Perceptions of well-being in public health practice

Approaches to measurement Sarah Stewart-Brown

Professor of Public Health

•Descartes was wrong•The mind and body are one

Debate about the meaning of wellbeing focuses on

mental wellbeing

• Health and wellbeing • Physical health and mental health• Mental wellbeing

– self-esteem– confidence – resilience

Healthy Lives Healthy People2010

Contributions • Philosophers

– Western: Aristotle Epicurus– Eastern: Buddhism, Hindu, Islam

• Psychologists – Psychological functioning, – Positive psychology– Flourishing

Wellbeing is something that is cultivated by the individual

Psychological Well-being (Eudaemonic)

Functioning well /flourishing • Autonomy• Self acceptance • Personal growth• Purpose in life• Environmental mastery• Positive relations with others

Ryff 1995

Jahoda 1958Positive Mental Functioning

• Autonomy • Environmental mastery • Self actualisation • Integration • Attitudes towards self • Perceptions of reality

Ryan and Deci (2001) Basic Psychological Needsfrom Self Determination Theory

• Autonomy–I have a say in what happens to me

and can voice opinions • Competence

–I feel very capable and effective • Relatedness

–I feel loved and cared about

Seligman (2002/2011)Authentic Happiness

• Pleasure• Engagement • Meaning

• Relationships • Accomplishment

Contributions • Social Scientists

Wellbeing is something that is determined by social conditions

–GDP –Income, wealth, poverty –Government –Services

• Education • Health • Social

Subjective Wellbeing (Hedonic) feeling good/happiness/

affective well-being

• Feeling good • Life satisfaction • Happiness

Diener 1993

Both matter

Both matter

Diener 2010

• Purpose in life, • Positive relationships, • Engagement, • Competence, • Self-esteem, • Optimism • Contribution towards wellbeing of others

Keyes 2002 Mental Health Continuum

Canada Holland • Happiness

• Psychological wellbeing (Ryff) • Social wellbeing

– Social acceptance – Social actualisation – Social contribution – Social coherence – Social integration

Huppert 2011European Social Survey

• Competence : Most days I feel a sense of accomplishment • Emotional stability: In the past week I felt calm and peaceful • Engagement: I love learning new things• Meaning : I generally feel what I do is valuable and worthwhile• Optimism: • Positive emotion: how happy would you say you are ? • Positive relationships – people in my life who really care about me • Resilience: when things go wrong takes a long time to get back to

normal • Self esteem: I feel very positive about myself • Vitality In the past week I had a lot of energy to space

New Economics Foundation

• Emotional wellbeing • Satisfaction with life• Vitality• Resilience and self esteem• Positive Functioning

Measurementin UK

Office of National Statistics: Approach

• Overall how satisfied are you with your life nowadays?

• Overall how happy did you feel yesterday ?

• Overall how anxious did you feel yesterday ?

• Overall, to what extent do you feel things you do in your life are worthwhile ?

STATEMENTS None of the time

Rarely Some of the time

Often All of the time

I’ve been feeling optimistic about the future 1 2 3 4 5

I’ve been feeling useful 1 2 3 4 5

I’ve been feeling relaxed 1 2 3 4 5

I’ve been feeling interested in other people 1 2 3 4 5

I’ve had energy to spare 1 2 3 4 5

I’ve been dealing with problems well 1 2 3 4 5

I’ve been thinking clearly 1 2 3 4 5

I’ve been feeling good about myself 1 2 3 4 5

I’ve been feeling close to other people 1 2 3 4 5

I’ve been feeling confident 1 2 3 4 5

I’ve been able to make up my own mind about things

1 2 3 4 5

I’ve been feeling loved 1 2 3 4 5

I’ve been interested in new things 1 2 3 4 5

I’ve been feeling cheerful 1 2 3 4 5

The Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

Issues

• Single measure or multiple measures?

• Positive or negative measures?

• Proportion or mean score ?

WEMWBS vs CESD-D

Pearson correlation .842

WEMWBS cf PHQ-9

Pearson correlation .74

Positive or Negative • Great majority of measures of mental health

focus on the negative/ disease / distress• Focusing on the positive is an intervention in its

own right. – ‘What you pay attention to is what you get

more of’• Public and patients prefer positive measures

Crawford et al. Selecting outcome measures in mental health. J. Mental Health 2011(20)336-346

Issues

• Single measure or multiple measures?

• Positive or negative measures?

• Proportion or mean score ?

WEMWBS vs CESD-D

Pearson correlation .842

NHS Direct

• http://www.nhs.uk/Livewell/mental-wellbeing/Pages/five-ways-mental-wellbeing.aspx

• 5 Steps to Mental Wellbeing • Wellbeing self assessment

Summing up • Perceptions of wellbeing derive from diverse

disciplines• Opinions are converging • Currently available measures vary, but are good

enough for:– Monitoring population wellbeing– Evaluating interventions– Studying determinants

• We have focused for too long on the negative and therefore know more about the determinants of illness

• Time to change