If you want mentally healthy children start promoting it
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If You Want Mentally Healthy Children, Start Promoting It. Corey Keyes Professor of Sociology. Mental Health. Why Conception Matters. From trephening, exorcism, whirling, confinement, bloodletting, burning at the stake; To asylums; To mesmerism, hypnosis, and psychoanalysis;

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If You Want Mentally Healthy Children, Start Promoting It

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If You Want Mentally Healthy Children, Start Promoting It

Corey Keyes

Professor of Sociology


Mental Health


Why Conception Matters

  • From trephening, exorcism, whirling, confinement, bloodletting, burning at the stake;

  • To asylums;

  • To mesmerism, hypnosis, and psychoanalysis;

  • To institutionalization, sedating, restraining, shocking;

  • To de-institutionalization;

  • To community mental health centers;

  • To proliferation of talk therapies;

  • To SSRI’s and deep brain stimulation;

  • To …?


Good News

10-14 Disorders

80-90% Benefit

SSRIs

fewer side-effects

helps 7 of 10

Public awareness

Bad News

Brief Remission

3 of 10 Drug-Resistant

Prevalent

20 to 30% Annually

50% Lifetime

Comorbid

Age-of-Onset

Recurrent

Prognosis: Mental Illness ca 21st Century


Prognosis: Mental Health ca 21st Century

Palliative


How Would You Describe the Current Approach to Population Mental Health?


The definition of insanity is doing the same thing over and over and expecting different results

Benjamin Franklin


What We Say

  • The mission of public health is “to protect and improve American health”

    • (www.surgeongeneral.gov)

  • . . . assure society’s collective interest in creating the conditions in which people can be healthy

    • (Institute of Medicine, 1988, 1996, 2003)

  • . . . ensure that good health, as well as long life, are enjoyed by all

    • (www.healthypeople.gov)


What We Do

  • Reduce leading causes of death

  • Reduce incidence and prevalence of illness

  • The NIMH seeks “To improve this nation’s mental health . . . “ by supporting ”. . . a wide range of research related to the etiology, diagnosis, treatment, and prevention of mental disorders“

    • (National Institute of Mental Health, 1995, p.1).

    • Cure therapeutics (Insel & Scolnick, 2006)


We Must Stop Saying One Thing and Doing Another


Triangulation of Health

Pathos

Salus

Hale


Mental Health From the Salutogenic Perspective

Flourishing

Eudaimonia

Hedonia

?

?


Mental Health from the Pathogenic Perspective

Major Depression

Malfunctioning

Anhedonia

Appetite or Weight Change

Depressed Mood

Loss of Pleasure or Interest in Life

Insomnia or Hypersomnia

Psychomotor Agitation, Retardation

Fatigue, Loss of Energy

Worthlessness or Guilt

Indecisiveness, Lack Concentration

Suicide Ideation


Positive Affect

cheerful

in good spirits

happy

calm and peaceful

satisfied

full of life

Avowed QOL

Satisfaction with life

Happy with life

Interest in life

Hedonia

Emotional Well-Being


Self-Acceptance

Personal Growth

Purpose in Life

Environmental Mastery

Positive Relations

Autonomy

Social Acceptance

Social Growth/Potential

Social Contribution

Social Interest/Coherence

Social Integration

Eudaimonia

Social

Well-Being

We or Us

Psychological

Well-Being

Me or I


Mental Health Continuum-Short Form


Mental Health

From the Salutogenic Perspective

Flourishing

Eudaimonia

Hedonia

Psychological

Well-Being

Social

Well-Being

Emotional

Well-Being


Feeling and Functioning Well

  • Three Factor Structure

    • In U.S. Adolescents

      • (Keyes, 2004)

    • In U.S. College Students

      • (Robitschek & Keyes, in press)

      • (Keyes and Eisenberg, in progress)

    • In U.S. Adults

      • (Keyes, 1996)

    • In Black Setswana-speaking South African Adults

      • (Keyes et al., 2008)

    • In Dutch Adult Population

      • (Westerhof & Keyes, in progress)


The DSM Approach to the Mental Health Continuum

  • Flourishing

    • “almost every day” or “every day”

      • 1 of 3 emotional well-being

      • 6 of 11 positive functioning

  • Moderate Mental Health

  • Languishing

    • “once or twice” or “never”

      • 1 of 3 emotional well-being

      • 6 of 11 positive functioning


Are We Stuck in One Dimension?


The Dual Continua Model

High HDL

Low LDL

High LDL

Low HDL


The Structure of Mental Health and Illness

U.S. Adolescent Population (Keyes, 2008)

- .68

Mental Illness

Mental Health

CDI-10

Item 1

. . .

CDI-10

Item 9

CDI-10

Item 10

Emotional Well-Being

Psychological Well-Being

Social Well-Being


The Structure of Mental Health and Illness

U.S. Adult Population (Keyes, 2005)

- .52

Mental Illness

Mental Health

Major Depression

Panic Disorder

Generalized Anxiety

Emotional Well-Being

Psychological Well-Being

Social Well-Being


Unfounded Biases Continue

Although the concept of positive mental health is one worth keeping in mind, it is not very helpful in classifying different persons, groups, or populations.

p. 2


The Hale Perspective

High Mental Health Symptoms

#4 Flourishing & Mental Illness

#1 Flourishing

High Mental Illness Symptoms

#5 Moderate Mental Health & Mental Illness

#2 Moderate

Low

Mental Health

#6 Languishing & Mental Illness

#3 Languishing

Low


CDS 2002 Data, Ages 12-18


Summary of Research To Date:Anything Less Than Flourishing

In Adults

  • Chronic Physical Illness with Age (Keyes, 2005b)

  • Cardiovascular Disease (Keyes, 2004a)

  • Psychosocial Liabilities (Keyes, 2005b)

  • Disability (Keyes, 2002)

  • Productivity Losses (Keyes, 2002, 2007; Keyes & Grzywacz, 2005)

  • Healthcare Use (Keyes & Grzywacz, 2005)

    • Overnight Hospitalizations

    • Medical Visits

      • Physical Health

      • Mental-Emotional Professional

    • Prescription Medications

      In Adolescents

  • Conduct Problems (Keyes, 2006)

  • Psychosocial Deficits (Keyes, 2006)

  • Missed Days of School (Keyes, in progress)

  • Schooling Aspirations (Keyes, in progress)


Working Paper #1: MIDUS Adults in 1995 and 2005


Adjusted* Odds Ratio of any 2005 Mental Illness (MDE, GAD or Panic Disorder) by Change in Mental Health Status

(*Adjusted for Race, Age, Sex, Education, and Any Chronic Physical Condition in 2005)

ns


Change in Adults’ Mental Health Status: Destinations and Origins Flourishing

19952005

Flourishing

Flourishing

19.2%

22.3%

50.6%

46.3%

3.1%

Moderate Mental Health

Moderate Mental Health

63.6%

60.4%

Languishing

17.3%

Languishing

17.2%


Change in Adults’ Mental Health Status: Destinations and Origins Moderate Mental Health

19952005

Flourishing

Flourishing

19.2%

22.3%

18.6%

Moderate Mental Health

Moderate Mental Health

67.5%

63.6%

60.4%

13.9%

Languishing

17.3%

Languishing

17.2%


Change in Adults’ Mental Health Status: Destinations and Origins Languishing

19952005

Flourishing

Flourishing

19.2%

22.3%

Moderate Mental Health

Moderate Mental Health

63.6%

60.4%

4.1%

50.2%

45.7%

Languishing

17.3%

Languishing

17.2%


Surely Most People Are Flourishing?


Point Prevalence of Complete Mental Health U.S. Adult Population, ages 35-84 in 2005 (MIDUS follow-up, n = 1,760)


Prevalence of Complete Mental Health U.S. Adolescent Population Ages 12-18 in the 2002 CDS Sample, n= 1,290


Universities That Participatedin Fall 2007 Healthy Minds Study

  • Miami (Ohio)

  • University of North Carolina Greensboro

  • Yeshiva

  • University of Illinois, Springfield

  • Emory

  • New Mexico State

  • UNC, Chapel Hill

  • Chico State

  • University of Michigan

  • Tufts

  • Penn State

  • University of Illinois, Urbana/Champaign

  • University of Illinois, Chicago


Association of Prevalence Screen for Depression (PHQ-9) by Diagnosed as Flourishing (MHC-SF)at n=13 Participating Universities in 2007 Healthy Minds Study

Pearson r = - .50 p < .05 (one-tailed)


Level of Depression (PHQ-9) by Level of Mental Health 2007 Healthy Minds Data


Mental Illness by Level of Mental Health in the 2007 Healthy Minds Data


Prevalence of Complete Mental Health 2007 Healthy Minds Data(n = 5,750)


Scientific Reasons For Closing the “Wanting-Doing Gap”

1. Illness is specific, and health is ‘something positive’; We have population measures for mental health as flourishing

2. Health and illness form a single continuum; Science supports the two continua model

3. Mental illness is a burden; Anything less than flourishing is a burden

4. Too much mental illness; Too little flourishing

5. Treatment and Cures; Promotion ergo I Prevent

6. Illness is more serious; The absence of health is more serious

  • Pathogenic and Salutogenic ‘strike the balance’


Start Where; Do What?

Campaign to Increase Awareness, Priorities, and Allure of Ingredients of Flourishing (complement to stigma reduction of mental illness)


Texas Tech UndergraduatesPerceived Importance of Each Domainof Flourishing(Note: All paired samples t-test contrasts were significant at p < .05)

Not at All Important Very Important


Texas Tech UndergraduatesPerceived Importance of Dimensions of Flourishing

Not at All Important Very Important


Texas Tech UndergraduatesCorrelations of Perceived Importance With Level of the Three Components of Flourishing


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