Health is

Health is not simply the

absence of disease: it

is something positive . . .

—Henry Sigerist (1941, p. 100).

Kinds of Happiness

Hedonia Eudaimonia

Origins of Flourishing

Hedonia

Eudaimonia

Flourishing

Signs of Mental Health(Keyes, 1999, 2002)

Hedonic Well-Being 1. Satisfied with your life 2. Positive affect in life

Eudaimonic Well-Being 3. Contribution to society 4. Social integration 5. Social growth and potential 6. Acceptance of others 7. Social interest and coherence 8. Self acceptance 9. Environmental mastery 10. Positive relations with others 11. Personal growth 12. Autonomy 13. Purpose in life

What’s Your Mental Health?

• High Level = Experience sign of mental health “every day” or “almost every day”

• Low Level = Experience a sign of mental health “once or twice” or “never”

• Flourishing– High level on 1 or more hedonic well-

being• and

– High level on 6 or more eudaimonic well-being

• Languishing– Low level on 1 or more hedonic well-

being• and

– Low level on 6 or more eudaimonic well-being

• Moderately Mentally Health– if you are neither flourishing nor

languishing

28

10.6

16

9.4

13.4

2.2

6 6.84.8

0.41

2.7

0

5

10

15

20

25

30

35

Languishing Moderately Mentally Healthy Flourishing

Major Depression Generalized Anxiety Panic Disorder Alcohol Dependence

%

DSM 12 Month Mental Disorders

MIDUS 1 AdultsKeyes (2005a)

Low

Low

High Mental Health

High Mental Illness

Data Support the Two Continua Model

MHC-SF Mental Health Diagnosis DSM 12-Month Mental Illness

Diagnosis

Languishing

Moderately

Mentally Healthy

Flourishing

No

Languishing 3

Moderate

Mental Health 2

Flourishing:

Complete Mental Health

1

Yes

Mental Illness

and Languishing 6

Mental Illness

and Moderately Mentally Healthy

5

Mental Illness

and Flourishing 4

Complete State Approach

Anything Less Than Mental Health as Flourishing in Adults

(Keyes, 2007)

• Productivity– Missed days of work– Workday cutbacks

• Chronic Physical Illness and Conditions– Any CVD– Number of conditions at all ages

• Disability– Health Limitations of IADLs

• Psychosocial Assets– Report Being More Resilient– Clearer Goals in Life– Feel More Loved and Cared For (Intimacy)– Low Sense of Helplessness

• Healthcare Utilization– Few Overnight Hospitalizations– Medical Visits (for physical or for emotional,

psychological)– Few Medical Prescriptions

Flourishing Across the Life-Span (MIDUS 1995 and MIDUS 2005 Longitudinal Follow

Up)

Cardiovascular Disease (CVD)

• CVD prevalent and costly • +6o million Americans have at

least one type of CVD – 40% are above the age of 65

• Highest combined direct and indirect costs cost ($180 billion in 1999)

• About 1 per 2.5 deaths directly result from CVD– 47% of men – 54% of women died from some CVD

(1999)

• Deaths from CVD decreased by 30%

• Less recognizable risk factor in the is mental illness (MDE)

Happy Heart Hypothesis(Keyes, 2004)

Happy Heart Hypothesis(Keyes, 2004)

2nd

1st

3rd

Chronic Physical Conditions (27 possible)

Keyes (2005b)

0

1

2

3

4

5

6

7

Young 25-39 Midlife 40-59 Older 60-74

MDE and Languishing

MDE

Languishing

Moderately Mentally Healthy

Flourishing

Mental Health and Illness:

Which is Cause and Effect?

1995 2005

Flourishing Flourishing

Moderate Mental Health

Moderate Mental Health

Languishing Languishing

19.2% 22.3%

17.2%

63.6% 60.4%

17.3%

3.1%

46.3%

50.6%

Change in Adults’ Mental Health Status: Destinations and Origins

Flourishing

1995 2005

Flourishing Flourishing

Moderate Mental Health

Moderate Mental Health

LanguishingLanguishing

19.2%22.3%

17.2%

63.6%60.4%

17.3%

Change in Adults’ Mental Health Status: Destinations and Origins

Moderate Mental Health

67.5%

18.6%

13.9%

1995 2005

Flourishing Flourishing

Moderate Mental Health

Moderate Mental Health

Languishing Languishing

19.2% 22.3%

17.2%

63.6% 60.4%

17.3%45.7%

Change in Adults’ Mental Health Status: Destinations and Origins

Languishing

50.2%

4.1%

5.5

7.7

3.83.5

2.3

1.4

1

4.5

0

1

2

3

4

5

6

7

8

9

10

Languishing 1995Languishing 2005

Flourishing orModerate MH

1995 Languishing2005

Languishing1995 Moderate

MH 2005

Moderate MH1995 Moderate

MH 2005

Flourishing 1995Moderate MH

2005

Languishing orModerate MH

1995 Flourishing2005

Flourishing 1995Flourishing 2005

Any Mental Illness1995

Adjusted* Odds Ratio of any 2005 Mental Illness (MDE, GAD or Panic Disorder)

by Change in Mental Health Status

(Adjusted for Race, Age, Sex, Education, and Total Chronic Physical Illness in 2005)

Keys to Aging Positive in Terms of Flourishing

6

45.248.8

5.6

54.5

39.9

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

12 to 14 Year Olds 15 to 18 Year Olds

Languishing Moderately Mentally Healthy Flourishing

Mental Health in Middle School and High School Youth in the U.S. (CDS 2002 Data; Keyes, 2006)

Keys of Aging Successfully

• Transition into adulthood

• Socially Engaged– Generativity

• Recognize social contact goals change– selectivity

• Compensate to continue things you love to do– Adapt

• Try to new things as some things are no longer possible– Innovate

• 4 Things to look out for

– Loss of purpose in life

– Loss of social contribution

– Loss of social interest and coherence

– Loss of personal growth

Why Governments, Public Health

and Healthcare Must Change

1. Health is something specific; mental health includes two kinds of happiness– Flourishing combines functioning well and feeling good

2. Absence of illness does not mean the presence of health– Mental health and illness are on separate continua

3. Presence of mental illness is a burden (yes!); but, the absence of mental health is also a burden

4. The is too much mental illness (yes!); but there is also too little (flourishing) mental health

5. Increase in mental health (flourishing) causes a decrease in odds of mental illness; declines in mental health cause an increase in odds of mental illness– Thus, increasing rates of flourishing will reduce mental illness

6. There is a “wanting — doing” gap in public health– We say we want “health”; we only focus on illness and disease

• “Can’t get to health through only illness reduction (see points 2-5)

7. What then is the greatest challenge facing our civilization this century and beyond ... presence of illness or the absence of health? – It is the absence of health, which increases the risks of onset

of illness• Salutogenic Healthcare Must Take Priority -- Promote,

Maintain, Respond to Early Deviations from, True Health• Pathogenic Healthcare Has Its Place -- Cures, Treatments, and

Risk Reduction for Illness and Disease