Editorial

DOIhttps://doi.org/10.1108/JPMH-12-2019-088
Published date05 December 2019
Pages211-213
Date05 December 2019
AuthorSarah Stewart-Brown
Subject MatterHealth & social care,Mental health,Public mental health
Sarah Stewart-Brown
Understanding of the determinants of mental wellbeing
Interest in mental wellbeing (positive mental health) is growing because of demonstrable
protective effects on health (Pressman and Cohen, 2005), longevity (Chida and Steptoe, 2008),
learning and productivity (Huppert, 2009). Although there is still debate about the nature of some
aspects of mental wellbeing, there is general agreement that it represents more than the absence
of mental illness and, for most authorities, that it includes both affective ( feeling) and behavioural
( functioning) components (Faculty of Public Health and Mental Health Foundation, 2016). In the
same way that mental illness is diagnosed on the basis of feeling bad and functioning poorly
mental wellbeing is thus recognised by both feeling good and functioning well.
This interest in mental wellbeing has stimulated researchers like Solin et al. (2019) to investigate
the determinants of mental wellbeing in different parts of the world. It might be assumed that the
determinants of mental wellbeing are the reverse of those well documented for mental illness
(e.g. Allen et al., 2014), but some have called this assumption into question (Huppert, 2009).
Whilst many studies contributing to this debate are cross-sectional and thus cannot reliably
distinguish causality from association, consistent findings from cross-sectional studies do make
a contribution to causality criteria and perhaps more importantly inconsistent findings make
causality unlikely. So it is of interest that there is less consistency in the findings of studies
investigating the social determinants of mental wellbeing than there is in those investigating the
social determinants of mental illness. It is also of interest that study methodology seems to
dictate the findings. Thus, studies that suggest that the determinants are the same,
demonstrating a positive trend for mental wellbeing with income and education, have either used
continuous regression analyses or dichotomised their study populations and used logistic
regression to compare the odds of low mental wellbeing with the odds of not low mental
wellbeing (e.g. Dreger et al., 2014). The study by Solin et al. (2019) uses a different approach in
which both low and high mental wellbeing are compared to the middle range. Like other studies
taking this approach (Stewart-Brown et al., 2015; Ng Fat et al., 2016), they find no evidence that
mental wellbeing is related to educational level and only weak evidence that it is related to
employment. These findings have been replicated in adolescent as well as adult populations
(Nielsen et al., 2016). It would seem that this lack of association with traditional social
determinants is concealed in studies which do not seek to specifically examine the upper end of
the distribution, because the strong social gradient for mental illness dominates findings.
So what do these studies show us about the determinants of mental wellbeing? The study by
Solin et al. (2019) undertaken in Lapland points strongly to the importance of human
relationships those who are not living alone have higher mental wellbeing than those who live
alone. And in both groups, the single most important determinant was social support (measured
with the Social Support Scale (Meltzer, 2003)). This was protective against low levels of mental
wellbeing and positively associated with high levels. Social isolation and loneliness are well
documented associates of both mental and physical illness and prospective studies confirm that
these are likely to be causal (Leigh-Hunt et al., 2017).
The capacity to make positive relationships with others of the sort which allow the giving and
receiving of social support is, however, embedded in the definitions of mental wellbeing
(Faculty of Public Health and Mental Health Foundation, 2016). So, it is possible that lack of
social support and living alone are manifestations of lack of mental wellbeing as much as
determinants. People with high levels of mental wellbeing cheerful, optimistic, confident people
DOI 10.1108/JPMH-12-2019-088 VOL. 18 NO. 4 2019, pp. 211-213, © Emerald Publishing Limited, ISSN 1746-5729
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JOURNAL OF PUBLIC MENTALHEALTH
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PAG E 21 1
Editorial

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