Concept of mental health and mental well-being, it's determinants and coping strategies

INTRODUCTION Over the years, besides the focus on mental disorders, the focus has shifted to mental health and well-being. In contrast to mental disorders, the concept of mental health and mental well-being is important for everyone in society. The World Health Organization (WHO) defines health as "a state of complete physical, mental and social well-being, not merely the absence of disease" (WHO, 2020).1 Accordingly, it can be said that since the beginning the WHO has integrated the concept of well-being into its definition of health. Three core concepts crucial to enhancing health emerge from the definition of health as per the WHO.2 Mental health is an intrinsic component of overall health, mental health encompasses more than just the absence of illness, and mental health is intricately intertwined with physical health and behavior. Defining mental health is crucial, but it is not necessarily required for its improvement. Value differences between countries, cultures, classes, and genders may appear to be too significant to allow for agreement on a definition. However, just as age and wealth have many diverse manifestations worldwide while maintaining a basic common-sense universal meaning, mental health can be defined without limiting its interpretation across cultures.2 The WHO defines mental health as follows: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 contribute to his or her community. It is a crucial element of health and well-being that supports both our individual and group capacity to decide, form connections, and influence the world we live in.3These WHO definitions differentiate between subjective happiness or life satisfaction (hedonic well-being) and positive psychological functioning (eudaimonic well-being).4 The American Psychological Association describes the concept of mental health as follows:5Mental health is a state of mind characterized by emotional well-being, good behavioural adjustment, relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive relationships and cope with the ordinary demands and stresses of life.5While this definition represents significant progress in moving away from the conceptualization of mental health as the absence of mental illness, it raises several concerns and lends itself to potential misunderstandings by identifying positive feelings and positive functioning as key factors for mental health.6 Researchers and health organizations acknowledged the difficulty in reaching a consensus on mental health due to cultural variations and sought to construct an inclusive definition while avoiding restrictive assertions. While it was commonly understood that mental health is more than the absence of mental disease, there was no universal agreement on equating mental health with well-being or functioning, resulting in a definition that includes a wide range of emotional states and "imperfect functioning."6 The proposed new definition by Galderisi et al.6 states that "Mental health is a dynamic state of internal equilibrium that enables individuals to use their abilities in harmony with the universal values of society. Basic cognitive and social skills; ability to recognize, express and modulate one's own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind represent important components of mental health which contribute, to varying degrees, to the state of internal equilibrium." CONCEPT OF POSITIVE MENTAL HEALTH It has been conceptualized as a positive emotion that leads to a feeling of happiness. The personality traits of people with positive mental health include psychological resources of self-esteem, mastery, and resilience, which is the capacity to cope with adversity and avoid a breakdown when confronted by stressors. Such people have the capacity to master their environments, and they have the ability to identify, confront, and solve problems. Mental health is clearly influenced by cultural, socioeconomic, and political situations.2 Mental health has intrinsic values, as described as follows.2 Mental health is critical for an individual's well-being and functioning. Good mental health is a valuable resource for individuals, families, communities, and nations. Mental health, as an integral component of overall health, contributes to societal functions and has an impact on overall productivity. Everyone is concerned about mental health because it is generated in our daily lives in our homes, schools, workplaces, and leisure activities. Good mental health contributes to a society's social, human, and economic capital. Spirituality can contribute significantly to the development of mental health, and mental health influences spiritual life.7 Culture and mental health Each culture has an impact on how people perceive and comprehend mental health. Understanding and sensitivity to culturally valued characteristics will boost the relevance and success of prospective treatments.2 Race, ethnicity and genetic- its influence on mental health and mental well-being Race and ethnicity, along with genetic factors, play complex roles in shaping mental health and well-being. Social determinants linked to race and ethnicity can contribute to disparities in access to mental health care and resources, impacting mental well-being. Genetic factors influence vulnerability to certain conditions, but interactions with the environment and experiences are vital. For instance, the "diathesis-stress" model highlights how genetic predisposition interacts with stressors.8 These intertwined factors underscore the need for culturally sensitive care and a comprehensive understanding of mental health influences. Culture significantly shapes perceptions of well-being, influencing emotional expression, social support systems, and coping strategies, ultimately impacting an individual's mental well-being. Mental health and social capital The idea of "social capital" has been central to the recent renaissance in thinking about social connectivity and health promotion. According to Putnam (1995), social capital "refers to features of social organization such as networks, norms, and social trust that facilitate coordination and cooperation for mutual benefit."9 Social capital is also impacted by economic and social conditions. Research over the previous two decades has shown relationships between social capital and economic development and the efficiency of human service systems and neighborhood improvement.2 According to Woolcock (1998), having more social capital can protect individuals from social isolation, create a sense of social security, lower crime, enhance education and societal functioning, and enhance job performance.10 There are continuous research and discussion on the connections between social capital, physical health, and mental health and the viability of promoting mental health to boost social capital. The strength of social capital lies in its capacity to view the world from a fresh perspective, considering both environmental and social factors and associated social groups. In contrast to aggregated individual health outcomes, this perspective on networks of people interacting with their environments offers the potential to explain a wider range of collective outcomes.2 Mental well-being The concept of mental well-being has developed over time in response to advances in domains, such as psychology, medicine, sociology, and public health. Initially, a focus on mental illness, with an emphasis on diagnosing and treating problems, typically overshadowed mental well-being. However, in recent decades, there has been a paradigm shift toward a more holistic and positive perspective on mental health. However, the term "mental well-being" can be ambiguous at times, as it may or may not indicate the absence of mental illness or distress. Well-being has been highlighted as an indicator of national prosperity and has been associated with enhanced physical and mental health.3 Mental well-being is characterized by the following: Optimal physical and behavioral health Life's purpose Active participation in enjoyable work and play Pleasant relationships Contentment Mental health and mental well-being are different phenomena. Ill mental health or mental disorders are characterized by abnormal psychological patterns, emotional distress, and impaired functioning. The Adult Psychiatric Morbidity Survey 2007 showed that mental well-being has relatively independent associations with symptoms of mental illness.11 It is possible for mental well-being to persist even when experiencing mental suffering.11 The determinants and variations of mental well-being among individuals with mental health issues are less studied and understood compared with those without such problems.11 Mental well-being can fluctuate with the phases of mental illnesses, which often involve relapses and remissions. The number, frequency, and duration of relapses may influence the variation in mental well-being.11 Defining well-being is crucial for understanding and discussing mental health and public mental health, but it has been the subject of much debate and some controversy in recent years. Well-being falls outside the medical model of health, as it is not a diagnostic entity. It is widely recognized that subjective well-being differs significantly among individuals, as well as the factors that influence it.12 Mental well-being aligns closely with the WHO's comprehensive and positive definition of health and with the positive psychology approach promoted by Seligman. A similar approach to defining mental well-being is used by faculties of public health in the UK.12 Seligman's proposed PERMA model of psychological well-being as mention in Figure 1.13Figure 1: Five core elements of psychological well-being Seligman's PERMA model 13 Social inclusion and well-being Wellness is inextricably linked to social elements that can either support or obstruct social inclusion. It is obvious that a variety of obstacles, such as trauma, poverty, unemployment, and other bad social situations, can all have a substantial impact on the onset of behavioral health issues in individuals. These issues not only have an impact on people's mental and emotional well-being, but they can also lead to a larger marginalization of people, limiting their access to critical social resources, such as education, economic opportunities, leisure activities, cultural involvement, and healthcare services. Recognizing this, it becomes critical for us as a society to actively participate in the process of building vibrant, holistic, and inclusive communities. We can try to close the gaps generated by these by creating an environment that appreciates and prioritizes well-being. MENTAL WELL-BEING AND QUALITY OF LIFE Mental well-being refers to a positive state of emotional, psychological, and social health, characterized by a sense of contentment, resilience, and the ability to effectively cope with life's challenges. It encompasses positive emotions, a sense of purpose, and the capacity to engage in fulfilling relationships and activities. Quality of life, however, is a broader concept that encompasses various domains of an individual's life, including physical health, psychological well-being, social relationships, environment, and personal goals. It reflects an individual's overall satisfaction with their life circumstances and their perceived ability to pursue their aspirations. Mental well-being is a key component of overall quality of life (QoL), as positive mental health contributes significantly to an individual's perception of their life's value and fulfillment. Although there are many methods for defining mental well-being, such as dimensional categorization as shown in Figure 2, mental well-being is thought to have both subjective and objective components.12Figure 2: Objective and subjective dimensions of mental well-beingAlthough the concept of QoL has been now used for more than half a century, there still needs to be more consensus on the definition of QoL. As per the WHO, QoL is defined as "an individual's perception of their position in life in the context of the culture and value systems in which they live and about their goals, expectations, standards and concerns".14 It is further clarified that QoL refers to a subjective assessment rooted in the person's cultural, social, and environmental context. Besides this, there are other definitions of QoL too. Wenger et al.15 defined QoL as "an individual's perceptions of his or her functioning and well-being in different domains of life." Another definition that only focuses on positive aspects of life defines QoL as "The essential characteristics of life, which in the general public is often interpreted as the positive values of life, or the good parts of life, or the total existence of an individual, group or society".16 Although it is emphasized that QoL is more of a subjective judgment, some of the researchers have argued that QoL is determined by a host of objective parameters and, accordingly, define QoL as "an overall general well-being that comprises objective descriptors and subjective evaluations of physical, material, social, and emotional well-being together with the extent of personal development and purposeful activity, all weighted by a personal set of values".17 There have been some efforts to distinguish QoL from other related concepts, especially in the context of health and diseases. QoL differs from symptoms of an illness or disability arising from the illness. In the context of any illness, QoL should be understood as the perceived effect of the illness by the person on their life (WHO, 2020). QoL also should not be understood as the same or similar to lifestyle, life satisfaction, mental state, or well-being. QoL is understood as the perception of the individual about their life, whereas "well-being" is more of an indication of positive emotions and satisfaction or contentment, with a lack of long-standing and persistent negative emotions. QoL also should not be equated with the standard of life, which is determined by wealth or material goods.18 NEUROBIOLOGY OF MENTAL WELL-BEING The concept of mental well-being has several dimensions and includes a variety of cognitive, emotional, and social components. It refers to a state involving complete psychological and emotional well-being that is defined by pleasant emotions, efficient functioning, and a feeling of fulfillment in life. A complex combination of neuronal circuits, neurotransmitters, hormones, and brain areas underlies the neurobiology of mental health. Here are some significant neurobiological aspects of mental well-being listed in Table 1.Table 1: Various hypotheses of the neurobiological model of well-beingRelationship between mental health and well-being The relationship between mental health and well-being can be viewed from two perspectives: the dual continuum model and the single continuum model.12 The dual continuum model sees mental health and well-being as separate but related, allowing for high well-being despite a mental illness diagnosis. The single continuum model integrates mental well-being into mental health on a spectrum, suggesting that improving overall population well-being can reduce mental illness prevalence. Although evidence supports a single continuum model for common mental health disorders, controversies persist in promoting mental health and measuring population well-being, particularly for severe and enduring mental illness. Mental health is a vital aspect of human life, affecting individuals, society, and culture. It contributes to well-being, productivity, and prosperity at both individual and societal levels. Being an inseparable part of general health, mental well-being is crucial for proper functioning in society and impacts various aspects of life. Positive mental health brings about significant social, human, and economic benefits, fostering growth and development in every society. Measuring mental well-being Measuring mental well-being is critical for gaining a better understanding of people's psychological health and general QoL. It entails evaluating a variety of factors, such as good emotions, life satisfaction, and a sense of purpose. Researchers and policymakers obtain vital insights into mental health promotion and intervention initiatives by investigating these variables. Effective assessment methods aid in the identification of areas for improvement and in assisting individuals in their pursuit of optimal well-being. Table 2 shows the scales used in measuring mental well-being.Table 2: Scales for assessment of well-beingMeasurement of Well-being and Quality of life: Different instruments have been developed to assess well-being over the years. As well-being is subjective, most of the instruments used to evaluate well-being are self-reported. The length of these instruments varies from a single-item global life satisfaction question to multiple-item scales assessing different components of well-being. Some of the available scales are listed in Table 2. Among all these scales, the WHO-5 Well-Being Index is possibly the only available in about not in any of the The various available QoL instruments can be into QoL instruments and those that are Some of the standard QoL instruments include World Health Organization World Health Organization Quality of Health Survey and involving with various physical in QoL. 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