1、MindHealth Index 2024AbstractA 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 2024Opening statement from Sandrine CoulangeChief Operating Officer,AXA Global HealthOur fourth edition of the Mind Health Index(MHI)allows us to chart the changing trends of global mind health and provide valuab

3、le insight to governments,employers and citizens.The 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 of causal factors and their impact on wellbeing.This is important becaus

4、e stress,anxiety and low mood are reaching epidemic proportions,but as issues often rooted in our lifestyle,work and environment.This years study continues the successful format started in 2022,which draws a distinction between struggling,languishing,getting by and flourishing.This formula gives us

5、a more stable view of where an individual is on the spectrum of mind health,the factors that put them there and,most importantly,what can we do as individuals and as a society to help everyone flourish.Having expanded to include five new countries in 2023,this years MHI is based on interviews with 1

6、6,000 people across16 countries.The results show that more people are struggling compared with last year.In fact,the numbers have returned to the same levels that were recorded during the pandemic.Worryingly,the index shows that too some people who are affected by mind health issues are unaware and

7、those living with severe mental health conditions do not consider accessing professional support to manage their struggles.We are seeing the same at work,though work can contribute to ones mental health,people are slow to recognise the link between mind health and issues such as tiredness,difficulti

8、es to focus and lack of sleep.The report underlines the important role that companies can play in identifying disengagement as the first sign of mind health issues in the workplace.Bringing awareness on early signals and taking preventive actions can lower the occurrence of sick leave.My sincere tha

9、nks to the scientific design and research teams in AXA,our team of international experts,Ipsos our fieldwork partner and the AXA Research Fund.Table of contents04 Introduction05 Core questions06 Predictors09 Modifiers10 Outcomes11 Methods4 I AXA Mind Health Index 2024 AXA Mind Health Index(MHI)and S

10、urvey WhitepaperIntroductionMind 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 As a major global investor and philanthropist in multiple health topics,AXA has iden

11、tified an opportunity to contribute meaningfully to the knowledge base of mental health through a global survey,known as the Mind Health Index(MHI).The goal of the MHI is to provide scientifically backed insights into mind health related topics for multiple audiences:the general public,employers,ins

12、urance industry,consulting partners,and government.Published in 2022,the first MHI was used to survey over 11,000 participants from eight European and three Asian countries(Belgium,France,Germany,Ireland,Italy,Spain,Switzerland,UK,Mainland China,Hong Kong and Japan).Shaped by the global backdrop of

13、COVID-19,MHI22 identified concrete levers and coping strategies which allowed people,employers and society to flourish.The success of the survey resulted in an ongoing commitment by AXA to track the MHI over the subsequent five-year period,with an extended offering to an additional five countries(Me

14、xico,Philippines,Thailand,Turkyie and USA).Carried out in 2023,this years MHI survey(MHI24)conducted 16,000 interviews with the general population aged 18 to 75 years old in the same 16 countries.MHI24 continues to track the progress of mind health across the four core categories of flourishing,gett

15、ing by,languishing and struggling.This latest report shone a light on lack of awareness,mental health stigma and the need for people who are struggling to access professional care.1 https:/www.mentalhealth.gov/basics/what-is-mental-health5 I AXA Mind Health Index 2024Core questionsThe survey consist

16、s of two main categories of questions:a)A static component(the index)which remains unchanged 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 theme

17、s and topics of interest.As in previous years,we used a systems approach to help understand the aetiology and maintenance of mind health2.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 multidimension

18、al approach is that it provides a more holistic understanding of mental health and wellbeing,and as a result provides greater insight into how mind health can be supported and improved.The core questions fell into 3 groups.These are also outlined in detail in the previous MHI White Paper,3 however a

19、 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 predictor of mental health,itreduces stress,anxiety and depression,whilst improving life satisfaction via multiple pathways)2)Outco

20、mes positive and negative mental health outcomes.On the negative side-stress,anxiety and depression,on the positive side happiness and lifesatisfaction.The behaviours and skills in the predictor group impact mental health outcomes,but they are impacted by an intermediary pathway:modifiers.3)Modifier

21、s 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 style,as well as past and currentmental health conditions.The MHI score is an aggregation of these three sub-indices.2 Bronf

22、enbrenner,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 of the AXAMindHealth Index.A key component of AXAs MHI strategy is to track the changing mind health of participants in the po

23、st 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 2024PredictorsPreventive actions/skills Authentic prideAuthentic pride is related to feelings of confidence and achievement and is associated wit

24、h a psychologically healthy and socially desirable personality profile marked by high levels of agreeableness and conscientiousness,intrinsic motivation,perseverance,and a tendency to engage in a range of prosocial behaviours,including empathy and respect.4 Whereas hubristic pride is viewed as arrog

25、ant and self-serving,authentic pride exudes accomplishment,conviction,and success.Challenge response ruminationDwelling on mistakes(rumination)and being overly self-critical has been found to negatively impact mental health and wellbeing.5 Rumination is essentially the opposite of resilience.Resilie

26、nt people move on more quickly,whereas ruminators tend to find it hard to move on.Delayed gratificationDelayed gratification is the ability to resist temptation 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

27、 emotional intelligence,and studies have shown that the ability to delay reward is present in highly successful people and is associated with better mental health outcomes.Delayed gratification is evident in children as young as four years of age and appears to be a potent predictor of success in la

28、ter 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 animal kingdom,having been demonstrated in creatures as diverse as chimpanzees to cuttlefish(Sepia officinalis).7Emotional CompetencyEmotional c

29、ompetency is the degree to which people successfully utilise EQ related skills.8 Self-awareness,emotional self-regulation,social awareness and 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

30、 2018 report,people with a high EQ are eight times more likely to have a high quality of life compared to those with lower scores.9ExerciseThe benefits of physical activity have been demonstrated definitively across a broad range of both physical and psychological health.Physical activity has been f

31、ound to reduce symptoms of anxiety and depression.10 Exercise participation has been linked to the prevention of mental health problems11 and as little as 16 weeks of regular exercise has been found to be equally as effective as antidepressant medication in treatment of mild to moderate depression.1

32、2Kindness/givingGiving and acts of kindness are pro-social behaviours that have been shown to improve immune function and stimulate the production of serotonin in both the recipient and the person extending the kindness.Even those observing the actof kindness have similar beneficial results.13Resear

33、ch has also found that participation in voluntary services is significantly predictive of better mental and physical health,life satisfaction,self-esteem,happiness,lower depressive symptoms,psychological distress,andmortality and functional inability.144 Tracy,J.L.,&Robins,R.W.(2014).Conceptual and

34、empirical strengths of the authentic/hubristic model of pride.Emotion,14(1),3337.5 Psychological Processes Mediate the Impact of Familial 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,Walte

35、r;Ebbesen,Ebbe B.(1970).Attention in delay of gratification.Journal of Personality and Social Psychology.16(2):329337.7 Schnell,Alexandra 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 th

36、e Royal Society B:Biological Sciences.288.8 Moradi,A.,et al,(2011),The Relationship between Coping strategies and Emotional Intelligence,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).Exerc

37、ise:a neglected intervention in mental health care?Journal of psychiatric and mental health nursing,11(4),476-483.11 Sui,X.,Laditka,J.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 psyc

38、hiatric research,43(5),546-552.12 Blumenthal,J.A.,et al,(2007).Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder.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:cumu

39、lative 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;17(1):736.7 I AXA Mind Health Index 2024Locus of controlLocus of control represents the degree to which we perceive to have control over our lives.Perceived control o

40、ver outcomes in life(i.e.internal locus of control)is associated with good health and wellbeing,while relying on chance 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 primar

41、ily to their own doing.An internal locus of control has been found to positively correlate with the ability to cope 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 outcom

42、es.Pushing through life without taking time out can lead to burnout,exhaustion,immunosuppression and consequently,more 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

43、 life are predictive of emotional wellbeing and result in better recovery from negative life events.18 A literature 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 o

44、f meaning in peoples lives in all cultures and age groups.19 This review also found that failure to address meaninglessness can lead to psychopathologies such as depression,anxiety,addiction,aggression,hopelessness,apathy,lower levels of wellbeing,physical illness,and suicide.MindfulnessMindfulness

45、is a way of paying attention to the present moment,using techniques like meditation,breathing and yoga.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-

46、based approaches can significantly reduce the symptoms of anxiety and depression.They can also help people who have had multiple depressive episodes to avoid relapsing.20NutritionMultiple studies have demonstrated the relationship between nutrition and mood disorders such as depression.Studies compa

47、ring traditional diets,like the Mediterranean diet and the traditional Japanese diet,to a typical Western 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 experienceOp

48、enness to experience is one of the Big 5 domains which are used to describe human personality 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 pr

49、efer routine.They are uncomfortable with change and trying new things,so they prefer the 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 lif

50、e.24OptimismOptimism is a tendency to see the positives;a glass half full vs half empty 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 exe

51、rts an indirect influence on quality of life.Optimistic people consistently outperform 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 wit

52、h greater flexibility,problem-solving capacity and a more effective processing of negative 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

53、.(2015),Locus of control and its relationship with mental health and adjustment.Journal 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 Schaef

54、er,Stacey M et al,(2013),Purpose in life predicts better emotional recovery from negative 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 M

55、indful Initiative(UK),(2015),A Report by the Mindfulness All-Party Parliamentary Group.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.41:4174

56、0.23 Malouff,John M.;Thorsteinsson,Einar B.&Schutte,Nicola S.(2005).The relationship between 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).Refi

57、ning the relationship between personality and Subjective wellbeing.Psychological Bulletin.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 o

58、n mental and physical wellbeing.Clin Pract Epidemiol Ment Health.6:2529.8 I AXA Mind Health Index 2024Positive 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.Re

59、siliencePsychologists define resilience as the process of adapting well in the face of 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

60、from these difficult experiences,it can also involve profound personal growth.27 Lack of 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

61、 to negative indicators of mental health.28Self-acceptance Self-acceptance is defined as 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

62、in psychological literature.Different theologies(e.g.,Christianity,Buddhism),psychological 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 continue

63、s to show that self-acceptance is strongly related to mental health and wellbeing in people 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

64、 of behaviour;without self-belief,the incentive to engage in protective/preventive actions 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 ameliorat

65、es the effects of daily stressors on mental health,with the strongest relationship being 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

66、 then being a key source of distress for the individual involved.32Social ConnectednessFrom 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 po

67、sitive psychological health.33 Conversely,loneliness has been described as a hidden epidemic found to be as damaging to our health assmoking 15 cigarettes a day.34Wellbeing locus of controlWhereas locus of control is generalised to a whole of life situation,wellbeing locus of control is a relatively

68、 new concept that limits the context to control of factors affectingwellbeing.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

69、 of Control(WB-LOC)and develop a multidimensional scale with which to measure it(WB-LOC12).35 This new scale showed robust psychometric properties and a WB-LOC question was therefore included in the MHI23 survey and retained in MHI2024.27 American Psychological Society(2012)https:/www.apa.org/topics

70、/resilience.28 Tianqiang Hu,et al(2015),A meta-analysis of the trait resilience and mental health.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

71、 family and friend support on LGB youths mental health and sexual orientation milestones.Family Relations,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.Internationa

72、l Journal of Clinical and Health Psychology,16(1),1-10.32 Scott,A.J.,Webb,T.L.,Martyn-St James,M.,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/comba

73、tting-epidemic-loneliness.34 Holt-Lunstad,J.,&Uchino,B.(2015).Social support and health.Health behavior: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 22,351335

74、42.9 I AXA Mind Health Index 2024ModifiersModifiers are also predictive,but they can be external 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

75、 that can impact on the outcome measures.Thepositive actions individuals use(knowingly or not)deliver 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

76、,but factors such as past/current mental health conditions,attachment style and access to health 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

77、 easy to accept that the mental health outcomes for these two people may differ depending on their 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 ne

78、ed,scared or under threat.The human need for attachment is said to have arisen out of evolutionary 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 behavi

79、our depending primarily on their experiences in these early relationships.36 Four categories have 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

80、and predicts their utilisation of mental health services.37 The health care systemMental health difficulties 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 fr

81、om general medical conditions and a higher risk of premature mortality.39 Amongthose with mental 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.,sch

82、izophrenia and bipolar disorder)constitute an increasingly marginalised population whose needs outstrip 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 hea

83、lth difficulties to the global burden of disease,the quality of care for these disorders remains 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,pa

84、tient-centred,timely,efficient,and equitable care.42Current and past mental health conditionsDiagnosed 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

85、 as outlined below.n Depressionn Anxiety disorder,phobia or PTSDn Substance abuse disordern Eating 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 menta

86、l health conditions was combined with the participants self-rating of how well the condition is/was managed to derive an overall score for these factors.A single well-managed condition was scored more favourably than multiple poorly-managed conditions.We also queried how a condition was diagnosed,an

87、d how it was managed.This enabled us to look at differential outcomes for self-diagnosis vs professional 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

88、.(1978).Patterns of Attachment:A Psychological Study of the Strange Situation.Hillsdale:Erlbaum.37 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),E

89、stimating the true global burden of mental illness,The Lancet Psychiatry 3(2):171-178.39 https:/www.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(20

90、18),Measuring and improving the quality of mental health care:a global perspective,World Psychiatry,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 2024OutcomesOutcomes

91、 were classified as either positive or negative emotional outcomes.For negative emotional outcomes,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

92、three variables over the previous week.Thedifference in time frames highlighted differences in responses 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 scori

93、ng Cronbachs Alpha questions from our literature review andthe Mental Wellbeing Assessment pilot study.11 I AXA Mind Health Index 2024Fieldwork and statisticsIpsos,a global leader in market research performed the survey fieldwork.They conducted online interviews with consumers 18-74 years old,recrui

94、ted via an online consumer panel.At the end of fieldwork the data has been weighted to make the sample match the general population 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 matche

95、d between waves on distributions of income and education.The method used by Ipsos is the RAS method:Ranking Adjust Statistics.All 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

96、 in the same way as classical margins of error,but acknowledge the uncertainty of an estimate(in our case,the probability that 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

97、 calculation to correct for theunknown.Bayesian models allow generalisation from a sample to a population,since they correct for 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

98、online polling.Applying this approach to the 16 participating countries/territories,the polling is deemed accurate to within+/-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

99、 14countries/territories).There were some cohorts that were under-represented following the initial survey of 30,000 people.In order to reach the nationally representative sample targets,Ipsos completed another 636 surveys in China,Thailand and HongKong.Literature reviewExtensive literature was leve

100、raged for the creation of the MHI.This review revealed dozens of skills and strategies related to effective psycho-emotional self-management that were considered candidates for inclusion due to their established validity and reliability as constructs supporting good mental health.These skills/strate

101、gies,which have been described earlier,often sit within various frameworks/models such as PERMA,48 Psychological Capital,49 Biopsychosocial,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 ot

102、hers(i.e.EQ encompasses elements of self-efficacy,self-awareness,connectedness,mindfulness and optimism).Some factors are more amenable to intervention than others and were afforded priority in theselectioncriteria.MethodsThese include:Resilience Self-efficacy/self-beliefOptimism Challenge response

103、styleSleep Self-worthSelf-acceptance Me timeSocial connectedness Self-awarenessLocus of control Attachment styleSelf-care Meaning/purposeIntimate relationships(authentic)pride/achievement Mindfulness Lifestyle(nutrition/activity/smoking/alcohol)Rational/logical Journalling/thinking(RET)bibliotherapy

104、Displacement activities HumourNature/green breaks SpiritualityWellbeing locus of control Openness to experienceKindness/giving 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,Avo

105、lio,Avey,&Norman(2007),Positive Psychological Capital:measurement and relationship to performance and satisfaction,Personal Psychology,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),Menta

106、l illness and/or mental health?Investigating axioms of the complete state model of health.Journal of Consulting and Clinical Psychology,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(20

107、08).Human abilities:emotional intelligence.Annual Review of Psychology.59:50736.54 Davidson,G.et al(2015),Models of Mental Health Foundations of Mental Health Practice,Bloomsbury Publishing.12 I AXA Mind Health Index 2024Factor selection criterian Demonstrated reliability and validity as a predictor

108、 of improved mental health in the peer reviewed literature(i.e.interventions result in decreased negative affect reduced stress/anxiety/depression,orimproved positive affect increased in happiness,joy,enthusiasm etc.).n Causality rather than correlation.Factors chosen should have demonstrated effica

109、cy using study designs that better demonstrate causation,preferably randomised control trials,but also cohort studies and case control studies.Cross sectional/epidemiological studies,case studies and expert opinions were considered a lesser quality of evidence.n General acceptance by psychological c

110、ommunityn Amenable to interventionn Non or minimally clinicaln Transdiagnostic(skills/strategies that impact positively on multiple psychological factors)By applying these selection criteria and applying results from previous AXA research using similar models,we developed the short list of component

111、s to include in the modelThese are defined,and their rationale for inclusion,are outlined in the sections on predictors,modifiers andoutcomes.Question selectionThe creation of a broad-based Mental Health Index created challenges in terms of survey length.With 28 factors in the shortlist of the posit

112、ive action group,multiple questions within each group would quickly cause us to exceed our targets in relation to completion time and total question numbers.This could cause respondent fatigue,meaning participants may lose interest and not complete the survey.We therefore applied routine statistical

113、 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 experience of previous work,and the published literature on K6/K10,DASS 21/12/9 and SISQ that shortened questionnaires,and indeed single questions,can

114、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 elimination of questions with low Cronbachs Alpha scores.CausalityCorrelation is not causality is the catch cry of statisticians who bemoan the inappr

115、opriate interpretation of correlational analysis.As the MHI is a multi-year project,run as a series of independent cross-sectional studies with no matching,no controls and no intervention,the index itself can never demonstrate causality.This underpins the importance of populating the MHI with questi

116、ons relating to factors where causality has already been demonstrated.Therefore,it is logically consistent to infer that if b is causally related to a,and a changes,then some of the change we see in b is attributable to changes in a.All of the shortlisted MHI candidate questions on positive actions

117、have strong causal credentials,with the exception of achievement it is difficult to design a study where achievement is manipulated as an independent variable.Research into authentic pride(a positive emotional reaction to personal success),however,has demonstrated a strong causal relationship with p

118、sychological health.55 Reverse causality In cross-sectional studies,predictors and outcomes are measured at the same time,meaning we cannot determine whether one has preceded the other.For example,in mental health literature a strong association has been found between exercise and reduced rates of d

119、epression.In one view,those who exercise more are less likely to have depression,suggesting exercise may improve depression.However,in another 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 depre

120、ssion.This means we cannot assume the predictor caused the outcome,but only observe an association between two variables,and draw on other research which tests causality to understand these relationships.Self-reportingIt should be noted that the measures of mental illness in this study are self-repo

121、rted,rather than a clinical measure or diagnosis.These measures are reliant on participant honesty and in some circumstances can be subject to bias causing over or underreporting.56“Correlation is not causality55 Dickens,L.R.,(2020),Pride:A meta-analytic project,American Psychological Association(AP

122、A PsychNet),Emotion.56 Bauhoff,S.(2014).Self-Report Bias in Estimating Cross-Sectional and Treatment Effects.In:Michalos,A.C.(eds)Encyclopedia of Quality of Life and Well-Being Research.Springer,Dordrecht.https:/doi.org/10.1007/978-94-007-0753-5_4046.13 I AXA Mind Health Index 2024Development of the

123、 MHIThe chosen constructs were required to fit a model which aggregates results at various levels,from factors,to sub-indices,to the overall MHI.The factor self-acceptance,for example,would be aggregated into both the sub-index of protective skills and the MHI.The application of a weighting factor w

124、as considered out of scope for this project as this analysis would require calculating the relative contribution 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 o

125、f three groups of questions that relate to either positive actions,modifiers or psychological wellbeing outcomes.The scoring system 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

126、contributing sub-indices.The overall index and every sub-index are scored between 0 to 100,with 100 being optimal.To help elucidate the significance of a score we have defined and colour coded four categories of results for the MHI:FLOURISHING:A score of 74 and above represents the pinnacle of menta

127、l health,encompassing the presence of good social,psychological and emotional wellbeing.Flourishing 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 t

128、he state of flourishing.Those getting by may experience a dampened sense of wellbeing compared 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 stru

129、ggle to focus.Those who are languishing are at an increased risk ofdeveloping mental illness.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 character

130、istics of a good index relate to its ability to readily differentiate good from bad.This means 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,th

131、e standard deviation of MHI for all participants was 15.1/100 with a mean of 61.9.The fact 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.14 I AX

132、A Mind Health Index 2024For 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 Health.AXA Health is a trading name of AXA ICAS Occupation

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