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If You Want Mentally Healthy Children, Start Promoting It

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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  1. If You Want Mentally Healthy Children, Start Promoting It Corey Keyes Professor of Sociology

  2. Mental Health

  3. 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 …?

  4. 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

  5. Prognosis: Mental Health ca 21st Century Palliative

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

  7. The definition of insanity is doing the same thing over and over and expecting different results Benjamin Franklin

  8. 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)

  9. 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)

  10. We Must Stop Saying One Thing and Doing Another

  11. Triangulation of Health Pathos Salus Hale

  12. Mental Health From the Salutogenic Perspective Flourishing Eudaimonia Hedonia ? ?

  13. 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

  14. 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

  15. 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

  16. Mental Health Continuum-Short Form

  17. Mental Health From the Salutogenic Perspective Flourishing Eudaimonia Hedonia Psychological Well-Being Social Well-Being Emotional Well-Being

  18. 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)

  19. 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

  20. Are We Stuck in One Dimension?

  21. The Dual Continua Model High HDL Low LDL High LDL Low HDL

  22. 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

  23. 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

  24. 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

  25. 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

  26. CDS 2002 Data, Ages 12-18

  27. 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)

  28. Working Paper #1: MIDUS Adults in 1995 and 2005

  29. 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

  30. 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%

  31. 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%

  32. 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%

  33. Surely Most People Are Flourishing?

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

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

  36. 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

  37. 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)

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

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

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

  41. 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’

  42. Start Where; Do What? Campaign to Increase Awareness, Priorities, and Allure of Ingredients of Flourishing (complement to stigma reduction of mental illness)

  43. 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

  44. Texas Tech UndergraduatesPerceived Importance of Dimensions of Flourishing Not at All Important Very Important

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

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