsistent across courts, and some TJCs implemented elements of the Guidelines, blurring the distinction between JDTCs and TJCs.