Health is
Health is
not simply the absence
of disease:
it is something
positive . . .
—Henry Sigerist (1941, p. 100).
Kinds of Happiness
Hedonia
Eudaimonia
Origins of Flourishing
Hedonia
Flourishing
Eudaimonia
Signs of Mental Health
(Keyes, 1999, 2002)
Hedonic Well-Being
1. Satisfied with your life
2. Positive affect in life
Eudaimonic Well-Being
3. Contribution to society
4. Social integration
5. Social growth and potential
6. Acceptance of others
7. Social interest and coherence
8. Self acceptance
9. Environmental mastery
10. Positive relations with others
11. Personal growth
12. Autonomy
13. Purpose in life
What’s Your Mental Health?
• High Level = Experience sign of
mental health “every day” or “almost
every day”
• Low Level = Experience a sign of
mental health “once or twice” or
“never”
• Flourishing
– High level on 1 or more hedonic well-being
• and
– High level on 6 or more eudaimonic wellbeing
• Languishing
– Low level on 1 or more hedonic well-being
• and
– Low level on 6 or more eudaimonic wellbeing
• Moderately Mentally Health
– if you are neither flourishing nor
languishing
DSM 12 Month Mental Disorders
MIDUS 1 Adults
Keyes (2005a)
Major Depression Generalized Anxiety Panic Disorder Alcohol Dependence
35
30
28
25
%
20
16
15
13.4
10.6
9.4
10
6
6.8
4.8
5
2.7
2.2
0.4
1
0
Languishing
Moderately Mentally Healthy
Flourishing
Data Support the Two
Continua Model
High
Mental Health
High
Mental Illness
Low
Low
Complete State Approach
MHC-SF Mental Health Diagnosis
DSM 12-Month
Mental Illness
Diagnosis
No
Yes
Languishing
Moderately
Mentally Healthy
Languishing
Moderate
Mental Health
3
2
Mental Illness
and Languishing
6
Flourishing
Flourishing:
Complete
Mental Health
1
Mental Illness
Mental Illness
and Moderately and Flourishing
Mentally Healthy
4
5
Anything Less Than Mental Health as
Flourishing in Adults
(Keyes, 2007)
• Productivity
– Missed days of work
– Workday cutbacks
• Chronic Physical Illness and Conditions
– Any CVD
– Number of conditions at all ages
• Disability
– Health Limitations of IADLs
• Psychosocial Assets
–
–
–
–
Report Being More Resilient
Clearer Goals in Life
Feel More Loved and Cared For (Intimacy)
Low Sense of Helplessness
• Healthcare Utilization
– Few Overnight Hospitalizations
– Medical Visits (for physical or for emotional,
psychological)
– Few Medical Prescriptions
Flourishing Across the Life-Span
(MIDUS 1995 and MIDUS 2005 Longitudinal Follow Up)
Cardiovascular Disease (CVD)
• CVD prevalent and costly
• +6o million Americans have at least
one type of CVD
– 40% are above the age of 65
• Highest combined direct and indirect
costs cost ($180 billion in 1999)
• About 1 per 2.5 deaths directly result
from CVD
– 47% of men
– 54% of women died from some CVD (1999)
• Deaths from CVD decreased by 30%
• Less recognizable risk factor in the is
mental illness (MDE)
Happy Heart Hypothesis
(Keyes, 2004)
Happy Heart Hypothesis
(Keyes, 2004)
2nd
1st
3rd
Chronic Physical Conditions (27 possible)
Keyes (2005b)
7
6
5
MDE and Languishing
4
MDE
3
Languishing
Moderately Mentally Healthy
Flourishing
2
1
0
Young 25-39
Midlife 40-59
Older 60-74
Mental Health and
Illness:
Which is Cause and
Effect?
Change in Adults’ Mental Health Status:
Destinations and Origins
Flourishing
1995
Flourishing
2005
19.2%
22.3%
Flourishing
50.6%
46.3%
3.1%
Moderate
Mental
Health
Languishing
63.6%
17.2%
60.4%
17.3%
Moderate
Mental
Health
Languishing
Change in Adults’ Mental Health Status:
Destinations and Origins
Moderate Mental Health
1995
Flourishing
2005
Flourishing
19.2%
22.3%
18.6%
Moderate
Mental
Health
63.6%
67.5%
60.4%
Moderate
Mental
Health
13.9%
Languishing
17.3%
17.2%
Languishing
Change in Adults’ Mental Health Status:
Destinations and Origins
Languishing
1995
Flourishing
Moderate
Mental
Health
2005
19.2%
22.3%
63.6%
60.4%
Flourishing
Moderate
Mental
Health
4.1%
50.2%
45.7%
Languishing
17.2%
17.3%
Languishing
Adjusted* Odds Ratio of any 2005 Mental Illness
(MDE, GAD or Panic Disorder)
by Change in Mental Health Status
(Adjusted for Race, Age, Sex, Education, and Total Chronic Physical Illness in 2005)
10
9
8
7.7
7
6
5.5
5
4.5
4
3.8
3.5
3
2.3
2
1.4
1
1
0
Languishing 1995
Languishing 2005
Flourishing or
Languishing
Moderate MH
1995 Moderate
1995 Languishing
MH 2005
2005
Moderate MH
1995 Moderate
MH 2005
Flourishing 1995 Languishing or Flourishing 1995 Any Mental Illness
Moderate MH
Moderate MH Flourishing 2005
1995
2005
1995 Flourishing
2005
Keys to Aging Positive in Terms
of Flourishing
Mental Health in Middle School and High
School Youth in the U.S.
(CDS 2002 Data; Keyes, 2006)
Languishing
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
Moderately Mentally Healthy
Flourishing
54.5
48.8
45.2
39.9
6
5.6
12 to 14 Year Olds
15 to 18 Year Olds
Keys of Aging Successfully
• Transition into adulthood
• Socially Engaged
– Generativity
• Recognize social contact goals change
– selectivity
• Compensate to continue things you love to do
– Adapt
• Try to new things as some things are no
longer possible
– Innovate
• 4 Things to look out for
–
–
–
–
Loss of purpose in life
Loss of social contribution
Loss of social interest and coherence
Loss of personal growth
Why Governments, Public Health
and Healthcare Must Change
1. Health is something specific; mental health includes two
kinds of happiness
– Flourishing combines functioning well and feeling good
2. Absence of illness does not mean the presence of health
– Mental health and illness are on separate continua
3. Presence of mental illness is a burden (yes!); but, the
absence of mental health is also a burden
4. The is too much mental illness (yes!); but there is also too
little (flourishing) mental health
5. Increase in mental health (flourishing) causes a decrease in
odds of mental illness; declines in mental health cause an
increase in odds of mental illness
– Thus, increasing rates of flourishing will reduce mental
illness
6. There is a “wanting — doing” gap in public health
– We say we want “health”; we only focus on illness and disease
• “Can’t get to health through only illness reduction (see points 25)
7. What then is the greatest challenge facing our civilization
this century and beyond ... presence of illness or the
absence of health?
– It is the absence of health, which increases the risks of onset
of illness
• Salutogenic Healthcare Must Take Priority -- Promote,
Maintain, Respond to Early Deviations from, True Health
• Pathogenic Healthcare Has Its Place -- Cures, Treatments,
and Risk Reduction for Illness and Disease