mental health promotion essay

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Mental Health Promotion

Categories: Health Promotion Universal Health Care

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Words: 1628 |

Published: Jun 5, 2019

Words: 1628 | Pages: 4 | 9 min read

Mental health essay outline, mental health essay example, introduction.

Definition of mental health according to the World Health Organization (WHO)
Importance of a support system for mental well-being

Nurses' Role in Maintaining Mental Well-being

The need for nurses to maintain holistic fitness for quality patient care
Resilience as a key attribute for nurses
The impact of psychosocial and environmental factors on mental health

Challenges Faced by Nurses

The stress and challenges of working in healthcare settings
Shift work disorder and its consequences
The prevalence of bullying in the healthcare industry

Strategies and Policies for Promoting Mental Health

Policies and guidelines for minimizing shift work disorder
Measures to prevent workplace bullying
The role of support systems for nurses' mental health
The importance of mental well-being for nurses
The need for policies and support systems to promote mental health in the healthcare industry

Works Cited:

Carr, E.H. (1961). What is history? Penguin Books.
Clark, T. (2007). The importance of understanding history. Learning Solutions Magazine. Retrieved from https://www.learningsolutionsmag.com/articles/331/the-importance-of-understanding-history
Johnson, P. (1999). A history of the American people. Harper Perennial.
Lerner, G. (1993). Learning disabilities: theories, diagnosis, and teaching strategies. Houghton Mifflin.
Loewen, J. (1995). Lies my teacher told me: Everything your American history textbook got wrong. The New Press.
MacMillan, M. (2013). The uses and abuses of history. Profile Books.
McNeill, W.H. (1985). Mythistory and other essays. University of Chicago Press.
Pomeroy, S.B., Burstein, S.M., Donlan, W., Roberts, J.T., & Tandy, D.W. (2004). Ancient Greece: A political, social, and cultural history. Oxford University Press.
Rosenzweig, R., & Thelen, D. (1998). The presence of the past: Popular uses of history in American life. Columbia University Press.
Wineburg, S. (2001). Historical thinking and other unnatural acts: Charting the future of teaching the past. Temple University Press.

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1 INTRODUCTION TO MENTAL HEALTH PROMOTION

Alanna Kaser and Megan Sponagle

1.1 HISTORY OF MENTAL HEALTH PROMOTION: MENTAL HEALTH VS. MENTAL ILL-HEALTH

1.1.1 Introduction

It is recognized that mental health is an inherent and central component of health and that promoting mental health optimizes our quality of life. In fact, mental health promotion has grown into a key field of health promotion research and programming, as well as a key priority in building thriving individuals, communities, and populations. However, recognition of mental health within the field of health promotion and the emergence of mental health promotion as its own distinct domain was delayed in part, by evolving perspectives and definitions of mental health and its scope of relevance. Understanding a brief history of the conceptualization of mental health is central to the evolution of mental health promotion and how it is widely understood and studied today.

1.1.2 Early Origins: Mental-Ill Health & Mental Illness

Early understandings and study of mental health existed within the domains of psychology and psychiatry, resulting in an approach focused on the treatment and prevention of mental illness at an individual level (Bertolote, 2008; Froh, 2004). By consequence, having “good” mental health was understood to be simply the absence of mental illness (Keyes, 2002). This was achieved and relevant only through a treatment lens, for individuals with existing mental health disorders. Eventually, this perspective expanded to include preventive approaches which identified and targeted risk factors to prevent poor mental health (i.e., the risk-reduction model). Fortunately, the utility of preventive approaches to extend beyond the individual-level (e.g., community programs, prevention policy) and the efficacy and reduced burdens available in seeking to prevent, instead of only treating mental health challenges enforced the recognition of protecting mental health as a key matter of public health. In 2001, the WHO published a report emphasizing the importance of addressing mental health on a global level and clarified the importance of the topic as a matter of public health. The report acknowledged mental health as having equal importance and interconnectedness with physical health, as well as, outlined its vital contributions to well-being, at and beyond the individual-level (WHO, 2001). However, the underlying view of mental health as solely the absence of illness and the dominant focus on treating and preventing mental disorders still informed the predominant prevention and treatment-based actions recommended within both programming and policy.

1.1.3 Influences from other disciplines: The paradigm shift in studying mental health

The paradigm shift towards a positive approach to mental health and its promotion was informed in part by health promotion and population/public health domains, but also by the fields of positive and community psychology. Although the views of more holistic and less-negative versions of mental health date back to the mid-1950s, the diseased-focused perspective of mental health remained dominant until positive psychology gained traction in the early-2000s. Positive psychology shifted focus towards identifying and promoting beneficial and strengthening factors that enhance people’s mental health and their overall quality of life, but the field remains largely focused on the individual (Froh, 2004; Seligman & Csikszentmihalyi, 2000). Community psychology functions to advance well‐being at multiple levels (i.e., individual, organizational, and community levels) to foster social change (Neigher et al., 2011). Therefore, contributions from community psychology have extended the promotion and positive-enhancement approach beyond the individual-level. Early research in these fields demonstrated that the enhancement of positive health-related factors can not only improve and prevent both mental and physical health challenges, but also enhance quality of life among individuals and communities in lasting ways (Fredrickson, 2001; Keyes, 2002; Seligman & Csikszentmihalyi, 2000). Additionally, positive psychology research clarified that mental illness and mental health are related, but distinct constructs, providing empirical evidence that mental health is more than the absence of mental illness (Keyes, 2002; Keyes, 2005), and introducing the concept of positive mental health. Early (mental) health promotion and population health research also supported the multi-level capacity and beneficial outcomes of promoting positive mental health. Findings demonstrated improved utility and health benefits of strengths-based programs focusing on positive psychosocial factors (i.e., empowerment, competence, resilience, active participation), in comparison to risk-reduction programs (Barry, 2001; Barry, 2007).

1.1.4 Solidifying mental health promotion as a distinct field of study

By 2005, the World Health Organization released their first report featuring mental health promotion, including a new definition of mental health as a state which encompasses positive functioning. The new definition cemented both the re-conceptualization of mental health and the essential place for mental health promotion in promoting population health. Around the same time, more and more research emerged, contributing to a growing body of literature studying theoretical and conceptual bases mental health promotion and demonstrating its utility and efficacy in improving health and preventing ill-health across a variety of settings (Barry, 2007; Barry, 2009; Jané-Llopis et al., 2005). The enhanced understanding of mental health and evidence of its utility across diverse populations and settings, emphasized the importance and efficacy of promoting positive mental health within the general population, as opposed to focusing only on individuals at-risk or diagnosed with mental illness. Although the disorder-focused model provides an important and necessary framework for treatment and prevention for individuals struggling with mental illness and for practitioners in relevant fields (e.g., clinical psychology, psychiatry), the shift towards a widely applicable and holistic view refined our understanding of mental health and unlocked its powerful ability to enhance overall health and prevent ill-health globally (Sharma et al., 2017). With this updated view taken in stride, contributions from positive psychology and mental health promotion pioneers have continued to inform an evolving framework for mental health promotion. Their research continues to explore MHP’s distinctiveness (as its own field), but inherent relevance to health promotion generally, its utility across multiple settings and scales, and its unique strengths-based capacity to simultaneously improve health and protect against poor health.

1.2 APPLYING PRINCIPLES OF HEALTH PROMOTION TO MENTAL HEALTH

1.2.1 Introduction

The meanings of health and well-being have evolved with time and vary across many contexts. There are various factors which can influence or contribute to both the absence/presence of disease, as well as good functioning. These are often referred to as types or sub-domains of health or well-being (i.e., physical, emotional, psychological, spiritual, social, and economic), all of which are important to overall quality of life (Government of Canada, 2019). The health promotion field operates within the public health domain and seeks to emphasize this holistic view of health by focusing on promoting well-being and supporting individuals facing illness at community, societal and governmental levels (World Health Organization, 2022). The scope of health promotion begins with improving healthy habits at the individual level, up to shaping health-related policy (World Health Organization, 2022). As effective health promotion results from the combined collaboration of individuals and institutions, everyone must take responsibility for their role in creating a healthy society (WHO, 1986). Rickwood (2011) found that mental health promotion has a goal to help individuals become their best selves, cope with stressors, and become active community participants at every life stage.

The World Health Organization (2005) provides the following definition of mental health: “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (p. 2). Mental Health is part of the “holistic definition of health and therefore builds on the basic tenets of health promotion” (Barry, 2017, p. 5).

Since all types of health are interconnected, mental health promotion theories should focus more on goals to improve overall health (Jané-Llopis et al., 2005). This makes health promotion theories an even better fit to be used in mental health promotion, as they already have a focus on overall well-being (World Health Organization, 2022). Specifically, mental health promotion refers to developing effective ways for individuals and communities to have positive mental health (Windsor-Essex County Health Unit, 2019). Barry (2017) describes mental health promotion (MHP) as multi-leveled (individual, communal, and socio environmental). MHP follows an upstream approach, meaning it focuses on making structural changes to improve mental well-being of the entire population (Barry, 2017; National Collaborating Centre for Determinants of Health, 2014). It is for everyone, as opposed to the downstream approach of clinical psychology, which as a primary focus on individuals with or at risk of mental illness (Barry, 2017; Gaspar de Matos et al., 2019; National Collaborating Centre for Determinants of Health, 2014; see figure 1 for comparison; source). The upstream and downstream approaches can be compared with an analogy by Irving Zola:

“A witness sees a man caught in a river current. The witness saves the man, only to be drawn to the rescue of more drowning people. After many have been rescued, the witness walks upstream to investigate why so many people have fallen into the river. The story illustrates the tension between public health’s protection mandates to respond to emergencies (help people caught in the current), and its prevention and promotion mandates (stop people from falling into the river)” (National Collaborating Centre for Determinants of Health, 2014, p. 2).

Here, clinical psychology (the downstream approach), can be compared to rescuing the individuals in the river- when an individual faces mental illness, clinical treatments aim to solve their mental health problems (National Collaborating Centre for Determinants of Health, 2014). In contrast, MHP (the upstream approach) consists of proactive measures that aim to prevent individuals from falling into the river in the first place (National Collaborating Centre for Determinants of Health, 2014). It responds to the determinants that contribute to an individual’s mental health, to inspire individuals to engage in a mentally healthy lifestyle (Barry, 2017).

Figure 1: A visual comparison of upstream and downstream approaches to mental health-promotion (National Collaborating Centre for Determinants of Health, 2014).

Adapted from: National Collaborating Centre for Determinants of Health. (2014). Let’s Talk: Moving upstream. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

This section describes the how various approaches in health promotion (The Ottawa Charter, The Socio-ecological Model, and Strengths-Focused Approaches) can be applied in MHP practice.

1.2.2 MHP in Programming and Policy

MHP programs vary in scope and context; however, true to the holistic and positive view of mental health, all programs focus on enhancing mental health and well-being, rather than the prevention or treatment of mental health challenges (Barry, 2009; Hill et al., 2023). Given this holistic mental health approach, programs less often target a specific mental health risk or disorder treatment populations. Although some focus on broad demographics, programs typically strive for inclusivity and are often embedded in diverse community contexts (Hill et al., 2023). MHP programs have been deemed an effective public health approach because evidence has demonstrated their effectiveness in improving population well-being. For instance, Barry et al. (2013) reviewed 22 mental health programs in populations of children and teens living in low and middle-class countries. Results showed most of the interventions that were implemented in a school setting positively impacted children’s emotional health and ability to cope with stressors (Barry et al., 2013). Similarly, community interventions for teens positively influenced their psychological and social health (Barry et al., 2013). Adult programming findings have also been promising. Le et al., (2021) found that across 33 adult MHP programs, the majority were effective, producing benefits that justified the program costs. Primary benefits included reducing the risk of depression, suicide, substance use, psychosis, anxiety, and eating disorders (Le et al., 2021). Preventative workplace models were one type of program found to be effective (Le et al., 2021). It is important to consider the benefits compared to the program cost because public health and mental health organizations have budgets they must adhere to, therefore more funds should be allocated to programs that are more successful in improving population mental health (Le et al., 2021). Cost-benefit analyses maximize the efficiency of both programs and their budgets (Le et al., 2021).

Many social factors, or determinants, interconnectedly influence mental health and general well-being (Compton & Shim, 2015). Policy creates and influences the social, economic, and political infrastructure which shapes these determinants and, thus, has the potential to impact mental health (Compton & Shim, 2015). Compared to implementation and evaluation of MHP programming, policy efforts relating to mental health status are less frequently evaluated. Growing recognition around mental health promotion, has resulted in the publication of various reports and initiatives (i.e., WHO, 2005; WHO, 2022). Additionally, certain countries have implemented policies and mandates which focus on the promotion of mental health, especially through positive enhancement lens. For example, New Zealand’s first “Well-Being Budget” recently committed to changing the way they prioritize and measure well-being, including looking beyond GDP as a sole measure of well-being and prioritizing the improvement of mental health and other related social determinants (i.e., poverty, Indigenous inequalities; Mintrom, 2019). However, there a need for research empirically evaluating effectiveness and utility of specific policies and initiatives across health, education, political, and economic sectors in both reducing mental health burdens, but enhancing mental health and overall well-being (Enns et al., 2016).

1.2.3 Using the Ottawa Charter to Inform Mental Health Promotion

One key framework used in the field of health promotion is the Ottawa Charter, a well-known set of guidelines that shape many programs seen today (WHO, 1986). The Ottawa Charter was created 37 years ago, at the first health promotion conference, when the world knew they needed a new positively oriented public health strategy (Jackson, 2016). The Ottawa Charter can be used effectively for MHP because it focuses not only on the individual but also on the well-being of society (Rickwood, 2011). The five pillars of the Ottawa Charter contribute to understanding how a well-known approach to health promotion can be applied in mental health settings; they are summarized in Figure 2 below: (Jané-Llopis et. al, 2005).

Figure 2: The five pillars of The Ottawa Charter (WHO, 1986), and how they can be applied in mental health promotion settings.

*MHP = mental health promotion, template by (Amabile, n.d.-a)

Chapter 4 ( The Social and Structural Determinants of Mental Health ) reminds us that mental health is shaped by numerous factors (e.g., social support, spirituality, coping skills, workplace, and economic status) known as the determinants of mental health. The Ottawa Charter can be used as a program framework, to enhance the positive determinants of mental health, and eliminate the negative determinants of mental health (Jane-Llopis, 2007). For instance, the Youth Mental Organization in Australia is called Headspace and has found an effective basis on the five pillars of the Ottawa Charter, focusing on communicating, promoting, and preventing mental health disorders. It plays a large role in modifying the healthcare services available to youth and has helped them grow up in improved mental health settings (Rickwood, 2011). Some health promotion programs that have a basis in the Ottawa Charter have been shown to improve mental health even if that was not their primary goal, showing MHP programs can be effectively guided by the Ottawa Charter (Jane-Llopis et al., 2005).

We can see that MHP program results can motivate a larger change in the community (Herrman et al., 2007). Jané-Llopis et. al (2005) comment on the examples that build healthy health promotion programs and policies, to help community members learn and grow to their full potential. This includes improving the ability to provide nutritious foods and quality education to all people, regardless of socioeconomic status (Jané-Llopis et. al, 2005). Individuals need an environment that allows and encourages them to improve their determinants of mental health (Jané-Llopis et. al, 2005). This could include having a mental health professional periodically visit the homes of families at risk or with mental health disorders to assist (Jané-Llopis et. al, 2005). When locations at the organizational level (schools and workplaces) work together with families and friends at the interpersonal level, there is an opportunity for an additive effect to promote mental health (Jané-Llopis et. al, 2005).

The Ottawa Charter can be used as an assessment tool to determine the strengths and future directions of both MHP programs and the field as a whole (Rickwood, 2011). Rickwood (2011) notes the Ottawa Charter has helped develop stronger community involvement at the micro and macro levels. Micro level programs (such as Headspace mentioned above), empower community members and caregivers to participate in improving the mental health of the people around them (Rickwood, 2011). Macro level programs target larger scale policy measures (Rickwood, 2011). For instance, the GetUp ! program focused on holding political leaders responsible to act on important causes (Rickwood, 2011). This has stimulated community growth in other locations like Ireland and has created changes in funding to help youth gain increased access to therapy. Overall, the Ottawa Charter provides well-thought-out guidelines that have been effective across multiple mental health settings.

1.2.4 Applying the Socio-Ecological Model to Mental Health Promotion

Another framework used in health promotion is the Socio-Ecological model. The Socio-Ecological approach shows that MHP operates at all levels- individual, interpersonal, organizational, community, and public (shown in Figure 3 below; Barry, 2007). Barry (2007) emphasizes the connection between an individual and their environment, and how that needs to be part of how we develop MHP theories. We need interventions that target more than one level of the Socio-Ecological hierarchy. The Socio-Ecological model can be applied to MHP because it demonstrates interconnection from the individual to the public level (Barry, 2007). For example, Kousoulis and Goldie (2021) adapted this model and created a visual illustration of how it is applicable to community mental health ( Figure 4 ). Kousoulis and Goldie (2021) show that resilience and agency at the individual level are needed to sustain positive mental health at the community level. Individuals at the bottom of the diagram have barriers to positive mental health that get in the way of making a positive contribution to the interpersonal, organizational, community, and public levels (Kousoulis & Goldie, 2021). This reminds us that a community must be built on public pillars of equity, human rights, and respect, so all members can be active participants in positive public mental health (Kousoulis & Goldie, 2021).

Figure 3: The levels of the Socio-Ecological Model (Heise, 1999)

Template by (Aida, n.d.)

Figure 4: A Visual illustration of the Socio-Ecological Model adapted to fit the Scope of Mental Health (Kousoulis & Goldie, 2021)

1.2.5 Using Strength-Focused Models to Enhance MHP in Practice

Strengths-based models of MHP (i.e., competence enhancement model) emphasize the importance of the determinants of mental health, as they are the components these programs try to improve (e.g. resilience, physical activity, and parenting styles; see Chapter 4: The Social and Structural Determinants of Mental Health ) (Barry, 2007). An important aspect of this model is that it focuses on promoting positive mental health, while others simply aim to reduce mental illness or treating it when it occurs (i.e., risk-reduction, pathogenic approaches; Barry, 2007). These programs see mental health as a resource which helps individuals thrive and thus, focus on helping participants be confident and capable in coping with everyday life stressors by building positive mental health enhancing factors (Barry, 2007). For example, the competence-enhancement model focuses on integrating empowerment, participation, and collaboration to promote mental health ( Figure 5 ) (Barry, 2007; Jane-Llopis et al., 2005). The skills and factors featured in specific strengths-based models have considerable overlap with skills needed for positive mental health, demonstrating the central importance of positive mental health to effective mental health promotion (Barry, 2007; Barry, 2009).

Have you ever joined a program and left feeling bored, disconnected, or worse about yourself? After a negative experience, most people will not return to the program. Additionally, policies which focus solely on the prevention of treatment of mental disorders only address certain populations (i.e., at-risk, or already mentally) after issues have already manifested (i.e., risk or diagnosed mental illness). By contrast, following a strengths-based approach means that policies and programs take an upstream approach which simultaneously prevents mental illness and enhances both positive mental health and general well-being in a more inclusive, efficient, and beneficial way (Barry, 2007; Barry, 2009).

The strengths-based model can be applied to MHP practice among both youth and adults, by building policies and programs which foster factors empirically supported in enhancing mental health and related competencies. The Community Mothers program provides home visits to first-time low-income mothers, educating and empowering them with the skills needed to be an effective parent (Barry, 2007). The strengths-focus impacts the design of this program by empowering parents by “drawing out the potential of parents rather than giving advice and direction” (Johnson et al., 2000, p. 337). Using an approach that empowers and works directly with participants allows needs and areas of growth to be identified so resources can be used efficiently and the program can succeed (Barry, 2007, Jane-Llopis et al., 2005). Strengths-based models have also been proven to be effective in programs for teens and youth (Barry, 2007). The Promoting Alternative Thinking Strategies (PATHS) program set a goal to help children understand the emotional expression and regulation, self-control, and problem-solving (Greenberg et al., 1995). This uses positive elements characteristic of the strengths-based approach, including participation (questions throughout the lesson) and collaboration (role-play of skills) based activities (Paths Program LLC, 2021). When PATHS was used in 30 second and third-grade classrooms, results showed children could communicate and manage their emotional experiences better (Greenberg et al., 1995).

Figure 5 : The three components of the competence enhancement model (Barry, 2007)

Template by (Amabile, n.d.-b)

1.2.6 Conclusion

This portion of chapter 1 provides on overview of public health contributions to health promotion and supports the application of a health promotion approach in improving and promoting mental health. The Ottawa Charter informs MHP efforts by identifying five pillars on which to act (healthy public policy, supportive environments, community action, personal skills, and health services; WHO, 1986). This has been proven effective in many mental health programs, including Headspace (an Australian youth program). Like the pillars in the Ottawa Charter, the Socio-Ecological Model prioritizes health at every level, from the individual to public policy (Barry, 2007). The Socio-Ecological Model intends to create a society where individuals improve the health of communities, and communities improve the health of individuals in return (Barry, 2007). Across all these levels, employing a strengths-focused approach greatly enhances the efficacy and success of mental health promotion in practice. For example, looking at the community level of the Socio-Ecological approach, the competence enhancement approach guides programs to be empowering, interactive, and collaborative (Barry, 2007; Jane-Llopis et al., 2005). When these various models are tailored and used effectively within relevant populations, public mental health and general well0ebing can be improved.

1.3 SYSTEMATIC CONCEPT ANALYSIS OF MENTAL HEALTH PROMOTION

Clarifying the concept of mental health promotion and pinpointing contributing factors are imperative to overcoming existing barriers, guiding future research and study in this field, and maximizing the current utility of mental health promotion among individuals, communities, and across countries.

1.3.1 Introduction

The emerging field of mental health promotion has built on many theoretical and conceptual frameworks from the domains of health promotion, public health, and positive/community psychology. Definitions, research, and practice of mental health promotion also vary across contexts, cultures, political landscapes, and over time (Kovess-Mastefy et al., 2005; Tamminen et al., 2016). We’ve discussed many of the current models and perspectives informing current understanding of mental health promotion, including the competence-enhancement approach and socio-ecological model. These perspectives all make important contributions to the field, however, differences between them have challenged our ability to develop a one-size-fits-all conceptualization of mental health and mental health promotion. Thankfully, our understanding of mental health is largely widely accepted. However, there remains division and uncertainty regarding other aspects of mental health promotion. For example, some argue that mental health promotion encompasses both the prevention and promotion of mental health, while others see prevention of mental disorders as a distinct, separate goal outside the direct scope of mental health promotion.

As MHP and programming grows in popularity, it becomes harder to manage existing inconsistencies in the definitions, aims, and components which translate into practice (i.e., prevention and treatment). Fortunately, Tamminen et al., (2016) conducted a systematic concept analysis, which involved reviewing the existing literature on MHP and using a structured framework to identify the most consistently agreed upon attributes, antecedents and consequences, related concepts, and reference terms (Figure 6). These identifications greatly advance and organize knowledge on MHP and provide the clarification necessary to streamline its scope of relevance and practice. The map of their work depicted below provides a great educational tool outlining the concept of mental health promotion.

Figure 6 : Visualization of a concept mapping of mental health promotion based on a concept analysis and figure map completed by Tamminen and colleagues (2016).

1.3.2 Mental Health Promotion: What, Why and How?

The attributes of mental health promotion describe the concepts’ unique characteristics and qualities, in other words, the “what” of MHP. Based on attributes, mental health promotion can be understood to promote positive mental health to achieve well-being through empowerment, participation, and multi-sectoral partnerships. Positive mental health includes self-esteem, optimism, subjective well-being, and stress/adversity coping skills and in addition to mental well-being, was recognized in existing MHP research mostly at the individual-level (Tamminen et al., 2016). Both these attributes were recognized as important to MHP, but not central in current policy or strategy literature. Alternatively, the attributes of partnerships and cross-sectoral integration/efforts were dominant in the extant policy and strategy articles (Tamminen et al., 2016). Both empowerment and participation were identified as key features of mental health promotion, most specifically, in relation to how to foster mental health promotion in practice. For example, empowerment is an aim of the Ottawa Charter and both empowerment and participation are key aims considered in building and evaluating MHP programs (Barry, 2007; WHO, 1986).

The references clarify the domains and circumstances which mental health promotion is most relevant while antecedents identify what is required or what comes before MHP. Tamminen and colleagues (2016) review of MHP references illustrates that mental health promotion aims to improve mental health and well-being across multiple socio-ecological levels through policy, strategy/research, and practice (aka programming). Further, these goals and actions are situated within the scope of overall health promotion, specifically in relation to public and population health domains (Barry, 2007). While references provide context for the identified attributes, there are also certain factors (i.e., antecedents) which help ensure MHP has the attention and resources to thrive. These include political will, strong research theory and evidence-base, and people who value mental health and mental health promotion (Tamminen et al., 2016). The antecedents help identify important emphasis points for what can be done across multiple levels to advance the promotion of mental health either through direct actions from individuals, communities, or institutions/government or further research. Together, the references and antecedents help to identify the “how” of mental health promotion, which explains the relevant context and concrete factors leading/contributing to MHP.

The identified consequences tie everything together. As the “why” of MHP, the outcomes which occur from MHP rationalize why it is so important and widely beneficial. Findings demonstrate that MHP improves well-being, strengthens many protective factors and reduces risk factors for mental disorders, and also permits a wide range of broader societal benefits (e.g., social and economic capital, societal productivity; Moodie & Jenkins, 2005). Thus, the consequences of MHP can extend beyond the initial points of focus (i.e., mental health) and goals (i.e., enhancing well-being; Tamminen et al., 2016). For example, the ability for positive mental health promotion efforts to be effective in primary intervention/prevention of mental illness, in addition to enhancing well-being. These extended benefits emphasize the broad utility and efficacy of MHP and suggest that investing in MHP is a worthwhile endeavour, in the interest of individual and community mental health, public health, and general societal functioning.

1.3.3 Barriers to MHP in Understanding and Practice

Despite the value gained from synthesizing and reviewing current knowledge on MHP, many barriers continue to limit MHP research and practice and challenge consistent conceptualization of mental health promotion. Some of these barriers include a lack of research (especially recent research and programming/policy evaluation research specifically), cross-cultural inequalities (lack of programming/policy and evaluation in developing countries), and a persistent lack of a clear definition of MH(P) (e.g., understanding mental health separate from mental illness, confusing well-being, and mental health, Barry, 2007; Moodie & Jenkins, 2005; Tamminen et al., 2016). Therefore, future research and practice must also address gaps in our understanding of MHP itself and build a more solid evidence basis for its effectiveness, as filling these knowledge gaps will improve the efficacy of MHP in research practice and provide stronger rationale for public health action to promote mental health promotion. Addressing these barriers might include integrating a more concrete and widely accepted theoretical and conceptual definition of mental health promotion that can be adapted for use across various contexts, funding more policy and program implementation, evaluation, feasibility research to build a stronger evidence base for building the most effective MHP programs and policy, etc.

1.3.4 The Value of Concept Analysis: Moving forward with MHP

Clarifying MHP as a concept is essential in optimizing study and practice of MHP. Examining the findings from Tamminen’s concept analysis help to elucidate how and in what circumstances each component of MHP distinctly contributes to mental health promotion efforts. They also identify precursor factors which can be enhanced to ensure MHP can flourish and outline the outcomes that occur when it does. The vital information gained from synthesizing the literature to conceptualize MHP is useful in multi-faceted ways. It can act as an educational tool which enhances public/political understanding and appreciation for of the meaning and benefits of MHP or even a conceptual/theoretical guide for future MHP practitioners and researchers. Evaluating the current concept of MHP can also reveal strengths and weaknesses and help to guide concrete solutions based on these evaluations. For example, mapping the consequences not only rationalizes the importance of MHP to relevant populations (i.e., policy makers, government funding evaluators, the public, etc.), but it also may provide a list of outcomes useful for both targeting certain outcomes with tailored MHP initiatives and/or evaluating the success of MHP efforts following implementation. Additionally, the widespread socio-ecological levels and importance of cross-sectoral partnerships to MHP suggest that MHP must be addressed as an issue of public health and employ cross-sectoral approaches to ensure MHP efforts are effectively carried out across all relevant socio-ecological domains (Tamminen et al., 2016).

1.4 FLOURISHING AS A GOAL FOR MENTAL HEALTH PROMOTION

1.4.1 Mental Well-Being vs Mental Health

As you may have noticed throughout the chapter, well-being and mental health are often discussed together and sometimes used interchangeably. Indeed, well-being has been identified as both an attribute and outcome of mental health promotion. However, well-being and mental health are separate but related constructs (Cloninger, 2006). Well-being refers to an overall sense of how life is going which is subject to daily fluctuations (Waterman, 2007), and mental health reflects a spectrum of functioning that shapes one’s ability to handle stress, make decisions, and cope with the ups and downs of daily life (Orpana et al., 2016). Mental health and well-being may bidirectionally influence one another; maintaining positive mental health may lead to a sense of well-being (such as being satisfied with one’s life), and vice versa, enjoying a sense of well-being may be a protective factor against poor mental health. As mental health is a necessary component of overall well-being, there is a need for effective population interventions across the globe (Barry, 2007).

1.4.2 Positive Mental Health as Flourishing

Positive mental health is a true state of well-being rather than just the lack of mental illness (Barry, 2009, pg. 4). Possessing and maintaining positive mental health is known as flourishing (Keyes, 2002). In other words, flourishing can be thought of as a state of complete mental health, shown through consistently high levels of well-being across three key domains (i.e., psychosocial, social and emotional well-being; see Figure 7; Keyes, 2002; Keyes, 2014). Keyes (2014) argues “anything less than flourishing creates problems for society, it’s not just depression and mental illness” (14:42-14:50). Indeed, his research clarified that although positive mental health is related to mental illness, the two concepts are distinct from one another (Keyes, 2002; Keyes, 2005). These findings illustrate that mental illness is not a limiting factor that keeps one from flourishing, and that all individuals are capable of it (Keyes, 2014). This is an important perspective we carry throughout the rest of this textbook, and that generates strong support for positive mental health as an important goal for MHP.

1.4.3 Flourishing and MHP

Promoting flourishing is a route to well-being that is possible for all populations and has the potential to be extremely beneficial, not only to mental health, but to broader levels of both societal and individual functioning in everyday life (VanderWeele, 2017; Hone et al., 2014). When people are flourishing, they miss less work and face fewer physical limitations (REF). Additionally, having positive mental health is linked with many positive outcomes including problem-solving, productivity, and stress management (Jané-Llopis et al., 2005). These findings support that flourishing may act as a central indicator of human functioning, with determinants and outcomes which include and extend beyond physical and mental health (i.e., financial stability, sense of purpose; VanderWeele, 2017). Positive mental health or flourishing has, therefore, become an attractive concept within the domain of public health and (mental) health promotion. Even early advances in health promotion identified the importance of striving for positive health in an inclusive way. For example, the World Health Organization (WHO; 1986) emphasizes that good health promotion approaches focus on advocating for positive health, choosing programs that equally enable everyone to maximize their potential, and mediate the effects by getting the government and other stakeholders involved. Since then, positive mental health has been identified as both a key attribute and important outcome/aim of mental health promotion (Tamminen et al., 2016). Promoting positive mental health is widely recognized as central to successful mental health promotion efforts (Barry, 2001; Barry, 2009; Keyes, 2007; Kobau et al., 2011).

Figure 7 : The criteria for an individual to fit the definition of flourishing based on the characteristics that make up the 3 types of well-being- Psychological, Social and Emotional (Keyes, 2014).

1.4.4 Overcoming barriers using an integrated approach

Despite the recognized importance of flourishing to mental health promotion, there remains many barriers to its study, practice, and implementation. While support for flourishing as a pathway to overall mental well-being is more extensive, research investigating implementation and evaluation of flourishing-aimed practice is limited (Keyes, 2010). This precludes clarity in identifying the most effective ways to implement and evaluate interventions and policies in promoting flourishing. These barriers will be discussed more in later chapters which focus on MHP programming across various settings, as well as MHP policy needs (i.e., Chapter 3). However, some existing barriers might also be addressed by integrating the largest existing bases of knowledge and practice relating to positive mental health and flourishing.

Although the term flourishing as positive mental health originates from positive psychology, positive mental health is a shared goal/concept within both positive psychology and public (mental) health promotion (Kobau et al., 2011). Additionally, the term flourishing in public health domains is used more loosely to extend beyond mental health and include optimal functioning across many social and personal domains (VanderWeele, 2017). Across both fields, positive mental health is viewed as the resource which permits social, emotional, and psychological functioning across multiple levels, but both fields also view, define, study, and aim to foster positive mental health in unique ways (Kobau et al., 2011). Positive psychology focuses on examining and identifying psychological assets (i.e., positive individual traits, emotions, relationships, and enabling institutions etc.) which permit individuals and communities to thrive and flourish (Kobau et al., 2011; Seligman & Csikszentmihalyi, 2000). In contrast, health promotion and public health efforts focus on building strong public policy, socio-ecological environments, personal skills, and health services to promote health (Kobau et al., 2011).

Given the many similarities and shared goals and concepts between these fields, there has been some opportunity for cooperative development, research and practice relating to flourishing in positive psychology, and positive mental health in the field of mental health promotion (Kobau et al., 2011; Keyes, 2010). However, the disconnect between these fields exacerbates existing limitations and barriers within each. For example, there are multiple different definitions and models of flourishing within positive psychology and limited research providing practical guidance for the implementation of interventions which promote flourishing (Hone et al., 2014; Keyes, 2010). Thus, conceptual differences in terminology and research gaps between fields contribute to lesser integration of flourishing research and practice into public health MHP efforts, which tend to focus on more social factors, than psychological (Kobau et al., 2011). The disconnect between fields therefore limits understanding of how both psychological and social components and factors come together to contribute to the promotion of positive mental health. However, many of the field-specific strengths and limitations complement one another, with strengths in positive psychology accounting for weaknesses in public health promotion and vice versa. The integration of more concepts, theory, and practice from positive psychology on flourishing and public health on positive mental health may advance and improve MHP efforts in building flourishing individuals, communities, and societies (Kobau et al., 2011; Tamminen et al., 2016).

1.4.5 Conclusion

This chapter summarizes the central concepts of this textbook and their origins, existing empirical evidence and theory supporting mental health promotion, and practical realities and implications for mental health promotion today. We’ve reviewed that mental health promotion is researched and practiced largely within a mental health promotion framework in the domain of public health, but also incorporates important influences from positive and community psychology. Mental health promotion has evolved with these fields, and with public understanding of mental health, to grow into a vital area of research and practice, with its own distinct features and outcomes. MHP informs how we can foster positive mental health across multiple socio-ecological levels and has benefits which extend to overall well-being and functioning of individuals, communities, and society at large. Integrating existing research and knowledge within the health promotion field, as well as beyond (i.e., positive psychology and flourishing) may guide future practice (i.e., policy and programming) and research adjustments needed to overcome barriers and advance the field.

About the Authors

name: Alanna Kaser

institution: Dalhousie University

Alanna Kaser is an honors thesis student in the Department of Psychology and Neuroscience at Dalhousie University. Her research interests are on mental health and personality. She has previously published papers on mental health promotion, positive mental health, and perfectionism.

name: Megan Sponagle

Megan Sponagle is an honors thesis student in the Department of Psychology and Neuroscience at Dalhousie University. Her research interests are on individual strengths that contribute to healthy and happy lives. Her undergraduate thesis examines students’ perceptions of mattering on campus. She plans to become an occupational therapist.

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Mental Illness Prevention and Mental Health Promotion: When, Who, and How

Michael T. Compton , M.D., M.P.H. , and
Ruth S. Shim , M.D., M.P.H.

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Classification as primary, secondary, or tertiary prevention is based on when during the course of disease the intervention is provided. Another approach to classification—as universal, selective, or indicated preventive interventions—relates to who receives the intervention. The social determinants of health framework also provides a guide to prevention, which requires changing both public policies and social norms. It also addresses the weaknesses of the first two approaches, such as persistent health inequities regarding who has access to preventive services. The social determinants framework is a guide to providing timely and targeted preventive interventions in a way that ensures equal access.

Many health professionals are familiar with two approaches to classification of disease prevention: classification as primary, secondary, or tertiary prevention and as universal, selective, or indicated preventive interventions.

Alternatively, the social determinants of health framework suggests that prevention requires changing public policies and social norms while focusing on eliminating health inequities.

According to our conceptualization ( 1 – 6 ), the social determinants of mental health are societal problems affecting large segments of the population (individuals, families, communities, and, indirectly, the entire population) that interfere with optimal mental health. These factors increase risk for mental illnesses and substance use disorders, worsen outcomes among those with existing mental illnesses or substance use disorders, and account for the mental health disparities and inequities that exist across population groups. Such determinants include adverse early life experiences; discrimination and the resultant social exclusion; exposure to violence, war, forced migration, and related issues; involvement in the criminal justice system; educational, employment, and financial inequalities; area-level and concentrated neighborhood poverty; poor access to stable housing, high-quality diet, transportation, health care, or health insurance; adverse features of the built environment (e.g., building design, city planning); neighborhood disorder; and exposure to pollution or the effects of climate change.

All of these problems, which are manifestations of social injustice, interfere with health and increase the risk of diseases, medical and psychiatric alike. At the individual level, they adversely affect health and cause disease through at least three mechanisms. First, these problems often result in reduced options for individuals. For example, lack of access to or lack of resources to purchase healthy food often results in reliance on an inexpensive, high-calorie, micronutrient-poor diet replete with processed food, junk food, and fast food. In turn, these poor options from which individuals must choose are behavioral risk factors for diseases and conditions such as obesity, diabetes, hypertension, and depression. Second, they create substantial and persistent stress, thereby triggering psychological and physiological stress responses that increase the risk for disease. Third, they can interact with genetic constitution through such mechanisms as gene-by-environment interactions and epigenetics.

Although the social determinants are relevant to the tertiary prevention work of clinical care, they are also central to health disparities and inequities, and they provide insights into how best to prevent mental illnesses and substance use disorders and promote mental health. Two frameworks are widely known to guide the medical and public health communities in thinking about how to approach prevention. The first provides a how-to guide by focusing on when to provide an intervention; the second focuses on who receives the intervention. A third framework—and our main focus here—provides a pair of upstream, population-based how-to approaches and crucially informs and improves the how-to guides for the first two frameworks.

When: Primary, Secondary, and Tertiary Prevention

The first framework centers on when in the course of a disease the preventive intervention is provided. Primary prevention occurs before any evidence of disease and aims to reduce or eliminate causal risk factors, prevent onset, and thus reduce incidence of the disease. Well-known examples include vaccinations to prevent infectious diseases and encouraging healthy eating and physical activity to prevent obesity, diabetes, hypertension, and other chronic diseases and conditions. Secondary prevention occurs at a latent stage of disease—after a disease has begun but before the person has become symptomatic. The goals, which ultimately reduce the prevalence of the disease, are early identification through screening as well as providing interventions to prevent the disease from becoming manifest. Screening tools and tests (e.g., checking body mass index, mammography, HIV testing) are examples of secondary prevention. Finally, tertiary prevention is an intervention implemented after a disease is established, with the goal of preventing disability, further morbidity, and mortality. Medical treatments delivered during the course of diseases can be considered tertiary prevention. This is the bulk of the work carried out by today’s medical field, including psychiatry. Relapse prevention is another form of tertiary prevention. In psychiatry, primary, secondary, and tertiary prevention are exemplified, respectively, by eliminating certain forms of dementia that stem from vitamin deficiencies, screening for problematic drinking that precedes alcohol use disorder, and providing psychosocial treatments to reduce disability among individuals with serious mental illnesses. One caveat of the when (primary, secondary, tertiary) framework is that it does not inherently address health inequities (e.g., unjust health disparities based on race inequities, socioeconomic status, or geographic location) that occur with regard to not only treatment but also access to primary and secondary prevention.

Who: Universal, Selective, and Indicated Preventive Interventions

The second approach for thinking through prevention largely focuses on who receives an intervention. This framework, popularized by Institute of Medicine reports in recent decades ( 7 , 8 ), also has three levels of prevention (universal, selective, and indicated), divided in terms of who should be given a preventive intervention. Universal preventive interventions are given to the entire group (e.g., a school, an entire community, or the whole population), regardless of individuals’ level of risk for the disease. Examples include fortification or enrichment of foods, school-based curricula about substance abuse, and informational campaigns, such as public service announcements about wearing seat belts or not texting while driving. Selective preventive interventions are those delivered to a subgroup at increased risk for a disease outcome. This category is exemplified by statin use among those with hyperlipidemia (to prevent later cardiovascular disease) and pneumococcal vaccination in older adults. Indicated preventive interventions are those given to an even more select group that is at particularly high risk or is already exhibiting subclinical symptoms. Examples include lifestyle modifications for prediabetes or prehypertension. In psychiatry, universal, selective, and indicated preventive interventions are exemplified, respectively, by social and emotional development curricula provided in elementary schools, group-based psychotherapy for children of parents with depressive disorders, and efforts to identify and treat adolescents and young adults who appear to be at clinical high risk (often termed “ultra-high risk,” although the rate of false positives remains high) for schizophrenia. Similar to the when framework, a weakness of the who framework is that inequities exist in access to these preventive interventions; this framework at times provides a pound of prevention for some groups and only an ounce for others.

How: Pursuing Prevention While Promoting Health Equity

Psychiatry has long been interested in how, as a field, we mental health professionals might pursue the prevention of mental illnesses. Several disciplines (e.g., the field of community psychology), academic and training programs (e.g., the Division of Public Behavioral Health and Justice Policy at the University of Washington), and esteemed researchers (including Sheppard Kellam, a child psychiatrist by training) have established and advanced the field of mental illness prevention. However, despite advances, the prevalence of and disability stemming from mental illnesses indicate that major strides are still needed. In addition to the very useful when (primary, secondary, and tertiary prevention) and who (universal, selective, and indicated preventive interventions) frameworks, the social determinants of health framework guides us on how to go about prevention in at least two ways.

First, reducing the population burden of any of the social determinants (which tend to be highly interconnected) will improve the physical and mental health of the population and will reduce the risk for disease. Given their societal roots (often built into the very structure of society), changing the social determinants of health is no easy task. It requires, in our conceptualization, changing both public policies (e.g., organizational policies, legislation, court decisions) and social norms (i.e., culturally sanctioned ways of interacting with one another on the basis of innate characteristics or social position). Reducing the burden of these social risks on individuals (e.g., in the clinical setting) will have a similar effect, albeit with just one patient at a time. Addressing the social determinants also has an effect on the disease course—in part, by making it easier to be adherent to treatment (and thus having a better response to therapeutic interventions) and by improving one’s ability for disease self-management—which is highly relevant to the tertiary prevention work in which nearly all health care providers engage. Therefore, addressing the social determinants themselves is a means of prevention.

Second, the social determinants of health framework guides practitioners on how to go about prevention because it reminds us that we must work to eliminate inequities (including inequities in access to preventive services and interventions). For the when and the who frameworks to be effective in preventing mental illnesses and substance use disorders, they need to be available to all. Changing public policies and social norms will move us toward realizing the promise of prevention, because those activities are preventive themselves but also because they will help us level the playing field (i.e., eliminate unjust health inequities) so that prevention is a right for everyone. We must ensure that measures are in place to monitor equity in access to all illness prevention and health promotion services. Given the social injustice that leads to the social determinants themselves, we must be wary of inequities not only with regard to treatment but also in all arenas of prevention.

The authors report no financial relationships with commercial interests.

1 Compton MT, Shim RS : The Social Determinants of Mental Health . Washington, DC, American Psychiatric Publishing, 2015 Google Scholar

2 Compton MT, Shim RS : The social determinants of mental health . Focus 2015 ; 13:419–425 Crossref , Google Scholar

3 Shim RS, Compton MT : Addressing the social determinants of mental health: if not now, when? If not us, who? Psychiatr Serv 2018 ; 69:844–846 Link , Google Scholar

4 Shim RS, Compton MT : The social determinants of mental health ; in The American Psychiatric Association Publishing Textbook of Psychiatry , 7th ed. Edited by Weiss Roberts L . Washington, DC, American Psychiatric Association Publishing, 2019 Google Scholar

5 Compton MT, Shim RS : Why employers must focus on the social determinants of mental health . Am J Health Promot 2020 ; 34:215–219 Crossref , Medline , Google Scholar

6 Shim RS, Compton MT : The social determinants of mental health: psychiatrists’ roles in addressing discrimination and food insecurity . Focus 2020 ; 18:25–30 Crossref , Medline , Google Scholar

7 Institute of Medicine: Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research . Washington, DC, National Academy Press, 1994 Google Scholar

8 National Research Council and Institute of Medicine: Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC, National Academies Press, 2009 Google Scholar

Robyn M. Powell , Ph.D., J.D. , and
Joanne Nicholson , Ph.D.

Health equity
Mental health promotion
Mental illness prevention
Social determinants
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Mindfulness’ Role in Mental Health Promotion Essay

Recent permutations within sociocultural, economic, and political contexts of the global community have created prerequisites for the development of anxiety in a substantial part of the global population. Therefore, concerns associated with a drop in the quality of life have become especially valid recently. By incorporating mindfulness into personal spiritual practices, social workers will be able to overcome stress and avoid mental health issues that it entails, thus, increasing clients’ quality of life.

The concept of mindfulness is fairly broad, yet it can be summarized succinctly as the awareness of emotional and mental health state, as well as the ability to maintain emotional balance and develop mechanisms for managing stress appropriately (Galante et al., 2021). Therefore, it is reasonable to assume that the focus on self-cognition and a thorough understanding of one’s emotional needs and mental health issues will guide one to building a strategy for resilience against adverse factors inducing stress (Galante et al., 2021). Thus, the integration of mindfulness as a skill of building strategic frameworks for addressing negative factors causing severe stress is vital for keeping the quality of life consistently high.

Furthermore, mindfulness allows people to introduce better control over their mental health and, therefore, their quality of life. Specifically, the integration of mindfulness techniques will inevitably lead to enhanced patient education (Galante et al., 2021). As a result, a range of ideas and perceptions that misalign with core goals of leading a healthy lifestyle will be dispelled among the target population. Most importantly, patients will be able to navigate the available plethora of information independently, distinguishing between useful and harmful ideas (Galante et al., 2021). The described change is expected to increase patients’ ability to avoid major risks to their heath, including the ones that stem from their currently misguided perceptions of their mental health (Galante et al., 2021). Namely, mindfulness will allow patients to prioritize their health and explore it, therefore, learning about their needs and the means of meeting them. Furthermore, the focus on mindfulness will help improve one’s perception of negative factors, allowing one to evaluate core risks to well-being properly and refrain from panicking in case of a threat (Galante et al., 2021). Overall, mindfulness should be regarded as a critical practice of mental health management and the resulting improvement in the quality of people’s lives.

The introduction of mindfulness techniques will allow minimizing people’s sensitivity toward negative factors that affect their mental health adversely, thus, avoiding multiple complications and disorders. As a result, patients’ quality of life will be improved to a substantial degree. With the incorporation of mindfulness into therapy, one will be able to reduce stress by promoting active health education and learning to a patient. As a result, opportunities for independent crisis management in patients can be discovered.

Galante, J., Friedrich, C., Dawson, A. F., Modrego-Alarcón, M., Gebbing, P., Delgado-Suárez, I., Gebbing, P., Delgado-Suárez, I., Gupta, T., Dean, L., Dalgleish, T., White, I. R., & Jones, P. B. (2021). Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: a systematic review and meta-analysis of randomised controlled trials . PLoS medicine , 18 (1), 1-40. Web.

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Article Contents

Introduction, identity development and the sources of negative self-esteem, outcomes of poor self-esteem, mechanisms linking self-esteem and health behavior, examples of school health promotion programs that foster self-esteem, self-esteem in a broad-spectrum approach for mental health promotion.

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Michal (Michelle) Mann, Clemens M. H. Hosman, Herman P. Schaalma, Nanne K. de Vries, Self-esteem in a broad-spectrum approach for mental health promotion, Health Education Research , Volume 19, Issue 4, August 2004, Pages 357–372, https://doi.org/10.1093/her/cyg041

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Self-evaluation is crucial to mental and social well-being. It influences aspirations, personal goals and interaction with others. This paper stresses the importance of self-esteem as a protective factor and a non-specific risk factor in physical and mental health. Evidence is presented illustrating that self-esteem can lead to better health and social behavior, and that poor self-esteem is associated with a broad range of mental disorders and social problems, both internalizing problems (e.g. depression, suicidal tendencies, eating disorders and anxiety) and externalizing problems (e.g. violence and substance abuse). We discuss the dynamics of self-esteem in these relations. It is argued that an understanding of the development of self-esteem, its outcomes, and its active protection and promotion are critical to the improvement of both mental and physical health. The consequences for theory development, program development and health education research are addressed. Focusing on self-esteem is considered a core element of mental health promotion and a fruitful basis for a broad-spectrum approach.

The most basic task for one's mental, emotional and social health, which begins in infancy and continues until one dies, is the construction of his/her positive self-esteem. [( Macdonald, 1994 ), p. 19]

Self-concept is defined as the sum of an individual's beliefs and knowledge about his/her personal attributes and qualities. It is classed as a cognitive schema that organizes abstract and concrete views about the self, and controls the processing of self-relevant information ( Markus, 1977 ; Kihlstrom and Cantor, 1983 ). Other concepts, such as self-image and self-perception, are equivalents to self-concept. Self-esteem is the evaluative and affective dimension of the self-concept, and is considered as equivalent to self-regard, self-estimation and self-worth ( Harter, 1999 ). It refers to a person's global appraisal of his/her positive or negative value, based on the scores a person gives him/herself in different roles and domains of life ( Rogers, 1981 ; Markus and Nurius, 1986 ). Positive self-esteem is not only seen as a basic feature of mental health, but also as a protective factor that contributes to better health and positive social behavior through its role as a buffer against the impact of negative influences. It is seen to actively promote healthy functioning as reflected in life aspects such as achievements, success, satisfaction, and the ability to cope with diseases like cancer and heart disease. Conversely, an unstable self-concept and poor self-esteem can play a critical role in the development of an array of mental disorders and social problems, such as depression, anorexia nervosa, bulimia, anxiety, violence, substance abuse and high-risk behaviors. These conditions not only result in a high degree of personal suffering, but also impose a considerable burden on society. As will be shown, prospective studies have highlighted low self-esteem as a risk factor and positive self-esteem as a protective factor. To summarize, self-esteem is considered as an influential factor both in physical and mental health, and therefore should be an important focus in health promotion; in particular, mental health promotion.

Health promotion refers to the process of enabling people to increase control over and improve their own health ( WHO, 1986 ). Subjective control as well as subjective health, each aspects of the self, are considered as significant elements of the health concept. Recognizing the existence of different views on the concept of mental health promotion, Sartorius (Sartorius, 1998), the former WHO Director of Mental Health, preferred to define it as a means by which individuals, groups or large populations can enhance their competence, self-esteem and sense of well-being. This view is supported by Tudor (Tudor, 1996) in his monograph on mental health promotion, where he presents self-concept and self-esteem as two of the core elements of mental health, and therefore as an important focus of mental health promotion.

This article aims to clarify how self-esteem is related to physical and mental health, both empirically and theoretically, and to offer arguments for enhancing self-esteem and self-concept as a major aspect of health promotion, mental health promotion and a ‘Broad-Spectrum Approach’ (BSA) in prevention.

The first section presents a review of the empirical evidence on the consequences of high and low self-esteem in the domains of mental health, health and social outcomes. The section also addresses the bi-directional nature of the relationship between self-esteem and mental health. The second section discusses the role of self-esteem in health promotion from a theoretical perspective. How are differentiations within the self-concept related to self-esteem and mental health? How does self-esteem relate to the currently prevailing theories in the field of health promotion and prevention? What are the mechanisms that link self-esteem to health and social outcomes? Several theories used in health promotion or prevention offer insight into such mechanisms. We discuss the role of positive self-esteem as a protective factor in the context of stressors, the developmental role of negative self-esteem in mental and social problems, and the role of self-esteem in models of health behavior. Finally, implications for designing a health-promotion strategy that could generate broad-spectrum outcomes through addressing common risk factors such as self-esteem are discussed. In this context, schools are considered an ideal setting for such broad-spectrum interventions. Some examples are offered of school programs that have successfully contributed to the enhancement of self-esteem, and the prevention of mental and social problems.

Self-esteem and mental well-being

Empirical studies over the last 15 years indicate that self-esteem is an important psychological factor contributing to health and quality of life ( Evans, 1997 ). Recently, several studies have shown that subjective well-being significantly correlates with high self-esteem, and that self-esteem shares significant variance in both mental well-being and happiness ( Zimmerman, 2000 ). Self-esteem has been found to be the most dominant and powerful predictor of happiness ( Furnham and Cheng, 2000 ). Indeed, while low self-esteem leads to maladjustment, positive self-esteem, internal standards and aspirations actively seem to contribute to ‘well-being’ ( Garmezy, 1984 ; Glick and Zigler, 1992 ). According to Tudor (Tudor, 1996), self-concept, identity and self-esteem are among the key elements of mental health.

Self-esteem, academic achievements and job satisfaction

The relationship between self-esteem and academic achievement is reported in a large number of studies ( Marsh and Yeung, 1997 ; Filozof et al. , 1998 ; Hay et al. , 1998 ). In the critical childhood years, positive feelings of self-esteem have been shown to increase children's confidence and success at school ( Coopersmith, 1967 ), with positive self-esteem being a predicting factor for academic success, e.g. reading ability ( Markus and Nurius, 1986 ). Results of a longitudinal study among elementary school children indicate that children with high self-esteem have higher cognitive aptitudes ( Adams, 1996 ). Furthermore, research has revealed that core self-evaluations measured in childhood and in early adulthood are linked to job satisfaction in middle age ( Judge et al. , 2000 ).

Self-esteem and coping with stress in combination with coping with physical disease

The protective nature of self-esteem is particularly evident in studies examining stress and/or physical disease in which self-esteem is shown to safeguard the individual from fear and uncertainty. This is reflected in observations of chronically ill individuals. It has been found that a greater feeling of mastery, efficacy and high self-esteem, in combination with having a partner and many close relationships, all have direct protective effects on the development of depressive symptoms in the chronically ill ( Penninx et al. , 1998 ). Self-esteem has also been shown to enhance an individual's ability to cope with disease and post-operative survival. Research on pre-transplant psychological variables and survival after bone marrow transplantation ( Broers et al. , 1998 ) indicates that high self-esteem prior to surgery is related to longer survival. Chang and Mackenzie ( Chang and Mackenzie, 1998 ) found that the level of self-esteem was a consistent factor in the prediction of the functional outcome of a patient after a stroke.

To conclude, positive self-esteem is associated with mental well-being, adjustment, happiness, success and satisfaction. It is also associated with recovery after severe diseases.

The evolving nature of self-esteem was conceptualized by Erikson ( Erikson, 1968 ) in his theory on the stages of psychosocial development in children, adolescents and adults. According to Erikson, individuals are occupied with their self-esteem and self-concept as long as the process of crystallization of identity continues. If this process is not negotiated successfully, the individual remains confused, not knowing who (s)he really is. Identity problems, such as unclear identity, diffused identity and foreclosure (an identity status based on whether or not adolescents made firm commitments in life. Persons classified as ‘foreclosed’ have made future commitments without ever experiencing the ‘crises’ of deciding what really suits them best), together with low self-esteem, can be the cause and the core of many mental and social problems ( Marcia et al. , 1993 ).

The development of self-esteem during childhood and adolescence depends on a wide variety of intra-individual and social factors. Approval and support, especially from parents and peers, and self-perceived competence in domains of importance are the main determinants of self-esteem [for a review, see ( Harter, 1999 )]. Attachment and unconditional parental support are critical during the phases of self-development. This is a reciprocal process, as individuals with positive self-esteem can better internalize the positive view of significant others. For instance, in their prospective study among young adolescents, Garber and Flynn ( Garber and Flynn, 2001 ) found that negative self-worth develops as an outcome of low maternal acceptance, a maternal history of depression and exposure to negative interpersonal contexts, such as negative parenting practices, early history of child maltreatment, negative feedback from significant others on one's competence, and family discord and disruption.

Other sources of negative self-esteem are discrepancies between competing aspects of the self, such as between the ideal and the real self, especially in domains of importance. The larger the discrepancy between the value a child assigns to a certain competence area and the perceived self-competence in that area, the lower the feeling of self-esteem ( Harter, 1999 ). Furthermore, discrepancies can exist between the self as seen by oneself and the self as seen by significant others. As implied by Harter ( Harter, 1999 ), this could refer to contrasts that might exist between self-perceived competencies and the lack of approval or support by parents or peers.

Finally, negative and positive feelings of self-worth could be the result of a cognitive, inferential process, in which children observe and evaluate their own behaviors and competencies in specific domains (self-efficacy). The poorer they evaluate their competencies, especially in comparison to those of their peers or to the standards of significant others, the more negative their self-esteem. Such self-monitoring processes can be negatively or positively biased by a learned tendency to negative or positive thinking ( Seligman et al. , 1995 ).

The outcomes of negative self-esteem can be manifold. Poor self-esteem can result in a cascade of diminishing self-appreciation, creating self-defeating attitudes, psychiatric vulnerability, social problems or risk behaviors. The empirical literature highlights the negative outcomes of low self-esteem. However, in several studies there is a lack of clarity regarding causal relations between self-esteem and problems or disorders ( Flay and Ordway, 2001 ). This is an important observation, as there is reason to believe that self-esteem should be examined not only as a cause, but also as a consequence of problem behavior. For example, on the one hand, children could have a negative view about themselves and that might lead to depressive feelings. On the other hand, depression or lack of efficient functioning could lead to feeling bad, which might decrease self-esteem. Although the directionality can work both ways, this article concentrates on the evidence for self-esteem as a potential risk factor for mental and social outcomes. Three clusters of outcomes can be differentiated. The first are mental disorders with internalizing characteristics, such as depression, eating disorders and anxiety. The second are poor social outcomes with externalizing characteristics including aggressive behavior, violence and educational exclusion. The third is risky health behavior such as drug abuse and not using condoms.

Self-esteem and internalizing mental disorders

Self-esteem plays a significant role in the development of a variety of mental disorders. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), negative or unstable self-perceptions are a key component in the diagnostic criteria of major depressive disorders, manic and hypomanic episodes, dysthymic disorders, dissociative disorders, anorexia nervosa, bulimia nervosa, and in personality disorders, such as borderline, narcissistic and avoidant behavior. Negative self-esteem is also found to be a risk factor, leading to maladjustment and even escapism. Lacking trust in themselves, individuals become unable to handle daily problems which, in turn, reduces the ability to achieve maximum potential. This could lead to an alarming deterioration in physical and mental well-being. A decline in mental health could result in internalizing problem behavior such as depression, anxiety and eating disorders. The outcomes of low self-esteem for these disorders are elaborated below.

Depressed moods, depression and suicidal tendencies

The clinical literature suggests that low self-esteem is related to depressed moods ( Patterson and Capaldi, 1992 ), depressive disorders ( Rice et al. , 1998 ; Dori and Overholser, 1999 ), hopelessness, suicidal tendencies and attempted suicide ( Overholser et al. , 1995 ). Correlational studies have consistently shown a significant negative relationship between self-esteem and depression ( Beck et al. , 1990 ; Patton, 1991 ). Campbell et al. ( Campbell et al. , 1991 ) found individual appraisal of events to be clearly related to their self-esteem. Low self-esteem subjects rated their daily events as less positive and negative life events as being more personally important than high self-esteem subjects. Individuals with high self-esteem made more stable and global internal attributions for positive events than for negative events, leading to the reinforcement of their positive self-image. Subjects low in self-esteem, however, were more likely to associate negative events to stable and global internal attributions, and positive events to external factors and luck ( Campbell et al. , 1991 ). There is a growing body of evidence that individuals with low self-esteem more often report a depressed state, and that there is a link between dimensions of attributional style, self-esteem and depression ( Abramson et al. , 1989 ; Hammen and Goodman-Brown, 1990 ).

Some indications of the causal role of self-esteem result from prospective studies. In longitudinal studies, low self-esteem during childhood ( Reinherz et al. , 1993 ), adolescence ( Teri, 1982 ) and early adulthood ( Wilhelm et al. , 1999 ) was identified as a crucial predictor of depression later in life. Shin ( Shin, 1993 ) found that when cumulative stress, social support and self-esteem were introduced subsequently in regression analysis, of the latter two, only self-esteem accounted for significant additional variance in depression. In addition, Brown et al. ( Brown et al. , 1990 ) showed that positive self-esteem, although closely associated with inadequate social support, plays a role as a buffer factor. There appears to be a pathway from not living up to personal standards, to low self-esteem and to being depressed ( Harter, 1986 , 1990 ; Higgins, 1987 , 1989 ; Baumeister, 1990 ). Alternatively, another study indicated that when examining the role of life events and difficulties, it was found that total level of stress interacted with low self-esteem in predicting depression, whereas self-esteem alone made no direct contribution ( Miller et al. , 1989 ). To conclude, results of cross-sectional and longitudinal studies have shown that low self-esteem is predictive of depression.

The potentially detrimental impact of low self-esteem in depressive disorders stresses the significance of Seligman's recent work on ‘positive psychology’. His research indicates that teaching children to challenge their pessimistic thoughts whilst increasing positive subjective thinking (and bolstering self-esteem) can reduce the risk of pathologies such as depression ( Seligman, 1995 ; Seligman et al. , 1995 ; Seligman and Csikszentmihalyi, 2000 ).

Other internalizing disorders

Although low self-esteem is most frequently associated with depression, a relationship has also been found with other internalizing disorders, such as anxiety and eating disorders. Research results indicate that self-esteem is inversely correlated with anxiety and other signs of psychological and physical distress ( Beck et al. , 2001 ). For example, Ginsburg et al. ( Ginsburg et al. , 1998 ) observed a low level of self-esteem in highly socially anxious children. Self-esteem was shown to serve the fundamental psychological function of buffering anxiety, with the pursuit of self-esteem as a defensive avoidance tool against basic human fears. This mechanism of defense has become evident in research with primary ( Ginsburg et al. , 1998 ) and secondary school children ( Fickova, 1999 ). In addition, empirical studies have shown that bolstering self-esteem in adults reduces anxiety ( Solomon et al. , 2000 ).

The critical role of self-esteem during school years is clearly reflected in studies on eating disorders. At this stage in life, weight, body shape and dieting behavior become intertwined with identity. Researchers have reported low self-esteem as a risk factor in the development of eating disorders in female school children and adolescents ( Fisher et al. , 1994 ; Smolak et al. , 1996 ; Shisslak et al. , 1998 ), as did prospective studies ( Vohs et al. , 2001 ). Low self-esteem also seems predictive of the poor outcome of treatment in such disorders, as has been found in a recent 4-year prospective follow-up study among adolescent in-patients with bulimic characteristics ( van der Ham et al. , 1998 ). The significant influence of self-esteem on body image has led to programs in which the promotion of self-esteem is used as a main preventive tool in eating disorders ( St Jeor, 1993 ; Vickers, 1993 ; Scarano et al. , 1994 ).

To sum up, there is a systematic relation between self-esteem and internalizing problem behavior. Moreover, there is enough prospective evidence to suggest that poor self-esteem might contribute to deterioration of internalizing problem behavior while improvement of self-esteem could prevent such deterioration.

Self-esteem, externalizing problems and other poor social outcomes

For more than two decades, scientists have studied the relationship between self-esteem and externalizing problem behaviors, such as aggression, violence, youth delinquency and dropping out of school. The outcomes of self-esteem for these disorders are described below.

Violence and aggressive behavior

While the causes of such behaviors are multiple and complex, many researchers have identified self-esteem as a critical factor in crime prevention, rehabilitation and behavioral change ( Kressly, 1994 ; Gilbert, 1995 ). In a recent longitudinal questionnaire study among high-school adolescents, low self-esteem was one of the key risk factors for problem behavior ( Jessor et al. , 1998 ).

Recent studies confirm that high self-esteem is significantly associated with less violence ( Fleming et al. , 1999 ; Horowitz, 1999 ), while a lack of self-esteem significantly increases the risk of violence and gang membership ( Schoen, 1999 ). Results of a nationwide study of bullying behavior in Ireland show that children who were involved in bullying as either bullies, victims or both had significantly lower self-esteem than other children ( Schoen, 1999 ). Adolescents with low self-esteem were found to be more vulnerable to delinquent behavior. Interestingly, delinquency was positively associated with inflated self-esteem among these adolescents after performing delinquent behavior ( Schoen, 1999 ). According to Kaplan's self-derogation theory of delinquency (Kaplan, 1975), involvement in delinquent behavior with delinquent peers can increase children's self-esteem and sense of belonging. It was also found that individuals with extremely high levels of self-esteem and narcissism show high tendencies to express anger and aggression ( Baumeister et al. , 2000 ). To conclude, positive self-esteem is associated with less aggressive behavior. Although most studies in the field of aggressive behavior, violence and delinquency are correlational, there is some prospective evidence that low self-esteem is a risk factor in the development of problem behavior. Interestingly, low self-esteem as well as high and inflated self-esteem are both associated with the development of aggressive symptoms.

School dropout

Dropping out from the educational system could also reflect rebellion or antisocial behavior resulting from identity diffusion (an identity status based on whether or not adolescents made firm commitments in life. Adolescents classified as ‘diffuse’ have not yet thought about identity issues or, having thought about them, have failed to make any firm future oriented commitments). For instance, Muha ( Muha, 1991 ) has shown that while self-image and self-esteem contribute to competent functioning in childhood and adolescence, low self-esteem can lead to problems in social functioning and school dropout. The social consequences of such problem behaviors may be considerable for both the individual and the wider community. Several prevention programs have reduced the dropout rate of students at risk ( Alice, 1993 ; Andrews, 1999 ). All these programs emphasize self-esteem as a crucial element in dropout prevention.

Self-esteem and risk behavior

The impact of self-esteem is also evident in risk behavior and physical health. In a longitudinal study, Rouse ( Rouse, 1998 ) observed that resilient adolescents had higher self-esteem than their non-resilient peers and that they were less likely to initiate a variety of risk behaviors. Positive self-esteem is considered as a protective factor against substance abuse. Adolescents with more positive self-concepts are less likely to use alcohol or drugs ( Carvajal et al. , 1998 ), while those suffering with low self-esteem are at a higher risk for drug and alcohol abuse, and tobacco use ( Crump et al. , 1997 ; Jones and Heaven, 1998 ). Carvajal et al. ( Carvajal et al. , 1998 ) showed that optimism, hope and positive self-esteem are determinants of avoiding substance abuse by adolescents, mediated by attitudes, perceived norms and perceived behavioral control. Although many studies support the finding that improving self-esteem is an important component of substance abuse prevention ( Devlin, 1995 ; Rodney et al. , 1996 ), some studies found no support for the association between self-esteem and heavy alcohol use ( Poikolainen et al. , 2001 ).

Empirical evidence suggests that positive self-esteem can also lead to behavior which is protective against contracting AIDS, while low self-esteem contributes to vulnerability to HIV/AIDS ( Rolf and Johnson, 1992 ; Somali et al. , 2001 ). The risk level increases in cases where subjects have low self-esteem and where their behavior reflects efforts to be accepted by others or to gain attention, either positively or negatively ( Reston, 1991 ). Lower self-esteem was also related to sexual risk-taking and needle sharing among homeless ethnic-minority women recovering from drug addiction ( Nyamathi, 1991 ). Abel ( Abel, 1998 ) observed that single females whose partners did not use condoms had lower self-esteem than single females whose partners did use condoms. In a study of gay and/or bisexual men, low self-esteem proved to be one of the factors that made it difficult to reduce sexual risk behavior ( Paul et al. , 1993 ).

To summarize, the literature reveals a number of studies showing beneficial outcomes of positive self-esteem, and conversely, negative outcomes of poor self-esteem, especially in adolescents. Prospective studies and intervention studies have shown that self-esteem can be a causal factor in depression, anxiety, eating disorders, delinquency, school dropout, risk behavior, social functioning, academic success and satisfaction. However, the cross-sectional character of many other studies does not exclude that low self-esteem can also be considered as an important consequence of such disorders and behavioral problems.

To assess the implications of these findings for mental health promotion and preventive interventions, more insight is needed into the antecedents of poor self-esteem, and the mechanisms that link self-esteem to mental, physical and social outcomes.

What are the mechanisms that link self-esteem to health and social outcomes? Several theories used in health promotion or prevention offer insight into such mechanisms. In this section we discuss the role of positive self-esteem as a protective factor in the context of stressors, the developmental role of negative self-esteem in mental and social problems, and the role of self-esteem in models of health behavior.

Positive thinking about oneself as a protective factor in the context of stressors

People have a need to think positively about themselves, to defend and to improve their positive self-esteem, and even to overestimate themselves. Self-esteem represents a motivational force that influences perceptions and coping behavior. In the context of negative messages and stressors, positive self-esteem can have various protective functions.

Research on optimism confirms that a somewhat exaggerated sense of self-worth facilitates mastery, leading to better mental health ( Seligman, 1995 ). Evidence suggests that positive self-evaluations, exaggerated perception of control or mastery and unrealistic optimism are all characteristic of normal human thought, and that certain delusions may contribute to mental health and well-being ( Taylor and Brown, 1988 ). The mentally healthy person appears to have the capacity to distort reality in a direction that protects and enhances self-esteem. Conversely, individuals who are moderately depressed or low in self-esteem consistently display an absence of such enhancing delusions. Self-esteem could thus be said to serve as a defense mechanism that promotes well-being by protecting internal balance. Jahoda ( Jahoda, 1958 ) also included the ‘adequate perception of reality’ as a basic element of mental health. The degree of such a defense, however, has its limitations. The beneficial effect witnessed in reasonably well-balanced individuals becomes invalid in cases of extreme self-esteem and significant distortions of the self-concept. Seligman ( Seligman, 1995 ) claimed that optimism should not be based on unrealistic or heavily biased perceptions.

Viewing yourself positively can also be regarded as a very important psychological resource for coping. We include in this category those general and specific beliefs that serve as a basis for hope and that sustain coping efforts in the face of the most adverse condition… Hope can exist only when such beliefs make a positive outcome seem possible, if not probable. [( Lazarus and Folkman, 1984 ), p. 159]

Incidence = organic causes and stressors/competence, coping skills, self-esteem and social support

Identity, self-esteem, and the development of externalizing and internalizing problems

Erikson's ( Erikson, 1965 , 1968 ) theory on the stages of psychosocial development in children, adolescents, and adults and Herbert's flow chart ( Herbert, 1987 ) focus on the vicissitudes of identity and the development of unhealthy mental and social problems. According to these theories, when a person is enduringly confused about his/her own identity, he/she may possess an inherent lack of self-reassurance which results in either a low level of self-esteem or in unstable self-esteem and feelings of insecurity. However, low self-esteem—likewise inflated self-esteem—can also lead to identity problems. Under circumstances of insecurity and low self-esteem, the individual evolves in one of two ways: he/she takes the active escape route or the passive avoidance route ( Herbert, 1987 ). The escape route is associated with externalizing behaviors: aggressive behavior, violence and school dropout, the seeking of reassurance in others through high-risk behavior, premature relationships, cults or gangs. Reassurance and security may also be sought through drugs, alcohol or food. The passive avoidance route is associated with internalizing factors: feelings of despair and depression. Extreme avoidance may even result in suicidal behavior.

Whether identity and self-esteem problems express themselves following the externalizing active escape route or the internalizing passive avoidance route is dependent on personality characteristics and circumstances, life events and social antecedents (e.g. gender and parental support) ( Hebert, 1987 ). Recent studies consistently show gender differences regarding externalizing and internalizing behaviors among others in a context of low self-esteem ( Block and Gjerde, 1986 ; Rolf et al. , 1990 ; Harter, 1999 ; Benjet and Hernandez-Guzman, 2001 ). Girls are more likely to have internalizing symptoms than boys; boys are more likely to have externalizing symptoms. Moreover, according to Harter ( Harter, 1999 ), in recent studies girls appear to be better than boys in positive self-evaluation in the domain of behavioral conduct. Self-perceived behavioral conduct is assessed as the individual view on how well behaved he/she is and how he/she views his/her behavior in accordance with social expectations ( Harter, 1999 ). Negative self-perceived behavioral conduct is also found to be an important factor in mediating externalizing problems ( Reda-Norton, 1995 ; Hoffman, 1999 ).

The internalization of parental approval or disapproval is critical during childhood and adolescence. Studies have identified parents' and peers' supportive reactions (e.g. involvement, positive reinforcement, and acceptance) as crucial determinants of children's self-esteem and adjustment ( Shadmon, 1998 ). In contrast to secure, harmonious parent–child relationships, poor family relationships are associated with internalizing problems and depression ( Kashubeck and Christensen, 1993 ; Oliver and Paull, 1995 ).

Self-esteem in health behavior models

Self-esteem also plays a role in current cognitive models of health behavior. Health education research based on the Theory of Planned Behavior ( Ajzen, 1991 ) has confirmed the role of self-efficacy as a behavioral determinant ( Godin and Kok, 1996 ). Self-efficacy refers to the subjective evaluation of control over a specific behavior. While self-concepts and their evaluations could be related to specific behavioral domains, self-esteem is usually defined as a more generic attitude towards the self. One can have high self-efficacy for a specific task or behavior, while one has a negative evaluation of self-worth and vice versa. Nevertheless, both concepts are frequently intertwined since people often try to develop self-efficacy in activities that give them self-worth ( Strecher et al. , 1986 ). Self-efficacy and self-esteem are therefore not identical, but nevertheless related. The development of self-efficacy in behavioral domains of importance can contribute to positive self-esteem. On the other hand, the levels of self-esteem and self-confidence can influence self-efficacy, as is assumed in stress and coping theories.

The Attitude–Social influence–self-Efficacy (ASE) model ( De Vries and Mudde, 1998 ; De Vries et al. , 1988a ) and the Theory of Triadic Influence (TTI) ( Flay and Petraitis, 1994 ) are recent theories that provide a broad perspective on health behavior. These theories include distal factors that influence proximal behavioral determinants ( De Vries et al. , 1998b ) and specify more distal streams of influence for each of the three core determinants in the Planned Behavior Model ( Azjen, 1991 ) (attitudes, self-efficacy and social normative beliefs). Each of these behavioral determinants is assumed to be moderated by several distal factors, including self-esteem and mental disorders.

The TTI regards self-esteem in the same sense as the ASE, as a distal factor. According to this theory, self-efficacy is influenced by personality characteristics, especially the ‘sense of self’, which includes self-integration, self-image and self-esteem ( Flay and Petraitis, 1994 ).

The Precede–Proceed model of Green and Kreuter (Green and Kreuter, 1991) for the planning of health education and health promotion also recognizes the role of self-esteem. The model directs health educators to specify characteristics of health problems, and to take multiple determinants of health and health-related behavior into account. It integrates an epidemiological, behavioral and environmental approach. The staged Precede–Proceed framework supports health educators in identifying and influencing the multiple factors that shape health status, and evaluating the changes produced by interventions. Self-esteem plays a role in the first and fourth phase of the Precede–Proceed model, as an outcome variable and as a determinant. The initial phase of social diagnosis, analyses the quality of life of the target population. Green and Kreuter [(Green and Kreuter, 1991), p. 27] present self-esteem as one of the outcomes of health behavior and health status, and as a quality of life indicator. The fourth phase of the model, which concerns the educational and organizational diagnosis, describes three clusters of behavioral determinants: predisposing, enabling and reinforcing factors. Predisposing factors provide the rationale or motivation for behavior, such as knowledge, attitudes, beliefs, values, and perceived needs and abilities [(Green and Kreuter, 1991), p. 154]. Self-knowledge, general self-appraisal and self-efficacy are considered as predisposing factors.

To summarize, self-esteem can function both as a determinant and as an outcome of healthy behavior within health behavior models. Poor self-esteem can trigger poor coping behavior or risk behavior that subsequently increases the likelihood of certain diseases among which are mental disorders. On the other hand, the presence of poor coping behavior and ill-health can generate or reinforce a negative self-image.

Self-esteem in a BSA to mental health promotion and prevention in schools

Given the evidence supporting the role of self-esteem as a core element in physical and mental health, it is recommended that its potential in future health promotion and prevention programs be reconsidered.

The design of future policies for mental health promotion and the prevention of mental disorders is currently an area of active debate ( Hosman, 2000 ). A key question in the discussion is which is more effective: a preventive approach focusing on specific disorders or a more generic preventive approach?

Based on the evidence supporting the role of self-esteem as a non-specific risk factor and protective factor in the development of mental disorders and social problems, we advocate a generic preventive approach built around the ‘self’. In general, changing common risk and protective factors (e.g. self-esteem, coping skills, social support) and adopting a generic preventive approach can reduce the risk of the development of a range of mental disorders and promote individual well-being even before the onset of a specific problem has presented itself. Given its multi-outcome perspective, we have termed this strategy the ‘BSA’ in prevention and promotion.

Self-esteem is considered one of the important elements of the BSA. By fostering self-esteem, and hence treating a common risk factor, it is possible to contribute to the prevention of an array of physical diseases, mental disorders and social problems challenging society today. This may also, at a later date, imply the prevention of a shift to other problem behaviors or symptoms which might occur when only problem-specific risk factors are addressed. For example, an eating disorder could be replaced by another type of symptom, such as alcohol abuse, smoking, social anxiety or depression, when only the eating behavior itself is addressed and not more basic causes, such as poor self-esteem, high stress levels and lack of social support. Although there is, as yet, no published research on such a shift phenomenon, the high level of co-morbidity between such problems might reflect the likelihood of its existence. Numerous studies support the idea of co-morbidity and showed that many mental disorders have overlapping associated risk factors such as self-esteem. There is a significant degree of co-morbidity between and within internalizing and externalizing problem behaviors such as depression, anxiety, substance disorders and delinquency ( Harrington et al. , 1996 ; Angold et al. , 1999 ; Swendsen and Merikangas, 2000 ). By considering the individual as a whole, within the BSA, the risk of such an eventuality could be reduced.

The BSA could have practical implications. Schools are an ideal setting for implementing BSA programs, thereby aiming at preventing an array of problems, since they cover the entire population. They have the means and responsibility for the promotion of healthy behavior for such a common risk and protective factor, since school children are in their formative stage. A mental health promotion curriculum oriented towards emotional and social learning could include a focus on enhancing self-esteem. Weare ( Weare, 2000 ) stressed that schools need to aim at helping children develop a healthy sense of self-esteem as part of the development of their ‘intra-personal intelligence’. According to Gardner (Gardner, 1993) ‘intra-personal intelligence’ is the ability to form an accurate model of oneself and the ability to use it to operate effectively in life. Self-esteem, then, is an important component of this ability. Serious thought should be given to the practical implementation of these ideas.

It is important to clearly define the nature of a BSA program designed to foster self-esteem within the school setting. In our opinion, such a program should include important determinants of self-esteem, i.e. competence and social support.

Harter ( Harter, 1999 ) stated that competence and social support, together provide a powerful explanation of the level of self-esteem. According to Harter's research on self-perceived competence, every child experiences some discrepancy between what he/she would like to be, the ‘ideal self’, and his/her actual perception of him/herself, ‘the real self’. When this discrepancy is large and it deals with a personally relevant domain, this will result in lower self-esteem. Moreover, the overall sense of support of significant others (especially parents, peers and teachers) is also influential for the development of self-esteem. Children who feel that others accept them, and are unconditionally loved and respected, will report a higher sense of self-esteem ( Bee, 2000 ). Thus, children with a high discrepancy and a low sense of social support reported the lowest sense of self-esteem. These results suggest that efforts to improve self-esteem in children require both supportive social surroundings and the formation and acceptance of realistic personal goals in the personally relevant domains ( Harter, 1999 ).

In addition to determinants such as competence and social support, we need to translate the theoretical knowledge on coping with inner self-processes (e.g. inconsistencies between the real and ideal self) into practice, in order to perform a systematic intervention regarding the self. Harter's work offers an important foundation for this. Based on her own and others' research on the development of the self, she suggests the following principles to prevent the development of negative self-esteem and to enhance self-worth ( Harter, 1999 ):

Reduction of the discrepancy between the real self and the ideal self.

Encouragement of relatively realistic self-perceptions.

Encouraging the belief that positive self-evaluations can be achieved.

Appreciation for the individual's views about their self-esteem and individual perceptions on causes and consequences of self-worth.

Increasing awareness of the origins of negative self-perceptions.

Providing a more integrated personal construct while improving understanding of self-contradictions.

Encouraging the individual and his/her significant others to promote the social support they give and receive.

Fostering internalization of positive opinions of others.

Haney and Durlak ( Haney and Durlak, 1998 ) wrote a meta-analytical review of 116 intervention studies for children and adolescents. Most studies indicated significant improvement in children's and adolescents' self-esteem and self-concept, and as a result of this change, significant changes in behavioral, personality, and academic functioning. Haney and Durlak reported on the possible impact improved self-esteem had on the onset of social problems. However, their study did not offer an insight into the potential effect of enhanced self-esteem on mental disorders.

Several mental health-promoting school programs that have addressed self-esteem and the determinants of self-esteem in practice, were effective in the prevention of eating disorders ( O'Dea and Abraham, 2000 ), problem behavior ( Flay and Ordway, 2001 ), and the reduction of substance abuse, antisocial behavior and anxiety ( Short, 1998 ). We shall focus on the first two programs because these are universal programs, which focused on ‘mainstream’ school children. The prevention of eating disorders program ‘Everybody's Different’ ( O'Dea and Abraham, 2000 ) is aimed at female adolescents aged 11–14 years old. It was developed in response to the poor efficacy of conventional body-image education in improving body image and eating behavior. ‘Everybody's Different’ has adopted an alternative methodology built on an interactive, school-based, self-esteem approach and is designed to prevent the development of eating disorders by improving self-esteem. The program has significantly changed aspects of self-esteem, body satisfaction, social acceptance and physical appearance. Female students targeted by the intervention rated their physical appearance, as perceived by others, significantly higher than control-group students, and allowed their body weight to increase appropriately by refraining from weight-loss behavior seen in the control group. These findings were still evident after 12 months. This is one of the first controlled educational interventions that had successfully improved body image and produced long-term changes in the attitudes and self-image of young adolescents.

The ‘Positive Action Program’ ( Flay and Ordway, 2001 ) serves as a unique example of some BSA principles in practice. The program addresses the challenge of increasing self-esteem, reducing problem behavior and improving school performance. The types of problem behavior in question were delinquent behavior, ‘misdemeanors’ and objection to school rules ( Flay and Ordway, 2001 ). This program concentrates on self-concept and self-esteem, but also includes other risk and protective factors, such as positive actions, self-control, social skills and social support that could be considered as determinants of self-esteem. Other important determinants of self-esteem, such as coping with internal self-processes, are not addressed. At present, the literature does not provide many examples of BSA studies that produce general preventive effects among adolescents who do not (yet) display behavioral problems ( Greenberg et al. , 2000 ).

To conclude, research results show beneficial outcomes of positive self-esteem, which is seen to be associated with mental well-being, happiness, adjustment, success, academic achievements and satisfaction. It is also associated with better recovery after severe diseases. However, the evolving nature of self-esteem could also result in negative outcomes. For example, low self-esteem can be a causal factor in depression, anxiety, eating disorders, poor social functioning, school dropout and risk behavior. Interestingly, the cross-sectional characteristic of many studies does not exclude the possibility that low self-esteem can also be considered as an important consequence of such disorders and behavioral problems.

Self-esteem is an important risk and protective factor linked to a diversity of health and social outcomes. Therefore, self-esteem enhancement can serve as a key component in a BSA approach in prevention and health promotion. The design and implementation of mental health programs with self-esteem as one of the core variables is an important and promising development in health promotion.

The authors are grateful to Dr Alastair McElroy for his constructive comments on this paper. The authors wish to thank Rianne Kasander (MA) and Chantal Van Ree (MA) for their assistance in the literature search. Financing for this study was generously provided by the Dutch Health Research and Development Council (Zorg Onderzoek Nederland, ZON/MW).

Abel, E. ( 1998 ) Sexual risk behaviors among ship and shore based Navy women. Military Medicine , 163 , 250 –256.

Abramson, L.Y., Metalsky, G.I. and Alloy, L.B. ( 1989 ) Hopelessness depression: a theory based subtype of depression. Psychological Review , 96 , 358 –372.

Adams, M.J. ( 1996 ) Youth in crisis: an examination of adverse risk factors effecting children's cognitive and behavioral–emotional development, children ages 10–16. Dissertation Abstracts International A: Humanities and Social Sciences , 56 (8-A), 3313 .

Ajzen, I. ( 1991 ) The theory of planned behavior. Organizational and Human Decision Processes , 50 , 179 –211.

Albee, G.W. ( 1985 ) The argument for primary prevention. Journal of primary prevention , 5 , 213 –219.

Alice, E. ( 1993 ) Mediating at risk factors among seventh and eighth grade students with specific learning disabilities using a holistically based model. Dissertation , Nove University.

Andrews, E.J. ( 1999 ) The effects of a self-improvement program on the self-esteem of single college mothers. Dissertation Abstracts International A: Humanities and Social Sciences , 60 (2-A), 0345 .

Angold, A., Costello, E.J. and Erkanli, A. ( 1999 ) Comorbidity. Journal of Child Psychology and Psychiatry , 40 , 57 –87.

Bandura, A. ( 1977 ) Social Learning Theory . Prentice-Hall, Englewood Cliffs, NJ.

Bandura, A. ( 1986 ) Social Foundations of Thought And Action: A Social Cognitive Theory . Prentice-Hall, Englewood Cliffs, NJ.

Baumeister, R.F. ( 1990 ) Suicide as escape from self. Psychological Review , 97 , 90 –113.

Baumeister, R.F., Bushman, B.J. and Campbell, W.K. ( 2000 ) Self-esteem, narcissism and aggression: does violence result from low self-esteem or from threatened egotism? Current Directions in Psychological Science , 9 , 26 –29.

Beck, A., Steer, R.A., Epstein, N. and Brown, G. ( 1990 ) Beck Self Concept Test. Psychological Assessment , 2 , 191 –197.

Beck, A.T., Brown, G.K., Steer, R.A., Kuyken, W. and Grisham, J. ( 2001 ) Psychometric properties of the Beck Self-Esteem Scales. Behavior Research and Therapy , 39 , 115 –124.

Bee, H.L. ( 2000 ) The Developing Child , 9th edn. Allyn & Bacon, Boston, MA.

Benjet, C. and Hernandez-Guzman, L. ( 2001 ) Gender differences in psychological well-being of Mexican early adolescents. Adolescence , 36 , 47 –65.

Block, J. and Gjerde, P.F. ( 1986 ) Distinguishing between antisocial behavior and under control. In Olweus, D., Block, J. and Radke-Yarrow, M. (eds), Development of Antisocial and Prosocial Behavior: Research , Theories and Issues . Academic Press, New York, pp. 117–206.

Bowlby, J. ( 1980 ) Attachment and Loss III: Loss Sadness and Depression . Hogarth Press, London.

Broers, S., Hengeveld, M.W., Kaptein, A.A., Le-Cessie, S., van de Loo, F. and de Vries, T. ( 1998 ) Are pretransplant psychological variables related to survival after bone marrow transplantation? A prospective study of 123 consecutive patients. Journal of Psychosomatic Research , 45 , 341 –351.

Brown, G.W., Bifluco, A. and Andrews, B. ( 1990 ) Self esteem and depression 3. Aetiological issues. Social Psychiatry and Psychiatry Epidemiology , 25 , 235 –243.

Burns, R. ( 1982 ) Self Concept—Developing and Education . Dorset Press, Dorchester.

Campbell, J.D., Chew, B. and Scrathley, L. ( 1991 ) Cognitive and emotional reactions to daily events: the effects of self esteem and self complexity. Journal of Personality and Social Psychology , 59 , 473 –505.

Caplan, N. ( 1974 ) Who's to blame? Psychology Today , 8 , 99 –104.

Carvajal, S.C., Clair, S.D., Nash, S.G. and Evans, R.I. ( 1998 ) Relating optimism, hope and self-esteem to social influences in deterring substance use in adolescents. Journal of Social and Clinical Psychology , 17 , 443 –465.

Chang, A.M. and Mackenzie, A.E. ( 1998 ) State self-esteem following stroke. Stroke , 29 , 2325 –2328.

Coopersmith, S. ( 1967 ) The Antecedents of Self Esteem . Freeman, San Francisco, CA.

Crump, R., Lillie-Blanton, M. and Anthony, J. ( 1997 ) The influence of self esteem on smoking among African American school children. Journal of Drug Education , 27 , 277 –291.

De Vries, H. and Mudde, A.N. ( 1998 ) Predicting stage transitions for smoking cessation applying the Attitude–Social influence–Efficacy Model. Psychology and Health , 13 , 369 –385.

De Vries, H., Dijkstra, M. and Kuhlman, P. ( 1988 a) Self-efficacy: the third factor besides attitude and subjective norm as predictor of behavioral intentions. Health Education Journal , 3 , 273 –282.

De Vries, H., Mudde, A.N., Dijkstra, A. and Willemsen, M.C. ( 1998 b) Differential beliefs, perceived social influences and self-efficacy expectations among smokers in various motivational phases. Preventive Medicine , 27 , 681 –689.

Devlin, S.D. ( 1995 ) Drug use in rural America: what you can do about it. Conference Proceedings of the American Council of Rural Special Education . ACRES, Las Vegas, NV.

Dori, G.A. and Overholser, J.C. ( 1999 ) Depression, hopelessness and self-esteem: accounting for suicidality in adolescent psychiatric inpatients. Suicide and Life Threatening Behavior , 29 , 309 –318.

Erikson, E.H. ( 1965 ) Childhood and Society . Norton, New York.

Erikson, E.H. ( 1968 ) Youth , Identity and Crisis . Norton, New York.

Evans, D.R. ( 1997 ) Health promotion, wellness programs, quality of life and the marketing of psychology. Canadian Psychology , 38 , 1 –12.

Fickova, E. ( 1999 ) Personality dimensions and self esteem indicators relationship. Studia Psychologica , 41 , 323 –328.

Filozof, E., Albertin, H., Jones, C., Sterne, S., Myers, L. and McDermott, R. ( 1998 ) Relationship of adolescent self esteem to selected academic variables. Journal of School Health , 68 , 68 –72.

Fisher, M., Pastore, P., Schneider, M., Pegler, C. and Napolitano, B. ( 1994 ) Eating attitudes in urban and suburban adolescents. International Journal of Eating Disorders , 16 , 67 –74.

Flay, B.R. and Ordway, N. ( 2001 ) Effects of the positive action program on achievement and discipline: two matched- control comparisons. Prevention Science , 2 , 71 –89.

Flay, B.R. and Petraitis, J. ( 1994 ) The theory of triadic influence: a new theory of health behavior with implications for preventive interventions. Advances in Medical Sociology , 4 , 19 –44.

Fleming, J., Mullen, P.E., Sibthorpe, B. and Bammer, G. ( 1999 ) The long-term impact of childhood sexual abuse in Australian women. Child Abuse and Neglect , 23 , 145 –159.

Furnham, A. and Cheng, H. ( 2000 ) Lay theories of happiness. Journal of Happiness Studies , 1 , 227 –246.

Garber, J. and Flynn, C. ( 2001 ) Predictors of depressive cognitions in young adolescents. Cognitive Theory and Research , 25 , 353 –376.

Garmezy, N. ( 1984 ) The study of stress and competence in children: a building block for developmental psychopathology. Child Development , 55 , 97 –111.

Gilbert, S.E. ( 1995 ) Violence in schools: why and what can we do about it? Journal of Health Care , 6 , 205 –208.

Ginsburg, G.S., La Greca, A.M. and Silverman, W.K. ( 1998 ) Social anxiety in children with anxiety disorders: relation with social and emotional functioning. Journal of Abnormal Child Psychology , 26 , 175 –185.

Glick, M. and Zigler, E. ( 1992 ) Premorbid competence and the courses and outcomes of psychiatric disorders. In Rolf, J., Masten, A.S., Cicchetti, D., Nuechterlein, K.H. and Weintraub, S. (eds), Risk and Protective Factors in the Development of Psychopathology . Cambridge University Press, Cambridge, pp. 497–513.

Godin, G. and Kok, G. ( 1996 ) The Theory of Planned Behavior: a review of its applications to health-related behaviors. American Journal of Health Promotion , 11 , 87 –98.

Greenberg, M.T., Domitrovich, C. and Bumbarger, B. ( 2000 ) Preventing Mental Disorders in School-age Children: A Review of the Effectiveness of Prevention Programs . Prevention Research Center for the Promotion of Human Development, College of Health and Human Development, Pennsylvania State University, University Park, PA.

Hammen, C. and Goodman-Brown, T. ( 1990 ) Self schemes and vulnerability in specific life stress in children at risk for depression. Cognitive Theory and Research , 14 , 215 –227.

Haney, P. and Durlak, J.A. ( 1998 ) Changing self-esteem in children and adolescents. A meta analytic review. Journal of Clinical Child Psychology , 27 , 423 –433.

Harrington, R., Rutter, M. and Fombonne, E. ( 1996 ) Developmental pathways in depression: multiple meanings, antecedents and points. Development and Psychopathology , 8 , 601 –616.

Harter, S. ( 1986 ) Processes underlying the construction, maintenance and enhancement of the self-concept in children. In Suls, J. and Greenwald, A.G. (eds), Psychological Perspectives on the Self . Lawrence Erlbaum, Hillsdale, NJ, vol. 3, pp. 137–181.

Harter, S. ( 1990 ) Causes, correlates and functional role of global self worth: a life span perspective. In Kollgian, J. and Sternberg, R. (eds), Perceptions of Competence and Incompetence across Life Span . Yale University Press, New Haven, CT, pp. 67–98.

Harter, S. ( 1999 ) The Construction of the Self. A Developmental Perspective . Guilford Press, New York.

Hay, I., Ashman, A.F. and van Kraayenoord, C.E. ( 1998 ) Educational characteristics of students with high or low self concept. Psychology in the Schools , 35 , 391 –400.

Herbert, M. ( 1987 ) Living with Teenagers . Basil Blackwell, Oxford.

Higgins, E.T. ( 1987 ) Self discrepancy; theory relation self and affect. Psychological Review , 94 , 319 –340.

Higgins, E.T. ( 1989 ) Self discrepancy theory: what patters of self beliefs cause people suffer? In Berkowitz, L. (ed.), Advances in Experimental Social Psychology . Academic Press, New York, vol. 22, pp. 23–63.

Hobfool, S.E. and Walfisch, S. ( 1984 ) Coping with a threat to life: a longitudinal study of self concept, social support and psychological distress. American Journal of Community Psychology , 12 , 87 –100.

Hoffman, M.L. ( 1999 ) Examining sex differences in adolescent adjustment: the effect of competence on gender role in differences in psychopathology. Dissertation Abstracts international: Section B: Science and Engineering , 59 (9-B), 5086 .

Horowitz, L.A. ( 1999 ) The relationship of childhood sexual abuse to revictimisation: mediating variables and developmental processes. Dissertation Abstracts International B: Sciences and Engineering , 60 (4-B), 1855 .

Hosman, C.M.H. (ed.) ( 2000 ) Naar een Geestelijke Gezonde Samenleving: Inleiding in de Preventieve Geestelijke Gezondheidszorg [Towards a Mentally Healthy Community: Introduction in Prevention in Mental Health]. Kluwer, Dordrecht.

Jahoda, M. ( 1958 ) Current Concepts of Positive Mental Health . Basil Books, New York.

Jessor, R., Turbin, M.S. and Costa, F.M. ( 1998 ) Risk and protection in successful outcomes among disadvantaged adolescents. Applied Developmental Science , 2 , 194 –208.

Jones, S. and Heaven, P. ( 1998 ) Psychosocial correlates of adolescent drug-taking behavior. Journal of Adolescence , 21 , 127 –134.

Judge, T.A., Bono, J.E. and Locke, E.A. ( 2000 ) Personality and job satisfaction: the mediating role of job characteristics. Journal of Applied Psychology , 85 , 237 –249.

Kashubeck and Christensen. ( 1993 ) Parental alcohol use, family relationship quality, self-esteem end depression in college. Journal of College Student Development , 36 , 431 –343.

Kihlstrom, J.F. and Cantor, N. ( 1983 ) Mental representations of the self. In Berkowitz, L. (ed.), Advances in Experimental Social Psychology . Academic Press, San Diego, CA, vol. 17, pp. 1–47.

Kressly, J.C. ( 1994 ) Middle level advisory: targeting potential violence before tragedy strikes. Schools in the Middle , 3 , 27 –30.

Lazarus, R.S. and Folkman, S. ( 1984 ) Coping and adaptation. In Gentry, W.D. (ed.), The Handbook of Behavioral Medicine . Guilford, New York, pp. 282–325.

Macdonald, G. ( 1994 ) Self esteem and the promotion of mental health. In Trent, D. and Reed, C. (eds), Promotion of Mental Health . Avebury, Aldershot, vol. 3, pp. 19–20.

Marcia, J.E., Waterman, A.S., Matteson, D.R., Archer, S.L. and Orlofsky, J.L. ( 1993 ) Ego Identity : A Handbook for Psycho-social Research . Springer, New York.

Markus, H. ( 1977 ) Self schemata and processing information about the self. Journal of Personality and Social Psychology , 35 , 63 –78.

Markus, H. and Nurius, P. ( 1986 ) Possible selves. American Psychologist , 41 , 954 –969.

Marsh, H.W. and Yeung, A.S. ( 1997 ) Causal effects of academic self-concept on academic achievement: structural equation models of longitudinal data. Journal of Educational Psychology , 89 , 41 –54.

Miller, P.M., Kreitman, N.B., Ingham, J.G. and Sashidharan, S.P. ( 1989 ) Self esteem, life stress and psychiatric disorder. Journal of Affective Disorders , 17 , 65 –75.

Muha, D.G. ( 1991 ) Dropout prevention and group counseling. High School Journal , 74 , 76 –80.

Nyamathi, A. ( 1991 ) Relationships of resources to emotional distress, somatic complaints and high risk behaviors in drug recovery and homeless minority women. Research in Nursing and Health , 14 , 269 –277.

O'Dea, J.A. and Abraham, S. ( 2000 ) Improving the body image, eating attitudes and behaviors of young male and female adolescents: a new educational approach that focuses on self-esteem. International Journal of Eating Disorders , 28 , 43 –57.

Oliver, J.M. and Paull, J.C. ( 1995 ) Self-esteem and self-efficacy; perceived parenting and family climate; and depression in university students. Journal of Clinical Psychology , 51 , 467 –481.

Overholser, J.C., Adams, D.M., Lehnert, K.L. and Brinkman, D.C. ( 1995 ) Self esteem deficits and suicidal tendencies among adolescents. Journal of American Academy Child and Adolescent Psychiatry , 34 , 919 –928.

Patterson, G.R. and Capaldi, D.M. ( 1992 ) Mediational model for boys depressed mood. In Rolf, J., Masten, A.S., Cicchetti, D., Nuechterlein, K.H. and Weintraub, S. (eds), Risk and Protective Factors in Development of Psychopathology . Cambridge University Press, Cambridge, pp. 141–163.

Patton, W. ( 1991 ) Relationship between self image and depression in adolescents. Psychological Reports , 68 , 687 –688.

Paul, J.P., Stall, R. and Davis, D.F. ( 1993 ) Sexual risk for HIV transmission among gay/bisexual men in substance-abuse treatment. AIDS Education and Prevention , 5 , 11 –24.

Penninx, B.W., van Tilburg, T., Boeke, A.J.P., Deeg, D.J., Kriegsman, D.M. and van Eijk, J.T. ( 1998 ) Effects of social support and personal coping resources on depressive symptoms: different for various chronic diseases? Health Psychology , 17 , 551 –558.

Poikolainen, K., Tuulio-Henrikkson, A., Aalto-Setaelae, T., Marttunen, M. and Loennqvist, J. ( 2001 ) Predictors of alcohol intake and heavy drinking in early adulthood: a 5-year follow-up of 15–19-year-old Finnish adolescents. Alcohol and Alcoholism , 36 , 85 –88.

Reda-Norton, L.J. ( 1995 ) Elementary school predictors of adolescent adjustment problems. Dissertation Abstracts International B: Science and Engineering , 56 (5-B), 2904 .

Reinherz, H.Z., Giaconia, R.M., Pakiz, B., Silverman, A.B., Farst, A.K. and Lefkowitz, E.S. ( 1993 ) Psychosocial risk for major depression in late adolescence. Journal of American Academy for Child and Adolescent Psychiatry , 32 , 1155 –1163.

Reston, V. ( 1991 ) HIV Prevention Education for Exceptional Youth: Why HIV Prevention Education is Important. Office of Educational Research and Improvement, Washington, DC.

Rice, K.G., Ashby, J.S. and Slaney, R.B. ( 1998 ) Self-esteem as a mediator between perfectionism and depression: A structural equations analysis. Journal of Counseling Psychology , 45 , 304 –314.

Rodney, H.E., Mupier, R. and Crafter, B. ( 1996 ) Predictors of alcohol drinking among African American adolescents: Implications for violence prevention. Journal of Negro Education , 65 , 434 –444.

Rogers, T.B. ( 1981 ) A model of the self as an aspect of the human information processing system. In Canton, N. and Kihlstrom, J.F. (eds), Personality , Cognition and Social Interaction . Erlbaum, Hillsdale, NJ, pp. 193–214.

Rolf, J. and Johnson, J. ( 1992 ) The challenges of Aids. In Rolf, J., Masten, A.S., Cicchetti, D., Nuechterlein, K.H. and Weintraub, S. (eds), Risk and Protective Factors in Development of psychopathology . Cambridge University Press, Cambridge, pp. 384–404.

Rolf, J., Masten, A.S., Cicchetti, D., Nuechterlein, K.H. and Weintraub, S. ( 1990 ) Risk and Protective Factors in the Development of Psychopathology . Cambridge University Press, Cambridge.

Rouse, K.A. ( 1998 ) Longitudinal health endangering behavior among resilient and nonresilient early adolescents. Journal of Adolescent Health , 23 , 297 –302.

Rutter, M. ( 1992 ) Psychosocial resilience and protective mechanisms. In Rolf, J., Masten, A.S., Cicchetti, D., Nuechterlein, K.H. and Weintraub, S. (eds), Risk and Protective Factors in the Development of Psychopathology . Cambridge University Press, Cambridge, pp. 181–214.

Sartorius, N. ( 1988 ) Health Promotion strategies: Keynote Address. Canadian Journal of Public Health , 79 (Suppl. 2), s3 –s5.

Scarano, G.M., Gina, M., Kaodner, M. and Cynthia, R. ( 1994 ) A Description of the continuum of eating disorders: implications for intervention and research. Journal of Counseling and Development , 72 , 356 –361.

Schoen. ( 1999 ) The etiology of violence and the voice of the perpetrator. Dissertation Abstracts International B: Science and Engineering , 60 (2-B), 0875 .

Seligman, M.E.P. ( 1975 ) Helplessness . Freeman, San Francisco, CA.

Seligman, M.E.P. ( 1995 ) What You Can Change and What You Can't . Knopf, New York.

Seligman, M.E.P. and Csikszentmihalyi, M. ( 2000 ) Positive psychology: an introduction. American Psychologist , 55 , 5 –14.

Seligman, M.E.P., Reivich, K., Jaycox, L. and Gillham, J. ( 1995 ) The Optimistic Child . Houghton Mifflin, Boston, MA.

Shadmon, O. ( 1998 ) Family and non-family supports as contributors to adjustment in school-aged children with employed mothers. Dissertation Abstracts International B: Science and Engineering , 59 (2-B), 0898 .

Shin, K.R. ( 1993 ) Factors predicting depression among Korean-American women in New York. International Journal of Nursing Studies , 30 , 415 –423.

Shisslak, C.M., Crago, M., Gray, N., Estes, L.S., McKnight, K., Parnaby, O.G., Sharpe, T., Bryson, S., Killen, J. and Barr-Taylor, C. ( 1998 ) The prevention of eating disorders. Studies in eating disorders. In Vandereycken, W. and Noordenbos, G. (eds), The McKnight Foundation Prospective Study of Risk Factors for the Development of Eating Disorders. An International Series . New York University Press, New York, vol. xii, pp. 56–74.

Short, J.L. ( 1998 ) Evaluation of a substance abuse prevention and mental health promotion program for children of divorce. Journal of Divorce and Remarriage , 28 , 139 –155.

Smolak, L., Levine, M.P. and Schermer, F. ( 1998 ) A controlled evaluation of an elementary school primary prevention program for eating problems. Journal of Psychosomatic Research , 44 , 339 –353.

Solomon, S., Greenberg, J. and Pysczynski, T. ( 2000 ) Pride and prejudice: fear of death and social behavior. Current Directions in Psychological Science , 9 , 200 –204.

Somali, A., Kelley, J., Heckman, T., Hackl, K., Runge, L. and Wright, C. ( 2001 ) Life optimism, substance use and AIDS-specific attitudes associated with HIV-risk behaviour among disadvantaged inner city women. Journal of Women's Health and Gender-based Medicine , 9 , 1101 –1110.

St Jeor, S.T. ( 1993 ) The role of weight management in the health of women. Journal of the American Dietetic Association , 93 , 1007 –1012.

Strecher, V.J., DeVillis, B.M., Becker, M.H. and Rosenstock, I.M. ( 1986 ) The role of self-efficacy in achieving health behaviour change. Health Education Quarterly , 31 , 73 –92.

Swendsen, J.D. and Merikangas, K.M. ( 2000 ) The comorbidity of depression and substance use disorders. Clinical Psychology Review , 20 , 173 –189.

Taylor, S. and Brown, J. ( 1988 ) Illusions and well-being: a social psychological perspective on mental health. Psychological Bulletin , 103 , 193 –210.

Teri, L. ( 1982 ) Depression in adolescence: its relationship to assertion and various aspects of self image. Journal of Clinical Child Psychology , 11 , 101 –106.

van der Ham, T., van der Strien, D.C. and van Engelan, H. ( 1998 ) Personality characteristics predict outcomes of eating disorders in adolescents: a 4-year prospective study. European Child and Adolescent Psychiatry , 7 , 79 –84.

Vickers, M.J. ( 1993 ) Understanding obesity in woman. Journal of Obesity and Gynecology , 22 , 17 –23.

Vohs, K.D., Voelz, Z.R., Pettit, J.W., Bardone, A.M., Katz, J. and Abramson, L.Y. ( 2001 ) Perfectionism, body dissatisfaction and self-esteem: an interactive model of bulimic symptom development. Journal of Social and Clinical Psychology , 20 , 476 –497.

Weare, K. ( 2000 ) Promoting Mental and Social Health: A Whole School Approach . Routledge, London.

WHO ( 1986 ) Discussion document on the concept and principles of health promotion. Health Promotion , 1 , 73 –76.

Wilhelm, K., Parker, G., Dewhurst-Savellis, J. and Asghari, A. ( 1999 ) Psychological predictors of single and recurrent major depressive episodes. Journal of Affective Disorders , 54 , 139 –147.

Zimmerman, S.L. ( 2000 ) Self-esteem, personal control, optimism, extraversion and the subjective well-being of midwestern university faculty. Dissertation Abstracts International B: Sciences and Engineering , 60 (7-B), 3608 .

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1Department of Health Education and Promotion, Maastricht University, Maastricht and 2Prevention Research Center on Program Development and Effect Management, The Netherlands

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Mental Health Essay

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Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

Frequently Asked Questions

What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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Speaking Up About Mental Health

National essay contest.

SUBMIT YOUR ESSAY The contest is open to high school students ages 16-18

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December 1, 2023

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Mental health is an important part of overall health across all life stages. However, far too often, symptoms are not addressed or recognized among teens.

Speaking Up About Mental Health is an essay contest that challenges high school students ages 16-18 to raise awareness of mental health. The contest gives students a platform to share ways to eliminate and/or reduce mental health stigma faced by young people, especially in diverse communities.

This contest is soliciting essays that:

Discuss ways to eliminate and/or reduce mental health stigma faced by young people, especially in diverse communities
Share resilience and coping strategies to overcome mental health issues such as social isolation and loneliness, depression, and anxiety
Address mental health stigma
Encourage conversations about mental health, social media, and/or technology
Suggest school policies or practices that could help reduce stigma
Describe barriers to mental health treatment
Cover other areas of concern to individuals and their communities with respect to mental health

Get details on contest rules and submit your entry on Challenge.gov

Promotion toolkit : Help promote the Speaking Up About Mental Health essay contest

The contest is led by:

National Institute of Mental Health

National Institute on Minority Health and Health Disparities

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Page updated Jan. 23, 2024

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Review of mental health promotion interventions in schools

Michelle o’reilly.

1 The Greenwood Institute, University of Leicester, Westcotes Drive, Leicester, LE3 0QU UK

Nadzeya Svirydzenka

2 Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester, LE1 9BG UK

Sarah Adams

3 School of Education, University of Leicester, University Road, Leicester, LE1 7RH UK

Nisha Dogra

The prevalence of mental disorders amongst children and adolescents is an increasing global problem. Schools have been positioned at the forefront of promoting positive mental health and well-being through implementing evidence-based interventions. The aim of this paper is to review current evidence-based research of mental health promotion interventions in schools and examine the reported effectiveness to identify those interventions that can support current policy and ensure that limited resources are appropriately used.

The authors reviewed the current state of knowledge on school mental health promotion interventions globally. Two major databases, SCOPUS and ERIC were utilised to capture the social science, health, arts and humanities, and education literature.

Initial searches identified 25 articles reporting on mental health promotion interventions in schools. When mapped against the inclusion and exclusion criteria, 10 studies were included and explored. Three of these were qualitative and seven were quantitative.

Conclusions

A range of interventions have been tested for mental health promotion in schools in the last decade with variable degrees of success. Our review demonstrates that there is still a need for a stronger and broader evidence base in the field of mental health promotion, which should focus on both universal work and targeted approaches to fully address mental health in our young populations.

Introduction

Globally 10–20% of children and young people experience a mental disorder [ 28 ]; and this is increasing [ 26 ]. Additionally, it is estimated that 50% of adults with disorders experienced them prior to age 15 [ 25 ]. To address this, it is important to pay attention to promotion and prevention practice, with schools being well-placed to deliver. This is because of the amount of time young people spend in this environment [ 49 ]. The focus of this review is therefore, on universal mental health promotion interventions in schools rather than those that target high-risk individuals or where health education is part of the treatment of a mental health disorder.

Mental health promotion and prevention: operational definitions

The World Health Organisation [ 58 ] defines mental health promotion as actions to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles. These include actions to optimise people’s chances of experiencing better mental health. The WHO noted that fundamental to mental health promotion are actions that facilitate an environment that respects and protects basic civil, political, socio-economic and cultural rights. Without the security and freedom provided by these rights, arguably it is difficult to maintain high levels of mental health. The WHO argued that mental health policies should include mental health promotion and not be limited to the health sector, but also involve education, labour, justice, transport, environment, housing, and welfare.

The WHO defines mental illness prevention as encompassing the reduction of incidence, prevalence, and recurrence of illness. Prevention strategies tend to be useful in targeting groups ‘at-risk’ to prevent them from developing disorders. However, although differentiated, it is important to note that the distinction is less rigid for young populations, because children develop skills as they mature [ 3 ] and skill development aimed at promoting well-being can have preventative effects [ 46 ].

Mental health promotion in schools

Schools are pervasive environments in young peoples’ lives and can positively impact on their mental health, mitigating some negative impacts of other social factors. However, for some, schools can present as considerable sources of stress, worry, and unhappiness [ 12 ], which can hinder academic attainment. In focusing on promotion, therefore, it is important to consider the educational context as a natural environment in which it is possible to build rights of agency, security, and personal freedom in young people, whilst recognising any limitations this may have.

Schools are positioned at the forefront of promoting positive mental health. This is an important way of tackling the growing prevalence of mental disorders worldwide. This has prompted the publication of numerous guidelines and policies in how this could be achieved in the UK and internationally. Recently, in England the government pledged that all secondary (high) schools will receive mental health training by 2020 and each school should have a mental health champion [ 38 ]. Similarly, governments in Wales and Scotland have produced policies and statements to advocate the promotion of positive mental health in school-aged children [ 43 , 57 ]. Furthermore, such thinking is reflected internationally as several countries have been exploring ways of integrating health and education [ 2 ].

Evidently, mental health promotion in schools needs to be achieved through the provision of a continuum of intervention programmes. Weist and Murray [ 55 ] argued that these should focus on social and emotional learning, competence for all students, and actively involve young people, schools and communities. The authors further argued that quality is central, and many factors need to be accounted for:

Inclusive approach.
Build programmes responsive to student, school and community needs, building connections between resources.
Focus on reducing barriers to student learning through programmes, based on evidence.
Emphasise and provide support for systematic quality assessment and improvement.
Ensure staff are engaged and supported.
Ensure efforts are sensitive to developmental and diversity factors of students.
Build interdisciplinary relationships in schools, strong teams and coordinating mechanisms.

Weist and Murray [ 55 ] observed that for change to happen, training and involvement from a range of people is needed to create a cultural shift in the educational context. This is mirrored in other western countries, where involvement of several people is considered necessary for successful mental health promotion programmes in schools (e.g. [ 32 , 42 ]). Furthermore, developing partnerships between the health and educational sectors can support meaningful engagement and lasting change [ 50 ].

Whole-school approaches

A ‘whole school approach’ for promoting positive mental health, recognises the importance of working collaboratively with all parts of the school community; students, families and staff, whilst acknowledging the impact of local and government policies [ 18 ]. Adopting this approach advocates that schools should tackle mental health and well-being through their behaviour policy, curriculum design, care and support for young people, as well as staff, and engagement of parents. Internationally, this has been implemented through schools adopting social and emotional programmes; for example, in the USA, the Collaborative for Academic, Social, Emotional Learning [ 8 ], in Australia, KidsMatter [ 10 ] and the UK, Social and Emotional Aspects of Learning (SEAL, DCSF, [ 9 ]). Where implemented, it has been found to not only support positive mental health, but also raise academic attainment [ 37 ].

Despite the outlined benefits of this approach, it is not without challenges. The whole-school approach advocated by many authors (e.g. [ 42 , 48 , 55 ]), may be undermined by:

lack of adequate support (in terms of staff willingness and/or funding)
clarity operationalisation, and consistency in terminology used (this would also need to consider how mental health and illness are conceptualised)
having appropriately trained staff to provide support and supervision, and
engaging young people in the development of the promotion of positive mental health.

Furthermore, recognition of the need to have sustainable multi-sector partnership in mental health promotion offers little guidance about who the partnerships should involve or specific roles of stakeholders. However, it would seem appropriate to engage the wider community and include families, as well as young people and their teachers.

Focus and aims of the review

Research has indicated that many young people worldwide are not well informed about mental health [ 13 , 39 , 40 , 44 , 47 ], and there is a clear need to raise awareness, educate, and provide interventions that facilitate the maintenance of mental well-being in young populations. Mental health promotions are potentially central to the solution, and therefore, it is unsurprising that many interventions that take this approach have been developed.

The focus of our review is on universal interventions of mental health promotion in schools, recognising that universal and target types require different approaches as the aim of the interventions are different. This review aims to examine advancements in mental health promotion in contemporary education, in the context of global austerity in the last 10 years. In presenting this review, it is necessary to be aware that terminology across the educational and health sectors differs [ 42 ] and sometimes mental health promotion is described as positive psychology (e.g. Terjesen et al. [ 51 ]) or emotional health (e.g. Kidger et al. [ 27 ]). This lack of universal terminology makes reviews complex and comparisons challenging. Therefore, for clarity our searches focused on studies that described interventions as promoting mental health and/or well-being.

As noted, the challenge in reviewing mental health promotion is the lack of universality in language and operational definitions of key terms. It is not always clear whether when the term mental health promotion is used, it is consistent with the WHO definition. Additionally, in education, several programmes go under a different title. For example, social and emotional learning (SEAL) is often used and interventions designed to promote effective mastery of social–emotional competencies aim to achieve greater well-being and better school performance by reducing risk factors and promoting protective mechanisms for positive adjustments [ 20 ]. For our review, we focused on searching for positive mental health promotion interventions as defined by the WHO, including social and emotional well-being, to capture an inclusive overview of the work that has been done.

Inclusion and exclusion criteria

To ensure included studies focused on mental health promotion interventions in schools we utilised the literature to facilitate our identification of appropriate inclusion and exclusion criteria. Studies eligible were:

Written in English.
Published between 1 January 2007 and 30 November 2017 for three reasons; (1) because there were reviews conducted in the early millennium that captured earlier work (e.g. Wells et al. [ 56 ]); (2) a decade is a sufficient time-frame to examine impact and change; and (3) captures recent policy changes that may impact on design and delivery of interventions.
Universal mental health promotion (or equivalent) (these should be different from targeted approaches as the interventions for universal and targeted interventions have different aims, objectives, intervention type and audience).
Whole-school interventions, programmes, frameworks, models, and tools, involving many levels of school personnel.
Target population was school age (that is, children of any age who are attending school. This spectrum varies internationally, but is generally from 3 to 18 years), and included any type of school (e.g. public, private, special, residential).
Original research.

We also provided parameters by identifying exclusion criteria:

Not published in English.
Not book chapters, editorials or guidance documents.
Not focused on risk factors or related to these.
Not reporting planning and development, and not pilots of interventions (as these would only present feasibility and would not be conclusive).
Not those interventions targeting children with pre-existing mental health problems.

Search strategy

Two large database systems were utilised for the search which captured the multidisciplinary nature of mental health promotion. First, was SCOPUS, a database that captures science, medicine, social science, arts and humanities research. Second, was ERIC, a database of the literature in the field of education. A range of search terms were utilised by two of the authors to ensure the searches were consistent. There were three independent searches across the two databases and these were:

Mental health AND promotion AND schools
Positive AND mental AND health AND promotion AND schools AND NOT illness
Mental health promotion AND well-being AND intervention AND schools

The top 100 results for each key-word combination based on relevance were searched as relevance dropped significantly after this point. This produced 25 articles that appeared to be appropriate. These were mapped against criteria and narrowed to 10 intervention studies.

When matched against the inclusion and exclusion criteria, a total of ten papers were returned. Three of these utilised a qualitative design and seven quantitative design. The literature was well spread globally (e.g. UK, Australia, USA, Sweden, Denmark, Germany, Ireland) and included different interventions, all of which were targeted at the general population of young people in schools. We organised our findings around four main issues: (1) the theoretical framework underpinning the intervention; (2) support, training and supervision for staff implementing the intervention; (3) outcomes of the interventions and (4) long-term impact. The findings were subsequently summarised and an overview of the articles is presented in Table 1 .

Description of studies

Theoretical frameworks

Most interventions were reported to be underpinned by a theoretical framework, but these were variable. Six studies reported a clear theory underpinning the intervention, and two described the theoretical position of the methodology; two of the studies made no explicit reference to theory. Mostly, studies were underpinned by the framework of a whole-school approach and/or a child-centred approach to mental health promotion [ 1 , 11 , 16 , 21 , 32 ], although the underpinning theoretical framework was not always clear in the way it was described. Neilsen et al. [ 32 ] integrated this whole–school approach framework in the intervention evaluation with an Action Competence focus, linking democracy, participation and empowerment [ 7 ]. Franz and Paulus [ 17 ] utilised the theoretical position of a resource-based conceptual theory, which balances internal and external needs and resources (see Becker, [ 4 ] [non-English publication] in Franze and Paulus, [ 17 ]) and did not make explicit reference to the whole-school framework, but did include school personnel in the implementation.

Support, training, and supervision of staff

A challenge for any intervention is, in part, dependent upon those who deliver it. Notably, seven of the interventions were delivered by teachers, although in one case this was implied rather than stated. Two of the interventions were delivered by specialists including physiotherapists [ 22 ] and educational psychologists [ 21 ]. For one intervention, the authors did not provide clear details [ 11 ]. The support, training, and supervision of teachers during the intervention was described in five of the seven papers that reported staff involvement. For some, training was provided via a workshop [ 32 ] and for others, through training sessions. Some staff had continued support and supervision [ 29 ], but many did not. Interventions delivered by school staff were also reported to be supported by instruction manuals. Most of these interventions were described as structured [ 1 , 16 , 17 ].

Mental health outcomes

In reviewing the interventions, all but two clearly reported a positive impact. Eight of the ten interventions highlighted some degree of impact and argued that the intervention was a successful mental health promotion tool. Notably, two interventions did not produce such positive results. Lendrum et al. [ 31 ] reported that the national SEAL programme had no significant impact, and this was the case in all schools. They noted that there were several barriers to success, including, challenges and confusion regarding implementation, staff skills and training needs, lack of awareness, reluctance of staff, poor communication and limited coordination of the whole-school approach. Similarly, Fitzpatrick et al. [ 16 ] found few differences following the comparison of a standard versus an enhanced intervention programme for mental health promotion. They argued that the difference between the enhanced and the standard programme may be too small to have a statistically significant effect on outcomes.

Long-term impact

Although most of the interventions demonstrated degrees of success in promoting mental health and well-being, the papers were less clear about the sustainability and maintenance of this success. The eight interventions reporting a positive impact highlighted variability in the long-term outcomes, mostly projecting the potential of the intervention and arguing that long-term evaluations are necessary [ 1 , 17 , 32 ]. Two of the interventions were tested over longer periods of 3- and 2-years [ 11 , 29 ] respectively, which suggested some sustainability. However, some caution must be exercised as most of the long-term outcomes in terms of mental health promotion were not known and authors argued that commitment from the schools and further evaluations are required in future. Indeed, interventions that showed no change demonstrated that flexibility of the intervention can cause confusion for implementation suggesting the need to balance prescriptive guidelines and flexible adaptations with school culture and ethos [ 31 ].

Overall results

This review has contextualised the broader literature on mental health promotion and specifically explored advancements of universal interventions in the last decade. The results demonstrated that there has been limited advancement of this field. Specifically, we have shown that terminology remains variable, there is still limited evaluation of long-term impacts, and there remains inconsistency regarding the people chosen to run the interventions, with their qualifications and training being varied. Like previous reviews in this area, we demonstrated that methods used were of variable quality, some authors were vague in their descriptions of the intervention, and there was not always clarity regarding sources of funding. Somewhat surprisingly, there was a lack of digital interventions, using AI, informatics, robotics, social media, or internet-based approaches.

Globally, there is continued development and implementation of various interventions in schools designed to promote positive mental health, and yet the effectiveness of most of these is not well evaluated [ 1 ]. If we are to move forward and make advances in mental health promotion and help young people cope with daily stresses, we need a better understanding of the outcomes and possible ways of sustaining them. Over the last decade, several mental health promotion interventions have been evaluated and were included in this review.

Universal school-based interventions have great potential to target large populations of young people to promote well-being at a general level. Indeed, this is a common approach taken by schools. Over time, several interventions has emerged based on different theoretical frameworks ([ 11 , 17 , 21 , 29 , 32 ], to name a few). A unifying factor that often underpins or is central to these universal approaches is the whole-school approach, or at least an approach that requires the cooperation of different levels of school personnel, wider communities, and other agencies. Previous reviews over the last couple of decades on the beneficial effects of mental health, social, emotional and educational outcomes have shown that a whole-school approach sustained for more than a year is positive for health promotion and prevention. These conclusions were supported by Weare and Murray [ 53 ] who found that a multi-dimensional and integrated whole-school approach is needed for mental health promotion to be effective and to create positive change in the well-being of young people. A more recent review highlighted that for positive outcomes to be achieved, any intervention must be sequenced in the sense that the activities need to be coordinated, incorporating an active form of learning, focused on personal or social skills and explicitly targeting specific skills rather than positive development [ 15 ].

However, these interventions also showcase variability in outcomes, challenges of concepts and ideas, difficulties in implementation and attitudes, and issues of sustainability. Early reviews by Wells and colleagues [ 56 ] showed a large variation in type and quality of publications and our review demonstrates that the situation has barely changed since. The quality of evidence has been appraised as generally low-to-moderate, with many studies relying on students’ accounts of their own behaviour, with some studies suffering from high attrition rates [ 30 ]. Therefore, while popularity of the universal whole-school approach is undeniable, shortcomings of these interventions need to be addressed. Green et al. [ 19 ] stated that “while the limited information from the reviews makes it difficult to comment on universal approaches to mental health promotion, whole-school approaches to the promotion of social and emotional health implemented over years appear to be more effective than brief class-based programmes aimed at preventing mental health problems”. However, like previous reviews, our findings demonstrated that considerable methodological issues remain.

Challenges of using interventions

The core challenge for successful mental health promotion is that most of the school-based interventions reported tended to be short-term with little long-term follow-up. Furthermore, they were also often evaluated immediately or shortly after the intervention. However, there is increasing evidence that some long-term effects are emerging and that although effects gradually decrease over time they can remain substantial [ 54 ].

Although some whole-school approaches related to mental health promotion have found fewer advantages than others, sometimes this is attributed to a lack of consistent, rigorous and faithful implementation of the overall programme and/or lack of support for teachers administering it [ 29 ]. For example, in a survey of 599 primary and 137 secondary schools in the UK, two-thirds of schools adopted universal approaches, but gaps in teacher training and support were identified as problematic [ 52 ]. For schools with limited resources or those that place high demands on teachers’ time, it may be more beneficial that the universal whole-school approach in the mental health promotion is set aside in favour of a smaller scale targeted intervention that is more manageable and sustainable. The crucial challenge of either model of intervention would be to effectively and consistently engage the learners (that is the young people themselves) in development and delivery.

In attempts to bolster schools’ responsibilities for catering for young peoples’ mental health, funding for schools in England has been provided to ensure all schools have a trained ‘mental health champion’ by 2020 [ 38 ]. By having an identified and trained responsible member of staff, this may alleviate some of the challenges faced in implementing a whole-school approach. The ‘mental health champion’ will be able to act as a strategic lead in implementing interventions designed to promote positive mental health, whilst also monitoring the impact and cost effectiveness. However, this raises issues for schools, as training will be central to successful implementation, but training for teachers cannot tackle mental health promotion in isolation from the practical difficulties of supporting children who have diagnosed conditions [ 41 ]. Additionally, while training teachers is a positive move to address the large-scale issues, in isolation it will not form the solution as it needs to be part of a continued process supported by greater funding for child mental health [ 24 ] otherwise it risks being a “sticking plaster solution” to the challenge [ 45 , n.p]. Currently, the Welsh government is piloting specialist CAHMS workers to act as a link between schools and CAHMS whereby school staff are supported to cater for the mental health of their pupils whilst also having support in place when more specialist interventions are needed [ 57 ].

Achieving the goals of mental health promotion, and implementing interventions, relies heavily on good quality evidence, and yet much work in this area is not sufficiently evidence-based [ 52 ]. Vostanis et al. argued that there is a clear need to improve this situation. These improvements could include more effective evaluation methodologies (e.g. rationalisation and operationalisation of selected theoretical frameworks and models, methods and instruments used), explicit application procedure of interventions, and details of teacher training and support packages [ 36 ]. Evidently, the popularity of a ‘one approach fits all’ needs to be matched with rigorous systematic development, recognising contributing/challenging factors as well as application and measurement across different populations, school systems, and wider cultural contexts. Additionally, more work needs to include the ‘child’s voice’, to be child-centred and respect children’s rights, and therefore, there is a need for more qualitative work in this area.

Strengths and limitations

This review is not without its limitations. First, to provide a targeted and focused message about mental health promotion in schools, we have been prescriptive in the search terms used to identify the scope of the literature. Given a broader search, we might have included papers that have not utilised specific terminology in their interventions. Additionally, research conducted prior to 2007 was not included, and this work may not have been replicated or evaluated since. These studies were excluded from the review as arguably they may not account for contemporary policy and older reviews may exist which evaluate that work. Second, we have only included results published in English, and therefore, rely on research that has been promoted through English publication streams. While included papers did offer an international perspective in terms of interventions across different educational systems in different countries, the sample remained focused on the developed world. No papers looked at mental health promotion efforts in schools in developing countries, which is an area of great significance in terms of mental health outcomes for young people. This is probably missing from the review due to publishing language barriers and/or research not being undertaken in this area as resources are often even more limited in the developing world. Therefore, the current review and discussion is limited in its applicability to countries with similar development profiles to the ones included. However, arguably, factors of effective and sustainable mental health promotion interventions outlined here could be applicable across variety of cultural contexts, albeit untested.

Directions for future research

In their review, Weare and Nind [ 53 ] identified that the characteristics of high-quality programmes that were successfully implemented include:

A sound theoretical base with specific, well-defined goals that were communicated effectively.
Focus on the desired outcomes.
Explicit guidelines and through training, which is quality assured.
Complete and accurate implementation.

This list of recommendations is consistent with the need for high-quality training interventions in any field [ 14 ]. Weare and Nind [ 54 ] argued that much of the evidence related to mental health work in schools would support that these characteristics will be beneficial in implementation, although the benefits may be small and not sustained, as supported by our review findings. The authors, however, argued that even change that is small in statistical terms may translate into a significant impact on well-being and this is something that should be explored.

Nonetheless, it is evident from our review, that there is still a need for a stronger and broader evidence base in the field of mental health promotion, which should focus on both universal work and targeted approaches to fully address mental health in our young populations. In terms of intervention development, research has demonstrated that it is essential to include young peoples’ views when developing interventions to ensure a child-centred approach and support at a whole-school level [ 21 , 35 ] and thus the co-development of programmes could be helpful. Further to this is the need to develop teachers’ understanding, competence and confidence in delivering and sustaining mental health promotion with their pupils [ 31 ], as research shows that teachers are resistant to holding too much responsibility in terms of mental health and lack confidence [ 34 ]. Methodologically, interventions need to be able to adapt to school culture and available resources while still offering measurable set of outcomes. More attention needs to be paid to the culture of schools as part of any intervention, as there may be little value in implementing programmes when it is already known that the factors needed for their success are not in place at the time or are not sustainable in long-term (e.g. if funding/support expires with termination of the research project). Furthermore, rigour and quality in the evaluation of interventions also needs attention. Programme effectiveness, safety, and cost is not always as rigorous and robust as it could be [ 30 , 33 ] and therefore, attention to the quality of studies is essential for future examinations of interventions. Validation tools can go some way to addressing these issues [ 5 ].

Our review has demonstrated that there is some success for interventions, many of which were underpinned by the whole-school approach or similar frameworks. This was also the case for other intervention types that were not so broad in scope. However, training teachers in delivery was important and long-term outcomes unclear. Thus, building on previous work, we have demonstrated that there remain gaps in knowledge, that there are issues with sustainability of universal approaches, and that success, to some extent, relies on cooperation, training and involvement of the schools and the young people themselves. Furthermore, modes of delivery and the nature of the interventions are important and need to appeal to young people. This could be facilitated by more scoping work in terms of digital health promotion. In a digital age, with digital tools, mobile apps, robotics, social media and the internet all forming a central part in daily life, there is potential to integrate a whole-school approach with digital interventions, and there is room to be creative with universal mental health promotion.

Compliance with ethical standards

Conflict of interest.

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Contributor Information

Michelle O’Reilly, Email: ku.ca.el@41ojm .

Nadzeya Svirydzenka, Email: [email protected] .

Sarah Adams, Email: ku.ca.el@1acjs .

Nisha Dogra, Email: ku.ca.el@31dn .

The Top 10 Bad Outcomes of Social Media Use, According to Students

The downsides of social media use are getting a lot of attention in 2024.

The year started with Facebook founder Mark Zuckerberg getting grilled in a congressional hearing about the negative impact of social media use on children. The U.S. House passed a bill in March to ban the use of TikTok in the United States, and the Senate is considering a similar measure. And at the end of March, Florida Gov. Ron DeSantis signed one of the country’s most restrictive state social media bans for minors that is scheduled to go into effect in January.

Addressing adolescents’ worsening mental health recently has become a top priority for school, district, state, and federal leaders as young people struggle with record-high rates of depression and anxiety. And much of the conversation around the mental health crisis has centered on young people’s constant use of cellphones and social media.

Custom illustration of a young female student in a meditative pose floating above a cell phone. She is surrounded by floating books and wide range of emotions reflected by different emojis. Digital / techie textures applied to the background.

“Children have been sold this belief that the more [social media] connections they have, the better off they are,” said Lisa Strohman , a clinical psychologist who specializes in technology-overuse issues and is featured in Education Week’s Technology Counts report. [But] their relationships are not deep, they’re not authentic.”

As part of its Technology Counts report, the EdWeek Research Center surveyed 1,056 high school students across the country about a whole host of issues related to social media use. The survey was conducted Feb. 9 through March 4.

One question asked students what negative consequences they had experienced as a result of their social media use. The question gave them 25 possible options to pick from. Here is a look at the top 10 answers:

1. I believed information I later learned was fake.

2. i was too tired to do what i needed to do because i didn't get enough sleep., 3. i have used social media, but i cannot think of any negative outcomes i experienced as a result., 4. i got in trouble with my parents/family/home., 5. my self-esteem got worse., 6. i was bullied., 7. i embarrassed myself., 8. i lost a friend or friends., 9. it made me feel more isolated/alone., 10. my grades/test scores got worse..

Data analysis for this article was provided by the EdWeek Research Center. Learn more about the center’s work.

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Call for Papers - December 2024

Call for papers - dec 2024.

call for papers for the YJBM December 2024 issue on Viruses and Autoimmunity

Call for manuscripts - Viruses and Autoimmunity Submission Deadline: June 19, 2024 Publication Date: December 2024

The Yale Journal of Biology and Medicine ( YJBM ) will be publishing an issue devoted to the topic of Viruses and Autoimmunity. We are inviting authors to submit original research articles, reviews, case reports, or perspectives within this field. Specific subtopics include:

Molecular mechanisms
Public health burden
Global trends and epidemiology
SARS-CoV-2 and Long COVID
Treatments: existing and experimental
Pre-existing autoimmunity, viral infection, and vaccination
Viral evolution in immunosuppressed hosts
Case reports

If you are unsure whether your manuscript matches with the issue topic, please reach out to Deputy Editors RuthMabel Boytz ( [email protected] ) and Evan Navori ( [email protected] ).

YJBM is a PubMed-indexed, open-access journal whose mission is to provide graduate students and medical students with experience in writing, reviewing, and publishing articles. The journal has been in publication since 1928 and is supported by an Editorial Board made up of both students and faculty members. Manuscripts are peer-reviewed by faculty in the field and there is no publication fee. The YJBM has a Scopus CiteScore of 5.4 for 2022 and an Impact Factor of 3.434 for 2021.

The length of the manuscript can vary depending on the article type. You can find guidelines for authors on our website ( https://medicine.yale.edu/yjbm/authorguidelines/index.aspx ). As part of YJBM ’s diversity efforts, we offer double-blind peer review. Reviewer bias (conscious or otherwise) should not affect the science that is published. While we encourage you to submit an anonymized manuscript, we also accept unblinded submissions for single-blind review, where only the reviewer names are kept anonymous.

International edition
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Volodymyr Zelenskiy at a press conference in Odesa.

Zelenskiy calls for operational changes to Ukraine military after sacking commander

President demands ‘new level of medical support for soldiers’ as questions mount over speed of counteroffensive against Russia

Volodymyr Zelenskiy has demanded rapid changes in the operations of Ukraine’s military and announced the dismissal of the commander of its medical forces.

The Ukrainian president’s move was announced on Sunday as he met defence minister, Rustem Umerov, and coincided with debate over the conduct of the 20-month-old war against Russia , with questions over how quickly a counteroffensive in the east and south is proceeding.

“In today’s meeting with defence minister Umerov, priorities were set,” Zelenskiy said in his nightly video address. “There is little time left to wait for results. Quick action is needed for forthcoming changes.”

Zelenskiy said he had replaced Maj Gen Tetiana Ostashchenko as commander of the medical forces.

“The task is clear, as has been repeatedly stressed in society, particularly among combat medics, we need a fundamentally new level of medical support for our soldiers,” he said.

This, he said, included a range of issues – better tourniquets, digitalisation and better communication.

Umerov acknowledged the change on the Telegram messaging app and set as top priorities digitalisation, “tactical medicine” and rotation of service personnel.

Ukraine’s military reports on what it describes as advances in recapturing occupied areas in the east and south and last week acknowledged that troops had taken control of areas on the eastern bank of the Dnipro River in southern Kherson region.

Ukrainian commander in chief, Gen Valery Zaluzhny, in an essay published this month, said the war was entering a new stage of attrition and Ukraine needed more sophisticated technology to counter the Russian military.

While repeatedly saying advances will take time, Zelenskiy has denied the war is headed into a stalemate and has called on Kyiv’s western partners, mainly the United States, to maintain levels of military support.

Ostashchenko was replaced by Maj Gen Anatoliy Kazmirchuk, head of a military clinic in Kyiv.

Her dismissal came a week after a Ukrainian news outlet suggested her removal, as well as that of others, was imminent after consultations with paramedics and other officials responsible for providing support to the military.

Meanwhile on Sunday, air defence units in Moscow intercepted a drone targeting the city, mayor Sergei Sobyanin said.

Sobyanin, writing on the Telegram messaging app, said units in the Elektrostal district in the capital’s east had intercepted the drone.

According to preliminary information, falling debris resulting from the operation had caused no casualties or damage, Sobyanin said.

Volodymyr Zelenskiy

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Call for Papers
Call for manuscripts - Viruses and Autoimmunity. Submission Deadline: June 19, 2024. Publication Date: December 2024. The Yale Journal of Biology and Medicine ( YJBM) will be publishing an issue devoted to the topic of Viruses and Autoimmunity. We are inviting authors to submit original research articles, reviews, case reports, or perspectives ...
Zelenskiy calls for operational changes to Ukraine military after
President demands 'new level of medical support for soldiers' as questions mount over speed of counteroffensive against Russia