Positive mental health as a predictor of recovery from mental illness

Highlights

• Individuals who gain or maintain high levels of positive mental health are much more likely to recover from an affective disorder than those with low positive mental health.

• Positive mental health and mental illness are separate constructs, and both should be included in the assessment of patients interacting with mental health care systems.

• Improving and maintaining positive mental health may be an important strategic focus for reducing the burden of mental illness.

• Mental health care systems should explore offering of services designed to improve positive mental health in addition to reducing mental distress.

Abstract

Background

High levels of positive mental health protect individuals from mental illness. This study investigates longitudinal change in positive mental health as a predictor of mental illness recovery in a cohort group.

Methods

Using data from the 1995 and 2005 Midlife in the United States cross-sectional surveys (n = 1,723), logistic regression was used to estimate the odds ratio that individuals diagnosed with a mental illness in 1995 would have recovered in 2005 based on whether their level of positive mental health changed over the 10-year period.

Results

Individuals who maintained or gained the highest levels of positive mental health were more than 27.6 and 7.4 times, respectively, more likely to recover when compared to those who maintained the lowest level of positive mental health. Those who maintained or gained moderate levels of positive mental health had more moderate likelihood of recovery, and those whose positive mental health declined to the lowest levels had no significantly different likelihood of recovery compared to participants whose positive mental health remained low.

Limitations

This study was limited by the age of the data, and the inability to control for some predictors of recovery.

Conclusions

This study suggests that positive mental health may be an important resource for individuals to recover from mental illness and stay mentally healthy. Results point to the need to include positive mental health assessment and interventions into mental health care systems.

Introduction

There has been little progress in reducing the burden of mental illness around the world, prompting calls for improved access to quality mental health care and assessment of mental disorders and for “programs to prevent mental disorders and promote mental health” (U. S. Burden of Disease Collaborators 2018, Vigo et al., 2016). The distinction between mental disorder and mental health is a fundamental underlying element of this call for improvement, but this important distinction is often misunderstood.

Mental illness and mental health are traditionally conceptualised as opposite ends of the same continuum, and modern mental health care systems are primarily designed to reduce mental illness to concurrently improve mental health. It has been argued that health care systems designed this way risk providing ‘reactive’ health care and creating avoidance, fear, and stigma of the pathology (see Herron and Trent (2000) for a review). However, evidence indicates that positive mental health and mental illness are distinct, yet interrelated, constructs that reflect separate continua (Keyes, 2005, Suldo and Shaffer, 2008) (Fig. 1).

Growing evidence suggests that high levels of positive mental health protect individuals from mental illness, and that low levels of positive mental health are a risk factor for mental illness. Keyes et al. (2010) conducted a longitudinal study of mentally healthy participants (without a diagnosis of mental illness) of the 1995 and 2005 waves of the Midlife in the United States (MIDUS) National Study of Health and Well-being. Participants were divided into 6 groups, based on their level of positive mental health and mental illness status in 1995 (Fig. 1). The study showed that participants who gained or maintained high levels of positive mental health over the 10-year period had a decreased risk of developing a mental illness (defined as depression, anxiety, and panic disorder), and that participants whose positive mental health declined or remained low had significantly increased odds of developing mental illness. Similar results were observed by Wood and Joseph (2010), who found that people with low levels of positive mental health were several times more likely to be depressed 10 years later. Grant et al. (2013) and Lamers et al. (2015) supported this bidirectional relationship between positive mental health and psychopathology, finding that low levels of positive mental health predicted risk of higher depressive symptoms within one year. This research indicates that mental health protection and promotion should become a mental health care priority to reduce the burden of mental illness, and that building and maintaining high levels of positive mental health is fundamental to this cause (Keyes, 2013).

Positive mental health is also proposed as an important resource for recovery from mental illness and therapies have been designed specifically to improve the positive mental health of individuals with diagnosed mental illness (Slade et al., 2017). However, there has been little to no research on whether positive mental health is associated with recovery (Seow et al., 2016). Investigating whether positive mental health is a resource for recovery can provide evidence necessary to develop better models of mental health care (Keyes, 2014).

In the current study, we extend the Keyes et al. (2010) study using the same large dataset, focusing instead on participants diagnosed with a mental illness at baseline (those who are situated to the left of the vertical axis in Fig. 1), rather than those that were mentally healthy (those who can be found in the right half of Fig. 1). We hypothesise that gains in positive mental health from 1995 to 2005 are associated with greater odds of ‘recovering’ from that mental illness in 2005, and that losses in positive mental health will be associated with lesser odds of recovery 10 years later. We acknowledge the important discourse between clinical and personal recovery, and use recovery here to indicate an individual that was assessed with depression, anxiety, or panic disorder in 1995 and not in 2005.