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1、MindHealth Index 2023AbstractA synopsis of the research and development effort undertaken to develop the AXA Mind Health Index as part of the Global AXA Mind Health Study 2023.This paper includes updates in relation to the second year of the survey,including new questions,formulation of new models,i
2、ndices,concept validation and field testing of the new survey.2 I AXA Mind Health Index 2023Opening statement from DrChris Tomkins2023 is the first year in which we can make year-on-year comparisons in order to provide insight to governments,employers and citizens about the trends in Mind Health.The
3、 development of the AXA Mind Health Index from over 200 scientific papers gave us a robust platform from which to widen the discussion from mental ill health to a broader view to include the ingredients of good mind health.This is important because stress,anxiety and low mood are reaching epidemic p
4、roportions,but are often rooted in our lifestyle,work and environment.The study was very successful in 2022 when we were able to draw a distinction between struggling,languishing,getting by and flourishing.This gives us a more stable view of where an individual is on the spectrum of mind health,what
5、 factors put them there and,most importantly,what can we do as individuals and as a society to help everyone flourish.The core index has changed little from 2022,with minor amendments to language.The scope has been expanded to other attributes such as Wellbeing Locus of Control,Gratification and Kin
6、dness and Loneliness.The design of the Index continues to be an international effort,involving expertise from multiple countries and we are delighted to have expanded to a further five countries giving us a more global footprint.Our focus this year has been now to apply the Index to gender,youth and
7、 the work lives.Last year we saw that women were more likely to struggle and men more likely to flourish,and this year we set the ambition to explain the drivers behind that.The insights around peoples lived experiences and the impact on whether they flourish are probably some of the most striking f
8、rom this years report.With both youth and workplaces we are seeing how developments at a societal level,whether it is the always-on society,technology or new models of work,fundamentally contribute to or detract from good mind health.Such is the wealth of insight this year,we have not been able to a
9、ddress it all in the Global Report,so for the first time we will be producing a series of addendum reports,andwe will continue to mine for furtherinsightsthroughout theyear.My sincere thanks to the scientific designand researchteamsin AXA UK,our team of internationalexperts,Ipsos our fieldwork partn
10、erandtheAXAResearch Fund.Dr Chris Tomkins,Head of Wellbeing Propositions,AXA Health UKTable of contents04 Background04 Introduction05 Core questions06 Predictors Preventive actions/skills06 Authentic pride06 Challenge response rumination06 Delayed gratification(new in MHI23)06 Emotional competency(r
11、evised in MHI23)06 Exercise06 Kindness/giving(new in MHI23)07 Locus of control(revised in MHI23)07 Meaning/purpose07 Me time07 Mindfulness(revised in MHI23)07 Nutrition07 Openness to experience(new in MHI23)07 Optimism08 Positive actions08 Resilience08 Self-acceptance08 Self-efficacy08 Sleep08 Socia
12、l connectedness08 Wellbeing locus of control(new in MHI23)09 Modifiers09 Attachment style09 The health care system09 Current and past mental healthconditions10 Outcomes Supplementary questions MHI2311 Gender theme11 Stigma11 Workplace Questions dropped from previous survey Previous reports12 AXA rep
13、ort on mental health and wellbeinginEurope12 AXA study of mind health and wellbeing in 202213 Methods Fieldwork and statistics Literature review14 Factor selection criteria14 Question level selection14 Causality14 Reverse causality14 Self-reporting Index creation Other indices16 Introduction16 List
14、of sub-indices18 Appendix A Questions used in creating thevariousindices19 Validation19 Summary Summary4 I AXA Mind Health Index 2023 AXA Mind Health Index(MHI)and Survey white paperBackgroundAXA is a major global investor and philanthropist in multiple health topics.Following the success of its fir
15、st Mind Health Study in 2020,during the pandemic,AXA decided to develop the first Mind Health Index(MHI)in 2021 which was used to survey over 11,000 participants from 8European and 3 Asian countries.This global report(MHI22)was released in early 2022.The success of the survey resulted in an ongoing
16、commitment by AXA to track the MHI over the subsequent 5-year period,with an extended offering to an additional fivecountries.This second MHI survey,MHI23,was conducted on over 30,000 participants from 16 countries in September/October 2022,spanning 3 continents,welcoming the America region.Introduc
17、tionMind health includes our emotional,psychological,and social wellbeing.It affects how we think,feel,and act.It also helps determine how we handle stress,relate to others,and make choices.1 In 2020 AXA identified an opportunity to contribute meaningfully to the knowledge base of mental health thro
18、ugh a survey that leveraged expert-inspired pan-European insights.The subsequent 2021 survey was shaped by the global backdrop of COVID-19,and as a result,identified concrete levers and coping strategies which allowed people,employers and society to flourish.The first survey sought to not only asses
19、s aspects of mental health across participating countries,but also gauge the impact of COVID-19 on mental health.The 2022 survey shifted focus from COVID-19 to new areas of interest the workplace,young people,climate change and gender.The latest survey includes all eleven countries from the previous
20、 survey(Belgium,France,Germany,Ireland,Italy,Spain,Switzerland,UK,Mainland China,Hong Kong and Japan),in addition to a further five countries Mexico,Philippines,Thailand,Turkey and the USA.The goal of the report is to provide scientifically backed insights into mind health related topics for multipl
21、e audiences:the general public,employers,insurance industry,consulting partners,and government.1 https:/www.mentalhealth.gov/basics/what-is-mental-health5 I AXA Mind Health Index 2023Core questionsThe survey consists of two main categories of questions:a)A static component(the index)which remains un
22、changed year on year,thereby allowing changes over time to be accurately and comparatively tracked,andb)A dynamic component of supplementary questions that are updated annually to provide insights into current themes and topics of interest.As in the previous year,we used a systems approach to help u
23、nderstand the aetiology and maintenance of mind health.2 Using this framework,we sought to understand the factors that impact mind health at the individual,social and societal levels.A benefit of taking a multidimensional approach is that it provides a more holistic understanding of mental health an
24、d wellbeing,and as a result provides greater insight into how mind health can be supported and improved.Our previous research identified areas of importance for mental health promotion and overall mind health.Subsequent research for MHI23 identified other factors which expanded the scope of the seco
25、nd survey.The core questions fell into 3 groups.These are also outlined in detail in the previous MHI White Paper,3 however a brief synopsis is provided here:1)Predictors individual skills and behaviours that have some predictive capability in terms of mental health outcomes(e.g.exercise is a predic
26、tor of mental health,itreduces stress,anxiety and depression,whilst improving life satisfaction via multiple pathways)2)Outcomes positive and negative mental health outcomes.On the negative side-stress,anxiety and depression,on the positive side happiness and lifesatisfaction.The behaviours and skil
27、ls in the predictor group impact mental health outcomes,but they are impacted by an intermediary pathway:modifiers.3)Modifiers factors that mediate the degree to which the predictors impact outcomes.These include factors such as the health care system,intractable personality traitssuch as attachment
28、 style,as well as past and currentmental health conditions.The MHI score is an aggregation of these three sub-indices.2 Bronfenbrenner,U.,&Ceci,S.J.(1994).Nature-nurture reconceptualised:A bio-ecological model.Psychological Review,10(4),568586.3 Mind Health Index 2022.A synopsis of the development o
29、f the AXAMindHealth Index.A key component of AXAs MHI strategy is to track the changing mind health of participants in the post COVID-19 era.It was therefore important that the key questions from which the MHI score is derived remained largely unchanged.6 I AXA Mind Health Index 2023PredictorsPreven
30、tive actions/skills Authentic prideAuthentic pride is related to feelings of confidence and achievement and is associated with a psychologically healthy and socially desirable personality profile marked by high levels of agreeableness and conscientiousness,intrinsic motivation,perseverance,and a ten
31、dency to engage in a range of prosocial behaviours,including empathy and respect.4 Whereas hubristic pride is viewed as arrogant and self-serving,authentic pride exudes accomplishment,conviction,and success.Challenge response ruminationDwelling on mistakes(rumination)and being overly self-critical h
32、as been found to negatively impact mental health and wellbeing.5 Rumination is essentially the opposite of resilience.Resilient people move on more quickly,whereas ruminators tend to find it hard to move on.Delayed gratification(new in MHI23)Delayed gratification is the ability to resist temptation
33、of an immediate pleasure in the expectation of obtaining a valuable and long-lasting reward in the longer-term.It is a pivotal component of emotional intelligence,and studies have shown that the ability to delay reward is present in highly successful people and is associated with better mental healt
34、h outcomes.Delayed gratification is evident in children as young as four years of age and appears to be a potent predictor of success in later life,as demonstrated by Walter Mischel of Stanford University in the legendary Marshmallow Test in 1972.6 The phenomenon appears to be pervasive in the anima
35、l kingdom,having been demonstrated in creatures as diverse as chimpanzees to cuttlefish(Sepia officinalis).7Emotional competency(revised in MHI23)Emotional competency is the degree to which people successfully utilise EQ related skills.8 Self-awareness,emotional self-regulation,social awareness and
36、social skills represent the foundations of good EQ.A higher EQ can improve lifelong physical and mental health even more than academic ability.According to a 2018 report,people with a high EQ are 8 times more likely to have a high quality of life compared to those with lower scores.9ExerciseThe bene
37、fits of physical activity have been demonstrated definitively across a broad range of both physical and psychological health.Physical activity has been found to reduce symptoms of anxiety and depression.10 Exercise participation has been linked to the prevention of mental health problems11 and as li
38、ttle as 16 weeks of regular exercise has been found to be equally as effective as antidepressant medication in treatment of mild to moderate depression.12Kindness/giving(new in MHI23)Giving and acts of kindness are pro-social behaviours that have been shown to improve immune function and stimulate t
39、he production of serotonin in both the recipient and the person extending the kindness.Even those observing the actof kindness have similar beneficial results.13Research has also found that participation in voluntary services is significantly predictive of better mental and physical health,life sati
40、sfaction,self-esteem,happiness,lower depressive symptoms,psychological distress,andmortality and functional inability.144 Tracy,J.L.,&Robins,R.W.(2014).Conceptual and empirical strengths of the authentic/hubristic model of pride.Emotion,14(1),3337.5 Psychological Processes Mediate the Impact of Fami
41、lial Risk,Social Circumstances and Life Events on Mental Health;Kinderman,P.et al,Published:October 16,2013 https:/doi.org/10.1371/journal.pone.0076564.6 Mischel,Walter;Ebbesen,Ebbe B.(1970).Attention in delay of gratification.Journal of Personality and Social Psychology.16(2):329337.7 Schnell,Alexa
42、ndra K.;Boeckle,Markus;Rivera,Micaela;Clayton,Nicola S.;Hanlon,Roger T.(10 March 2021).Cuttlefish exert self-control in a delay of gratification task.Proceedings of the Royal Society B:Biological Sciences.288.8 Moradi,A.,et al,(2011),The Relationship between Coping strategies and Emotional Intellige
43、nce,Procedia-Social and Behavioral Sciences,30:748-751.9 State of the Heart 2018:https:/www.6seconds.org/2018/09/05/state-of-the-heart-2018.10 Callaghan,P.(2004).Exercise:a neglected intervention in mental health care?Journal of psychiatric and mental health nursing,11(4),476-483.11 Sui,X.,Laditka,J
44、.N.,Church,T.S.,Hardin,J.W.,Chase,N.,Davis,K.,&Blair,S.N.(2009).Prospective study of cardiorespiratory fitness and depressive symptoms in women and men.Journal of psychiatric research,43(5),546-552.12 Blumenthal,J.A.,et al,(2007).Exercise and Pharmacotherapy in the Treatment of Major Depressive Diso
45、rder.Psychosomatic Medicine,69(7),587596.13 Dyer,Wayne(2011),The Power of Intention.14 Yeung JWK,Zhang Z,Kim TY.Volunteering and health benefits in general adults:cumulative effects and forms.BMC Public Health.2017 Jul 11;18(1):8.doi:10.1186/s12889-017-4561-8.Erratum in:BMC Public Health.2017 Sep 22
46、;17(1):736.7 I AXA Mind Health Index 2023Locus of control(revised in MHI23)Locus of control represents the degree to which we perceive to have control over our lives.Perceived control over outcomes in life(i.e.internal locus of control)is associated with good health and wellbeing,while relying on ch
47、ance and/or powerful others(i.e.external locus of control)is related to stress and poor health.15 Individuals with an internal locus of control attribute the events in their life primarily to their own doing.An internal locus of control has been found to positively correlate with the ability to cope
48、 with stress and negatively with depression,anxiety and interpersonalproblems.16Me time Time out for self is fundamental to life balance which is linked to positive mental health outcomes.Pushing through life without taking time out can lead to burnout,exhaustion,immunosuppression and consequently,m
49、ore frequent and severe illness.Once considered an indulgence,Me time is now considered a vital inclusion in any mental health self-care strategy.17Meaning/purposeMeaning and purpose in life are predictive of emotional wellbeing and result in better recovery from negative life events.18 A literature
50、 review of thirty-two papers on meaning in life and mental health found overwhelmingly that relationships,particularly relationships with family,are cited as the most important source of meaning in peoples lives in all cultures and age groups.19 This review also found that failure to address meaning
51、lessness can lead to psychopathologies such as depression,anxiety,addiction,aggression,hopelessness,apathy,lower levels of wellbeing,physical illness,and suicide.Mindfulness(new in MHI23)Mindfulness is a way of paying attention to the present moment,using techniques like meditation,breathing and yog
52、a.It helps people become more aware of their thoughts and feelings,in a non-judgemental fashion,so that instead of being overwhelmed,they are better able to manage them.Studies show that mindfulness-based approaches can significantly reduce the symptoms of anxiety and depression.They can also help p
53、eople who have had multiple depressive episodes to avoid relapsing.20NutritionMultiple studies have demonstrated the relationship between nutrition and mood disorders such as depression.Studies comparing traditional diets,like the Mediterranean diet and the traditional Japanese diet,to a typical Wes
54、tern diet have shown that the risk of depression is 25%to 35%lower in those who eat a traditional diet.21 Changes in eating habits are also a common symptom of mood disorders.Openness to experience(new in MHI23)Openness to experience is one of the Big 5 domains which are used to describe human perso
55、nality in the Five Factor Model.22 Openness to experience refers to ones willingness to try new things as well as engage in imaginative and intellectual activities.People who score low on openness to experience prefer routine.They are uncomfortable with change and trying new things,so they prefer th
56、e familiar over the unknown.On the whole,openness appears to be largely unrelated to symptoms of mental disorders23 but does have significant(positive)associations with happiness,positive affect,and quality of life.24OptimismOptimism is a tendency to see the positives;a glass half full vs half empty
57、 mentality.This is important because how we see the world and events around us has a big impact on our mental wellbeing and quality of life.25 Through the deployment of specific coping strategies,optimism also exerts an indirect influence on quality of life.Optimistic people consistently outperform
58、neutral or pessimistic people in quality of life measures.Optimism influences mental and physical wellbeing by promoting a healthy lifestyle,as well as by adaptive behaviours and cognitive responses associated with greater flexibility,problem-solving capacity and a more effective processing of negat
59、ive information.2615 Reknes,I.,et al(2019),Locus of Control Moderates the Relationship Between Exposure to Bullying Behaviors and Psychological Strain,Frontiers in Psychology,6th June 2019.16 Madhu,J.and Suyesha,S.(2015),Locus of control and its relationship with mental health and adjustment.Journal
60、 of Mental Health and Human Behaviour,Vol 20:1,pp 16-21.17 Fredrickson,B.(2002).Positive emotions.In C.Snyder&S.Lopez(Eds.),Handbook of positive psychology(pp.120 134).New York,NY:Oxford University Press.18 Schaefer,Stacey M et al,(2013),Purpose in life predicts better emotional recovery from negati
61、ve stimuli.PloS one Vol.8(11).19 Glaw X,Kable A,Hazelton M,Inder K.Meaning in Life and Meaning of Life in Mental Health Care:An Integrative Literature Review.Issues Ment Health Nurs.2017 Mar;38(3):243-252.20 The Mindful Initiative(UK),(2015),A Report by the Mindfulness All-Party Parliamentary Group.
62、21 Selhub,E.,(2020),Nutritional psychiatry:Your brain on food,Harvard Health Publishing,March 26,2020.22 Digman JM(1990).Personality structure:Emergence of the five-factor model.Annual Review of Psychology.41:41740.23 Malouff,John M.;Thorsteinsson,Einar B.&Schutte,Nicola S.(2005).The relationship be
63、tween the five-factor model of personality and symptoms of clinical disorders:a meta-analysis.Journal of Psychopathology and Behavioral Assessment.27(2):101114.24 Steel,Piers;Schmidt,Joseph&Shultz,Jonas(2008).Refining the relationship between personality and Subjective wellbeing.Psychological Bullet
64、in.134(1):138161.25 Taylor,S.E.,&Brown,J.D.(1988).Illusion and wellbeing:a social psychological perspective on mental health.Psychological bulletin,103(2),193.26 Conversano,C.,et al(2010).Optimism and its impact on mental and physical wellbeing.Clin Pract Epidemiol Ment Health.6:2529.8 I AXA Mind He
65、alth Index 2023Positive actionsThe positive actions constitute those factors which are both predictive of mental health,and internal to the individual.These factors can be self-managed for improved mentalhealth.ResiliencePsychologists define resilience as the process of adapting well in the face of
66、adversity,trauma,tragedy,threats,or significant sources of stress such as family and relationship problems,serious health problems,or workplace and financial stressors.As much as resilience involves bouncing back from these difficult experiences,it can also involve profound personal growth.27 Lack o
67、f resilience means the adverse psycho-emotional consequences of the threat linger well after the threat has passed,exacerbating its impact.Ameta-analysis of 60 studies showed that lack of resilience was correlated to negative indicators of mental health.28Self-acceptance Self-acceptance is defined a
68、s an individuals acceptance of all of their attributes,positive or negative.29 Historically,self-acceptance has long been a stimulus for personal improvement in Eastern and Western religion and culture,as well as in psychological literature.Different theologies(e.g.,Christianity,Buddhism),psychologi
69、cal theories(e.g.,Humanism),and therapies(e.g.,RET,CBT)view self-acceptance as a mechanism for reducing emotional misery.Self-acceptance supports the progression towards happiness and fulfillment.Research continues to show that self-acceptance is strongly related to mental health and wellbeing in pe
70、ople of all ages.For example,it has been found to influence the differential risk of being a member of aminority group on mental health.30Self-efficacy Belief in ones abilities underpins successful self-management of behaviour;without self-belief,the incentive to engage in protective/preventive acti
71、ons in relation to mental health is undermined.Poor self-belief therefore not only lowers the likelihood of success,it lowers the likelihood of an attempt to succeed.Research has found that self-efficacy ameliorates the effects of daily stressors on mental health,with the strongest relationship bein
72、g found between self-efficacy and positive mental health.31Sleep Sleep disturbances have been shown to be an important factor in many different mental health difficulties,both contributing to their development and then being a key source of distress for the individual involved.32Social connectedness
73、From the very young,to the very old,social relationships promote health and wellbeing.There is evidence to support the role of our social networks in both protecting from negative mental health and facilitating positive psychological health.33 Conversely,loneliness has been described as a hidden epi
74、demic found to be as damaging to our health assmoking 15 cigarettes a day.34Wellbeing locus of control(new in MHI23)Whereas locus of control is generalised to a whole of life situation,wellbeing locus of control is a relatively new concept that limits the context to control of factors affectingwellb
75、eing.A fundamental underlying assumption of positive psychology is that an individual can influence their wellbeing through their own behaviour.Research published in 2021 was the first to validate the concept of Wellbeing Locus of Control(WB-LOC)and develop a multidimensional scale with which to mea
76、sure it(WB-LOC12).35 This new scale showed robust psychometric properties and a WB-LOC question was therefore included in the MHI23 survey.27 American Psychological Society(2012)https:/www.apa.org/topics/resilience.28 Tianqiang Hu,et al(2015),A meta-analysis of the trait resilience and mental health
77、.Personality and Individual Differences,Vol.76,pp.18-27.29 Pillay,S.(2016).Greater self-acceptance improves emotional wellbeing.Journal of Medical School,1(1),1-13.30 Shilo,G.,&Savaya,R.(2011).Effects of family and friend support on LGB youths mental health and sexual orientation milestones.Family R
78、elations,60(3),318-330.31 Schnfeld,P.,Brailovskaia,J.,Bieda,A.,Zhang,X.C.,&Margraf,J.(2016).The effects of daily stress on positive and negative mental health:Mediation through self-efficacy.International Journal of Clinical and Health Psychology,16(1),1-10.32 Scott,A.J.,Webb,T.L.,Martyn-St James,M.
79、,Rowse,G.,&Weich,S.(2021).Improving sleep quality leads to better mental health:A meta-analysis of randomised controlled trials.SleepMedicine Reviews,101556.33 https:/www.gse.harvard.edu/news/21/02/combatting-epidemic-loneliness.34 Holt-Lunstad,J.,&Uchino,B.(2015).Social support and health.Health be
80、havior:Theory,research and practice,183-204.35 Farnier,J.,Shankland,R.,Kotsou,I.et al.(2021),Empowering Well-Being:Validation of a Locus of Control Scale Specific to Well-Being.J Happiness Stud 22,35133542.9 I AXA Mind Health Index 2023ModifiersModifiers are also predictive,but they can be external
81、or personal factors.We chose to use the mental health continuum as a universal outcome measure in the MHI(from poor to optimum mental health).Mental health conditions can therefore be viewed as modifiers that can impact on the outcome measures.Thepositive actions individuals use(knowingly or not)del
82、iver the mental health outcomes via modifiers,which gives us the MHI model.Positive actions Modifiers OutcomesMany modifiers are simple demographics such as age/gender,education and socio-economic status,but factors such as past/current mental health conditions,attachment style and access to health
83、care also play an important role in moderating the impact of actions on outcomes.A simple manifestation of the model is that,given a certain skill set shared by two people,say resilience and optimism,its easy to accept that the mental health outcomes for these two people may differ depending on thei
84、r age,socio-economic status and knowledge of the health care system.Attachment style Attachment theory describes the dynamics of human relationships,in particular when people are feeling distressed,in need,scared or under threat.The human need for attachment is said to have arisen out of evolutionar
85、y pressures for infants to elicit the care and protection of their caregivers in order to ensure survival.Research in the 1960s and 70s showed that infants develop different patterns of attachment behaviour depending primarily on their experiences in these early relationships.36 Four categories have
86、 been identified:secure,insecure avoidant,insecure anxious and fearful avoidant.An adults attachment style has been shown to be an important predictor in their ability to cope with stressful life events and predicts their utilisation of mental health services.37 The health care systemMental health d
87、ifficulties are responsible for 32%of years of disability and 13%of disability adjusted life years(DALYs)globally.38 In addition,those with mental health difficulties face increased rates of morbidity from general medical conditions and a higher risk of premature mortality.39 Amongthose with mental
88、health difficulties,disparities in quality and outcomes of care are more pronounced forracial/ethnic minorities,and those of lower socio-economicstatus.Those with severe mental health conditions(e.g.,schizophrenia and bipolar disorder)constitute an increasingly marginalised population whose needs ou
89、tstrip the available health care resources in almost every country in the world.40 It is estimated that life expectancy is reduced by up to 25 years in these groups.Despite the contribution of mental health difficulties to the global burden of disease,the quality of care for these disorders remains
90、suboptimal,and there are persistent gaps in access to and receipt of mental health services worldwide.41The six characteristics that determine quality of care in mental health are safety,effectiveness,patient-centred,timely,efficient,and equitable care.42Current and past mental health conditionsDiag
91、nosed mental health conditions are a powerful modifier of mental health outcomes.We asked participants about their personal history regarding the major mental health conditions using DSMV/ICD11 groupings as outlined below.n Depressionn Anxiety disorder,phobia or PTSDn Substance abuse disordern Eatin
92、g disorder(i.e.Anorexia/bulimia/binge eating disorder etc.)n Schizophrenia,bipolar or related disordersn Obsessive-compulsive disordern Other/prefer not to sayThe number and type of current or past mental health conditions was combined with the participants self-rating of how well the condition is/w
93、as managed to derive an overall score for these factors.A single well managed condition was scored more favourably than multiple poorly managedconditions.We also queried how a condition was diagnosed,and how it was managed.This enabled us to look at differential outcomes for self-diagnosis vs profes
94、sional diagnosis,as well as for different management strategies(i.e.self-managed,GP/psychologist/psychiatrist managed,with or without medication etc.).36 Ainsworth,M.D.S.,Blehar,M.C.,Waters,E.,&Wall,S.N.(1978).Patterns of Attachment:A Psychological Study of the Strange Situation.Hillsdale:Erlbaum.37
95、 Adams GC,Wrath AJ,Meng X.The Relationship between Adult Attachment and Mental Health Care Utilization:A Systematic Review.The Canadian Journal of Psychiatry.2018;63(10):651-660.38 Vigo,D.,et al(2016),Estimating the true global burden of mental illness,The Lancet Psychiatry 3(2):171-178.39 https:/ww
96、w.who.int/news-room/fact-sheets/detail/depression.40 Saraceno,B.,(2002),Mental health resources in the world:results from Project Atlas of the WHO.World Psychiatry,1(1):40-44.41 Amy M.Kilbourne et al(2018),Measuring and improving the quality of mental health care:a global perspective,World Psychiatr
97、y,Vol 17(1):30-38.42 US Institute of Medicine.Crossing the quality chasm:a new health system for the 21st century.Washington:National Academies Press,2001.10 I AXA Mind Health Index 2023OutcomesOutcomes were classified as either positive or negative emotional outcomes.For negative emotional outcomes
98、,we used the single item stress questionnaire(SISQ)to determine self-rated stress over the previous 12 months.This was combined with the Depression,Anxiety and Stress Scales(DASS)which quantified these three variables over the previous week.Thedifference in time frames highlighted differences in res
99、ponses to one-week stress and 12-month stress,perhaps an impact of the post pandemic situation.Positive emotions were assessed using happiness and life satisfaction questions derived from the high scoring Cronbachs Alpha questions from our literature review andthe Mental Wellbeing Assessment pilot s
100、tudy.Supplementary questions MHI23To add context to the model,and to facilitate a deeper understanding of its power,additional questions were included in the survey.Although these items were scored for analytical/statistical purposes,they do not contribute to the calculation of the final Index.Numer
101、ous changes were made to the non-scored questions to facilitate a deeper understanding through statistical analysis of the report themes youth,gender workplace,and financial wellbeing.The addition/subtraction of supplementary questions represent an annual update that is designed to give the MHI cont
102、ext and relevance in relation to items/issues of significance at the time.MHI23 represented a move away from the COVID-19 focus of the previous year,to a focus on topical matters including mind health in the context of youth,gender,climate change,and the workplace.As the list below demonstrates,the
103、new supplementary questions in MHI23 cover a diverse array of topics relevant toour focus areas for this year.n Body Imagen Bullying and harassmentn Child/elder caren Climate changen Control over workflow and conditionsn Discriminationn Distress caused by long working hoursn Divorce/separationn Dome
104、stic abusen Drugs and alcoholn Equity and inclusionn The economyn Gender inequalityn Illness/pandemicn Intention to leave/resign(from work)and its driversn Isolation home vs office workn Job demands vs resources(JD-R model)n Job fitn Job securityn Lonelinessn Productivity work from home vs work from
105、 officen Rising prices/cost of livingn Reward and recognitionn Role clarityn Sexismn Short,medium and long-term financial securityn Societal expectationsn Support for mental health at work n Tech addiction/social media/always onn Training and developmentn Unemploymentn Unequal domestic responsibilit
106、iesn Wage inequalityn Warn Work ethicn Work life balancen Workplace cultureResponses to these survey questions allow us to answer questions such as:Does financial pressure impact stress,anxiety and depression?If so,is it related to age,gender,country or any of the skills known support emotionalwellb
107、eing?Does workplace culture,job security or work-life balance impact life satisfaction?Does a supportive work environment mitigate against the negative impact ofbullying and feeling harassed?11 I AXA Mind Health Index 2023Gender theme The MHI22 report highlighted a gender gap in flourishing.We ask a
108、bout gender in terms of how a person thinks of themselves.We were able to identify some factors that contributed to the gap in flourishing.However,many questions remained unanswered as to why men were more likely to be flourishing than women and non-binary people.As a result,we revisited the literat
109、ure to help craft additional questions to better understand the flourishing gap.We reviewed two papers which used an open data source to find patterns in the reports of peoples lived experiences.43,44 Theresearchers used text mining and topic modelling to uncover emerging themes.The three key themes
110、 found were:n Sex discrimination n Gender harassment n Unwanted sexual attention Based on the literature we developed questions to cover each theme.The unwanted sexual attention questions were asked in the context of a work environment and therefore only answered by the working population.The sex di
111、scrimination and gender harassment questions were not work specific and therefore could be answered by all participants.As a result,the lived experiences metric is based on these two questions(see Appendix A).This year with a larger sample size we are able to report further insights on non-binary pe
112、oples experiences and mental health outcomes.However,to maintain a suitable sample size,fewer filters can be applied to this population.Finally,further questions were included this year to explore the prevalence and differential degree of impact of different societal factors on wellbeing.The followi
113、ng topics were anticipated to also influence the gender flourishing gap:body image,unequal domestic responsibilities and societalexpectations.Stigma Research has consistently demonstrated the adverse effects of stigma on the mental health of minority groups.Arecent meta-analysis on the associations
114、between stigma and mental health from 49 empirical studies found the correlation between stigma and average mental health scores was 0.28.45 Stigma can therefore account for nearly 10%of the deterioration in mental health observed in minority groups.Workplace Workplace stress routinely rates in the
115、top three sources of stress for the employed population.Data from the Harvard School of Public Health shows that workplace issues contribute significantly to stress in 53%of workers,third behind too many responsibilities overall(54%)and problems with finances(53%).46 According to the UK Health and S
116、afety Executive(HSE),the six main areas that lead to work related stress are demands,lack of control over workflow,inadequate support,relationship issues,poor role fit and change.47Questions dropped from previoussurveyThe majority of non-core questions retired from the MHI22 survey for related large
117、ly to the main theme from last year the pandemic.n Job loss due to pandemicn Factors impacting happiness and wellbeingn Coping skills(what helped people manage psycho-social wellbeing during the pandemic)n Productive and destructive challenge responsesn Demographics most impacted by pandemicn Satisf
118、action with family(parent/partner/children)n Impact of pandemic on childcare43 Karami,A.,Swan,S.C.,White,C.N.,&Ford,K.(2019).Hidden in plain sight for too long:Using text mining techniques to shine a light on workplace sexism and sexual harassment.Psychology of Violence.44 Melville,S.,Eccles,K.,&Yas
119、seri,T.(2019).Topic modeling of everyday sexism project entries.Frontiers in Digital Humanities,5,28.45 Mak,W.S.et al(2007),Meta-analysis of stigma and mental health,Social Science&Medicine,Volume 65,Issue 2,July 2007,Pages 245-261.46 NPR/Robert Wood Johnson Foundation/Harvard School of Public Healt
120、h(2014),The Burden of Stress in America,https:/cdn1.sph.harvard.edu/wp-content/uploads/sites/21/2014/07/Burden-of-Stress-Report-July-7-2014.pdf.47 https:/www.hse.gov.uk/stress/causes.htm12 I AXA Mind Health Index 2023Previous Mental Health and Mind Health Reports from AXA Committed to studying and s
121、haring extensive findings on the topic of mental health,AXA first published its 2020 Report on Mental Health&Wellbeing in Europe.Focused on Western Europeans,5,800 citizens from seven European countries were surveyed.Countries included were UK,Switzerland,Italy,Spain,France,Belgium andGermany.The su
122、ccess of this activity inspired the expansion of the study to form an international index.A collaborative research program was initiated across multiple AXA country leaders,supported by academic experts to establish a scientific and evidence-based survey,advanced models,and extensive insights.The AX
123、A Study of Mind Health and Wellbeing in 2022 and the Mind Health Index aims to provide an empirical approach to understanding the mental health of multiple countries,with a rich comparative view to support strategic and meaningful analysis.Both the AXA Report on Mental Health&Wellbeing in Europe and
124、 the AXA Study of Mind Health and Wellbeing in 2022 reports can be accessed on AXAs website.The current Mind Health Index 2023 builds upon this previouswork,but as an annually run survey,COVID-19 was de-emphasised to make way for more topical factors,relevance and continuity.13 I AXA Mind Health Ind
125、ex 2023Fieldwork and statisticsIpsos,a global leader in market research performed the survey fieldwork.They conducted online interviews with consumers 18-74 years old,recruited via an online consumer panel.At the end of fieldwork the data has been weighted to make the sample match the general popula
126、tion in terms of distributions of gender,age,region and occupation.In addition,when comparisons were made with results from the previous wave,the sample profiles were matched between waves on distributions of income and education.The method used by Ipsos is the RAS method:Ranking Adjust Statistics.A
127、ll reported outcomes are based on weighted data.The precision of the Ipsos online poll is calculated using a Credibility Interval.Bayesian Credibility Intervals operate much in the same way as classical margins of error,but acknowledge the uncertainty of an estimate(in our case,the probability that
128、any given person completes an online survey),and incorporate external factors,such as what we know about the world,opinions,expertise,context,history and other data into its calculation to correct for theunknown.Bayesian models allow generalisation from a sample to a population,since they correct fo
129、r unbalanced samples due to non-response,coverage or other biases.One does not need to know the actual probabilities of selection,which arenearly impossible to ascertain in online polling.Applying this approach to the 16 participating countries/territories,the polling is deemed accurate to within+/-
130、3.5 percentage points in countries/territories with sample size of 1,000(Philippines and Thailand),and+/-2.5 percentage points in those with a sample size of 2,000(remaining 14countries/territories).There were some cohorts that were under-represented following the initial survey of 30,000 people.In
131、order to reach the nationally representative sample targets,Ipsos completed another 636 surveys in China,Thailand and HongKong.Literature reviewThe 2021 extensive literature was leveraged for the 2022 survey.This review revealed dozens of skills and strategies related to effective psycho-emotional s
132、elf-management that were considered candidates for inclusion due to their established validity and reliability as constructs supporting good mental health.These skills/strategies,which have been described earlier,often sit within various frameworks/models such as PERMA,48 Psychological Capital,49 Bi
133、opsychosocial,50 Complete State,51 the Five Factor model,52 Emotional Intelligence,53 and variousothers.54Many of these constructs overlap,with some considered a subset of others(i.e.EQ encompasses elements of self-efficacy,self-awareness,connectedness,mindfulness and optimism).Some factors are more
134、 amenable to intervention than others and were afforded priority in theselectioncriteria.MethodsThese include:Resilience Self-efficacy/self-beliefOptimism Challenge response styleSleep Self-worthSelf-acceptance Me timeSocial connectedness Self-awarenessLocus of control Attachment styleSelf-care Mean
135、ing/purposeIntimate relationships(authentic)pride/achievement Mindfulness Lifestyle(nutrition/activity/smoking/alcohol)Rational/logical Journalling/thinking(RET)bibliotherapyDisplacement activities HumourNature/green breaks SpiritualityWellbeing locus of control Openness to experienceKindness/giving
136、 Delayed gratification48 Fallon R.et al(2017),Measuring well-being:A comparison of subjective well-being and PERMA,Journal of Positive Psychology,13(4),321-332.49 Luthans,Avolio,Avey,&Norman(2007),Positive Psychological Capital:measurement and relationship to performance and satisfaction,Personal Ps
137、ychology,Vol.60(3),541-572.50 Engel,George L.(1980).The clinical application of the biopsychosocial model.American Journal of Psychiatry.137(5):535544.51 Keyes,C.(2005),Mental illness and/or mental health?Investigating axioms of the complete state model of health.Journal of Consulting and Clinical P
138、sychology,73(3),539-548.52 Digman JM,(1990).Personality structure:Emergence of the five-factor model.Annual Review of Psychology.41:41740.53 Mayer JD,Roberts RD,Barsade SG(2008).Human abilities:emotional intelligence.Annual Review of Psychology.59:50736.54 Davidson,G.et al(2015),Models of Mental Hea
139、lth Foundations of Mental Health Practice,Bloomsbury Publishing.14 I AXA Mind Health Index 2023Factor selection criterian Demonstrated reliability and validity as a predictor of improved mental health in the peer reviewed literature(i.e.interventions result in decreased negative affect reduced stres
140、s/anxiety/depression,orimproved positive affect increased in happiness,joy,enthusiasm etc.).n Causality rather than correlation.Factors chosen should have demonstrated efficacy using study designs that better demonstrate causation,preferably RCTs,but also cohort studies and case control studies.Cros
141、s sectional/epidemiological studies,case studies and expert opinions were considered a lesser quality ofevidence.n General acceptance by psychological communityn Amenable to interventionn Non or minimally clinicaln Transdiagnostic(skills/strategies that impact positively on multiple psychological fa
142、ctors)Applying these selection criteria and applying results from previous AXA research using similar models,we developed the short list of components to include in the model.These are defined,and their rationale for inclusion,are outlined in the sections on predictors,modifiers andoutcomes.Question
143、 selectionThe creation of a broad-based Mental Health Index created challenges in terms of survey length.With 28 factors in the shortlist of the positive action group,multiple questions within each group would quickly cause us to exceed our targets in relation to completion time and total question n
144、umbers.This could cause respondent fatigue,meaning participants may lose interest and not complete the survey.We therefore applied routine statistical procedures to choose a single question in each group that would retain the maximal predictive value.Whilst this is not ideal,we know from extensive e
145、xperience of previous work,and the published literature on K6/K10,DASS 21/12/9 and SISQ that shortened questionnaires,and indeed single questions,can provide a reasonable estimate of competency in the factor being considered.For many factors,we were able to condense to a single question through the
146、elimination of questions with low Cronbachs Alpha scores.CausalityCorrelation is not causality is the catch cry of statisticians who bemoan the inappropriate interpretation of correlational analysis.As the MHI is a multi-year project,run as a series of independent cross-sectional studies with no mat
147、ching,no controls and no intervention,the index itself can never demonstrate causality.This underpins the importance of populating the MHI with questions relating to factors where causality has already been demonstrated.It is logically consistent to infer therefore,that if b is causally related to a
148、,and a changes,we can infer that some of the change we see in b is attributable to changes in a.The shortlisted MHI candidate questions on positive actions,all have strong causal credentials,with the exception of achievement it is difficult to design a study where achievement is manipulated as an in
149、dependent variable.Research into authentic pride(a positive emotional reaction to personal success)however,has demonstrated astrong causal relationship with psychological health.55 Reverse causality In cross-sectional studies,predictors and outcomes are measured at the same time,meaning we cannot de
150、termine whether one has preceded the other.For example,in mental health literature a strong association has been found between exercise and reduced rates of depression.In one view,those who exercise more are less likely to have depression,suggesting exercise may improve depression.However,in another
151、 view,those who already have depression may have less motivation to exercise,which could explain why lack of exercise is associated with higher rates of depression.This means we cannot assume the predictor caused the outcome,but only observe an association between two variables,and draw on other res
152、earch which tests causality to understand these relationships.Self-reportingIt should be noted that the measures of mental illness in this study are self-reported,rather than a clinical measure or diagnosis.These measures are reliant on participant honesty and in some circumstances can be subject to
153、 bias causing over or underreporting.56“Correlation is not causality55 Dickens,L.R.,(2020),Pride:A meta-analytic project,American Psychological Association(APA PsychNet),Emotion.56 Bauhoff,S.(2014).Self-Report Bias in Estimating Cross-Sectional and Treatment Effects.In:Michalos,A.C.(eds)Encyclopedia
154、 of Quality of Life and Well-Being Research.Springer,Dordrecht.https:/doi.org/10.1007/978-94-007-0753-5_4046.15 I AXA Mind Health Index 2023Development of the Mind Health IndexThe chosen constructs were required to fit a model which aggregates results at various levels,from factors,to sub-indices,to
155、 the overall Mind Health Index(MHI).The factor self-acceptance for example,would be aggregated into the sub-index of protective skills and into the MHI.The application of a weighting factor was considered out of scope for this project as this analysis would require calculating the relative contribut
156、ion of 45 different factors pursuant to their contribution to mental health,something which has not yet been achieved in the psychologicalliterature.Index creationThe MHI therefore consists of three groups of questions that relate to either positive actions,modifiers or psychological wellbeing outco
157、mes.The scoring system used allowed these questions to be scored,scaled and aggregated into a single MHI score.Best depicted as a wheel for ease of understanding,each segment is surrounded by its contributing sub-indices.The overall index and every sub-index are scored between 0 to 100,with100 being
158、 optimal.To help elucidate the significance of a score we have defined and colour coded four categories of results for the Mind Health Index:FLOURISHING:A score of 74 and above represents the pinnacle of mental health.Encompassing the presence of good social,psychological and emotional wellbeing.Flo
159、urishing individuals do well across a range of mental wellbeing determinates and outcomes.GETTING BY:A score between 61-74 describes those who may have some areas of good wellbeing but not enough to be reach the state of flourishing.Those getting by may experience a dampened sense of wellbeing compa
160、red to those who are flourishing.LANGUISHING:A score between 46-61 represents the absence of positive wellbeing.If you are languishing you are not functioning at full capacity,you may feel unmotivated and struggle to focus.Those who are languishing are at an increased risk ofdeveloping mental illnes
161、s.STRUGGLING:A score less than 46.The absence of wellbeing in most areas is likely to result in struggle and difficulty.Struggling is associated with emotional distress and psychosocialimpairment.The characteristics of a good index relate to its ability to readily differentiate good from bad.This me
162、ans choice of questions is pivotal,but so is the spread of response options.In general,a wider spread of results,which amplifies the difference between best and worst results,is preferred.In the MHI22 study,the standard deviation of MHI for all participants was 15.1/100 with a mean of 61.9.The fact
163、that the standard deviation represents approximately 15%of the range is a strong endorsement of the capacity of the MHI todifferentiate between those at the upper andlowerendsofthe mind health spectrum.Other MHI23 sub-indicesIntroductionAggregating individual question scores from related items in a
164、survey can help condense information for ease of understanding.We refer to these as indices or sub-indices(Singular index).By way of example,the Health Behaviours Sub-Index combines data from nutrition,exercise,smoking,alcohol and sleep into a single score which reflects the degree to which an indiv
165、idual or an entire country adopts health behaviours which are likely to enhance both quality and quantity of life.We created 9 additional sub-indices,and two proprietary models,for MHI23.These facilitate understanding of key principles that would not otherwise be obvious from simple means,standard d
166、eviations,and frequency histograms of response options at question level.List of sub-indicesFLOW:Flow is often described as being in the zone,a highly productive mental state where an individual us fully focussed on a specific task.Mihaly Csikszentmihalyi,possibly the world leader in the field of po
167、sitive psychology,and Distinguished Professor of Psychology at the University of Chicago,recognised and named the psychological concept of flow,a highly focused mental state conducive to productivity.Studies have continued to validate the benefit of the flow state,showing that executives are up to 5
168、00%more productive when working in flow,and that flow can halve the time required to train target skills to an expert level.57A number of factors contribute to flow,but a prime determinant of flow is the matching of skill level with the degree of challenge the task presents.Of the eight sectors show
169、n in the graphic below,flow is the most productive.The survey questions used to determine flow are provided inAppendix A.STRAIN:Strain is the antithesis of flow,being an unproductive mental state which is exacerbated by factors such as high demand/low control,high effort/low reward,high challenge/lo
170、w skill(the worry and anxiety sectors in the graphic above)or high demand/low resources(the so call JD-R model).High job strain impairs cognitive function and memory,stifles creativity,as well as reducing processing speed and spatial ability.58Skill levelLowChallenge levelMediumHighLowMediumHighArou
171、salBoredomWorryControlAnxietyRelaxationApathyFlow57 Csikszentmihalyi,M.(2020),Why flow states are the key to peak productivity performance,https:/ 58 Nilsen,C.et al,(2021),Job Strain and Trajectories of Cognitive Change Before and After Retirement,The Journals of Gerontology:Series B,Volume 76,Issue
172、 7,September 2021,Pages 1313132216 I AXA Mind Health Index 202317 I AXA Mind Health Index 2023Flow-strain modelUnderstanding flow and stain suggests the ideal work environment one which fosters employee productivity isone of high flow,with low strain.We combine the individual flow and strain scores
173、to derive a single metric which provides a measure of how effective the work environment is in maximising workforce productivity.TOXICITY:A workplace may be considered toxic for a myriad of reasons.These include lack of respect,malicious gossip,nepotism,unrealistic expectations,unfair work practices
174、,lack of action in deterring racism,sexism,bullying and harassment and/or discrimination.and much more.Whatever the causes,the outcomes are generally the same,stressed out,disillusioned and demotivated workers with high turnover.We measure more than a dozen factors that contribute to workplace toxic
175、ity(see Appendix A).SUPPORTIVE WORK ENVIRONMENT:Supportive work environments do what they say,they support their people.Through reward and recognition,training and development opportunities to enhance career prospects,EAP/wellness programs,fair treatment,clear goals,good communication and adequate r
176、esources,supportive workplaces enhance employee performance and reduce staff turnover.Toxicity-support modelCleary,a work environment that has low toxicity and high support is preferable to an unsupportive,toxic one.We combine the individual toxicity and support scores to derive a single metric whic
177、h provides a measure of how engaging the work environment is to employees.CLIMATE CONCERN SUB-INDEX:People differ regarding their level of concern for the future of the planet in relation to climate change.We created a sub-index for this which takes into account both the degree of concern and the em
178、otional outcomes(i.e.frustration,helplessness,anger etc.).FINANCIAL SECURITY SUB-INDEX:Finances can be viewed over the short,medium and long term.We ask finance questions ranging from day to day expenses,all the way to long term financial future,in order to calculate the financial security index.BUL
179、LYING AND HARASSMENT SUB-INDEX:The Bullying&Harassment Sub-index quantifies the degree to which various types of bullying occur in the workplace,the impact on the target of the bullying,and the actions which follow.Theseactions may or may not result in successful resolution or the issue.EMPLOYEE SKI
180、LLS SUB-INDEX:The flow,strain,toxicity and support sub-indices outlined previously are about the work environment and how conducive it is to employee productivity.The employee skills index considers the attributes of the employee,rather than the employer.Flexibility,resilience,work ethic and other i
181、ndicators arefactored into the sub-index.A work environment which is high in Flow/Strain and Support/Toxicity,combined with a high Employee Skills Index,optimises the value of human capital in the workplace.18 I AXA Mind Health Index 2023Appendix AQuestions used in creating the various indices Bully
182、ing&harassmentn Feel safe from bullying and harassment at workn Type of bullying and harassment Verbal of a sexual nature Physical not of a sexual nature Physical of a sexual nature Based on race/religion,sexual orientation,disability,age or similarn Reporting and outcomes in relation to incident(s)
183、Climate concern indexn Belief(or not)in climate changen Concern that climate change threatens people and theplanet?n The degree to which climate change impacts current emotional wellbeing?Employee skills indexn Good work ethicn Accommodate quickly to changen Good fit between employee skills and the
184、role at workn Able to keep up with the pace of change at workFinancial security indexn No trouble meeting day to day/weekly/monthly expensesn Current financial situation causes significant stressn Sufficient financial resources-not concerned about unexpected expensesn Feeling secure regarding financ
185、ial futureFlown Good job fit(job requirements match skills)n Adjust quickly to change at workn Keep up with the pace of changen Happy to go outside comfort zone openness toexperiencen Self-confidenceLived experiencesn Ability has been doubted or undervalued because of gendern Experience unwanted com
186、ments related to genderStrainn Poor job fit(job requirements dont match skillsn Slow to adjust to change at workn Little control over workflow and conditionsn Long work hours resulting in emotional distressn Working more than 10 hours per week over contractedhoursn Unmanageable work-related demandsn
187、 Feeling overwhelmed by factors beyond your controlSupportiven Appropriate action in relation to B&H incidentsn Feeling of belonging/inclusion at workn Equal opportunity to succeedn Equal treatment of gendersn Not working over and above contracted hoursn Positive workplace culturen Feeling safe from
188、 bullying and harassment at workn No experience of bullying and harassment at workn Feel free to report B&H incidentsn Adequate resources to excel in jobn Role clarityn Manager/supervisor is approachable and supportiven Company supports employees to develop skills to support career progressionn Comp
189、any provides good support to employees regarding their mental healthToxicn Poor response to workplace bullying and harassmentincidentsn Negative emotional impact on B&H incidentsn No sense of belonging/inclusion at workn Lack of equal opportunities to succeedn Unequal treatment between gendersn Inte
190、ntion to quit due to poor culture,poor management,lack of recognition,poor work:life balance etc.n Working more than 10 hours over contracted hoursn Long working hours resulting emotional distress n Toxic corporate culturen Do not feel safe from bullying and harassment at workn Lack of action by man
191、agement in relation to B&Hn Personal experience regarding sexism at workn Witnessed an incident relating to sexism at workn Overwhelming work-related demandsn Feeling uncertain about career prospects19 I AXA Mind Health Index 2023ValidationIt is important to note that the validation study from last
192、years pilot was followed by the full survey with a sample size of 11,000.As the core questions remain unchanged,it was deemed unnecessary to repeat the full factor analysis and more in-depth statistical procedures on these to re-validate core questions for MHI23.MHI23 did however contain new questio
193、ns which we felt duty bound to test in a small pilot study to solicit feedback on issues such as ease of understanding,breadth of topics,relevance,repetition etc.The pilot was completed between the 17th and 30th of June 2022,with 195 employees from several UK organisations taking part.The data from
194、the pilot was used to assess numerous aspects of the new survey questions,as well as to check correlations found in the previous year remain strong.A summary of participant feedback is shown below,showing most items were scored positively.We did use this feedback to reword,clarify or even reject a n
195、umber or items to further improve the robustness of the survey.SummaryThe Mind Health Index was initially developed in 2021 through an iterative method of reviewing quality literature and testing the initial questions in a pilot study.Subsequent determination of statistical parameters relating to va
196、lidity,reliability,factor weightings and correlations was used to further refine the overarching model,and the individualquestions.The first full MHI study was conducted on 11,000 participants from 11 countries/territories in September/October of 2021.Data from this survey was used to further refine
197、 thequestions.Through extensive collaboration with corporate stakeholders and academic partners,the current Mind Health Index was updated with new questions.These formed the non-core components of the survey,further strengthened organically through pilot activity to create the final version of MHI23
198、 which was used for this years survey.The survey was conducted at the end of 2022 on over 30,000 participants spanning 16 countries,in partnership with Ipsos.Applying a scientific method to the survey designprocess allowed the research aims of the survey to be met,whilst persevering a strong scienti
199、fic grounding with respect to the latest peer reviewed literature andrelevantpsychologicaltheories.%of participants who agreed/strongly agreed with the following:Question topicEasy to understandTopics of relevanceto meNot repetitiveComprehensiveResponses allow mymental wellbeing tobe understood100%8
200、0%60%40%20%0%Percentage who agree/strongly agree20 I AXA Mind Health Index 2023For more information on our approach to mental health,please visit our website at Follow us: by:DrJohnLang,AliKhan,AmyCreedon,FaizanZakir,HarrietMorgan,KarenPateDesign&typesetting:OLIVERThis promotion is issued by AXA Hea
201、lth.AXA Health is a trading name of AXA ICAS Occupational Health Services Limited.Registered office:20 Gracechurch Street,London EC3V0BG.Registered in England and Wales No.1336017.Write to us at:AXA Health,AXIS House,23 St Leonards Road,Eastbourne,East Sussex BN21 3PX.We may record and/ormonitor calls for quality assurance,training and as a record of our conversation.