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Well-Being and Mental Wellness Well-Being and Mental Wellness

May 2021

DOI:10.1093/acrefore/9780190632366.013.162

Authors:

Gerard Bodeker

University of Oxford

Sergio Pecorelli

University of Brescia

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Well-Being and Mental Wellness

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Subject: Epidemiology Online Publication Date: Jul 2020

DOI: 10.1093/acrefore/9780190632366.013.162

Well-Being and Mental Wellness

Gerard Bodeker, Sergio Pecorelli, Lawrence Choy, Ranieri Guerra, and Kishan

Kariippanon



Summary and Keywords

The scientific landscape of wellbeing and mental wellness has developed significantly

through interdisciplinary cross-pollination by researchers in molecular genetics, neuro

science, sociology, economics, including traditional and complementary medicine. The

public health challenge lies in using this diverse body of scientific evidence to reframe

wellbeing and mental wellness within a 21st-century global public health framework that

incorporates evidence-based modalities alongside Western biomedical practice. Evidence

on modalities, case studies, policy examples, and emerging directions in societal objec

tives in wellbeing and mental wellness are discussed in the context of a way forward that

focuses on individual self-care, development of resilience, lifespan pathways for wellbe

ing, and a different economic calculus in framing public health priorities and policies.

Keywords: first thousand days, SDGs, wellbeing, wellness, thriving, resilience, happiness, mental well-being, men

tal wellness, human potential, brain plasticity

Introduction

In 2017, the World Health Organization (WHO) produced the WHO Mental Health Atlas

with data from questionnaires completed by 177 of WHO’s 194 member states (World

Health Organization [WHO], 2018) and used to monitor the development and implementa

tion of WHO’s Comprehensive Mental Health Action Plan 2013–2020 (WHO, 2013).

The WHO Atlas reported that the level of public expenditure on mental health in low- and

middle-income countries was low, and more than 80% of funds went to mental health hos

pitals. The allocation for human resources for mental health services has an extreme vari

ation between low- and high-income countries (from 1 in low-income countries to 72 in

high-income countries), whereas globally, the median number of mental health workers is

9 per 100,000 population (WHO, 2018). The number of mental health beds per 100,000

population is less than 8 in low- and lower-middle-income countries but over 50 in high-

income countries (WHO, 2018). In the sector of mental health promotion and prevention,

only 63% of WHO member states have a minimum of two functioning multisectoral men

tal health promotion and prevention programs at a national level, even though 72% of

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member states have a dedicated policy or plan for mental health, and 57% have a stand-

alone mental health law (WHO, 2018).

The WHO has taken the position that mental health

is a state of wellbeing in which every individual realizes his or her own potential

can cope with the normal stresses of life, can work productively and fruitfully, and

is able to make a contribution to her or his community.

(WHO, 2019)

With mental health given its due importance in the UN Sustainable Development Goals

(SDGs), for the first time leaders of the world have acknowledged that mental health pro

motion wellbeing, and the prevention and treatment of substance abuse, is likely to have

a positive impact on communities and countries where millions of people require much-

needed help. Goal 3 of the SDG framework, for example, is to ensure healthy lives and

promote wellbeing for everyone and at all ages. Target 3.4 calls on countries to reduce

premature mortality from non-communicable diseases by a third, through prevention,

treatment, and mental health and wellbeing promotion by 2030. Target 3.5 calls on gov

ernments to reinforce and increase efforts in the prevention and treatment of substance

abuse, including narcotic drug abuse and the use of alcohol at harmful levels.

The Lancet in 2007 consolidated decades of interdisciplinary studies and practice in a

multitude of contexts and raised a call to action to stakeholders globally to “scale up ser

vices for people affected by mental disorders (including substance use disorders, self-

harm, and dementia)” (Patel et al., 2018, p. 1553). The call to improve mental health ser

vices included a focus on disadvantaged communities living in low- and middle-income

countries, where rights to care and dignity left much room for improvement. As The

Lancet Commission reassessed the global mental health agenda, ten years on, and consid

ering the SDGs, the global burden of disease related to mental disorders has “risen in all

countries in the context of major demographic, environmental, and socio-political

transitions” (Patel et al., 2018, p. 1553).

The opportunity is at hand to reconceptualize a global mental health agenda (in light of

the SDGs and the Comprehensive Mental Health Action Plan from WHO), based on pro

tecting the rights of people with psychosocial disabilities, through the consolidation of ev

idence from a variety of scientific disciplines and the adoption of ubiquitous digital tech

nology. Additionally, the world leaders convened in New York on September 23, 2019, for

the High-Level Meeting on Universal Health Coverage, at the margins of the UN General

Assembly, and in their political declaration committed to implementing measures to pro

mote and improve mental health and wellbeing as an essential component of universal

health coverage addressing such areas as comprehensive and integrated services for the

prevention and treatment of mental health conditions, specifically suicide prevention;

substance abuse; and social determinants, in line with the human rights concept.

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The Lancet Commission provided a four-pillar agenda to reframe global mental health at

a population level. The Commission reported that:

Mental health is a global public good and is relevant to sustainable development in all

countries regardless of their socio-economic status.

Second, mental health problems exist along a continuum from mild, time-limited distress

to chronic, progressive, and severely disabling conditions. The binary approach to diag

nosing mental disorders, although useful for clinical practice, does not accurately reflect

the diversity and complexity of the mental health needs of individuals or populations.

Third, the mental health of each individual is the unique product of social and environ

mental influences, in particular during the early life course, interacting with genetic, neu

ro-development, psychological processes and affecting biological pathways in the brain.

Fourth, mental health is a fundamental human right for all people that requires a rights-

based approach to protect the welfare of people with mental disorders, those at risk of

poor mental health and an enabling environment that promotes mental health for all. (Pa

tel et al., 2018, p. 1553)

Crisis in Non-Communicable Disease

The number of years lived with disability (YLD) from non-communicable diseases (NCDs)

increased between 1990 and 2017 by 61.1% (James et al., 2018). A series paper on “syn

demics,” published in The Lancet in 2017, refers to synergistic health problems that af

fect the health of populations under the influence of persistent social and economic in

equalities. Medical anthropologists developed the term “syndemics” as a call for re

searchers and policymakers to alter their conceptual frameworks to understand risk fac

tors better and improve the implementation of prevention and intervention programs. The

purpose of the call is to account for the health burdens of transitioning populations, par

ticularly in low- to middle-income countries (LMIC) (Mendenhall, Kohrt, Norris, Ndetei, &

Prabhakaran, 2017). For example, diabetes is not only a syndemic interaction with pover

ty but may include structural factors such as forced migration, unemployment, gender in

equality, racism, and a lack of social capital in a local context (Corburn & Hildebrand,

2015).

This crisis in NCDs is multifaceted because it requires a framework that can harness the

power of “medicine, health systems, and human rights by bringing multiple fields togeth

er to recognise, describe, and appropriately intervene in the complex various disease bur

dens that afflict susceptible populations” (Mendenhall et al., 2017, p. 952).

A compelling example of using a syndemic framework to understand the crisis in NCDs is

based on epidemiological evidence where depression is common among those with dia

betes compared with the general population in LMICs. In India, anthropological research,

referenced by Mendenhall et al. (2017), describes how depression is experienced differ

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ently among the rich and the poor. This is exacerbated by a variety of social factors that

contribute to mental illness for those living with diabetes. Social isolation affects upper-

middle-class Indian mothers, whereas financial insecurity in low-income mothers causes

high levels of stress and psychological distress, which tend to result in depression

(Mendenhall et al., 2017).

When researchers and policymakers consider the gravitas of the global syndemic of

NCDs, a convergent model to address mental health by unifying the evidence from devel

opmental science, neuroscience, intervention science, and epidemiology may provide a

way forward (Patel et al., 2018).

In this article, the authors bring together the life course perspective (the first 1,000 days

of life) and new developments in neuroscience, to reframe mental health and wellness in

the context of brain plasticity throughout the adult lifespan, and address the insufficient

care gap in mental health against a backdrop of the development of evidence-based, self-

directed pathways toward growth and resilience in mental wellness.

Epidemiology and Global Public Policy

Mental and substance-use disorders are responsible for approximately 8% of the global

burden of disease, with 700 million people worldwide falling victim to preventable causes

(Ferrari et al., 2014; Whiteford et al., 2013). The burgeoning field of psychiatric epidemi

ology since the 1990s and a systematic review of the global prevalence of common mental

disorders provided aggregated estimates for the prevalence of common mental disorders

across a combined population of 829,673 participants, with 63 countries taking part in

the survey. Of these, 106 surveys were from high-income countries (HIC), and 68 surveys

from 37 low- to middle-income counties (LMIC) (Steel et al., 2014).

Despite limitations in the data, such as the presence of inter-survey heterogeneity and

samples with potentially differing underlying population age structures between HIC and

LMIC, the key findings paint a clear picture of the global epidemiology of mental health

(Steel et al., 2014). The data indicate that one in five adults (17.6%) experienced a com

mon mental disorder within the preceding 12 months and almost 30% across their lifes

pan. Across both HIC and LMIC, women were more at risk of experiencing a mood or anx

iety disorder. In contrast, men were more likely to experience alcohol or other substance

misuse disorder.

to Concerning lifetime prevalence, English-speaking HIC returned a higher prevalence, at

39.7% compared to other HIC and LMIC contexts. This may be due to the “English speak

ing sample including persons of more senior age who has passed through a more extend

ed period of risk, particularly in comparison with surveys undertaken within

LMICs” (Steel et al., 2014, p. 489).

Although these figures underestimate the actual burden of disease because of the univer

sal complexity of diagnosing and reporting mental illness based on a narrow definition of

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disease burden that excludes the impact it has on families and society, it is mostly due to

the limited and far from equitable global provision of mental health services (Gilbert, Pa

tel, Farmer, & Lu, 2015).

Through the use of the Creditor Reporting System, Gilbert et al. (2015) reported that the

amounts and patterns of development assistance for global mental health (DAMH) in de

veloping countries between 2007 and 2013 saw an increase but remained low both in ab

solute terms and in terms proportionate to the total development assistance or health.

The average annual DAMH funding provided from 2007 to 2013 was US$133.57 million,

which is less than 1% of the total financing of development assistance for health. Mental

health has not received significant development assistance despite sustainable mental

healthcare being integrated into the existing health systems at a relatively low cost

(Gilbert et al., 2015).

A fundamental critique of the global policy is the interpretation by policymakers, plan

ners, and researchers of the treatment gap as referring entirely to curative clinical inter

ventions that exclude all effective psychosocial wellness modalities (Pathare, Brazinova,

& Levav, 2018). As the use of the term “treatment” often prioritizes a biomedical ap

proach to mental health disorders and the often-overlooked needs of children and adoles

cents with highly unattended physical comorbidity and early mortality, Pathare et al.

(2018) proposed a holistic approach in the care continuum called the mental health care

gap. Hence the Mental Health Care Gap = Treatment Gap (biomedical approach) + Psy

chosocial Care Gap + Physical Care Gap (Pathare et al., 2018, p. 464).

A study of treatment provision in HIC (Australia, Canada, England, United States) to re

duce the prevalence of common mental disorders, found “none of the four countries had

any evidence for a reduction in the prevalence of disorders or symptoms.” Instead “there

were indications of changes in the opposite direction in Australia, England and the Unit

ed States”(Jorm, Patten, Brugha, & Mojtabai, 2017). This review by Jorm et al. (2017)

shows that in Canada, the United States, and Australia, treatment was not of an adequate

standard. Another critical point was that in Australia, England, and the United States,

treatment was often received by people who did not meet the criteria for a diagnosis

(Jorm et al., 2017).

Defining Well-Being and Mental Wellness

A diverse set of scientific disciplines, such as psychology, sociology, and economics, have

contributed to the task of defining wellbeing. The pursuit of a definition dates back to the

time of Aristotle. He considered hedonic “‘happiness to be a vulgar ideal’ and preferred

eudemonic wellbeing as the ultimate state of human potential” (Ryan & Deci, 2001, in

Hanc, McAndrew, & Ucci, 2019, p. 145). A practical example of interdisciplinary work is a

collaboration between researchers and practitioners from the Mental Wellness Initiative

(MWI) of the Global Wellness Institute, resulting in a white paper, mapping contemporary

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wellness pathways and evidence, as well as future implications for mental health and

wellbeing (Bodeker et al. 2018).

The MWI’s white paper Mental Wellness: Pathways, Evidence and Horizons conceptualize

wellness in terms of a general sense of wellbeing in the physical, social, occupational,

spiritual, financial, and environmental aspects of our lives. The process of maintaining

mental wellness is viewed as lifelong and involves developing the skills and knowledge to

make conscious choices about living a healthy, purposeful, and fulfilling life. This lifelong

process enables individuals to realize their potential, cope with daily stresses, work pro

ductively, and contribute meaningfully to family, community, and society (Bodeker et al.,

2018).

The Better Life Initiative of the Organisation of Economic Co-operation and Development

(OECD, 2011) identifies three pillars for understanding and measuring people’s wellbe

ing:

Material living conditions (or economic wellbeing), which determine people’s con

sumption possibilities and their command over resources.

Quality of life, which is defined as the set of non-monetary attributes of individuals

that shapes their opportunities and life chances and has intrinsic value under dif

ferent cultures and contexts.

The sustainability of the socioeconomic and natural systems where people live and

work, which is important for wellbeing to last over time. Sustainability depends on

how current human activities impact on the stocks of different types of capital

(natural, economic, human, and social) that underpin wellbeing.

Psychological Perspectives of Well-Being

The stream of research that defines wellbeing by the degree of positive feelings experi

enced, such as happiness, and the perception of one’s overall life (whether the individual

is satisfied or not) is emotional wellbeing (Dodge, Daly, Huyton, & Sanders, 2012; Magyar

& Keyes, 2019). The next stream of research, known as psychological wellbeing, accord

ing to Magyar and Keyes (2019), is based on eudemonic wellbeing and includes modali

ties of positive functioning where individuals realize their potential in terms of autonomy

and personal growth. Those who are high in emotional wellbeing feel good about life

while those who have high psychological wellbeing or social wellbeing function well in

daily routine and are resilient (Magyar & Keyes, 2019; Patel et al., 2018).

Mental wellness can be “defined as an asset or resource that enables positive states of

wellbeing and provides the capability for people to achieve their full potential” (Patel et

al., 2018, p. 1562). The challenge to demarcate the differences between mental wellness

and disorder is such that individuals could struggle with symptoms of mental disorder but

at the same time also be able to maintain a degree of mental health parallel to their ex

pectations of life satisfaction, flourishing, and achieving their potential. According to Pa

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tel et al. (2018), the association between mental health and disorder is not linear, even

though it may seem that they exist on a continuum.

In a scoping review by Christmas and Khanlou (2018) on the definition of youth re

silience, mental health is seen as “a state of wellbeing in which an individual realizes his

or her own abilities, can cope with the normal stresses of life, can work productively and

is able to make a contribution to his or her community” (WHO, 2016). The notion of “nor

mal stresses of life” stands in contrast to the definition of resilience provided by Tusaie,

Puskar, & Sereika (2007, quoted in Christmas & Khanlou, 2018), where good mental

health or resilience is the capability to adapt better than expected in the face of signifi

cant adversity or risk. The ambiguity of definition can lead to an incomplete understand

ing and the inability to measure wellbeing and mental wellness. Panter-Brick (2014, p.

432, quoted in Christmas and Khanlou, 2018) defined resilience “as the process of har

nessing key resources to sustain wellbeing.” Well-being has also been framed as a state

instead of a construct: “a condition of a system in which the essential qualities are rela

tively stable” (Reber, 1995, p. 750). Building on this, Hanc et al. (2019, p. 230) offer a def

inition of wellbeing that is “the balance point between an individual’s resource pool and

the challenges faced.”

A multidimensional construct of the definition of wellbeing with the term “flourishing” or

“optimal functioning” is a common approach in wellbeing research (Hanc et al., 2019).

Seligman, Parks, and Steen (2004) aligned their definition of wellness to endeavors that

strive to capture the complex nature of human flourishing (through positive emotion, en

gagement, relationships, meaning, and accomplishment) instead of preventing or amelio

rating “mental illness” (Hanc et al., 2019).

Sociological Perspectives of Well-Being

Keyes (1998, p. 122) defined wellbeing as “the appraisal of one’s circumstance and func

tioning in society” and proposed five dimensions that capture the global definition of so

cial wellbeing: social integration, social contribution, social coherence, social actualiza

tion, and social acceptance. Veenhoven (2008) proposed that reality is constructed be

tween and among social agents, and subjective wellbeing is a cognitive construct:

Ancient thinkers viewed happiness as a far more social phenomenon, co-produced

and collective rather than the individualised notion that we see today.

(Hanc et al., 2019, p. 770)

Social capital is also considered a dimension of wellbeing, a determinant linked to subjec

tive wellbeing intertwined with interrelationships such as marriage, family, friendships,

work colleagues, and neighbors; and with concepts such as engagement with the broader

society, trustworthiness, and trust (Hanc et al., 2019).

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Economic Perspectives of Well-Being

Amartya Sen’s research in capacity and capabilities asserts that wellbeing can be as

sessed by understanding the individual’s capabilities to act and that the evaluation of that

individual should be based on the context of the opportunities available and not his or her

achievements (Hanc et al., 2019). The New Economics Foundation (NEF) (Michaelson,

Mahony, & Schifferes, 2012) has been successful at bridging hedonic elements of wellbe

ing with economists’ theories of capabilities. The NEF proposed that the feeling of “hap

piness” can enable improved overall wellbeing by building personal resources and capa

bilities and triggering positive responses in moments of crisis. The NEF asserts that the

interaction between the internal drivers (such as health, optimism, and self-esteem) and

external drivers (income, housing, education, and social networks) enables functioning at

an individual level, resulting in the experience of positive emotions and

“flourishing” (Hanc et al., 2019).

In microeconomics, a larger pool of choice is assumed to contribute to a higher quality of

life, where individuals can make decisions that maximize their wellbeing (Kahneman,

2003, in Hanc et al., 2019). Diener and Seligman (2004) clarify this apparent contradic

tion, which equates to a higher level of wellbeing, with income as a proxy:

One challenge for a society based on wellbeing is that individuals do not have

ready and concrete models of how to pursue the goal of greater wellbeing, other

than following the economic model. When people are asked what would improve

the quality of their lives, the most frequent response is higher income. It is not

clear to people how they would achieve greater positive emotions and life satisfac

tion. Until there are concrete and proven steps toward these non-economic aims,

people are unlikely to abandon the dominant economic paradigm.

(Diener & Seligman, 2004, p. 25)

The OECD Framework for Statistics of the Distribution of Household Income, Consump

tion and Wealth (2013a) presents several options for measurement and makes a case for

the development of economic indicators as proxies for wellbeing, in particular addressing

two options: a macro-approach (which has its roots in national accounts and, in particu

lar, the accounting-based standards laid out in the System of National Accounts); and a

micro-approach (which has its roots in microeconomics and particularly in the study of

poverty and its effect on different socioeconomic groups within society), probably more

relevant when assessing societal impacts.

Measuring Wellness

Population measures of wellness are based on objective indicators of progress and have

been challenged by researchers in several behavioural and social science disciplines (Di

ener & Seligman, 2004; Huppert et al., 2009; Layard, 2011), who have recommended that

they are supplemented with subjective measures of how respondents experience life. Ob

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jective indicators such as gross domestic product (GDP), financial status, consumption,

crime rate, and education are most often associated with people’s experiences when mea

suring happiness or life satisfaction (Huppert et al., 2009).

In 2011, The UN General Assembly passed the resolution Happiness: Towards a Holistic

Approach to Development, urging member nations to follow the example of Bhutan for

measuring happiness and wellbeing, and calling happiness a “fundamental human

goal” (United Nations [UN], 2011). In 2012, Bhutan’s prime minister Hon. Jigme Thinley

and the UN secretary-general Ban Ki-Moon convened the High-Level Meeting on Well-Be

ing and Happiness to encourage the spread of Bhutan’s Gross National Happiness (GNH)

philosophy (UN, 2012). Shortly after the high-level meeting, March 20 was declared to be

International Day of Happiness by the UN in 2012 with resolution 66/28.

The World Happiness Report (Helliwell, Huang, & Wang, 2019), which has contributed to

our knowledge of wellbeing with analysis on how happiness is defined and distributed

globally, is concerned with how people evaluate their lives holistically instead of via do

main-specific wellbeing outcomes (de Neve & Ward, 2017). Happiness is studied through

the lens of social inequality; for example, “those who feel their livelihood is at risk sys

tematically report lower levels of subjective wellbeing than those who report having high

levels of perceived job security (de Neve & Ward, 2017, p. 18).

Studies on inequality mainly focus on how income and wealth are distributed. Helliwell et

al. (2019) argued that income is insufficient in scope as an indicator of overall quality of

life, and income inequality is a limited measure of overall inequality. For example, in

equalities in the distribution of health have direct effects on the levels of life satisfaction

beyond perceptions of wellbeing based on income alone. Another example is when social

trust measures are lower where income inequality is greater and is best measured

through inequality of subjective wellbeing (Helliwell et al., 2019).

The research on the connection of one or more dimensions of religion and health has

been extensive, but not between the concept of spirituality and health (Peterman et al.,

2002). Many of the studies on the role of religion in health (e.g., in living with cancer)

used measures that were not validated or reliable (Peterman, Fitchett, Brady, Hernandez,

& Cella, 2002). The study of the role of spirituality in health has come as researchers are

finding that there has been a change in the baby boomer generation with regard to reli

gion, which can be described as a “defection from organized religion and worship and a

more personal search for spiritual fulfilment” (Huppert et al., 2009, p. 49). By examining

spirituality instead of specific religious beliefs, as many of the tools were designed to

measure Christian denominations, researchers could be more inclusive in their studies of

the vast diversity of religious traditions and those that identify as spiritual, but not reli

gious (Peterman et al., 2002).

In a report to the French government, Stiglitz, Sen, and Fitoussi (2017) stated that what

is measured has a direct impact on how interventions are designed to improve wellbeing.

Beyond a simplistic focus on the dichotomy of positive-negative emotions, wellbeing is

characterized as a set of indicators across multiple domains instead of a single factor

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(Forgeard, Jayawickreme, Kern, & Seligman, 2011; Frey & Stutzer, 2010; Kern, Waters,

Adler, & White, 2015).

Based on Seligman’s (2011) work, a model of flourishing called PERMA was introduced to

measure indicators in an educational setting (Kern et al., 2015). The indicators measured

in this model are positive emotions [P], engagement [E], relationships [R], meaning [M],

and accomplishment [A] (citation for PERMA). Positive emotions are defined as life out

comes such as satisfaction, hope, gratitude, physical vitality, and activity. Engagement

measures psychological interest and an active approach to life. Relationships measures

the feelings of connection and being supported by others. Meaning measures individual

sense of personal purpose, daily accomplishments, and social support; and accomplish

ment identified people’s level of perseverance and success in areas such as marriage, ca

reer, and self-mastery or self-determination (Ryan & Deci, 2001). These multidimensional

measures to assess wellbeing and its gauge on the subjective perspectives of wellbeing

will potentially support successful promotion of wellbeing.

The Economist Intelligence Unit found that cost-effectiveness—or return of investment

(ROI) of wellness programs in the corporate sector—is no longer a primary measure used

by employers. Employers, however, still lack adequate information to evaluate their top

wellness program objectives (i.e., improving employee health as an indirect driver of pro

ductivity, morale, and engagement), caused by a lack of guarantee on how employee pri

vacy and data sharing concerns can be resolved (Economist Intelligence Unit, 2014). The

Future of Wellness at Work Report from the Global Wellness Institute indicates that the

evaluation of employees’ perception of their company as caring about their health and

wellness (which only 37% did), resulting in the significant improvement of the employees’

overall health and job engagement/satisfaction (Global Wellness Institute, 2016).

In Meiselman (2016), ten dimensions of wellness were identified from 20 published well

ness models. These wellness dimensions, though lacking in critical reflection on their

Western middle-class perspective, are grouped into five broader categories; Physical, So

cial, Emotional/Psychological, Intellectual, and Spiritual (Meiselman, 2016).

A randomized controlled trial of 5,000 participants of a multiyear research project

claimed zero benefits from a corporate wellness program after its first year of implemen

tation. The study found that measuring ROI was not as suitable as measuring the value on

investment (VOI) of employee wellness programs. The factors that are used to measure

effectiveness with a VOI model are improved culture of wellness, increased employee ed

ucation on wellness (i.e., improved sleep, rest, eating less fast food), improved health sta

tus (i.e., more and better nutritional choices), and regular positive feedback from employ

ees who benefited from the wellness program (Kohll, 2018). Limitations to this study,

however, must be acknowledged. Although this is a multiyear study, data were only col

lected in the first year, employees who participated in the program were already leading

healthy lifestyles, and the outcome measures were related to health behaviors—which

may be too complex a behavior change outcome to aim for.

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The Organisation for Economic Co-operation and Development Guidelines for measuring

subjective wellbeing urged investigators to measure cognitive evaluations of one’s life as

well as positive and negative emotions. The guidelines enable a more comprehensive

measure of people’s quality of life and a more nuanced understanding of its determinants

(OECD, 2013B).

Another helpful perspective from the corporate sector on what should be measured in

wellness programs is a list of five key factors:

1. Employee levels of engagement with the wellness program

2. Tracking of minimum improvements in employee health trends

3. Employee access to health services

4. Employee performance at work

5. Employee work satisfaction

Such indicators are useful in measuring the effectiveness on wellness programs for em

ployees (Rook, 2015).

Early-Life Prevention: The First 1,000 Days of

Life

Wellness strategies before conception and during pregnancy, as well as in early child

hood, all combine to tip the scales toward health (including mental health) rather than

disease.

The future of an individual’s mental health may be affected during the developmental

process and calls for the examination of the phenomena that lead both to positive and

negative influences of the state of mental health later in the lifespan. The focus here is

the developmental stage of early life, from conception, or even preconception, to new

born and two-year-old children: this period is now recognized as “the first 1,000 days of

life.”

This article looks at specific mechanisms that have been shown to mediate molecular sig

nalling and cause biological perturbations with a deleterious impact on health during ear

ly human developmental phases. Furthermore, parental epigenetic inheritance and expo

sures to stressors during pregnancy have been recurrently associated with the offspring’s

onset of non-communicable diseases (NCDs), including neurodegenerative diseases.

Environmental Plasticity and Predictive Adap

tive Response

Much of what a pregnant woman encounters in her daily life is shared in some fashion

with her fetus, and the fetus incorporates these into his or her own body and mind. The

events during this time will permanently influence the functioning of the organs and the

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wiring of the brain—the so-called fetal programming and neurodevelopment that repre

sent the blueprint of the individual’s future existence. It has been a revolutionary shift;

from a paradigm in which DNA was a static and unchangeable program to build our body,

to a DNA that is vulnerable and modifiable by everything that surrounds human beings

(the environment) even before the parental germ line fuses.

The interplay between inherited genes and the exogenous stimuli through gene-environ

ment interaction represents the organism’s effort to fine-tune the genome functioning by

producing phenotypic profiles adapted to the predicted changing environment (Gluckman

& Hanson, 2004). In fact, during the ontogenetic development of most species, including

humans, the process of plasticity induces phenotypic variations that provide a fit adapta

tion to the ever-changing environment (Bateson, Gluckman, & Hanson, 2014). Through

molecular mechanisms, including epigenetic control of DNA expression (Godfrey, Lilly

crop, Burdge, Gluckman, & Hanson, 2007), the organism responds to environmental stim

uli that do not cause changes in the genome. Environmental distress causes perturbation

of biological development with differential sensitivity, and according to tissue-specific

critical windows of susceptibility. This phenomenon is known as adaptive developmental

plasticity (Bateson et al., 2004; West-Eberhard, 2003). The program transmitted by par

ents and prior generations have the potential to be completely modified by the environ

ment. The environment includes air, water, earth, food, the physical exercise practised,

the connections between human beings, and even the music an individual listens to on a

mobile phone.

All these interactions allow a differential expression of an individual’s DNA based on the

positive or negative stimuli from the environment, generating a reaction from the

person’s biological system and determining who the person is and how he or she is doing.

The magnitude of these stimuli on the body is incredibly more intense during the early

phases of life when the plasticity is highest.

But there is another environment, perhaps more profound and more powerful: the envi

ronment of emotions. A mother’s emotions during pregnancy condition the micro-RNA

that in turn regulate gene expressions of the fetus and the future offspring of this fetus,

for three generations.

Positive emotions, which provide a proper development of the brain, can set up excellent

conditions; however, negative ones, such as maternal stress, fear, and anxiety, may pro

duce a disruption in the brain development, whose outcome can be irreversible disorders

later in life, such as schizophrenia or Parkinson’s disease.

Emotions are a fundamental epigenetic factor that acts on what is called the connectome,

the system of neural networks, the connections within the brain, and the nervous system.

The emotions are thoroughly shaped by connectomes, and 100 billion interconnected neu

rons, including the senses, are connected with the connectome. When people touch each

other, when a mother touches her baby, when human beings look at each other, when the

mother looks at her baby and smiles at him—these emotions activate the whole body and

act on the DNA. DNA responds to emotions because, as pointed out, it is an adaptive DNA

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Figure 1. The First 1,000 Days of Life—the most op

timal stage for public health and mental wellness in

tervention.

that learns from experience. It is a powerful phenomenon called interdependence. Human

beings are connected. The mother and the baby are connected, and it is a connection of

memories, looks, smiles, and touches.

Each day people have the opportunity to modify their relationships by changing their dai

ly activity and behaviour. Only a few days after birth, a baby can recognize 70 different

types of its mother’s smiles. A 30-second hug activates oxytocin and many other hor

mones that will dramatically shape the way the baby will relate to his or her family, to

friends, and the world.

It has been suggested that developmental plasticity may lead to a postnatal phenotype

predicted by the conditions of early life and that a mismatch between prediction and sub

sequent reality leads to later health problems (Godfrey et al., 2007). The plasticity of tis

sues is mainly affected by environmental exposure during development in utero, although

in some other cases (respiratory, immune systems, and the brain) tissue development ex

tends into childhood. As tissues develop, sensitivity to environmental insults and function

al changes drop, leading to an increased susceptibility to diseases later in life (Barouki,

Gluckman, Grandjean, Hanson, & Heindel, 2012).

The Parental Role

Parental environmental exposures affecting gametes may play an essential role in deter

mining the newborn’s phenotypes. As tissues develop, sensitivity to environmental insults

and functional changes gradually decrease, leading to the second phase of susceptibility

to diseases later in life (Barouki et al., 2012).

The effect of parental epigenetic inheritance on various chronic conditions is confirmed

by increasing evidence. Several major neurodevelopmental disorders are linked to pater

nal and maternal epigenetic inheritance. Exposures to stressors during pregnancy has

been recurrently associated with offspring’s onset of cardiovascular (atherosclerosis, hy

pertension, coronary heart disease, and heart failure), metabolic disease (reduced fetal

growth, obesity, and diabetes) (Bell, 2017; Gehring, Tamburic, Sbihi, Davies, & Brauer,

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2014; Harris & Seckl, 2011; Jimenez-Chillaron, Ramon-Krauel, Ribo, & Diaz, 2016). The

impact has also been documented in neurological (vasomotor disorders, attention deficit,

impaired cognition, a potential delay of temporal processing acuity, and reduced brain

volume in children), renal (chronic kidney disease) (Yzydorczyk et al., 2017), mental and

psychiatric conditions (Ambeskovic, Roseboom, & Metz, 2017), with gender differences.

Rational Preventive Interventions in the First

1,000 Days

Practical preventive interventions for populations can be created to significantly lower

the burden of healthcare costs and increase the quality of life, but these require a change

in mindset. The target of interventions needs to focus on an individual (the fetus/infant)

who is not responsible for his or her lifestyle. It involves an environment (that often can

be rarely or only narrowly changed) that is much wider than the fetus/infant’s immediate

surroundings.

Such efforts require a systemic approach representing a challenge for governments and

stakeholders, and it may generate a dramatic social, health, and economic impact. The

private sector shares responsibilities with public institutions while foreseeing an opportu

nity to redesign market strategies toward more ethical products. Technological develop

ment and societal advances must work in parallel with education for a systemic integra

tion of prevention strategies, highlighting their societal importance and high-impact sta

tus.

Mental health and wellness underpin all health and wellbeing and optimize the conditions

for a resilient and thriving population; preventive efforts should continue to focus on the

first 1,000 days, providing a game-changing perspective shift to develop more efficient

healthcare systems. A consistent, sustainable, commitment and active investment by gov

ernments, industry, academic and civil society represents a prerogative to tackle pre

ventable health issues and inequities globally.

So far, priority efforts to prevent NCDs have primarily focused on adult individuals’ risk

factors (poor diet, physical inactivity, smoking, and alcohol consumption) while almost ig

noring early stages of development for individuals.

Ultimately, the assessment of the feasibility, efficacy, effectiveness, and efficiency of pre

ventive strategies, inspired by the first 1,000 days paradigm with a life-course and multi

level outcome perspective, represents an essential step to support specific policy activi

ties objectively.

In the 21st century, there is an agreement that the first 1,000 days of life, from concep

tion to the second year of life, are the most critical determinants of health of individuals

and probably account for 70% of good health and wellness in life.

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When faced with the issue of the prevention of NCDs, including mental health and well

ness, there should be the realization that prevention must begin early in life, even before

conception. It is also remarkable how lifestyles, including parental behaviour, and the en

vironment play a vital role in the early developmental process of life, and these impact

the individual directly. The implications are that the wellness world and wellness prac

tices, so profoundly rooted in prevention practices, can play a critical role in the world to

have positive impact from the beginning of life; and it is an individual and societal respon

sibility to educate and empower the population with this life-changing perspective.

Neuroplasticity and Mental Wellness

Until the last several decades, the “hard science” explanation for the impact of wellness

practices evaded scientists; this changed with the advent of revolutionizing research

technologies in brain imaging and molecular genetics. In the book entitled Decade of the

Brain, published during the 1990s, knowledge of the most complex structure in the uni

verse underwent a paradigm shift (Goldstein, 1993). Although the scientific community

had been convinced that the human brain was fixed and incapable of change on reaching

adulthood and that people were born with a fixed number of brain cells that would de

cline inevitably with age, new evidence emerged that proved this paradigm was not only

inaccurate but far from the truth. It was discovered that stem cells exist in the adult brain

and are shown to have the capacity to develop into mature functional neurons that aid in

memory and learning in a remarkable process called neurogenesis. In line with this new

evidence, there is substantial knowledge that can explain how wellness habits promote

our brain to change and rewire itself through a lifelong process termed neuroplasticity.

Neuroplasticity refers to the ability of the nervous system to adapt, change, and rebuild,

and is strongest during our first five years of life. The agile nature of neural cells occurs

on multiple levels, ranging from microscopic to the observable and behavioural. On the

other hand, brain plasticity is also vulnerable to harmful, dysfunctional, and undesirable

adaptations and change, despite its ability to make favourable positive changes. There

fore, in this critical period of activity-dependent plasticity, neural connections are formed

at an immensely rapid pace. This window of heightened plasticity, our first five years of

life, provides us with the invaluable ability to learn with enormous ease. Even new skills

may be acquired through mere observation, immersion, and interaction in our social envi

ronment. During the developmentally sensitive periods of “use it or lose it,” neural con

nections become stronger and more permanent through repeated use. Weak or unused

neural connections may Prune off, and hence repetition is the key to learning and mas

tery.

The impact of stress on a developing brain, such as on a child or an adolescent, can have

a lifelong effect and is avoidable when provided with the right wellness support. Psy

chosocial stressors in childhood, such as poverty, parental separation and divorce, emo

tional neglect, psychological, physical or sexual abuse, mental illness and substance

abuse in the home environment, are capable of negative rewiring in the development of

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Figure 2. Yerkes-Dodson Law: Inverted U-relation

ship between stress/arousal level and performance

(see Teigen, 1994).

Figure 3. Stress inoculation shifts the inverted U-

shaped curve to promote resilience (reused with per

mission (see Russo, Murrough, Han, Charney, &

Nestler, 2012).

our prefrontal cortex. The prefrontal cortex is the part of the higher-level brain regions

that benefit from wellness practices.

When the prefrontal cortex is exposed to experiential stimuli (i.e., sensory, emotional, and

intellectual) at moderate levels of stress, the brain is capable of optimal performance. Too

little or too much arousal impairs functioning. The ability to challenge oneself outside the

comfort zone promotes neuroplasticity in favour of growth and resilience. Therefore, the

deliberate and active maintenance of this perpetual back-and-forth state of balance be

tween optimal stress and restorative rest is vital for driving positive neuroplastic

changes.

Committing to a life of mental wellness is instrumental to thriving in the 21st century. In

order to meet the evolving needs of our present and the future, the brain’s plasticity must

be harnessed toward positive growth. Wellness-based neuroplasticity enables people to

achieve self-actualization and ultimately undergo a transformation toward self-transcen

dence. Only when this dimension of wellbeing is realized are people able to set aside their

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own needs to help others fulfil theirs. To this end, people will be able to create a sustain

able, integrated, and harmonious path toward personal and global wellness.

Overview of Wellness Modalities

Wellness modalities are a range of activities and programs that have positive effects on

somatic, psycho, and emotional wellbeing. This section provides a general introduction to

a few modalities that experienced a surge in research activities, now translated to the

broader population.

The microbiome of the human gut comprises bacteria, protozoa, fungi, nematodes, and

viruses, among others (Wang & Wang, 2016). Disruption of the gut-brain axis is indicated

in the pathogenesis of a diverse range of diseases, including Parkinson’s disease and irri

table bowel syndrome (Wang & Wang, 2016). There are more than 500 million informa

tion-transmitting neurons embedded in the wall of the human gut, outnumbering those in

the spinal cord by five to one. These information-transmitting neurons provide the body

with “a second brain,” known as the enteric nervous system (ENS).

The ENS connects with the central nervous system (CNS), the brain, the spinal cord, and

the autonomic nervous systems (ANS), creating a bidirectional gut-brain axis (GBA),

which links physiological, behavioural, and cognitive functions with intestinal digestion,

absorption, and excretion. The vagus nerve is central to this gut–brain axis. The nerve

contains 80% of afferent fibres and 20% of efferent fibres, and innervates the entire di

gestive tract. Chronic stress in the early stages of life induces dysbiosis in rats through

modifications of intestinal permeability and may later sensitize adult rats to visceral hy

persensitivity (Moussaoui et al., 2017). Stress inhibits the vagus nerve and stimulates the

nervous system to produce inflammatory disorders and thus favour dysbiosis by disrupt

ing homeostasis (Bonaz, Bazin, & Pellisier, 2018). Gut disorders, known as functional gas

trointestinal disorders (FGIDs) are associated with the prevalence of both depression and

anxiety, and these increase with both the number of FGIDs and the frequency and severi

ty of GI symptoms (Pinto-Sanchez et al., 2015).

Nutrition and the Brain

The immune system, oxidative biology, brain plasticity, and the microbiome–gut–brain ax

is are critical targets for nutritional interventions. The most effective way to provide re

siliency against the pathogenesis of mental disorders is higher intakes of whole foods,

whole grains, lean meat, nuts, and legumes, with avoidance of processed foods (Sarris,

Mischoulon, & Schweitzer, 2012). Dietary habits modulate the function of the immune

system, which is also implicated in mental disorders, operates with the support of nutri

ent cofactors and is implicated in mental disorders, and operates with the support of nu

trient cofactors and phytochemicals (Sarris et al., 2012).

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The relationship between unhealthy dietary patterns and poorer mental health in children

and adolescents (increased consumption of processed foods) has been independently as

sociated with a higher likelihood of risk of depression and anxiety, as has better mental

health with a good-quality diet (O’Neil et al., 2014). The evidence is clear that supple

ments such as omega-3 fatty acids, S-adenosyl methionine (SAMe), N-acetyl cysteine

(NAC), zinc, vitamin B (including folic acid), and vitamin D influence neurochemical mod

ulation that in turn benefits the management of mental disorders (Jacka, 2017; Sarris et

al., 2012).

Landmark research by Professor A. David Smith of Oxford University has found that af

fordable vitamin B supplements stopped shrinkage of the area of the brain, the medial

temporal lobe, that contribute to Alzheimer’s disease. A combination of vitamin B6 (20

mg), B12 (500 mcg), and folic acid (800 mcg) slowed the process of decline associated

with Alzheimer’s disease by eightfold compared to those on the placebo. The evidence

strongly indicative that vitamin B supplements may be slowing or potentially arresting

the disease process associated with early-stage cognitive decline and the first treatment

of its kind to show this (Douaud et al., 2013).

Inflammation and Mental Health

Inflammation might be a common mechanism underlying the comorbidities between de

pression, schizophrenia, coronary heart disease, and diabetes mellitus. Sugar, saturated

fats, trans fats, refined carbohydrates, red meat, and alcohol have all been found to cause

inflammation in the body, which in turn is associated with pain, cancer, diabetes, obesity,

and arthritis. Mood disorders such as depression and anxiety, as well as more severe con

ditions such as autism, dementia, and even schizophrenia, have all been linked to inflam

mation of the brain (Danzter, O’Connor, Freund, Johnson, & Kelley, 2008).

Wellness approaches tackling inflammation focus mainly on diet and supplements. Nu

merous studies have demonstrated the potent anti-inflammatory effects of turmeric,

which in turn accounts for this being one of the most significant selling products in the

wellness supplement market (Zecha, 2017). Anti-inflammatory foods include fruits and

vegetables high in antioxidants and polyphenols.

Dr Francesco Branca in the BBC (Branca, 2019) referred to obesity and malnutrition as a

burden on emerging countries where failing food systems is a new reality, thereby in

creasing poor mental health outcomes, especially for children. In addition, The Lancet

and the WHO makes the point that those food systems contribute to nutritional psychiatry

and are at the core of mental health and wellbeing (Branca, 2019; Mendenhall et al.,

2017).

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Rest

Using a newly developed Living Well Index, researchers from Oxford Economics and the

National Centre for Social Research in the United Kingdom (Oxford Economics & Nation

al Centre for Social Research, 2019) reported that a good night’s sleep is worth more

than quadrupling disposable income and is the most significant single contributor to liv

ing better (Sainsbury’s & Oxford Economics, 2018).

Researchers from the University of Basel found a connection between the brain, the dif

ferent phases of the moon and how it affects human biology, particularlysleep, and subse

quently, physical and mental health (Cajochen et al., 2013). The effects of the lunar cycle,

possibly due to disturbances of the Earth’s electromagnetic field or to changes of the lu

nar gravitational force on Earth, are purported to affect the “biological tide,” which re

sults in an altered autonomic neural activity and cardiovascular activity during different

lunar phases (Chakraborty, 2014).

Meditation

Meditation was a poorly understood personal development technique of both the East and

West until 1970, until Science published the first rigorous scientific research paper show

ing that during meditation, oxygen consumption and heart rate decreased, skin resis

tance increased, and the electroencephalogram showed specific changes in certain brain

frequencies. Led by Dr R. K. Wallace, a study that measured the physiological effects of

the Transcendental Meditation (TM) technique, distinguished meditation from other rest

ing states, and began the steady growth of meditation research that has progressed un

abated for the almost half a century that followed (Wallace, 1970).

Studies on the technique studied by Wallace have found reductions in anxiety (Tomljen

ovic, Begic, & Mastrovic, 2016) and post-traumatic stress (Rees, Travis, Shapiro, &

Chant, 2014), and improvement in the mental health of caregivers. In a study on survivors

of the Japanese earthquake-tsunami of 2011, advances were made in both psychological

and physical symptoms when following instructions in the TM meditation technique

(Yoshimura et al., 2015).

In studies on mindfulness meditation, researchers found some forms of meditation may

have salutary effects on telomere length and hormonal factors that may promote telom

ere maintenance by reducing cognitive stress, stress arousal and increasing positive

states of mind (Conklin et al., 2018; Epel, Daubenmier, Moskowitz, Folkman, & Black

burn, 2009).

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Massage

According to the U.S. National Institutes of Health National Center for Complementary

and Integrative Health (NCCIH), much of the scientific research on massage therapy is

preliminary or conflicting. Still, much of the evidence points toward beneficial effects on

pain and other symptoms associated with several different conditions. Evidence suggests

that these effects are short term and that people need to continue receiving massages for

the benefits to endure (NCCIH, 2019).

A 2010 meta-analysis of 17 clinical trials concluded that massage therapy might help to

reduce depression. According to a 2012 NCCIH-funded clinical trial a brief twice-weekly

yoga and massage session for 12 weeks was associated with a decrease in depression,

anxiety, back and leg pain in pregnant women with depression (NCCIH, 2019). For gener

alized anxiety disorder, massage therapy may help temporarily reduce pain, fatigue, and

other symptoms associated with fibromyalgia, but the evidence is not definitive (NCCIH,

2019).

Aroma

Aromatherapy uses essential oils, which contain a mix of active ingredients (concentrated

extracts taken from the roots, leaves, seeds, or blossoms of plants), and this mix deter

mines how it is used. Some oils are used to promote physical healing, for example, to

treat swelling or fungal infections. Others are used for emotional value, which may en

hance relaxation. Orange blossom oil, for example, contains a large amount of an active

ingredient that is thought to be calming. Smell loss occurs with both Parkinson’s disease

and Alzheimer’s, and studies have indicated that a diminishing sense of smell can be an

early sign of the onset of both conditions, occurring several years before motor skill prob

lems develop (Doty, 2017).

The University of Maryland’s Center for Integrative Medicine reports evidence suggest

ing that citrus oils may strengthen the immune system and that peppermint oil may help

with digestion. Fennel, aniseed, sage, and clary sage have estrogen-like compounds that

may help relieve symptoms of premenstrual syndrome and menopause.

Technology is keeping pace with this growth in aromatherapy. One such innovation is

Cyrano, described as a “digital scent speaker and mood modification platform.” Cyrano is

a small device that connects to a smartphone and releases a “symphony” of distinct

smells from one place. With a few presses of a button, users can match the scent to what

ever their mood is. The increasing availability of essential oil-based products and tech

nologies makes self-managed aromatherapy an available home-based option and hence

democratizes a dimension of the wellness industry, often perceived as out of reach for the

majority.

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Being in Nature

A cross-cutting theme in this article is complexity. A recommended approach to working

with complexity is to embrace the uncertainties of intervention and policy implementation

addressing syndemics (Khan et al., 2018). What do climate, anxiety, and children have in

common? Depression and post-traumatic stress disorder are connected to global con

cerns of climate change, affecting children’s mental health as well as their physical

health (Clayton, Manning, Krygsman, & Speiser, 2017; Wiley, 2019). As the air that we

breathe becomes more polluted and may reduce child life expectancy, for example, in

Birmingham (Matthews-King, 2019), many adults, youth, and—interestingly—children ex

perience eco-anxiety. Eco-anxiety is a recent psychological disorder afflicting people who

show concerns about the environmental crisis (Castelloe, 2018). Research by Kassouf

suggests that people include their interaction with the Earth as a new object relation and

use ecotherapy as a treatment modality to channel a client’s emotional energy toward as

pects of the natural environment. Activities such as gardening, forest bathing, and com

munity recycling projects are examples of tackling mental health challenges associated

with climate change (Kassouf, 2017).

The British Medical Journal published a study in 2005 that built on the concept of biophil

ia (Wilson, 1984) as well as that of Gregory Bateson’s theoretical framework for improv

ing health through conserving nature, also known as ecotherapy, or restoring health

through contact with nature (Burls & Caan, 2005).1

In a review of 67 studies on nature immersion, also known as “forest bathing” and “Shin

rin-Yoku,” findings pointed to a reduction in human heart rate and blood pressure and an

increase in relaxation for participants exposed to natural green spaces (Bodeker et al.,

2018). From a qualitative and psychological perspective, Danish participants reported a

sense of safety, calm, and overall general wellbeing following exposure or engagement

with nature. South Korean participants with a known alcohol addiction and high pretest

scores of depression benefited more from the Forest Therapy Camp than participants

with lower pretest scores of depression and alcohol abuse. Differences in culture, gender,

education, marital, or economic status were not associated with confounding factors in

many of the empirical studies (Hansen, Jones, & Tocchini, 2017).

In considering the benefits of ecotherapy from a public policy perspective, green spaces

have been noted to achieve unanticipated social capital and natural capital outcomes

(Burls, 2007). The 7th-century master of Chinese medicine and encyclopedist Sun Simiao

advised that fresh air, daily walks in natural landscapes, and food from a fresh, whole

some garden cultivated in part by the owner were the fundamentals of creating and main

taining good health.

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Altruism

Based on scientific evidence (Dulin & Hill, 2003; Liang, Krause, & Bennett, 2001), it is en

tirely plausible that altruism enhances mental health. Altruism is a character trait or be

haviour that pertains to the emotionally kind—those who are charitable in action toward

others (in moderation)—and is yet to be studied by mainstream public health researchers

(Oman, Thoresen, & McMahon, 1999) for its beneficial impact of positive emotional states

at a population health level (Post, 2005). The American Psychological Association high

lights six dimensions of health, of which emotions (emotional wellbeing), thoughts, and

action (psychological and behavioural wellbeing) are factors closely co-related to altruism

(Anderson, 2003) and enhance health by their ability to push aside negative emotions. Al

truism, or unselfish love toward others, repels feelings of “sadness/depression, fear/anxi

ety, and anger/hostility” according to Anderson (2003, p. 243). The generosity that comes

from a love of humanity is protective against “the big three” negative emotions—anger,

fear, and grief—which are a result of a preoccupation with the self (Anderson, 2003).

Transcending the self through acts of kindness and generosity is confirmed to protect

against morbidity and mortality, reducing the stress on the immune function, reducing

cortisol levels and blood pressure, and regulating endorphin production and norepineph

rine levels (Post, 2005).

Cited in de Neve et al.’s (2019) research on pro-sociality in the workplace, an experiment

at a large Australian bank (Anik, Aknin, Norton, Dunn, & Quoidbach, 2013) found that

employees who randomly allocated their bonuses in the form of small financial contribu

tions to local charities, “showed significant, immediate improvements in job satisfaction

and happiness compared to employees who were not given these bonuses” (de Neve et

al., 2019, p. 102).

Social Laughter

Researchers from the University of Oxford, through a series of experiments, found that

pain thresholds, an indicator of endorphins being released into the bloodstream, were sig

nificantly higher after laughter. Dunbar et al. (2012) suggested that “laughter through an

endorphin-mediated opiate effect, may play a crucial role in social bonding (Dunbar et al.,

2012, p. 1161). A subsequent study found that social laughter “increased pleasurable sen

sations and triggered endogenous opioid release in thalamus, caudate nucleus, and ante

rior insula” (Manninen et al., 2017, p. 6125)

Global Wellness Policy

European Union

In European countries, worksite health and wellness (WHW) policy covered physical and

mental wellbeing, psychosocial issues, and the working environment. Greece, for exam

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ple, focused on physical wellbeing, whereas in Lithuania, the focus was stronger on social

wellbeing. Respondents of an EU-wide survey reported having legislation in place relat

ing to some aspects of WHW and having a strategy for WHW in place, and noted that

countries were involved in promoting a range of WHW activities. Some of these activities

are (a) guidelines on WHW and healthy lifestyle; (b) healthy eating; (c) exercise and

smoking cessation campaigns; (d) drug and alcohol prevention; and (e) health examina

tions such as eye tests, glaucoma and cancer screening (Guazzi et al., 2014).

United States of America

Workplace Health in America 2017 is the first government survey of workplace health and

wellness programs in 13 years. The study found 69% of worksites had a health and well

ness program that had been operating for three years or longer. Stress management pro

grams were offered in 20% of worksites, and 14% provided programs to address exces

sive alcohol and other drug misuse (Centers for Disease Control and Prevention, 2019).

United Kingdom

The British government’s strategy for public health in England laid out in the Healthy

Lives, Healthy People paper (Secretary of State for Health, 2012) called for a new ap

proach to public health with mental health as an integral and complementary part of a

proposed new direction. The paper places health improvement as everyone’s responsibili

ty, where factors of self-esteem, confidence, and resilience are seen as key to health be

haviour change. This self-care focus is aligned with wellness philosophy and its emphasis

on self-guided pathways to wellbeing (Thompson, Watson, & Tilford, 2018).

A subsequent British survey of GPs found almost three-quarters are seeing between one

and five people a day suffering from loneliness, which is a contributing factor to damag

ing health impacts such as cardiovascular disease, strokes, and dementia. The prime

minister’s office noted that around 200,000 older people had not had any social interac

tions with a friend or relative in more than a month (Gov.UK, 2018) and prompted the

government to launch a loneliness strategy and a ministerial portfolio. The long-term plan

by the National Health Service (NHS) is to allocate funding to connect patients to a vari

ety of activities, including walking clubs, art groups, cooking classes, and so on. Support

was received from high-profile businesses such as Sainsbury’s, Transport for London, Co-

op, British Red Cross, National Grid, and the Civil Service, all of which pledged to reduce

loneliness in the workplace and support employees’ health and social wellbeing (Gov.UK,

2018).

Latin America

Hispanic school children living in the United States have a lack of intervention programs

explicitly designed to meet the nutrition needs that physical activity requires. The Well

ness Policy from the Child Nutrition and Women’s, Infants and Children Reauthorization

Act of 2004 requires that schools produce and implement wellness policies that, since

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2006–2007, tackle nutrition and sedentary behaviour because of the high rates of child

hood obesity and subsequently poor mental wellbeing among Hispanic children (Sawyer

& Oria, 2007). Resources to help schools develop wellness policies such as the CDC’s

School Health Index and USDA’s Changing the Scene guidelines. Besides, wellness policy

development tools, training from Action for Healthy Kids also includes specific Spanish

programs: My Pyramid for Kids, MiPiramide, and What to Eat (Sawyer & Oria, 2007).

Chile

Promondo Corporate Wellness, led by Professor Volney Henriquez, has celebrated 28

years of promoting wellness in the workplace. Its study laboratory measured the impact

of employee wellness on absenteeism and presenteeism. The results of its Productivity

Plus Survey contributed to the development of an intervention to address “musculoskele

tal pathologies, treatments for better sleep, reduction of work shifts, plans for prevention

of risks and safety at work, salary improvement, dynamics of approach between workers

and management (psychosocial risk), psychological support for workers and family, and

treatments for addiction” (Henriquez, 2019). Promondo has also shared all its data and

experiences with the National Productivity Commissions, to add validated metrics to in

crease investment in health and labour welfare.

Brazil

Empowering Women’s Wellness

In Rio de Janeiro, business partners Shula Melamed and founder Bella Bablumian created

an innovative methodology for health that was designed to be neither boring nor arduous.

They report that their program is not composed of circuits, diets, and pills, but is one that

guides their clients toward “effortless wellness with intuitively healthy behaviours.” The

company’s focus is to help women become more in tune with natural needs and desires,

and to fulfill the body’s blueprint for a complete healthy being. For example, they view

stress, when used in the right way, as a positive source of energy and fitness.

Community Mental Health: Projeto Quatro Varas

An influential and innovative community mental health model in Fortaleza-Ceara, north

east of Brazil, is called “Projeto Quatro Varas,” and was co-founded by Dr Adalberto Bar

reto, a psychiatrist and mental health researcher, and his brother, Airton Barreto, a

lawyer. Dr Barreto generated the Community Therapy (CT) methodology to provide com

munity care grounded in both societal and academic understanding. He developed the CT

program initially in the favela of Fortaleza, after carrying out research showing that local

curanderos (Traditional Healers), who use herbs and other traditional cultural remedies,

have a positive impact on community health (Neville, 2008).

The CT program consisted of a range of components, including collective therapy circles,

“living pharmacies,” (i.e., herbal medicines), and curing houses with complementary

treatments. He studied the importance of parteiras (traditional female obstetricians), the

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value of raizeiros (medicinal plants) and rezadeiras (prayers) (XXX), and the cultural treat

ment of death, marital conflicts, and neighborhood disputes.

The CT approach has now become widely diffused throughout Brazil and is used among

many different groups and populations, mainly through formal partnerships established

between the Universidade Federal do Ceara and various levels of federal, state, and mu

nicipal health services. In research conducted in 10,000 community therapy circles and

100,000 consultations, 88% of attendees had experienced improvement through commu

nity therapy and its support system. Based on these research findings and the success of

more than 600,000 therapeutic sessions, Dr. Barreto managed to get community therapy

approved as national public health policy, and trained 1,100 government public health

and social assistance employees (Barreto & Grandesso, 2010).

A Model of “Leadership Through Love, Dedication, and Respect, to Improve

Population Wellness”

The founder and CEO of Cecilia Negrini, a consultancy in the health sector in 2018, wrote

that the impeachment of the former Brazilian president, Dilma Roussef, was not the end

of corruption in the country. The people of Brazil lack inspiring leaders, and this had

caused severe consequences in several sectors in society, creating significant losses in

personal wellness and quality of life. Cecilia proposed the Servant Leadership model, cou

pled with coaching, to develop leaders in Brazil who are an example of character and jus

tice, and an inspiration for their population. Servant Leaders is a concept of leadership as

service to others, formulated by Robert K. Greenleaf (Greenleaf, 2002). The Servant

Leader coaching has been implemented in hospitals, clinics, and medical centres, as

clients of Cecilia Negrini, with outcomes that validate the effectiveness of the methodolo

gy (Negrini, 2018).

Asia

Throughout Asia, mental disorder results in productivity losses that hurt national

economies. In low-to middle-income countries (LMIC), fewer than 20% of people living

with a common mental disorder such as depression or anxiety have access to adequate

mental health treatment and care. Economic studies have also revealed the massive bur

den on national economies of lost productivity attributable to a high prevalence of mental

disorders. Many studies in LMIC have demonstrated that effective, and affordable treat

ments can be provided in low resource settings. Economic modelling has shown that in

vestments in mental health services produce substantial economic, social, and health re

turns (Arango et al., 2018; Vigo et al., 2019).

A mental wellness strategy is preventive and focuses on building resilience at every level

of society, such as schools, workplace, and in the retired population, based on self-care or

self-help, group support, and community-based programs. Evidence is there to support

the efficacy of Asian traditions of wellbeing, such as meditation, yoga, and Tai Chi, and in

cluding individually tailored nutrition programs along with support from the local commu

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nity and interest groups in the prevention and management of mental health conditions

by individuals themselves (Huang, Feng, Li, & Lu, 2017; Solloway et al., 2016).

Asia is home to many of the wellness modalities that are now foundational in the global

wellness repertoire, and has been identified by Global Wellness Institute research as the

region showing the highest growth rate in the wellness economy. Yet Asia appears to be

suffering from a deficit in wellbeing within its shores.

Research by the Asian Century Institute has found that only 14% of Asian respondents

are thriving in three or more elements, which is a score less than the global average and

equal to that of the former Soviet Union. Asia also scored poorly for a sense of purpose,

which consists of liking what you do each day and feeling motivated to achieve personal

goals. Only 13% of Asians are thriving in this aspect, equaling the Middle East and North

Africa for the world’s lowest score on this point. The continent also scored poorly for so

cial wellbeing, with only 19% thriving, but scored close to the world’s average when it

comes to financial, community, and physical wellbeing (West, 2014).

Bhutan Gross National Happiness Index

The term Gross National Happiness (GNH) Index, coined by the ruler of Bhutan, King

Jigme Singye Wangchuk in 1972, gave more importance to this index than to the Index of

gross domestic product. The construction of the GNH includes nine domains: psychologi

cal wellbeing, health, education, time use, cultural diversity and resilience, good gover

nance, community vitality, ecological diversity and resilience, and living standards. The

index is based on the Alkire–Foster method of multidimensional measurement adapted for

this purpose. The analysis explored levels of happiness by subsections of the demograph

ic and what policies can do to increase happiness and sufficiency among the unhappy and

marginally happy people (Centre for Bhutan Studies & GNH Research, 2016).

United Arab Emirates

In 2010, Dubai launched the UAE Vision 2021 policy, highlighting six priority areas for

the government:

1. Cohesive society and preserved identity

2. Safe public and fair judiciary

3. Competitive knowledge economy

4. First-rate education system

5. World-class healthcare

6. Sustainable environment and infrastructure. (Mathias, Fargher, & Beynon, 2018)

Dubai’s ruler, H. H. Sheikh Mohammad, advised federal employees that “the

government’s role is to make the nation and the people happy.” In fostering this vision, he

incorporated the National Agenda and, in 2016, formulated the position of Minister of

State for Happiness and Wellbeing. The minister introduced a Happiness Index to mea

sure the nation’s happiness with government services, through the use of smart devices

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(Mathias et al., 2018). A National Program for Happiness and Positivity was also devel

oped with the following goals: (a) incorporating happiness and positivity at work, (b) de

veloping tools for measuring happiness and its progress, and (c) fostering a political envi

ronment to make happiness and positivity a lifestyle (Schwartzstein, Hall, Chang, Sameh,

& Thapar, 2018).

The National Program for Happiness covers four agendas and 16 portfolios. Its website

states:

The Happiness Agenda will pursue an objective, scientific approach to influencing

happiness for the whole city. With a dedicated focus to measuring people’s happi

ness, our teams are continually researching and refining a scientific model for city

happiness that is informed by city-data. We are developing a live, target-driven

measurement tool to monitor satisfaction and happiness levels for the whole city.

Big data insights are not limited to the technology sector. By implementing cus

tomer satisfaction and sentiment analysis tools for the entire city, the Happiness

Agenda will empower decision-makers to act for people’ happiness in real-time,

supported by data

(National Program for Happiness & Wellbeing, 2020)

Aging Well

Some countries in the Asia-Pacific region are now taking the lead to offer a regional mod

el such as Japan’s Asia Health and Wellbeing Initiative (AHWIN). AHWIN provides data

and resources on population aging and elderly care in Asia to help aging Asian societies

by providing Japanese knowledge and expertise on nursing care and social welfare sys

tems, as well as expanding related business opportunities as a nation at the forefront of

super-aging communities. Japan is also in the process of mainstreaming its traditional Iki

gai—“purpose in life” philosophy across all government ministries. Ikigai can be about the

joy a person finds in day-to-day living, or about values in life, a pragmatic, unique, and in

dividualized method of perceptions of one’s purpose in living (Mitsuhashi, 2018).

A New Accounting

In New Zealand, from 2019, the government will present an annual “wellbeing budget” to

gauge the long-term impact of policy on the quality of people’s lives. New Zealand Prime

Minister Jacinta Arden announced that

the Wellbeing Budget will broaden the Budget’s focus beyond economic and fiscal

policy by using the Treasury’s Living Standards Framework to inform the

Government’s investment priorities and funding decisions. The Government will

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measure and report against a broader set of indicators to show a more rounded

measure of success, as a country and as a Government.

(Parker, 2019)

Arden argued for a shift beyond short-term cycles and for seeing politics through a lens of

“kindness, empathy and wellbeing.”

Workplace Wellness

Workplace or corporate wellness will become a U.S.$7.4 billion market by the end of

2024, according to Transparency Market Research (Corporate Wellness Market, 2016).

Employees are increasingly expecting wellness programs within their workplace, particu

larly millennial job seekers who are driving this growth along with the abundance of new

technologies adopted as part of living well.

Malaysia, a country with the highest NCD rates in Southeast Asia, saw a shift in govern

ment policy that in April 2019 required all public servants to take a 15-minute exercise

break every day (Singh, 2019). In India, corporations are increasingly offering wellness

programs for their employees, such as health check-ups, dietary advice, personalized

counselling sessions, and tele-counselling sessions. Although it is just in the beginning

stages, these wellness programs are proven tools for change in the workplace. As more

and more employees are making wellness a priority, employers have little choice but to

adapt to the changing landscape of work and wellness. Yoga has been trialled and found

useful in the treatment of diabetes according to two studies conducted in India. The stud

ies found that a yoga-based lifestyle for the remission of prediabetes and prevention of di

abetes was adequately productive for normal and overweight/obese groups. Yoga, there

fore, can be utilized as a part of workplace wellness policy to complement the efforts

made by employees outside of work (Arumugam et al., 2019; Nagarathna et al., 2019)

The Contribution of Big Data to Well-Being Science and Policy

Big data in the context of well-being and mental wellness refers to the large data sets that

contain multiple observations about individuals, often gathered without consent. The use

of mood analysis, for example, counting the positive and negative effect of words used in

Twitter feeds, Facebook posts, and many other social media profiles—whether through

mobile phone apps or websites—are becoming more common (Bellet & Frijters, 2019).

The potential gain from the use of big data, other than to tell current levels of mood and

life satisfaction, is to enable government and corporate entities to deliberately manipu

late programs or policies aimed at specific communities such as workplaces, childcare fa

cilities, or potential voters (Bellet & Frijters, 2019).

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Gallup Report and Global Findex

The Gallup Report’s indexes of positive and negative experiences measure feelings and

emotions not captured by traditional methods used in the gross domestic product (GDP)

reports. According to de Neve et al. (2018), the use of measures of subjective well-being

in economic research is burgeoning. The 2019 Global Emotions Report, for example, is

based on 151,000 interviews with adults in more than 140 countries in 2018. Jon Clifton,

the global managing partner at Gallup, gives an example of why this measure provides a

data set that paints a better picture of global well-being and mental wellness. He says

that

if you interview two women, one with a child and another without a child – which

one has more stress? On average, it’s the woman with the child. But if you asked

them to rate their overall lives—which one is higher? It’s also the woman with the

child. So, the woman with more stress also rates her life higher.

(Global Emotions Report, 2019, p. 1)

The Global Findex (in partnership with the World Bank) is an evidence-based indicator of

global efforts to promote financial inclusion. The Global Findex Database (2017) used to

track progress toward the United Nations Sustainable Development Goals (indicator

8.10.2), and the World Bank’s Goal to Universal Financial Access by 2020 included the

G20 Digital Financial Inclusion Indicators. The most recent survey in 2017 shows that 1.2

billion adults globally have opened a bank account since 2011. Approximately 69% of

adults worldwide, 3.8 billion people, now have a bank account with a physical bank or

with a mobile money provider. Research that uses subjective well-being data as a welfare

measure indicates that economic downturns have a “greater influence on wellbeing than

equivalent economic growth” (de Neve et al., 2018).

Where to Next?

The call to improve mental health services in a crisis of NCDs in WHO’s Mental Health At

las and the Mental Health Action Plan 2013–2000 (2013) is based on the high burden of

global mental health disorder. Mental health disorder is not just about clinical conditions

but also considers factors such as demographics, environment, and sociopolitical transi

tions, particularly in low-to middle-income countries (LMIC). The Lancet Commission

identified a four-pillar agenda to reference global mental health at a population level,

where the approach in addressing mental health syndemics requires systems thinking and

interdisciplinarity in public health programs and interventions (Mendenhall et al., 2017).

The inadequate attention to financial needs of mental health programs in 63% of WHO

member states, brings to the fore a glaring challenge of insufficient resources, training of

healthcare professionals, and a lack of supporting community health workers with the

right technology and skills to create local solutions for a local context.

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Figure 4. Schema of interdisciplinarity in addressing

the global burden of mental health disorder.

The crisis in NCDs, along with the global burden of mental health disorders, requires pre

ventive strategies, approaches that build resilience in separate but interconnected levels

of society (i.e., educational institutions, workplaces, and aged care facilities), and inte

grates a wide variety of wellness modalities through well-trained public health practition

ers and policymakers. Efforts to reduce sedentary behaviour—even in hospitals during

acute care (also known as “deconditioning syndrome”)—as a result of fear of falls is

proven to be detrimental to recovery (McNally et al., 2017). As we implement this new

framework of mental health promotion, questions remain over how to measure effective

ness or success and what the indicators are that give us a 360-degree view of the mental

health of an individual as well as a population. What does the training of public health

practitioners look like when we consider the complexity of global mental health disorder

and the rising rates of NCDs in low- to middle-income countries?

This article has brought to the discourse on well-being and mental wellness an evolving

paradigm, informed by evidence, measured with validated tools, and already in implemen

tation in different parts of the world, including in both civil society and the corporate sec

tor. An understanding of the importance of the first 1,000 days of life, the neuroplasticity

of our brain, and the potential for mental wellness to play an integral role in how people

grow, play, work, and live are changing the way people frame health promotion in the

21st century. The vast array of wellness modalities such as yoga, meditation, sleep, nutri

tion (Firth et al., 2019), technology, and the availability of real-time data are yet to be in

corporated into our vision of the future of public health education and program design.

Implications for Public Health Education

The Mailman School of Public Health (MPH) 2009 review of the Master of Public Health

Program found no school-wide requirements with developing interdisciplinary skills in

leadership, communication, and systems thinking. However, some departments and

tracks may have incorporated the skills independently (Begg, Galea, Bayer, Walker, &

Fried, 2014). As a result, after ten subcommittees and the involvement of 170 faculty in

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the renewal of Columbia’s MPH program, a pattern emerged in the mapping of core skills

that are required for the school’s graduates to tackle the public health challenges of 2020

to 2050. In the context of the 21st-century crisis in NCDs and the syndemics that fuel its

rising rates, Mailman designed courses to foster decision-making skills as well as critical

and creative thinking. Students were challenged to specialize in an area outside their dis

ciplinary concentration. The idea behind this initiative is to expand the latitude in inter

disciplinary training (Begg et al., 2014).

The WHO Report in 2006 stressed the importance of interdisciplinary collaboration

(WHO, 2006). The report encouraged key stakeholders to step outside disciplinary silos

and “work together through inclusive alliances and networks—local, national and global—

across health problems, professions, disciplines, ministries, sectors and

countries” (Jogerst et al., 2015, p. 241). To tackle tough problems and acknowledge the

complexity of the challenges facing public health administrators, interdisciplinary collab

oration becomes a foundation for reflection and action, spurring organizational change

from within through innovation in leadership (Kegan, Kegan & Lahey, 2009; Snowden,

2002). Relevant to this section is the identification of two Interprofessional Global Health

competencies from a systematic review of curricula around the world. One of these is the

ability to describe how cultural context influences the perception of health and disease;

the second has to do with the skills to co-design or co-create strategies with local commu

nities in using local assets and resources to improve health and well-being through the re

cruitment of diverse stakeholders and work within a team (Jogerst et al., 2015). At the un

dergraduate level of global health education, findings from a systematic review of univer

sities providing comprehensive health education recommend developing an interdiscipli

nary framework toward addressing the socioeconomic determinants of health and health

inequalities (Drain et al., 2017). Brewer (2017, p. 2) argued that public health profession

als addressing global health challenges should partner with not just “engineers or

lawyers, but philosophers, artists, anthropologists, and historians.” Brewer (2017, p. 2)

calls on the National Institutes of Health to fund the preservation of ancient texts of Chi

nese herbal medicine as only a few discoveries of the past decades have as “profound an

impact as on health globally as that made by YouTube and others.”

One avenue that can be quite effective in addressing the global burden of mental health

disorder is for public health practitioners to use the competencies discussed earlier to

partner with educational settings and teachers in the development and implementation of

mental health interventions. The importance of embedding mental health content into ex

isting education and health policy in low- to middle-income countries is well recognized

(Kutcher et al., 2015). From the perspective of salutogenesis (Mittelmark et al., 2017)

thinking about mental health promotion in a framework that is comprehensible, manage

able, and meaningful for the public is a sustainable pathway for intervention. Comprehen

sibility, manageability, and meaningfulness stem from the recognition that promoting a

climate of unconditional positive regards and empathy, as well as developing the partici

pants’ unique capacities and extending coping resources to go beyond educational pro

grams and health literacy interventions (Mittelmark et al., 2017).

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Another aspect to consider in achieving innovation in the education and public health pro

grams is the inclusion of altruism, generous emotions, as behavioural goals so that they

take their rightful place in addressing mental health efforts in schools and workplaces. It

is possible that volunteerism, as an attribute of altruistic behaviour, becomes a standard

prescription for an aging population faced with social isolation and loneliness, as report

ed in the United Kingdom (Gov.UK, 2018)

A movement to do good, as part of a public health agenda to focus on civic engagement

may require longitudinal studies to understand how best to manage population-level pro

grams based on the nurturing of benevolent effect and helpfulnessu without causing ad

verse effects such as “burn-out” syndrome and being overwhelmed.

Conclusion

There is little doubt that our understanding of the social determinants of health—and in

this case of well-being and mental wellness—is less “determining” and may only be “influ

ential.” When the possibilities for reframing the Global Mental Health framework in an

age of molecular genetics, neuroplasticity, and traditional and complementary medicine

are considered, an understanding begins to form that there is no turning back from an in

terdisciplinary genre of 21st-century public health practice.

In moving forward, new metrics will be needed for assessing wellness policy, as will poli

cies accounting for cultural relativities such as promoting increased vegetable and fruit

consumption and reduced refined carbohydrate and red meat intake in South Asia.

School-based curriculum around wellness in everyday life and the science behind this will

be necessary for generational transformation to occur. Consumer demand will lead to a

shift in industry practice. Still, it will need to be accompanied by a government-led em

phasis on the production and supply of healthy foods and beverages as the required stan

dards for these products. Comparative policy research will help determine successful

strategies for creating wellness within and across sectors of society while accounting for

cost savings in health systems, loss of productivity, academic attainment ,and healthy ag

ing.

The Global Wellness Institute reports that as a global society, people are coming together

to achieve everyday purposes and do essential work. The idea of work moving from me to

we have resulted in teams, global networks, partnerships, and ad hoc project groups that

have strategies for well-being. Organizations are exploring and implementing ways to fos

ter high-trust environments of mutual respect and psychological safety and improve the

shared outcomes they achieve. The movement is toward individual flourishing through

collective action (Global Wellness Institute, 2019).

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Gerard Bodeker

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Well-Being and Mental Wellness

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PRINTED FROM the OXFORD RESEARCH ENCYCLOPEDIA, GLOBAL PUBLIC HEALTH (oxfordre.com/publichealth). (c) Ox

date: 04 August 2020

Sergio Pecorelli

Yale University, School of Medicine

Lawrence Choy

Portola Wellness

Ranieri Guerra

World Health Organization

Kishan Kariippanon

University of Wollongong, School of Health and Society

AnxPred: A Hybrid CNN-SVM Model with XAI to Predict Anxiety among University Students

Conference Paper

Full-text available

Mar 2025

Perceived anxiety is a prevalent issue among university students, negatively affecting both mental health and academic outcomes. Prompt evaluation of anxiety triggered by academic factors is essential to promote student wellness and academic success. Recent studies have incorporated Machine Learning (ML) and Deep Learning (DL) models to assess academic anxiety. However, most of these investigations apply ML or DL models independently without thoroughly analyzing feature interpretation (i.e., academic stressors associated with anxiety) in relation to model efficiency. In this research, a hybrid model, AnxPred is introduced that combines neural network (CNN) and support vector machine (SVM) to improve the accuracy of anxiety predictions through superior feature extraction. The rationale here is that CNN’s feature extraction capability combined with SVM’s classification ability would better extract the relevant mental stressors to achieve an accurate prediction of anxiety. The model is trained and validated using an extensive dataset of student academic anxiety measured by the GAD-7 model. A total of 2,028 responses are recorded from 15 leading universities in Bangladesh. In addition, Explainable Artificial Intelligence (XAI) is applied to assess the effectiveness of the model in extracting the relevant anxiety stressors to measure the anxiety level. The reported results suggest that the hybrid AnxPred model performs better than the conventional ML and DL models, achieving a precision of 99.125%, a recall of 99.125%, and a f1 score of 99.134%. The LIME (XAI) assessment indicates that the model reliably extracts relevant anxiety stressors to measure the level of anxiety. Therefore, the proposed model can be used for the diagnosis and early detection of mental anxiety in students and accordingly plan mental health counseling in an automated way, thus supporting the improvement of the academic process.

Mindful escapes: Unveiling the transformative wellness journeys of generation Z

Article

Full-text available

Feb 2025

Wellness tourism has emerged as a prominent source of healing and stress relief, significantly enhancing the tourist experience. This present study aims to analyze the mindfulness journey of Generation Z (Gen Z) during their visits to wellness centers. Semi-structured interviews were conducted with eligible participants who had spent a week or stayed longer at wellness centers or retreat spots, and data was collected using purposive sampling techniques. Data analysis was performed using NVivo (14), employing thematic and content analysis methods to achieve research objectives. The study identifies five key factors influencing the mindfulness experience at wellness centers: spirituality, nature connectedness, focus mind, self-awareness and thoughts regulation. The findings contribute to understanding the emerging market segment, i.e., Gen Z, and their mindfulness experience during visits to wellness centers. Furthermore, the study offers theoretical insights into the factors that shape Gen Z's experiences while visiting wellness centers, enabling service providers to enhance their offerings and ensure better tourist experiences according to the preferences of Gen Z tourists.

Pragmatics of Eco-compassion in Angelic Speech Therapy: An Effective Communication Strategy for Individuals with Serious Mental Illness

Article

Dec 2024

Misunderstanding and misperception in communication often occur due to listeners’ failure to grasp the accurate meaning of a speaker’s utterances. These failures are typically caused by a lack of pragmatic competence in understanding the contexts and conditions of speakers when interacting with listeners in specific situations. An example of communication failure is seen with individuals experiencing serious mental illness (ISMI). Communicating and interacting with ISMI is challenging due to their communication disorders. Their speech and behavior are often impacted by hallucinations, delusions, disorganized talk and abnormal thought processes. This study aimed to explore effective communication strategy to deal with ISMI. The case study involved 3 (three) ISMI who met the eligibility criteria. An inductive qualitative method employing participant observation and documentary analysis was used. Data collection included primary, secondary and tertiary sources, which were triangulated with in-depth interviews with their families. Data analysis was conducted through thematic coding, which revealed that pragmatic competence (80%), Compassionate Psychiatric Care (CPC; 15%) and ecological conduciveness (5%) are key factors in improving communication fluency with ISMI. This article concludes that the speech therapy method developed by Angelicdolly, which combines pragmatic principles with compassion for the ecological conduciveness of ISMI is an effective strategy for enhancing communication with these individuals.

The Mediating Role of Psychological Capital Between Academic Stress and Well-Being Among University Students

Article

Full-text available

Feb 2023

In the current study, we investigated the relationships among academic stress, psychological capital (PsyCap), and well-being and the effect of the demographic variables of gender, majors, and academic years on academic stress and PsyCap. We used the structural equation model to investigate the mediating role of PsyCap between academic stress and well-being. The participants (N = 827) included students from a midsized university in the Eastern Province of Saudi Arabia (636 females, 191 males) who comprised 450 science and 377 humanities majors from all academic years. To collect data, we utilized the Academic Stress Inventory, the Psychological Capital Questionnaire, and the Warwick-Edinburgh Mental Well-Being Questionnaire. The structural equation model analysis results revealed that PsyCap was a full mediator between academic stress and well-being. Gender did not affect on PsyCap or academic stress. In addition, the academic majors affected PsyCap: Students in the humanities majors had better PsyCap than those in the science majors. Furthermore, the academic years affected academic stress; specifically, academic stress decreased as students progressed through their academic years. Therefore, science majors in their first academic year were the most in need of a PsyCap-based intervention.

Promoting planetary health and well-being for all: harnessing indigenous knowledges for health with traditional, complementary and integrative health systems

Article

Full-text available

Apr 2025

The concept of well-being extends beyond individual health practices to encompass a burgeoning industry focusing on healthy lifestyles and products. This trend reflects a global paradigm shift toward prioritizing the holistic well-being of individuals and the planet within socioeconomic policies. This shift underscores the integration of social, economic, and environmental considerations into policy frameworks, signaling a concerted effort toward a more sustainable and health-conscious future. The article highlights the crucial role of Indigenous Knowledges for Health (IKH) and Traditional, Complementary and Integrative Health/Medicine (TCIH) systems in contributing to the interconnectedness between human well-being and the health of our planet through innovation, health promotion, and fair, equitable and sustainable benefit sharing. Various contemporary global problems stem from ways of thinking that prioritize the short-term economic interests of individuals or specific groups over the well-being of Peoples and the planet as a whole. In contrast, IKH and TCIH systems often inherently adopt a holistic, sustainable worldview where individual, community, and Planetary Health and well-being are intertwined, providing transformative solutions and models toward integrative health. By incorporating IKH and TCIH systems into contemporary development models, health, and medicine, we can promote health equity, improve well-being, and create a sustainable future for Peoples and the planet.

Giving Organization Stakeholders Better Help: A Taxonomy for Making Sense of Workplace Mental Health Offerings

Article

Jun 2024
GROUP ORGAN MANAGE

Mental health has grown increasingly important as an aspect of employee well-being, with organizations expected to address these needs through offerings to support employee mental health. Broad societal forces like stigma and low levels of literacy surrounding mental health make it challenging for many people to understand these offerings. As the marketplace for these offerings grows to meet this demand, employees, HR professionals, and business leaders need better resources to understand, organize, and distinguish among their choices. The current research offers a 3-dimensional taxonomy for organizing these offerings, distinguishing them according to their (a). Primary Purpose-To Restore or Enrich; (b). Delivery Agent Location-External or Internal; (c). Latitude in Providing-Legally Required or Voluntary Provided. We provide theoretical approaches for scholars to consider these offerings’ impact in workplaces, and briefly demonstrate the taxonomy’s value in organizing some of the commonly available offerings in many modern workplaces. Finally, we provide two attainable research avenues for researchers to explore to inform organizational stakeholders on the (1). prevalence, costs, outcomes of these offerings in the workforce and (2). helpers and hurdles to employees' using these offerings.

نمذجة العلاقات السببية بين الرفاهية النفسية ورأس المال النفسي والضغوط الأکاديمية وبعض المتغيرات الديموجرافية لدى طلبة الجامعة أثناء جائحة کوروناCovid-19

Article

Full-text available

Dec 2021

هدفت الدراسة الحالية إلى تحديد مستوي رأس المال النفسي والضغوط الأکاديمية والرفاهية النفسية، والتحقق من النموذج السببي للعلاقات بين الرفاهية النفسية ورأس المال النفسي والضغوط الأکاديمية وبعض المتغيرات الديموجرافية مثل: النوع، والتخصص والبرنامج، والفرقة الدراسية لعينة من طلبة الجامعة أثناء جائحة کورونا Covid-19. وشارک في الدراسة (1160) من طلبة الجامعة. وتم استخدام مقياس الرفاهية النفسية Tennant, et al. (2007)، ومقياس رأس المال النفسيفي البيئة الأکاديميةLuthans, Luthans & Jensen (2012) ، وقائمة الضغوط الأکاديمية Lin & Chen (2009) . وکشفت النتائج عن وجود مستوى مرتفع لدى عينة الدراسة في کل من الرفاهية النفسية ورأس المال النفسي والضغوط الأکاديمية، وتم التوصل إلى نموذج سببي ذي ملاءمة جيدة للعلاقات بين المتغيرات محل الدراسة، وکشفت النتائج عن وجود تأثير مباشر سالب ودال إحصائياً من الضغوط الأکاديمية في کل من رأس المال النفسي، والرفاهية النفسية، ووجود تأثير غير مباشر سالب ودال إحصائياً من الضغوط الأکاديمية في الرفاهية النفسية من خلال رأس المال النفسي، ووجود تأثير مباشر ودال للتخصص في رأس المال النفسي، حيث کان رأس المال النفسي لدى طلبة التخصص الإنساني أعلى من نظيره لدى طلبة التخصص العلمي، وتأثير مباشر ودال لنوع البرنامج والفرقة الدراسية في الضغوط الأکاديمية، حيث کانت الضغوط الأکاديمية لدى طلبة البکالوريوس أعلى من نظيرتها لدى طلبة الدراسات العليا، والضغوط الأکاديمية لدى طلبة السنوات الدراسية الأولى أعلى من نظيرتها لدى طلبة السنوات المتقدمة، کما کان هناک تأثير غير مباشر ودال من التخصص في الرفاهية النفسية خلال رأس المال النفسي، وتأثير غير مباشر ودال للفرقة الدراسية والبرنامج في رأس المال النفسي والرفاهية النفسية من خلال الضغوط الأکاديمية، وتم مناقشة نتائج الدراسة وتطبيقاتها في البيئة الأکاديمية.

Market Overview of Herbal Medicines for Lifestyle Diseases

Chapter

Feb 2024

The global herbal medicine industry is rapidly growing due to increasing consumer demand for natural and alternative healthcare options. Herbal medicines are valued for their antioxidant and anti-inflammatory properties, making them popular choices for addressing health-related issues and promoting overall well-being. The market includes a variety of products, such as pharmaceuticals, functional foods, dietary supplements, and beauty products, all of which are sought after for their nontoxic nature, fewer side effects, and affordability. Despite the promising opportunities, the industry faces challenges related to safety, efficacy, and regulatory considerations. To succeed in this market, herbal market players must focus on educating consumers, investing in research, and providing evidence-based products that meet the needs of health-conscious individuals. Quality control and standardization are crucial for maintaining the consistent quality of herbal products and differentiating them in a competitive market. Collaborating with healthcare professionals can help integrate herbal medicine into mainstream healthcare, gaining acceptance through recommendations and prescriptions. Personalization and customization are important to attract health-conscious consumers seeking targeted solutions for their specific lifestyle-related health issues. Leveraging e-commerce and digital marketing can broaden the reach of herbal market players globally. Sustainability and ethical sourcing resonate with environmentally conscious consumers, enhancing the appeal of herbal products. Exploring international markets, especially in developing countries with a deep-rooted herbal medicine culture, presents significant growth opportunities. Despite challenges and regulations, the herbal medicine market has vast growth potential due to increasing global demand for natural health solutions, the prevalence of lifestyle diseases, growing awareness, research validation, and integration with conventional healthcare. By adhering to regulations, promoting evidence-based practices, and investing in research and quality control, herbal market players can shape the future of healthcare and wellness, contributing to a healthier and more sustainable approach to healthcare.

Content validation of a mental wellness measuring instrument for adolescents living with HIV: a modified delphi study

Article

Full-text available

Oct 2023

A growing body of evidence suggests that improving the mental wellness of adolescents living with HIV (ALHIV) will also result in improved adherence to antiretroviral therapy (ART), as well as improving their general health and wellbeing as they age into adulthood. However, to develop effective strategies and interventions aimed at improving mental wellness, we require age and culturally appropriate instruments to build an evidence base. Currently, there is a lack of mental wellness measures developed for ALHIV, especially in the African context. To address this gap, we developed a measure of mental wellness following modified guidelines set out by DeVellis [1] and Godfred et al. as a guiding framework [2]; (1) Identifying the gap, (2) Set the theoretical foundations and identify domains and (3); Instrument development and initial validation. For the first two steps, we conducted a systematic review, photovoice study and integrative review – which we briefly describe as the findings have been published. Following this we describe the processes to develop the instrument and to establish content validity through a modified Delphi Study. Through this process we were able to refine the instrument which will be subject to further testing. Implications and Contribution: This study aims to add to the body of knowledge on promoting mental health (mental wellness) among adolescents living with HIV in South Africa through developing an appropriate and valid measure of mental wellness for this population. This study reports on the results of a Delphi Study aimed at improving the content validity of the instrument Mental Wellness Measure for Adolescents Living with HIV (MWM-ALHIV).

Mental healthcare services support: the social role of medical educator involved in the destigmatization process to generate inclusion.

Article

Full-text available

Jul 2023

Introduction: The stigmatization of mental healthcare services and users is a barrier to the achievement of mental wellness present on a global level. 800000 suicides are estimated each year, 25 suicide attempts for every suicide (ratio of 25:1), and in 2017 estimated a prevalence > 10% of people suffering from mental disorder or substance abuse (global data). The stigmatization is a multifactorial phenomenon and process that involves different factors, which overall cause health, social and economic damage. Slowing down and reducing access to mental health and well-being pathways due to their influence in the community, also affect social relationships and self-determination. Purpose: to identify and describe the process, causes, and factors of stigmatization. Propose destigmatization activities led by the medical educator. Methodology: The manuscript develops a proposal focused on the destigmatization process of mental health/wellbeing services and users, through the guidance of the medical educator as a figure of connection between different professions (interdisciplinary and multidisciplinary), and between different stakeholders. Conclusion: each identifies factor described, can be involved in the destigmatization process to generate inclusion, through different social interventions led by the role of the medical educator, with the aim of supporting access to patient support processes and quality of life in communities, generating inclusion through destigmatization

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials

Article

Full-text available

Sep 2019

The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from “nutrient supplements”, such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta‐analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta‐review of this top‐tier evidence, we identified, synthesized and appraised all meta‐analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta‐analyses of placebo‐controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention‐deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate‐based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high‐dose methylfolate in major depressive disorder. There was emergent evidence for N‐acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence‐based supplements, to further elucidate the underlying mechanisms.

Changing World Happiness

Chapter

Full-text available

Mar 2019

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Article

Full-text available

Nov 2018
LANCET

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury.

Defining Youth Resilience: a Scoping Review

Article

Full-text available

Jun 2019
Int J Ment Health Addiction

The ways in which youth resilience are understood, defined, and subsequently measured in health policy and practice influence health intervention, prevention, and promotion strategies. A scoping review compiled and synopsized empirical evidence of strength-based approaches to understanding and promoting resilience in youth. Arksey & O’Malley’s (International Journal of Social Research Methodology, 8(1), 19-32, 2005) five-stage framework for scoping reviews was followed to review studies published between 2000 and 2016 from PubMed Central, CINAHL Nursing, Proquest, PsychArticles, and ERIC. Two thousand six hundred five articles were identified: 28 met the selection criteria. Twelve authors developed their own definition of resilience by synthesizing the literature, 11 quoted definitions from other academics, and 5 did not define resilience. None consulted with youth. There is no universally agreed-upon definition. Approaches to youth resilience still tend to be deficit-based, deterministic, and reductionist, focused on individual behaviors and motivations, and outcomes of behavioral problems and pathologies. Research, policy, and program development around youth well-being would benefit by including youth’s voices.

Work and Well-being: A Global Perspective

Chapter

Full-text available

Feb 2018

The Global Happiness Policy Report is produced by the Global Happiness Council and contains papers by expert working groups on happiness for good governance. Our chapter on work and well-being provides evidence and policy recommendations on best practices to promote happiness and well-being in the workplace. The first Global Happiness Policy Report was presented at the World Government Summit in Dubai on February 10, 2018.

129-OR: Diabetes Prevention through Yoga-Based Lifestyle: A Pan-India Randomized Controlled Trial

Article

Jun 2019
DIABETES

Objective: The study tested the potency of yoga-based intervention on risk reduction of diabetes. Research Design and Methods: This study is an offshoot of a large, 2 group cluster randomized, translational research trial on 11,212 individuals, aged >20 years, with high-risk (>60) for diabetes on IDRS (Indian diabetes risk score) and type 2 diabetes. The present study included a subgroup of 3,366 prediabetes individuals [A1C range of 5.70-6.49% (39-47 mmol/mol)]. Eligible individuals were selected by community-based (rural and urban) screening from 29 states/union Indian territories and were cluster randomized. The wait list control group received lifestyle advice. The experimental group performed a validated yoga-based lifestyle intervention developed by a group of 16 yoga and diabetes experts using the Delphi method. The study outcomes, diabetes incidence/prediabetes remission were obtained by respective A1c values >6.5% (48 mmol/mol) or <5.7% (38 mmol/mol) (normoglycemia) at 3 months of follow-up. Results: At 3 months of follow-up, 11.2% of the yoga-intervention group and 21.6% of the control group developed diabetes (p<0.05); the relative risk reduction (RRR) was 47% (95% CI: 26-70). Interestingly, the intervention resulted in an effective shift to a normal range of A1c values in 52.0% of individuals as compared to only 39.9% in the control (p<0.05). Yoga-intervention was found to be beneficial for both the normal BMI (<23 Kg/m2) and the overweight/obese sub-groups (≥23 Kg/m2), as indicated by the respective RRRs of 69% (95% CI: 52-85) and 51% (95% CI: 32-70). Conclusion: This is the first report on the effectiveness of a yoga-based life style intervention for remission of prediabetes and prevention of diabetes. The intervention was adequately effective for normal and overweight/obese subgroups. The short-term findings demand the need for longer follow-up. We speculate positive long-term outcomes based on the reported effects of yoga on self-control and feeding behavior. Disclosure Raghuram Nagarathna: None. C. Venkata Ram: None. Sasidharan Rajesh: None. Amit Singh: None. Vijaya Majumdar: None. Suchitra Patil: None. Hongasandra Nagendra: None. Funding The Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy; Government of India Ministry of Health and Family Welfare

A partnership for transforming mental health globally

Article

Apr 2019

The large and increasing burden of mental and substance use disorders, its association with social disadvantage and decreased economic output, and the substantial treatment gaps across country-income levels, are propelling mental health into the global spotlight. The inclusion of targets related to mental health and wellbeing in the UN's Sustainable Development Goals, as well as several national and global initiatives that formed during the past 5 years, signal an increasing momentum toward providing appropriate financing for global mental health. Drawing on the organisational and financial architecture of two successful global health scale-up efforts (the fight against HIV/AIDS and the improvement of maternal and child health) and the organisational models that have emerged to finance these and other global health initiatives, we propose a multi-sectoral and multi-organisational Partnership for Global Mental Health to serve two main functions. First is the mobilisation of funds, including raising, pooling, disbursing, and allocating. Second is stewardship, including supporting countries to use funds effectively, evaluate results, and hold stakeholders accountable. Such a partnership would necessarily involve stakeholders from the mental health field, civil society, donors, development agencies, and country-level stakeholders, organised into hubs responsible for financing, scale-up, and accountability.

The Lancet Commission on global mental health and sustainable development

Article

Oct 2018

Conceptual approaches to wellbeing in buildings: a scoping study

Article

Oct 2018
BUILD RES INF

Several industry-led initiatives in various countries demonstrate a new interest in wellbeing and buildings. This paper adopts a scoping review method aiming to establish the most prevalent and insightful definitions and dimensions of wellbeing in buildings applied in the recent published literature. The paper adopts a two-step method for identifying and categorizing the conceptual approaches to wellbeing encountered in the current literature. First, an overview is presented of the term ‘wellbeing’ and its development over time. Second, the broad wellbeing categories identified are further refined and complemented via a deductive approach, drawing the final set of conceptual themes informed by the papers reviewed in this study. Nine themes were identified, two of which deductively emerged from the papers included in this study: environmental satisfaction/comfort and cognitive performance/productivity. The findings emphasize the heterogeneity of conceptual approaches to research concerning ‘wellbeing in buildings’, an ambiguity between wellbeing outcomes or determinants, and the need for greater clarity on the relative contributions of different wellbeing dimensions to overall individual or population wellbeing. Based on these findings, future work could be carried out to provide guidance on how to evaluate claims of evidence-based building design which foster individual or population wellbeing.

Preventive strategies for mental health

Article

May 2018

Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated preventive mental health strategies that might reduce the incidence of mental health disorders, or shift expected trajectories to less debilitating outcomes. Some of these interventions also seem to be cost-effective. In the transition to mental illness, the cumulative lifetime effect of multiple small effect size risk factors progressively increases vulnerability to mental health disorders. This process might inform different levels and stages of tailored interventions to lessen risk, or increase protective factors and resilience, especially during sensitive developmental periods. Gaps between knowledge, policy, and practice need to be bridged. Future steps should emphasise mental health promotion, and improvement of early detection and interventions in clinical settings, schools, and the community, with essential support from society and policy makers.