Martin Seligman, former president of the American Psychological Association and a proponent of positive psychology, found that the number of studies on depression disproportionately outweighs those about joy, happiness, or fulfillment by more than 95 to one. His approach is helping to build the gap between coping and thriving in life.
Undoubtedly, mental health shapes and is shaped by various aspects of life. Momentum has also been building in recent years to shift the conversation away from the sole prevention of mental ill-health and onto the promotion of positive mental health or high levels of emotional and psychological well-being (Organisation for Economic Co-operation and Development [OECD], 2023)[2]. Indeed, good mental health can boost people’s resilience to stress, help them realize their goals, and actively contribute to their communities. Health and other government agencies across the OECD increasingly recognize positive mental health as a policy target, be it through the development of regularly monitored indicators of population-positive mental health, dedicated guidance on how to improve it, or funding mechanisms that explicitly target resilience factors for mental health promotion.
Mapping the relationship between mental health and people’s economic, social, relational, civic, and environmental experiences reveals that those with mental distress also fare poorly in most other aspects of well-being. For instance, compared to the general population, those at risk of mental distress are nearly twice as likely to be at the bottom of the income distribution, to be unemployed, or to be dissatisfied with the safety and availability of green spaces in their neighborhoods. They are also more than twice as likely to be unhappy with how they spend their time and to report low trust in other people; their risk of feeling lonely is more than four times higher than the general population.
Conversely, protective factors – such as being financially secure, being in good physical health, living in a safe and clean living environment, and having healthy social relationships – can provide resilience against poor mental health outcomes and support good emotional and psychological well-being.
The relationship between mental health outcomes and quality-of-life indicators – physical health, knowledge, skills, educational attainment, environmental quality, and natural capital – is often bidirectional. Well-being deprivations are associated with an elevated risk for mental ill-health and lower positive mental health. At the same time, a higher quality of life serves as a resilience factor for better mental health outcomes.
Examples of interventions available to policymakers include better integrating physical and mental health services, promoting physical activity, establishing school-based interventions and lifelong learning programs, funding eco-therapy and green interventions and promoting green cities, and a better accounting of the mental health costs of climate change and the benefits of climate action.
Research findings by OECD
OECD research estimates that half the population will experience some form of mental health condition at least once over their lifetime, and the economic costs of this amount to at least 4% of annual GDP (OECD, 2021)[3].
Microdata analysis for European OECD countries shows that — regardless of whether considering risk for mental distress or low levels of positive mental health— people with poor mental health outcomes fare far worse in every domain of the OECD Well-being Framework compared to the general population. For instance, compared to the general population, those at risk of mental distress are nearly twice as likely to be at the
bottom of the income distribution, to be unemployed, or to be dissatisfied with the safety and availability of green spaces in their neighborhoods. They are also more than twice as likely to be unhappy with how they spend their time and to report low trust in other people, and their risk of feeling lonely is more than four times higher. Conversely, protective well-being factors – including being financially secure, being in good physical health, living in a safe and clean living environment, and having healthy social relationships – can
provide resilience against poor mental health outcomes. Multiple regression analysis suggests that each well-being area remains a significant independent protective factor against mental distress even when controlling for other well-being outcomes, demographic factors, and country context (i.e., country fixed effects).
Mental Health and Financial Well-being
The two-way relationship between income poverty and mental health is often described as a cyclical vicious circle: poor mental health inhibits one’s ability to shore up financial resources or find employment opportunities, while at the same time, the chronic stress and instability of monetary poverty can lead to the onset or perpetuation of mental disorders (WHO, 2014[4]; WHO, 2022[5]; Clark and Wenham, 2022[6]).
Each process exacerbates the other, worsening outcomes across all dimensions of well-being.
Research Studies
1. A national cohort study in Finland found that being diagnosed with a mental health disorder between the ages of 15 and 25 is associated with significantly lower earnings and income over the subsequent three decades, primarily because of lower education and a greater likelihood of experiencing unemployment (Hakulinen et al., 2019[7]).
2. Research in the United States suggests that people with serious mental illnesses earn around USD 16,000 less than their peers with no such conditions, totaling more than USD 190 million for society over a 12-month period, primarily due to worse employment outcomes (e.g., higher likelihood of unemployment and lower earnings when employed) (Kessler et al., 2008[8]).
3. Workers with mental health conditions are more likely to have higher rates of absence and to be less productive while on the job (OECD, 2021)[3], in part because of increased fatigue, an inability to concentrate, and less motivation (Ridley et al., 2020[9].)
4. A study in New Zealand found that job seekers reported losing out on job offers after disclosing their mental health history to prospective employers. Also, hired individuals felt discriminated against in the workplace by colleagues; those seeking loans reported discrimination from financial institutions in the form of rejected applications for mortgages or insurance policies or being charged higher fees or premiums (Peterson et al., 2007[10].)
Another finding is that broader macroeconomic conditions, quality of employment, homelessness, housing unaffordability, conditions of residential space, and instability are significant drivers of mental health conditions.
Mental Health and Physical Well-being
Having worse physical health can lead to worse mental health outcomes. Research has shown that people experiencing long-term, chronic illnesses are two to three times as likely as the general population to experience poor mental health (Naylor et al., 2012[11].)
Poor physical and mental health outcomes often co-occur. There is extensive evidence showing the close association between poor mental health outcomes and cardiovascular diseases, diabetes, chronic obstructive pulmonary disease (COPD), musculoskeletal disorders, asthma, arthritis, cancer, and HIV/AIDS (Naylor et al., 2012[11]; Fenton and Stover, 2006[12]; NICE, 2010[13]; Sheehy, Murphy and Barry, 2006[14].)
Conversely, high levels of positive mental health can provide resilience to health risks. Individuals with higher levels of positive mental health are more likely to be physically healthy, and both affect life evaluative measures associated with better long-term health and life expectancy (OECD, 2013[17].)
Research Studies
1. The relationship is bidirectional (OECD, 2021[3]; Ohrnberger, Fichera and Sutton, 2017[15]): having poor physical health can lead to the development of specific mental health conditions or lower levels of positive mental health, and at the same time, having low levels of mental health can lead to the onset of a range of physical health problems. The interaction between poor physical health and poor mental health can lead to increased morbidity and premature mortality (OECD, 202[13]).
2. Research from the World Health Organization has found that type 2 diabetes is associated with a 60% increased risk for depression, and COPD is associated with an up to 20% increased likelihood of exhibiting symptoms of anxiety disorders (OECD, 2021[3]; Cohen, 2017[16].) Diabetic patients with co-morbid depression have worse biological (e.g., worse glycemic control) and psycho-social practices (e.g., less adherence to treatment, less physical activity, poorer dietary habits) that can worsen their symptoms and lead to worse physical health outcomes (Fenton and Stover, 2006[12].)
3. Physical health conditions such as COPD can result in patients becoming more socially isolated or require them to stop doing activities that bring them joy, which can, in turn, cause depression (NICE, 201013.) Among the population of people diagnosed with rheumatoid arthritis, those who feel the disease will last indefinitely or who feel helpless to manage their symptoms and the disease course are more likely to develop symptoms of depression (Sheehy, Murphy, and Barry, 2006[14].)
4. Long-term health and life expectancy are associated with positive mental health for specific physical health conditions and not just general self-reported assessments of health: for example, there is a link between psychological well-being – and optimism, in particular – and better cardiovascular health (Boehm and Kubzansky, 2012[18].)
5. Research has found that individuals with high levels of positive affect are less likely to become ill when exposed to a cold virus and, even when infected, recover more quickly than those with low affect (OECD, 2013[17]; Pressman and Cohen, 2005[19].)
It has also been found that healthy lifestyle behaviors can improve future physical and mental health. These strong interlinkages underscore the need for better integration between providing physical and mental health care services.
Mental Health and Lifelong Learning
Knowledge and skills encompass the cognitive abilities gained over a lifetime. Those with mental health conditions tend to perform worse in school and have lower levels of educational attainment than the general population. However, the causal mechanisms behind these relationships are less well-studied than those pertaining to physical health. Performance in school and eventual educational attainment highly correlate with other well-being outcomes, including socioeconomic status, the educational attainment of one’s parents, and the home environment.
Because mental health conditions typically first present themselves during early adolescence – 50% of mental health problems are established by age 14 (Kessler et al., 2005[20]) – and because all young people spend a significant amount of time in schooling, school-based interventions can be a particularly effective way of promoting mental health. However, educational spaces are not just for young people: in fact, the act of learning promotes positive mental health. It provides psychological resilience, making adult lifelong learning a good way to foster positive mental health.
Research Studies
1. Performing poorly in school is associated with low levels of self-esteem; low self-esteem is associated with a greater risk for mental distress, including suicidal ideation, poorer physical health, and criminality in adulthood (Trzesniewski et al., 2006[21]; Nguyen et al., 2019[22].)
2. Research has shown that youths who feel isolated at school are more likely to subsequently develop depression or substance use behaviors (OECD, 2017[23]; Kochel, Ladd, and Rudolph, 2012[24]; Rigby and Cox, 1996[25].)
3. Bullying at school not only can impact educational outcomes but also can lead to an increased likelihood of children developing symptoms of anxiety, depression, and eating disorders; these negative impacts can persist into adulthood (OECD, 2017[23].)
4. Students with mental health conditions are 35% more likely to have repeated a grade and are at greater risk of dropping out of school early (OECD, 2021[3].) Lower levels of life satisfaction have also been associated with higher rates of truancy and early drop-out (OECD, 2017[23].)
Another finding is that emotionally balanced students perform better on reading tests. Those diagnosed with a mental health condition are less likely to pursue adult learning or workplace training. Peer behavior – especially bullying and social isolation – are also major risk factors for both mental health and learning outcomes.
Mental Health and Social Engagement
Community relations encompass how safe people are and feel, with whom and how people spend their time, and how they relate to one another and their institutions. These factors are intrinsically vital for fulfilled and connected lives and can contribute to achieving other material and quality-of-life aspirations. There is a strong, and in some cases bidirectional, link between good mental health and good community relations.
Well-being deprivations in these areas – including feeling and being unsafe in one’s neighborhood, home, or society; an inadequate work-life balance; loneliness and social isolation; and poor motivation to participate in civic engagement – are all linked to an elevated risk for mental ill-health and lower positive mental health.
Conversely, doing well in these areas can promote good mental health. Examples of interventions available to policymakers to improve these areas include integrating safety and social connectedness considerations into urban design, making better social connectedness an explicit policy priority, tackling the gender gap in unpaid work, and expanding the representation of those with lived experience of mental ill-health in politics.
Being safe is about being free from harm – whether in crime, conflict, violence, or natural disasters. Here, we focus on people’s safety and its effect on mental health in the spaces where they spend most of their time (their neighborhoods and homes, including violence committed by intimate partners), as well as on experiences of discrimination.
Research Studies
Longitudinal evidence using administrative crime records from Scotland shows that increases in local area crime are associated with a higher risk of self-reported mental health conditions as well as with rising antidepressant and antipsychotic prescriptions among both people who remained in the area and those who moved out (Baranyi et al., 2020[26].)
Multiple pathways explain the link between neighborhood safety and mental health. Most directly, becoming a victim of and witnessing crime – first- or second-hand – increases the risk of developing mental disorders, particularly PTSD and depression (Fowler et al., 2009[27]; Lorenc et al., 2012[28]; Meyer, Castro-Schilo and Aguilar-Gaxiola, 2014[29]).
An Australian study found that the mean impact of experiencing physical violence on mental well-being is well over that of losing one’s job, though smaller than experiencing the death of a spouse or sustaining a serious personal illness (Mahuteau and Zhu, 2016[30].)
The effect of violence extends across the whole life course, with well-established connections between experiences of abuse in childhood and lifelong (mental and physical) health outcomes (Moffitt, 2013[31], Metzler et al., 2017[32].)
More broadly, constantly feeling vulnerable and being afraid for one’s safety can be considered a chronic environmental stressor with substantial cumulative effects on mental health (Lorenc et al., 2012[28].)
Exposure to crime can also impact people’s mental health. People with mental health conditions, particularly serious ones, are at greater risk of being victimized (Choe, Teplin, and Abram, 2008[33]; Maniglio, 2009[34]; Teplin et al., 2005[35]; Dean et al., 2018[36]). For instance, a study of Londoners found that nearly 45% of people with severe mental ill-health reported experiencing crime in the past year; compared to those without, people with severe mental ill-health were three times more likely to be a victim of any crime and five times more likely to be a victim of an assault. Compared to the general population, they were also significantly more likely to report that the police had been unfair or disrespectful (Pettitt et al., 2013[37].)
Takeaways
Mental health is a complex and crucial aspect of overall well-being. Foundations, philanthropists, and policymakers are increasingly recognizing the importance of promoting positive mental health and preventing mental ill-health. This involves addressing factors like self-awareness, financial stability, access to quality healthcare and clean environments, and fostering healthy social relationships. Poor mental health is linked to negative outcomes like lower socioeconomic status and increased loneliness.
OECD studies have shown that half the population will experience a mental health condition at some point in their lives, which has substantial economic consequences. Additionally, there is a two-way relationship between physical and mental health: poor physical health can lead to worse mental health outcomes. In comparison, good mental health can promote better physical health outcomes. Research has also shown that individuals with higher levels of positive emotions are less likely to fall ill when exposed to viruses.
Foundations, philanthropists, and policymakers must prioritize initiatives that promote positive mental health. Lifelong learning is one initiative that can greatly contribute to the well-being of people from all backgrounds.
The Foundation for Talent Transformation’s mission is to foster stronger, healthier, and more equitable societies by cultivating an environment of inclusivity and understanding where every person feels valued and connected and has an opportunity to thrive personally and professionally. Together, we can create a healthier world for ourselves and future generations by recognizing the importance of promoting and investing in positive mental health.
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